Rezumat Decompresia digestivã în prevenåia fistulelor digestive dupã rezecåia gastricã pentru neoplasmIntroducere: Riscul de fistulã digestivã la pacienåii operaåi pentru neoplasm gastric este crescut datoritã dezechilibrelor biologice generate de evoluåia cancerului, de stadiile avansate la prezentare aei de amploarea intervenåiei. În aceste condiåii utilizarea unor metode tehnice care sã protejeze suturile digestive la aceaeti pacienåi este utilã. Scop: Analiza eficienåei mijloacelor tehnice de protejare a suturilor digestive la pacienåii operaåi în diferite stadii de evoluåie a cancerului gastric. Material aei metodã: Am efectuat un studiu retrospectiv pentru un lot format din 130 pacienåi operaåi pentru cancer gastric în Clinica de Chirurgie Generalã aei Oncologicã I IOB, între 2010-2014. Rezultate: În lotul studiat 38,46% dintre pacienåi au fost în stadiul IV cu complicaåii aei multiple dezechilibre biologice. S-au efectuat 52 de gastrectomii totale, 40 de rezecåii gastrice, iar la 34 pacienåi s-au efectuat "excizii tumorale" paliative sau alte tipuri de intervenåii chirurgicale paliative. La 15 pacienåi dintre cei cu rezecåii gastrice s-a utilizat sondã de decompresie duodenalã, iar la 13 pacienåi dintre cei cu gastrectomie totalã s-a utilizat sonda de aspiraåie esojejunalã alãturi de sonda de alimentaåie jejunalã ca mãsuri tehnice suplimentare de prevenire a fistulei. Incidenåa fistulei de bont duodenal a fost de 7,69%, cea a fistulei de anastomoza esojejunalã de 2,3%, cu o mortalitate generalã de 3,07%, iar la anastomoza gastro-jejunalã a fost de 0,76%. Concluzie: Având în vedere riscul de fistulã la pacienåii cu cancer gastric precum aei creaeterea acestui risc în stadiile avansate de evoluåie, apreciem cã utilizarea mijloacelor tehnice de protecåie a suturilor digestive este beneficã aei oportunã ducând la scãderea incidenåei fistulelor, la scãderea debitului aei a efectelor fiziopatologice ale acestora precum aei la reducerea mortalitãåii.

RFA of CRLMs is a safe procedure with low rates of local relapses and recurrences, as well as acceptable survival rates, in the first 24-36 months post-procedure. It is recommended for patients with no indications for liver resection or having major resection risks.

(1) Background: Among new anti-angiogenesis agents being developed and ever-changing guidelines indications, the question of the benefits/safety ratio remains unclear. (2) Methods: We performed a systematic review combined with a meta-analysis of 23 randomized controlled trials (12,081 patients), evaluating overall survival (OS), progression free survival (PFS) and toxicity (grade ≥ 3 toxic effects, type, and number of all adverse effects. (3) Results: The analysis showed improvement of pooled-PFS (HR, 0.71; 95% CI, 0.64–0.78; I2 = 77%; p < 0.00001) in first-line (HR, 0.85; 95% CI, 0.78–0.93; p = 0.0003) or recurrent cancer (HR, 0.62; 95% CI, 0.56–0.70; p < 0.00001) and regardless of the type of anti-angiogenesis drug used (Vascular endothelial growth factor (VEGF) inhibitors, VEGF-receptors (VEGF-R) inhibitors or angiopoietin inhibitors). Improved OS was also observed (HR, 0.95; 95% CI, 0.90–0.99; p = 0.03). OS benefits were only observed in recurrent neoplasms, both platinum-sensitive and platinum-resistant neoplasms. Grade ≥ 3 adverse effects were increased across all trials. Anti-angiogenetic therapy increased the risk of hypertension, infection, thromboembolic/hemorrhagic events, and gastro-intestinal perforations but not the risk of wound-related issues, anemia or posterior leukoencephalopathy syndrome. (4) Conclusions: Although angiogenesis inhibitors improve PFS, there are little-to-no OS benefits. Given the high risk of severe adverse reactions, a careful selection of patients is required for obtaining the best results possible.

BACKGROUND: NK cells are characterized by cytotoxic activity against tumor cells and CD3-CD16+CD56+ phenotype. Two distinct subpopulations of NK cells were characterized in the peripheral blood: NK-CD56dim representing over 95% of NK cells and involved in antitumor cytotoxicity, and NK-CD56bright representing approximately 10% of NK cells and involved in secretion of cytokines.AIM: The aim of the study was to compare the presence of NK-CD56dim/NK-CD56bright subpopulations and their CD16/CD57 expression in peripheral blood NK cells during the particular development stages of malignancy: primary tumor (PT), lymph node invasion (LNI) and distant sites metastases (Mt). MATERIAL AND METHODS: We have analyzed by flow-cytometry peripheral blood samples from total 36 cancer patients: 24 patients with PT, 6 patients with LNI and 6 patients with Mt.RESULTS: The presence of the overall NK cells showed no significant variation between patients in different stages of tumor development. The phenotype analysis showed that CD16+ and/or CD57+ cells were lower in LNI patients compared to PT or Mt patients. Double-positive CD16+CD57+ cells were found decreased in patients with Mt, compared to patients with PT. During the stages of tumor development, NK-CD56bright subpopulation increased progressively (7% in PT patients, 13% in LNI patients, 65% in Mt patients), whereas NK-CD56dim subpopulation gradually decreased (92%, 86%, and 35% respectively). CD16/CD57 expression decreased in NK-CD56dim and increased in NK-CD56bright cells over the three studied stages.CONCLUSION: Our results show changes in NK cells characteristics during tumor development: reversal of NK-CD56dim/NK-CD56brightdistribution and modification of CD16/CD57 expression. Both types of changes can concur in reducing the efficiency of NK cell activity in patients with progressive tumors.