Background/Aim: Although pelvic exenteration is an aggressive surgical procedure, it remains almost the only curative solution for patients diagnosed with large pelvic malignancies. Patients and Methods: We present a series of 100 patients submitted to pelvic exenteration with curative intent. Results: The origin of the primary tumor was most commonly represented by cervical cancer, followed by, endometrial cancer, rectal cancer, ovarian cancer and vulvovaginal cancer. An R0 resection was confirmed in 68 cases, while the remaining 32 cases presented lateral positive resection margins or perineal positive margins. The postoperative morbidity rate was 37% while the mortality rate was 3%. As for the-long term outcomes, the median overall survival time was 38.7 months, being most significantly influenced by the origin of the primary tumor. Conclusion: Although pelvic exenteration is still associated with an increased morbidity, an important improvement in the long-term survival can be achieved, especially if radical resection is feasible.

Paragangliomas, as well as phaeochromocytomas, are vascular neuroendocrine lesions that might be encountered between neck and pelvis. In certain cases, a preoperative diagnosis is difficult to be established, so resection might be needed whenever a suspect mass is discovered at the imaging studies. Moreover, there are cases in which resection and reconstruction of an important vascular structure might be imposed. In this case report a 59-year-old patient was investigated for upper abdominal pain with postprandial features and was diagnosed with a retroperitoneal tumor of 4/6/7cm invading the celiac trunk. The tumor was successfully resected and the common hepatic artery was reinserted in the celiac stump.

Splenic artery aneurysms are common arterial lesions which might remain asymptomatic for a long period of time. In certain cases, these lesions might encounter a significant growth and might become symptomatic. Once diagnosed, a therapeutic strategy should be taken in consideration in order to avoid the apparition of life-threatening complications such as aneurysmal rupture. This is a case report of a 45-year-old patient diagnosed with a splenic artery aneurysm who was successfully submitted to an aneurysmal resection en bloc with distal spleno-pancreatectomy and parcelar gastrectomy.

Probably, the most variable anatomic pattern relates to the iliac arteries system. There are reported here multiple rare anatomic variants found in a single case, at CT evaluation: (a) the unilaterally present common trunk of origin of the obturator, inferior epigastric, and medial circumflex femoral arteries and (b) the medial insertion of the deep femoral artery (DFA) onto the femoral artery, which placed the DFA initially on the medial side of the femoral vein. Such rare, but possible, anatomic variations should recommend surgeons to plan the procedures on a case-by-case basis.

Liver resection for breast cancer liver metastases seems to be associated with the best outcomes in terms of survival in patients presenting positive hormonal receptors status.

Background/Aim: The aim of this study was to analyze the influence of preoperative status on the risk of developing further postoperative complications after debulking surgery for advanced-stage ovarian cancer. Patients and Methods: A total of 80 consecutive patients submitted to surgery between 2014 and 2019 for advancedstage ovarian cancer were retrospectively reviewed. Results: Among the 80 cases there were seven patients who developed serious postoperative complications requiring reintervention. Among these cases it seems that association of obesity, poor nutritional status (defined as a lower than 3.5 g/dl serum albumin level) and elderly age were significantly associated with the risk of developing further complications. Conclusion: When selecting the candidates for debulking surgery for advanced-stage ovarian cancer attention should be focused on excluding cases presenting such preoperative risk factors in order to decrease the postoperative morbidity.

Abstract.Hepatic artery aneurysms account for up to 20% of all reported visceral aneurysms and might remain asymptomatic for a long period of time (1, 2). In cases presenting large lesions, compression on the elements of the hepatic pedicle might be encountered, inducing portal hypertension. It is estimated that the risk of aneurysmal rupture ranges between 20% and 80%, and the mortality rate reaches up to 21% (3, 4). Due to this reason, and the fact that there is no strong evidence to demonstrate any correlation between aneurysm size and rupture risk, all hepatic aneurysms should be treated (5). The main therapeutic procedures in uncomplicated aneurysms include endovascular techniques, such as percutaneous embolization or classical surgical approach, consisting of aneurysmal resection with or without vascular reconstruction. On the other hand, reconstructive procedures are mainly indicated when a patent collateral vascularization is not present (6). Case ReportA 68-year-old patient, who was investigated for recurrent upper digestive tract bleeding, was diagnosed during a computed tomography examination with a large aneurysm affecting the common and the proper hepatic artery as well as the gastroduodenal artery, and compressing the portal vein. The imagistic examinations revealed the presence of an accessory left hepatic artery entering the left liver lobe, originating from the left gastric artery. Due to the presence of the large, partially thrombosed aneurysm involving the common and the proper hepatic artery, as well as the gastroduodenal artery, the patient was initially submitted to a percutaneous right portal branch embolization in order to induce a left hemiliver hypertrophy. Two months later the patient was submitted to surgery; intraoperatively the findings of the imagistic examinations were confirmed. The 979

Background/Aim: The aim of this study was to analyse the influence of the preoperative status on the perioperative outcomes of patients submitted to pelvic reconstructions after exenteration. Materials and Methods: Between January 2017 and December 2018, pelvic exenteration was performed in 86 cases; patients were classified according to their age, nutritional status and association of reconstructive surgery. Results: The median age was 56 years, while the median level of serum albumin was 3.6 g/dl. Reconstructive surgery was more frequently performed in younger patients, while the rate of postoperative complications was similar between the two groups, while the rate of postoperative complications was significantly higher among cases with lower serum albumin levels. Conclusion: Reconstructive surgery should be performed in selected patients. Elderly cases as well as those presenting a poorer nutritional status are at higher risk of developing postoperative complications.