Background Tumours involving the supra‐renal segment of IVC have dismal prognosis if left untreated. Currently, aggressive surgical management is the only potentially curative treatment but is associated with relatively high morbidity and mortality. This study aims to evaluate perioperative factors, associated with adverse postoperative outcomes, based on the perioperative characteristics and type of IVC reconstruction. Methods We identified 44 consecutive patients, who underwent supra‐renal IVC resection with a mean age of 57.3 years. Isolated resection of IVC was performed in four patients, concomitant liver resection was performed in 27 patients and other associated resection in 13 patients. Total vascular exclusion was applied in 21 patients, isolated IVC occlusion in 11 patients. Neither venovenous bypass (VVB) nor hypothermic perfusion was used in any of the cases. Results The mean operative time was 205 min (150–324 min) and the mean estimated blood loss was 755 ml (230–4500 ml). Overall morbidity was 59% and major complications (Dindo‐Clavien ≥ III) occurred in 11 patients (25%). The 90‐day mortality was 11% (5pts). Intraoperative haemotransfusion was significantly associated with postoperative general complications (p < 0,001). With a mean follow‐up of 26.2 months, the actuarial 1‐, 3‐ and 5‐year survival is 69%, 34%, and 16%, respectively. Conclusions IVC resection and reconstruction in the aspect of aggressive surgical management of malignant disease confers a survival advantage in patients, often considered unresectable. When performed in experienced centres it is associated with acceptable morbidity and mortality.

Introduction: Multiple synchronous neoplasms were first described in a study by Billroth in 1889. Since then, many researches have been conducted in this field till 1932 when Warren and Gates published their criteria for the diagnosis of two synchronous tumors. Synchronous colorectal and renal blastomas are rare. The number of case reports published so far is relatively small. Case presentation: We report a case of a 63-years old male patient who was admitted to our clinic with symptomatic, histologically confirmed rectal adenocarcinoma located near the anorectal line. Contrast-enhanced CT showed evidence of synchronous lesion in the left kidney area. Laparoscopic left nephrectomy was performed, followed by abdominoperineal resection of the rectum with total mesorectal excision and para-aortic lymph dissection. Both resectates were extracted through the perineal access with no need for additional abdominal incision. No similar case was found in our literature review without using abdominal incision. Conclusion:The simultaneous multi-visceral laparoscopic resection of synchronous neoplasms is a reliable and safe method in certain patients. When performed by an experienced surgical team, the oncological outcomes are comparable to those achieved; using a conventional approach. A specific advantage is that this is a one-stage surgery that provides quick recovery with lower risk of postoperative complications.

Introduction Multivisceral resections (MVRs) in gastric cancer are potentially curable in selected patients in whom clear resection margins are possible. However, there are still uncertain data on their feasibility and safety considering short- and long-term results. The study compares survival, morbidity, mortality, and other secondary outcomes between standard and MVRs for gastric cancer. Materials and Methods A monocentric retrospective study in patients with gastric adenocarcinoma, covering 2004 to 2020. Of the 336 operable cases, 101 patients underwent MVRs. The remaining 235 underwent standard gastric resections (SGRs), of which 173 patients were in stage T3/T4. To compare survival, a control group of 101 patients with palliative procedures was used—bypass anastomosis or exploration. Results MVR had a lower survival rate than the SGR but significantly higher than the palliative procedures. The predominant gender in MVR was male (72.3%), with a mean age of 61 years. The perioperative mortality was 3.96% (n = 4), and the overall median survival was 28.1 months. The most frequently resected organs were the spleen (67.3%), followed by the pancreas (32.7%) and the liver (20.8%). In 56.4% of the cases two organs were resected, in 28.7% three organs, and in 13.9% four organs. The main complication was bleeding (9.9%). The major postoperative complications in the MVR were 14.85%, and in the SGR 6.4% (p < 0.05). Better long-term results were observed in patients who underwent R0 resections compared with R1. Conclusion Multiorgan resections are characterized by poorer survival and a higher complication rate than gastrectomies. On the other hand, they have better long-term outcomes than palliative procedures. However, MVRs are admissible when performed by an experienced surgical team in high-volume centers.

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Background: Synchronous tumors are rare clinical entity. In most cases, they are found accidentally in the process of primary tumor staging. The detection rate of synchronous blastomas has increased over the past decades due to the advance and more frequent use of imaging modalities. Only a few cases of colorectal carcinoma (CRC) and concurrent incidental renal tumors have been reported in recent years, with their incidence rates varying as reported by different authors (0.043-4.85%). Methods: We performed retrospective analysis of our database for patients, admitted for elective colonic resection for CRC, who had adequate preoperative staging (abdominal CT or MRI), and presented with simultaneous renal tumors. Between 2009 and 2018 we identified 1472 cases of CRC. Of them 1345 underwent radical surgery, preoperative imaging was available for 1117 patients (83%), among whom 4 were diagnosed with synchronous neoplasms (0.35%). Results: The average age in our group was 52.5 years (43-63), with male/female ratio of 1:1. CRC was the initial diagnosis, and renal tumors were accidentally detected by CT scan in the staging process. Three of the patients had combination of rectal and left kidney cancer, and one had ascending colon cancer and right kidney cancer. All 4 patients underwent simultaneous removal of both tumors: two patients underwent open and two laparoscopic procedures. Conclusions: Although rare, synchronous colorectal and renal tumors may be encountered, mainly thanks to preoperative diagnostic imaging. Performing simultaneous resection is safe and is not associated with increased complication rate. The laparoscopic approach is a viable option, when performed by an experienced team.