Chirurgia

Platelet to Lymphocyte Ratio as a Predictive Tool for the Perioperative and Postoperative Outcomes in Advanced Stage Ovarian Cancer

The Effect of Upper Abdominal Surgery on Complication Profile in Ovarian Cancer

Surgical and Anatomical Basics of Pelvic Debulking Surgery for Advanced Ovarian Cancer - the "Hudson Procedure" as a Cornerstone of Complete Cytoreduction

Ovarian cancer (OC) is the fifth most common cause of death in women and accounts for more deaths than any other cancer of the female reproductive tract. OC usually spreads through peritoneal dissemination and direct invasion. Optimal cytoreduction (no macroscopic residual disease) and adjuvant platinum-based chemotherapy are the fundaments of OC treatment. OC is usually diagnosed at advanced stages, hence the obliteration of the Douglas pouch by the tumor as well as disseminated pelvic peritoneal carcinomatosis are commonly seen. Radical surgical cytoreduction typically requires a retroperitoneal approach to the pelvic masses and multivisceral resections in the upper abdomen. In 1968, Christopher Hudson introduced a new retroperitoneal surgical technique ("radical oophorectomy") for fixed ovarian tumors. Since then, numerous modifications have been described, including visceral peritonectomy, the "cocoon" technique, Bat-shaped en-bloc total peritonectomy (Sarta-Bat approach), or en-bloc resection of the pelvis. Although these modifications expanded the classical description in many ways, the concepts and key surgical steps are derived from the Hudson procedure. However, there are some gaps or disagreements regarding the anatomical or practical rationale for certain surgical steps. The purpose of this article is to outline the critical steps of radical pelvic cytoreduction ("Hudson procedure"), and to delineate the anatomical basis for the procedure in the proposed form. In addition, we discuss the controversies and address the perioperative morbidity associated with the procedure.

Postoperative Ileus Complicated with Incomplete Evisceration after Hysterectomy for Benign Pathology

Postoperative ileus (POI) is a complex phenomenon with important morbidity and mortality, well known in many surgical fields. POI occurs commonly after abdominal and pelvic surgery, especially in cancer patients. We report the case of a 63-year-old patient without known risk factors for POI, who underwent total hysterectomy with bilateral adnexectomy for ovarian tumor with suspicion of malignancy, invalidated by the extemporaneous pathology examination. The postoperative evolution is marked by reduced bowel movements, lack of intestinal transit for flatus and stool for 6 days. In cooperation with the general surgeon conservative treatment for POI was administered, without effect. The abdomen remained distended, with no nausea or vomiting. On the 6th postoperative day a wound dehiscence with incomplete evisceration occurred, after a CT scan of the abdomen and pelvic region was requested to make a differential diagnosis between an intestinal mass and other pathology involving the bowell. In conjunction with the General Surgery team the surgical reintervention was decided and performed. After the procedure, the patient successfully regained transit, with flatus and stool emission, but another 2 complications occurred, which were successfully treated: sepsis and deep vein thrombosis. Understanding the pathophysiology could help to prevent, diagnose, and implement protocols in order to avoid POI and its complications, to reduce hospital stay and cost burden.

Prognostic Factors in Advanced Ovarian Cancer - A Clinical Trial

Giant Ovarian Thecoma Associated with Meigs Syndrome: A Striking Case

Fibrosis Associated with Retroperitoneal Abscess after Multimodal Treatment of Cervical Carcinoma - A Case Report and Brief Review of the Literature

New Insights into Lynch Syndrome: A Narrative Review

Lynch syndrome, characterized by DNA mismatch repair deficiency, represents a significant paradigm among cancer predisposition syndromes and is notably associated with heightened susceptibility to various cancers, particularly colorectal and endometrial malignancies. The primary aim of this research paper is to scrutinize specific associations and delve into the underlying molecular mechanisms of Lynch syndrome. Genetic alterations in MMR genes, including MLH1, MSH2, MSH6, PMS2, and EPCAM, compromise DNA repair mechanisms, predisposing affected individuals to a spectrum of malignancies. This paper comprehensively investigates current screening methodologies and preventive measures tailored for individuals identified or at risk of Lynch syndrome. The integration of advanced sequencing technologies and refined bioinformatics tools has significantly improved mutation detection accuracy, facilitating precise identification of mutation carriers and their at-risk relatives. Moreover, this review emphasizes the evolving diagnostic landscape, which have revolutionized the identification of potential mutation carriers. The structured diagnostic algorithm, incorporating clinical criteria, tumor testing, and genetic analysis, plays a pivotal role in systematically identifying and managing individuals with Lynch syndrome. While the well-established association of Lynch syndrome with colorectal and endometrial cancers is recognized, emerging evidence suggests an increased risk for other types of malignancies. A crucial aspect of this literature review is to extensively analyze the less commonly acknowledged correlation between Lynch syndrome and prostate or testicular malignancies. Understanding these correlations holds significant importance in guiding tailored screening protocols and preventive strategies for individuals carrying Lynch syndrome-associated genetic mutations. The comprehensive assessment of this diverse spectrum of cancers underscores the necessity for tailored surveillance strategies and multidisciplinary approaches to effectively manage and mitigate risks in individuals harboring Lynch syndrome-associated genetic alterations.

Is There a Role for Minimally Invasive Surgery in Cervical Cancer Treatment: Carry on, Discard, or Modify? A Literature Review and Case Series Presentation

Oncological surgery is constantly evolving. Recommendations and guidelines are updated periodically in light of new research. Since surgery is a key step in the treatment of cervical cancer in Romania and considering the new findings, this study aims to assess the new guideline recommendations and the surgical treatment options available. The paradigm shift that took place in 2018 left the question: does minimally invasive surgery still play a role in the treatment of cervical cancer? K ouml;hler surgical technique seems to address some of the issues raised by the minimally invasive surgery with good results. H ouml;ckel proposes total mesometrial excision to decrease the risk of recurrence. This study presents 3 cases of cervical cancer patients with stages ranging from IB1 to IIIB that had undergone total mesometrial excision and vaginal cuff closure using the laparoscopic approach to minimize the risk of local recurrence. The case series presented showed that it is feasible and safe to merge these techniques. Further prospective studies are needed in order to assess the risk and benefits of these techniques.

Pancreatic Resection for Non-Renal Pancreatic Metastases - Experience of a Single Surgical Center

Sternal Metastasis from Serous Ovarian Carcinoma - A Narrative Review Highlighting the Importance of Multidisciplinary Management in These Cases

The Role of Laparoscopic Triage in the Management of Advanced Ovarian Cancer: A Review of Literature

Advanced ovarian cancer is frequently diagnosed at late stages, necessitating precise and individualized treatment strategies. Surgical cytoreduction remains the cornerstone of treatment, with complete macroscopic tumor resection offering the best survival outcomes. However, accurately assessing resectability remains a major challenge. This review aims to evaluate the role of staging laparoscopy in triaging patients with advanced epithelial ovarian cancer, with a focus on its utility in determining surgical resectability and guiding treatment pathways. Emphasis was placed on predictive scoring systems: clinical scores (Suidan score), operative scores (Fagotti, PCI, Eisenkop) and postoperative scores (Aletti). Laparoscopic triage has shown greater predictive accuracy than traditional imaging in evaluating tumor resectability. Scoring systems such as the Fagotti and the Peritoneal Cancer Index provide validated intraoperative frameworks. International guidelines, such as ESMO, ESGO, NCCN, and ASCO, support laparoscopy for preoperative assessment, although its implementation remains limited in some countries, including Romania. Challenges include the lack of standardization, restricted access to advanced laparoscopic infrastructure, and the risk of port-site metastases. Staging laparoscopy is a valuable tool in the management of advanced ovarian cancer, aiding in the selection of optimal treatment strategies. Future integration of radiomics, artificial intelligence, and molecular profiling holds promise for fully personalized patient care.

The Impact of BRCA Mutation on the Efficacy of Neoadjuvant Chemotherapy in Advanced Ovarian Cancer

this retrospective study aimed to evaluate the impact of BRCA mutational status on the outcomes of patients with advanced ovarian cancer treated with either primary debulking surgery (PDS) or neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS). Material and BRCA mutational status is a critical factor influencing survival outcomes in advanced ovarian cancer. While BRCAwt patients may slightly benefit from PDS, BRCAmut patients exhibit significantly improved OS with NACT-IDS. These findings support the need for individualized treatment strategies based on BRCA status to optimize outcomes in ovarian cancer.

Ovarian Carcinoma - A Single Centre Case-Series Descriptive Analysis of Surgical Procedures

Ovarian Carcinoma: A Single-Centre Eight-Year Case-Series Study with Survival Analysis

The Role of Palliative Surgery in the Management of Acute Intestinal Obstruction Secondary to Peritoneal Carcinomatosis

Hyponatremia as a Prognostic Factor in Advanced Stage Ovarian Cancer Patients

Status of the Sentinel Lymph Node in Patients with Endometrial Cancer Stage I-II

Endometrial cancer (EC) is the most common gynecological cancer in developed countries. In literature, there are discordant data regarding the therapeutic value of systematic lymphadenectomy whereas the importance of lymph node status for determining prognosis and the need for adjuvant treatment is undoubted. Given the low risk of lymph node metastases in stage I-II of EC and the significant surgical and postoperative risks when performing a complete pelvic lymphadenectomy, the surgical approach in these patients is controversial, ranging from no nodal evaluation to comprehensive pelvic and aortic lymphadenectomy. The recent introduction of sentinel node detection represents the mid-way between the execution and omission of node dissection in EC patients. Indeed, the sentinel node mapping has rapidly emerged as an alternative to complete lymphadenectomy to reduce morbidity. In the present research, we discuss the role of sentinel node mapping in the surgical management of EC in early stage. Results of study on SLN in EC in early stages seem to be promising, but only a small series have been published so far.

Three Dimensional Conformal versus Volumetric Arc Therapy in Gynecological Cancer: A Retrospective Study Evaluating Therapeutic Effect and Toxicity

Sentinel Lymph Node Mapping in Endometrial Cancer: Our Initial Experience in a Resource Limited Setting

Lymphadenectomy Indications in Endometrial Cancer. A Surgeonâ??s Dilemma in the Era of Perpetual Changes

Follow the River to the Lake: Sentinel Lymph Node Identification Using the Robotic Platform in Endometrial Cancer Patients

Sentinel lymph node biopsy for the management of endometrial cancer patients has been introduced into surgical staging of these patients. Several articles and guidelines have evaluated and found sentinel lymph node biopsy as an efficient and oncological safe procedure. The aim of this article is to highlight the most important tips and tricks in order to optimize sentinel lymph node identification and dissection based on our experience. Each step of sentinel lymph node identification technique is analyzed. Tips and tricks, such as site and time of indocyanine green dye injection are essential in optimal identification of sentinel lymph node in patients with endometrial cancer. The standardization of the technique and the recognition of anatomic landmarks are essential as they lead to an improved and effective identification of sentinel lymph node.

Low-Cost and Reproductible Method to Obtain Mapping of Lymphatic Drainage in Patient with Early Endometrial Cancer

Cutaneous and Inguinal Lymph Nodes Metastases Disseminated from an Endometrial Serous Carcinoma - Case Report and Literature Review

Cutaneous metastases from endometrial cancer are rare and unusual. This is the case of a 72 years old female patient, diagnosed in 2018 with G3 endometrial serous carcinoma (ESC). At 18 months from the surgical intervention, the patient developed bilateral inguinal lymph nodes metastases and skin secondary lesions; histological and immunohistochemical tests were performed. Computed tomography scan did not indicate visceral secondary lesions, local or regional relapses. We present the treatment practiced, the case's evolution and we discuss about epidemiology, molecular biology, treatment options and management of advanced and local lesions. The appearance of skin metastases in theses cases is associated with poor prognosis and treatment options are limited to palliative chemotherapy and radiotherapy.