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Abstract The American Joint Committee on Cancer/Union Internationale Contre le Cancer ( AJCC / UICC ) TNM staging system provides the most reliable guidelines for the routine prognostication and treatment of colorectal carcinoma. This traditional tumour staging summarizes data on tumour burden (T), the presence of cancer cells in draining and regional lymph nodes (N) and evidence for distant metastases (M). However, it is now recognized that the clinical outcome can vary significantly among patients within the same stage. The current classification provides limited prognostic information and does not predict response to therapy. Multiple ways to classify cancer and to distinguish different subtypes of colorectal cancer have been proposed, including morphology, cell origin, molecular pathways, mutation status and gene expression‐based stratification. These parameters rely on tumour‐cell characteristics. Extensive literature has investigated the host immune response against cancer and demonstrated the prognostic impact of the in situ immune cell infiltrate in tumours. A methodology named ‘Immunoscore’ has been defined to quantify the in situ immune infiltrate. In colorectal cancer, the Immunoscore may add to the significance of the current AJCC / UICC TNM classification, since it has been demonstrated to be a prognostic factor superior to the AJCC / UICC TNM classification. An international consortium has been initiated to validate and promote the Immunoscore in routine clinical settings. The results of this international consortium may result in the implementation of the Immunoscore as a new component for the classification of cancer, designated TNM ‐I ( TNM ‐Immune). © 2013 The Authors. Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.

To determine whether the tumor immune infiltrate, as recently evaluated with the Immunoscore methodology, could be a useful prognostic marker in patients with rectal cancers.The influence of the immune infiltrate on patient's outcome was investigated in patients with or without preoperative chemoradiation therapy (pCRT). The density of total (CD3(+)) and cytotoxic (CD8(+)) T lymphocytes was evaluated by immunohistochemistry and quantified by a dedicated image analysis software in surgical specimens of patients with rectal cancer (n = 111) who did not receive pCRT and in tumor biopsies performed before pCRT from additional 55 patients. The results were correlated with tumor recurrence, patient's survival, and response to pCRT.The densities of CD3(+) and CD8(+) lymphocytes and the associated Immunoscore (from I0 to I4) were significantly correlated with differences in disease-free and overall survival (HR, 1.81 and 1.72, respectively; all P < 0.005). Cox multivariate analysis supports the advantage of the Immunoscore compared with the tumor-node-metastasis (TNM) staging in predicting recurrence and survival (all P < 0.001). Lymph node ratio added information in a prognostic model (all P < 0.05). In addition, high infiltration of CD3(+) and CD8(+) lymphocytes in tumor biopsies was associated with downstaging of the tumor after pCRT (CD3(+) cells; Fisher exact test P = 0.01).The Immunoscore could be a useful prognostic marker in patients with rectal cancer treated by primary surgery. The determination of the immune infiltrate in biopsies before treatment could be a valuable information for the prediction of response to pCRT.

Cholangiocarcinoma (CCA) is a rare and heterogeneous biliary cancer, whose incidence and related mortality is increasing. This study investigates the clinical course of CCA and subtypes (intrahepatic [iCCA], perihilar [pCCA], and distal [dCCA]) in a pan-European cohort.The ENSCCA Registry is a multicenter observational study. Patients were included if they had a histologically proven diagnosis of CCA between 2010-2019. Demographic, histomorphological, biochemical, and clinical studies were performed.Overall, 2,234 patients were enrolled (male/female=1.29). iCCA (n = 1,243) was associated with overweight/obesity and chronic liver diseases involving cirrhosis and/or viral hepatitis; pCCA (n = 592) with primary sclerosing cholangitis; and dCCA (n = 399) with choledocholithiasis. At diagnosis, 42.2% of patients had local disease, 29.4% locally advanced disease (LAD), and 28.4% metastatic disease (MD). Serum CEA and CA19-9 showed low diagnostic sensitivity, but their concomitant elevation was associated with increased risk of presenting with LAD (odds ratio 2.16; 95% CI 1.43-3.27) or MD (odds ratio 5.88; 95% CI 3.69-9.25). Patients undergoing resection (50.3%) had the best outcomes, particularly with negative-resection margin (R0) (median overall survival [mOS] = 45.1 months); however, margin involvement (R1) (hazard ratio 1.92; 95% CI 1.53-2.41; mOS = 24.7 months) and lymph node invasion (hazard ratio 2.13; 95% CI 1.55-2.94; mOS = 23.3 months) compromised prognosis. Among patients with unresectable disease (49.6%), the mOS was 10.6 months for those receiving active palliative therapies, mostly chemotherapy (26.2%), and 4.0 months for those receiving best supportive care (20.6%). iCCAs were associated with worse outcomes than p/dCCAs. ECOG performance status, MD and CA19-9 were independent prognostic factors.CCA is frequently diagnosed at an advanced stage, a proportion of patients fail to receive cancer-specific therapies, and prognosis remains dismal. Identification of preventable risk factors and implementation of surveillance in high-risk populations are required to decrease cancer-related mortality.This is, to date, the largest international (pan-European: 26 hospitals and 11 countries) observational study, in which the course of cholangiocarcinoma has been investigated, comparing the 3 subtypes based on the latest International Classification of Diseases 11th Edition (ICD-11) (i.e., intrahepatic [2C12], perihilar [2C18], or distal [2C15] affected bile ducts), which come into effect in 2022. General and tumor-type specific features at diagnosis, risk factors, biomarker accuracy, as well as patient management and outcomes, are presented and compared, outlining the current clinical state of cholangiocarcinoma in Europe.

No biomarker capable of improving selection and monitoring of patients with rectal cancer managed by watch-and-wait (W&W) strategy is currently available. Prognostic performance of the Immunoscore biopsy (ISB) was recently suggested in a preliminary study.This international validation study included 249 patients with clinical complete response (cCR) managed by W&W strategy. Intratumoral CD3+ and CD8+ T cells were quantified on pretreatment rectal biopsies by digital pathology and converted to ISB. The primary end point was time to recurrence (TTR; the time from the end of neoadjuvant treatment to the date of local regrowth or distant metastasis). Associations between ISB and outcomes were analyzed by stratified Cox regression adjusted for confounders. Immune status of tumor-draining lymph nodes (n = 161) of 17 additional patients treated by neoadjuvant chemoradiotherapy and surgery was investigated by 3'RNA-Seq and immunofluorescence.Recurrence-free rates at 5 years were 91.3% (82.4%-100.0%), 62.5% (53.2%-73.3%), and 53.1% (42.4%-66.5%) with ISB High, ISB Intermediate, and ISB Low, respectively (hazard ratio [HR; Low v High], 6.51; 95% CI, 1.99 to 21.28; log-rank P = .0004). ISB was also significantly associated with disease-free survival (log-rank P = .0002), and predicted both local regrowth and distant metastasis. In multivariate analysis, ISB was independent of patient age, sex, tumor location, cT stage (T, primary tumor; c, clinical), cN stage (N, regional lymph node; c, clinical), and was the strongest predictor for TTR (HR [ISB High v Low], 6.93; 95% CI, 2.08 to 23.15; P = .0017). The addition of ISB to a clinical-based model significantly improved the prediction of recurrence. Finally, B-cell proliferation and memory in draining lymph nodes was evidenced in the draining lymph nodes of patients with cCR.The ISB is validated as a biomarker to predict both local regrowth and distant metastasis, with a gradual scaling of the risk of pejorative outcome.

Abstract Purpose: No biomarker to personalize treatment in locally advanced rectal cancer (LARC) is currently available. We assessed in LARC whether a diagnostic biopsy-adapted immunoscore (ISB) could predict response to neoadjuvant treatment (nT) and better define patients eligible to an organ preservation strategy (“Watch-and-Wait”). Experimental Design: Biopsies from two independent cohorts (n1 = 131, n2 = 118) of patients with LARC treated with nT followed by radical surgery were immunostained for CD3+ and CD8+ T cells and quantified by digital pathology to determine ISB. The expression of immune-related genes post-nT was investigated (n = 64 patients). Results were correlated with response to nT and disease-free survival (DFS). The ISB prognostic performance was further assessed in a multicentric cohort (n = 73 patients) treated by Watch-and-Wait. Results: ISB positively correlated with the degree of histologic response (P &amp;lt; 0.001) and gene expression levels for Th1 orientation and cytotoxic immune response, post-nT (P = 0.006). ISB high identified patients at lower risk of relapse or death compared with ISB low [HR, 0.21; 95% confidence interval (CI), 0.06–0.78; P = 0.009]. Prognostic performance of ISB for DFS was confirmed in a validation cohort. ISB was an independent parameter, more informative than pre- (P &amp;lt; 0.001) and post-nT (P &amp;lt; 0.05) imaging to predict DFS. ISB combined with imaging post-nT discriminated very good responders that could benefit from organ preservation strategy. In the “Watch-and-Wait” cohort (n = 73), no relapse was observed in patients with ISB high (23.3%). Conclusions: ISB predicts response to nT and survival in patients with LARC treated by surgery. Its usefulness in the selection of patients eligible for a Watch-and-Wait strategy is strongly suggested.

Background New and fully validated tests need to be brought into clinical practice to improve the estimation of recurrence risk in patients with colon cancer. The aim of this study was to assess the analytical performances of the Immunoscore (IS) and show its contribution to prognosis prediction. Methods Immunohistochemical staining of CD3+ and CD8+ T cells on adjacent sections of colon cancer tissues were quantified in the core of the tumor and its invasive margin with dedicated IS modules integrated into digital pathology software. Staining intensity across samples collected between 1989 and 2016 (n=595) was measured. The accuracy of the IS workflow was established by comparing optical and automatic counts. Analytical precision of the IS was evaluated within individual tumor block on distant sections and between eligible blocks. The IS interlaboratory reproducibility (n=100) and overall assay precision were assessed (n=3). Contribution of the IS to prediction of recurrence based on clinical and molecular parameters was determined (n=538). Results Optical and automatic counts for CD3+ or CD8+ were strongly correlated (r=0.94, p&lt;0.001 and r=0.92, p&lt;0.001, respectively). CD3 and CD8 staining intensities were not altered by the age of the tumor block over a period of 30 years. Neither the position of tested tissue sections within a tumor block nor the selection of the tissue blocks affected the IS. Reproducibility of the IS was not affected by multiple variables (eg, antibody lots, DAB revelation kits, immunohistochemistry automates and operators). Interassay repeatability of the IS was 100% and interlaboratory reproducibility between two testing centers was 93%. Finally, in a case series of patients with stage II–III colon cancer, the relative proportion of variance for time to recurrence was greatest for the IS (53% of prognostic variability) in a model that included IS, T-stage, microsatellite instability status and total number of lymph nodes. Conclusion IS is a robust and validated clinical assay leveraging immune scoring to predict recurrence risk of patient with localized colon cancer. The strong and independent prognostic value of IS should pave the way for it use in clinical practice.

Individualized gastric cancer (GC) treatment aims at providing targeted therapies that translate the latest research into improved management strategies. Extracellular vesicle microRNAs have been proposed as biomarkers for GC prognosis. Helicobacter pylori infection influences the therapeutic response to and the drivers of malignant changes in chronic gastritis. The successful use of transplanted mesenchymal stem cells (MSCs) for gastric ulcer healing has raised interest in studying their effects on tumor neovascularization and in potential antiangiogenic therapies that could use mesenchymal stem cell secretion into extracellular vesicles—such as exosomes—in GC cells. The use of MSCs isolated from bone marrow in order to achieve angiogenic modulation in the tumor microenvironment could exploit the inherent migration of MSCs into GC tissues. Bone marrow-derived MSCs naturally present in the stomach have been reported to carry a malignancy risk, but their effect in GC is still being researched. The pro- and antiangiogenic effects of MSCs derived from various sources complement their role in immune regulation and tissue regeneration and provide further understanding into the heterogeneous biology of GC, the aberrant morphology of tumor vasculature and the mechanisms of resistance to antiangiogenic drugs.

Background and Objectives: A positive pathological circumferential resection margin is a key prognostic factor in rectal cancer surgery. The point of this prospective study was to see how well different MRI parameters could predict a positive pathological circumferential resection margin (pCRM) in people who had been diagnosed with rectal adenocarcinoma, either on their own or when used together. Materials and Methods: Between November 2019 and February 2023, a total of 112 patients were enrolled in this prospective study and followed up for a 36-month period. MRI predictors such as circumferential resection margin (mCRM), presence of extramural venous invasion (mrEMVI), tumor location, and the distance between the tumor and anal verge, taken individually or combined, were evaluated with univariate and sensitivity analyses. Survival estimates in relation to a pCRM status were also determined using Kaplan–Meier analysis. Results: When individually evaluated, the best MRI predictor for the detection of a pCRM in the postsurgical histopathological examination is mrEMVI, which achieved a sensitivity (Se) of 77.78%, a specificity (Sp) of 87.38%, a negative predictive value (NPV) of 97.83%, and an accuracy of 86.61%. Also, the best predictive performance was achieved by a model that comprised all MRI predictors (mCRM+ mrEMVI+ anterior location+ &lt; 4 cm from the anal verge), with an Se of 66.67%, an Sp of 88.46%, an NPV of 96.84%, and an accuracy of 86.73%. The survival rates were significantly higher in the pCRM-negative group (p &lt; 0.001). Conclusions: The use of selective individual imaging predictors or combined models could be useful for the prediction of positive pCRM and risk stratification for local recurrence or distant metastasis.

Multiple synergistic combination approaches with cancer drugs are developed to overcome primary resistance to immunotherapy; however, the mechanistic rationale to combine chemoradiotherapy (CRT) with immune checkpoint inhibitors remains elusive.This study described the immunological landscape of tumor microenvironment (TME) exposed to CRT. Tumor samples from patients with rectal cancer (n=43) treated with neoadjuvant CRT or radiotherapy were analyzed by nanostring and immunohistochemistry. Studies in mice were performed using three syngeneic tumors (TC1, CT26 and MC38). Tumor-bearing mice were treated either with platinum-based CRT, radiotherapy or chemotherapy. Anti-CTLA-4 and/or anti-Programmed Cell Death Receptor-1 (PD-1) therapy was used in combination with CRT. The therapy-exposed TME was screened by RNA sequencing and flow cytometry and tumor-infiltrating T lymphocyte functionality was evaluated by interferon (IFN)-γ ELIspot and intracellular cytokine staining.Front-to-front comparison analysis revealed the synergistic effect of CRT to establish a highly inflamed and Th1-polarized immune signature in the TME of patients and mice. In both settings, CRT-exposed TMEs were highly enriched in newly-infiltrated tumor-specific CD8+ T cells as well as tissue resident memory CD103+CD8+ T cells. In mice, CD8 T cells were involved in the antitumor response mediated by CRT and were primed by CRT-activated CD103+ dendritic cells. In the three tumor models, we showed that concurrent combination of CRT with a dual CTLA-4 and PD-1 blockade was required to achieve an optimal antitumor effect and to establish a broad and long-lasting protective antitumor T cell immunity.Our results highlight the ability of CRT to stimulate strong antitumor T-cell-mediated immunity and tissue resident memory T activation in TME, to foster immune checkpoint inhibitors action. These findings have implications in clinic for the design clinical trials combining chemoradiation with immunotherapy.

Left atrial structural, functional and electrical remodelling are linked to atrial fibrillation (AF) pathophysiology and mirror the phrase "AF begets AF". A structurally remodelled left atrium (LA) is fibrotic, dysfunctional and enlarged. Fibrosis is the hallmark of LA structural remodelling and is associated with increased risk of stroke, heart failure development and/or progression and poorer catheter ablation outcomes with increased recurrence rates. Moreover, increased atrial fibrosis has been associated with higher rates of stroke even in sinus-rhythm individuals. As such, properly assessing the fibrotic atrial cardiomyopathy in AF patients becomes necessary. In this respect, late-gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging is the gold standard in imaging myocardial fibrosis. LA structural remodelling extension offers both diagnostic and prognostic information and influences therapeutic choices. LGE-CMR scans can be used before the procedure to better select candidates and to aid in choosing the ablation technique, during the procedure (full CMR-guided ablations) and after the ablation (to assess the ablation scar). This review focuses on imaging several LA structural remodelling CMR parameters, including size, shape and fibrosis (both extension and architecture) and their impact on procedure outcomes, recurrence risk, as well as their utility in relation to the index procedure timing.

Between 1980 and 1993, 18 patients underwent formal laparotomy after laparostomy and healing of the peritoneal cavity by granulation. The majority (12 patients) were men and the median age was 47 (range 22-67) years. Intraabdominal infection following surgery for Crohn's disease (four patients) and necrotizing pancreatitis (six) was the most common primary condition requiring laparostomy. A total of 23 reconstructive operations were carried out on the 18 patients a median of 6 (range 1-18) months after laparostomy. The indication for surgery was for closure and/or resection of an enteric fistula in 13 patients. The site of the fistula included three gastric, two duodenal, 11 small bowel and seven colonic. A further four patients required operation for closure or refashioning of a stoma. Five patients subsequently required a second laparotomy: two for elective restoration of bowel continuity, two for recurrent fistula and one for an acute abdomen. After reconstructive surgery following laparostomy 16 patients were discharged home alive and well, one requiring home parenteral nutrition for short bowel syndrome. In contrast, the two oldest patients in the series died from multiple organ failure immediately after initial reconstructive surgery. Both had pre-existing medical problems and in neither was there evidence of further intra-abdominal infection after reconstruction.

Objective Abdominal radical trachelectomy (ART) is one of the fertility-sparing procedures in women with early-stage cervical cancer. The published results of ART, in comparison with vaginal radical trachelectomy, so far are limited. Materials and Methods This retrospective study comprises all cases of female patients referred to ART with early-stage cervical cancer from 2 gynecologic oncology centers in Romania. Results A total of 29 women were referred for ART, but subsequently, fertility could not be preserved in 3 of them. Eleven women had stage IA2 disease (42.3%), 14 (53.8%) women had stage IB1 disease, and 1 (3.8%) woman had stage IB2 disease. Histologic subtypes were 15 (57.6%) squamous, 8 (30.7%) adenocarcinoma, and 3 (11.5%) adenosquamous. There were no major intraoperative complications in both hospitals. Early postoperative complications were mainly related to the type C parametrectomy—bladder dysfunction for more than 7 days (8 [30.7%] women) and prolonged constipation (6 [23.0%] women). Other complications consisted in symptomatic lymphocele in 2 (7.6%) patients, which were drained. Median follow-up time was 20 months (range, 4–43 months). Up to the present time, there has been 1 (3.8%) recurrence in our series. Most patients did not experience late postoperative complications. Three (11.5%) women are amenorrheic, and 1 (3.8%) woman developed a cervical stenosis. Of the 23 women who have normal menstruation and maintained their fertility, a total of 7 (30.4%) women have attempted pregnancy, and 3 (42.8%) of them achieved pregnancy spontaneously. These pregnancies ended in 2 first trimester miscarriages and 1 live birth at term by cesarean delivery. Conclusions Our results demonstrate that ART preserves fertility and maintains excellent oncological outcomes with low complication rates.

Breast sarcoma (BS) is a very rare and poorly studied condition. This has led to a lack of studies with a high level of evidence and to low efficacy of current clinical management protocols. Here we present our experience in treating this disease in the form of a retrospective case series study including discussion of clinical, imaging, and pathological features and treatment. We also compare the main clinical and biological features of six cases of BS (phyllodes tumors were excluded) with a cohort of 184 patients with unilateral breast carcinoma (BC) from a previous study performed at our institution. Patients with BS were diagnosed at a younger age, presented no evidence of lymph node invasion or distant metastases, had no multiple or bilateral lesions, and underwent a shorter length of hospital stay versus the breast carcinoma group. Where recommended, adjuvant chemotherapy consisted of an anthracycline-containing regimen, and adjuvant external radiotherapy was delivered in doses of 50 Gy. The comparison data obtained from our BS cases and the ones with BC revealed differences in diagnosis and treatment. A correct pathological diagnosis of breast sarcoma is essential for the right therapeutic approach. We still have more to learn about this entity, but our case series could add value to existing knowledge in a meta-analysis study.

(1) Objective: Artificial intelligence (AI) has become an important tool in medicine in diagnosis, prognosis, and treatment evaluation, and its role will increase over time, along with the improvement and validation of AI models. We evaluated the applicability of AI in predicting the depth of myometrial invasion in MRI studies in women with endometrial cancer. (2) Methods: A systematic search was conducted in PubMed, SCOPUS, Embase, and clinicaltrials.gov databases for research papers from inception to May 2023. As keywords, we used: "endometrial cancer artificial intelligence", "endometrial cancer AI", "endometrial cancer MRI artificial intelligence", "endometrial cancer machine learning", and "endometrial cancer machine learning MRI". We excluded studies that did not evaluate myometrial invasion. (3) Results: Of 1651 screened records, eight were eligible. The size of the dataset was between 50 and 530 participants among the studies. We evaluated the models by accuracy scores, area under the curve, and sensitivity/specificity. A quantitative analysis was not appropriate for this study due to the high heterogeneity among studies. (4) Conclusions: High accuracy, sensitivity, and specificity rates were obtained among studies using different AI systems. Overall, the existing studies suggest that they have the potential to improve the accuracy and efficiency of the myometrial invasion evaluation of MRI images in endometrial cancer patients.

Right heart masses are usually suspected during a routine examination by transthoracic echocardiography or due to cardiac symptoms. Although very important, sometimes it may be a challenge to differentiate between normal structures (variants) and aberrant or pathologic masses regarding the right heart cardiac tumors. In the last entity, the majority of primary cardiac tumors in adults and children are benign; however, they may have a malignant counterpart. Right heart tumors might involve not only the walls (myocardium, endocardium and pericardium), but also valves and cardiac chambers. Cardiac tumors exhibit altered signal intensity and enhancement characteristics, requiring the use of several imaging methods following a multimodality-imaging algorithm that culminates in the excision or biopsy of the tumor formation. Therefore, various imaging modalities, including echocardiography, computer tomography, positron emission tomography, cardiac magnetic resonance imaging, scintigraphy or, even, invasive angiography, can be useful during their diagnosis. Echocardiography is the first-line non-invasive imaging modality used in the evaluation of the right heart tumors. Before the other diagnosis imaging modalities it is essential for defining morphology, assessing size, observing dynamic appearance, and evaluating functional abnormalities and hemodynamic consequences,. However, all imaging methods have frequently a complementary role; therefore, an integrated imaging approach is recommended.

Background: The tumor histological grade is closely related to the prognosis of patients with endometrial cancer (EC). Multiparametric MRI, including diffusion-weighted imaging (DWI), provides information about the cellular density that may be useful to differentiate between benign and malignant uterine lesions. However, correlations between apparent diffusion coefficient (ADC) values and histopathological grading in endometrial cancer remain controversial. Material and methods: We retrospectively evaluated 92 patients with endometrial cancers, including both endometrioid adenocarcinomas (64) and non-endometrioid adenocarcinomas (28). All patients underwent DWI procedures, and mean ADC values were calculated in a region of interest. These values were then correlated with the tumor grading offered by the histopathological examination, which was considered the gold standard. In this way, the patients were divided into three groups (G1, G2, and G3). The ADC values were then compared to the results offered by the biopsy to see if the DWI sequence and ADC map could replace this procedure. We also compared the mean ADC values to the myometrial invasion (&lt;/&gt;50%) and lymphovascular space invasion. Results: We have divided the ADC values into three categories corresponding to three grades: &gt;0.850 × 10−3 mm2/s (ADC1), 0.730–0.849 × 10−3 mm2/s (ADC2) and &lt;0.730 × 10−3 mm2/s (ADC3). The diagnostic accuracy of the ADC value was 85.71% for ADC1, 75.76% for ADC2, and 91.66% for ADC3. In 77 cases out of 92, the category in which they were placed using the ADC value corresponded to the result offered by the histopathological exam with an accuracy of 83.69%. For only 56.52% of patients, the biopsy result included the grading system. For each grading category, the mean ADC value showed better results than the biopsy; for G1 patients, the mean ADC value had an accuracy of 85.71% compared to 66.66% in the biopsy, G2 had 75.76% compared to 68.42%, and G3 had 91.66 compared to 75%. For both deep myometrial invasion and lymphovascular space invasion, there is a close, inversely proportional correlation with the mean ADC value. Conclusions: Mean endometrial tumor ADC on MR-DWI is inversely related to the histological grade, deep myometrial invasion and lymphovascular space invasion. Using this method, the patients could be better divided into risk categories for personalized treatment.

A right heart tumor can be identified by transthoracic echocardiography during a routine examination or due to cardiac symptoms. The first step is the assessment by echocardiography, with its multiple techniques, and the obtained information must be judged in a clinical and biological context. The second step comprises one, sometimes even two, of the more complex modality imaging methods. The choice is driven not only by the advantages of each imaging technique but also by local expertise or the preferred imaging modality in the center. This step is followed by staging, follow-up, and/or imaging-guided excision or biopsy, which is performed in selected cases in order to obtain anatomopathological confirmation. In the presence of features suggestive of malignancy or causing hemodynamic impairment, a transvenous biopsy is essential before the more complex imaging modalities (which are still relevant in the staging process). Using a structured imaging approach, it is possible to reach an appropriate diagnosis without a biopsy. Frequently, these imaging techniques have a complementary role, so an integrated imaging approach is recommended. This proposed algorithm for appropriate diagnosis of right heart tumors could serve as a practical guide for clinicians (not only imaging specialists).

Landiolol is an ultra-short-acting, selective ß1- adrenergic receptor blocker that was originally approved by Japan for the treatment of intraoperative tachyarrhythmias. It has gained attention for its use in the management of tachyarrhythmias and perioperative tachycardia, especially atrial fibrillation for both cardiac and non-cardiac surgeries. It can be the ideal agent for heart rate control due to its high β1‐selectivity, the potent negative chronotropic effect, a limited negative inotropic potential, and an ultrashort elimination half‐life (around 4 min); moreover, it may have a potential therapeutic effect for sepsis and pediatric patients. Landiolol seems to be superior to other short‐acting and selective beta‐blockers such as esmolol. This review aims to provide a comprehensive overview of landiolol, a new ultra-short-acting ß1 selective antagonist, including its pharmacology, clinical applications, efficacy, safety profile, and future directions in research and clinical data.

(1) Background: Numerous variables could influence the risk of rectal cancer recurrence or metastasis, and machine learning (ML)-based algorithms can help us refine the risk stratification process of these patients and choose the best therapeutic approach. The aim of this study was to assess the predictive performance of 4 ML-based models for the prediction of local recurrence or distant metastasis in patients with locally advanced low rectal adenocarcinomas who underwent neoadjuvant chemoradiotherapy and surgical treatment; (2) Methods: Patients who were admitted at the first Oncologic Surgical Clinic from the Regional Institute of Oncology, Iasi, Romania were retrospectively included in this study between November 2019 and July 2023. Decision tree (DT), naïve Bayes (NB), support vector machine (SVM), and random forest (RF) were used to analyze imagistic, surgical, and pathological data retrieved from the medical files, and their predictive performance was assessed; (3) Results: The best predictive performance was achieved by RF when used to predict disease recurrence (accuracy: 90.85%) or distant metastasis (accuracy: 89.63%). RF was closely followed by SVM (accuracy for recurrence 87.8%; accuracy for metastasis: 87.2%) in terms of predictive performance. NB and DT achieved moderate predictive power for the evaluated outcomes; (4) Conclusions: Complex algorithms such as RF and SVM could be useful for improving the prediction of adverse oncological outcomes in patients with low rectal adenocarcinoma.

Landiolol is an ultra-short-acting, selective β1-adrenergic receptor blocker that was originally approved in Japan for the treatment of intraoperative tachyarrhythmias. It has gained attention for its use in the management of tachyarrhythmias and perioperative tachycardia, especially atrial fibrillation for both cardiac and non-cardiac surgeries. It can be the ideal agent for heart rate control due to its high β1-selectivity, potent negative chronotropic effect, a limited negative inotropic potential, and an ultrashort elimination half-life (around 4 min); moreover, it may have a potential therapeutic effects for sepsis and pediatric patients. Landiolol seems to be superior to other short-acting and selective beta-blockers such as esmolol. This review aims to provide a comprehensive overview of landiolol, a new ultra-short-acting β1 selective antagonist, including its pharmacology, clinical applications, efficacy, safety profile, and future directions in research and clinical data.

RezumatIntroducere: Anemia şi transfuzia reprezintă factori de risc independenţi de evoluţie nefavorabilă în cancerul colorectal.Anemia severă poate creşte agresivitatea tumorală iar transfuzia poate induce imunosupresie, promovând astfel recurenţa cancerului.Strategiile de Gestionare a Sângelui Pacientului (GSP), specifice pentru pacienţii oncologici, sunt în prezent insuficient definite şi recomandate.Obiectiv primar: Evaluarea prevalenţei anemiei şi a ratei de transfuzie perioperator la pacienţii cu neoplasm colorectal.Obiectiv secundar: Analiză subgrup pacienţi anemici versus non

To analyze the main causes of death in patients with stage 0-II breast cancer who undergo breast conserving surgery or radical mastectomy, and to establish the role of imaging surveillance protocols following breast cancer treatment.We conducted a retrospective medical record review between January 2005 and December 2012, when breast cancer was the primary cause of death for 113 inpatients. All patients were admitted to the Oncology Clinic of the Iasi Regional Cancer Institute (IRCI), Romania. Patients were stratified by clinical stage 0, I and II, of which 33 (29.2%) patients were managed by breast conservation therapy and 80 (70.8%) underwent radical mastectomy. From the patient medical records all diagnostic imaging studies performed (ultrasound, radiography and computed tomography) were identified and analyzed according to a standard protocol for imaging the postoperative breast.Bone, liver, lung, lymph nodes and local-regional recurrence were the most common sites for metastasis, while the most frequent cause of death were metastases to the liver, pleura, lung and brain. The time interval between recurrence and death ranged from 0-24 years among patients with one type of metastasis, and decreased to 0-3 years since the last recurrence for patients with multiple metastases.The current imaging protocol for monitoring the postoperative breast could be optimized to improve the prognosis and quality of life in patients with stage 0-II breast cancer.

În echilibrul perfect dintre invazia tumorală şi sistemele noastre de apărare, rolul jucat de răspunsul imun adaptiv la nivel tumoral este critic.Dincolo de faptul că toate elementele sistemului imun ce intervin în răspunsul imun înnăscut şi cel adaptativ pot fi observate la diferite grade în micromediul tumoral, se pare că există o densitate crescută de limfocite cu memorie T citotoxice, în contextul unei orientări imune Th1 la nivel intratumoral şi al frontului de invazie tumorală, ce oferă un marker de prognostic de importanţă majoră în cancerul colorectal şi în tumorile solide în general.Înţelegerea rolului pe care imunitatea îl are în cancer, în urma unui secol de intensă cercetare, a condus la o schimbare completă a paradigmei.Pentru a arăta impactul major al acestui concept revoluţionar, vom evidenţia aici prin exemplul cancerului colorectal, cum un test imun eficient şi anume "Immunoscore" a fost dezvoltat.De asemenea, oferim date actualizate care demonstrează capacitatea Immunoscorului de a prezice cu o acurateţe superioară stadializării TNM evoluţia clinică a pacienţilor şi ghidarea strategiilor terapeutice.

Pancreatic pseudocysts are frequent complications of both acute and chronic pancreatitis. By contrast, pancreatico-pleural fistula is rare. Here we report a case of massive pleural effusion secondary to a fistula in the left hemi-diaphragm, between a pancreatic pseudocyst and the left pleura, in a patient with a right kidney tumor and bilateral massive pulmonary thromboembolism. This fistula developed after several episodes of un-investigated acute pancreatitis. The pleural effusion was treated by three thoracocenteses, without recurrence.

The adipocyte expansion is a critical process with implications in the pathogenesis of obesity associated metabolic syndrome. Impaired adipogenesis leads to dysfunctional, hypertrophic adipocytes, local inflammation and peripheric insulin resistance. We assessed the relationship between the adipogenic differentiation capacity of the subcutaneous adipose derived stem cells (ASCs), evaluated by total lipid accumulation, and the metabolic and hormonal profile in a group of obese female patients proposed for bariatric surgery (N = 20) versus normal weight female controls (N = 7). The lipid accumulation (measured as optical density at 492 nm) of ASCs during their differentiation to adipocytes was significantly lower in ASCs isolated from obese patients as compared to ASCs isolated from normal weight patients (0.49 ± 0.1 vs. 0.71 ± 0.1, p < 0.001). Significant negative correlations between lipid accumulation in adipogenic differentiated ASCs and plasma concentrations of triglycerides (p < 0.01), insulin (p < 0.001), HOMA-IR (p < 0.01), adiponectin (p < 0.05) and leptin/adiponectin ratio (p < 0.05) were found in obese group. In severely obese female patients, the abnormal adipogenesis is related to insulin resistance and leptin/adiponectin ratio. The abnormal lipid accumulation in the mature adipocyte derived from obese ASCs could possible predict the further development of type 2 diabetes mellitus in severely obese patients and influence the selection of patients for bariatric surgery.

Rationale: Male adenomyoepithelioma of the breast with malignant features is a rare tumor with only one previous case reported in the literature over 25 years ago. Patient concerns: We report the case of a 63-year-old man admitted to our Oncology Institute with a painless tumor mass of 6 cm in the left breast with no additional regional lymph nodes. Ultrasound revealed a complex cystic tumor mass of 60 mm in the left breast, with both anechoic (cystic) and echogenic (solid) components, with ill-defined margin. Diagnoses: Extemporaneous assessment showed a solid (invasive) papillary intracystic carcinoma. Definitive pathology examination revealed the presence of a breast malignant adenomyoepithelioma. Interventions: Based on the extemporaneous assessment, wide tumor excision was performed. The tumor board decided to continue treatment with adjuvant anthracycline-based chemotherapy. Outcomes: After 6 years of follow-up, the patient is cancer-free. No chronic side effects were noted. Lessons: Because this pathology is extremely rare, no guidelines are available for its therapeutic approach. All decisions regarding patient management should be made by a multi-disciplinary team and can only be based on clinical experience and the few cases reported in female patients.

Hepatic arterial infusion (HAI) was evaluated for different drugs to treat hepatic metastasis from colorectal cancer (CRC). Combination treatment with 5-fluorouracil (5-FU), leucovorin, oxaliplatin and irinotecan (FOLFOXIRI) is effective for CRC. A phase II study was conducted to evaluate concomitant HAI administration of oxaliplatin and intravenous leucovorin, 5-FU and irinotecan (FOLFIRI) for patients with inoperable liver metastasis, which had chemotherapy with oxaliplatin (OX) 85 mg/m2 HAI plus systemic intravenous chemotherapy [leucovorin 200 mg/m2, 5-FU 2400 mg/m2 and irinotecan (IRI) 160 mg/m2 in 48 hours]. We treated 24 patients. Neutropaenia was the most frequent toxicity. The main HAI-related toxicity was pain. Two patients (8%) obtained complete response and 17 patients (70%) partial response, giving an objective response rate of 78%. Median follow-up was 22.8 months, and median overall and disease-free survival times were 29 and 20 months, respectively. Therefore, OX HAI and intravenous FOLFIRI is feasible and effective in patients with metastatic CRC.

According to evidence accumulated in the last years, many cancer centers recommend a treatment plan based solely on chemo-radiotherapy and exclude surgery from the treatment options in locally advanced cervical cancer (LACC). In Romania, surgery was at the forefront of therapeutic options. Nevertheless, current data shows that in fact, a large number of patients are still referred to surgery in various stages of diagnosis and treatment. It was noted that recommendations may differ, in spite of the wide dissemination of the literature data.Works published so far, discussing the role of surgery in LACC treatment shows a lack of consensus. A group of experts in oncology (SURCECAN research group - Surgery of Cervical Cancer) met for a session of the Romanian Surgical Society (Bucharest) on April 18, 2018. They found that LACC therapeutic strategy in Romania may differ somewhat from the European recommendations.On top of that, late enrolement to RT and low acces to specialized centers are the problem. Performing surgery not only allows the evaluation of the pathological response to chemo-radiotherapy, but also achieves a better local control. In conclusion, there is still a place for surgery within locally advanced cervical cancer treatment options. More trials need to be carried out in order to confirm the findings and establish high levels of confidence for each piece of information provided.

Multiple breast cancer (MBC) is a controversial topic due to the lack of a consensus regarding its definition, classification issues and imprecise management recommendations in current reference guidelines. In four years, 756 patients with breast cancer (BC) were surgically treated in our Unit, 91 (12.03%) of them being pathologically diagnosed as MBCs. We present the results of our retrospective case-control study that performed a comparison between the clinicopathological characteristics and immunohistochemical (IHC) profiles of our MBC group versus a control group, represented by a sample of 184 cases randomly chosen from those with unifocal breast cancer (UBC). Starting from the premise of increased biological aggressivity of MBC, showed by several reports, we proposed to research the possible differences between these groups and to highlight their potential predictive and/or prognostic value. We found that MBC patients have a poorer prognosis than UBC ones - younger age at diagnosis [more cases less than 50 years old (p=0.03)], a lower frequency of T1 and a higher rate of T3 tumors [when using aggregate tumor size measuring method (p<0.001)], fewer node-negative (N0) cases (p=0.046) and a higher frequency of mucinous breast carcinoma (p=0.026). It worth mentioning that we obtained lower rates of poorly differentiated (G3) tumors (p=0.022) in the MBC group, this result being opposite to those found by other researchers. Our study also revealed a higher rate of human epidermal growth factor receptor 2 (HER2∕neu)-type cases in MBC group (p=0.022), these patients having the chance to benefit from treatment with monoclonal antibodies, with a better outcome than patients with triple-negative type. We registered significantly lower progesterone receptor (PR) positivity rates in patients with MBC, thus having a negative predictive value by showing a worse response to hormone-based therapies. Besides, we found heterogeneity of IHC features among tumor foci in MBC that may influence the therapeutic decisions. Our results sustain that MBC is biologically a more aggressive type of mammary neoplasia requiring a more particular therapeutic approach.

Introduction: Brain metastases (BMs) originating in colorectal cancer (CRC) have a significant importance for patients' survival.Because in literature there are only isolated case reports and only few series published on this issue, we aimed to assess the incidence of BMs from CRC, to identify patient's characteristics and BMs clinical, histopathological (HP) and immunohistochemical (IHC) features, and to compare the data we obtained with those from literature.Patients, Materials and Methods: We present a retrospective study of 27 histologically confirmed cases of BMs from CRC among all 1040 patients who received metastasectomy in the Department of Neurosurgery, Prof. Dr. Nicolae Oblu Emergency Clinical Hospital, Iaşi, Romania, in an eight-year period (January 2011 to December 2018).Patients' characteristics (gender, age), primary tumor location, time from primary tumor surgery to BMs surgery and BMs features (number, location and HP characteristics) were investigated.Histochemical [Alcian Blue (AB) and Periodic Acid-Schiff (PAS)] staining and IHC stainings for cytokeratin (CK) 7, CK20, caudal-type homeobox 2 (CDX2) and human epidermal growth factor receptor 2 (HER2)/neu were performed on all available BMs specimens.Results: There were 27 consecutive patients with BMs from CRC, corresponding to 2.59% of all patients with BMs during the eight-year period we have studied, most of them being diagnosed and treated in 2016.Male:female ratio was 1.45.The mean age for all patients at diagnosis of the BMs was 62.25 years (range: 40-79 years).The origin of the primary cancer was mainly the colon (62.96% of all cases).Of all 27 patients, only two (7.4%) presented neurological symptoms without a diagnosis of CRC.BMs were identified in a period ranging from six months to 70 months after the initial diagnosis.The average time between diagnosis of the primary tumor and of the BMs was 25.92 months.At the moment of the diagnosis of BMs, 17 (62.96%)patients also had other systemic metastases.Most of the cases (55.55%) were situated in the supratentorial compartment.IHC stainings were negative for CK7 and positive for CK20 and CDX2 in all BMs from colonic adenocarcinomas (ADCs), a profile consistent with a non-neuronal and gastric origin.AB and PAS stainings revealed pools of extracellular mucin, especially in cases of mucinous ADC.Ki67 labeling index ranged between 90% and 100%.IHC staining with anti-HER2/neu antibody showed in 25 (96.15%)cases a strong and diffuse aberrant nuclear staining.Conclusions: BMs originating in CRC represent a rare pathology and have particular clinical and IHC features that could vary from one series to another series.In a few cases, BMs may be diagnosed in the absence of a known CRC diagnosis and in these situations, the correct diagnosis is of interest.However, a panel of antibodies can help in establishing a correct diagnosis.Our study was among the first to analyze the HER2/neu expression pattern in BMs from CRC and we found a strong aberrant nuclear expression of this molecular marker on IHC investigation.Related to the data published so far in the literature, it is possible that HER2/neu aberrant expression in the tumor nuclei of the BMs from our series may express the metastatic tumor cell phenotype that was previously subjected to cytostatics and radiation therapies.As such, we suggest that HER2/neu aberrant expression in BMs originating in CRC could represent a proof for the worst prognosis of these patients.

Introduction: Smooth muscle tumor of uncertain malignant potential (STUMP) still represents a medical and surgical challenge, being rare and hard to diagnose. Normally STUMP consists in a multitude of uterine tumors that do not meet the current histologic criteria for a specific malignant or benign tumor. Clinical, imagistic and laboratory investigations seem to only raise the presumptive diagnosis in these cases, the diagnosis being confirmed during histological examination of the post hysterectomy/myomectomy specimen. Case report: We present the case of a 50-year-old female patient who was examined for the first time for pelvic pain and sensation of increased pressure in the lower abdomen in June 2020. A gynecology consultation was performed, during which a large uterine mass was felt on vaginal digital examination combined with pelvic palpation. Further pelvic ultrasound examination revealed a voluminous tumor of the left ovary. Then, a magnetic resonance imaging was performed, which showed a large pelvi-abdominal tumor of probable ovarian origin with a mixt tissue type and cystic structure, the presence of pathological abdominal and pelvic lymph nodes, ascites with a suspicion of peritoneal carcinomatosis. The patient was referred to a tertiary center and the multidisciplinary team recommended surgical treatment. A total hysterectomy with bilateral oophorectomy and stadial lymphadenectomy was performed. After surgery, the patient had a favorable evolution and was discharged five days after the intervention in a good health condition. Macroscopic and histological examinations of the biopsy pieces showed morphological aspects of uterine smooth muscles tumors with uncertain malignancy potential/STUMP and multiple uterine leiomyomas. Discussion:Due to the rarity of these tumors, the scientific literature needs to be constantly updated in order to help physicians to correctly identify and treat this pathology. It is highly recommended to identify tumors with a high malignancy potential, so that the follow up will be sufficient to discover and treat recurrences before they become life-threatening. Conclusion:Smooth muscle tumor of uncertain malignant potential remains a difficult diagnosis due to uncertainty between malignancy and benign features. Treatment approaches are difficult in these cases and must always be in accordance with the patients' desire to maintain their reproductive functions and fertility. Recurrence of STUMP has been reported, therefore a close follow up of these patients must always be performed.

Objective We aimed to evaluate the prognostic value of circulating tumor cells (CTCs) and the impact of intraoperative tumor manipulation on CTCs in colorectal cancer (CRC) patients. Methods We performed a prospective study on 40 patients with CRC stages I to IV who received curative surgery using the no-touch technique. Flow cytometry was used to identify CTCs in peripheral blood samples (4 mL/sample) collected at two surgical moments: skin incision (T1) and after surgical resection (T2). A threshold of ≥4 CTCs/4 mL blood was established for considering patients CTC positive. Results In the univariate analysis, CTC evaluation at T2 was correlated with female sex, vascular invasion, tumor localization in the colon and metastatic lymph nodes. In the multivariate analysis, only female sex and colon cancer maintained statistical significance. At a medium follow-up of 15 months (1–25 months), the mortality rate was 10% (n = 4), with no significant differences between the overall survival of T1 or T2 CTC-positive and CTC-negative patients. Conclusions Flow cytometry is a feasible CTC identification technique in CRC, and although surgical manipulation has no influence on CTC numbers, CTCs may serve as a prognostic and predictive factor.

It is important for surgeons to keep up with improvements both in and outside their field. As medicine evolves, new techniques appear, and oncology is one of the main beneficiaries. "Liquid biopsy" is one of the most recent domains of interest in oncology, as it may provide important details regarding the characteristics of the main tumor and its metastases. Malignant cells are in a continuous dynamic, which makes the initial diagnostic biopsy and the pathological specimen evaluation insufficient in the late evolution of the disease, when relapse or metastases may appear. The fact that the healthcare provider is able to find out additional information about the tumor at a given time, by evaluating a blood sample to obtain a "liquid biopsy" is of utmost importance and gives multiple potentially usable data. There are three means of obtaining biological material that may be used as "liquid biopsy": evaluation of circulating tumor cells, circulating tumor DNA and exosomes. The most intensely studied entity is that of circulating tumor cells, with different applications, amongst which the most important, at present time, is the prognostic value that has important demonstrated implications, not only in breast and prostate cancer, but also in colorectal cancer. Although surgery will, most certainly, not be replaced by other treatments when aiming for a curative approach to rectal cancer, it is important for the surgeon to know information about complementary fields, one of which is comprised by "liquid biopsy".

Background &amp; Aims: Diverticular disease of the colon is a common clinical condition in developed countries, and is associated with significant (direct and indirect) economic burden. The aim of this Position Paper is to provide clinical guidance for appropriate definition, prevalence, risk factors, diagnosis, and treatment of colonic diverticular disease.Methods: A working group of recognized experts established by the Board of the Romanian Society of Gastroenterology and Hepatology (RSGH) screened the literature and the available guidelines on colonic diverticular disease. Statements were formulated based on literature evidence. These statements were discussed within the working group and decision for each of them was taken by consensus.Results: Thirty two statements were elaborated. The grade of recommendation, according to the level of evidence was established for each statement. Short comments with literature support accompany each statement.Conclusion: This Position Paper represents a practical guide for clinicians dealing with patients affected by colonic diverticular disease.

Multifactorial analysis of local and lymph node recurrences in stage 0-II breast cancer treated by conservative or radical surgery.In the interval January 1, 2005-July 31, 2013, 477 breast cancer patients were assessed by imaging techniques at the Radiology Clinic of Iasi "Sf. Spiridon" Hospital and Radiology Service of the Iasi Regional Cancer Institute. Of these 229 (48%) patients underwent conservative surgery and 248 (52%) patients radical surgery.Local recurrences were 2.8 times more frequent in conservatively vs. radically treated patients, and lymph node recurrences 2 times more frequent in patients treated conservatively. Breast tumors larger than 3 cm in diameter were at higher risk for local and distant recurrence in lymph nodes.Assessment in patients with local and lymph nodes recurrences of the relative risk for developing other types of recurrences (bone, pleuro pulmonary, liver, brain metastases) indicated that these are a risk factor for other types of recurrences, influencing the prognosis of patients. Local recurrences showed a higher relative risk for other types of recurrences than nodal recurrences.

Background: Pylorus preserving (PP) pancreaticoduodenectomy (PD) has several advantages in terms of shorter operation time and improved nutritional status but with an increased risk for delayed gastric emptying. Methods: We performed a retrospective study on all patients in which PD was performed from May 2012 to May 2018. It was analyzed early postoperative outcomes and the incidence of delayed gastric emptying (DGE) syndrome for patients with pylorus PP PD technique and pancreaticogastrostomy (PG). Results: There were 47 PD, in which PP technique was performed in 42 cases. The tumour location was in the pancreatic head (n=21, 44.68%), periampullary (ampulla of Vater) (n=14,29.78%), distal bile duct (n=7,14.89%), duodenum (n=2, 4.25%) and advanced right colon cancer (n=3, 6.38%). There were 10 cases (21.2%) of grade III-V complications, grade A pancreatic fistula (PF)8 cases (17%), grade B in 3 cases (6.4%) and grade C in 1 case (2.12%). DGE was encountered in 17 cases (36.17%), grade A 2 cases (4.25%), grade B in 4 cases (8.5%) and grade C in 2 cases (4.25%). Biliary fistula occurred in 3 cases (6.4%) and in 4 cases relaparotomy was needed. Conclusions: The results of our study are concluding with the previous studies, the addition of PG to PP PD does not increase the risk of DGE.

Numerous studies associate adipokines with colorectal malignancy, but few data deal with patients suffering exclusively of rectal carcinoma (RC).We evaluated leptin and adiponectin levels in RC patients compared to healthy population and their dynamics after surgery.Serum leptin and adiponectin were evaluated before surgery in 59 RC consecutive patients (38 males and 21 females), and in age and weight matched healthy controls. Measurements were repeated at 24, 72 hours and 7 days after surgery.Adipokine levels were higher in women. Controls had higher leptin (32.±4.34 vs 9.51±1.73 ng/ml in women and 11±2.66 vs 2.54±0.39 ng/ml in men, p = 0.00048 and 0.0032) and lower adiponectin (9±0.64 vs 11.85±1.02 μg/ml in women and 7.39±0.51 vs 8.5±0.62 μg/ml in men, p = 0.017 and 0.019) than RC patients. Surgery caused an increase of leptin from 5.11±0.8 to 18.7±2.42 ng/ml, p = 6.85 x 10¨8, and a decrease of adiponectin from 9.71±0.58 to 7.87±0.47 μg/ml, p = 1.4 x 10¨10 for all RC patients and returned thereafter to the initial range at 7 days. Adipokines were correlated with body weight (BW). The significance of correlation persisted after surgery only in males, but disappeared in females. Adipokines were not modified by tumor position, presurgical chemoradiotherapy or surgical technique. Women with RC experiencing weight loss had higher adiponectin than women without weight modifications (p<0.05 at all time points).Adipokine levels of patients with RC differ from the healthy population, possibly reflecting an adaptation to disease. Adipokine modifications after surgery may be related to acute surgical stress. Whether leptin and adiponectin directly interact is not clear. Women have higher adipokine levels, more so after significant weight loss, but the strength of their correlation with BW decreases after surgery. These data suggest gender differences in the adipokine profile of RC patients which may find clinical applications.

Colorectal cancer represents one of the most important causes worldwide of cancer related morbidity and mortality. One of the complications which can occur during cancer progression, is peritoneal carcinomatosis. In the majority of cases, it is diagnosed in late stages due to the lack of diagnostic tools capable of revealing the early-stage peritoneal burden. Therefore, still associates with poor prognosis and quality of life, despite recent therapeutic advances. The aim of the study was to develop a fuzzy logic approach to assess the probability of peritoneal carcinomatosis presence using routine blood test parameters as input data. The patient data was acquired retrospective from patients diagnosed between 2010-2021. The developed model focuses on the specific quantitative alteration of these parameters in the presence of peritoneal carcinomatosis, which is an innovative approach as regards the literature in the field and validates the feasibility of using a fuzzy logic approach in the noninvasive diagnosis of peritoneal carcinomatosis.

The incidence of colon, rectal, and colorectal cancer is very high, and diagnosis is often made in the advanced stages of the disease. In cases where peritoneal carcinomatosis is limited, patients can benefit from newer treatment options if the disease is promptly identified, and they are referred to specialized centers. Therefore, an essential diagnostic benefit would be identifying those factors that could lead to early diagnosis. A retrospective study was performed using patient data gathered from 2010 to 2020. The collected data were represented by routine blood tests subjected to stringent inclusion and exclusion criteria. In order to determine the presence or absence of peritoneal carcinomatosis in colorectal cancer patients, three types of machine learning approaches were applied: a neuro-evolutive methodology based on artificial neural network (ANN), support vector machines (SVM), and random forests (RF), all combined with differential evolution (DE). The optimizer (DE in our case) determined the internal and structural parameters that defined the ANN, SVM, and RF in their optimal form. The RF strategy obtained the best accuracy in the testing phase (0.75). Using this RF model, a sensitivity analysis was applied to determine the influence of each parameter on the presence or absence of peritoneal carcinomatosis.

Incidentally discovered solid adrenal tumors must be evaluated from two points of view: the risk of malignancy and the secretory feature.Our aim was to evaluate the surgical technique option in relation with clinical and histopathologic features.We performed a retrospective study that included patients with adrenal gland tumors.All patients were operated between 2012 and 2019 by the same surgical team in a single center.The batch included 102 patients with adrenal tumors operated through open surgery (OS, n=41) and laparoscopic surgery (LS, n=61). Tumor localization was especially on the right adrenal gland (n=52, 50.98%). Primary origin of the adrenal gland tumors was in 82 cases (80.39%) and a metastatic origin in 16 cases. Average dimension for surgical resected tumors was 4.02 cm (0.9-12 cm) for the LS group as compared to 7.22 cm (1.3-19 cm) for OS group with a predominant type of surgery represented by adrenalectomy and a conversion rate of 2.94%. The hospital stay was 7.22 days (5-12 days) in the LS group versus 12.72 days (6-57 days) in OS group with significant differences (p<0.01). Also, the postoperative recovery was significantly different (6.5 days versus 2.62 days, p<0.01).Laparoscopic approach represents the gold standard in adrenal gland tumors less than five centimeters in size. Adrenalectomy is mostly performed by LS and adenoma is the most frequent histopathologic type, while pheochromocytoma is operated through OS. LS has a significantly reduced hospitalization and postoperative stay compared to OS.

The treatment of breast cancer has evolved over the past 40 years. Followed by radiotherapy, conservative surgical procedures are options increasingly more preferred by surgeons and patients. This paper aims to highlight comparative aspects of local and distant recurrence in patients who had radical or conservative surgery for breast cancer. We performed a retrospective study between January, 2005 - July 2013, that included 477 breast cancer patients from the Regional Institute of Oncology Iasi, who were evaluated by imaging in the Radiology Clinic,Hospital "St. Spiridon", Iasi. We included in the study patients in curable stages 0, I and II; 248 (52 %) patients had radical surgery and 229 (48 %) patients had conservative surgery. We used the ultrasound scan, mammography, CT and MRI, that allowed diagnosis, pretherapeutic staging and diagnosing of the loco-regional and distant recurrences. Local and distant recurrences were higher in patients with conservative surgery(86 recurrences), than in patients who had radical surgery (55 recurrences). Local recurrences are more common in younger individuals and in patients treated with conservative surgery and radiotherapy, than in patients with radical mastectomy.The most common metastases are located in the bone, liver and lung.

Introduction: This article reports the authors' experience with their first 50 consecutive robotic pelvic procedures, aiming to determine the feasibility and safety of adopting robotic pelvic surgery. Robotic surgery offers several benefits for minimally invasive surgery, but its applicability is hindered by cost and limited regional experience. This study aimed to evaluate the feasibility and safety of robotic pelvic surgery. Material and Methods: This is a retrospective review of our initial experience with robotic surgery for colorectal, prostate, and gynaecologic neoplasia, between June and December 2022. The surgical outcomes were evaluated in terms of perioperative data, such as operative time, estimated blood loss, and length of hospital stay. Intraoperative complications were recorded, and postoperative complications were evaluated at 30 days and 60 days after surgery. The feasibility of the roboticassisted surgery was assessed by measuring the conversion rate to laparotomy. The safety of the surgery was evaluated by recording the incidence of intraoperative and postoperative complications. Results: Fifty robotic surgeries were performed over 6 months, including 21 interventions for digestive neoplasia, 14 gynaecologic cases, and 15 prostatic cancers. Operative time ranged from 90 to 420 minutes, with two minor complications and two grade II Clavien-Dindo complications. One patient required prolonged hospitalization and an end-colostomy, deriving from an anastomotic leakage requiring reintervention. No thirty-day mortality or readmissions were reported. Conclusion: The study found that robotic-assisted pelvic surgery is safe and has a low rate of transfer to open surgery, making it a suitable addition to conventional laparoscopy.

&lt;p&gt;PDF file - 83KB, Kaplan Meier curves for the duration of OS according A, to T cell (CD3+) density evaluated in combined tumor regions (CT and IM). B, to T cell (CD8+) density evaluated in combined tumor regions (CT and IM).&lt;/p&gt;

&lt;p&gt;Supplementary Table 1: characteristics of the HEGP cohort of rectal cancer patients Supplementary Table 2: Characteristics of the St Spiridon Hospital cohort of patients Supplementary Table 3: Immune infiltration of CD3+ and CD8+ cells in tumor regions and clinical outcome. Cohort of 111 patients eligible to primary surgery. Supplementary Table 4: Patients at risk at each interval in the Kaplan Meier survival curves for the duration of DFS and OS according to the Immunoscore (CD3-CD8). Supplementary Table 5: Repartition of the "surgery cohort" patient's according to Stage and Immunoscore&lt;/p&gt;

&lt;p&gt;Kaplan Meier curves for the duration of OS according A: to T cell (CD3+) density evaluated in combined tumor regions (CT and IM). B: to T cell (CD8+) density evaluated in combined tumor regions (CT and IM).&lt;/p&gt;

&lt;p&gt;PDF file - 107KB, Table 1. characteristics of the HEGP cohort of rectal cancer patients. Table 2. Characteristics of the St Spiridon Hospital cohort of patients. Table 3. Immune infiltration of CD3+ and CD8+ cells in tumor regions and clinical outcome. Cohort of 111 patients eligible to primary surgery. Table 4. Patients at risk at each interval in the Kaplan Meier survival curves for the duration of DFS and OS according to the Immunoscore (CD3-CD8). Table 5. Repartition of the "surgery cohort" patient's according to Stage and Immunoscore.&lt;/p&gt;

&lt;p&gt;PDF file - 104KB, Immunoscore.&lt;/p&gt;

&lt;p&gt;To reinforce the confidence on the statistical analyses, patients with poor postoperative outcome (I0 and I1) were pooled. The Kaplan–Meier curves illustrate the DFS according to the Immunoscore and show significant differences between patient groups. The multivariate analysis shows the prognostic power of the Immunoscore and illustrates how the Immunoscore overcomes the TNM scoring system.&lt;/p&gt;

&lt;p&gt;To reinforce the confidence on the statistical analyses, patients with poor postoperative outcome (I0 and I1) were pooled. The Kaplan–Meier curves illustrate the DFS according to the Immunoscore and show significant differences between patient groups. The multivariate analysis shows the prognostic power of the Immunoscore and illustrates how the Immunoscore overcomes the TNM scoring system.&lt;/p&gt;

&lt;p&gt;Supplementary Table 1: characteristics of the HEGP cohort of rectal cancer patients Supplementary Table 2: Characteristics of the St Spiridon Hospital cohort of patients Supplementary Table 3: Immune infiltration of CD3+ and CD8+ cells in tumor regions and clinical outcome. Cohort of 111 patients eligible to primary surgery. Supplementary Table 4: Patients at risk at each interval in the Kaplan Meier survival curves for the duration of DFS and OS according to the Immunoscore (CD3-CD8). Supplementary Table 5: Repartition of the "surgery cohort" patient's according to Stage and Immunoscore&lt;/p&gt;

&lt;p&gt;PDF file - 104KB, Immunoscore.&lt;/p&gt;

&lt;p&gt;Kaplan Meier curves for the duration of OS according A: to T cell (CD3+) density evaluated in combined tumor regions (CT and IM). B: to T cell (CD8+) density evaluated in combined tumor regions (CT and IM).&lt;/p&gt;

&lt;p&gt;PDF file - 83KB, Kaplan Meier curves for the duration of OS according A, to T cell (CD3+) density evaluated in combined tumor regions (CT and IM). B, to T cell (CD8+) density evaluated in combined tumor regions (CT and IM).&lt;/p&gt;

&lt;p&gt;PDF file - 107KB, Table 1. characteristics of the HEGP cohort of rectal cancer patients. Table 2. Characteristics of the St Spiridon Hospital cohort of patients. Table 3. Immune infiltration of CD3+ and CD8+ cells in tumor regions and clinical outcome. Cohort of 111 patients eligible to primary surgery. Table 4. Patients at risk at each interval in the Kaplan Meier survival curves for the duration of DFS and OS according to the Immunoscore (CD3-CD8). Table 5. Repartition of the "surgery cohort" patient's according to Stage and Immunoscore.&lt;/p&gt;

&lt;p&gt;Supplementary Figures&lt;/p&gt;

&lt;p&gt;Supplementary Tables&lt;/p&gt;

&lt;div&gt;Abstract&lt;p&gt;&lt;b&gt;Purpose:&lt;/b&gt; To determine whether the tumor immune infiltrate, as recently evaluated with the Immunoscore methodology, could be a useful prognostic marker in patients with rectal cancers.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Experimental design:&lt;/b&gt; The influence of the immune infiltrate on patient's outcome was investigated in patients with or without preoperative chemoradiation therapy (pCRT). The density of total (CD3&lt;sup&gt;+&lt;/sup&gt;) and cytotoxic (CD8&lt;sup&gt;+&lt;/sup&gt;) T lymphocytes was evaluated by immunohistochemistry and quantified by a dedicated image analysis software in surgical specimens of patients with rectal cancer (&lt;i&gt;n&lt;/i&gt; = 111) who did not receive pCRT and in tumor biopsies performed before pCRT from additional 55 patients. The results were correlated with tumor recurrence, patient's survival, and response to pCRT.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; The densities of CD3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt; lymphocytes and the associated Immunoscore (from I0 to I4) were significantly correlated with differences in disease-free and overall survival (HR, 1.81 and 1.72, respectively; all &lt;i&gt;P&lt;/i&gt; &lt; 0.005). Cox multivariate analysis supports the advantage of the Immunoscore compared with the tumor–node–metastasis (TNM) staging in predicting recurrence and survival (all &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Lymph node ratio added information in a prognostic model (all &lt;i&gt;P&lt;/i&gt; &lt; 0.05). In addition, high infiltration of CD3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt; lymphocytes in tumor biopsies was associated with downstaging of the tumor after pCRT (CD3&lt;sup&gt;+&lt;/sup&gt; cells; Fisher exact test &lt;i&gt;P&lt;/i&gt; = 0.01).&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; The Immunoscore could be a useful prognostic marker in patients with rectal cancer treated by primary surgery. The determination of the immune infiltrate in biopsies before treatment could be a valuable information for the prediction of response to pCRT. &lt;i&gt;Clin Cancer Res; 20(7); 1891–9. ©2014 AACR&lt;/i&gt;.&lt;/p&gt;&lt;/div&gt;

&lt;div&gt;AbstractPurpose:&lt;p&gt;No biomarker to personalize treatment in locally advanced rectal cancer (LARC) is currently available. We assessed in LARC whether a diagnostic biopsy-adapted immunoscore (IS&lt;sub&gt;B&lt;/sub&gt;) could predict response to neoadjuvant treatment (nT) and better define patients eligible to an organ preservation strategy (“Watch-and-Wait”).&lt;/p&gt;Experimental Design:&lt;p&gt;Biopsies from two independent cohorts (&lt;i&gt;n&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt; = 131, &lt;i&gt;n&lt;/i&gt;&lt;sub&gt;2&lt;/sub&gt; = 118) of patients with LARC treated with nT followed by radical surgery were immunostained for CD3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt; T cells and quantified by digital pathology to determine IS&lt;sub&gt;B&lt;/sub&gt;. The expression of immune-related genes post-nT was investigated (&lt;i&gt;n&lt;/i&gt; = 64 patients). Results were correlated with response to nT and disease-free survival (DFS). The IS&lt;sub&gt;B&lt;/sub&gt; prognostic performance was further assessed in a multicentric cohort (&lt;i&gt;n&lt;/i&gt; = 73 patients) treated by Watch-and-Wait.&lt;/p&gt;Results:&lt;p&gt;IS&lt;sub&gt;B&lt;/sub&gt; positively correlated with the degree of histologic response (&lt;i&gt;P&lt;/i&gt; &lt; 0.001) and gene expression levels for Th1 orientation and cytotoxic immune response, post-nT (&lt;i&gt;P&lt;/i&gt; = 0.006). IS&lt;sub&gt;B&lt;/sub&gt; high identified patients at lower risk of relapse or death compared with IS&lt;sub&gt;B&lt;/sub&gt; low [HR, 0.21; 95% confidence interval (CI), 0.06–0.78; &lt;i&gt;P&lt;/i&gt; = 0.009]. Prognostic performance of IS&lt;sub&gt;B&lt;/sub&gt; for DFS was confirmed in a validation cohort. IS&lt;sub&gt;B&lt;/sub&gt; was an independent parameter, more informative than pre- (&lt;i&gt;P&lt;/i&gt; &lt; 0.001) and post-nT (&lt;i&gt;P&lt;/i&gt; &lt; 0.05) imaging to predict DFS. IS&lt;sub&gt;B&lt;/sub&gt; combined with imaging post-nT discriminated very good responders that could benefit from organ preservation strategy. In the “Watch-and-Wait” cohort (&lt;i&gt;n&lt;/i&gt; = 73), no relapse was observed in patients with IS&lt;sub&gt;B&lt;/sub&gt; high (23.3%).&lt;/p&gt;Conclusions:&lt;p&gt;IS&lt;sub&gt;B&lt;/sub&gt; predicts response to nT and survival in patients with LARC treated by surgery. Its usefulness in the selection of patients eligible for a Watch-and-Wait strategy is strongly suggested.&lt;/p&gt;&lt;/div&gt;

&lt;div&gt;Abstract&lt;p&gt;&lt;b&gt;Purpose:&lt;/b&gt; To determine whether the tumor immune infiltrate, as recently evaluated with the Immunoscore methodology, could be a useful prognostic marker in patients with rectal cancers.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Experimental design:&lt;/b&gt; The influence of the immune infiltrate on patient's outcome was investigated in patients with or without preoperative chemoradiation therapy (pCRT). The density of total (CD3&lt;sup&gt;+&lt;/sup&gt;) and cytotoxic (CD8&lt;sup&gt;+&lt;/sup&gt;) T lymphocytes was evaluated by immunohistochemistry and quantified by a dedicated image analysis software in surgical specimens of patients with rectal cancer (&lt;i&gt;n&lt;/i&gt; = 111) who did not receive pCRT and in tumor biopsies performed before pCRT from additional 55 patients. The results were correlated with tumor recurrence, patient's survival, and response to pCRT.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results:&lt;/b&gt; The densities of CD3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt; lymphocytes and the associated Immunoscore (from I0 to I4) were significantly correlated with differences in disease-free and overall survival (HR, 1.81 and 1.72, respectively; all &lt;i&gt;P&lt;/i&gt; &lt; 0.005). Cox multivariate analysis supports the advantage of the Immunoscore compared with the tumor–node–metastasis (TNM) staging in predicting recurrence and survival (all &lt;i&gt;P&lt;/i&gt; &lt; 0.001). Lymph node ratio added information in a prognostic model (all &lt;i&gt;P&lt;/i&gt; &lt; 0.05). In addition, high infiltration of CD3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt; lymphocytes in tumor biopsies was associated with downstaging of the tumor after pCRT (CD3&lt;sup&gt;+&lt;/sup&gt; cells; Fisher exact test &lt;i&gt;P&lt;/i&gt; = 0.01).&lt;/p&gt;&lt;p&gt;&lt;b&gt;Conclusions:&lt;/b&gt; The Immunoscore could be a useful prognostic marker in patients with rectal cancer treated by primary surgery. The determination of the immune infiltrate in biopsies before treatment could be a valuable information for the prediction of response to pCRT. &lt;i&gt;Clin Cancer Res; 20(7); 1891–9. ©2014 AACR&lt;/i&gt;.&lt;/p&gt;&lt;/div&gt;

&lt;div&gt;AbstractPurpose:&lt;p&gt;No biomarker to personalize treatment in locally advanced rectal cancer (LARC) is currently available. We assessed in LARC whether a diagnostic biopsy-adapted immunoscore (IS&lt;sub&gt;B&lt;/sub&gt;) could predict response to neoadjuvant treatment (nT) and better define patients eligible to an organ preservation strategy (“Watch-and-Wait”).&lt;/p&gt;Experimental Design:&lt;p&gt;Biopsies from two independent cohorts (&lt;i&gt;n&lt;/i&gt;&lt;sub&gt;1&lt;/sub&gt; = 131, &lt;i&gt;n&lt;/i&gt;&lt;sub&gt;2&lt;/sub&gt; = 118) of patients with LARC treated with nT followed by radical surgery were immunostained for CD3&lt;sup&gt;+&lt;/sup&gt; and CD8&lt;sup&gt;+&lt;/sup&gt; T cells and quantified by digital pathology to determine IS&lt;sub&gt;B&lt;/sub&gt;. The expression of immune-related genes post-nT was investigated (&lt;i&gt;n&lt;/i&gt; = 64 patients). Results were correlated with response to nT and disease-free survival (DFS). The IS&lt;sub&gt;B&lt;/sub&gt; prognostic performance was further assessed in a multicentric cohort (&lt;i&gt;n&lt;/i&gt; = 73 patients) treated by Watch-and-Wait.&lt;/p&gt;Results:&lt;p&gt;IS&lt;sub&gt;B&lt;/sub&gt; positively correlated with the degree of histologic response (&lt;i&gt;P&lt;/i&gt; &lt; 0.001) and gene expression levels for Th1 orientation and cytotoxic immune response, post-nT (&lt;i&gt;P&lt;/i&gt; = 0.006). IS&lt;sub&gt;B&lt;/sub&gt; high identified patients at lower risk of relapse or death compared with IS&lt;sub&gt;B&lt;/sub&gt; low [HR, 0.21; 95% confidence interval (CI), 0.06–0.78; &lt;i&gt;P&lt;/i&gt; = 0.009]. Prognostic performance of IS&lt;sub&gt;B&lt;/sub&gt; for DFS was confirmed in a validation cohort. IS&lt;sub&gt;B&lt;/sub&gt; was an independent parameter, more informative than pre- (&lt;i&gt;P&lt;/i&gt; &lt; 0.001) and post-nT (&lt;i&gt;P&lt;/i&gt; &lt; 0.05) imaging to predict DFS. IS&lt;sub&gt;B&lt;/sub&gt; combined with imaging post-nT discriminated very good responders that could benefit from organ preservation strategy. In the “Watch-and-Wait” cohort (&lt;i&gt;n&lt;/i&gt; = 73), no relapse was observed in patients with IS&lt;sub&gt;B&lt;/sub&gt; high (23.3%).&lt;/p&gt;Conclusions:&lt;p&gt;IS&lt;sub&gt;B&lt;/sub&gt; predicts response to nT and survival in patients with LARC treated by surgery. Its usefulness in the selection of patients eligible for a Watch-and-Wait strategy is strongly suggested.&lt;/p&gt;&lt;/div&gt;

&lt;p&gt;Supplementary Tables&lt;/p&gt;

&lt;p&gt;Supplementary Figures&lt;/p&gt;

Chemotherapy-induced peripheral neuropathy (CIPN) is a common side effect of many anticancer drugs that may cause various symptoms altering the quality of life. We conducted a systematic review to evaluate the peripheral and central nervous system changes associated with CIPN and detected by magnetic resonance imaging (MRI). Medical literature databases (PubMed, Scopus, Thomson Reuters - Web of Science and Embase) were searched for original studies reporting the use of MRI in the evaluation of CIPN. A total of 31 studies were identified and 9 were eligible for analysis. Results indicate few changes of the peripheral nervous system, most CIPN-associated nervous alterations involving pain processing areas and circuits inside the central nervous system. Distinct patterns of pain processing, changes in cerebral perfusion and gray matter density together with chronic activation of somatosensory areas have been observed in patients with CIPN compared to healthy subjects or cancer patients who did not develop CIPN. Identification of vulnerable brain areas and circuits may indicate future targets for novel therapies directed to prevent or treat CIPN. A preexisting vulnerability suggested by a unique pattern of brain activation following nociceptive stimulation prior to chemotherapy could help identify high-risk individuals, candidates to close monitoring and preventive strategies.

Malignant mesothelioma of the peritoneum is a rare neoplasm with a rapidly fatal course. The median survival range is from 5 to 12 months in untreated cases with little improvement seen in patients receiving multimodality therapy. Although most cases occur in the fifth and sixth decades, peritoneal mesothelioma can be seen in any age group. Approximately 30% of all mesotheliomas arise solely from the peritoneum. Asbestos exposure, primarily of the crocidolite variety, has been implicated in the pathogenesis of this malignancy, as was established in South Africa in the 1960s. Half of reported cases have a history of asbestos exposure. The diagnosis of peritoneal mesothelioma is often delayed, in part because of the usually long latent period (peaking at 40-45 years from the time of initial exposure to asbestos) and because the common presenting symptoms of weight loss, usually with a full abdomen, malaise, and abdominal discomfort, are mild and nonspecific. This paper aim is to present a case report regarding a patient diagnosed with malignant peritoneal mesothelioma with an unpredictable evolution.

Concluzii: Complicaţiile severe după gastrectomia pentru cancer ramân cel mai important factor care împiedică sau întârzie iniţierea tratamentului multimodal.Comorbiditaţile la momentul intervenţiei, statusul nutritional şi extensia actului chirurgical sunt factori cheie care pot influenţa apariţia şi gravitatea acestor complicaţii.

RezumatIntroducere: Tumorile stromale gastrointestinale sunt unele din cele mai întalnite tumori mezenchimale ale tractului digestiv.Scopul studiului este de a evalua manifestările clinice şi tratamentul GIST-urilor gastrice.Metodologie: Am realizat un studiu retrospectiv multicentric pe o perioadă de 5 ani condus pe o baza de date colectate prospectiv ce a inclus pacienţi cu GIST gastric ce au fost operaţi.Am selectat pacienţii cu GIST gastric şi am analizat manifestarile clinice, tratamentul primit şi factorii prognostici.

Shewanella spp. are gram-negative bacteria, saprophytes, and rarely pathogenic. Saccharomyces cerevisiae is the well-known yeast used for fermentation in industry and molecular biology for research. In humans, it is a very rare pathogen which colonizes the digestive tract, and its utility has been linked to the treatment and prevention of diarrhea associated with Clostridium difficile.A 27-year-old male, victim of aggressive, blunt trauma with a 4-day history of symptoms was admitted to our surgery unit. Abdominal sonography revealed peritoneal fluid in all spaces with fibrin. We performed laparotomy and observed perforations on the ileum and general peritonitis with pus. Following surgery, patient was admitted to the intensive care unit with septic shock. The antibiogram from the peritoneal liquid revealed S. putrefaciens and S. cerevisiae.Although very rare, S. putrefaciens and S. cerevisiae may colonize in the peritoneum after blunt abdominal trauma.

Porocarcinoma is a rare tumor of the eccrine sweat glands that usually disseminates to the regional lymph nodes, but it can also develop distant metastasis. Case presentation: We report the case of a 67 year-old female patient who underwent wide surgical resection of a left cervical cutaneous tumor in a primary care center, for which the histology exam of the specimen was mixed basal cell and squamous cell carcinoma. She was referred to our hospital's oncology clinic and histologic re-evaluation changed the diagnosis to eccrine porocarcinoma (EPC). Computer-tomography (CT) revealed cervical lymphadenopathies for which the patient underwent 4 cycles of chemotherapy, without regression. She subsequently underwent a left upper anterior jugular lymphadenectomy (group IIa) with all nodes being negative and, three months later, she developed a unique adenopathy under the parotid gland that was excised and confirmed to be metastatic. Postoperative external radiotherapy was administered with a good outcome on CT scan. Nine months after her last surgery, the patient did not show any sign of recurrence or distant metastasis. Conclusion: EPC is a challenge, both diagnostically and therapeutically. In the absence of consensus regarding the indications and extent of lymphadenectomy and adjuvant therapy, patients with EPC should be referred to an experienced multidisciplinary team in a tertiary center.

Priority level Institutional resources Assumed operational strategy (relative to the treatment of COVID-19 patients) (Human and material) Low There are enough resources Elective procedures for colorectal oncological surgery.Patients should be treated in non-COVID-19 hospitals / departments.Surgery for benign conditions should be postponed until the peak of the pandemic has been exceeded Moderate The hospital's resources are limited All surgical cases and elective endoscopic procedures should be postponed High Critical unavailability of hospital Surgery should be limited to those patients with life-threatening resources conditions (eg.gastrointestinal bleeding, perforation or obstruction), advanced symptomatic tumors, urgent anorectal, etc.)Table 1.

Certain combinations of the hematological components, specifically, neutrophils and lymphocytes, named neutrophil to lymphocyte ratio (NLR) or multiplication of neutrophil and monocyte (MNM) have been shown to have prognostic value in a variety of cancers.Retrospective study which included 133 patients with uterine cervical cancer with or without neoadjuvant therapy based on prognostic factors and correlations between NLR and MNM values, markers that were analyzed as continuous variables. This study aimed to establish the critical value of hematological markers. Results: NLR is significantly lower for preoperative stages I and II (p = 0.0004). There is a significant association between NLR and lymph node metastasis (p = 0.016), parametrial invasion (p = 0.035), lymphovascular space invasion (p = 0.0151) and tumor size (p = 0.0017). Correlational analysis showed that there is a significant association between MNM and lymph node metastasis (p = 0.020), parametrial invasion (p = 0.00010), lymphovascular space invasion materially affecting the value MNM (p = 0.0018), tumor size more than 4 cm (p = 0.0314). NLR and MNM were significantly lower in patients with complete response to neoadjuvant treatment. Discussion: The results of this study outlines the importance of hematological panel and parameters that can be easily used at no extra cost to establish further evolution of patients to treatment.

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Systemic inflammation is evident from 7 days onward with increased plasma IL-6 levels ( p = 0.0002).From 14 days on, 3D reconstructed cortical microglial cells reveal activated morphology, indicating neuroinflammation (Figure 1).CCL2 levels are significantly increased in the cortex 28 days after BDL ( p = 0.0418), coinciding with increased BBB permeability ( p = 0.0031). Conclusion:Murine BDL reproduces clinical, metabolic and gliovascular features of type C HE. Early behavioural changes are obvious before plasma ammonia and brain glutamine accumulate, and potentially reflect the effect of systemic inflammation and cerebral bile acid/tryptophan accumulation on behaviour.Altogether, these data support the clinical relevance of this HE model, which can now be used for further neurobiological and intervention studies.

Abdominoperineal resection remains the “gold standard” for cancers of the lower rectum and of the anal canal as a result of the failure of the primary conservative care. Total pelvic exenteration leaves an important pelviperineal defect which requires reconstruction techniques to be applied when primary closure cannot be performed. Pelvic floor reconstruction is required and various complications, especially infectious, may occur in this area. The pelvis can be reconstructed using flaps. The perineal reconstruction that uses the numerous perforator flaps described lately raises the following question: which flap should be chosen? Each flap and its variants have their own advantages and disadvantages, and the choice of the appropriate reconstructive technique involves a collaboration between the gastrointestinal oncology surgeon, the radiologist, the anaesthesiologist and the plastic surgeon in order to identify when and which surgical reconstruction is to be preferred, using reconstruction algorithms to choose the appropriate technique. Various studies are presented describing the experience of one or more centers regarding reconstruction options and the decisional tree adopted in the form of an algorithm both in relation to neoadjuvant irradiation therapy and without irradiation.

The pathologist's role in the multidisciplinary treatment of rectal cancer is to evaluate and stage the tumor according to the latest standards, as well as indicate the quality of the surgical act. This study aims to evaluate circumferential and distal resection margins as well as quality of mesorectal resection and correlate them with different clinical, pathological and therapeutic factors.Four hundred ninety-eight patients treated radically for mid and low rectal cancer within one Clinic of Oncological Surgery in Iasi, Romania, were included in this study.The distal resection margin showed significant correlations with the type of surgical intervention, chemotherapy in the neoadjuvant treatment plan and pathological node staging. The circumferential resection margin depended mostly on pathological node staging and the length of the interval between neoadjuvant treatment and surgery. Finally, the aspect of the mesorectum varied according to neoadjuvant treatment and the type of surgical intervention performed.The study reached its aim in providing important data for the expected outcome of the specimen after curative treatment for rectal cancer.

Abstract Background. Numerous studies associate adipokines with colorectal malignancy, but few data deal with patients suffering exclusively of rectal carcinoma (RC). Aims. We evaluated leptin and adiponectin levels in RC patients compared to healthy population and their dynamics after surgery. Material and methods. Serum leptin and adiponectin were evaluated before surgery in 59 RC consecutive patients (38 males and 21 females), and in age and weight matched healthy controls. Measurements were repeated at 24, 72 hours and 7 days after surgery. Results. Adipokine levels were higher in women. Controls had higher leptin (32.±4.34 vs 9.51±1.73 ng/ml in women and 11±2.66 vs 2.54±0.39 ng/ml in men, p=0.00048 and 0.0032) and lower adiponectin (9±0.64 vs 11.85±1.02 µg/ml in women and 7.39±0.51 vs 8.5±0.62 µg/ml in men, p=0.017 and 0.019) than RC patients. Surgery caused an increase of leptin from 5.11±0.8 to 18.7±2.42 ng/ml, p=6.85 × 10 8 , and a decrease of adiponectin from 9.71±0.58 to 7.87±0.47 µg/ml, p=1.4 × 10 10 for all RC patients and returned thereafter to the initial range at 7 days. Adipokines were correlated with body weight (BW). The significance of correlation persisted after surgery only in males, but disappeared in females. Adipokines were not modified by tumor position, presurgical chemoradiotherapy or surgical technique. Women with RC experiencing weight loss had higher adiponectin than women without weight modifications (p&lt;0.05 at all time points). Conclusions. Adipokine levels of patients with RC differ from the healthy population, possibly reflecting an adaptation to disease. Adipokine modifications after surgery may be related to acute surgical stress. Whether leptin and adiponectin directly interact is not clear. Women have higher adipokine levels, more so after significant weight loss, but the strength of their correlation with BW decreases after surgery. These data suggest gender differences in the adipokine profile of RC patients which may find clinical applications.

2628 Background: We investigated whether an adaptation to rectal biopsies of the recently validated consensus Immunoscore, could predict the response to neoadjuvant treatment and delineate clinical responders that could benefit from a “Watch and Wait” (W&amp;W) strategy with acceptable outcomes. Methods: Initial biopsies from 273 patients with locally advanced rectal cancer (LARC) treated by neoadjuvant chemoradiotherapy (nCRT) followed by Total Mesorectal Excision (TME), were immunostained for CD3+ and cytotoxic CD8+ T cells and quantified by digital pathology to determine the Immunoscore within pre-treatment Biopsy (IS B ). Expression level of 44 immune related genes post-neoadjuvant treatment was investigated by Nanostring technology (n = 64 patients). Results were correlated with response to neoadjuvant treatment, disease free survival (DFS) and time to recurrence (TTR). Prognostic performance of IS B was finally assessed in 73 LARC treated by W&amp;W strategy. Results: IS B Low, Intermediate and High were respectively observed in 23.3, 50.4 and 26.3 % of the cohort. IS B was positively and significantly correlated with the response to nCRT, as evaluated by Dworak classification (P = .0034), ypTNM (P = .0003), down-staging (P = .0014), and neoadjuvant rectal (NAR) score, (P &lt; .0001). IS B status was also positively associated with the degree of local immune activation post-neoadjuvant treatment. IS B High patients were at low risk of relapse, with 5-year DFS rates of 81.1 % (CI, 71.3-92.1 %) as compared to 57.8 % (CI, 45.9-72.9 %) in IS B low patients. In multivariate analysis, IS B was the only significant parameter at presentation associated with DFS (High vs Low: P = .001). Among W&amp;W patients, significant difference was observed for TTR according to IS B status (High vs Low: P = .025). Conclusions: IS B could provide a reliable estimate of the response to nCRT and risk of recurrence in LARC patients' treated by TME or W&amp;W strategy.

Colon cancer is a major public health problem. The treatment of colon cancer is primarily surgical using open and minimally invasive techniques. Minimally invasive surgery approaches for colon cancer include single-port laparoscopy, natural orifice transluminal endoscopic surgery, and robotic-assisted laparoscopic surgery. The techniques are based on the same principles: complete mesocolic excision, high vascular ligation, and extended lymphadenectomy. Laparoscopic surgery is characterized by short hospital stay, reduced postoperative pain, and less need for painkillers. Laparoscopic resections are less expensive than open surgery, but with similar quality of life outcomes. Robotic surgery is an alternative to open and laparoscopic techniques. This type of surgery results in a lower conversion rate and a shorter learning curve than laparoscopic surgery. When comparing the clinical outcomes of laparoscopic surgery versus open surgery no difference in disease free survival and overall survival were found. This article shows the role of minimally invasive surgery in colon cancer, the clinical outcomes of laparoscopic and open colon being similar.

Peritoneal mesothelioma represents a rare disease, among its manifestations it can be encountered ascites and tumoral abdominal masses and this condition, untreated can lead to death by bowel obstruction, perforation and cachexia.Due to the rarity of the disease, some patients are misdiagnosed and thus they cannot benefit from a radical form of treatment which leads to an increased survival.We hereby present the case of a 62 year-old male with previous surgery for a retroperitoneal tumor with relapse of the disease.The pathological examination and immunochemistry showed a diffuse peritoneal mesothelioma with poor differentiation.The patient was submitted to chemotherapy and 16 months after surgery on regular control imaging he presented a retroperitoneal recurrence.Unfortunately the patient refused the treatment; we believe that he could benefit from radical surgery associated with hyperthermic intraperitoneal chemotherapy.Preoperative diagnosis of diffuse peritoneal mesothelioma can be difficult due to the lowest predictability of the clinical and imaging studies.

Pelvic exenteration represents a radical intervention performed on highly selected cases for locally advanced pelvic (gynecologic and digestive) tumours. Due to the high complexity of the intervention and of the impact of the neoplastic disease on the patient this intervention is accompanied by a high degree of postoperative morbidity. We hereby present the case of a patient with recurrent rectal cancer involving the bladder, small bowel and anterior abdominal wall in which a supralevatorial pelvectomy was performed. Although it was performed on a patient with infected tumour, the postoperative course of the patient was uneventful; the patient is disease-free at 6 months after pelvectomy. Although pelvic exenteration is associated with increased morbidity, many patients with recurrence after rectal resection that undergo this intervention can have increased disease-free survival.

Ovarian and breast cancer are the most common causes of gynaecological cancer-related deaths.We hereby present the case of a patient treated in our surgical unit which was diagnosed with synchronous neoplasia of the ovary and breast with an uncommon form of clinical presentation.The particularities of this case are the presence of an ulcerated cutaneous metastasis from the ovarian cancer in the right hypochondrium that was diagnosed simultaneously and a synchronous breast neoplasia.

Anorectal manometry is one way of evaluating the patient's quality of life, as it is an efficient way of assessing the anal function before and after neoadjuvant and/or surgical treatment. It is important to evaluate the function of the anal sphincter, as it can dictate the surgical treatment that is applied to the patient. The main issue that arises is the large variability of results, related to the operator-linked bias, as well as the different types of equipment that are used. Standardization is required. The studies in literature lack homogeneity, as some studies show there is a link between neoadjuvant therapy and anal incontinence, whereas others say there is no relation, while others even show the benefic effect on the short term of neoadjuvant radiation therapy on anal sphincter function. There is also the issue of long-term results and follow-up. In the instance of a "sphincter-saving" intervention, evaluation of the tonicity of the anal sphincter is important, as it can dictate between choosing a colorectal/coloanal anastomosis and realizing a terminal colostomy.

The efficiency of neoadjuvant therapy in cervical carcinoma has been well demonstrated, although the cellular mechanisms of different response to this treatment have not been thoroughly investigated.The present study consists of 24 patients with cervical cancer, including 12 patients in stages IB-IIIB with first-line surgical treatment and 12 patients in stages IIB-IIIB, with neoadjuvant therapy followed by radical hysterectomy.The aim of our study was to assess the correlations between the alterations in E-cadherin and CD44v6 immunoexpression in cervical carcinoma, as a tool of evaluation the response to neoadjuvant therapy and its prognostic significance.The intensity of CD44v6 immunoexpression was higher in more aggressive tumors and E-cadherin immunoexpression was approximately constant among the cases with neoadjuvant therapy.Our results demonstrate that the evaluation of CD44v6 immunoexpression in cervical carcinomas is useful for the assessment of tumor response to neoadjuvant therapy and of tumor aggressiveness.The high level of Ecadherin immunoexpression in tumors with neoadjuvant therapy reflects its involvement in the prevention of HPV oncoproteins action, with benefits on the outcome.A larger group of patients and a panel of antibodies, including CD4 and COX2, could provide a better characterization of the tumor response to neoadjuvant therapy, with a positive prognosis impact.

Background: Malnutrition is a common feature in gastric cancer patients and it is directly correlated with tumour stage. The goal of our study was the assessment of nutritional status in a large series of gastric cancer patients. Methods: We performed a retrospective study which included all the patients newly diagnosed with gastric cancer which were submitted in our unit in a 2 year period. We performed a comparative analysis between the patient in which radical resection was performed and the patient in which a palliative procedure was made. Results: There were 136 gastric cancer patients; radical resections were performed in 81 patients (34 total gastrectomies and 47 subtotal gastrectomies). Palliative procedures included 17 gastroenterostomy, 13 feeding jejunostomy and 25 exploratory laparoscopies. Patients in which radical resection was performed presented higher Karnofsky (P=0.006) and Charlson (P=0.007) indexes, higher BMI (P=0.017), higher albumin (P=0.001), lymphocytes (P=0.03) and Onodera index (P=0.0032). Conclusion: An accurate clinical and biological nutritional assessment of newly diagnosed gastric cancer patients could identify the subgroup of patients with more advanced or metastatic lesions in which a thorough stadialisation should be performed.

Pleomorphic adenoma, a common salivary gland tumor, is a rare benign breast tumor.It doesn't have specific features and its diagnosis can be made on the final histopathological examination.There have been reported few cases of malignant transformation and many recurrences, therefore it is required an adequate excision of this tumor with clear margins.We present the case of a woman of 47 years old, who was admitted in our Department for a right perimamelonar lump, with uncertain imaging features.A right mammary segmentectomy was performed and the routine histopathological and immunohistochemical examination led to the diagnosis of pleomorphic adenoma of the breast.

The particularity of the presented case is bilateral synchronous male breast cancer of uncommon histologic type – invasive cribriform carcinoma. In the practice of our surgical unit it is the first and only case of synchronous bilateral male breast cancer. The patient was followed up regularly for the last 4 years after a modified radical bilateral mastectomy with axillary lymph node clearance followed by adjuvant chemotherapy and endocrine therapy and he showed no signs of local recurrence or metastatic disease.

Esophageal cancer remains an important health problem mainly due to the rising incidence of the adenocarcinoma of the gastro-esophageal junction.Esophagectomy is often performed on a fragile patient with an impaired nutritional status and requires often an open thoracic approach.Minimally invasive techniques were accepted in treatment of esophageal cancer in order to decrease the morbidity and postoperative mortality.However, several limitations of conventional minimally invasive techniques (e.g.two-dimensional view, camera operator fatigue, lack of tactile feedback during the complex maneuvers) imposed the use of surgical robots in esophageal surgery.We review the literature data about the use of robotic assissted surgical techniques in esophageal surgery.The postoperative outcomes, as well technical details and learning curve and training are highlighted.

origin, but in rare cases could originate in the subserosa. We report the case of a 72 year-old male who presented dyspeptic syndrome and superior gastro-intestinal bleeding (melena). The upper gastrointestinal endoscopy revealed a large, almost stenotic, submucosal oval-shaped mass, with a diameter of 10 cm located in the gastric antrum, with an area of ulcerated gastric mucosa. The abdominal computer tomography revealed a homogeneous well-defined mass with negative densitometry values that corresponded to the fatty tissue. The tumor was enucleated through antrotomy, with an uneventful postoperative course. CONCLUSION: Although rare, the gastric lipoma can be a cause of gastrointestinal bleeding, mimicking a malignant tumor.

BACKGROUND: Surgical resection can offer the best curative treatment for oesophageal cancer but is associated with high postoperative morbidity rates.Most common surgical approaches are transthoracic (TT) and transhiatal (TH) techniques.Transhiatal approach has the advantage of reducing the pulmonary morbidity in patients with impaired pulmonary function.AIM: The aim of this study is to compare the TT and TH approach, in terms of preoperative assessment and short term outcomes.MATERIALS AND METHODS: We performed an observational study on a prospective collected database which included all the patients diagnosed with oesophageal cancer in which surgery was performed.A detailed assessment of comorbidities was performed using several scales: Charlson and age adjusted Charlson score, physiological score of POSSUM.Postoperative complications were graded according to the Dindo-Clavien classification.RESULTS: During a 9 years period surgery was performed in 50 cases, 33 by TT approach and 17 by TH approach respectively.The mean age was 58.7 ± 2.21 years old (95% CI 56.3-61.2).Patients in the TH group had a higher Charlson score (3 vs 2, P = 0.01), age adjusted Charlson score (5 vs 4, P = 0.03) and physiological score (17 vs 15, P = 0.04).TT techniques were mainly used for middle oesophageal cancers (69.7%) and TH for lower oesophageal tumors (82.4%).The overall operative morbidity was 60% with no difference between the two groups even for minor and major complications.Pulmonary complications occurred in 23 cases (46%), cardiac complications in 5 cases (10%), anastomotic leakage in 6 cases (12%) and recurrent nerve paralysis in 6 cases (12%).Multivariate analysis showed that age adjusted Charlson score (OR = 2.77;) and physiological score (OR = 1.7601; 95% CI 1.2067-2.5674)were predictors for complications.CONCLUSION: In our study mortality and morbidity showed no statistical difference in relation to the surgical approach.An accurate preoperative assessment and tailoring an adequate surgical approach can limit the percentage of postoperative complications.

THE IMPORTANCE OF CLINICAL TARGET VOLUME FOR RADIATION THERAPY IN RECTAL CANCER (Abstract): Neoadjuvant chemoradiotherapy is the standard treatment in locally advanced rectal cancer and it was demonstrated that radiation therapy associated with total mesorectal excision reduces local recurrence rate. It is very important to precisely determine the area that is subjected to radiation, in order to avoid side effects. The clinical target volume (CTV) is dependent on tumor location, lymphatic drainage area and the degree of tumor invasion into nearby organs. The CTV determination must take into account the internal organ motion during the treatment. The radiotherapy simulating is possible due to specialized CT and/or MRI and planning software. Using this method, it is possible to modulate the intensity of radiation on tumor tissue, with minimal effects on normal tissues.

EARLY POSTOPERATIVE OUTCOMES IN PATIENTS WITH UTERINE CERVICAL CANCER (Abstract): BACKGROUND: Uterine cervical cancer still presents high percentages of locally advanced tumors on diagnosis due to the lack of screening programs. The multidisciplinary approach in these cases requires neoadjuvant radio-chemotherapy followed in selected cases by surgery. The aim of this study was the assessment of early postoperative outcomes in a consecutive series of cervical cancer patients. METHODS: We performed a comparative analysis in terms of patients and tumor characteristics, type of surgery and postoperative complications on 83 patients with radical surgery divided in terms of neoadjuvant treatment protocol. Two groups were designed: group A, patients who underwent neoadjuvant therapy (n=38; 45.78%) and group B, patients operated without neoadjuvant therapy (n=45; 54.22%). RESULTS: The patients mean age was 54.1±11.6 years old. Most cases on diagnosis were stage IIB (41 cases, 49.39%) followed by stage IB (24 cases, 28.9%). Neoadjuvant treatment was performed in 38 patients (45.78%) (stage IIA - 1 patient, IIB - 31 patients, IIIA - 1 patient and IIIB - 5 patients), with a complete response in 16 (42.1%). Most common intervention was type II radical hysterectomy with pelvic lymphadenectomy in 54 cases (65%). There was no difference in terms of deep vein thrombosis, postoperative urinary and medical morbidity. Digestive complications were relatively higher in neoadjuvant group (28.94% in group A vs. 6.66% in group B, P=0.008) with a longer hospitalization (8.1±2.7 days for group A vs. 6.6±1.6 for group B, P=0.01). CONCLUSION: Radical hysterectomy is a relatively safe technique in terms of postoperative morbidity for patients with cervical cancer despite the use of neoadjuvant therapy. This provides the chance for cure in early stages and a local control for more advanced cases.

BACKGROUND: The gold standard in low rectal cancer today is a multimodal approach, tailored for each patient.AIM: The aim of this study was to evaluate the histopathological tumor response after long term neoadjuvant chemoradiation in locally advanced rectal cancer and the possibilities of preserving the anal sphincter.MATERIALS AND METHODS: We retrospectively analyzed 115 cases of advanced low rectal cancer that received preoperative treatment and underwent rectal resection with total mesorectal excision.The pretreatment tumor-node-metastasis stage (cTNM) was as follows: 38 patients were assigned as stage II and 77 patients as stage III.Long-term radiotherapy was delivered at a median dose of 47.24 Gy (± 5.47 Gy) and for 80 patients (69.56%) was associated with chemotherapy.The tumors "downstaging" was defined as any pathologic stage (ypTNM) less than pretreatment imagistic stage (cTNM).Sphincter-sparing surgery after preoperative radiotherapy was performed in safety oncological conditions.RESULTS: Comparison of preoperative and pathologic staging revealed that the depth of invasion was downstaged in 42 patients (36.52%) and lymph nodes status was downstaged in 16 patients of 77 patients (20.77%).Complete regression with absence of residual cancer was reported in 6 patients (5.21%).The sphincter sparing surgery was performed in 38 patients (33.04%).The procedures performed were resections considered low and very low, with total mesorectal excision and ratio hand sewn anastomosis/double stappled anastomosis was 20 to 18. CONCLUSION: The response to neoadjuvant treatment in rectal cancer is an important factor in preserving the anal sphincter in low rectal cancer.

BACKGROUND: Despite advances in neoadjuvant treatment, rectal resection remains the gold-standard treatment for rectal cancer.AIM: The aim of this study was to assess the benefits of anal sphincter preservation and to compare the quality of life in terms of functional outcome in long term survivors who underwent low (or ultra low) anterior resection with total mesorectal excision to patients with abdominoperineal excision for locally advanced rectal cancer with neoadjuvant therapy.MATERIAL AND METHODS: We retrospectively analyzed the medical records of 319 patients who underwent surgery for rectal cancer from 2006 to 2011.Quality of life in 69 eligible patients with preoperative treatment and rectal resection with total mesorectal excision was assessed using the EORTC QLQ C 30 and EORTC QLQ CR29 questionnaires.We evaluated the overall status of quality of life and functional status of these patients symptoms scale.High score for functional scores shows better function whereas high symptom score shows more problems.Results were compared for patients with anal sphincter preservation (SP, 20 patients) versus abdominoperineal excision (APE, 49 patients) using t-Student test for independent samples.RESULTS: The median follow up in 69 patients was 32 months (range 11-74 months, 32±2,3SD).Quality of life for our group is significantly higher than the reference EORTC population (P < 0.001).Physical functioning (P = 0.050), cognitive functioning (P = 0.039), emotional functioning (P = 0.006), physical and social functioning (P = 0.005), constipation (P = 0.018), body image (P = 0.003), abdominal pain (P = 0.004), embarrassment (P = 0.003) were significantly better for patients with SP.There was no significant differences in the general symptoms of the radiochemotherapy treatment (mouth dryness, hair loss, flavor).Most of the symptom scales like sexual interest, impotence, dyspareunia, diarrhoea did not differ.APE patients suffered more from anxiety (P = 0.020).CONCLUSIONS: Patients after APE have restrictions in their postoperative quality of life.Although avoidance of a permanent colostomy is regarded as beneficial for patient´s quality of life by most surgeons, patients undergoing sphincter sparing surgery may develop a number of functional problems.

Peritoneal carcinomatosis of gastrointestinal origin (PC-GI) is an advanced digestive tumor and is found in 10-30% of patients (P) with primary surgery for cancer (C) and up to 50% of C recurrences.To evaluate the main characteristics, ethio-pathogenesis, prognosis and imaging to track of P with PC-GI admitted to the Third Surgical Clinic, "St. Spiridon" Hospital, Iaşi.A retrospective study was carried out on series of 203 patients admitted in the period June 2006 - March 2011. The patients were aged between 27-80 years (average 62), with a women/men ratio of 95/108. The duration of hospitalization was between 1 and 61 days, with an average of 13.5 days for emergency cases and 15 days for elective cases. The data from observation files, the operating protocols, pathology reports and follow-up files were collected and analyzed.136 patients were hospitalized with synchronous PC (the most common gastric N = 60) and 67 with metachronous PC (the most common colon N = 29). Imaging investigations consisted of ultrasound and computer tomography that showed a sensibility and specificity of 80% and 73% respectively, mainly in regard to ascites but less in assessing the presence of peritoneal deposits. The most common complication was septic shock and mortality was 9.5% (17 patients). Average survival was 5.7 months.PC-GI is a disease with a poor prognosis, posing difficulties in early diagnosis, establishing the surgical indication and protocol. Consistent advances in systemic and locoregional chemotherapy, surgical techniques, intraoperative radiotherapy, as well as immunotherapy are expected to improve prognosis.

Aim: this study was aimed at analyzing the immediate postoperative course in rectal cancer patients who underwent a low anterior re-section of the rectum with total mesorectal excision. Material and methods: A retrospective study was carried out on a series of 75 patients operated between January, 1 2004 and December, 31 2010 at the IIIrd Surgical Unit of the Iasi “St. Spiridon” Hospital,. Low ante-rior resection of the rectum with total mesorectal excision was performed in all the patients. Data from medical files regarding the immediate postoperative course were analyzed. Re-sults: Neoadjuvant therapy was instituted in 32 patients. There were 28 mechanical colorec-tal anastomoses and 47 manual anastomoses. Protective ileostomy was performed in 46 cases, including 11 manual anastomosis and 35 mechanical anastomosis cases. Anastomotic fistulas occured in 11 patients (6 with manual suture and 5 with stapler). Wound complica-tions were identified in 5 cases, while retraction of ileostomy in 2. Two patients died from anastomotic fistula causing abdominal sepsis and multiple organ failure. In both cases ileos-tomy was performed at the reintervention, concomitantly with drainage of the abdominal abscesses. Conclusions: Healing of the colorectal anastomosis remains the major problem with low anterior resection of the rectum. Protective ileostomy reduces the risk of serious complications in the event of anastomotic fistula.