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Aiolfi A, Bona D, Bonitta G, Lombardo F, Manara M, Sozzi A, Schlanger D, Popa C, Cavalli M, Campanelli G, Biondi A, Bonavina L. Long-Term Impact of D2 Lymphadenectomy during Gastrectomy for Cancer: Individual Patient Data Meta-Analysis and Restricted Mean Survival Time Estimation. Cancers (Basel) 2024; 16:424. [PMID: 38275865 PMCID: PMC10814228 DOI: 10.3390/cancers16020424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/11/2024] [Accepted: 01/12/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Debate exists concerning the impact of D2 vs. D1 lymphadenectomy on long-term oncological outcomes after gastrectomy for cancer. METHODS PubMed, MEDLINE, Scopus, and Web of Science were searched and randomized controlled trials (RCTs) analyzing the effect of D2 vs. D1 on survival were included. Overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS) were assessed. Restricted mean survival time difference (RMSTD) and 95% confidence intervals (CI) were used as effect size measures. RESULTS Five RCTs (1653 patients) were included. Overall, 805 (48.7%) underwent D2 lymphadenectomy. The RMSTD OS analysis shows that at 60-month follow-up, D2 patients lived 1.8 months (95% CI -4.2, 0.7; p = 0.14) longer on average compared to D1 patients. Similarly, 60-month CSS (1.2 months, 95% CI -3.9, 5.7; p = 0.72) and DFS (0.8 months, 95% CI -1.7, 3.4; p = 0.53) tended to be improved for D2 vs. D1 lymphadenectomy. CONCLUSIONS Compared to D1, D2 lymphadenectomy is associated with a clinical trend toward improved OS, CSS, and DFS at 60-month follow-up.
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Affiliation(s)
- Alberto Aiolfi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Davide Bona
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Gianluca Bonitta
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Francesca Lombardo
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Michele Manara
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Andrea Sozzi
- I.R.C.C.S. Ospedale Galeazzi–Sant’Ambrogio, Division of General Surgery, Department of Biomedical Science for Health, University of Milan, Via C. Belgioioso, 173, 20157 Milan, Italy; (D.B.); (G.B.); (F.L.); (M.M.); (A.S.)
| | - Diana Schlanger
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, “Iuliu Hațieganul” University of Medicine and Pharmacy, 400394 Cluj-Napoca, Romania; (D.S.); (C.P.)
| | - Calin Popa
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. Octavian Fodor”, “Iuliu Hațieganul” University of Medicine and Pharmacy, 400394 Cluj-Napoca, Romania; (D.S.); (C.P.)
| | - Marta Cavalli
- I.R.C.C.S. Ospedale Galeazzi-Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy; (M.C.); (G.C.)
| | - Giampiero Campanelli
- I.R.C.C.S. Ospedale Galeazzi-Sant’Ambrogio, Division of General Surgery, Department of Surgery, University of Insubria, 20157 Milan, Italy; (M.C.); (G.C.)
| | - Antonio Biondi
- Department of General Surgery and Medical Surgical Specialties, G. Rodolico Hospital, Surgical Division, University of Catania, 95131 Catania, Italy;
| | - Luigi Bonavina
- Department of Biomedical Sciences for Health, Division of General and Foregut Surgery, IRCCS Policlinico San Donato, University of Milan, 20097 Milan, Italy;
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Zaharie F, Valean D, Zaharie R, Popa C, Mois E, Schlanger D, Fetti A, Zdrehus C, Ciocan A, Al-Hajjar N. Surgical management of hydatid cyst disease of the liver: An improvement from our previous experience? World J Gastrointest Surg 2023; 15:847-858. [PMID: 37342852 PMCID: PMC10277938 DOI: 10.4240/wjgs.v15.i5.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/12/2023] [Accepted: 03/24/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Hydatid liver disease remains an important issue in endemic areas, which may require immediate surgery. Although laparoscopic surgery is on the rise, the presence of certain complications may require conversion to the open approach.
AIM To compare the results of laparoscopic treatment and the open approach in the context of a 12-year single institution experience, and to perform a further comparison between results from the current study and those from a previous study.
METHODS Between January 2009 and December 2020, 247 patients underwent surgery for hydatic disease of the liver in our department. Of the 247 patients, 70 underwent laparoscopic treatment. A retrospective analysis between the two groups was performed, as well as a comparison between current and previous laparoscopic experience (1999-2008).
RESULTS There were statistically significant differences between the laparoscopic and open approaches regarding the cyst dimension, location, and presence of cystobiliary fistula. There were no intraoperative complications in the laparoscopic group. The cutoff value for the cyst size regarding the presence of cystobiliary fistula was 6.85 cm (P = 0.001).
CONCLUSION Laparoscopic surgery still plays an important role in the treatment of hydatid disease of the liver, with an increase in its usage over the course of years that has shown benefits regarding the postoperative recovery with a decreased rate of intraoperative complications. Although experienced surgeons can perform laparoscopic surgery in the most difficult conditions, there are some selection criteria that need to be maintained for higher quality results.
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Affiliation(s)
- Florin Zaharie
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Dan Valean
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Roxana Zaharie
- Department of Gastroenterology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
- Department of Gastroenterology, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400012, Cluj, Romania
| | - Calin Popa
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Emil Mois
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Diana Schlanger
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Alin Fetti
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Claudiu Zdrehus
- Department of Anaesthesiology, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Andra Ciocan
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
| | - Nadim Al-Hajjar
- Department of Surgery, “Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400636, Cluj, Romania
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Popa C, Schlanger D, Prunoiu VM, Puia IC, Zaharie F. A novel step-by-step training program for transanal endoscopic surgery. BMC Med Educ 2023; 23:327. [PMID: 37170198 PMCID: PMC10176938 DOI: 10.1186/s12909-023-04296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 04/23/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND The objective of our study is to develop an effective training platform for transanal endoscopic surgery and to validate a step-by-step training program for learning the basic skills necessary for this approach. METHODS We have designed a two-part study: an experimental study (with the aim to design the training platform and the training exercises - on synthetic and biological material) and a prospective analytical study, in order to validate the training program by enrolling as participants general surgery residents and specialists, without previous experience in transanal endoscopic interventions. The performance of the participants was assessed based on the time of completion, as well as the quality of the execution. RESULTS We have developed three different diameter platforms (5 cm, 7.5 and 10 cm), that can be used with both the TEO and TAMIS platforms; specific exercises were developed to train different surgical skills like manipulation of tissue, cutting, dissection and suturing. Forty participants were enrolled for the validation of the proposed training program (12 young residents, 16 senior residents and 12 specialist surgeons). A statistically significant improvement of the performance time, from round to round, was observed for all participants in all exercises. The time of completion for the exercises, considering the correct technical execution, was the shortest for more experienced surgeons: specialist surgeons, followed by senior residents and young residents. The biological material exercises, that closely recreate intraoperative conditions and had more strict technical requirements, were difficult to be performed by young residents; better completion rates were seen in senior residents, while all the participants in the specialist surgeons group have completed these exercises. CONCLUSIONS Our training program is an effective simulation based educational model for recreating intraoperative conditions particular to transanal endoscopic surgery. The proposed step-by-step training program has demonstrated to be useful in developing the important basic skills needed for transanal endoscopic surgery and assured the progress of all the participants, regardless of their surgical experience.
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Affiliation(s)
- Călin Popa
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania
| | - Diana Schlanger
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania.
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania.
| | - Virgiliu Mihail Prunoiu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Clinic I General and Oncological Surgery "Prof. Dr. Alexandru Trestioreanu", Bucharest, Romania
| | - Ion Cosmin Puia
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania
| | - Florin Zaharie
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no 13, Cluj-Napoca, 400023, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Street Croitorilor no 19-21, 400162, Cluj- Napoca, Cluj-Napoca, Romania
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Popa C, Prunoiu VM, Puia P, Schlanger D, Brătucu MN, Strâmbu V, Brătucu E, Moisă HA, Chiru EG, Ileanu BV, Radu P. Specific Septic Complications after Rectal Cancer Surgery: A Critical Multicentre Study. Cancers (Basel) 2023; 15:cancers15082340. [PMID: 37190267 DOI: 10.3390/cancers15082340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 04/15/2023] [Indexed: 05/17/2023] Open
Abstract
The postoperative septic complications in gastrointestinal surgery impact immediate as well as long-term outcomes, which lead to reinterventions and additional costs. The authors presented the experience of three surgery clinics in Romania regarding the specific septic complications occurring in patients operated on for rectal cancer. The study group comprised 2674 patients who underwent surgery over a 5-year period (2017-2021). Neoplasms of the middle and lower rectum (76%) were the majority. There were 85% rectal resections and 15% abdominoperineal excisions of the rectum. In total, 68.54% of patients were operated on laparoscopically, and 31.46% received open surgery. Without taking wound infections into account, 97 (3.67%) patients had abdominal-pelvic septic complications. The aim was to evaluate the causes of the complications. The percentage of suppurations after surgery of the rectum treated by radiochemotherapy was considerably higher than after surgery of the non-radiated upper rectum. The fatality rate was 5.15%. The risk of fistulas was significantly associated with the preoperative treatment, tumour position and type of intervention. Sex, age, TNM stage or grade were not significant at 0.05 the threshold. The risk of fistulas is reduced with low anterior resection, but the gravity of these complications is higher in the lower rectum compared with the superior rectum. Preoperative radiochemotherapy is a contributing factor to septic complications.
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Affiliation(s)
- Călin Popa
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganul" University of Medicine and Pharmacy, Croitorilor Street 19, 400394 Cluj-Napoca, Romania
| | - Virgiliu-Mihail Prunoiu
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Paul Puia
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganul" University of Medicine and Pharmacy, Croitorilor Street 19, 400394 Cluj-Napoca, Romania
| | - Diana Schlanger
- Surgery Clinic 3, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", "Iuliu Hațieganul" University of Medicine and Pharmacy, Croitorilor Street 19, 400394 Cluj-Napoca, Romania
| | - Mircea-Nicolae Brătucu
- General Surgery Clinic, Clinical Hospital "Dr. Carol Davila", "Carol Davila" University of Medicine and Pharmacy, Calea Griviței 4, 010731 Bucharest, Romania
| | - Victor Strâmbu
- General Surgery Clinic, Clinical Hospital "Dr. Carol Davila", "Carol Davila" University of Medicine and Pharmacy, Calea Griviței 4, 010731 Bucharest, Romania
| | - Eugen Brătucu
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Hortensia-Alina Moisă
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Eduard-Georgian Chiru
- Clinic I General and Oncological Surgery, "Prof. Dr. Alexandru Trestioreanu" Oncological Institute, "Carol Davila" University of Medicine and Pharmacy, Fundeni Street 252, 022328 Bucharest, Romania
| | - Bogdan Vasile Ileanu
- Center for Health Outcomes and Evaluation, Splaiul Unirii Street 45, 030126 Bucharest, Romania
| | - Petre Radu
- General Surgery Clinic, Clinical Hospital "Dr. Carol Davila", "Carol Davila" University of Medicine and Pharmacy, Calea Griviței 4, 010731 Bucharest, Romania
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Popa C, Abdul Halim N, Pestean C, Ober C, Elisei R, Al Momani T, Schlanger D, Graur F, Zaharie F, Al Hajjar N. Residents can do it! A hands-on training program in laparoscopic liver surgery for general surgery residents. Eur Surg Res 2023:000528691. [PMID: 36592620 DOI: 10.1159/000528691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Laparoscopic liver resections (LLR) constitute an area of surgery that has been kept away from residents in their hands-on training. The aim of our study is to assess the feasibility and the value of a didactic "step-by-step" program for LLR performed by residents using the swine training model Methods: From May 2018 to November 2019, three hands-on workshops were held. The protocol involved the performance of cholecystectomy, liver mobilization, minor and major hepatectomies. The participants' performance results in terms of operative time, blood loss, conversion, trainers' intervention and intraoperative mortality, were recorded. The first workshop was comprised of 30 residents who previously participated in laparoscopic surgery workshops. In the second workshop, after six residents dropped out due to residency completion, the findings for the remaining 24 residents were compared to those for 24 junior attending surgeons who didn't follow the protocol and had not performed LLR previously, and to another 24 residents in a third workshop, who had not taken the training program before but followed the protocol Results: All residents fully completed the surgical procedures. Trained residents achieved better operative times and less blood loss compared to senior surgeons (p<0.017), however, the remaining parameters were comparable. When compared to non-trained residents, those who underwent training achieved significantly better results only in operative times (p<0.001) Conclusion: A continuous LLR "step-by-step" training program on swine for residents is feasible and the "step-by-step" protocol is a valuable tool for a proper surgical education.
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Puia A, Schlanger D, Fetti A, Popa C, Necula A, Al Hajjar N. Do Patient Delay and Diagnostic Delay Influence Long Term Survival in Patients with Gastric Cancer? J Gastrointestin Liver Dis 2022; 31:396-402. [PMID: 36535052 DOI: 10.15403/jgld-4486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/25/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Gastric cancer is one of the most common malignancies, with an aggressive evolution and a poor long-term prognosis. No screening program is available in Europe for this pathology; therefore, the delay from the appearance of the first symptom until the initiation of treatment might influence the prognosis of gastric cancer patients. We aimed to investigate the impact on the prognosis of the delay in the presentation and diagnosis in patients with gastric adenocarcinoma. METHODS Our study is a retrospective, single-center, observational cohort study, based on patients diagnosed with gastric adenocarcinoma and operated in our institution between 2013 and 2021. We have defined patient delay as the time from the onset of symptoms to the first encounter with a health care provider and diagnosis delay as the time from the first consultation with a health care provider to the establishment of the final diagnosis. RESULTS A total of 671 patients were included in our study. The survival rate at 5 years was 55% for the patients operated with curative intent and 7.4% for the patients operated with palliative intent. Patient delay and diagnosis delay were not correlated with the overall survival. A lower survival was observed for patients admitted through transfer (p<0.001) or the emergency department (p<0.001). No statistically significant relationship was identified between patient delay or diagnosis delay and the age, gender or area of origin of patients. Patients that experienced melena or hematemesis had a shorter patient delay, with a highly significant statistical relationship (p<0.01). Patients that experienced nausea, epigastric pain, palpable epigastric tumor mass or anorexia also had a highly significant statistical relationship between the symptoms and the patient delay interval. CONCLUSIONS The overall survival is not influenced by the patient delay or diagnosis delay. An earlier presentation was correlated with some specific exhibited symptoms: upper gastro-intestinal bleeding, abdominal pain, palpable epigastric tumor, nausea.
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Affiliation(s)
- Aida Puia
- Community Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. .
| | - Diana Schlanger
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania. .
| | - Alin Fetti
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Calin Popa
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Alexandru Necula
- Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Nadim Al Hajjar
- Surgery Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca; Surgery Department, Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
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Popa C, Schlanger D, Chirică M, Zaharie F, Al Hajjar N. Emergency pancreaticoduodenectomy for non-traumatic indications—a systematic review. Langenbecks Arch Surg 2022; 407:3169-3192. [DOI: 10.1007/s00423-022-02702-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
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Schlanger D, Popa C, Ciocan A, Șofron C, Al Hajjar N. Emergency Pancreatoduodenectomy: A Non-Trauma Center Case Series. J Clin Med 2022; 11:jcm11102891. [PMID: 35629017 PMCID: PMC9143146 DOI: 10.3390/jcm11102891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/14/2022] [Accepted: 05/17/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival.
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Affiliation(s)
- Diana Schlanger
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-074-357-8432
| | - Andra Ciocan
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Cornelia Șofron
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac no 13, 400023 Cluj-Napoca, Romania; (D.S.); (A.C.); (C.Ș.); (N.A.H.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor, Street Croitorilor no 19–21, 400162 Cluj-Napoca, Romania
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Schlanger D, Popa C, Pașca S, Seicean A, Al Hajjar N. The role of systemic immuno-inflammatory factors in resectable pancreatic adenocarcinoma: a cohort retrospective study. World J Surg Oncol 2022; 20:144. [PMID: 35513845 PMCID: PMC9074307 DOI: 10.1186/s12957-022-02606-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/14/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Pancreatic cancer is an aggressive malignancy, surgery being the only potentially curative treatment. The systemic inflammatory response is an important factor in the development of cancer. There is still controversy regarding its role in pancreatic cancer. METHODS Our study is a retrospective observational cohort study. We included patients diagnosed with pancreatic ductal adenocarcinoma (PDAC), who underwent surgical resection in our hospital, between January 2012 and December 2019. We gathered information from preoperative and postoperative blood tests. Neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) were determined. RESULTS We included 312 patients. All the immune-inflammatory scores assessed significantly changed after the surgery. The impact on overall survival of these markers showed that only some of the postoperative scores predicted survival: high PLR had a negative prognostic impact, while high lymphocyte and PNI values had a positive effect on overall survival. DISCUSSION The circulating immune cells and their values integrated in the assessed prognostic scores suffer statistically significant changes after curative pancreatic surgery. Only the postoperative values of lymphocyte count, PLR, and PNI seem to influence the overall survival in PDAC. TRIAL REGISTRATION ClinicalTrials.gov-identifier NCT05025371 .
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Affiliation(s)
- D. Schlanger
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - C. Popa
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
| | - S. Pașca
- Department of Haematology, “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400012 Cluj-Napoca, Romania
| | - A. Seicean
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162 Cluj-Napoca, Romania
| | - N. Al Hajjar
- “Iuliu Haţieganu” University of Medicine and Pharmacy, Cluj-Napoca, Romania. Street Emil Isac no. 13, 400023 Cluj-Napoca, Romania
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Cluj-Napoca, Romania. Street Croitorilor no. 19-21, 400162 Cluj-Napoca, Romania
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Zaharie RD, Popa C, Schlanger D, Vălean D, Zaharie F. The Role of IL-22 in Wound Healing. Potential Implications in Clinical Practice. Int J Mol Sci 2022; 23:3693. [PMID: 35409053 PMCID: PMC8998254 DOI: 10.3390/ijms23073693] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/14/2022] Open
Abstract
Wound healing is a complex process that is mediated and influenced by several cytokines, chemokines, and growth factors. Interleukin-22 (IL-22) is a cytokine that plays a critical role in tissue regeneration. Our study is a systematic review that addressed the implications of IL-22 in the healing of wounds caused by external factors. Thirteen studies were included in our review, most of them being experimental studies. Three clinical studies underlined the potential role of IL-22 in day-to-day clinical practice. IL-22 plays a central role in wound healing, stimulating the proliferation, migration, and differentiation of the cells involved in tissue repair. However, overexpression of IL-22 can cause negative effects, such as keloid scars or peritoneal adhesions. The results of the presented studies are promising, but further research that validates the roles of IL-22 in clinical practice and analyzes its potential implication in surgical healing is welcomed.
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Affiliation(s)
- Roxana Delia Zaharie
- Gastroenterology Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania;
- Gastroenterology Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Călin Popa
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Diana Schlanger
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Dan Vălean
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
| | - Florin Zaharie
- Surgery Department, “Iuliu Haţieganu” University of Medicine and Pharmacy, Street Emil Isac No. 13, 400023 Cluj-Napoca, Romania; (D.V.); (F.Z.)
- Surgery Department, Regional Institute of Gastroenterology and Hepatology “Prof. Dr. O. Fodor”, Street Croitorilor No. 19–21, 400162 Cluj-Napoca, Romania
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Schlanger D, Graur F, Popa C, Moiș E, Al Hajjar N. The role of artificial intelligence in pancreatic surgery: a systematic review. Updates Surg 2022; 74:417-429. [PMID: 35237939 DOI: 10.1007/s13304-022-01255-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/10/2022] [Indexed: 12/13/2022]
Abstract
Artificial intelligence (AI), including machine learning (ML), is being slowly incorporated in medical practice, to provide a more precise and personalized approach. Pancreatic surgery is an evolving field, which offers the only curative option for patients with pancreatic cancer. Increasing amounts of data are available in medicine: AI and ML can help incorporate large amounts of information in clinical practice. We conducted a systematic review, based on PRISMA criteria, of studies that explored the use of AI or ML algorithms in pancreatic surgery. To our knowledge, this is the first systematic review on this topic. Twenty-five eligible studies were included in this review; 12 studies with implications in the preoperative diagnosis, while 13 studies had implications in patient evolution. Preoperative diagnosis, such as predicting the malignancy of IPMNs, differential diagnosis between pancreatic cystic lesions, classification of different pancreatic tumours, and establishment of the correct management for each of these lesions, can be facilitated through different AI or ML algorithms. Postoperative evolution can also be predicted, and some studies reported prediction models for complications, including postoperative pancreatic fistula, while other studies have analysed the implications for prognosis evaluation (from predicting a textbook outcome, the risk of metastasis or relapse, or the mortality rate and survival). One study discussed the possibility of predicting an intraoperative complication-massive intraoperative bleeding. Artificial intelligence and machine learning models have promising applications in pancreatic surgery, in the preoperative period (high-accuracy diagnosis) and postoperative setting (prognosis evaluation and complication prediction), and the intraoperative applications have been less explored.
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Affiliation(s)
- D Schlanger
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania
| | - F Graur
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania. .,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania.
| | - C Popa
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania
| | - E Moiș
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania
| | - N Al Hajjar
- "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania street Emil Isac no 13, 400023, Cluj-Napoca, Romania.,Surgery Department, Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor", Cluj-Napoca, Romania. Street Croitorilor no 19-21, 400162, Cluj-Napoca, Romania
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Schlanger D, Calin P, Nadim AH. The role of systemic immunologic and nutritional parameters as prognostic factors for surgically resected pancreatic adenocarcinoma. Eur J Surg Oncol 2022. [DOI: 10.1016/j.ejso.2021.12.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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13
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Zaharie F, Valean D, Popa C, Mois E, Graur F, Munteanu D, Schlanger D, Ciocan A, Puia C, Al Hajjar N. Surgical technique in the laparoscopic repair of Morgagni hernia in adults. How do we do it? Hernia 2022; 26:1389-1394. [PMID: 35013791 DOI: 10.1007/s10029-021-02559-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Adult Morgagni hernias are rare congenital diaphragmatic hernias, which can present with an array of symptoms based on the size and the contents of it. This article focuses primarily on the laparoscopic repair with transfascial suturing. METHODS A number of five patients over the course of 10 years were admitted in our clinic, one of them being admitted with emergency symptoms. Four of the patients were treated laparoscopically, one of them requiring conversion to open approach. RESULTS The median age was 53 (range 44-71), 80% of the patients being females. Four of the patients received laparoscopic treatment with transfascial suturing, the fifth being converted, but respecting the same technique. The median surgery duration was 110 min, with a median blood loss of 30 ml. Removal of the sac was attempted in two cases. Median hospitalization stay was 3 days, with a median follow-up of 21 months, with no postoperative complications reported. CONCLUSIONS Laparoscopic repair with transfascial suturing provides an feasible and efficient repair, compared to the other laparoscopic techniques. Although no postoperative complications were reported, the removal of the sac still remains an controversial issue.
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Affiliation(s)
- F Zaharie
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Valean
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.
| | - C Popa
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - E Mois
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - F Graur
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Munteanu
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - D Schlanger
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania
| | - A Ciocan
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - C Puia
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
| | - N Al Hajjar
- Regional Institute of Gastroenterology and Hepatology "O. Fodor", Cluj-Napoca, Romania.,University of Medicine and Pharmacy "Iuliu Hațieganu", Cluj-Napoca, Romania
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Ciocan RA, Ciocan A, Zaharie FV, Popa C, Schlanger D, Alexa A, Ionescu D, Hajjar NA. Perioperative Management of Patients with Pancreatic Cancer - the ERAS Protocols. Chirurgia (Bucur) 2022; 117:415-422. [DOI: 10.21614/chirurgia.2761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
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15
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Schlanger D, Popa C, Rusu I, Hajjar NA. Pancreatic Adenocarcinoma Associated to Intraductal Papillary Mucinous Neoplasia: Histopathological Particularities and Clinical Implications. Chirurgia (Bucur) 2022; 117:454-462. [DOI: 10.21614/chirurgia.2760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 11/23/2022]
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Caziuc A, Schlanger D, Amarinei G, Fagarasan V, Andras D, Dindelegan GC. Preventing Breast Cancer-Related Lymphedema: Feasibility of Axillary Reverse Mapping Technique. J Clin Med 2021; 10:jcm10235707. [PMID: 34884409 PMCID: PMC8658501 DOI: 10.3390/jcm10235707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Our study aimed to determine the feasibility of axillary reverse mapping (ARM) technique, the identification rate of ARM nodes and their metastatic involvement, as well as to identify the factors that influence the identification and metastatic involvement. MATERIAL AND METHODS In total, 30 breast cancer patients scheduled for axillary lymph node dissection were enrolled in our study. The lymphatic nodes that drain the arm were identified by injecting 1 mL of blue dye in the ipsilateral upper arm; then, the ARM nodes were resected along with the other lymph nodes and sent for histological evaluation. RESULTS Identification of ARM node was successful in 18 patients (60%) and 22.22% of the identified ARM lymph nodes had metastatic involvement. Patients with identified ARM nodes had a significant lower BMI and a statistically significant relationship between axillary lymph node status and ARM node metastases was proven. Most of ARM lymph nodes (96.3%) were found above the intercostobrachial nerve, under the axillary vein and lateral to the thoracodorsal bundle. CONCLUSIONS The ARM procedure is easy to reproduce but might not be appropriate for patients with a high BMI. The rate of metastatic involvement of ARM nodes is significant and no factor can predict it, showing that the preservation of these nodes cannot be considered.
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Affiliation(s)
- Alexandra Caziuc
- 1st Surgical Clinic, Surgical Department, University of Medicine and Pharmacy Cluj Napoca, 400006 Cluj Napoca, Romania; (A.C.); (G.A.); (V.F.); (D.A.); (G.C.D.)
| | - Diana Schlanger
- 3rd Surgical Clinic, Surgical Department, University of Medicine and Pharmacy Cluj Napoca, 400162 Cluj Napoca, Romania
- Correspondence:
| | - Giorgiana Amarinei
- 1st Surgical Clinic, Surgical Department, University of Medicine and Pharmacy Cluj Napoca, 400006 Cluj Napoca, Romania; (A.C.); (G.A.); (V.F.); (D.A.); (G.C.D.)
| | - Vlad Fagarasan
- 1st Surgical Clinic, Surgical Department, University of Medicine and Pharmacy Cluj Napoca, 400006 Cluj Napoca, Romania; (A.C.); (G.A.); (V.F.); (D.A.); (G.C.D.)
| | - David Andras
- 1st Surgical Clinic, Surgical Department, University of Medicine and Pharmacy Cluj Napoca, 400006 Cluj Napoca, Romania; (A.C.); (G.A.); (V.F.); (D.A.); (G.C.D.)
| | - George Calin Dindelegan
- 1st Surgical Clinic, Surgical Department, University of Medicine and Pharmacy Cluj Napoca, 400006 Cluj Napoca, Romania; (A.C.); (G.A.); (V.F.); (D.A.); (G.C.D.)
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Popa C, Schlanger D, Buliarca A, Mocan T, Procopeţ B, Spârchez Z, Hajjar NA. Is There a Role for Surgery in BCLC B Hepatocellular Carcinoma? Chirurgia (Bucur) 2021; 116:1-8. [PMID: 34463246 DOI: 10.21614/chirurgia.116.ec.2424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
Intermediate stage hepatocarcinoma, classified b Barcelona Clinic Liver Cancer (BCLC) comprises a large number of patients, with diverse characteristics, being defined by multiple tumours, preserved liver function and good performance status. The recommended treatment for this stage is transarterial chemoembolization (TACE), but there are a few studies that discuss the role of surgery in this stage. We report a case of a 59-year-old woman diagnosed with BCLC B hepatocarcinoma (two tumours of 34 and 25 mm, in liver segments 5 and 6) who was successfully treated with surgical resection. This patient had additional risk factors like morbid obesity, clinically significant portal hypertension, and thrombocytopenia. Despite these characteristics, the evolution was favourable. In conclusion, we believe that surgery has an important role in the treatment of well-selected BCLC B patients and a good preoperative assessment of the patient can minimize the perioperative risk.
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Schlanger D, Popa C, Rusu I, Seicean A, Hajjar NA. Synchronous Pancreatic Tumours: Intraductal Papillary Mucinous Neoplasm with Pancreatic Ductal Adenocarcinoma and Neuroendocrine Tumour: A Case Presentation and Review of Literature. Chirurgia (Bucur) 2021; 116:1-9. [PMID: 34463245 DOI: 10.21614/chirurgia.116.ec.2425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 11/23/2022]
Abstract
Synchronous tumours of the pancreas are rare encounters, with few reported cases. Thus, new information can be brought about the diagnosis, proper management, and prognosis of cases. We believe that the presentation of this case can help to establish relevant conclusions. We report the case of a 54-year-old man, with the preoperative diagnosis of a cephalic intraductal papillary mucinous neoplasm (IPMN), who underwent a planned cephalic pancreatoduodenectomy with completion to total pancreatectomy based on the intraoperative extemporaneous histopathological examination of the resection margin. The final histopathological diagnosis was cephalic IPMN associated with invasive ductal adenocarcinoma (PDAC) and a small well-differentiated neuroendocrine tumour (NET) in the tail of the pancreas. No recurrence was detected in the 3 years of follow-up. We conducted a review of the literature to illustrate the particularities of the presented case; it identified 4 articles about the association of PDAC and NET and 8 articles regarding the association of IPMN with NET. Only 2 patients had a histopathological diagnosis of three synchronous tumours (IPMN, PDAC, and NET). We present a rare case of three synchronous pancreatic tumours, with a favourable evolution after a total pancreatectomy, only two other similar cases being reported in medical literature.
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Caziuc A, Schlanger D, Amarinei G, Dindelegan GC. Neutrophils-to-lymphocytes, lymphocytes to-monocytes and platelets-to-lymphocytes ratios - predictive biomarkers for response to neoadjuvant chemotherapy in breast cancer. J BUON 2020; 25:182-187. [PMID: 32277630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE Several biomarkers have been reported to correlate with neoadjuvant chemotherapy response. Our aim was to establish the correlation between neutrophils-to-lymphocytes (NLR), lymphocytes-to-monocytes (LMR), and platelets-to-lymphocytes ratios (PLR) and the Miller Payne grade (MPG) and Residual Cancer Burden Score (RCB), as indicators to response to chemotherapy. METHODS Data were retrospectively collected from the First Surgical Clinic database between January 2016 and December 2018. RESULTS 96 patients were included in the study. The multivariate regression analysis showed a statistical correlation between oestrogen (ER) and progesterone receptor (PR) status, Ki67 over 15%, and tumour infiltrating lymphocytes (TILs) and MPG and RCB. For the three studied ratios, p value was statistical not significative. ROC curve showed a cut-off value of 2.7 NLR, for which correlation with the pathological complete response to chemotherapy (pCR) was significative (p=0.03). CONCLUSIONS Our findings suggest that NLR can be a predictive biomarker for pCR. Further studies, on larger sample size, are necessary to establish the correlation with MPG and RCB.
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Affiliation(s)
- Alexandra Caziuc
- First Surgical Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Romania
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Caziuc A, Schlanger D, Amarinei G, Dindelegan GC. Can Tumor-Infiltrating Lymphocytes (TILs) Be a Predictive Factor for Lymph Nodes Status in Both Early Stage and Locally Advanced Breast Cancer? J Clin Med 2019; 8:jcm8040545. [PMID: 31013579 PMCID: PMC6517873 DOI: 10.3390/jcm8040545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 12/25/2022] Open
Abstract
The status of axillary lymph nodes is an important prognostic factor in the outcome of breast cancer tumors. New trials changed the attitude towards axillary clearance. In the era of development of new immune therapies for breast cancer, it is important to identify a biomarker that can predict lymph node status. Tumor-infiltrating lymphocytes (TILs) are a valuable indicator of the immune microenvironment that plays the central role in new anticancer drugs. Although the correlation between TILs and response to chemotherapy was established by previous studies, our retrospective study investigated the correlation between TILs and lymph node status. We analyzed data on 172 patients. According to stage, patients were divided in two groups: patients who underwent primary surgical treatment (breast-conserving or mastectomy and sentinel lymph node (SLN) biopsy +/− axillary clearance in conformity with lymph node status) and patients who received chemotherapy prior to surgical treatment (breast-conserving or mastectomy + axillary clearance). We showed a good inverse correlation between TILs and lymph nodes status for both early stage and locally advanced breast cancers. Moreover, TILs are a predictor for positive lymph nodes in the axilla in patients undergoing axillary clearance after SLN biopsy, with no statistical difference between the intrinsic or histological subtype of breast cancers. We also obtained a significant correlation between TILs and response to chemotherapy with no significative difference according to histological subtype. Although further data have still to be gathered before meeting the criteria for clinical utility, this study demonstrates that TILs are one of the most accredited forthcoming biomarkers for breast cancer (BC) patients.
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Affiliation(s)
- Alexandra Caziuc
- First Surgical Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu", Victor Babes Street, no. 8, 400000 Cluj-Napoca, Romania.
| | - Diana Schlanger
- First Surgical Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu", Victor Babes Street, no. 8, 400000 Cluj-Napoca, Romania.
| | - Giorgiana Amarinei
- First Surgical Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu", Victor Babes Street, no. 8, 400000 Cluj-Napoca, Romania.
| | - George Calin Dindelegan
- First Surgical Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu", Victor Babes Street, no. 8, 400000 Cluj-Napoca, Romania.
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