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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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Gherman B, Hajjar NA, Tucan P, Radu C, Vaida C, Mois E, Burz A, Pisla D. Risk Assessment-Oriented Design of a Needle Insertion Robotic System for Non-Resectable Liver Tumors. Healthcare (Basel) 2022; 10:healthcare10020389. [PMID: 35207006 PMCID: PMC8872014 DOI: 10.3390/healthcare10020389] [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: 11/30/2021] [Revised: 01/19/2022] [Accepted: 02/15/2022] [Indexed: 11/16/2022] Open
Abstract
Medical robotics is a highly challenging and rewarding field of research, especially in the development of minimally invasive solutions for the treatment of the worldwide leading cause of death, cancer. The aim of the paper is to provide a design methodology for the development of a safe and efficient medical robotic system for the minimally invasive, percutaneous, targeted treatment of hepatocellular carcinoma, which can be extended with minimal modification for other types of abdominal cancers. Using as input a set of general medical requirements to comply with currently applicable standards, and a set of identified hazards and failure modes, specific methods, such as the Analytical Hierarchy Prioritization, Risk Analysis and fuzzy logic Failure Modes and Effect Analysis have been used within a stepwise approach to help in the development of a medical device targeting the insertion of multiple needles in brachytherapy procedures. The developed medical device, which is visually guided using CT scanning, has been tested for validation in a medical environment using a human-size ballistic gel liver, with promising results. These prove that the robotic system can be used for the proposed medical task, while the modular approach increases the chances of acceptance.
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Affiliation(s)
- Bogdan Gherman
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Nadim Al Hajjar
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Paul Tucan
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Corina Radu
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Calin Vaida
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Emil Mois
- “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology Cluj-Napoca, Croitorilor Street, No. 19-21, 400162 Cluj-Napoca, Romania; (N.A.H.); (C.R.); (E.M.)
| | - Alin Burz
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
| | - Doina Pisla
- CESTER—Research Center for Industrial Robots Simulation and Testing, Technical University of Cluj-Napoca, Bulevardul Muncii Street, No. 103-105, 400641 Cluj-Napoca, Romania; (B.G.); (P.T.); (C.V.); (A.B.)
- Correspondence:
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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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Mois E, Pop CP, Graur F, Moldovan S, Puia IC, Zdrehus C, Muresan I, Hajjar NA. Duodenopancreatectomy for PDAC Associated with MALS: A Case Report. Chirurgia (Bucur) 2022; 117:493-498. [DOI: 10.21614/chirurgia.2757] [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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Graur F, Puia A, Mois E, Pop P, Berar M, Elisei R, Zaharie F, Nechita V, Rusu I, Buiga R, Puia C, Al Hajjar N. Analysis of the MLH1, MLH2, MLH6, PMS2 genes and their correlations with clinical data in rectal mucinous adenocarcinoma. Ann Ital Chir 2022; 93:188-194. [PMID: 34807001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Microsatellites are short repeated DNA sequences normally found in the human genome. Following specific mutations, microsatellites can vary in the number of repeats thus making the DNA unstable. Microsatellite instability (MSI) is responsible for approximately 20% of rectal cancers, while the remaining 80% are caused by chromosomal instability. One of the following genes, MLH1, MLH2, MLH 6, and PMS2, is inactivated, leading to MSI colorectal cancers. AIM This study aimed to analyze the expression of some MMR system genes presenting mutations in mucinous rectal cancer and their correlations with clinical data. METHODS A retrospective study was performed on patients with rectal mucinous adenocarcinoma who underwent surgery between January 2000 and January 2017. We collected a total of 42 patients and analyzed the demographic data, histopathological results and MMR system genes mentioned above. RESULTS Almost 93% of the cases analyzed had MSI-H and only 7% were MSI-L. For MLH1, 50% of stage T2 and 50% of stage T4 had weak expression, while in stage T3, 42.50% had moderate expression. Regarding the N stage, we found that 66.67% of the patients with moderate gene expression (2+) were N2, while 42% of the patients with weak expression were N0. For MSH2, the majority of patients with strong gene expression were in stage T3 (27%). Weak expression was found in 50% of the patients in stage T2, 35% of the patients in stage T3, and 33.3% in T4. In 44.44% of the weak expression was N2, while for strong expression, there was an equivalent percentage of 33.33% in stages N1 and N2. Describing the MSH6 gene, we found that the most heterogeneous results were in stage T3. Weak expression was observed in 38.46% of the patients, while moderate and strong expression was observed in 30.77% and 11.54% respectively. Analysis of PMS2 revealed that 66.67% of the patients in stage T4 had a weak expression of the gene, while the same expression was found in 38.46% of the patients in stage T3. A total of 23.08% of patients in stage T3 had strong gene expression. We also analyzed the overall gene expression. Thus, we found that three patients (7.14%) had only 1, three genes were expressed, nine (21.42%) had two genes and the remaining 27 patients had all 4. The 1-year survival rate in the analyzed lot was 75%, decreasing to 60% in the second year and 35% in the 3rd. There were no statistically significant differences in survival data between the stages or gene expression. CONCLUSIONS Our study showed no statistical difference regarding the survival on different gene expression or staging, consistent with studies that found that mucin expression does not have a significant impact on local recurrence, nor does it affect nodal down staging. KEY WORDS Mucinous adenocarcinoma, Microsatelites instability.
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Mocan T, Horhat A, Mois E, Graur F, Tefas C, Craciun R, Nenu I, Spârchez M, Sparchez Z. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how? World J Gastrointest Oncol 2021; 13:2050-2063. [PMID: 35070041 PMCID: PMC8713328 DOI: 10.4251/wjgo.v13.i12.2050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 02/28/2021] [Revised: 04/28/2021] [Accepted: 10/14/2021] [Indexed: 02/06/2023] Open
Abstract
Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dim prognosis. The role of preoperative and palliative biliary drainage has long been debated. The most common techniques are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD); however, recently developed endoscopic ultrasound-assisted methods are gaining more atention. Selecting the best available method in any specific scenario is crucial, yet sometimes challenging. Thus, this review aimed to discuss the available techniques, indications, perks, pitfalls, and timing-related issues in the management of hCCA. In a preoperative setting, PTBD appears to have some advantages: low risk of postprocedural complications (namely cholangitis) and better priming for surgery. For palliative purposes, we propose ERCP/PTBD depending on the experience of the operators, but also on other factors: the level of bilirubin (if very high, rather PTBD), length of the stenosis and the presence of cholangitis (PTBD), ERCP failure, or altered biliary anatomy.
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Affiliation(s)
- Tudor Mocan
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
- Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Adelina Horhat
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
- Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Emil Mois
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
- Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Florin Graur
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
- Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Cristian Tefas
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
- Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Rares Craciun
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
- Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Iuliana Nenu
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
- Institute for Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Mihaela Spârchez
- Second Pediatric Department, University of Medicine and Pharmacy, "Iuliu Hatieganu", Cluj-Napoca 400162, Romania
| | - Zeno Sparchez
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
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Mocan T, Horhat A, Mois E, Graur F, Tefas C, Craciun R, Nenu I, Spârchez M, Sparchez Z. Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma: When and how? World J Gastrointest Oncol 2021. [PMID: 35070041 DOI: 10.4251/wjgo.v13.i12.2050.pmid:35070041;pmcid:pmc8713328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/13/2023] Open
Abstract
Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dim prognosis. The role of preoperative and palliative biliary drainage has long been debated. The most common techniques are endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic biliary drainage (PTBD); however, recently developed endoscopic ultrasound-assisted methods are gaining more atention. Selecting the best available method in any specific scenario is crucial, yet sometimes challenging. Thus, this review aimed to discuss the available techniques, indications, perks, pitfalls, and timing-related issues in the management of hCCA. In a preoperative setting, PTBD appears to have some advantages: low risk of postprocedural complications (namely cholangitis) and better priming for surgery. For palliative purposes, we propose ERCP/PTBD depending on the experience of the operators, but also on other factors: the level of bilirubin (if very high, rather PTBD), length of the stenosis and the presence of cholangitis (PTBD), ERCP failure, or altered biliary anatomy.
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Affiliation(s)
- Tudor Mocan
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Adelina Horhat
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Emil Mois
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Florin Graur
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Cristian Tefas
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Rares Craciun
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Iuliana Nenu
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
| | - Mihaela Spârchez
- Second Pediatric Department, University of Medicine and Pharmacy, "Iuliu Hatieganu", Cluj-Napoca 400162, Romania
| | - Zeno Sparchez
- Third Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca 400162, Romania
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Sparchez Z, Mocan T, Radu P, Nenu I, Comsa M, Hajjar NA, Mois E, Bartos A, Kacso G, Sparchez M. Microwave ablation in the treatment of liver tumors. A better tool or simply more power? Med Ultrason 2020; 22:451-460. [PMID: 32905567 DOI: 10.11152/mu-2556] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
It has been a long time since tumor ablation was first tested in patients with liver cancer, especially hepatocellular carcinoma. Since than it has become a first line treatment modality for hepatocellular carcinoma. Over the years, the indications of thermal ablation have expanded to colorectal cancer liver metastases and intrahepatic cholangiocarcinoma as well. Together with the new indication for ablation, new ablation devices have been developed as well. Among them microwave ablation shows potential in replacing radiofrequency ablation as the preferred method of thermal ablation in liver cancer. The debate whether radiofrequency or microwave ablation should be the preferred method of treatment in patients with liver cancer remains open. The main purpose of this review is to offer some answers to the question: Microwave ablation in liver tumors: a better tool or simply more power? Various clinical scenarios will be analyzed including small, medium, and intermediate size hepatocellular carcinoma, colorectal cancer liver metastases and intrahepatic cholangiocarcinoma. Furthermore, the advantages, limitations, and technical considerations of MWA treatment will be provided also.
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Affiliation(s)
- Zeno Sparchez
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Tudor Mocan
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Pompilia Radu
- Hepatology, Department of Clinical Research, University of Bern, Bern, Switzerland; University Clinic for Visceral Surgery and Medicine, Inselspital Bern, Bern, Switzerland.
| | - Iuliana Nenu
- 1) 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania 2) Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Mihai Comsa
- Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Nadim Al Hajjar
- Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania 3rd Surgical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Emil Mois
- Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania 3rd Surgical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Adrian Bartos
- Institute for Gastroenterology and Hepatology, Cluj-Napoca, Romania 3rd Surgical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Gabriel Kacso
- Oncological Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
| | - Mihaela Sparchez
- Paediatric Department, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj-Napoca, Romania.
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Crisan D, Procopet B, Epure A, Stefanescu H, Suciu A, Fodor A, Mois E, Craciun R, Crisan N. Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival. World J Hepatol 2020; 12:829-840. [PMID: 33200020 PMCID: PMC7643216 DOI: 10.4254/wjh.v12.i10.829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/25/2020] [Revised: 07/06/2020] [Accepted: 09/04/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their prognosis. While evaluating the burden of malnutrition in cirrhosis is gathering momentum, as suggested by multiple recently published reports, there is still a persistent scarcity of solid data in the field, especially with regards to the role of nutritional interventions.
AIM To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on survival.
METHODS One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment (SGA) criteria and the mid-arm circumference (MAC). Malnutrition was defined as SGA class B and C and MAC < 10th percentile. All patients were interviewed regarding their food intake using an adapted questionnaire. Subsequently, total energy intake was calculated and further subdivided in main nutrients. The data were then compared to the available recommendations at the time of analysis to assess adherence.
RESULTS 54/79 patients (68.4%) in the decompensated group had malnutrition, while only 3/22 patients (13.6%) were malnourished in the compensated group. After a median follow-up time of 27 mo (0-53), the overall mortality was 70%. Survival was significantly lower among patients with malnutrition. The mortality rates were 50% at 1 year and 63% at 2 years for the patients with malnutrition, compared to 21% at 1 year and 30% at 2 years for patients without malnutrition (P = 0.01). On multivariate analysis, the factors independently associated with mortality were age, creatinine level and adherence to the protein intake recommendations. The mortality was lower in patients with the appropriate protein intake: 8% at 1 year and 28% at 2 years in the adherent group, compared to 47% at 1 year and 56% at 2 years in the non-adherent group.
CONCLUSION The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherence to nutritional recommendations, especially with regards to protein intake.
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Affiliation(s)
- Dana Crisan
- Internal Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
| | - Bogdan Procopet
- 3rd Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
- Hepatology Unit, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Alexandra Epure
- 3rd Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
| | - Horia Stefanescu
- Hepatology Unit, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
| | - Alina Suciu
- 3rd Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
| | - Andreea Fodor
- 3rd Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
| | - Emil Mois
- Surgery Department, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400126, Romania
| | - Rares Craciun
- Hepatology Unit , “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400126, Romania
| | - Nicolae Crisan
- Internal Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
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Zaharie R, Mois E, Al Hajjar N, Zdrehuș C, Rusu I, Zaharie F. A Rare Case of Ciliated Foregut Cyst of the Common Hepatic Duct. J Gastrointestin Liver Dis 2019; 28:264. [PMID: 31517321 DOI: 10.15403/jgld-419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 11/01/2022]
Affiliation(s)
- Roxana Zaharie
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania.
| | - Emil Mois
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Claudiu Zdrehuș
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Ioana Rusu
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Florin Zaharie
- Iuliu Hațieganu University of Medicine and Pharmacy, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Affiliation(s)
- Luminita Furcea
- Iuliu Hațieganu University of Medicine and Pharmacy; Prof. Dr. O.Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Emil Mois
- Iuliu Hațieganu University of Medicine and Pharmacy; Prof. Dr. O.Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Iuliu Hațieganu University of Medicine and Pharmacy; Prof. Dr. O.Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca,
| | - Andrada Seicean
- Iuliu Hațieganu University of Medicine and Pharmacy; Prof. Dr. O.Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Radu Badea
- Iuliu Hațieganu University of Medicine and Pharmacy;Prof. Dr. O.Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Florin Graur
- Iuliu Hațieganu University of Medicine and Pharmacy; Prof. Dr. O.Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Popovici BI, Matei D, Iacoban L, Simion I, Man M, Al Hajjar N, Mois E, Popovici C, Chira R, Iancu C. The impact of thoracic paravertebral block over post-operatory evolution in open lobectomy. Ann Ital Chir 2019; 90:551-559. [PMID: 31525164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
AIM The thoracic paravertebral block (PVB), a technique of post-thoracotomy analgesia of similar effectiveness as continuous epidural analgesia (CEA) but with a better safety profile, is underutilized in current practice. This study compares the outcome of post-lobectomy patients in relation to the analgesic method used: parenteral analgesia (PA) vs. PVB + PA, and provides justification for the routine use of PVB in all patients where CEA is contraindicated. METHODS We randomized 213 consecutive patients undergoing open lobectomy to benefit from two different protocols of postoperative analgesia: PA vs. PVB +PA. We compared the frequency of cardiac hemodynamic, respiratory, pleural or surgical-related complications. RESULTS After lobectomy, the PVB patients (72/213) were found to have a significantly lower frequency of congestive heart failure (7.1%vs.0.0%)(p=0.049), ischemic cardiomyopathy (10.6%vs.0.0%)(p=0.010), pulmonary atelectasis (35%vs.1.1%)(p<0.001), residual pleural space (29.8%vs.15.3%)(p=0.032) and residual intrapleural blood clots (14.9%vs.1.4%)(p=0.005). Other postoperative complications, Intensive Care stay, total hospital stay and mortality rate were less frequent in the PVB group but without reaching statistical significance. CONCLUSION The use of SPVB is associated with significant less postoperative complications than PA only. This study suggests that the SPVB might be the ideal choice in post-thoracotomy pain management when CEA cannot be used. KEY WORDS Open lobectomy, Post-lobectomy, Thoracic paravertebral block.
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Procopet B, Fischer P, Horhat A, Mois E, Stefanescu H, Comsa M, Graur F, Bartos A, Lupsor-Platon M, Badea R, Grigorescu M, Tantau M, Sparchez Z, Al Hajjar N. Good performance of liver stiffness measurement in the prediction of postoperative hepatic decompensation in patients with cirrhosis complicated with hepatocellular carcinoma. Med Ultrason 2018; 20:272-277. [PMID: 30167578 DOI: 10.11152/mu-1548] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED The evaluation of patients with early hepatocellular carcinoma (HCC) referred for liver resection is still a matter of debate. Aims: 1) to compare liver stiffness measurement (LSM) by transient elastography with hepatic venous pressure gradient (HVPG) in the prediction of decompensation after liver resection in patients with cirrhosis and early HCC; 2) to identify which definition for posthepatectomy liver failure is better associated with survival. MATERIAL AND METHODS Fifty-one patients (MELD score of 10±3) were included. In this group, 34 patients underwent HVPG measurement, of which 13 (38%) had clinically significant portal hypertension (CSPH) and 35 patients underwent LSM (21.8±17.9 kPa). The study's end-points were: posthepatectomy liver failure (PHLF) defined according to International Study Group of Liver Surgery criteria and 3-month decompensation defined as de novo ascites, variceal bleeding, jaundice, hepatic encephalopathy and acute kidney injury. The performance of LSM compared to HVPG in predicting the end-points were assessed by AUROC curves and accuracy. RESULTS Twenty (39%) patients developed PHLF and 15 (29%) developed decompensationat 3 months. Three-month decompensation tended to be better correlated with survival. LSM performed well in predicting decompensation at 3 months (AUROC=0.78, 95%CI: 0.63-0.94; p=0.01), comparable with HVPG (AUROC=0.89, 95%CI: 0.79-1.00; p<0.01) (DeLong test p=0.21). LSM was not sufficiently accurate to predict PHLF. CONCLUSION LSM has a similar performance to HVPG in predicting decompensation at 3 months in patients with early HCC submitted to liver resection. Three-month decompensation is better associated with survival.
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Affiliation(s)
- Bogdan Procopet
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Medical Clinic, Gastroenterology Department, Cluj-Napoca, Romania.
| | - Petra Fischer
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Medical Clinic, Gastroenterology and Hepatology Department, Cluj-Napoca, Romania.
| | - Adelina Horhat
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Medical Clinic, Gastroenterology and Hepatology Department, Cluj-Napoca, Romania.
| | - Emil Mois
- University of Medicine and Pharmacy "Iuliu Hatieganu", Surgery Department, Cluj-Napoca, Romania.
| | - Horia Stefanescu
- Regional Institute of Gastroenterology and Hepatology "Octavian Fodor", Gastroenterology and Hepatology Department, Cluj-Napoca, Romania.
| | - Mihai Comsa
- University of Medicine and Pharmacy "Iuliu Hatieganu", Imaging Department, Cluj-Napoca, Romania.
| | - Florin Graur
- University of Medicine and Pharmacy "Iuliu Hatieganu", Surgery Department, Cluj-Napoca, Romania.
| | - Adrian Bartos
- University of Medicine and Pharmacy "Iuliu Hatieganu", Surgery Department, Cluj-Napoca, Romania.
| | - Monica Lupsor-Platon
- University of Medicine and Pharmacy "Iuliu Hatieganu", Imaging Department, Cluj-Napoca, Romania.
| | - Radu Badea
- University of Medicine and Pharmacy "Iuliu Hatieganu", Imaging Department, Cluj-Napoca, Romania.
| | - Mircea Grigorescu
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Medical Clinic, Gastroenterology and Hepatology Department, Cluj-Napoca, Romania.
| | - Marcel Tantau
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Medical Clinic, Gastroenterology and Hepatology Department, Cluj-Napoca, Romania.
| | - Zeno Sparchez
- University of Medicine and Pharmacy "Iuliu Hatieganu", 3rd Medical Clinic, Gastroenterology and Hepatology Department, Cluj-Napoca, Romania.
| | - Nadim Al Hajjar
- University of Medicine and Pharmacy "Iuliu Hatieganu", Surgery Department, Cluj-Napoca, Romania.
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Cote A, Florin FG, Mois E, Elisei R, Badea R, Mare C, Hajjar NA, Iancu C, Lebovici A. The accuracy of endorectal ultrasonography and high-resolution magnetic resonance imaging for restaging rectal cancer after neoadjuvant chemoradiotherapy. Ann Ital Chir 2018; 89:168-176. [PMID: 29848812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM Endorectal ultrasonography (ERUS) and high-resolution Magnetic Resonance Imaging (HR-MRI) are two frequently used techniques for the preoperative staging of rectal cancer to offer proper neoadjuvant or surgical treatment. Because tumor restaging after neoadjuvant therapy using ERUS and HR-MRI remains challenging the aim of this study is to determine which of the two imaging methods used in restaging rectal cancer has the highest accuracy. MATERIAL AND METHODS We included patients with rectal cancer who underwent ERUS and HR-MRI scans before and after neoadjuvant chemo-radiotherapy (n-CRT). The n-CRT was followed by imagistic restaging at 6 weeks after the last therapy session and by surgical resection. The pathology stage from the surgical sample was compared with the HR-MRI and ERUS restaging. RESULTS Fifty-four patients underwent n-CRT and 47 were restaged by both ERUS and HR-MRI. ERUS was accurate in tumor restaging after n-CRT in 29 cases (61.7%) and HR-MRI in 32 cases (68%). Regarding lymphatic node status, ERUS was accurate for 34 patients (72.3%) and had an overall rate of over-staging of 12.8% and 14.9% of under-staging. HR-MRI was accurate for 30 patients (63.8%) in restaging the lymph nodes after n-CRT and had an overall rate of over-staging of 25.5% and 10.7% of under-staging. CONCLUSION Restaging rectal cancer after n-CRT remains difficult because of radiotherapy tissue alteration, which results in low diagnostic accuracy for both methods. KEY WORDS Endorectal Ultrasonography (ERUS), High-Resolution Magnetic Resonance Imaging (HR-MRI), Neoadjuvant Chemo-Radiotherapy, Rectal Cancer Restaging.
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Graur F, Mois E, Margarit S, Hagiu C, Al Hajjar N. Gallbladder carcinoma. Surgical management of gallblad-der carcinoma. An analysis of 37 cases. Ann Ital Chir 2018; 89:501-506. [PMID: 30665219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND & AIMS Gallbladder carcinoma is a rare yet very aggressive cancer. In this study we evaluate the presentation, staging, procedures, complications and survival of patients with gallbladder carcinoma. MATERIAL AND METHODS Data at presentation, operative findings, postoperative evolution, complications and survival data were analyzed for 37 patients with gallbladder carcinoma (as cohort study) confirmed at histopathology between January 2005 and December 2011 in Surgical Department of Regional Institute of Gastroenterology And Hepatology "Octavian Fodor" Cluj-Napoca, Romania. RESULTS In 12 cases we had the suspicion of GBC (gallbladder carcinoma) before surgery, in 6 cases GBC was suspected intraoperatory and in 19 cases only after the histopathology exam. Radical cholecystectomy was considered in 9 cases (24.32%): 4 cases with cholecystectomy alone (patients with Tis-T1) and in 5 cases liver resection was associated. CONCLUSION The GBC has a low incidence (0.35% out of all cholecystectomies), the females being more affected (F:B=4.3:1). GBC was associated with low resecability rate (24.32%) and having a bad prognosis (survival under a year in stages T3 and T4). In most cases the diagnosis was hidden by an acute inflammatory process (acute cholecystitis) and the diagnosis was made after surgical intervention, therefore, the histopathology is crucial in these situations. KEY WORDS Gallbladder carcinoma, Jaundice, Palliative treatment, Resection, Survival.
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Graur F, Mois E, Elisei R, Furcea L, Dragota M, Zaharie T, Al Hajjar N. Malignant endometriosis of the abdominal wall. Ann Ital Chir 2017; 6:S2239253X17026895. [PMID: 28430112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
UNLABELLED Endometriosis is a disease represented by the presence of extra uterine endometrial tissue. It is a rare condition, and malignant transformation is seldom. We report a case with clear cell adenocarcinoma oncogenesis on abdominal wall scar that appeared after years of a caesarian section. After diagnosis, surgical treatment was performed twice, due to the fact that the margins were infiltrated with tumor cells, with replacement of the defect with a polypropylene mesh. The patient was cured and discharged with a favorable prognostic. To the best of our knowledge, there are few reported cases of clear cell adenocarcinoma arising from abdominal wall endometriosis. It is a rare condition that appears mostly after abdominal surgical interventions that clinicians must be aware. KEY WORDS Abdominal wall, Endometriosis, Cesarean section, Clear cell adenocarcinoma, Malignant transformation.
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Graur F, Furcea L, Mois E, Biliuta A, Rozs AT, Negrean V, Al Hajjar N. Analysis of p53 Protein Expression in Hepatocellular Carcinoma. J Gastrointestin Liver Dis 2017; 25:345-9. [PMID: 27689199 DOI: 10.15403/jgld.2014.1121.253.p53] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND AND AIMS Hepatocellular carcinoma (HCC) has a growing incidence and studies regarding the risk factors or pathogenesis for this type of carcinoma benefit special interest. This study evaluates the correlations between p53 protein expression and clinical and laboratory factors in patients with HCC. METHODS The study group included 76 patients diagnosed with HCC, either by biopsy or after surgical resection (with curative intent). Immunohistochemistry for p53 protein assessment was performed in all patients. Correlations between the protein 53 expression and age, tumour size, viral infection, liver cirrhosis were performed using the chi-square test (Pearson's chi-square) together with the contingency coefficient Kendall's coefficient in the tau-b form. RESULTS In the study group, 51 patients were male (67%) and 25 female (33%). Cirrhosis due to hepatitis virus B or C infection (in a proportion of 63% of the study group) was not significantly associated with the presence of HCC. Altered expression of p53 protein was observed in 69 patients (91%). The relationship between p53 protein expression and patient sex (p=0.067), age (p=0.531), tumour size (p=0.270), presence of hepatitis B and C viral infections (p=0.7), and of liver cirrhosis (p=0.511) was not statistically significant. CONCLUSION The p53 protein expression was not significantly associated with the demographic characteristics of the patients, tumour size, presence of viral B and C infections or liver cirrhosis.
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Affiliation(s)
- Florin Graur
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy; Cluj-Napoca, Romania
| | - Luminita Furcea
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy; Cluj-Napoca, Romania
| | - Emil Mois
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy; Cluj-Napoca, Romania
| | - Andrei Biliuta
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Aliz-Timea Rozs
- Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Vasile Negrean
- Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca; Universitary Hospital CF, Cluj-Napoca, Romania.
| | - Nadim Al Hajjar
- Prof. Dr. Octavian Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca; Iuliu Hațieganu University of Medicine and Pharmacy; Cluj-Napoca, Romania
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Mois E, Graur F, Hajjar NA, Puia C, Cote A, Zaharie F, Bartos A, Momani NA, Pop F, Neagos H, Ciorogar G, Iancu C. The influence of circumferential resection margins on survival following rectal cancer surgery. Ann Ital Chir 2017; 88:S0003469X16026300. [PMID: 27941239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIMS A negative (R0) circumferential resection margin (CRM) is described as one of the most important factor that decrease the rate of local recurrence in rectal cancer. The primary outcome of the study was the status of the CRM, while the secondary outcomes were local recurrence and overall survival. METHODS Study includes 192 patients with rectal cancer operated between January 2012 and December 2013 in our Institute. The incidence of positive CRM and its impact on the survival rates after oncologic surgical resection were investigated along with factors that determine positive CRM. R1 was defined as a distance of ≤ 1 mm between the tumor and the resection margin. RESULTS The R1 rate was 3.6 % (7 cases). Nine patients (4.68%) developed local recurrence during a median followup period of 720 days. A positive CRM was found to be a risk factor of local recurrence (p-value = 0.031) and it decreased the overall survival (p-value=0.001). pT4 stage (p-value=0.008) and vascular invasion (p-value=0.005) are factors that play significant roles in determining CRM positivity. In case of inferior rectal tumours abdomino-perineal resection (APR) determines significantly higher (p-value=0.048) rates of positive CRM than anterior resection (AR) of the rectum. CONCLUSIONS Positive CRM affects overall survival and local recurrence in rectal cancer. pT4 stage and vascular invasion play determinant roles in determine CRM status. APR is a risk factor for positive CRM in inferior rectal tumors. KEY WORDS Abdomino-perineal resection, Circumferential resection margins, Local recurrence, Rectal cancer, Overall survival.
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Ciorogar G, Bartos A, Bartos D, Vesa SC, Pop M, Herdean A, Betea I, Ciorogar A, Mois E, Zaharie F, Iancu C. Rectal cancer: factors predicting short outcomes after radical anterior resection. Ann Ital Chir 2017; 88:505-513. [PMID: 29339590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM This study analyzes risk factors implicated in postoperative complications and mortality after anterior resection in rectal cancer. MATERIAL AND METHODS A total number of 378 patients with anterior rectal resection, diagnosed with rectal cancer and admitted at the IIIrd Surgery Clinic, "Octavian Fodor" Regional Institute of Gastroenterology and Hepatology, Romania, between 2009 and 2016. The inclusion criteria were anterior rectal resections with curative visa for rectal cancer. The complications we assessed are the following: anastomotic fistula, intra-abdominal infections, postoperative bowel obstruction and wound infection. RESULTS There was statistical significance regarding male gender, emergency hospitalization, hypoproteinemia and the resumption of intestinal transit. Anterior rectal resection of tumors located on the middle rectum was associated with high rate of anastomotic fistula. Patients with manual suture of anastomosis developed intraabdominal abscess more frequently. In the multivariate analysis, hypoproteinemia and a number of lymph nodes >1 remained independently associated with the occurrence of wound infection. The 30-day mortality rate was 4.8% with 18 deaths and morbidity rate 20.6% with 78 cases. CONCLUSIONS Major complications after radical resection for rectal cancer are dependent on multiple variables such as male patients, those admitted in emergency and patients with hypoproteinemia. Location of tumor on middle rectum, manual suture of anastomosis, number of lymph nodes > 1 were associated with high rate of morbidity. Patients with coronary heart disease and diabetes mellitus didn't had statistical significance, but the rate of morbidity and mortality remains high in this groups. KEY WORDS Complications, Radical anterior resection, Rectal cancer, Risk factors.
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Mois E, Graur F, Al-Hajjar N, Zaharie F, Bartos A, Bodea R, Zaharie T, Rusu I, Iancu C. Microscopically positive (R1) resections do not affect survival in pancreatic head cancer. Ann Ital Chir 2017; 88:491-496. [PMID: 29339587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Obtaining negative microscopic resection margins (R0) in cephalic duodenopancreatectomy (CDP) is the gold standard. Resection line involvement at microscopic histopathological examination (R1) could change prognostic unfavorable. Regarding R1 resections in CDP (data from the literature show rates between 20-80%), we considered it necessary to perform a study in Regional Institute of Gastroenterology and Hepatology "Prof. Dr. O. Fodor'' Cluj-Napoca. METHODS Here we present the results of a retrospective study carried out between January 2012 - December 2013 in our Institute. This study includes 63 patients with pancreatic head resections for pancreatic cancer. The circumferential soft tissue margin, the pancreatic transection margin, the bile duct and duodenum/stomach margins were analyzed. We investigated the incidence of R1 and its impact on the survival rates after oncologic pancreatic resections using a nonstandardized pathologic routine protocol. R1 status was defined as the distance of the tumor from the resection margin of ≤ 1 mm. RESULTS Pancreatic ductal adenocarcinoma (PDAC) was diagnosed in 93.65 %. The R1 rate was 36.5 % (23 cases). The circumferential margins were most commonly involved as R1 (91,3%). No statistically significant differences were found between patients with R1 to those with R0 (p ≥ 0.1) regarding 3-year survival. CONCLUSIONS Survival for pancreatic head cancer at 3 years is not influenced by the margins of resection (R1/R0). Microscopic resection margin involvement is not an independent marker of survival. KEY WORDS Circumferential margins, Nonstandardized pathologic protocol, Pancreatic ductal adenocarcinoma, Positive margins R1 Survival.
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Cote A, Graur F, Lebovici A, Mois E, Al Hajjar N, Mare C, Badea R, Iancu C. The accuracy of endorectal ultrasonography in rectal cancer staging. Med Pharm Rep 2015; 88:348-56. [PMID: 26609269 PMCID: PMC4632895 DOI: 10.15386/cjmed-481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 04/14/2015] [Revised: 05/25/2015] [Accepted: 06/12/2015] [Indexed: 01/04/2023] Open
Abstract
Background and aims The incidence of rectal cancer in the European Union is about 35% of the total colorectal cancer incidence. Staging rectal cancer is important for planning treatment. It is essential for the management of rectal cancer to have adequate preoperative imaging, because accurate staging can influence the therapeutic strategy, type of resection, and candidacy for neoadjuvant therapy. The aim of this work is to evaluate the accuracy of endorectal ultrasound (ERUS) in rectal cancer staging. Methods A retrospective study was performed to assess the accuracy of ERUS by analyzing patients discharged from Regional Institute of Gastroenterology and Hepatology (IRGH) Cluj-Napoca, Romania, diagnosed with rectal cancer between 01 January 2011 and 31 December 2013. Patients who were preoperatively staged by other imaging methods and those who had ERUS performed in another service were excluded from the analysis. As inclusion criteria remained ERUS performed for patients with rectal cancer in IRGH Cluj-Napoca where they were also operated. We analyzed preoperative T stage obtained by ERUS and it was compared with the histopathology findings. Results The number of patients discharged with a diagnosis of rectal cancer were 200 (operated – 157) in 2011, 193 (operated – 151) in 2012, and 198 (operated – 142) in 2013. We analyzed a total of 51 cases diagnosed with rectal cancer who performed ERUS in IRGH Cluj-Napoca. The results according to the T stage obtained by ERUS and histopathology test were: Conclusions ERUS is a method of staging rectal cancer which is human dependent. ERUS is less accurate for T staging of stenotic tumours, but the accuracy may still be within acceptable limits. Surgeons use ERUS to adopt a treatment protocol, knowing the risk of under-staging and over-staging of this method. The accuracy of ERUS is higher in diagnosing rectal cancer in stages T1, T2 and even in stage T3 with malignant tumor which is not occlusive. ERUS is less accurate for T staging of locally advanced and stenotic tumours.
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Affiliation(s)
- Adrian Cote
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Surgery Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Florin Graur
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Surgery Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Andrei Lebovici
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Radiology Department, Emergency County Hospital, Cluj-Napoca, Romania
| | - Emil Mois
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Surgery Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Surgery Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Codruta Mare
- Department of Statistics-Forecasting-Mathematics, Faculty of Economics and Business Administration, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Radu Badea
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Ultrasonography Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Cornel Iancu
- Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania ; Surgery Department, Prof. Dr. O. Fodor Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
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Abstract
Primary pure squamous cell carcinoma of the duodenum is a very rare type of duodenal neoplasm and is more likely to be presented as a metastatic tumor. The literature offers little information on this subject and includes very few articles and case reports. Laboratory tests, CT and ultrasound examinations, x-rays and immunohistochemical markers assisted us in making this rare diagnosis of primary squamous cell carcinoma of the duodenum in a 47 year old female patient, who presented with weight loss and melena. The 8 cm duodenal tumor with pancreas invasion was resected by a cephalic duodenopancreatectomy. The pathology examination revealed a primary duodenal squamous cell carcinoma moderately differentiated (G2), invasive in the head of the pancreas, with keratinization, stage II B (pT4N0MxL0V0R0). Positive outcome after surgery was highlighted, no recurrence being registered at the 6 month CT scan follow-up.
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Affiliation(s)
- Florin Graur
- Iuliu Hatieganu University of Medicine and Pharmacy, 3rd Surgical Clinic; Prof. O. Fodor Regional Institute of Gastroenterology and Hepatology , Cluj-Napoca, Romania
| | - Emil Mois
- Iuliu Hatieganu University of Medicine and Pharmacy, 3rd Surgical Clinic; Prof. O. Fodor Regional Institute of Gastroenterology and Hepatology , Cluj-Napoca, Romania
| | - Nadim Al Hajjar
- Iuliu Hatieganu University of Medicine and Pharmacy, 3rd Surgical Clinic; Prof. O. Fodor Regional Institute of Gastroenterology and Hepatology , Cluj-Napoca, Romania.
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