Chirurgia最新文献

{"title":"Collision Tumor Consisting of Mantle Cell Lymphoma and Mucinous Adenocarcinoma in Ascending Colon: Case Report.","authors":"Marija Milic Perovic, Aleksandar Karamarkovic, Radmila Jankovic, Svetlana Lazarevic, Jovan Juloski, Vladica Cuk","doi":"10.21614/chirurgia.120.eC.3082","DOIUrl":"https://doi.org/10.21614/chirurgia.120.eC.3082","url":null,"abstract":"<p><p><b>Introduction:</b> Mixed neoplasms represent a big family of complex tumors that consist of more than one neoplastic tissue. Mixed tumors are categorized into collision, composite, carcinosarcomas, and amphicrine tumors. Case Report: Hereinafter, we describe a case of a collision tumor composed of mantle cell lymphoma and mucinous adenocarcinoma located in the ascending colon in a 63-year-old man. A patient was admitted to the hospital due to sideropenic anemia, central abdominal pain spreading into the right lumbal area, and occasional loose stools. <b>Results:</b> Laboratory tests revealed sideropenic anemia, thrombo-cytosis, and inflammatory syndrome. A colonoscopy detected an ulcer-proliferative mass located at the hepatic flexure. Endoscopic biopsy from the mass confirmed poorly differentiated adenocarcinoma. A computed tomographic scan demonstrated a circumferential thickening of the hepatic flexure that narrows the colon lumen to the length of 10 cm. Multiple regional lymph nodes were enlarged. Consequently, the patient underwent a right hemicolectomy with ileotransverse colon anastomosis. Pathologic findings showed an ulcer-exophytic mass in ascedens. Microscopic examination of the lesion detected a poorly differentiated mucinous adenocarcinoma colliding with mantle cell lymphoma that was confirmed by immunohistochemistry. Regional lymph nodes were enlarged, involved by lymphoma. Following the surgery, the patient received R-CHOP chemotherapy. To the best of our knowledge, only four such cases have been reported in the literature so far. Unfortunately, long-term follow-up was not available. <b>Conclusions:</b> The diagnosis of collision tumors can be very challenging, and prognosis and therapy are still not investigated enough. More reports of collision tumors should be documented to establish standard protocols for treatment.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 eCollection","pages":"1"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Perioperative and Postoperative Outcomes in Patients with Urinary Diversions: Direct Cutaneous Ureterostomy versus Bricker Ileal Conduit Technique Following Radical Cystectomy.","authors":"Cosmin-George Radu, Petrino-Cristian Călinoiu, George Daniel Rădăvoi, Justin Aurelian, Ion-Florin Achim, Cosmin Medar, Iulia Andraş, Maximilian Buzoianu, Nicolae Crişan, Silviu Constantinoiu, Viorel Jinga","doi":"10.21614/chirurgia.3091","DOIUrl":"https://doi.org/10.21614/chirurgia.3091","url":null,"abstract":"<p><p><b>Background:</b> Muscle-invasive bladder tumors (MIBT) usually require radical cystectomy (RC) followed by urinary diversion to maintain urinary flow. The two main methods used are simple direct cutaneous ureterostomy (SDCU) and Bricker ileal conduit diversion (BICD), each with distinct advantages and disadvantages. This study compares the outcomes of these two techniques across two university centers in Romania, with each center employing a different surgical approach Material and <b>Methods:</b> A retrospective study was conducted on 64 patients with MIBT, divided into two equal groups.One center performed the SDCU technique with a classical approach and the other used BICD via a laparoscopic approach. Glomerular filtration rates (GFR), blood loss, operative time, length of hospitalization and postoperative complications were assessed. <b>Results:</b> Both techniques provided similar postoperative renal function outcomes. The BICD group exhibited a more pronounced decrease in hemoglobin levels (median decrease of 2.1 g/dL compared to 1.8 g/dL in the SDCU group, p=0.007) and a significantly shorter hospital stay (median of 11 days for BICD versus 15 days for SDCU, p 0.001). Moreover, the incidence of urinary tract infections was significantly lower in the BICD group (p=0.016) <b>Conclusions:</b> The BICD technique is preferable for patients at increased risk of infections due to a shorter hospital stay and a lower incidence of urinary tract infections. Conversely, the SDCU technique remains a viable option for elderly patients. The significant difference in hospital stay duration (11 vs. 15 days) underscores the necessity for a rigorous and individualized selection of the urinary diversion type, tailored to the patientâ??s specific needs and the surgical approach of each center.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"103-116"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast Cancer: A Heterogeneous Pathology. Prognostic and Predictive Factors - A Narrative Review.","authors":"Maria-Teodora Popa, Aniela Nodiţi, Teodora-Mihaela Peleaşă, Smaranda Stoleru, Alexandru Blidaru","doi":"10.21614/chirurgia.3100","DOIUrl":"https://doi.org/10.21614/chirurgia.3100","url":null,"abstract":"<p><p>Breast cancer (BC) is recognized as one of the leading malignancies affecting women worldwide. Its remarkable heterogeneity is a defining characteristic, contributing to both diverse patterns of disease progression and varied therapeutic responses. This review explores the evolution of breast cancer classifications, focusing on key prognostic and predictive factors. It examines traditional systems, such as the TNM staging and histological differentiation, while also incorporating modern elements like molecular subtypes, genomic alterations, and advanced diagnostic assays. By combining classical clinicopathological insights with cutting-edge molecular genetic technologies, the goal is to refine the precision of treatment strategies, ultimately advancing both our understanding and management of this complex disease. The review also emphasizes the importance of a global perspective, as achieving the primary treatment goals - prolonged survival and enhanced quality of life - requires addressing the disease in a broader, more comprehensive context. Breast cancer's complexity, driven by significant variability both across and within tumors, presents major challenges to conventional diagnostic and therapeutic approaches. However, breakthroughs in genomic research, such as molecular profiling and genetic testing, have deepened our understanding of this cancer's intricate nature. These advances have led to the identification of critical genetic alterations - including mutations in BRCA1/2, TP53, PALB2, PTEN, and PIK3CA - that profoundly impact tumor behavior, treatment efficacy, and patient prognosis. Genomic assays like Oncotype DX, MammaPrint, PROSIGNA, and EndoPredict offer valuable insights into recurrence risks and treatment choices, underscoring the growing importance of precision medicine. Moreover, the implementation of Molecular Tumor Boards further enhances personalized treatment strategies, contributing to improved patient outcomes and survival rates. This review underscores the significance of tailored therapeutic approaches and highlights the dynamic evolution of breast cancer in clinical practice.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"32-47"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572255","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Retroperitoneoscopic Bilateral Adrenalectomy: A New Standard for Bilateral Pheochromocytoma? (with video).","authors":"Bogdan-Ovidiu Feciche, Silvestru-Alexandru Big, Simona Mirt, Victor Ona, Vlad-Ilie Barbos","doi":"10.21614/chirurgia.3075","DOIUrl":"https://doi.org/10.21614/chirurgia.3075","url":null,"abstract":"<p><p>video width=\"640\" height=\"480\" controls controlsList=\"nodownload\" poster=\"https://www.revistachirurgia.ro/pdfs/video/posterior_retroperitoneoscopic_bilateral_adrenalectomy.jpg\" style=\"margin-top: -20px;\" source src=\"https://www.revistachirurgia.ro/pdfs/video/posterior_retroperitoneoscopic_bilateral_adrenalectomy.mov\" type=\"video/mp4\" Your browser does not support the video tag. /video <b>Introduction:</b> Bilateral adrenal involvement occurs in about 20% of pheochromocytomas, more commonly in genetic syndromes like MEN2A (Multiple Endocrine Neoplasia 2A). Posterior retroperitoneoscopy surpasses the disadvantages of the other laparoscopic approaches, being particularly useful when bilateral adrenalectomy is indicated. The aim of this study was to present the first published experience in Romania with posterior retroperitoneoscopic bilateral adrenalectomy in the treatment of bilateral pheochromocytoma. <b>Materials and Methods:</b> We report the case of a 47-years-old female referred in Urology department for surgical treatment of bilateral pheochromocytoma in the setting of MEN2A syndrome (her daughter and sister with the \"high risk\" mutation in RET gene) for which she has been actively screened. The ultrasound of thyroid gland and the significantly increased serum calcitonin were highly suggestive for medullary thyroid carcinoma. The computed tomography of chest/abdomen/pelvis revealed inhomogeneous, contrast-enhancing bilateral adrenal masses, 38/38 mm on the right and 36/26 mm on the left side, respectively. The free plasma metanephrines were significantly increased. After adequate preoperative preparation of the patient, we performed bilateral adrenalectomy using posterior retroperitoneoscopic approach, during the same procedure. <b>Results:</b> The total operative time was 90 minutes. The estimated blood losses were minimal. The postoperative surgical evolution of the patient was uneventful. Major cardiovascular and metabolic perioperative complications were prevented by anesthesia team. The lumbar drain was removed in the postoperative day 1. The pathology results reported negative surgical margins, PASS score of six on the left side and two on the right side, respectively. Three months later, the patient underwent total thyroidectomy with cervical lymph node dissection for medullary thyroid carcinoma (pT1bN0L0V0Mx). The last clinical and imaging evaluation (at 12 months postoperatively) revealed no evidence of tumour recurrence. Conclusion: Posterior retroperitoneoscopic adrenalectomy is a direct, painless, cosmetic and feasible technique and the ideal option when bilateral procedure is considered. To our knowledge, it is the first publication regarding bilateral adrenalectomy in Romania using this approach.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"125-126"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Totally Laparoscopic Colectomy is Feasible for Acute Complicated Appendicitis with Necrotic Appendiceal Base in the Emergency Setting.","authors":"Giulio M Mari, Jacopo Crippa, Francesca Roufael, Richard Sassun, Emanuele Di Fratta, Angelo Miranda, Carmelo Magistro, Angelo Guttadauro, Barbara Vignati, Martino Gerosa, Mauro Santonocito, Dario Maggioni","doi":"10.21614/chirurgia.3065","DOIUrl":"https://doi.org/10.21614/chirurgia.3065","url":null,"abstract":"<p><p><b>Introduction:</b> Acute appendicitis remains one of the most common surgical emergencies worldwide. Complicated acute appendicitis may present as perforated or gangrenous appendicitis with a compromised appendiceal base. This is a challenging scenario for surgeons that may require, in some cases, an ileocolic resection. This study aims to demonstrate the advantages and efficacy of a minimally invasive approach to complicated appendicitis requiring ileocolic resection. <b>Materials and Methods:</b> We reviewed patients who underwent extended resection for complicated acute appendicitis at our hospital from January 2022 to May 2024. Baseline, preoperative, intraoperative and postoperative features were analyzed. <b>Results:</b> During the study period, 15 patients with acute appendicitis required laparoscopic extended resection. Nine (56.2 %) underwent ileocecal resection, and 6 (43.8%) underwent right colectomy. All patients had an intracorporeal side to side, isoperistaltic 60 mm mechanical anastomosis. Mean length of stay was 7 Ã+- 1.3 days with no CD III and IV complications. No postoperative abdominal abscesses or anastomotic leaks occurred. <b>Conclusions:</b> Totally laparoscopic approach is a safe procedure for patients with complicated appendicitis requiring ileocolic resection.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"89-95"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adenocarcinoma of the Interposed Colon Graft for Esophageal Substitution-Point of View from a Tertiary Center in Esophageal Surgery and Review of Literature.","authors":"Adrian Constantin, Cristian Gelu Rosianu, Florin Achim, Anthony Rasuceanu, Alexandru Rotariu, Alex-Claudiu Moraru, Dragos-Viorel Scripcariu, Dragos Predescu","doi":"10.21614/chirurgia.3093","DOIUrl":"https://doi.org/10.21614/chirurgia.3093","url":null,"abstract":"<p><p>Resection or bypass surgery for benign or malignant esophageal pathologies presents multiple challenges, which is why it is addressed to centers of digestiveexcellence. One such challenge is the restoration of the continuity of the digestive tract, the colon being an important option for esophageal substitution. Lon-term follow up of patients with colon reconstruction is essentially related to digestive-nutritional problems. An exceptional situation, by its particularity and evolution, is the appearance of pre-malignant lesions (polyps) or frankly malignant lesions of the colon graft. The aim of the article was to draw attention to the risk of such a long-term complication, unforeseen, difficult to manage diagnostically and therapeutically. At the same time, the limited data in the literature, usually case reports, leave a series of unanswered questions for the attending physician, both in terms of etiology and case management. That is why we wanted to review the literature, identify common elements with other authors, so as to seek working hypotheses and identify mechanisms or, at least, to signal such a possible complication.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"15-31"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic Lateral Hysteropexy versus Hysterosacropexy in Women with Stage III Uterine Prolapse.","authors":"Irina Niţu, Vasile Sârbu, Silvia Savin, Neacşu Sabina, Silvia Șerban, Stere Popescu, Teodor Ștefan Niţu, Mihaela Pundiche, Răzvan Cătălin Popescu, Nicoleta Leopa","doi":"10.21614/chirurgia.119.eC.3015","DOIUrl":"https://doi.org/10.21614/chirurgia.119.eC.3015","url":null,"abstract":"<p><p><b>Background:</b> Minimally invasive techniques in gynecological pathology have well-known benefits, the \"gold standard\" of uterine prolapse being currently managed laparoscopically. Laparoscopic lateral hysteropexy and hysterosacropexy are surgical techniques that can be performed for uterine prolapse. Laparoscopic management of such cases is recommended, but requires well-trained teams in laparoscopic surgery. <b>Methods:</b> This study is a prospective analysis of patients who required surgical treatment for stage III uterine prolapse, hospitalized in the Surgery Department of Constanta County Hospital, for which laparoscopic lateral hysteropexy or laparoscopic hysterosacropexy was performed. <b>Results:</b> Between 2016-2020, 61 patients were hospitalized with stage III uterine prolapse that required surgery. All patients underwent laparoscopic surgery. Symptomatology was dominated by urinary incontinence (50%, 44.89%) and obstructive defecation (16.66%, 18.36%). Intraoperative complications were encountered in 33.3% of cases undergoing laparoscopic hysterosacropexy and in 8.16% undergoing laparoscopic lateral hysteropexy. At one year, the recurrence rate was 2.04% for patients who underwent lateral hysteropexy and 8.33% for patients who underwent hysterosacropexy. No patient had a recurrence at the 3-year visit. <b>Conclusions:</b> Laparoscopic lateral hysteropexy is emerging as an appropriate, safe, and effective procedure to treat advanced apical prolapse that requires further clinical attention and development to fully understand its surgical place in the treatment of pelvic defects.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"96-102"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gastroesophageal Reflux Disease - A Review of Important Management Components.","authors":"Karl-Hermann Fuchs, Alexander Hann, Alexander Meining","doi":"10.21614/chirurgia.3090","DOIUrl":"https://doi.org/10.21614/chirurgia.3090","url":null,"abstract":"<p><p><b>Background:</b> Gastroesophageal Reflux Disease (GERD) has a persisting high prevalence in western industrial countries and a rising prevalence in some asian industrial societies. Management of the disease, i.e. the multimodal care for the affected patients consists of the application of a definition of GERD to clearly define the cohort, using a systematic and differentiated diagnostic work-up as well as using selection criteria for conservative versus interventional and surgical therapy and long-term accompaniment. The purpose of this manuscript is a review of the information in literature on items involved in the current management of GERD and their clinical application. <b>Methods:</b> A list of items was established with all components necessary for the multimodal management of patients with GERD. A literature search was performed using the term [management of GERD] or [GERDmanagement] in medline pubmed.gov (USA). All abstracts were evaluated for their usefulness regarding the aim of the study, those with a different focus on GERD-issues were excluded. <b>Results:</b> Initially 8 items were identified necessary for the multimodal management of GERD-patients. In total, 2193 abstracts were found between 2017 and 2023, which were evaluated and 53 full articles were analyzed. Out of these 53 publications with the correct focus on GERD-management, 34 were excluded for not providing at least 4 of the available 8 items of the complete spectrum of GERD-management. Finally, 19 reports were selected for final assessment. Remarkably, 16 out of 19 publications used either a symptom questionnaire or the Montreal classification, while others used esophageal acid exposure or esophagitis for defining the presence of GERD. Regarding suggestions for a multimodal therapeutic concept, only 9 publications reported on all available therapeutic management options of GERD. Most publications described conservative therapy, while 9 articles included surgical procedures as an option in the overall GERD-management. <b>Conclusions:</b> GERD cannot be handled as just one disease, but should be considered as a multi-factorial disease consisting of several subgroups of GERD-patients with different phenotypes. All these different sub-groups of the disease may need their individual management options. Only half of publications on GERD-management provided the complete spectrum of involved management components.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"5-14"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Minimally Invasive Surgery in Patients with Colorectal Cancer and Type 2 Diabetes Mellitus.","authors":"Nicoleta Leopa, Mihaela Pundiche, Cristina Dan, Teodor Ștefan Niţu, Stefan Paitici, Andreea Badea, Alina Doina Nicoară, Răzvan Cătălin Popescu","doi":"10.21614/chirurgia.3097","DOIUrl":"https://doi.org/10.21614/chirurgia.3097","url":null,"abstract":"<p><p><b>Background:</b> Laparoscopic surgery is now widely recognized as a very safe and effective standard treatment for colorectal cancer as compared with laparotomy. Diabetes causes significant mortality and morbidity in the general population, and in particular in patients who associate an oncological pathology. In the postoperative period, diabetic patients have a significantly higher risk of developing important complications. The aim of this study was to analyze the impact of minimally invasive surgery in patients with colorectal cancer and type 2 diabetes mellitus. <b>Methods:</b> Between January 2018-2022, 482 patients diagnosed with colorectal cancer were enrolled in the study, of whom 52 were eligible for inclusion. General characteristics and the presence of diabetes before colon cancer diagnosis were identified. Kaplan-Meier analyses were performed according to type of surgery, gender, stage of disease, and associated comorbidities. <b>Results:</b> Fifty-two patients were included in the study, divided into two groups: 24 underwent laparoscopic surgery and 28 open surgery. Postoperative recovery was faster in patients who underwent laparoscopic surgery, this being also evidenced by a lower number of postoperative hospitalization days (6.67+-1.97 vs 9.21+-2.36, p 0.001). Regarding postoperative complications, patients with open surgery, had higher rate of minor and major complications according to the Clavien-Dindo classification (67.9% vs 25%), and the long-term survival of patients who underwent laparoscopic surgery was higher. <b>Conclusions:</b> Laparoscopic surgery is recommended for patients with colorectal cancer and type 2 diabetes, the patients having minimal postoperative complications and a faster postoperative recovery period.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"71-78"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Rectal Cancer: Does Robotic Surgery Emerge as the Best Alternative? A Narrative Review.","authors":"Maria-Manuela Răvaş, Virgiliu-Mihail Prunoiu, Eugen Brătucu, Marian Marincaş, Laurenţiu Simion, Laura-Maria Manea, Mircea-Nicolae Brătucu","doi":"10.21614/chirurgia.3079","DOIUrl":"https://doi.org/10.21614/chirurgia.3079","url":null,"abstract":"<p><p>Rectal cancer is one of the most frequently diagnosed malignancies, associated with high morbidity and mortality, which justify the constant interest in fine-tuning the available therapeutic methods and developing new ones. The preference for one surgical technique over another is highly dependent on the stage, the location of the tumor, other patient-related factors and the experience of the surgical team. This article aims to offer a comprehensive review of the surgical modalities utilized at the present time for the curative treatment of rectal cancer, as well as the future directions in this field, pointing out the latest progress and the most recent shifts in paradigm in the management of rectal cancer. The evolution of open surgery, laparoscopy, robotic surgery, and transanal techniques is described in chronological fashion, highlighting the advantages and disadvantages of each procedure. Although open surgery remains the gold standard for emergency situations such as occlusion or massive bleeding, minimally invasive surgery has gained ground over the past decade due to its benefits - faster discharge, lower infection rates, better short-term outcomes, while demonstrating similar oncological long term outcomes as in the traditional surgical approach. The main disadvantage is strongly connected with the training process, especially with gaining experience in complicated cases, as well as the total cost of equipment and maintenance. While robotic surgery has been lately successfully implemented in advanced or/and recurrent low and medium rectal cancer, laparoscopy remains the most utilized minimally invasive modality which has the undeniable advantage of shorter operating time. Additionally, one of the most discussed topics comprises the newly developed transanal techniques which offer an elegant solution for distal rectal tumors, especially in obese patients or with narrow pelvises. Continuous optimization and new developments of surgical techniques in rectal cancer lead to accomplishing the goals of precision medicine.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 1","pages":"48-60"},"PeriodicalIF":0.8,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143572223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}