Chirurgia最新文献

{"title":"Quality of Life and Functional Outcomes after Lichtenstein Inguinal Hernia Repair: A Prospective Comparative Study of Cyanoacrylate Adhesive (Histoacryl®) vs. Suture Mesh Fixation and Questionnaire Validation.","authors":"Rares Trisca, Valentin Oprea, Mihai Toma, Carmen Elena Bucuri, Florentina Finascu, Florian Bodog, Ileana Matei, Costel Siserman, Ovidiu Chiroban, Claudia Gherman","doi":"10.21614/chirurgia.3324","DOIUrl":"10.21614/chirurgia.3324","url":null,"abstract":"<p><strong>Background: </strong>Chronic post-herniorrhaphy pain remains a significant clinical challenge, often attributed to nerve entrapment by traditional suture fixation. This study evaluates the impact of mesh fixation techniques on patient quality of life (QoL) using both generic and disease-specific instruments.</p><p><strong>Methods: </strong>A prospective, randomized study was conducted on 167 patients undergoing Lichtenstein tension-free repair. Patients were divided into two groups: Group Cy (N= 81, Histoacryl glue fixation) and Group Su (N= 86, non-absorbable monofilament sutures). Quality of Life was assessed preoperatively and at 1, and 12, postoperatively using the EuraHS-QoL score and a newly developed disease-specific instrument (RoHeQ â?\" Romanian Hernia Questionnaire). Long-term surveillance up to 24 months was maintained to assess recurrence rates and chronic pain. Statistical analysis included ROC curve analysis to determine pain predictability and the Intraclass Correlation Coefficient (ICC) to assess concordance between the two QoL instruments.</p><p><strong>Results: </strong>The Glue group demonstrated significantly lower acute pain scores (VAS) during the first 7 days, and a shorter mean operative time with statistical significance (p < 0.01). EuraHS-QoL scores showed superior results for the glue group regarding \"pain in the groin\" and \"restriction of activities\" at the 1-month follow-up. ROC curve analysis identified an early pain threshold (VAS > 4 at day 1) as a strong predictor of diminished QoL at one year (AUC = 0.82). A substantial agreement was found between the domains of EuraHS-QoL activity scores and RoHeQ (ICC =0.74, p < 0.001). At 24 months, a total of three late recurrences occurred (two in the Glue group and one in the Suture group; p > 0.05).</p><p><strong>Conclusions: </strong>Mesh fixation with Histoacryl in Lichtenstein repair significantly improves early postoperative quality of life and reduces acute pain compared to suture fixation. Early pain intensity serves as a reliable prognostic factor for long-term outcomes, while adhesive fixation maintains a safety and recurrence profile comparable to traditional sutures.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"413-422"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900148","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":"PRIMARCH-APP AI: Development and Internal Validation of an Explainable Machine Learning Model for Preoperative Prediction of Complicated Acute Appendicitis.","authors":"Dragoș Călin Molnar, Cătălin Dumitru Cosma, Marian Botoncea, Adrian Tudor, Vlad Olimpiu Butiurcă, Călin Molnar, Bogdan Suciu Andrei","doi":"10.21614/chirurgia.3376","DOIUrl":"10.21614/chirurgia.3376","url":null,"abstract":"<p><strong>Background: </strong>Early identification of complicated acute appendicitis may improve preoperative risk stratification and support surgical decision-making. This study aimed to develop and internally validate an explainable machine-learning model for predicting complicated acute appendicitis using routinely available preoperative variables.</p><p><strong>Methods: </strong>In this prospective observational cohort study, 199 adult patients undergoing emergency appendectomy were included. Demographic, clinical, laboratory, scoring, and imaging variables collected before surgery were used to develop logistic regression, random forest, and XGBoost models. Performance was evaluated using five-fold cross-validation and a stratified held-out test set. Model explainability was assessed using SHapley Additive exPlanations (SHAP).</p><p><strong>Results: </strong>Complicated acute appendicitis was identified in 57/199 patients (28.6%). Random forest and XGBoost achieved the highest test ROC-AUC (0.934). Random forest demonstrated the best overall probability performance, with 87.5% accuracy, 72.7% sensitivity, 93.1% specificity, and a Brier score of 0.091. SHAP analysis identified heart rate, Alvarado score, rebound tenderness, symptom duration, and appendiceal diameter among the most influential predictors.</p><p><strong>Conclusions: </strong>PRIMARCH-APP AI demonstrated high discrimination and clinically interpretable prediction of complicated acute appendicitis using routinely available preoperative data. External and prospective multicenter validation is required before clinical implementation.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"371-382"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900155","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":"Vaginal Morbidity and Quality of Life after CT-Guided Hybrid Brachytherapy for Locally Advanced Cervical Cancer.","authors":"Beatrice Anghel, Elena Manea, Viorel Scripcariu, Teodor Florin Georgescu, Anca Daniela Stanescu","doi":"10.21614/chirurgia.3367","DOIUrl":"10.21614/chirurgia.3367","url":null,"abstract":"<p><strong>Background: </strong>Vaginal morbidity after brachytherapy for locally advanced cervical cancer (LACC) is frequent but inadequately characterised in CT-guided settings. This study examined vaginal toxicity, quality of life (QoL), and predictors of grade >= 2 stenosis in a prospectively maintained CT-guided hybrid image-guided adaptive brachytherapy (IGABT) cohort.</p><p><strong>Methods: </strong>A cohort of 180 LACC patients (FIGO 2018 IB1â?\"IVA) treated with chemoradiotherapy and CT-based hybrid brachytherapy at SANADOR Clinical Hospital (2020-2022) was analysed retrospectively. Vaginal toxicity was graded using CTCAE v5.0; QoL was assessed with EORTC QLQ-C30 and QLQ-CX24 at baseline, 3 months, and 12 months. Exploratory logistic regression identified predictors of grade >= 2 stenosis.</p><p><strong>Results: </strong>Before the 12-month toxicity assessment, 15 patients were censored (10 due to recurrence, 5 due to death), leaving 165 evaluable patients. Among these, overall composite CTCAE grade >= 3 vaginal toxicity occurred in 9/165 (5.5%). These findings must be interpreted separately from anatomically graded stenosis: 155/165 evaluable patients (93.9%) had any degree of vaginal stenosis at 12 months, and grade 3 stenosis was observed in 48/165 evaluable patients (29.1%), corresponding to 48/155 patients with any stenosis (31.0%). Global QoL improved significantly at 12 months (p < 0.05), driven by pain and fatigue reduction, whereas sexual function declined progressively. Non-use of vaginal dilators (OR 3.1, 95% CI 1.4-6.8) and menopausal status (OR 2.4, 95% CI 1.1-5.1) independently predicted grade >= 2 stenosis. HR-CTV D90 EQD2 strongly predicted survival (p < 0.001).</p><p><strong>Conclusions: </strong>CT-guided hybrid IGABT was associated with favourable tumour control. Composite CTCAE grade >= 3 vaginal toxicity occurred in 9/165 evaluable patients (5.5%) at 12 months; however, grade 3 vaginal stenosis on clinical examination was observed in 48/165 evaluable patients (29.1%), corresponding to 48/155 patients with any stenosis (31.0%) - a finding that must be clearly distinguished from the composite rate and communicated transparently to patients. A clinically meaningful dissociation between improving global QoL and declining sexual function underscores the need for structured vaginal rehabilitation programmes after IGABT.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"423-431"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900140","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":"Preoperative Predictors of Anastomotic Leak Following Digestive Cancer Surgery: A Retrospective Cohort Study.","authors":"Ovidiu-Florin Ghirlea, Sorin Olariu, Marius-Sorin Murariu","doi":"10.21614/chirurgia.3294","DOIUrl":"10.21614/chirurgia.3294","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak remains one of the most severe complications in digestive oncologic surgery, significantly impacting postoperative morbidity and mortality.</p><p><strong>Methods: </strong>A retrospective observational study was conducted. We collected and analyzed the data for 394 patients with digestive cancer, of which 248 received resection with primary anastomosis. The following variables were analyzed: tumor origin distribution, body mass index (BMI), gender, age, smoking status, tumor stage, American Society of Anesthesiologists score (ASA), hemoglobin levels and surgical indication (elective or emergency).</p><p><strong>Results: </strong>Anastomotic leakage occurred in 38,4% of cases. Univariate analysis showed significant associations with ASA >= 3, advanced tumor stage, emergency surgery, smoking, underweight BMI, and anemia severity (risk increased in a severity-dependent manner). Multivariate analysis identified ASA >= 3 (OR 9.60; p<0.001), mild anemia (OR 3.11; p=0.005), moderate/severe anemia (OR 7.63; p<0.001), and advanced tumor stage (OR 2.43; p=0.018) as independent predictors.</p><p><strong>Conclusions: </strong>Preoperative physiological status and anemia severity are independently associated with anastomotic leak following digestive cancer surgery. The graded effect of anemia suggests a potentially modifiable risk factor amenable to preoperative optimization. Advanced malignancy (stages III and IV) plays an independent role in anastomotic leakage incidence.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"404-412"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900188","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":"From Scope to Scalpel: A Review of the Timing and Outcomes of Conversion in Minimally Invasive Liver Resections.","authors":"Doaa Abdulaziz, Dinesh Sharma","doi":"10.21614/chirurgia.3247","DOIUrl":"10.21614/chirurgia.3247","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive liver resection (MILR), encompassing laparoscopic and robotic techniques, has transformed hepatobiliary surgery. Despite its advantages, intraoperative conversion to open surgery remains a critical event, often associated with increased blood loss, morbidity, and longer hospital stay. Timing of conversion - whether early or delayed - emerges as a key determinant of patient outcomes yet remains poorly defined in the literature.</p><p><strong>Aim: </strong>This review synthesizes current evidence on the indications, timing, and outcomes of conversion in MILR, with a focus on identifying risk factors, perioperative consequences, and existing knowledge gaps.</p><p><strong>Methods: </strong>A systematic search of PubMed, MEDLINE, and Embase was performed (2010-2025). We included studies comparing converted vs. non-converted MILR. A quantitative synthesis was performed for key outcomes.</p><p><strong>Results: </strong>Fifteen studies (15,834 patients) were included. A quantitative analysis revealed that conversion was associated with significantly increased blood loss (mean difference: 450 mL), higher overall morbidity (OR: 2.5), and longer hospital stays (mean difference: 4.2 days). We propose an operational definition: Early Conversion (<60 mins or pre-parenchymal transection), **Late Conversion** (>60 mins or post-parenchymal transection), and Emergency Conversion (life-threatening event). We propose operational definitions for conversion timing (Early, Late, Emergency) and developed a decision-making algorithm.</p><p><strong>Conclusion: </strong>Conversion during MILR is a pivotal safety measure, but its timing substantially influences outcomes. There is a pressing need for a national, prospective, multicentre UK-based audit to define optimal conversion timing, identify modifiable risk factors, and inform standardised intraoperative decision-making frameworks.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"453-462"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900131","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":"Thirty-Day Postoperative Outcomes Following Surgery for Colorectal Malignancy: A Single-Centre Cohort Study.","authors":"Nida Khan, Meena Kumar, Jayant Pednekar","doi":"10.21614/chirurgia.3360","DOIUrl":"https://doi.org/10.21614/chirurgia.3360","url":null,"abstract":"<p><strong>Background: </strong>Surgery remains the cornerstone of treatment for colorectal malignancies, with post-operative complications significantly impacting short and long-term outcomes. This study aimed to evaluate 30-day post-operative complications following surgery for colorectal malignancies in a single tertiary care teaching hospital in Navi Mumbai, India.</p><p><strong>Methods: </strong>Thirty patients who underwent surgical resection for colorectal malignancy were followed up for 30 days. Surgical site infection was the most frequent complication, occurring in 36.66% of patients. Emergency surgery was associated with a higher complication burden than elective surgery.</p><p><strong>Results: </strong>Thirty-day mortality was 10%, predominantly in patients with advanced disease and poor physiological reserve. No significant association was found between tumour location, disease stage, or surgical setting and postoperative complication rates. The median hospital stay was 20 days (IQR 16 20.75).</p><p><strong>Conclusions: </strong>Emergency surgery carried a higher complication burden, and advanced disease with poor physiological reserve was associated with increased mortality. These findings highlight the burden of post-operative morbidity following colorectal cancer surgery and the poorer outcomes associated with emergency presentation.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 Ahead of print","pages":"1-6"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618645","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":"Multidisciplinary Management of Fungating Locally Advanced and Metastatic Breast Cancer: Report of Two Cases.","authors":"Radu Meșină, Alexandru Marin Pascu, Raluca Câmpeanu, Dragoș George Popa, Andrei Mircea Dicianu, Ion Vasile, Cosmin Vasile Obleaga","doi":"10.21614/chirurgia.3377","DOIUrl":"10.21614/chirurgia.3377","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background/objectives: &lt;/strong&gt;The therapeutic management of breast cancer is continuously evolving, leading to improved cure and survival rates. However, despite these advances, the management of fungating breast cancer has remained largely unchanged and is frequently regarded as a condition requiring palliative treatment rather than a potentially curative approach. Furthermore, metastatic and locally advanced fungating breast cancers, particularly in younger patients, remain challenging to manage due to the lack of clear therapeutic recommendations in international guidelines (NCCN, ESMO), while published reports on this topic are scarce. This report presents two clinical cases of locally advanced, metastatic fungating breast cancer managed through individualized multidisciplinary strategies. The cases illustrate the complexity of therapeutic decision-making in these challenging scenarios and highlight the role of adaptive, multidisciplinary management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The first case involved a 38-year-old woman diagnosed with stage IV triple-negative invasive ductal carcinoma complicated by sepsis, severe anemia, and left subclavian vein thrombosis. Initial systemic therapy, radiotherapy, antibiotic treatment, and correction of anemia achieved temporary local and systemic disease control. However, subsequent tumor necrosis and recurrent sepsis necessitated palliative (toilet) mastectomy. The second case involved a 58-year-old woman diagnosed with locally advanced Luminal B invasive ductal carcinoma complicated by infection and bleeding, who refused neoadjuvant systemic treatment and subsequently underwent modified radical mastectomy with reconstruction of the chest wall defect using a split-thickness skin graft, followed by systemic oncological treatment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;These cases illustrate the potential role of individualized treatment sequencing adapted to disease evolution and patient condition. Case 1 demonstrated that aggressive multidisciplinary management, including systemic chemotherapy, radiotherapy for brain metastases, and surgical control of local complications may achieve sustained disease control in carefully selected triple-negative patients. Case 2 demonstrated that in patients refusing neoadjuvant treatment, surgical resection with reconstructive techniques may achieve local control, followed by effective systemic management of subsequent metastatic disease.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Our findings suggest that a personalized treatment plan, close monitoring by a multidisciplinary tumor board, and continuous reassessment of the therapeutic strategy in response to newly emerging clinical challenges are key elements in the management of locally advanced fungating breast cancer. These observations should be regarded as hypothesis-generating examples of adaptive multidisciplinary care rather than evidence supporting generalized therapeutic recommendations. Future studies are n","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 4","pages":"472-481"},"PeriodicalIF":1.1,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148900109","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":"AI-Powered Predictions of Breast Ductal in Situ Carcinoma Morphology and Surgical Outcomes.","authors":"Andras David, Radu Alexandru Ilies, Victor Esanu, George Călin Dindelegan","doi":"10.21614/chirurgia.3254","DOIUrl":"10.21614/chirurgia.3254","url":null,"abstract":"<p><strong>Background/objectives: </strong>Artificial intelligence (AI) is increasingly integrated into oncological imaging, but its ability to predict detailed histopathological features from standard mammography remains understudied in ductal carcinoma in situ (DCIS). This study aimed to evaluate the performance of a large language model (ChatGPT-4, Open AI, May 2025) in predicting nuclear grade, architectural subtype, comedo necrosis, and stromal invasion from specimen mammography.</p><p><strong>Materials and methods: </strong>We conducted a retrospective and methodological study of 29 patients with histologically confirmed DCIS or invasive carcinoma with DCIS components. Our clinical protocol is based on NCCN/ESMO guidelines of treatment ductal carcinoma in situ. Preoperatively, all patients with confirmed disease benefited from wire guide localization of the breast lesion. Patients were then submitted to surgical excision (lumpectomy) and surgical specimen mammography to confirm the complete macroscopic excision. For each of these cases, mammographic specimens were analyzed using an AI model designed to extract and process radiomic features. AI-model reports were compared with histopathological reports which served as the gold standard. Diagnostic performance was evaluated for four parameters: DCIS nuclear grade, architectural subtype, comedo necrosis, and stromal invasion. Accuracy, sensitivity, specificity, precision, and F1 scores were computed.</p><p><strong>Results: </strong>The size of mammographic lesions ranged from 1.2 to 10.0 mm (mean +- SD: 4.46 +- 2.25 mm). Histopathological diagnoses included pure DCIS (n = 17), invasive NST carcinoma with DCIS (n = 10), and mixed histologies (n = 2). The AI model achieved 65.5% accuracy for detecting comedo necrosis (sensitivity 75.0%, specificity 53.8%) and 72.4% accuracy for detecting stromal invasion (specificity 94.1%, sensitivity 41.7%). Nuclear grade classification matched histopathology in 20.7% of cases, while architectural subtype classification achieved 17.2% agreement. Multiclass predictions showed low F1 scores for most categories.</p><p><strong>Conclusion: </strong>Although the AI model demonstrated acceptable utility for detection of comedo necrosis and excluding stromal invasion, it faced several difficulties regarding nuclear grading and architectural subtype classification. Although limited by the small sample size and 2D imaging, this methodological study provides an insight for future AI and radiomics approaches in breast tumor characterization.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"239-248"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535382","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":"Risk Factors for Acute on Chronic Pancreatitis - A Multicentric Case-Control Study.","authors":"Alina Florentina Pistriţu, Mihai Radu Pahomeanu, Andreea Irina Ghta, Irina Ștefania Diaconu, Hosein Nayyerani, Andreea Daniela Bota, Deniz Gunşahin, Cristian George Tieranu, Vasile Șandru, Carmen Monica Preda, Bogdan Silviu Ungureanu, Lucian Negreanu","doi":"10.21614/chirurgia.3194","DOIUrl":"10.21614/chirurgia.3194","url":null,"abstract":"<p><strong>Background/objectives: </strong>Acute on chronic pancreatitis (ACP) is defined as acute worsening of the inflammatory process associated with chronic pancreatitis (CP) and typically results in deteriorating clinical condition and increased pancreatic pain. The heterogeneity of this disease hinders understanding the details behind important clinical data, such as sex differences, etiology, or outcome at discharge. We aim to find if congenital pancreatic abnormalities are a factor for ACP development. <b>Methods:</b> In this multicentric case-control study, 181 cases of acute on chronic pancreatitis (ACP) were compared with 1754 controls with acute pancreatitis (AP) from four centers. The patients were consecutively hospitalized between January 1, 2015 and December 31, 2023. Frequencies, logistic regression, and the Pearson chi-square, Shapiroâ?\"Wilk, and Mann Whitney U tests were deployed in the statistical analysis. <b>Results:</b> The males had a 2.6 times higher likelihood of suffering from ACP (p 0.01). If the patients had pancreatic abnormalities, they had a 51.2 times higher probability of developing ACP (p 0.01). A 70% lower chance of dying during hospitalization if a patient suffered from ACP rather than AP was observed (p 0.01).</p><p><strong>Conclusion: </strong>Males with pancreatic abnormalities have a higher risk of developing ACP.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"321-327"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535496","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":"Comparative Performance of Postoperative Day 3 Biomarkers for Predicting Anastomotic Leakage after Colorectal Cancer Surgery - A Retrospective Cohort Study.","authors":"Ovidiu-Florin Ghirlea, Paul Paşca, Dragoş-Eugen Georgescu, Ciprian Duţă, Sorin Olariu, Marius-Sorin Murariu","doi":"10.21614/chirurgia.3327","DOIUrl":"10.21614/chirurgia.3327","url":null,"abstract":"<p><p><b>Background:</b> Anastomotic leakage (AL) represents a serious postoperative complication after surgery, especially for digestive tract malignancies, concerning both patients and surgeons. Due to severe clinical repercussions, early identification of patients at risk is essential for improving postoperative outcomes. This study focused on assessing clinical risk factors and the postoperative day 3 (POD 3) biomarkers in early detection of anastomotic leakage. <b>Materials and Methods:</b> A retrospective observational study was conducted including 166 patients who underwent resection with primary anastomosis for colorectal cancer. Patient-related factors, tumor characteristics, operative factors, and POD 3 laboratory data were collected. Receiver operating characteristics (ROC) curves and logistic regression models were used to assess predictive performance and identify independent risk factors. <b>Results:</b> Anastomotic leakage occurred in 44 patients (26.50%) and was associated with prolonged hospitalization and higher postoperative mortality (25.00% vs 6.60%, p=0.002). Multivariable logistic regression identified emergency surgery, rectal tumor location, intraoperative transfusion, and open surgical approach as independent risk factors. Among POD 3 biomarkers, C-reactive protein-to-albumin ratio (CAR) demonstrated the highest predictive accuracy for AL. After adjustment in the multivariable model, CAR remained an independent predictor of AL (OR=1.91, p 0.001). <b>Conclusions:</b> Anastomotic leakage after colorectal cancer surgery remains a multifactorial complication influenced by operative conditions, local tumor-related factors, and the postoperative inflammatory response. In this retrospective cohort, POD 3 CAR showed the highest discriminatory performance among the evaluated biomarkers and may support early postoperative risk stratification when interpreted with clinical findings and operative risk factors.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 3","pages":"286-295"},"PeriodicalIF":1.1,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535505","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}