Chirurgia最新文献

{"title":"Acute Pancreatitis as an Extrapulmonary Manifestation and Pulmonary Embolism as a Complication of COVID-19: A Case Report.","authors":"Ljiljana Milić, Dragana Arbutina, Dragica Mitrović, Marko Šurlan, Aleksandar Karamarković","doi":"10.21614/chirurgia.3278","DOIUrl":"10.21614/chirurgia.3278","url":null,"abstract":"<p><p><b>Introduction:</b> Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, first emerged in Wuhan, China, in late 2019. Besides respiratory involvement, COVID-19 may cause coagulation abnormalities, leading to thromboembolic events. Mild forms of acute pancreatitis have also been reported in patients with COVID-19 pneumonia. The aim of this case report is to highlight rare extrapulmonary manifestations of SARS-CoV-2 infection, with emphasis on pancreatic involvement. Case Report: A male patient was admitted with sore throat, dry cough, and fever up to 38.0°C. He had received the first dose of the Sinopharm COVID-19 vaccine three weeks prior and was obese (BMI 44.7 kg/m²). On admission, he developed pulmonary thromboembolism. Color Doppler ultrasonography of the lower extremities showed no signs of superficial or deep vein thrombosis. On the eleventh day of treatment, laboratory tests revealed elevated serum amylase, lipase, and leukocyte count. Abdominal ultrasonography demonstrated a hyperechoic, non-enlarged pancreas, consistent with mild acute pancreatitis. Given the widespread presence of endothelial cells, SARS-CoV-2 infection may affect multiple extrapulmonary organs, including the CNS, cardiovascular system, kidneys, pancreas, liver, and gastrointestinal tract. Conclusion: SARS-CoV-2 infection may lead not only to pneumonia but also to thromboembolic complications and mild acute pancreatitis. Awareness of such rare extrapulmonary manifestations is important for timely diagnosis and management.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"228-233"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834431","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":"Continuous Training, Protocol Adherence and Safety Culture in Anaesthesia and Intensive Care Units in Romania: A Cross-Sectional Study.","authors":"Gabriel Petre Gorecki, Ovidiu Horea Bedreag, Dorel Săndesc, Horaţiu Moldovan, Dan Gabriel Costea, Anamaria Hărăbor, Dan Nicolae Păduraru, Alexandru Cosmin Palcău, Magdalena Miulescu, Ioana Roşca, Dragoş Predescu, Silviu Constantinoiu","doi":"10.21614/chirurgia.3271","DOIUrl":"10.21614/chirurgia.3271","url":null,"abstract":"<p><p><b>Background:</b> High-quality and safe care in Anaesthesia and Intensive Care Units (AICUs) relies on continuous professional development, strict adherence to safety protocols, and a supportive organisational culture. Understanding how these factors interact is essential for improving both patient safety and staff well-being. <b>Methods:</b> A cross-sectional online survey was conducted in November 2024 among 109 healthcare professionals working in Romanian AICUs. The questionnaire assessed access to professional training, compliance with safety procedures, communication quality, managerial support, and job satisfaction, using five-point Likert scales. Data were analysed using descriptive statistics, Chi-square tests, Mann Whitney U tests, and Spearman s correlation coefficients. <b>Results:</b> Training satisfaction was significantly associated with perceived preparedness for emergency situations (ÃÂ=0.44, p 0.01). Adherence to safety protocols correlated positively with perceptions of a strong safety culture (ÃÂ=0.39, p 0.01). Managerial support showed a moderate positive correlation with job satisfaction (0.48, p 0.01) and willingness to report incidents ( 0.42, p 0.01). Respondents from private hospitals reported slightly higher openness to feedback and more frequent training opportunities compared to those from public institutions. <b>Conclusions:</b> The findings underscore the importance of interdisciplinary training, empathetic leadership, and constructive feedback mechanisms in fostering a positive safety culture and enhancing professional motivation in AICU settings.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"172-181"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834349","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":"Clinicopathological Characteristics of Breast Tumors with Neuroendocrine Features: A Retrospective Case Series.","authors":"Mihaela-Mădălina Gavrilescu, Alexandra Nicoleta Dumitraşcu, Răzvan Vieriu, Maria-Gabriela Aniţei, Iulian Radu, Viorel Scripcariu","doi":"10.21614/chirurgia.3286","DOIUrl":"10.21614/chirurgia.3286","url":null,"abstract":"<p><p><b>Introduction:</b> Breast neoplasms with neuroendocrine characteristics form a rare and heterogeneous group that includes both invasive carcinomas showing neuroendocrine differentiation and primary neuroendocrine tumors arising in the breast. Because these lesions are uncommon, their clinicopathological features and biological behavior are still not fully elucidated. <b>Methods:</b> We conducted a retrospective analysis of 22 patients diagnosed with breast tumors showing neuro-endocrine features and treated in 1st Surgical Unit of Regional Institute of Oncology, Iasi. Clinicopathological characteristics, immunohistochemical profile and treatment patterns were analyzed. <b>Results:</b> The median age at diagnosis was 66.1 years (range: 35 83). Most tumors corresponded to invasive carcinoma of no special type with neuroendocrine differentiation, while a smaller subset fulfilled the criteria for primary neuroendocrine neoplasms of the breast. Immunohistochemical analysis revealed a predominantly luminal immunophenotype, characterized by strong estrogen receptor expression and absence of HER2 overexpression. T0he median Ki-67 proliferation index was 40.3%. Lymph node involvement was observed in 45.5% of cases. All patients were treated according to standard breast cancer protocols, including surgery, chemotherapy, endocrine therapy and radiotherapy when indicated. The median follow-up was 26 months. Survival analysis included 20 patients with available follow-up data, while 2 patients were lost to follow-up. During the follow-up period, 9 deaths were recorded, corresponding to an overall mortality rate of approximately 45%. <b>Conclusions:</b> In our study, breast tumors with neuroendocrine features exhibited a luminal immunophenotype and did not demonstrate a clearly distinct clinical behavior compared with conventional hormone receptor positive breast cancer. Neuroendocrine differentiation may therefore represent a morphological feature within the luminal spectrum rather than a distinct biological entity.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"130-138"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834358","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 Axillary Dissection to Sentinel Node Biopsy: Three Decades Redefining Axillary Surgery in Early Breast Cancer - A Narrative Review.","authors":"Draga-Maria Mandi, Florin Grama, Daniel Cristian, Adrian Bordea, Răzvan Valentin Scăunaşu, Iulia-Alecsandra Sălcianu, Traian Pătraşcu","doi":"10.21614/chirurgia.3289","DOIUrl":"10.21614/chirurgia.3289","url":null,"abstract":"<p><p><b>Introduction:</b> Axillary lymph node dissection (ALND) has been the gold standard for axillary staging in breast cancer for over a century. The introduction of sentinel lymph node biopsy (SLNB) in the 1990s offered a minimally invasive alternative with comparable staging accuracy and significantly reduced morbidity. Multiple landmark randomized controlled trials have since demonstrated that completion ALND can be safely omitted in selected patients with positive sentinel lymph nodes without compromising oncologic outcomes. This narrative review aims to examine the evolution from ALND to SLNB, critically evaluate the landmark trials that shaped current practice, and discuss ongoing controversies and future directions in axillary management in early breast cancer. <b>Materials and Methods:</b> A comprehensive literature search was performed using PubMed/MEDLINE, Scopus, and Web of Science databases. Search terms included \"sentinel lymph node biopsy\", \"axillary lymph node dissection\", \"breast cancer\", and \"axillary management.\" Landmark randomized controlled trials, systematic reviews, meta-analyses, and current clinical practice guidelines were identified and reviewed. <b>Results:</b> The NSABP B-32 trial validated SLNB as an accurate staging tool equivalent to ALND. The ACOSOG Z0011 trial demonstrated no survival benefit from completion ALND in patients with 1-2 positive sentinel lymph nodes undergoing breast-conserving surgery. The AMAROS trial demonstrated that irradiation of the axilla provides equivalent locoregional disease control compared to surgical dissection, while carrying a substantially more favorable morbidity profile.The IBCSG 23-01 trial confirmed that ALND can be omitted for sentinel node micrometastases. Most recently, the SENOMAC trial extended these findings to patients with 1-2 macrometastases in a broader population. <b>Conclusions:</b> SLNB has become the established standard for axillary staging in early breast cancer with a clinically negative axilla, superseding ALND entirely. Progressive de-escalation of axillary surgery has been consistently supported by high-level evidence without compromising survival. Future research will determine the feasibility of further de-escalation, particularly after neoadjuvant chemotherapy.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"200-210"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834414","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":"Serum Biomarkers and CT-Derived Muscle Indices in Sarcopenia Associated with Pancreatic Neoplasm: A Comparative Clinical Study.","authors":"Costel-George Gherghescu, Radu Andrei Baz, Constantin Dina, Eugen Dumitru, Georgeta Camelia Cozaru, Mihaela Manea, Ioana Popescu, Ana-Maria Grigorescu, Stere Popescu, Andrei Dumitru","doi":"10.21614/chirurgia.3291","DOIUrl":"10.21614/chirurgia.3291","url":null,"abstract":"<p><p><b>Background:</b> Sarcopenia is a frequent and clinically relevant condition in patients with pancreatic neoplasm, contributing to poor prognosis, reduced therapeutic tolerance, and increased mortality. The identification of reliable circulating biomarkers, alongside imaging-based muscle assessment, may improve early detection and risk stratification. <b>Methods:</b> This randomized prospective study included 61 patients, of whom 36 had pancreatic neoplasm associated with sarcopenia and 25 served as controls. Serum levels of osteonectin (SPARC), C-terminal agrin fragment (CAF), procollagen type III N-terminal peptide (P3NP), myostatin (MSTN), and insulin-like growth factor-1 (IGF-1) were measured using ELISA. Skeletal muscle index (SMI) and psoas muscle index (PMI) were assessed using CT at the L3 level. <b>Results:</b> Patients with pancreatic neoplasm and sarcopenia showed significantly altered biomarker profiles compared to controls. Osteonectin (median 936.4 vs. 539.9, p 0.001), CAF (2135.9 vs. 1165.5, p 0.001), P3NP (8.01 vs. 5.34, p 0.001), myostatin (47.71 vs. 7.85, p 0.001), and IGF-1 (142 vs. 106.7, p 0.001) were all elevated. The highest biomarker levels were consistently observed in the pancreatic neoplasm group compared to other disease groups. Additionally, 100% of patients with pancreatic neoplasm exhibited reduced SMI, confirming the high prevalence of sarcopenia. Biomarker levels were not significantly influenced by tumor location. <b>Conclusions:</b> The combined use of circulating biomarkers and CT-derived muscle indices provides a clinically relevant approach for identifying sarcopenia in pancreatic cancer.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"151-161"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834354","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":"Strategic Challenges of Hysterectomy in Benign Gynecological Pathology - Perspectives from a Systematic Review.","authors":"Nicoleta Alina Mareş, Alexandru Iordache, Niculae Iordache","doi":"10.21614/chirurgia.3172","DOIUrl":"10.21614/chirurgia.3172","url":null,"abstract":"<p><p>Hysterectomy is the most common non-obstetric surgical procedure performed in women of all ages, representing a point of intersection between surgery and gynecology, with multiple possible approaches. The lack of a clear consensus on standardized selection criteria for benign pathology results in variability and decisions that may not accurately reflect the specific characteristics of each case. This is a narrative systematic review aimed at identifying and organizing the criteria reported in the literature regarding the selection of surgical techniques for hysterectomy, providing an informative foundation for an individualized and practical approach that supports evidence-based, personalized surgical decision-making. We performed a systematic search in the PubMed, Cochrane Library, and Embase databases between January 1, 2015, and June 1, 2025, considering only English-language randomized controlled trials. The search strategy included both controlled and free terms, combined using Boolean operators. We selected the eight most relevant studies, with a high level of confidence following the quality assessment and consistent findings with the specialized literature. The choice of the optimal surgical technique should be individualized, based on a thorough evaluation of each patient and the expertise of the medical team, to achieve the best possible functional outcomes and quality of life after the intervention.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"188-199"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834399","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 AIMS Academy Medical Writing Training for Clinicians and Medical Students: A 3-year Prospective Educational Intervention Study and Survey.","authors":"Giulio Mari, Richard Sassun, Jacopo Crippa, Pietro Achilli, Antonino Spinelli, Isacco Montroni, Abe Fingerhut","doi":"10.21614/chirurgia.3283","DOIUrl":"10.21614/chirurgia.3283","url":null,"abstract":"<p><p><b>Background:</b> Despite its importance, the ability to produce high-quality scientific manuscripts is often perceived as the domain of academics and researchers. Traditional medical writing courses often focus on the critical appraisal of existing articles, which may not let participants develop a manuscript. <b>Methods:</b> A prospective, non-randomized intervention study was conducted over three years medical writing courses (2022 2024). Each course included manuscript drafting, peer collaboration, expert review, and a final workshop. <b>Results:</b> All 18 participants contributed to a clinical manuscript, resulting in three peer-reviewed publications following minor revisions with a mean time to publication of 85 days. Questionnaire responses (10-point Likert scale) showed high satisfaction: overall course rating 9.0 +-0.8, skill improvement 8.4+-1.2, and expert benefit 7.8+-1.5. Seventy-two percent reported significant improvement in writing skills. All participants expressed willingness to attend again and recommend the course. <b>Conclusions:</b> Hands-on medical writing is an effective, replicable model for improving medical writing skills among clinicians.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"182-187"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834446","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 Pancreaticoduodenectomy - Initial Experience in a Hepatopancreatobiliary High-Volume Center.","authors":"Elena-Mihaela Vrabie, Mihai Adrian Eftimie, Ion Barbu, Iulian Mosteanu, Robert Ciortan, Alexandra Trotea, Bianca Badescu, Andreea Godja, Calina Aranghelovici, Cristina Abuzan-Constantin, Adriana Ion, Ovidiu Magdoiu, Irina Balescu, Gheorghe Potlog, Marian Tudoroiu, Elena Badea, Ecaterina Scarlatescu, Mara Stefan, Alexandru Dinca, Raluca Istrate, Daniela Ungureanu, Daniela Dobre, Cristina Martac, Gabriela Droc, Dana Tomescu, Nicolae Bacalbasa, Cezar Stroescu, Vladislav Brasoveanu","doi":"10.21614/chirurgia.3296","DOIUrl":"10.21614/chirurgia.3296","url":null,"abstract":"<p><p><b>Introduction:</b> Pancreaticoduodenectomy is a complex surgical procedure involving meticulous resection and reconstruction steps. <b>Materials and Methods:</b> We analyzed the first 15 laparoscopic pancreaticoduodenectomies performed for ampullary, periampullary, and cephalic pancreatic tumors at the Fundeni Clinical Institute, Bucharest, a high-volume center with extensive expertise in hepatopancreatobiliary surgery. Patient demographics, medical history, intraoperative parameters, early postoperative outcomes, and oncological results regarding radical resection were evaluated. <b>Results:</b> The mean patient age was 59.4 years, with 53.33% males. Cardiovascular comorbidities were present in 60% of patients, while 26.66% had controlled type 2 diabetes mellitus. Previous cholecystectomy was noted in 46.66% of cases, and 60% presented with jaundice at diagnosis. The mean operative time was 360 minutes. Pancreaticogastrostomy was performed in 66.66% of cases and pancreaticojejunostomy in 33.33%, with 26.66% of procedures being fully laparoscopic. Biochemical leakage occurred in 13.33% of cases, while grade B pancreatic fistula developed in 6.67% of cases and was managed conservatively. Moderate biliary fistula occurred in 13.3% of the patients, with remission under conservative treatment. All resections achieved negative margins (R0). The mean number of retrieved lymph nodes was 15.6, and the average hospital stay was 18.7 days. Discussions: Laparoscopic pancreaticoduodenectomy provides oncological outcomes comparable to the open approach and may improve postoperative recovery in experienced centers. <b>Conclusions:</b> Our results are encouraging, with potential for further improvement through careful patient selection and refinement of surgical technique.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"139-150"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834363","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 Concerning Lack of Mammography in the Early Detection of Breast Cancer in Romania.","authors":"Alexandru Blidaru, Maria-Teodora Popa, Octav Ginghină, Bogdan Severus Gaşpar, Teodora-Mihaela Peleaşă, Mihaela Năstase, Andreea Preda, Cristian Bordea","doi":"10.21614/chirurgia.3292","DOIUrl":"10.21614/chirurgia.3292","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Background:&lt;/b&gt; Breast cancer is the most common malignancy among women and represents a leading cause of worldwide cancer-related mortality. Mammographic screening substantially reduces breast cancer-specific mortality by enabling its early detection. Organized mammographic screening is recognized as the most effective strategy for early detection, mortality reduction, and for improving quality of life. Romania currently lacks an organized, functional, invitation-based system. National data regarding the utilization of mammography remain limited and poorly characterized. &lt;b&gt;Materials and Methods:&lt;/b&gt; A cohort of 2,500 women aged 40-90 years diagnosed with breast cancer was analyzed. The study was conducted in four medical centers in Bucharest, Romania: the Prof. Dr. Alexandru Trestioreanu Institute of Oncology, Medicover Pipera Hospital, Profmedica Clinic, and CIB Medical Clinic, between June and December 2025. Information regarding mammographic examinations performed prior to diagnosis was obtained through a structured interview and subsequently validated by reviewing medical records. The sociodemographic variables analyzed included age, place of residence, and educational level. Patients were categorized into two groups according to their pre-diagnostic mammography status: those who had never undergone mammography in their lifetime and those who had undergone at least one mammographic examination prior to breast cancer detection. For patients in the latter group, the interval between the most recent mammography and the time of diagnosis was recorded and analyzed. &lt;b&gt;Results:&lt;/b&gt; Overall, 76% of the patients had not undergone any mammographic examination prior to diagnosis. Among those who had undergone at least one mammography, 37.3% had their most recent examination more than four years before diagnosis. When these two subgroups were combined, it was found that 85% of patients diagnosed with breast cancer had not received a recent mammographic evaluation within the four years preceding diagnosis that might have enabled earlier detection of the disease. Conclusion: This study highlights the limited use of mammography for the early detection of breast cancer in Romania through periodic examinations within an opportunistic screening setting. Consequently, most cases are diagnosed only after the onset of signs and symptoms. This finding reflects insufficient public awareness of the benefits of early detection of this disease. Among the 2,500 women with breast cancer who were interviewed in this study, 76% had never undergone a mammographic examination in their lifetime. Moreover, 85% had not undergone any mammography within the four years preceding diagnosis. The development and consolidation of public information and medical education initiatives are essential to increase participation and improve population-level understanding of the benefits of early detection for breast cancer. However, even when it is widely implemented, opportunist","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"121-129"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834381","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 Changing Landscape of Breast Cancer Treatment.","authors":"Mihai Stana, Teodor Florin Georgescu, Dragoş Eugen Georgescu, Maria Francisca Georgescu, Vlad Alexandru Ionescu, Gina Gheorghe, Mihai Teodor Georgescu, Claudiu Turculeţ","doi":"10.21614/chirurgia.3257","DOIUrl":"10.21614/chirurgia.3257","url":null,"abstract":"<p><p><b>Background:</b> Breast cancer management has undergone an important evolution, from aggressive, invasive surgical interventions towards personalized, multidisciplinary strategies guided by tumor biology and patient oriented outcomes. Recent advances: Randomized trials have enabled the possibility of less invasive surgery in some cases, while advances in systemic therapy including targeted agents, antibody drug conjugates (ADCs) such as Trastuzumab emtansine (T-DM1) and Trastuzumab deruxtecan (T-Dxd), endocrine therapy and immunotherapy in selected cases have improved survival and quality of life. Emerging technologies such as oral selective estrogen receptor degraders (SERDs), selective estrogen receptor covalent antagonists (SERCAs), proteolysis targeting chimeric (PROTACs) and complete estrogen receptor antagonists (CERANs) are expanding therapeutic options. <b>Conclusions:</b> Modern breast cancer management is defined by precision medicine, multidisciplinary integration and less invasive surgical interventions in selected cases. Ongoing challenges include therapeutic resistance, toxicity, cost, and equitable access to innovation.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"121 2","pages":"211-218"},"PeriodicalIF":1.1,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834387","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}