Chirurgia最新文献

{"title":"The Impact of Laparoscopic Transversus Abdominis Release on the Intra-Abdominal Pressure in Patients with Large Anterior Wall Defects.","authors":"Mihai Alexandru Vasile, Daniel Cochior, Victor Stefanescu, Cezar Betianu, Andrei Neagu, Alexandru Bucur, Flavia Liliana Turcu, Dragoş-Eugen Georgescu, Octavian Enciu, Traian Pătraşcu","doi":"10.21614/chirurgia.3129","DOIUrl":"10.21614/chirurgia.3129","url":null,"abstract":"<p><p><b>Introduction:</b> The objective of this study was to collect and analyze data on patient demographics, lifestyle, abdominal cavity characteristics, and their impact on intra-abdominal pressure before and after minimally invasive treatment of large parietal defects in hernia pathology. Additionally, the study examines the role of the CT scan as a reliable and valid measure of defect and muscle characteristics, which can help establish the indication for performing Transversus Abdominis Release (TAR) and evaluate the outcomes of this procedure along with differences in intra-abdominal pressure (IAP) and plateau pressure (Pplat). <b>Methods:</b> This prospective study involved 20 patients with parietal defects wider than 10 cm, treated over four years at the Central Military Hospital in Bucharest. All procedures were performed using the laparoscopic TAR technique by the same surgical team. Preoperative assessments included CT imaging to measure defect size, volumes, and IAP. Data including defect dimensions, muscle measurements, IAP, and Pplat were systematically recorded in a dedicated database with a follow-up at 6 months with clinical and imaging evaluations. <b>Results:</b> In our cohort of 20 patients, all female, the mean BMI was 26.81Ã+-3.05, and the hernia sac volume (HSV) averaged 159.01+-189.79 cm³. The defect area was 69.53 cm² (+-30.11). IAP decreased from 5 cmH2O (+-1.28) preoperatively to 1.91 cmH2O (+-1.93) postoperatively. The reduction in Pplat was similarly significant. Pressure variations were influenced by the topographic location of the defect, with higher pressures seen in epigastric defects, and by the characteristics of the peritoneo-fascial defects, including number, size, and localization, which affect pressure outcomes. Additionally, dimensions of the anterior-lateral abdominal muscles correlated with pressure changes. These findings highlight the importance of comprehensive preoperative assessment of defect characteristics, muscular anatomy, and defect location for predicting pressure reductions and guiding surgical planning. <b>Conclusions:</b> Higher BMI and large, multiple parietal defects predict increased IAP and Pplat postoperatively. Preoperative volumetric and morphometric parameters, defect localization, and topographic characteristics significantly influence pressure outcomes. The TAR technique effectively manages large defects while minimizing pressure increases, but consideration of morphological factors is crucial for optimal results. Further research is needed to refine patient selection and surgical strategies.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"657-667"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984582","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":"Technical Parameters and Patient Characteristics Influence on the Main Outcomes of Phacoemulsification Cataract Surgery: Results from a Tertiary Healthcare Center.","authors":"Adela-Laura Ciorba, George Roiu, Claudia Florida Costea, Sameh Saber, Amir Mohamed Abdelhamid, Simona Cavalu","doi":"10.21614/chirurgia.3160","DOIUrl":"10.21614/chirurgia.3160","url":null,"abstract":"<p><strong>Objectives: </strong>To assess the influence of technical parameters (such as phaco time and ultrasound energy) and patient`s characteristics (associated diseases, endothelial cell density (CD), intra-ocular pressure (IOP)) on visual acuity outcomes in individuals undergoing phacoemulsification surgery with intraocular lens implantation.</p><p><strong>Methodology: </strong>This cross-sectional, retrospective study involved 122 eyes divided into 4 groups using the LOCS III system classification: Grade 1 (25 eyes), Grade 2 (21 eyes), Grade 3 (30 eyes) and Grade 4 (46 eyes). Specular microscopy was performed pre- and postoperatively, while the ultrasound energy consumption and the effective phaco time were observed intraoperatively. <b>Results:</b> A progressive decrease of cell density (CD) was observed in all groups at end of the 1st week postoperatively, with a mean endothelial cell loss of about 700 cell/mm2. The postoperative intraocular pressure (IOP) dropped significantly in Grade 4 cataract group from a mean value of 21.3 +- 10.06 to 17.43 +- 3.81 mmHg, accompanied by higher ultrasound energy consumption. A progressive improvement of visual acuity was observed, from the 1st day postsurgical visit to the 1st week follow-up evaluation in all the groups. Visual acuity improvement was maintained significant after 1st week only when comparing groups 1 and 4. The multiple regression analysis identified cataracts Grade 3 and 4 along with the preoperative visual acuity as strong predictors for the final visual acuity outcomes, while gender, age, IOL type, comorbidities, phaco time (EPT), ultrasound energy (U/S), preoperative intraocular pressure and cell density were not independently associated with visual acuity outcomes.</p><p><strong>Conclusion: </strong>Our results indicated that 95.9% of the patients evaluated 1 day postoperative had visual acuity better than 6/18, while 4.1% had borderline visual acuity in the range of 6/18-6/60, being in line with the World Health Organization (WHO) standards for cataract surgery outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"696-706"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984445","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":"Primary Musculoskeletal and Retroperitoneal Hydatid Disease: A Case Report and Literature Review.","authors":"Vlad-Olimpiu Butiurca, Marian Botoncea, Andrei Modiga, Raluca-Adnana Zaharia, Karoline Becker Uta, Călin-Dragoş Molnar, Bogdan-Andrei Suciu","doi":"10.21614/chirurgia.3238","DOIUrl":"10.21614/chirurgia.3238","url":null,"abstract":"<p><p>Hydatid disease is a parasitic infection caused by Echinococcus granulosus, most commonly affecting the liver and lungs. Musculoskeletal localization accounts for only 1-4% of cases, and primary muscular hydatidosis without thoracic or abdominal organ involvement is extremely rare. We report the case of a 65-year-old man who presented in an emergency setting with acute respiratory distress and an irreducible left inguinal hernia. Computed tomography revealed an extensive multiloculated cystic lesion involving the left iliopsoas and proximal thigh muscles, associated with pelvic bone destruction and a secondary right testicular cyst, in the absence of hepatic or pulmonary hydatid disease. Emergency surgery included hernia repair and excisional biopsy of the thigh masses, which intraoperatively showed the typical appearance of hydatid cysts. Histopathology confirmed Echinococcus granulosus infection, and postoperative albendazole therapy was initiated. The postoperative course was complicated by severe chronic obstructive pulmonary disease, and, despite initial recovery, the patient later developed a hip abscess and repeatedly refused further surgery, ultimately being lost to follow-up. An institutional 10-year review and a focused literature review underline the rarity and diagnostic difficulty of primary musculoskeletal hydatid disease. Primary musculoskeletal and retroperitoneal hydatid disease should be considered in the differential diagnosis of cystic soft-tissue lesions, even in the absence of hepatic or pulmonary involvement, particularly in patients from endemic areas.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"714-722"},"PeriodicalIF":0.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984452","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":"Assessment of Medical Students Knowledge for Polytrauma Cases in Romania: A Cross-sectional Study.","authors":"Octavian Andronic, Vlad Buica, Andreea-Delia Panaete, Dan Nicolae Păduraru, Alexandra Bolocan, Daniel Ion, Florentina Muşat, Daniel Preda, Suzana Măceş, Stelian Pantea, Cătălin Pîrvu, Cristian Nica, Alin Mihai Vasilescu, Costel Bradea, Călin Molnar, Adrian Tudor, Vlad Olimpiu Butiurcă, Marian Botoncea, Cătălin Cosma, Valeriu Șurlin","doi":"10.21614/chirurgia.3225","DOIUrl":"10.21614/chirurgia.3225","url":null,"abstract":"<p><strong>Background: </strong>Polytrauma is a major cause of morbidity and mortality, yet formal training in its management is often absent from undergraduate medical curricula. This study aimed to assess the knowledge and perceptions of Romanian medical students regarding polytrauma management and evaluate the need for dedicated curricular courses.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted among medical students from seven major universities in Romania. The questionnaire included demographic data, knowledge about polytrauma, skills related to first aid, and perceptions on introducing polytrauma courses. The study took place at several prominent medical universities across Romania, including Bucharest, Craiova, Timisoara, Iasi, Cluj-Napoca, Targu Mures, and Sibiu. Overall, 413 students participated in the survey and were recruited through online platforms and direct interaction. All participants completed the survey voluntarily.</p><p><strong>Results: </strong>Of all the participants, 78.7% had heard about polytrauma primarily through clinical rotations in General Surgery, Emergency Medicine, and Orthopedics. However, only 31% of the participants who heard about polytrauma accurately defined it. No correlation was found between confidence in providing first aid and actual knowledge (p=0.097). Almost 80% believed that polytrauma management should be a mandatory subject in the curriculum.</p><p><strong>Conclusion: </strong>The study highlights a significant gap in Romanian medical education regarding polytrauma management skills among students. It supports the introduction of mandatory courses on trauma care to enhance practical skills and knowledge retention among future healthcare professionals.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"668-676"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984491","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":"Inflammatory Biomarkers as Prognostic Factors in Short-Term Postoperative Complications in Operable Gastric Cancer.","authors":"Nicolae Suciu, Orsolya Bauer, Călin Crăciun, Rareş Georgescu, Sorin Sorlea, Flavius Mocian, Orsolya Katona, Marius Florin Coros","doi":"10.21614/chirurgia.3179","DOIUrl":"10.21614/chirurgia.3179","url":null,"abstract":"<p><p>The study aimed to evaluate the effect of inflammatory blood markers on the postoperative outcomes of gastric cancer patients. We sought to assess the prognostic value of biomarkers and prognostic scores concerning short-term postoperative results. Material and methods: A non-randomized retrospective study was conducted, including gastric cancer patients proposed for curative-intent gastrectomy between 2012-2024 in the general surgery department of Mures County Hospital. We measured systemic inflammation by determining the neutrophile-to-lymphocyte ratio, neutrophile-toplatelet ratio, and platelet-to-lymphocyte ratio, prognostic nutritional index (PNI), modified Glasgow score (mGS), and Systemic Inflammatory Index (SII). <b>Results:</b> the white blood cell count (p 0.0001), the neutrophile count (p 0.0001), the lymphocyte count (p=0.001), the platelet count (p=0,01), the C-reactive protein levels (p 0.0001), the albumin levels (p 0.0001), the neutrophilto- platelet ratio (p=0.01), the prognostic nutritional index (p 0.0001), the modified Glasgow score (p 0.0001) and the Systemic inflammatory index (p 0.0001) were strongly associated with the postoperative outcome. In the multivariate analysis, CRP levels and modified Glasgow score were significantly associated with postoperative outcome. Conclusion: Systemic inflammatory markers play a significant role in predicting postoperative complications in gastric cancer. The interplay between inflammatory markers, surgical techniques, nutritional support, and complication management forms a multifaceted approach to predict postoperative outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"643-649"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984462","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":"Quality of Life Evaluation Using Questionnaires in Breast Cancer Patients after Surgery: A Systematic Review.","authors":"Mihaela Năstase, Ciprian-Andrei Coroleucă, Aniela Nodiţi, Teodora-Mihaela Peleaşă, Maria-Teodora Popa, Cristian Ioan Bordea, Alexandru Blidaru","doi":"10.21614/chirurgia.3243","DOIUrl":"10.21614/chirurgia.3243","url":null,"abstract":"<p><p><b>Introduction:</b> breast cancer continues to dominate as the most frequently diagnosed malignancy among women globally, with surgery playing a key role in treatment. Despite advances in disease management and improved survival, the impact on patients quality of life (QoL) remains an important issue. This review aims to synthesize evidence on QoL outcomes, focusing on patient-reported outcomes following different types of breast cancer surgery. <b>Methods:</b> A systematic search was performed in PubMed, Scopus, and Web of Science from January 2022 until May 2025 to identify English-language publications on breast cancer QoL using validated PROMS. Seventeen studies met the inclusion criteria and were reviewed independently by two authors. <b>Results:</b> The EORTC QLQ-C30 and BR23 instruments demonstrated superior body image and emotional functioning following breast-conserving surgery. However, 40 to 60% of patients undergoing mastectomy without reconstruction reported persistent sexual dysfunction. SF-36 and FACT-B indicated improvements in physical and mental health postreconstruction, although 31% of mastectomy patients remained below functional thresholds. BREAST-Q revealed higher satisfaction and better psychosocial well-being in autologous reconstruction compared to implant-based reconstruction. Oncoplastic breast surgery was associated with significantly higher mean BREAST-Q breast-conserving treatment (BCT) scores compared to conventional wide local excision, with patients in the oncoplastic group reporting approximately 90% mean satisfaction with breast appearance versus 75% in the conventional group. <b>Conclusions:</b> Breast-conserving surgery or reconstruction after mastectomy improves quality of life compared to mastectomy alone. Oncoplastic breast surgery significantly enhances body image relative to conventional wide local excision (BCT). Autologous breast reconstruction is associated with greater patient satisfaction but carries a higher risk of complications compared to implant-based reconstruction.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 6","pages":"611-624"},"PeriodicalIF":1.1,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984455","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":"Unstable Pelvic Ring Fractures: From Bleeding Control to Bone Repair Along the Trauma Pathway.","authors":"Kayaththery Varathan, Adele Zacken, Mustafa Albayati, Vishwajeet Singh, Uzair Khan, Janusha Ganeshathasan, Shanmukha Koppolu, Havil Stephen Alexander, Ruqaiya Al-Habsi","doi":"10.21614/chirurgia.3217","DOIUrl":"10.21614/chirurgia.3217","url":null,"abstract":"<p><p>Unstable pelvic ring fractures pose significant clinical challenges due to their intricate anatomy, substantial bleeding risk and frequent involvement of multiple organ systems. In the prehospital setting, early haemorrhage control with pre-peritoneal pelvic packing (PPP) and angioembolisation (AE) is critical: PPP rapidly controls venous bleeding, while AE targets arterial sources. Following initial resuscitation, timely bone repair with temporary external fixation (ExFix) and definitive bone repair, with open reduction and internal fixation (ORIF), is vital in minimising long-term complications. Hence, to coordinate these approaches from prehospital care to surgical intervention, a multidisciplinary approach is required along the trauma pathway. Advancements in trauma network systems may also offer improvements in survival and functional recovery. Therefore, this literature review critically evaluates the indications, timing and synergistic use of PPP, AE, ExFix and ORIF to optimise outcomes for patients with unstable pelvic ring fractures.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 eCollection","pages":"1-8"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145630328","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":"Evaluation of Quality of Life in Gastric Cancer Patients Undergoing Different Surgical Reconstruction Methods. A Comparative Study using the EORTC QLQ-STO22 Questionnaire.","authors":"Catalin Cosma, Vlad Olimpiu Butiurca, Cosmin Nicolescu, Paul Cristian Russu, Marian Botoncea, Calin Molnar","doi":"10.21614/chirurgia.3203","DOIUrl":"10.21614/chirurgia.3203","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer remains a major global health burden. Beyond oncologic outcomes, health-related quality of life (HRQoL) is increasingly recognized as a critical endpoint influenced by the reconstruction method after gastrectomy.</p><p><strong>Methods: </strong>A prospective observational study was conducted between December 2021 and December 2024 at the Emergency County Hospital of Targu Mures, Romania, including 150 patients undergoing curative-intent gastrectomy. Patients were divided into two groups: gastroduodenal anastomosis (Billroth I, n=72) and gastrojejunal anastomosis (Billroth II/Roux-en-Y, n = 78). HRQoL was assessed using the EORTC QLQ-STO22 preoperatively and at 3 and 6 months postoperatively. Scores were linearly transformed to a 0 - 100 scale. Statistical analysis was performed with EasyMedStat</p><p><strong>Results: </strong>The mean age was 61 years, with similar baseline characteristics. Postoperative complications occurred in 32.0% of patients, mostly grade I - II. Both groups showed deterioration in dysphagia, pain, reflux, and anxiety at 3 months, followed by partial recovery at 6 months. Reflux scores were consistently higher in the gastrojejunal group at all timepoints (baseline 26.1 vs. 17.6; 3 months 36.5 vs. 24.5; 6 months 27.2 vs. 14.7; p 0.001). Eating restrictions were also greater at 3 and 6 months.</p><p><strong>Conclusions: </strong>Both reconstruction methods impair short-term HRQoL, with partial recovery by 6 months. Gastrojejunal reconstruction is associated with higher reflux and eating restrictions, whereas gastroduodenal reconstruction shows more favorable functional outcomes.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 Ahead of print","pages":"1-11"},"PeriodicalIF":0.8,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539339","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":"Concurrent Pelvic Organ and Rectal Prolapse: A Narrative Review of Surgical Perspectives.","authors":"Marian Botoncea, Călin Molnar, Cosmin Lucian Nicolescu, Catalin Dumintru Cosma, Vlad Olimpiu Butiurca, Dragoş Călin Molnar, Claudiu Varlam Molnar","doi":"10.21614/chirurgia.3210","DOIUrl":"https://doi.org/10.21614/chirurgia.3210","url":null,"abstract":"<p><p>Pelvic organ prolapse (POP) and rectal prolapse (RP) frequently co-occur as manifestations of global pelvic floor dysfunction. This narrative review (January 1, 2015, to August 1, 2025) synthesizes research on the evaluation and surgical management of concurrent disease, emphasizing symptom mapping, standardized examination, and dynamic magnetic resonance defecography (DMRD) - guided phenotyping. Across retrospective series and small prospective studies, single-session, minimally invasive repair - most commonly sacrocolpopexy (Ã+- hysteropexy) with ventral rectopexy - appears feasible in well-selected patients, with perioperative morbidity similar to that in isolated procedures and consistent improvements in bulge symptoms, obstructed defecation, and quality of life. Key principles include multidisciplinary planning, nerve-sparing ventral dissection, non-overlapping meshes with complete peritonealization, and enhanced-recovery pathways. Mesh complications after rectopexy are uncommon. Across recent series, 30-day readmission rates are approximately 2-3%, and early recurrence rates are about 10% for rectal prolapse and 5-8% for apical prolapse at roughly 1-2 years; moreover, a meta-analysis of 16,471 patients found no increase in short-term complications with concomitant repair. Overall, despite encouraging outcomes, heterogeneity, selection bias, and limited follow-up constrain certainty. Higher-quality comparative and long-term studies are needed to refine indications and establish long-term effectiveness.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 5","pages":"502-510"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450888","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":"Lymphadenectomy Indications in Endometrial Cancer. A Surgeon's Dilemma in the Era of Perpetual Changes.","authors":"Ioana-Maria Ignat, Corina-Elena Minciuna, Romina-Marina Sima, Liana Ples, Mircea Octavian Poenaru, Andrei Diaconescu, Catalin Vasilescu","doi":"10.21614/chirurgia.3216","DOIUrl":"10.21614/chirurgia.3216","url":null,"abstract":"<p><p><b>Background:</b> The role of lymphadenectomy in endometrial cancer has long been debated. Once considered to have prognostic and therapeutic value, it is now evident that balancing accurate staging with procedure-related morbidity remains a challenge. Objective: This review aims to clarify the current indications for systematic lymphadenectomy in endometrial carcinoma, integrating the updated FIGO 2023 staging system, the ESGOESTRO- ESP 2025 guidelines, and the emerging role of molecular classification. \u0000<b>Methods:</b> We analyzed landmark randomized controlled trials, updated guideline recommendations, and the evolving paradigm of sentinel lymph node (SLN) mapping, with emphasis on risk stratification based on histology, grade, lymphovascular space invasion (LVSI), and molecular features. \u0000<b>Results:</b> High-level evidence demonstrated that systematic lymphadenectomy does not improve survival in early-stage disease, while significantly increasing morbidity. Current guidelines remain complex, but consistently emphasize SLN mapping as the preferred method of nodal assessment. Systematic lymphadenectomy is no longer justified as routine; it is reserved for high-intermediate and high-risk patients when SLN mapping fails, performed as side-specific dissection. In advanced disease, the surgical goal is complete cytoreduction, with selective removal of bulky or suspicious nodes; systematic lymphadenectomy must not be performed in stages III-IV. \u0000<b>Conclusion:</b> The paradigm has shifted from universal lymphadenectomy to a tailored, risk-adapted approach. SLN biopsy represents the new standard, reducing morbidity without compromising oncologic outcomes. Expanding access to molecular profiling, still limited in Romania, is crucial for better oncological results and alignment with European standards.</p>","PeriodicalId":10171,"journal":{"name":"Chirurgia","volume":"120 5","pages":"519-528"},"PeriodicalIF":0.8,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145450998","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}