Mircea Beuran

Mircea Beuran

Histopathological Characteristics – Immediate Prognostic Factors for Left Colon Cancer

Introduction: Colorectal cancer represents the second leading cause of cancer mortality in our country, the survival rates being determined by the stage of the disease and the presence of metastases, being of 90% for early stages at 5 years, of 70% for the tumors with local invasion and of 10% in case of distal metastases. The aim of our study is to evaluate the prognosis of left colon cancer according to its histopathological characteristics. Material and methods: A number of 171 patients with left colon cancer (splenic flexure, descending colon, sigmoid colon and rectosigmoidian junction) were included in the study. The patients were admitted to the Surgical Unit of the Emergency Clinical Hospital of Bucharest between January 1st 2015 – December 31st 2016. The histopathological analysis followed the norms of the Americal College of Pathologists, and the determination of tumor staging was done based on the TNM classification. Results: Most patients are in the 3rd stage (65.5%) and in the 4th stage (19.3%) of cancer, only 2.3% being diagnosed in the 1st stage. A number of 36 patients present distal metastases, the most frequent location being in the liver (21 patients). 24% of the patients presented postoperative complications, while 2.3% died, without any differences determined by the presence of lymph nodes or distal metastases. Distal metastases are associated with the resistance environment (p=0.048), while the invasion of lymph nodes is significantly higher (p=0.049) in patients with tubulovillous adenoma. The degree of differentiation of tumors differs significantly from a statistical point of view (p=0.002), according to the histopathological type. Conclusions: The incidence of lymphatic metastases differs according to the histopathological type of the tumor, the tubulovillous adenoma being more frequently associated with lymphatic metastases; distal metastases are more frequently seen in patients in the rural areas, based on the low addressability and accessibility to medical services. The frequency of postoperative complications and nosocomial death is determined by the advanced stage of the disease (stages 3 and 4), as well as by the late arrival of the patient to the emergency room, especially patients with intestinal occlusion.

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Multivisceral Resection for Pancreatic Adenocarcinoma. Case Report and Literature Review

Pancreatic cancer (PC) remains a deadly disease with a dismal prognosis in which the mortality rate nearly equals its incidence [1,4]. Despite advances in modern chemoradiotherapy, the best and only chance of cure for patients with PC is an oncological surgical resection aimed at complete removal of all gross and microscopic disease[5]. Early disease and curative-intent surgery are the best predictors of outcome. Locally advanced cancer of the pancreatic tail involving adjacent organs is often considered unresectable. Radical distal pancreatectomy with en bloc resection of the invaded viscera with or without vascular reconstruction was introduced to treat these tumors[2,3]. Tumors of the body and tail have evidence of involvement of surrounding structures either by tumor infiltration or inflammatory adhesions. In such circumstances, it is advisable to perform en bloc resections to obtain negative surgical margins[6]. According to Shoup, multivisceral resections are technically feasible and, based on the limited data available, these resections are associated with improved survival (5-year survival rates of 16-22%) [7,8]. Given the high morbidity and mortality associated with these procedures, they should be performed only when the possibility of achieving R0 seems distinctly feasible[3,6,8]. [...]

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Intrathoracic Anastomotic Leak after Ivor Lewis Esophagectomy: Non-Surgical Management

Esophagectomy is the best therapy for the patients with locoregionally advanced esophageal cancer, but carries serious risks of associated morbidity and mortality. Esophageal anastomotic leak is a severe post-operative complication with a rate of mortality that can reach 60%. Clinical presentations of esophageal anastomotic leaks varies from asymptomatic to severe sepsis and death. The prognosis depends on the duration to diagnosis and the severity of contamination. An anastomotic esophageal leak has a great impact on the length of hospitalization, morbidity, stricture formation and dysphagia. The management of intrathoracic anastomotic leaks include conservative, surgical or endoscopic treatment, but the indication between these options of treatment remains controversial. [...]

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Technical Challenges of Laparoscopic Cholecystectomy in Patients with Cholestasis

Although mainly asymptomatic, patients with biliary gallstones frequently associate common bile duct (CBD) stones. A percent ranging between 10-18% (1,2) from the patients that underwent cholecystectomy for gallbladder stones associate CBD lithiasis. The presence of CBD stones can be anticipated in the presence of jaundice, cholangitis, pancreatits, with altered hepatic function, or directly identified by imagistics (3). The percentage of preoperative undiagnosed CBD reaches almost 25% even for the newest imagistics (4). Acute cholecystitis is the most common infectious complication of gallstones, occuring with a frequency of 6-11% for the patients with 7-11 years of symptomatic gallstones (5). Recent studies are showing indirect signs of CBD stones in 37.7% of patients with acute cholecystitis, these signs being noticed for 72 % of patients with prooved choledocholithiasis (6).

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Laparoscopic Management of Concomitant Gallstones and Common Bile Duct Stones - Current Practice and Our Experience

Despite many advances in the last decades the optimal treatment for concomitant gallstones and common bile duct (CBD) stones is still controversial. While for the asymptomatic gallbladder stones the need for surgery is still under debate, there is large consensus regarding the indication to remove the CBD stones, which appear to be associated in 3-10% of patients (1). Before the laparoscopic era the standard treatment for CBD stones was open cholecystectomy and CBD exploration. For the patients unfit for surgery, or with severe complica-tions such as acute cholangitis, jaundice and pancreatitis, ERCP with endoscopic sphincterotomy (ES) and stone extraction was a valuable, seldom stand alone, life saving, alternative. With the advent of laparoscopic cholecystectomy (LC) in 1987-1988, new techniques added to the armamentarium of CBD stones treatment. Reddick & Olsen (2,3) sustained the ERCP with endoscopic sphincterotomy (ES) and stone extraction as early as 1990
Petelin (4), introduced almost simultaneously, the laparoscopic CBD exploration (LCBDE). The current standards of practice recognise 3 options: the combined laparo-endoscopic, the totally laparoscopic and the open approach.

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