Journal of Surgery

Esophageal cancer remains one of the most severe malignancies in terms of overall survival despite the introduction of novel radiation regimens and chemotherapy agents. Many of the patients are diagnosed in advanced cases in which a multimodal treatment protocol is applied, finding the biomarkers that are involved in the resistance to neoadjuvant treatment could select the subgroup of patients that could be submitted either to surgical treatment or to an experimental drug trial. Hereby, we reviewed the potential biomarkers (immunohistochemical, blood-based, miRNA markers and gene expression profiling) that promised novel therapeutic pathways protocols.

Pancreatic ductal adenocarcinoma is one of the most common malignant disease of the pancreas having its origin in the ductal epithelium. With an increasing incidence, it is considered one of the most aggressive human tumours. It has a high degree of lethality, survival at 5 years being reported to be up to 4%. This poor outcome is due to both a low specificity of onset symptoms (e.g. the disease is usually diagnosed in advanced stages) and also to a lack of tumour markers in order detects the presence of the tumour in the early stage, as well as the absence of effective non-surgical treatment modalities. Up to now, surgery is the only treatment modality that can provide a greater chance of survival, but unfortunately is an option only for about 15% of patients. The resections for the pancreatic cancer have entered the therapeutic arsenal for almost 70 years, but despite hundreds of reports written about this topic, there is no unanimity on the effectiveness of the resection. In this way, we will describe here some current aspects and survival numbers related to resectability in the pancreatic cancer.

Background: Pancreatic fistula (PF) is the most widely recognized complication of pancreaticoduodenectomy (PD) with diversely reported occurrence rates. Present review focusses on dissecting the surgical treatment modalities that leads to development of PF.

Methods: A retrospective study with the use of hospital database as cases and controls was carried out. Data were tabulated and subjected to strong statistical analysis and inferences were drawn.

Results: As observed the occurrence of PF did not differ in terms of mean age, sex, surgical timings to the procedure, anastomosis techniques or vascular resection.

Conclusion: The surgical approach for PF is related with a higher mortality and morbidity. There is no preferred method of performing pancreatectomy as any procedure can give rise to same mortality rates and risk of endocrine deficiency. In instances of muddled PF, radiological or surgical conservative treatment is needed and surgically duct to mucosal double layered anastomosis have been successful in reducing the PF rates and its validation is still awaited from the trials.

Introduction: Kummell's disease is an avascular necrosis of the vertebral body, secondary to a vertebral compression fracture. This entity is characterized by the gradual development in time of a vertebral body collapse following a trivial spinal trauma, involving a worsening back pain associated to a progressive kyphosis. Following the progressively ageing population the prevalence of osteoporosis is increasing and as a consequence, the incidence of spinal crush fractures; therefore evidence of Kummell's disease is quite common, also favoured by the great accuracy of modern diagnostic equipment.

Purposes: The aim of this article is to carry out an international literature review regarding Kummell's disease, addressing its physiopathology, histopathology, clinical presentation, radiological characteristics and treatment modalities; at the same time, literature is updated through the description of a new and interesting case, symbol of the pathology long- term potential complications, if not diagnosed and therefore not suitably treated.

Case report: A patient with osteoporosis, following a slight spinal trauma, suffered a progressive necrosis of the D11 body; although the radiological exams showed a constant worsening of the thoracic lumbar kyphosis and a restriction of the spinal canal, in another medical centre he was only treated with a corset and painkillers. A year after the injury, motor deficits concerning the lower limbs appeared. He was then sent to us and indication for posterior internal fixation was given. On the basis of both his medical history and radiological and histological findings, Kummell's disease was diagnosed.

Conclusion: Is necessary to have a complete knowledge of the clinical, pathological and radiological characteristics of Kummell's disease, as to follow a correct diagnostic course enabling to prepare the most suitable therapy.

Despite advances in modern anastomotic techniques for colorectal surgery, anastomotic fistulas are still considered a dreaded complication, with a reported rate varying from 2 to 25%. Although fistulas can appear after any bowel anastomosis, it seems that low colorectal anastomosis are the most prone to such complications. Herein we aim to provide a review on our own experience with postoperative anastomotic fistulas after low colorectal anastomosis. Between 1998 and 2016, 62 patients had a LAR procedure with TME and low colorectal anastomosis. The mean age was 62.29 years. Triple stapled side to end colorectal anastomosis was the preferred technique with protective ileostomy. We report a fistula rate of 9.67% (6 cases) after Low Anterior Resection including blind fistula seen on first month follow-up endoscopic evaluation. While blind fistulas generated little morbidity, clinically manifested fistulas posed significant management challenge. Nevertheless we report no mortality related to fistula. Indubitably, more research is needed to establish a proper prevention guideline for anastomotic leaks, a “golden-standard” anastomotic technique and ideal management criteria for fistulas.

Aim: This study aims to assess the variation of the levels of circulating tumor cells during surgical manipulation, by in vivo evaluation at three key points during treatment.

Materials and methods: This was a pilot study with 20 included patients with mid and low locally advanced rectal cancer, with neoadjuvant treatment. The device used to evaluate the number of circulating tumor cells in the bloodstream of the patients was the “Detektor Cancer” GILUPI Cell Collector®. The tests were performed at 8 weeks after the end of the neoadjuvant treatment, at three key moments: in the preoperative period, during surgery - after the surgical dissection and at 7 days postoperatively.

Results: There was an increase in the number of circulating tumor cells after the surgical sequence, but no statistical significance could be achieved due to the small number of patients included in the study.

Conclusion: The circulating tumor cell number is a useful biomarker for the prognosis of the patients with colorectal cancer, demonstrated through several studies. However, there is need for standardization in this field of research. Our study, although with visible differences between the preoperative, intraoperative and postoperative values, showed no statistical significance.

Introduction: The post cholecystectomy syndrome is defined as the maintenance or the occurrence of digestive tract symptoms after cholecystectomy due to extra hepatic biliary duct disorders. The introduction of a laparoscopic approach has revolutionized the procedure in the treatment of cholecystolithiasis. Laparoscopic cholecystectomy is less invasive for patients as compared to the classic surgical procedure.

Aim: Determination of the frequency and the intensity of abdominal symptoms occurring after laparoscopic surgery and classic cholecystectomy related to the post cholecystectomy syndrome. Material and methods: The study group consisted of 105 patients of the Clinical Department of Surgery of the Regional Specialist Hospital in Tychy, Poland. Patients were divided into two groups: patients who underwent laparoscopic (n=83) or classic (n=22) cholecystectomy. The assessments were performed preoperatively, 1 month and 6 months postoperatively, using the “Gastric Symptom Questionnaire”.

Results: The results were compared using statistical methods. Results: The symptoms of the syndrome were observed in 32 (30.5%) patients from the study group. Symptoms related to the post cholecystectomy syndrome included abdominal pain, flatulence, nausea, vomiting, movement difficulties, loss of appetite or diarrhea. These symptoms occurred more frequently after classic cholecystectomy as compared to the laparoscopic approach, 1 month and 6 months after cholecystectomy.

Conclusions: The post cholecystectomy syndrome may occur in 1/3 of patients after cholecystectomy. The symptoms occur less frequently in laparoscopically treated patients. In a large number of patients the syndrome may be related to the treatment method.

Aim: The aim of this study was to report and analyze outcomes associated 7 patient’s in-hospital evaluation and investigate of the cliniopathological features diagnosis and treatment of duodenal neuroendocrine neoplasms. So provide knowledge for further understanding of this condition.

Methods: The number of 7 consecutive patients who underwent duodenal (NEN) of the first affiliated hospital of Anhui medical university of December 2012 to 2015 were identified and included for analysis. Demographic and operative data, pathological findings and post-operative outcomes were entered into a computer database. Prognostic factors were analyzed by univariate and multivariate analysis.

Results: The number of 7 patients 3 cases was male and 4 were female; all cases underwent ultrasound and CT examination, 5 cases had endoscopy examination and 1 case had MRI examination. The imaging examinations showed that the tumor was located at descendant duodenum in 2 cases, at duodenal papilla in 1 case and at horizontal duodenum in 1 case. The endoscopy examination showed that the tumor was located at descendant duodenum in 1 case at duodenal papilla in 1 cases and at duodenal bulb in 1 case The 7 patients exhibited dissimilar clinical symptoms. Duodenal NEN was manifested as abdominal pain in 3 cases as jaundice in 2 cases and as headache and fatigue in 2 cases. All patients received surgical treatment, and their diagnoses were confirmed by postoperative pathological and immune histochemical examinations.

Conclusion: Duodenal NEN has low prevalence, insidious onset and usually without specific clinical signs and symptoms. Its diagnosis mainly relies on pathological biopsy and immunohistochemical staining, and surgery is the first option of treatment.

Mediastinal fibromatosis is a rare entity affecting individuals of all age groups, and is extremely rare in children. Fibromatosis can occur anywhere in the body; most commonly in the superficial soft tissues, extremities, or abdomen. Bilateral pleural and mediastinal fibromatosis extending to neck along the tissue planes has not previously been reported in the literature. Most fibromatoses are benign but 10-20% can undergo malignant transformation. These tumours are initially asymptomatic, but can present with compressive symptoms as they grow in size. We present a rare case of fibromatosis of neck and mediastinum which developed in a 4 year old boy who had undergone cardiac surgery 2 years previously. Diagnostic dilemma and challenges in surgical removal are outlined.

This report documents an extremely rare case of anterior mediastinal fibromatosis, desmoid type that occurred immediately after cardiac surgery in a young child.

The laparoscopic right colectomy became a well-established technique in the surgical armamentarium of colorectal operations. It has well proved advantages: reduction in postoperative pain, time to return of bowel function, and length of hospital stay. Different studies have also proven its safety in colorectal adenocarcinoma, with equivalence in nodal harvest, recurrence rates, disease-free survival, and overall survival. We present herein the technique of laparoscopic right colectomy from “up” to “bottom”. Different anatomical and technical key-points are highlighted. The results of a short series of the first 11 cases are also presented: men to woman ratio: 8 to 3; mean age 53.72 ± 12.39 years old; BMI 26.18 ± 2.92 kg/m2; surgical time: 132.75 ± 16.43 minutes; mean harvest lymphnodes: 16.72 ± 3.17; tumor stage: pTis (N=2); pT1 (N=6); pT2 (N=2); pT3 (N=1). Laparoscopic right colectomy using the “up” to “bottom” approach is a feasible and safe technique and allows the mesocolon excision with outstanding number of harvest lymph nodes. The procedure can be performed in good conditions by a single surgeon with one assistant.