Low Anterior Resection Syndrome. Anatomical Changes after Anterior Rectal Resection.

In this editorial, the authors bring to the attention of surgeons a personal point of view with the intention of offering a series of anatomical arguments to explain the high rate of functional complications following ultralow rectal resections, resections dominated by faecal incontinence of various intensities. Having as a starting point the anatomy of the pelvic floor and the posterior perineum, the authors are concerned with the functional outcomes of the sphincter-saving anterior rectal resection, regarding the low and ultralow resection. Technically, a conservative surgery for low rectal cancer has been currently performed. If 25 years ago the abdominoperineal resection was the gold standard for rectal cancer located under 7cm from the anal verge, nowadays the preservation of the anal canal as a partner for colon anastomosis has been accomplished. Progressively, from a desire to preserve the normal passage of stool into the anal canal, as anatomically and physiologically as possible, the distal limit of resection was lowered to 2-4 cm from the anal verge and ultra-low anastomoses were created, within the anal sphincter complex. The stated goal: keep the oncological safety standard and, at the same time, avoid definitive colostomy. Starting from the normal anatomy of the pelvic floor and the anorectal segment, the authors take a look at the alterations of the visceral, muscular, and nerve structures as a consequence of the low anterior resection and, particularly, the ultralow anterior resection. A significant degree of functional outcomes regarding defecation, with the onset of marked disabilities of anal continence, the major consequence being anal incontinence (30-70%), have been noticed. The authors go under review for the main anatomical and physiological changes that accompany anterior rectal resection. Conclusions: Thus, the following questions arise: what is the lower limit of resection to avoid total fecal incontinence? Is total incontinence a greater handicap than colostomy or is it not? The answers cannot be supported by solid arguments at this time, but the need to initiate future studies dedicated to this problem emerges.

The Impact of Patient Characteristics, Risk Factors, and Surgical Intervention on Survival in a Cohort of Patients Undergoing Neoadjuvant Treatment for Cervical Cancer.

Introduction: Cervical cancer is among the most frequent types of neoplasia worldwide and remains the fourth leading cause of cancer death in women, a fact that raises the necessity for further development of therapeutic strategies. NCCN guidelines recommend radiation therapy with or without chemotherapy as the gold standard for locally advanced cervical cancer. Also, some studies claim that performing surgery after chemo-radiation therapy does not necessarily improve the therapeutic outcome. This study aims to determine the impact of the risk factors, various characteristics, and surgical treatment for patients in different stages of the disease on survival rate. Material and methods: Our study started as a retrospective, observational, unicentric one, carried out on a cohort of 96 patients diagnosed with cervical cancer from the surgical department of the Bucharest Oncological Institute, followed from 1 January 2019 for a period of 3 years. After the registration of the initial parameters, however, the study became prospective, as the patients were closely monitored through periodical check-ups. The end-point of the study is either the death of the participants or reaching the end of the follow-up period, and, therefore, we divided the cohort into two subgroups: the ones who survived after three years and the ones who did not. All 96 patients, with disease stages ranging from IA2 to IIIB, underwent radio-chemotherapy followed by adjuvant surgery. Results: Among the 96 patients, 45 (46%) presented residual tumor after radio-chemotherapy. Five patients (5%) presented positive resection margins at the post-operative histopathological examination. The presence of residual tumor, the FIGO stage post-radiotherapy, positive resection margins, and lympho-vascular and stromal invasions differed significantly between the subgroups, being more represented in the subgroup that reached the end-point. Variables correlated with the worst survival in Kaplan-Meier were the pelvic lymph node involvement-50% at three years (p-0.015)-and the positive resection margins-only 20% at three years (p < 0.001). The univariate Cox model identified as mortality-associated risk factors the same parameters as above, but also the intraoperative stage III FIGO (p < 0.001; HR 9.412; CI: 2.713 to 32.648) and the presence of post-radiotherapy adenopathy (p-0.031; HR: 3.915; CI: 1.136 to 13.487) identified through imagistic methods. The independent predictors of the overall survival rate identified were the positive resection margins (p-0.002; HR: 6.646; CI 2.0 to 22.084) and the post-radiotherapy stage III FIGO (p-0.003; HR: 13.886; CI: 2.456 to 78.506). Conclusions: The most important predictor factors of survival rate are the positive resection margins and the FIGO stage after radiotherapy. According to the NCCN guidelines in stages considered advanced (beyond stages IB3, IIA2), the standard treatment is neoadjuvant chemoradiotherapy. In our study, with radical surgery after neoadjuvant therapy, 46% of patients presented residual tumor at the intraoperative histopathological examination, a fact that makes the surgical intervention an important step in completing the treatment of these patients. In addition, based on the patient's features/comorbidities and the clinical response to chemotherapy/radiotherapy, surgeons could carefully tailor the extent of radical surgery, thus resulting in a personalized surgical approach for each patient. However, a potential limitation can be represented by the relatively small number of patients (96) and the unicentric nature of our study.

Choledochal Lithiasis. Multidisciplinary Therapeutic Target. Past and Present.

Introduction: Cholelithiasis still remains one of the most frequent pathologies encountered in surgical practice. The authors review the stages which marked the evolution of the treatment of choledochal lithiasis (CL) during the last 50 years, based on their own experience. From the exclusively surgical choledochus, we have reached a multidisciplinary therapy in which both endoscopy and interventional radiology have found their place. Material and Method: The authors studied 2 groups of patients: Group 1 included patients from the period 1959-1997 (38 years - 982 cases of choledocholithiasis) who underwent classical surgery. Group 2 included patients treated between 1997-2017 (20 years â?" 347 cases) in whom both endoscopic surgery and classic surgery were used to obtain choledochal clearance. The types of choledochal lithiasis (CL) according to which the method of obstruction clearance was decided upon and chosen are presented here. Results: All the patients in group 1 underwent classical surgery, representing 9.8% of operations for biliary lithiasis. In group 2, classical surgery was recorded in 23.4% of patients, and endoscopic surgery in 76.6% of them. We mention that there was no laparoscopic approach for the treatment of CL due to the absence of experience. In group 2 we recorded 26.3% endoscopic failure, while in the classical approach group there was 12.3% failure of obstruction clearance, the solution being biliodigestive anastomoses. Conclusions: The authors propose three categories of therapeutic indications in CL. A first category is represented by the "endoscopic choledochus", which includes migrated lithiasis. A second category is the "surgical choledocus". It is the situation of complex and complicated lithiases. Finally, there would be a third category - the "lithogenic choledocus". This last group includes the most aggressive lithiases with repeated relapses, panlithiases, etc. For categories 2 and 3, endoscopic - laparoscopic clearance attempts have no chance of success or are even contraindicated.

Current Therapeutic Approaches in Cervical Cancer Based on the Stage of the Disease: Is There Room for Improvement?

Cervical cancer continues to be among the most common malignancies in women, and in recent decades, important measures have been taken to reduce its incidence. The first and most important steps to achieve this goal are oriented toward prevention through screening programs and vaccination, mainly against oncogenic human papillomavirus (HPV) strains 16 and 18. The therapeutic approach is based on the diagnosis and treatment guidelines for cervical cancer, which establish for each stage (FIGO, TNM) specific conduct. These guidelines summarize quite precisely the elements of therapeutic practice, but, in some places, they leave optional variants based on which nuanced approaches could be established. Adherence to these guidelines, which include the performing of minor or major surgery, with or without chemotherapy and radiation therapy, combined with advanced imaging investigations, has been able to lead to a substantial increase in survival. The purpose of this literature review is to discuss the diagnosis and treatment options in cervical cancer depending on the histological type, FIGO staging, and patient performance index, taking into account the hospital resources available in middle-income countries (percentage of gross domestic product allocated to health services around 5.5%, in the case of Romania).

Specific Septic Complications after Rectal Cancer Surgery: A Critical Multicentre Study.

The postoperative septic complications in gastrointestinal surgery impact immediate as well as long-term outcomes, which lead to reinterventions and additional costs. The authors presented the experience of three surgery clinics in Romania regarding the specific septic complications occurring in patients operated on for rectal cancer. The study group comprised 2674 patients who underwent surgery over a 5-year period (2017-2021). Neoplasms of the middle and lower rectum (76%) were the majority. There were 85% rectal resections and 15% abdominoperineal excisions of the rectum. In total, 68.54% of patients were operated on laparoscopically, and 31.46% received open surgery. Without taking wound infections into account, 97 (3.67%) patients had abdominal-pelvic septic complications. The aim was to evaluate the causes of the complications. The percentage of suppurations after surgery of the rectum treated by radiochemotherapy was considerably higher than after surgery of the non-radiated upper rectum. The fatality rate was 5.15%. The risk of fistulas was significantly associated with the preoperative treatment, tumour position and type of intervention. Sex, age, TNM stage or grade were not significant at 0.05 the threshold. The risk of fistulas is reduced with low anterior resection, but the gravity of these complications is higher in the lower rectum compared with the superior rectum. Preoperative radiochemotherapy is a contributing factor to septic complications.

Augmented Reality in Surgical Oncology. A Literature Review.

Introduction: Augmented reality (AR) devices enable doctors to associate visualizing diagnostic data, to establish therapeutic procedures in order to improve work efficiency and safety and to develop the surgical training of young doctors. This new approach may contribute to an increase in the quality of medical training and a decrease in the costs of surgeries. This paper assesses whether augmented reality can improve the results of surgical procedures as well as its possible progress in the future. Methods and results: The intra-operative use of augmented reality by using Google Glass glasses, on which we projected MRI/CT images of the anatomical areas invaded by tumors and/or images of normal anatomy, helps us to perform surgeries, as well as to present them as teaching material. We have also performed a review of the available literature, beginning with 2011 and ending with November 2021, by looking up the terms "augmented reality" and "surgical oncology" in PubMed. The results of the search were 308 studies in this field which prove the utility of the method. Many papers show that the performance of the augmented reality systems is superior and compatible with traditional imaging techniques. Conclusions: The specialty literature reveals a growing interest on the part of surgeons regarding the use of augmented reality during surgery. This procedure enables the improvement of the safety and efficiency of surgical techniques, as well as their presentation to students and residents alike. The method is innovative and has to be carefully approached before being introduced into routine practice.

The Portosystemic Shunt for the Control of Variceal Bleeding in Cirrhotic Patients: Past and Present.

Based on an experience of more than 50 years in the treatment of portal hypertension (PHT), the authors review and analyze the evolution of the surgical portocaval shunt (PCS). We would like to provide an insight into the past of PCS, in order to compare it with the current state of the treatment of PHT complications. As a landmark of the past, we shall present statistics of more than 500 cases of PHT operated between 1968 and 1983. From this group, 238 patients underwent surgical portocaval shunting during a fifteen-year period. The behavior of the portal hemodynamics following PCS was studied and the postoperative decrease in portal pressure (PP), as well as the residual PP, were recorded. The portal manometric determinations were made by electronic recordings using the Hellige device and direct intraoperative recordings through the catheterization of a ramus in the portal area. The results of PCS are superposable, in terms of hemodynamic efficiency, with those of the intrahepatic shunt (TIPS-transjugular intrahepatic portosystemic shunt). The authors discuss the current place of PCS, in obvious decline in comparison with the situation 50 years ago. The current methods of controlling variceal bleeding represent obvious progress. PCS remains with very limited indications, in specific situations when the other therapeutic methods have failed or are not recommended.

Primary Non-Hodgkin Uterine Lymphoma of the Cervix: A Literature Review.

Introduction: Non-Hodgkin lymphomas (NHL) comprise 85% of the total lymphomas diagnosed, with the histological type of diffuse large B-cell lymphomas (DLBCL) being the most prevalent in adults. In about 40% of cases, the location is extranodal. Uterine cervix lymphomas of this type are extremely rare (0.5-1.5%) and represent a diagnostic challenge. A case of DLBCL of the cervix is presented here along with a review of the literature. Materials and methods: A 75-year-old patient was referred with a bleeding vegetant tumour occupying her entire vagina. The histological and pathological investigations performed following the tumour biopsy indicated a malignant, diffuse, vaguely nodular lymphoid tumour proliferation. The immunohistochemistry results were in favour of a diffuse B-cell non-Hodgkin lymphoma (DLBCL). CHOP (Cyclophosphamide, Hydroxydaunorubicin (also called doxorubicin or adriamycin), Oncovin (vincristine), Prednisone or Prednisolone) polychemotherapy and radiotherapy were effective and resulted in tumour regression (from 3.4 cm to tumour disappearance, with the cervix returning to normal size). Conclusions: The uterine cervix lymphoma prognosis is more conservative than that for a nodal lymphoma, mainly due to a later diagnosis determined via immunohistochemistry. Chemotherapy is the main treatment.

Unusual Complicated Gastric Ulcers.

We here draw attention to a practical issue: the approach to certain unusual gastric ulcers with haemorrhage- or perforation-induced complications. This category of ulcers, i.e., giant (over 2-3 cm) and multiple ulcers, is rarely encountered. We discuss the circumstances determining the occurrence of such lesions, their diverse aetiology and pathogenesis, their common manifestations, and the severity of their evolution. Some of the lesions are benign (chronic or acute ulcers), whereas others are neoplastic: carcinoma, stromal tumours, and lymphomas. In gastric ulcers, the characteristics of this particular and rare category of lesions strictly places them in the surgical field, requiring primary surgical intention. Conservative treatments are not effective in such cases, and preoperative biopsies are not appropriate for emergency interventions. Whether these unusual ulcers are benign or malign, they need to be surgically removed.

Rectal Neuroendocrine Tumour with an Aggressive Behaviour.

Neuroendocrine tumors are rare epithelial neoplasms with the specific biological characteristics which can make the diagnosis and treatment questionable, and, which in general, have a good prognosis. In recent decades, the incidence of rectal neuroendocrine tumors has increased due to the accessibility of colonoscopy and the introduction of screening programs for colorectal tumors. We present the case of a 55-year-old patient who presented for rectal bleeding started 6 months before. At the moment of the hospital admission, the general state of the patient was good, and the clinical and paraclinical examination confirmed the diagnosis of stage IV rectal tumor. The pathology examination could not distinguish between a non-differentiated carcinoma and a neuroendocrine tumor. The diagnosis of Rectal neuroendocrine tumor with an aggressive behaviour was established via immunohistochemistry (ki 67 index of 75-80%, G3 grading). Due to the high aggressiveness of the tumor, the patient had a rapid evolution towards a severe state and the onset of liver failure did not allow the systemic anti-tumor treatment. In conclusion, we can state that in the case of rectal neuroendocrine tumors, the stage of the disease and the ki67 index have an important prognostic value, and it is crucial for both the diagnosis and tumor aggressiveness to have an immunohistochemical examination. Even though, in general, they are small well-differentiated tumors with a rather good prognosis, there are forms with tumors of greater dimensions and with metastases and severe prognosis.

Surgical Oncology in Romania: An Analysis of Research and Impact Based on Literature Search in PubMed and Web of Science.

BACKGROUND: With a long tradition and outstanding contributions over time, medical scientific research in Romania has experienced major changes in the last two decades, marked by an increase in scientific publications, originating especially from university centers and fostered by national regulations on publication standards required for professional promotion. This study is aimed at assessing the literature on surgical oncology in Romania, published by Romanian authors in journals indexed in international databases. MATERIALS AND METHODS: A literature search was performed, focused on surgical oncology performed in Romania. Two databases, PubMed and Web of Science (WoS), were finally selected and included in the study, which included bibliometric parameters and subject analysis. RESULTS: The PubMed search retrieved 464,295 articles being published in only 3 Romanian journals, Chirurgia, The Medical-Surgical Journal (Iasi), and Romanian Journal of Morphology and Embryology. The search of the Web of Science retrieved 494 records on the subject of surgical oncology in Romania, 449 of which were published after 1989. The 494 articles received 2,102 citations, 4.26 per year, and an overall Hirsch index of 21. Most articles were published in the same 3 Romanian journals as in PubMed. Neoplasms of the digestive system prevailed, followed by articles on general surgical oncology issues, cancer research, and therapy. Bucharest has the highest number of authors, followed by Cluj-Napoca and Iasi. CONCLUSION: Research originating from Romania in the field of surgical oncology is present and visible at an international level mainly through Romanian journals. Sustained effort is required from surgical oncology authors to be published in international journals on this subject, as it is the only way to increase global visibility and impact.

Idiopathic Retroperitoneal Fibrosis.

The world of surgery has been concerned with idiopathic retroperitoneal fibrosis (RPF) ever since 1948, when J. K. Ormond published the first case of ureteral stenosis following a retroperitoneal scleroinflammatory process due to unknown reasons. Until 1960, 82 such cases were reported in the literature. The authors present two new cases of RPF, located exclusively in the pelvic (subperitoneal) compartment of the retroperitoneal space. The literature on this subject is reviewed, current etiological theories are mentioned and treatment opportunities are discussed.

The Value of C Reactive Protein and the Leukocytes in the Peritoneal Fluid in the Predicting Postoperative Digestive Fistulas.

Anastomotic fistulas in digestive surgery are a severe complication of the patient. The identification of paraclinical laboratory investigations which would allow an early diagnosis of fistulas would lead to the optimization of patient's management. We have performed a retrospective study on 100 cancer patients, with digestive tract surgeries, between May 2016 and December 2017, in the First Clinic of General surgery and Surgical Oncology from the Bucharest Oncology Institute. The postoperative follow-up included: the testing of the C reactive protein (CRP ), and also the monitoring of the number of leukocytes (Ld) from the abdominal cavity, with probes taken from the drainage tube, all in association with the number of leukocytes in the blood (Ls) in all patients (with or without digestive fistula). By calculating the values of these tests and comparing them always with the clinical evolution of the patients, and sometimes with other tests as well, one would confirm an early diagnosis of fistula. The data obtained have shown that in patients with digestive fistulae there is a rapid growth and maintaining of increased values of serum PCR and of the leukocytes from the peritoneal cavity, values to which we associated also an increase in blood leukocytes. The modifications appear with approx. two days before the appearance of clinical signs or their confirmation through imagery (ultrasound, computed tomography). The regular and standardized follow-up in days 1, 3 and 5 postoperatively of the PCR value in blood, of the number of leukocytes in the abdominal cavity and of the serum leucocytosis, increasing the value of these parameters, could allow the early identification of the patients with a risk of fistula and the rapid selection of those which need supplementary investigations and/or surgical intervention.

The Importance of the Nutritional Factor and the Stage of the Disease in Postoperative Fistula in Patients with Gastric Cancer.

Introduction: In gastric cancer there are multiple local and general risk factors for the occurrence of postoperative fistulas. In the present study, we proposed to analyse the role of the preoperative nutritional state and nutritional therapy along with the disease stage, the age and the sex of patients in the occurrence of fistulas. Material and method: This retrospective study included 158 patients operated for gastric cancer in Surgery Department of Bucharest Oncology institute between January 2010 and December 2016 in which we analysed the incidence of anastomotic fistula according to the nutritional status, disease status, age and sex of the patients. Results: The global incidence of fistulas was of 11%, out of which 8 % were fistulas of the duodenal stump and 3.19% fistulas of the eso-jejunal anastomosis. Out of the 30 patients with weight loss and parenteral nutrition in the preop period, we had 4 fistulas (13%), and out of the 36 patients with weight loss and nutritional measures in the postop we had 5 fistulas (14%), also, out of the 24 patients with weight loss and without nutritional intervention, we had 5 fistulas (21%), finally, out of the 68 patients without weight loss we had fistulas in 4 patients (6%).. The incidence of fistulas was 5% in patients with stage I, II and III and 24% in stage IV patients. The distribution of fistulas according to the age of the patients showed a much higher incidence of fistulae in patients over 70 years old. Conclusions: The number of postoperative fistulas was higher in the advanced stages of the disease (p=0.027) and in patients over 70 years old (p=0.047) and the differences were statistically significant. The difference between the number of fistulae occurred in patients who had weight loss but did not receive nutritional support from those who received this support was not statistically significant (p 0.001).

A Rare Case of a Testicular Teratoma Associated with a Neuroendocrine Tumour.

Introduction: We report a rare case of testicular teratoma combined with a neuroendocrine tumour, emphasizing the difficulty of the following aspects: the clinical and laboratory diagnosis, the treatment options and the evolution of patients suffering from this disease. Case presentation: The patients with testicular neuroendocrine tumours represent a rarity, considering that as of 2017, only 22 cases had been reported in the literature. The case operated on in our clinic presents an association between a testicular teratoma and a neuroendocrine tumour. A 39-year-old patient was admitted in our Department for a non-painful abdominal tumour and concomitant testicular tumour. The serum tumour markers (-human chorionic gonadotropin, -phetoprotein and lactate dehydrogenase) were within normal limits. Lung and bone metastases were diagnosed CT scan. The histopathological diagnosis consisted of immunohistochemical study of the orchidectomy specimen as well as of the bioptic material from bone marrow puncture. Conclusions: The diagnosis of testicular carcinoids is based on immunohistochemistry study. Radical orchidectomy is the only potentially curative treatment for this type of malignancy. Adjuvant chemotherapy determined size reduction of the lung and bone metastases and the disappearance of the lymph node metastases.

Prognostic Factors of Treatment Failure for Early Breast Cancer after Breast Conserving Surgery.

Introduction: Breast cancer is the most common cancer in women in developed Western countries and is becoming even more significant in many developing countries. Breast conserving surgery (BCS) has become the gold standard for patients with early breast cancer (EBC) (Stage I, II) with an appropriate patient selection. Important risk factors for treatment failure, include margin status, age, tumour multicentricity and use of radiotherapy and adjuvant hormone therapy. AIM: To establish the prognostic variables for ipsilateral breast tumour recurrence (IBTR) in EBC after BCS and the survival rate. Materials and Methods: We analyzed 100 patients with EBC who underwent BCS. Data were analyzed for treatment failure, an analysis was performed by Chi-square (χ²) test, Cox multivariate regression and Kaplan Maier for survival analysis. Results: 100 female patients underwent BCS for EBC. There were 75% of patients above 40 years old. T2 tumours were observed in 87% of patients and 53% patients had nodal involvement. There was a pattern of recurrence of 14%; Using the multivariate analysis tumour grade and margin were correlated to local disease free survival. The 3 years local disease free survival and overall survival was of 86 % and 97% respectively. CONCLUSION: Breast conservative surgery is a highly accepted surgery for early breast cancer with good result. Tumour grade and margin were correlated to local disease free survival.

Postoperative Investigations Resulting in Cost Reduction in Oncological Patients Undergoing Major Abdominal and Pelvic Surgery.

AIM: Rising costs in health care are of progressively growing interest and a major factor affecting hospitalization costs is represented by postoperative complications. Complications of Major Abdominal Surgery (MAS) are associated with increased morbidity and mortality. This study estimates the costs of postoperative care associated with complications. Material and Methods: We performed a retrospective study on 254 patients admitted to the 1st General and Oncological Surgery Clinic of the Bucharest Oncology Institute who were submitted to MAS. The total hospitalization, complications and treatment costs were analysed. Results: For a patient undergoing MAS, the average costs for surgery without complications are 5,791.3 RON and reach an average of 20,806 RON after major complications. CONCLUSION: The results provide insight into the costs of hospitalization for oncology patients submitted to surgical interventions. Complications occur in 20.86% of patients undergoing MAS and account for 50% of total care costs. Establishing and implementing a protocol aimed at early diagnosis and treatment of specific complications could lead to a decrease in morbidity and mortality, as well as of the costs of hospitalization.

Digestive Decompression to Prevent Digestive Fistulas After Gastric Neoplasm Resection.

Introduction: The risk of digestive fistula in patients operated for gastric neoplasm is increased due to biological imbalances generated by the cancer's progression, by diagnosis in advanced stages, and by the scale of intervention. Under these circumstances the use of some technical means to protect digestive sutures in these patients is useful. AIM: To analyse the efficiency of technical means to protect the digestive sutures in patients operated in various stages of development of gastric cancer. Material and Methods: We conducted a retrospective study on a group of 130 patients operated for gastric cancer in the 1st General Surgery and Oncology Clinic of the Bucharest Institute of Oncology, between 2010-2014. Results: 38.46% of the patients in the study group presented stage IV cancer with multiple complications and biological imbalances. 52 total gastrectomies and 40 gastric resections were carried out, while in 34 patients palliative "tumour excisions" or other types of palliative surgery were performed. In 15 of the cases with gastric resection a duodenal decompression probe was used, while in 13 of the patients with total gastrectomy an oeso-jejunal aspiration probe together with an oeso-jejunal feeding probe were used as additional technical measures to prevent fistula formation. The incidence of duodenal stump fistula was 7.69%, that of oeso-jejunal anastomosis fistula was 2.3%, with an overall mortality of 3.07% and that of gastro-jejunal anastomosis fistula was 0.76%. CONCLUSION: Given the risk of fistula development in patients with gastric cancer, as well as the increased risk in advanced stages of cancer development, we consider that the use of technical means of protection of digestive sutures is beneficial and opportune, lowering the incidence of fistulas, reducing their output, pathophysiological effects, and mortality.

Therapy of Stenosing Rectal Cancer.

Develop a rectal cancer management aims to establish an algorithm diagnostic, surgical treatment strategy implementation, strategy and neoadjuvant and adjuvant treatment response and optimal methods for assessing response to specific treatment. In trying to track this management, we studied the issues listed above, we conducted a retrospective clinical study, descriptive and included the analysis of data obtained on a sample selected 90 patients diagnosed with stenosing rectal cancer between January 2008 and December 2012 treated on the General Surgery Clinic I of "Prof. Dr. Al. Trestioreanu" Oncology Institute and on the General Surgery Clinic of Colentina Clinical Hospital, in Bucharest and aimed at analyzing the therapeutic attitudes of stenosing rectal cancer. Choosing the surgery, especially when applying preoperative and postoperative radiotherapy, with or without concomitant chemotherapy, it took into account the presence of stenosis (obstruction complete or incomplete) and the evolutionary stage locally and remotely disease.

A Pilot Study on Tamoxifen Sexual Side Effects and Hand Preference in Male Breast Cancer.

Recent clinical and imaging studies suggest that sex hormones modulate sexuality according to a psychophysiologic process of lateralization of the brain, with androgens playing a greater role in sexual functioning of left hemibrain/right handedness and estrogens possibly for right hemibrain/left handedness. Based on this perspective, the current study attempted to specify the relationship between hand preference, estrogens, and sexual function in subjects with male breast cancer, taking into account the sexual side effects of tamoxifen as the agent for inhibiting estrogen action. Twenty-eight Romanian men-17 right-handed and 11 left-handed-undergoing treatment with tamoxifen for male breast cancer participated in this study. These men were assessed both prior to and during tamoxifen treatment using the International Index of Erectile Function, a standardized instrument used for the evaluation of various aspects of sexual functioning, including erectile function (EF), orgasmic function (OF), sexual desire (SD), and overall functioning (OF). A main effect for handedness was found on EF, OF, SD, and OS scales, with right-handed men showing higher functioning than left-handed men. Regarding interaction effects, the left-handed group of men showed greater decreased sexual functioning during tamoxifen (on three subscales: OF, SD, OS) compared to right-handed men. Further research should be conducted in order to support and refine this potential lateralized process of sexual neuromodulation within the brain.