The Impact of the COVID-19 Pandemic on Colorectal Cancer Patients in a Tertiary Center in Romania. Single Center Retrospective Study.

Background: The novel coronavirus, SARS-COV-2, was first reported in Wuhan, China in the end of 2019. To curb its spread, social distancing measures and new safety regulations were implemented which led to major disruptions in colorectal cancer care. It is however unknown how it influenced the Romanian colorectal cancer care. Methods and Material: We assessed the demographical, clinical, intraoperative and pathological data of our colorectal cancer patients, 302 in total, between 15.03.2019-14.03.2021. The first year's data was considered as the control group and the second one, the study (pandemic) group. Results: We observed a 12% decrease in colorectal cancer hospitalizations in the first year, 38,6% in the first six months. The rate of emergency admissions, colo/ileostomy formatting procedures, palliative resections, clinical metastasis was higher in the pandemic group. More advanced locoregional invasion, a higher tumor stage, higher rate of vascular, perineural invasion, positive resection margin, and a higher lymph node yield was seen after the restrictions were implemented. Conclusion: The COVID-19 pandemic and the response against it had a major effect on the colorectal cancer care in our country. The outcomes of these worse clinical and pathological findings are unknown, but it is important to do further research in this field. We think colorectal cancer care should have an absolute priority in future pandemics.

The diagnostic challenges in a child with intestinal tuberculosis.

INTRODUCTION: Romania is one of the European countries with a significant burden of tuberculosis (TB). Although pulmonary TB is still highly prevalent, intestinal TB is very rare and remains a diagnosis of exclusion, especially in children. The authors aimed to raise the awareness on this pathology by discussing the challenges faced in the management of one difficult case. CASE PRESENTATION: A 3-year-old boy was hospitalized in the Pediatrics Department of Grigore Alexandrescu Emergency Children's Hospital, Bucharest, Romania, for abdominal pain and melena. On clinical examination, he was malnourished, with generalized edema and marked abdominal distension. Laboratory tests revealed iron-deficiency anemia, low plasma proteins, inflammatory syndrome and high fecal calprotectin. The abdominal ultrasound showed bowel wall thickening and diffuse edematous mesentery; the colonoscopy described multiple ulcers with edematous margins. Parenteral nutrition and complex antibiotic treatment were initiated with no effect. During the hospital stay, the medical staff observed how the mother chewed the patient's food. The child's pulmonary X-ray was normal, but the mother's was suggestive for pulmonary TB. The QuantiFERON® test was positive. Biopsy of the bowel mucosa revealed numerous granulomas; the Auramine O∕Rhodamine B staining of the specimen was positive. Specific TB treatment was started with good results: the patient resumed growth, abdominal pain and distention disappeared. CONCLUSIONS: Intestinal TB poses a diagnostic challenge, especially in the absence of pulmonary disease. It may mimic many other intestinal pathologies. Since correct treatment depends on making the correct diagnosis, a high index of suspicion must be kept when facing atypical abdominal symptoms.

Elderly Patients with Colorectal Cancer - A Predisposed Category for Postoperative Complications.

Introduction: Colorectal cancer (CRC) is among the leading causes of cancer-related deaths around the world. Elderly patients are often considered as a high-risk category of patients, predisposed for postoperative complications. Materials and methods: 138 patients aged over 75 years and diagnosed with colorectal cancer were retrospectively reviewed. Patients were divided in two groups, as follows: Study Group including patients who developed postoperative complications, and Control Group including patients without problems in the postoperative period. There were compared clinical, preoperative, surgical, postoperative and oncological data. The aim of study was to determine possible risk factors for short-term postoperative complications and analyze of the influence of postoperative complications on survival. Results: Risk factors as male gender, obesity, heart failure, diabetes type II, severe anemia, low total protein level, ASA III-IV classification, emergency surgery, prolonged surgical intervention, increased intraoperative blood loss, prolonged hospital stay, distal localization of tumors, TNM stages III-IV, surgery for digestive cancer and non-cancerous major abdominal surgery in the medical history were identified. Conclusion: The surgical treatment of colorectal cancer in the aging population still remains a challenge, these category of patients should benefit of special attention in order to ensure a chance to minimize or avoid these complications.

Safety of Anastomoses in Right Hemicolectomy for Colon Cancer.

Introduction: Colorectal cancer is one of the most common malignant tumor of the digestive system, the incidence of this cruel disease has been increasing at a constant rate. Materials and methods: 236 patients diagnosed with right colon cancer were retrospectively reviewed. For all patients included in this study, right hemicolectomy or extended right hemicolectomy with ileo-colonic anastomosis was performed. Patients were divided in two groups, as follows: study group including patients which developed anastomotic leakage, and control group including patients without anastomotic leak. There were compared clinical, surgical, postoperative and anastomotic leakage (AL) related data within the two groups.The study investigates possible risk and protective factors for developing anastomotic leakage, furthermore the relationship between anastomotic leakage and mortality was analyzed. Results: risk factors for AL as advanced age, tumors of the right 1/3 of transvers colon, emergencysurgery, mechanical suture, S-E anastomosis, late start of bowel motility were identified during the current research. S-S anastomotic technique were identified as protective factor in the development of fistula. Conclusion: According to the results of the present research, in right colon tumors S-S anastomotic technique should be used, being linked with the lowest chances of anastomotic leakage.

Long-term outcomes of laparoscopic sleeve gastrectomy - a single-center prospective observational study.

INTRODUCTION: Laparoscopic sleeve gastrectomy (LSG) is an established bariatric procedure. AIM: We present our long-term results regarding weight loss and comorbidities during 9 years. MATERIAL AND METHODS: We calculated the percent excess weight loss (%EWL) and changes in body mass index (ΔBMI). We evaluated arterial hypertension (AHT), type 2 diabetes (T2DM) and obstructive sleep apnea syndrome (OSAS). RESULTS: One hundred seventy-nine patients were included (136 female/43 male), mean age of 40.47 ±11.08 years, median preoperative body mass index (BMI) of 42.93 kg/m2. Median follow-up period was 72 months (36-84 months). The %EWL during follow-up was 41.8 (n = 179 patients, at 3-month follow-up), 64.1 (n = 163), 75.33 (n = 134), 77.1 (n = 103), 76,03 (n = 99), 73.78 (n = 64), 71.58 (n = 37), 63.83 (n = 22) and 64.1 (n = 14) at 6, 12, 18, 24, 36, 48, 60 and 72 months, respectively. We noted a negative correlation between %EWL and both the age and initial weight and BMI of the patient; a negative correlation between gender (male patients) and %EWL was also found. After LSG, 68.2% of patients with AHT presented resolution (no medication) or significant improvement (doses reduced) of the disease. As regards T2DM, 65.8% described resolution or significant improvement after surgery. Furthermore, 31 (70.4%) patients with preoperative OSAS reported resolution/improvement within a year from surgery. CONCLUSIONS: Laparoscopic sleeve gastrectomy is a safe and effective procedure, with good results in the short and medium term. Long-term follow-up reveals a tendency to weight regain after approximately 2 years from primary surgery, with the need for revisional surgery in some cases.

A prospective follow-up study on completion thyroidectomy for well-differentiated thyroid cancer. A single-center report.

BACKGROUND: Completion thyroidectomy (cT) becomes a choice after any type of less than total thyroid surgery, when a "total" would have been indicated on primary intervention if malignancy diagnosis had been available. The study main aim is to define predictive factors of malignancy in the thyroid remnant and to assess the morbidity risk after cT according to the type of initial intervention. MATERIAL AND METHOD: Sixty-three patients on whom cT was performed were finally included with 61 surgeries performed in our department. RESULTS: Or cohort included 55 (87.3%) women and 8 men (12.7%), with a mean age of 48.3 on whom were primary performed 34 lobectomies with isthumusectomies (LwI=53.96%) and 29 subtotal thyroidectomies or hemithyroidectomies (STT=46.03%). Histopathological examination after reintervention detected malignancy in 30.15% of excised thyroid remnants (19 patients), in the majority of these cases microcarcinoma. We found statistically significant correlations between the risk of malignancy in the thyroid remnant and both the primary thyroid tumor multicentricity (p=0,001) and its extracapsular and/or vascular invasion (p=0,006) respectively. The time span between the two interventions ranged from 3 days to 12 months (mean 63 days). No 30-day mortality occurred in our group of patients. We noted 3 cases of RLN palsy (4.76%) of which one permanent (1.58%) and 12 cases (19.04%) of postoperative hypoparathyroidism, of which two (3.17%) permanent. CONCLUSIONS: Multicentricity and capsular and/ or vascular invasion of the initial tumor are factors predictive of malignancy in the remnant thyroid. The rate of postoperative hypoparathyroidism is higher after initial subtotal thyroidectomy. KEY WORDS: Completion thyroidectomy, Incidental parathyroidectomy, Multifocality, Thyroid cancer.

Fatal Hypocalcaemia Due to Hungry Bone Syndrome with Secondary Refractory HyperParathyroidism After Parathyroidectomy: A Case Report.

INTRODUCTION: Hungry bone syndrome (HBS) refers to the rapid, profound, and prolonged hypocalcaemia associated with hypophosphatemia and hypomagnesaemia, and is exacerbated by suppressed parathyroid hormone (PTH) levels, which follows parathyroidectomy in patients with severe primary hyperparathyroidism (PHPT) and preoperative high bone turnover. [1]. CASE REPORT: This report concerns a dialysed patient who underwent surgical treatment for secondary refractory hyperparathyroidism. Haemodialysis was carried out pre-operatively, and subsequently, a total parathyroidectomy with auto-transplantation of parathyroid tissue in the sternocleidomastoid muscle (SCM) was performed. Rapid and progressive hypocalcaemia symptoms developed during the second day postoperatively. Acute cardiac symptoms with tachyarrhythmia, haemodynamic instability and finally asystole occurred, which required cardiopulmonary resuscitation (CPR). The ionic calcium level was 2.2 mg/dL being consistent with a diagnosis of HBS. A second cardiac arrest unresponsive to CPR followed an initial period of normal sinus rhythm. Death ensued shortly after. Before death, the ionic calcium was 3.1 mg/dL. CONCLUSION: HBS, after parathyroidectomy in patients with secondary hyperparathyroidism (SHPT), may be severe, prolonged and sometimes fatal. Generally, HBS symptomatology is that of a mild hypocalcaemia. It can, however, include heart rhythm disturbances with haemodynamic alterations requiring intensive care measurements and even cardiopulmonary resuscitation. A close clinical and laboratory post-parathyroidectomy monitoring of dialysed patients is of the utmost importance.