EARLY COMPLICATIONS FOLLOWING ANATOMIC LUNG RESECTIONS--EXPERIENCE OF A THORACIC SURGICAL ONCOLOGY UNIT.

AIM: To analyze the medical and socioeconomic impact of the complications of anatomic lung resections performed at the Thoracic Surgery Unit of the Iasi Regional Cancer Institute. METHODS: This retrospective study included patients who underwent anatomic lung resections between January 2013 and August 2015. RESULTS: Over this interval a total of 172 major lung resections were performed: 31 (18.02%) pneumonectomies, 5 (2.91%) bilobectomies, and 136 (79.06%) lobectomies. Complications occurred in 36 patients, including bronchial stump fistula in 7 patients (4.06%), bronchopneumonia (9/5.23%), pleural empyema without bronchoscopically documented bronchial stump fistula (1/0.58%), chylothorax (1/0.58%), postoperative arrhythmia (3/1.74%), early postoperative stroke (1/0.58%), prolonged air leak (requiring hospital stay longer than 14 days) (11/6.38%), and postoperative hemothorax requiring reintervention (3/1.74%). Secondary to complications, a number of 3 (1.74%) patients died early postoperatively. CONCLUSIONS: The incidence of immediate and early postoperative complications is comparable to those reported by other authors.

PELVIC ACTINOMYCOSIS MIMICKING A LOCALLY ADVANCED PELVIC MALIGNANCY--CASE REPORT.

We present the case of a former user of an intrauterine contraceptive device (IUD) for 10 years, diagnosed with a bulky, fixed pelvic tumor involving the internal genital organs and the recto sigmoid, causing luminal narrowing of the rectum, interpreted as locally advanced pelvic malignancy, probably of genital origin. Intraoperatively, a high index of suspicion made us collect a sample from the fibrous wall of the tumor mass, large Actinomyces colonies were thus identified. Surgery consisted in debridement, removal of a small amount of pus and appendectomy, thus avoiding a mutilating and useless surgery. Specific antibiotic therapy was administered for 3 months, with favorable postoperative and long-term outcomes. Pelvic actinomycosis should always be considered in the differential diagnosis of pelvic tumors in women using an IUD. The association of long-term antibiotic treatment is essential to eradicate the infection and prevent relapses.

PALLIATIVE TREATMENT OF MALIGNANT ESOPHAGOPULMONARY FISTULAS WITH COVERED SELF-EXPANDABLE METALLIC STENTS (SEMSS). A SINGLE CENTER EXPERIENCE.

AIM: The aim of our study was to determine the efficiency of SEMSs in patients with esophagopulmonary fistulas, regarding fistula closure, enhancement of dysphagia scores and survival rates. MATERIALS AND METHODS: Between January 2004 and June 2014, from a total of 133 patients who underwent stent placement procedures, 26 were diagnosed with esophagopulmonary fistulas. In 19 cases the fistulas were caused by esophageal carcinomas and in 7 cases by bronchogenic ones. 16 patients developed aspiration pneumonia, 3 lung abscess and 7 subclinical fistulas. RESULTS: Complete fistula sealing occurred in 26 patients (100%). There were no immediate procedural complications except chest pain in 5 cases. After sealing of the fistulas and antibiotic treatment, pneumonia has regressed. After stent insertion, the dysphagic syndrome improved significantly (mean dysphagia scores decrease from 3.28 to 1.3 after stent insertion). The main goal of palliative therapy in patients with unresectable cancer and esophago-pulmonary fistulas is to close the fistulas, thus preventing the aspiration of saliva and food into the bronchus. Other goals include amelioration of dysphagia symptoms, maintenance of oral intake and improvement of quality of life. Ultimately covered expandable metal stents may increase survival rate as compared with other therapies. CONCLUSIONS: The endoscopic placement of covered SEMSs is the treatment of choice for malignant esophago-pulmonary fistulas.

POSTOPERATIVE ARTERIAL RELAXATION AND INTRAOPERATIVE VENOUS DILATION AS INTERCONNECTED PROGNOSTIC FACTORS FOR THE MATURATION OF ARTERIOVENOUS FISTULAS.

AIM: To investigate if immediate arterial distention can be used as a predictive factor for the development of a good fistula. MATERIAL AND METHODS: Over a 5-months period (January- May 2015) all the patients who underwent an arteriovenous fistula between the radial artery and the cephalic vein of the forearm at the Second Surgical Clinic of the Iasi Regional Cancer Institute and were willing to participate were enrolled in the study. The diameters of the vessels were measured 1 hour and 8 weeks after surgery. RESULTS: We found statistically significant differences for all measured diameter variations between the calcified artery and normal artery groups (p < 0.001 for the arterial distention at 1 hour and 8 weeks after surgery and p = 0.002 for the venous distention 8 weeks after surgery). A linear regression also showed that the degree of arterial distention immediately after surgery and the venous distention 8 weeks after surgery were statistically correlated. CONCLUSIONS: Arterial distention immediately after surgery and therefore the lack of it due to the presence of arterial calcifications can be used to predict whether or not a good fistula can be achieved at a 1% statistical significance level.

Corelation of lymphocytic infiltrates with the prognosis of recurrent colo-rectal cancer.

BACKGROUND: Recent studies are focusing on complementary prognostic and predictive markers that could complete the predictive TNM staging and one of the most promising directions is the study of tumor immune infiltrates. MATERIALS AND METHODS: Our 2-year retrospective study includes resection specimens from the primary tumors of 23 patients presenting to our clinic for a local or a distant relapse after colon or rectal cancer. From every primary tumor specimen we obtained immunohistochemically stained slides in order to assess cd3, cd4, cd8, cd45ro and cd68 infiltrates. Digital analysis assessed the density and percentage of positively stained cells in the normal peritumoral tissue, invasive margin and center of the tumor. RESULTS: A small density of cd8 positive cells in the peritumoral region was strongly correlated with a longer disease-free interval (p=0.009) and the Kaplan-Meier survival analysis showed that the percentage of cd8+ T cells could be used to stratify patients in terms of relapse risk (p=0.006). We found no correlation between invasion front infiltrates and intra tumoral infiltrates and the disease-free interval. CONCLUSION: Our study concludes that cytotoxic T-cell infiltrates in the normal peritumoral tissue could be used to predict a more aggressive tumor in terms of the relapse risk.

Laser microdissection--a novel approach for accessing the molecular basis of cancer.

BACKGROUND AND AIM: It has been known for quite a lot of time that tumours are cellular aggregates of different cells, mainly malignant cells but also immune cells--of which the most well-known are the tumour infiltrating lymphocytes (TIL) and the tumour associated macrophages (TAM). By observing hematoxylin--eosin stained or immunohistochemical stained slides belonging to different areas of the tumour it is clear that there are clusters of malignant cells within the tumour itself that seem to behave differently from the rest of the tumour. Another fact is that different areas of the tumour contain different inflammatory cells which may promote carcinogenesis or may help to confine it. Whereas different immune cells can be recognised by using immunohistochemistry, a satisfactory characterization of the molecular characteristics of the malignant clusters of the tumour cannot be made without further use of different molecular techniques such as different PCR techniques or microarray methods. Laser microdissection thus comes as a valuable aid in choosing exactly which cells will be analyzed further on. PRINCIPLE OF THE METHOD: Laser microdissection is based on using the energy of a focused laser beam to cut through the thickness of the tissue that is placed on a microscope slide in order to obtain cell samples previously selected by the pathologist through special software. CONCLUSIONS: To be able to cut the cells that you want and analyze them further without having them contaminated with other cells means that you can get more insight into the progression of the mutations that occur in these malignant cells, mutations that cause them to become more aggressive or multidrug-resistant. This could in time lead to the discovery of new molecular targets for cancer therapy.