Impact on Long-term Survival of a Standardized Histopathological Protocol on the R1 Incidence in Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma.

Background: Pancreatic Ductal Adenocarcinoma (PDAC) is a pathology with a very poor prognostic, the only curative treatment option being surgery, in association with chemotherapy. This study aims to assess the influence that the use of a standardized pathology report after a pancreaticoduodenectomy (PD) has on the R1 margins rate and the impact that this has on long term survival. Material and Methods: We included 116 patients admitted to the Regional Institute of Gastroenterology and Hepatology Prof. Dr. O. Fodor Cluj Napoca, who underwent PD for PDAC (Pancreatic Ductal Adenocarcinoma) between January 2012 and May 2017. We divided them in two groups: 59 patients for which a nonstandardized histopathological protocol was used and 57 patients for which a standardized protocol was implemented. We considered a margin to be R1 when there were tumor cells at ¤ 1 mm from the resection margin. Results: The R1 percentage in the first group of patients was of 39%, while the R1 resection rate in the second group was of 68.4%. The median survival rate was similar in the two groups, with no statistically significant difference between them, but in the prospective study when comparing R0 vs R1 margins there was a statistically differences in 5 year OS with a p-value = 0.03. Conclusion: The use of a standardized pathology report reveals a significant increase in R1 resection rates. Also study revealed not only increasing R1 incidence when using a standardized histopathology report, but also that those margins (R1) playing a determinant role in 5-year OS. The mesopancreas is the most frequently R1 resection margin.

Microscopic Positive Margins in Gastric Adenocarcinoma Following Oncological Resection: Prognostic Factors and Long-Term Survival.

BACKGROUND: In the context of gastric cancer, surgical resection stands as the sole curative treatment. Central to influencing overall survival are the resection margins. This research aims to identify the factors influential in determining microscopically positive resection margins (R1) and to evaluate overall survival. METHODS: Our study encompassed 549 patients diagnosed with adenocarcinoma of the stomach who underwent curative-intent surgery between January 2011 and December 2021 in our Surgery Department. We investigated the incidence of positive margins (R1) and their impact on survival rates, as well as the determinants of R1. The standardization of R1 involved ensuring a margin distance of less than 1 mm from the tumor line to the margin. RESULTS: The incidence of R1 margins was 13.29% (73 patients). Among these, proximal R1 margins were observed in 29 patients (39.72%), while 49 cases (67.12%) presented circumferentially positive margins, with 20 cases (27.39%) exhibiting distally positive margins. Nineteen patients (26.02%) had two R1 margins, and 3 patients had all resection margins microscopically positive (4.10%). Factors such as tumor dimension, invasion of other organs, pT stage, pN stage, pL1 stage, pV1 stage, pPn stage, Lauren type, and tumoral grading demonstrated significance (p < 0.01) in the occurrence of positive R1 margins. CONCLUSION: Tumor dimension, invasion of other organs, pT stage, pN stage, pL1 stage, pV1 stage, pPn stage, Lauren type, and tumoral grading could be regarded as factors for predicting microscopically positive margins. Moreover, positive resection margins have a detrimental impact on overall survival.

Perineal Hernia Mesh Repair Using Only the Perineal Approach: How We Do It.

Perineal hernia is a rare complication of rectal surgery. Different types of surgical approach have been described, but none of them have proven their superiority. Although there are many methods of closing the defect, we selected two cases to present from a series of five cases, in which the perineal hernia was successfully resolved surgically using only the perineal approach. The reconstruction of the perineal floor and closure of the defect were performed using a synthetic polypropylene mesh. The significance of this Technical Note article lies in the fact that we describe, step by step, a surgical technique for perineal hernia using just a perineal approach.

SARS-CoV-2 associated liver injury: a six-month follow-up analysis of liver function recovery.

Background and aims: SARS-CoV-2 infection has raised the interest in clinical and paraclinical research worldwide, representing a public health issue since the beginning of 2020. Studies have established the variable, unpredictable character of COVID-19. Our main objective was to assess the liver function of patients without pre-existing liver disease, diagnosed with SARS-CoV-2 associated liver injury in a 6-month follow-up study after discharge from hospital. Methods: We conducted a prospective paraclinical and imagingstic follow-up study between 1st September 2020 and 30th April 2021 on patients without pre-existing liver disease previously diagnosed with SARS-CoV-2 associated liver injury who had been admitted in Mures County Clinical Hospital, Targu Mures, Romania. We followed up the patients 'clinical and paraclinical datacharacteristics at index COVID-19 hospitalization and at T1 (6-month follow-up visit). Results: We performed abdominal ultrasonography and laboratory examinations in 78 patients (mean age 45±10 years) hospitalized 6 months earlier for symptomatic COVID-19, with a male:female ratio of 1.3:1.Thirty patients (38.46%) were discharged at index COVID-19 hospitalization with abnormal liver function tests, while the rest presented paraclinical normalization at discharge and mean duration of liver injury of approximately 7 days. Follow-up examination revealed abnormal liver function tests in twenty-four patients, most of which presented with mild liver injury. All patients with severe COVID-19 at index hospitalization presented with abnormal liver function tests at follow-up examination. Conclusions: By performing a complete clinical and paraclinical 6-month follow-up study, with a specific focus on 34.6% of patients in which we noted a persistence of liver function tests abnormality, we could analyzse a possible long-term effect of SARS-CoV-2 infection over liver function and also raise awareness of liver function tests monitoring and therapeutic management in post COVID-19 patients. Long-term follow-up studies of COVID-19 multi-organ sequelae are therefore mandatory in order to improve the practice of consultant gastroenterologists.

Duodenopancreatectomy for PDAC Associated with MALS: A Case Report.

Introduction: Pancreatic ductal adenocarcinoma (PDAC) is an aggressive form of pancreatic malignancy which occurs in over 90% of such cases. Pancreaticoduodenectomy (PD) is used with a curative purpose for localized PDAC. Case presentation: A 68-year-old woman presented to our service through a transfer from another service, to be investigated and treated for a head of the pancreas tumor in a tertiary referral hospital. After a complete clinical and paraclinical evaluation, the patient was diagnosed with a PDAC and also with a median arcuate ligament syndrome (MALS). The surgical treatment was considered adequate, therefore, the patient underwent a PD with transmesocolic hepaticojejunostomy, pancreaticogastric anastomosis, precolic end-to-side gastrojejunostomy, Witzel jejunostomy and with the help of the cardiovascular surgery team from the Heart Institute, Cluj- Napoca, an aortohepatic bypass using saphenous vein graft was performed. Conclusion: Bypass was essential because the blood flow in the proper hepatic artery was not restored after sectioning the median arcuate ligament and clamping the gastroduodenal artery. The patient had a favorable outcome. The particularity of the present case consists of the complete occlusion of the celiac trunk by MALS and the total vascularization of the supramesocolic organs due to the superior mesenteric artery through the gastroduodenal artery.

Nanotechnology in the Diagnostic and Therapy of Hepatocellular Carcinoma.

Hepatocellular carcinoma is the most common liver malignancy and is among the top five most common cancers. Despite the progress of surgery and chemotherapy, the results are often disappointing, in part due to chemoresistance. This type of tumor has special characteristics that allow the improvement of diagnostic and treatment techniques used in clinical practice, by combining nanotechnology. This article presents a brief review of the literature focused on nano-conditioned diagnostic methods, targeted therapy, and therapeutic implications for the pathology of hepatocellular carcinoma. Within each subdomain, several modern technologies with significant impact were highlighted: serological, imaging, or histopathological diagnosis; intraoperative detection; carrier-type nano-conditioned therapy, thermal ablation, and gene therapy. The prospects offered by nanomedicine will strengthen the hope of more efficient diagnoses and therapies in the future.

Antimicrobial Meshes for Hernia Repair: Current Progress and Perspectives.

Recent advances in the development of biomaterials have given rise to new options for surgery. New-generation medical devices can control chemical breakdown and resorption, prevent post-operative adhesion, and stimulate tissue regeneration. For the fabrication of medical devices, numerous biomaterials can be employed, including non-degradable biomaterials (silicone, polypropylene, expanded polytetrafluoroethylene) or biodegradable polymers, including implants and three-dimensional scaffolds for tissue engineering, which require particular physicochemical and biological properties. Based on the combination of new generation technologies and cell-based therapies, the biocompatible and bioactive properties of some of these medical products can lead to progress in the repair of injured or harmed tissue and in tissue regeneration. An important aspect in the use of these prosthetic devices is the associated infection risk, due to the medical complications and socio-economic impact. This paper provides the latest achievements in the field of antimicrobial surgical meshes for hernia repair and discusses the perspectives in the development of these innovative biomaterials.

Impact of the Severity of Liver Injury in COVID-19 Patients Admitted to an Intensive Care Unit During the SARS-CoV2 Pandemic Outbreak.

INTRODUCTION: The World Health Organization (WHO) identified a novel coronavirus, originating in Wuhan, China, in December 2019, as a pneumonia causing pathogen. Epidemiological data in Romania show more than 450.000 confirmed patients, with a constant number of approximately 10% admission in intensive care unit. METHOD: A retrospective, observational study was conducted from 1st March to 30th October 2020, comprising 657 patients, confirmed as having COVID-19, and who had been admitted to the intensive care unit of the Mures County Clinical Hospital, Tîrgu Mures, Romania, which had been designated as a support hospital during the pandemic. Patients who presented at admission or developed abnormal liver function tests in the first seven days of admission, were included in the study; patients with pre-existing liver disease, were excluded. RESULTS: The mean (SD) age of patients included in the study was 59.41 (14.66) years with a male: female ratio of 1.51:1. Survivor status, defined as patients discharged from the intensive care unit, was significantly associated with parameters such as age, leukocyte count, albumin level, glycaemia level (p<0.05 for all parameters.). CONCLUSIONS: Liver injury expressed through liver function tests cannot solely constitute a prognostic factor for COVID-19 patients, but its presence in critically ill patients should be further investigated and included in future guideline protocols.