Mihaela Vartic

Complete mesocolic excision for colon cancer is technically challenging but the most oncological appealing

We read with really great interest the paper published by Gao et al. in Annals of Surgery (1). The authors presented the 3-year interim results of the Efficacy Study of Complete Mesocolic Excision, which is a prospective, non-randomized study with a planned duration of 5 years, started in 2012 (1). The main objective of this study is to evaluate the safety and effectiveness of complete mesocolic excision for colon cancer treatment. Gao et al. included 220 and 110 patients in the CME and conventional surgery groups, respectively. An important strength of the current study is the evaluation of the specimens by blinded third-party experts (1).

The laparoscopic approach in emergency surgery: A review of the literature

The role of laparoscopy in the acute care surgery had significantly increased during the latest years, both as a diagnostic and treatment method of all the upper or lower gastrointestinal pathologies. The objective of the present research is to review the current indications for laparoscopy in bdominal emergencies and to detail the benefits and complications associated with this approach. We have reviewed the relevant literature about this topic published between January 2005 and December 2017, using the PubMed/Medline and Web of Science Core Collection databases. According to the current evidence, we may conclude that the laparoscopic approach is an integral part of the emergency surgery for all the abdominal pathologies. Although laparoscopy requires specialized training and curricula, it brings all the benefits of minimal access in acute care arena.

Nonelective Left-Sided Colon Cancer Resections are Associated with Worse Postoperative and Oncological Outcomes: A Propensity-Matched Study

Background: Emergency general surgery patients are at significant risk of postoperative complications and mortality compared with their elective counterparts. Although challenged by some studies, increasing evidence shows that emergency colectomy for cancer is associated with worse early postoperative and long-term outcomes. Methods: We have included all patients with colon cancer admitted to the Emergency Hospital of Bucharest between January 2011 and January 2016. SELECTION CRITERIA (1) colon tumor; (2) left-sided localization of the tumor; (3) pathology exam revealing adenocarcinoma. EXCLUSION CRITERIA (1) rectal cancers; (2) benign pathology (e.g. diverticulitis). Results: We included 615 patients with left-sided colon cancer. 275 (44.7%) patients presented complicated disease. The complication was represented by obstruction in 205 (33.3%) patients (OG), hemorrhage in 55 (8.9%) patients (HG), and perforation in 15 (2.4%) patients (PG). The anastomotic leakage rate was similar between obstructive and elective cases (6.2% versus 6.5%, P 0.05), but was significantly higher for hemorrhagic patients (16%) (P=0.046). The 30-day complication rate and mortality were significantly higher in emergency patients (P 0.05). Conclusions: We found significant worse short- and long-term outcomes for patients with nonelective left-sided colon cancer resections. Correlating the ominous prognosis with the high incidence of the complicated disease, we may emphasize the impact on de complicated colon cancer on the general population.

Intraluminal Postpancreatoduodenectomy Hemorrhage - Last 5 Years Experience

Background: One of the most significant complications following pancreaticoduodenectomy is represented by postoperative hemorrhage. AIM This study undertook an analysis of the cases that presented intraluminal bleeding of mechanical gastrojejunal anastomosis following pancreatico duodenectomy (PD) in the last five years. Methods: From January 2012 until January 2017, 84 consecutive pancreaticoduodenectomies were performed and managed by the same surgical team. The preferred procedure of reconstruction was Whipple (76 patients). The gastrojejunal anastomosis was performed with Panther linear stapler GIA in all cases. ISGPS classification regarding postpancreatectomy hemorrhage was used to evaluate severity. Results: Out of 84 consecutive PD, a total of 7cases of intraluminal bleeding (8.33 %) were observed, detected on average on postoperative day 4. Relaparotomy was inevitable in two patients. Three patients from the studied group with intraluminal postpancreatectomy hemorrhage died. In the studied group there were no cases of bleeding from the pancreatico-enteric or bilio-enteric anastomosis. CONCLUSION Mechanical anastomosis might be questionable, severe hemorrhage demanding urgent relaparotomy which is correlated with high mortality rates. Intralumenal postpancreatoduodenectomy hemorrhage is a significant complication whose management depends on multiple factors and with a potentially fatal outcome.

Massive lower gastrointestinal bleeding after low anterior resection for middle rectal cancer – case report

Abstract Objective To emphasize the value of emergency diagnostic angiography and angioembolization in massive postoperative bleeding. Methods A case report was presented and electronic search of U.S. National Library of Medicine National Institutes of Health PubMed/MEDLINE, EMBASE, Google Scholar, ISI Web of Knowledge, to identify original articles and reviews about the subject. Results A 55 year-old male patient was addmited for rectal bleeding. ECOG index=2, digital rectal examination revealed the inferior pole of a middle rectal tumor. Colonoscopy exam validated the presence of a middle rectal tumor, 8 cm from the anal verge. CT scan showed rectal wall thickening up to 3 cm, that extends 9 cm proximally, whit infiltration of the perirectal fatty tissue and multiple enlarged lymph nodes up to 12 mm in dimension. There was a laparoscopic converted to open approach, with low anterior resection of the rectum and total mesorectal excision, an end to end stapled colorectal anastomosis and protective loop ileostomy. In the 5th postoperative day a massive lower gastrointestinal bleeding occured, with hypovolemic shock and a decrease in hemoglobin. Emergency angiography was performed. This revealed active bleeding from an internal iliac branch that was successfully angioembolized. Conclusions Angiography with angioembolization is an effective tool in emergency setting, avoiding the morbidity and associated mortality of a surgical reinervention. In early postoperative hemorrhages, only a rapid clinical recognition, a personalized diagnostic workup and an agressive intervention may offer the patient the best chances for cure.