Impact of immunotherapy with pseudomonas serotip xv etanolic extract (Cantastim) on local recurrence and survival at 3 and 5 years in operated rectal cancer

Although most recurrences (approximately 80%) occur in the first three years after a curative resection, a recurrence of CRC can occur even ten years after the initial curative resection (dormant spread of cancer cells). Immunotherapy is an emerging therapy with high potential. The immune system plays a major role in the development of CRC. This has led to innovative new therapies, such as cancer vaccines and T-cell stimulation therapies. Cantastim belongs to the class of nonspecific immunostimulators or immunomodulators, most of which are of bacterial origin and are used as mono- or polymicrobial suspensions. Cantastim is an ethanolic extract obtained from a pathogenic strain of Pseudomonas aeruginosa serotype XV. The beneficial effect of immunotherapy with Cantastim was more pronounced for the local developmental stages (I and II) than for the later stages

CRITERIA FOR THE DEFINITION AND CLASSIFICATION OF COMPLEX POST-INCISION HERNIAS

Recurrence after postinicizsional hernia surgery is an unsolved problem so far. In literature the hernia reccurence varies between 1% and 50%, influenced by the postoperative follow-up period. The purpose of this paper is to describe the term „complex postincisional hernia“. It becomes necessary to clarify the term and make a classification in order to be able to apply a surgical treatment adapted to the patient's plurifactorial pathology and to allow comparison of the results between the different surgical methods. This paper is a review of the literature on this subject, obtained through the use of EPOS, NCBI, PubMed, MedLine, Embase and other international databases

CLINICAL-STATISTICAL STUDY OF MULTIPLE SYNCHRONOUS AND METACRONE TUMORS

Multiple malignant tumors, synchronous, metachronous, represent a subject currently under development. Risk assessment, standardization of screening and and to map the sequences of the occurrence and localization represents current issues. For further study, we evaluated 30 patients who developed 3 or more malignancies. The study has a retrospective character, the information being obtained from the history and the medical documents of the patients admitted to the General Surgery II of the Bucharest Emergency Hospital during 2010-2019

Emergency surgery in complex incisional hernias management

Introduction. Complex incisional hernias are a surgical challenge and a current socio-economic problem. In the emergency surgery of this pathology, the surgeon faces the need to obtain a "tension-free" hernia repair being limited in the use of parietal prosthesis due to the frequent needs of opening the gastrointestinal tract and thus contamination of the operating field. Purpose. The aim of this study is to evaluate and adapt emergency surgical treatment in order to reduce the risk of postoperative complications. Material and methods. The present study has a retrospective character and evaluates a group of 390 patients with complex incisional hernias admitted and operated in the General and Emergency Surgery III section of the Bucharest University Emergency Hospital during 2008-2018. Results. We identified 390 patients diagnosed with complex incisional hernias, of whom 95 were presented to the hospital as an emergency. The prosthetic hernioraphy was used in 51 of these patients, and complications were found in 18 patients in the total study group, ranging from wound infection to death. Discussions. The occurrence of postoperative complications was not statistically significantly associated with emergency surgical treatment. Instead, vital complications were much more common in this group. Conclusions. Increasing the degree of information and education of the patient, increasing addressability and avoiding emergency operations for this pathology are long-term objectives in the treatment of complex incisional hernia pathology

ANASTOMOTIC RECURRENCE AFTER 1/3-YEAR RECTAL NEOPLASM OPERATED WITH PRESERVATION OF THE ANAL SPHINCTER

The quality of surgery, the limits of resection, the total excretion of "mesorectum", mechanical or manual anastomosis and pre-and postoperative oncologic treatment of rectal cancer, all these, may influence the incidence of local recurrence. We have analyzed the case of a 62-year old patient with rectal bleeding , diarrhea, and rectal tenesmus. The colonoscopy revealed a rectal tumor located at 10 cm from anal-rectal limit. A biopsy was taken from the tumor: moderately differentiated adenocarcinoma. CEA and CA19.9 tumor markers were found within normal limits. There was performed rectal resection with end-to-end colonic – rectal anastomosis with Stapler 32. Postoperatively, pathological examination: rectal adenocarcinoma NOS with low degree of malignancy G2 – moderately differentiated, diffuse infiltration to the musculature, without metastasis in regional nodes (only identified 5), completely excised surgically – it was classified as pT2pNo (G2) stage. Postoperatively, the patient did not perform oncology treatment. Colonoscopy which was performed 1 year after surgery, revealed a bleeding tumor located at the anastomosis level. Biopsies were taken from the anastomosis tumor. The result confirms the local recurrence of invasive adenocarcinoma. Milles rectum amputation is decided and practiced. Postoperatively the patient performs oncological treatment. Preoperative staging is an important factor in determining the indication of radiotherapy

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous