The use of Mobile Applications in the Perioperative Management of Patients with Colorectal Cancer

Background and Aim: Colorectal cancer is the third most common cancer worldwide both in men and women. The scope of this systematic review was to investigate if mobile applications exists and what are the benefits in the screening, diagnostic, pre-operative preparation, or post-operative follow-ups on the patients with colorectal cancer.  Materials and Methods: We used the frame of PRISMA guideline. On September 1th, 2023, we systematically searched PubMed using the MeSH terms “Colorectal Neoplasms” and “Mobile Applications”. No restrictions on the types of articles or publication date were imposed. Results: A total of 24 items were retained. The article’s titles and abstracts were screened and 7 articles were removed due to the absence of the abstracts (n=2), the article described a prognostic scoring model (n=2), one was a systematic review, one was reviewing the use of SMS and one was a letter to the editor.  Out of the 17 remaining articles, only 7 were available in full text and all were testing mobile applications. The scope of using the applications was to facilitate screening (n=3), recovery (n = 3) and monitor chemotoxicity (n=1). Conclusions: Mobile tools appear as an opportunity for rapid access and increased adherence to colorectal cancer screening guidelines. Mobile applications focused on patient recovery post colorectal cancer surgery need a more patient-centric approach. The mobile application built for monitoring chemotoxicity was deemed to address many of the limitations of identifying and quantifying chemotherapy toxicities. All in all, mobile applications may enhance existing clinical care and provide cost‐effective real‐time patient support, which may reduce the likelihood of hospital admission

A Systematic Literature Review of the Use of Robotic Surgical Procedures in Thyroid Neoplasms

Background and Aim: The incidence of thyroid cancer has increased worldwide during the last decade, being one of the most common endocrine malignancies. Surgical resection, namely conventional thyroidectomy, remains at the frontline of therapy, Minimally invasive techniques gained popularity through the years. The purpose of this systematic review was to understand the most common techniques and to evaluate the outcomes of minimally invasive techniques. Materials and Methods: A literature search was conducted on 20 August 2023 using two MeSH terms: “Robotic Surgical Procedure” and “Thyroid Neoplasms” using PICOTS and PRISMA Statements. The results were narrowed to the articles available in full text. Results: A total of 31 items were retained. The article’s titles and abstracts were screened and nine articles were removed as five articles were reviews, two articles were case repots, one was a letter to the editor and one was describing the impact of augmented reality. Remaining 22 articles to analyze the content. Conclusion: This study found that the most used minimally invasive thyroid surgical techniques are robotic transaxillary thyroidectomy and robotic thyroidectomy by bilateral axillo-breast approach. From the systematic review, it can be concluded that for selected patients (well-differentiated thyroid carcinoma), these modern techniques are not inferior to standard of care and are a safe alternative, with the advantage of avoiding a potentially disfiguring scar in the neck, when performed by surgeons who are familiar with and experienced in endoscopic and robotic techniques

Iatrogenic bile duct injuries – the road to consensus

Scop: Leziunile iatrogene de cale biliară după colecistectomia laparoscopică reprezintă o problemă serioasă care trebuie manageriată corect din punct de vedere diagnostic și al unui tratament prompt. Multiple clasificări au fost dezvoltate și utilizate pentru descrierea acestor leziuni. Material și metode: Studiul nostru este un studiu de tip retrospectiv descriptiv cu scopul de a identifica rolul unei clasificări uniforme și complete, dar și implicarea acesteia în managementul leziunilor de cale biliară. Au fost incluși pacienți referați în centru nostru terțiar, pentru tratamentul leziunilor de cale biliară survenite după colecistectomia laparoscopică, pe o perioadă de 10 ani (2011-2020). Rezultate: O sută de pacienți au fost incluși în studiu; 15% din leziuni au fost întâmpinate la cazuri operate primar în serviciul nostru. În 73% din cazuri, leziunile nu au fost clasificate, în 23% din cazuri s-a utilizat clasificarea Strasberg, în 3% din cazuri clasificarea Bismuth, iar în 1% din cazuri clasificarea ATOM. După reclasificarea retrospectivă a tuturor cazurilor, s-a observat că clasificarea Straberg, dar chiar și clasificarea Hannover suprasimplifică complexitatea leziunii. Tratamentul în majoritatea cazurilor a fost derivația biliodigestivă (60% din cazuri). Concluzii: Clasificarea ATOM realizează o descriere comprehensivă a leziunilor biliare, putând ghida astfel tratamentul corespunzător în funcție de severitatea fiecărei leziuni. O clasificare uniformă ar trebui adoptată la scară largă pentru a asigura un limbaj comun în discuția referitoare la leziunile de cale biliară.Aim: Iatrogenic bile duct injuries after laparoscopic cholecystectomy represent a significant problem, that needs to be addressed correctly in terms of diagnosis and prompt treatment. Several classifications have been developed and used to describe these lesions. Methods: Our study is a retrospective descriptive study that aims to identify the role of an uniform and comprehensive classification and its implication on the consecutive management of the bile duct injury. We have included patients diagnosed with bile duct injury after laparoscopic cholecystectomy, referred to a tertiary centre, in a ten-year period (2011-2020). Results: We included in our study 100 patients; 15% of the BDI occurred in our center. No classification system was used in 73% of patients; 23% of the BDI were classified by the Strasberg system, 3% were classified by the Bismuth classification, 1% being classified by the ATOM classification. After retrospectively classifying all BDI, we observed that especially the Strasberg classification, as well as Hannover, over-simplifies the characteristics of the injury. Most main bile duct injuries underwent a bilio-digestive anastomosis (60%), as a definitive treatment. Conclusions: The ATOM classification performs a comprehensive description of the bile duct injury and subsequent guidance of the correct treatment according to the severity of each lesion. A consistent classification should be adopted, in order to assure a uniform discussion on iatrogenic bile duct injuries

Challenges and controversies in open pancreatoduodenectomies

Duodenopancreatectomia cefalopancreatica este o procedura intricata, ce necesita o inalta precizie datorita proximitatii structurilor vitale, sustinuta prin expertiza. O data cu evolutia chirurgiei si aparitia de instrumente inovatoare, mortalitatea a scazut sub 5%, dar morbiditatea a ramas la 30%, in special datorita fistulelor de anastomoza si a evenimentelor hemoragice. In acest sens, chirurgia deschisa confera rezultate mai bune, cu o curba de invatare rezonabila. Cu atat mai mult, cu cat efectuarea de trialuri clinice este dificila in acest domeniu, atat in chirurgia deschisa, cat si minim invaziva, pentru a obtine evidente valoroase, astfel subiectul ramane unul de dezbatere.Whipple procedure is intricate and demands high precision due to the proximity of critical structures, which requires an achieved expertise. With the innovative instruments and evolution of surgery, the perioperative morbidity still stands at 30% with a mortality lower than 5%, primary because of anastomotic leaks and haemorrhagic events. Therefore open surgery provides better outcomes with a decent learning curve. Furthermore, it is challenging to conduct clinical trials in the field of pancreatic surgery both open or minimally-invasive to obtain high-level evidence, remaining a subject open to debate

SARS-CoV-2 Breakthrough Infections: Incidence and Risk Factors in a Large European Multicentric Cohort of Health Workers

The research aimed to investigate the incidence of SARS-CoV-2 breakthrough infections and their determinants in a large European cohort of more than 60,000 health workers

Receiver Operating Characteristic Prediction for Classification: Performances in Cross-Validation by Example

The stability of receiver operating characteristic in context of random split used in development and validation sets, as compared to the full models for three inflammatory ratios (neutrophil-to-lymphocyte (NLR), derived neutrophil-to-lymphocyte (dNLR) and platelet-to-lymphocyte (PLR) ratio) evaluated as predictors for metastasis in patients with colorectal cancer, was investigated. Data belonging to patients admitted with the diagnosis of colorectal cancer from January 2014 until September 2019 in a single hospital were used. There were 1688 patients eligible for the study, 418 in the metastatic stage. All investigated inflammatory ratios proved to be significant classification models on both the full models and on cross-validations (AUCs > 0.05). High variability of the cut-off values was observed in the unrestricted and restricted split (full models: 4.255 for NLR, 2.745 for dNLR and 255.56 for PLR; random splits: cut-off from 3.215 to 5.905 for NLR, from 2.625 to 3.575 for dNLR and from 134.67 to 335.9 for PLR), but with no effect on the models characteristics or performances. The investigated biomarkes proved limited value as predictors for metastasis (AUCs < 0.8), with largely sensitivity and specificity (from 33.3% to 79.2% for the full model and 29.1% to 82.7% in the restricted splits). Our results showed that a simple random split of observations, weighting or not the patients with and whithout metastasis, in a ROC analysis assures the performances similar to the full model, if at least 70% of the available population is included in the study

Evaluation of Patients with Lower Extremity Peripheral Artery Disease by Walking Tests: A Pilot Study

Peripheral arterial disease (PAD) directly affects the quality of life, patients experimenting limited walking ability and disability. The purpose of the current study was to investigate the walking and climbing patterns of patients with lower extremity PAD in relation with several risk factors, applied on Romanian population. A cohort non-randomized design was conducted and all eligible subjects who self-referred for medical care since March 2016 until February 2017 at the Second Surgery Department, County Clinical Emergency Hospital of Cluj-Napoca were included. The eligible patients were older than 18 years, with leg pain and Rutherford grade from I to IV. The following tests were applied to each subject included in the study to investigate the capacity to walk as far as possible in six minute (6 minute walking test), the capacity to climb stairs (climbing stairs test) and the capacity to walk on a treadmill (treadmill test) until the pain occurred. Twenty-four patients with mean age of 65.08±8.53 years were investigated. Almost 81% of patients were with chronic pain, 46% were overweight, and 79% were smokers. The results on applied walking tests were as follows: 279.17±70.58 meters to 6-minutes walking test, 77.50±21.80 stairs and 182.50±73.34 meters on treadmill test. The results of the walking tests significantly correlate with each other (ρ>0.93, p|0.52|, p0.62, p<0.002). It can be concluded that any of the applied walking test proved reliable instrument, able to identify the patients with most severe PAD

Demographic and Comorbidity Pattern of Patients with Critical Limb Ischemia

Aim: The present study aimed at identifying the pattern of patients with critical limb ischemia (CLI) compared with those with peripheral arterial occlusive disease (PAOD)

Emergency Pancreatoduodenectomy: A Non-Trauma Center Case Series

(1) Background: Emergency pancreatoduodenectomy (EPD) is a rare procedure, especially in non-trauma centers. Pancreatoduodenectomy is a challenging intervention, that has even higher risks in emergency settings. However, EPD can be a life-saving procedure in selected cases. (2) Methods: Our study is a single-center prospective consecutive case series, on patients that underwent emergency pancreatoduodenectomies in our surgical department between January 2014 to May 2021. (3) Results: In the 7-year period, 4 cases were operated in emergency settings, out of the 615 patients who underwent PD (0.65%). All patients were male, with ages between 44 and 65. Uncontrollable bleeding was the indication for surgery in 3 cases, while a complex postoperative complication was the reason for surgery in one other case. In three cases, a classical Whipple procedure was performed, and only one case had a pylorus-preserving pancreatoduodenectomy. The in-hospital mortality rate was 25% and the morbidity rate was 50%; the two patients that registered complications also needed reinterventions. The patients who were discharged had a good long-term survival. (4) Conclusion: EPD is a challenging procedure, rare encountered in non-traumatic cases, that can be a life-saving intervention in well-selected cases, offering good long-term survival

The impact of glycogen storage restoration in elective liver resections

Ocluzia temporara a aportului vascular pe de o parte si pierderile sanguine importante, pe de alta parte, reprezinta componente cheie ale chirurgiei hepatice. Totodata, aceste strategii de management vor produce alterari ale functiei hepatice in postoperator. Studiul nostru isi propune sa elucideze efectul refacerii rezervelor de glicogen la pacientii propusi pentru rezectii hepatice elective asupra evolutiei biologice si a insuficientei hepatice postoperatorii.Temporary occlusion of blood inflow for resection on one hand and important blood loss on the other hand is a common strategy in liver surgery. However, hepatic vascular occlusion will undoubtedly impair liver function and anemia will produce systemic imbalances. Our study was designed to elucidate the effect of hepatocellular glycogen storages in alleviation of liver ischemia - reperfusion injury during intraoperative haemodynamic liver injuries for elective hepatectomies, the postoperative impairement and consecutive biologic liver failure