Port-site metastasis after laparoscopic surgery for colorectal cancer--still a real concern? Case report and review of the literature.

BACKGROUND: The recently published long-term oncological results of the large multicentric randomized prospective trials, such as COST, COLOR, and UK MRC CLASICC, have diminished once more the initial skepticism from the mid '90s, regarding the safety of laparoscopic approach for colorectal cancer surgery. The actual incidence of port-site metastases (PMSs) in the laparoscopic surgery for colorectal cancer is just arround 1%, being statistically simmilar to the wound metastases after open colorectal surgery. We followed up a series of 122 laparoscopic-assisted resections for colorectal adenocarcinoma, 49 for rectal cancer and 73 for colon cancer. The operations were performed at the Center of Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania, between 1st January 2002 and 31st december 2008. There was only one case of PMS (0.81%). CASE-REPORT: A 83-year old man developed a recurrent parietal tumor on the site of extraction minilaparotomy, 4 months after laparoscopic-assisted right hemicolectomy for a Dukes C, poorly differentiated (G3) adenocarcinoma of the cecum. DISCUSSIONS: We have reviewed the scientific relevant literature regarding the incidence and multi-factor etiology of PMSs in the laparoscopic surgery for colorectal cancer as well as the methods suggested for prevention of parietal tumour dissemination to the trocar or wound sites. CONCLUSION: PMSs consecutive to laparoscopic surgery for colorectal cancer are no longer a big concern enough to contraindicate this beneficial surgery for oncological reasons. However, PMSs continue to represent a reality which must be taken into consideration by any laparoscopic surgeon. There are different prevention measures that should be applied for reducing the occurence of this possible complication.

Stem cells therapies for gastrointestinal and liver diseases.

Stem cells therapies represent a new field of biomedical science which could provide in the future the cure for diseases until now incurable. The present paper reviews current knowledge on key biological properties of stem cells with focus on hepatic and gastrointestinal stem cells and current applications of stem cells therapies in gastrointestinal and liver diseases. Potential clinical applications for stem cells therapies have been suggested from animal model trials in acute liver failure, inherited metabolic liver disease and endstage liver disease (cirrhosis). Hematopoietic autologous stem cells transplantation has already been successfully performed in patients with severe inflammatory bowel disease or patients with refractory celiac disease with aberrant T cells. Future stem cells therapies for gastrointestinal postoperative or Crohn's disease fistulas are currently under investigation. More research is needed for perfecting stem cells harvesting protocols from different sources, in vitro expansion and differentiation protocols which can be used in phase II and III clinical trials.

[Orthotopic liver transplantation in adult patients with cadaveric grafts. Experience of the Fundeni Center of General Surgery and Liver Transplantation]. / Transplantul hepatic ortotopic de la donator cadavru la adult. Experienta Centrului de Chirurgie Generalai si Transplant Hepatic Fundeni.

We analyze the experience of the Center of General Surgery and Liver Transplantation from the Fundeni Clinical Institute (Bucharest, Romania) regarding orthotopic liver transplantation (OLT) in adult recipients, with whole liver grafts from cadaveric donors, between April 2000 (when the first successful LT was performed in Romania) and December 2004. This series includes 37 OLTs in adult recipients (16 women and 21 men, aged between 29-57 years--average 46 years). Other two LT with whole liver cadaveric grafts and two reduced-size LT were performed in children; also, in the same period, due to the acute organ shortage, other methods of LT were performed in 28 patients (21 living donor LT, 6 split LT and one "do mino" LT), that were not included in the present series. The indications for OLT were HBV cirrhosis--10, HBV+HDV cirrhosis--4, HCV cirrhosis--11, HBV+HCV cirrhosis--2, biliary cirrhosis--5, Wilson disease--2, alcoholic cirrhosis--1, non-alcoholic liver disease--1, autoimmune cirrhosis--1. With three exceptions, in which the classical transplantation technique was used, the liver was grafted following the technique described by Belghiti. Local postoperative complications occurred in 15 patients (41%) and general complications in 17 (46%); late complications were registered in 18 patients (49%) and recurrence of the initial disease in 6 patients (16%). Intrao- and postoperative mortality was 8% (3/37). There were two patients (5%) who died because of immunosuppressive drug neurotoxicity at more than 30 days following LT. Four patients (11%) died lately because of PTLD, liver venoocclusive disease, recurrent autoimmune hepatitis and liver venoocclusive disease, myocardial infarction, respectively. Thirty-four patients survived the postoperative period (92%); according to Kaplan-Meier analysis, actuarial patient-survival rate at month 31 was 75%.

Liver hemangioma revisited: current surgical indications, technical aspects, results.

BACKGROUND/AIMS: New developments regarding the diagnosis of liver hemangiomas, surgical indication and therapeutic options emerged recently. We reviewed our experience from the point of view of these modern developments. METHODOLOGY: Fifty-seven patients with liver hemangiomas were retrospectively studied. The relationship between size, symptoms and treatment was assessed. RESULTS: Indication for surgery was the size of the lesion in 5 patients, symptomatology in 48 and uncertain diagnosis in 4. Increase in size was noted in four patients. Six patients had associated intraabdominal benign or malignant pathology. The treatment of choice was enucleation. Postoperative complications were noted in 6 patients and mortality was nil. In 3 patients the hemangiomas recurred and were reresected in 2. CONCLUSIONS: Hemangiomas should be resected when larger than 10 cm and when they become symptomatic. With the modern diagnostic work-up, uncertainty of diagnosis as an indication for surgery should be rare. Surgery remains the main treatment, with a low morbidity and mortality if performed in a specialized hepatobiliary unit. Enucleation is the surgical option of choice. In selected cases laparoscopic enucleation can be performed with good results.

[Pyogenic liver abscess]. / Abcese hepatice piogene. Evaluarea schimbarilor aparute în etiologie, diagnostic, tratament si evolutie.

The objective of this study was to investigate and report changes in presentation, management and outcome of patients with pyogenic liver abscess (PLA). Between 01.01.1995-31.12.1999, 27 patients with PLA were treated in the General Surgical Service of the Fundeni Clinical Hospital. The incidence of cryptogenic abscesses was dominant (55.5%). The symptoms and the biological status are frequently nonspecific. The CT scan and echographic examination sensibility in the diagnosis of the PLA was 89.5% and 78.3%. The aerobe germs are most involved. All patients received antibiotic treatment in preoperative as in postoperative period. The surgical treatment was performed in 24 patients: in 9 patients (33.3%), the abscess was surgically evacuated and drained and in 15 patients (55.5%), a liver resection was performed. Percutaneous catheter drainage under CT or echo-guidance was performed in three patients (11.1%). The clinical evolution was good in 21 patients (77.7%). There was four complications (14.8%) and two death (7.4%). Although with a better prognostic, the PLA remains an important pathology.

[Hepatic serial resection. Portal vein resection followed by hepatic resection in second time]. / Rezectia hepatica seriata. Ligatura de vena porta urmata de rezectie hepatica în timpul doi.

Hepatic resection still remains the only potential curative treatment for either primary or secondary malignant liver tumors. In order to increase the resectability of initially considered non-resectable tumors and to decrease the posthepatectomy morbidity and mortality, ligature of a portal branch with consecutive hepatic resection is recommended. The ligature of a portal venous branch was performed in 12 patients with gross hepatic tumor: hepatocellular carcinoma (2), peripheral cholangiocarcinoma (5), hepatic metastases from colorectal cancer (5). Two-stage hepatectomy was performed in 5 patients. The interval between the two operations ranged between 4 weeks and 6 months. Hepatic resection could not be performed in 7 cases due to the loco-regional progression of the disease (4 cases) or to the absence of the hypertrophy-atrophy process (3 cases). Hepatic failure occurred posthepatectomy in 2 patients, resulting in the death of one of the patients. Two patients died at 5 and 10 months respectively while two other patients are still alive, free of recurrence at 6 and 12 months respectively. In conclusion, portal vein ligature can be considered in selected cases of unresectable gross hepatic tumors that can be eventually, resected in a second operation. The two-staged hepatectomy is not always feasible. Moreover, the hypertrophy of the controlateral lobe does not always prevent the postoperative hepatic failure..

[Liver transplantation--considerations over 8 cases operated in the year 2000]. / Transplantul hepatic--consideratii asupra a 8 cazuri operate în anul 2000.

In the year 2000, at the Department for General Surgery and Liver Transplantation from The Fundeni Clinical Institute Bucharest, seven OLTs and one living-related transplantation were performed in 6 adults and 2 children. Postoperative complications were: bile leakage, hemoperitoneum, lower gastrointestinal hemorrhage, parietoabdominal hematoma. There was only one postoperative death due to septic complications in the 18th p.o.d. and one late death due to pneumonia of unknown origin. After the results in the year 2000 there was an increased number of donors and referrals. We consider that now in Romania this is an established program that will continue depending on the number of donors and financing.

Collagen-based scaffolds for skin tissue engineering.

The aim of this study was to obtain four collagen based porous scaffolds and to assess their in vitro biocompatibility and biodegradability in order to use them for skin tissue engineering. We have prepared four variants of collagen-based biodegradable sponges by liophilization of type I collagen solution and three variants of collagen-agarose mixture in different ratios 2:1 (A), 1:1 (B) and 1:2 (C). These scaffolds had microporous structure with a higher than 98% porosity and a reduced biodegradation after their exposure to UV radiation. The incorporation of agarose into the collagen scaffolds has improved their structural stability. In vitro biocompatibility testing for the four types of sponges was performed on a stabilized fibroblast cell line and showed that both cell viability and morphology were not altered by collagen and collagen-agarose variants A and B sponges. These three porous sponges demonstrated potential for future application as cell scaffolds in skin tissue engineering.