Role of radio-ablative technique for optimizing the survival of patients with locally advanced pancreatic adenocarcinoma (Review).

Pancreatic ductal adenocarcinoma (PDAC) is one of the most common and frequently diagnosed malignant tumor of the pancreas with few treatment options and poor life expectancy. Despite the advances in the surgical field, 40% of the patients are diagnosed with locally advanced disease which is not suitable for surgery. Radio-frequency ablation (RFA) has been described as a new 'weapon' in the multimodal treatment of PDAC, representing a cytoreductive procedure which must be completed with radiotherapy or chemo-radiotherapy. A systematic research was carried out utilizing the PubMed database in regards to this subject, to evaluate the role of RFA in PDAC management. Abstracts, letters-to-the-editor and non-English language manuscripts were excluded. The literature showed that RFA can be used in open and laparoscopic surgery but it is also feasible for endoscopic ultrasound (EUS-guided RFA) or percutaneous approach. Even though we found optimistic and encouraging reports on overall survival (OS), randomized studies are still required to corroborate these findings. Our review research underline that surgical resection remains the only radical treatment option, RFA being a safe and feasible technique reserved for unresectable, non-metastatic pancreatic tumors. Its combination with oncological treatment can improve the OS of these patients.

Intraoperative ultrasound in liver and pancreatic surgery.

This paper summarizes the current knowledge of intraoperative ultrasonography (IOUS) in open and laparoscopic ab-dominal surgery. The abdominal IOUS contributes to the diagnosis and staging (for parenchymal organ tumors), to establish surgical procedure and to guide surgical maneuvers. The main applications are represented by liver, biliary tract and pancreatic pathology. Diagnostic approaches are frequently combined with therapeutic purposes. The technique, equipment, training, benefits and limits of IOUS in abdominal surgery are discussed and cases from our experience are used as examples.

Endoscopy-assisted, single trans-gastric trocar, laparoscopic pseudocysto-gastrostomy A minimally invasive alternative for drainage of large pseudocysts.

INTRODUCTION: Pancreatic pseudocyst is a complication of acute and chronic pancreatitis, which requires treatment in correlation with its size, symptomatology and mass effect on adjacent structures. Currently, pseudocyst drainage can be done within the stomach or small intestine through endoscopic, laparoscopic or open surgery approach. AIMS: In this paper we present a hybrid surgical technique applied by our team on 3 consecutive patients with pancreatic pseudocyst. METHOD: The pseudocysts were in all cases internally drained by endoscopic assisted laparoscopic approach, this article highlighting the technical aspects of this procedures. The patients were known with repeated episodes of acute pancreatitis. Imaging examinations indicated the presence of large pancreatic pseudocysts in all cases, for which we decided to perform a mechanical pseudo-cysto-gastro-anastomosis done laparoscopically-trans-gastric through a single trocar under endoscopic guidance. RESULTS: The length of surgery was from 60 to 90 min with no intraoperative blood loss recorded. The laparoscopic ultrasound was used in all cases to facilitate the safe localization of the future anastomotic site. The laparoscopic examination of the pseudocyst cavity was done systematically and in 2 cases revealed necrotic areas requiring debridement. The patients had no postoperative complications and were discharged 4-6 days after surgery. CONCLUSIONS: Internal drainage of pancreatic pseudocyst inside the stomach, by the technique described above, is facile, giving the patient the advantages of endoscopy and minimally invasive surgery. In these circumstances, we consider it superior to endoscopic drainage, by providing a broad communication between the pseudocyst and stomach cavity, reducing the risk of relapse and abscess formation. Moreover, it offers the possibility of exploring the pseudocyst cavity and of removing any necrotic tissues. The endoscopic assistance makes possible the single trans-gastric trocar approach, limiting the injury of the gastric wall. KEY WORDS: Endoscopic assisted laparoscopic procedure, Hybrid technique, Pancreatic pseudocyst, Pseudo-cystogastro- anastomosis technique.

Detection of epithelial specific cell adhesion molecules in colon cancer and the correlation with clinical and pathological characteristics EpCAM expression in colon cancer.

AIM: The aim of this study was to evaluate the correlation between EpCAM expression in colon cancer tissue and the clinico-pathological characteristics of the patients. MATERIAL AND METHODS: This is a prospective, longitudinal, observational study on 80 patients undergoing for colon cancer between January - December 2017. EpCAM expression at tumoral level was analyzed in relation with clinical and pathological variables of the patients using anti-EpCAM specific antibody. RESULTS: EpCAM expression was predominant in tumoral tissue compared to normal colonic mucosa and most of the cases (58.7%) showed increased EpCAM expression. Although increased EpCAM expression was observed in advanced stages and in patients with advanced locoregional disease, there was no statistically significant correlation with the clinical and pathological characteristics of the patients. DISCUSSION: The majority of the analyzed samples showed increased EpCAM expression in tumoral tissue suggesting its involvement in the carcinogenesis process. Numerous studies have identified EpCAM overexpression in colon cancer as a negative prognostic factor, being associated with advanced stage of the disease and a poor prognosis of the patient but results are inconsistent. Nevertheless, assessing a possible correlation between EpCAM expression at tumoral level and clinico- pathological characteristics is dependent on the type of antibody used to identify the molecule of interest. CONCLUSIONS: EpCAM detection in colon cancer using anti-human CD326/EpCAM clone VU-1D9 does not allow the correlation between its expression and the clinico-pathological characteristics of the patients and it should only be used for EpCAM identification in colon cancer tissues. KEY WORDS: Cancer, Colon, EpCAM, Immunohistochemistry.

Intraorbital Penetrating and Retained Foreign Bodies - A Neurosurgical Case Series.

AIM: To present the particularities of the intraorbital foreign bodies from a neurosurgical perspective by summarizing the findings of a case series. MATERIAL AND METHODS: A retrospective study was conducted including a consecutive series of 30 patients with intraorbital foreign bodies treated between 1999 and 2017. Statistical analysis was performed in order to characterize the factors that influence the location of the foreign bodies and the clinical signs. RESULTS: The orbital trauma occurred mostly in working accidents. Multiple intraorbital foreign bodies were found in 23.3% of the patients. Metallic foreign bodies were seen in 66.6%, and 30% had wooden foreign bodies. Nonmetallic foreign bodies were significantly associated with displacement of the eyeball, palpebral oedema and upper lid ptosis. Posterior orbit location was associated with displacement of the eyeball and conjunctival hemorrhage. Intraconal location was associated with mydriasis and conjunctival hemorrhage. The posterior orbit was occupied by foreign bodies in 63% of the patients. The foreign bodies were in the extraconal compartment in 55.55% of the cases. Small foreign bodies tend to be retained in the anterior orbit while large ones tend to be retained in the posterior orbit. CONCLUSION: The diagnosis and management of intraorbital foreign bodies must be tailored according to their type and location and to the clinical aspect of the patient.