Comprehensive Analysis of Perioperative Factors Influencing the Risk of Biochemical Recurrence in Patients with Radical Prostatectomy.

PURPOSE: To analyze the perioperative factors that influence the risk of biochemical recurrence (BCR) in patients with localized PCa undergoing radical prostatectomy MATERIALS and METHODS: A total of 457 patients, operated by 2 surgeons in our high-volume oncological center were included in the initial database. Patients who underwent RP for clinically localized PCa in our clinic from 2016 to 2021 were included in the study. Perioperative data were retrospectively reviewed for this study. Follow-up data including post-operative PSA and adjuvant treatment was prospectively gathered by contacting the patients or from the follow-up consultation. Final database was composed of 366 patients who underwent open or 3D laparoscopic RP. Statistical analysis was performed to emphasize the most powerful parameters that influence the BCR.  Results: Accounting for multivariable analysis, 4 parameters were statistically significant: initial PSA (iPSA), Gleason score, vascular involvement and positive surgical margins. For the group of patients with no positive margins, 3 parameters were statistically significant: iPSA above 10,98 ng/mL (AUC=0,71); lymph node involvement and Gleason score. Multivariable Cox regression showed that positive margins and iPSA had a significant impact on the time to BCR. Patients that received adjuvant therapy were excluded from the study. Out of the whole cohort, 27,3% of patients presented BCR. RESULT: Accounting for multivariable analysis, 4 parameters were statistically significant: initial PSA (iPSA), Gleason score, vascular involvement and positive surgical margins. For the group of patients with no positive margins, 3 parameters were statistically significant: iPSA above 10,98 ng/mL (AUC=0,71); lymph node involvement and Gleason score. Multivariable Cox regression showed that positive margins and iPSA had a significant impact on the time to BCR. Patients that received adjuvant therapy were excluded from the study. Out of the whole cohort, 27,3% of patients presented BCR. CONCLUSION: Perioperative factors need to be carefully analyzed and a detailed follow-up needs to be conducted in order to assess the risk of biochemical recurrence, resulting in the optimal time for adjuvant treatment implementation.

Laparoscopic Gastric Plication vs Laparoscopic Sleeve Gastrectomy - A Single Center, Prospective and Case-Control Study.

BACKGROUND AND OBJECTIVES: The laparoscopic gastric plication (LGP) is a restrictive bariatric procedure, still under investigation, considered to be an alternative to laparoscopic sleeve gastrectomy (LSG). The aim of the present study was to compare the outcome of LGP with the results of LSG. Materials and Methods: The study was conducted on a total of 100 patients, from which 50 patients underwent LGP and other 50 patients had the LSG operation. To analyze the effectiveness of both procedures total weight loss (%TWL), change in body mass index ( BMI) and percentage of excess weight loss (%EWL) were measured and calculated for four distinct timelines: 6 months, 12 months, 24 months and 36 months after the procedure. Comorbidities were evaluated based on clinical and laboratory investigation. Results: Starting from 6 months after surgery, weight reduction was statistically significant in favor of the LSG group, with the highest differences found after two and three years postoperatively (p=0.0001). No differences were found between the two procedures in terms of compliance or improvement of the main comorbidities. Conclusions: As compared to LSG, LGP has similar outcomes in terms of the length of hospitalization, major complications and improvement of the main comorbidities. LSG procedure was found to be superior in terms of medium- to long-term weight reduction. LGP is a technique that may provide better results in obese patients with a lower BMI (less than 40 kg/m2).

Neuroendocrine pancreatic tumor - diagnosis circumstances, staging and treatment: a case report.

Neuroendocrine neoplasms (NENs) of the pancreas are rare and frequently malignant. Our presentation of a pancreatic NEN analyzes the diagnosis circumstances, staging, treatment, one-year evolution and disease particularities. A 39-year-old nonsmoker patient was admitted in the Clinic of Pulmonology, Tirgu Mures, Romania with a pneumonia suspicion (fever, thoracic pain irradiated below the diaphragm, mild dyspnea). The chest X-ray showed a rise of the left diaphragm. Abdominal ultrasound revealed a large pancreas-related tumor. Computerized tomography (CT) scan with contrast confirmed a well-vascularized pancreatic tumor, which invades spleen, collateral circulation of the splenic vein, enlarged liver without secondary lesions and no retroperitoneal adenopathies. The patient was referred to the surgery where there was performed total tumor resection, spleen resection, and large lymphadenectomy. Histopathology and immunohistochemistry revealed the pancreatic NEN G2 grade, T3N1M0 and allowed accurate treatment. 2010 World Health Organization (WHO) NENs classification recommends further treatment-related biomarkers determination only in selected cases. Our case evolution after one year was favorable without local tumor relapse or metastases. The close survey of the patient (by clinical exam, imaging and biological markers) is ongoing. The onset of asymptomatic pancreatic tumor may have atypical respiratory symptoms. Imaging methods (ultrasound, contrast CT) are recommended in borderline symptomatology. Radical surgical resection of the tumor with lymphadenectomy, histopathology with immuno-histochemistry play an essential role in the correct diagnostic, grading, staging and treatment of pancreatic NENs. Close survey of the clinical, imagistic and biological markers is recommended.