Chapters authored
Thyroidectomy without Ligatures in Differentiated Thyroid Cancer
Technical improvements in thyroid surgery are nearly close with the progress of the vessels sealing systems. In all cases, we need to obtain a radical and safe thyroid excision. This chapter is conducted to evaluate the technical key point and the postoperative benefits of our procedure using vessels sealing devices in differentiated thyroid cancers. A prospective study, carried out in First Surgical Clinic, Emergency County Clinical Hospital Tirgu Mureș, Romania from January 01, 2013 to March 01, 2018, based on 100 consecutive patients, divided into two groups: first group without ligatures, using Small Jaw LigaSure™, and the second group operated by conventional procedure. Statistical analysis of some parameters (the thyroid pathology, operative time, hospitalization days, analgesic drugs, immediate postoperative complications and histopathological findings) shows that this procedure provides a total and “complete” removal of the thyroid specimen, with a decreased operative time and fewer hospitalization days.
Part of the book: Cancer Survivorship
Quality of Life Following Intersphincteric Resections for Low Rectal Cancer: Early Results
Intersphincteric resections are part of the therapeutic arsenal that preserves the sphincterian apparatus. This chapter analyzes the evolution of rectal surgery leading up to intersphincteric resections, deals with anatomical and oncological aspects in rectal cancer, and finally shows our own personal experience with ISR in a series of 40 cases focusing on oncological outcomes, continence, and defecation. As a conclusion, intersphincteric resection represents a feasible therapeutic option in highly selected cases that exempts the patient from the need of a permanent colostomy bag without compromising oncological principles. The Wexner score system is simple and effective in objectifying continence in patients that undergo this type of surgery.
Part of the book: Cancer Survivorship
Emergency Treatment of Transverse Colon Cancer
This chapter deals with the emergency treatment of transverse colon cancer. The main complications that classify transverse colon cancer in an emergency setting are obstruction, perforation accompanied by localized or generalized peritonitis, and hemorrhage which may be occult or cataclysmic with hemorrhagic shock. We present the technical principles of radical surgical resection using embryological, anatomical, and oncological concepts. In this chapter we also discuss the principles of lymphadenectomy associated with complete excision of the mesocolon with high vascular ligation, in particular with T3 or T4 cancers requiring D2/D3 lymphadenectomy. The use of infrapyloric, gastro-epiploic, and prepancreatic lymphadenectomy is recommended due to the frequent metastases in these regional lymph nodes.
Part of the book: Current Topics in Colorectal Surgery
The Utility of Magnetic Resonance Imaging in the Multidisciplinary Treatment of Patients with Rectal Cancer
Rectal cancer is one of the most common types of cancer in both men and women. In recent years, the importance of magnetic resonance imaging (MRI) has greatly increased in the multidisciplinary treatment of patients with rectal cancer. MRI has a particularly important role in the most accurate preoperative staging of these patients, both in terms of assessing the local invasion of the tumor and in terms of assessing the status of pelvic lymph nodes. Many patients with rectal cancer, especially those in the advanced stage of the disease, in the preoperative period undergo neoadjuvant radio chemotherapy. The evaluation of the clinical response of these patients to neoadjuvant therapy is of crucial importance both in terms of personalized treatment and in terms of their prognosis. In this regard, MRI has its clearly defined role at present in evaluating the efficacy of neoadjuvant therapy, as well as in postoperative follow-up.
Part of the book: Current Topics in Colorectal Surgery