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Quality assessment of surgery for colorectal cancer:Where do we stand?

World Journal of Gastrointestinal Surgery 2024年第4期16卷 982-987页

作者： Stefan Morarasu Cristian Livadaru gabriel-mihail dimofte The Second Department of Surgical Oncology Regional Institute of OncologyIasi 707483Romania

Quality assurance in surgery has been one of the most important topics of debate among colorectal surgeons in the past *** has produced new surgical standards that led in part to the impressive oncological outcomes we see in many units *** mesorectal excision,complete mesocolic excision(CME),and the Japanese D3 lymphadenectomy are now benchmark techniques embraced by many surgeons and widely recommended by surgical ***,there are still ongoing discrepancies in outcomes largely based on surgeon *** is one of the main reasons why many countries have shifted colorectal cancer surgery only to high volume *** markers of surgical quality is thus a perquisite to ensure that standards and oncological outcomes are met at an institutional *** the evolution of CME surgery,various quality markers have been described,mostly based on measurements on the surgical specimen and lymph node yield,while others have proposed radiological markers(*** stumps)measured on postoperative scans as part of the routine cancer *** is no ideal marker;however,taken together and assembled into a new score or set of criteria may become a future point of reference for reporting outcomes of colorectal cancer surgery in research studies and defining subspecialization requirements both at an individual and hospital level.

关键词： Colorectal cancer Colon surgery Arterial stump Complete mesocolic excision Surgical quality

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Post-operative computed tomography scan – reliable tool for quality assessment of complete mesocolic excision

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World Journal of Gastrointestinal Oncology 2019年第3期11卷 208-226页

作者： Cristian Livadaru Stefan Morarasu Tudor Cristian Frunza Florina A Ghitun Elena Florina Paiu-Spiridon Florina Sava Cristina Terinte Dan Ferariu Sorinel Lunca gabriel mihail dimofte "Grigore T Popa" University of Medicine and Pharmacy 2~(nd) Clinic of Surgical Oncology Regional Oncology Institute "Grigore T Popa" University of Medicine and Pharmacy Department of Radiology Regional Oncology Institute "Grigore T Popa" University of Medicine and Pharmacy Department of Pathology Regional Oncology Institute "Grigore T Popa" University of Medicine and Pharmacy

BACKGROUND Quality control in colon cancer surgery is an ongoing debate ever since standardization proved to be highly efficient in improving survival in rectal cancer. Complete mesocolic excision(CME) is widely acclaimed as the new goldstandard in colon cancer resections, thus it is imperative to establish quality criteria of CME in order to make it easily understood and verified by surgeons worldwide. One simple and reproducible tool could be the measurement of arterial stumps postoperatively and a straightforward way to test its reliability is to test it in a comparative study between CME and non-CME *** To validate arterial stump measurement as a surgical quality tool by comparing CME with conventional radical *** This was a retrospective study, carried out on a prospective database. We collected data from two groups of patients, divided according to standard CME with D2 central vascular ligation(group A) and non-standardized surgery(group B). The two groups were compared with regard to the arterial stump length after right-and left-sided colectomies for colon cancer. The actual stump lengths of the ileocolic artery(ICA) and inferior mesenteric artery(IMA) were compared with their theoretical best D2 position of predicted ligation levels(D2 PLLs) for calculating the potential for improvement. Measurements on follow-up computed tomography scans were carried out by three observers. Pathological data were recorded(specimen length, lymph node yield) and correlated with stump *** We analysed 58 colectomies. The stump lengths(mean ± SD) in group A were16.97 ± 4.77 mm for ICA and 31.70 ± 15.71 mm for IMA, whereas group B had 49.93 ± 20.29 mm for ICA and 67.24 ± 28.71 mm for IMA. Shorter lengths were obtained in group A, by a mean difference of 35.66 mm(χ~2 = 27.38, P < 0.001),which was significant for all types of colectomies. Except for a 5.85 ± 4.71 mm difference for right colectomies, all the ligations from group A significantly re

关键词： Complete mesocolic excision Central vascular ligation Colon surgery Arterial stump measurement Computed tomography

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Age,blood tests and comorbidities and AIMS65 risk scores outperform Glasgow-Blatchford and pre-endoscopic Rockall score in patients with upper gastrointestinal bleeding

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World Journal of Clinical Cases 2023年第19期11卷 4513-4530页

作者： Bianca Codrina Morarasu Victorita Sorodoc Anca Haisan Stefan Morarasu Cristina Bologa Raluca Ecaterina Haliga Catalina Lionte Emilia Adriana Marciuc Mohammed Elsiddig Diana Cimpoesu gabriel mihail dimofte Laurentiu Sorodoc Department of Internal Medicine and Toxicology Saint Spiridon University Regional Emergency HospitalFaculty of Medicine“Grigore T.Popa”University of Medicine and PharmacyIasi 700111Romania Department of Emergency Medicine Saint Spiridon University Regional Emergency HospitalFaculty of Medicine“Grigore T.Popa”University of Medicine and PharmacyIasi 700111Romania Second Department of Surgical Oncology Regional Institute of OncologyFaculty of Medicine“Grigore T.Popa”University of Medicine and PharmacyIasi 700111Romania Department of Radiology Emergency Hospital“Prof.Dr.N.Oblu”Faculty of Medicine“Grigore T.Popa”University of Medicine and PharmacyIasi 700309Romania Department of Gatroenterology Beaumont HospitalDublin D09V2N0Ireland

BACKGROUND Upper gastrointestinal(GI)bleeding is a life-threatening condition with high mortality *** To compare the performance of pre-endoscopic risk scores in predicting the following primary outcomes:In-hospital mortality,intervention(endoscopic or surgical)and length of admission(≥7 d).METHODS We performed a retrospective analysis of 363 patients presenting with upper GI bleeding from December 2020 to January *** calculated and compared the area under the receiver operating characteristics curves(AUROCs)of Glasgow-Blatchford score(GBS),pre-endoscopic Rockall score(PERS),albumin,international normalized ratio,altered mental status,systolic blood pressure,age older than 65(AIMS65)and age,blood tests and comorbidities(ABC),including their optimal cut-off in variceal and non-variceal upper GI bleeding *** subsequently analyzed through a logistic binary regression model,if addition of lactate increased the score *** All scores had discriminative ability in predicting in-hospital mortality irrespective of study ***65 score had the best performance in the variceal bleeding group(AUROC=0.772;P<0.001),and ABC score(AUROC=0.775;P<0.001)in the non-variceal bleeding ***,ABC score,at a cut-off value of 5.5,was the best predictor(AUROC=0.770,P=0.001)of inhospital mortality in both *** score was a good predictor for endoscopic treatment(AUC=0.604;P=0.046)in the variceal population,while GBS score,(AUROC=0.722;P=0.024),outperformed the other scores in predicting surgical *** of lactate to AIMS65 score,increases by 5-fold the probability of in-hospital mortality(P<0.05)and by 12-fold if added to GBS score(P<0.003).No score proved to be a good predictor for length of *** ABC score is the most accurate in predicting in-hospital mortality in both mixed and non-variceal bleeding *** and GBS should be used to determine need for endoscopic and surgical intervention,respective

关键词： Glasgow-Blatchford Pre-endoscopic Rockall Age older than 65 Age,blood tests and comorbidities Risk score Gastrointestinal bleeding

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Role of immunotherapy in gastric cancer with liver metastasis

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World Journal of Clinical Oncology 2024年第11期15卷 1383-1389页

作者： Bogdan Gafton Stefan Morarasu gabriel dimofte Department of Oncology Regional Institute of OncologyIasi 700483Romania Department of Oncology Grigore T.Popa University of Medicine and PharmacyIasi 700115Romania Second Department of Surgical Oncology Regional Institute of OncologyFaculty of MedicineGrigore T.Popa University of Medicine and PharmacyIasi 700115Romania Department of Surgery University of Medicine and Pharmacy Grigore T.Popa IaşiRegional Institute of Oncology IasiIasi 700483Romania

Gastric cancer continues to be a significant issue for public health,marked by its widespread occurrence and high mortality rates,even as the incidence of the disease shows a declining *** liver is the primary site for metastatic spread,with the peritoneum,lungs,and bones also being common *** the advent of biologic treatments and the introduction of immunotherapy for patients with metastatic conditions,the options to treat metastatic gastric cancer have *** diversified therapeutic approach is designed to enhance patient quality of life and prolong survival,showcasing the progress in treatment modalities for individuals with gastric cancer and liver metastases.

关键词： Gastric cancer Immunotherapy Liver metastases Metastatic gastric cancer Oncology Surgical oncology

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