(1) Background: Takotsubo cardiomyopathy, or stress cardiomyopathy, is an acute heart failure condition with transient left ventricular (LV) motion abnormalities but no significant coronary artery obstruction. It mimics acute coronary syndrome (ACS), with symptoms like chest pain, dyspnea, and ECG changes. (2) Case Report: We present the case of a 44-year-old female with relapsed colon cancer and peritoneal carcinomatosis. After undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC), she experienced cardiac arrest from ventricular fibrillation 18 h postoperatively. Echocardiography revealed a reduced LV ejection fraction (20%) and apical akinesia, suggesting a Takotsubo Cardiomyopathy. Intensive resuscitation and inotropic support led to gradual recovery. Coronary angiography confirmed no coronary artery obstruction. (3) Discussion: This case highlights TTS as a rare but severe complication following major oncological surgeries, possibly triggered by both physical and emotional stressors. TTS should be considered in the differential diagnosis of perioperative cardiac events in cancer patients. (4) Conclusions: Prompt recognition and management of TTS in the perioperative period are crucial to improving outcomes, especially in high-risk oncological patients undergoing extensive surgeries.

This case report details the application and outcomes of a novel therapeutic approach involving hyperthermic intraperitoneal chemotherapy (HIPEC) and hyperthermic intrathoracic chemotherapy (HITOC) in a single patient diagnosed with advanced ovarian neoplasm. The treatment protocol included pleural cytoreductive surgery (CRS) and HITOC followed by a second surgical intervention consisting of peritoneal CRS and HIPEC. HIPEC targeted the intraperitoneal space with heated chemotherapy, while HITOC extended the thermal perfusion to the thoracic cavity. The patient has shown significant progression in disease-free survival over one year and eight months of observation, demonstrating lower recurrence rates and an overall survival outcome exceeding expectations based on conventional therapy outcomes. The combined modality demonstrated a manageable toxicity profile, with no significant increase in peri- or postoperative complications observed.

(1) Background: We aim to present our experience with resection of the inferior vena cava (IVC) without reconstruction in two patients diagnosed with renal tumors. (2) Case Report: The first case was diagnosed with right renal vein sarcoma and the second case was diagnosed with clear cell renal carcinoma; both presented signs of invasion and thrombosis of the IVC at infrarenal and cruoric levels, along with the development of collateral circulation with the help of the paravertebral plexus. In both patients, en bloc right nephrectomy was performed along with the resection of the thrombosed IVC without further reconstruction. In the case of the patient with right vein sarcoma, preservation of the left renal and caval intrahepatic vein was possible, whilst in the second case diagnosed with clear cell renal carcinoma, the associated left renal thrombosis also enforced the resection of the left renal vein. (3) Discussion: Postoperative evolution was favorable in both cases and did not exhibit major complications. Antibiotic therapy, analgesics, and anticoagulant medication were administered at therapeutic doses after surgery in both cases. The histopathological examination of the surgical specimen confirmed the diagnoses of renal vein sarcoma in the first case and clear cell renal carcinoma in the second case. Surgical treatment and adjuvant chemotherapy prolonged survival for two years for the first case and for two months, up until this moment, for the second case. The survival of clear cell renal carcinoma is currently at two months. (4) Conclusions: The resection of the inferior vena cava, without subsequent reconstruction in cases presenting diffused distal thrombosis, can represent an alternative to IVC reconstruction, which might lead to a major ulterior risk of thrombosis. In some cases, this can result in long-term survival.

This chapter is dedicated to cytoreductive procedures and hyperthermic intraperitoneal chemotherapy (HIPEC) in the treatment of advanced ovarian cancer. Cytoreductive procedures and HIPEC constitute nowadays an important weapon in the surgical armamentarium used to treat ovarian cancer. Our service led by Dr. Moldovan Bogdan has an experience of 235 patients that underwent a HIPEC procedure, with an average of 33,5 cases/year which places us among some of the most experienced teams worldwide. We propose a chapter describing the indications and contraindications of such procedures, the surgical approach, followed by a description of our experience, including a review of our indications, the type of chemotherapeutic agents and a case example.

Introduction Gastroesophageal reflux disease (GERD) is a major public health problem. The "gold standard" in the surgical treatment of this condition is the laparoscopic technique called Nissen fundoplication. Aim This paper presents a safer alternative of the laparoscopic Nissen fundoplication, with special focus on the most difficult moment of the intervention, the creation of a retroesophageal passage. Material and method (presentation of the surgical technique) The conventional Nissen technique consists of the dissection of the esogastric junction in a clockwise direction, right to left: right pillar, hiatus, left pillar, retroesophageal passage, skeletonization of the fornix and reconstruction of the valve. We decided to perform a technique inspired from laparoscopic sleeve gastrectomy, which starts in anticlockwise direction, with the skeletonization of the upper third of the greater curvature of the stomach, then continues with the complete dissection of the left diaphragmatic pillar ("left side first") and finally with the dissection of the right pillar and the creation of the retroesophageal passage, thus, the procedure becoming less complicated. A complete decollement of the area nuda is performed, this way avoiding possible complications at this stage, like: bleeding from the area nuda or short vessels, ruptures of the stomach, esophagus, spleen, penetrating the thoracic cavity with a retroesophageal clamp, etc. Results Introduced in 2011, this technique was applied with success in all 20 consecutive cases of hiatus hernia operated in our clinic. There were neither intraoperative accidents and conversions nor early or late postoperative complications. 19 cases were primary Nissen while one case was a recurrent hiatal hernia after an insufficient cruroplasty made in another center. There were three cases in which we had to use Parietene Composite type mesh to strengthen the cruroplasty. Conclusion The applied modification has improved the original laparoscopic Nissen fundoplication technique, thus this has become a less complicated procedure at the same time providing more security to the patient.