Background and Objectives: The objective of this article is to evaluate the long-term oncological and functional outcomes following modified intersphincteric resections (ISR) for low rectal cancer. The modified technique consisted of the abandonment of colonic J-pouches, transverse coloplasty, or defunctioning temporary stoma in favor of a direct handsewn coloanal anastomosis (CAA). Material and Methods: Sixty consecutive patients with type II and III (juxta-anal or intra-anal) low rectal tumors underwent modified ISR by the same surgical team and were followed for a period of five years. Functional outcomes using the Wexner Score, postoperative complications, recurrence rates, morbidity, and mortality rates were assessed. Results: The five-year survival rate was 93.3% with a disease-free interval at three years of 98%. Morbidity was 15% (n = 9) consisting of intestinal wall necrosis (n = 6), stenosis (n = 2), and sacral metastasis (n = 1). The Wexner score values were, at 1 year, 8.5 (range, 4–13); at three years 7.2 (range, 2–11); and at 5 years 6.7 (range, 2–12). A second surgery was needed in only one case that showed postoperative transmural necrosis of the colonic wall. Conclusions: In highly selected patients with type II or III low rectal tumors and proper preoperative imaging staging, ISR might be a viable alternative to other techniques such as abdominoperineal resection and low anterior resection, both from a functional and an oncological perspective.

Background: Gastric cancer surgery requires not only oncological radicality but also functional reconstruction. Billroth I remains the most physiological method of restoring continuity, whereas Billroth II and Roux-en-Y are most frequently adopted in the oncological treatment. Nutritional and immune competence strongly influence postoperative outcomes, and the Controlling Nutritional Status (CONUT) score has emerged as a validated biomarker integrating albumin, lymphocyte count, and cholesterol in predicting complications in surgically treated patients. Methods: We conducted a prospective observational single-center study including 150 patients undergoing curative distal gastrectomy between October 2021 and December 2024. Reconstruction was performed using Billroth I (n=72) or Billroth II/Roux-en-Y (n=78). The CONUT score was assessed preoperatively (T0), early postoperatively (T1), and at three months (T2). Outcomes included CONUT evolution, postoperative complications (Clavienâ?"Dindo), length of stay, readmission, and mortality. Results: Both reconstruction groups demonstrated a significant postoperative increase in CONUT score (median 2 [1-3] at T0 to 3 [2-4] at T1, p 0.001), followed by partial recovery at three months. No differences were observed between Billroth I and Billroth II/Roux-en-Y at any timepoint. Higher CONUT values at T0, T1, and T2 independently predicted overall and major complications (OR range 1.15â?"1.25, p 0.05). Postoperative morbidity, mortality (3.3%), and hospital stay were similar across groups. Conclusions: The CONUT score is an independent predictor of perioperative morbidity in gastric cancer, while the choice of reconstruction method does not significantly alter immunonutritional trajectories. Serial CONUT monitoring may enhance perioperative risk stratification.

Background: The desire for perfect haemostasis has led the medical equipment industry to produce "ideal" instruments for safe thyroidectomy. Thus, haemostasis and sealing instruments such as the LigaSure (TM) Small Jaw, Thunderbeat (TM) Open Fine Jaw and Harmonic (TM) Focus have been indicated for thyroid surgery. Aim: The purpose of this study is to present the initial results of using these three surgical instruments for performing monobloc thyroidectomy. Material and Methods: We performed a prospective study between January 2014 and July 2019 in which we included all the patients operated by same surgeon using those 3 sealing devices. Thyroidectomies were performed using LigaSure (TM) Small Jaw (group 1), the Thunderbeat (TM) Open Fine Jaw (group 2) and Harmonic (TM) Focus (group 3). The groups were statistically compared in term of duration of surgery and hospitalisation, early postoperative complications as well as voice alteration or acute respiratory failure. Results: No significant differences were observed among groups in terms of patient demographics, pathological diagnoses, postoperative complications, length of hospitalization, and clinical outcomes. Operating time was shorter in group 1. Conclusions: New surgical instruments have beneficial properties, including shortening the operative time, maintaining a clean operating field, and minimising smoke released during the operation.

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.

Background: Pelvic exenteration is an ultra-radical surgical procedure described by Brunschwig in 1948, which attempts to surgically cure patients with recurrent pelvic cancer after radiotherapy. Several variants of pelvic exenteration are described that allow a more limited or extensive resection, depending on the stage of the disease. Case report: We report the case of a 54-year-old woman, who was diagnosed with a tumoral rectovaginal fistula after a recurrent cervical cancer that had been treated with a total hysterectomy with bilateral adnexectomy and a left percutaneous nephrostomy, as well as interaortocaval lymph node resection. The patient had undergone a supralevator total pelvic exenteration with pelvic and interaortocaval lymphadenectomy. The reconstruction process included right ureterostomy, left nephrostomy, and colocutaneous anal anastomosis (Parks procedure). Conclusions: Supralevator total pelvic exenteration provides hope for cure in patients with pelvic malignancies that reappear after radiotherapy. The restoration of the digestive tract and avoiding colostomy with a colocutaneous anastomosis increases the quality of life in these cases.