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Background: The present study proposes to analyze the results obtained after transhiatal esophagectomies (THE), from the perspective of an Eastern European surgical center with low esophageal resection volume (LV). Aims: Our analysis, which to the authors' knowledge is the first of its kind in Romania, has the purpose of comparing our results with those obtained in higher or similar volume centers, in order to derive conclusions regarding the quality of therapeutic management for patients diagnosed with esophageal cancer in Romania. Study Design: Retrospective observational study. Methods: In total, 70 patients were included, in whom THE was performed during the period 1997-2013 by six senior surgeons. The majority of our patients had esophageal cancers (n=66; 94.3%); we also performed 4 THE procedures for benign conditions (n=3; 4.27%) and esophageal perforation (n=1; 1.42%). Results: The majority of cancer-group patients had T3/N+ tumors. The nodal involvement in the T2, T3 and T4 categories was 9.9%, 21.6% and 35.1%, respectively. Complications were identified in 45 patients (68.2%), with the majority being represented by pulmonary complications (16 patients; 24.3%) and cervical leaks (15 cases; 22.7%). In-hospital mortality was 9.09%. We found a one-year overall survival rate of 58.7% (95%CI: 51.7-65.7%), 27.2% at 2 years (95%CI: 21.2-36.2%) and 10.5% at 3 years (95%CI: 6.5-14.5%). The median survival rate was estimated to be 16 months. Conclusion: Morbidity and in-hospital mortality after THE was performed in low-volume centers, despite being significantly higher than reported in HV centers, could be kept at reasonable rates. In our opinion, the measures which have the potential to raise the standard of care for patients diagnosed with esophageal cancer in Romania are represented by the standardization of therapeutic and diagnostic protocols for esophageal cancer and the centralization of these major oncologic interventions in surgical excellence centers. [ABSTRACT FROM AUTHOR]

Introduction: Toxic megacolon represents one of the most severe complications linked to Clostridioides difficile infection, a life-threatening condition characterized by an acute dilatation of the colon, specifically exceeding 6 cm, contributing to elevated rates of morbidity and mortality. Case Report: This case report presents a 75-year old male patient, previously diagnosed with chronic ischemic heart disease, type 2 diabetes mellitus, with an operated and radiotreated colon tumor. He comes to the Emergency room complaining of affected general state, asthenia, dyspnea, diarrheal stools (2-3 per day) and hypotension. Examination was notable for confusion and diffuse abdominal tenderness, distended abdomen, painful to palpation with tympany. Also, out of laboratory analyses performed, a severe hyponatremia is revealed (Na:114mmol/l), mild hyperkalemia, acute kidney injury, coagulation dysfunction and elevated C-reactive protein (CRP) levels. Biological samples are collected for Clostridioides difficile exotoxin testing with a positive result, which is why targeted antibiotic treatment is initiated. Thoracoabdominal-pelvic computed tomography (CT) is also performed, leading to the discovery of abdominal level diffuse distension of the transverse colon up to 7 cm, as well as of visible hydroaerial levels and ascites. Considering the serious condition of the patient, it is decided to admit him to medical clinic for monitoring and specialized treatment. Discussions : The patient presented in this case is of advanced age, which represents a risk factor itself for the development of a possible complication following the infection with Clostridioides Difficile. In addition, the fact that he is an immunosuppressed, diabetic patient who underwent a surgical intervention on the colon, confirms that his medical history features multiple risk factors for the development of complications. Conclusions: Although it is a rare complication, when it occurs it has a fulminant evolution. In more than 80% of cases, it results in death, as proven by multiple studies, as well as by the facts highlighted in the presented case. [ABSTRACT FROM AUTHOR]

Introduction: Colon cancer is a common type of cancer that occurs in older patients. The colon can be affected at any level, often due to the presence of benign polyps that develop into malignant tumors over time. Colorectal cancer is described as having a slow and unfavorable evolution, and there are multiple types of oncological treatments available. Case Report: The 72-year-old patient, known as an alcoholic and a heavy smoker, has chronic obstructive pulmonary disease, hypertension, presents with mucopurulent cough, dyspnea, tachypnea, and diffuse abdominal pain for 3 days. The thoracic radiography doesn't descriebe any pleural fluid, but after the chest CT scan was presented, a 30 mm homogeneous hypodense mass in the left upper lobe was in contact with the aortic arch. The abdominal-pelvic CT scan highlights a liver with nodular contour and inhomogeneous structure due to the presence of numerous sized hypodense formations distributed throughout the entire hepatic parenchyma. Due to the increased values of the carcioembryonic antigen and CA19-9, the presence of a cholangiocarcinoma is suspected, and due to the lack of MRI, contrast ultrasound was performed, describing the presence of a 10x12 cm tumour in the splenic flexure with multiple liver metastases (some necrotic) and hepatomegaly until the right iliac fossa. Discussions : The absence of digestive symptoms in the advanced stage of the disease and the evolution up to acute hepatic insufficiency 4 days after presentation are unique features of the case. The patient refused the lung and liver biopsy. His prognosis is unfavorable because of the agressive form of the descending colon cancer with the presence of remote liver and pulmonary metastases which requires palliative care. Conclusions: The survival rate of patients with colon carcinoma is based on the stage of the illness. Multidisciplinary approaches including surgery, chemotherapy and targeted therapies, play crucial roles in managing this disease. [ABSTRACT FROM AUTHOR]