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Aim: To present a rarely diagnosed case of gastric Dieulafoy lesion. Description of case: A 62-year-old male was hospitalized with hematemesis. Laparoscopic ligature of two gastric ulcers located in the antrum was performed but the upper gastrointestinal bleeding was not stopped. The patient was transferred to another surgical clinic and he underwent an emergency abdominal laparotomy with re-suture of gastric ulcers. Considering his general condition and another recurrent bleeding, he was transferred to our hospital and a total gastrectomy of necessity was performed. The patient died four days after surgery because of sepsis. At autopsy, we identified diffuse peritonitis, hypertrophic cardiomyopathy and chronic pancreatitis with expanded fibrotic areas. Histological examination of the surgical specimen showed oversized tortuous vessels in the gastric submucosal layer with expansion into mucosa. Some of the vessels presented acute and/or organized thrombi with recanalization, in the others, lipid-rich atherosclerotic plaques were observed. Based on these criteria, the 'caliber-persistent artery', also known as 'Dieulafoy's lesion', was diagnosed. Conclusion: Dieulafoy's lesion should be suspected in every case of gastrointestinal bleeding in both adults and children. [ABSTRACT FROM AUTHOR]

Background: Osteonecrosis of the jaw is an uncommon but serious complication related to oral and intravenous bisphosphonate (BP) therapy. Its pathogenesis is not well understood, and there are no universal protocols accepted to treat it.

Hydatid cyst is caused by a cestode parasite class, called Taenia Echinococcus and its predominant localization is achieved in the liver (55-60%). It affects mainly young socio-professional active population in endemic areas and especially in rural areas. Surgery is central to the treatment of liver hydatid cyst. Surgical procedure chosen in the treatment of remaining cavity of liver hydatid cyst should be adapted to location, size and particularly its complications. [ABSTRACT FROM AUTHOR]

The wide variability of bronchial stump suturing technique shows us that an ideal method has not been discovered yet. The aim of the present study is to assess the outcomes in terms of occurrence of bronchial fistula after use of an original technique of bronchial stump closure. Material and methods: Data were extracted from medical charts of hospitalized patients admitted in Surgery Department, University County Hospital Tg Mureş, between 1 January 2005 and 31 December 2010. All patients admitted for surgical treatment of tumoral bronchopulmonary diseases were enrolled in our study. Results: Between 1 January 2005 and 31 December 2010, 197 patients with tumoral bronchopulmonary disease were admitted in our Surgery Department. We random the sample in two groups based on the type of surgical technique. Subgroup A in which we included 106 surgical interventions: 13 bilobectomy (12.27%), 52 lobectomy (49, 06%) 41 pneumonectomy (38.67%). Subgroup B in which we included 91 surgical interventions: 54 atypical pulmonary resection (59.34%) and 37 exploratory toracotomy and biopsy (40.66%). We recorded 2 cases with early bronchial fistula (one case after right pneumonectomy and one case secondary to left pneumonectomy) and 5 cases with late bronchial fistula( one case after lobectomy, one case after bilobectomy, one case after left pneumonectomy, and two cases after right pneumonectomy). Conclusions: The bronchial fistula after adjusted pneomonectomy for lung cancer exposes these patients to a bad outcome. The incidence of bronchial fistula is increase by follow conditions: radiotherapy treatment, blood transfusion treatment before surgery treatment, right pneumonectomy and diabetes mellitus. The main risk factor for late bronchial fistula occurrence is radiotherapy. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of pancreatic leakage, impacting postoperative morbidity and mortality, led to numerous surgical techniques for the treatment of the remnant pancreatic tissue following pancreaticoduodenectomy. Aim: The purpose of this study is to evaluate the incidence of pancreatic leakage correlated with the different procedures used in the treatment of the pancreatic stump after pancreaticoduodenectomy. Material and method: We performed a transversal, retrospective study on 181 patients, operated during 1994-2009 (only pancreaticoduodenectomies). We compared the incidence of pancreatic leakage after different techniques used in the treatment of the remnant pancreatic tissue. We also analysed patients' mortality rate with pancreatic leakage after different proceedings. Results: Pancreatic leakage was registered in 5 cases (5.88%) of pancreaticogastrostomy, in 13 cases (14.30%) of pancreaticojejunostomy, in 1 case of suture of the pancreatic stump and in 1 case of occlusion with Ethibloc (each of it - 50%). Mortality in patients with pancreatic leakage was 7.60% after pancreaticojejunostomy, 7.05% following pancreaticogastrostomy and 50% after occlusion with Ethibloc. Conclusion: The multitude of proceedings in the treatment of the remnant pancreatic tissue created to diminish the incidence of pancreatic leakage proves that none of it is safe enough. Therefore we consider pancreaticogastrostomy is a real option in reconstruction after pancreaticoduodenectomy by diminishing the incidence of pancreatic leakage (5.88% in our study) with a great impact on the early postoperative recovery. [ABSTRACT FROM AUTHOR]

Introduction: Rectal cancer treatment has registered a remarkable progress in the last two decades, leading to the decrease of local reappearance, improvement of survival rates in remote locations and increase of quality of life by performing operations that spares the sphincter. These developments were made possible through multidisciplinary and stadial evolution of rectal cancer management, where surgical resection maintains the role of "key factor", and implies mesorectal excision in all operations meant to be radical. Material and method: This is an observational study on the medical records submitted to surgery for rectal cancer cases hospitalized and treated in Targu Mures, at the Surgical Clinic during January 2000 and December 2009. Results: There were a total of 618 recorded cases, where the location of the tumor at the level of the rectum, the analysis of distal, circumferential and proximal resection margins, the presence of tumoral infiltration at the level of resection margins, the importance of metastasis at the level of the mesorectum as well as the type of operation imposed by these were monitored. Out of the total 618 patients, 505 of them underwent surgical procedure, where besides the rectal tumor the perirectal lymph-nodal tissue was also excised. Conclusion: surgery is the main therapeutic method and the only one with curative visa, but pre-and postoperative radio-chemotherapy reduced the number of local recurrences and improved survival rates. [ABSTRACT FROM AUTHOR]

Osteonecrosis of the jaws is a complication after treatment with antiresorptive drugs. Bisphosphonates (BPs) are widely used to treat conditions with bone metastases of malignant tumors such as multiple myeloma, breast cancer, prostatic cancer, as well as hypercalcemia of malignancy, osteoporosis, Paget’s disease, and osteogenesis imperfecta. Denosumab is an antiresorptive agent that is used for the treatment of osteoporosis or metastatic bone diseases. These antiresorptive agents improve the quality of life of patients by increasing strength and bone mineral density, and reducing the risk of bone fractures. More than a decade had passed since the first publication of this pathology, and the occurrence of the disease, its pathophysiology, and proper treatment methods are still not fully elucidated. Prevention is critical in medication-related osteonecrosis of the jaw, because the treatment is difficult, and there are no universally accepted treatment protocols. There is an accepted approach of palliation of symptoms and controlling the associated infections. Treatment may follow one of three procedures: conservative management of pain, conservative or extensive (segmental) surgery, depending on the disease stage.

Introduction: The lymphatic oedema of the upper limb, clinically known as the chronic swelling of the arm, due to the axillary lymph node dissection, performed for breast cancer, is one of the most important factors regarding the quality of life of these women. The methods of prevention for this complication consist in sentinel lymph node biopsy, axillary lymph node dissection limited to the Berger I and II lymphatic stations; and also in retrograde axillary lymph node mapping. Material and methods: The paper describes a preliminary study on 40 cases, regarding the efficiency of the retrograde axillary lymph node mapping versus the classic lymph node dissection. Results: The lymphatic oedema, defined through an average increase in the upper limb diameter, on the operated side, is greater than 1 cm in 8 out of 25 cases of classic axillary lymph node dissection; and it was not encountered on patients with ARM. Other factors, which may have an influence on the occurrence of lymph oedema, are: the number of sampled lymph nodes and the association with postoperative axillary radiotherapy. Discussions and conclusions: ARM seems to be an efficient method of early postoperative lymph oedema prevention, in women who underwent axillary lymph node dissection for breast cancer; on the 2 studied patient groups we discovered a significant statistic difference of p = 0.044. [ABSTRACT FROM AUTHOR]

Introduction: Regarding the rate of local recurrences, improvement of survival rates and quality of life, the treatment of rectal cancer has registered a remarkable progress during the last two decades. This was possible through multidisciplinary and gradual development of rectal cancer management, where surgical resection remains the "key factor" and all surgical interventions considered radical involve mesorectal excision. The status of lymph nodes is probably the only and most important marker of global survival in patients with rectal cancer, which is associated with the risk of systemic dissemination rather than local recurrence. Material and method: The aim of this study was to analyze the importance of mesorectal lymph nodes, in case of rectal cancer disseminated locally and in remote organs, based on treated rectal cancer cases at the 1st Surgery Clinic, Tîrgu Mureş between January 2000 and December 2009. During this period, out of the 618 recorded rectal cancer cases, in 505 cases the patients underwent surgical intervention where besides the rectal tumor, the perirectal lymphatic tissue was also excised. Results: The performed histopathological examinations revealed in 223 cases lymph node invasion (stage III and stage IV). We also studied different surgical interventions regarding lymph node excision performed during rectal cancer surgery, analyzed the average number of excised perirectal (mesorectal) lymph nodes and the average number of lymph nodes with histopathologically confirmed tumor metastasis resulted from rectal resection. Conclusion: In our study, we found that in surgical interventions involving resection with anastomosis the average number of lymph nodes per specimen is biger than the number recorded subsequent to abdominoperineal rectal resection. Therefore the resection with mesorectal excision is the best option for rectal cancer surgery any time is possible. [ABSTRACT FROM AUTHOR]

Background: In the literature there are a number of studies that suggest a possible correlation between cholelithiasis/cholecystectomy and colorectal cancer. The exposure of the colon mucosa to the action of bile acids that potentially have a carcinogenic effect due to the change in anatomy after cholecystectomy, seems to be the explanation of this association. The purpose of this paper was to search for such a correlation in our study group. Methods: We performed a retrospective cross-sectional study, analyzing the patients admitted to the First Surgical Clinic of the County Emergency Clinical Hospital Tîrgu Mureș, between January 1st, 2005-December 31st, 2010. Analyzing the medical records, operation protocols and histopathological results, we paid attention to demographics, location of neoplasia, the time elapsed since the cholecystectomy to the discovery of neoplasia, histological types, trying to perform correlations between these parameters and the lithiasic factor. Results: Out of the 534 patients admitted and operated with the diagnosis of colorectal cancer, 15.6% (n = 83) showed a history of gallbladder stone affection. Most patients came from urban areas, the average age was 67.2 (range 39-88 years), females were more affected. The most common locations were: the sigmoid colon (26.5%), rectum (36.3%) and the most common histological form was moderately differentiated adenocarcinoma. Conclusions: Similar to other studies, our work suggests a slight increase in the incidence of colorectal cancer in patients that underwent a cholecystectomy, without drawing a firm conclusion. We deem it necessary to see if diet changes of the Romanian population affect this relationship. [ABSTRACT FROM AUTHOR]

Background: Rectal cancer management has as its main component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles. Material and method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in the Surgical Clinic I of the County Emergency Clinical Hospital of Tîrgu Mureș, for a period of one year (April 2012-April 2013) and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed. Results: From the total of 69 patients diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior rectosigmoidian resections with low and very low colorectal anastomosis („very low” Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications. Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and „physiological” alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy. [ABSTRACT FROM AUTHOR]

Introduction: Spiegelian hernias are rare entities in abdominal wall pathology (2%). They occur in the semilunar line described by Adriaan van den Spiegel. Klinklosch (1764) defined it as a congenital or acquired defect of the transverse abdominal aponeurosis junction with the Douglas arch. Port-site hernias due to wrong placement of laparoscopic trocars in the right abdominal fl ank are rare, but possible complications of laparoscopic cholecystectomy. Case presentation: Our observation shows diagnostic and therapeutic aspects in a patient with port-site Spigelian hernia post laparoscopic cholecystectomy admitted in Surgical Clinic 1, County Emergency Clinical Hospital Tîrgu Mureș in the 28.01.2013-30.01.2013 period. Following surgery performed using an open approach, postoperative evolution was favorable, with no signs of recurrence at 9 months postoperatively. Conclusions: Spigelian port-site hernia post laparoscopic cholecystectomy is a very rare entity, iatrogeny being a certainty in its development. [ABSTRACT FROM AUTHOR]

Introduction: There are many authors who have devoted their time and expertise to find creative ways for an ideal suture of bronchial stump. Despite their efforts, the bronchial fistula rate reported in the specialty literature remains high, between 2--16%, depending on the author. There are two methods for closing bronchial stumps: manual and mechanical suture. The aim of this study was to experiment a new technique for closing bronchial stumps after lung resections. Material and method: In order to carry out this study we used 15 common rabbits. We performed left inferior lobectomy in these rabbits. These rabbits were divided into three groups according to the methods used to close the bronchial stump. We used three methods for closing the bronchial stump: simple running suture, suture of the bronchial stump using two vicryl mesh patches and suture of the bronchial stump using two heterologous bovine pericardial patches. Results: We did not notice any cases of bronchial stump fistula. The most important changes that appear during the bronchial stump healing are: inflammatory response, angiogenesis, hyperplasia of the smooth muscle fibres, migration of fibroblasts and fibrogenesis. Conclusions: Healing signs appeared on all examined samples, but they were more intensive in the group where we used the heterologous bovine pericardium for closing the bronchial stump. Some further studies are necessary to examine the effectiveness of the use of heterologous bovine pericardium to protect the bronho-anastomosis. [ABSTRACT FROM AUTHOR]

Introduction: Breast cancer is still the world's most common cancer in women. Multidisciplinary approach represents the gold standard in diagnosis. Case presentation: In order to emphasize the importance of this issue, we present three of our cases. In these cases of invasive carcinoma, in women ranged from 42 to 54 years, the diagnosis tools were clinical examination, mammography, ultrasound and histopathology. Minimal invasive breast biopsy and preoperative localisation procedures, under ultrasound and stereotactic guidance contributed to preoperative planning. Conclusions: Interdisciplinary approach in diagnosis provides optimal management of breast cancer. [ABSTRACT FROM AUTHOR]

Background: Ampulla Vater carcinoma is a rare condition, having the best prognosis in periampullary malignant tumors. The purpose of this paper is to analyze the factors involved in long term survival after duodenopancreatectomy for carcinoma of the ampulla of Vater. Material and method: This paper is a retrospective study across a 15-year period (1995-2009), during which 130 interventions for ampullary vaterian carcinoma were performed in Surgery Clinic I Tîrgu Mureşand Surgery Clinic III Cluj-Napoca. Cephalic pancreatoduodenectomy was performed in 86 cases, and we have obtained informations regarding late postoperative survival in 63 cases. The data was processed in Microsoft Excel, and the statistical analysis was performed with SPSS v. 17 for Windows. The threshold of significance was p <0.05. Results: Survival at 5 years after cephalic pancreatoduodenectomy, in the group analyzed (63 cases) was 43.1%. We found a higher percentage of survival rate at 5 years for stage T1 tumors (tumor limited to the ampulla of Vater or sphincter of Oddi) - 68.3%, in the absence of regional adenopathies N0 - 68.3%, well differentiated tumors G1 - 90.5%, in tubulo-papillary adenocarcinoma histological type - 66.6%, in patients without lymphovascular invasion - 91.3% and in those without perineural invasion - 82.3%. Multivariate analysis of prognostic factors shows a high risk of death in the presence of lymphovascular invasion (p = 0.0031). Conclusions: 1. Survival at 5 years after cephalic pancreatoduodenectomy was 43.1%, which is influenced by tumor extension, the presence of regional lymphadenopathy, the histopathological type of tumor, the degree of tumor differentiation, the lymphovascular or perineural invasion. 2. Multivariate analysis of prognostic factors shows that lymphovascular invasion is statistically significant in postoperative survival. [ABSTRACT FROM AUTHOR]

Introduction:Lymph node status is the most important predictive factor in cancer of the colon. Sentinel node biopsy can proceed colon cancer from stage I to stage II, with consequences in the postoperative treatment. Adjuvant chemotherapy indicated in cases with nodal invasion significantly improves survival. Materials and methods:We used peritumoral subserosal injection of methylene blue dye for SLN identification, in cases of 40 patients operated with colon cancer in the First Surgery Clinic of County Hospital Mures. Whe used to detect metastases histological examination hematoxylin-eosin stain (HE). If the sentinel lymph node was negative (pN0) in routine staining with hematoxylin-eosin whe performed immunohistochemical examination with citokeratin (IHC). Results:We performed the procedure successfully to 38/40 patients (95%). A total of 530lymph nodes were examined, of them have branded as a total of 76 sentinel nodes (in average 1.89/ ase). SLN was negative for a total of 24 both patients in how HE and IHC staining, 20 patients non-SLN lymph nodes were also negative with a negative predictive value 83.33% and a 93% accuracy. In 9 patients with SLN negative in HE staining, IHC were positive, leading upstaging of a 23.68%. Conclusions:The use of sentinel lymph node examination and its identification using methylene blue is a feasible and accurate method. Whe performed upstaging using immunohistochemistry (IHC) in 9 cases (23.68%). Biopsy sentinel node can proceed colon cancer from stage I to stage II, with consequences in the postoperative treatment. The clinical value method treatment effectiveness will be assessed by benefits of postoperative chemotherapy in these patients. [ABSTRACT FROM AUTHOR]

Background: Treatment of esophageal and esocardial cancer in patients over 60 years involves a particular management. Considering the comorbidities specific to this category of patients, recent data from the literature indicate an increased incidence of mortality and morbidity following therapy. Material and method: We retrospectively studied a group of 55 patients admitted to the Surgical Clinic I of the County Emergency Clinical Hospital Tîrgu Mureș, in the January 1st, 2007-December 31st, 2011 period, diagnosed with esophageal and esocardial cancer. Patients were divided into two groups: group I under the age of 60 years, and group II over this age. Inclusion criteria were age, diagnosis (tumor location), and we followed a series of parameters: demographics, type of surgery, the biological profile of patients, immediate postoperative morbidity and mortality. Results: No statistically significant differences were observed in terms of demographics: gender (p = 0.78), area of origin (p = 0.69). The number of hospitalization days (p = 0.20) was influenced by the type of surgery, as well as pre- and postoperative comorbidities. Immediate postoperative mortality was 16.56%, the differences between the two groups was not statistically significant (p = 0.58). Parameters with statistical significance were found to be: age (p <0.0001), tumor location, type of surgery (p = 0.0031) and radical versus palliative surgery (p = 0.03). Conclusions: Therapeutic attitude in patients over 60 years should be correlated with specific particularities to this category. Selection of patients for surgery and type of surgery is dictated by the patient's condition and quantified by anesthesia and surgery team. [ABSTRACT FROM AUTHOR]

Background: Treatment of variceal rupture from portal hypertension remains a therapeutic problem with implications and socio-economic challenge, still insufficient crystallized from a practical point of view, therefore, we considered it necessary to research new therapeutic options. Methods: We conducted a single center non-interventional observational study on a group of 20 patients in the 2010-2011 period, with the diagnosis of esophageal varices in portal hypertension. We analyzed cases based on physical and laboratory examinations collected from observation sheets, intraoperatory or endoscopic examination, terlipressin efficiency being quantified postterapeutically. Results: Out of the 20 patients, 75% had ethanol cirrhosis, while a viral etiology was recognized in 25% of cases, class Child-Pugh A and B being the most common. Control of bleeding was achieved in 85% of cases within 12 hours, in 10% of cases the bleeding stopped at intervals over 12 h after the first administration, and only in one case the bleeding persisted despite therapy with terlipressin. Conclusions: Use of terlipressin is an important option in obtaining hemostasis of upper gastrointestinal bleeding due to variceal rupture. Pharmacologic therapy with terlipressin can save cirrhotic patients with severe or moderate bleeding, requiring transfusion with two units. [ABSTRACT FROM AUTHOR]

Introduction: Local postoperative complications are affecting the evolution of surgical patients, which is the main reason why early diagnosis is a priority concern. Our objective was to Objective: To study the opportunity of protein analysis of the proteins from the drain fluid, as evolution markers of the surgical patient. Material and method: We have analyzed drain fluid collected after 24 h, 72 h and 5 days after surgery. We have used the following: determination of protein concentration by spectrophotometric analysis at 280 nm and protein separation by geometric electrofocusing (patent no. 109585C1/30.03.1995) Results: From the analyzed liquids, we obtained variable protein concentrations. In all cases, electrophoretic separation showed the presence of protein fractions similar to those of reference serum. Conclusion: The analysis protocol allows precise quantitative determination of the proteins from the drain fluid. Geometric electrofocusing, approached for the first time for this specific type of analysis, has proved to be highly effective in terms of quality and affordable due to the low cost. [ABSTRACT FROM AUTHOR]

Introduction: For patients who are candidates for surgical resection of the liver, advanced age has, for many years, been considered to be a limiting factor or has precluded intervention. More recently, improvements in diagnostic, surgical and anesthetic techniques and the increase in the average age of the population have gradually broadened the indications for hepatic resection in elderly patients. Material and methods: We aimed to study early outcomes of major liver resections in older patients who underwent hepatectomies in our clinic between 1st of January 2003 and 31st of December 2009. We divided patients into two groups (group A: n = 57, under 70 years and group B: n = 12, over 70 years) and we compared intra- and postoperative parameters such as admission period, blood loss, changes in biological parameters levels, complications and mortality. Results: Our study showed that early results weren't significantly different between younger and older patients. There was no morbidity in patients over 70, while patients under 70 presented complications such as wound infection (3 cases), subphrenic abscess (1 case) or hemorrhage (1 case). Concerning mortality, there were registered three deaths in group A and one death in group B. Early outcomes of major liver resections were similar between the two groups. Conclusion: In conclusion, major liver resections can be safely performed in patients over 70. [ABSTRACT FROM AUTHOR]

Background: The management of rectal cancer recognizes surgical resection as the most important step towards a permanent cure. Respecting the oncological principles, functional preservation represents a priority in achieving an acceptable quality of life for the patient. This study aimed to compare the results after low anterior resection (LAR) versus very low anterior resection (VLAR), in terms of postoperative outcome. Methods: We conducted a retrospective, observational study on a group of 147 patients with LAR or VLAR done for low rectal cancer in the 1st Department of General Surgery of the Emergency County Hospital of Targu Mures, between January 2015 and December 2019. We considered as low rectal cancer tumors located between 5-10 cm from the anal verge and very low those situated less than 5 cm from it. Patients were divided in two groups according to the type of operation. The postoperative evolution was followed. Results: The two groups, LAR with 81 and VLAR with 66 cases, had homogenous distribution regarding patients demographic and biological parameters and tumor pathological features. A significantly (p=0.0223) longer surgical intervention time was reported in VLAR than in LAR procedures. We found no statistically significant differences between LAR and VLAR in terms of associated postoperative morbidity or mortality, neither in hospitalization time. Conclusions: There was no statistical difference in terms of early postoperative outcomes among LAR and VLAR. The most important factor in achieving good oncologic and functional results in low rectal cancer is choosing the adequate, tailored to the case surgical management., (Celsius.)

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., Competing Interests: The authors declare no conflict of interest