BACKGROUND AND OBJECTIVES:Indocyanine green fluorescence angiography (ICG-FA) is increasingly used in colorectal cancer surgery to assess intraoperative anastomotic perfusion and potentially reduce postoperative complications, particularly anastomotic leakage. However, the magnitude and consistency of the benefit remain debated, especially regarding complication severity. We report the impact of ICG-FA on postoperative complications in a single-center prospective comparative cohort study with cluster-based group allocation, with particular focus on an unexpected severity signal observed in our data. METHODS:Between January 2020 and December 2025, 315 patients undergoing elective resection for colorectal cancer were prospectively enrolled at a tertiary surgical department in Bucharest, Romania. Group allocation was determined by the temporal availability of the operating theater equipped with a near-infrared laparoscopic tower (one to two days per week, dedicated to extensive laparoscopic procedures). Sixty-six patients underwent ICG-FA-guided resection (3 mg intravenous bolus, standard institutional protocol); 247 underwent conventional resection. Primary outcomes were overall postoperative complications (Clavien-Dindo grade II or higher) and severe complications (anastomotic leak or Clavien-Dindo grade III or higher). Statistical analyses were performed with JASP version 0.94.5. RESULTS:The overall complication rate was 31.8% in the ICG group versus 39.4% in the non-ICG group, a numerical reduction that did not reach statistical significance (chi-square = 1.26, p = 0.26). The postoperative hospital stay was significantly shorter in the ICG group (6.92 ± 4.78 days vs. 9.21 ± 8.07 days, p < 0.01). Among patients who developed any postoperative complication (n = 119), the proportion of severe complications was significantly higher in the ICG arm: 28.57% (6/21) versus 9.18% (9/98) in the non-ICG arm (chi-square = 5.90, p = 0.02; Fisher log odds ratio = 1.38, p = 0.03). Multivariate logistic regression identified right-colon tumor location as the strongest independent predictor of postoperative complications (odds ratio = 7.01, p < 0.01), with preoperative albumin showing a borderline protective effect (odds ratio = 1.94, p = 0.05). CONCLUSIONS:In our cohort, ICG-FA was associated with shorter hospital stay and a non-significant reduction in overall complications, but with an unexpected and statistically significant increase in the proportion of severe complications among patients who developed any complication. We discuss this counter-intuitive finding openly, considering three plausible mechanisms: statistical fragility related to small event numbers, confounding by procedural complexity inherent to the cluster-based design, and a real component possibly related to false reassurance and learning curve effects. Honest reporting of such signals is essential for refining the appropriate clinical use of ICG-FA. Larger, stratified, prospective studies are needed to clarify whether the observed signal reflects a true phenomenon or chance.

Introduction: Low and ultralow colorectal anastomoses, used in the surgical treatment of lower rectal cancer, are associated with an increased risk of anastomotic fistula and local complications, especially in the context of sphincter-sparing procedures. Near-infrared/ICG fluorescence technology enables objective assessment of tissue viability and can influence intraoperative decisions by modifying the transection level or adjusting the anastomotic configuration. Clinical data and the literature suggest a more pronounced potential benefit in anastomoses located at 4–8 cm from the anal margin, where vascular reserve is limited. Methods and Results: We conducted a prospective study at our service during 2021–2025, including patients in whom the ICG/NIR intraoperative technique was used, with a predilection for colorectal tumor pathology. In 2021–2025, our department surgically treated 420 patients with colorectal cancer, of whom 70 had rectal cancer, with 27 undergoing sphincter-sparing resections and the rest undergoing abdominoperineal amputation. Indocyanine green (ICG) was used in 22 cases to evaluate the viability of colonic segments and the perfusion of anastomoses, aiming to optimize reconstructive safety. Our department’s experience indicates an upward trend in restorative procedures, but this is accompanied by an increase in morbidity due to local complications, which necessitates integrating modern perfusion assessment methods, such as ICG, into treatment algorithms. Conclusions: Preservation of the anal sphincter remains an important goal for patients and a technical and oncologic challenge for the surgeon, requiring careful selection, rigorous counseling, and standardized intraoperative evaluation of perfusion. ICG/NIR technology can be a truly helpful instrument in the surgical decision-making process, influencing the surgical strategy and the postoperative evolution of patients.

The management of advanced low rectal cancer is shaped by an ongoing tension between two surgical philosophies regarding lateral pelvic lymph node (LPLN) disease. Eastern and Western guidelines diverge on whether systematic lateral lymph node dissection (LLND) should accompany total mesorectal excision (TME), reflecting different views of the locoregional behavior of LPLN involvement and different thresholds for accepting the urinary and sexual morbidity that accompanies full sidewall clearance. In this editorial, we argue that intraoperative interrogation of each individual case offers a way to refine, rather than resolve by regional consensus, this geography-driven dichotomy, and that indocyanine green (ICG) near-infrared fluorescence provides a principled means of individualizing the extent of lateral dissection. Peritumoral submucosal injection of ICG enables real-time visualization of lymphatic drainage and intraoperative identification of lateral pelvic sentinel lymph nodes (LPSLNs), which can be biopsied and submitted for frozen section. It is important to distinguish between the two applications of this signal. As an intraoperative visualization adjunct, ICG improves lateral node retrieval, and the supporting comparative evidence is relatively consistent. As a sentinel-based decision tool for safely omitting lateral dissection when the sentinel node is negative, the concept is promising but rests on a smaller and less mature evidence base; it remains investigational and requires validation in larger prospective studies with long-term oncologic and functional outcomes before it can guide the omission of lateral dissection in practice. We outline the operative protocol used in our department, extended from sentinel node mapping for gynecological malignancies, and place it in the context of contemporary systematic, propensity-matched, and prospective sentinel biopsy series. In our view, fluorescence-assisted selective LLND may serve as a pragmatic bridge between existing paradigms, preserving the oncologic intent of Japanese-style lateral clearance while aligning with Western priorities of minimizing unnecessary morbidity through tailored, image-guided surgery.

BackgroundThe choice between sphincter-saving surgery and abdominoperineal resection (APR) for low rectal cancer balances oncological radicality against functional preservation. Indocyanine green fluorescence angiography (ICG-FA) provides objective intraoperative assessment of bowel perfusion at the colonic stump, where ischemia is a leading cause of anastomotic failure.Materials and methodsIn this prospective, single-center, descriptive cohort study (January 2021–December 2025) of more than 400 patients operated for colorectal cancer, 70 had low rectal cancer (≤6 cm from the anal verge) and 27 underwent sphincter-saving surgery — 7 intersphincteric resections, 4 immediate low colorectal or coloanal anastomoses, and 16 two-staged Turnbull–Cutait pull-through procedures. ICG-FA of the colonic stump was performed in 22 patients (81.5%), with proximal repositioning of the resection line whenever fluorescence was inadequate.ResultsICG-FA prompted modification of the resection line in 9 of 22 patients (40%), almost always proximally, but never altered the decision between sphincter preservation and APR. A radical (R0) resection was achieved in 19 of 21 patients with margin status recorded; two had an involved circumferential margin (R1), both in locally advanced node-positive tumors. Postoperative complications occurred in 15 of 27 patients (56%), mostly Clavien–Dindo grade I–II. There was no 30-day mortality; one late in-hospital death from an independent myocardial infarction occurred beyond 30 days.ConclusionsSphincter-saving surgery for low rectal cancer is feasible but carries substantial morbidity. ICG-FA is a reproducible, low-risk adjunct that informs intraoperative decision-making; whether it reduces anastomotic complications requires confirmation in randomized studies.

Background/Aim: This case report navigates through the challenges of a complex clinical scenario involving germ cell tumors (GCTs), one of the most frequently encountered malignancies in adolescents and young adults. Case report: We present the case of an 18-year-old patient exhibiting atypical clinical manifestations, prompting emergent extensive surgical intervention. Upon admission to the Oncology Department, the adolescent presented with jaundice and dyspnea, being diagnosed with pure non-seminomatous embryonal carcinoma, a poor-risk prognosis group. Based on his prognostic group, the patient should have undergone chemotherapy with a well standardized regimen, but the imminent “liver visceral crisis” did not allow for the standard dose chemotherapy administration, so an adapted regimen of chemotherapy was considered and the full number of cycles was applied after this induction cycle. The treatment journey was protracted, emphasizing the need for early recognition and intervention in such cases. A comprehensive ongoing evaluation, including imagistic examinations and laboratory tests, revealed the presence of extensive refractory disease, which led to urgent treatment. Conclusions: This case provides valuable insights into the management of advanced testicular germ cell tumor in young patients facing imminent organ failure and underlines the importance of interdisciplinary collaboration. Understanding the complexities of this condition can aid in improving patient outcomes and enhancing the quality of care provided.

Background and Objectives: Lower extremity amputations (LEAs) represent a significant health problem. The aim of our study was to analyse the type and trends of diabetes-related LEAs in patients hospitalized in one surgical centre in Bucharest between 2018 and 2021. The second aim was to assess the impact of the COVID-19 pandemic on the trends of LEAs. Materials and Methods: We performed a retrospective analysis of all lower limb amputations performed between 01 January 2018 and 31 December 2021 in the Department of Surgery, Dr. I. Cantacuzino Clinical Hospital, Bucharest, Romania. We evaluated demographic parameters, type of LEA, the level, the laterality and trends of the amputations, the main aetiologies leading to amputation, and the length of hospitalization. Results: During the study period, 1711 patients underwent an LEA. The mean age was 64.53 ± 9.93 years, 71.6% (n = 1481) being over 60. Men outnumbered women by a ratio of 3.62:1. The most frequent interventions were ray amputations in 41.2% (n = 705) of patients; then, there were amputations of the toe (20.4%, n = 349), transtibial amputations (18.9%, n = 323), transfemoral amputations (10.6%, n = 181), and midfoot amputations (9%, n = 154). Wet gangrene was the most frequent aetiology (40.9%, n = 699). The total number of LEAs decreased constantly throughout the analysed period, such that 616 LEAs were performed in 2018 and 323 LEAs in 2021 (p < 0.001). There was a statistically significant increase in the rate of major LEAs in the pandemic vs. pre-pandemic period (37% vs. 24.4%, p < 0.001). Conclusions: In our study, the total number of LEAs decreased throughout the analysed period, but there was an increase in the rate of major LEAs in the pandemic vs. pre-pandemic period. Being over 65 years of age, leucocytosis, sepsis at presentation, and diabetic polyneuropathy were important risk factors for the necessity of LEA in complicated diabetes-related foot disease.

The relationship between diabetes mellitus and ocular complications has been extensively studied by many authors. Diabetic keratopathy has already been well characterized and defined as a clinical entity. This review focuses on exploring corneal epithelial changes in diabetic patients, aiming to provide a pragmatic overview of the existing knowledge on this topic. The paper systematically examines alterations in corneal epithelial structure and their impact on diabetic patients. Advanced imaging techniques are also discussed for their role in precise characterization and improved diagnostics. Additionally, the paper explores the mechanisms behind corneal epithelial changes in diabetes, looking at factors such as hyperglycemia, oxidative stress, and Advanced Glycation End-Products. The impact of altered corneal epithelial integrity on barrier function and susceptibility to external issues is considered, addressing potential links to heightened proteolytic enzyme activities and delayed wound healing observed in diabetic individuals. The review also covers the practical implications of corneal epithelial changes, including the association with corneal erosions, persistent epithelial defects, and an increased risk of dry eye syndrome in diabetic patients.

Red cell distribution width [RDW] represents a new prognostic marker which has been widely studied in malignant tumors including ovarian cancer patients. Therefore, it has been stipulated that RDW can be also used as a prognostic marker and a follow up tool for these patients. The aim of the current paper was to analyze the variations of this parameter on a study group of 31 patients diagnosed with advanced stage ovarian cancer and respectively 48 cases with benign ovarian lesions submitted to surgery between 2017-2020 in “Cantacuzino” Clinical Hospital.

The presence of thrombocytosis has been widely associated with poor prognostic in patients diagnosed with ovarian cancer at the time of the initial diagnostic. Once this fact has been widely accepted, attention was focused on studying whether this biological parameter could be also a diagnostic tool for identifying patients with poorer outcomes at the time of secondary cytoreduction. Therefore the most commonly encountered questions are whether patients presenting thrombocytosis at the time of primary cytoreduction are expected to have also thrombocytosis at the time of relapse and if thrombocytosis at the time relapse is corelated with lower disease free intervals, with higher rates of incomplete debulking and with poorer rates of overall survival respectively. This is a literature review of the most relevant studies conducted on this issue.

Ovarian cancer remains one of the most aggressive gynecological malignancies after cervical and endometrial cancer especially due to the multiple patterns of spread cited so far. Although it has been stated that the peritoneal route is the most dangerous pattern of spread leading to the apparition of disseminated intraabdominal lesions, other pathways such as hematogenous or lymphatic route can be also important, leading to the apparition of abdominal and extra-abdominal metastases. The aim of the current paper is to discuss about the risk of developing axillary metastases from ovarian cancer primaries.

Even nowadays the diagnostic of ovarian cancer is difficult to be established preoperatively, and therefore a significant number of patients are submitted to a much too extensive or to an incomplete surgical procedure. Therefore attention was focused on identifying more reliable markers which might help the clinician to distinguish between benign and malignant ovarian lesions. The aim of the current paper is to analyze the differences between benign and malignant ovarian tumors based on the preoperative levels of the mean platelet volume.

Background: platelet to lymphocyte ratio remains a significant prognostic factor in different malignancies. The aim of the current paper is to study the correlation between the preoperative values of platelet to lymphocyte ratio (PLR) and the postoperative outcomes in ovarian cancer patients. Method: we conducted a retrospective study on 57 patients submitted to cytoreductive surgery between 2014-2020. We determined the optimal cut off value of PLR for predicting survival outcomes by using the Receiver Operating Characteristic curve a value of 350 being obtained. The patients were further classified in two groups according to the PLR value. Results: there were 37 patients with PLR 350 and respectively 20 patients with PLR 350. Patients in the second group were significantly older and presented significantly higher rates of perioperative complications, a significantly higher level of circulating platelets, of CA125 and respectively a significantly lower level of circulating lymphocytes and of preoperative hemoglobin level. Meanwhile, patients in the second group reported a significantly poorer disease free and overall survival. Conclusions: ovarian cancer patients with higher preoperative levels of PLR trend to have a poorer early and long-term postoperative outcome. Therefore, in such cases more aggressive systemic therapies might be needed.

Ovarian cancer is recognized for the high capacity of spread which leads to the apparition of distant metastases via multiple pathways such as peritoneal, hematogenous or lymphatic route. If cases presenting peritoneal dissemination usually present extended but limited to the abdominal cavity lesions, patients with hematogenous or lymphatic spread will lead to the apparition of both intra-abdominal and extra-abdominal lesions. Even though, the presence of extra-abdominal lymphatic metastases is rather a rare event; however, contamination of extra-abdominal lymph nodes and is considered as distant metastasization and considered as stage IV of disease. The aim of the current paper is to review the cases presented so far with histopathological documented supraclavicular metastases originating from ovarian cancer.

Neutrophil to lymphocyte ratio represents a novel prognostic marker which is usually associated with the presence of proinflammatory conditions such as obesity, metabolic syndrome or certain benign and even malignant diseases. Moreover, in cases in which a malignant condition is present, the value of the neutrophil to lymphocyte ratio also seems to be positively corelated with the biological aggressivity of the tumor. The aim of the current paper is to discuss about the most relevant studies which discuss about the role of this parameter as a new biological marker in ovarian cancer patients.

Ovarian cancer remains one of the most aggressive malignancies which is frequently diagnosed in advanced stages of the disease, when disseminated lesions are already present. In order to maximize the rates of complete debulking surgery, different prognostic markers have been investigated. The aim of the current paper is to investigate the prognostic value of neutrophil to lymphocyte ratio in advanced stage ovarian cancer patients submitted to debulking surgery.

Although multiple studies have been conducted so far on the issue of advanced stage ovarian cancer, the overall prognostic of these patients reports a wide variety even in cases in which complete debulking surgery is feasible. Therefore, attention was focused on identifying other prognostic markers which might influence the long term outcomes of these patients. In this paper special attention was focused on studying the impact of mesenteric lymph node involvement in advanced stage ovarian cancer.

Gallbladder cancer represents the most commonly encountered malignancy of the biliary tract which becomes symptomatic only in advanced stages of the disease when, in most cases, local invasion in unresectable structures is already present. Another significant problem regarding this pathology is related to the fact a positive diagnostic is difficult to be established preoperatively. The aim of the current paper is to discuss about the possible relationship between the preoperative number of circulating platelets and the overall prognosis in gallbladder cancer patients.

Once the techniques of minimally invasive surgery improved and the benefits in terms of early postoperative recovery have been widely demonstrated, minimally invasive surgical procedures have been widely implemented in the setting of surgical oncology. However, in cases in which peritoneal contamination already exists, attention was focused on identifying the risk factors of developing port site metastases and, in the meantime, on preventing this event. The aim of the current paper is to analyze these risk factors and to discuss about the possibilities to prevent this event.

Endometrial cancer is recognized to be one of the most commonly encountered malignancies, which is usually diagnosed from early stages of the disease. Even though, in certain cases recurrences might occur, in such cases different therapeutic strategies might be proposed, depending on the extent of the lesions. The aim of the current paper is to report a case of a 56 year old patient with previously treated endometrial cancer, diagnosed with a solitary precaval adenopathy which was successfully surgically removed.

In the last decades understanding the relationship between the circulating platelets and the biological aggressivity of ovarian cancer gave the opportunity to researchers to introduce new therapeutic lines in ovarian cancer patients with promising results. Therefore, this subject has become intensively studied and surprising correlation ships have been observed. One of the most recently investigated issues regards the influence of circulating platelets on epithelial ovarian cancer refers to the platelets’ ability to induce the epithelial to mesenchymal transition. The current paper aims to discuss about this subject and about the clinical implications of the process.