Background: The purpose of this retrospective study is to assess a link between different characteristics of the tumor (other than TNM staging) and the probability of a cancer relapse after the patient has been operated on with a curative purpose.

Background: The abnormal presence of the pancreatic tissue in other digestive organs is rare but sometimes is the cause of some surgical diseases.Material and Method: This retrospective study is focussed on heterotopic pancreas cases diagnosed in 2nd Surgical Clinic of "Sf. Spiridon" Emergency Hospital from Iasi between jan. 1986 and dec. 2008.Results: 22 patients (15 males/68,2% and 7 females/31,8%) aged between 23 and 76 years were grouped in A group - clinical symptomatic cases (3 patients/13,6%), group B- coincidental cases (17 patients/77,3%) and group C - incidental cases (2 patients/9%). Group A patients presented with obstructing prepyloric polypoid tumors and recquired antrectomy and gastroduodenal anastomosis. 13 patients of group B (76,4%) recquired surgery for pyloroduodenal stenosis and in 4 cases of this group with severe upper-GI bleeding, a subtotal gastric resection (3 patients) or antrectomy (1 case) was performed. In group C patients jejunal HP was histopathologically diagnosed during extensive intestinal resection for colonic malignancies (ascendant colonic and transverse colonic cancers) with jejunal invasion. HP cases were categorized as type I in 40,9% cases (ducts, acini and pancreatic islets), type II in 45,4% cases (ducts and acini) and type III (exclusively with ducts) in 13,6% cases. In 76% patients HP was localized in mucosal and submucosal layers, in 16% intramucosal and in 8% in subserous layer.Conclusion: HP is most often an unexpected symptomless coincidental diagnosis during gastrointestinal surgical diseases.

Background The ampulla of Vater is a junction with four histologic epithelial types: ampullary, duodenal, pancreatic and biliary. The tumors of this region are named periampullary adenocarcinomas, but the histologic type of these malignancies seems to have an important significance for survival. Aim Our purpose is to determine whether the histologic type of the resectable vaterian adenocarcinomas is a prognostic factor. Methods We reviewed the medical records of 38 patients who underwent RO-R1 pancreatoduodenectomy for periampullary adenocarcinomas between 1998 and 2007 in one single surgical center. The histopathologic reports and the microscopic samples were reevaluated independently by two senior pathologists. Using our database we assessed the overall survival based on histologic type, tumor stage, lymph nodes involvement, tumor size and the level of differentiation. Results The histologic type of the adenocarcinomas was intestinal in 23 cases (60.5%) and pancreatobiliary in 15 cases (39.5%). The median overall survival was significantly higher in patients with well differentiate intestinal-type in T1-T2 stage without nodes involvement. In a multivariable Cox regression analysis the regional lymph nodes involvement and the differentiation degree remained significant prognostic factors. Conclusion The intestinal type of periampullary adenocarcinomas has a long survival, but the lymph nodes involvement and the lower degree of differentiation are associated with a high risk of death in these malignancies.

BACKGROUNDBile duct injuries are the main serious technical complication of laparoscopic cholecystectomy (LC). Each lesion is peculiar in its features as well as the surgeon's reaction when face it.AIMTo reveal the place of the human error according to accepted principles of cognitive psychology, beside other risk-factors involved in biliary accidents during LC.METHODRetrospective study on 18 patients treated for severe biliary lesions during LC in 1st Surgical Clinic of "Sf. Spiridon" Hospital, Iaşi, Romania, between March 1993 and March 2008. According to Strasberg's classification the lesions were: type C (n=1; 3%), type D (n=13; 39.4%), type E1-2 (n=2; 6.1%) and type E5 (n=2; 6.1%). In the medical records we followed up the technical aspects of the procedure (section, dissection, clips) and the lesional and anatomic factors attended at the moment of LC. We also assessed the concerned surgeons experience based on the number of the LC at time of the biliary accident.RESULTSIn our experience (10046 LC) the incidence of the biliary injuries was 0.1% only. We met four lesional and/or anatomic factors (mean) on each case with biliary lesion. Only five cases (27.7%) were detected intraoperatively, but Spearman's correlation between time of detection and surgeons experience is insignificant.CONCLUSIONOur results, rounded with cognitive psychology data from literature, suggest the role of the absence of haptic perception during laparoscopic procedures, in the occurrence of some errors, even in circumstances with "perfect visibility".