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Article ; Online: Risk Factors for Severe Postoperative Complications after Oncologic Right Colectomy: Unicenter Analysis.

Zarnescu, Eugenia Claudia / Zarnescu, Narcis Octavian / Sanda, Nicoleta / Costea, Radu

2022 Volume 58, Issue 11

Abstract: Background and Objectives: ...

Abstract	Background and Objectives:
MeSH term(s)	Male ; Female ; Humans ; Retrospective Studies ; Colectomy/adverse effects ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Colonic Neoplasms/surgery ; Risk Factors
Language	English
Publishing date	2022-11-04
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina58111598
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Article: Abdominal Compartment Syndrome in Acute Pancreatitis: A Narrative Review.

Zarnescu, Narcis Octavian / Dumitrascu, Ioana / Zarnescu, Eugenia Claudia / Costea, Radu

Diagnostics (Basel, Switzerland)

2022 Volume 13, Issue 1

Abstract: Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra- ... ...

Abstract	Abdominal compartment syndrome (ACS) represents a severe complication of acute pancreatitis (AP), resulting from an acute and sustained increase in abdominal pressure >20 mmHg, in association with new organ dysfunction. The harmful effect of high intra-abdominal pressure on regional and global perfusion results in significant multiple organ failure and is associated with increased morbidity and mortality. There are several deleterious consequences of elevated intra-abdominal pressure on end-organ function, including respiratory, cardiovascular, gastrointestinal, neurologic, and renal effects. It is estimated that about 15% of patients with severe AP develop intra-abdominal hypertension or ACS, with a mortality rate around 50%. The treatment of abdominal compartment syndrome in acute pancreatitis begins with medical intervention and percutaneous drainage, where possible. Abdominal compartment syndrome unresponsive to conservatory treatment requires immediate surgical decompression, along with vacuum-assisted closure therapy techniques, followed by early abdominal fascia closure.
Language	English
Publishing date	2022-12-20
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics13010001
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery.

Zarnescu, Eugenia Claudia / Zarnescu, Narcis Octavian / Costea, Radu

Diagnostics (Basel, Switzerland)

2021 Volume 11, Issue 12

Abstract: Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been ... ...

Abstract	Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate.
Language	English
Publishing date	2021-12-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2662336-5
ISSN	2075-4418
ISSN	2075-4418
DOI	10.3390/diagnostics11122382
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Article ; Online: Risk Factors for Severe Postoperative Complications after Oncologic Right Colectomy

Eugenia Claudia Zarnescu / Narcis Octavian Zarnescu / Nicoleta Sanda / Radu Costea

Medicina, Vol 58, Iss 1598, p

Unicenter Analysis

2022 Volume 1598

Abstract: Background and Objectives: This study aimed to investigate the potential risk factors for severe postoperative complications after oncologic right colectomy. Materials and Methods : All consecutive patients with right colon cancer who underwent right ... ...

Abstract	Background and Objectives: This study aimed to investigate the potential risk factors for severe postoperative complications after oncologic right colectomy. Materials and Methods : All consecutive patients with right colon cancer who underwent right colectomy in our department between 2016 and 2021 were retrospectively included in this study. The Clavien–Dindo grading system was used to evaluate postoperative complications. Univariate and multivariate logistic regression analyses were used to investigate risk factors for postoperative severe complications. Results : Of the 144 patients, there were 69 males and 75 females, with a median age of 69 (IQR 60–78). Postoperative morbidity and mortality rates were 41.7% (60 patients) and 11.1% (16 patients), respectively. The anastomotic leak rate was 5.3% (7 patients). Severe postoperative complications (Clavien–Dindo grades III–V) were present in 20 patients (13.9%). Univariate analysis showed the following as risk factors for postoperative severe complications: Charlson score, lack of mechanical bowel preparation, level of preoperative proteins, blood transfusions, and degree of urgency (elective/emergency right colectomy). In the logistic binary regression, the Charlson score (OR = 1.931, 95% CI = 1.077–3.463, p = 0.025) and preoperative protein level (OR = 0.049, 95% CI = 0.006–0.433, p = 0.007) were found to be independent risk factors for postoperative severe complications. Conclusions : Severe complications after oncologic right colectomy are associated with a low preoperative protein level and a higher Charlson comorbidity index.
Keywords	Clavien–Dindo classification ; risk factors ; right colon cancer ; right colectomy ; severe complications ; nutrition ; Medicine (General) ; R5-920
Subject code	610 ; 616
Language	English
Publishing date	2022-11-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Updates of Risk Factors for Anastomotic Leakage after Colorectal Surgery

Eugenia Claudia Zarnescu / Narcis Octavian Zarnescu / Radu Costea

Diagnostics, Vol 11, Iss 2382, p

2021 Volume 2382

Abstract	Anastomotic leakage is a potentially severe complication occurring after colorectal surgery and can lead to increased morbidity and mortality, permanent stoma formation, and cancer recurrence. Multiple risk factors for anastomotic leak have been identified, and these can allow for better prevention and an earlier diagnosis of this significant complication. There are nonmodifiable factors such as male gender, comorbidities and distance of tumor from anal verge, and modifiable risk factors, including smoking and alcohol consumption, obesity, preoperative radiotherapy and preoperative use of steroids or non-steroidal anti-inflammatory drugs. Perioperative blood transfusion was shown to be an important risk factor for anastomotic failure. Recent studies on the laparoscopic approach in colorectal surgery found no statistical difference in anastomotic leakage rate compared with open surgery. A diverting stoma at the time of primary surgery does not appear to reduce the leak rate but may reduce its clinical consequences and the need for additional surgery if anastomotic leakage does occur. It is still debatable if preoperative bowel preparation should be used, especially for left colon and rectal resections, but studies have shown similar incidence of postoperative leak rate.
Keywords	anastomotic leakage ; anastomotic fistula ; risk factors ; colorectal surgery ; colorectal cancer ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2021-12-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: The Impact of Postoperative Complications on Survival after Simultaneous Resection of Colorectal Cancer and Liver Metastases.

Alexandrescu, Sorin Tiberiu / Zarnescu, Narcis Octavian / Diaconescu, Andrei Sebastian / Tomescu, Dana / Droc, Gabriela / Hrehoret, Doina / Brasoveanu, Vladislav / Popescu, Irinel

Healthcare (Basel, Switzerland)

2022 Volume 10, Issue 8

Abstract: Background: The aim of this study was to investigate the impact of postoperative complications on the long-term outcomes of patients who had undergone simultaneous resection (SR) of colorectal cancer and synchronous liver metastases (SCLMs).: Methods!# ...

Abstract	Background: The aim of this study was to investigate the impact of postoperative complications on the long-term outcomes of patients who had undergone simultaneous resection (SR) of colorectal cancer and synchronous liver metastases (SCLMs). Methods: We conducted a single-institution survival cohort study in patients with SR, collecting clinical, pathological, and postoperative complication data. The impact of these variables on overall survival (OS) and disease-free survival (DFS) was compared by log rank test. Multivariate Cox regression analysis identified independent prognostic factors. Results: Out of 243 patients, 122 (50.2%) developed postoperative complications: 54 (22.2%) major complications (Clavien-Dindo grade III-V), 86 (35.3%) septic complications, 59 (24.2%) hepatic complications. Median comprehensive complication index (CCI) was 8.70. Twelve (4.9%) patients died postoperatively. The 3- and 5-year OS and DFS rates were 60.7%, 39.5% and 28%, 21.5%, respectively. Neither overall postoperative complications nor major and septic complications or CCI had a significant impact on OS or DFS. Multivariate analysis identified the N2 stage as an independent prognostic of poor OS, while N2 stage and four or more SCLMs were independent predictors for poor DFS. Conclusion: N2 stage and four or more SCLMs impacted OS and/or DFS, while CCI, presence, type, or grade of postoperative complications had no significant impact on long-term outcomes.
Language	English
Publishing date	2022-08-19
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2721009-1
ISSN	2227-9032
ISSN	2227-9032
DOI	10.3390/healthcare10081573
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Article ; Online: The Impact of Postoperative Complications on Survival after Simultaneous Resection of Colorectal Cancer and Liver Metastases

Sorin Tiberiu Alexandrescu / Narcis Octavian Zarnescu / Andrei Sebastian Diaconescu / Dana Tomescu / Gabriela Droc / Doina Hrehoret / Vladislav Brasoveanu / Irinel Popescu

Healthcare, Vol 10, Iss 8, p

2022 Volume 1573

Abstract	Background: The aim of this study was to investigate the impact of postoperative complications on the long-term outcomes of patients who had undergone simultaneous resection (SR) of colorectal cancer and synchronous liver metastases (SCLMs). Methods: We conducted a single-institution survival cohort study in patients with SR, collecting clinical, pathological, and postoperative complication data. The impact of these variables on overall survival (OS) and disease-free survival (DFS) was compared by log rank test. Multivariate Cox regression analysis identified independent prognostic factors. Results: Out of 243 patients, 122 (50.2%) developed postoperative complications: 54 (22.2%) major complications (Clavien–Dindo grade III–V), 86 (35.3%) septic complications, 59 (24.2%) hepatic complications. Median comprehensive complication index (CCI) was 8.70. Twelve (4.9%) patients died postoperatively. The 3- and 5-year OS and DFS rates were 60.7%, 39.5% and 28%, 21.5%, respectively. Neither overall postoperative complications nor major and septic complications or CCI had a significant impact on OS or DFS. Multivariate analysis identified the N2 stage as an independent prognostic of poor OS, while N2 stage and four or more SCLMs were independent predictors for poor DFS. Conclusion: N2 stage and four or more SCLMs impacted OS and/or DFS, while CCI, presence, type, or grade of postoperative complications had no significant impact on long-term outcomes.
Keywords	liver metastases ; colorectal cancer ; simultaneous resection ; survival ; postoperative complications ; Medicine ; R
Subject code	616 ; 610
Language	English
Publishing date	2022-08-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Synchronous biliary gallstones and colorectal cancer: A single center analysis.

Zarnescu, Narcis Octavian / Zarnescu, Eugenia Claudia / Dumitrascu, Ioana / Chirca, Alexandru / Sanda, Nicoleta / Iliesiu, Andreea / Costea, Radu

Experimental and therapeutic medicine

2021 Volume 23, Issue 2, Page(s) 138

Abstract: Gallstones and colorectal cancer (CRC) are two common disorders that may develop simultaneously. In such situations, there is a significant chance of missing one of the conditions due to the primary clinical presentation. Late detection, diagnosis and ... ...

Abstract	Gallstones and colorectal cancer (CRC) are two common disorders that may develop simultaneously. In such situations, there is a significant chance of missing one of the conditions due to the primary clinical presentation. Late detection, diagnosis and treatment can be especially problematic in the case of unrecognized CRC. In the present study, the medical charts were retrospectively reviewed for all consecutive patients who were treated in the Second Department of Surgery, University Emergency Hospital Bucharest (Romania) between February 2015 and December 2017 following a diagnosis of CRC and/or biliary stones. There were 203 patients with CRC, 433 with biliary gallstones and 19 patients with both conditions. There were 125 men (61.6%) in the CRC group and 138 men (31.9%) in the gallstone group. The average age was 54.1±15.9 years in the gallstone group and 66.1±11.6 years in the CRC group. Obesity was observed in 96 patients (22.2%) with gallstones and in 14 (6.9%) patients in the CRC group. In the CRC group, 80 patients had medical comorbidities (39.4%), while in the gallstone group 126 patients (29.1%) had medical comorbidities. Bivariate analysis comparing gallstone only vs. gallstone and CRC identified age (P=0.001), male sex (P=0.001) and thyroid disease (P=0.001) as significant factors associated with synchronous diagnosis. The multivariable logistic regression of factors predicting CRC in patients with gallstones identified age (OR, 1.06; 95% CI, 1.023-1.105; P=0.002) and thyroid diseases (OR, 11.15; 95% CI, 2.532-49.06; P=0.001) as independent factors. There were significant differences regarding the location of the tumor between the CRC-only group and the gallstone and CRC group (P=0.001): Rectum (39.7 vs. 5.3%), left colon (26.6 vs. 21.1%), transverse colon (13 vs. 26.3%) and right colon (20.7 vs. 47.4%). The study concluded that, in patients with gallstones, age and thyroid conditions were significantly associated with CRC. Patients with a synchronous diagnosis of gallstones and CRC had significantly more right-sided CRC compared with regular CRC.
Language	English
Publishing date	2021-12-13
Publishing country	Greece
Document type	Journal Article
ZDB-ID	2683844-8
ISSN	1792-1015 ; 1792-0981
ISSN (online)	1792-1015
ISSN	1792-0981
DOI	10.3892/etm.2021.11061
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Article: A rare case of clear-cell carcinoid of appendix.

Ilieşiu, Andreea / Zărnescu, Narcis Octavian / Chirca, Alexandru / Zărnescu, Eugenia Claudia / Ungureanu, Irena Antonia / Neagu, Ştefan Ilie / Costea, Radu Virgil

Romanian journal of morphology and embryology = Revue roumaine de morphologie et embryologie

2018 Volume 58, Issue 4, Page(s) 1509–1513

Abstract: The carcinoids are the most frequent type of tumors arising from the appendix. In the majority of cases, these tumors are asymptomatic and usually are discovered after appendectomy. Definitive diagnosis relies on pathological examination of the resected ... ...

Abstract	The carcinoids are the most frequent type of tumors arising from the appendix. In the majority of cases, these tumors are asymptomatic and usually are discovered after appendectomy. Definitive diagnosis relies on pathological examination of the resected appendix, size of the tumor being critical for the further management. Clear-cell change in neuroendocrine tumors (NETs) has rarely been described in the appendix. We choose to present a clear-cell carcinoid subtype of appendiceal NET to raise awareness on this potentially curable and rare condition that can be overlooked. We highlight the importance of the pathological exam and the morphological and immunohistochemical behavior of the tumor in confirming the diagnosis and aiding in the treatment decision making. Also, important entities should be considered in the process of differential diagnosis such as goblet-cell carcinoid or renal-cell÷ovarian carcinoma.
MeSH term(s)	Adult ; Appendix/pathology ; Carcinoid Tumor/diagnosis ; Carcinoid Tumor/pathology ; Female ; Humans
Language	English
Publishing date	2018-03-16
Publishing country	Romania
Document type	Case Reports ; Journal Article
ZDB-ID	1062519-7
ISSN	2066-8279 ; 1220-0522 ; 0035-4007
ISSN (online)	2066-8279
ISSN	1220-0522 ; 0035-4007
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Management of Acute Pancreatitis in the Early Stage.

Zarnescu, Narcis Octavian / Barbu, Sorin Traian / Zarnescu Vasiliu, Eugenia Claudia / Costea, Radu / Neagu, Stefan

Maedica

2017 Volume 10, Issue 3, Page(s) 257–263

Abstract: Acute pancreatitis (AP) is a potential fatal disease with an overall mortality around 5%. The current treatment for AP relies on supportive medical therapy, sometimes associated with endoscopic procedures and/or surgical interventions. In this review we ... ...

Abstract	Acute pancreatitis (AP) is a potential fatal disease with an overall mortality around 5%. The current treatment for AP relies on supportive medical therapy, sometimes associated with endoscopic procedures and/or surgical interventions. In this review we discuss the recent concepts regarding the fluid therapy, pain management, antibiotic prophylaxis, apheresis for hypertriglyceridemia-induced AP, timing and indications for ERCP and cholecystectomy in biliary AP. For each component, the importance and the impact of early phase treatment is presented in terms of benefits and risks.
Language	English
Publishing date	2017-02-11
Publishing country	Romania
Document type	Journal Article
ZDB-ID	2399972-X
ISSN	2069-6116 ; 1841-9038
ISSN (online)	2069-6116
ISSN	1841-9038
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