Timisoara Medical Journal

Purpose of the Study: Evaluation and classification of celiac trunk variants and assessment of their impact on visceral surgery. Material and Methods: The study was carried out on 50 anatomical specimens, over a period of 5 years. The macroscopic dissection method was used. The data were statistically and mathematically processed, schematically and percentage grouped. The results obtained were centralized and compared with those existing in the studied bibliography. Results and Discussions: The complete celiac trunk appears in 81% of cases (90% in the literature), and the incomplete one in 19% of cases (10% in the literature). The complete celiac trunk can be trifurcated, bifurcated, or of common origin with the superior mesenteric artery (SMA). In the trifurcated artery, the left gastric artery (LGA), hepatic artery (HA) artery and the splenic artery (SA) have a common origin. The bifurcated celiac trunk first gives rise to AGS, after which it bifurcates into HA and SA. Left HA, doubled by right HA, originating from a hepato-mesenteric trunk (H-M), occurs in 4% of cases. Incomplete celiac trunks: i) hepato-splenic (H-S) and LGA directly from the aorta - 3%; ii) hepato-spleno-mesenteric (H-S-M) and LGA from a gastro-phrenic trunk – 1%; iii) gastro-splenic (G-S) and HA directly from the aorta – 5%; iv) G-S and HA from a H-M trunk – 3%; v) H-M for HA and LGA, and SA directly from the aorta - 2%; vi) gastro-hepatic (G-H) and SA from a common H-M trunk - 5%. Conclusions: The celiac trunk originates directly from the abdominal aorta -99% of cases and in 1% through a celiac-mesenteric trunk. The complete celiac trunk appears in 81% of cases, and the incomplete one in 19% of cases. The complete celiac trunk can be systematized into 4 distinct morphological categories, while the incomplete celiac trunk can be systematized into 3. The knowledge of the variants of origin of the celiac trunk is of both theoretical, anatomical and surgical importance, due to the vascularization of a vast territory, with complex medical-surgical pathology. Full article

The objective of the study. Colorectal cancer (CRC) is the third most common neoplasm and the fourth leading cause of cancer death worldwide. About 3.5% of patients develop synchronous colorectal tumors (SCRT). The aim of the study was to evaluate the clinical-pathological characteristics of TSCR, in an attempt to outline the profile of these patients and to identify the parameters associated with the risk of aggressive evolution of the disease. Materials and methods. We performed a retrospective observational study on a group of patients with TSCR diagnosed on surgical resection pieces performed on patients operated on in the County Clinical Emergency Hospital “Pius Brȋnzeu” Timişoara (CCEHPBT), in a ten-year interval (2009 - 2018). Clinical data were collected from the accompanying notes of the biopsy material, from the clinical observation sheets, and the pathological parameters were extracted from the histopathological bulletins from the database of the Pathological Anatomy Service of the CCEHPBT. Results. A number of 73 (4%) cases met the criteria for inclusion in the study. The age of the patients was between 18 and 90 years, the average age being 64.8 years. TSCR were diagnosed more frequently in men (65.76%) and predominantly located in the left colon (47.94%). In most cases, conventional adenocarcinomas were identified - ADK NOS (73.97%), deeply invasive in the intestinal wall - pT3-pT4 (89.04%), with metastases in regional lymphnodules - pN1/pN2 (58.9%), and lympho- vascular – LV1 was identified in 47.95% of cases. Lymph node metastases were more frequent in the elderly (p=0.045) and were associated with pT3-pT4 (p=0.0169) and LV1 (p<0.0001), Table 1, Figure 1. Conclusions. Our study highlights the heterogeneity of the clinical-pathological picture of TSCR patients, which increases the difficulty of therapeutic management. We recommend a thorough examination and long-term clinical surveillance of these cases. In addition, the identification of patients at high risk of multiple tumors as well as prognostic factors is needed as complementary tools for the establishment of personalized therapy. Full article