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RezumatChirurgia colorectalã minimal invazivã prezintã numeroase avantaje în ceea ce priveşte morbiditatea, abordul laparoscopic utilizat în cazul repunerilor în tranzit dupã Hartmann îmbunãtãţind rata de repunere şi evoluţia postoperatorie. A fost analizatã baza de date a Institutului Clinic Fundeni, Departamentul de Chirurgie Generalã, fiind selectate cazurile de refacere a continuitãţii intestinale utilizând laparoscopia. Au fost identificate nouã cazuri, cu vârsta medianã de 63 de ani, cu o medie a BMI-ului de 29, dintre care trei pacienţi operaţi iniţial deschis. Timpul operator mediu a fost de 223 de minute şi nu au necesitat ileostomie de protecţie. Nu au fost raportate cazuri de dehiscenţã de anastomozã. Abordul laparoscopic rãmâne o alternativã fezabilã pentru repunerea în tranzit dupã operaţia Hartmann, luând în considerare experienţa echipei chirurgicale şi particularitaţile pacientului. Sunt necesare studii suplimentare pe loturi mai mari pentru a stabili clar avantajele acestui abord. AbstractMinimally invasive colorectal surgery showed multiple advantages in terms of morbidity, surgeons applied this approach to Hartmann reversal considering improving the reversal rate and postoperative

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Background and objectives: Gastric cancer (GC) is often diagnosed in the metastatic stage. Palliative systemic therapy is still considered the gold standard, even for patients with resectable oligometastatic disease. The aim of the current study is to assess the potential benefit of up-front gastric and liver resection in patients with synchronous resectable liver-only metastases from GC (LMGC) in a Western population. Materials and Methods: All patients with GC and synchronous LMGC who underwent gastric resection with or without simultaneous resection of LMs between January 1997 and December 2016 were selected from the institutional records. Those with T4b primary tumors or with unresectable or more than three LMs were excluded from the analysis. All patients who underwent emergency surgery for hemorrhagic shock or gastric perforation were also excluded. Results: Out of 28 patients fulfilling the inclusion criteria, 16 underwent simultaneous gastric and liver resection (SR group), while 12 underwent palliative gastric resection (GR group). The median overall survival (OS) of the entire cohort was of 18.81 months, with 1-, 3- and 5-year OS rates of 71.4%, 17.9% and 14.3%, respectively. The 1-, 3- and 5-year OS rates in SR group (75%, 31.3% and 25%, respectively) were significantly higher than those achieved in GR group (66.7%, 0% and 0%, respectively; p = 0.004). Multivariate analysis of the entire cohort revealed that the only independent prognostic factor associated with better OS was liver resection (HR = 3.954, 95% CI: 1.542–10.139; p = 0.004). Conclusions: In a Western cohort, simultaneous resection of GC and LMGC significantly improved OS compared to patients who underwent palliative gastric resection.