RezumatCancerul gastric rămâne una din cele mai agresive malignităţi, fiind asociat cu rezultate terapeutice nesatisfăcătoare, în special la pacienţii cu boală avansată. Din cauza acestui aspect atenţia comunităţii medicale actuale este concentrată în a identifica un tratament mai bun, un control mai eficient al bolii şi în a îmbunătăţi ratele de supravieţuire. Odată ce beneficiile chirurgiei citoreductive în asociere cu hipertermia intraperitoneală (HIPEC) au fost demonstrate pe scală largă la pacienţii diagnosticaţi cu carcinomatoză peritoneală din origine colorectală sau ovariană, atenţia a fost axată pe posibila utilizare a acestei metode la pacienţii diagnosticaţi cu carcinomatoză peritoneală de origine gastrică. Mai mult decât atât, prin utilizarea laparoscopiei pentru efectuarea chirurgiei citoreductive (L-CRS) în asociere cu chimioterapia hipertermică intraperitoneală (L-HIPEC), se aşteaptă ca beneficiile intervenţiei chirurgicale minimal invazive (MIS) să contribuie la îmbunătăţirea rezultatelor postoperatorii. În acest mod, pacienţii beneficiază de o administrare mai rapidă a tratamentului chimioterapeutic adjuvant ori de câte ori este necesar. Scop: de a prezenta tehnica L-CRS + L-HIPEC şi rezultatele obţinute într-o serie de cazuri de doi pacienţi diagnosticaţi cu carcinomatoză peritoneală din cancerul gastric. Metodă: În toate cazurile, a fost efectuată o procedură completă de investigare, incluzând laparoscopia exploratorie pentru evaluarea Indexului de Carcinomatoză Peritoneală (PCI). Consiliul Surgical TechniqueChirurgia (2017) AbstractGastric cancer remains one of the most aggressive malignancies, being associated with very poor therapeutic outcomes, especially in the advanced disease patients. Due to this evidence, finding a better treatment, a better control and higher survival rates is the current scientific focus of the medical community. Once the benefits of cytoreductive surgery in association with intraperitoneal hyperthermy (HIPEC) have been widely demonstrated in patients presenting peritoneal carcinomatosis from colorectal or ovarian origin,attention was focused on the possible benefit of this method in patients diagnosed with peritoneal carcinomatosis with gastric origin. Moreover, using laparoscopy for the cytoreductive surgery (L-CRS) and hyperthermic intraperitoneal chemotherapy (L-HIPEC), the advantages of minimal invasive surgery (MIS) are expected to contribute to improved postoperative outcomes. In this way, the patients benefit from a faster administration of the adjuvant chemotherapeutic treatment, whenever is necessary. Aim: to present the technique of L-CRS + L-HIPEC and the early therapeutic outcomes in a case series of two patients diagnosed with peritoneal carcinomatosis from gastric cancer. Method: A complete investigational work-up including diagnostic laparoscopy to evaluate the Peritoneal Carcinomatosis Index (PCI) was fulfilled in all the cases. The institutional Tumor Board decided the therapeutic strategy: laparoscopic radical resection and HIPEC (L-CRS +L-HIPEC)...

Krukenberg tumors from pulmonary adenocarcinoma represent an extremely rare situation; only a few cases have been reported. The aim of this paper is to report an unusual such case in which almost complete dysphagia and ureteral stenosis occurred. The 62-year-old patient was initially investigated for dysphagia and weight loss. Computed tomography showed the presence of a thoracic mass compressing the esophagus in association with a few suspect pulmonary and peritoneal nodules, one of them invading the right ureter. A biopsy was performed laparoscopically on the peritoneal nodules. The right adnexa presented an atypical aspect; right adnexectomy was also found. The histopathological and immunohistochemical studies confirmed that the primitive origin was pulmonary adenocarcinoma. Although both peritoneal carcinomatosis and ovarian metastases from pulmonary adenocarcinoma represent a very uncommon situation, this pathology should not be excluded, especially in cases presenting suspect pulmonary lesions.