Octav Ginghina

Background/Objectives: Breast cancer management relies on multidisciplinary team (MDT) decisions that integrate clinical, radiological, pathological, and patient-related factors. Large language models (LLMs) may support such decisions, but evidence based on real-world cases remains limited. Methods: We evaluated the agreement between ChatGPT-5.5 (OpenAI, San Francisco, CA, USA) and real MDT management of patients with invasive breast cancer. In this single-center, retrospective, proof-of-concept study, standardized preoperative clinical vignettes for 86 patients with invasive breast carcinoma were independently evaluated by GPT-5.5 (frozen prompt, Medium reasoning mode, Web Search enabled). AI-generated recommendations were compared with the MDT reference standard across eight therapeutic domains (four surgical, four non-surgical), yielding 688 individual decisions. Agreement was summarized descriptively and with Cohen’s κ. Results: GPT-5.5 produced complete recommendations for all vignettes. Overall concordance was 90.8% (625/688). Agreement was highest for endocrine therapy, radiotherapy, and targeted therapy (100% each) and for axillary surgery (93.0%, κ = 0.86), and lowest for breast reconstruction (80.2%), oncoplastic surgery (82.6%) and neoadjuvant chemotherapy (83.7%). Surgical concordance was 85.8% (295/344). Discordances occurred predominantly in individualized surgical decisions; none were observed for endocrine therapy, radiotherapy, or targeted therapy. Conclusions: GPT-5.5 showed high overall concordance with real MDT decisions, particularly for guideline-driven systemic therapy, but was less reliable for individualized surgical planning. These findings should be regarded as exploratory and cannot be assumed to be generalizable across institutions or clinical settings. LLMs should complement, not replace, multidisciplinary expertise; prospective multicenter validation is warranted.

Hiatal hernia is a complex pathology, associated with gastroesophageal reflux disease, and for which management involves complex surgical treatment. Knowing the role of gastropexy in reducing postoperative recurrences, the current study aimed to highlight the intraoperative advantages and results of this surgical technique. Our study includes 29 patients aged between 34 and 84 years. Regarding the mechanism of occurrence, two thirds of the patients presented with mixed hiatal hernias (65.52%), 31.03% with sliding hiatal hernias, and 3.45% with paraesophageal hiatal hernias. The hernia size played a decisive role in the choice of surgical procedure, whereby for large hernias (with a diameter of over 7 cm), the Nissen procedure associated with gastropexy was preferred. For hernias with a diameter of less than 7 cm, the Nissen procedure associated with hernia orifice repair was performed. For hernias between 5 and 6 cm, gastropexy was also performed. Statistical analysis revealed a close correlation between the surgical procedure and the hernia size, with p = 0.005. Out of a total of 29 patients, 18 patients had gastropexy and 11 were without gastropexy. The association of gastropexy does not increase hospitalization costs, but in the long term, it has the advantage of reducing relapse.

Hiatal hernia is a complex pathology, associated with gastroesophageal reflux disease, and whose management involves complex surgical treatment. Knowing the role of gastropexy in reducing postoperative recurrences, the current study aimed to highlight the intraoperative advantages and results of this surgical technique. Our study includes 29 patients, aged between 34 to 84 years. Regarding the mechanism of occurrence, two thirds of the patients presented with mixed hiatal hernias, 31.03% with sliding hiatal hernias and 3.45% with paraesophageal hiatal hernias. The hernia size played a decisive role in the choice of surgical procedure, for large hernias (with a diameter of over 7 cm) the Nissen procedure associated with gastropexy was preferred.For hernias with a diameter of less than 7 cm, the Nissen procedure associated with hernia orifice repair was performed. For hernias between 5 and 6 cm, gastropexy was also performed. The association of gastropexy does not increase hospitalization costs, but in the long term it has the advantage of reducing relapse.

The diagnosis in the early stages of renal tumors, as well as the oncological outcomes equivalent to extensive nephrectomies, have increased interest in partial nephrectomy (PN), which is the preferred method for treating renal cell carcinoma less than 7 cm. The literature confirms that PN offers oncological outcomes equivalent to radical nephrectomy, especially in early stages. This is a prospective study, conducted in a single university center over a period of three years, aimed to evaluate the surgical and oncological outcomes regarding positive safety margins after PN performed using laparoscopic and open approaches. Following the analysis of the causes and consequences of incomplete tumor resection, the obtained results align with data from the literature. We found that specimens from laparoscopic surgery were approximately twice as likely to have positive surgical margins compared to tumors resected using the open approach, meaning that these patients require more intense follow-up both clinically and imaging. According to current published studies, positive safety margins are not predictors for disease recurrence rate, progression-free survival, or overall survival.

Introduction: The Preoperative Aspects and Dimensions Used for Anatomical Classification (PADUA) score was developed based on an algorithm incorporating anatomical characteristics and renal tumor size to predict surgical risk and perioperative complications in patients undergoing open nephrectomy. For the current study, we extended the application of the PADUA score to laparoscopic partial nephrectomy and analyzed the outcomes. Materials and Methods: Our study was based on a retrospective analysis of 94 patients who underwent partial nephrectomy at the Urology Department of Prof. Th. Burghele Clinical Hospital between 2020 and 2024. Two groups were analyzed: the first included 44 cases (54.5% male) treated laparoscopically (38 via transperitoneal and 6 via retroperitoneal approach), and the second included 50 cases (54% male) treated with open surgery via a lumbar approach. Results: The mean age of patients in the open (OPN) and laparoscopic (LPN) groups was 64 and 61.2 years, respectively. We analyzed three variables in relation to the PADUA score: ischemia time, operative time, and body mass index (BMI). In the laparoscopic group, no correlation was found between ischemia time and operative time (p=0.655 and p=0.686, respectively). Similarly, no correlation was observed in the open group (p=0.882 and p=0.787, respectively). The PADUA score was significantly correlated with BMI in the laparoscopic group (p=0.023), but not in the open group (p=0.202). Regarding complications, the PADUA score was significantly associated with postoperative complications in the laparoscopic group (p=0.013), but not in the open group (p=0.287). Conclusion: The PADUA score was used to assess the complexity of renal tumor resection using both open and laparoscopic approaches. Our study demonstrated that a higher BMI is associated with a higher PADUA score, suggesting that obesity may increase the complexity of the laparoscopic approach in partial nephrectomy. Furthermore, in the laparoscopic group, a high PADUA score was significantly correlated with the occurrence of postoperative complications.

Cryptorchidism is defined as the extra-scrotal position of the testes. It is a common disorder in male children, but rarely in adult patients. The association of cryptorchidism with hernia is a common finding in childhood, but is not frequent in adults or the elderly. Herein, we report a series of three cases (28-, 24-, and 34-year-old men) of adult inguinal hernia combined with cryptorchidism successfully managed by laparoscopic surgery under the same operative view. Laparoscopic transabdominal preperitoneal repair and orchiectomy were performed in all patients. No complications occurred in the postoperative period, and the patients were discharged on the first or second postoperative day. Pathological examination of the specimens revealed atrophic testes without malignancy. No hernia recurrence was observed during follow-up. The laparoscopic approach in the combined pathology of inguinal hernia and cryptorchidism is feasible in adult patients and has multiple advantages in terms of diagnosis and management.

Ectopic pregnancies are a frequently encountered cause of first-trimester metrorrhagia. They occur when an embryo is implanted and grows outside the normal uterine space. Uncommonly, the embryo can be implanted in the intramural portion of the uterine tube, a condition referred to as interstitial localization. This specific type of ectopic pregnancy may have an unpredictable course, potentially leading to severe uterine rupture and catastrophic bleeding if not promptly diagnosed and managed. We present a rare case of a multiparous 36-year-old female patient who underwent pelvic ultrasonography in the emergency department for intense pelvic pain associated with hypotension and moderate anemia. A history of right salpingectomy for a ruptured tubal ectopic pregnancy 10 years previously was noted. High beta-HCG levels were also detected. A pelvic ultrasound allowed us to suspect a ruptured ectopic interstitial pregnancy at 8 weeks of amenorrhea. An association with hemoperitoneum was suspected, and an emergency laparoscopy was performed. The condition was confirmed intraoperatively, and the patient underwent a right corneal wedge resection with suture of the uterine myometrium. The postoperative course was uneventful, and the patient was discharged on the fourth day postoperatively. Interstitial ectopic pregnancy is a rare yet extremely perilous situation. Timely ultrasound-based diagnosis is crucial as it can enable conservative management with Methotrexate. Delayed diagnosis can lead to uterine rupture with consecutive surgery based on a transection of the pregnancy and cornual uterine resection.

Octav GINGHINA*, Marius ZAMFIR, Mara MARDARE, Andrei VACARASU, Irina BONDOC, Alin BURLACU, Razvan IOSIFESCU, Theodor VOIOSU, Carmen PANTIS, Bogdan TANASE. Ann Hepatobiliary Pancreat Surg 2023;27:S432. https://doi.org/10.14701/ahbps.2023S1.EP-166