Classical colorectal cancer surgery has been considered the gold standard in the surgical treatment of this disease for decades. Advances in technology and modern medicine have led to the emergence and progression of minimally invasive surgery in the treatment of this malignancy. Surgical procedures differ in relation to the localization of the tumor, as well as in relation to the pathways of hematogenous and lymphogenic spread of the disease. These surgical procedures are applied to the same extent during both classical and laparoscopic surgery. Regarding the indications for the laparoscopic approach in the elective treatment of colorectal cancer, there are no differences compared to classical colorectal surgery. The specificity of the method of work and visualization in laparoscopic colorectal surgery has developed the existence of two characteristic approaches: a) the lateral approach is taken from the classical-open colorectal surgery (“lateral-to medial approach”). It implies that the operation itself begins with the separation and preparation of the adjacent lateral peritoneum from the colon (rectum), and only then is the vascular structures approached from the medial side; b) medial-to-lateral approach, is an approach where after the creation of the pneumoperitoneum and access to the abdomen, the operation begins with the preparation of vascular elements (a.mesentericae inferior and v.mesenterice inferior, for example), and only then access to the lateral associated peritoneum. Most laparoscopic surgeons apply a more medial approach given the numerous advantages of this approach over the medial one that have been proven in comparative analyzes of these two approaches on a large sample of patients. At the same time, these studies did not show statistically significant differences in terms of postoperative complications, mortality, and malignant recurrence rate between the two approaches.

The debate of proponents of laparoscopic and classical colorectal surgery is still ongoing, especially on the oncological principles of colorectal malignancy treatment. For now, there are promising results in terms of the adequacy of laparoscopic surgery in the treatment of this disease. The study involved 60 patients with acceptable generalized operability and a diagnostically verified malignant neoplasm of colorectum. Patients were divided into two groups of 30 patients: patients who were operated with open and laparoscopically assisted colorectal surgery. Two groups of factors were collected and analyzed for all patients. The first group of factors was known preoperatively and the second group of factors was known postoperatively. There was no significant differences between the two groups concerning the age, sex, ASA score, preoperative hemoglobin values, blood type. Both groups were the most represented in the rectum cancer. The largest number of patients was G2 grade 49.1%. Surgical margins were negative for cancer in all examined patients. There was a statistically significant difference, in terms of a larger number of removed lymph glands in open surgery treated patients. The average number of lymph nodes removed laparoscopically was 14 (range 5-40), while in the classic-open group number was 20 (range 8-44). Laparoscopic group were able to retrieve >12 LNs in 70% of the cases while in classic-open group were able to retrieve >12 LNs in 93% of the cases. The third stage of the disease was significantly more prevalent in the classical group of patients than in laparoscopic group of patients (17: 7 patients). The average volume of the removed tumor in the laparoscopic group is 73 cm3, while in the classical group the average volume is 99 cm3. Our results show that classic-open and laparoscopic approaches in colorectal cancer surgery are associated with the retrieval of greater than 12 LNs, therefore both are adeqate for safe oncological treatment of this disease. With classic-open colorectal surgery, we are still able to retrive more matching LNs, compared to laparoscopic surgery.

Caecal diverticulosis is a rare cause of ileocoecal pain in western population. It represents 3.6% of all colonic diverticular disease. Signs and symptoms of this disease may mimic acute appendicitis and it is found in one in every 300 appendicectomies. Giving its low incindence the correct diagnosis is usually intraoperative. Eighty-three years old male presented to the surgical admission unit with a two days long history of pain in ileocaecal region. The pain started suddenly, it was constant and worsened on cough and excertion. He was afebrile, denied nausea and vomiting, changes in bowel movements and urination. The abdomen was not distended, it was soft and tender in low right quadrant, without organomegaly. Renal sucussion was negative. There were no signs of hernias. There were traces of normal stool on the rectal examination. Blood tests revealed an elevated total leukocyte count with granulocytosis and elevated parametrs of inflamation. A provisional diagnosis of acute appendicitis was made. Taking into consideration the atypical presentation we decided to do the multislice computed tomography (MSCT) of the abdomen. It revealed a heterogenous soft tissue mass in the area of right hemicolon infiltrating the surrounding fat tissue. The patient was operated on the same day. The procedure revealed a normal looking appendix and caecal diverticulum with an inflamed wall with localized perforation. We performed a right hemicolectomy. The postoperative course was uneventful and the patient made a full recovery. Caecal diverticulosis, although a rare disease in the westwrn world should be taken into consideration in patients with pain in right lower quadrant of the abdomen. The management of this disease should be individual, depending on patient's health status and the stage of disease in the moment of diagnosis. Management of patients with confirmed caecal diverticulitis can be conservative or surgical. Surgical treatment include diverticulectomy, ileocaecal resection and right hemicolectomy.

Retroperitoneal sarcomas are mesodermic origin and include less than 1% of all malignant tumors. The most frequent histological type of sarcoma are liposarcomas. Most commonly they are located in lower extremitetes while intraabdominal findigs are rare. Early diagnosis is quite challenging because the first symptoms occur only in advanced stages of disease. The gold standard for diagnosing is MSCT. The therapeutic approach is surgical by combining radiation therapy in case of recurrence and excision was not comletly. The chemotherapy is still controversial, and most authors consider that it is not adequate way of treatment. Seventy years old woman was admitted to the department of surgery because of the pain located in theleft half of the abdomen. It lasts for 3 monthsand in recent times became stronger and accompanied by nausea. Stooll and urin were regular . Physical examination revealed painfully formation. Velaues of blood examples were within normal range. US and MSCT of the abdomen were made before operation. MSCT showed retroperitoneal TU formation size 52x35cm. The findings were confirmed during the operation. Tumor weight was 9250g. Histopathological examination showed that it was a low-grade myxoid liposarcoma. One year after surgery, there was a recurrence. The first symptoms of abdominal liposarcoma manifests only in advanced stages of the disease. Radical surgical excision first choice in treatment. If the excsion lines could not be clear radiotherapy should be added.

Renocelularni karcinom (RCC) je najčešći maligni tumor bubrega kod odraslih. Čini oko 3% adultnih maligniteta i 90-95% neoplazmi bubrežnog porekla. Renocelularni karcinom može biti asimtomatski tokom najvećeg dela svoje evolucije a klasična trijada koja obuhvata lumbalni bol, hematuriju i lumbalnu masu je neuobičajena. RCC se karakteriše čestom pojavom paraneoplastičnog sindroma. Muškarac starosti 46 godina se žalio na uporan kašalj koji je trajao oko godinu dana. Negirao je druge tegobe i nije uzimao blokatore angiotenzin konvertujućeg enzima. Fizikalni nalaz po sistemima je bio u granicama normale. Rezultati laboratorijskih analiza su ukazali na ubrzanu sedimentaciju (SE 92 mm/1.h), leukocitozu i sideropenijsku anemiju (hemoglobin 103 g/L, serumsko gvožđe 4.3 μmol/l). Radiografija srca i pluća i spirometrija su bili uredni. Test na okultno krvarenje u stolici je bio negativan a vrednosti tumor markera su bile u referentnim granicama. Ultrazvuk abdomena je pokazao postojanje tumorske mase duž desnog bubrega. Kompjuterizovana tomografija abdomena je potvrdila postojanje tumorske mase veličine 93x72 mm duž celog desnog bubrega bez znakova invazije okolnih organa. Postavljena je radna dijagnoza renocelularnog karcinoma i izvršena je otvorena desna radikalna nefrektomija. Postoperativni tok je protekao uredno uporni kašalj je nestao 2 dana nakon operacije sa brzim poboljšanjem anemije i normalizacijom SE a uporni kašalj je nestao 2 dana nakon operacije. Tri meseca nakon operacije pacijent nije imao nikakve tegobe niti je bilo znakova rekurencije tumora. Veoma je važno imati u vidu čitav spektar simptoma i znakova kojima se renocelularni karcinom može prezentovati.