Lateral lymph node metastasis (LLNM) is an important cause of local recurrence in middle and lower rectal cancer. This study aimed to develop an integrated imaging-based prediction model to improve risk stratification for LLNM. This retrospective study included 288 patients with stage II–III rectal cancer located below the peritoneal reflection who underwent curative resection with LLND. Preoperative magnetic resonance imaging (MRI) and computed tomography colonography (CTC) were used to evaluate extramural venous invasion (EMVI) on MRI, mesorectal lymph node size (MLN), lateral lymph node size (LLN), and tumor distance from the anal verge measured on CTC (AV distance). Multivariable logistic regression was performed to identify independent predictors and develop a prediction model. Model discrimination was assessed using receiver operating characteristic curves and internally validated using bootstrap resampling. Risk stratification was performed based on predicted probabilities. LLNM was observed in 33 patients (11.5
Ammer et al. reported no significant difference in low anterior resection syndrome (LARS) between open and robotic rectal cancer surgery. This commentary addresses the interindividual variability in LARS outcomes. This conceptual commentary critically reviews the outcome assessment strategy used in the original study and integrates supporting evidence from the psycho-oncology literature. Functional burden, as captured by the LARS score, does not necessarily equal psychological burden. Psychological adaptation—resilience, coping style, distress, and illness perception—is hypothesised to mediate the relationship between functional impairment and patient-reported quality of life. Functional burden and psychological burden are related but distinct constructs. Future studies should test mediation and moderation models to determine whether psychological adaptation explains the variability between LARS severity and quality of life.
Parastomal hernia (PSH) is the most common long-term complication after stoma formation and remains one of the greatest challenges in abdominal wall surgery. Although several anatomical classifications and reconstructive techniques have been described, considerable heterogeneity remains in patient selection and surgical management. This narrative review evaluates contemporary evidence on PSH and proposes a practical framework for individualized reconstruction. A structured narrative review of the literature was conducted using PubMed, Embase, and the Cochrane Library. International guidelines, systematic reviews, meta-analyses, randomized controlled trials, and observational studies published between 2000 and 2026 were critically appraised. Evidence was synthesized around four key domains: definition of complexity, quality of life and surgical indications, principles of repair, and advanced abdominal wall reconstruction. Current evidence indicates that PSH complexity is multidimensional, reflecting the interaction of anatomical characteristics, patient-related biological factors, and functional impairment. Quality of life should be the principal determinant of the indication for elective surgery, whereas anatomical findings should guide the reconstructive strategy. Mesh reinforcement remains the standard approach for most elective repairs, while advanced abdominal wall reconstruction should be reserved for selected patients with complex disease. Complex PSH should be regarded as a multidimensional clinical entity rather than a purely anatomical condition. We propose proportional reconstruction as a conceptual framework in which operative complexity increases only when justified by disease complexity, thereby supporting individualized decision-making and a more rational use of advanced reconstructive techniques.
To evaluate long-term oncologic outcomes of pT2 colorectal cancer after upfront resection, based on tumor location within the large bowel. This retrospective cohort study included patients with pT2 colorectal adenocarcinoma treated with upfront surgery at a referral cancer center between 1990–2007. Outcomes included lymph node metastasis (LNM), recurrence, and disease-specific survival by tumor location. 567 patients with pT2 colorectal adenocarcinoma were identified: 289 (51
Metastatic early-onset colorectal cancer (mEO-CRC) is a clinically distinct subgroup with substantial survival heterogeneity, yet prognostic tools specifically validated for this population remain limited. We aimed to develop and independently externally validate a survival model for prognostic stratification in patients with mEO-CRC and to explore molecular features associated with survival heterogeneity. A total of 7061 patients aged 18–49 years with mEO-CRC from the SEER database (2010–2020) were randomly assigned to a training cohort (n = 4942) and an internal validation cohort (n = 2119). An independent cohort from Nanfang Hospital (n = 182) was used for external validation. A Cox regression model incorporating 16 clinicopathological and treatment-related predictors was developed and presented as a nomogram. Model performance was assessed using the C-index, time-dependent AUC, quantitative calibration metrics, Brier score, and decision curve analysis (DCA). Missingness, LODDS categorization, proportional hazards assumptions, and multiple imputation by chained equations (MICE) sensitivity analyses were further evaluated. Exploratory bioinformatic analyses based on GEO and TCGA datasets were performed as hypothesis-generating analyses. Sixteen predictors were incorporated into the model. The C-index was 0.720 (95
