BACKGROUND:Anorectal incontinence is a major health issue due to its economic burden and impact on quality of life. Its true prevalence remains under-estimated and a matter of debate. Our aim was to evaluate the prevalence of anal incontinence among the collaborators of a tertiary hospital. METHODS:An anonymous survey was distributed to all collaborators of a tertiary hospital using a standardized electronic questionnaire, incorporating Jorge-Wexner and LARS scores and items covering different definitions of anorectal incontinence, along with demographic characteristics and specific medical history. RESULTS:Among 14,270 collaborators, 2535 filled the questionnaire. This sample was comparable to the total hospital staff concerning age, gender and occupation. Anorectal incontinence (defined by a Jorge-Wexner score ≥ 3) was present in 20.9% of participants. However, only 2.3% fulfilled the strict Rome IV criteria for faecal incontinence. The presence of anorectal incontinence was higher in women (16.2% vs. 4.7%, p = 0.001), but the Rome IV criteria were comparable. In women, vaginal delivery was not associated with anal incontinence in univariate and multivariate analyses or with Rome IV criteria after adjustment. Diabetes was markedly associated with the presence of Rome IV criteria (OR: 3.3, 95% CI: 1.09-10.08, p = 0.035). History of proctological procedure was also substantially associated with anorectal incontinence and Rome IV criteria (OR: 4, 95% CI: 1.86-8.6, p < 0.001). CONCLUSION:Prevalence of anal incontinence was higher than expected in an active population, and in this medically sensitized working cohort, traditional obstetric factors appeared less strongly associated with anorectal incontinence than anticipated, suggesting a more complex risk profile.

In light of the recent publication of two multicentric controlled trials, this systematic review and meta-analysis aims to update the evidence of the efficacy of Indocyanine Green fluorescence angiography in preventing the risk of anastomotic leak after colorectal surgery. MEDLINE, EMBASE, and CENTRAL databases were searched for randomized controlled trials using relevant keywords from 2015 until September 2025. The outcomes were the overall rate of anastomotic leaks, the rate of reoperations, and the rate of intraoperative surgical strategy changes. Ten randomized controlled trials were selected, including 4.885 patients, 2.432 (49.7 2.453 (50.3

AIM:Rectopexy is the preferred abdominal intervention for rectal prolapse. Despite similar procedural steps - rectal mobilisation, prolapse reduction, and fixation - techniques vary widely, and onsensus on the optimal approach is lacking. This study aimed to assess global surgeon preferences and practices in rectopexy. METHODS:An international 28-item online survey was distributed between November 2023 and March 2024 through professional networks and social media. Questions addressed surgeon demographics, perioperative strategies, and technical approaches to rectopexy. Responses were analysed descriptively and stratified by region and specialty. RESULTS:A total of 226 surgeons from 36 countries across four continents completed the survey. Most respondents (79.6%) administered preoperative intravenous antibiotics, and 80.5% used some form of mechanical bowel preparation. Minimally invasive approaches predominated (81%), with laparoscopy being most common. Posterior dissection was preferred by 61.5%, while 38.5% favoured ventral (anterior) dissection. Two-thirds (68.1%) routinely used mesh, predominantly synthetic. Only 15% performed rectopexy as a day-case procedure. Regional and specialty-related variations were evident in approach, mesh type, and perioperative protocols. CONCLUSION:This international survey reveals marked variability in rectopexy practice worldwide. Despite common principles, surgeon preference and regional factors strongly influence decision-making. The findings emphasise the need for updated international guidelines to harmonise technique selection and perioperative management in rectal prolapse surgery.

In laparoscopic right hemicolectomy (lapRHC) for colorectal cancer, intra-corporeal anastomosis (ICA) has been associated with faster recovery and lower incidence of incisional hernia (IH) compared with extra-corporeal anastomosis (ECA). However, due to technical constraints, ICA is not widely adopted, and ECA remains the standard approach. Robotic surgery, with enhanced dexterity and suturing capability, facilitates ICA and may therefore improve short-term outcomes and reduce IH incidence. We designed a monocentric, double-blind randomized controlled trial to compare robotic right hemicolectomy (robRHC) with D2 lymphadenectomy, ICA, and off-midline extraction (fully minimally invasive) versus lapRHC with D2 lymphadenectomy, ECA, and midline extraction (standard of care). The primary endpoint is bowel recovery, assessed by time to first passage of stool. Secondary endpoints include perioperative safety (morbidity, mortality, resection margins, lymph node yield), length of stay, IH incidence, and patient-reported esthetic and quality-of-life outcomes. Based on a hypothesized 1-day reduction in bowel recovery, a total of 70 patients will be randomized. The trial complies with the Declaration of Helsinki, ICH-GCP, and Swiss regulatory standards. It has been approved by the local ethics committee (CCER 2024 − 00975) and registered in ClinicalTrials.gov (NCT06067620, 09.05.2024).

BackgroundUreteral injury is a severe complication in colorectal surgery, with an incidence up to 2.5%. Despite meticulous surgical technique, intraoperative ureter identification can be challenging, particularly in cases involving prior operations or extensive inflammation. Indocyanine green (ICG) fluorescence imaging has emerged as a promising adjunct to enhance ureter visualization. In parallel, novel fluorophores with renal excretion properties (e.g., CW800-CA, ZW800-1) are undergoing investigation to avoid routine ureteral catheterization. This systematic review evaluates the efficacy, safety, and clinical impact of ICG-based and emerging fluorescence approaches for ureter identification in colorectal surgery.MethodsA systematic literature search was performed in PubMed and Embase, up to March 2025, following PRISMA 2020 guidelines. Studies assessing intraoperative ureter identification via ICG fluorescence or other near-infrared fluorophores during adult colorectal surgery were included. Exclusion criteria comprised pediatric populations, non-colorectal procedures, reviews, editorials, and animal experiments. Primary outcomes were ureter visualization rate and intraoperative ureteral injury rate, while secondary outcomes included procedure-related complications, operative time, adverse effects, and preliminary cost data.ResultsTen studies comprising 716 patients undergoing colorectal surgery with ICG fluorescence imaging were analyzed. Ureter visualization rates ranged from 95.3% to 100%, with most studies reporting a rate of 100%. No ICG-related complications were documented. ICG administration was primarily via cystoscopy with intra-ureteral injection or ureteral catheterization, predominantly in laparoscopic and robot-assisted procedures. Mean duration of the cystoscopy varied from 7 to 29 min. Improved intraoperative ureter identification compared with conventional visualization was reported in available comparative studies.ConclusionICG fluorescence imaging safely and effectively enhances intraoperative ureter visualization during colorectal surgery, potentially reducing the risk of ureteral injuries. However, the need for routine ureteral catheterization prolongs procedure duration. Emerging renally excreted fluorophores may eliminate the need for catheterization and should be prioritized in future clinical trials.Systematic Review RegistrationPROSPERO [CRD420250653992].

Summary:. Several reconstructive procedures have been documented for large perianal defects after extensive surgical resection. The lotus petal flap (LPF) is a fasciocutaneous flap, the use of which remains limited compared with alternative surgical techniques for the same indications. Extramammary Paget disease in the perianal area is a rare tumoral skin condition that severely affects patient autonomy. If not treated correctly, this disease can be lethal. The authors present the case of a 68-year-old male patient with a recurrence of extramammary Paget disease despite previous interventions, including multiple incomplete resections. To address the aggressive growth of perianal skin ulceration, a multistep approach including extensive en bloc resection, temporary negative pressure dressing coverage, and delayed reconstruction of the perianal area was recommended. Initially, the patient underwent a radical bilateral perianal surgical excision with wide margins. Two successive excisions were then performed to completely remove the tumor. The multistage approach was completed with wound closure using 2 bilateral LPFs, raised in the inner thigh area, measuring 11 × 16 cm on the left and 13 × 18 cm on the right. At 12-month postoperative follow-up, satisfaction was obtained in both aesthetic and functional outcomes. No impairments in ambulatory function were observed. This bilateral LPF reconstruction, associated with an extensive multistage perianal tumoral resection, offers a reliable and effective method to address extramammary Paget disease in the perianal region.

INTRODUCTION:The incidence of colorectal cancer in adults younger than 50 years has increased, but the trends of incidence in Switzerland has not been yet described. We assessed long-term incidence, stage distribution, and survival of early-onset colorectal cancer (EOCRC) in Switzerland. MATERIALS AND METHODS:We conducted a nationwide, population-based study including all patients aged 20 years or older who were diagnosed with a first colorectal adenocarcinoma between 1980 and 2021, based on data from the National Cancer Dataset provided from the National Agency for Cancer Registration (NACR). Age-standardized incidence rates per 100'000 person-years were calculated using the 1976 European Standard Population. Temporal trends were assessed using joinpoint regression, expressed as annual percent change (APC). Stage distribution was analysed for 2010-21, when harmonized TNM data were available. Five-year net survival was estimated using the Pohar-Perme estimator. RESULTS:Among 96'410 patients, 5'928 (6.1%) were below 50 years old. Rectal cancers comprised 31.8% of EOCRC, versus 22.9% in those aged ≥ 75 years, whereas proximal colon cancers were less common (30.5% vs 42.7%, respectively). From 2010 to 2021, 27.7% of EOCRC were UICC stage IV, compared with 22.1% at ages 50-74 and 19.4% at ≥ 75. EOCRC incidence rose steadily (men: APC +0.46% [95% CI 0.17-0.76]; women: +0.49% [0.17-0.81]), driven by rectal cancers in both sexes and proximal colon cancers in young women. In contrast, incidence declined in older adults after the mid-2000s. Five-year net survival improved and reached a peak of 76.9% in 2010 for young men and 78.2% in 2007 for young women. DISCUSSION:EOCRC incidence in Switzerland has risen continuously, with advanced stage at diagnosis and heterogeneous survival gains, underscoring the need for adapted prevention, awareness, and screening strategies.

Surgical techniques for right hemicolectomy (RHC) show considerable heterogeneity. To identify potential areas for improvement and standardization, the objective of this survey was to evaluate and report current practices and preferences among surgeons for performing RHC for colorectal cancer. An international online survey consisting of 31 questions was distributed to general surgeons worldwide to assess their preferred techniques for performing RHC. A total of 368 surgeons from 48 countries responded. Among them, 47% reported performing at least 90% of RHC laparoscopically, while 40% used a robotic approach. The most common dissection technique was a medial-to-lateral vessel-first approach, used by 82.3% of respondents. During laparoscopic procedures, 51.6% of surgeons performed extracorporeal anastomosis, whereas 82.9% of those using a robotic approach favored intracorporeal anastomosis. Fluorescence angiography was routinely used by 39.9% of respondents. The Pfannenstiel incision was the most frequently selected extraction site (46.5%) especially if intracorporeal anastomosis was performed (81.8%). The preferred technique for performing RHC includes a laparoscopic approach with intracorporeal lymph node dissection and extracorporeal anastomosis. Most RHC procedures therefore remain laparoscopy-assisted rather than fully minimally invasive. Robotic surgery appears to facilitate a fully minimally invasive approach including intracorporeal anastomosis.

Peritoneal carcinomatosis is a major therapeutic challenge in gynecological and gastrointestinal malignancies, associated with poor quality of life and short survival. Little is known about the tumor microenvironment (TME) of peritoneal carcinomatosis resistant to chemotherapy. Using multiplexed immunohistochemistry (FoxP3, CD163, CD8, CD68, FAP and Cytokeratin) and sensitive T cell receptor (TCR) repertoire analysis, we investigated spatial and longitudinal changes of the TME of 54 biopsies collected from 18 patients with peritoneal carcinomatosis (six ovarian cancer, nine gastric cancer and three pancreatic cancer) treated in the Nab-PIPAC phase IB trial (repeated cisplatin and nab-paclitaxel by pressurized intraperitoneal aerosol chemotherapy [PIPAC]). Overall, tumors were cold with low T cell infiltration. There was high intra- and inter-patient heterogeneity of TCR repertoire and immune cell distribution, with different tumor patterns and TME compositions depending on the primary cancer. Ovarian and gastric cancers were enriched in CD163+ tumor-associated macrophages while pancreatic cancer was enriched in FAP+ cancer-associated fibroblasts and FoxP3+ regulatory T cells. TCR clonality was higher in ovarian cancer, as compared to oesogastric cancer, likely reflecting expansion of tumor reactive T cells. Focusing on ovarian cancer, hyperexpanded T cells were more abundant in the tumor core as compared to matched stroma. Our spatial and longitudinal study brings new insights into the TME of peritoneal carcinomatosis, with implications for the future design of precision medicine in this disease. Laura Grassi, Raphael Genolet, Valentine Du Bois, Manuela Undurraga, Thibaud Koessler, Jean-Christophe Tille, Antonella Diciola, Mariagrazia Di Marco, Noémie Lang, Nicolas Mach, remi Peanne, Eileen Zhao, Nawel Zouggari, Julie Terzic, Catherine Raimond, Patrick Petignat, Christian Toso, Stefan Monig, Martin Hübner, Frederic Ris, Alexandre Harari, Intidhar Labidi-Galy. Spatial and longitudinal characterization of tumor microenvironment of peritoneal carcinomatosis: Nab-PIPAC phase IB trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 6541.

Locally advanced rectal cancer (LARC) is treated with neoadjuvant chemoradiotherapy (nCRT), but only a minority of patients achieve a pathological complete response (pCR). Predictive biomarkers of response could help guide treatment decisions, yet none have reached clinical practice. In this exploratory study, we integrated six publicly available transcriptomic datasets and applied machine learning to derive a 186-gene signature predictive of nCRT response. The signature showed good performance in cross-validation (AUC 0.80) and was associated with consensus molecular (CMS4) and immune (iCMS3) subtypes enriched in responders. Gene set enrichment analyses highlighted pathways involved in tumor growth, immune regulation, and resistance. Spatial transcriptomic profiling of pre-treatment biopsies further identified compartment-specific markers, with tumor-associated genes showing greater predictive value. These results provide biological insights into response mechanisms and generate hypotheses for future validation. Larger prospective studies are required to assess the clinical utility of this approach.

Background/Objectives: Treatment of locally advanced rectal cancer (LARC) very often requires a neoadjuvant multimodal approach. Neoadjuvant treatment (NAT) encompasses treatments like chemoradiotherapy (CRT), short-course radiotherapy (SCRT), radiotherapy (RT) or a combination of either of these two with additional induction or consolidation chemotherapy, namely total neoadjuvant treatment (TNT). In case of complete radiological and clinical response, the non-operative watch-and-wait strategy can be adopted in selected patients. This strategy is impacted by a regrowth rate of approximately 30%. Predicting biomarkers of tumor response to NAT could improve guidance of clinicians during clinical decision making, improving treatment outcomes and decreasing unnecessary treatment exposure. To this day, there is no validated biomarker to predict tumor response to any NAT strategies in clinical use. Most research focused on CRT neglects the study of other regimens. Methods: We conducted a narrative literature review which aimed at summarizing the status of biomarkers predicting tumor response to NAT other than CRT in LARC. Results: Two hundred and fourteen articles were identified. After screening, twenty-one full-text articles were included. Statistically significant markers associated with improved tumor response pre-treatment were as follows: low circulating CEA levels; BCL-2 expression; high cellular expression of Ku70, MIB-1(Ki-67) and EGFR; low cellular expression of VEGF, hPEBP4 and nuclear β-catenin; the absence of TP53, SMAD4, KRAS and LRP1B mutations; the presence of the G-allel of LCS-6; and MRI features such as the conventional biexponential fitting pseudodiffusion (Dp) mean value and standard deviation (SD), the variable projection Dp mean value and lymph node characteristics (short axis, smooth contour, homogeneity and Zhang et al. radiomic score). In the interval post-treatment and before surgery, significant markers were as follows: a reduction in the median value of circulating free DNA, higher presence of monocytic myeloid-derived suppressor cells, lower presence of CTLA4+ or PD1+ regulatory T cells and standardized index of shape changes on MRI. Conclusions: Responders to neoadjuvant SCRT and RT tended to have a tumor microenvironment with an immune–active phenotype, whereas responders to TNT tended to have a less active tumor profile. Although some biomarkers hold great promise, scarce publications, inconsistent results, low statistical power, and low reproducibility prevent them from reliably predicting tumor response following NAT.

Background/Objectives: Sacral chordomas are rare, locally invasive tumors that pose significant surgical and oncological challenges due to their anatomical complexity, proximity to critical structures, and resistance to conventional therapies. Methods: A literature search focused on contemporary multidisciplinary management of sacral chordoma was conducted. An illustrative case of such a multidisciplinary approach is presented. Results: Achieving optimal outcomes necessitates a multidisciplinary approach that balances en-bloc resection with negative margins and preservation of biomechanical stability and neurological function. Negative resection margins are a key determinant of long-term survival and reduced recurrence, particularly for tumors involving the upper sacrum (S1–S2). While postoperative radiation therapy provides adjunctive benefits, precision in surgical planning and execution remains paramount. Emerging technologies, such as augmented reality and 3D-printed anatomical models, are enhancing surgical precision, while the role of multidisciplinary surgical teams in improving outcomes requires further study. Conclusions: This review highlights the complexities of sacral chordoma management, focusing on surgical strategies, functional trade-offs, and future directions to optimize oncological and functional outcomes.

OBJECTIVE:Anastomotic leak occurs in 8.1% of right colectomies and up to 17.1% of low anterior resections. Fluorescence angiography has gained acceptance in recent years as a method for assessing anastomosis vascularization, a key element implicated in anastomotic leak. Our objective was to perform a systematic review and meta-analysis of randomized controlled trials on the effect of fluorescence angiography on anastomotic leak and postoperative morbidity. METHODS:A systematic review was performed on Medline, Embase and CENTRAL according to the PRISMA statement until 16 March 2025. Randomized controlled trials in English that compared fluorescence angiography with standard care were considered eligible. Articles were screened, bias was detected, data were extracted, pooled and analysed. RESULTS:Among 477 identified studies, 401 were retained for screening but only eight were included in the quantitative analysis (3999 patients). Fluorescence angiography was significantly protective against anastomotic leak, with an odds ratio of 0.64 (95% CI: 0.39-0.98, I2: 0%, p < 0.0001) and a reduction in risk of 4 percentage points (95% CI: -0.05 to 0.02, I2: 0%, p < 0.0001). When analysis was restricted to colorectal anastomosis, the effect of fluorescence angiography on anastomotic leak was maintained (OR 0.59, 95% CI 0.44-0.79, I2: 0%, p < 0.0005). However, fluorescence angiography did not reduce postoperative morbidity compared with the control group. CONCLUSION:High-quality evidence shows that fluorescence angiography reduces the rate of anastomotic leak in colorectal surgery with a decrease in the incidence of 4 percentage points.