BACKGROUND:Management of low locally advanced rectal cancer (LARC) requires balancing oncologic radicality, sphincter preservation, postoperative function, and long-term stoma acceptability. These challenges are amplified in settings where socioeconomic and cultural factors influence treatment decisions. This study aimed to provide a descriptive comparison of surgical and reconstructive pathways for LARC in France and Morocco. METHODS:This retrospective bicentric study included patients operated on between January 2017 and December 2024 for low LARC (cT3/T4 and/or node-positive adenocarcinoma within 5 cm of the anal verge). Outcomes were compared between Tours University Hospital, France (LARC-Fr), and the National Institute of Oncology, Rabat, Morocco (LARC-Mo). RESULTS:A total of 224 patients were included (80 LARC-Fr; 144 LARC-Mo). French patients were older (68 vs 57 years, p < 0.001) and had higher ASA III-IV scores (26.3% vs 2.1%, p < 0.001), whereas cT4 tumors were more frequent in Morocco (22.9% vs 7.5%, p = 0.003). Sphincter-preserving procedures, including intersphincteric resection (35.0% vs 0%, p < 0.001) and TaTME (35.0% vs 2.8%, p < 0.001), were more common in France, while abdominoperineal resection (APR) predominated in Morocco (79.2% vs 48.8%, p < 0.001). Among Moroccan patients with a definitive stoma, pseudocontinent perineal colostomy (PCPC) was performed in 64.1%. Major postoperative morbidity and reoperation rates did not differ significantly between cohorts. Complete mesorectal excision and R1 resection rates did not differ significantly. Three-year disease-free survival was 74.5% versus 73.2% (p = 0.075), and overall survival was 85.0% versus 71.9% (p = 0.279), respectively. CONCLUSIONS:This bicentric retrospective study describes distinct surgical and reconstructive pathways for low rectal cancer in France and Morocco. In the Moroccan cohort, PCPC was used after abdominoperineal resection as an alternative to a conventional permanent abdominal colostomy when sphincter preservation was not considered appropriate.

Background For carefully selected patients with peritoneal surface malignancies (PSMs), secondary cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can provide similar oncological results as primary CRS/HIPEC. However, the mortality rate and the incidence of reoperations due to perioperative complications after secondary CRS/HIPEC remain understudied. Methods A retrospective analysis was conducted using the StuDoQ|HIPEC registry, a prospectively maintained national German CRS/HIPEC database, to compare reoperation rates and 30-day mortality between patients undergoing primary and secondary CRS/HIPEC. The analysis included patients treated at 83 centers between 2011 and 2024. Propensity-score matching was performed to adjust for confounding factors prior to comparing outcomes between the matched cohorts. Results A comprehensive analysis of 5,011 primary CRS/HIPEC cases and 236 secondary CRS/HIPEC cases showed no significant differences in reoperation rates (15% vs. 12%, p = 0.192) or 30-day mortality (2% vs. 1%, p = 0.240). After propensity-score matching to control for confounding factors, outcomes remained comparable, with identical reoperation rates of 12% in both groups (p = 1.000) and similar 30-day mortality (2% vs. 1%, p = 0.685). Within the secondary CRS/HIPEC group, the male-to-female ratio was 1:3, and the median age was 55 years. The majority of these patients underwent secondary CRS/HIPEC primarily for appendiceal cancer (27%), pseudomyxoma peritonei (21%), or colorectal cancer (20%), mesothelioma (12%) and ovarian cancer (10%). Conclusions Secondary CRS/HIPEC can be performed safely in selected patients with PSMs, comparable to primary CRS/HIPEC. Reoperation rates and 30-day mortality rates were similar between groups, even after adjusting for confounding factors.

Background Appendicitis is one of the most common surgical emergencies in general surgery. To our knowledge, this is the first reported case of diaphragmatic necrosis associated with appendicitis. Case A 38-year-old male north African patient with no past medical history presented with fever and right lower quadrant pain, for which he started oral self-medication with ibuprofen. Clinical and radiological examinations revealed perforated appendicitis with right-sided pleural empyema and pneumomediastinum. During the initial surgical procedure, we performed an appendicectomy, inserted a chest tube and administered a broad-spectrum antibiotic therapy. The following day, respiratory failure occurred, necessitating right sided thoracoscopy. This revealed diaphragmatic necrosis, which was treated by excision and tension-free suturing after conversion to open thoracotomy. Six days later, persistent sepsis necessitated a new exploratory laparotomy and a right-sided hemicolectomy with an ileocolostomy to treat colonic necrosis. The postoperative course was uneventful, and the patient was discharged one month after admission. Bowel continuity was restored six months later. After a one-and-a-half-year follow-up, the patient remained healthy with no long-term physical impairment. Conclusion To the best of our knowledge, this is the first case of acute appendicitis complicated by diaphragmatic necrosis, empyema and pneumomediastinum to be reported in the medical literature. The pleural empyema and diaphragmatic defect were treated by conversion from thoracoscopy to thoracotomy and direct suture.

In this study, we aim to assess the impact of tumor height on surgical strategy, oncological outcomes, and long-term function in locally advanced rectal cancer. This retrospective cohort study included patients with cT3–T4 and/or N+ rectal cancer treated between 2017 and 2024. Tumors were classified as low locally advanced rectal cancer (LARC; 0 to < 5 cm) or middle locally advanced rectal cancer (MARC; ≥ 5 to < 10 cm). All patients underwent total mesorectal excision (TME) following multimodal therapy. Outcomes included perioperative variables, overall survival (OS), disease-free survival (DFS), and functional results assessed using Wexner, low anterior resection syndrome (LARS), the 36-Item Short-Form health survey (SF-36), and Five-Item International Index of Erectile Function (IIEF-5) scores. Predictors of permanent stoma were analyzed using multivariable regression. A total of 164 patients were included (MARC n = 84; LARC n = 80). Sphincter-sacrificing procedures were significantly more frequent in LARC (abdominoperineal resection [APR]: 48.8

Rectal cancer treatment relies on multimodal approaches including surgery, radiotherapy, and chemotherapy, which are frequently associated with persistent functional sequelae such as bowel dysfunction, stoma formation, and sexual or urinary impairments. These long-term complications are increasingly recognized as key determinants of patients’ quality of life. This narrative review aims to synthesize current evidence on the psychological consequences associated with functional sequelae following rectal cancer treatment. A targeted literature search was conducted across PubMed, PsycINFO, Embase, and Scopus to identify relevant studies published between 2015 and 2025, focusing on patient-reported outcomes and psychosocial dimensions. The findings indicate that bowel dysfunction, particularly Low Anterior Resection Syndrome (LARS), is consistently associated with psychological distress, including anxiety, depressive symptoms, and social withdrawal. Stoma formation is associated with body image disturbances, reduced self-esteem, and impaired sexual functioning. Across studies, these functional impairments appear to interact with psychological and social factors, contributing to multidimensional experiences of isolation. Socioeconomic difficulties and reduced participation in daily activities are also associated with increased psychological burden. Functional sequelae following rectal cancer treatment are closely associated with substantial psychological burden and multidimensional disruptions in patients’ lives. A biopsychosocial perspective may help better understand these complex interactions and guide more comprehensive survivorship care. Greater integration of psychological support into routine care pathways may improve adaptation, reduce distress, and enhance long-term quality of life for rectal cancer survivors. Tailored interventions addressing both functional and psychosocial needs appear essential for optimizing survivorship outcomes.

Surgical power devices generate surgical smoke that may contain infectious components. Various technologies have been developed to improve surgical smoke management, but comparative performance data from human studies are limited. A prospective, single-centre study was performed for evaluating three smoke management technologies - continuous passive filtration (CPF), electrostatic precipitation (ESP), and continuous active filtration (CAF) - during laparoscopic sleeve gastrectomy in 15 bariatric patients. Surgical smoke concentration was monitored by condensation particle counting and single particle light scattering. Efficiency of intraoperative smoke clearance was assessed by the concentration half-life (T-1/2). Secondary outcomes included total CO2 consumption, intraoperative pressure stability, and intraoperative visibility. ESP showed the highest smoke clearance efficiency (T-1/2 = 7.2 s), followed by CAF (18.3 s) and CPF (20.6 s) with significant differences. Total CO2 consumption was highest for CAF (452.0 L) compared CPF (242.0 L) and ESP (80.1 L). All groups maintained a stable capnoperitoneal pressure and a good/very good intraoperative visibility. Electrostatic precipitation showed the lowest CO2 consumption and significantly higher smoke particle removal efficiency compared to continuous active/passive filtration. All technologies provided good/very good intraoperative visibility and capnoperitoneal pressure stability.

Introduction: Liposarcomas are rare malignant tumors of adipocytic origin with a high propensity for local recurrence. Although desmoid tumors are benign, they may present with clinical and radiological features similar to those of soft tissue sarcomas, which may complicate the differential diagnosis. Presentation of case: We present the case of a patient who underwent an initial resection of a retroperitoneal liposarcoma. During routine follow-up, imaging suggested a local recurrence. Following a multidisciplinary discussion, a second surgical intervention was performed, revealing histopathological features consistent with a desmoid tumor rather than a recurrent liposarcoma. Discussion: This case demonstrates that a lesion initially suspected to be recurrent liposarcoma may actually be a desmoid tumor. It highlights the importance of a thorough multidisciplinary evaluation and histological confirmation prior to planning further treatment, given that management strategies differ significantly between these conditions. Conclusion: This observation highlights that lesions following abdominal liposarcoma resection do not always represent tumor recurrence, and that biopsy remains essential for accurate diagnosis and optimal management.

Esophageal perforation is a rare but life-threatening condition associated with high morbidity and mortality. Optimal management remains controversial, particularly regarding the indications for conservative, endoscopic, and surgical strategies. We conducted a retrospective single-center cohort study including adult patients treated for esophageal perforation between January 2018 and November 2023. Patients were categorized into conservative management (CM) or surgical management (SM). Clinical presentation, etiology, treatment modalities, complications, and mortality were analyzed. A subgroup analysis compared esophageal preservation with esophagectomy within the surgical group. Fifty-eight patients were included (CM: n = 30; SM: n = 28). Patients in the SM group presented with significantly greater severity, including higher rates of mediastinitis (96.4

The expansion of minimally invasive surgery has transformed surgical practice and training worldwide. However, operative exposure to laparoscopic and open procedures may vary across healthcare systems. Comparative international data on operative autonomy and procedural experience during surgical residency remain limited. This study aimed to compare operative exposure, autonomy, and trainee perceptions regarding open and laparoscopic surgery among surgical trainees at selected centers in France and Morocco. A multicenter cross-sectional survey was conducted among surgical trainees at academic centers in France and Morocco. Participants were stratified by postgraduate year (PGY 1–8). Self-reported operative exposure and autonomy were assessed for common general surgical procedures (appendectomy, cholecystectomy, and inguinal hernia repair) and complex colorectal procedures (colectomy and proctectomy) performed using open and laparoscopic approaches. Trainee perceptions of preparedness for minimally invasive surgery and the value of prior training in open surgery were also evaluated. Comparisons were made according to country and level of training. A total of 131 trainees participated, including 67 from Morocco and 64 from France. Trainees at French centers reported significantly greater exposure to laparoscopic procedures across training levels (p < 0.001), whereas trainees at Moroccan centers reported greater exposure to open appendectomy, inguinal hernia repair, and proctectomy (p < 0.001). Operative autonomy increased with training seniority in both groups, although trainees at French centers reported greater autonomy in laparoscopic procedures. Trainees at Moroccan centers were significantly more likely to consider prior training in open surgery necessary before performing laparoscopic procedures (p < 0.01). These findings support context-adapted curricula that preserve competence in open surgery while expanding access to structured, supervised training in minimally invasive surgery.

A comparative ex vivo study was conducted to evaluate the impact of different nebulizer designs on spatial distribution, tissue concentration, and penetration depth of drugs delivered via pressurized intraperitoneal aerosol chemotherapy (PIPAC). Three nebulizer designs were evaluated in a PIPAC box: group 1 [full spray cone-multidirectional nebulizer (FSC-MDN)], group 2 [full spray cone-single directional nebulizer], and group 3 [hollow spray cone-single directional nebulizer]. Spatial aerosol deposition was measured using methylene blue for three-dimensional gravimetry in gram (g). PIPACs with doxorubicin and cisplatin were performed to assess penetration depth (µm) and drug concentrations (µg/g) in porcine peritoneal tissue samples from the bottom, sides, and top of the box. Doxorubicin penetration was evaluated using fluorescence microscopy, and cisplatin concentrations were quantified using inductively coupled plasma mass spectrometry. Group 3 had significantly higher methylene blue deposition at the bottom (35.59 ± 1.46 g) compared with group 1 (24.2 ± 0.23 g, p = 0.0022) and group 2 (31.47 ± 0.52 g, p = 0.0001). Conversely, group 1 showed significantly greater side and top deposition (10.11 ± 0.26 g) than groups 2 (5.01 ± 0.68 g, p = 0.0022) and 3 (3.99 ± 0.42 g, p = 0.0022). Group 1 also demonstrated higher cisplatin concentrations (6.254 ± 2.57 µg/g, p = 0.05) and deeper doxorubicin penetration (179.9 ± 78.77 µm, p = 0.05) than the other groups. Compared with the other single directional nebulizers, group 1 (FSC-MDN) achieved greater side and top deposition, along with enhanced doxorubicin penetration and platinum concentration in the ex vivo PIPAC model.

Advances in neoadjuvant therapy, imaging, and surgical techniques over the past three decades have significantly transformed the management of low rectal cancer. However, in this anatomically and functionally sensitive region, where decisions intersect with continence, identity, and quality of life, strict adherence to standard protocols is often inadequate. This article explores four recurring dilemmas that influence contemporary surgical decision-making: whether to preserve the sphincter or perform an abdominoperineal resection, whether to create a stoma or avoid it, whether to use minimally invasive techniques or prioritize oncologic clarity, and whether to standardize or personalize care. Drawing from clinical experience and literature, this article argues that oncologic safety must be balanced with functional outcomes and patient acceptability. Sphincter preservation does not always equate to a better quality of life, and stomas, though stigmatized, can offer improved autonomy when framed appropriately. Minimally invasive approaches should be judged by context, expertise, and outcomes, not just technology. Lastly, as metastatic patterns become more complex, personalized care increasingly supersedes algorithmic rigidity. The paper ultimately calls for nuanced, patient-centered strategies that redefine success beyond margins and recurrence toward dignity, function, and survivorship on the patient’s terms.

The objective of this study is to compare the perioperative clinical outcomes between power-assisted circular staplers (PCS) and manually-operated circular staplers (MCS) with directional stapling technology (DST) for deep colorectal anastomoses. A retrospective analysis of a prospective database of 64 consecutive patients who underwent elective surgery for low colorectal anastomosis (< 7 cm from the anal verge) between February 2020 and December 2022 at a tertiary referral center for colorectal surgery at the University Hospital of Tours, France. Patients were divided into two groups according to the stapler used: PCS group II; (n = 35) and MCS (group I; n = 29). Data collected included demographic characteristics, intraoperative parameters, postoperative complications (Dindo-Clavien), and oncological outcomes. The PCS group had significantly lower overall rates of postoperative complications compared to the MCS group (31.4

The most prevalent conditions affecting the pelvic floor include fecal incontinence (FI) and urinary incontinence (UI), both of which are particularly common among women with obesity. Although the effect of metabolic bariatric surgery (MBS) on FI remains a topic of ongoing discussion, the present study seeks to assess the impact of effective bariatric surgery on UI and FI in women with obesity. An observational prospective study was conducted at the Tours University Hospital, involving 212 women who underwent MBS. Participants completed pre-operative and post-operative questionnaires to evaluate UI and FI one-year after surgery. Additionally, urinary symptom profile (USP) and Wexner score (WS) were utilized for the assessment of UI and FI, respectively. Of the 212 patients, 148 achieved a weight loss of more than 20

Various nozzle designs are used in pressurized intraperitoneal aerosol chemotherapy (PIPAC), but comparative in vivo data on their pharmacologic effects are limited. Three groups of four pigs each received PIPAC with oxaliplatin (92 mg) using nebulizers with different designs: group 1 (full-spray-cone single directional), group 2 (hollow-spray-cone single directional), and group 3 (full-spray-cone multidirectional). Oxaliplatin concentrations (µg/g) were measured in blood, peritoneal tissue, and intra-abdominal fluid using inductively coupled plasma mass spectrometry. No significant differences in mean oxaliplatin concentrations in peritoneal tissue were observed: group 1 (12.37 ± 10.81 µg/g), group 2 (5.83 ± 6.18 µg/g), group 3 (9.46 ± 6.10 µg/g) ( p = 0.1002). However, group 3 had a significantly higher mean total oxaliplatin concentration in visceral peritoneal tissue (3.97 ± 0.63 µg/g) than group 1 (2.6 ± 0.56 µg/g) or group 2 (2.15 ± 0.37 µg/g ( p = 0.028). The mean total tissue uptake was also higher in group 3 (41.98 mg) than in group 1 (28.14 mg) or group 2 (36.65 mg) (p = 0.05). Pairwise comparisons showed no significant differences (group 1 vs group 2 [p = 0.1000], group 2 vs group 3 [p = 0.700]). No significant differences in blood absorption were noted (p = 0.106). The full-spray-cone multidirectional nebulizer design in group 3 resulted in significantly higher oxaliplatin concentrations in the small bowel peritoneum with greater total oxaliplatin tissue uptake than with the two other designs.

BACKGROUND/AIM:During low anterior rectal resection for rectal cancer, a protective ileostomy (PI) is routinely created to reduce the severity of anastomotic complications. The aim of this study was to investigate the side-effects of PI during adjuvant chemotherapy. PATIENTS AND METHODS:A retrospective cohort of patients was operated on for non-metastatic rectal cancer with a PI during 2005-2022. Patients treated with adjuvant chemotherapy (AC) were compared with those not receiving AC. A subgroup analysis compared patients with early PI closure (<10 weeks) and those with a PI in place during chemotherapy. RESULTS:A total of 242 patients were included: 178 (73.6%) without adjuvant chemotherapy and 64 (26.4%) with. History, tumour location, neoadjuvant treatment and postoperative follow-up were similar for both groups. Patients treated with AC had a greater risk of renal failure (37.5% vs. 14.6%, p=0.0002), ionic disorders (45.3% vs. 26.9% p=0.008), malnutrition (23.4% vs. 5.6%, p=0.0002) and rehospitalization (35.9% vs. 18.5% p=0.007). Patients treated with AC needed significant dose adjustments of oxaliplatin in 40.6% of cases, this adjustment being higher in patients with a PI compared to patients with early closure (47.1 vs. 9.1%, p=0.021). CONCLUSION:Presence of a PI during chemotherapy predisposes to increased episodes of renal failure, and requires major adaptation of chemotherapy doses, especially of oxaliplatin.

It is assumed that robotic-assisted surgery (RAS) may facilitate complex pelvic dissection for rectal cancer compared to the laparoscopic-assisted resection (LAR). The aim of this study was to compare perioperative morbidity, short- and long-term oncologic, and functional outcomes between the RAS and LAR approaches. Between 2015 and 2021, all rectal cancers operated on by (LAR) or (RAS) were retrospectively reviewed in two colorectal surgery centers. A total of 197 patients were included in the study, with 70

BACKGROUND/AIM:This study evaluated the feasibility and safety of whole-body hyperthermia pressurized intraperitoneal aerosol chemotherapy (WBH-PIPAC) in patients with peritoneal surface malignancies. PATIENTS AND METHODS:This study retrospectively analyzed a database of 28 patients who had received one cycle of normothermic PIPAC prior to repetitive WBH-PIPACs. WBH (39-40°C) was induced using a Water-filtered infrared A device. Doxorubicin plus cisplatin or oxaliplatin was nebulized into a constant capnoperitoneum of 20 mmHg for 30 min at doses of 6.0 mg, 30.0 mg, or 120 mg per m2 body surface area, respectively. The primary outcome measures were feasibility and perioperative complications. RESULTS:The median age was 62 years (range=45-78 years). Primary tumor sites included the upper gastrointestinal tract (n=9), colon/rectum (n=7), hepato-pancreato-biliary system (n=3), peritoneum (n=2), ovaries (n=2), and unknown primary (n=5). The induction of WBH failed in one patient (6 liters ascites). After a median warming period of 95 min (53-117 min), the median rectal temperature (Trec) was 39.5°C (39.2-39.9°C). No hyperthermia-related side effects were observed. Twenty-seven patients received 50 WBH-PIPACs. The median time of therapeutic capnoperitoneum and treatment time with Trec ≥39°C was 39 min (37-43 min) and 66 min (53-69 min), respectively. The overall rate of postoperative procedure-related complications was 9/50, including seven grade I and two grade II complications. There were no grade III-V complications. CONCLUSION:In a highly selected group of patients, the feasibility and perioperative safety of WBH-PIPAC was comparable to normothermic PIPAC.

BackgroundThe incidence of incisional hernia following laparotomy varies between 2% and 30%. It is well-established that the need to control several risk factors prior to surgery exists (weight loss before surgery, diabetes control). Postoperative abdominal binder (AB) is often recommended by surgeons, yet evidence on this topic is lacking. The aim of this review was to present current evidence on the use of abdominal binders after abdominal surgery.Material and MethodsA comprehensive literature review between January and May 2024 was conducted using a range of search engines, including PubMed, Science Direct, EMBASE, Google Scholar, and Google. The following keywords were used: “abdominal binder,” “abdominal support,” “hernia,” “girdle and hernia,” “compression belt and hernia,” and “abdominal support and hernia.”ResultsSixteen articles were selected for further analysis (7 RCTs, 6 non-RCTs and 3 meta-analyses). None of the studies reported a reduction in the incidence of abdominal dehiscence or incisional hernia. Postoperative use of the AB has been shown to reduce postoperative discomfort and pain for a limited period of up to 48–72 h. There was no discernible difference in the incidence of surgical site complications.ConclusionThe current evidence indicates that the use of AB following abdominal surgery is safe, although no benefit has been established (except 48 h after surgery). AB may enhance comfort in select patients; however, further studies are necessary to justify their routine use, with a particular focus on the medical and economic implications.