Type III and IV hiatal hernias require surgical repair to improve symptoms and prevent complications. Long-term patient-reported outcomes following minimally invasive repair, particularly with robotic-assisted techniques, remain incompletely described. This single-center retrospective cohort study evaluated consecutive patients who underwent elective hiatoplasty for type III or IV hiatal hernia between 2014 and 2024. Quality of life (QoL) was assessed using validated scores (GERD-HRQL, DeMeester symptom score) and a 5-point Likert satisfaction scale. The primary outcome of interest was postoperative QoL. Secondary outcomes included complications, recurrence, and associations with surgical technique (robotic vs. laparoscopic), mesh use, and fundoplication. Eighty patients were selected from 152 treated during the study period. The cohort comprised 71.3

Objective This study aimed to describe the location, treatments and postoperative outcomes of patients with anastomotic leak (AL) after total gastrectomy for gastric cancer (GC).Methods A retrospective review was conducted of patients who experienced AL after total gastrectomy for GC, treated at a high-volume European institution between 2019 and 2024. Data collected included AL location, clinical outcomes, treatments and 90-day mortality. ALs were categorised as early or late, and their association with surgical and clinical data was assessed. Finally, a comparison with patients who underwent total gastrectomy for GC without AL (controls) was also performed.Results Out of 151 total gastrectomies, 13 patients had an AL. The median time to diagnosis was 3 days; 7 patients were categorised in the early leak group. Overall, 84.6% reported AL on the right side of the anastomosis. Surgical intervention was required for most cases, either alone (53.8%) or in combination with endoscopic treatment (38.5%). Half of the patients required emergency intensive care unit (ICU) admission, and the mean postoperative stay was 48.5 days. The 90-day mortality was 15.4%. Patients with AL experienced significant delays in resuming adjuvant chemotherapy. When compared with the 133 controls, patients with AL were documented with more comorbidity (American Society of Anesthesiologists 3-4 53.9% vs 18.8%, p 0.003), and lower preoperative haemoglobin values (112 g/L vs 122 g/L, p 0.002), with longer hospitalisation and increased emergency ICU admissions.Conclusions ALs are more common on the right side of the oesophagojejunostomy. Leaks continue to represent a critical challenge following total gastrectomy, with significant implications for patient morbidity and mortality.

Colorectal cancer (CRC) is extremely rare in paediatrics with aggressive histopathology and advanced presentation. Whilst pembrolizumab has shown efficacy in adult microsatellite instability-high or mismatch repair deficiency CRC, paediatric data remain scarce. A 12-year- old boy with Lynch syndrome-associated CRC developed severe cardiac toxicity after initial chemotherapy. Treatment was switched to off-label pembrolizumab, resulting in a complete response after 24 cycles. Despite good tolerability, the patient developed a delayed bowel stricture at the tumour site. After surgery, there was no pathological evidence of residual adenocarcinoma. This case demonstrates the potential of pembrolizumab in paediatric CRC, highlighting the importance of molecular-guided rather than age-restricted therapy selection.

BACKGROUND:Perioperative FLOT is the reference regimen for resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma, yet predictors of response and survival remain incompletely defined. We evaluated pathological response, molecular associations, and survival in a real-world cohort from a high-volume Italian institution, with the aim of benchmarking contemporary outcomes and generating hypotheses for future risk stratification. METHODS:Consecutive patients with stage IB-IVa resectable GC/GEJ treated with neoadjuvant FLOT (2017-2025) at a tertiary center were retrospectively analyzed. Primary endpoints were Mandard tumor regression grade (TRG) and overall survival (OS) from diagnosis. Secondary endpoints included event-free survival (EFS), disease-free survival (DFS), R0 rate, safety, and associations between clinicopathologic/molecular features (HER2, PD-L1 CPS, MMR) and TRG. Multivariable logistic and Cox models were applied. RESULTS:Among 159 patients, 95% proceeded to resection; 11.9% progressed during neoadjuvant therapy. Pathological complete response was 6.9%, major response (TRG1-2) 17.0%, and R0 rate 92% in non-metastatic resections. Severe (≥G3) neoadjuvant toxicity occurred in 15%. Two-year OS and EFS from diagnosis were 78.2% and 58%, respectively; two-year DFS after R0 resection was 64.5%. Signet-ring cells and clinical nodal positivity independently predicted poorer TRG. PD-L1 CPS>1 was associated with inferior tumor regression in exploratory analysis. Baseline cT, cN, and cM stage predicted EFS, whereas post-therapy stage ypTNM and receipt of adjuvant therapy were associated with DFS. CONCLUSIONS:In real-world practice, perioperative FLOT shows feasible delivery and outcomes consistent with contemporary real-world benchmarks, but pathological response remains limited in biologically unfavorable subgroups. Baseline tumor burden and specific phenotypes identify underperforming populations, supporting prospective validation of risk-adapted perioperative strategies.

Background Accurate preoperative staging is essential for risk stratification and treatment planning in localized colon cancer (lCC), particularly in the context of emerging neoadjuvant strategies. However, the reproducibility of CT-based classification and its concordance with pathology remain incompletely defined. Patients and Methods We analyzed 175 patients with lCC who underwent baseline contrast-enhanced CT followed by curative-intent surgery. Two independent radiologists assessed clinical tumor (cT) and nodal (cN) stages, with discrepancies resolved by consensus. Interobserver agreement was evaluated using Cohen’s kappa. Radiological-Pathological (R–P) concordance was assessed for T, N, and overall stage. Multivariable logistic regression analyses was performed to identify predictors of concordance. Results Interobserver agreement was good for cT classification (κ = 0.77) and excellent for cN classification (κ = 0.94), with overall concordance of 82.9%. R–P concordance was achieved in 78.3% for T staging and 73.7% for N staging, while overall concordance was 57.1%. Most discrepancies reflected adjacent misclassification (29.3%), whereas gross errors were rare (2.3%). CT showed moderate diagnostic performance for T stage (sensitivity 75.7%, specificity 81.6%) and lower sensitivity for nodal involvement (sensitivity 52.3%, specificity 87.3%). Performance varied by tumor location, with higher accuracy in left-sided tumors. Lymphovascular invasion was associated with lower interobserver agreement (OR 0.34; p=0.014), while advanced cT stage predicted reduced R–P concordance for T staging (OR 0.04; p=0.004). Conclusion CT classification demonstrates high interobserver reproducibility but only moderate concordance with pathology in lCC. Misclassification may impact clinical decision-making, underscoring the need for improved staging strategies and multidisciplinary integration.

Background: Almost 30% of patients with rectal cancer (RC) who submit to comprehensive treatment experience relapse. Surveillance plays a leading role in early detection. The landmark approach provides a more flexible and dynamic framework for survival prediction. Objective: This large retrospective study aims to develop a machine learning algorithm to profile the patient prognosis, especially the risk and the onset of RC relapse after curative resection. Methods: A cohort of 2450 RC patients were analyzed using landmark analysis. Model A applied a classical cause-specific Cox approach with a landmarking approach, while Model B implemented a landmarking-based RSF (random survival forest) competing risk algorithm. The two models were compared in terms of predictive and interpretative ability. A bootstrapped validation strategy was employed to validate the model’s performance and prevent overfitting. The best-performing hyperparameters were selected systematically, ensuring the model’s robustness within the landmark approach. The study assessed these factors’ importance and interactions using RSF and compared the predictive accuracy to that of the classical Cox model. Results: Model B outperformed Model A (mean C-index 0.95 vs. 0.78), capturing complex interactions and providing dynamic, individualized relapse predictions. Clinical factors influencing survival outcomes were identified across time with the landmark approach allowing for more accurate and timely predictions. Conclusions: The landmark approach offers an improvement over traditional methods in survival analysis. By accommodating time-dependent variables and the evolving nature of patient data, this approach provides a precise tool for profiling RC survival, thereby supporting more informed and dynamic clinical decision-making.

Background/Objectives: Colorectal cancer (CRC) is the third most common cancer and a leading cause of death worldwide. Identifying non-invasive, early indicators of CRC risk remains essential and could help reduce its health burden. Excess adiposity and chronic inflammation are major predisposing factors for precancerous adenomatous polyposis (AP) and CRC, while diet- or surgery-induced weight loss was associated with a reduced risk. Viral infections also represent cancer risk factors through direct or synergic mechanisms, though no definitive causal link has been established for CRC. Moreover, interest is growing on the role of oral viruses as predictors of disease. Methods: In this study, highly sensitive and specific Luminex-based screening assays were used to perform a comprehensive characterization of oral infections by Human Herpes (HHV), Polyoma (HPyV) and Papilloma (HPV) Viruses in CRC patients (N = 50), healthy controls (N = 46; normal weight, NW = 26; overweight, OW = 20), and high-risk individuals with obesity (N = 35) or adenomatous polyposis (AP, N = 22). Results: We observed increased HPyV prevalence in AP, and higher single and multiple β-HPV infection rates in AP and CRC compared to controls. A panel of β-HPV genotypes, including oncogenic HPV5, was overrepresented in CRC and high-risk groups, and some of them showed an association with the male sex. The prevalence of most infections decreased in the obese cohort following bariatric surgery, alongside weight loss and reduction of inflammatory markers. Furthermore, oral infections by viral types previously detected in CRC tissue and adjacent mucosa also declined after surgery. Conclusions: Altogether, these findings suggested a role for oral β-HPV types as potential sex- and lifestyle-related, modifiable indicators of cancer risk.

There is a clinical need to identify early predictors for response to neoadjuvant chemotherapy (NAC) in patients with gastric and gastroesophageal junction cancer (GC and GEJC). Radiomics involves extracting quantitative features from medical images. This study aimed to apply radiomics to build prediction models for the response to NAC. All consecutive patients with non-metastatic GC and GEJC undergoing NAC and surgical resection in an Italian high-volume referral center between 2005 and 2021 were considered eligible. In patients selected, the CT scans performed upon staging were reviewed to segment the tumor and extract radiomic features using MODDICOM. The primary endpoint was to develop and validate radiomic-based predictive models to identify major responders (MR: tumor regression grade TRG 1–2) and non-responders (NR: TRG 4–5) to NAC. Following an initial feature selection, radiomic and combined radiomic-clinicopathologic prediction models were built for the MR or NR status based on logistic regressions. Internal validation was performed for each model. Radiomic models (in the entire case series and according to NAC regimens) were evaluated using the receiver operating characteristic area under the curve (AUC), sensitivity, and negative predictive value (NPV). The study included 77 patients undergoing NAC and subsequent tumor resection. The MR prediction model after all types of NAC (AUC of 0.876, CI 95

Gastric cancer is a worldwide disease for which several risk factors are involved. Helicobacter pylori (H. pylori) infection is considered the main micro-organism impacting carcinogenesis. One of the new scientific approaches in gastric microbiome studies is the 16S ribosomal RNA (16S rRNA) amplification by liquid biopsies with next-generation sequencing (NGS) techniques. This study is a metagenomic meta-analytic investigation based on genomic data uploaded in online medical databases. These works were selected on the basis of the amplification of the 16S rRNA gene regions of the microbiomes in gastric biopsies aiming to describe the microbial taxonomy of the patients with Helicobacter pylori infections, distinguishing relative abundance in patients. Subgroups were differentiated according to pathological diagnosis, the molecular techniques used, the study design, and the geographical origin of the individuals.

BACKGROUND:Patients older than 70 years account for 44% of all rectal cancer cases. Although surgery is the criterion standard treatment, elderly patients can also be offered other treatments, such as total neoadjuvant therapy with watch and wait. OBJECTIVE:This study aimed to investigate whether postoperative 90-day mortality is higher in elderly patients than in younger patients. DESIGN:This nationwide retrospective study included all consecutive resections of rectal cancer performed between 2005 and 2016 using data from the RALAR study. Patients were divided into 2 groups based on age: nonelderly (younger than 70 years) and elderly (70 years or older). SETTING:Data were obtained from 19 Italian referral centers for colorectal surgery. PATIENTS:A total of 3573 patients underwent rectal surgery: 2071 (57.9%) nonelderly and 1502 (42%) elderly. MAIN OUTCOME MEASURES:The primary end point was 90-day postoperative mortality. Secondary end points included intensive care unit stay, hospitalization, surgical and general postoperative complications, overall survival, disease-specific survival, and recurrence rate. RESULTS:Ninety-day postoperative mortality was comparable between groups (0.41% nonelderly vs 1.05% elderly, p = 0.087). Elderly patients were monitored more frequently in intensive care units and developed more postoperative general complications, whereas no differences were found between the groups in terms of postoperative surgical complications. Hospitalization was longer in elderly patients (median [interquartile range]: 12.3 [9.7] vs 11.1 [14.6] days). Five-year overall survival was higher in the nonelderly group (77.3%) than in the elderly group (45.8%; adjusted OR 1.70; 95% CI, 0.57-5.65), whereas the disease-specific survival was similar between groups. LIMITATIONS:There are limitations inherent in this retrospective study, including the long accrual period and the unknown proportion of patients who did not undergo surgery. CONCLUSIONS:Although elderly patients experience a higher rate of postoperative general complications without an increase in postoperative mortality, rectal surgery yields similar surgical and oncological outcomes compared with younger patients. This study suggests that age alone should not exclude a patient from surgery. See Video Abstract . CNCER RECTAL EN PERSONAS MAYORES OPERAR O NO OPERAR ESTUDIO RETROSPECTIVO A NIVEL NACIONAL DEL GRUPO COLABORATIVO DE LA RED DE CNCER COLORRECTAL DE LA SOCIEDAD ITALIANA DE ONCOLOGA QUIRRGICA:ANTECEDENTES:Los pacientes mayores de 70 años representan el 44 % de todos los casos de cáncer rectal. Aunque la cirugía es el tratamiento de referencia, a los pacientes de edad avanzada también se les pueden ofrecer otros tratamientos, como la terapia neoadyuvante total con vigilancia y espera.OBJETIVO:El objetivo de este estudio fue investigar si la mortalidad postoperatoria a los 90 días es mayor en los pacientes de edad avanzada en comparación con los pacientes más jóvenes.DISEÑO:Este estudio retrospectivo a nivel nacional incluyó todas las resecciones consecutivas de cáncer rectal entre 2005 y 2016 utilizando datos del estudio RALAR. Los pacientes se dividieron en dos grupos según su edad: no ancianos <70 años y ancianos.ENTORNO:Los datos se obtuvieron de 19 centros de referencia italianos para cirugía colorrectal.PACIENTES:Un total de 3573 pacientes se sometieron a cirugía rectal: no ancianos (2071, 57,9 %) y ancianos (1502, 42 %).PRINCIPALES MEDIDAS DE RESULTADO:El criterio de valoración principal fue la mortalidad postoperatoria a los 90 días. Los criterios de valoración secundarios incluyeron la estancia en la unidad de cuidados intensivos, la hospitalización, las complicaciones quirúrgicas y generales postoperatorias, la supervivencia global, la supervivencia específica de la enfermedad y la tasa de recurrencia.RESULTADOS:La mortalidad postoperatoria a los 90 días fue comparable entre los grupos (0,41 % en los no ancianos frente al 1,05 % en los ancianos, p = 0,087). Los pacientes de edad avanzada fueron monitorizados con mayor frecuencia en la unidad de cuidados intensivos y desarrollaron más complicaciones generales posoperatorias, mientras que no se encontraron diferencias entre los grupos en cuanto a complicaciones quirúrgicas posoperatorias. La hospitalización fue más prolongada en los pacientes de edad avanzada (mediana [IQR]: 12,3 [9,7] frente a 11,1 [14,6] días). La supervivencia global a cinco años fue mayor en los no ancianos (77,3 %) en comparación con los ancianos (45,8 %, OR ajustado 1,70, IC del 95 %: 0,57, 5,65), mientras que la supervivencia específica de la enfermedad fue similar entre los grupos.LIMITACIONES:Este estudio retrospectivo presenta limitaciones inherentes, como el largo periodo de acumulación y la proporción desconocida de pacientes que no se sometieron a cirugía.CONCLUSIONES:Aunque los pacientes de edad avanzada experimentan una mayor tasa de complicaciones generales postoperatorias sin un aumento de la mortalidad postoperatoria, la cirugía rectal produce resultados quirúrgicos y oncológicos similares a los de los pacientes más jóvenes. Este estudio sugiere que la edad por sí sola no debería ser motivo para excluir a alguien de la cirugía. ( AI-generated translation ).

Background Despite the documented technical advantages in terms of pelvis dissection and increased rate of sphincter-preserving procedures, the long-term oncological outcomes after transanal total mesorectal excision (TaTME) are still a matter of debate. This study aimed to report mid- and long-term survival outcomes of patients with rectal cancer treated with TaTME. Methods Patients with non-metastatic mid to low rectal adenocarcinoma who underwent double-team trans-anal/laparoscopic trans-abdominal total mesorectal excision between 2015 and 2020 were selected and reviewed. Three and 5-year overall survival (OS), 3 and 5-year disease-free survival (DFS), 3 and 5-year disease-specific survival (DSS), and 3 and 5-year local recurrence (LR) rate. Univariable and multivariable analyses were performed to correlate clinical and pathological variables with the outcomes of interest. Results Of 146 patients treated with TaTME during the study period, 114 non-metastatic patients were analyzed (M/F 1.7; mean age: 69.1 years). The mean follow-up time was 58.6 months. Sixty four percentage received neoadjuvant treatment before TaTME. Pathologic stages were documented as being stage 0-I in 62 (54.4%) and stage II-III in the remaining 52 patients (45.6%); 5 patients had a positive circumferential margin (4.4%), and overall, one-third of the cohort received adjuvant therapy. 3-year survival outcomes were: OS 89.4%, DFS 95.5%, DSS 85.5%, and LR 3.5%.The multivariable analysis of the 3-year outcomes showed a significant association between OS and age at the time of surgery and between DFS and pathological stages. A 5-year survival analysis was conducted on 68 patients. 5-year survivals were OS 75.0%, DFS 91.0%, and DSS 82.0%. Multivariate analysis showed that elderly age had a negative impact on 5-year OS. Conclusions When performed by experienced surgeons in a high-volume center, TaTME is a mini-invasive procedure with good mid/long-term oncological outcomes.

Impaired functional outcomes are common issues after total gastrectomy, although seldom explored at a long distance from surgery. The primary aim of this study was to investigate the long-term postoperative functional and nutritional results after Roux-en-Y total gastrectomy (RYTG). Patients with gastric neoplasms or CDH1 mutation undergoing RYTG between 2000 and 2021, with a minimum follow-up of 12 months, were interviewed to assess their functional and nutritional status and to measure their quality of life (QoL) with the GIQLI, EORTC-QLQ20 and EORTC-STO22 questionnaires. Statistical analysis was used to present these results and assess variables associated with body weight variation (BWV), dumping syndrome and QoL. Eighty patients were selected out of 265 RYTGs performed. The mean BWV was − 19.4

Background: The management of colorectal cancer (CRC) is a complex process. Defining the disease burden, assessing the radiological response and identifying the right time for surgery or other locoregional treatments are crucial factors which can require the involvement of a multidisciplinary tumor board (MDTB) comprising several specialists. This study investigates the impact of MDTB on management of CRC in our institution. Methods: We retrospectively assessed all cases discussed by our MDTB between September 2019 and April 2023. In particular, we collected data concerning radiology, surgery and radiotherapy indication before and after MDTB meetings. The primary endpoint was the overall rate of discrepancy between pre-and post-discussion evaluations. Results: Our analysis involved 1150 cases. Median age was 64 years (16-90), 629 patients (54.7%) were male and 915 (79.5%) had metastatic disease at the time of the relevant MDTB discussion. After the meetings, 325 treatment decisions were modified, producing an overall discrep ancy rate of 28.3%. In particular: (1) of 648 cases discussed for radiological assessment, 156 decisions (24.1%) were altered after a central imaging review; (2) of 327 cases considered for surgical approach, treatment strategy changed in 118 (36.1%); and (3) of the 160 cases discussed regarding radiotherapy, the treatment strategy changed in 51 of them (31.9%). Conclusions: Our analysis shows significant discrepancies between the radiology and locoregional evaluations from both before and after the MDTB meetings. Our results highlight that the discussions of a MDTB can considerably change the management of CRC, maximizing the treatment strategy.

Background: Previous studies have shown that microsatellite instability (MSI) is associated with better survival outcomes in gastric cancer (GC). This study aimed to assess the MSI status in a cohort of GC patients treated with neoadjuvant therapy and examine its relationship with tumor characteristics and oncological outcomes.

Background/Objectives: The textbook outcome (TO) is a composite tool introduced to uniform surgical units and regulate surgical quality and outcomes. A patient is considered TO only if all predetermined items are met. In colorectal surgery, TO represents a new tool that can achieve important results given the prevalence of colorectal cancers. However, at present, there is a lack of uniformity in the TO’s definition. This study utilized the Delphi process to define an Italian version of the TO in colorectal cancer. Methods: The survey consisted of two rounds of online questionnaires submitted to an expert panel in colorectal oncological surgery, renowned academic surgeons, who had attended multiple scientific conferences and who were authors of papers on this specific topic. Five main topics with 26 questions were investigated through an online modified Delphi method. Items with almost 75% agreement achieved consensus. Results: Twenty-eight Italian experts were selected and participated in the two rounds. The Italian version of the textbook outcome in colorectal surgery was defined as the presence of 90-day postoperative survival, negative margins and at least 12 lymph nodes, a minimally invasive approach, ostomy fashioning if preoperatively planned, postoperative complication < Clavien–Dindo 3b, at least 10 ERAS items, no readmission, proper CHT and RT regimens, complete colonoscopy after or before surgery and Tumor Board Evaluation. Conclusions: The textbook outcome in colorectal cancer patients is a quality instrument providing a complete overview of the care of such patients, from diagnosis to treatment. We hereby propose an Italian version of the TO with outcomes chosen by an expert panel.

Clostridium difficile infection (CDI) has been described in the early post-operative phase after stoma reversal. This systematic review aimed to describe the incidence of CDI after stoma reversal and to identify pre-operative variables correlated with an increased risk of infection. A systematic review of the literature was conducted according to the PRISMA guidelines in March 2024. Manuscripts were included if reported at least one patient with CDI-associated diarrhoea following stoma reversal (colostomy/ileostomy). The primary outcome of interest was the incidence of CDI; the secondary outcome was the comparison of clinical variables (age, sex, time to stoma reversal, neo-adjuvant and adjuvant therapies after index colorectal procedure) in CDI-positive versus CDI-negative patients. A meta-analysis was performed when at least three studies reported on those variables. Out of 43 eligible manuscripts, 1 randomized controlled trial and 10 retrospective studies were selected, including 17,857 patients (2.1

BackgroundPeritoneal recurrence is a significant cause of treatment failure after radical gastrectomy for gastric cancer. The prediction of metachronous peritoneal recurrence would have a significantly impact risk stratification and tailored treatment planning. This study aimed to externally validate the previously established PERI-Gastric 1 and 2 models to assess their generalizability in an independent population.MethodsRetrospective external validation was conducted on a cohort of 8,564 patients who underwent elective gastrectomy for stage Ib-IIIc gastric cancer between 1998 and 2018 at the Yonsei Cancer Center. Discrimination was tested using the area under the receiver operating characteristic curves (AUROC). Accuracy was tested by plotting observations against the predicted risk of peritoneal recurrence and analyzing the resulting calibration plots. Clinical usefulness was tested with a decision curve analysis.ResultsIn the validation cohort, PERI-Gastric 1 and PERI-Gastric 2 exhibited an AUROC of 0.766 (95% C.I. 0.752-0.778) and 0.767 (95% C.I. 0.755-0.780), a calibration-in-the-large of 0.935 and 0.700, a calibration belt with a 95% C.I. over the bisector in the risk range of 24%-33% and 35%-47%. The decision curve analysis revealed a positive net benefit in the risk range of 10%-42% and 15%-45%, respectively.ConclusionsThis study presents the external validation of the PERI-Gastric 1 and 2 scores in an Eastern population. The models demonstrated fair discrimination and satisfactory calibration for predicting the risk of peritoneal recurrence after radical gastrectomy, even in Eastern patients. PERI-Gastric 1 and 2 scores could also be applied to predict the risk of metachronous peritoneal recurrence in Eastern populations.