A major factor in the development of morbidity after surgery is the surgical stress response. The aim of this interventional multicenter randomized open label, parallel group trial is to evaluate the possible lower inflammatory stress response induced by robot-assisted versus laparoscopic surgery for colorectal resections. A total of 593 patients diagnosed with colorectal cancer planned for elective, curative surgery was screened for eligibility. 314 patients planned for right colectomy, left colectomy or rectal resection were randomly assigned 1:1 to robotic (n = 161) or laparoscopic group (n = 153). The primary endpoint was the 24-hours postoperative ∆% change of IL-6 serum levels. Subgroup analyses included the assessment of IL-6 ∆% changes stratified according to age, obesity, comorbidities, tumor staging and resection type have been also performed. In conclusion robotic surgery was associated to a lower surgical stress after colorectal surgery and this finding may help in decision-making regarding when to proceed to robotic approach for colorectal cancer, especially in selected high risk clinical settings.

Background The double-stapled anastomosis (DSA) technique is widely considered the standard approach for colorectal anastomosis after anterior rectal resection (AR). Recently, the single-stapled anastomosis (SSA) technique has gained attention because it may reduce potential weak points that could contribute to anastomotic leakage by avoiding stapler line intersections. This systematic review and meta-analysis aim to compare surgical and functional outcomes between SSA and DSA. Methods A systematic literature search of PubMed, Embase-Medline, and the Cochrane Library was performed in November 2025 to identify studies comparing SSA and DSA after AR. The endpoints were postoperative complications and major low anterior resection syndrome (LARS). A random-effect meta-analysis was performed to synthesise the results. Results Thirteen studies met the inclusion criteria and were included in the meta-analysis (nine cohort studies, one matched case-control study, and three randomised controlled trials). Indications for AR included colorectal cancer, diverticular disease, inflammatory bowel disease, and endometriosis. Overall, 2,537 patients were analysed. SSA was associated with a non-significant reduction in the risk of anastomotic leak (RR 0.77, 95% CI 0.46–1.31; I2 = 49.3%), major postoperative complications (RR 0.67, 95% CI 0.37–1.20; I2 = 4.1%), and anastomotic stricture (RR 0.19, 95% CI 0.02–1.92) compared with DSA. The major LARS risk was similar across techniques (RR 0.94, 95% CI 0.39–2.30). Conclusions SSA appears to be a safe alternative to the DSA technique after restorative AR. Although no statistically significant differences were observed in anastomotic leak, postoperative complications, anastomotic stricture and major LARS risk, SSA may represent a technically appealing option. Further large multicentre randomised trials are required.

Purpose To develop and evaluate RectoMap, a robust open-source deep learning pipeline for fully automatic 3D segmentation of rectal cancer and mesorectum on T2-weighted MRI, with a specific focus on generalization across MRI scanner vendors in heterogeneous multi-institutional data. Methods In this retrospective multi-institutional study, 226 patients with locally advanced rectal cancer were imaged across 19 scanner models from four vendors (Siemens, Philips, GE, Hitachi) at 1.5T and 3T. Two complementary 3D architectures (nnUNet and U-MambaBot) were trained with 5-fold cross-validation under standard and extended MRI-specific data augmentation. Four ensemble strategies based on softmax averaging and the STAPLE algorithm were evaluated on an in-distribution (ID; n = 45) and an out-of-distribution (OOD; n = 63, previously unseen vendors) test set. Segmentation performance was quantified using the Dice similarity coefficient (DSC) and the 95th-percentile Hausdorff distance. Results 226 patients (mean age, 62.7 years ± 12.7 [SD], 139 men) were analyzed. In the ID setting, two-level STAPLE aggregation with extended augmentation achieved the highest rectal cancer DSC (0.767 ± 0.119), while full-model aggregation yielded the best mesorectum DSC (0.794 ± 0.131). MRI-specific augmentation consistently improved mesorectum segmentation. In the OOD setting, despite vendor shift, full-model aggregation achieved DSC 0.798 ± 0.126 for rectal cancer and 0.776 ± 0.161 for mesorectum, demonstrating stable cross-vendor performance. Conclusion RectoMap enables accurate and robust automatic segmentation of rectal cancer and mesorectum across heterogeneous MRI data. It is publicly released as an open-source tool that can be applied directly or fine-tuned on local datasets, providing a reliable baseline even when limited institutional data are available.

Purpose This study aimed to determine whether the benefits of robotic surgery can be applied to the treatment of colon cancer by evaluating short-term outcomes of robotic versus laparoscopic colonic resection. Methods This interim analysis of an interventional multicenter randomized trial was conducted to compare outcomes of robotic and laparoscopic colorectal surgery performed between January 2017 and December 2019. The study specifically assessed short-term outcomes in patients undergoing laparoscopic or robotic right or left colectomy for cancer. In addition, all short-term outcomes were evaluated in separate subgroups of right and left colonic resections through prespecified subgroup analyses. Results A total of 323 patients were analyzed, of whom 142 underwent robotic-assisted surgery and 181 underwent laparoscopic surgery. Overall, 109 complications (33.7%) occurred in the short-term period, 41 (28.9%) in the robotic group and 68 (37.6%) in the laparoscopic group, with no differences between groups in intraoperative or postoperative complications. However, grade III complications were significantly more frequent in the laparoscopic group, with 17 cases (9.4%) compared to 5 cases (3.5%) in the robotic group. Oncological radicality was similar between groups. Functional recovery after surgery was superior in the robotic group, as reflected by a shorter time to mobilization (17.5±10.2 hours vs. 21.1±11.5 hours). In the right colectomy subgroup, rates of grade III complications (1.9% vs. 11.7%) and lymph nodes retrieved (20.3±10.3 vs. 20.2±6.4) favored robotic surgery. In the left colon cancer subgroup, functional recovery was also improved with robotic surgery (44.3±22.2 hours vs. 61.1±31.1 hours, as measured by the composite recovery outcome). Conclusion Robotic surgery is associated with fewer severe complications and improved postoperative recovery following colonic resections. Trial registration ClinicalTrials.gov identifier: NCT02871960

Anastomotic leakage (AL) remains one of the most feared complications after rectal surgery for cancer, with stable incidence rates despite advances in surgical technique and perioperative care. Multiple anastomotic reinforcement strategies have been proposed, yet evidence remains heterogeneous and no clear consensus exists regarding their routine use. A structured expert position panel process was conducted. Eleven clinical scenarios based on AL risk factors and twenty thematic items addressing indications, devices, timing, contraindications, surgical approach, stoma use, costs, and expected outcomes were developed. A panel of experts evaluated each statement using a five-point Likert scale through a two-round process. Consensus was assessed using median scores and interquartile ranges (IQR). Consensus was not reached for most individual or combined preoperative risk factors. Most reinforcement techniques did not receive clear endorsement because of inconsistent and heterogeneous evidence. Strong agreement emerged regarding the central role of intraoperative assessment: tissue perfusion, mechanical tension, tissue quality, and unexpected technical difficulty were identified as key determinants. The panel agreed that reinforcement may still be appropriate in the presence of a diverting stoma, as diversion reduces clinical severity but does not prevent leakage or long-term sequelae. Surgical approach and material cost were not considered influent factors. This position statement highlights the lack of robust evidence supporting routine, indication-driven, or device-specific anastomotic reinforcement in rectal cancer surgery. The main shared recommendation was to base reinforcement on intraoperative surgical judgment, including tissue perfusion, tension, tissue quality, and unexpected technical difficulty.Keywords: anastomotic leakage, rectal cancer surgery, anastomotic reinforcement.

Background . Pelvic exenteration (PE) and multivisceral resection are complex surgical procedures indicated for highly selected patients with locally advanced primary and recurrent pelvic malignancies. This study aimed to evaluate the actual short-term outcomes of patients undergoing PE in two coordinating centers for the Pelv-ITA project. Methods . Patients who underwent curative-intent PE for locally advanced colorectal and anal cancers between 2018 and 2024 were included in the study. The outcomes were major postoperative complications (Clavien–Dindo grade ≥ 3), length of hospital stay (LOS), 30-day readmission, 30-day mortality, and 2-year overall- (OS), recurrence-free- (RFS), local recurrence-free- (LRFS), and distant recurrence-free survival (DRFS). Results . Among the 78 patients who underwent PE, median age was 62.0 (IQR 56.0–72.0) years. Indications for PE were locally advanced rectal cancer (n = 48, 61.5%), followed by colon (n = 19, 24.4%) and anal malignancies (n = 11, 14.1%). Among these, 34 (43.6%) had a recurrent disease. An R0 resection was achieved in 59 (77.6%) patients. Major postoperative complications occurred in 20 (25.6%) of patients. The 2-year OS was 93.0% for rectal cancers, 84.6% for colon cancers, and 76.2% for anal cancers. The 2-year RFS was 54.9%, 81.5%, and 30.0%, respectively. The 2-year LRFS was 49.2% for rectal cancers, 72.7% for colon cancers, and 50.0% for anal cancers, while the 2-year DRFS was 65.6%, 81.5%, and 65.6%, respectively. Conclusion. PE is a surgical option for selected locally advanced pelvic malignancies. The establishment of multi-institutional networks such as Pelv-ITA supports the centralization of care and facilitates standardized decision-making.

Single-port (SP) robotic platforms have recently been introduced in colorectal surgery to further reduce surgical invasiveness. Evidence comparing SP and multiport (MP) robotic colectomy for colonic neoplasia in routine clinical practice remains limited, particularly regarding short-term outcomes and learning-curve dynamics. This retrospective single-centre study compared consecutive patients undergoing elective SP or MP da Vinci robotic colectomy for colonic neoplasia between July 2024 and October 2025. Short-term operative, postoperative, and early oncological outcomes were analysed. Group comparisons were performed using non-parametric tests, while univariate regression models explored associations between surgical approach and outcomes. A learning-curve analysis within the SP cohort assessed changes in docking time over consecutive cases. Fifty-three patients were included (SP = 15; MP = 38), with comparable baseline characteristics. Docking time was shorter in the MP group (median SP 9 vs MP 7 min, p < 0.01), whereas overall operating time did not differ significantly (median 200 vs 227 min, p = 0.41). Conversion to open surgery occurred in 13.3

Gender disparities in surgical careers are increasingly recognized in both academic research and everyday clinical practice. Although women now represent a substantial proportion of medical graduates and surgical trainees, they remain underrepresented in surgical specialties, particularly in technically demanding and high-stress fields such as colorectal surgery. In Italy, Women in Surgery (WIS) has previously explored gender dynamics among surgeons in general. The aim of the present study was to investigate the professional experience of female colorectal surgeons. A national, anonymous, web-based survey was conducted as a joint initiative of Women in Surgery Italia (WIS) and the Italian Society of Colorectal Surgery (SICCR). The questionnaire was developed, reviewed, and finalized collaboratively by members of both societies. A total of 119 female surgeons completed the survey. Operative exposure was limited, and perceptions of gender bias and microaggressions were common. Ergonomic discomfort and challenges related to maternity reintegration were frequently reported. This study provides the first national overview of the professional experiences of female colorectal surgeons in Italy and highlights persistent structural and cultural barriers affecting career development.

BACKGROUND:In rectal cancer patients managed with rectal-sparing after neoadjuvant chemoradiotherapy (nCRT), total mesorectal excision (TME) is recommended in selected cases, such as local regrowth, recurrence, or high-risk histopathological features. However, the oncologic impact of delayed TME remains unclear. This study aimed to assess whether delayed TME compromises oncologic outcomes and increases postoperative complications. METHODS:Patients were identified from a prospective, multicentre observational study (ReSARCh trial, NCT02710812). Those who underwent TME following rectal-sparing approach-either as completion surgery (cTME) after local excision (LE), or as salvage surgery (sTME) for local regrowth after watch-and-wait (WW) strategy or local recurrence after LE-were included in the delayed TME group. This cohort was propensity score-matched 1:2 to a control group of patients who underwent standard TME after nCRT at our institution. Primary outcomes were overall survival (OS) and cumulative incidence of recurrence (overall, local, distant). RESULTS:Overall, 38 patients were included in delayed TME and 217 in standard TME groups. Among delayed TME patients, 25 (65.8%) had prior LE and 13 (34.2%) were managed with WW. cTME was performed in 18 cases (47.4%) and sTME in 20 (52.6%). After matching, 66 patients were included in standard TME group. Thirty-day complications, reintervention and mortality were comparable. At a median follow-up of 44 months, 5-year OS was similar. The 5-year cumulative incidence of overall recurrence was 18% vs 28% (p = 0.5), and distant recurrence 15% vs 26% (p = 0.4). CONCLUSION:Delayed TME after rectal-sparing strategies does not appear to compromise survival or increase recurrence.

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.

AIM:The aim of this work was to apply the 'win ratio' to compare the outcomes of rectal-sparing approaches [watch and wait (WW) and local excision (LE)] in the management of locally advanced rectal cancer responding to neoadjuvant chemoradiotherapy. METHOD:Patients enrolled in the ReSARCh study (NCT02710812) between 2016 and 2021 were divided into two cohorts (WW vs. LE). The win ratio was calculated by dividing the number of successes (or wins) in the WW group by the number of successes in the LE group on matched pairs. Oncological outcomes (overall survival, distant and local recurrence), presence of a stoma and rectum not preserved were considered as outcomes of interest. RESULTS:Overall, 108 (62.1%) patients underwent LE and 66 (37.9%) WW. Patients who underwent WW were more likely to have a complete clinical response (cCR) at restaging [i.e. ycT = 0: n = 51 (80%) for WW vs. n = 45 (42%) for LE, p < 0.001]. After matching for age, sex, distance from the anal verge and T stage at restaging, i.e. ycT, 57 pairs of patients were identified. The overall win ratio considering only oncological outcomes was 0.4 (95% CI 0.02-0.94). The disadvantage of WW was mainly due to a higher rate of local recurrences. The overall win ratio considering oncological outcomes, presence of a stoma and rectum not preserved was 0.6 (95% CI 0.04-1.38), indicating a potential disadvantage for WW, but with wide confidence intervals suggesting uncertainty. CONCLUSIONS:LE may have an advantage in terms of local recurrence rates compared with WW, potentially conferring a survival benefit. These results should be confirmed in further prospective randomized trials.

BACKGROUND:This prospective observational multicenter cohort study aimed to establish the functional outcomes and quality of life (QoL) of patients with rectal cancer who showed a major (mCR) or complete clinical response (cCR) after neoadjuvant therapy and underwent a rectum sparing approach (watch and wait, WW, or local excision, LE). MATERIALS AND METHODS:QoL and functional function were investigated using the EORTC QLQ-30, EORTC QLQ-CR29, the MSKCC bowel function instrument, and the FIQL index. Patients filled these questionnaires at the time of enrolment (T1), and 6 (T2) and 12 months (T3) thereafter. Variation overtime for each group and comparisons between cCR patients who underwent WW or LE were performed. RESULTS:Of 161 patients who were enrolled, 112 had a cCR (LE n = 50, WW n = 62) and 49 a mCR (all LE). LE patients showed changes after surgery, WW patients showed more gradual changes. LE patients showed reduced anxiety and depression and improved emotional functioning but also an increased fecal incontinence and reduced sexual function in men after surgery. WW patients showed a significant improvement overtime in role functioning and anxiety, while their diarrhea and stool frequency progressively reduced. Among patients with a cCR, LE patients showed a significantly higher incontinence compared to WW patients. However, the two groups did not differ in terms of impact of incontinence on QoL. CONCLUSION:Functional outcomes and QoL of patients underwent to WW or LE approach generally improve overtime, but LE patients also showed some impact of surgery.

Background: Anorectal melanoma (AM) is a rare and aggressive malignancy, often misdiagnosed due to its clinical resemblance to benign anorectal conditions. Early diagnosis remains challenging, with a poor prognosis and high rates of metastasis at presentation. Methods: We conducted a retrospective multicenter study of 21 patients diagnosed with AM between 2013 and 2023 across four high-volume Italian surgical centers. Patients were stratified into two groups based on whether AM was suspected at initial evaluation (Group A) or incidentally diagnosed after surgery for presumed benign disease (Group B). Clinical, diagnostic, treatment, and outcome data were analyzed. Results: Only 24% of patients had AM suspected at first presentation. These patients were younger (median age 49 vs. 70 years) and had larger, more readily identifiable tumors. However, nodal and distant metastases were equally frequent in both groups (lymph node metastases: 52.4%; distant metastases: 19%). Most patients underwent wide local excision (71.4%), while only one required abdominoperineal resection. Postoperative recurrence occurred in 47.6% of cases. Median survival was 11 months in Group A and 24 months in Group B. In 90.5% of cases, previous specialist consultations had failed to achieve timely diagnosis, highlighting missed diagnostic opportunities. Conclusions: AM is frequently overlooked due to its rarity and non-specific presentation. Earlier recognition alone may not improve outcomes, but systematic histopathological assessment, targeted biopsy, and multidisciplinary management remain essential. Conservative surgery with early use of systemic therapy should be prioritized when feasible.

Following the publication of the above article, an interested reader drew the authors' attention to the fact that the CTK18 panel in Fig. 2E on p. 1917, showing the results of RT‑PCR analysis of cytokeratin 18 from patient no. 88, appeared to be very similar to the CTK18 panel in Fig. 2F (showing the results from patient no. 93). After having re‑examined their original data, which were also presented to the Editorial Office, and considering that the observed experiment is an end-point RT-PCR performed more than ten years ago, the authors cannot definitively rule out the possibility that Fig. 2E was inadvertently misassembled. Therefore, given the high similarity of the two images, it was decided to publish a revised version of Fig. 2, which now shows data from a different replicate of the experiment for the CTK18 panel in Fig. 2E, shown on the next page. Note that this revision did not affect the overall conclusions reported in the study. The authors are grateful to the Editor of International Journal of Oncology for allowing them this opportunity to publish a Corrigendum, and all the authors agree with its publication. Furthermore, the authors apologize to the readership for any inconvenience caused. [International Journal of Oncology 46: 1913‑1923, 2015; DOI: 10.3892/ijo.2015.2911].