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Introduction: The impact of colorectal surgery on older adults' (≥65 years) health-related quality of life (HRQoL) is rarely reported. Methods: This prospective multi-institutional cohort study involving 217 participants investigated factors affecting older colorectal cancer (CRC) patients' HRQoL following surgery with the EORTC QLQ-C30 and the HADS. Results: The trend of the global QoL and individual subscales show an overall dip in QoL from baseline to pre-discharge, before slowly rising until the 6-month mark. Baseline score of individual outcome measures was the only constant predictor of the outcome measure over time. Conclusion: Age was not found to be a significant predictor of HRQoL in older adults undergoing colorectal surgery, while baseline scores of individual outcome measures consistently predicted post-operative HRQoL scores. Interventions should be targeted at specific subgroups of older adults scheduled for colorectal surgery, such as those with lower baseline scores., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Central venous catheter (CVC) related bacteremia is an essential cause of hospital infections associated with morbidity, mortality, and healthcare costs. Recent advancements in catheter coatings have demonstrated an effective strategy for preventing microbial colonization and biofilm formation. In this study, CVCs coated with green and facile laccase-manganese phosphate hybrid nanostructures [(Mn 3 (PO 4 ) 2 ·HNSs] prevented bacterial adhesion by 100%, 80%, 60%, and 58% for Staphylococcus aureus , Staphylococcus epidermidis, Pseudomonas aeruginosa , and Escherichia coli , respectively. The modified CVCs inhibited planktonic bacterial growth by up to 95% under static and dynamic flow conditions. Furthermore, the prepared CVCs showed high hemocompatibility, appropriate mechanical properties, and long-term antibacterial performance, meeting the essential requirements of catheterization. The modified catheter offered superior detectability in magnetic resonance imaging (MRI) and computed tomography (CT) scans, a valuable advancement for ongoing patient monitoring. Moreover, in vivo assessment using the mouse catheterization model revealed no inflammatory response associated with the implanted CVCs. Therefore, the prepared laccase@ Mn 3 (PO 4 ) 2 ·HNSs could be a promising strategy for developing safe and effective antibacterial coatings to combat infections associated with biomedical devices.

Colorectal cancer (CRC) is a leading cause of cancer-related deaths worldwide, characterized by high incidence and poor survival rates. Glycosylation, a fundamental post-translational modification, influences protein stability, signaling, and tumor progression, with aberrations implicated in immune evasion and metastasis. This study investigates the role of glycosylation-related genes (Glycosylation-RGs) in CRC using machine learning and bioinformatics. Data from The Cancer Genome Atlas (TCGA) and the Molecular Signatures Database (MSigDB) were analyzed to identify 67 differentially expressed Glycosylation-RGs. These genes were used to classify CRC patients into two subgroups with distinct survival outcomes, highlighting their prognostic value. Weighted gene coexpression network analysis (WGCNA) revealed key modules associated with CRC traits, including pathways like glycan biosynthesis and PI3K-Akt signaling. A machine-learning-based prognostic model demonstrated strong predictive performance, stratifying patients into high- and low-risk groups with significant survival differences. Additionally, the model revealed correlations between risk scores and immune cell infiltration, providing insights into the tumor immune microenvironment. Drug sensitivity analysis identified potential therapeutic agents, including Trametinib, SCH772984, and Oxaliplatin, showing differential efficacy between risk groups. These findings enhance our understanding of glycosylation in CRC, identifying it as a critical factor in disease progression and a promising target for future therapeutic strategies.

Background: Bowel preparation has long been used to prevent infectious complications and facilitate easy colorectal surgery. Both mechanical and oral antibiotic bowel preparation have been thoroughly studied in the elective colorectal resection population, but no studies exist on their use before adult colostomy reversals. This study aims to evaluate the effect of preoperative bowel preparation on anastomotic leak and infectious complication rates after colostomy reversal surgery., Methods: Retrospective cohort analysis of the 2016-2020 American College of Surgeons National Surgical Quality Improvement Program colorectal-specific database was performed. Adults who underwent elective colostomy reversal were stratified into 4 groups: no bowel preparation, oral antibiotic only, mechanical bowel preparation only, or combined oral antibiotic + mechanical bowel preparation. Outcomes measured were infectious complications, anastomotic leak, prolonged ileus, wound disruption, acute kidney injury, Clostridium difficile colitis, return to the operating room, survivor-only length of stay, mortality, and unplanned readmissions. Logistic regression analyses were performed to identify predictors of infectious complications and anastomotic leak., Results: A total of 793 patients who underwent colostomy takedown were identified (no bowel preparation: 37%; oral antibiotic only: 7%; mechanical bowel preparation only: 13%; combined oral antibiotic + mechanical bowel preparation: 42%). Patients who had oral antibiotic + mechanical bowel preparation had significantly lower 30-day rates of organ/space surgical site infection, sepsis, septic shock, anastomotic leak, prolonged ileus, wound disruption, and length of stay (P < .05). On multivariate analysis, combined oral antibiotic + mechanical bowel preparation was associated with lower adjusted odds of infectious complications (adjusted odds ratio: 0.52, P < .05) and anastomotic leak (adjusted odds ratio: 0.37, P < .05)., Conclusion: This is the first study specifically demonstrating that combined oral antibiotic and mechanical bowel preparation may reduce infectious complications and anastomotic leaks without increasing Clostridium difficile colitis and acute kidney injury after adult elective colostomy reversal. Granular, large-scale, prospective studies are warranted to replicate these findings and identify opportunities for quality improvement., Competing Interests: Conflict of Interest/Disclosure All authors report no conflicts of interest for this study., (Copyright © 2025 Elsevier Inc. All rights reserved.)

Background: Colorectal cancer (CRC) incidence and mortality in those aged 50 years and above have decreased over the past 2 decades. However, there is a rising incidence of CRC among individuals under 50 years of age, termed early-onset colorectal cancer (EOCRC). Patients with EOCRC are diagnosed at an advanced stage and may be in more psychosocial, emotional, and financial distress., Objective: Our study examined the epidemiological shifts in CRC in Singapore, a multiethnic country., Methods: CRCs diagnosed at age 20 years and above were identified from the Singapore Cancer Registry (SCR) from 1968 to 2019. Patient characteristics included gender, ethnicity, and age of CRC diagnosis. Population information was obtained from the Department of Statistics Singapore (SingStat). Age-specific incidence rates (ASRs) and age-standardized incidence rates (ASIRs) were calculated. The cohort was divided into 3 age groups: 20-49, 50-64, and ≥65 years. Temporal trends in incidence rates were modeled with joinpoint regression. Birth cohort models were fitted using the National Cancer Institute (NCI) age-period-cohort analysis tool. Cancer-specific survival analysis was performed with the Cox proportional hazards model., Results: In total, 53,044 CRCs were included, and 6183 (11.7%) adults aged 20-49 years were diagnosed with EOCRC. The ASR of EOCRC rose from 5 per 100,000 population in 1968 to 9 per 100,000 population in 1996 at 2.1% annually and rose to 10 per 100,000 population in 2019 at 0.64% annually. The ASR for CRC among adults aged 50-64 years rose at 3% annually from 1968 to 1987 and plateaued from 1987, while the ASR for adults aged 65 years and above rose at 4.1% annually from 1968 to 1989 and 1.3% annually from 1989 to 2003 but decreased from 2003 onwards at 1% annually. The ASR of early-onset rectal cancer increased significantly at 1.5% annually. There was a continued rise in the ASR of EOCRC among males (annual percentage change [APC] 1.5%) compared to females (APC 0.41%). Compared to the 1950-1954 reference birth cohort, the 1970-1984 birth cohort had a significantly higher incidence rate ratio (IRR) of 1.17-1.36 for rectal cancer, while there was no significant change for colon cancer in later cohorts. There were differences in CRC trends across the 3 ethnic groups: Malays had a rapid and persistent rise in the ASR of CRC across all age groups (APC 1.4%-3%), while among young Chinese, only the ASR of rectal cancer was increasing (APC 1.5%). Patients with EOCRC had better survival compared to patients diagnosed at 65 years and above (hazard ratio [HR] 0.73, 95% CI 0.67-0.79, P<.001) after adjusting for covariates., Conclusions: The rise in the incidence of rectal cancer among young adults, especially among Chinese and Malays, in Singapore highlights the need for further research to diagnose CRC earlier and reduce cancer-related morbidity and mortality., (©Hui Lionel Raphael Chen, Qingqing Dawn Chong, Brenda Tay, Siqin Zhou, Evelyn Yi Ting Wong, Isaac Seow-En, Ker Kan Tan, Yi Wang, Adeline Seow, Kwong-Wei Emile Tan, Bee Huat Iain Tan, Sze Huey Tan. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 14.02.2025.)

Objective: This article aims to provide a concise overview of the benefits, challenges, and suggestions pertaining to extreme forms of telesurgery, as documented in existing publications. In the future, medical personnel will have to overcome the challenges of providing health services in extreme settings, such as on the sea, humanitarian assistance missions, battlefields, underwater missions, and space missions. The advancement of telesurgery technology over the past 25 years will gradually resolve this problem. Methods: This study conducted a narrative review and a comprehensive literature search to explore the topics of extreme telesurgery. This article only included real attempts or experiments with telesurgery on humanitarian missions, on sea or hospital ships, underwater, on planes, and in space station settings. It has also summarized the benefits, challenges, and recommendations related to the extreme types of telesurgery and how they could be useful to shape the future of extreme health care. Results: Over the course of the past quarter century, telesurgery has undergone remarkable advancements, which have made it possible to receive effective treatment for even the most critical cases. When providing surgical care in difficult environments such as a battlefield, humanitarian mission, underwater, zero gravity planes, or in space, it is important to have comprehensive medical support for telesurgery in case the initial plan fails. Conclusions: The use of robotic systems in health care can augment human surgeons' skills and provide accurate support for a broad range of surgical operations.

Primary enterolithiasis is characterized by the formation of stones within the small bowel. The prevalence is estimated to be ~0.3% to 10% in selected populations. Due to its rarity, diagnosis is often delayed. We present the case of a 77 year old male who presented with small bowel obstruction, which was initially thought to be due to intussusception seen on abdominal computed tomography scan. He underwent two diagnostic laparoscopies within 1 month because his small bowel obstruction did not resolve with the initial surgery. The primary enterolith was not discovered until the second surgery where a 5 cm primary enterolith was seen in the small bowel causing early mucosal necrosis. The stone was removed, and the enterotomy was closed. After the enterolith was removed, the patient's upper gastrointestinal symptoms completely resolved., Competing Interests: The authors declare there is no conflict of interest., (Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2025.)

Purpose: To examine the relationship between endoluminal and pathologic complete response after chemoradiotherapy for rectal cancer and identify predictors of a pathologic complete response., Method: The anatomic pathology reports of 102 consecutive patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by proctectomy between 2013 and 2017 were reviewed for the presence or absence of endoluminal complete response. The presence of endoluminal complete response was compared with the anatomopathological stage. The residual lesion area was compared with the final pathologic stage to identify predictors of complete response., Results: Of 102 patients, 20 (19.6 %) achieved a pathologic complete response (ypT0N0). Of these, 9 (45 %) did not achieve an endoluminal complete response. The presence of endoluminal complete response had a sensitivity of 55.00 %, specificity of 96.34 %, and accuracy of 88.24 % to identify ypT0N0. The presence of endoluminal complete response, residual lesion area ≤ 4 cm 2 , and tumor located in the mid-rectum were associated with pathologic complete response (ypT0N0)., Conclusion: Almost half of the patients who had a pathologic complete response did not achieve an endoluminal complete response. Tumors located in the mid-rectum with a residual size of ≤ 4 cm 2 and the presence of endoluminal complete response were significantly associated with the achievement of ypT0N0., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2025 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Most patients with colorectal cancer do not achieve durable clinical benefits from immunotherapy, underscoring the existence of alternative immunosuppressive mechanisms. Here we found that activation of the lactate receptor HCAR1 signaling pathway induced the expression of chemokines CCL2 and CCL7 in colorectal tumor cells, leading to the recruitment of immunosuppressive CCR2 + polymorphonuclear myeloid-derived suppressor cells (PMN-MDSCs) to the tumor microenvironment. Ablation of Hcar1 in mice with colorectal tumors significantly decreased the abundance of tumor-infiltrating CCR2 + PMN-MDSCs, enhanced the activation of CD8 + T cells and, consequently, reduced tumor burden. We detected immunosuppressive CCR2 + PMN-MDSCs in tumor specimens from individuals with colorectal and other cancers. The US Food and Drug Administration-approved drug reserpine suppressed lactate-mediated HCAR1 activation, impaired the recruitment of CCR2 + PMN-MDSCs, boosted CD8 + T cell-dependent antitumor immunity and sensitized immunotherapy-resistant tumors to programmed cell death protein 1 antibody therapy in mice with colorectal tumors. Altogether, we described HCAR1-driven recruitment of CCR2 + PMN-MDSCs as a mechanism of immunosuppression., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: Tumour immune macroenvironment is comprised of tumour and surrounding organs responding to tumourigenesis and immunotherapy. The lack of comprehensive analytical methods hinders its application for prediction of survival and treatment response in colorectal cancer (CRC) patients., Methods: Cytometry by time-of-flight (CyTOF) and RNA-seq was applied to characterise immune cell heterogeneity in a discovery cohort including tumour, blood and intestinal architecture comprising epithelium, lamina propria, submucosa, muscularis propria of normal bowel and tumour-adjacent bowel tissues. Immunoprofiling was also validated by a validation cohort using single-cell RNA sequencing, spatial transcription, CyTOF and multiplex immunofluorescent staining., Results: Based on cell phenotype and transcription, we identify distinct immunotypes in the CRC macroenvironment including blood, tumour and different intestinal architecture, showing disturbed immune cell compositions, increasing expression of immunosuppressive markers and cell-cell interactions contributing to immunosuppressive regulation. Furthermore, we evaluate immune macroenvironment influencing factors including tertiary lymphoid structures (TLSs), consensus molecular subtypes (CMSs) and immune checkpoint inhibitors (ICIs). TLS presence fuels anti-tumour immunity by promoting CD8 + T cell infiltration and altering activation or suppression of T cell systematically. TLS presence correlates with patient survival, intrinsic CMS and therapeutic efficacy of ICI. PD-1 and CD69 expressed in effector memory CD8 + T cells from blood can predict TLS presence in the CRC macroenvironment, serving as potential biomarkers for stratifying CRC patients into immunotherapy., Conclusions: Our findings provide insights into the CRC immune macroenvironment, highlighting immune cell suppression and activation in tumourigenesis. Our study illustrates the potential utility of blood for predicting immunotherapy response., Key Points: Distinct immunotypes are identified in the CRC macroenvironment. TLS and immunotherapy exert influence on the immune macroenvironment. TLS presence correlates with patient survival, CMS and therapeutic efficacy of ICI. PD-1 and CD69 expressed in CD8+ Tem from blood can predict TLS presence in the CRC macroenvironment., (© 2025 The Author(s). Clinical and Translational Medicine published by John Wiley & Sons Australia, Ltd on behalf of Shanghai Institute of Clinical Bioinformatics.)

Colorectal cancer is a leading cause of cancer-related morbidity and mortality worldwide, with more than 1.9 million new cases reported in 2020, and is associated with major survival challenges, particularly in patients with locally advanced colon cancer (LACC). LACC often involves T4 invasion or extensive nodal involvement and requires a multidisciplinary approach for management. Radical surgery followed by adjuvant chemotherapy remains the primary treatment strategy for LACC. However, achieving complete tumor resection (R0) is challenging because locally advanced colon tumors typically infiltrate adjacent organs or nodes. Advancements in LACC treatment have involved neoadjuvant chemotherapy (NACT), neoadjuvant chemoradiotherapy (NACRT), and neoadjuvant immunotherapy (NAIT). Studies such as FOxTROT and PRODIGE 22 have demonstrated that NACT, particularly with FOLFOX or CAPOX, can lead to major tumor downstaging, improved survival rates, and increased R0 resection rates. Predictive biomarkers, such as mismatch repair (MMR) status and T stage, are crucial in identifying candidates who may benefit from NACT. NACRT has demonstrated promise in enhancing tumor regression, particularly in patients with rectal cancer, underscoring its potential for use with LACC. NAIT, particularly for deficient MMR tumors, has emerged as a novel approach, with studies such as NICHE-2 and NICHE-3 reporting excellent pathologic responses and pathologic complete responses. Integrating these therapies can enhance the surgical and survival outcomes of patients with LACC, highlighting the importance of personalized treatment strategies based on tumor characteristics and response to neoadjuvant interventions. This review discusses the evolving landscape of LACC management, focusing on optimizing treatment approaches for improved patient outcomes., (© 2024 The Author(s). The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University.)

Background: Single port robotic platform offers articulation and 360° camera rotation for anorectal tumour excision in a narrow pelvic space. This study assesses the clinical usefulness and outcomes of SP robotic transanal surgery., Methods: Nine patients who underwent transanal excision using the SP robotic platform were included. A GelPOINT path Transanal Access channel with insufflation stabilisation bag was used to maintain rectal inflation., Results: All patients underwent full-thickness excision without intraoperative complications. The mean distance from anal verge was 6.41 cm. Prone position was used regardless of the direction of the tumour due to the 360° rotation. The mean operative time was 66.1 min. The mean docking time was 8.7 min with only one docking. All oncologic resection margins were negative, and recurrence was not observed during follow-up., Conclusions: SP robotic transanal surgery allows flexible vision and meticulous procedures in narrow spaces; therefore, this method has greater feasibility and oncologic safety., (© 2024 John Wiley & Sons Ltd.)

Introduction: We explored the clinical characteristics, treatment, and outcomes of colitis-associated colorectal cancer (CAC) and compared with sporadic colorectal cancer in Taiwan., Methods: In this retrospective study spanning 1987-2022, CACs diagnosed according to endoscopic and pathological reports from 14 tertiary centers were reported to our cohort. Clinical demographics, endoscopic findings, histological results, treatment modalities, and outcomes were analyzed. Sporadic colorectal cancer data were retrieved from the Cancer Registry Annual Report, Ministry of Health and Welfare, Taiwan., Results: We enrolled 65 patients with CAC (median age: 56 years; male: 66.2%). Distal colon was the most common tumor location (41.5%). Of patients with ulcerative colitis, 77.2% had extensive colitis, and 76.5% had Mayo endoscopic subscores of ≥2. Moreover, 50% of lesions were nonpolypoid with indistinct borders in 66.7%. Signet-ring cell subtype consisted of 12.3%. Surveillance colonoscopy adherence was 78.4%, yet 51.3% interval cancers occurred. Disease stage 0-4 distribution was 15%, 20%, 13.3%, 20%, and 31.7%, respectively. Endoscopic resection was feasible for 14%, whereas 67.7% required surgery. During follow-up (median: 21.5 months), we recorded 23.2% recurrence and 34.5% mortality. Lesions with indistinct borders were associated with adverse outcomes (adjusted odds ratio = 11.5 [1.35-98.16]). Colitis-associated rectal cancers, diagnosed later ( P < 0.001), had worse outcomes than sporadic rectal cancers., Discussion: This is the largest Asian CAC cohort study, emphasizing the need for stringent disease control, improving detection, and reducing interval cancers. Signet-ring cell subtype was prevalent. Rectal colitis-associated cancers were diagnosed later with poorer outcomes than sporadic rectal cancers., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.)

Background: Enhanced recovery after surgery (ERAS) protocols aim to improve surgical patient outcomes, although their effectiveness may vary. This study assessed the impact of multi-institutional ERAS implementation on postoperative morbidity in patients undergoing elective colorectal surgery., Study Design: We conducted a multicenter retrospective cohort study using the American College of Surgeons NSQIP database from 2012 to 2020. We analyzed patient outcomes before (2012 to 2014) and after (2015 to 2020) ERAS implementation across 4 hospitals. Multivariable logistic regression was used to determine the impact of ERAS program on certain outcomes., Results: A total of 8,930 cases were analyzed: 3,573 in the pre-ERAS and 5,357 in the ERAS cohort. The ERAS cohort demonstrated significant reductions in superficial surgical site infection (SSI; 7.5% vs 2.5%, p < 0.001), deep SSI (0.6% vs 0.2%, p = 0.016), urinary tract infection (3.3% vs 1.5%, p < 0.001), pulmonary embolism (0.7% vs 0.4%, p = 0.022), deep vein thrombosis (1.4% vs 0.9%, p = 0.020), sepsis (3.0% vs 2.1%, p = 0.006), and other complications. Median length of stay decreased from 5 to 4 days (p < 0.001), and 30-day readmission rate dropped from 11.3% to 9.8% (p = 0.022). Overall, ERAS implementation was associated with a 35% decrease in the odds of all 30-day complications (odds ratio 0.65, 95% CI 0.59 to 0.73). There was no effect on 30-day (p = 0.962) or overall mortality rates (p = 0.732)., Conclusions: A standardized ERAS protocol, used across multiple institutions, significantly improves elective colorectal surgery outcomes, reducing complications, length of hospital stay, and readmissions. These findings support the broader implementation of ERAS to enhance patient care and reduce healthcarecosts., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

Background/aim: To evaluate the safety and survival benefits of adjuvant chemotherapy (AC) in elderly patients who underwent radical resection for stage II/III colon cancer., Patients and Methods: This retrospective study included patients aged >70 years treated at a tertiary hospital between January 2012 and December 2017. We evaluated the clinical and pathological characteristics and adverse events of chemotherapy. The 5-year overall survival (OS) and disease-free survival (DFS) of the surgery-only (SO) and AC groups were compared by stage using the Kaplan-Meier method and Cox-regression analysis., Results: Of the 163 patients included in the study, 75 were diagnosed with stage II cancer, with 43 patients in the SO group and 32 in the AC group. A total of 88 patients were diagnosed with stage III cancer, including 20 in the SO group and 68 in the AC group. Patients with stage II disease in the SO group were older, with less frequent venous invasion than the AC group. Comorbidities, tumor location, and surgical methods did not differ. In stage III, age, comorbidities, tumor location, surgical methods, and pathological outcomes did not differ. The 5-year OS and DFS did not differ significantly in those with stage II disease but were significantly better in the AC than the SO group in stage III cases (48.2% vs. 71.6%, p=0.012; and 42.6% vs. 60.0%, p=0.029)., Conclusion: AC may provide a survival advantage in elderly patients with stage III colon cancer., (Copyright © 2025 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Background: The inflammatory bowel disease (IBD), comprising Crohn's disease (CD) and ulcerative colitis (UC) is a complex disease with multifactorial etiology. The intestinal dysbiosis have been investigated to play an important role in IBD pathogenesis and disease activity. The aim of our study was to analyze the intestinal microbiota composition in IBD across different severity levels and the impact of biologic therapy on microbiota modulation., Methods: In this study, 27 IBD patients were recruited, including 14 patients undergoing biologic therapy for moderate to severe disease activity and 13 controls with inactive disease. The gut microbial composition was determined by 16 S ribosomal RNA gene sequencing of stool samples., Results: Biologic therapy led to significant clinical improvement in IBD disease activity after 48 weeks. About species richness, community alpha diversity was significant lower in active CD patients and enriched gradually after biologic therapy. The beta-diversity regard to the difference of bacterial community composition showed significant difference between patients in biologic and control group. A decrease in Firmicutes and increase in Bacteroidetes abundance were observed in patients with active disease, both in CD and UC. Biologic treatment induced shifts in gut microbiota, with increased Firmicutes and decreased Bacteroidetes, as well as improved F/B ratio gradually after treatment, correlating with disease activity., Conclusions: Our study suggested that gut microbiota differences changed after biologic therapies among IBD with different disease activity, and a rising Firmicutes/Bacteroidetes ratio could be a potential predictor for disease activity and treatment response monitoring., Competing Interests: Declaration of competing interest All authors declared there was no conflict of interests., (Copyright © 2024. Published by Elsevier B.V.)

Background: The surgical management of complicated diverticulitis varies across Europe. EAES members prioritized this topic to be addressed by a clinical practice guideline through an online questionnaire., Objective: To develop evidence-informed clinical practice recommendations for key stakeholders involved in the treatment of complicated diverticulitis; to improve operative and perioperative outcomes, patient experience and quality of life through a systematic evidence-to-decision approach by a diverse, multidisciplinary panel., Methods: Informed by a linked individual participant data network meta-analysis of resection and primary anastomosis (PRA) versus Hartmann's resection (HR) versus laparoscopic lavage (LPL), a panel of general and colorectal surgeons, patient partners, trialists, and fellows appraised the certainty of the evidence using GRADE and CINeMA. The panel discussed the evidence using the evidence-to-decision framework during a synchronous consensus meeting. An asynchronous modified Delphi survey was used to establish consensus., Results: The panel suggests that patients with complicated diverticulitis without sepsis receive PRA over HR or LPL when there is availability of a surgeon with skills and experience in colorectal surgery. HR is suggested over PRA or LPL in the subgroups of septic, frail, as well as immunocompromised patients. These recommendations apply to patients with an indication for surgery. Surgeons and patients should first consider conditionally recommended interventions, then conditionally recommended against. Based on the evidence, the key benefit of PRA was a higher likelihood of not having a stoma at 1 year, with similar risks across comparisons. Conditional recommendations call for shared decision-making when considering management options. The full guideline with user-friendly decision aids is available in https://app.magicapp.org/#/guideline/7490 ., Conclusion: This clinical practice guideline provides evidence-informed recommendations on the management of patients with complicated diverticulitis in accordance with the highest methodological standards through a structured framework informed by an international, multidisciplinary panel of stakeholders., Competing Interests: Declarations. Disclaimers: This clinical practice guideline has been developed under the auspice of the European Association for Endoscopic Surgery (EAES). It is intended to be used primarily by health professionals (e.g., surgeons, anesthetists, physicians) and to assist in making informed clinical decisions on diagnostic measures and therapeutic management. It is also intended to inform individual practice of allied health professionals (e.g., surgical nurses, dieticians, physical rehabilitation therapists, psychologists); to inform strategic planning and resource management by health care authorities (e.g., regional and national authorities, health care institutions, hospital administration authorities); and to inform patients wishing to obtain an overview of the condition of interest and its management. The use of recommendations contained herein must be informed by supporting evidence accompanying each recommendation and by research evidence that might not have been published by the time of writing the present document. Users must thus base their actions informed by newly published evidence at any given point in time. The information in the guideline should not be relied upon as being complete or accurate, nor should it be considered as inclusive of all proper treatments or methods of care or as a statement of the standard of care. With the rapid development of scientific knowledge, new evidence may emerge between the time the guideline is developed and when it is published or read. The guideline is not continually updated and may not reflect the most recent evidence. The guideline addresses only the topics specifically identified therein and is not applicable to other interventions, diseases, or stages of diseases. This guideline does not mandate any particular course of medical care. Further, the guideline is not intended to substitute the independent professional judgment of the treating provider, as the guideline does not necessarily account for individual variation among patients. Even if evidence on a topic suggests a specific diagnostic and/or treatment action, users and especially health professionals may need to decide against the suggested or recommended action in view of circumstances related to patient values, preferences, co-morbidities and disease characteristics; available human, financial and material resources; and healthcare infrastructures. EAES provides this guideline on an “as is” basis, and makes no warranty, express or implied, regarding the guideline. Disclosures: Stavros A. Antoniou, Bright Huo, Monica Ortenzi, Roi Anteby, Yegor Tryliskyy, Francesco Maria Carrano, Georgios Seitidis, Dimitris Mavridis, Vincent T. Hoek, Alberto Serventi, Willem A. Bemelman, Gian Andrea Binda, Rafael Duran, Triantafyllos Doulias, Nauzer Forbes, Nader K. Francis, Fabian Grass, Jesper Jensen, Marianne Krogsgaard, Lisa H. Massey, Luca Morelli, Christian E. Oberkofler, Dorin E. Popa, Johannes Kurt Schultz, Shahnaz Sultan, Jean-Jacques Tuech, and Hendrik Jaap Bonjer declare no direct conflicts of interest related to this work. Indirect conflicts of external advisors were documented and managed as per Guidelines International Network Standards. Detailed conflict of interest statements of all contributors can be found in the online appendix [15]. A patient version of this guideline is available in Supplementary File 2. Ethics approval: Not applicable. Consent to participate: Not applicable., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Current guidelines recommend selective adjuvant chemotherapy for stage II colon cancer with high-risk features. This study aimed to assess survival benefit of adjuvant chemotherapy in patients with stage II colon adenocarcinomas ≥5 cm without high-risk features., Methods: The National Cancer Database was retrospectively reviewed (2010-2019) for all patients with pathologic stage II colonic adenocarcinomas ≥5 cm who underwent colectomy. Patients were divided into adjuvant and control groups that were propensity-score matched for baseline and treatment confounders. The primary outcome was 5-year overall survival (OS)., Results: Of 23,937 included patients, adjuvant chemotherapy was given to 2581 (10.8 %). Patient given adjuvant chemotherapy were younger, more often male, Black, had a Charlson score of 0 and private insurance, presented with left-sided cancers and microsatellite stable (MSS) tumors, and more frequently underwent segmental resections and open surgery. 796 patients in the adjuvant group were matched to 1592 patients in the control group. Adjuvant chemotherapy was associated with lower mortality (HR: 0.79; p = 0.022), however, it was not independently associated with improved OS when adjusted for other confounders (HR: 0.84; p = 0.157). The adjuvant group had significantly longer restricted mean OS than the control group (104.9 vs. 100.8 months; p = 0.007). The survival benefit was only noted in patients >50 years, female, White, with non-mucinous adenocarcinomas, MSS tumors, normal CEA levels, and had undergone open and emergency surgery., Conclusions: The study did not demonstrate a clear survival benefit from adjuvant chemotherapy in patients with stage II adenocarcinoma ≥5 cm. A possible potential survival benefit was observed only in a subgroup of patients., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Steven Wexner reports a relationship with Baxter that includes: consulting or advisory. Steven Wexner reports a relationship with Becton Dickinson and Company that includes: consulting or advisory. Steven Wexner reports a relationship with Glaxo Smith Kline that includes: consulting or advisory. Steven Wexner reports a relationship with Intuitive Surgical Inc that includes: consulting or advisory. Steven Wexner reports a relationship with Livsmed that includes: consulting or advisory. Steven Wexner reports a relationship with Medtronic Inc that includes: consulting or advisory. Steven Wexner reports a relationship with OstomyCure that includes: consulting or advisory. Steven Wexner reports a relationship with Stryker that includes: consulting or advisory. Steven Wexner reports a relationship with Takeda that includes: consulting or advisory. Steven Wexner reports a relationship with Virtual Ports that includes: consulting or advisory. Sameh Emile reports a relationship with Becton Dickinson and Company that includes: consulting or advisory. Steven Wexner has patent issued to Intuitive Surgical. Steven Wexner has patent issued to Karl Storz Endoscopy America Inc. Steven Wexner has patent issued to Unique Surgical Innovations LLC. Member of the Data Safety Monitoring Board of JSR/WCG/ACI (chair), Polypoid (chair), and Boomerang If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 Elsevier Ltd. All rights reserved.)

Purpose: To examine the adaptive self-management strategies of enterostomy patients across different health trajectory phases and explore how patients utilize a combination of digital tools and traditional practices to manage their condition effectively within the Chronic Illness Trajectory Framework (CITF)., Methods: Participants were recruited from Qingdao Municipal Hospital's Stoma Clinic between October 2022 and August 2024. A total of 26 adults who had undergone permanent enterostomy surgery at least six months prior were selected through purposeful sampling to capture diverse experiences across different health trajectory phases. Semi-structured interviews were conducted, and data were analyzed using thematic analysis, with saturation reached when no new insights emerged., Results: Three primary trajectory types emerged: (1) Living with a Stable Enterostomy Condition, where structured routines and preventive practices helped patients maintain health stability; (2) Experiencing Cycles of Deterioration and Recovery, characterized by proactive monitoring and recovery practices, often supported by family and telemedicine; and (3) Responding to Unstable Changes, requiring immediate actions, real-time adjustments, and crisis planning, with patients relying on both wearable monitors and established self-care routines. Across all phases, a balanced use of digital and non-digital methods enhanced adaptability and resilience., Conclusion: The findings underscore the importance of phase-specific, adaptive self-management strategies that blend digital innovations with foundational self-care practices. CITF offers a valuable framework for clinicians to assess patients' trajectory phases and provide tailored support that aligns with their unique health needs. This approach can promote patient autonomy, improve quality of life, and inform the development of comprehensive, patient-centered care models for enterostomy and other chronic conditions., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Jia Qiao reports administrative support was provided by China Social Welfare Foundation. None of the other authors have any known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The costs related to robotic surgery are known to be greater than those associated with laparoscopy. However, the potential for better outcomes of the former could lead to a cost-effectiveness advantage. The aim of this study is therefore to highlight the difference in cost-effectiveness between robotic and laparoscopic rectal resection., Methods: This is an observational, multicenter, national prospective study (ROBOCOSTES). From 2022, for 1 year, all consecutive patients undergoing minimally invasive rectal resection were included. Quality-adjusted life year and cost data were prospectively collected. The primary aim was to assess the cost-effectiveness of robotic rectal resection and laparoscopic rectal resection . Secondary aims included clinical outcomes and quality of life., Results: Overall, 182 patients underwent rectal resection (152 anterior and 30 abdominoperineal excisions) at 14 centers, of whom 95 received robotic rectal resection and 87 laparoscopic rectal resection. Robotic rectal resection was associated with lesser blood loss (58.55 ± 51.68 vs 131.68 ± 191.92, P < .001), lower pain score at day 1 (-1.04 visual analog scale, P < .001) and day 7 (-0.81, P < .001) after surgery, and with fewer hospital readmissions (2.1% vs 15%, P = .005) compared with laparoscopic rectal resection. The overall costs of robotic rectal resection (including hospitalization) were 919.66 euros greater compared with laparoscopic rectal resection, but quality-adjusted life years in the robotic rectal resection group were better than laparoscopic approaches to rectal resection both at 30-day (0.8914 vs 0.8139) and 90-day (0.9573 vs 0.8740) follow-up. At a willingness-to-pay threshold of 20,000 and 30,000 euros, there was an 84.38% and 89.36% probability that robotic rectal resection was more cost-effective than laparoscopic rectal resection., Conclusion: This study showed that robotic rectal resection, even if associated with greater direct costs in the short term, outperforms laparoscopic rectal resection in terms of quality-adjusted life years and should therefore be preferred where available., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Although surgery is the most effective treatment for rectal prolapse, a risk of recurrence reported in literature is 6-27%. The aim of this meta-analysis is to compare the abdominal and perineal approach for surgical treatment of recurrent external rectal prolapse., Methods: A systematic search of PubMed and Embase was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. A comprehensive literature search of PubMed and Embase was conducted from January 2000 to May 2024, for studies reporting surgery for recurrent external rectal prolapse. The primary outcome was the recurrence at the last available follow-up. Secondary endpoints included surgical complications and length of postoperative hospitalization., Results: Nine studies, with a total of 531 patients, were included in the analysis. The overall recurrence rate among the studies was 26.3% at a mean follow-up time of 30.5 months. The proportional meta-analysis showed a recurrence rate of 27.9% (95% CI 22.54 to 33.85, I 2 75.1%, p = 0.0012) after perineal surgery and of 15.6% (95% CI 11.43 to 20.64, I 2 63.7%, p = 0.016) after abdominal surgery. Comparing the two approaches, the meta-analysis showed an OR of 0.66 (95% CI 0.41 to 1.17, I 2 66.5%, p = 0.029). The OR for complications was 1.44 (95% CI 0.77 to 2.70, I 2 0.0%, p = 0.945), while SMD for length of hospital stay was 0.49 (95% CI 0.20 to 0.79, I 2 - 67.9%, p = 0.077)., Conclusions: Our meta-analysis revealed that the recurrence rate for the perineal approach was almost double the recurrence rate for the abdominal approach. More randomized trials are needed to determine which is the best approach for patients with recurrent external rectal prolapse., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s).)

Objective: The clinical benefits of neoadjuvant bevacizumab plus chemotherapy in locally advanced gastric cancer patients are controversial. This study intended to evaluate the efficacy and safety of neoadjuvant bevacizumab plus chemotherapy in these patients., Methods: In this retrospective study, 71 locally advanced gastric cancer patients receiving neoadjuvant bevacizumab plus chemotherapy or neoadjuvant chemotherapy alone were divided into bevacizumab plus chemo group (N = 23) and chemo group (N = 48)., Results: Objective response rate (52.2% vs. 35.4%), disease control rate (91.3% vs. 81.3%), surgical resection rate (95.7% vs. 85.4%), R0 resection rate (87.0% vs. 75.0%), and the proportion of patients with tumor regression grade 0-1 (31.8% vs. 17.1%) tended to increase in bevacizumab plus chemo group versus chemo group, although there was no statistical significance. The 48-month progression-free survival (PFS) rates were 58.3% and 33.4% in bevacizumab plus chemo group and chemo group. The 48-month overall survival (OS) rates were 65.1% and 46.5% in bevacizumab plus chemo group and chemo group, respectively. PFS tended to ascend, but OS did not vary in bevacizumab plus chemo group versus chemo group. Bevacizumab plus chemo (vs. chemo) independently related to longer PFS [hazard ratio (HR) = 0.263, P = 0.015], but not OS (HR = 0.207, P = 0.056) in locally advanced gastric cancer patients. The incidence of grade 3-4 adverse events did not vary between groups (all P > 0.05)., Conclusion: Neoadjuvant bevacizumab plus chemotherapy achieves higher treatment response and longer survival to some extent, with tolerable adverse events versus neoadjuvant chemotherapy alone in locally advanced gastric cancer patients, but its application needs further verification., Competing Interests: Declarations. Ethics approval and consent to participate: The Ethics Committee approved the study. The informed consents were obtained from patients or their family members. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Last decades led to a revolution in the management of ulcerative colitis (UC), due to the development of novel advanced therapies and the identification of increasingly ambitious therapeutic goals. Nevertheless, a subset of patients, refractory to available therapies, still requires proctocolectomy with ileal pouch-anal anastomosis (IPAA). Pouchitis, an inflammatory condition of the ileal pouch, is the most common long-term complication of IPAA, affecting almost one-half of patients in the first 10 years after surgery. Symptoms of pouchitis include increased stool frequency, urgency, and abdominal discomfort, significantly affecting patients' quality of life. Traditionally the mainstay treatment of acute pouchitis involves the use of antibiotics, but one-fifth of patients develop chronic pouchitis (CP), which may be dependent or resistant to antibiotics, posing significant challenges in the management of this condition. Currently, there is still no consensus on the optimal management for CP, though recent progress in understanding the pathophysiology of pouchitis has paved the way for innovative therapeutic approaches, based on biological therapies and small molecules. This review aims to discuss the recent advanced therapies available for pouchitis and provide a comprehensive review on the topic to guide physicians in their clinical practice., Competing Interests: F.L. has no conflict of interest. C.A.M.H. has no conflict of interest. M.K.M. served as a speaker of Janssen, Takeda, and Abbvie, and an advisory board member of Janssen and Takeda. N.S.F.Q. has served as a speaker and advisory board member of Janssen, Takeda, and Abbvie., (© The Author(s), 2025.)

Objective: To compare the impact of different treatment strategies on the survival outcomes in rectal cancer patients with poor response to neoadjuvant therapy, and to explore the survival-related influencing factors. Methods: A retrospective cohort study was conducted. Between January 2018 and November 2022, the clinical, pathological, and follow-up data of 106 rectal cancer patients who received neoadjuvant therapy and were evaluated as grade 4 or 5 based on the Magnetic Resonance Tumor Regression Grade (mrTRG) from the rectal cancer database at Peking Union Medical College Hospital were retrospectively collected. Based on the post-neoadjuvant therapy assessment, patients were classified into three groups: the chemotherapy-radiotherapy group (23 patients), the consolidation therapy group (18 patients), and the standard treatment group (65 patients). General condition, pathological findings, selection of neoadjuvant therapy, comorbidities, as well as 3-year expected DMFS and OS were observed in the three groups. Results: All 106 patients were followed up, with a median follow-up time of 28 (21, 38) months. The overall 3-year DMFS rate was 60%, and the 3-year OS rate was 74%. The 3-year DMFS in the standard treatment and consolidation therapy groups were 74% and 72%, respectively; the 3-year OS were 84%, 81%, respectively. The Log-rank test showed that there was no significant difference in the 3-year expected DMFS and OS between the standard treatment group and the consolidation therapy group (both P >0.05), but both groups had better survival outcomes than the chemotherapy-radiotherapy group (10% and 39%, respectively; all P <0.001). Multivariate Cox regression analysis indicated that the chemotherapy-radiotherapy only regimen was an independent risk factor for DMFS (HR=12.425, 95% CI: 4.436-34.594, P <0.001), and the independent risk factors for OS were chemotherapy-radiotherapy only regimen (HR=8.991, 95%CI:2.220-36.403, P =0.002) and age≥65 years (HR=3.495, 95%CI: 1.017-12.009, P =0.047). Stratified analysis showed that chemotherapy-radiotherapy only regimen was the independent risk factors for DMFS and OS in patients with extramural vascular invasion (EMVI) positive ( n =66) and mesorectal fascial invasion (MRF) positive (n=56) (all P <0.05). Whether consolidation therapy was added to the standard neoadjuvant treatment regimen was not an independent factor affecting 3-year expected DMFS or OS in rectal cancer patients with poor response to neoadjuvant therapy. Further comparisons between the standard neoadjuvant treatment and consolidation therapy groups showed no statistically significant differences in spincter-preservation rate or postoperative complication rates (both P >0.05). However, the consolidation therapy group had a longer interval between the end of radiotherapy and surgery [80.1 (50.8, 109.4) days vs. 61.8 (48.8, 74.8) days, P <0.001], and a higher incidence of chemotherapy-related adverse effects ([10/18] vs. 26.2% [17/65], P =0.018). Conclusion: In rectal cancer patients with poor response to neoadjuvant therapy and clear adverse prognostic features before surgery (locally advanced stage, MRF positive or EMVI positive), the addition of short- or long-course chemotherapy-based systemic therapy does not provide short- or long-term survival benefits. Moreover, an extended chemotherapy duration increases the incidence of chemotherapy-related adverse effects.

Background: Gastric cancer peritoneal metastasis lacks effective predictive indices. This article retrospectively explored predictive values of DNA ploidy, stroma, and nucleotyping in gastric cancer peritoneal metastasis., Methods: A comprehensive analysis was conducted on specimens obtained from 80 gastric cancer patients who underwent gastric resection at the Department of Gastrointestinal Surgery of Wuhan University Renmin Hospital. Tumor tissues were sectioned and stained. DNA ploidy, stroma, and nucleotyping were quantified using microscopy and digital analysis software. Data analysis was employed by Pearson Chi-square, continuous correction Chi-square, and binary logistic regression., Results: Using both univariate and multivariate analysis, pathological T stage and nucleotyping exhibited a positive correlation with peritoneal metastasis. DNA ploidy and stroma showed a positive correlation in univariate analysis. Chi-square tests demonstrated a positive correlation of DNA ploidy, stroma, and nucleotyping with peritoneal metastasis. The combined application of these three indicators displayed heightened predictive value for peritoneal metastasis. Non-diploid status, high stroma, and chromosomal heterogeneity emerged as positive factors for peritoneal metastasis in gastric cancer., Conclusions: DNA ploidy, stroma, and nucleotyping prove to be predictive factors for peritoneal metastasis, with enhanced predictive efficacy when combined in pairs., Competing Interests: Declarations. Ethics approval and consent to participate: The experimental plan for this study was developed based on the ethical guidelines of the Helsinki Declaration and approved by the Ethics Committee of Renmin Hospital of Wuhan University (WDRY2022-K227). For patients participating in this study, informed consent has been obtained from themselves or their guardians and a written informed consent form has been signed. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Leishmaniasis is a significant zoonotic infection with global health implications, particularly in regions where human and animal health are closely interconnected. This cross-sectional study assessed the knowledge, attitudes, and practices (KAP) of 5,074 participants regarding leishmaniasis and the One Health concept. The socio-demographic data revealed that most respondents were young (82.6%), male (82.3%), and from rural areas (50.8%), with a majority based in Khyber Pakhtunkhwa (57.4%). Veterinary professionals (42.1%) and students (27.4%) constituted the primary respondents, with 32.4% working in government hospitals. Knowledge about leishmaniasis was high, with 97.5% of participants recognizing Leishmania and 86% correctly identifying it as a protozoan disease. The majority (71.8%) believed in the zoonotic transmission of Leishmania from animals to humans. Attitudes toward the One Health concept were positive, with 90.2% of respondents aware of it, and 95.5% acknowledged the zoonotic nature of the disease. Practices for controlling sandfly populations were observed by 56.4% of participants, with bed nets (44.9%) being the most common preventive measure. Results showed that younger participants had significantly better knowledge, attitude, and perception regarding leishmaniasis and One Health compared to older individuals. Veterinarians and government hospital staff demonstrated better KAP toward VL. This study underscores the importance of educational interventions and community-based control measures to enhance understanding and prevention of leishmaniasis, with the One Health approach playing a crucial role., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Khan, Lin, Khan, Kanwal, Wajid, Khan, Noor, Almajwal, Chen and Qadeer.)

Purpose: Carcinoembryonic antigen (CEA) is an important prognostic factor for rectal cancer. This study aims to introduce a novel cutoff point for CEA within the normal range to improve prognosis prediction and enhance patient stratification in rectal cancer patients., Methods: A total of 316 patients with stages I to III rectal cancer who underwent surgical tumor resection were enrolled. The Cox proportional hazards regression model was used to evaluate the impact of preoperative CEA level and other co-variates on overall survival (OS). The Youden Index method was used for CEA optimal cutoff estimation., Results: The mean follow-up period was 46.47 months. In risk-adjusted Cox proportional analysis, higher preoperative CEA levels (HR 1.17, CI 1.131.21; P < 0.001), and T-stage were associated with poor OS. The mean preoperative CEA level was significantly higher in patients with positive lymphovascular invasion (LVI) and perineural invasion (PNI) (CI: 1.06-2.45 and 0.75-2.33, respectively, P < 0.001, t test). Pathologic complete response (pCR) occurred in 71 (22.4%) cases. Patients with pCR had lower levels of preoperative CEA than non-pCR group (P = 0.002, CEA pCR -CEA nonpCR  =  - 1.3; t test). Using Youden Index, the estimated optimal CEA cutoff value for predicting OS was 2.8 ng/mL (sensitivity 90%; specificity 78.5%). Lower preoperative CEA levels predict higher pCR rates, aiding patient stratification and planning., Conclusion: Preoperative CEA may play a role in the prediction of pCR in rectal cancer. Considering the CEA level of 2.8 ng/ml, as a newly defined cutoff point, patients with a worse prognosis can be identified prior to operation. PNI, along with LVI as independent predictors, may be contemplated as prognostic indicators to improve treatment strategies., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This study aims to compare the survival discrimination of the Tumor-Node-Metastasis (TNM) eighth and ninth editions for patients with localized and locally advanced (LLA) anal squamous cell carcinoma (ASCC) treated non-surgically and to evaluate the prognostic impact of T classification and lymph node (LN) status with data from the Surveillance, Epidemiology, and End Results database. We retrospectively included 6,876 patients in the comparison. We observed the inversion of survival outcomes for stages IIB and IIIA diseases in the TNM eighth edition [median overall survival (OS): 112 months for stage IIB vs. not reached for stage IIIA]. By contrast, it demonstrated improvement in the TNM ninth edition (median OS: not reached for IIB disease vs. 120 months for IIIA disease, P<0.001). In the correlation analysis, we observed an increased correlation between T classification and TNM staging systems (r value increased from 0.78 to 0.93) and a decreased correlation for the LN status (r value decreased from 0.83 to 0.59). For OS, variable importance analysis demonstrated more weight of importance for the T classification than the LN status (0.0871 vs. 0.0048). Additionally, decision curve analysis and time-dependent receiver operating characteristic analysis confirmed the prognostic accuracy of T classification rather than the LN status. In conclusion, TNM ninth edition is a better prognostic indicator than the eighth edition for patients with LLA ASCC treated non-surgically. T classification plays a more important prognostic role than the LN status and warrants further validation., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Zheng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background and Objective : Colorectal cancer (CRC) is the third most common cancer worldwide, with colon cancer accounting for approximately 60% of all CRC cases. Surgery remains the primary and most effective treatment. Robotic-assisted surgery (RAS) has emerged as a promising approach for colon cancer resection. This retrospective study compares RAS and laparoscopic-assisted surgery (LSS) for stage I-III colon cancer resections at a single medical center in East Asia. Methods : Between 1 January 2018, and 29 February 2024, patients undergoing colectomy were classified into right-side and left-side colectomies. Propensity score matching was conducted based on age group, gender, ASA score, and BMI to ensure comparability between groups. After matching, there were 50 RAS and 200 LSS cases for right colectomy (RC), and 129 RAS and 258 LSS cases for left colectomy (LC). Perioperative outcomes were compared between the two surgical approaches. The primary outcomes were recovery milestones, while secondary outcomes included complications and postoperative pain scores. Results : RAS demonstrated faster recovery milestones compared to LSS (hospital stay: 6.5 vs. 10.2 days, p = 0.005 for RC; 5.5 vs. 8.2 days, p < 0.001 for LC). RAS also resulted in lower rates of ileus (14% vs. 26%, p = 0.064 for RC; 6.2% vs. 15.9%, p = 0.007 for LC) and higher lymph node yields (31.4 vs. 26.8, p = 0.028 for RC; 25.8 vs. 23.9, p = 0.066 for LC). Major complication rates showed no significant difference between RAS and LSS (4.0% vs. 7.0%, p = 0.746 for RC; 4.7% vs. 3.1%, p = 0.563 for LC). Patients in the RAS group experienced earlier diuretic phases and reported significantly lower postoperative pain scores (3.0 vs. 4.1, p = 0.011 for RC; 2.9 vs. 4.1, p < 0.001 for LC). Conclusions : Robotic-assisted surgery is associated with faster recovery, lower rates of ileus (LC), higher lymph node yield (RC) and reduced postoperative pain compared to laparoscopic-assisted surgery for colon cancer resection.

Objectives: This study aims to assess the potential mechanism of rutin to treat triple-negative breast cancer (TNBC) based on network pharmacology followed by in vitro experiments., Methods: The potential rutin targets were predicted, and the DisGeNET database was used to obtain the disease targets. The intersection targets were identified with Venny 2.1 software, with the String database subsequently used as input to produce the "drug-target-disease" visual network employing Cytoscape 3.7.2. Gene ontology. Kyoto Encyclopaedia of Genes and Genomes analyses were performed for intersection targets, while AutoDock Vina was used for molecular docking and visualization. Cell viability was assessed using the Colorimetric CCK-8 test, and apoptosis was analyzed using PI/Annexin V. The predicted core targets were confirmed by qPCR and western blotting assays., Results: EGFR, IL6, TNF, and INS were found as the primary targets. The molecular docking analysis revealed the rutin interaction with the core targets. The in vitro results confirmed that rutin inhibited the growth of the MDA-MB-231 cell line. Rutin also induced cell death and decreased the expressions of IL6, TNF, INS, and EGFR., Conclusion: Rutin's multi-target effects and molecular mechanism for treating TNBC were confirmed through preliminary results. The results provide a theoretical base for rutin's possible function in breast cancer treatment., Competing Interests: Conflict of interest: The authors declare that they have no conflict of interest., (© 2025 the author(s), published by De Gruyter.)

Purpose: Neoadjuvant immunochemotherapy (NAIC) markedly induces pathologic regression in locally advanced gastric adenocarcinoma. However, specific biomarkers are still lacking to effectively identify the beneficiary patients for NAIC., Patients and Methods: A prospective, single-arm, phase II study was conducted to treat locally advanced gastric adenocarcinoma with NAIC (NCT05515796). Correlation between clinicopathologic characteristics and neoadjuvant efficacy was investigated. Bulk RNA sequencing data from 104 samples (from 75 patients in two independent cohorts) and single-cell RNA sequencing data from 105 treatment-naïve gastric adenocarcinomas were comprehensively analyzed to decipher the association of epithelial and microenvironmental characteristics and clinical responses., Results: The prespecified primary endpoints were achieved: pathologic complete regression rate was 30%, major pathologic regression rate was 43%, and the regimen was well tolerated. Analysis of baseline clinical-pathologic parameters revealed the intestinal subtype of Lauren's classification as a key feature stratifying patients with increased sensitivity to NAIC. Mechanistically, an increased pool of DNA damage repair-active cancer cells and enrichment of CLEC9A+ dendritic cells in the tumor microenvironment were associated with enhanced responsiveness of the intestinal subtype gastric adenocarcinoma to NAIC. More importantly, an intestinal subtype-specific signature model was constructed by the machine learning algorithm NaiveBayes via integrating the transcriptomic features of both DNA damage repair-active cancer cells and CLEC9A+ dendritic cells, which accurately predicted the efficacy of NAIC in multiple independent gastric adenocarcinoma cohorts., Conclusions: Intestinal subtype is a histologic biomarker of enhanced sensitivity of gastric adenocarcinoma to NAIC. The intestinal subtype-specific signature model is applicable to guide NAIC for patients with locally advanced gastric adenocarcinoma., (©2024 American Association for Cancer Research.)