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Aim: To retrospectively analyse the short- and long-term oncological, morbidity and mortality outcomes in patients diagnosed with acute right-sided obstructing colon cancer. Patients who underwent pre-optimisation prior to the oncological resection were compared to patients who did not undergo pre-optimisation.

Methods: All consecutive patients with right-sided obstructing colon cancer, either with a high clinical suspicion or confirmed diagnosis by histological analysis, who underwent curative-intent treatment between March 2013 and December 2020 were included. Patients were divided into two groups: an optimised group and a non-optimised group. Preoperative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. Data about disease-free survival and mortality were collected up to three years after surgery.

Results: Sixty-two patients were included. Thirty patients underwent the optimisation protocol before postponed surgery, and 32 patients received emergency surgery, without optimisation (surgery performed with a median of 9.6 days versus 22 h after admission). The postoperative complication rate was significantly lower in the optimisation group (50 % vs 78 %, p = 0.033). No significant differences were found in the 90-day mortality rate (7 % vs 13 %, p = 0.672) and three-year overall survival rate (43 % vs 56 %, p = 0.49). After three years, sixteen (53 %) patients in the optimised group and twenty (63 %) in the non-optimised were deceased (p = 0.672).

Conclusion: Postponing the surgery with preoperative optimisation in patients with obstructing right-sided colon cancer results in a significantly lower 90-day complication rate and suggests no negative effect on survival rates compared to an acute resection. Although, further research with a larger sample size is needed.

Background: Breast reconstruction practices, predominantly implant-based, have evolved, with meshes aiding in overcoming traditional limitations. However, data comparing mesh-assisted prepectoral reconstruction with implants alone are lacking. This study aimed to assess whether synthetic meshes in prepectoral reconstruction impact postoperative complications.

Material and methods: We retrospectively studied 238 prepectoral immediate implant-based breast reconstructions (IBBR) in 211 patients from 2020 to 2022. Our primary endpoint was the 90-day revision surgery rate comparing mesh and non-mesh groups. Secondary endpoints included postoperative complications: seroma formation, skin necrosis, implant exposure, hematomas, surgical site infections, and implant loss. We conducted univariate and multivariate analyses to assess complications and risk factors for postoperative revision in the entire cohort.

Results: There was a statistically significant higher rate of revision surgery in the mesh group (22 % vs. 9.0 %, p = 0.022) and more early complications in the mesh group, although there was no significant difference between the two groups. During the study period, the number of immediate IBBR significantly increased, reflecting expanded surgical indications that were no longer dependent on potential adjuvant treatments. and practices have changed. The multivariate analysis revealed no specific evidence of mesh use affecting surgical revision. However, it identified implant volume as a significant factor increasing the risk of revision surgery (p = 0.01).

Conclusion: This study underscores a significant practice shift: standardizing surgical techniques, particularly reducing mesh usage, did not lead to higher revision surgery rates. These findings suggest that the non-mesh assisted prepectoral approach is a valid technique.

Background: Fluorescence molecular imaging, a potent and non-invasive technique, has become indispensable in medicine for visualizing molecular processes. In surgical oncology, it aids treatment by allowing visualization of tumor cells during fluorescence-guided surgery (FGS). Targeting the urokinase plasminogen activator receptor (uPAR), overexpressed during tissue remodeling and inflammation, holds promise for advancing FGS by specifically highlighting tumors. This study explores the extended use of Nanobody-based (Nb) anti-uPAR tracers, evaluating their receptor binding, ability to visualize and demarcate colorectal (CRC) and gastric cancer (GC), and detect localized (PC) and metastatic (PC-M) pancreatic carcinoma.

Methods: First, the receptor structure interactions of Nb15, which binds specifically to the human homologue of uPAR, were characterized in vitro to deepen our understanding of these interactions. Subsequently, Nbs 15 and 13-where Nb13 targets the murine uPAR homologue-were labeled with the s775z fluorescent dye and validated in a randomized study in mice (n = 4 per group) using orthotopic human CRC, GC, and PC models, as well as a mouse PC-M model.

Results: Nb15, which binds to the D1 domain of uPAR and competes with urokinase's binding fragment, showed rapid and specific tumor accumulation. It exhibited higher tumor-to-background ratios in CRC (3.35 ± 0.75) and PC (3.41 ± 0.46), and effectively differentiated tumors in GC (mean fluorescence intensity: 0.084 ± 0.017), as compared to control Nbs. Nb13 successfully identified primary tumors and liver metastases in PC-M models.

Conclusion: The tested fluorescently-labeled anti-uPAR Nbs show significant preclinical and clinical potential for improving surgical precision and patient outcomes, with Nb15 demonstrating promise for real-time surgical guidance.

Introduction: Recent clinical researches have reported that neoadjuvant chemoimmunotherapy (NCIT) significantly improve the pathological complete response (pCR) and major pathological response (MPR) rates. However, surrogate endpoints for survival remains controversy for locally advanced gastric cancer (LAGC) after NCIT.

Methods: A retrospective analysis was performed on 84 patients with LAGC who had undergone NCIT following radical resection in three medical centers in China, between July 2020 and September 2023. Survival curves for event-free survival (EFS) and overall survival (OS) were estimated using the Kaplan-Meier method, and the log-rank test was used to compare survival outcomes. Univariate and multivariate analyses for prognostic factors were based on Cox regression analysis.

Results: The rates of ypN0, pCR and MPR were 60.7 % (51/84), 26.2 % (22/84) and 39.3 %(33/84),respectively. Patients with ypN0 had better EFS and OS than those with ypN+ (all p < 0.05). Survival was equivalent between pCR and non-pCR group (all p > 0.05). while patients with MPR had better EFS than those with non-MPR (p = 0.028). Furthermore, a multivariate analysis revealed that the lymph nodes(LNs) status was an independent prognostic factor for the EFS (hazard ratio [HR] 5.533, 95 % confidence interval [CI] 1.186-25.804, p = 0.029) and OS (HR 5.116, 95 % CI 1.357-19.281, p = 0.016), but not pCR and MPR (all p > 0.05). Based on the status of pathologic LNs, ypN0 group showed lower depth of tumor invasion, and lower rate of perineural and vascular invasion (all p < 0.05).

Conclusion: These findings demonstrated that ypN0 may be important as a surrogate of favorable clinical outcome in LAGC patients who received NCIT plus curative surgery.

Introduction: The impact of overweight and obesity on pathological outcomes, complications, and oncologic outcomes following surgery for gastric adenocarcinoma has been poorly reported in Western populations. This study aimed to better understand the impact of overweight and obesity on both surgical and oncological outcomes in patients who underwent surgery for gastric cancer.

Methods: Data were retrospectively collected from a multi-institutional European database. 1589 patients underwent surgery for gastric adenocarcinoma between 2007 and 2017. Patients were divided into three groups according to their body mass index (BMI): 722 normoponderal patients (45.4 %), 585 overweight patients (36.8 %), and 282 obese patients (17.7 %).

Results: The tumor stage, administration of perioperative chemotherapy, number of harvested lymph nodes, and reoperation rates were similar. Tumor location differed between the groups, with more distal locations in normoponderal patients than in overweight patients (51.4 % vs. 44.1 %, p = 0.04). Surgical complications were more frequent in obese patients than in normoponderal patients (34.8 % vs. 24.2 %, p = 0.005), and severe postoperative complications too. The medical complication rate was higher in overweight and obese patients (31.5 % and 32.6 % vs. 24.1 %, p = 0.003). There was no difference in the overall survival.

Conclusions: Obesity was not related to tumor stage, pre- or intraoperative strategies, or survival in patients undergoing surgery for gastric adenocarcinoma. However, postoperative morbidity increases in patients with obesity. Surgery for gastric adenocarcinoma should be proposed for all patients and should be performed as usual, regardless of their BMI. However, obese patients should be counseled regarding the higher risk of postoperative complications.

The current scientific evidence suggests that surgical navigation (SN) can contribute to improve oncologic outcomes in sinonasal and craniofacial surgery. The present study investigated the feasibility of intraoperative SN and its role in improving the outcomes of surgically treated sinonasal and craniofacial tumors. This prospective study compared navigation-guided surgery for sinonasal or craniofacial malignancies with a pair-matched cohort (1:2 matching) of patients operated without SN. A systematic review of the literature was performed. Thirty-five patients who underwent navigation-guided surgery were included. The pair-matched control cohort included 70 patients operated without SN. The margin status analysis demonstrated a lower rate of positive margins (p = 0.013) in the SN group, especially in pT4 (p = 0.034), recurrent (p = 0.024), high-grade tumors (p = 0.043), and endoscopic-assisted open surgery (p = 0.035). The mean preoperative time did not show a significant difference between surgeries performed with or without SN (1.26 vs. 1.23 h, p = 0.445). However, surgeries utilizing SN had a significantly longer median duration compared to those without (8.10 vs. 6.00 h, p = 0.029). A total of 209 patients were included in the meta-analysis; 91 patients (43.5 %) underwent surgery with SN. The results of the meta-analysis showed an improvement in terms of negative margins rate with the use of SN (OR = 2.62; 95%-confidence interval: 1.33-5.17). In conclusion, intraoperative SN can contribute to achieve a clear margin resection, especially in locally advanced tumors, recurrences, highly aggressive histologies, and when endoscopic-assisted open surgery is employed.