Prospective evaluation of the novel BADCAL score for predicting colorectal anastomotic leak.

Creating and validating an anastomotic leakage risk prediction model after laparoscopic low anterior resection for rectal cancer.

High-volume hospitals experience fewer postoperative complications after neonatal surgery: Analyses of the National Clinical Database Pediatric Surgical Registry in Japan.

The right side of the anastomosis is the leakage-prone site following McKeown esophagectomy with cervical circular-stapled anastomoses.

Natural history and clinical significance of postoperative pneumoperitoneum: a systematic review and meta-analysis.

Utility and safety of near-infrared fluorescent marking clips for tumor localization in robot-assisted laparoscopic gastric cancer surgery.

The aim of this study is to compare the efficacy of the laparoscopic pylorus-preserving gastrectomy (LPPG) and laparoscopic distal gastrectomy (LDG) for gastric cancer (GC) on postoperative complications and nutritional status. We conducted a literature search of PubMed, EMBASE, Scopus, and Cochrane Library databases before April 20th, 2025. We found that the rate of delayed gastric emptying and gastric stasis after LPPG was higher than that after LDG, while there was no significant difference in the incidence of pulmonary diseases, anastomotic leakage, pulmonary fistula, or other complications. The prevention of dumping syndrome and the improvement in nutritional status seemed to be better in LPPG. No more valuable benefits of LDG in reducing complications was found.

Background: In emergency as well as in elective situations, gastrointestinal anastomosis is an essential step to maintain the continuity of gastrointestinal tract following intestinal resection. Anastomotic complications, primarily, anastomotic leaks is one of the most widely feared and extensively studied problems in GI surgery. That’s why this study was conducted to identify the risk factors for early complications in gastrointestinal anastomosis Methods: This was a cross sectional observational Study which took place in the department of Surgery, Rangpur Medical College Hospital and private hospitals in Rangpur, Bangladesh from 1st October 2018 to 31st March 2019 over a period of 6 months. All statistical analysis was performed using the SPPS software program version 26.0 (SPSS, Inc., Chicago, IL, United States of America). A p value<0.05 was considered statistically significant. Results: A total number of 200 patients were included in the study by purposive sampling method. Mean age of the study population was 46±13.6 years with a male female ratio of 2:1. Among them 44% patients had gastro-jejunal anastomosis and 66% patients had anastomosis involving small and large gut. Anastomotic leaks (AL), (4.5%) and hemorrhage (2.2%) were the main post-operative complications. Re-operation was required in 3.5% patients. Operative mortality rate was 5.5%, with 06 deaths (54%) secondary to anastomotic complications. Univariate analysis of the overall population male patient, age, malnutrition, malignancy, sepsis and uses of steroids were independent predictors of postoperative complication following gastrointestinal anastomosis. Conclusions: Anastomotic complications, particularly anastomotic leaks, remain a major unsolved problem in GI surgery.

Patients desire postoperative transurethral catheter removal as early as possible after radical Prostatectomy (RP). Therefore, we strived to obtain risk factors for radiographic anastomotic leakage (AL) at postoperative day 3 (POD3) to assess whether a cystogram (CG) before removal is still necessary in all patients. We retrospectively analyzed the data of 409 patients undergoing RP at our clinic in 01-06/2022. Out of these, 334 were included for further analysis. Patients with a robotic-assisted approach (RARP) received their CG on postoperative day 3 as standard, after open surgery (ORP) on day 5. We employed univariable analyses to examine potential risk factors for AL, such as surgical approach, intraoperative bladder neck reconstruction, obesity or locally advanced disease stages. In total, the rate of AL was low: 22/334 patients (6.7%) showed extravasation on initial standard (POD 3,5) CG after RP. Only surgical approach (ORP 30% vs. RARP: 5.1% p<0.001, OR 0.12, 95%CI 0.04 - 0.37, p<0.001) and need for bladder neck reconstruction (5.6%vs.16.7%, p=0.02, OR0.30, 95%CI0.10-0.87,p=0.027) could be determined as risk factor for AL. None of the other factors showed statistically significant associations. Omitting CG at POD 3 following RP would miss approximately 7% of AL. It is unclear whether this would always cause disruption and urinoma. Since catheterization time for safe removal without CG has yet to be defined, we recommend early CG for all patients. Early catheter removal has a 5% risk for acute urinary retention.

IntroductionRetroperitoneal sarcomas (RPS) are rare and often large malignancies that frequently require extensive surgery for complete tumour removal. Resections of the colorectum are part of the standard resection, this way contributing to complication rates, including anastomotic leakage or obstruction. Surgical strategies for stoma formation and colorectal reconstruction remain poorly defined. The Colorectal Resections and Postoperative Quality of Life in Retroperitoneal Sarcoma Patients Across German-Speaking Sarcoma Centres (COLOSARC-Q) study aims to explore surgical procedures and health-related quality of life (HRQoL) in patients undergoing colorectal procedures during RPS surgery.Methods and analysisCOLOSARC-Q is a prospective, multicentre, non-interventional study and will recruit 120 patients with primary RPS who undergo colorectal resection as part of sarcoma surgery in a sarcoma referral centre in Germany or Switzerland. HRQoL is assessed using standardised questionnaires (EORTC QLQ-C30, QLQ-CR29) as well as semi-structured interviews by psycho-oncology services and patient advocates. Data will be collected via an electronic Case Report Form, encompassing demographic, clinical, surgical and outcome-related information. All data will be centrally analysed. For the assessment of quality of life, a qualitative analysis with content and context analysis, as well as evaluation of the questionnaires according to a standardised scoring system, is planned. The primary aim is to evaluate surgical techniques for bowel resection and reconstruction and their influence on the further course of disease. Secondary endpoints assess postoperative complications as well as tumour-, patient- and treatment-related factors.Ethics and disseminationEthical approval was granted by the Ethics Committee II of the University of Heidelberg (approval number 2024-562; 13 June 2024). The data protection review was approved by the data protection officer of the University of Heidelberg. Participation of other centres in the study requires local ethical approval. All patients will be required to sign an informed consent form. Results of primary and secondary endpoints will be published.Trial registration numbersNCT06943612; German Clinical Trials Registry (DRKS00034135).

Postoperative C-reactive protein (CRP) levels are good predictors of anastomotic leak (AL) following colorectal surgery, with postoperative day-3 CRP thresholds ranging between 162 and 195mg/L in open and laparoscopic resections. This study aims to determine a cut-off CRP value that predicts ALs following robotic colorectal surgery and identifies patients suitable for safe early discharge. A single-center retrospective analysis of patients who underwent an elective robotic colorectal resection, with primary anastomosis, between February 2017 and December 2024, was conducted. Primary outcome measure was clinically and radiologically confirmed AL (graded). Data were analyzed using IBM SPSS v30.0.0. Seven hundred eighty-four elective robotic colorectal resections with anastomosis were performed. Median age was 69years (IQR 60-77), 448 male, 336 female, and BMI 27.5 (IQR 24.4-31.1), indication for surgery was cancer in 681 (86.9%) patients. 51 (6.5%) patients had an AL, of which 12/51 (23.5%) had a grade ≥3 leak. A POD-3 CRP level of 136.0mg/L (73% sensitivity, 79% specificity, and AUC 0.788) and POD-4 CRP level of 94.4mg/L (84% sensitivity, 62% specificity, and AUC 0.806) were predictive of AL. At POD-5, a cut-off CRP of 243mg/L (88% sensitivity, 73% specificity, and AUC 0.818) was predictive of ALs requiring re-operation and/or escalation to level 2-3 care. Male sex, colo-rectal anastomoses, and resections performed before 2020 were associated with higher AL rates. Postoperative CRP levels have high predictive value in early detection and exclusion of AL, facilitating early patient discharge under the enhanced recovery after surgery (ERAS) pathways. CRP thresholds in robotic colorectal resections are lower than previously reported thresholds in open and laparoscopic surgery.

Abstract Aim Anastomotic leak remains a significant source of morbidity and mortality following oesophagogastric resections. Early detection is essential in this high-risk population. C-reactive protein (CRP) is a well-established marker of post-operative complications. This study aimed to assess the association between early post-operative CRP changes and anastomotic leaks, identifying a predictive threshold in our centre. Method All patients undergoing oesophagogastric resection from November 2023 to November 2024 were included. Changes in CRP (delta CRP) over the first 10 post-operative days (POD) were analysed. Univariate and multivariate analyses were conducted to identify significant predictors of anastomotic leak. A predictive model was developed to determine an optimal CRP threshold. Results A total of 156 patients were included; 112 were male, with a median age of 66 years and BMI of 27. Open procedures accounted for 69% of cases, and the anastomotic leak rate was 9.6%. The maximum delta CRP between POD1 and POD5 was significantly associated with leaks. A delta CRP &amp;gt;106 mg/L in this window yielded an AUC of 0.821 (sensitivity 1.00, specificity 0.55). Between POD1 and POD3, the same threshold gave an AUC of 0.77 (sensitivity 0.93, specificity 0.59). Conclusions In this single-centre study, a delta CRP &amp;gt;106 mg/L by POD3 serves as an early warning marker for anastomotic leak, with continued elevation by POD5 strongly predictive of leakage. CRP monitoring can guide earlier intervention and potentially improve outcomes following oesophagogastric surgery.

Osteopenia, marked by low bone mineral density, is a sign of patient frailty and has been linked to poor survival in patients with esophageal squamous cell carcinoma. However, its impact on overall survival (OS) and disease-free survival (DFS) in patients with esophageal adenocarcinoma is still unclear. Our aim was to assess the impact of osteopenia on long-term survival in patients with resectable esophageal adenocarcinoma. This was a retrospective study (January 2014-December 2024) including patients with resectable Siewert I-II esophageal adenocarcinoma who underwent Ivor-Lewis esophagectomy. Osteopenia was defined as reduced bone mineral density (<160 Hounsfield units) measured at the level of the first lumbar vertebra on preoperative computed tomography scan. Overall, 338 patients were included. The prevalence of osteopenia was 27.8%. Anastomotic leak (22.3% vs. 11.9%; p=0.04), pneumonia (17.1% vs. 6.9%; p=0.01), and 90-day mortality (8.5% vs. 2.1%; p=0.02) were higher in patients with osteopenia. On multivariate analysis, osteopenia was an independent predictor of pneumonia (hazard ratio [HR] 1.42; 95% confidence interval [CI] 1.06-1.86) and 90-day mortality (HR 1.35; 95% CI 1.12-1.95) but not anastomotic leak (HR 1.51; 95% CI 0.91-1.76). Patients with osteopenia had significantly lower 60-month OS probability(49.9% vs. 70.5%; p<0.001) and DFS probability(45.7% vs. 61.5%; p=0.002). Osteopenia independently predicted poorer OS (HR 2.03; 95% CI 1.54-2.95) and DFS (HR 1.51; 95% CI 1.12-2.35). Osteopenia may affect up to one-third of patients with esophageal adenocarcinoma. Osteopenia was independently associated with postoperative pneumonia and 90-day mortality and poor long-term survival. Patients with osteopenia have lower OS and DFS than those without osteopenia.

Anastomotic leak is a serious complication of bowel anastomosis, with multifactorial etiology. Thorough intraoperative evaluation of the anastomosis using white light endoscopy and leak tests is critical. Indocyanine green fluorescence angiography (ICG-FA) has emerged as a tool to assess bowel perfusion, but has limitations, including patient allergies and procedural complexity. The FUJIFILM ELUXEO® VISION Endoscopic Imaging System uses oxygen saturation imaging (OSI) to measure tissue oxygen saturation (StO2) in real time, without requiring dye injection. This study investigates a novel quantitative approach for assessing bowel perfusion endoscopically by evaluating StO2 at colon anastomoses. The FUJIFILM VISION was used to obtain intraoperative mucosal StO2 measurements in 12 patients' post-colon resection with anastomosis. Measurements were taken at four locations: proximal base, proximal staple line, distal staple line, and distal base. Two-tailed paired t tests were used to compare StO2 measurements at distant healthy mucosa (base) to the staple line, both proximal and distal to the anastomosis. Patients were followed longitudinally via chart review to monitor outcomes. The average StO2 differences were +12.58% (95% CI 1.96-23.19%) between the proximal base and proximal staple line and +15.34% (95% CI 6.76-23.9%) between the distal base and distal staple line. Significant StO2 differences were observed between baseline normal mucosa and staple line adjacent mucosa (proximal: p = 0.025; distal: p = 0.003). No patients had intraoperative complications or developed anastomotic leaks during the study. This study shows that the ELUXEO® VISION Endoscopic Imaging System is a potentially useful tool for providing quantitative data on tissue perfusion at and near anastomotic sites, complementing traditional white light endoscopy and leak tests. Larger prospective studies with long-term follow-up are needed to confirm the relationship between StO2 measurements and clinical outcomes such as anastomotic leaks and stricture.

Abstract Aim To evaluate perioperative outcomes, pathological findings, and long-term survival following transhiatal oesophagectomy (THO) for distal oesophageal tumours. Method: A retrospective review was conducted using a prospectively maintained database of all patients who underwent THO from 2007 to 2024. Data included demographics, comorbidities, pathological staging, complications, and survival. Kaplan-Meier and log-rank tests assessed survival. Results A total of 248 patients (median age 66; 81.9% male) underwent THO, with 85.1% receiving neoadjuvant chemotherapy. Cardiopulmonary exercise testing (CPET) was performed in 74.2%, with 30.3% classified high risk (anaerobic threshold &amp;lt;11 ml/kg/min). Complications occurred in 36.3%, including cardiac events (15.3%) and anastomotic leak (16.9%). Vocal cord neuropraxia was seen in 8.5%, with permanent injury in 1.6%. Unplanned ITU admission occurred in 12.5%, and in-hospital mortality was 0.4%. R0 resection was achieved in 75.8%. CRM involvement occurred in 23.8%. Median lymph node yield was 18. Advanced disease was common (47.6% pT3). Among adenocarcinoma patients treated with neoadjuvant therapy, median survival was 66.0 months (stage II), 27.0 (IIIB), and 21.0 (IVA); not reached for stage I or IIIA. Median overall survival was 94.0 months, increasing to 162.0 in R0 cases vs 28.0 with CRM involvement (p&amp;lt;0.0001). Conclusions Transhiatal oesophagectomy remains a viable and oncologically effective approach for selected patients with distal oesophageal cancer, demonstrating comparable survival with relatively low perioperative morbidity. Margin status and pathological stage were key predictors of survival. These findings support the use of THO beyond early-stage disease in appropriately chosen patients and reinforce the critical importance of achieving R0 resection to improve survival.

Abstract Aim Enhanced recovery (ER) has become the standard of care in OG surgery. Routine artificial nutrition support (ANS) is commonly used to minimise deterioration in nutritional status postoperatively. There is growing interest in a more selective approach to ANS. Early reintroduction of diet would be paramount in patients not receiving routine ANS. This study reviewed compliance with ER pathway for diet progression, and duration of PN usage in one centre. Method Seventy-one patients who underwent elective oesophagectomy (n=64) and total gastrectomy (n=7) between May 2024-May 2025 were included. Data on time to reintroduction of diet, causes of delays and days on PN was collated. Results Twenty-seven percent (n=19) of patients progressed to diet by day 5 in accordance with the ER pathway. Seventy-three percent (n=52) experienced delays, with the median day of diet progression on day 8 (6-141). Postoperative complications were the most common reasons (overall 61.5%; chest/respiratory (n=17), anastomotic leak (n=6), pharyngeal dysphagia (n=5), postoperative delirium (n=3), chyle leak (n=1)). Potentially avoidable factors (water soluble swallow test delay, no clear reason documented) accounted for 38.5% of delays. Seventy patients received PN after surgery, with 57 (81%) discontinuing by day 10. Conclusions The majority of patients did not progress to diet in accordance with the local ER pathway. Whilst most delays were related to clinical reasons, some were potentially avoidable. Education and a quality improvement project could address these factors. Further research is required to evaluate the potential risks and benefits of a selective approach to ANS.

Abstract Aim To compare outcomes of transhiatal oesophagectomy (THO) and transthoracic oesophagectomy (TTO) in patients with ypT3 distal oesophageal tumours. Method A retrospective review was conducted using a prospectively maintained database at a single UK regional centre. Between 2007 and 2024, 270 patients with ypT3 tumours underwent either TTO (n=156) or THO (n=114). Surgical approach was determined via MDT discussion. A hybrid TTO technique was introduced during this period and used in 47 cases. Results Baseline demographics and cardiopulmonary fitness were comparable between groups. Postoperative pulmonary complications (53.2% vs 29.8%; p&amp;lt;0.01) and anastomotic leaks (24.4% vs 12.3%; p=0.013) were significantly more frequent in the TTO group. Vocal cord neuropraxia was more common following THO (10.5% vs 1.3%; p&amp;lt;0.001), although most cases resolved. No significant differences were observed in unplanned ITU admissions (20.5% vs 14%) or in-hospital mortality (3.2% vs 0.9%). R0 resection rates (TTO: 53.2%, THO: 57.9%; p=0.52) and CRM involvement (TTO: 44.9%, THO: 41.2%; p=0.64) were similar. Median lymph node yield was 19 in both groups. Median overall survival was 30.0 months (TTO) vs 32.0 months (THO) (p=0.59). Conclusions With the selection criteria used in our centre, patients with ypT3 tumours experience lower postoperative morbidity when managed with transhiatal oesophagectomy compared to transthoracic oesophagectomy, without compromise in overall survival. The higher-than-expected anastomotic leak rate observed in the TTO group may be partly attributable to the learning curve associated with the adoption of a hybrid approach.

The management of left-sided colonic oncological emergencies remains challenging, especially in choosing the optimal approach to control fecal contamination while minimizing surgical risks. This retrospective study evaluates intraoperative colonic lavage (IOCL) versus manual decompression (MD) in emergency left-sided colonic resections with primary anastomosis. Data from 70 patients who underwent emergency colorectal surgery at Pisa University Hospital between 2010 and 2022 were divided into two groups: IOCL (Group A, n = 23) and MD (Group B, n = 47). Primary endpoint was the rate of anastomotic leakage while secondary endpoints included incisional surgical site infections (SSI), overall morbidity, mortality, and length of hospital stay (LOS). Although IOCL significantly increased operative time (p < 0.0001), it was associated with a shorter ICU stay (p < 0.0001). No significant differences were observed between groups regarding anastomotic leakage, incisional SSI rates, overall morbidity, or LOS. These results align with previous studies suggesting that while IOCL may offer benefits in reducing ICU stays, it does not significantly impact overall morbidity or infection risk compared to MD. Our findings suggest that IOCL could be advantageous in selected, hemodynamically stable patients; however, further research is needed to confirm its efficacy. Given the similar morbidity and infection rates, MD remains a viable alternative. Future multicenter randomized studies could further clarify IOCL's clinical benefits in left-sided colonic emergencies, helping to establish guidelines for its use in routine practice.

Abstract Background Leaks following oesophago-gastric (OG) surgery result in sepsis and increased mortality. Their management is challenging and associated with high morbidity and extended recovery times; preventing the systemic impact could improve outcomes and negate the need for invasive procedures. Prophylactic Endoluminal Vacuum Therapy (pEVT), placed across the anastomosis intra-operatively, minimises the clinical impact of an anastomotic breakdown, by preventing the leakage of gastrointestinal contents into the mediastinum. Method 30 high-risk patients undergoing elective OG Cancer surgery (March’21 – January’25) were prospectively identified. pEVT was initiated at the surgeon’s discretion. The primary outcome was 30-day anastomotic leak (AL) rate; secondary outcomes included hospital-acquired pneumonia (HAP) and length of stay. A 1:3 propensity-score-matched analysis compared 30 pEVT patients who underwent a resection for OG cancer to historical controls, matched on age, Charlson Comorbidity Index, anaesthetic assessment, and surgical approach. Covariate balance and outcomes were analysed using standardised mean differences, Fisher’s exact, and Wilcoxon rank-sum tests. Results Technical success was achieved in all patients; there were no complications related to the insertion or removal of the device. The median duration of pEVT was 6 days (range: 4 - 16). Compared to controls, the pEVT group had significantly lower: 30-day AL rate (p=0.036), incidence of HAP (p=0.046), shorter ICU stay (p=0.006) and shorter total hospital stay (p=0.038). Conclusions pEVT can be delivered safely and significantly improves post-operative outcomes in high-risk patients undergoing OG cancer resection surgery. These findings support the use of pEVT as an adjunct to surgery in this group, and warrants further investigation in larger, multicentre studies.

Abstract Background Early-onset-oesophago-gastric-adenocarcinoma (EO-OGA) is a growing clinical concern.We aimed to describe outcomes in EO-OGA patients compared Late-onset-oesophago-gastric-adenocarcinoma (LO-OGA) patients. Method Patients between 11/2014–12/2024 were stratified as EO-OGA (age&amp;lt;55years) or LO-OGA, (≥55years). Demographic, clinicopathological and outcome data were collected. Hereditary syndromes were excluded. Primary outcome was disease-free-survival(DFS); secondary outcomes included anastomotic-leak(AL), hospital-acquired pneumonia(HAP), intensive-care-unit (ICU) stay&amp; length of stay (LOS). Survival analyses were performed using Kaplan-Meier curves. Results 135-patients had EO-OGA (24%signet-ring). EO-OGA increased from 8/year(median,2014–2018) to 16/year(median,2019–2024,p=0.082). 74 EO-OGA &amp; 407 LO-OGA patients had curative-surgery; EO-OGA more likely to presented with advanced-stage (III/IV=78.4% vs 67.5%LO-OGA,p=0.0037); LO more likely presented with Stage I/II (32.0% vs 17.6%). AL-rates were 4.1% in EO-OGA vs.7.4% LO-OGA (p=0.45). HAP was more common in LO-Gastric-Adenocarcinoma (46% vs 11%,p = 0.0005), but comparable in oesophageal-adenocarcinoma (LO 38% vs EO 24%, p = 0.071). ICU-stay was longer in LO-oesophageal-adenocarcinoma (9.5 vs 7.0 days,p &amp;lt; 0.001); but comparable in gastric-adenocarcinoma (LO 5.0 vs EO 6.0 days,p = 0.54). Median EO-OGA-LOS was 10.0 days vs LO-OGA 11.0 days (p = 0.10). DFS was 85.6%, 56.0%, and 40.0% in EO-OGA vs 95.1%, 88.9%, and 84.8% in the LO-OGA group, respectively (p &amp;lt; 0.0001). Conclusions EO-OGA has doubled in the last decade in our unit. EO-OGA presents more advanced than LO-OGA.Short-term outcomes likely reflect improved physiological reserve; however, DFS is significantly reduced in EO-OGA.This suggests an undiagnosed aggressive tumour biology necessitating improved treatment regimes.Translational work on somatic mutational landscapes will identify potential-disease aetiology and personalised treatment strategies to improve outcomes.