Maturation signatures of conventional dendritic cell subtypes in COVID-19 suggest direct viral sensing.

Growing evidence suggests that conventional dendritic cells (cDCs) undergo aberrant maturation in COVID-19, which negatively affects T-cell activation. The presence of effector T cells in patients with mild disease and dysfunctional T cells in severely ill patients suggests that adequate T-cell responses limit disease severity. Understanding how cDCs cope with SARS-CoV-2 can help elucidate how protective immune responses are generated. Here, we report that cDC2 subtypes exhibit similar infection-induced gene signatures, with the upregulation of IFN-stimulated genes and IL-6 signaling pathways. Furthermore, comparison of cDCs between patients with severe and mild disease showed severely ill patients to exhibit profound downregulation of genes encoding molecules involved in antigen presentation, such as MHCII, TAP, and costimulatory proteins, whereas we observed the opposite for proinflammatory molecules, such as complement and coagulation factors. Thus, as disease severity increases, cDC2s exhibit enhanced inflammatory properties and lose antigen presentation capacity. Moreover, DC3s showed upregulation of anti-apoptotic genes and accumulated during infection. Direct exposure of cDC2s to the virus in vitro recapitulated the activation profile observed in vivo. Our findings suggest that SARS-CoV-2 interacts directly with cDC2s and implements an efficient immune escape mechanism that correlates with disease severity by downregulating crucial molecules required for T-cell activation.

Mimicking Natural Metabolisms: Cell-Free Flow Preparation of Dopamine.

The biosynthesis of dopamine (DA) from L-tyrosine as starting material is an excellent yet challenging strategy. Here we developed a versatile, multi-enzymatic platform for the biocatalytic preparation of DA in a continuous mode with excellent conversion (90 %) and reaction time (45 min). The system exploits the immobilization of a decarboxylase from Bacillus pumilis (Fdc) and a tyrosinase from Agaricus bisporus (Tyr), which were combined to mimic the in-vivo synthesis of DA (both primary and secondary metabolisms) giving rise to an efficient strategy with a considerable reduction of process associated costs and environmental impact. To enhance the system automation, an in-line purification via catch-and-release procedure was added.

Skeletal muscle wasting and long-term prognosis in patients undergoing rectal cancer surgery without neoadjuvant therapy.

BACKGROUND: Derangement of body composition has been associated with dismal long-term survival in several gastrointestinal cancers including rectal tumors treated with neoadjuvant therapies. The role of specific preoperative anthropometric indexes on the oncologic outcomes of patients undergoing upfront surgery for rectal cancer has not been investigated. The aim of the study is to evaluate the association of body composition and overall survival in this specific cohort. METHODS: Lumbar computed tomography images, obtained within the 30 days previous to surgery, between January 2009 and December 2016, were used to calculate population-specific thresholds of muscle mass (sarcopenia), subcutaneous and visceral adiposity, visceral obesity, sarcopenic obesity, and myosteatosis. These body composition variables were related with overall survival (OS), tumor-specific survival (TSS), and disease-free survival (DFS). OS, TSS, and DFS were evaluated by the Kaplan-Meier method. Cox regression analysis was used to identify independent predictors of mortality, tumor-specific mortality, and recurrence, and data were presented as hazard ratio (HR) and 95% confidence interval (CI). RESULTS: During the study period, 411 patients underwent rectal resection for cancer, and among these, 129 were without neoadjuvant chemoradiation. The median follow-up was 96.7 months. At the end of the follow-up, 41 patients (31.8%) had died; of these, 26 (20.1%) died for tumor-related reasons, and 36 (27.1%) experienced disease recurrence. One-, three-, and five-year OS was 95.7%, 86.0%, and 76.8% for non-sarcopenic patients versus 82.4%, 58.8%, and 40.0% for sarcopenic ones respectively (p < 0.001). Kaplan-Meier survival curves comparing sarcopenic and non-sarcopenic patients showed a significant difference in terms of OS (log-rank < 0.0001). Through multivariate Cox regression, overall mortality risk was associated only with sarcopenia (HR 1.96; 95%CI 1.03-3.74; p = 0.041). Disease stage IV and III (HR 13.75; 95% CI 2.89-65.6; p < 0.001 and HR 4.72; 95% CI 1.06-21.1; p = 0.043, respectively) and sarcopenia (HR 2.62; 95% CI 1.22-5.6; p = 0.013) were independently associated with TSS. The other body composition indexes investigated showed no significant association with prognosis. CONCLUSIONS: These results support the inclusion of body composition assessment for prognostic stratification of rectal cancer patients undergoing upfront resection.

Quasi-elective left colectomy after endoscopic colon stenting for obstructive cancer yields comparable oncologic outcome to full-elective operation.

PURPOSE: Whether deferring surgery after endoscopic self-expandable metal stent (SEMS) placement for neoplastic stricture, and operating patients in a quasi-elective situation, may result in similar oncologic outcomes to elective operations is unclear. This study aimed to evaluate the disease-free survival (DFS) rates of patients who underwent an interval colon resection after SEMS placement or an elective operation with comparable cancer stages. METHODS: From a prospective dataset, we retrospectively selected patients with the following characteristics: (1) left-sided colon cancer and (2) cancer stage I to III. Exclusion criteria were as follows: (1) palliative surgery and (2) emergency operation. Then we stratified patients into two groups: (A) full-elective left colon resection and (B) quasi-elective left colon resection, defined as surgery performed after SEMS placement for obstructive colon cancer. DFS function was studied by the Kaplan-Meier method. RESULTS: After 1:2 matching based on cancer stage, 106 patients of the group A were compared with 53 patients of group B. In each group, there were 9.4% of stage I, 39.4% of stage II, and 50.9% of stage III patients. The rate of technical failure in SEMS placement was 3.8%. After a mean follow-up of 54 months, 16 (15.1%) patients in the full-elective groups and 10 (18.9%) in the quasi-elective group experience cancer recurrence (log rank = 0.588). DFS curve did not reach the median value. CONCLUSIONS: SEMS placement with interval colon resection for obstructive neoplastic strictures seems to provide similar long-term oncologic outcomes to operations performed in an elective setting when a low rate of technical failure is achieved.

Metastatic liver disease from non-colorectal, non-neuroendocrine, non-sarcoma cancers: a systematic review.

BACKGROUND: Hepatic resection of liver metastases of non-colorectal, non-neuroendocrine, and non-sarcoma (NCNNNS) primary malignancies seems to improve survival in selected patients. The aims of the current review were to describe long-term results of surgery and to evaluate prognostic factors for survival in patients who underwent resection of NCNNNS liver metastases. METHODS: We identified 30 full texts (25 single-center and 5 multicenter studies) published after year 1995 and published in English with a total of 3849 patients. For NCNNNS liver metastases, 83.4 % of these subjects were resected. RESULTS: No prior systematic reviews or meta-analyses on this topic were identified. All studies were case series without matching control groups. The most common primary sites were breast (23.8 %), genito-urinary (21.8 %), and gastrointestinal tract (19.8 %). The median 5- and 10-year overall survival were 32.3 % (range 19-42 %) and 24 % (indicated only in two studies, range 23-25 %), respectively, with 71 % of R0 resections. CONCLUSIONS: There is evidence suggesting that surgery of NCNNNS metastases is safe, feasible, and effective if treatment is part of a multidisciplinary approach and if indication is based on the prognostic factors underlined in literature analysis.

Single-incision versus standard multiple-incision laparoscopic cholecystectomy: a meta-analysis of experimental and observational studies.

OBJECTIVE: The advantages of single-incision surgery for the treatment of gallstone disease is debated. Previous meta-analyses comparing single-incision laparoscopic cholecystectomy (SILC) and standard laparoscopic multiport cholecystectomy (SLMC) included few and underpowered trials. To overcome this limitation, we performed a meta-analysis of randomized and nonrandomized studies. METHODS: A MEDLINE, EMBASE, and Cochrane Library literature search of studies published in and comparing SILC with SLMC was performed. The primary outcome was safety of SILC as measured by the overall rate of postoperative complications and biliary spillage. Feasibility was another primary outcome as measured by the conversion and operative time. Postoperative pain, length of hospital stay, perioperative blood loss, time to return to normal activity, and cosmetic satisfaction were secondary outcomes. RESULTS: We identified 43 studies of which 30 were observational reports and 13 experimental trials, for a total of 7489 patients (2090 SILC and 5389 SLMC). The overall rate of complications was comparable between groups (relative risk [RR] = 1.08; 95% CI = 0.87-1.35; P = .46), as were the rates of biliary spillage (RR = 1.16; 95% CI = 0.73-1.84; P = .53) and conversion rate (RR = 0.88; 95% CI = 0.53-1.46; P = .62). Operative time was in favor of SLMC (weighted mean difference = 0.73; 95% CI = 0.67-0.79; P < .0001). Secondary outcomes favored SILC, but with marginal advantages. CONCLUSIONS: SILC is a feasible technique but without any significant advantage over SLMC for relevant end points. Although secondary outcomes favored SILC, the small magnitude of the advantage and the low quality of assessment methods question the clinical significance of these benefits.

Fabrication of double layer nanoparticle infused starch-based thermoplastic food packaging system for meat preservation.

The current work aims to produce nanoparticle-infused starch-based bioactive thermoplastic packaging films. The FeO and ZnO nanoparticles were examined to be potential active ingredients for the production of nanoparticle-infused bioactive thermoplastic packaging films. The bio-thermoplastic films infused with FeO and ZnO nanoparticles showed high oxygen scavenging and antimicrobial activity, respectively. Consecutively, both films were combined to form a double-layer Nano-Biothermoplastic packaging system for food preservation. The distribution and diffusion of nanoparticles in starch-based films were examined to be influenced by the amorphous character of starch and the swelling index of the film, respectively. The amorphous property of starch molecules showed a masking effect on the crystalline characteristics of nanoparticles in Nano-Biothermoplastic films. The diffusion of nanoparticles from the Nano-Biothermoplastic packaging system was found to influence the microbial, chemical, and color characteristics of mutton and chicken meat stored at 4 °C.

A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction.

BACKGROUND: The efficacy and safety of self-expandable metallic stent (SEMS) placement as a bridge to elective surgery or definitive palliation versus emergency operation to treat colorectal obstruction is debated. This study aimed to evaluate the outcomes of patients with colorectal obstruction treated using different strategies. METHODS: Subjects admitted to the authors' department with colorectal obstruction (n = 134) were studied prospectively. They underwent endoscopic stenting as a bridge to elective surgery (SEMS group: n = 49) or for definitive palliation (n = 34). A total of 51 patients underwent immediate surgery without stenting (NO-SEMS). Treatment was decided by the senior on-call surgeon. RESULTS: Placement of SEMS was technically successful in 95.3 % and clinically successful in 98.7 % of cases. The short-term complications in the SEMS group were perforation (n = 1, 1.2 %), migration (n = 4, 4.9 %), occlusion (n = 4, 4.9 %), colon bleeding (n = 3, 3.7 %), and abdominal pain (n = 6, 7.4 %). The postoperative complication rate was 32.7 % in the SEMS group versus 60.8 % in the NO-SEMS group (P = 0.005), with a significant reduction in wound infections (26.5 vs 54.9 %; P = 0.004), abdominal abscess (14.3 vs 39.2 %; P = 0.006), respiratory morbidity (10.2 vs 37.3 %; P = 0.002), and intensive care treatment (10.2 vs 33.3 %; P = 0.007). The median postoperative hospital stay was 10 versus 15 days (P = 0.001). The in-hospital mortality rate in both groups was 2 %. Long-term follow-up evaluation showed less incisional hernia (6.3 vs 22.0 %; P = 0.04) and definitive stoma formation (6.3 vs 26.0 %; P = 0.01) in the SEMS group than in the NO-SEMS group, respectively. Kaplan-Meier survival curves showed a benefit for the SEMS group (log-rank test, 0.004). The long-term SEMS-related complication rate for the palliative patients was 43.8 %. The hospital readmission rate for SEMS complications was 34.4 %. Overall clinical success was 81.2 %. CONCLUSIONS: In case of colorectal obstruction, endoscopic colon stenting as a bridge to elective operation should be considered as the treatment of choice for resectable patients given the significant advantages for short- and long-term outcomes. Palliative stenting is effective but associated with a high rate of long-term complications.

Inguinal polypropylene plug: a cause of unusual testicular tumor pelvic metastasis.

We report the case of a patient who had undergone polypropylene plug placement 3 years before and referred to our institution with testicular tumor. CT scan demonstrated an enlargement of pelvic lymph nodes on the tumor side while retroperitoneal nodes were normal. Orchifunicolectomy was performed and histopathological examination showed a mixed germ cell tumor involving the tunica vaginalis, rete testis, epididymis and spermatic cord. After surgery the patient was addressed to adjuvant chemotherapy according to PEB scheme. Clinical re-staging showed a decrease of the pelvic bulk disease whereas retroperitoneal nodes were still normal and tumor markers were negative. Left external, internal and common iliac lymphadenectomy as well as left modified template nervesparing retroperitoneal lymph node dissection was performed. Intraoperatively the node bulk was firmly adherent to the external iliac artery and extended until the common iliac bifurcation. In the deeper part of this enlarged and firm lymphatic chain the polypropylene plug placed at the time of hernioplasty was found. Behind the plug all retroperitoneal nodes appeared normal and resulted negative on histopathologic examination. The patient had an unusual metastatization, probably due to the plug.

Evaluating the Natural History of Groin Hernia from an "Unplanned" Watchful Waiting Strategy.

Groin hernia is one of the most common surgical diagnoses worldwide. The indication for surgery in asymptomatic or mildly symptomatic patients is discussed. Some trials have demonstrated the safety of a watchful waiting strategy. During the pandemic, waiting lists for hernia surgery dramatically increased the opportunity to evaluate the natural history of groin hernias. The present study aimed to evaluate the incidence of emergency hernia surgery in a large cohort of patients that were selected and were waiting for elective surgery. This is a retrospective cross-sectional cohort study including all patients evaluated and selected for elective groin hernia surgery at San Gerardo Hospital between 2017 and 2020. Elective and emergency hernia surgeries were recorded for all patients. The incidence of adverse events was also evaluated. Overall, 1423 patients were evaluated, and 964 selected patients (80.3%) underwent elective hernia surgery, while 17 patients (1.4%) required an emergency operation while waiting for an elective operation. A total of 220 (18.3%) patients were still awaiting surgery in March 2022. The overall cumulative risk levels for emergency hernia surgeries were 1%, 2%, 3.2%, and 5% at 12, 24, 36, and 48 months, respectively. There was no association between longer waiting periods and an increased need for emergency surgery. Our study indicates that up to 5% of patients with groin hernia require emergency surgery at 48 months from the evaluation; the increased waiting time for surgery for elective groin hernia repair was not associated with an increased incidence of adverse events.

The usefulness of preoperative CT in colon cancer staging: impact of radiologists' experience.

PURPOSE: To assess the agreement between radiologists in the detection of specific features related to T- and N-stage and evaluate accuracy in colon cancer staging. METHODS: Patients who underwent contrast-enhanced computed tomography (CECT) before surgery were enrolled and evaluated by three radiologists with different experience. Pathological data were used as the reference standard. Tumor location, presence of tumor bulging, fat stranding, lateroconal fascia invasion, enlarged vessels, axial short diameter of the biggest node, shape, enhancement pattern, intranodal necrosis, and cluster were collected. Reliability analysis was performed with κ statistics and intraclass correlation coefficients (ICCs). Logistic regressions were used to determine independent predictors associated with staging. RESULTS: Seventy five patients were evaluated. The reliability analysis was moderate to substantial for tumor location (κ = 0.853), T staging (κ = 0.531), tumor bulging (κ = 0.478), fat stranding (κ = 0.490), lateroconal fascia invasion (κ = 0.436), enlarged vessels (κ = 0.401), the axial short diameter of the biggest node (ICC = 0.732), shape (κ = 0.484), enhancement pattern (κ = 0.431), intranodal necrosis (κ = 0.606), and cluster (κ = 0.358). For all readers, sensitivity was higher for T3 lesions (60-69%) and specificity was higher for T2 and T4 lesions (84.5-90.0% and 82.4-85.1%). The diagnostic accuracy was acceptable for all lesions and among all readers (50.7-92.1%). The lateroconal fascia invasion and enlarged vessels resulted as independent predictor factors (OR = 3.292 and OR = 2.651) for T staging, while nodes' cluster and dimension as independent predictor factors of N staging [OR = 3.798 and OR = 1.083]. CONCLUSION: Reader's experience is one of the most important factors associated with the correct classification of colon cancer. Moreover, CECT can help depict radiological features independently associated with the T and N stages.

3D bioprinted colorectal cancer models based on hyaluronic acid and signalling glycans.

In cancer microenvironment, aberrant glycosylation events of ECM proteins and cell surface receptors occur. We developed a protocol to generate 3D bioprinted models of colorectal cancer (CRC) crosslinking hyaluronic acid and gelatin functionalized with three signalling glycans characterized in CRC, 3'-Sialylgalactose, 6'-Sialylgalactose and 2'-Fucosylgalactose. The crosslinking, performed exploiting azide functionalized gelatin and hyaluronic acid and 4arm-PEG-dibenzocyclooctyne, resulted in biocompatible hydrogels that were 3D bioprinted with commercial CRC cells HT-29 and patient derived CRC tumoroids. The glycosylated hydrogels showed good 3D printability, biocompatibility and stability over the time. SEM and synchrotron radiation SAXS/WAXS analysis revealed the influence of glycosylation in the construct morphology, whereas MALDI-MS imaging showed that protein profiles of tumoroid cells vary with glycosylation, indicating that sialylation and fucosylation of ECM proteins induce diverse alterations to the proteome of the tumoroid and surrounding cells.

Surgical treatment of liver metastases of gastric cancer: state of the art.

BACKGROUND: The prognosis of patients with liver metastases from gastric cancer (LMGC) is dismal, and little is known about prognostic factors in these patients; so justification for surgical resection is still controversial. Furthermore the results of chemotherapy for these patients are disappointing. The purpose of this study was to review recent outcomes of hepatectomy for LMGC and to determine the suitable candidates for surgery, assessing the surgical results and clinicopathologic features. Moreover we compare these results with those obtained with alternative treatments.

Surgical treatment of liver metastases of gastric cancer: is local treatment in a systemic disease worthwhile?

OBJECTIVES: The prognosis of patients with liver metastases of gastric cancer (LMGC) is dismal, but little is known about prognostic factors in these patients; thus justification for surgical resection is still controversial. The purpose of this study was to review recent outcomes of hepatectomy for LMGC and to determine which patients represent suitable candidates for surgery by assessing surgical results and clinicopathologic features. METHODS: Outcomes in 21 patients with LMGC who underwent hepatectomy between 1998 and 2007 were assessed. Isolated metastases and potential to perform a curative resection were requisite indi-cations for surgery. Surgical outcome and clinicopathologic features of the hepatic metastases were analysed. RESULTS: Overall 1-, 3- and 5-year survival rates after hepatic resection were 68%, 31% and 19%, respectively; three patients survived for >5 years without recurrence. Univariate analysis revealed a solitary metastasis, negative margin (R0) resection and the presence of a peritumoral fibrous capsule as significant favourable prognostic factors. These characteristics were present in all of the three patients who survived for >5 years. CONCLUSIONS: Solitary metastases from gastric cancer should be treated surgically and confer a better prognosis. Surgical resection should provide microscopically negative margins (R0). A new prognostic factor, the presence of a pseudocapsule, may be associated with improved prognosis.

Pharmaconutrition: Which substrates?

With the term "pharmaconutrition" or "immunonutrition" is intended the use of specific nutritional substrates having the ability of modulating specific mechanisms involved in several immune and inflammatory pathways. To achieve these goals, these substrates have to be administered with over physiologic dose. Glutamine and omega-3 polyunsaturated fatty acids, used as single substrate, did not show clear clinical advantages on solid endpoints such as postoperative complications. Despite several multiple substrate enteral feeds are available on the market, very few of them have been tested in randomized clinical trial to prove efficacy. The most extensive investigated formulation is a combination of arginine, omega-3 fatty acids, ribonucleic acid with or without glutamine. Several meta-analyses of randomized clinical trials have been conducted to compare the effects of enteral immunonutrition with control diets on post-surgical morbidity. The results consistently showed that the use of enteral multiple substrate formulas significantly reduced infectious complications and duration of hospitalization. In a more contemporary view, pharmaconutrition should be tested more accurately in the contest of enhanced recovery programs, during neoadjuvant chemotherapy, and in the prehabilitation setting.

Safety, feasibility, and tolerance of early oral feeding after colorectal resection outside an enhanced recovery after surgery (ERAS) program.

INTRODUCTION: It is generally believed that resumption of feeding after colorectal resection is indicated only after recovery of bowel function. This study was designed to verify safety, feasibility, and tolerance of early oral postoperative feeding (EOF) outside an enhanced recovery after surgery (ERAS) program. MATERIALS AND METHODS: One hundred patient candidates to elective colorectal resection were prospectively enrolled in an EOF program. Feeding was started on postoperative day (POD) 1 with oral nutritional supplement (ONS). On POD 2, patients had normal food plus ONS to reach 1,000-1,200 kcal/day with progressive increase until 1,800-2,000 kcal/day. Results were compared with historical controls (n = 100) in whom oral feeding was allowed only after full bowel function recovery. The ERAS program was not applied in both groups. RESULTS: The EOF group had a better recovery of short half-life protein synthesis compared with the control group (P < 0.001). Stool canalization occurred after a median of 3 days (range, 1-6 days) in the EOF group versus 5 days (range, 2-8 days) in the control group (P = 0.001). The feeding protocol was completed in 89 patients within POD 5. Tolerance to resumption of feeding was similar in the two groups. The overall rate of postoperative complication was 22% in the EOF group vs. 27% in the control group (P = 0.51). The median length of hospitalization was 9 days (range, 6-25 days) in the EOF group vs. 12 days (range, 6-31 days) in controls (P = 0.01). CONCLUSIONS: EOF after colorectal operations is feasible and safe outside an ERAS program.

Gut oxygenation and oxidative damage during and after laparoscopic and open left-sided colon resection: a prospective, randomized, controlled clinical trial.

BACKGROUND: Pneumoperitoneum (PP), established for laparoscopic (LPS) operation, has been associated with potential detrimental effects, such as mesenteric ischemia-reperfusion injury. The objective of the trial was to measure intestinal tissue oxygen pressure (PtiO2) and oxidative damage during laparoscopic (LPS) and open colon surgery and during the postoperative course. METHODS: Forty patients candidate to left-sided colectomy were randomized to undergo open or LPS resection (20 patients/group). During the operation, PtiO2 was measured at established changes of PP pressure (from 0-15 mmHg) and for 6 days postoperatively. PtiO2 was determined by a polarographic microprobe implanted in the colon wall. Ischemia-reperfusion injury was assessed by plasma malondialdehyde (MDA). ClinicalTrial.gov registration number: NCT01040013. RESULTS: LPS was associated with a higher PtiO2 at the beginning of surgery (73.9±9.4 vs. 64.3±6.4 in open; P=0.04) and at the end of the operation (57.7±7.9 vs. 53.1±4.7 in open; P=0.03). PtiO2 decreased significantly during mesentery traction vs. beginning in both groups (respectively 58.7±13.2 vs. 73.9±9.4 in LPS and 55.3±6.4 vs. 64.3±6.4 in open group; minimum P=0.02). During LPS, there was a significant decrease of PtiO2 only when PP was increased to 15 mmHg (63.2±7.5 vs. 76.6±10.7 at 10 mmHg; P=0.03). PtiO2 also was significantly better in the LPS group during the first 3 days after operation (minimum P=0.04 vs. open). MDA significantly increased in both groups after mesentery traction and at the end of operation vs. baseline levels with no difference between techniques. CONCLUSIONS: LPS seems to be associated with a better intra- and postoperative PtiO2. High-pressure PP may impair PtiO2.

Colon Cancer Surgery: Does Preoperative Blood Transfusion Influence Short-Term Postoperative Outcomes?

BACKGROUND: While perioperative red blood cell transfusion has been widely associated with poor surgical outcomes, few studies have focused specifically on the preoperative transfusional risk-benefit ratio. The aim of the present study was to evaluate the effects of preoperative red blood cell transfusion on short-term surgical outcomes in a cohort of anemic colon cancer patients. METHODS: Moderate and severe anemic patients undergoing colectomy for cancer were divided into two groups based upon the receipt of preoperative transfusion and compared in terms of short-term outcomes. RESULTS: A total of 271 patients with moderate or severe anemia were identified, 93 (34.3%) of whom were preoperatively transfused with a median of two units of packed red blood cells per patient (interquartile range: 2-4 units). The overall morbidity rate did not differ significantly between the two groups (35.5% vs. 36.2%; p = 0.63), while an increased incidence of major morbidity (Clavien-Dindo grade > 3a) observed in transfused patients [14% vs. 6.2% respectively; odds ratio (OR): 2.47, 95% confidence interval (CI): 1.06-5.75; p = 0.03]. The increase in major morbidity was confirmed by multivariate analysis, adjusted for potential confounders (OR: 3.45; 95% CI: 1.32-9.04; p = 0.01). CONCLUSIONS: Preoperative blood transfusion is associated with severe postoperative complications following colectomy in moderate and severe anemic cancer patients. Further studies are needed to establish an optimal preoperative transfusional cutoff value to optimize postoperative outcomes and balance clinical costs.

Does preoperative stent positioning in obstructive left sided colon cancer increase the risk of perineural invasion?

Colonic stenting as a bridge to surgery has been shown to be a safe and effective treatment for left-sided malignant colonic obstruction depending on local expertise. However, concerns still exist regarding its oncological safety. In particular, several reports showed an increased prevalence of perineural tumor invasion following stent placement. Since perineural invasion negatively affects oncological outcomes, the present study sought to evaluate this controversial association. We retrospectively reviewed 114 patients presenting with left-side obstructing colon cancer over a 10-year period. The relationship between perineural invasion and colonic stenting was analyzed using univariate and multivariate analyses. Perineural invasion was found to be strongly associated with pathological features, including TNM stage, (p < 0.001), poor differentiation (p = 0.002), vascular invasion (p < 0.001), lymphatic invasion (p < 0.001), whereas no significant association with preoperative stenting was observed (p = 0.918) after performing univariate analysis. In the multivariate model, only TNM stage III-IV (OR: 6.810, 95% CI 1.972-23.518, p = 0.002) and venous invasion (OR: 5.325, 95% CI 1.911-14.840, p = 0.001) were independently associated with perineural invasion. The results of this study suggest no association between preoperative colonic stenting and perineural invasion.

Clinical Validation of the Comprehensive Complication Index in Colon Cancer Surgery.

(1) Introduction: To date, the sensitivity of the Comprehensive Complication Index (CCI) in a homogeneous cohort of colonic resections for oncologic purposes has not been reported. The present study aims to compare the CCI with the conventional Clavien-Dindo classification (CDC) in colon cancer patients. (2) Methods: The clinical data of patients submitted to an elective colectomy for adenocarcinoma were retrieved from a prospectively maintained database. Postoperative complications and length of stay were reviewed, and CDC and CCI scores were calculated for each patient. The association of the CCI and the CDC with the length of stay, prolongation of stay and readmission rate were assessed and compared. (3) Results: The overall postoperative morbidity was 26.9%. In particular, 157 (20.4%) patients had more than one complication. A strong correlation between the two scoring systems was observed (r = 99.4%; 95%CI: 99.3-99.5%). In multivariate analysis, CCI had a higher predictive ability for all endpoints. Regarding subgroup analysis, the difference between the CCI and CDC was progressively increased when evaluating outcome measures in complicated and multi-complicated patients. (4) Conclusion: Both scoring systems adequately report the overall burden of postoperative complications. The CCI showed a greater ability than the CDC to predict hospital stay, particularly in patients with multiple postoperative complications.