Background: This study aimed to compare the outcomes of older and younger patients with T4 colorectal cancer (CRC) treated with surgery. Methods: Consecutive patients with T4 CRC treated surgically at Henri Mondor Hospital between 2008 and 2016 were retrospectively analyzed in age subgroups (1) 50–69 years and (2) ≥70 years for overall and relative survival. The multivariable analyses were adjusted for adjusted for age, margin status, lymph node involvement, CEA level, postoperative complications (POC), synchronous metastases, and type of surgery. Results: Of 106 patients with T4 CRC, 57 patients (53.8%) were 70 years or older. The baseline characteristics were generally balanced between the two age groups. Older patients underwent adjuvant therapy less commonly (42.9 vs. 57.1%; p = 0.006) and had a longer delay between surgery and chemotherapy (median 40 vs. 34 days; p < 0.001). A higher trend for POC was reported among the older patients but did not impact the survival outcomes. After adjusting for confounding factors, the overall survival was shorter among the older patients (HR = 3.322, 95% CI 1.49–7.39), but relative survival was not statistically correlated to the age group (HR = 0.873, 95% CI 0.383–1.992). Conclusions: Older patients with CRC were more prone to severe POC, but age did not impact the relative survival of patients with T4 colorectal cancer. Older patients should not be denied surgery based on age alone.

Background: Bariatric surgery (BS) is the most effective treatment for severe obesity, but a significant proportion of patients experience insufficient weight loss (IWL) or weight regain. Glucagon-like peptide-1 receptor agonists (arGLP-1) have emerged as a promising adjunctive therapy for managing these suboptimal outcomes. This study evaluates the efficacy and safety of arGLP-1 in patients with IWL or WR after BS. Methods: A retrospective analysis was conducted on 100 patients who underwent BS (96 sleeve gastrectomy, 4 gastric bypass) and received arGLP-1 therapy (semaglutide or dulaglutide) for IWL (defined as < 50% excess weight loss (EWL) from baseline), and WR (a ≥ 10 kg increase from the nadir weight post-surgery). Data on weight loss, comorbidities, and adverse events were collected over a median follow-up of 1 year. Statistical analyses included paired t-tests, Wilcoxon signed-rank tests, and chi-squared tests. Results: At 1 year, patients achieved significant weight loss with a median total weight loss (%TWL) of 25.5% and a median excess weight loss (%EWL) of 66.3% compared to 16.6% and 40.8%, respectively, at treatment initiation with BMI reduction of 3.7 kg/m². Significant improvements were observed in comorbidities, including reductions in obstructive sleep apnea (− 30%), hypertension (− 40%), and arthralgia (− 56.5%). Glycated hemoglobin levels decreased by 0.8 points. Treatment was well-tolerated, with nausea being the most common side effect (5% discontinuation rate). Conclusion: arGLP-1 are effective and safe for managing IWL or WR after BS, leading to significant weight loss, comorbidity improvement, and sustained %TWL. These findings support their use as a valuable adjunctive obesity management medication (OMMs) in post-bariatric care, though long-term adherence and cost-effectiveness require further investigation. Graphical

Background: The role of minimally invasive surgery (MIS) for hepatocellular carcinoma (HCC) remains controversial because of concerns regarding oncologic adequacy, particularly margin status. While robotic-assisted hepatectomy has gained adoption, its true perioperative advantages over conventional laparoscopy and open surgery remain unclear. SIMMILR-5 was designed to evaluate the short-term outcomes of open, laparoscopic, and tele-robotic laparoscopic hepatectomy for HCC using rigorous adjustment for confounding. Methods: A retrospective international multicenter study was conducted including patients undergoing liver resection for HCC between June 2004 and November 2024 at five high-volume hepatobiliary centers. Surgical approaches included open (O), conventional laparoscopy (L), and tele-robotic laparoscopy (TRL). Propensity score matching was performed using demographic, clinical, and tumor-related variables. The primary endpoint was short-term mortality (30 and 90 days). Secondary outcomes included estimated blood loss (EBL), operative time, length of stay (LOS), R0 resection status, and major complications. Results: A total of 904 patients were identified (302 O, 568 L, 34 TRL). After matching, conventional laparoscopy was associated with significantly lower EBL, shorter operative time, and shorter LOS compared with open surgery (all p < 0.00001). Compared with open surgery, TRL was associated with lower EBL but no improvement in operative time or LOS. Compared with laparoscopy, TRL was associated with longer operative time and longer LOS. Short-term oncologic surrogates were comparable across approaches. Conclusions: Minimally invasive hepatectomy offers perioperative advantages over open surgery for selected patients with HCC, driven primarily by conventional laparoscopy. Tele-robotic hepatectomy is feasible and safe in experienced centers but does not demonstrate superiority over advanced laparoscopic techniques.

Introduction: This international multicenter study compared five surgical approaches for liver resection in colorectal metastases: open (O), standard laparoscopy (L), laparoscopy with 3D imaging (3D), laparoscopy with single robotic-arm assistance (1RA), and with complete robotic systems utilizing 4 robotic arms(4RA). A subcohort analysis was done for enhanced L, this cohort was termed collaborative assisted robotics (cobotic surgery) and consisted of L with the addition of 3D imaging or a single robotic arm to hold the laparoscope. This study aimed to evaluate whether 4RA offers any significant advantages over laparoscopy with and without cobotic enhancements. Methods: We analyzed 1,257 patients across five centers using propensity score matching. Surgical approaches were compared for blood loss, operative time, hospital stay, resection margins (R0 status), and major complications (Clavien-Dindo grade ≥3). Statistical analysis used Student's t-test and Mann-Whitney U-test for continuous variables, with p<0.05 considered significant. Results: Minimally invasive techniques without 3-D imaging, a solitary robotic arm to hold the laparoscope or utilization of handheld robotic GIA staplers showed superior outcomes to open surgery. Laparoscopic approaches demonstrated significantly reduced blood loss (L: 553 mL vs O: 695 mL, p<0.001) and shorter hospital stays when compared to open surgery (L: 8 days vs O: 14 days, p<0.001). The 4RA cohort had similar benefits when compared to O resection (blood loss: 382 mL vs 542 mL, p<0.001; LOS: 8 vs 24 days, p<0.001), but longer operative times (280 vs 305 minutes (min), p<0.001). The 1RA and 3D approaches showed comparable outcomes to 4RA in most measures. Conclusions: While robotic assistance offers technical advantages, complete robotic systems (4RA) did not demonstrate clear superiority over laparoscopy with or without cobotics. Cost-effective modular enhancements to standard laparoscopy may provide future benefits while allowing resource allocation toward AI-driven surgical innovations. Future studies should employ prospective designs with standardized protocols to validate these findings and assess long-term oncologic outcomes.