Percutaneous transhepatic biliary drainage (PTBD) is a decompression procedure for malignant proximal biliary obstruction. In this research, over a six-year period, 89 patients underwent PTBD procedure for jaundice caused by malignant disease to restart chemotherapy or for palliative intent. Clinical outcomes after PTBD procedure in the two groups of patients, according to the adequate bilirubin decline (ABD) needed for subsequent chemotherapy, are presented in this paper. Survival and logistic regression were plotted and compared using Kaplan–Meier survival multivariate analysis with a long-range test. Results were processed by MEDCALC software. In the series, 58.4% (52/89) of patients were in good performance status (ECOG 0/1), and PTBD was performed with the intention to (re)start chemotherapy. The normalization of the bilirubin level was seen in 23.0% (12/52), but only 15.4% (8/52) received chemotherapy. The median survival time after PTBD was 9 weeks. In patients with ABD that received chemotherapy, the median survival time was 64 weeks, with 30-day mortality of 27.7%, and 6.4% of death within 7 days. The best outcome was in patients with good performance status (ECOG 0–1), low bilirubin (<120 µmol/L) and LDH (<300 µmol/L) levels and elevated leukocytes at the time of the procedures. PTBD is considered in ABD patients who are candidates for chemotherapy.

The treatment of patients with metastatic colorectal cancer (mCRC) is complex and is impacted by the location of the primary tumor (LPT). Our study aims to emphasize the importance of LPT as a prognostic and predictive marker as well as to examine the significance of HER2 overexpression in patients with mCRC, particularly in relation to the response to Epidermal Growth Factor Receptor Antibody treatment (anti-EGFR therapy). In this study, 181 patients with Kirsten RAS (KRAS) wild-type mCRC who received anti-EGFR therapy were included. Among them, 101 had left colon cancer (LCC) and 80 had right colon cancer (RCC). Results demonstrated that patients with KRAS wild-type LCC had better median overall survival (OS) (43 vs. 33 months, p = 0.005) and progression-free survival (PFS) (6 vs. 3 months, p < 0.001) compared to those with RCC. Multivariate analysis identified mucinous adenocarcinoma (p < 0.001), RCC location (p = 0.022), perineural invasion (p = 0.034), and tumors at the resection margin (p = 0.001) as independent predictors of OS, while mucinous adenocarcinoma (p = 0.001) and RCC location (p = 0.004) independently correlated with significantly shorter PFS. In addition, human epidermal growth factor receptor 2 (HER2) positive expression was significantly associated with worse PFS compared to HER2 negative results (p < 0.001). In conclusion, LPT is an important marker for predicting outcomes in the treatment of wild-type mCRC using anti-EGFR therapy, since patients with RCC have a statistically significantly shorter PFS and OS. Further investigation is needed to understand the role of HER2 overexpression in wild-type mCRC, as these patients also exhibit shorter survival.

Introduction. Pancreatic cancer is among the most aggressive malignancies, with a poor prognosis. The liver, peritoneum, lungs, and distant lymph nodes are the most common metastatic sites. However, metastasis of pancreatic cancer to the large bowel is extremely rare. Case Report. A 48-year-old male with pancreatic cancer underwent radical pancreatosplenectomy in August 2022, accompanied by subtotal gastrectomy, partial resection of the transverse colon, and resection with reconstruction of the splenic vein. He subsequently received six cycles of adjuvant therapy based on the 5-fluorouracil/Leucovorin protocol, which concluded in February 2023. Routine follow-ups revealed multiple liver metastases by June 2023. First-line systemic treatment with the mono-Gemcitabine protocol was initiated, but disease progression occurred after three cycles. The patient then transitioned to second-line therapy with the De Gramont/Cisplatin protocol. During the second cycle, he developed intestinal obstruction necessitating emergency surgery, during which a sigmoidostomy was performed. Intraoperative biopsy of a tumor mass in the sigmoid colon confirmed metastasis of the previously operated pancreatic ductal adenocarcinoma into the colonic wall. Conclusion. Metastasis of invasive ductal pancreatic adenocarcinoma to the colon wall, causing intestinal obstruction, is an extremely rare occurrence, with only a few cases documented in the literature. Histopathological analysis of any colonic mass in patients with a history of pancreatic ductal adenocarcinoma is crucial to differentiate between primary colorectal cancer and metastatic lesions originating from pancreatic cancer.

The treatment of patients with metastatic colorectal cancer (mCRC) is complex and impacted by the location of the primary tumor (LPT). Our study aims to emphasize the importance of LPT as a prognostic and predictive marker, as well as to examine the significance of HER2 overexpression in patients with mCRC, particularly in relation to response to anti-EGFR therapy. In this study, 181 patients with KRAS wild-type mCRC who received anti-EGFR therapy were included. Among them, 101 had left colon cancer (LCC) and 80 had right colon cancer (RCC). Results demonstrated that patients with KRAS wild-type LCC had better median overall survival (OS) (43 vs. 33 months, p = 0.005) and progression-free survival (PFS) (6 vs. 3 months, p < 0.001) compared to those with RCC. Multivariate analysis identified mucinous adenocarcinoma (p < 0.001), RCC location (p = 0.022), perineural invasions (p = 0.034), and tumors at the resection margin (p = 0.001) as independent predictors of OS, while mucinous adenocarcinoma (p = 0.001) and RCC location (p = 0.004) independently correlated with significantly shorter PFS. In addition, HER2 positive expression was significantly associated with worse PFS compared to HER2 negative results (p < 0.001). In conclusion, LPT is an important marker for predicting outcomes in the treatment of wild-type mCRC using anti-EGFR therapy, since patients with RCC have a statistically significantly shorter PFS and OS. Further investigation is needed to understand the role of HER2 overexpression in wild-type mCRC, as these patients also exhibit shorter survival.

Objective Considering the established intertwined relationships between burnout and other psychiatric disorders, this study aimed to clarify the existing levels of depression, anxiety, stress, emotional exhaustion, depersonalization, and personal accomplishment and their relationship among oncologists—a seemingly professional group at risk for mental health issues development.Methods A cross-sectional observational study was conducted in January 2024, involving 159 oncologists from Serbia and the Serbian Republic. Participants completed an online questionnaire assessing socio-demographic characteristics and working conditons, depression, anxiety, stress, and burnout using validated scales—the Depression Anxiety Stress Scale-21 and the Maslach Burnout Inventory-Human Services Survey.Results Results indicate that respondents were mildly depressed, moderately anxious, and mildly stressed overall. Regarding three dimensions of burnout respondents have moderate emotional exhaustion, depersonalization, and low personal accomplishment. No significant differences were found in depression, anxiety, and stress among medical, surgical, and radiation oncologists. Whether the respondents are seeing a psychiatrist and/or undergoing psychiatric therapy was predictive of depression, anxiety, and stress. Economic status was predictive for depression and stress, while an additional predictive factor of anxiety was the presence of somatic illness. Further analysis showed depression and stress levels can be predicted by all three dimensions of burnout, whereas anxiety levels can be predicted by the level of depersonalization.Conclusion These findings emphasize the complex interplay between burnout and other mental health disorders in oncologists, highlighting the need for targeted mental health interventions and support systems within the oncology field to mitigate the psychological toll on these physicians.

Background: Colorectal cancer (CRC) is one of the leading causes of cancer-related morbidity and mortality worldwide. Microsatellite instability (MSI) is a crucial biomarker with prognostic and predictive value, influencing treatment decisions in CRC. Methods: This retrospective study investigated the impact of the MSI status on clinical outcomes in 184 CRC patients treated at the Oncology Institute of Vojvodina between 2018 and 2023. The MSI status was determined using the immunohistochemical analysis of mismatch repair proteins. Results: Among the cohort, 75% of tumors were microsatellite-stable (MSS), 4.3% exhibited low MSI (MSI-L), and 20.6% displayed high MSI (MSI-H). MSI-H tumors were significantly associated with right-sided CRC, mucinous differentiation, and female gender (p<0.05). The survival analyses revealed that the MSI-H patients with stage II disease had significantly better disease-free survival (DFS) and overall survival (OS) than the MSS counterparts (p=0.024 and p=0.006, respectively). Conversely, the MSI-H status in stage II patients receiving adjuvant therapy was linked to shorter DFS (p=0.000), highlighting the limited benefit from 5-fluorouracil-based regimens. In stage III CRC, the MSI status did not significantly affect DFS or OS. Conclusion: These findings underscore the dual role of MSI as a favorable prognostic marker in early-stage CRC and a predictor of the reduced benefit from adjuvant chemotherapy in stage II disease. This study emphasizes the need for individualized treatment strategies based on the MSI status and supports the potential integration of immunotherapy in the adjuvant setting for MSI-H CRC.