Exosomes have the potential to be the future of personalized diagnostics and therapy. They are nano-sized particles between 30 and 100 nm flowing in the extracellular milieu, where they mediate cell–cell communication and participate in immune system regulation. Tumor-derived exosomes (TDEs) secreted from different types of cancer cells are the key regulators of the tumor microenvironment. With their immune suppressive cargo, TDEs prevent the antitumor immune response, leading to reduced effectiveness of cancer treatment by promoting a pro-tumorigenic microenvironment. Involved signaling pathways take part in the regulation of tumor proliferation, differentiation, apoptosis, and angiogenesis. Signal transducers and activators of transcription factors (STATs) and Janus kinase (JAK) signaling pathways are crucial in malignancies and autoimmune diseases alike, and their potential to be manipulated is currently the focus of interest. In this review, we aim to discuss exosomes, TDEs, and the JAK/STAT pathways, along with mediators like interleukins, tripartite motif proteins, and interferons.

Upper gastrointestinal hemorrhage is a common clinical symptom of various diseases of esophagus, stomach and duodenum. Aortoesophageal fistula is considered a rare but particularly serious condition, which can lead to a series of life-threatening complications.

Despite rapid advances in colorectal surgery, morbidity and mortality rates in elective gastrointestinal surgery play a significant role. For decades, there have been tempestuous discussions on preventative measures to minimize the risk of anastomotic dehiscence. When mechanical bowel preparation before an elective procedure, one of the key hypotheses, was introduced into practice, it was assumed that it would decrease the number of infectious complications and anastomotic dehiscence. The advancements in antibiotic treatment supported the concomitant administration of oral antibiotics and mechanical bowel preparation. In the prospective study conducted at our clinic, we performed left-side colorectal procedures without prior mechanical preparation. All patients enrolled in the study underwent the surgery and were observed in the 3rd Surgical Clinic, Faculty of Medicine, Comenius University in Bratislava, Slovakia, from January 2019 to January 2020. As a control group, we used a similar group of patients with MBP. Our observed group included 87 patients with tumors in the left part of their large intestine (lineal flexure, descendent colon, sigmoid colon, and rectum). Dixon laparoscopic resection was performed in 26 patients. Sigmoid laparoscopic resection was performed in 27 patients. In 12 patients, the procedure was started laparoscopically but had to be converted due to adverse anatomical conditions. The conservative approaches mostly included Dixon resections (19 patients), sigmoid colon resections (5 patients), left-side hemicolectomies (6 patients), and Miles’ tumor resections, with rectal amputation (4 patients). Our study highlighted the fact that MBP does not have an unequivocal benefit for patients with colorectal infection, which has an impact on the development of anastomotic dehiscence.

Objective: The aim of this study was to investigate the impact of low vascular ligation on oncological outcomes in upper and middle rectal cancer surgery. Despite significant progress in colorectal surgery, many questions remain unanswered, and there is ongoing debate about optimal management. One of the key issues is the height of vascular ligation of arteria mesenterica inferior (IMA) during rectal resection. Many believe that high vascular ligation is beneficial from an oncological point of view in terms of survival. However, the available data indicate that the height of ligation is not decisive in terms of its oncological impact, as the number of lymph nodes harvested (minimum are 12 lymph nodes) with high vascular ligation is not significantly greater than the number harvested with low vascular ligation. Methods: This study identified and followed all stage I–III/b rectal cancer patients with a tumor in the upper or middle rectum who underwent abdominal surgery with curative intent between 2013 and 2017 at the 3rd Surgical Clinic of Comenius University in Bratislava. In this study we included 96 patient, consisting of 44 females and 52 males and they were subdivided into two groups based on the tumor's distance from the anus: the first group included upper rectal tumors (12-16 cm from the anus), and the second group included middle rectal tumors (6-12 cm from the anus). Preoperative tumor evaluation included a physical examination with a digital rectal exam and anoscopy, serum CEA and CA19-9, total colonoscopy with biopsy, pelvic MRI, and CT. The primary outcome was cancer-specific survival, while the secondary outcomes included overall and relative survival, locoregional and distant recurrence, and lymph node harvest. Results: The study evaluated 96 patients with rectal tumors located in the upper and middle parts of the rectum who underwent MRI examination followed by surgical resection. In all the patients, due to anatomical conditions, a low vascular ligation was performed with subsequent anastomosis. Conclusion: In this study, low ligation did not influence any patient-oriented oncological outcomes in comparison with the literature. The literature suggests that high vascular ligation can harvest more lymph nodes (1-2), but it does not affect survival. Therefore, the height of the ligation should be determined during surgery.

Background: The incidence of pilonidal sinus shows a steadily rising tendency, especially in the patient age group of up to 40 years. Treatment of this condition is often protracted involving lengthy sick leave and an increased risk of recurrence. The optimal treatment of pilonidal sinus remains open to debate, but it should focus on decreasing the length of hospitalization, promoting a rapid return to daily life, maintaining low pain levels, and keeping costs at a minimum. Materials and methods: In our study conducted between 2017 and 2021, we focused on treatment of pilonidal sinus. We performed 50 elastic ligature procedures with a median observation time of 30 months. The patients were divided into three groups according to the characteristics of pilonidal sinus: (1) acute primary abscess; (2) acute recurrent abscess; and (3) chronic fistula. Results: Out of a total of 50 patients with a subsequent 30-month follow-up, we observed complete recovery in 47 patients and recurrence in three patients. Return to work was possible immediately after the operation, with an average total treatment time of 1 month for complete healing of the defect. Conclusion: The current results suggest that the technique of elastic ligature is a desirable solution for pilonidal sinus, because of the initial low costs, no need for hospitalization, and good patient tolerance.