Background and aim: Gastric cancer is among the commonly occurring cancers worldwide and is one of the leading causes of cancer-related deaths. Malnutrition is an important factor affecting the course of disease and treatment response in gastric cancer patients this study aimed to investigate the effect of the Prognostic Nutritional Index (PNI) on postoperative complications and long-term survival in gastric cancer patients, and to comparatively examine PNI values among different histological subtypes.Methods: Data from patients who underwent curative surgical resection for gastric cancer between 2014 and 2020 were retrospectively analyzed. PNI values were calculated using the formula: 10 × serum albumin (g/dl) + 0.005 × lymphocyte count (cells/mm³). The optimal cut-off value for PNI was determined through ROC analysis. The relationship between PNI values and clinicopathological features, postoperative complications, 5-year overall survival (OS), and histological subtypes was evaluated.Results: A total of 220 patients (161 males, 59 females; mean age: 60.63 ± 10.56) were included in the study. The mean PNI value was 47.15 ± 6.07. ROC analysis established an optimal PNI cut-off value of 46.2 (AUC = 0.673, 95% CI: 0.599-0.747, p<0.001; sensitivity 78.8%, specificity 51.9%). Complication rates were significantly higher in the patient group with PNI < 46.2 (p = 0.006). The 5-year OS rate was 30.0%. Patients with low PNI values had significantly shorter survival (log-rank p = 0.001). Major complications were more frequent in patients with low PNI (p = 0.006). Patients diagnosed with signet ring cell carcinoma (SRCC) had significantly lower PNI values compared to other adenocarcinoma subtypes (p = 0.001). PNI values were lower in the presence of perineural invasion (p = 0.005) and lymphovascular invasion (p = 0.032). In multivariate analysis, tumor stage (for Stage I p = 0.01, Stage II p = 0.034, Stage III p = 0.002) and PNI value (p = 0.001) were identified as independent prognostic factors affecting 5-year OS. Conclusion: PNI is an important marker for predicting long-term survival and postoperative complication risk in patients with gastric cancer. The significantly lower PNI values in the SRCC subtype compared to other histological subtypes indicate the necessity of closer monitoring of nutritional status in this patient group. Our results suggest that preoperative PNI assessment could be a valuable parameter in planning patient-specific treatment approaches.

Background: This study aimed to compare the clinical, pathological, and biochemical characteristics of upper rectal cancer (URC) and mid–lower rectal cancer (MLRC) in stage II and III non-metastatic rectal cancer and to identify distinct prognostic factors influencing survival and recurrence. Material and Methods: This retrospective cohort study included 100 patients with stage II and III non-metastatic rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy (nCRT) followed by curative-intent surgery between 2021 and 2024. Patients were categorized into URC (n = 53) and MLRC (n = 47) groups. Parameters analyzed included demographic factors, ASA score, surgical characteristics, pathological features (tumor stage, lymph node involvement, lymphovascular invasion (LVI), perineural invasion (PNI), tumor budding, tumor regression grade (TRG)), and biochemical markers (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), white blood cell (WBC) count, neutrophil count, platelet count (PLT), and C-reactive protein (CRP)). One-year overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan–Meier survival curves, and Cox regression models identified independent prognostic factors. Results: Preoperative CEA levels were higher in MLRC (p = 0.05), whereas WBC count (p = 0.01), neutrophil count (p = 0.02), PLT (p = 0.01), and CRP levels (p = 0.01) were higher in URC. Pathological analysis revealed higher LVI (p = 0.04), PNI (p = 0.04), and tumor budding (p = 0.03) in MLRC. At one-year follow-up, OS rates were 82.1% (URC) vs. 80.3% (MLRC) (p = 0.85), and DFS rates were 78.6% (URC) vs. 73.4% (MLRC) (p = 0.72). Multivariate Cox regression analysis identified age (HR: 1.04, p = 0.03), ASA score (HR: 1.22, p = 0.01), CRP (HR: 1.18, p < 0.001), preoperative CEA (HR: 1.12, p = 0.02), preoperative CA19-9 (HR: 1.09, p = 0.03), LVI (HR: 1.42, p < 0.001), PNI (HR: 1.35, p = 0.02), and tumor budding (HR: 1.28, p = 0.03) as independent prognostic factors for OS. Similar trends were observed for DFS, with T stage (HR: 1.35, p = 0.01) and tumor size (HR: 1.22, p = 0.01) also being found significant. Conclusions: Inflammatory markers, tumor burden indicators (LVI, PNI, budding, tumor size, T stage), and preoperative CEA/CA19-9 were identified as significant predictors, suggesting a risk-adapted approach to rectal cancer treatment.

Background: The management of locally advanced rectal cancer (LARC) has seen the emergence of total neoadjuvant therapy (TNT) as a promising approach. TNT has shown potential in enhancing tumor regression, increasing pathological complete response (pCR) rates, and improving the control of systemic disease. However, the impact of TNT on complications during and after surgery remains uncertain. This research aimed to assess surgical complications linked to TNT in comparison with conventional neoadjuvant chemoradiotherapy (nCRT). Additionally, this study explored the potential of the Prognostic Nutritional Index (PNI) as a predictor of surgical outcomes. Methods: A retrospective cohort study was conducted at Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, including patients with LARC who underwent either TNT or nCRT followed by curative excision (TME). Demographic data, perioperative complications, and tumor-related variables were also analyzed. The prognostic value of the PNI in predicting surgical complications was assessed using multivariate logistic regression analysis. Statistical significance was set at p < 0.05. Results: A total of 103 patients with LARC were included, of whom 38 (36.9%) received TNT and 65 (63.1%) underwent nCRT. TNT was associated with significantly higher rates of anastomotic leakage (13.2% vs. 6.2%, p = 0.04) and wound infections (23.7% vs. 9.2%, p = 0.02). The mean tumor size was significantly smaller in the TNT group (3.22 ± 1.10 cm) than in the nCRT group (3.65 ± 1.26 cm, p = 0.02). The PNI was significantly lower in the TNT group (38.96 ± 5.54) than in the nCRT group (41.31 ± 4.65, p = 0.03). Multivariate logistic regression analysis demonstrated that a lower PNI was independently associated with increased surgical complications (β = −1.09, p = 0.028, 95% CI: −2.06–−0.12). Conclusions: Although TNT demonstrates clear oncological benefits in LARC, it is associated with increased perioperative morbidity. Our findings suggest that the PNI is a valuable predictive biomarker of surgical complications in patients treated with TNT. Preoperative nutritional assessment and optimization may improve perioperative outcomes and mitigate the risks associated with TNT. Future prospective studies should explore targeted interventions to enhance the safety profile of TNT while preserving its oncological advantages.

Background: This study aimed to evaluate the diagnostic yield of colonoscopy in asymptomatic individuals aged 45–49 years compared with those aged 50–54 years in a Turkish population, providing insights into region-specific screening strategies. Methods: This retrospective multicenter study was conducted across three tertiary endoscopy units in Turkey. Screening colonoscopy data from 3943 asymptomatic individuals aged 45–54 years between 2018 and 2023 were analyzed. The patients were stratified into two groups: 45–49 years (Group 1) and 50–54 years (Group 2). Demographic characteristics, polyp size, histological features, and prevalence of early-onset advanced colorectal neoplasia (EAO-aCRN) were assessed. Results: A total of 3943 patients were included, with 862 in Group 1 (45–49 years) and 3081 in Group 2 (50–54 years). The polyp detection rate was 16.6% in Group 1 and 22.9% in Group 2 (p < 0.001). The adenoma detection rates were 10.8% and 13.9% in Groups 1 and 2, respectively (p = 0.018). The advanced polyp detection rates were 3.2% and 7.3% in Groups 1 and 2, respectively (p < 0.001). Mean polyp size was 6.5 ± 5.1 mm in Group 1 and 8.8 ± 8.4 mm in Group 2 (p < 0.001). The mean number of polyps per patient was 1.5 ± 0.8 in Group 1 and 1.9 ± 1.6 in Group 2 (p = 0.023). Advanced neoplasia was detected in 16.6% of Group 1 patients compared with 22.9% of Group 2 patients (p < 0.001). Conclusions: While CRC screening at age 45 demonstrated lower detection rates of polyps and advanced neoplasia than at age 50, the higher prevalence of EAO-CRN among 45–49-year-olds in Turkey underscores the importance of early screening in high-risk populations. Tailored regional strategies incorporating individual risk factors are crucial for optimizing CRC prevention policies.

Background and Objectives: This study aimed to assess the diagnostic accuracy and prognostic significance of staging laparoscopy (SL) compared to computed tomography (CT) and positron emission tomography–computed tomography (PET-CT) in gastric cancer staging. We evaluated the ability of SL to detect occult peritoneal metastases and influence of SL on survival outcomes across cancer stages and treatment approaches. Materials and Methods: In this retrospective cohort study, 95 patients with gastric cancer underwent preoperative assessment using CT, PET-CT, and SL between 2018 and 2024. Diagnostic performance metrics were calculated for SL, CT, and PET/CT across the local, locally advanced, and metastatic stages. Survival outcomes were analyzed using Kaplan–Meier curves, and comparisons were made using log-rank tests. A multivariable Cox proportional hazards model incorporating interaction terms was used to determine the independent prognostic factors affecting survival, focusing on SL findings and cytology results. Results: The cohort comprised 75 males (78.9%) and 20 females (21.1%), with a mean age of 57.4 ± 10.1 years. The tumor location distribution was predominant in the corpus (31.1%) and cardia. Tumor staging revealed that 48.1% were classified as T3 and 28.8% as T4, respectively. Diagnostic accuracy analysis showed that SL outperformed CT and PET-CT in detecting peritoneal metastasis across all stages. Specifically, SL demonstrated a sensitivity and specificity of 85% and 95% for local disease, 92% and 80% for locally advanced disease, and 95% and 99% for metastatic disease, significantly exceeding those of CT and PET-CT. Patients with SL findings had a median overall survival (OS) of 30 months compared with 20 months for those assessed only with CT and PET-CT (p < 0.05). The stage-specific median OS for SL patients was 40 months in the local, 25 months in the locally advanced (p < 0.05), and 15 months in the metastatic disease (p < 0.01) groups, indicating significant survival benefits. Multivariable Cox regression identified SL findings as an independent factor associated with reduced mortality risk (HR: 0.70, 95% CI: 0.50–0.90, p < 0.01), while positive cytology findings predicted poorer survival (HR: 1.80, 95% CI: 1.25–2.60, p < 0.01). Interaction terms revealed that SL yielded greater survival benefits in patients with metastatic disease (hazard ratio [HR]: 0.60, p < 0.01) and those undergoing systemic therapy (HR: 0.75, p = 0.04). Conclusions: SL provides superior diagnostic accuracy and prognostic information for advanced gastric cancer staging compared with CT and PET-CT. By accurately detecting peritoneal metastasis, SL aids in optimizing treatment plans, particularly in advanced stages, thus potentially improving patient outcomes.

Background: Anastomotic leakage (AL) is a severe complication of colorectal surgery and is associated with high morbidity, mortality, and prolonged hospital stay. Current predictive models vary in complexity and utility, highlighting the need for clinically accessible and accurate tools. This study aimed to develop and validate the clinical framework–anastomotic leakage prediction score (CF–ALPS) score, a practical and accessible risk prediction model for AL that integrates patient-, tumor-, and surgery-related factors. Methods: A retrospective cohort of 294 patients who underwent colorectal surgery between 2019 and 2024 was analyzed. Patients were categorized into the AL (n = 84) and non-AL groups (n = 210). The factors included age, sex, hypoalbuminemia, and comorbidities. Tumor-related factors included lymph node stage and neoadjuvant therapy, while surgical variables included urgency, duration, and type of procedure. The outcomes evaluated were the incidence of AL, duration of hospital stay, and in-hospital mortality. Independent predictors were identified using multivariate logistic regression analysis. The CF–ALPS score, which was developed from significant predictors, was validated using ROC curve analysis and 10-fold cross-validation. Results: A total of 294 patients who underwent colorectal surgery were included, of whom 84 (28.57%) developed AL. A male predominance was observed in the AL group (73.81% vs. 36.19%; p = 0.001). Nutritional status played a critical role, with significantly lower albumin levels in AL patients (2.8 ± 0.5 g/dL vs. 3.5 ± 0.4 g/dL; p < 0.001). Independent predictors of AL included hypoalbuminemia (<3.0 g/dL, OR: 0.52, p < 0.001), ASA score (OR, 1.85; p = 0.004), advanced lymph node stage (N2/N3, OR: 1.94, p = 0.037), neoadjuvant therapy (OR, 2.89; p = 0.002), and emergent surgery (OR, 1.67; p = 0.042). These variables formed the basis of the CF–ALPS score, which assigns weighted points based on the magnitude of their ORs. The CF–ALPS model achieved a ROC AUC of 0.82 (95% CI: 0.75–0.89) with a sensitivity of 85.0% and specificity of 78.0%. A cutoff score ≥7 demonstrated optimal risk stratification, classifying patients into high- and low-risk groups with a positive predictive value (PPV) of 72.0% and a negative predictive value (NPV) of 88.0%. Cross-validation yielded a moderate AUC of 0.44 (SD = 0.062). Conclusions: The CF–ALPS score offers a simple and effective tool for AL risk prediction in colorectal surgery, emphasizing its practicality and clinical integration. Although its predictive accuracy was moderate, further prospective multicenter validation is warranted.