Background: Anastomotic leakage (AL) is one of the most feared complications in colorectal surgery, with an incidence of 12–39% and associated risk of mortality of 2–24%. The causes of AL and the ways to prevent it are currently under investigation. This study aims to verify if a quadruple assessment of colorectal anastomosis could reduce AL incidence. Methods: A retrospective analysis of prospectively collected data on rectal cancer surgery performed from January 2015 to December 2017 and from January 2021 to December 2023 at a tertiary referral cancer centre was performed. Demographics, clinicopathological features, short-term outcomes, recurrences, and survival were investigated. Results: A total of 293 patients were enrolled. AL incidence was lower in the quadruple assessment group than in the control group, reaching a statistically significant result (7.7% vs. 16%; p = 0.001). This result was also confirmed after a propensity score match analysis (PSM), in which the AL rate was lower in the quadruple assessment group (5.4% vs. 12.3%; p = 0.01). Conclusions: This study shows how the systematic implementation of a quadruple assessment when performing a colorectal anastomosis could increase awareness on anastomotic success and reduce the incidence of AL.

Secondary peritonitis is a life-threatening intra-abdominal condition arising from gastrointestinal perforation, chemical injury, or catheter-related infections, characterized by marked heterogeneity in presentation and progression. Major subtypes include stercoraceous peritonitis with fecal contamination, fibrinous peritonitis triggered by bile or gastric contents, peritoneal dialysis-associated infections, and pancreatitis-associated chemical peritonitis. Regardless of etiology, these conditions share profound local and systemic inflammatory responses, contributing to high morbidity and mortality. Biomarkers such as procalcitonin (PCT), interleukin-6 (IL-6), high mobility group box 1 (HMGB1), C-reactive protein (CRP), lipopolysaccharide (LPS), neutrophil-to-lymphocyte ratio (NLR), and neutrophil gelatinase-associated lipocalin (NGAL) have emerged as tools for early diagnosis, subtype stratification, and monitoring of therapeutic response. Their prognostic value is particularly relevant in peritoneal dialysis and postoperative intensive care. Advances in multi-omics, patient-derived organoids, peritoneum-on-chip models, and microbiota profiling are reshaping understanding of peritoneal pathophysiology, revealing cellular heterogeneity, immune-microenvironment interactions, and mechanisms of fibrotic remodeling. Key translational challenges include assessing whether omics-derived signatures can predict the need for early re-laparotomy or the risk of abdominal compartment syndrome. Integration of high-dimensional biomarker profiling with mechanistic and functional studies promises a new era of precision medicine in secondary peritonitis, enabling risk-adapted interventions, complication prevention, and tailored strategies to improve outcomes.

Introduction: Robotic surgery has been widely adopted in colorectal surgery worldwide over the last decade, but it is still associated with significant cost. With the recent introduction of new robotic platforms, several studies reported the feasibility of different surgical procedures using newer robotic platforms. This study aims to present the first case series of colonic splenic flexure resection with the novel platform robotic‐assisted surgery (RAS) Hugo™. Tips for effective setup of the system and detailed configuration of tilt and docking angles are also provided. Methods: Three cases of colonic splenic flexure resection with Hugo RAS™ system are reported. OR setup and port placement allowing for a full robotic resection were used to perform vascular ligation, colonic splenic flexure mobilization, and side‐to‐side linear intracorporeal anastomosis, without the need for re‐docking. Results: Mean docking time was 11 (range 8–14) minutes and the median total operating time was 243 (range 180–350) minutes. Mean estimated blood loss was 116 (range 50–300) mL. No intraoperative complications or conversions were observed. One patient developed postoperative pneumonia. Conclusions: Total robotic splenic flexure resection with Hugo™ RAS system is feasible with good postoperative outcomes. Further studies are needed to confirm our results and to evaluate the surgical strategy and setup.

Background/Objectives: This retrospective study evaluates the predictive role of magnetic resonance imaging (MRI) in complications and recurrence in rectal cancer patients undergoing surgery and neoadjuvant therapy, highlighting the impact of structured reporting templates on MRI quality. Compared to traditional free-text reports, structured radiology reports offer a point-by-point evaluation, improving clarity and completeness by thoroughly addressing all relevant findings. MRI is critical in rectal cancer staging, guiding treatment based on tumor characteristics like T stage, sphincter involvement, vascular invasion, and lymph node status. Methods: A retrospective analysis of MRI and reports from 67 rectal cancer patients at the time of diagnosis, who were subsequently treated with neoadjuvant radiochemotherapy and surgery, was conducted. MRI report features, including tumor location, morphology, T stage, sphincter infiltration, mesorectal fascia involvement, lymph nodes, and extramural vascular invasion, were evaluated against European Society of Gastrointestinal and Abdominal Radiology (ESGAR) recommendations. Multivariate and univariate analyses were performed to correlate MRI findings with postoperative outcomes such as complications, local recurrence, bleeding, and 30-day anastomotic leaks. Results: Sphincter involvement showed a strong association with increased complications (multivariate β = 0.410, univariate r = 0.270). Extramural vascular invasion was linked to higher rates of local recurrence (multivariate β = 0.199, univariate r = 0.127). Lymph node involvement correlated with an elevated risk of postoperative bleeding (multivariate β = 0.133, univariate r = 0.293). Additionally, advanced T staging predicted a higher incidence of 30-day anastomotic leaks (multivariate β = 0.210, univariate r = 0.261). These findings may provide clinically relevant insights to support personalized surgical planning and improve preoperative risk stratification. Conclusions: Detailed MRI reporting, aligned with structured templates, significantly guides surgical and therapeutic strategies in rectal cancer management. However, the retrospective nature of the study and the limited sample size may affect the generalizability of the results.

Background: Robotic liver surgery is emerging as a key advancement in minimally invasive techniques, though it still faces several challenges. Meanwhile, colorectal cancer (CRC) continues to be a leading cause of cancer deaths, with liver metastases affecting 25–30% of patients. These metastases significantly burden healthcare systems by raising costs and resource demands. Methods: A narrative literature review was performed, resulting in the inclusion of 14 studies in our analysis. Fourteen studies met the inclusion criteria and were analyzed with attention to patient characteristics, surgical details, perioperative outcomes, and reporting limitations. For consistency, simultaneous robotic-assisted resection (RAR) refers to cases in which the colorectal primary and liver metastasectomy were performed during the same operative session. Results: The 14 studies included a total of 771 patients (520 males and 251 females), aged between 31 and 88, undergoing simultaneous robotic-assisted resection (RAR). Most were affected by rectal cancer (76%) and unilobar liver metastases (82%). All surgeries using the DaVinci system are represented by 62% wedge resection and 38% anatomical (21.39% major and 16.61% minor). Patients’ BMI ranged from 19.5 to 40.4 kg/m², the average blood loss was 181.5 mL (30–780), the median hospital stay was 7 days (range 2–28), and the mean operative time ranged from 30 to 682 min. Data on POLF (postoperative liver failure) are reported in two studies: Rocca et al., 1/90 patients; Marino et al., 1/40 patients. Biliary leak is reported in one case by Marino et al., while Winckelmans et al. reported a 2.6% incidence of biliary leak in the laparoscopic group and 3.4% in the robotic group. Conclusions: As research advances and new therapies emerge for colorectal liver metastasis (CRLM), surgery remains the mainstay of treatment. However, evidence is limited by small sample sizes, heterogeneous study designs, inconsistent reporting of perioperative chemotherapy, timing of surgery, metastasis localization, and complications. Robotic liver surgery has become a well-established technique and possibly represents the future for managing colorectal liver metastases. Further prospective and comparative studies with standardized outcome reporting are needed to define optimal patient selection and long-term effectiveness.

Purpose: Stoma reversal is associated with notable postoperative morbidity. Several techniques exist for skin closure after stoma reversal, with linear primary closure (LC) and purse-string closure (PS) being the most common. This systematic review and meta-analysis aim to compare LC and PS skin closure after stoma reversal in terms of surgical site infection (SSI) rates, wound healing, and cosmesis.Methods: In accordance with the PRISMA statement, a systematic review of skin closure after stoma reversal was conducted using MEDLINE (PubMed), Embase, Web of Science, and Scopus.Results: Eleven studies, enrolling 1,052 patients (PS, n=534; LC, n=518), published between 2006 and 2024, were included. The overall quality of the studies was considered acceptable, with a mean Jadad scale score of 4 (range, 3–5). Patients underwent ileostomy or ileostomy/colostomy in 6 and 5 studies, respectively. No differences were observed between groups in operative time, length of hospital stay, intestinal obstruction, or incisional hernia. However, SSI and overall infection rates were higher in the LC group, with a statistically significant difference for SSI.Conclusion: Skin closure following stoma reversal using the PS technique may offer advantages over LC. PS is associated with significantly lower SSI rates compared to LC. Although a large randomized controlled trial with long-term follow-up is still required, current findings suggest that PS could be considered the standard of care for wound closure after ileostomy reversal.