Colorectal surgery for cancer is associated with a high rate of surgical complications, including anastomotic leakage. The ability to predict the risk of leakage early enough seems to be of high value, since it would facilitate the design of personalized treatment and duration of hospitalization. Although different studies present the neutrophil-to-lymphocyte ratio [NLR] as having a strong predictive value, there is a discrepancy with respect to which postoperative day is the most reliable. We evaluated a series of NLR values, from the day before surgery up to the POD7, in a cohort of 245 colorectal surgery patients in order to clarify the best predictable score for the identification of the risk of anastomotic leakage. There were 28 patients with leaks. ROC curve analysis of NLR on POD1 indicates that a cut-off point ≥ 7.4 exerts a negative prediction for leakage (AUC 0.881, sensitivity 68.7%, specificity 96.4%, PPV 28.4%, and NPV of 99.3%), thus excluding 150 patients from the risk of leakage. Furthermore, the ROC curve analysis of NLR on POD4 indicates that a cut-off point ≥ 6.5 gives a positive prediction of leakage (AUC 0.698, sensitivity 82.1%, specificity 51.6%, PPV 17.6%, and NPV of 95.6%), thus indicating 52 patients as being at high risk of leakage. Finally, NLR failed to identify five leaks out of twenty-eight. These results strongly indicate the ability of NLR on POD1 to predict patients at low risk of developing a leak and then on POD4 to predict the high-risk patients. This makes our study particularly innovative, in that it enables doctors to concentrate on potential high-risk patients from POD1.

Endometriosis is a clinical entity affecting up to 10% of women of reproductive age, characterized by ectopic endometrial tissue outside the uterine cavity. While extrapelvic endometriosis has been documented, pancreatic endometriosis remains extremely rare and poses significant diagnostic challenges due to its similarity to other pancreatic diseases. At the same time, splenic mesothelial cysts are also rare and typically benign. This report presents a unique case of pancreatic endometriosis coexisting with a splenic mesothelial cyst in a 31-year-old woman. The patient presented to the emergency department with complaints of persistent epigastric and low back pain. She noted having similar symptoms approximately a year prior. Her past medical history was otherwise unremarkable, and there was no known family history of pancreatic disease or neoplasms. Initial imaging revealed a 3.8 cm cystic lesion in the pancreatic tail, with features suggestive of mucinous cystadenoma. Following clinical evaluation and confirmation of the cyst’s nature through endoscopic ultrasound-guided biopsy, the patient subsequently underwent laparoscopic distal pancreatectomy and splenectomy due to worsening symptoms. Gross examination revealed a multilocular pancreatic cyst with a smooth, hemorrhagic wall. Microscopic analysis showed the cyst to be lined by cuboidal to columnar epithelium, consistent with pancreatic endometriosis, confirmed by immunohistochemical staining. The spleen showed cystic formations, diagnosed as a multifaceted mesothelial cyst. In conclusion, this report is the first to document the coexistence of pancreatic endometriosis and splenic mesothelial cysts, highlighting the importance of accurate imaging and pathologic evaluation in the diagnosis of these rare conditions. Early diagnosis and surgical intervention lead to favorable outcomes, reinforcing the importance of comprehensive diagnostic strategies.

Background: Postoperative hypoparathyroidism is a common complication of thyroid surgery. Sunlight is a natural source of ultraviolet B (UVB) radiation, which facilitates the synthesis of vitamin D3 in the skin. Inadequate sunlight exposure has been linked to vitamin D deficiency, potentially exacerbating the risk of hypocalcemia in patients undergoing thyroid surgery. The aim of the present study is to evaluate the effect of sunshine levels on postoperative hypoparathyroidism. Method: We retrospectively evaluated patients that underwent total thyroidectomies at two different centers (Thessaloniki and Rhodes) by the same surgical team from 2021 to 2023 in terms of postoperative hypoparathyroidism. We compared the sunshine levels at each center the year before surgery and correlated them with postoperative levels of parathyroid hormone, serum ionized calcium, and phosphorus. Results: One-hundred twenty patients (Group Thessaloniki = 60 patients, Group Rhodes = 60 patients) who were matched for demographic characteristics and type of thyroid disease and surgery were enrolled in our study. The sunshine levels were different between the two centers (Rhodes > Thessaloniki, p < 0.001). It was found that sunshine levels affect preoperative serum ionized calcium (p = 0.002) and postoperative parathyroid hormone levels (p = 0.025). Conclusions: Sunlight exposure levels may play a crucial role in preventing postoperative hypoparathyroidism. Patients living in locations with higher sunshine levels may have lower rates of postoperative hypoparathyroidism.