Background: Malnutrition affects patients undergoing surgery for gastrointestinal cancers and contributes to poor postoperative outcomes, including increased complication rates, longer hospital stays, and higher mortality. Despite the availability of several malnutrition screening tools and prognostic scores, their effectiveness in predicting postoperative outcomes remains unclear. This study aimed to compare the predictive accuracy of Patient-Generated Subjective Global Assessment (PG-SGA), Global Leadership Initiative on Malnutrition (GLIM), Geriatric Nutritional Risk Index (GNRI), and Controlling Nutritional Status (CONUT) score for postoperative outcomes in patients undergoing surgery for colorectal, hepato-pancreato-biliary and upper gastrointestinal cancers. Methods: A cross-sectional observational study from March 2022 to October 2023 was conducted in two university surgical departments, after registration on ClinicalTrials database (NCT05795374). Patient characteristics, preoperative nutritional status and postoperative outcomes were analyzed. Results: In total, 480 patients were enrolled. CONUT and GNRI demonstrated high specificity (over 90% and 80%, respectively) for predicting overall complications, major complications, prolonged hospital stay, mortality, and advanced disease stage across all cancer types. Notably, CONUT showed a specificity over 97% and GNRI over 89.7% for colorectal and upper gastrointestinal cancer patients, respectively, despite their lower sensitivity. On the contrary, PG-SGA and GLIM presented better sensitivity (up to 50%), but slightly lower specificity (up to 86.4%). Conclusions: CONUT and GNRI are valuable for ruling out non-at-risk patients for adverse postoperative outcomes, while PG-SGA and GLIM provide better sensitivity. A step-up approach—initial screening with PG-SGA and GLIM, followed by detailed evaluation with CONUT or GNRI— should be validated in future studies across diverse clinical settings.

Background/Objectives: Anastomotic leakage is one of the most frightening and potentially fatal complications after esophagectomy. The collaboration between the surgical team, interventional gastroenterologists, and radiologists has the potential to improve the hospital stay, as well as morbidity and mortality. The aim of this study is to present our experience and evaluate the results of the multimodal management of anastomotic leak following esophagectomy in our unit. Methods: This is a retrospective study analyzing a single referral center’s prospectively maintained database of all patients diagnosed with anastomotic leak between March 2019 and March 2025 using the definition of the Esophageal Complications Consensus Group. The treatment pathways and the patient outcomes are presented. The primary endpoint was 90-day mortality and in-hospital mortality. Results: A total of 241 esophageal resections were performed between March 2019 and March 2025. Lymphadenectomy of the mediastinum was performed in 88.4% of the patients. Cervical and intrathoracic anastomosis were performed in 143 (59.3%) and 98 (40.7%) cases, respectively. Twenty-nine patients (12%) with a mean age of 59.1 years developed anastomotic leak. Anastomotic leak occurred in 14.3% of intrathoracic anastomoses and 10.5% of cervical anastomoses. The median day of leak diagnosis was the sixth postoperative day. Leak management involved conservative strategies, wound exploration, endoscopic stent placement or vacuum therapy, drainage of effusions under radiologic guidance, and reoperation. The 90-day and in-hospital mortality rate was 3.4%. No cases of conduit necrosis or mediastinitis were reported. Endoscopic management was employed in 18 patients (62.1%) as a first- or second-line treatment, while reoperation was required in 6 patients (20.7%). The median interval from diagnosis to anastomosis healing was 21 days and the median duration of hospital stay 32 days. The management was successful in 27 patients (93.1%) except for 1 who developed tracheoesophageal fistula and 1 who died due to hemorrhagic complication of anticoagulant treatment. Conclusions: Anastomotic leak after esophagectomy is considered a complex, diversified, and morbid clinical entity. The evolving potential of multidisciplinary management encompassing surgical and interventional radiological and endoscopic treatment addresses the mortality rates and heralds a new era of minimizing morbidity.

Introduction: Video games have a positive impact on the skills required for laparoscopic surgery. Several studies have assessed the impact of video games on laparoscopic skills. Aim: This study aims to systematically review the existing evidence. Materials and methods: A search strategy was implemented to retrieve relevant articles from MEDLINE and SCOPUS databases. The retrieved articles were reviewed for further evaluation according to the predetermined inclusion/exclusion criteria. Results: Twenty-six studies were included in this systematic review. These included prospective (n=9), retrospective (n=5) and interventional (n=12). Other review papers were cited in the discussion section. Studies with positive outcomes significantly outweighed the negative ones (21 vs. 5, respectively). Conclusions: Although there is some evidence that video game experience could give some advantage in laparoscopy no firm conclusions could be drawn yet. The reasons for that lay in the various aims, approaches and results of different study reports. Gaming could be used as a daily warm-up or as a tool to speed-up mastering new skills. A standardized protocol is needed for answering the different questions regarding the impact of video game exposure to laparoscopic skills development and progression.

Gastric cancer is a significant global contributor to cancer-related mortality. Stage IV gastric cancer represents a significant percentage of patients in Western countries, with peritoneal dissemination being the most prevalent site. Peritoneal disease comprises two distinct entities, macroscopic (P1) and microscopic (P0CY1), which are associated with poor long-term survival rates. Although the present standard of treatment is palliative chemotherapy, a global controversy has arisen concerning specific patients with limited disease burden or conversion to negative lavage cytology following chemotherapy. Available approaches include systemic or intraperitoneal chemotherapy, upfront gastrectomy, and conversion surgery. This review consolidated the current evidence regarding multimodal management, indicating prolonged survival for this distinct subgroup of patients. Considering the complexity of peritoneal metastases, the potential of the multimodal approach unveils promising prospects for identifying the optimal treatment for this particular subset of stage IV patients and thus enhancing their survival outcomes.

Pancreatic cancer is one of the deadliest malignancies, and this is attributed to the fact that it is diagnosed at a late stage and there are limited treatment options. Tumor biomarkers are used to improve early diagnosis, treatment, and decision-making and to estimate patients’ outcomes. This review aims to discuss the new functions of important biomarkers, such as miRNAs, GATA6, L1CAM, and MUC1 in pancreatic cancer. MiRNAs, including miR-21, miR-155, and miR-196a, are prognostic in PC and may be potential therapeutic targets through the regulation of oncogenic pathways and chemoresistance. GATA6, a transcription factor that controls tumor differentiation and immune escape, has been proposed as a pancreatic ductal adenocarcinoma (PDAC) subtyping marker and a predictor of chemotherapy response. L1CAM promotes tumor growth, invasion, and immune suppression, which leads to the formation of new metastases and perineural invasion. MUC1, a glycoprotein with altered glycosylation, is a marker of tumor progression, immune escape, and resistance to chemotherapy. These biomarkers can be combined into diagnostic panels that may increase the accuracy of the diagnosis and help to individualize the treatment plan. However, the present study is inconclusive, and more clinical evidence is needed to apply these biomarkers in clinical practice. More specific research should be directed towards the development of new targeted therapies that would act on these molecular targets and improve the prognosis and treatment of pancreatic cancer.

Background/Objectives: Chemerin, which is a multifunctional cytokine and adipokine, has been implicated in inflammatory and metabolic processes and might play a role in upper gastrointestinal (GI) malignancies, particularly gastric and esophageal cancer. The aim of this review is to explore the role of chemerin in the pathophysiology of upper GI cancers, as well as its potential as a biomarker for early detection and as a therapeutic target. Methods: A comprehensive review of recent studies about chemerin’s biochemical properties and interaction with its receptors, as well as its effects on inflammatory responses, immune regulation, and metabolic processes, was conducted. The clinical implications of chemerin for gastric and esophageal cancer were analyzed, whereas the potential therapeutic strategies targeting chemerin were discussed. Results: Elevated chemerin levels are associated with poor prognosis in gastric cancer and promote invasiveness and metastasis in esophageal cancer. Chemerin receptor antagonists show promising results in inhibiting cancer cell migration, invasion, and progression. Conclusions: Chemerin could represent a valuable prognostic biomarker and therapeutic target for upper GI cancers. Future observational studies should validate its clinical applications and investigate the efficacy of chemerin inhibitors as potential therapeutic targets.