Background and Aims: The correlations between primary tumor location (right colon cancer – RCC, left colon cancer – LCC and rectal cancer – RC) and the incidence of metastatic sites are scarce and divergent. The current study is the first which compares the pattern of metastatic distribution (M1a: metastasis to one organ/site, excluding peritoneum; M1b: two or more metastatic sites; M1c: peritoneal metastases) between RCC, LCC and RC, respectively. Methods: All patients operated for colorectal cancer (CRC) between January 2006 and December 2015 were analyzed to assess the primary tumor location, the presence and site of synchronous metastases. Univariate analysis determined the statistical significance of association between each CRC location and the metastatic pattern. Multinomial logistical regression model compared the prevalence of each metastatic pattern for each CRC location. Results: Out of 5,107 patients, 1,318 (25.80%) had metastases on the moment of CRC diagnosis. There were no statistically significant association between the metastatic pattern and the patients’ gender (M1a, p=0.321; M1b, p=0.539; M1c, p=0.417, Chi-square) or patients’ age (p=0.616 Mann–Whitney U-test). RC had a significant higher relative risk for M1a (RR of 1.437, p=0.014) and a lower relative risk for M1c (RR of 0.564, p=0.001), compared to LCC. On the contrary, compared with LCC, the RCC showed a significant lower relative risk for M1a (RR of 0.673, p=0.006) and a higher relative risk for M1c (RR of 1.834, p=0.0001). Conclusion. There is a strong correlation between the primary location of CRC and the pattern of the metastatic spread, with potential prognostic implications.

In today’s world, with its continuing advancements in genetics, the identification of Lynch syndrome (LS) increasingly relies on sophisticated genetic testing techniques. Most guidelines recommend a tailored surveillance program, as well as personalized prophylactic and therapeutic approaches, according to the type of dMMR gene mutation. Carriers of path_MLH1 and path_MSH2 genes have a higher risk of developing colorectal cancer (CRC), despite intensive colonoscopic surveillance. Conversely, carriers of path_MSH6 and path_PMS2 genes have a lower risk of developing CRC, which may be due to their lower penetrance and later age of onset. Thus, carriers of path_MLH1 or path_MSH2 would theoretically derive greater benefits from total colectomy, compared to low-risk carriers (path_MSH6 and path_PMS2), in which colonoscopic surveillance might achieve an efficient prophylaxis. Furthermore, regarding the risk of endometrial/ovarian cancer development, there is a global agreement to offer both hysterectomy and bilateral salpingo-oophorectomy to path_MLH1, path_MSH2 and path_MSH6 carriers after the age of 40. In patients with CRC, preoperative knowledge of the diagnosis of LS is of tremendous importance, due to the high risk of metachronous CRC. However, this risk depends on the type of dMMR gene mutation. For carriers of the high-risk variants (MLH1, MSH2 and EPCAM) who have already developed colon cancer, it is strongly recommended a subtotal or total colectomy is performed, while partial colectomy followed by endoscopic surveillance is an appropriate management approach to treat colon cancer in carriers of the low-risk variants (MSH6 and PMS2). On the other hand, extended surgery for index rectal cancer (such as total proctocolectomy) is less effective than extended surgery for index colon cancer from the point of view of metachronous CRC risk reduction, and is associated with a decreased quality of life.

Background and Objectives: The tumor-node-metastasis (TNM) classification system is the standard for staging gastric cancer and predicting survival. However, its accuracy can be compromised by insufficient lymph node (LN) dissection during surgery or inadequate pathologic examination. Alternative staging systems, such as the lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS), may provide better prognostic value when LN examination is suboptimal. Because the current N staging system was not able to accurately stratify patients relative to their survival outcomes in our series, this study assessed the prognostic impact of LNR and LODDS on overall survival (OS) of patients who underwent radical gastrectomy for cancer. Materials and Methods: Between March 2005 and June 2025, the authors performed gastrectomy for gastric carcinoma in 114 patients. Out of these patients, 39 were excluded (19 had stage IV, while 20 underwent palliative gastrectomy with D1 lymphadenectomy). Thus, the study cohort included 75 patients who underwent curative gastrectomy, with 4 (5.3%) of them dying postoperatively. Potential prognostic factors associated with OS (including age, sex, tumor location, T stage, N stage, TNM stage, LNR, and LODDS) were evaluated by univariate and multivariate analysis. Because the recurrence data were missing in 41 patients, the disease-free survival (DFS) analysis would not be meaningful. Results: The OS analysis was based on the 71 patients surviving postoperatively. Because successive N stage groups could not accurately stratify patients according to their OS, we used X-tile software version 3.6.1 to identify two cut-offs (both for LNR and LODDS) that were able to stratify patients in three subgroups with significantly distinct survival outcomes. Multivariate analysis found that both LODDS and LNR systems were independent prognostic factors for OS. Conclusions: LNR and LODDS provide more detailed insights into lymph node status and have demonstrated potential for enhancing prognostic accuracy compared to N staging, even in patients who underwent curative gastrectomy with D2 lymphadenectomy. Although LNR and LODDS are usually useful in patients who underwent suboptimal lymphadenectomy, the current study demonstrated that these systems could improve prognostic stratification even in patients with more than 15 retrieved LNs. However, due to the small sample size, the current observations and proposed cut-offs of LNR and LODDS have to be validated in larger studies including such patients.

Background/Objectives: In patients with peritoneal metastases from ovarian cancer, current clinical guidelines recommend “optimal cytoreductive surgery (CRS)”, defined as leaving no residual tumor nodules greater than 1 cm in diameter. Of note, the 1 cm threshold is somewhat arbitrary, as even a minimal residual tumor burden may adversely impact the patient’s outcomes. The aim of the current study is to identify the independent risk factors associated with overall survival (OS) and progression-free survival (PFS) after “optimal” CRS, with a special focus on the impact of completeness of cytoreduction (defined according to Sugarbaker’s scoring system). Methods: This retrospective cohort study included all the patients with peritoneal metastasis from ovarian cancer who underwent “optimal CRS” (residual nodules less than 1 cm), performed by a single team. Regarding the completeness of cytoreduction (CC), the patients were divided into two groups (without residual disease or with residual nodules less than 2.5 mm (CC0/CC1), and those with residual nodules larger than 2.5 mm and less than 1 cm (“optimal” CC2)). Risk factors associated with OS and PFS were identified by univariate and multivariate analysis. Results: Between September 2010 and February 2025, 52 patients with a median age of 62 [53.25–66.5] years underwent “optimal” CRS. For the entire group, the median OS was 70.83 months, and the median PFS was 25.8 months. In univariate analysis, the factors associated with significantly better OS were a peritoneal cancer index (PCI) lower or equal to 10 (vs. PCI > 10; p = 0.025) and CC0/CC1 status (vs. “optimal” CC2; p = 0.004), while in multivariate analysis, the only independent factor associated with higher OS was CC0/CC1 (HR = 0.253; 95% CI: 0.092–0.696, p = 0.008). Regarding PFS, the only factors independently associated with higher PFS were CC0/CC1 (HR = 0.155; 95% CI: 0.046–0.527, p = 0.003) and no preoperative chemotherapy (HR = 0.387; 95%CI: 0.155–0.963, p = 0.041). Conclusions: To the best of our knowledge, this is the first study to reveal that in patients with peritoneal metastases from ovarian carcinoma who underwent “optimal” CRS, the only independent factor associated with both better OS and PFS was the achievement of CC0/CC1 (no residual macroscopic nodules or residual nodules less than 2.5 mm). This observation supports the notion of redefining the threshold of “optimal” cytoreduction and potentially of implementing the Sugarbaker classification of cytoreduction even in ovarian cancer.