Background and Objectives: Perforated gastro-duodenal ulcers (PGDUs) are life-threatening surgical emergencies with high morbidity and mortality. This study aimed to evaluate surgical strategies, outcomes, and prognostic factors in patients treated for PGDUs in a tertiary Eastern European center. Materials and Methods: We conducted a retrospective cross-sectional analysis of 156 patients admitted with PGDUs between 2020 and 2024. Data on demographics, risk factors, ulcer location, type of surgical approach, operative details, hospital stay, and mortality were collected. Statistical analysis included chi-square, Mann–Whitney U, and multivariate logistic regression. Results: The mean age was 57.6 ± 15.9 years (range 18–91), with men accounting for 64.7% of cases. Alcohol use was significantly associated with male sex (p = 0.012), while NSAID use was equally distributed. Open surgery was the mainstay of treatment (85.9%), with laparoscopy performed in 12.8% and conversion in 1.9%. Median hospital stay was shorter after laparoscopic repair (7.5 vs. 9 days, p = 0.039. On multivariate analysis, both age and comorbidity burden were independent predictors of mortality (p < 0.01). Conclusions: PGDU management in Eastern Europe remains dominated by open surgery. Laparoscopy, though underutilized, is associated with shorter recovery. Age is the strongest determinant of mortality, highlighting the need for early risk stratification, wider adoption of minimally invasive techniques, and preventive measures targeting modifiable risk factors.

Although laparoscopy has some limitations related to tumor size or location along the colon, it has been demonstrated that the oncological results are just as good as for open surgery. One can also add to the benefits faster recovery and start of chemotherapy, with lower rates of complications. Our study aimed to compare open surgery to laparoscopy for non-complicated colon tumors operated in an average case-load center and appreciate its feasibility with regards to the T stage, lymph node yield and conversions. The study is retrospective and expanded over four years (January 2020-January 2024). One hundred sixty-two patients were included in the study. We observed that female patients were frequently operated through laparoscopy (p=0.003). T1 and T2 tumors represented the majority of the tumors in the laparoscopy group (p=0.004). No statistical difference existed in terms of lymph node yield. Laparoscopy was avoided for tumors of the splenic angle (p=0.006). Concluding our results, minimally invasive surgery for non-complicated colon cancer is non-inferior to open surgery. Considerable expertise is required to take on more complex cases such as difficult-to-access tumors or large, invasive cancers. It can and should be offered to patients as an alternative to open surgery.

Acute promyelocytic leukemia (APL) is generated by the PML-RARA fusion gene. In patients suffering from APL, the early diagnosis and treatment are essential in the successful management. We reported a case of a 27-year-old 17th-week pregnant patient diagnosed with APL. After an extensive hematological diagnostic panel, the acute promyelocytic leukemia was confirmed, and the patient received all-trans retinoic acid (ATRA), idarubicin (IDA), and dexamethasone, following national guidelines. Due to ATRA-related differentiation syndrome, the therapy was adjusted, and hydroxycarbamide was added with a good outcome. The patient was admitted to the ICU secondary to hypoxemic respiratory failure on the 2nd day after hospital admission. Our patient received an individualized drug combination, adjusted by the clinical response. Furthermore, the drugs used in APL treatment are all teratogenic. Despite various major complications, including severe acute respiratory distress syndrome (ARDS), which needed mechanical ventilation; ICU-acquired myopathy; and spontaneous abortion, the patient had a good outcome and was transferred from the ICU after a total stay of 40 days. APL during pregnancy is a rare entity of intermediate-risk APL. Our study emphasized the need for individualized therapy in a rare case of a pregnant woman diagnosed with a potentially fatal hematologic disease.

Background/Objectives: Acute gastrointestinal (GI) emergencies require timely and accurate prediction of surgical necessity to avoid delayed intervention and improve patient outcomes. Traditional scoring systems offer limited accuracy and fail to integrate multimodal data. This study aimed to develop and validate an explainable machine learning model for early prediction of surgical necessity in patients presenting with GI emergencies. Methods: A retrospective cohort of 1032 consecutive adult patients admitted with acute GI emergencies at a tertiary referral center (2019–2024) was analyzed. Three predictive models were developed: logistic regression, Random Forest, and XGBoost. Features included clinical, laboratory, and contrast-enhanced CT imaging variables available within the first 24 h. Model performance was evaluated using AUC, sensitivity, specificity, PPV, NPV, and F1-score. Shapley Additive Explanations (SHAP) were applied for global and individual-level interpretability. The study followed STROBE and TRIPOD+AI reporting guidelines. Results: Surgical intervention was required in 312 patients (30.2%). The XGBoost model achieved the highest AUC (0.89; 95% CI: 0.86–0.92), outperforming Random Forest (AUC 0.86) and logistic regression (AUC 0.79), with sensitivity 0.84, specificity 0.81, and NPV 0.90. The most influential predictors were serum lactate, CT findings (free intraperitoneal air, bowel ischemia), IL-6, and shock index. Decision curve analysis confirmed net clinical benefit across threshold probabilities of 10–70%. Subgroup performance remained robust across diagnostic categories (AUC 0.87–0.91). Conclusions: An explainable XGBoost model integrating early clinical, laboratory, and imaging data accurately predicts surgical necessity in GI emergencies and outperforms traditional scoring systems. SHAP-based explainability supports clinical adoption and transparency. Prospective multicenter validation is warranted. The positive predictive value of 0.74 indicates that approximately one in four patients flagged as requiring surgery may not need operative intervention. The model should be regarded as a decision-support adjunct, rather than a standalone surgical decision tool, that is most relevant in settings where immediate experienced surgical judgment is limited.

Background and Objectives: Early identification of patients with acute pancreatitis (AP) who will require operative intervention remains a major clinical challenge. Traditional severity scores and delayed inflammatory biomarkers offer limited early predictive accuracy. This study aimed to evaluate the combined predictive value of IL-6, necrotic burden, and organ failure parameters for determining the need for surgical management in AP. Materials and Methods: We performed a retrospective cohort study of 325 consecutive patients with AP admitted to Floreasca Emergency Hospital between January 2020 and December 2024. Clinical, laboratory, and imaging parameters were collected, including IL-6 at 24 h, CRP at 48–72 h, SOFA and BISAP scores, and morphologic complications. The primary endpoint was the requirement for operative intervention. Univariate and multivariable logistic regression analyses were conducted, and model performance was assessed using ROC curves and calibration testing. Results: Sixty patients (18.5%) underwent surgery for pancreatitis-related complications. Operated patients demonstrated higher IL-6 levels (median 120 vs. 55 pg/mL), necrosis >30% (68.3% vs. 14%), infected necrosis (55% vs. 2.3%), and persistent organ failure (46.7% vs. 9.8%) (all p < 0.001). In multivariable analysis, IL-6 at 24 h (OR 1.35 per 50 pg/mL), necrosis > 30% (OR 4.80), infected necrosis (OR 6.20), persistent organ failure ≥48 h (OR 2.60), SOFA score (OR 1.18 per point), and CRP at 48–72 h (OR 1.09 per 50 mg/L) independently predicted surgery. The final model showed excellent discrimination (AUC 0.88) and good calibration. Conclusions: IL-6-driven inflammatory escalation, combined with necrotic burden and persistent organ dysfunction, provides a robust early predictive framework for identifying AP patients likely to require surgical intervention. Integration of these parameters may improve triage, timing of intervention, and multidisciplinary decision-making in acute pancreatitis.

Oligometastatic colorectal cancer (CRC) refers to a state in which distant metastatic spread is limited to a few sites, offering the potential for curative treatment with aggressive local therapies. The surgical management of oligometastatic CRC has gained increasing attention due to its potential to improve survival. This review explores the evolving role of surgery in the treatment of oligometastatic disease, focusing on the criteria for selecting patients, surgical techniques, and outcomes. While systemic therapy remains essential, surgery can offer long-term survival benefits for appropriately selected patients with limited metastatic disease, particularly those with metastases confined to the liver. Advances in imaging technologies, minimally invasive surgical techniques, and perioperative care have enhanced the safety and efficacy of these procedures. The integration of multimodal therapies, such as chemotherapy, targeted therapy, and immunotherapy, in conjunction with surgery, is also discussed, with a focus on optimizing outcomes. To conclude, surgical resection of liver metastases improves survival compared to systemic therapy alone; thus, resection should be taken into consideration whenever possible. For initially unresectable diseases, personalized conversion therapy is indicated. This review aims to clarify how and when liver resection can first be chosen; when preoperative systemic treatment is needed; and if this is chosen, what is the best approach.