Background/Objectives: Emergency colorectal cancer (CRC) surgery combines acute physiological disturbance with heterogeneous operative decisions. We evaluated the discrimination, calibration, and prediction error of the contemporary American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator in an institutional emergency CRC cohort. Methods: This retrospective study included 198 patients undergoing clinically indicated emergency CRC resection during 2020–2024. Recorded 30-day outcomes were compared with version 4.0.4 predictions using area under the receiver operating characteristic curve (AUC), observed-to-expected (O/E) ratios, exploratory calibration plots, and Brier scores. Renal-failure analysis included 170 patients, and leak analysis included 118 patients with an anastomosis. Results: Mortality occurred in 25 patients (12.6%); discrimination was strong (AUC 0.882, 95% confidence interval [CI] 0.807–0.958), with an O/E ratio of 1.03 (95% CI 0.67–1.52). Pneumonia and cardiac complications had AUCs of 0.768 and 0.799 but were underpredicted (O/E 3.48 and 3.62). Surgical site infection occurred in 40.4%, with limited discrimination (AUC 0.544, 95% CI 0.462–0.626) and underprediction (O/E 3.15, 95% CI 2.49–3.92). Anastomotic leak occurred in 12 of 118 patients (10.2%). Mean absolute error for hospital stay was 5.46 days. Conclusions: Mortality ranking was strong, while absolute-risk estimation differed by outcome. Larger multicenter validation with consistent outcome definitions is necessary before these probabilities can support reliable individual risk communication in emergency CRC surgery.

Background: Predicting tumor regression following neoadjuvant chemoradiotherapy (nCRT) remains a major challenge in the management of locally advanced rectal cancer (LARC). Readily available inflammatory biomarkers may provide useful information regarding treatment response. Methods: This retrospective single-center study included 88 patients with stage II–III rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by curative-intent surgery between 2017 and 2025. Patients were classified according to the College of American Pathologists tumor regression grading system as CAP 0 (pathological complete response, n = 22), CAP 2 (partial response, n = 50), or CAP 3 (poor/no response, n = 16). Pretreatment C-reactive protein, carcinoembryonic antigen (CEA), neutrophil, platelet, monocyte, and lymphocyte counts, together with NLR, PLR, and PIV, were compared across groups. Receiver operating characteristic and logistic regression analyses were performed for pathological complete response (pCR). Results: None of the evaluated biomarkers differed significantly across CAP groups. The smallest omnibus p-values were observed for neutrophil count (p = 0.052), monocyte count (p = 0.075), and CEA (p = 0.088). Monocyte count showed the highest discriminatory performance for pathological complete response (AUC = 0.663), followed by CEA (AUC = 0.640). In sensitivity analyses adjusted for baseline clinical T stage and receipt of total neoadjuvant therapy, CEA, neutrophil count, and monocyte count were not independently associated with pathological complete response. More favorable tumor regression was associated with lower residual tumor burden and reduced nodal involvement. Conclusions: Pretreatment inflammatory biomarkers showed biologically plausible numerical patterns across tumor regression groups, but their discriminatory and independent predictive performance was limited. These markers should not be considered stand-alone clinical prediction tools and should be validated within larger, multimodal prospective models.

Aims: Self-expandable metal stenting (SEMS) may convert emergency surgery for malignant left-sided colorectal obstruction into elective resection. This study evaluated SEMS placement as a bridge to surgery (BTS).Methods: This retrospective single-centre case series included consecutive SEMS attempts for malignant obstruction of the descending colon, sigmoid colon or rectosigmoid. Technical success was the primary outcome. Clinical success and procedure-related adverse events were assessed, with operative, postoperative and pathological outcomes described after successful bridging.Results: Of 26 patients undergoing attempted or completed SEMS placement, five treated with palliative intent were excluded. Technical success and successful bridging were achieved in 16/21 BTS attempts (76.2%; 95% confidence interval, 52.8-91.8). All 16 achieved clinical decompression. The five technical failures underwent emergency Hartmann’s procedure. No perforation or clinically significant bleeding occurred in 21 attempts; no migration or re-obstruction occurred after 16 successful deployments. Among successfully bridged patients, the median interval to surgery was 5 days. Primary anastomosis was performed in 15 (93.8%), and seven (43.8%) received a stoma, including six diverting ileostomies. Five (31.3%) developed postoperative complications; four had a highest Clavien-Dindo grade of I and one had grade II. No anastomotic leakage, reoperation or 30-day mortality was recorded in this cohort. Median postoperative stay was 6.5 days (interquartile range, 5-9).Conclusion: Successful SEMS placement enabled decompression and elective resection. The 76.2% technical success rate, selected population and small retrospective cohort limit conclusions regarding overall safety and comparative effectiveness.

Background/Objectives: We compared the prognostic performance of preoperative prognostic nutritional index (PNI) and Gustave Roussy Immune Score (GRIm-s) after curative-intent gastrectomy. Methods: This retrospective cohort included 168 patients, including five postoperative in-hospital deaths. Continuous PNI and ordinal GRIm-s were compared using censoring-adjusted time-dependent AUC and concordance, with paired bootstrap confidence intervals. Preoperative prediction models underwent bootstrap internal validation; restricted mean survival time and time-varying Cox analyses addressed non-proportional hazards. Results: There were 92 deaths and 107 disease-free survival (DFS) events. At 36 months, overall survival (OS) AUC was 0.659 for PNI and 0.527 for GRIm-s (difference 0.132, 95% CI 0.039–0.226); corresponding DFS values were 0.650 and 0.516 (difference 0.134, 95% CI 0.035–0.228). After optimism correction, preoperative PNI-model AUCs were 0.610 for OS and 0.595 for DFS. PNI associations weakened over time. The cohort-derived 49.6 threshold was used only in secondary exploratory analyses. Conclusions: PNI showed better unadjusted discrimination than GRIm-s at three years, but modest internally validated model performance limits clinical interpretation. These findings do not establish clinical utility, a validated cutoff, or a substitute for pathological assessment. External validation is required.

Background and Objectives: Diverting ileostomy is frequently used after low anterior resection (LAR) for rectal cancer to mitigate the clinical consequences of anastomotic leakage. The one-stitch method (OM) has been proposed as a simplified alternative to the traditional method (TM), with potential procedural advantages. However, evidence regarding its short-term outcomes and procedural efficiency remains limited and largely context-specific. This study aimed to compare perioperative outcomes of OM and TM in a single-center cohort. Materials and Methods: This retrospective cohort study included patients who underwent LAR with diverting ileostomy for rectal cancer, between January 2022 and November 2025. A total of 67 patients were analyzed (OM: n = 31; TM: n = 36). Operative time, intraoperative blood loss, length of hospital stay, stoma-related complications, overall postoperative morbidity and anastomotic leakage were compared. Subgroup analysis was performed for laparoscopic cases. Multivariable logistic regression was used to explore factors associated with postoperative complications. Results: Baseline demographic and clinical characteristics did not differ significantly between groups. The OM was associated with shorter operative time and lower intraoperative blood loss compared with TM, both in the overall cohort and in the laparoscopic-only subgroup. No statistically significant differences were observed between OM and TM regarding stoma-related complications, overall postoperative complications or anastomotic leakage. Length of hospital stay was shorter in the TM group. In multivariable analysis, ileostomy technique was not independently associated with postoperative complications, whereas laparoscopic surgery was associated with a lower likelihood of postoperative complications. Given the limited sample size, the study was underpowered for infrequent safety endpoints. Conclusions: In this single-center retrospective analysis, the OM was associated with improved procedural efficiency but did not demonstrate a clear advantage in postoperative recovery or hospital stay. No statistically significant differences in short-term morbidity were observed; however, equivalence cannot be inferred due to limited statistical power. These findings should be interpreted as regional validation data and underscore the need for larger prospective studies incorporating longer-term and patient-centered outcomes.