Background/Objectives: The improved long-term survival of rectal cancer patients has led to a major increase in the prevalence of functional complications. Understanding which patients are prone to develop major LARS is important for their preoperative counselling and follow-up. Herein, we aimed to assess the risk factors for LARS. Methods: This is a retrospective cohort study on rectal cancer patients. All patient and tumour variables, management plan, type of neoadjuvant therapy, radiation dose to anal sphincter, and perioperative outcomes were collected from the hospital electronic databases. We quantified LARS and compared the score before and after surgery (mean follow-up of 42.2 ± 32 months). Results: A total of 182 patients were included for the final analysis. LARS was present in 43.4% (n = 79) of patients, with 14.8% (n = 27) having minor LARS and 28.5% (n = 52) having major LARS. Age (p = 0.03), male gender (p < 0.00001), smoking (p = 0.04), neoadjuvant radiotherapy (p = 0.02), rectal stump length (p = 0.008), end-to-end anastomosis (p = 0.008), and ileostomy (p = 0.002) were found to significantly increase the rate of LARS. A logistic regression model based on the above variables was able to predict major LARS with good predictive value (AUC 0.700). Conclusions: LARS is highly common after sphincter-preserving surgery, and it is significantly more common in young, male patients with a history of smoking, having mid-lower rectal cancers with neoadjuvant radiotherapy, and undergoing TME surgery with end-to-end low anastomosis and ileostomy.

Background: Low anterior resection syndrome (LARS) is a frequent functional complication after sphincter-preserving rectal cancer surgery. Although tumor location and treatment-related factors are established determinants, the contribution of pelvic skeletal anatomy assessed by magnetic resonance imaging (MRI) pelvimetry remains uncertain. This study evaluated whether three conventional MRI-derived skeletal pelvimetry measurements provide incremental predictive information for major LARS beyond a parsimonious preoperative clinical reference model. Methods: This single-center observational cohort study included 168 patients who underwent sphincter-preserving rectal cancer surgery and completed postoperative LARS assessment. MRI pelvimetry included anteroposterior pelvic diameter, interspinous distance, and sacral curvature depth. Associations with LARS score and major LARS were evaluated using correlation analyses, pelvic-tertile comparisons, and multivariable logistic regression. Firth penalized logistic regression was prespecified as a sensitivity analysis. The primary clinical reference model included age, categorical tumor position, and neoadjuvant radiotherapy. Internal validation used stratified five-fold cross-validation repeated 100 times. Incremental model fit was assessed using a likelihood-ratio test. Results: Major LARS occurred in 48 patients (28.6%), and the median postoperative LARS score was 18 (interquartile range 9–31). LARS scores and major LARS prevalence were similar across anteroposterior pelvic diameter tertiles. In the parsimonious multivariable model, low tumor position was associated with major LARS (OR 9.51, 95% CI 2.00–45.15; p = 0.005), whereas anteroposterior pelvic diameter and interspinous distance were not associated with major LARS. The parsimonious preoperative clinical model achieved a mean repeated five-fold cross-validated AUC of 0.669, compared with 0.671 after addition of MRI pelvimetry (ΔAUC = +0.002, 95% CI −0.052 to 0.054), with no statistically detectable improvement in nested-model fit (likelihood-ratio p = 0.122). Brier scores were 0.187 for both models. Calibration, overall prediction error, and decision-curve performance were similar between models. Conclusions: In this selected retrospective cohort, the three conventional MRI-derived skeletal pelvimetry measurements evaluated did not demonstrate a clear incremental improvement in prediction of major LARS beyond the parsimonious preoperative clinical reference model.

Background/Objectives: Breast cancer mortality remains disproportionately high in Eastern Europe, partly due to delayed diagnosis and limited access to organized screening programs. Socioeconomic deprivation and rural residence may contribute to inequalities in breast cancer detection and disease burden at presentation. This study aimed to evaluate the association between sociodemographic disparities and mammographic tumor burden at breast cancer diagnosis within a large regional screening cohort from Eastern Romania. Methods: This retrospective study was conducted within the ONCOFEM regional breast cancer screening initiative between August 2020 and December 2023. A total of 23,886 asymptomatic women aged 50–69 years underwent screening mammography using fixed and mobile digital mammography units. Sociodemographic variables included residential environment (urban/rural) and vulnerability status. Histopathologically confirmed malignant lesions were analyzed regarding maximum mammographic tumor dimension and focality status (unifocal, multifocal, multicentric). Statistical analysis included Mann–Whitney U tests and Chi-square/Fisher exact tests, with p < 0.05 considered statistically significant. Results: The screened population included 12,652 rural women (53.0%) and 11,234 urban women (47.0%). Urban participants demonstrated significantly higher recall rates compared with rural women (7.75% vs. 4.85%, respectively; p < 0.001). Similarly, the Cancer Detection Rate (CDR) was significantly higher in the urban subgroup, reaching 7.21 cancers per 1000 screened women, compared with 4.19 cancers per 1000 screened women in the rural population (p = 0.002). The final analytic cohort included 134 patients with histopathologically confirmed breast cancer, corresponding to 138 malignant lesions. Median tumor size was 25 mm overall. Rural and vulnerable women demonstrated numerically higher proportions of tumors exceeding 20 mm; however, no statistically significant differences were observed regarding maximum tumor dimensions according to residential environment (p = 0.799) or vulnerability (p = 0.934). Multifocal and multicentric disease represented a minority of cases, without significant associations with the sociodemographic subgroup. Conclusions: Although significant urban–rural differences were identified in screening performance metrics, mammographic indicators of tumor burden demonstrated relatively similar distributions across sociodemographic subgroups. The persistently high proportion of tumors exceeding 20 mm across all groups suggests a substantial burden of relatively advanced disease at diagnosis within the Romanian population. No statistically significant disparities in mammographic tumor burden were identified across the analyzed sociodemographic subgroups; however, the present study cannot determine whether the use of mobile mammography units contributed to this observation.