This literature review looks at the epidemiology, clinical manifestations, diagnostics and current medical and surgical management of Clostridium difficile (C. difficile) infection. A literature search of PubMed and Cochrane database regarding C. difficile infection was performed. Information was extracted from 43 published articles from 2000 to the present day which met inclusion criteria. C. difficile is a gram-positive, anaerobic bacillus, which is widely found in the environment, especially in the soil. The occurrence of more resistant strains, which is mainly connected with the wide use of antibiotics, resulted in the rapid spread of the bacteria to different hospital departments. Particularly, elderly patients in surgical wards and intensive care units are at significant risk of developing C. difficile infection, which greatly increases morbidity and mortality. Symptoms of infection with C. difficile vary greatly. At one end of the spectrum, there are asymptomatic carriers, at the other patients with life-threatening toxic megacolon. Metronidazole is considered to be the drug of choice, but recent guidelines recommend Vancomycin. Fulminant colitis and toxic megacolon warrant surgical intervention. The optimal time for surgery is within 48 h of initiating conservative treatment without seeing a response, the development of multiple organ failure or a bowel perforation. A factor that has become increasingly important and relevant is the escalating expense of treatment for patients with C. difficile infection. It is, therefore, highly recommended to consider reviewing all hospital antibiotic policies and clinical guidelines that may contribute to the prevention of the infection.

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can cure selected patients with colorectal peritoneal metastases (CPM). Real-world prognostic data, especially for the Peritoneal Cancer Index (PCI) and completeness of cytoreduction (CCR), are limited. Methods: We retrospectively analysed 75 consecutive patients treated with CRS + HIPEC at a tertiary centre (2014–2022), giving ≥36 months potential follow-up. Overall survival (OS) was assessed by Kaplan–Meier and Cox models. PCI was grouped 0–10, 11–20, >20; CCR was dichotomised (CCR-0 vs. CCR 1/2). Multivariable analysis included PCI, CCR, and resection extent; HIPEC drug was examined univariately. Results: The median follow-up was 41 months. Crude 3-year OS was 50.7% (38/75). Survival decreased with higher PCI: 69% for 0–10 (n = 42), 38% for 11–20 (n = 21), and 0% for > 20 (n = 4). Versus PCI 0–10, the adjusted hazard ratios (HR) were 3.02 (95% CI 1.52–6.03) for PCI 11–20 and 7.29 (1.72–30.81) for > 20. CCR-0 improved OS univariately (HR 0.43) but was non-significant after adjustment (HR 0.89). Resection limited to the peritoneum (HR 0.99) and choice of intraperitoneal drug showed no independent effect. Conclusions: In this real-world cohort, PCI was the only independent predictor of 3-year survival after CRS + HIPEC for CPM; neither CCR status, surgical extent, nor HIPEC agent altered prognosis once PCI was considered. PCI should therefore remain the principal selection criterion while molecular and biological markers are integrated into future risk models.

Anastomotic leakage remains a major complication in colorectal surgery. Although several risk factors have been identified, the specific risks associated with TaTME procedures require further clarification. The aim of this study was to determine the frequency of anastomotic leakage after TaTME and to identify factors influencing leakage rates. Out of 237 patients who underwent TaTME, 229 received an anastomosis. Seventeen were excluded from further analysis—14 due to lack of leakage assessment before ileostomy closure and 3 due to missing follow-up data—resulting in a final cohort of 212 patients. Cases were analysed with respect to anastomotic technique and other variables potentially affecting the incidence of anastomotic leakage. Data were obtained from a prospectively maintained institutional database. The mean tumour distance from the anorectal junction (ARJ) was 2.92 cm (± 1.56). Anastomotic leakage occurred in 27 patients (12.74%). The only statistically significant risk factor for leakage was the type of anastomosis: leakage occurred in 18.28% of patients with hand-sewn anastomosis and in 8.47% of those with stapled anastomosis. Tumour height indirectly influenced the leakage rate, as hand-sewn anastomosis was used predominantly in lower tumours (1.78 cm vs. 3.82 cm from the ARJ). Anastomotic leakage rates after TaTME are comparable to those reported for other rectal cancer surgical techniques. Leakage risk is primarily determined by the type of anastomosis and, indirectly, by tumour height. TaTME appears to be a feasible option for selected patients in experienced centres, although further validation is required.