Introduction: In rectal cancer, the choice of treatment strategy depends on the tumor stage and the response to neoadjuvant therapy. Accurate assessment of tumor regression through magnetic resonance imaging (MRI) may help to guide personalized approaches, including delayed or nonoperative management. This study aimed to assess the correlations between pathological complete response (pCR) and clinical staging before and after neoadjuvant treatment in rectal cancer patients. Methods: We conducted a retrospective analysis of rectal cancer patients treated with neoadjuvant therapy followed by radical resection in our oncological surgery department between July 2012 and December 2024. Clinical staging and tumor response were assessed using MRI, focusing on T- and N-stage evaluation. Pathological complete response (pCR) was defined as the absence of tumor cells on histopathological examination. Associations between pCR and clinical variables were explored. Results: Out of a total of 1693 rectal cancer patients, 783 (46.25%) received neoadjuvant therapy, with 62 patients (7.92%) presenting pCR. The majority had tumor stage cT3 (n = 45, 72.6%) and lymph node stage cN2b (n = 25, 40.3%) before treatment. Post-treatment MRI showed complete tumor response (T0) in 20 patients (32.3%) and nodal downstaging to N0 in 34 patients (54.8%). MRI provided imaging findings that indicate a limited correlation between clinical assessment of tumor response and pathological outcome. Six patients (9.6%) developed distant metastases, and there were no local recurrences. Conclusions: While MRI provides valuable preoperative information, its accuracy in predicting pCR remains limited. Achieving pCR is a favorable prognostic indicator, but it does not eliminate the risk of distant metastasis; therefore, continued surveillance and individualized management strategies remain essential to optimize outcomes in rectal cancer patients.

Background/Objectives: Gastric cancer remains one of the most frequent abdominal malignancies, being the 5th in incidence, and it is often diagnosed at advanced stages. Perioperative chemotherapy has been introduced to improve oncological outcomes, although concerns persist regarding increased postoperative complications after radical gastrectomy following neoadjuvant treatment (NAT). Methods: We performed a retrospective study on a continuous series of gastric cancer patients who underwent radical gastrectomy between January 2016 and December 2025. Patients were divided into two groups: those receiving NAT and those undergoing upfront surgery (US). Demographic data, clinical characteristics, operative variables, postoperative complications, 30-day mortality, and pathological findings were compared. Results: There were 383 patients included in the study; NAT was performed in 105 (27.4%) cases and US in 278 (72.6%) cases, with a mean age of 64.99 (63.09–66.88) vs. 67.83 (66.44–68.91) years. Baseline characteristics (Charlson score 3.8 vs. 4.26, p = 0.131), hemoglobin, and albumin levels, were similar between groups. Tumors in the NAT group were more frequently located in the upper stomach 19 (18.1%) vs. 33 (11.9%) or at the gastro-esophageal junction (only Siewert III tumors were included) 17 (16.2%) vs. 23 (8.3%) p = 0.04. Tumor stage was most frequently stage IIIB for radical surgery 111 (28.9%) and for the NAT group 20 (19.1%) and surgery first group 91 (32.7%). The overall grade III and above complication rates were 26 (6.8%) esojejunal fistula, 19 (4.9%) duodenal stump fistula, seven (1.8%) hemorrhagic complications, 31 (8.1%) cases of sepsis, and 33 (8.6%) medical complications. Anastomotic fistulas were more frequent in the surgery-first group, with 23 cases (8.3%), compared with the neoadjuvant group, with 3 patients (2.9%)—the result were not statistically significant. The number of resected lymph nodes was similar (35.4 vs. 35.2; p = 0.96), while NAT group had significantly fewer positive lymph nodes (5.7 vs. 8.0; p < 0.001). Complete pathological response was achieved in 10 (9.5%) of NAT patients. Conclusions: Neoadjuvant treatment does not appear to increase the complications rate following radical gastrectomy. This study supports the surgical safety of the perioperative adjuvant treatment for advanced gastric cancer patients. Further studies are necessary to assess long-term outcomes.

Background/Objectives: Anastomotic leakage (AL) remains one of the most severe postoperative complications following colorectal surgery and is associated with increased morbidity, delayed adjuvant therapy, and impaired oncological outcomes in CRC patients. Increasing evidence suggests that alterations in the gut microbiome contribute to the pathogenesis of AL through effects on epithelial integrity, collagen metabolism, inflammatory pathways, and immune regulation. This review aimed to provide an updated overview of AL in CRC patients and to evaluate current evidence regarding the perioperative use of probiotics, prebiotics, and synbiotics as microbiome-modulating interventions in reducing AL after radical CRC surgery. Methods: A comprehensive literature review of randomized controlled trials (RCTs) investigating perioperative microbiome-targeted interventions in CRC patients undergoing colorectal surgery was conducted. Searches of PubMed, Embase, Cochrane Library, Scopus, and Clarivate databases identified 477 records, of which 21 RCTs met the inclusion criteria and were included in the final analysis. Results: Current evidence supports the role of probiotics in modulating postoperative immune and inflammatory responses. Four studies demonstrated a statistically significant reduction in AL incidence. Perioperative probiotic administration was additionally associated with lower rates of infectious complications, attenuation of systemic inflammatory responses, and earlier recovery of bowel function. Multi-strain formulations containing Lactobacillus and Bifidobacterium species appeared particularly promising. Overall, microbiome-targeted interventions were safe and well tolerated. However, treatment efficacy varied according to bacterial strain composition, dosage, and timing of administration. Conclusions: Perioperative microbiome modulation may contribute to restoration of gut microbial diversity and reduction in AL risk after radical CRC surgery. Multi-strain formulations containing Lactobacillus and Bifidobacterium species appear particularly promising. Nevertheless, further large-scale, standardized clinical trials are required before definitive recommendations can be established.