The Schlafen 11 (SLFN11) protein has recently emerged as pivotal in DNA damage conditions, with predictive potential for tumor response to cytotoxic chemotherapies. Recent discoveries also showed that the programmed death ligand 1 (PD-L1) protein can be found on malignant cells, providing an immune evasion mechanism exploited by different tumors. Additionally, excessive generation of free radicals, redox imbalance, and consequential DNA damage can affect intestinal cell homeostasis and lead to neoplastic transformation. Therefore, our study aimed to investigate the significance of SLFN11 and PD-L1 proteins and redox status parameters as prognostic biomarkers in CRC patients. This study included a total of 155 CRC patients. SLFN11 and PD-L1 serum levels were measured with ELISA and evaluated based on redox status parameters, sociodemographic and clinical characteristics, and survival. The following redox status parameters were investigated: spectrophotometrically measured superoxide dismutase (SOD), sulfhydryl (SH) groups, advanced oxidation protein products (AOPP), malondialdehyde (MDA), pro-oxidant–antioxidant balance (PAB), and superoxide anion (O₂^•–). The prooxidative score, antioxidative score, and OXY-SCORE were also calculated. The results showed significantly shorter survival in patients with higher OXY-SCOREs and higher levels of serum SLFN11, while only histopathology-analysis-related factors showed significant prognostic value. OXY-SCORE and SLFN11 levels may harbor prognostic potential in CRC patients.

Background/Objectives: With advances in surgical techniques for rectal cancer—particularly laparoscopic and robotic-assisted approaches—the choice of operative method may influence not only oncological but also functional outcomes. This study aimed to compare open and laparoscopic rectal cancer surgery regarding pelvic autonomic nerve identification, preservation and its impact on postoperative urinary, sexual, and quality-of-life outcomes. Methods: A total of 181 patients who underwent curative rectal cancer surgery at the Clinic for Digestive Surgery, University Clinical Center of Serbia, were included. Six types of procedures were performed using both open and laparoscopic approaches. Intraoperative identification and preservation of pelvic autonomic nerves were assessed and verified postoperatively through evaluation of urinary, sexual, and quality-of-life parameters. Urinary function and related life quality were assessed using the International Prostate Symptom Score (IPSS and IPSS-QoL), while sexual function was evaluated using gender-specific validated questionnaires (IIEF-15 and FSFI) preoperatively and at 2, 4, and 6 months postoperatively. Results: Nerve non-visualization and/or injuries were significantly more frequent in the open surgery group. The laparoscopic approach was associated with better preservation of urinary function, particularly among male patients, better sexual function in both sexes, and a transient advantage in quality of life. Conclusions: Laparoscopic rectal cancer surgery demonstrated superior pelvic autonomic nerve visualization and preservation and better short-term urinary and sexual function. Nonetheless, quality-of-life outcomes were comparable by 6 months of follow-up, underscoring the importance of meticulous nerve-preserving technique regardless of surgical approach.

Locally advanced rectal cancer (LARC) presents a clinical challenge due to lack of reliable molecular biomarkers for early diagnosis, prognosis, and prediction of response to neoadjuvant chemoradiotherapy (nCRT). Long non-coding RNAs (lncRNAs) have emerged as promising candidates due to their characteristics and regulatory roles. H19, NEAT1, MALAT1 and HOTAIR are lncRNAs deregulated in gastrointestinal cancers, with insufficient data on their biomarker potential in LARC. The study aimed to analyze the diagnostic, prognostic and predictive utility of H19, NEAT1, MALAT1 and HOTAIR in LARC. Relative expression was evaluated by RT-qPCR in tumor and non-tumor tissues from 25 LARC patients before and after nCRT. H19, NEAT1, and MALAT1 showed significantly altered expression in tumor tissue, as well as non-tumor tissue before and after nCRT. H19 expression was significantly higher in tumor vs. non-tumor tissue before treatment and demonstrated moderate potential to discriminate between tumor and non-tumor. None of the lncRNAs showed statistically significant predictive values for nCRT response or association with treatment outcomes in our study, which was limited by the small number of responders. Our results suggest that H19 might be considered as a potential therapeutic target in LARC. Further studies with larger patient groups are required to confirm its diagnostic and prognostic utility.

Introduction. Lipomas are slow-growing, benign tumors of mesenchymal origin. In most cases, they are incidental findings during endoscopic examinations. Lipomas in the gastrointestinal tract are rare entities with the lowest rate of occurrence in the rectum. They are mostly asymptomatic but can cause pain, intussusception, bleeding, volvulus, prolapse, and weight loss if larger than 4 cm. The aim of the presented case report was to demonstrate that abundant rectorrhagia can be caused by a rare entity such as rectal lipoma. Case report. We presented the case of a fifty-year-old male patient with a soft-structure prolapse through the anus accompanied by extensive bleeding. After repositioning, the structure was endoscopically removed. Histopathological analysis confirmed the presence of a lipoma. Conclusion. Rectorrhagia can be a clinical manifestation of this rare condition ? incarcerated rectal lipoma ? and should be considered in practice as a differential diagnosis in cases where the existence of more common conditions like hemorrhoidal disease and malignant tumors is excluded.

Background/Objectives: Schlafen 11 (SLFN11) encodes a DNA damage response protein implicated in sensitivity to DNA-damaging therapies and has been proposed as a predictive biomarker in several malignancies. This study aimed to characterize SLFN11 expression and evaluate its prognostic and predictive significance in locally advanced rectal cancer (LARC). Methods: Publicly available datasets were interrogated using UCSC Xena, GEPIA2, TNMplot, KMplot, ROC Plotter, and GEO databases. SLFN11 expression was assessed by quantitative real-time PCR in paired tumor and adjacent non-tumor tissues collected before and after neoadjuvant chemoradiotherapy (nCRT) from 26 patients with LARC. Associations with clinicopathological characteristics, pathological response, and survival outcomes were analyzed. Results: Publicly available datasets demonstrated lower SLFN11 expression in rectal tumor tissues compared with non-tumor tissues. In our cohort, no significant differences in SLFN11 expression were observed between paired tumor and adjacent non-tumor tissues either before or after nCRT. However, SLFN11 expression increased significantly following nCRT in both tissue types. Nevertheless, neither bioinformatic analyses nor our cohort demonstrated a significant association between SLFN11 expression and survival outcomes. Likewise, no significant predictive value of SLFN11 expression for response to nCRT was observed in ROC Plotter analysis, most GEO datasets, or our clinical cohort. The prognostic and predictive findings should be considered exploratory due to limited statistical power. Conclusions: Although SLFN11 expression is reduced in rectal tumor tissues and appears to be influenced by nCRT, its prognostic and predictive value in LARC remains uncertain. Larger studies are warranted to clarify its biological and clinical significance.

Background: Reliable and accurate prediction of treatment response to neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC) is usually demanding and continues to pose a challenge. Kurtosis as a histogram parameter calculated on T2-weighted MRI sequences might be an additional tool, as it represents a quantitative biomarker for response prediction. It is defined as a measure of distributions’ tails relative to the center of the distribution curve, which reflects tissue heterogeneity. The aim of the study was to evaluate the added value of T2-weighted kurtosis in predicting pathological response to nCRT in patients with LARC. Methods: a single-center cohort study included 71 patients with LARC who underwent both initial and post-nCRT MRI examinations followed by surgical resection in the form of the total mesorectal excision (TME). Histogram analysis was performed using software MIPAV (Medical Image Processing, Analysis, and Visualization, version 11.3.2, developed by the National Institutes of Health, Bethesda, MD, USA) on T2-weighted sequences, extracting kurtosis along with other histogram parameters. Pathological tumor regression grade (pTRG) in accordance with Mandard classification was considered the gold standard. Patients were classified as responders (pTRG 1–2) or non-responders (pTRG 3–5). Results: while other histogram parameters did not show statistically significant differences between groups, post-treatment values of kurtosis were significantly higher in responders compared to non-responders (4.28 ± 0.73 vs. 3.01 ± 0.17, p = 0.024). The F1 score as a classification metric (0.821) indicates an improvement in classification performance following therapy. Conclusions: T2-weighted kurtosis might be a significant tool in predicting pathological response to nCRT, representing a potentially valuable quantitative biomarker that could improve treatment response assessment.