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.

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.

A recent comprehensive pan-cancer study indicated the high translational potential of the transcript PHF19-207 as a biomarker for colon cancer. This study aimed to analyze the expression of PHF19-207 in colon tissue samples from two different settings to evaluate its clinical utility for diagnosis and screening. Surgical samples of colon tumor and non-tumor tissue were analyzed to determine the diagnostic value of PHF19-207 and its potential correlation with tumor characteristics. Additionally, biopsied samples from individuals undergoing national colorectal cancer screening were examined to assess the potential use of PHF19-207 in early detection. PHF19-207 expression levels were measured in all samples using Real-Time Polymerase Chain Reaction. A statistically significant difference was observed between tumor and non-tumor tissue (p = 0.002) and between tumor tissue and healthy mucosa samples (p < 0.001). Furthermore, polyp samples exhibited significantly higher PHF19-207 expression compared to healthy mucosa (p = 0.035). Receiver operating characteristic (ROC) analysis indicated that PHF19-207 can effectively differentiate malignant from healthy tissue, with an AUC value of 0.9044. Considering the increasing incidence of colorectal cancer in younger populations and the need for improved early detection, PHF19-207 expression could be explored as the basis for a relatively simple and efficient test, enabling a more comprehensive and affordable screening strategy.

Background/Aim. Colorectal cancer still presents a major health problem, with around 10% of patients in whom the tumor invades surrounding structures or organs. These patients are usually challenging even for an experienced colorectal surgical team. The decision for performing multivisceral resection (MVR) is often made intraoperatively, with no sufficient data on the tumor and patient condition. The percentage of perioperative morbidity and mortality is high and oncological outcome is often unfavorable.The aim of this study was to investigate the poor oncological outcome risk factors after MVR in the patients with colorectal carcinoma. Methods. This was a retrospective analysis of patients operated at the Department for Colorectal Surgery of the First Surgical Clinic, Clinical Centre of Serbia, Belgrade. The en bloc multivisceral resection for the primary adenocarcinoma of the colon and rectum was uniformly performed. Data were collected in prospectively designed database. Follow- up period was minimum 2 years. The patients were analyzed in terms of histopathological, demographical and follow- up data. Survival and time to recurrence were evaluated using the Kaplan?Meier method and the log-rank test. Results. Two hundred and thirteen patients were included in the study Their mean age was 59.9 ?12.0 years. The followup period was 33.8 ?29 months. Histopathology confirmed the true tumor infiltration of surrounding organ/structure in 126 (59.2%) patients. The R0 resection was confirmed in 173 (81.2%) patients. Five-year overall survival was 43.4%. Five-year survival for colon patients was 45.9% and in the rectal cancer group 40.9%. In the N0 group of patients, the overall survival in 5-year period was 66.7%. The N1 and N2 status proved the adverse effect on survival (overall 5-year survival 31.3% and 15.9%, respectively). The five-year local recurrence rate in the R0 group of patients was 17.7% and the percentage of distant metastases was 66.3%. Conclusion. The multivisceral resections are demanding procedures requiring a highly specialized surgical team and a high volume hospital. The oncological outcome of these procedures is still unfavorable. In the cases with the node positive disease, or the R1 resection, the perspective is poor. On the other hand, in the absence of these unfavorable factors, we can expect a good oncological outcome. More meticulous preoperative staging and aggressive preoperative treatment can further improve the results.

Background/Objectives: Postoperative urinary tract infections (UTIs), particularly catheter-associated UTIs (CAUTIs), are potentially preventable complications of colorectal surgery. This study evaluated their incidence, timing, microbiology, antimicrobial resistance, and associated factors among patients undergoing colorectal cancer surgery. Methods: This prospective cohort study included 300 patients undergoing colorectal cancer surgery at a Serbian tertiary hospital. Associations with postoperative UTI, defined according to ECDC criteria, were examined using Firth penalized logistic regression and cause-specific Cox regression, with cumulative catheter exposure modeled as a time-dependent covariate. Results: Nineteen patients (6.3%) developed postoperative UTI, including 17 CAUTIs (89.5%) and two asymptomatic bacteriuria. The incidence rates of all UTIs and CAUTIs were 12.0 (95% confidence interval [CI], 7.2–18.8) and 10.8 (95% CI, 6.3–17.2) per 1000 catheter-days, respectively. Seventeen infections occurred by postoperative day 30, and no additional events occurred after day 45. In the multivariable Firth penalized logistic regression model, cumulative catheter exposure per five catheter-days (adjusted odds ratio [aOR], 1.45; 95% CI, 1.17–1.84), operative duration per 30 min (aOR, 1.59; 95% CI, 1.13–2.21), and preoperative leukocyte count (aOR, 1.20; 95% CI, 1.02–1.42) were associated with UTI. In the primary Cox model, cumulative catheter exposure (adjusted hazard ratio [aHR], 2.66; 95% CI, 2.03–3.50) and operative duration (aHR, 1.60; 95% CI, 1.16–2.21) remained associated with postoperative UTI after adjustment for the other covariates included in the model. Gram-negative organisms predominated, with notable third-generation cephalosporin and carbapenem resistance among Klebsiella–Enterobacter isolates. Conclusions: Most surveillance-defined postoperative UTI events were symptomatic and catheter-associated. Greater cumulative catheter exposure and longer operative duration showed consistent associations with UTI across exploratory models. These findings support careful review of catheter necessity but require confirmation in larger cohorts.