This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms.

Background and Objectives: To compare the Comprehensive Complication Index (CCI) with the conventional Clavien–Dindo (CD) classification for association with readmission after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal metastases. Materials and Methods: Single-center retrospective cohort of 26 patients treated with CRS-HIPEC for peritoneal metastases of colonic or rectal origin. The patient-level CD grade was the highest of the individually graded complications of the index admission; the CCI was calculated with the standard formula. A prespecified threshold of CCI ≥ 26.2—the value of a single CD grade IIIa complication—defined a high cumulative burden. Unplanned readmission was assessed at 30 and 90 days after discharge as co-primary outcomes; classification agreement and correlates of CCI level were exploratory, without adjustment for multiplicity. Results: Agreement was moderate (kappa = 0.54, 95% confidence interval [CI] 0.25–0.83). Six of 26 patients (23.1%) had no major complication by the CD classification yet a high cumulative burden by the CCI (exact McNemar p = 0.031). Readmission occurred in 32.0% by 30 days and 44.0% by 90 days. For 90-day readmission the CCI gave a numerically higher area under the curve than the CD classification (0.672 vs. 0.555; DeLong p = 0.074), and readmission was more frequent above the CCI threshold (55.6% vs. 14.3%; odds ratio 6.95, 95% CI 0.64–378.69); neither comparison was significant. CCI level correlated with body mass index (rho = 0.541) and the Peritoneal Cancer Index (rho = 0.423), both p < 0.05. Conclusions: The CCI identified a high cumulative burden in six patients recorded as having no major complication by the CD classification, but its numerically higher discrimination for readmission was not statistically demonstrated. These exploratory findings require confirmation in larger cohorts.

For decades, peritoneal metastases (PM) have been regarded as a terminal manifestation of advanced malignancies and managed primarily with palliative intent because of limited sensitivity to systemic therapies. Accumulating clinical, molecular, and immunological evidence now supports the view that PM is not merely an anatomic pattern of spread but a distinct metastatic niche with characteristic biological, microenvironmental, and therapeutic features. This review summarizes the major routes of PM development—transcoelomic, lymphatic, and hematologic dissemination—and emphasizes how these pathways converge through shared biological programs. Core mechanisms include epithelial–mesenchymal transition (EMT), adhesion signaling, extracellular matrix remodeling, and tumor–immune cell interactions. A central focus is the peritoneal tumor microenvironment: mesothelial-to-mesenchymal transition, cancer-associated fibroblast activity, adipocyte-derived metabolic support, macrophage polarization, and regulatory T-cell enrichment collectively shape an immunotolerant and treatment-resistant niche on the peritoneal surface. In addition, evidence from pre-metastatic niche biology suggests that primary tumor-derived exosomes and epitranscriptomic regulation can prime the peritoneal environment before overt implantation. These features provide a biological rationale for locoregional strategies such as cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, as well as emerging intraperitoneal modalities and microenvironment-targeted approaches. Finally, organoid platforms, liquid biopsy-based minimal residual disease monitoring, and theranostic technologies may enable more personalized, biology-driven management of PM.

Tıp Tarihinde Safra Kesesi Osman Gökhan GÖKDERE Safra Kesesi Anatomisi Rifat Mert GÜLMEZ Safra Kesesi ve Safra Fizyolojisi İsa KARACA Safra Kesesi Hastalıklarına Genel Bakış Serdar ACAR Safra Kesesi Hastalıklarında Tanı Yöntemleri Abdulselam ÖZDEMİR Mustafa GÜVEN Kolelitiazis Abdül Rıdvan KULU Safra Kesesi Hastalığında Semptomlar Değercan YEŞİLYURT Safra Taşı Risk Faktörleri ve Korunma Yöntemleri M.Emin UNUTMAZ Safra Kesesi Hastalıkları ve Beslenme Ezgi TATLISU Akut Kolesistit Mustafa YENİ Akalküloz Kolesistit Ramazan Serdar ARSLAN Kronik Kolesistit Serhat BİNİCİ Mirizzi Sendromu Berke MANOĞLU Biliyer Diskinezi Yusuf Murat BAĞ Marlen SÜLEYMAN Safra Kesesi Cerrahisi Öncesinde Hastanın Preoperatif Değerlendirilmesi Ahmet KAYA Safra Kesesi Cerrahisi Öncesi Hazırlık Aziz BULUT Robotik Kolesistektomi Gökhan ULUDAĞ Saygın ALTINER Ahmet Çağrı BÜYÜKKASAP Açık Kolesistektomi Mert ADALI Hamilelikte Safra Kesesi Hastalıklarına Yaklaşım Yunus KAYCI Burak YAVUZ Yaşlılarda Safra Kesesi Hastalıklarına Yaklaşım Abdullah AS Çocuklarda Safra Kesesi Hastalıklarına Yaklaşım Murat KEĞİN Siroz ve Karaciğer Hastalıklarında Safra Kesesi Hastalıklarına Yaklaşım Halim KALE Kolesistektomi Sonrası Beslenme Ali İŞLER Postkolesistekomi Sendromu Erhan KIZILKAYA Kolesistektomi Komplikasyonları İshak AYDIN İbrahim ÇOĞAL Safra Kesesi Histolojisi & Embriyolojisi: Güncel Literatür Taraması Hayrunnisa YEŞİL SARSMAZ İatrojenik Safra Yolu Yaralanmalarına Yaklaşım Seyyit Muhsin SARIKAYA Perkütan Kolesistostomi Mustafa ORUÇ Obezite Cerrahisi ve Safra Kesesi Can AKGÜN Ahmet Can SARI Safra Kesesi Hastalıklarında Patoloji Ali Hikmet ÖZALP Zor Kolesistektomiler Burak YAVUZ Yunus KAYCI Ne Zaman Açığa Dönelim Gülay ÖZGEHAN Sils Kolesistektomi (Single İncision Laparoscopic Surgery) Mehmet UÇAR Safra Kesesi Polipleri / Porselen Kese ve Diğer Özellikli Durumlar Mustafa GÜN Mehmet Alperen AVCI