Double inferior vena cava (DIVC) is rare and usually detected incidentally. DIVC may be associated with several anatomical variants of the retroperitoneal and pelvic veins. These variants can pose a clinical problem during colorectal surgery. We present two patients with lower rectal cancer who also had a DIVC. Case 1 was a 72-year-old man with advanced lower rectal cancer (T3N0M0) who underwent robot-assisted low anterior resection after neoadjuvant therapy. A DIVC was detected on preoperative computed tomography (CT). During the operation, a presacral vein was injured while mobilizing the rectum and hemostasis could not be achieved. We converted to open surgery and packed the pelvic cavity for hemostasis. Retrospective analysis suggested the injured vein arose from an interiliac vein of the presacral pelvic venous plexus. Case 2 was a 50-year-old woman with lower rectal cancer (T3N0M0), immune thrombocytopenic purpura, and a DIVC. Although preoperative three-dimensional CT angiography showed no obvious pelvic vein abnormalities, a short course of preoperative radiotherapy was delivered to avoid lateral pelvic lymph node dissection. Chemotherapy was deferred owing to her thrombocytopenic disease. Laparoscopic abdominoperineal resection was performed meticulously to minimize bleeding and achieve rapid hemostasis. No intraoperative complications occurred. DIVC is often accompanied by venous malformations that may pose a problem when mobilizing the mesorectum from the retroperitoneum. Preoperative assessment of pelvic vessel anatomy using three-dimensional CT is essential in patients with a DIVC who undergo rectal surgery.

Background/Objectives. Systemic inflammatory responses influence treatment response and oncological outcomes in patients with cancer. Growing evidence indicates that the inflammatory burden index (IBI) serves as a reliable prognostic indicator across various malignancies. However, the clinical significance of the peri-treatment inflammatory status in patients with RC undergoing preoperative chemoradiotherapy (CRT) remains unclear. Methods. We assessed the pre- and post-treatment IBI in 97 patients with rectal cancer (RC) who received preoperative CRT followed by total mesorectal excision at our institution. Results. Although no significant changes were observed in the pre- or post-CRT IBI and no associations were found with most clinicopathological factors, survival analysis revealed that a high pre-CRT IBI was significantly associated with shorter overall survival (OS) and disease-free survival (DFS). Multivariable analysis revealed that a high pre-CRT IBI and pathological lymph node metastasis remained independent prognostic factors for both outcomes. Subgroup analysis demonstrated that the prognostic value of the peri-treatment IBI differed according to the ypN status, with the pre-CRT IBI showing particularly strong prognostic performance in patients without pathological lymph node metastasis (ypN−). Conclusion. Pre-treatment assessment of the IBI may improve risk stratification in patients with RC undergoing preoperative CRT followed by curative resection.

Background: The da Vinci single port (SP) system is a novel robotic surgical platform that allows multiple robotic instruments and a flexible camera to be introduced through a single umbilical incision. Compared with conventional multi-port robotic or laparoscopic approaches, it offers cosmetic advantages, reduced abdominal wall trauma, and potentially less postoperative pain. These features make it especially suitable for technically demanding gastrointestinal procedures, including simultaneous resections for synchronous malignancies.Case Presentation: An 81-year-old woman was referred with lower rectal cancer, staged as cT3N0M0 (Stage IIA). Preoperative investigations also identified a synchronous gastric cancer, staged as cT2N0M0 (Stage I). To minimize incision size and surgical invasiveness, the SP system was selected. A distal gastrectomy and low anterior resection were successfully performed in a single session through a single umbilical incision, supplemented by three additional ports, two of which were later used for drain placement. The operation was accomplished without intraoperative difficulties, and the patient recovered smoothly, being discharged without postoperative morbidity.Conclusion: This case highlights the feasibility and safety of the SP system in simultaneous multi-organ resections for synchronous gastrointestinal cancers. The approach provides an advanced minimally invasive option that minimizes surgical trauma while maintaining oncologic adequacy.

Background: This study aimed to compare the outcomes and safety profiles of total neoadjuvant therapy (TNT) combined with dose-escalated intensity-modulated radiotherapy (IMRT) and conventional neoadjuvant chemoradiotherapy (NACRT) using three-dimensional conformal radiotherapy (3D-CRT) for locally advanced lower rectal cancer. Methods: This single-institution retrospective study included 51 patients treated with TNT using IMRT from 2018 to 2023 and 53 patients treated with conventional NACRT from 2001 to 2018. TNT consisted of IMRT at a total dose of 54 Gy with capecitabine, whereas NACRT consisted of 3D-CRT at a total dose of 45 Gy with a 5-fluorouracil-based regimen. Survival outcomes, treatment compliance, adverse events, surgical complications, and combined complete response (CR), defined as clinical CR plus pathological CR, were evaluated. Results: The combined CR rate was significantly higher in the TNT with IMRT group than in the NACRT group (43.1% vs. 5.7%). Overall survival and local recurrence-free survival did not differ significantly between the groups, whereas recurrence-free survival was significantly better in the TNT with IMRT group. Treatment compliance was comparable between the groups. Grade ≥ 3 adverse events during radiotherapy were less frequent in the TNT with IMRT group than in the NACRT group (7.8% vs. 22%), and major surgical complications did not differ significantly. Conclusions: TNT combined with dose-escalated IMRT was associated with a higher combined CR rate, favorable disease-free survival, and acceptable toxicity in this cohort. However, given the retrospective historical control design, chronological differences, follow-up imbalance, and potential residual confounding, these findings should be interpreted cautiously and require validation in prospective studies with longer follow-up.

Background/Objectives: Systemic inflammatory responses influence treatment response and oncological outcomes in patients with cancer. Growing evidence indicates that the inflammatory burden index (IBI) serves as a reliable prognostic indicator across various malignancies. However, the clinical significance of the peri-treatment inflammatory status in patients with rectal cancer (RC) undergoing preoperative chemoradiotherapy (CRT) remains unclear. Methods: We assessed the pre- and post-treatment IBI in 97 patients with RC who received preoperative CRT followed by total mesorectal excision at our institution. Results: Although no significant changes were observed in the pre- or post-CRT IBI and no associations were found with most clinicopathological factors, survival analysis revealed that a high pre-CRT IBI was significantly associated with shorter overall survival (OS) and disease-free survival (DFS). Multivariable analysis revealed that a high pre-CRT IBI and pathological lymph node metastasis remained independent prognostic factors for both outcomes. Subgroup analysis demonstrated that the prognostic value of the peri-treatment IBI differed according to the ypN status, with the pre-CRT IBI showing particularly strong prognostic performance in patients without pathological lymph node metastasis (ypN−). Conclusions: Pre-treatment assessment of the IBI may improve risk stratification in patients with RC undergoing preoperative CRT followed by curative resection.