Background: The optimal timing of surgery in relation to chemoradiation is still controversial. Retrospective analysis has demonstrated in the recent decades that the regression of adenocarcinoma can be slow and not complete until after several months. More recently, increasing pathologic Complete Response rates have been demonstrated to be correlated with longer time interval. The purpose of the trial is to demonstrate if delayed timing of surgery after neoadjuvant chemoradiotherapy actually affects pathologic Complete Response and reflects on disease-free survival and overall survival rather than standard timing. Methods: The trial is a multicenter, prospective, randomized controlled, unblinded, parallel-group trial comparing standard and delayed surgery after neoadjuvant chemoradiotherapy for the curative treatment of rectal cancer. Three-hundred and forty patients will be randomized on an equal basis to either robotic-assisted/standard laparoscopic rectal cancer surgery after 8 weeks or robotic-assisted/standard laparoscopic rectal cancer surgery after 12 weeks. Discussion: To date, it is well-know that pathologic Complete Response is associated with excellent prognosis and an overall survival of 90%. In the Lyon trial the rate of pCR or near pathologic Complete Response increased from 10.3 to 26% and in retrospective studies the increase rate was about 23–30%. These results may be explained on the relationship between radiation therapy and tumor regression: DNA damage occurs during irradiation, but cellular lysis occurs within the next weeks. Study results, whether confirmed that performing surgery after 12 weeks from neoadjuvant treatment is advantageous from a technical and oncological point of view, may change the current pathway of the treatment in those patient suffering from rectal cancer. Trial registration: ClinicalTrials.gov NCT3465982.

Background Traditional outcome assessment after liver surgery mainly relies on perioperative mor-bidity and mortality. However, these parameters fail to capture the multidimensional recovery experienced by patients after hepatic resection. This study aimed to evaluate perioperative quality of life (QoL) trajectories using Patient-Reported Outcome Measures (PROMs) and to identify predictors of impaired postoperative recovery. Methods A prospective observational study was conducted including 71 consecutive patients undergoing liver resection at a tertiary hepatobiliary referral center between May 2024 and May 2025. QoL was assessed preoperatively and three months after surgery using the EORTC QLQ-C30 and QLQ-LMC21 questionnaires. PROMs were correlated with de-mographic, clinical, operative, and postoperative variables. Univariable and multivar-iable analyses were performed to identify factors associated with worse postoperative QoL. Results Significant improvements in postoperative QoL were observed at three months compared with baseline for both the QLQ-C30 and QLQ-LMC21 questionnaires (both p < 0.001). Psychological domains also significantly improved after surgery. Patients with ASA score ≥3 (p = 0.044) and those requiring perioperative blood transfusion (p = 0.011) reported significantly worse postoperative quality-of-life scores. On multivariable regression analysis, Grade B bile leak was associated with impaired postoperative QLQ-C30 out-comes (95% CI 0.75–23.81; p = 0.038). Conclusions Liver resection was associated with significant improvement in patient-reported QoL three months after surgery. PROMs provide clinically relevant information beyond conventional surgical metrics and may help identify patients requiring tailored peri-operative support. The integration of PROMs into liver surgery pathways may contribute to the development of a more patient-centered model of surgical care.

Background: Traditional outcome assessment after liver surgery mainly relies on perioperative morbidity and mortality. However, these parameters fail to capture the multidimensional recovery experienced by patients after hepatic resection. This study aimed to evaluate changes in quality of life (QoL) between the preoperative and three-month postoperative assessments using Patient-Reported Outcome Measures (PROMs) and to identify factors associated with impaired postoperative recovery. Methods: A prospective observational study was conducted including 71 consecutive patients undergoing liver resection at a tertiary hepatobiliary referral center between May 2024 and May 2025. QoL was assessed preoperatively and three months after surgery using the EORTC QLQ-C30 and QLQ-LMC21 questionnaires. PROMs were correlated with demographic, clinical, operative, and postoperative variables. Univariable and multivariable analyses were performed to identify factors associated with worse postoperative QoL. Results: Significant improvements in postoperative QoL were observed at three months compared with baseline in both the QLQ-C30 and QLQ-LMC21 questionnaires (both p < 0.001). Psychological domains also significantly improved after surgery. Patients with ASA scores ≥ 3 (p = 0.044) and those requiring intraoperative blood transfusion (p = 0.011) reported significantly worse postoperative quality-of-life scores. On multivariable regression analysis, Grade B bile leak was associated with impaired postoperative QLQ-C30 outcomes (95% CI 0.75–23.81; p = 0.038). Conclusions: Liver resection was associated with improvement in patient-reported QoL three months after surgery. PROMs provide clinically relevant information beyond conventional surgical metrics and may help identify patients requiring tailored perioperative support. The integration of PROMs into liver surgery pathways may contribute to the development of a more patient-centered model of surgical care.