Background: Combining cytoreductive surgery (CRS) with Hyperthermic IntraPeritoneal Chemotherapy (HIPEC) can benefit patients with peritoneal metastasis from colorectal cancer. The present study evaluates the small bowel subset of the Peritoneal Cancer Index (Small-Bowel-PCI score (SB-PCI), min-max 0–12) as a prognostic factor in such patients. Methods: We retrospectively analyzed patients that underwent CRS and HIPEC for recurrent colorectal cancer with peritoneal metastasis. Patient characteristics, procedure details, and clinical outcomes were evaluated. Results: Eighty patients were included. The mean intraoperative PCI-score was 16.8, with a mean SB-PCI score of 5.9. CC0/1 was achieved in 62/80 patients. The mean follow-up period was 26.3 months. Univariate regression analysis showed that the ECOG status, the presence of severe complications, the HIPEC regimen (oxaliplatin vs. mitomycin-C), the PCI score, the SB-PCI score and the completeness of cytoreduction correlated significantly with overall survival. In multivariate analysis, the SB-PCI and CC score were identified as independent prognostic factors of survival. When the SB-PCI was stratified in three groups (0–4, 5–8 and 9–12), Kaplan–Meier curve analysis showed significant difference in survival (p<0.001). Conclusions: The SB-PCI correlates with overall survival in patients with peritoneal metastases secondary to colorectal cancer in this retrospective cohort. Its use should be validated in prospective patient series.

Perihilar cholangiocarcinoma (pCCA) is the most common subtype of a rare malignancy arising from the biliary tract. Its challenging diagnosis results in delayed treatment, most often when the disease is locally advanced or widespread. Management includes surgery followed by systemic chemotherapy; however, a negative resection margin (R0) is the mainstay for achieving an adequate survival benefit, in the absence of metastatic disease. While minimally invasive surgery (MIS) initially is adopted across every surgical field, laparoscopy’s inherent limitations hinder its implementation for the treatment of pCCA and results in skepticism even for the robotic approach. However, since its initial feasibility phase fifteen years ago, comparable results to open surgery have been reported regarding its safety and oncologic outcomes, in highly selected patients. Moreover, the robotic approach seems to be associated with favorable outcomes regarding post-operative complications, length of hospital stay, and estimated blood loss. International guidelines for the diagnosis and management of pCCA, centralization, definition of a learning curve for MIS, and more comparative studies assessing long term outcomes and randomization are key elements to ensure patient’s safety and technical efficiency. The aim of our review is to provide an updated perspective of the existing literature in the utilization of MIS for patients with pCCA.

Perihilar cholangiocarcinoma (pCCA) is the most common subtype of a rare malignancy arising from the biliary tract. Its challenging diagnosis results in delayed treatment, most often when the disease is locally advanced or widespread. Management includes surgery followed by systemic chemotherapy; however, a negative resection margin (R0) is the mainstay for achieving an adequate survival benefit, in the absence of metastatic disease. While minimally invasive surgery (MIS) initially infiltrated every surgical field, lapa-roscopy’s inherent limitations hindered its implementation for the treatment of pCCA and resulted in skepticism even for the robotic approach. However, since its initial feasibility phase fifteen years ago, comparable results to open surgery have been reported, re-garding its safety and oncologic outcomes, in highly selected patients. Moreover, the robotic approach seems to be associated with favorable outcomes regarding postoperative complications, length of hospital stay and estimated blood loss. International guidelines for the diagnosis and management of pCCA, centralization, definition of a learning curve for MIS, more comparative studies assessing long term outcomes and randomization, are key elements to ensure patient’s safety and technical efficiency. The aim of our review is to provide an updated perspective of the existing literature in the utilization of MIS for patients with pCCA.

Background/Objectives: The concurrent occurrence of papillary (PTC) and medullary (MTC) thyroid carcinoma within the same thyroid gland is an exceptionally rare clinical entity. We conducted a systematic review to synthesize available evidence on the clinicopathological features, diagnostic pathways, and therapeutic outcomes of patients presenting with simultaneous PTC and MTC. Methods: This systematic review was conducted in accordance with PRISMA guidelines and was registered in PROSPERO. Comprehensive electronic searches across PubMed, MEDLINE, EMBASE, Scopus, and Web of Science were performed up to January 2025. Original clinical cohorts reporting on synchronous PTC and MTC (sample size ≥ 10) were included, while single-case reports and small series (n < 10) were excluded. Study quality was evaluated using the Newcastle–Ottawa Scale (NOS), and a narrative synthesis was performed. Results: Eight studies comprising 462 patients met the inclusion criteria. Over 70% of patients had preoperative cytological suspicion or biochemical evidence (elevated calcitonin) of MTC, whereas synchronous preoperative identification of both malignancies occurred in only 24% of cases. Among patients with available histological subtype data, 61% (148/243) presented with true collision tumors separated by normal thyroid parenchyma, whereas 39% (95/243) exhibited mixed medullary–follicular thyroid carcinoma (MMFTC) morphology. Primary MTC lesions were generally larger than the concurrent PTCs. Overall lymph node metastasis was reported in 44% of evaluated patients (predominantly MTC-derived), and distant metastasis occurred in 8%. Conclusions: Simultaneous PTC and MTC are predominantly characterized by an incidental PTC microcarcinoma alongside a larger MTC component that dictates disease staging and nodal dissemination. Further prospective studies and basic research are required to fully understand the potential shared pathophysiological mechanisms and the behavior of these coexisting tumors.

Introduction Emergency General Surgery (EGS) comprises a heterogeneous group of acute surgical conditions that require prompt evaluation and, frequently, urgent operative intervention. Patients presenting for EGS often have significant comorbidity, physiological derangement, sepsis, or hemodynamic instability, and are exposed to substantially higher postoperative morbidity and mortality than patients undergoing elective surgery. Although contemporary Greek data on emergency laparotomy have recently emerged, outcomes across the broader operatively managed spectrum of EGS remain ill-determined. We aimed to characterize 30-day postoperative mortality and associated risk factors across operatively managed EGS - defined as procedures of immediate or urgent priority - in a single Greek tertiary center. Methods We conducted an ambispective, single-center observational cohort study of adults undergoing emergency general surgery of National Confidential Enquiry into Patient Outcome and Death (NCEPOD) immediate or urgent priority at a tertiary academic center in Athens, Greece, between January 2020 and July 2025. The primary outcome was 30-day postoperative mortality. Associations with mortality were examined using univariable logistic regression and a multivariable model incorporating age, American Society of Anesthesiologists (ASA) grade, preoperative sepsis severity, emergency laparotomy, and generalized peritonitis/gross contamination. Established emergency-surgery risk-prediction scores (National Emergency Laparotomy Audit (NELA), Emergency Surgery Acuity Score (ESAS), Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM), and Surgical Risk Scale (SRS) were additionally evaluated for discrimination in an exploratory analysis. Results Of 2,506 screened cases, 2,040 patients were included, with a 30-day mortality of 7.6% (156/2,040), increasing to 12.5% (52/415) after emergency laparotomy and 11.6% (42/361) among NELA-eligible patients. Mortality varied markedly by diagnosis (0.7% (3/430) for appendicitis to 50.9% (29/57) for bowel ischemia) and increased progressively with ASA grade (2.0% (8/403) for ASA I to 52.9% (9/17) for ASA V) and preoperative sepsis severity (3.6% (41/1141) without sepsis to 45.6% (31/68) with septic shock). In the multivariable model (n=2,019), mortality was independently associated with ASA grade (ASA III vs I: aOR 2.53, 95% CI 1.05-6.08; ASA IV-V vs I: aOR 4.53, 95% CI 1.67-12.30) and preoperative sepsis severity (systemic inflammatory response syndrome (SIRS)/infection vs none: aOR 1.95, 95% CI 1.26-3.03; sepsis or septic shock vs none: aOR 3.52, 95% CI 2.10-5.88). Risk-prediction scores showed moderate discrimination on exploratory analysis (AUROC 0.66-0.72); calibration was not assessed. Conclusions Thirty-day mortality following emergency general surgery was substantial and varied markedly according to underlying diagnosis, ASA grade, and preoperative sepsis severity. In this multivariable model, ASA grade and sepsis severity were independently associated with mortality although these associations were sensitive to model specification and residual confounding by diagnosis cannot be excluded. Established risk-prediction scores showed only moderate discrimination in this heterogeneous EGS population, supporting the need for dedicated validation and calibration before their use for risk prediction or benchmarking in Greek practice.