Background: Tumor-node-metastasis (TNM) staging is the central gastric cancer (GC) staging system, but it has some disadvantages. However, the lymph node ratio (LNR) can be used regardless of the type of lymphadenectomy and is considered an important prognostic factor. This study aimed to evaluate the relationship between LNR and survival in patients who underwent curative GC surgery. Methods: All patients who underwent radical gastric surgery between January 2014 and June 2022 were retrospectively evaluated. Clinicopathological features of tumors, TNM stage, and survival rates were analyzed. LNR was defined as the ratio between metastatic lymph nodes and total lymph nodes removed. The LNR groups were classified as follows: LNR0 = 0, 0.01 < LNR1 ≤ 0.1, 0.1 < LNR2 ≤ 0.25 and LNR3 > 0.25. Tumor characteristics and overall survival (OS) of the patients were compared between LNR groups. Results: After exclusion, 333 patients were analyzed. The mean age was 62 ± 14 years. According to the LNR classification, no difference was found between groups regarding age and sex. However, TNM stage III disease was significantly more common in LNR3 patients. Most patients (43.2%, n = 144) were in the LNR3 group. In terms of tumor characteristics (lymphatic, vascular, and perineural invasion), the LNR3 group had significantly poorer prognostic factors. The Cox regression model defined LNR3, TNM stage II—III disease, and advanced age as independent risk factors for survival. Patients with LNR3 demonstrated the lowest 5-year OS rate (35.7%) (estimated mean survival was 30 ± 1.9 months) compared to LNR 0–1–2. Conclusion: Our study showed that a high LNR was significantly associated with poor OS in patients who underwent curative gastrectomy. LNR can be used as an independent prognostic predictor in GC patients.

Purpose: Laparoscopic Transabdominal Preperitoneal (TAPP) videos on YouTube and WebSurg have an important place in surgical training. However, there are differences between these platforms in terms of training quality and compliance with standard surgical steps. The aim of this study was to compare laparoscopic TAPP videos on YouTube (limited to individually uploaded content) and WebSurg in terms of surgical technique and educational quality. Methods: Twelve videos meeting specific criteria were selected from both platforms. The 2 groups were compared using the 9 Commandments, which assessed compliance with surgical steps, and the Procedure Presentation Score (PPS), which assessed video quality/educational content. Data on video characteristics, such as view count, publication date, and duration, were also collected. Results: Although YouTube videos reached more viewers, WebSurg videos had higher compliance with the 9 Commandments (WebSurg median score 8/9 vs. YouTube median score 5/9, p < 0.01). In addition, WebSurg videos had higher PPS scores (median: 8) than YouTube videos (median: 5) ( p = 0.02). Conclusion: When utilizing online video platforms for surgical training, institutional training platforms such as WebSurg should be preferred. When the videos included here were compared with YouTube in the light of the defined criteria; it was seen that YouTube videos were not of sufficient quality.

SUMMARY OBJECTIVE: In T4 colorectal cancer, the risk of peritoneal carcinomatosis is high, and the prognosis is poor. The aim of this study was to assess recurrence risk factors, peritoneal recurrence rates, and survival outcomes in patients radiologically diagnosed with T4 tumors who underwent curative surgery with prophylactic hyperthermic intraperitoneal chemotherapy. METHODS: Between January 2018 and December 2022, 38 radiologically diagnosed T4 colorectal cancer patients who underwent prophylactic hyperthermic intraperitoneal chemotherapy were retrospectively analyzed. All patients had R0 resection; those with intraoperative macroscopic peritoneal or distant metastases were excluded. Demographic data, tumor location, histopathology, and pathological T/N stages were recorded. During follow-up, local/distant recurrence, peritoneal carcinomatosis, metastatic sites, and mortality were assessed. RESULTS: The median age was 57 years, and 57.9% were male. The primary tumor originated mainly from the colon (81.6%), with moderately differentiated adenocarcinoma being the most common histology (57.8%). Recurrence occurred in four patients (10.5%): 2 hepatic, 1 pulmonary, and 1 peritoneal, with no local recurrence. One patient (2.6%) died within 90 days; no additional mortality was observed. Median overall survival was 55 months (95%CI 49.82–60.90). Univariate analysis showed no significant association between recurrence and tumor location, differentiation, pT or pN stage, or histologic subtype. CONCLUSION: In cT4 colorectal cancer patients treated with prophylactic hyperthermic intraperitoneal chemotherapy, recurrence was infrequent, peritoneal recurrence was rare, and radiological staging frequently overestimated tumor depth, supporting a potential benefit of prophylactic hyperthermic intraperitoneal chemotherapy in this setting.

Total mesorectal excision quality as a predictor of overall survival in rectal cancer: A retrospective cohort study - Turkish Journal of Surgery

Background and Objectives: Tumor budding (TB) has emerged as an important histopathological parameter associated with aggressive tumor behavior in colorectal cancer. Increasing evidence has supported its prognostic relevance, particularly regarding lymph node metastasis and adverse pathological features. This study aimed to evaluate whether the established association between TB and lymph node metastasis could be reproduced in our colon cancer cohort and to examine its relationship with other clinicopathological features. Materials and Methods: This retrospective observational study included 136 patients who underwent surgery for colon cancer and whose pathology reports included information on TB. TB was categorized as Bd0, Bd1, Bd2, and Bd3 to evaluate its association with lymph node positivity. The investigation also uncovered the associations between TB and several prognostic indicators, such as T stage, perineural invasion, venous invasion, tumor size, lymphatic invasion and lymph node ratio. Results: Higher TB grade was associated with lymph node positivity in the four-tier analysis (p = 0.012), as well as with lymphatic and venous invasion. However, the association between TB grade and lymph node positivity did not reach statistical significance using the standard ITBCC three-tier classification (p = 0.058). In the primary parsimonious multivariable model, Bd1 was associated with higher odds of lymph node positivity compared with Bd0 (aOR 3.36, 95% CI 1.02–11.02), whereas the estimates for Bd2 (aOR 3.36, 95% CI 0.96–11.75) and Bd3 (aOR 2.76, 95% CI 0.82–9.30) did not reach statistical significance. Conclusions: Higher TB grades were associated with lymph node positivity and other adverse pathological features in unadjusted analyses. In the parsimonious multivariable model, the association with lymph node positivity remained significant only for Bd1, while the estimates for Bd2 and Bd3 did not reach statistical significance. These findings should be interpreted cautiously given the limited sample size and the non-significant association observed using the standard ITBCC three-tier classification.