Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) can cure selected patients with colorectal peritoneal metastases (CPM). Real-world prognostic data, especially for the Peritoneal Cancer Index (PCI) and completeness of cytoreduction (CCR), are limited. Methods: We retrospectively analysed 75 consecutive patients treated with CRS + HIPEC at a tertiary centre (2014–2022), giving ≥36 months potential follow-up. Overall survival (OS) was assessed by Kaplan–Meier and Cox models. PCI was grouped 0–10, 11–20, >20; CCR was dichotomised (CCR-0 vs. CCR 1/2). Multivariable analysis included PCI, CCR, and resection extent; HIPEC drug was examined univariately. Results: The median follow-up was 41 months. Crude 3-year OS was 50.7% (38/75). Survival decreased with higher PCI: 69% for 0–10 (n = 42), 38% for 11–20 (n = 21), and 0% for > 20 (n = 4). Versus PCI 0–10, the adjusted hazard ratios (HR) were 3.02 (95% CI 1.52–6.03) for PCI 11–20 and 7.29 (1.72–30.81) for > 20. CCR-0 improved OS univariately (HR 0.43) but was non-significant after adjustment (HR 0.89). Resection limited to the peritoneum (HR 0.99) and choice of intraperitoneal drug showed no independent effect. Conclusions: In this real-world cohort, PCI was the only independent predictor of 3-year survival after CRS + HIPEC for CPM; neither CCR status, surgical extent, nor HIPEC agent altered prognosis once PCI was considered. PCI should therefore remain the principal selection criterion while molecular and biological markers are integrated into future risk models.

Anastomotic leakage remains a major complication in colorectal surgery. Although several risk factors have been identified, the specific risks associated with TaTME procedures require further clarification. The aim of this study was to determine the frequency of anastomotic leakage after TaTME and to identify factors influencing leakage rates. Out of 237 patients who underwent TaTME, 229 received an anastomosis. Seventeen were excluded from further analysis—14 due to lack of leakage assessment before ileostomy closure and 3 due to missing follow-up data—resulting in a final cohort of 212 patients. Cases were analysed with respect to anastomotic technique and other variables potentially affecting the incidence of anastomotic leakage. Data were obtained from a prospectively maintained institutional database. The mean tumour distance from the anorectal junction (ARJ) was 2.92 cm (± 1.56). Anastomotic leakage occurred in 27 patients (12.74%). The only statistically significant risk factor for leakage was the type of anastomosis: leakage occurred in 18.28% of patients with hand-sewn anastomosis and in 8.47% of those with stapled anastomosis. Tumour height indirectly influenced the leakage rate, as hand-sewn anastomosis was used predominantly in lower tumours (1.78 cm vs. 3.82 cm from the ARJ). Anastomotic leakage rates after TaTME are comparable to those reported for other rectal cancer surgical techniques. Leakage risk is primarily determined by the type of anastomosis and, indirectly, by tumour height. TaTME appears to be a feasible option for selected patients in experienced centres, although further validation is required.

Background: Anastomotic leak remains a major complication after colorectal cancer surgery. While most studies focus on prediction or prevention, less is known about the clinical course after leak diagnosis. We aimed to evaluate the occurrence, severity, management, and early postoperative consequences of anastomotic leak after elective colorectal cancer surgery. Methods: This retrospective multicenter cohort study included consecutive patients undergoing elective colorectal cancer resection with restoration of bowel continuity in five tertiary referral centers. Patients without an evaluable anastomosis were excluded. The primary endpoint was 30-day anastomotic leak incidence. Secondary endpoints included Clavien–Dindo severity, therapeutic management, major morbidity, surgical reintervention, length of hospital stay, intensive care unit admission, readmission, and 30-day mortality. Firth penalized logistic regression was used for adjusted analyses. Results: Among 943 patients with an evaluable anastomosis, 55 developed an anastomotic leak (5.8%). Leak was more frequent after rectal than colon cancer surgery (8.8% vs. 4.5%; crude OR 2.04, 95% CI 1.18–3.53; p = 0.016). After adjustment, rectal cancer remained independently associated with leak occurrence (adjusted OR 3.61, 95% CI 1.74–7.48; p < 0.001), whereas intraoperative indocyanine green fluorescence angiography was not (adjusted OR 1.02, 95% CI 0.48–2.17; p = 0.962). Once leak occurred, 92.7% of patients developed major morbidity, 76.4% required surgical reintervention, and, among patients with available length-of-stay data, 65.4% had a postoperative hospital stay exceeding 14 days; 30-day mortality was 10.9%. Conclusions: Anastomotic leak occurred in fewer than 6% of elective colorectal cancer resections but was associated with severe postoperative deterioration. Its impact is better captured by evaluating severity, management, and downstream consequences, rather than incidence alone.

Introduction: Low-grade appendiceal mucinous neoplasm (LAMN) is a rare appendiceal tumor with indolent histology but a clinically relevant risk of peritoneal dissemination and pseudomyxoma peritonei, creating uncertainty in surgical extent and follow-up.Aim: To synthesize evidence on surgical decision-making in LAMN, including indications for right hemicolectomy, TNM interpretation, perforation management, imaging limitations, Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) selection, and surveillance.Methods: A targeted narrative review was conducted using biomedical sources (2000–2026), supplemented by manual reference screening and citation tracking of key guidelines, consensus statements, and cohort studies. Evidence on pathology, staging, imaging, operative strategy, intraperitoneal treatment, and surveillance was narratively synthesized into clinical decision frameworks.Results: Contemporary evidence supports de-escalation for most localized LAMN. Routine right hemicolectomy is usually overtreatment in non-perforated pTis/pT3 disease after complete appendectomy and is not routinely indicated in selected perforated cases with acellular mucin. LAMN staging differs from adenocarcinoma, including absence of T1/T2 categories and prognostic distinction between M1a and M1b disease. Perforation increases recurrence risk and supports risk-adapted surveillance but does not alone mandate right hemicolectomy.Discussion: The evidence base remains predominantly retrospective and surveillance protocols are heterogeneous, limiting standardization.Conclusions: Risk-stratified, evidence-based algorithms can reduce overtreatment while preserving oncologic safety in LAMN.Significance of the study: This review integrates staging, operative strategy, and surveillance into a practical framework for standardized LAMN management and future multicenter research planning.

Background/Objectives: Computed tomography (CT) informs preoperative staging in colon cancer, yet its diagnostic accuracy for lymph node involvement relative to pathological staging remains uncertain. We examined nodal concordance and multicentre variation in Poland. Methods: This retrospective diagnostic accuracy study included adults who underwent upfront resection for nonmetastatic colon cancer at five centres between January 2022 and August 2025. All underwent preoperative CT; recorded cN categories were dichotomised as cN0 versus cN+ (any positive cN category), and pathological pN was the reference. We estimated accuracy, sensitivity, specificity, predictive values, and kappa with 95% confidence intervals. A centre-adjusted exploratory analysis examined the association between cT3–4 and occult pN+ among cN0 patients. Results: Of 662 otherwise eligible patients, 590 had evaluable cN and pN. CT and pathology agreed in 386 (65.4%; 95% CI, 61.5–69.2; κ = 0.276; 95% CI, 0.199–0.353). Occult pN+ occurred in 73 of 335 cN0 patients (21.8%; 95% CI, 17.7–26.5); 131 of 255 cN+ patients were pN0 (51.4%; 95% CI, 45.3–57.4). Sensitivity was 62.9% and specificity 66.7%. Centre-level cN/pN completeness ranged from 73.5% to 100%. cT3–4 was associated with occult pN+ after centre adjustment (OR, 3.10; 95% CI, 1.71–5.62). Sensitivity analyses were materially consistent. Conclusions: Routine CT nodal classification showed limited concordance with pathology. The cT3–4 association is exploratory and does not establish a prediction or treatment selection rule; cN alone should not determine treatment.