Traditionally, the therapeutic approach to rectal cancer has involved neoadjuvant chemoradiotherapy followed by surgical resection, and, in some cases, adjuvant chemotherapy. This study aims to present current advances and ongoing controversies in the management of patients with locally advanced rectal cancer (LARC), with a particular focus on clarifying the role of total neoadjuvant therapy (TNT) in contemporary treatment strategies. Methods: We conducted a systematic literature review in Medline/PubMed using various keyword combinations, including “rectal cancer/neoplasia” and“therapy” or “neoadjuvant therapy” or “TNT”, and included articles published between 2015 and 2025. Results: The association of neoadjuvant radiochemotherapy with preoperative systemic chemotherapy has led to the current concept of total neoadjuvant therapy. The advantages of preoperative chemotherapy include better patient compliance, a decrease in the rate of local recurrence and distant metastases via the early destruction of infra-clinical micrometastases, and higher rates of pathological complete response. All of these have led to the inclusion of this strategy in treatment guidelines for patients with locally advanced rectal cancer. Conclusions: However, the selection of patients with advanced rectal tumors for optimal therapy requires comprehensive imaging assessments, molecular and genetic testing, and a multidisciplinary team to determine the most appropriate total neoadjuvant therapy approach.

Goblet cell adenocarcinomas (GCAs) are an exceedingly rare subtype of tumors, almost exclusively occurring in the appendix, and characterized by features overlapping both adenocarcinomas and neuroendocrine tumors (NETs), which has historically led to confusion and varied nomenclature. This study presents a comprehensive review of the literature highlighting particularities of this type of malignancy, starting from a rare case of a 54-year-old female operated on in our clinic for an appendiceal tumor, initially suspected to be a mucinous neoplasm based on colonoscopic biopsy, which was ultimately confirmed to be goblet cell adenocarcinoma on both intraoperative frozen section and definitive pathological examination. Exhibiting signs and symptoms associated with an abdominal mass, she underwent a right hemicolectomy with partial omentectomy for locally advanced, high-grade, invasive goblet cell adenocarcinoma of the appendix with lymphatic macro metastases and epiploic invasion, categorized as AJCC stage IVb carcinomatosis. The patient received FOLFOX adjuvant. Six months later, she required reoperation due to the progression of carcinomatosis, which was again confirmed histopathologically. A second-line oncological protocol comprising irinotecan, capecitabine, and bevacizumab was initiated. Given the rarity of GCAs and the absence of a consensus on nomenclature, classification, and diagnostic criteria, we conducted a comprehensive literature review to highlight current trends related to this entity, including its classification within different systems (Tang, Yozu, WHO, AJCC), as well as the therapeutic surgical approaches—ranging from simple appendectomy to extensive multiorgan resection, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC), and the use of systemic therapy. Adhering to these recommendations will enhance communication among pathologists, surgeons, and oncologists regarding the natural history and prognosis of this rare malignancy.

Chylothorax is a rare complication, especially after esophageal cancer surgery It may occur mainly in the thoracic stage of esophagectomy. The management of chylothorax is usually conservative, surgical reoperation with thoracic duct ligation being reserved for those cases refractory to that treatment. We discuss issues of diagnosis and therapeutic attitude, as evidenced by the literature, although a general consensus has not been established, most likely due to the low frequency of this complication. We emphasize the minimally invasive thoracoscopic approach, as it has been applied for two cases with this type of complication. A high rate of suspicion for thoracic duct injury should be maintained in all patients after esophageal surgery, with any pleural effusion entering the differential diagnosis of chylothorax

Background and Clinical Significance: Typically, late complications of temporary or left-in-situ cholecystostomy in patients with acute calculous cholecystitis are related to retained calculi, which are ultimately resolved by cholecystectomy. Neoformation of gallstones secondary to temporary cholecystostomy in an acalculous (disease-free) gallbladder may be neglected because of a low index of suspicion, until the occurrence of late complications. Case presentation: A 54-year-old female underwent surgery (open procedure, May 2003) for a complicated postbulbar ulcer (stenosis with gastric outlet obstruction; penetration into the common bile duct): troncular vagotomy, distal hemigastrectomy, Roux-en-Y gastrojejunostomy. Temporary cholecystostomy (in an acalculous gallbladder) was added as a supplementary precaution to prevent duodenal stump leakage. Despite medical advice, she never presented for control and was lost for follow-up. The patient (now aged 75) was urgently admitted 21 years later (September 2024) with acute pain in the right upper abdominal quadrant and fever. She was unable to provide medical documentation and had a poor recall of surgical history; we were able to retrieve the operative report because the patient had been operated in our clinic. Physical examination was suggestive of an abscess, overlying cellulitis centered on spontaneous purulent discharge (presumed through the pre-existing drainage tract of the previous cholecystostomy). Abdominal CT demonstrated: emphysematous calculous cholecystitis, an abdominal abscess, and cholecystocutaneous fistula. A transverse incision, centered on the cutaneous fistulous orifice, was followed by discharge of pus and calculi, parietal debridement, and extraction of a fragment of gangrenous gallbladder tissue. Magnetic resonance cholangiopancreatography (MRCP) on day 17 demonstrated a remnant gallbladder containing multiple calculi; the patient was advised to undergo complete cholecystectomy, but once again, neglected medical advice and was lost for follow-up. Conclusions and Further Directions: Temporary cholecystostomy in a disease-free (acalculous) gallbladder, associated with gastric surgery, leads to gallbladder dysmotility and neoformation of gallstones. The first clinical manifestation of silent, undetected neo-formatted calculi may consist of late, potentially lethal, biliary complications. Patients must be subjected to follow-up because the incidence of neo-formed calculi is higher than expected, compared with common gallstones. Prophylactic cholecystectomy for asymptomatic neo-formatted gallstones is a reasonable choice.