Łukasz Dziki

Background/Objectives: Accurate assessment of submucosal invasion is important when selecting patients with early colorectal cancer for organ-preserving treatment. Endoscopic submucosal dissection (ESD) and endoscopic intermuscular dissection (EID) enable en bloc resection and detailed histopathological assessment. This study explored whether routinely recorded pre-resection endoscopic characteristics differed between SM1 and SM2–3 lesions within a selected cohort of patients who underwent salvage surgery after non-curative endoscopic resection. Methods: We retrospectively analyzed 43 patients with T1 colorectal cancer who underwent ESD or EID and subsequently underwent salvage surgery because of non-curative histopathological findings. Among the 43 included patients, 37 underwent ESD and 6 underwent EID. Pre-resection Paris morphology and pit-pattern classification were compared according to final histopathological depth of submucosal invasion. Exploratory univariable logistic regression was used to examine associations with SM2–3 invasion. Results: Five patients had SM1 invasion and 38 had SM2–3 invasion. No statistically significant differences in the evaluated baseline or endoscopic variables were observed between the two groups. Exploratory regression estimates were imprecise, with wide confidence intervals, reflecting the small number of SM1 cases. Conclusions: In this selected cohort of patients undergoing salvage surgery after non-curative ESD/EID, Paris morphology and pit-pattern classification did not show statistically significant differences between SM1 and SM2–3 lesions. Because curatively treated patients were not included and only five patients had SM1 invasion, these findings do not estimate the diagnostic performance of these classifications in the broader pre-resection population and should be considered hypothesis-generating.

Background: Rectal neuroendocrine tumors (r-NETs) measuring 20 mm or less are increasingly diagnosed during colorectal cancer screening, but the optimal depth of endoscopic resection remains uncertain. Endoscopic submucosal dissection (ESD) is well established, whereas endoscopic intermuscular dissection (EID) may provide deeper resection for fibrotic or recurrent lesions. We hypothesized that EID would provide reliable deep-margin clearance without compromising safety. Methods: We retrospectively reviewed 42 consecutive patients treated at a tertiary center between 2018 and 2025. Thirty-two primary lesions underwent ESD and 10 lesions or scars suspicious for deep invasion underwent EID. Primary outcomes were en bloc and R0 resection; secondary outcomes were procedure time, adverse events, and length of stay. Groups were compared with the t, Mann–Whitney U, and chi-square tests. Results: En bloc resection was achieved in all cases. Histology confirmed R0 resection in all 26 primary lesions. Among 16 excision scars, 14 showed fibrosis only and 2 harbored grade 1 NET recurrence; both recurrent lesions were resected R0 with EID. Lesion size and procedure time were similar between groups. No major adverse events occurred. Self-limited intraprocedural bleeding occurred in five patients, and all patients were discharged within 2 postoperative days. Conclusions: Both techniques are safe and effective for r-NETs measuring 20 mm or less, and EID may be preferred for fibrotic or recurrent lesions. Large prospective multicentre studies are needed to validate the depth-tailored use of EID in r-NETs.

Background and Objectives: Acute cholecystitis is a common indication for emergency surgery. While acute calculous cholecystitis (ACC) is most common, acute acalculous cholecystitis (AAC) occurs without gallstones and is often associated with severe systemic illness. We compared early postoperative outcomes after cholecystectomy for AAC versus ACC, with emphasis on complication severity and overall morbidity burden. Materials and Methods: We performed a single-center retrospective cohort study of consecutive adults undergoing urgent or emergent cholecystectomy for acute cholecystitis between December 2020 and April 2025. Patients with chronic cholecystitis, duplicate records, missing group assignment, or incomplete 30-day follow-up were excluded. The primary 30-day endpoints were postoperative complications, their severity (assessed with Clavien–Dindo scale), and cumulative morbidity assessed using the Comprehensive Complication Index. Secondary outcomes included operative approach, postoperative length of stay, 30-day readmission, and mortality. Results: A total of 221 patients were analyzed (181 ACC, 40 AAC). Patients with AAC were older and more frequently male. Any complication within 30 days occurred substantially more often in AAC patients than in ACC patients. Morbidity severity also differed markedly, with higher-grade complications occurring more frequently in the AAC group. AAC patients exhibited a substantially greater overall morbidity burden, indicating not only more frequent complications but also a heavier cumulative impact. Thirty-day mortality was considerably higher in AAC. Open surgery was more commonly required in AAC, whereas postoperative length of stay and 30-day readmission rates were similar between groups. Conclusions: In this cohort, AAC was associated with substantially worse early outcomes after cholecystectomy than ACC, characterized by a pronounced increase in clinically significant complications (Clavien–Dindo ≥ IIIa), greater cumulative morbidity (CCI), and markedly higher 30-day mortality. These findings support treating AAC as a high-risk phenotype warranting intensified perioperative optimization and vigilant postoperative monitoring.

Background and Objectives: Circular stapled hemorrhoidopexy (CSH) is a surgical method to treat patients with hemorrhoidal disease. Compared to conventional hemorrhoidectomy, it is associated with reduced postoperative pain and a shorter recovery time, supporting a quicker return to daily activities. However, in populations treated using this technique performed with first-generation staplers, a higher recurrence rate was observed. Ongoing advancements in stapler technology appear to improve the surgical outcomes of CSH, maintaining its previous advantages. The aim of this study is to compare the surgical outcomes and recovery process between CSH performed with the new-generation TST-36 stapling device (TS-CSH) and the Milligan–Morgan hemorrhoidectomy (MMH). Materials and Methods: Medical records of 48 patients with grade III or higher hemorrhoids treated electively with MMH (n = 24) or TS-CSH (n = 24) between January 2023 and January 2025 were retrospectively reviewed. MMH patients were matched by age, sex, and perioperative risk (American Society of Anesthesiologists Physical Status Classification System, ASA-PS). Those with a history of previous hemorrhoid surgery, fewer than two columns excised, ASA-PS III or higher, patients who underwent urgent surgery, or declining participation were excluded. During the follow-up period, ranging from 3 to 28 months, in the outpatient clinic, patients’ medical records were updated regarding postoperative recovery time, pain (NRS), analgesic use, urinary retention, defecation difficulties, bleeding, complications, satisfaction, and symptom recurrence. Demographic and perioperative data were collected from electronic records. Results: The TS-CSH group experienced significantly lower pain scores at first defecation (p = 0.003), 24 h (p = 0.016), and 7 days postoperatively (p < 0.001). Additionally, time to full recovery was significantly shorter following TS-CSH compared to MMH (14.0 vs. 30.0 days, p < 0.001). No cases of fecal incontinence and anal stenosis were recorded. Three patients were identified as presenting symptoms of recurrence, all in the TS-CSH group; however, this finding did not reach the threshold of statistical significance. Conclusions: CSH performed with the new generation of stapling devices is minimally invasive, feasible, and a safe technique for treating grade III or IV hemorrhoids. TS-CSH should be considered as an alternative to conventional hemorrhoidectomy, associated with a trend toward lower pain and faster return to daily activities while maintaining a comparable satisfaction rate.

Introduction: Colorectal cancer (CRC) is the second most common cancer worldwide. Much attention has recently been paid to the epigenetic features of CRC. Homologous recombination repair (HRR) is a biochemical pathway that plays a crucial role in maintaining genome integrity through the repair of double-strand breaks (DBS). RAD51 recombinase is widely considered a key enzyme in HRR. Genome-wide single nucleotide polymorphisms (SNPs) are a significant type of genetic variation.Aim: The aim of this study was to assess the association between the occurrence of individual genotypes/alleles of the RAD51 172G/T polymorphism (rs1801321) and the risk of CRC.Materials and methods: The material used for DNA isolation was peripheral blood from patients at the Department of General and Colorectal Surgery, Medical University of Lodz. The study recruited patients (n = 188) with histologically confirmed colorectal cancer. The control group consisted of undiagnosed individuals (n = 200), matched for age and gender, without a family history of cancer among first-degree relatives.Results: No statistically significant association was found between the frequency of the assessed alleles/genotypes and the presence of CRC. The analysis also showed that the 127G/T variant of the RAD51 gene was not statistically significantly associated with the development of colorectal cancer.Discussion: The 127G/T polymorphism of the RAD51 gene appears to be an unpromising marker for colorectal cancer. However, new observations regarding the variant in the distal promoter may open up prospects for future research on molecular markers.Conclusions: The study results indicate no association between the RAD51 172G/T polymorphism and the risk of CRC. Therefore, there is a need for further research in the area of selected polymorphisms in CRC.

Exosomes are small extracellular vesicles found in body fluids. They contain proteins and nucleic acids that reflect the condition of the parent cell. Because of this, they may be useful in colorectal cancer (CRC) diagnostics. In this study we compared three plasma isolation methods: ultracentrifugation (UC), size exclusion chromatography (SEC), and a commercial Exo-spin kit. The material obtained with each method was checked for protein content, purity, and vesicle integrity using protein measurements, Western blots, and scanning electron microscopy. From these results SEC was chosen for further use. Exosomes isolated with this method were tested by an enzyme-linked immunosorbent assay (ELISA) for four CRC-related proteins: HSP70, CK19, CA125, and TAG72. Patient samples showed higher levels of HSP70, CK19, and CA125 than controls. TAG72 levels did not differ. In addition, men had more HSP70 than women. These findings show that SEC can be applied for exosome isolation from plasma and that specific proteins detected in exosomes, including HSP70, CK19, and CA125, may serve as promising markers for non-invasive colorectal cancer diagnosis and monitoring.

Peripheral nerve injuries (PNIs) present significant clinical challenges, often leading to severe motor, sensory, and autonomic dysfunction, with profound impacts on patient quality of life and considerable healthcare costs. This review synthesizes current knowledge on the therapeutic potential of Pulsed Electromagnetic Fields (PEMF) and Low-Intensity Pulsed Ultrasound (LIPUS) as non-invasive modalities for promoting peripheral nerve regeneration. We explore their cellular and molecular mechanisms of action, discuss optimal treatment parameters, and present evidence from preclinical and clinical studies, including their synergistic effects with other therapies and emerging applications beyond neurological repair. Clinical studies have shown that PEMF therapy can significantly reduce neuropathic pain and improve functions, whereas LIPUS demonstrates the ability to enhance nerve conduction.

The pH gradient inversion is one of the characteristic features of cancer cells. The acidic environment outside the tumor and the alkaline inside cancer cells significantly affect its growth and ability to metastasize and reduce the effectiveness of therapy. In this study, we examined the effect of the alkaline pH on the viability of colorectal cancer (CRC) cells Caco-2 and Ht-29, and normal human fibroblasts BJ-CRL-2522 as a control cell line. Moreover, we analyzed the expression level of 3 genes at different pH: pro-apoptotic BAX, proliferation marker MKI67, and pH-sensitive receptor GPR4 using the RT-qpCR method. We demonstrated increased Ht-29 cell viability at alkaline pH, with simultaneous morphological changes, and decreased Caco-2 cell viability at pH above 9. The expression of BAX, GPR4 was upregulated in Ht-29 and BJ cells cultured at alkaline pH, whereas in Caco-2 cells the expression was significantly different between conditions. MKI67 expression was slightly increased in HT-29 and BJ, while decreased in Caco-2 cells. Our study shed new light on the cellular processes occurring under the influence of alkalization, but it is difficult to assess what role alkalization may play in the potential therapy of CRC, therefore, further studies are necessary.

Background/Objectives: The aim of this study was to determine the assessment of the percentage of NK and NKT-like cells expressing Toll-like receptors (TLR-2, TLR-3, TLR-4, and TLR-9) in patients with gastric cancer (GC) compared with healthy volunteers (HV) and to investigate differences according to cancer subtype. We also assessed TLR gene expression by RT-qPCR to assess whether TLRs could be diagnostic and prognostic biomarkers. Methods: The study included 86 patients with histologically confirmed gastric cancer and 30 healthy volunteers. Peripheral blood samples were collected from the participants, and TLR expression on NK and NKT-like cells was assessed by flow cytometry and RT-qPCR. The expression of TLR2, TLR3, TLR4, and TLR9 genes was assessed using genetic material derived from NK and NKT-like cells sourced from PBMC. The obtained results were statistically analyzed using Mann–Whitney U and Kruskal–Wallis tests, and the predictive ability of variables was assessed using ROC curve analysis. Results: A significantly higher expression of TLR receptors (TLR-2, TLR-3, TLR-4, and TLR-9) was found in patients with gastric cancer compared to healthy volunteers (p < 0.05). TLR expression also differed depending on the cancer subtype, and higher expression was observed in more advanced GC subtypes. RT-qPCR analysis showed significantly increased expression of TLR genes in the group of GC patients. ROC curves indicate a high ability of TLRs to differentiate between GC patients and healthy individuals. Conclusions: The expression of TLRs on NK and NKT-like cells is clearly increased in patients with gastric cancer, especially in more advanced subtypes of the tumor. The results suggest that TLRs could potentially be used as diagnostic and prognostic biomarkers and represent potential targets for immune therapies in GC. However, further studies are needed to determine the functional role of TLRs in disease progression and the possibility of their use in personalized treatment.

(1) Introduction: Toll-like receptors (TLRs) are key in immune response by recognizing pathogen-associated molecular patterns (PAMPs) and damage-associated molecular patterns (DAMPs). In gastric cancer (GC), TLR2, TLR3, TLR4, and TLR9 are crucial for modulating immune response and tumor progression. (2) Objective: This study aimed to assess the percentage of dendritic cells and monocytes expressing TLR2, TLR3, TLR4, and TLR9, along with the concentration of their soluble forms in the serum of GC patients compared to healthy volunteers. Factors such as disease stage, tumor type, age, and gender were also analyzed. (3) Materials and Methods: Blood samples from newly diagnosed GC patients and healthy controls were immunophenotyped using flow cytometry to assess TLR expression on dendritic cell subpopulations and monocytes. Serum-soluble TLRs were measured by ELISA. Statistical analysis considered clinical variables such as tumor type, stage, age, and gender. (4) Results: TLR expression was significantly higher in GC patients, except for TLR3 on classical monocytes. Soluble forms of all TLRs were elevated in GC patients, with significant differences based on disease stage but not tumor type, except for serum TLR2, TLR4, and TLR9. (5) Conclusions: Elevated TLR expression and soluble TLR levels in GC patients suggest a role in tumor pathogenesis and progression, offering potential biomarkers and therapeutic targets.