Pedro Villarejo-Campos

Objectives: Magnetic resonance imaging plays a pivotal role in the management of locally advanced rectal cancer. This study aims to assess the correlation between magnetic resonance tumor regression grade and pathological tumor regression grade following neoadjuvant therapy in patients with locally advanced rectal cancer. Material and Methods: A retrospective analysis was conducted on 97 patients diagnosed with LARC (T3-T4 or any T stage with regional lymph node involvement) who underwent neoadjuvant chemoradiotherapy followed by radical surgery between 2014 and 2020. The correlation between mrTRG and pTRG was evaluated primarily using the weighted Kappa statistic. Additional clinical and imaging data were collected for a comprehensive analysis. Results: The median interval between completion of neoadjuvant therapy and restaging MRI was 40 days, with a median of 69 days from completion of chemoradiotherapy to surgery. The weighted Kappa was 0.27, indicating fair agreement between mrTRG and pTRG. MRI demonstrated a sensitivity of 52.1% and specificity of 81.6% for detecting a good response (pTRG 1–2). For identification of a complete response (pTRG 1), MRI showed a sensitivity of 10% and specificity of 98.7%. Conclusions: The correlation between mrTRG and pTRG shows fair agreement. Although MRI alone may not be sufficient to reliably predict pathological response, its high specificity suggests it can be a useful tool to confirm good and complete responses. Therefore, MRI should be integrated with other diagnostic methods, such as endoscopy and digital rectal examination, especially in organ preservation strategies. Moreover, MRI retains potential as a prognostic factor to guide clinical decision-making in LARC.

Background: Pancreatic metastases from cervical cancer are exceptionally rare, with limited cases described in the literature. Their diagnosis and management remain challenging due to the absence of standardized protocols and the often poor prognosis. Case Presentation: We report the case of a 39-year-old woman with a history of treated stage IIIB cervical squamous cell carcinoma who presented with a solitary mass in the pancreatic tail. Diagnosis was established through cross-sectional imaging, PET-CT, and EUS-guided needle biopsy. The patient underwent systemic chemotherapy and SBRT followed by surgical resection. Histopathological analysis confirmed metastatic squamous cell carcinoma associated with HPV. Despite an initially favorable recovery, peritoneal metastases developed three months later. The patient died seven months after surgery under palliative care after disease progression on immunotherapy. Methods: A systematic review following PRISMA guidelines was conducted across PubMed, Cochrane, and Embase (2000–2025) to identify case reports and series describing pancreatic metastases from cervical cancer. A total of 14 published cases, together with the present case, were analyzed for demographic, clinical, diagnostic, therapeutic, and outcome data. Results: The mean age at diagnosis was 52.5 years (range 36–70). Squamous cell carcinoma was the predominant histology (73%). The pancreatic head was the most common metastatic site (53%). Diagnosis typically relied on abdominal CT, PET-CT, and EUS-guided biopsy. Surgical resection was performed in 28.6% of cases, while systemic therapy—most commonly cisplatin, paclitaxel, and bevacizumab—remained the mainstay for inoperable patients. Conclusions: Pancreatic metastases from cervical cancer usually occur in advanced disease stages and are associated with poor outcomes. Accurate diagnosis requires integration of imaging and histopathology, with PET-CT useful for detecting additional metastases. Surgery may be beneficial in selected patients with isolated lesions, but systemic therapy remains the primary treatment for most. Emerging immunotherapies show promise but are still in early development. Multidisciplinary management and further research are needed to optimize outcomes in this rare presentation.

Background: Most of the advances in liver surgery have been achieved in the last few decades. The development of new diagnostic and therapeutic techniques has aided diagnosis and has facilitated more efficient and personalized resections for liver disorders. The estimation of the hepatic reserve has gained great importance because it marks the limit for more aggressive liver resections. It was hypothesized that determination of hepatic reserve by measuring plasma clearance of indocyanine green—following hepatic parenchymal liver resection—could provide earlier and more accurate knowledge of hepatic reserve and thus allow for more personalized therapy. Methods: A prospective observational post-authorization study was performed. Results: Applying ROC curves and the area under the curve (AUC) for the evaluation of the different tests as predictors of liver failure, favorable data were obtained in relation to bilirubin (AUC = 0.922) and prothrombin time (AUC = 1), and for postoperative PDR (AUC = 0.879) and GOT (AUC = 0.857), but not for preoperative PDR (AUC = 0.667) or GPT (AUC = 0.6). Conclusions: The gold standard for predicting early liver failure (the 50:50 criterion at on postoperative day 5) has a very good relationship with the plasma clearance rate of indocyanine green on postoperative day 1 and therefore has the potential to support earlier and more personalized therapeutic interventions, pending further validation.

Colorectal cancer (CRC) is one of the most prevalent and lethal cancers worldwide, with few effective treatment options and substantial associated side effects. As a result, there is growing interest in therapeutic alternatives that reduce toxicity. Natural compounds such as sodium butyrate (NaB), a microbial metabolite of dietary fiber, and bromelain, a proteolytic enzyme from pineapple, have shown individual anticancer properties. However, their combined effect in CRC remains underexplored. This study investigates the synergistic potential of NaB and bromelain in colorectal cancer cell lines, focusing on their ability to inhibit proliferation, induce apoptosis, and modulate key molecular pathways. Findings reveal that co-treatment enhances antitumor activity in vitro, suggesting a promising and safer therapeutic strategy for CRC.

Background/Objectives: The aim of this study was to evaluate fluid administration and intraoperative bleeding of patients who had major hepatic resection. We used artery pulse contour analysis monitor (ProAQT™) and personalized hemodynamic target-guided therapy, in which the administration of fluid, inotropes and vasopressors is guided by stroke volume, pulse pressure variation (SVV, PPV) and continuous cardiac index (CI). Methods: This trial was a prospective, randomized, parallel-group in adults scheduled for major hepatic resection. Participants were randomly assigned in equal numbers to one of two groups: (1) a control group receiving conventional perioperative care, and (2) an intervention group managed with goal-directed hemodynamic therapy guided by radial artery pulse contour analysis. Results: 45 patients were randomized to the GDHT (n = 16) and control group (n = 19). Blood loss was significantly higher in the control group than in GDHT group (728.13 ± 618.59 versus 292.63 ± 274.06, p = 0.009). The number of patients receiving intraoperative transfusion was significantly higher in the first group (6 ± 16 versus 0 ± 19, p = 0.005). Total volume infused was significantly higher in control group (CG) than in GDHT group (GG) (2853.13 ± 1432.18 versus 1125.79 ± 751.2, p = 0.001). Conclusions: Personalized goal-directed therapy optimizes intraoperative fluid administration during major liver resection and reduces blood transfusion.

The tumor microenvironment (TME) plays a critical role in cancer progression and response to treatment. In colorectal cancer (CRC), a collagen-rich extracellular matrix (ECM) is a well-established feature of primary tumors and liver metastases. However, the composition of the ECM in peritoneal metastases remains poorly characterized. In this descriptive study, we analyzed the histological distribution of four major collagen types (I, II, III, and IV) in peritoneal metastases from 39 CRC patients using immunohistochemical techniques. Type III fibrillar collagen was predominant, showing moderate to high expression in 80 percent of cases, followed by type IV collagen in 56 percent. Type I collagen demonstrated low intensity in 64 percent of cases. Notably, type II collagen, typically restricted to cartilaginous tissues, was also detected within the tumor stroma, an unexpected finding given its usual absence in this histological contex. These results highlight the unique collagen-rich stroma in CRC peritoneal metastases, dominated by types III and IV collagen, and identify type II collagen as a novel component. This study provides new insight into the stromal architecture of CRC peritoneal metastases and may serve as a foundation for future research on collagen-targeted therapeutic strategies.

Background: In recent years, the use of minimally invasive approaches in pancreatic surgery has progressively increased. One of the key components of pancreaticoduodenectomy is the creation of a pancreato-enteric anastomosis, due to the high risk of postoperative complications, particularly the development of postoperative pancreatic fistula. Among the types of anastomoses, the Blumgart technique has gained popularity due to its ease of reproducibility. Methods: In this guide, we summarize and systematize step by step how to perform a feasible, reproductible and safe robotic Blumgart pancreaticojejunostomy, providing some instructions for its successful completion. Results: Despite the heterogeneity of the published data, duct-to-mucosa Blumgart anastomosis seems to be superior in terms of clinically relevant postoperative pancreatic fistula rates compared with other types of pancreato-enteric anastomosis. The advantages of robotic surgery, such as improved precision, greater control, and enhanced visualization, make robotic Blumgart anastomosis a safe, practical, and reproducible technique in the context of robotic pancreaticoduodenectomy. Conclusions: Robotic Blumgart pancreaticojejunostomy is a safe and feasible technique for pancreato-enteric anastomosis following pancreaticoduodenectomy when surgical technique is systematized step by step.

Objectives: Inflammatory fibroid polyps, also known as Vanek’s tumors, are rare benign lesions of the gastrointestinal tract. Although the exact cause remains unclear, several theories suggest an association with inflammatory processes and genetic factors. This study aims to present the largest cohort of inflammatory fibroid polyp cases to date, analyzing their clinical presentation, diagnostic methods, and treatment approaches. Materials and methods: A retrospective multicentric analysis was conducted on 67 patients diagnosed with inflammatory fibroid polyps between 2013 and 2023 across four hospitals. Clinical data regarding tumor location, size, symptoms, and treatment were collected. Non-parametric statistical tests, including the chi-square test, Cramér’s V coefficient, and the Mann–Whitney U test, were used to identify association between tumor characteristics, location, and treatment outcomes. Results: The cohort included 67 patients (58.2% female, median age 60 years). The stomach was the most common tumor site (47.8%), followed by the colon (32.8%), and small intestine (10.4%). The majority of patients (73.1%) were asymptomatic, while 9% experienced intestinal obstruction, all of which were located in the small intestine. Endoscopic resection was successful in 77.6% of cases, but surgical intervention was more frequently required for tumors in the small intestine. A significant association was found between larger tumor size, emergency presentation, intestinal location, and the need for surgery. Conclusions: Inflammatory fibroid polyps are commonly managed with endoscopic resection, particularly in gastric and colonic locations. However, small intestinal tumors more often need surgical treatment, especially when presenting with complications like intestinal obstruction.

Oval cells (OCs) is the name of hepatic progenitor cells (HPCs) in rodents. They are a small population of cells in the liver with the remarkable ability to proliferate and regenerate hepatocytes and cholangiocytes in response to acute liver damage. Isolating OCs generally requires a pretreatment with special diets, chemicals, and/or surgery to induce hepatic damage and OC proliferation in mice. Unfortunately, these pretreatments are not only painful for the mice but also increase the cost of the assays, and the effects on the different organs as well as on various liver cells are still unclear. Therefore, the search for a protocol to obtain OCs without prior liver damage is mandatory. In our study, we present a protocol to isolate murine OCs from healthy liver (HL-OCs) and compare them with OCs isolated from mice pretreated with 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC-OCs). Our results demonstrated that cells derived from untreated mice exhibited similar behavior to those from treated mice in terms of surface marker expression, proliferation, and differentiation capacity. Therefore, given the impracticability of isolating human cells with prior hepatotoxic treatment, our model holds promise for enabling the isolation of progenitor cells from human tissue in the future. This advancement could prove invaluable for translational medicine in the understanding and treatment of liver diseases.