Nicola De’aNgelis

Background: Gastric cancer (GC) remains a leading cause of cancer death worldwide. A subset of patients presents acutely with life-threatening complications such as perforation, obstruction, or bleeding, requiring surgery under suboptimal conditions. This multicenter Italian study aimed to explore outcomes of emergency GC surgery, identify prognostic factors, and compare survival across clinical presentations. Methods: Between 2013 and 2022, 263 GC patients presented emergently at two high-volume Italian centers. Among them, 90 patients with histologically proven adenocarcinoma who underwent emergency surgery were included. Primary outcomes were 30-day mortality and overall survival (OS). Results: Obstruction was the most frequent presentation (41.1%), followed by hemorrhage (34.4%) and perforation (24.4%). Severe complications (Clavien–Dindo ≥ 3) occurred in 28.8% of patients, and thirty-day mortality reached 13.3%. Median OS was 6.5 months. Diffuse-type GC predicted shorter OS than intestinal-type (5.5 vs. 14 months; p = 0.015). Radical surgery was performed in 63.3% of cases and was associated with superior OS compared with palliative procedures (14 vs. 4.5 months; p < 0.001). The clinical presentation did not influence survival. On exploratory multivariable analysis, advanced age and diffuse histology were associated with higher 30-day mortality, while gastric resection was associated with better OS. Conclusions: Emergency GC surgery carries high morbidity and mortality. Age, histology, and gastric resection were independent prognostic factors, whereas clinical presentation did not significantly affect survival. Early diagnosis and tailored perioperative strategies are needed to improve outcomes.

Introduction: Minimally invasive right colectomy (MIRC) is the gold standard for the treatment of right‐sided colonic diseases, particularly in cancer patients. However, mastering this procedure requires overcoming a significant learning curve (LC). This systematic review (SR) analyzes existing evidence on LC in MIRC. Methods: This SR was conducted according to the PRISMA guidelines. The PubMed, Scopus, EMBASE, and Cochrane Library databases were screened without time restrictions up to June 2024. The risk of bias was assessed for individual studies according to the ROBINS‐I tools, while the certainty of the evidence was assessed according to the GRADE approach. The protocol was registered on PROSPERO (ID: CRD42024507060). Results: Nine cohort studies published between 2005 and 2022 met the inclusion criteria. The median number of cases needed to overcome the LC for MI‐RC was 26 (range 13–55), 25 (range 18–55) procedures for the laparoscopic, and 27 (range 13–44) for the robotic approach. The comparison between the learning and the proficiency phase shows a significant reduction of operative time (MD: −41.51 min; p = 0.0027) and postoperative morbidity (OR = 0.49; p = 0.043) after the LC was achieved. No differences were detected in the estimated blood loss (MD: −3.3 mL; p = 0.77), whit a significantly high heterogeneity ( I ² = 68.8%). Conclusions: The lack of standardization in defining and assessing the LC contributes to the heterogeneity of findings among studies. The development of standardized guidelines is essential to improve colorectal surgical training.

Background/Objectives: In modern medicine, humanization of care is a central theme that highlights the complementarity of clinical care with empathy, communication, and patient-centered values. The increasing use of robotic surgery is rapidly modifying surgical practice, introducing new challenges and opportunities in preserving the human dimension of care. This review aimed to synthesize the available evidence and propose a conceptual model of humanized robotic surgical care. Methods: A structured narrative review of the PubMed/MEDLINE database (from inception to January 2026) was conducted using predefined keywords related to humanization of care, robotic surgery, patient perception, surgeon experience, human factors, communication, ethics, and technological mediation. Relevant English-language publications were critically synthesized to develop a conceptual framework. Results: The literature indicates that robotic surgery influences humanized care through three interconnected domains. First, patients frequently perceive robotic surgery as more precise and technologically advanced, which may generate unrealistic expectations and misconceptions regarding robotic autonomy. Second, robotic platforms reshape the surgeon’s experience by improving ergonomics while simultaneously modifying cognitive workload, sensory feedback, and professional identity. Third, technology itself acts as an active mediator influencing communication, trust, decision-making, and relational dynamics. Building upon these findings, we propose an original triangular conceptual framework integrating the patient, the surgeon, and the technology as three interdependent determinants of humanized robotic surgical care. The framework also provides a conceptual basis for understanding the future integration of artificial intelligence into surgical practice. Conclusions: Humanization of care in the era of robotic surgery requires an integrated approach that recognizes the interdependence of patient perception, surgeon experience, and technological mediation. Ensuring effective communication, supporting surgeon well-being, and preserving ethical principles will be essential to aligning innovation with patient-centered care.

Background: Oncologic quality in colon cancer surgery hinges on achieving adequate longitudinal margins, lymphadenectomy, and mesenteric excision, yet international standards and segment-specific practices remain heterogeneous. Methods: A focused PubMed/MEDLINE search from inception to October 2025 identified international guidelines, randomized and non-randomized comparative studies, large registries, and meta-analyses addressing: (1) longitudinal resection margins; (2) lymph node (LN) yield and nodal metrics; and (3) complete mesocolic excision (CME) with central vascular ligation (CVL)/D3 versus standard colectomy in curative-intent colon cancer surgery. The study aimed to delineate current standards in colon cancer resection. Results: Mapping studies and guidelines converge on 5–7 cm longitudinal margins for most tumors, with extension toward 10 cm in advanced T stage (cT3–cT4 disease) or when arterial geometry indicates a longer at-risk pericolic segment. LN assessment beyond the historical ≥12 minimum improves staging accuracy and survival, with several large datasets suggesting a plateau around 18–22 examined nodes. CME/CVL/D3 reliably increases nodal yield and specimen quality without excess morbidity in optimized settings and appears to confer an oncologic advantage across stages II–III, with the most consistent survival signal in stage III disease. Conclusion: An oncologically adequate colectomy should aim for: (1) R0 resection with 5–7 cm margins, extendable toward 10 cm when dictated by tumor stage or vascular anatomy; (2) mesenteric resection to the feeding-vessel origin targeting 18–22 LNs (minimum ≥12), with systematic reporting of tumor deposits and LN ratio; and (3) thoughtful use of CME/CVL/D3 embedded within structured training and routine audit of outcomes, particularly for stage III right colon cancers.

Background: Despite the advantages of robotic-assisted liver resection (RALR), intraoperative blood loss (IBL) remains a main concern in hepatic surgery. The current multicenter study was designed to evaluate the determinants of significant intraoperative bleeding in RALR and the clinical impact of such bleeding. Methods: This study retrospectively analyzed 708 consecutive RALR performed in nine high-volume European centers between 2011 and 2023. All demographic, intraoperative, and postoperative data were extracted from a shared database. Patients were stratified into two groups based on the IBL value (< 500 mL vs. ≥ 500 mL). Variables that reached the level of p < 0.10 at univariable analysis were included in a multivariate logistic regression model. Results: The mean IBL was 224.7 mL, and 9.6% of patients experienced IBL ≥ 500 mL. Both cirrhosis (OR 3.00, 95% CI 1.63–5.52; p < 0.001) and higher TAMPA score (OR 1.09 per point, 95% CI 1.03–1.16; p = 0.004) independently predicted major bleeding. Patients with IBL ≥ 500 mL had longer operative times (372 vs. 239 min, p < 0.001), higher morbidity (72% vs. 46%, p < 0.001), and greater mortality (4.4% vs. 0.6%, p = 0.022). Conclusions: During RALR significant bleeding persists in 10% of cases. Cirrhosis and procedural complexity remain independent predictors. Early identification of the high-risk patient and tailored perioperative strategies are of paramount importance in reducing bleeding and improving overall outcomes following robotic hepatobiliary surgery.

Background: Breast cancer is a widespread disease and, when metastatic, has a bleak prognosis. The surgical approach for BCLM has had a limited role, but robotic surgery could find an important place. Methods: Data were collected from a multicenter retrospective database that includes 1070 consecutive robotic liver resections performed in nine European hospital centers from 2011 to 2023. Of the entire series, 35 were performed for BCLM in five European hospital centers. Results: The post-operative complication rate was 11.44%, but no severe complications occurred. The mean hospital stay was 4.65 days. One patient (2.85%) was readmitted to the hospital within 90 days after discharge and died due to heart failure, with a 90-day mortality of 2.85%. Conclusions: Robotic liver resection for BCLM is feasible and safe when performed in experienced centers by surgeons who have completed the learning curve.