Piotr Richter

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by the presence of hepatic steatosis and at least one cardiometabolic risk factor. Differences in the incidence of MASLD between men and women are primarily due to distinct metabolic and cardiovascular profiles. The aim of this observational study was to investigate the prevalence and characteristics of MASLD in men and women. Methods: The study included patients from the Polish Gallstone Surgery Registry diagnosed with MASLD according to current criteria. Results: Among 3419 patients, MASLD was diagnosed in 24.2%. Its prevalence was significantly higher in men (29.8%) than in women (21.9%) (p < 0.0001), with the highest incidence observed in men aged 70–79 (32.1%) and women aged 70–79 (33.3%). MASLD was associated with overweight in individuals aged < 50 years (OR 1.87; 95% CI: 1.11–3.14; p < 0.0186) and in those aged ≥ 50 years (OR 1.99; 95% CI: 1.48–2.68; p < 0.001), as well as with obesity in patients aged < 50 years (OR 6.53; 95% CI: 4.08–10.47; p < 0.001) and in those aged ≥ 50 years (OR 3.9; 95% CI: 2.92–5.22; p < 0.0001). Conclusions: In this study, MASLD was diagnosed more frequently in men than in women, and its incidence showed a positive association with increasing BMI. These findings indicate that excess body weight and sex are key predictors of MASLD, highlighting the need for individualized treatment strategies.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is defined by the presence of hepatic steatosis and at least one the cardiometabolic risk factors. Differences in the incidence of MASLD between men and women are primarily due to distinct metabolic and cardiovascular profiles. The aim of this observational study was to investigate the prevalence and characteristics of MASLD in men and women. Methods: The study included patients from The Polish Gallstone Surgery Registry diagnosed with MASLD according to current criteria. Results: Among 3419 patients, MASLD was diagnosed in 24.2%. Its prevalence was significantly higher in man (29.8%) than in women (21.9%) (p< 0.0001), with the highest incidence observed in men aged 70-79 (32.1%) and women aged 70-79 (33.3%). MASLD was associated with overweight in both men (OR 1.60; 95% CI: 1.03–2.48) and women (OR 2.45; 95% CI: 1.80–3.35), as well as with obesity in men (OR 3.44; 95% CI: 2.21–5.34) and women (OR 5.51; 95% CI: 4.10–7.40). Conclusions: In this study, MASLD was diagnosed more frequently in men than in women. The incidence of MASLD increased with age and BMI, with this relationship being more pronounced in women. Therefore, age and excess body weight are key predictors of MASLD, highlighting the need for individualized treatment strategies, regardless of gender.

Objective: To assess the rate of textbook outcome (TO) and textbook oncological outcome (TOO) in the European population based on the GASTRODATA registry. Background: TO is a composite parameter assessing surgical quality and strongly correlates with improved overall survival. Following the standard of treatment for locally advanced gastric cancer, TOO was proposed as a quality and optimal multimodal treatment parameter. Methods: TO was achieved when all the following criteria were met: no intraoperative complications, radical resection according to the surgeon, pR0 resection, retrieval of at least 15 lymph nodes, no severe postoperative complications, no reintervention, no admission to the intensive care unit, no prolonged length of stay, no postoperative mortality and no hospital readmission. TOO was defined as TO with the addition of perioperative chemotherapy compliance. Results: Of the 2558 patients, 1700 were included in the analysis. TO was achieved in 1164 (68.5%) patients. The use of neoadjuvant chemotherapy [odds ratio (OR) = 1.33, 95% CI: 1.04–1.70] and D2 or D2+ lymphadenectomy (OR = 1.55, 95% CI: 1.15–2.10) had a positive impact on TO achievement. Older age (OR = 0.73, 95% CI: 0.54–0.94), pT3/4 (OR = 0.79, 95% CI: 0.63–0.99), ASA 3/4 (OR = 0.68, 95% CI: 0.54–0.86) and total gastrectomy (OR = 0.56, 95% CI: 0.45–0.70), had a negative impact on TO achievement. TOO was achieved in 388 (22.8%) patients. Older age (OR = 0.37, 95% CI: 0.27–0.53), pT3 or pT4 (OR = 0.52, 95% CI: 0.39–0.69), and ASA 3 or 4 (OR = 0.58, 95% CI: 0.43–0.79) had a negative impact on TOO achievement. Conclusions: Despite successively improved surgical outcomes, stage‐appropriate chemotherapy in adherence to the current guidelines for multimodal treatment of gastric cancer remains poor. Further implementation of oncologic quality metrics should include greater emphasis on perioperative chemotherapy and adequate lymphadenectomy.

Background/Aim: Bioelectrical Impedance Analysis is a method that evaluates body composition, useful in assessing the nutritional status of cancer patients. The analysis of its indicators may be helpful in predicting clinical course. The aim of the study was to evaluate the following body composition parameters: fat mass (FM), fat-free mass (FFM), skeletal muscle mass (SMM), muscle mass index (MMI), visceral fat (VF) and body mass index (BMI) measured before and after surgery in patients with gastrointestinal cancer and to determine the relationship between body composition and the course of treatment. Patients and Methods: The study included 125 patients, aged 65-68, operated on due to gastric, pancreatic or colorectal cancer. Body composition was assessed with electrical bioimpedance before and on the fifth postoperative day. The severity of complications was assessed with the Clavien-Dindo classification. Results: In the whole group of patients, the percentage of FM, VF, and BMI levels measured before surgery were significantly higher in curative surgery patients in comparison to palliative surgery patients, p<0.001. The MMI value was also significantly higher, p=0.045. In patients after curative surgery, the values of BMI and FM significantly decreased (BMI – p<0.001; FM – p=0.003) after the surgery. There was no relation between body composition parameters and severity of postoperative complications. Conclusion: In the investigated group, body composition differed between radical and palliative surgery groups. Surgery with curative intent produced more changes in body composition parameters in the early postoperative period than palliative surgery. These observations may be helpful in prehabilitation planning for such patients.

Background: Liver resections have become the first-line treatment for primary malignant tumors and, therefore, are considered a core aspect of surgical training. This study aims to evaluate the learning curve for the safety of open hemihepatectomy procedures for patients suffering from hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC). Methods: This single tertiary center retrospective analysis includes 81 consecutive cases of right or left hemihepatectmy. A cumulative sum (CUSUM) control chart was used to investigate the learning curve. Results: The CUSUM curve for operative time and blood loss level peaked at the 29th and 30th case, respectively. The CUSUM curve for minor adverse effects (mAEs) and severe adverse effects (sAEs) showed a downward slope after the 27th and 36th procedures; the curve, however, remained within the acceptable range throughout the entire study. Conclusion: When performing open hemihepatectomies in patients with HCC and ICC, the stabilization of the operative time and intraoperative blood loss level are gained earlier than sAEs risk reduction.

This document - "Polish Consensus on Gastric Cancer Diagnosis and Treatment - Update 2022" - represents an expert consensus following a year's worth of dedicated effort by a team of specialists throughout 2021, put forward in a conference in December 2021 in Krakow, and finalized below for publication in 2022. The effective date of this document is June 14th 2022. The work that went into updating this consensus was made under auspices of the Polish Society of Surgical Oncology and the Association of Polish Surgeons.

Background: Liver resections have become the first-line treatment for primary and metastatic tumors and, therefore, are considered a core aspect of surgical training. This study aims to evaluate the learning curve of the extent and safety of liver resection procedures for patients with metastatic colorectal cancer. Methods: This single tertiary center retrospective analysis includes 158 consecutive cases of small liver resection (SLR) (n = 107) and major liver resection (MLR) (n = 58) procedures. A cumulative sum control chart (CUSUM) method was used to investigate the learning curve. Results: The operative time, total blood loss level, and incidence of adverse effects showed a learning curve. For SLRs, the CUSUM curve for operative time and blood loss level peaked at the 19th and 17th case, respectively, while for MLRs, these curves peaked at the 28th and 24th case, respectively. The CUSUM curve for minor adverse effects (MAEs) and severe adverse effects (SAEs) showed a downward slope after the 16th and 68th procedures in the SLRs group and after the 29th and 39th procedures in the MLRs cohort; however, it remained within the acceptable range throughout the entire study. Conclusion: SLR procedures were performed faster with less intraoperative blood loss and shorter postoperative stays than MLRs, and a higher number of completed procedures was required to gain stabilization and repeatability in the operating time and intraoperative blood loss level. In MLR procedures, the reduction of SAEs was accomplished significantly later than the stabilization of the operative time and intraoperative blood loss level.

By 2030, 70% of all pancreatic cancer will be diagnosed in the older population. However, pancreas operations are a complex surgical procedure with a high rate of morbidity and mortality. Therefore, the benefits of surgical resection in older patients are controversial and decisions about treatment for this group must be well balanced. Chronological age alone should not be a contraindication for multimodal radical treatment in older patients. Fit patients, according to the comprehensive geriatric assessment (SGA), should be qualified for the same treatment as younger patients to benefit the same outcomes. However, they should be operated on in high-volume hospitals by experienced surgeons. Prefrail patients should undergo prehabilitation, during neoadjuvant treatment also, and then reevaluated. Frail patients should be discussed in an oncogeriatric meeting. We still do not have evidence-based data to design a tailored approach for them so as to balanced good oncologic outcomes and the appropriate postoperative quality of life. By 2030, 70% of all pancreatic cancer will be diagnosed in the older population. However, pancreas operations are a complex surgical procedure with a high rate of morbidity and mortality. Therefore, the benefits of surgical resection in older patients are controversial and decisions about treatment for this group must be well balanced. Chronological age alone should not be a contraindication for multimodal radical treatment in older patients. Fit patients, according to the comprehensive geriatric assessment (SGA), should be qualified for the same treatment as younger patients to benefit the same outcomes. However, they should be operated on in high-volume hospitals by experienced surgeons. Prefrail patients should undergo prehabilitation, during neoadjuvant treatment also, and then reevaluated. Frail patients should be discussed in an oncogeriatric meeting. We still do not have evidence-based data to design a tailored approach for them so as to balanced good oncologic outcomes and the appropriate postoperative quality of life.

A significant problem for long-term rectal cancer survivors may be the late toxicity of radiotherapy. It creates the possible risk of developing second primary malignancy and a theoretical decrease in overall survival. This study aimed to assess the influence of short-course preoperative radiotherapy in patients with locally advanced rectal cancer on overall survival, local recurrence rate, and second malignancy at 18-year follow-up. The rectal cancer trial was conducted in a single tertiary center between February 1992 and June 2006. A total of 389 patients with locally advanced rectal cancer (cT2-cT4, cN0/+, cM0) were included in the study. Preoperative radiotherapy was conducted in 148 patients and 241 patients underwent surgery alone. The propensity-matched group consisted of 105 patients operated on after radiotherapy and 105 controls. The number of local recurrences was 7 (6.7%) in the preoperative radiotherapy group and 22 (21%) in the surgery alone group (p = 0.016). The 18-year survival analysis showed no survival benefit in the preoperative radiotherapy group (38% versus 48%, p = 0.107) but improved recurrence-free survival (81% versus 58%, p = 0.001). The preoperative short-course radiotherapy significantly decreases the risk of local recurrence in locally advanced rectal cancer and may improve recurrence-free survival without an increased risk of second primary malignancy.