Magdalena Leśniewska

Background: Composite immunonutritional biomarkers reflecting systemic inflammation, nutritional status, and immune competence have emerged as promising tools for perioperative risk stratification in colorectal cancer (CRC). However, their prognostic value during the perioperative period following minimally invasive CRC surgery remains unresolved. This study aimed to evaluate the association between perioperative inflammatory biomarkers, including the neutrophil-to-lymphocyte ratio (NLR), hemoglobin–albumin–lymphocyte–platelet (HALP) score, and Host Index (H-index), and short-term postoperative outcomes after minimally invasive colorectal cancer surgery. Methods: This retrospective single-center study included 105 patients who underwent minimally invasive curative-intent surgery for CRC between 2023 and 2025. Biomarkers were assessed preoperatively and during the first four postoperative days. Severe postoperative morbidity was defined as a Comprehensive Complication Index (CCI) ≥ 20.9. Results: Among all parameters, NLR measured on postoperative day 3 demonstrated the highest apparent discriminatory ability for severe complications (AUC = 0.87, 95% CI: 0.74–0.95; sensitivity 91.7%; specificity 73.7%). Preoperative HALP was the most informative preoperative marker (AUC = 0.78, 95% CI: 0.66–0.87; sensitivity 76.5%; specificity 87.7%). Conclusions: Perioperative inflammatory and immunonutritional biomarkers are associated with postoperative morbidity following CRC surgery. Preoperative HALP and postoperative day 3 NLR demonstrated the strongest apparent discrimination for CCI ≥ 20.9; however, these findings require confirmation in larger, independent prospective cohorts.

Although malignancies during pregnancy are relatively rare, breast cancer emerges as the most common neoplasm affecting pregnant women. Diagnostic workup and multimodal treatment of breast cancer during pregnancy must be weighed against the potential risk to the fetus. With the increasing number of breast cancer diagnoses during pregnancy, this narrative review aimed to outline the epidemiological and molecular background, followed by presenting available therapeutic options. Surgery remains the treatment of choice among patients with breast cancer during pregnancy. However, systemic therapy based on anthracyclines, fluoropyrimidines, taxanes and platinum derivatives is possible after 12 weeks gestation and can be administered in both neoadjuvant and adjuvant settings. Novel diagnostic and therapeutic directions are investigated. Due to its complexity, the treatment process should be managed by multidisciplinary team.

In 2022, colorectal cancer (CRC) was the third most prevalent malignancy worldwide. The therapeutic approach for CRC typically involves a multimodal regimen. The human gut microbiota comprises over 35,000 bacterial species. The composition of the gut microbiota is influenced by dietary intake, which plays a crucial role in food absorption, nutrient extraction, and the development of low-grade inflammation. Dysbiosis in the gut microbiota is a key driver of inflammation and is strongly associated with CRC development. While the gut microbiome influences CRC initiation and progression, emerging evidence suggests a role for the gut microbiome in modulating the efficacy and toxicity of cancer treatments. Therapeutic strategies targeting the gut microbiome, such as probiotics, hold promise as effective interventions in the modern therapeutical approach to CRC. For example, Microbiota Implementation to Reduce Anastomotic Colorectal Leaks (MIRACLe) implementation has resulted in improvements in clinical outcomes, including reduced incidence of anastomotic leakage (AL), surgical site infections (SSIs), reoperation, as well as shorter recovery times and hospital stays compared with the control group. Therefore, this review aims to describe the current state of knowledge regarding the involvement of the gut microbiota in CRC pathogenesis and its potential therapeutic implications to treat CRC.

The incidence of gastric cancer (GC) is expected to increase to 1.77 million cases by 2040. To improve treatment outcomes, GC patients are increasingly treated with neoadjuvant chemotherapy (NAC) prior to curative-intent resection. Although NAC enhances locoregional control and comprehensive patient care, survival rates remain poor, and further investigations should establish outcomes assessment of current clinical pathways. Individually assessed parameters have served as benchmarks for treatment quality in the past decades. The Outcome4Medicine Consensus Conference underscores the inadequacy of isolated metrics, leading to increased recognition and adoption of composite measures. One of the most simple and comprehensive is the “All or None” method, which refers to an approach where a specific set of criteria must be fulfilled for an individual to achieve the overall measure. This narrative review aims to present the rationale for the implementation of a novel composite measure, Textbook Neoadjuvant Outcome (TNO). TNO integrates five objective and well-established components: Treatment Toxicity, Laboratory Tests, Imaging, Time to Surgery, and Nutrition. It represents a desired, multidisciplinary care and hospitalization of GC patients undergoing NAC to identify the treatment- and patient-related data required to establish high-quality oncological care further. A key strength of this narrative review is the clinical feasibility and research background supporting the implementation of the first and novel composite measure representing the “ideal” and holistic care among patients with locally advanced esophago-gastric junction (EGJ) and GC in the preoperative period after NAC. Further analysis will correlate clinical outcomes with the prognostic factors evaluated within the TNO framework.

The 5th edition of the World Health Organization (WHO) classification of tumors of the digestive system distinguishes four categories of appendiceal tumors (ATs): serrated lesions and polyps, mucinous neoplasms, adenocarcinomas, and neuroendocrine neoplasms (NENs). The differential diagnosis of ATs can be challenging in medical practice, due to their rarity and lack of data from randomized controlled trials on a large, diverse group of patients. ATs are usually noted in specimens obtained during appendectomies due to clinical acute appendicitis. In the European population, most ATs (65%) occur over the age of 50 and among women (56.8%). According to histological type, 54.6% are neuroendocrine tumors (NETs); 26.8% cystic, mucinous, and serous neoplasms; and 18.6% adenocarcinoma not otherwise specified (NOS). On pathologic analysis, most AT findings are benign lesions or small NENs that do not require further therapeutic measures. The presence of appendiceal mucinous neoplasm (AMN) can lead to pseudomyxoma peritonei (PMP). While the multimodal treatment for abdominal malignancies has evolved over the past several decades, the clinical workup and treatment of ATs remain a challenge. Therefore, this review aims to describe the diagnostic possibilities, molecular-based diagnosis, staging, differences in the treatment process, and prognostic factors associated with ATs.

Since increasing evidence underlines the prominent role of systemic inflammation in carcinogenesis, the inflammation burden index (IBI) has emerged as a promising biomarker to estimate survival outcomes among cancer patients. The IBI has only been validated in Eastern gastric cancer (GC) patients; therefore, the aim of this study was to evaluate the IBI as a prognostic biomarker in Central European GC patients undergoing multimodal treatment. Ninety-three patients with histologically confirmed GC who underwent multimodal treatment between 2013 and 2021 were included. Patient recruitment started with the standardization of neoadjuvant chemotherapy (NAC). Blood samples were obtained one day prior to surgical treatment. The textbook outcome (TO) served as the measure of surgical quality, and tumor responses to NAC were evaluated according to Becker’s system tumor regression grade (TRG). A high IBI was associated with an increased risk of postoperative complications (OR 2.95, 95% CI 1.13–7.72). In multivariate analysis, a high IBI (HR = 2.56, 95% CI 1.28–5.13) and a high neutrophil-to-lymphocyte ratio (NLR, HR = 2.55, 95% CI 1.32–4.94) were associated with an increased risk of death, while NAC administration (HR = 0.40, 95% CI 0.18–0.90) and TO achievement (HR = 0.42, 95% CI 0.22–0.81) were associated with a lower risk of death. The IBI was associated with postoperative complications and mortality among GC patients undergoing multimodal treatment.

Gastrointestinal cancers are characterized by high incidence and mortality. However, there are well-established methods of screening. The endoscopy exam provides the macroscopical image and enables harvesting the tissue samples for further histopathological diagnosis. The efficiency of endoscopies relies not only on proper patient preparation, but also on the skills of the personnel conducting the exam. In recent years, a number of reports concerning the application of artificial intelligence (AI) in medicine have arisen. Numerous studies aimed to assess the utility of deep learning/ neural network systems supporting endoscopies. In this review, we summarized the most recent reports and randomized clinical trials regarding the application of AI in screening and surveillance of gastrointestinal cancers among patients suffering from esophageal, gastric, and colorectal cancer, along with the advantages, limitations, and controversies of those novel solutions.

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and is one of the leading causes of cancer-related deaths worldwide. Despite advances in medicine, it is still a cancer with a very poor prognosis. Both imaging and liver biopsy still have important limitations, especially in very small nodules and those which show atypical imaging features. In recent years, liquid biopsy and molecular analysis of tumor breakdown products have become an attractive source of new biomarkers. Patients with liver and biliary malignancies, including hepatocellular carcinoma (HCC), may greatly benefit from ctDNA testing. These patients are often diagnosed at an advanced stage of the disease, and relapses are common. Molecular analysis may indicate the best cancer treatment tailored to particular patients with specific tumor DNA mutations. Liquid biopsy is a minimally invasive technique that facilitates the early detection of cancer. This review summarizes the knowledge of ctDNA in liquid biopsy as an indicator for early diagnosis and monitoring of hepatocellular cancer.

The COVID-19 pandemic has affected the entire society, being particularly detrimental to ethnic and racial minorities. Moreover, the problems faced by these communities are characterised and the measures that can be implemented to improve their situation are put forward. Many authors have suggested introducing the solutions according to the socio-ecological model which considers individual, organisational, community and policy factors. Due to the lack of trust of ethnic minorities in health care, no effort should be spared to restore their trust. To achieve this goal, educational programs should be carried out to dispel doubts about research and treatment. Furthermore, the impact of social media on the dissemination of discriminatory content should be meticulously analysed. The present paper is a systematic review of current literature, which analyses the authors` opinions on racial and ethnic discrimination during the COVID-19 pandemic.