Julia Szostek

Background: Tumor sidedness in colon cancer has been linked to biological and clinical differences, but its impact on survival and prognostic factors remains unclear. This study aimed to find the predictors of overall survival (OS) in patients with right-sided colon cancer (RCC) and left-sided colon cancer (LCC) undergoing surgical treatment. Methods: A retrospective single-center study was conducted on 247 patients with colon cancer, including 117 with RCC and 130 with LCC. Clinical, surgical, and pathological variables were analyzed. Cox regression and ROC curve analyses were used to identify independent predictors of OS in the overall cohort and tumor-side subgroups. Results: RCC patients were older (69 vs. 68 years, p = 0.03), had lower hemoglobin levels (11.7 vs. 12.95 g/dL, p < 0.01), and more often presented with anemia (34.18% vs. 11.48%, p < 0.001). LCC patients more frequently underwent emergency surgery (13.74% vs. 5.69%, p = 0.03). Mucinous adenocarcinomas were more frequent in RCC (12.82% vs. 5.38%, p = 0.03), whereas distant metastases (15.38% vs. 6.84%, p = 0.03) and liver metastases (14.61% vs. 6.84%, p = 0.04) were more common in LCC. The one-year overall survival was similar between LCC and RCC before (88.09% vs. 91.52%, p = 0.15) and after propensity score matching (89.32% vs. 91.87%, p = 0.60) In multivariate Cox regression, independent predictors of lower OS included advanced AJCC stage (HR = 34.54, p < 0.001) in RCC, while, in LCC, AJCC stage (HR = 31.14, p = 0.001 and stoma (HR = 5.86, p = 0.01) were significant. Tumor location itself was not associated with OS (p = 0.18). Conclusions: Prognostic factors in colon cancer vary with tumor location. Side-specific risk stratification may improve outcome prediction and guide personalized management.

Background: Carotid artery stenting (CAS) is a common revascularization approach for carotid artery stenosis. While its impact on the internal carotid artery (ICA) has been extensively studied, the effects on the external carotid artery (ECA)—a key collateral pathway for cerebral perfusion—remain insufficiently explored. This study aimed to assess structural changes in the ECA following CAS and their clinical significance. Methods: A retrospective observational cohort study of 963 patients treated with CAS between 2018 and 2024 was conducted. Demographic data, comorbidities, and procedural characteristics were collected. Pre- and postprocedural ICA and ECA diameters were measured via angiography. Spearman’s correlation, regression modeling, and receiver operating curver (ROC) analysis were used to identify predictors of ECA narrowing and occlusion and their relationship with neurological outcomes. Results: The median ECA diameter decreased post-CAS (from 4.7 mm to 3.8 mm, p < 0.001). ECA overstenting occurred in 96.4% of cases, with 71.7% exhibiting diameter reduction. De novo ECA occlusion occurred in 2.5% of patients and was associated with a higher incidence of stroke, transient ischemic attack, and in-stent restenosis (ISR). Multivariate analysis identified preoperative ECA diameter (p < 0.001), ICA diameter (p = 0.001), and second-generation stents (p = 0.02) as independent predictors of ECA narrowing. ROC analysis confirmed that a preoperative ECA diameter ≤ 3.05 mm strongly predicted occlusion (Area under the curve (AUC) = 0.93, p < 0.001). Conclusions: CAS frequently leads to ECA remodeling, including occlusion, compromising collateral perfusion and contributing to adverse ischemic incidences and ISR. Preprocedural ECA assessment may aid in optimizing patient selection and procedural planning.

Background: Global colorectal cancer (CRC) incidence is significant, constituting 15% of all cancer cases with 1.4 million new diagnoses annually. Recent research suggests categorizing CRC into three clinical groups: right colon cancer (RCC), left colon cancer (LCC), and rectal cancer, each with distinct embryological and molecular characteristics. Methods: A retrospective analysis of 189 patients (103 men, 86 women) undergoing surgery for RCC and LCC from January 2018 to December 2023 was performed. Results: LCC was a more common localization (98, 51.85%) than RCC (91, 48.15%). Patients with RCC were older than patients with LCC (70 (36–92, IQR 11) vs. 68 (38–84, IQR 12.5) years; p = 0.02). The duration of surgical procedure was comparable in both groups (225 (120–420, IQR 80) vs. 210 (105–505, IQR 85) minutes; p = 0.16). Complications occurred in 16 (17.58%) patients with RCC and in 15 (15.31%) patients with LCC (p = 0.72). One-year overall survival was 92.76% (SE 2.16%) (91.57% (SE 3.43%) in the RCC group and 93.99% (SE 2.61%) in the LCC group; p = 0.79). Conclusions: Colon cancer incidence is increasing globally due to economic and lifestyle factors. Our study reflects this trend, noting a rise in cases from 2018 to 2023. Despite several differences, overall survival rates do not significantly differ between RCC and LCC patients. Understanding clinical disparities is crucial for optimizing patient outcomes.

Background: The external carotid artery (ECA) plays a vital role in facial perfusion and acts as a collateral pathway for cerebral blood flow during internal carotid artery (ICA) stenosis. In cases of carotid near-occlusion (CNO), characterized by severe ICA stenosis with hemodynamic changes, carotid artery stenting (CAS) is rising as a potential new treatment. During CAS, the stent is deployed in ICA, covering the ECA orifice. Therefore, this study aims to evaluate the effects of CAS on ECA. Materials and Methods: This retrospective study included 159 patients diagnosed with CNO and treated with CAS between February 2018 and May 2023. Preoperative and postoperative ECA diameters were measured using angiography. Data on patient demographics, procedural details, and outcomes were analyzed. Results: The median preoperative ECA diameter was 4.34 mm, decreasing to 3.40 mm post-CAS (p < 0.001). ECA narrowing occurred in 76.39% of patients, while 4.17% experienced occlusion. A larger preoperative ECA diameter was predictive of narrowing (odds ratio (OR) = 1.35, p = 0.02) and protective against occlusion (OR = 0.1, p < 0.001). Weak correlations between ICA and ECA diameter changes were observed, indicating procedural influences on ECA dynamics. Conclusions: CAS for CNO significantly reduces ECA diameter, with a subset of patients developing occlusion. The preoperative ECA diameter is a key predictor of postoperative changes. These findings emphasize the need for further research on CAS-related ECA hemodynamic alterations to optimize patient outcomes and minimize complications.

Background: Peripheral arterial disease (PAD) is becoming an increasingly prevalent clinical issue, leading to a growing number of patients requiring surgical interventions. Consequently, there is an increasing occurrence of para-anastomotic aneurysms as late complications following primary treatment for PAD. These aneurysms typically arise at the sites of graft implantation and necessitate individualized management strategies based on factors such as location, size, and the patient’s overall condition. Materials and Methods: This five-year retrospective study, conducted at a single center, aimed to evaluate the anatomical location, clinical presentation, diagnostic methods, and management strategies for 55 patients treated for femoral and popliteal artery para-anastomotic pseudoaneurysms of the lower limb between January 2018 and June 2024. Treatment approaches were determined based on aneurysm size, the extent of atherosclerosis, and the patient’s surgical risk. This study analyzed patient demographics, surgical techniques, postoperative complications, and aneurysm characteristics. Results: Most pseudoaneurysms occurred between 6 and 10 years after the primary procedure. The most common surgical intervention was aneurysmectomy with graft interposition, performed in 46 patients (83.64%), followed by aneurysmectomy with extra-anatomical bypass in 6 patients (10.91%), and endovascular repair (EVAR) in 3 patients (5.45%). Early postoperative complications occurred in 16.36% of patients. The 12-month freedom from graft stenosis was 87.23%, and freedom from anastomotic aneurysm recurrence at 12 months was 100%. Conclusions: This study highlights the critical need for individualized treatment strategies and ongoing surveillance in managing lower-limb para-anastomotic pseudoaneurysms, particularly given the prevalence of lower-limb pain and the high occurrence of such in the common femoral artery. The favorable long-term graft patency rates observed suggest that aneurysmectomy with graft interposition is an effective intervention, reinforcing its role as the primary approach within this patient population.

Background: Peripheral aneurysms, although known about for centuries, are challenging to monitor due to their asymptomatic nature. Advanced imaging has improved detection, which is crucial for preventing emergent complications. This five-year retrospective study from a single center aimed to evaluate the location, presentation, diagnosis, and management of 110 patients with aneurysms of the femoral and popliteal arteries of the lower limb. Materials and methods: The study included 71 true aneurysms and 39 pseudoaneurysms patients treated between 2018–2023. Treatment methods were based on aneurysm size, atherosclerosis severity, and operation risk. The study assessed patient demographics, surgical details, postoperative complications, and aneurysm characteristics. Results: Acute limb ischemia was more prevalent in true aneurysms (25.4% vs. 7.7%; p = 0.02). Aneurysmectomy was performed more frequently in pseudoaneurysms (87.2% vs. 54.9%; p < 0.001), while endovascular treatment and surgical bypass were more common in true aneurysms (Endovascular: 22.5% vs. 2.6%; p = 0.01; bypass: 21.1% vs. 0%; p < 0.001). Early postoperative complications occurred in 22.7% of patients. The 12-month freedom from reoperations (73.7% vs. 87%; p = 0.07), amputations (97.7% vs. 93.8%; p = 0.2), and graft stenosis (78.7% vs. 86.87%; p = 0.06) showed no significant differences between groups. Conclusions: Lower limb aneurysms often present with non-specific symptoms, leading to late diagnosis and life-threatening complications. Both open and endovascular treatments are feasible, though more research is needed for pseudoaneurysms. Vigilant follow-up is crucial due to potential adverse events, though overall mortality and morbidity remain low.