Digestive Surgery最新文献

{"title":"Adaptive anastomosis for anterior resection in sigmoid and proximal rectal cancer or premalignant lesions: protocol for a multicentre, non-randomised, clinical effectiveness trial (ADAPT).","authors":"Lodi Grosheide, Wytze Lameris, Jurriaan Benjamin Tuynman, Andre D Apos Hoore, Roel Hompes","doi":"10.1159/dsu/acoag002","DOIUrl":"https://doi.org/10.1159/dsu/acoag002","url":null,"abstract":"<p><strong>Introduction: </strong>Anastomotic leakage (AL) after colorectal surgery is an impactful complication, associated with increased morbidity and reduced quality of life. The circular stapler commonly used for anterior resections (AR), introduces risks of cross-stapling, dog-ears, overcompression, and foreign body response, all associated with AL. An adaptive anastomosis technique eliminates these risk factors, potentially lowering the incidence of AL.</p><p><strong>Methods: </strong>The ADAPT trial is an international multicentre, non-randomised, prospective clinical effectiveness trial evaluating the clinical safety and efficacy of the C-REX adaptive anastomosis in minimally invasive AR. 165 Patients with proximal rectum or sigmoid cancer, or premalignant lesions requiring AR will be enrolled throughout multiple European colorectal centres. An adaptive colorectal anastomosis will be constructed using the C-REX RectoAid Cath. The primary endpoint is 30-day AL rate. Secondary endpoints include 90-day AL, 1-year anastomotic integrity, intraoperative performance of the C-REX device, time to evacuation of the anastomotic ring, postoperative morbidity, functional outcomes, cost-effectiveness, and surgical quality assessment.</p><p><strong>Conclusion: </strong>The ADAPT trial will evaluate whether an adaptive anastomotic technique using the C-REX RectoAid Cath, designed to eliminate key technical risk factors, reduces AL after colorectal AR in an international multicentre setting. The findings could guide strategies to improve postoperative outcomes and reduce leakage-related morbidity.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov - NCTNCT07056374, July 2025.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal Cancer and Advanced Neoplasia in Patients with Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study Using Fecal Occult Blood Test-Positive Controls.","authors":"Yuichi Hirano, Yasushi Yamasaki, Kenta Hamada, Yoshiyasu Kono, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Kazuhiro Noma, Motoyuki Otsuka","doi":"10.1159/dsu/acoag001","DOIUrl":"10.1159/dsu/acoag001","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with esophageal squamous cell carcinoma (SCC) may be more likely to harbor colorectal cancer (CRC) because of shared lifestyle risk factors such as smoking and alcohol. However, its prevalence and clinical significance remain unclear. We evaluated prevalence and risk factors for colorectal advanced neoplasia (CAN) and CRC in patients with esophageal SCC and compared them with fecal occult blood test (FOBT)-positive controls.</p><p><strong>Methods: </strong>We retrospectively analyzed 457 patients with esophageal SCC who underwent colonoscopy between 2017 and 2024. CRC was defined as colorectal adenocarcinoma invading submucosal layer or beyond. CAN was defined as ≥10-mm lesion, high-grade dysplasia, villous histology, or CRC. Risk factors were assessed using logistic regression. Propensity score matching (PSM) compared incidence of CAN and CRC with FOBT-positive controls matched for age, sex, and body mass index (caliper=0.05).</p><p><strong>Results: </strong>Among patients with esophageal SCC, 25.4% had CAN and 10.3% had CRC. Brinkman Index (OR 1.02, 95% CI 1.00-1.04) and alcohol history (OR 2.60, 95% CI 1.13-5.97) were independently associated with CAN (P = 0.048 and 0.025), while no variable was associated with CRC in multivariate analysis. After PSM (135 matched pairs; all standardized mean difference <0.1), CRC incidence remained significantly higher in SCC than FOBT-positive group (OR 3.79 (95% CI 1.21-11.8; P = 0.015)), whereas CAN incidence did not differ.</p><p><strong>Conclusions: </strong>Patients with esophageal SCC had a higher prevalence of CRC compared with FOBT-positive group after PSM. Lifestyle factors were linked to CAN but not CRC. Colonoscopy should be considered in patients with esophageal SCC.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Proctored Learning Curve in Upper Gastrointestinal Robotic Surgery.","authors":"Franco Badaloni, Mauricio G Ramirez, David Solinas, Federico Saba Zotto, Nicole Miraglia, Clara Llamosas, Adolfo E Badaloni, Richard van Hillegersberg, Jelle P Ruurda, Alejandro Nieponice","doi":"10.1159/000553630","DOIUrl":"https://doi.org/10.1159/000553630","url":null,"abstract":"<p><strong>Background: </strong>Safe implementation of robotic upper gastrointestinal surgery requires an optimized learning process. We report the initial experience, outcomes and learning curve of a team introducing this technique in Argentina through the Upper GI International Robotic Association (UGIRA) structured training pathway.</p><p><strong>Methods: </strong>Consecutive patients who underwent robotic upper gastrointestinal surgery using the Da Vinci Xi® system were included from a prospective database. All procedures were performed by a single console surgeon, proctored by an experienced team from UMC Utrecht. Proctoring was performed on-site or remotely via telementoring system. The learning curve plateau was assessed using CUSUM analysis for operative time and lymph node yield.</p><p><strong>Results: </strong>Between 2022 and 2026, 66 robotic upper gastrointestinal procedures were performed by our team, including 26 esophagectomies (RAMIE), 8 total gastrectomies, and 32 benign procedures. No major complications, conversions, or mortality occurred in the benign group. In the RAMIE cohort, major complications (Clavien-Dindo ≥III) occurred in 34.6% of patients, with an anastomotic leak rate of 15.4% and a single case of 30-day mortality (3.8%). R0 resection was achieved in 96.2% of cases, with a median lymph node yield of 26 [IQR 22-32]. In the gastrectomy group, major complications occurred in 25.0% of patients, with no anastomotic leaks or mortality, and a median lymph node yield of 28 nodes [IQR 26-32]. CUSUM analysis for RAMIE identified an operative time plateau at case 7 and a lymph node yield trough at case 18.</p><p><strong>Conclusion: </strong>This study reports the initial implementation of robotic upper gastrointestinal surgery in Argentina following the UGIRA structured training pathway enhanced by telementoring. Despite limited case volume and follow-up, the approach appears feasible and safe, with acceptable short-term perioperative and oncologic outcomes.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-23"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Dilemma of Vanishing Lesions after Systemic Therapy in Oligometastatic Esophagogastric Cancer: A Narrative Review.","authors":"Sebastiaan F C Bronzwaer, Iris van Haarlem, Tiuri E Kroese, Hanneke W M van Laarhoven, Jelle P Ruurda, Richard van Hillegersberg, Peter S N van Rossum","doi":"10.1159/000553588","DOIUrl":"10.1159/000553588","url":null,"abstract":"<p><strong>Background: </strong>Radical local metastasis-directed treatment is increasingly considered in oligometastatic cancer. Disappearance of metastases after systemic therapy (\"vanishing lesions\") poses management dilemmas, as invisibility does not prove complete response, but local therapy carries morbidity.</p><p><strong>Summary: </strong>We searched PubMed for studies on vanishing metastases after systemic therapy in esophagogastric cancer. Complete disappearance of all metastases occurred in 1-3% of patients treated with chemotherapy alone and in 5-17% in trials using targeted or immune therapies. Series reported ≥1 vanishing lesion(s) in 8-44% of patients. Definitions relied on CT, without comparison to MRI or PET-CT. Lesion-level pathology was lacking; vanishing sites were not resected. Survival benefits were linked to radiologic complete response, but the impact of locally treating vanishing sites was not studied. Because esophagogastric data are scarce, colorectal metastases were reviewed for context: CT disappearance often overestimated cure, liver MRI frequently altered plans, 33-69% of CT/MRI-negative liver lesions still harbored viability or recurred, and survival was comparable between unresected vs. resected vanishing lesions.</p><p><strong>Key messages: </strong>Current evidence does not support routine local treatment of vanishing lesions in oligometastatic esophagogastric cancer, although this conclusion is based on a very limited and retrospective evidence base. Imaging besides CT (e.g., MRI, PET-CT) may improve staging. Individualized benefit-risk assessment and studies addressing diagnostic and therapeutic strategies are needed.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148445185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Management of Colorectal Cancer Peritoneal Metastases: Current Indications, Controversies, and Future Directions.","authors":"Michelle Horowitz, Christopher T Aquina","doi":"10.1159/000552611","DOIUrl":"10.1159/000552611","url":null,"abstract":"<p><strong>Background: </strong>Isolated peritoneal metastases occur in approximately 4-8% of patients with colorectal cancer and are associated with a very poor prognosis with systemic therapy alone. While cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have traditionally been a controversial treatment regimen for colorectal cancer peritoneal metastases due to a high rate of morbidity and a perceived limited efficacy, recent studies have confirmed its safety and have demonstrated the ability to achieve long-term survival in carefully selected patients.</p><p><strong>Summary: </strong>This narrative review presents the current indications, controversies, and future directions of CRS, HIPEC, and additional emerging treatment modalities in the surgical management of colorectal cancer peritoneal metastases.</p><p><strong>Key messages: </strong>Peritoneal metastases in colorectal cancer signify a poor prognosis. Management of peritoneal disease includes CRS with or without HIPEC. The use of CRS has been established as an effective treatment modality with acceptable morbidity and long-term quality of life. However, the efficacy of HIPEC continues to be debated. Patient functional status, tumor biology, degree of disease burden, and the feasibility of achieving complete cytoreduction are central to the success of the operation. Emerging treatment options, such as pressurized intraperitoneal aerosolized chemotherapy, represent promising alternative treatment options for patients.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-15"},"PeriodicalIF":1.2,"publicationDate":"2026-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Basic Robotic Training Course for Residents in General Surgery in the Netherlands.","authors":"Frank Jan Voskens, Johannes Peter Maarten Burbach, Femke Julie Amelung, Daan Lips, George van der Schelling, Marc J van Det, Theo J Aufenacker, Werner A Draaisma, Jeroen Hagendoorn, Koen J Hartemink, Bart P L Witteman, Ivo Broeders, Jelle P Ruurda","doi":"10.1159/000553002","DOIUrl":"10.1159/000553002","url":null,"abstract":"<p><strong>Introduction: </strong>The continued adoption of robotic-assisted surgery (RAS) in digestive surgery has created an increasing demand for structured training of surgical residents. However, standardized basic RAS training programs specifically designed for residents remain limited, resulting in variable exposure and skill acquisition. This study describes the development and evaluation of a structured basic RAS training course, to standardize education and improve residents' robotic surgery skills.</p><p><strong>Methods: </strong>A 2-day, on-site basic RAS training course was developed by the Dutch Robotic Surgery Working Group and implemented at the OLV Robotic Surgery Institute (ORSI) academy between June 2021 and October 2023. The curriculum included lectures, interactive didactic sessions, simulation-based training, and both dry and wet laboratory exercises. The impact of the course on skill enhancement was assessed using pre- and post-course assessments.</p><p><strong>Results: </strong>Seventy-five senior surgical residents with a specific interest in RAS participated. Simulator assessments showed significant improvements in overall score, task completion time, and economy of motion across all three exercises following course completion: exercise 1 (p < 0.001), exercise 2 (p < 0.001), exercise 3 (p < 0.001).</p><p><strong>Conclusion: </strong>This 2-day basic robot training course significantly improved basic robotic skills of general surgery residents. The program provides essential preparation for safe clinical utilization of robotic surgery and may serve as a scalable model for future basic robotic training courses within surgical residency programs.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2026-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148249642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial Colonization in Resected Lymph Nodes during Pancreatic Surgery: A Pilot Study.","authors":"Saadet Coşkun Gürçınar, Ibrahim H Gürçınar, Kathrin Rothe, Alexander Muckenhuber, Carsten Jäger, Rüdiger Göß, Ilaria Pergolini, Carmen Mota Reyes, Okan Safak, Mert Erkan, Helmut Friess, Rouzanna Istvanffy, Güralp O Ceyhan, Ihsan Ekin Demir, Elke Demir","doi":"10.1159/000552484","DOIUrl":"10.1159/000552484","url":null,"abstract":"<p><strong>Introduction: </strong>The detection of bacterial colonization in postoperative pancreatic fistula (POPF) fluid has renewed interest in the role of bacterial translocation during pancreatic surgery. In this context, we hypothesized that peripancreatic lymph nodes (PLNs) might similarly harbor bacterial colonization. This study aimed to investigate the presence of bacteria in these lymph nodes, identify factors potentially contributing to their colonization, and assess the clinical significance of these findings.</p><p><strong>Methods: </strong>In this observational pilot study, PLNs (station 8a) resected during pancreatic surgery were analyzed for bacterial DNA using 16S rDNA-PCR, and the microbiological findings were correlated with detailed perioperative and postoperative clinical data.</p><p><strong>Results: </strong>Between 2019 and 2026, lymph node station 8a was resected and analyzed in 37 patients undergoing pancreatic surgery. Bacterial colonization was found in 3 patients (8.1%). No significant association was observed between lymph node colonization and the type of surgical procedure, histopathological diagnosis, or the development of clinically relevant POPF or other major postoperative complications. All cases with bacterial colonization had undergone preoperative endoscopic retrograde cholangiopancreatography (ERCP; p = 0.230).</p><p><strong>Conclusion: </strong>In this pilot study, bacterial colonization of PLNs was uncommon and was observed only in patients with a history of ERCP. Although no association with POPF was identified, a potential relationship with overall postoperative morbidity cannot be ruled out. Further studies with larger patient cohorts are needed to better define the clinical relevance and underlying mechanisms of lymphatic bacterial translocation.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.2,"publicationDate":"2026-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148239099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Significance of Nutritional and Inflammatory Factors in Gastric Cancer Surgery.","authors":"Yoshinori Fujiwara, Shunji Endo, Masaharu Higashida, Yoko Endo, Ryoko Makieda, Hisako Kubota, Masaaki Hori, Toshimasa Okada, Kazuhiko Yoshimatsu, Tomio Ueno","doi":"10.1159/000552039","DOIUrl":"10.1159/000552039","url":null,"abstract":"<p><strong>Introduction: </strong>Various nutritional and inflammatory biomarkers have been proposed to predict prognosis in cancer patients. This study aimed to identify the most significant of these, along with clinical features, in gastric cancer patients who underwent gastrectomy.</p><p><strong>Methods: </strong>We retrospectively analyzed gastric cancer patients who underwent gastrectomy. Preoperative markers included mGPS (modified Glasgow Prognostic Score), neutrophil-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, prognostic nutritional index, and Controlling Nutrition Status score. Postoperative markers were CRPmax, postoperative complications, and operative procedures. The primary endpoints were overall survival (OS) and recurrence-free survival (RFS). Survival was analyzed with the Kaplan-Meier method. Key prognostic factors were identified using stepwise univariate and multivariable Cox regression.</p><p><strong>Results: </strong>360 patients were analyzed. Stepwise Cox analysis showed mGPS as the strongest preoperative predictor of OS and RFS. When including both pre- and postoperative variables, age, pathological stage, and surgical procedure were independent prognostic factors. In a model limited to modifiable factors, mGPS and postoperative complications independently predicted both OS and RFS, while surgical procedure independently predicted RFS only.</p><p><strong>Conclusions: </strong>Improving preoperative mGPS and minimizing postoperative complications may enhance survival after gastrectomy. When appropriate, stomach-preserving procedures (e.g., subtotal distal gastrectomy) should be favored over total gastrectomy.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.2,"publicationDate":"2026-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147980791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PIPAC for Malignant Peritoneal Mesothelioma: Current Insights and Future Directions.","authors":"Arianna Castagna, Aphrodite Fotiadou, Ali Ramouz, Preslava Gesheva, Niall Brindl, Wiebke Solass, Andreas Brandl","doi":"10.1159/000552426","DOIUrl":"10.1159/000552426","url":null,"abstract":"<p><strong>Background: </strong>Malignant peritoneal mesothelioma (MPM) is a rare and aggressive tumour with poor prognosis, often diagnosed late due to nonspecific symptoms. Current standard treatment involves systemic chemotherapy and cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy, but this approach is limited to selected patients.</p><p><strong>Summary: </strong>Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel technique improving drug delivery and penetration in the peritoneal cavity. This narrative review evaluates the role of PIPAC in the treatment of MPM, analysing data from clinical studies on its feasibility, safety, and efficacy. Evidence suggests that PIPAC is a well-tolerated procedure, with a manageable safety profile and potential to improve survival and tumour response in patients with unresectable or recurrent disease. Limitations in current studies include small cohorts and heterogeneous patient populations, underscoring the need for further research.</p><p><strong>Key message: </strong>PIPAC represents a promising therapeutic option, offering enhanced intraperitoneal chemotherapy delivery with minimal systemic toxicity. Future investigations should focus on optimizing treatment protocols and evaluating long-term benefits to better define PIPAC's role in clinical practice.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-12"},"PeriodicalIF":1.2,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147927408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low Preoperative Haemoglobin Is a Risk Factor for Clavien-Dindo Grade IV-V and Non-Surgical Complications in Colorectal Cancer Surgery.","authors":"Pekka Peroja, Heikki Huhta, Tero Rautio, Jukka Rintala","doi":"10.1159/000552166","DOIUrl":"10.1159/000552166","url":null,"abstract":"<p><strong>Introduction: </strong>Preoperative anaemia is common in patients undergoing colorectal cancer surgery, but the association between preoperative haemoglobin (Hb) and postoperative morbidity remains unclear.</p><p><strong>Methods: </strong>This retrospective cohort study included all 2,374 patients who underwent elective colorectal segmental resection for colorectal cancer at Oulu University Hospital between 2014 and 2024. After exclusions for missing Hb data (n = 49), procedures other than primary curative resection (n = 735), missing complication data (n = 117), and age under 18 years (n = 1), 1,472 patients were analysed. Receiver operating characteristic analysis was used to determine the optimal Hb cut-off, and logistic regression was used to identify factors associated with Clavien-Dindo classification (CDC) grade IV-V complications.</p><p><strong>Results: </strong>Preoperative anaemia was present in 444/859 (51.7%) men and 208/613 (33.9%) women. Overall, 758/1,472 (51.5%) patients developed a postoperative complication. Compared with non-anaemic patients, anaemic patients had higher rates of CDC grade IV-V complications (7.4% vs. 2.6%, p < 0.001) and non-surgical complications (31.4% vs. 20.4%, p < 0.001). The optimal Hb cut-off for CDC grade IV-V complications was 117.5 g/L. Low Hb was associated with severe complications in univariable (odds ratio [OR] 3.02, 95% confidence interval [CI] 1.79-5.10) and multivariable analyses (OR 1.76, 95% CI 1.01-3.05).</p><p><strong>Conclusion: </strong>Low preoperative Hb is an independent risk factor for severe postoperative complications, particularly non-surgical events, after colorectal cancer surgery. Data-driven Hb thresholds may improve preoperative risk stratification.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}