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Abstract Introduction Colorectal cancer (CRC) ranks among the top three most common cancers in Brazil, and the carcinoembryonic antigen (CEA) is one of the most used and established methods for prognostic evaluation and recurrence monitoring in CRC patients. Objective To analyze the pre- and postneoadjuvant levels of CEA in patients with middle or low rectal adenocarcinoma who underwent elective retossigmoidectomy with total mesorectal excision or abdominoperineal amputation of the rectum and to correlate the differences in pre- and postneoadjuvant CEA levels with the pathological staging. Materials and Methods Retrospective analysis of patients over 18 years old who underwent elective retossigmoidectomy with total mesorectal excision or abdominoperineal resection of the rectum. Data regarding age, sex, type of surgery, absolute CEA values, and differences in pre- and postneoadjuvant CEA levels were evaluated. Results The electronic medical records of 77 patients diagnosed with middle or low rectal adenocarcinoma who underwent surgery were analyzed. The mean pre- and postneoadjuvant levels of CEA were of 15.21(± 26.41) ng/mL and 7.17(± 15.6) ng/mL respectively, indicating a statistically significant decrease (p = 0.00058). The cutoff value for the analysis of neoplastic invasion depth (T) was determined to be 4.9 ng/mL, with a sensitivity of 73%, specificity of 63%, positive predictive value of 81%, and accuracy of 66.7%. For disease stage N, a cutoff value of 16.5 ng/mL was used. In this sample, the CEA test showed that the sensitivity and specificity for identifying patients with positive N disease were 41% and 89%, respectively, with a positive predictive value of 70% and an accuracy of 59.7%. Conclusion Carcinoembryonic antigen levels significantly decreased after neoadjuvant therapy in patients with middle and low rectal cancer. Pretreatment CEA levels were primarily associated with tumor invasion depth.

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Abstract Introduction Despite the advances in pain therapy, postoperative hemorrhoidectomy pain is still common and annoying. The present study aims to minimize post-hemorrhoidectomy pain and improve the quality of life. Materials and Methods The current study is a single-center, prospective, randomized, comparative clinical trial performed in the General Surgery Department from January to October 2024. The study included 150 hemorrhoidectomy patients randomly allocated to five groups: group I – control group; group II – local injection of ketorolac and light bupivacaine; group III – injection of light bupivacaine; group IV – local injection of corticosteroids; and group V – topical diclofenac sodium gel. Results Compared ot the other groups, group IV presented significantly better outcomes (p < 0.001) regarding the need, dose, and frequency of nalufin, postoperative pain score, and time until first ambulation. However, it presented longer healing time than the other groups. Conclusion Local injections of corticosteroids can effectively reduce pain after hemorrhoidectomy.

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Abstract Introduction Colorectal cancer (CRC) ranks third as the most incidental in the world. One of its hereditary forms is Lynch syndrome (LS), characterized by mutations in one of the DNA mismatches repairs (MMR) genes (MLH1, MSH2, MSH6, PMS2, or EPCAM). Current protocols suggest screening with clinical criteria followed by immunohistochemistry (IHC) before next-generation sequencing (NGS) for an early diagnosis. However, using IHC as an isolated screening test may interfere with the diagnosis of LS. Objective To assess the correlation between IHC and NGS to diagnose LS in patients who meet the Amsterdam II clinical criteria. Materials and Methods Observational study comprising 32 patients of both genders, aged between 20 and 64 years at the time of CRC diagnosis. They must meet the Amsterdam II clinical criteria and be registered in the Hereditary Cancer Program of Hospital de Câncer de Pernambuco (HCP). All patients underwent IHC assessment of malignant tumor and blood sample NGS. Results The NGS yielded 11 (34%) positive results for LS. There was a correlation between IHC and NGS in 23 cases. In 8 (35%), there was diagnostic confirmation of IHC by NGS, and in 15 cases (65%) there was diagnostic exclusion of LS by IHC and NGS. In three cases, there was confirmation of a pathogenic variant in MLH1 by NGS. The cases presented the same large deletions, contradicting IHC with proficient MMR. Conclusion A moderate correlation between IHC and NGS has been established, as indicated by the Kappa coefficient of 0.410 utilizing the Amsterdam II clinical criteria.

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Abstract Introduction Urinary and sexual dysfunctions are recognized as serious complications that affect patients' quality of life after mid-rectal cancer surgery; however, studies that focus on the urogenital function after robot-assisted compared to laparoscopic rectal cancer surgery are limited. Objective To compare functional outcomes between patients undergoing robotic and laparoscopic approaches for middle rectal cancer submitted to neoadjuvant chemoradiation. Materials and Methods Patients with mid-rectal cancer were prospectively enrolled in this phase-II randomized trial to robotic or laparoscopic total mesorectal excision (TME). After eligibility was confirmed and chemoradiation therapy was completed, patients underwent randomization in a 2:1 ratio (robotic: laparoscopic TME groups) with stratification according to gender (male or female) and body mass index (BMI) < 35 or ≥ 35. The assessment of urinary function was carried out using complete urodynamic study, urinary symptoms questionnaire (International Consultation on Incontinence Questionnaire – Short Form [ICIQ-SF]), and urinary continence questionnaire (International Prostate Symptom Score [I-PSS]). The complete urodynamic study and the questionnaires were carried out before the start of any treatment and after neoadjuvant therapy (before surgery) and was repeated in the 1st, 3rd, 6th, 12th, 18th and 24th postoperative months. The analysis of male sexual function was carried out using International Index of Erectile Function (IIEF-5) questionnaire. Female sexual function was analyzed using the specific Female Sexual Functiona Index (FSFI) questionnaire, and the Quality-of-Life Questionnaire Core 30 (QLQ-C30) and Quality-of-Life Questionnaire - Colorectal Cancer 29 (QLQ-CR29 were applied to patients at the same time as the sexual and urinary function assessment questionnaires. Results Between 2017 and 2022, 32 patients entered the trial, and 30 were eligible to participate (2 patients were excluded due to screening failure). Among them, only 21 were randomized to robotic or laparoscopic group. Only 9 (42.9%) and 12 patients (57.1%) underwent urodynamic testing at the 3rd and 6th month of postoperative follow-up, respectively. Eighteen (85.7%) and 16 patients (76.2%) completed both the ICIQ-SF and I-PSS questionnaires at the 3rd and 6th month of postoperative follow-up, respectively. Only 7 and 10 patients (33.3% and 47.6%, respectively) completed the IIEF-5 and FSFI at the 3rd month of postoperative follow-up. There was no significant difference in age, BMI, tumor location, neoadjuvant therapy, postoperative pathological results, and adjuvant therapy between the two groups. Our study did not identify any parameter that could suggest lower urinary tract dysfunction in both groups analyzed, either by evaluating maximum flow, postvoid residue and, mainly, by the results of detrusor pressure at maximum flow. On the other hand, the present study demonstrated better sexual function outcomes with robotic surgery in male patients as assessed by the IIEF-5 score. There was a slight advantage to robotic surgery at the 3-month follow-up (median score 18 for robotic versus 17 for laparoscopic). By 6 months, the difference became more pronounced in favor of the robotic group (median score 23 for robotic versus 15 for laparoscopic). Additionally, there was better sexual desire at 3 months in the robotic group according to the QLQ-C29 (median score 66.7 in the robotic group versus 16.6 in the laparoscopic group). Conclusion The robotic approach for TME was associated with potentially better male sexual function than the laparoscopic approach. More randomized studies with a larger number of patients are necessary to confirm our findings.

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Abstract Introduction The incidence of diverticulitis has increased in recent years. Management strategies have shifted from routine elective colectomy after two episodes of uncomplicated diverticulitis to more individualized decision-making. Objective To evaluate the impact of updated management guidelines on trends and outcomes of elective colectomy for uncomplicated diverticulitis. Methods A retrospective cohort study was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (2012–2019). Patients undergoing elective colectomy for uncomplicated diverticulitis were included. Exclusion criteria were complicated diverticulitis, emergent surgery, malignancy on final pathology, and ASA score of 5 or unknown. Emergent cases were analyzed only for temporal trends. Results From 2012 to 2019, elective colectomies for uncomplicated diverticulitis increased from 2,326 (96.7% elective) to 3,740 (98.9% elective) (p < 0.001). After excluding emergent cases, 25,045 patients were analyzed. Overall morbidity decreased from 16.4% to 10.7% (p < 0.001), and serious morbidity from 7.4% to 6.5% (p = 0.005). Other improvements included reductions in reoperation (4.2% to 3.5%), anastomotic leak (3.5% to 2.8%), wound infection (7.7% to 2.9%), transfusion (2.8% to 2.3%), shock/sepsis (3.1% to 2.4%), ileus (7.2% to 5.4%), and median length of stay (4 to 3 days). Operative time increased slightly (172 to 181 minutes, p = 0.002). Ostomy and mortality rates remained unchanged. Conclusion Despite guideline changes encouraging individualized management, elective colectomies for uncomplicated diverticulitis are increasing, with significantly improved postoperative outcomes, possibly due to better patient selection and surgical care.

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Abstract Introduction Colorectal trauma presents a significant clinical challenge due to its complexity and high morbidity. Although well-documented in international literature, data on its incidence and management in Brazil—particularly in the Federal District—remain scarce. Objective To determine the incidence, causes, and treatment approaches of colorectal trauma in patients treated at a tertiary hospital in Brasília, Brazil, over a five-year period. Methods: This retrospective cohort study analyzed medical records of patients aged ≥18 years diagnosed with colorectal trauma and treated at the Regional Hospital of Taguatinga from January 2020 to January 2025. Data on demographics, mechanisms and types of injury, injury severity, and treatment were collected. Statistical analysis included descriptive and inferential tests with a significance level set at p < 0.05. Results A total of 40 patients was included. The majority were male (82.05%) with a mean age of 32.39 ± 10.04 years. Most injuries (92.5%) were due to penetrating trauma, especially gunshot wounds (50%) and stab wounds (42.5%). The transverse colon was the most frequently affected site (37.5%). Transfixing injuries were the most common type (51.72%). The mean Injury Severity Score (ISS) was 45.31 ± 25.06. Primary repair was the most common surgical approach (47.37%), followed by resection with anastomosis (26.32%) and colostomy (10.53%). A significant association between gender and trauma mechanism was observed (p = 0.026), with men more often suffering firearm injuries and women more likely to experience blunt trauma. Conclusion Findings align with global trends, highlighting the predominance of penetrating trauma and a shift toward conservative surgical approaches like primary repair. The results underscore the need for public health strategies targeting firearm-related violence and emphasize the importance of national guidelines adapted to the Brazilian context.

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Abstract Introduction Colorectal cancer (CRC) is one of the main causes of death by cancer. Patients diagnosed with colon adenocarcinoma and unresectable liver metastases have a poor prognosis, with a median overall survival (OS) of 24 months. Case Presentation We herein report the case of a 7-year sustained complete response (CR) with 2 cycles of modified 5-fluorouracil plus oxaliplatin (mFLOX) in a metastatic setting. The patient is a White Brazilian male aged 59 years. Conclusion There is scarce evidence on the clinical evolution of non-operable patients with metastasis to establish a definitive cure only with a chemotherapy regimen, without complimentary liver resection. The patient herein reported achieved CR with only two cycles of treatment, which is not usual in this scenario. He was deemed non-operable because of the number and position of the lesions detected before the start of chemotherapy.

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Abstract Perianal Paget Disease (PPD) is a rare form of extramammary Paget disease characterized by erythematous or eczematous plaques in the perianal region. Its rarity and resemblance to benign skin conditions often result in delayed diagnosis. We present the case of a 56-year-old woman with a 4-year history of a refractory perianal lesion. A sharply demarcated erythematous plaque was identified, and biopsy confirmed PPD. Further workup excluded any underlying malignancy. Wide local excision with a 10-mm margin was performed, sparing the anal sphincters, followed by immediate reconstruction using a right gluteal fasciocutaneous V-Y advancement flap. The postoperative period was uneventful, and pathology confirmed negative margins. Perianal Paget Disease requires differentiation from benign skin conditions and thorough evaluation for underlying malignancies. Many treatment options are available. However, surgery—more specifically wide local excision—remains the standard treatment. Despite the lack of standardized guidelines, long-term follow-up is essential due to the risk of recurrence and malignancy. The present report highlights the importance of considering PPD in cases of chronic refractory perianal lesions and the need for developing guidelines for managing patients with PPD.

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Abstract Case report We present the case of a 20-year-old female with purulent umbilical drainage. Materials and Methods Workup initially included a contrast-enhanced computed tomography scan of the abdomen and pelvis, which revealed large bilateral tubo-ovarian abscesses communicating with a tract to the umbilicus, with concern regarding involvement of the sigmoid colon. A drain was placed, and cultures from the abscess demonstrated growth of α-hemolytic streptococci and Trueperella (Arcanobacterium) bernardiae . Results Colonoscopy was normal. During preparation for colonoscopy, the patient noted passage of high volume of clear fluid from the umbilicus. A fistulogram through the umbilical opening revealed a complex fistulous network involving the umbilicus, bilateral adnexa and rectosigmoid, with concern for small bowel involvement. Magnetic resonance enterography was unremarkable for bowel inflammation, but the study suggested the possibility of an underlying urachal remnant. Diagnostic laparoscopy was performed, which excluded presence of any small bowel involvement, and demonstrated dense adhesions of the omentum and left adnexa to the abdominal wall. Ultimately, the patient underwent a multi-disciplinary robotic-assisted urachal remnant excision, with en-bloc left oophorectomy and sigmoidectomy. Conclusion Urachal and omphalomesenteric remnants outside of the pediatric population are rare. To the best of our knowledge, this is the first report of such complication of a urachal remnant, with a complex fistula involving the rectosigmoid colon, adnexa and bladder. Here, we present the diagnostic and operative approach.

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Abstract Introduction Malignant large-bowel obstruction (LBO) occurs in 8 to 15% of colorectal cancer cases, and it is linked to high rates of complications and death. Identifying patient risk before surgery is essential to choose between emergency surgery and stenting. Objective To predict outcomes in patients with obstructed colon cancer by comparing traditional clinical scoring systems (such as the American Society of Anesthesiologists [ASA] Physical Status Classification System, the Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity [POSSUM], and the Association of Coloproctology of Great Britain & Ireland [ACPGBI] score) with modern artificial intelligence (AI) and machine learning (ML) models (such as Random Forest [RF], K-Nearest Neighbors [KNN], Extreme Gradient Boosting [XGBoost], and nomograms). Materials and Methods We conducted a narrative review of peer-reviewed articles on prognostic models for malignant LBO. For each study, we recorded the variables used by the model, how user-friendly and interpretable it was, its performance metrics (such as the area under the receiver operating characteristic [AUROC] curve and accuracy), and its potential for clinical use. We organized the findings into five summary tables, comparing conventional risk scores and AI-based approaches in multiple dimensions. The focus is on practical, clinically-relevant insights rather than detailed algorithmic explanations. Results Traditional scores rely on a fixed set of clinical and operative variables. While easy to calculate and widely understood, they perform suboptimally in emergent LBO, with the Colorectal POSSUM (CR-POSSUM) showing an AUROC of approximately 0.65, and the ACPGBI reaching an AUROC of approximately 0.80 in elective settings. Conversely, AI models that leverage multiple perioperative inputs achieve higher accuracy: a Random Forest model yielded an AUROC of approximately 0.79 (95%CI: 0.71–0.87) on training and ranging from 0.75 to 0.82 on validation; a KNN model recorded approximately 88% of accuracy (AUROC: ~ 0.77); and logistic regression nomograms attained AUC values near 0.84 for specific outcomes. Conclusion Models based on AI generally outperform traditional risk scores in predicting short-term outcomes of malignant bowel obstruction, but they require high-quality electronic data and technological infrastructure. Traditional scores offer ease-of-use and interpretability, but they are less accurate in this setting. Clinicians should consider hybrid strategies, such as using familiar scores (ASA, the Charlson Comorbidity Index [CCI]) for quick triage, and AI/nomogram tools for detailed risk when data is available. Future work must address implementation barriers (such as data integration, model explainability, external validation, and prospective impact studies) to translate these tools into real-world perioperative decision-making.