Rethinking risk in Crohn’s surgery: age at onset fails to predict surgical outcomes after ileocecal resection, insights from a tertiary referral center T. Violante, S. Cardelli, F. Flamini, G. Calini, M. Novelli, et al. Techniques in Coloproctology, 2026 Background Early age at diagnosis in Crohn’s disease is linked to aggressive phenotypes, yet evidence regarding its impact on surgical risk remains inconsistent. This study aimed to elucidate the relationship between age at diagnosis, utilizing Vienna and Montreal classifications, and surgical prognosis in patients undergoing ileocecal resection. Methods A retrospective analysis of a prospective database identified 810 patients undergoing ileocecal resection between 2014 and 2022. Patients were stratified by Vienna ( 40 years) and Montreal (A1, A2, A3) classifications. Primary end points included 30-day overall complications, serious complications, reoperation and readmission. Statistical analysis employed multivariable regression, propensity score matching, G-computation and Random Forest models to adjust for confounders. Results Baseline characteristics differed significantly: younger patients exhibited more penetrating disease and biologic exposure, while older patients had higher ASA scores and comorbidities. After robust adjustment, the Vienna and Montreal age classification showed no significant association with postoperative complications, serious complications, reoperation or readmission. Random Forest analysis consistently identified ASA score and comorbidities, rather than age at onset, as the dominant predictors of surgical outcomes. Conclusions Age at diagnosis does not independently predict short-term surgical outcomes after ileocecal resection. Postoperative morbidity is driven primarily by general health markers, such as ASA score, rather than disease onset timing. These findings highlight the need for validated disease-specific risk scores.
Reduced conversion and readmission rates in robotic ileocecal resection for Crohn’s disease: a propensity-matched analysis of the Hugo™ RAS system Tommaso Violante, Stefano Cardelli, Giacomo Calini, Marco Novelli, Matteo Rottoli Surgical Endoscopy, 2026 Background Robotic surgery is increasingly adopted in inflammatory bowel disease to address the technical limitations of conventional laparoscopy. This study aimed to compare the perioperative outcomes of robotic ileocecal resection for Crohn’s disease (CD) using the Hugo™ RAS system against laparoscopic and open approaches. Methods Data were retrospectively collected from a prospectively maintained database of patients undergoing ileocecal resection for CD between January 2003 and June 2025 at a tertiary referral center. Patients were stratified by surgical approach: robotic, laparoscopic, or open. Multivariable regression, 1:1 and 1:4 propensity score matching (PSM), and G-computation were utilized to compare postoperative complications, readmissions, conversion rates, and length of hospital stay (LOS). Results A total of 1392 patients were included (62 robotic, 623 laparoscopic, 707 open). The robotic approach was associated with a significantly lower rate of conversion to open surgery compared to laparoscopy (1.6% vs 15.2%; p = 0.001). After adjustment, robotic surgery remained independently associated with an 89% reduction in the odds of conversion (adjusted OR 0.11; 95% CI 0.02–0.77; p = 0.027). In the primary PSM analysis, the robotic group demonstrated a 16.1% absolute risk reduction in 30-day readmissions (p = 0.025) and a significantly lower risk of severe complications (Clavien–Dindo ≥ III) compared to laparoscopy (p = 0.037). Sensitivity analyses confirmed a statistically significant reduction in LOS for the robotic group compared to both laparoscopic (p = 0.049) and Open (p < 0.001) approaches. Adjusted operative times were comparable between robotic and laparoscopic procedures (p = 0.572). Conclusion Robotic ileocecal resection using the Hugo™ RAS system is a safe and effective alternative to conventional techniques. It offers distinct clinical advantages, including marked reductions in conversion rates and hospital readmissions, as well as a shorter length of stay, without compromising operative efficiency.
Surgical management of small bowel adenocarcinoma in Crohn disease: a multicenter retrospective analysis Tommaso Violante, Davide Ferrari, Matteo Rottoli, Marco Novelli, David W Larson, et al. Inflammatory Bowel Diseases, 2026 Background Patients with Crohn disease (CD) face an elevated risk of developing small bowel adenocarcinoma (SBA), a malignancy characterized by late-stage diagnosis and poor prognosis. In this study we aimed to characterize surgical management and oncologic outcomes for CD-associated SBA. Methods A retrospective review was conducted across 3 tertiary IBD centers, analyzing 99 patients with CD who underwent surgery for SBA between 1992 and 2025. Data included patient demographics, CD history, surgical details, and oncologic outcomes. Results The median time from CD diagnosis to SBA was 25 years. The SBA diagnosis was incidental in 74.8% of cases, discovered during surgery for other complications. Tumors were predominantly located in the ileum (80.8%) and showed aggressive features: 56.6% were poorly differentiated (grade 3), and 85.9% were pathologically advanced (T3/T4 on TNM staging). Nodal involvement was present in 45.5% of patients, and 18.2% had distant metastases at diagnosis. A complete (R0) resection was achieved in 90.9% of surgeries, with a 30-day morbidity rate of 26.3%. After a median follow-up of 36 months, the distant recurrence rate was 28.3%, and overall mortality was 27.3% (18.2% cancer related). Conclusion In patients with long-standing CD, SBA is typically an incidental diagnosis made at an advanced stage. While high rates of complete surgical resection are possible, the prognosis remains guarded due to aggressive tumor biology and high recurrence rates. These findings highlight a critical need for improved risk stratification to guide surveillance and for the development of evidence-based adjuvant treatment strategies.
Association Between Colorectal Cancer Screening and Survival in Patients Older Than 70 Years: Results of A National Multicenter Retrospective Study Matteo Rottoli, Giacomo Calini, Giovanni Castagna, Alice Gori, Stefano Cardelli, et al. Journal of Surgical Oncology, 2026 Background Colorectal cancer screening mainly targets a population between 50 and 70 years of age; however, it is inconsistently implemented in people over 70. The aim of this study was to analyze the association between colorectal cancer (CRC) screening, postoperative mortality, and perioperative and oncologic outcomes in a large population of patients over 70 years of age who underwent surgery for CRC. Methods Data regarding people over 70 who underwent CRC surgery were retrieved from a nationally validated retrospective database, including four consecutive years (2018–2021) and 81 centers. The patients were divided into two groups according to their participation in the CRC screening program: Screening versus No Screening. The outcomes of the study were 30‐day mortality; urgent, palliative and minimally invasive surgery rates; Clavien‐Dindo ≥ III; advanced oncologic stage; R0 resection and length of hospital stay (LOS). Logistic regression analysis was carried out and adjusted for multiple confounders. Results Of the 10,346 patients over 70,676 were in the screening group, and 9670 were in the no screening group. At logistic regression, CRC screening was significantly associated with a reduction in 30‐day mortality (OR 0.41, 95% CI 0.18–0.92, p = 0.032), urgent surgery (OR 0.06, 95% CI 0.02–0.14, p < 0.001), palliative surgery (OR 0.32, 95% CI 0.19–0.54, p < 0.001), Clavien‐Dindo ≥ III complications (OR 0.69, 95% CI 0.51–0.93, p = 0.016) and advanced oncologic stage (OR 0.53, 95% CI 0.45–0.62, p < 0.001), and a significant increase in R0 resections (OR 3.15, 95% CI 1.67–5.94, p < 0.001) and laparoscopic surgery (OR 1.93, 95% CI 1.57–2.38, p < 0.001). The crude and adjusted Odds Ratio similarity confirmed this correlation, regardless of the comorbidities and confounders. Conclusions Adherence to CRC screening should be further encouraged and standardized for people over 70.
Evaluating the Impact of Robotic Ileal Pouch-anal Anastomosis Tommaso Violante, Davide Ferrari, Marco Novelli, Kevin T. Behm, William R. Perry, et al. Annals of Surgery, 2026 Objective: To compare robotic-assisted proctectomy with ileal pouch-anal anastomosis (R-IPAA) outcomes and laparoscopic proctectomy with ileal pouch-anal anastomosis (L-IPAA) within a specialized robotic surgery center, using matching techniques to minimize potential confounding factors. Summary Background Data: Minimally invasive approaches, particularly laparoscopy, have improved outcomes for IBD and FAP patients undergoing IPAA. Robotic-assisted surgery offers potential technical advantages, but its definitive superiority over laparoscopy in this context remains under debate. Methods: This retrospective, STROBE-compliant study analyzed 234 consecutive IPAA patients (117 robotic, 117 laparoscopic). Data encompassed patient demographics, intraoperative details, and postoperative outcomes. We employed various matching techniques to address potential bias. Primary endpoints focused on 30-day complications, readmissions, and reoperations, with secondary endpoints including hospital stay, blood loss, and stoma closure rates. Results: R-IPAA demonstrated a lower conversion rate to open surgery (P=0.02), a shorter hospital stay (P=0.04), and reduced blood loss (P=0.0003) compared to L-IPAA. While overall 30-day morbidity rates were similar (P=0.4), matched analyses suggested a trend towards fewer reoperations and 3-month IPAA-associated complications after diverting loop ileostomy closure in the robotic group. However, these differences did not reach statistical significance. Conclusions: In a high-volume robotic surgery center, R-IPAA reduced the risk of conversion to open surgery while reducing intraoperative blood loss and providing shorter length of stay with equivalent perioperative outcomes. Promising trends to reduce 30-day reoperations and surgical complications following DLI closure were observed after a matching analysis.
Communication skill training in surgical residency: insights from Y-SICO (Young-Italian Society of Surgical Oncology) Rossella Melcarne, Federico Cappellacci, Filippo Carannante, Ludovico Carbone, Federica Ferracci, et al. Updates in Surgery, 2026 Surgical training programs primarily emphasize technical skills for diagnosis and treatment. However, communication and interpersonal skills are equally essential for residents. Trainees often face sensitive situations, such as delivering bad news and discussing end-of-life decisions and lack of communications skills could result in a negative impact on patients and malpractice claims. Despite their importance, communication skills training is often underrepresented in surgical education. This study aimed to explore the extent to which such training is offered during surgical residency in Italy, and to investigate how surgical trainees and young surgeons perceive their own communication competence and confidence, particularly in emotionally demanding scenarios. The “COSTRUIRE” (COmmunication Skills TRaining in sUrgIcal REsidency) survey, conducted from July to September 2024 by the Young Group of the Italian Society of Surgical Oncology, utilized a 30-item online questionnaire to gather data on participants’ communication experiences, emotional experiences, burnout risk, and training preferences. The responses were analyzed in accordance with the CHERRIES guidelines. A total of 189 participants met the inclusion criteria, including general surgery residents (61.4%) and early-career surgeons. Most respondents (85.2%) reported having communicated a difficult diagnosis without supervision during training. While participants rated their communication skills positively, over 70% expressed a desire to have handled these conversations differently, often citing the need for better tools or support. Notably, 73.9% reported learning communication informally by observing mentors. Only 7.9% received formal training during residency, despite 91% recognizing its importance. Emotional impact was significant, with high levels of emotional involvement but also early signs of burnout. The COSTRUIRE survey identified the importance of structured communication skills training in Italian surgical residency. Addressing this gap may contribute to improving self-perceived competence and confidence in managing emotionally challenging clinical interactions.
