Background: The optimal adjuvant strategy for incidentally detected node-positive rectal cancer following curative intent surgery remains uncertain, particularly in early-stage disease where nodal involvement is only identified postoperatively. This systematic review evaluates the survival impact of available adjuvant modalities and highlights prognostic factors that may justify selective use of postoperative radiotherapy (RT). Methods: A systematic search of PubMed, EMBASE, MEDLINE and the Cochrane Library was conducted to August 2023 following PRISMA guidelines. Retrospective studies reporting outcomes in patients with incidental nodal disease who underwent curative rectal resection without neoadjuvant therapy were included. Risk of bias was assessed using the Newcastle–Ottawa Scale. Heterogeneity precluded meta-analysis. Results: Nine studies comprising 5,989 patients were analysed. Adjuvant therapy demonstrated superior outcomes compared with observation alone. Overall survival ranged from 61.3–92% with adjuvant chemotherapy (CT) and 63–93% with chemoradiotherapy (CRT), compared with 42–82.1% without adjuvant treatment. Disease-free survival ranged from 43–90%. Local recurrence (2–9.1%) was consistently lowest with CRT. Importantly, several studies reported comparable survival between CT and CRT in pT1–2N1 disease, suggesting that routine CRT may not be required in all incidental stage IIIA cases. Poorer outcomes were consistently associated with pN2 disease, positive margins, lymphovascular or perineural invasion, high lymph node ratio and low tumour location. Conclusion: Adjuvant CT should be considered the minimum standard of care for incidental node-positive rectal cancer. RT appears most appropriate for patients with specific high-risk features or unfit for CT rather than universally for all stage IIIA patients. These findings support risk-adapted postoperative decision-making within colorectal multidisciplinary teams, and reinforce the need for prospective, stratified adjuvant treatment protocols.

Background: The objective of this study was to evaluate sleeve gastrectomy plus jejunal bypass (SG-JJB) for type 2 diabetes mellitus (T2DM) in Chinese patients with a body mass index (BMI) ≥32.5 kg/m2. We also compared the outcomes of SG-JJB to those of sleeve gastrectomy (SG). Methods: This retrospective study included 60 patients between September 2023 and October 2024 at shanghai ninth people’s Hospital, in shanghai, or lancing first people’s Hospital, Pu’er, China. Among them, 40 patients were underwent SG and 20 patients were received SG-JJB. SG-JJB consists of SG and performing a jejunoileal anastomosis 240 cm distal to the angle of Treitz. Postoperative total weight loss (TWL), T2DM remission and patient complication were compared. Resluts: All the operations were performed laparoscopically and the mean postoperative follow-up was 18 months (13-27). The mean age was 36 years (21–53), 85 % of patients were female and Mean preoperative BMI was 37.6 kg/m2 (33–50.2 kg/m2) in SG group, while it was 37 years (23–61), 83 % and 38.3 kg/m2 (34.5–48.8 kg/m2) in SG-JJB group (P>0.05). Patients in SG-JJB group had a longer operation time (135± 15 min vs 106± 10 min) and postoperative hospital stay (6 days vs 4 days) than patients in SG group (P<0.01). SG-JJB yielded higher TWL than SG alone (32.3±7.1% vs 28.9±9.1%, P<0.05). Complete T2DM remission was achieved in 85% of patients (17/20) and partial remission in 15% (3/20) in SG-JJB, while it was 70% (28/40) and 30% (12/40) in SG group. It suggests that SG-JJB has a greater advantage in T2DM. There were no deaths, no postoperative bleeding, no re-operation and no gastric fistula in all patients. The incidence of postoperative gastroesophageal reflux disease (GERD) symptoms is similar in SG-JJB (10%, 2/20) and SG (12.5% 5/40)(P>0.05). Conclusion: SG-JJB is a safe surgical technique for T2DM in patients with BMI ≥32.5 kg/m2, it yielded higher TWL and diabetes remission than SG.

Background 10-15% of patients with gallstone related pathology have choledocholithiasis, with endoscopic retrograde cholangiopancreatography (ERCP) being a treatment option. Spontaneous passage of common bile duct (CBD) stones not infrequently result in negative ERCPs with unnecessary procedural risks and resource utilisation. To reduce this, we aim to derive predictors for spontaneous stone passage. Methods We performed a single centre, retrospective cohort study at St John of God Midland Hospital in Western Australia, Perth on 78 patients who underwent ERCP following imaging confirmed choledocholithiasis from June 2022 – Sep 2024. Multivariable logistic regression models were used to analyse predictors for spontaneous stone passage. Receiver Operating Characteristics (ROC) curve and Youden Index were used to investigate if the drop in liver function test (LFT) indices from initial diagnosis of choledocholithiasis to just prior to ERCP can predict spontaneous stone passage. Results 21.5% of patients with imaging proven choledocholithiasis had no evidence of stones on ERCP, suggestive of interval spontaneous passage. Size of CBD stone was independently associated with spontaneous stone passage. For each 1mm increase in stone size, the odds of spontaneous passage decreased by 54% (adjusted OR 0.46, 95% CI 0.27–0.77; p=0.003). Among the 5 biochemical predictors evaluated (bilirubin, AST, ALT, ALP, GGT), the drop in ALT from initial choledocholithiasis diagnosis to just prior to ERCP demonstrated a fair diagnostic performance with an area under curve (AUC) of 0.708 (95% CI: 0.548-0.868). At the optimal ALT cutoff of 210.5 U/L, the test achieved moderate sensitivity (70.6%) and moderate specificity (74.2%) in predicting spontaneously passed stones, resulting in a Youden Index of 0.448. Conclusion 1 in 5 CBD stones will likely pass spontaneously. For patients with a small CBD stone and ALT drop of 210.5 U/L, repeat imaging could be considered prior to ERCP for reassessment.