Increasing evidence advocates the prognostic role of RDW in various tumours. We analysed 591 patients to assess whether RDW is a prognostic factor for overall (oS) and cancer-related survival (cRS) for patients with colorectal cancer (cRc). the data were retrieved from a retrospective database. the optimal cutoff value for RDW was set at 14.1%; accordingly, two groups were considered: those with a value equal or lower than 14.1% (L-RDW), and those with a value higher than 14.1% (H-RDW). The mean value of RDW rose from pT1 to pT4 tumours. H-RDW correlated with age above the mean, colonic location of the lesion, pT and TNM stage. Finally, H-RDW was significantly associated with the intent of surgery: almost 50% of patients who underwent a non-curative resection presented H-RDW, compared to 19.3% in R0 resections. OS was significantly lower in patients with H-RDW. CRS was similar in the two groups. Stratifying patients according to TNM stage worse OS was associated with H-RDW only in early stages, whereas there was no difference for stages II-IV. Multivariate analysis confirmed that H-RDW was not an independent prognostic factor. Although H-RDW correlated with some negative clinicalpathological factors, it did not seem to independently influence OS and CRS. Colorectal cancer (CRC) is the third most common cancer worldwide, with more than 1 million new cases and 600.000 deaths per year 1. Several biochemical markers related to the inflammatory processes that accompanies this malignancy have recently surged as diagnostic and prognostic tools 2-4. Beside classical 'inflammatory related' markers such as acute phase proteins (CRP and globulins), also parameters that reflect changes in certain bone marrow lineages such as PLR and NLR have been described 2,5. Amongst these, red blood cell distribution width (RDW) is a parameter that reflects the size heterogeneity of red blood cells and is normally used to differentiate various types of anemia 6. More recently, RDW has surged as a biochemical marker in several chronic inflammatory and cardiovascular disease 7-9. Recent reports have shown how it can be used as a prognostic marker in various cancer such as, lung, liver, esophago-gastric and breast 10-15. RDW has been studied as a potential prognostic marker also in CRC. In the context of this malignancy, however, its role remains unclear, as reports so far published have shown inconsistent results. The aim of this retrospective study was to evaluate the prognostic value of red blood cell distribution width in a large cohort of patients undergoing surgery for colorectal cancer.

Background Artificial intelligence (AI) is gaining traction in medicine and surgery. AI-based applications can offer tools to examine high-volume data to inform predictive analytics that supports complex decision-making processes. Time-sensitive trauma and emergency contexts are often challenging. The study aims to investigate trauma and emergency surgeons’ knowledge and perception of using AI-based tools in clinical decision-making processes. Methods An online survey grounded on literature regarding AI-enabled surgical decision-making aids was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to 917 WSES members through the society’s website and Twitter profile. Results 650 surgeons from 71 countries in five continents participated in the survey. Results depict the presence of technology enthusiasts and skeptics and surgeons' preference toward more classical decision-making aids like clinical guidelines, traditional training, and the support of their multidisciplinary colleagues. A lack of knowledge about several AI-related aspects emerges and is associated with mistrust. Discussion The trauma and emergency surgical community is divided into those who firmly believe in the potential of AI and those who do not understand or trust AI-enabled surgical decision-making aids. Academic societies and surgical training programs should promote a foundational, working knowledge of clinical AI.

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BACKGROUNDThere is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.AIMTo investigate the impact of age on feasibility and short-term results of enhanced recovery protocol (ERP) after laparoscopic colorectal resection.METHODSData from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed. Three groups were considered according to patients’ age: Group A, 65 years old or less, Group B, 66 to 75 years old and Group C, 76 years old or more. Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications, mortality and readmission rate. Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.RESULTSAmong the 225 patients, 112 belonged to Group A, 57 to Group B and 56 to Group C. Thirty-day overall morbidity was 32.9% whilst mortality was nihil. Though the percentage of complications progressively increased with age (25.9% vs 36.8% vs 42.9%), no differences were observed in the rate of major complications (4.5% vs 3.5% vs 1.8%), prolonged post-operative ileus (6.2% vs 12.2% vs 10.7%) and anastomotic leak (2.7% vs 1.8% vs 1.8%). Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal (P = 0.032) and autonomous deambulation (P = 0.013) in elderly patients. Although discharge criteria were achieved later in older patients (3 d vs 3 d vs 4 d, P = 0.040), post-operative length of stay was similar in the 3 groups (5 d vs 6 d vs 6 d).CONCLUSIONERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.

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