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BACKGROUND AND OBJECTIVE:Achieving undetectable prostate-specific antigen (PSA) has been correlated with improved outcomes for patients with metastatic prostate cancer. Comprehensive involved site radiotherapy (ISRT) consisting of local therapy to the prostate and radiation to all visible metastases has emerged as a method of treatment intensification for prostate cancer oligometastases. The objective of this study was to evaluate the frequency and predictors of undetectable PSA in patients who received radiotherapy for oligometastases. METHODS:Thirty-five consecutive men with oligometastatic prostate cancer were treated with comprehensive ISRT with a median follow-up of 33.3 months. Undetectable PSA was defined as <0.2 ng/ml. The primary outcome of interest was the prognostic significance of undetectable PSA following combined radiotherapy and systemic treatment. Bivariate comparisons were conducted using Fisher's exact and Mann-Whitney U tests, and multivariate comparisons were made with Cox and logistic regressions. RESULTS AND LIMITATIONS:Baseline characteristics include median age 73, median PSA 24.0 ng/ml, 74% Gleason 8 to 10, 77% hormone sensitive, 74% bone metastases, 37% distant lymph node metastases, 60% PSMA PET staged. Overall, 74% of patients achieved a PSA nadir of <0.2 ng/ml. Hormone-sensitive patients were significantly more likely to achieve PSA clearance than castrate-resistant patients (93% vs. 12.5%). Patients achieving a PSA nadir of <0.2 ng/ml had a 3-year disease-free survival of 86% vs. 22% for patients with a higher PSA nadir (P < 0.001). CONCLUSIONS:Comprehensive ISRT is effective at achieving undetectable PSA in patients with hormone-sensitive oligometastatic prostate cancer. Longer-term follow-up is needed to determine if these results are durable.
Minimally invasive approaches such as laparoscopic surgery (LS) and robotic-assisted surgery (RAS) have transformed colorectal cancer (CRC) management. This systematic review and meta-analysis evaluated nine randomized controlled trials encompassing 2,758 patients to compare RAS and LS regarding perioperative, oncological, and long-term outcomes. RAS showed longer operative time but yielded benefits such as reduced conversion rates, greater lymph node retrieval, and lower circumferential resection margin (CRM) positivity. Both techniques demonstrated comparable safety, mortality, and overall complication rates. While RAS presents certain advantages, further research is required to determine its cost-effectiveness and long-term oncological impact. Trial Registration: PROSPERO CRD420251025102.
Solid pseudopapillary neoplasms (SPNs) of the pancreas primarily affect young women, placing the surgical decision for distal tumors at a clinical crossroads: the oncologic necessity of splenectomy vs the long-term immunologic benefit of spleen preservation. This study synthesizes the current evidence to guide clinical practice. We conducted a systematic review and meta-analysis comparing laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with laparoscopic distal pancreatectomy with splenectomy (LSDP) for SPN, identifying 3 retrospective studies (n = 96 patients). The evidence base, though limited, showed comparable perioperative morbidity. No significant differences were found in overall complications (OR = 0.73; 95% CI: 0.23 to 2.31; P = 0.60), postoperative pancreatic fistula (OR = 0.51; 95% CI: 0.09 to 2.92; P = 0.45), or severe complications (OR = 0.32; 95% CI: 0.05 to 1.96; P = 0.22). Laparoscopic distal pancreatectomy with splenectomy was associated with a significantly shorter operative time (MD = −63.49 min; 95% CI: −123.79 to −3.18; P = 0.04). A non-significant trend toward a higher lymph node yield was observed in the LSDP group (MD = +4.29; 95% CI: −0.29 to 8.86; P = 0.07). The available evidence suggests LSPDP is a safe and feasible option in selected patients, achieving comparable short-term morbidity to LSDP. Given the low malignant potential of SPNs and the lifelong immunologic benefits of splenic function, especially in the typical young patient demographic, LSPDP should be the preferred approach when oncologically and technically feasible. This review provides a practical framework for surgical decision making in this rare tumor.
INTRODUCTION:Colonoscopy is the gold standard test for detecting colorectal cancer. Its accuracy relies on adequate bowel preparation (BP), but the current literature shows that hospitalized patients have high rates of inadequate BP. Data about strategies to improve BP in the inpatient population are limited and controversial. Thus, we conducted a systematic review and meta-analysis comparing enhanced instructions (EIs) with regular instructions (RIs) for inpatients undergoing colonoscopy. EIs are educational interventions that provide clearer, more comprehensive guidance, often using visual aids, to optimize patient adherence to BP regimens. METHODS:PubMed, Embase, and Cochrane Central were searched for studies comparing EIs to RIs for inpatients undergoing colonoscopy. The outcomes of interest were total inpatients who achieved Boston Bowel Preparation Scale (BBPS) ≥6 with all segments ≥2; total BBPS mean score; and BBPS mean score in the right, transverse, and left colon. RESULTS:Six randomized controlled trials were selected, with a total of 1070 patients, of whom 526 (49.2%) received EIs. In the pooled analysis, patients in the EI group were more likely to achieve BBPS ≥6 with all segments ≥2 when compared to those in the RI group (76% versus 60.5%; risk ratio 1.26; 95% confidence interval 1.15-1.37; P < 0.00001; I2 = 6%). Patients receiving EIs, compared to RIs, presented higher mean BBPS scores in the left colon (mean difference 0.24; 95% confidence interval 0.09-0.38; P = 0.001; I2 = 41%). CONCLUSIONS:EI significantly improves the overall quality of BP and BBPS score in the left colon of inpatients undergoing colonoscopy. Therefore, EI should be applied to increase colonoscopy visibility and accuracy in hospitalized patients.
Background Spontaneous coronary artery dissection (SCAD) and peripartum cardiomyopathy (PPCM) are distinct cardiovascular conditions affecting predominantly female patients, yet comparative data on their long-term outcomes remains limited. This study compared mortality, arrhythmic events, and other cardiovascular outcomes between propensity-matched cohorts of patients with these conditions. Methods This retrospective cohort study utilized the TriNetX Research Network, analyzing de-identified electronic health record data from 131 healthcare organizations. We identified 12,250 patients with PPCM and 8,261 with SCAD. After propensity score matching for age, race, ethnicity, and key comorbidities, cohorts of 2,814 patients each were analyzed. Outcomes were assessed using risk analysis, Kaplan-Meier survival analysis, and number of instances analysis over a five-year follow-up period. Results All-cause mortality did not differ significantly between groups (PPCM 3.8% vs SCAD 3.9%, p=0.883). Patients with PPCM had significantly higher risks of cardiogenic shock (HR 1.654, 95% CI 1.093-2.504, p=0.016), heart failure (HR 2.072, 95% CI 1.755-2.447, p<0.001), ventricular tachycardia (HR 1.498, 95% CI 1.126-1.994, p=0.005), acute kidney injury (HR 1.738, 95% CI 1.336-2.261, p<0.001), and pacemaker implantation (HR 1.848, 95% CI 1.377-2.480, p<0.001). Conversely, SCAD patients demonstrated higher risks of cerebrovascular disease (HR 0.378, 95% CI 0.299-0.479, p<0.001) and coronary artery disease (HR 0.132, 95% CI 0.110-0.158, p<0.001). Conclusion Despite similar mortality rates, PPCM and SCAD exhibit distinct cardiovascular outcome profiles, suggesting different pathophysiological mechanisms and highlighting the need for condition-specific management strategies. PPCM patients face greater risks of heart failure, arrhythmias, and device therapy, while SCAD patients have higher cerebrovascular and progressive coronary disease burdens.
