Obstructive colorectal cancer is associated with substantial morbidity and stoma formation. Bridge-to-surgery (BTS) using self-expanding metallic stents (SEMS) can convert emergency surgery into an elective procedure, but evidence in robotic colorectal surgery remains limited. This study evaluated the feasibility of SEMS-based BTS in robotic surgery for obstructive left-sided colorectal cancer. This retrospective single-center cohort study included consecutive patients who underwent robotic colorectal resection between February 2023 and December 2025. After excluding right-sided colon cancer, 161 patients were analyzed: 37 underwent BTS and 124 underwent upfront elective surgery. Propensity score matching using preoperative variables generated 36 matched pairs. The primary outcome was major postoperative complications, defined as Clavien–Dindo grade ≥ III complications. Secondary outcomes included perioperative outcomes, robotic intraoperative metrics, and short-term oncological surrogate outcomes. After matching, robotic intraoperative metrics showed no statistically significant differences between the non-BTS and BTS groups, including console time (136.50 vs. 148.00 min, P = 0.166), total operative time (250.00 vs. 274.50 min, P = 0.205), estimated blood loss (3.00 vs. 3.00 mL, P = 0.936), and conversion to open surgery (0
The double bipolar method (DBM) using Maryland and fenestrated bipolar forceps has been advocated as a bipolar-centered energy strategy for robotic colorectal surgery; however, evidence beyond small case series is limited. This study therefore evaluated the feasibility, safety, and learning curve of DBM in a consecutive single-institution cohort. We retrospectively analyzed 100 consecutive robotic colorectal resections performed using DBM between June 2023 and September 2025. The primary endpoint was operative time and its learning curve, assessed using the cumulative sum (CUSUM) and segmented regression. Key safety endpoints—anastomotic leakage and major complications (Clavien–Dindo ≥ III)—were summarized descriptively. Secondary endpoints included blood loss, conversion, length of stay, and readmission. Sensitivity analyses employed risk-adjusted CUSUM. The mean operative time was 244 min, and the median blood loss was 3 mL. No cases required conversion to open surgery. Anastomotic leakage and major complications were observed in 0
BACKGROUND:The efficacy and safety of early direct oral anticoagulant (DOAC) (re)initiation in patients with non-valvular atrial fibrillation (NVAF) after acute onset of intracranial hemorrhage (ICH) are unknown. This study evaluated ischemic and hemorrhagic risks following early DOAC (re)initiation after ICH in patients with NVAF. METHODS AND RESULTS:SAFE-ICH is a multicenter prospective observational single-arm registry study at 32 Japanese hospitals. Eligible patients had NVAF, were aged ≥20 years, and (re)initiated DOAC ≤14 days following symptomatic ICH. Among 240 patients who (re)initiated DOAC (61.3% male; mean [±SD] age 79.4±9.3 years), intraparenchymal hemorrhage predominated (84.6%), followed by subdural (12.9%), intraventricular (1.7%), and epidural (0.8%) hemorrhage. The median (interquartile range) baseline National Institutes of Health Stroke Scale score was 10 (3-16) and time to DOAC (re)initiation was 7 days (5-10 days). Edoxaban, apixaban, and rivaroxaban were used in 55.0%, 35.8%, and 9.2% of patients, respectively. The primary endpoint (composite of symptomatic ICH, any stroke, or death ≤30 days following DOAC [re]initiation) occurred in 12 (5.0%) patients. There were 4 recurrent ICH events (1.7%; all recurrent subdural hemorrhages). Five (2.1%) patients died of non-vascular causes. CONCLUSIONS:In Japanese patients with NVAF, early DOAC (re)initiation ≤14 days after ICH appears to have an acceptable risk for ischemic and hemorrhagic events, particularly in patients with intraparenchymal hemorrhage. In patients with subdural hematoma, early DOAC (re)initiation requires vigilant monitoring.
BACKGROUND:The aim of this study was to investigate the clinical and biological impact of TP53 gain-of-function (GOF) mutations in epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). Although concurrent TP53 mutations are associated with poor outcomes in EGFR-mutant NSCLC, the specific impact of TP53 GOF mutations on resistance to EGFR tyrosine kinase inhibitors has remained unknown. MATERIALS AND METHODS:Genomic profiling was performed for pretreatment tumor samples from 140 individuals with advanced or recurrent EGFR-mutant NSCLC who received first-line osimertinib monotherapy. TP53 mutations were functionally classified into GOF and non-GOF mutations. Progression-free survival (PFS) was evaluated according to TP53 status. Underlying biological characteristics of tumors positive for TP53 mutations were explored by transcriptome analysis in 53 patients. RESULTS:TP53 mutations were detected in 64 (45.7%) of 140 patients, with GOF and non-GOF mutations being identified in 19 (13.6%) and 45 (32.1%) patients, respectively. PFS was significantly shorter in individuals with TP53 GOF mutations than in those wild type for TP53 (median of 12.0 versus 31.4 months, P = 0.0016) or those with TP53 non-GOF mutations (median of 12.0 versus 21.9 months, P = 0.038). The GOF mutations were not associated with baseline clinical features or a reduced objective response rate, suggestive of a role in early development of osimertinib resistance. Transcriptomic analysis revealed upregulation of the ephrin signaling pathway in TP53 GOF-mutant NSCLC. CONCLUSIONS:TP53 GOF mutations define a biologically and clinically distinct subtype of EGFR-mutant NSCLC characterized by early resistance to osimertinib.
Unidirectional counter-clockwise manipulation of the Evolution RL sheath after adequate dissection enables controlled lead body rotation and gradual unscrewing. This technique may reduce myocardial injury during non-retractable screw-in lead removal.
