Oncological surgery is undergoing profound transformation driven by advances in systemic therapy, immunotherapy, and minimally invasive techniques. This narrative review examines whether open abdominal surgery retains clinical relevance in gynecological malignancies or has been superseded by modern alternatives. A literature search was conducted in PubMed combining terms related to gynecological malignancies, abdominal surgical procedures (open, laparoscopic, robotic, cytoreduction, pelvic exenteration), and personalized systemic therapies. Original articles, reviews, and guidelines in German and English were included. Two independent reviewers screened titles, abstracts, and full texts, extracting data on study design, interventions, and clinical endpoints (R0 resection, morbidity, progression-free and overall survival). For cervical cancer, open radical abdominal hysterectomy as the standard of care was internationally confirmed. In endometrial cancer, minimally invasive approaches are established for early-stage disease, while laparotomy remains the gold standard in advanced stages requiring cytoreductive surgery. For ovarian, tubal, and primary peritoneal carcinoma, open cytoreductive surgery with the goal of macroscopically complete resection remains guideline recommended. Emerging biomarkers such as circulating tumor DNA may further refine patient selection and surgical decision-making. Open abdominal surgery remains indispensable in gynecological oncology. Rather than being replaced, it is evolving into a specialized, biology-adapted component of multimodal treatment strategies. Surgical indications are becoming less frequent but more complex and individualized. Patient selection in experienced centers remains the decisive factor.
Minimally invasive D2 lymphadenectomy for gastric cancer is technically demanding, and its quality varies across patients, surgeons, platforms, and institutions. Conventional endpoints, including lymph node yield, margin status, operative time, blood loss, postoperative morbidity, and survival, remain essential but do not consistently capture intraoperative procedural fidelity, safety-critical deviations, or case complexity. This narrative framework review synthesized evidence from MEDLINE, Embase, and Web of Science from inception to May 10, 2026, focusing on technical difficulty, surgical quality assessment, pathology-centered oncologic adequacy, risk-adjusted outcomes, and artificial intelligence (AI)-enabled audit. Technical difficulty was conceptualized as a case- and context-dependent risk-adjustment layer shaped by anatomical complexity, vascular variation, therapy-altered tissue planes, visceral adiposity, operative platform, team workflow, and learning stage. Surgical quality was defined as a multidomain construct integrating process metrics, pathology metrics, and risk-adjusted clinical outcomes. The proposed framework provides audit-oriented guidance for identifying a simplified minimum dataset, prioritizing high-risk D2 segments for selective process review, and interpreting process, pathology, and outcome indicators together after adjustment for technical difficulty. AI may support scalable audit through video indexing, phase and step recognition, extraction of high-risk operative segments, assisted event logging, and structured feedback. However, AI outputs should be treated as candidate measurement signals requiring human confirmation, expert surgical review, pathology-based assessment, external validation, governance, and post-deployment monitoring. Future validation should proceed stepwise, from feasibility testing and inter-rater reliability assessment to prospective workflow evaluation and multicenter assessment of audit efficiency, benchmarking validity, and process- or patient-level outcomes. Quality assessment in minimally invasive D2 lymphadenectomy should shift from isolated surrogate endpoints toward an auditable, difficulty-adjusted framework that makes “D2 achieved” more measurable, reviewable, and clinically meaningful.
Prior research suggests miR‑572 may suppress breast cancer (BC), but its precise role and mechanism in disease progression, particularly in triple‑negative breast cancer (TNBC), remain unclear. Tumor and matched adjacent normal tissues were collected from 100 patients with TNBC. TNBC cell lines were analyzed by RT‑qPCR for their miR‑572 expression. Kaplan‑Meier, multivariate Cox regression, and ROC analyses were used to assess the prognostic role of miR‑572. Separately, the effects of miR‑572 on TNBC cell proliferation, migration, and invasion were analyzed using CCK‑8 and Transwell assays. Potential target genes of miR-572 were predicted using bioinformatics, followed by GO and KEGG enrichment analyses. The direct regulatory relationship between miR-572 and the target gene CDKN1A was validated by dual‑luciferase reporter assay, with CDKN1A protein levels further confirmed by Western blot. TNBC tissues and cells exhibited significantly reduced miR‑572 expression versus normal. Low levels of miR‑572 were linked to TNM stage as well as lymph node metastasis. Kaplan‑Meier curves showed poor prognosis in patients with low miR-572 expression, and ROC analysis for prognosis yielded an AUC of 0.896. TNBC cell proliferation, migration, and invasion were all suppressed upon miR‑572 overexpression. CDKN1A was confirmed as a direct target gene of miR-572. CDKN1A upregulation partially counteracted the inhibition of TNBC cell proliferation, migration, and invasion induced by miR‑572 mimics. Downregulation of miR-572 in TNBC patients may be associated with poor prognosis. miR-572 inhibits proliferation, migration, and invasion of TNBC cells at least in part by regulating CDKN1A.
Upper tract urothelial carcinoma (UTUC) with venous tumor thrombus is exceedingly rare and highly aggressive, and its anatomical complexity poses major surgical challenges in the absence of standardized operative strategies. We retrospectively reviewed UTUC patients who underwent radical nephroureterectomy with thrombectomy at the First and Third Medical Centers of the Chinese PLA General Hospital. Baseline, perioperative, and pathological data were collected. Overall survival (OS), disease-free survival (DFS), perioperative renal function, and the applicability of the Mayo and “301” classifications were evaluated. By August 2024, 11 patients (7 men; 60.45 ± 8.68 years) were included. Flank pain and gross hematuria were the most common symptoms. On preoperative MRI-based assessment, Mayo thrombus levels 0, I, II, III, and IV were observed in 2, 2, 5, 1, and 1 patient(s), respectively. Using the 301 classification, levels 0, 0a, I, II, III, and IV were observed in 1, 1, 4, 3, 1, and 1 patient(s), respectively. Ten patients underwent robot-assisted radical nephroureterectomy with thrombectomy and IVC reconstruction or patch angioplasty when needed; one patient required conversion to open surgery. Median operative time was 222 min (IQR 170–255), and median blood loss was 300 mL. One perioperative death occurred after massive postoperative hemorrhage, corresponding to a perioperative mortality rate of 9.1
Breast cancer is the most common malignancy in women, and surgery remains a cornerstone of treatment. Traditional quality indicators, such as complication or margin status, often fail to capture the overall quality of surgical care. In recent years, indicators such as Textbook Outcomes (TO) and benchmarking (BM) have been proposed to provide a more comprehensive assessment. We conducted a systematic review, registered in PROSPERO (CRD420251131786), following PRISMA guidelines, to evaluate their role in breast cancer surgery. A total of 344 studies were screened, and seven were included (four addressing TO and three BM). TO was defined by negative margins, adequate lymph node dissection, no 30-day mortality or readmission, and no prolonged hospital stay, was consistently associated with improved overall survival. BM studies revealed significant interhospital variability and opportunities for improvement. Both TO and BM appear promising as tools for quality evaluation, but international consensus and prospective validation are required for widespread implementation.
Gastric cancer remains a global health burden with poor prognosis despite advances. Adding systemic therapy to surgery has improved outcomes, and perioperative FLOT chemotherapy is the European standard of care following the FLOT4 trial, showing superiority over ECF/ECX. However, practices remain heterogeneous worldwide, and recent studies have assessed whether adding targeted therapies to FLOT further improves outcomes. This systematic review aimed to evaluate the efficacy of perioperative FLOT, alone or combined with immunotherapy or targeted agents, in resectable gastric adenocarcinoma. We systematically searched PubMed (MEDLINE), Scopus, and Web of Science. Randomised controlled trials, non-randomised trials, and cohort or observational studies published between 2019 and 2025 evaluating perioperative FLOT, alone or combined with immunotherapy or targeted agents, in resectable gastric adenocarcinoma were included. Data on tumour stage, margin-negative resection rate, pathological and radiological response, overall survival, and other time-to-event outcomes were extracted and synthesised narratively, as substantial heterogeneity precluded meta-analysis. Eighteen studies were included. Across studies comparing perioperative regimens, FLOT was associated with more favourable pathological and survival outcomes in most, though not all, comparisons; however, the evidence rests largely on non-randomised studies, and the magnitude of benefit varied with the comparator. In the adjuvant setting, FLOT improved survival compared with omitting adjuvant chemotherapy, though this appeared restricted to selected subgroups. Regarding the addition of immunotherapy or targeted agents, most studies reported improved pathological outcomes in the experimental arm; however, these have not yet translated into consistent survival benefits. This review reinforces perioperative FLOT as the current standard of care for resectable gastric adenocarcinoma and highlights the potential of adding immunotherapy or targeted agents. Interpretation is limited by between-study heterogeneity, predominance of non-randomised evidence, and immature survival data in the targeted-therapy studies, underscoring the need for longer-term follow-up and prospective comparative trials.
Hypoxia is a key feature of the bladder cancer tumor microenvironment, but its cellular organization, prognostic value, and functional effectors remain incompletely defined. Here, we integrated single-cell RNA sequencing, bulk transcriptomic cohorts, machine-learning modeling, immune deconvolution, spatial transcriptomics, and functional experiments to characterize hypoxia-driven tumor microenvironment remodeling in bladder cancer. Single-cell analysis showed that hypoxia-related activity was enriched in malignant epithelial and stromal compartments and was associated with altered tumor–stromal communication. In bulk cohorts, high hypoxia activity was linked to poor overall survival and activation of aggressive biological programs. By integrating hypoxia-associated differentially expressed genes, WGCNA-derived module genes, and survival-related genes, we developed a six-gene Bladder Cancer Hypoxia-Related Signature (BCHRS) using an optimized CoxBoost plus stepwise Cox model. BCHRS consistently stratified patient survival across TCGA-BLCA and two independent validation cohorts and provided prognostic information beyond conventional clinicopathological variables. High BCHRS scores were associated with epithelial–mesenchymal transition, extracellular matrix remodeling, metabolic reprogramming, and an immunosuppressive immune microenvironment. Spatial transcriptomics further prioritized TPST1 as a tumor-localized hypoxia-associated effector. Functional experiments confirmed that TPST1 promoted bladder cancer cell proliferation, migration, invasion, EMT-related changes, xenograft tumor growth, and experimental lung colonization. These findings define BCHRS as a hypoxia-related prognostic framework and identify TPST1 as a functional effector of aggressive bladder cancer progression.
Persistent high low anterior resection syndrome (LARS) severely impairs quality of life after sphincter-preserving surgery for rectal cancer, highlighting the urgent need for robust predictive tools. This prospective longitudinal study enrolled 208 patients who underwent rectal cancer resection. LARS scores were prospectively assessed at 1, 3, 6, and 12 months postoperatively. Latent growth mixture modeling (LGMM) was used to identify distinct LARS trajectories. The primary clinical objective was to identify patients with persistent High LARS; accordingly, trajectory groups were designated, and the 6-month Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36 were used to validate this classification. Ten machine learning algorithms and a clinical nomogram were developed to predict persistent High LARS. To identify patients with clinically meaningful persistent bowel dysfunction, we defined the High LARS Group as those with a High‑stable trajectory. The Low‑stable and Progressive improvement trajectories, which showed comparable HRQoL at 6 months, were combined into a Controlled LARS Group. This grouping was further validated by the significantly lower PCS and MCS scores in the High‑stable group versus the other two trajectories (all p < 0.001). Among the ten machine learning algorithms, Support Vector Machine (SVM) achieved the highest predictive performance (AUC = 0.811, 95
Patients often present at advanced stages of early-onset rectal cancer (EORC), which is becoming more common. Within a year following rectal resection, some patients experience early adverse outcomes (EAO), such as severe complications, recurrence, or death; however, there is currently no validated postoperative risk-stratification tool for this population. Current prognostic models concentrate on individual endpoints rather than the composite adversity spectrum that is pertinent to younger patients because they were mostly established in older cohorts. This work sought to create and externally validate a model for detecting EORC patients at greater risk of EAO using a stacking ensemble machine learning approach with SHAP interpretability in order to guide individualized postoperative surveillance and adjuvant therapy decisions. In this two-center retrospective cohort study, 648 EORC patients from Center A (2020–2025) constituted the development cohort and 102 patients from Center B (2024–2025) the external validation cohort. Eleven individual machine learning models and a two-layer stacking ensemble (combining three base learners with logistic regression meta-learner) were trained. Model performance was assessed by area under the receiver operating characteristic curve (AUC), calibration, and decision curve analysis. Boruta feature selection identified eleven important predictors, with pathological T stage (pT), lymphovascular invasion (LVI), and pathological TNM stage (pTNM) contributing most to model predictions. The stacking ensemble outperformed all 11 individual models, achieving AUCs of 0.91 (95
STIL is a key molecule influencing the proliferation and cell cycle of gastric cancer cells; however, STIL is also expressed in normal tissues. Therefore, designing a drug delivery system that targets gastric cancer cells is crucial for STIL-targeted therapy. In this study, we constructed exosomes targeting the HER-2 receptor and loaded with siSTIL (Anti-HER-2-Exo-siSTIL), and validated the inhibitory effects of Anti-HER-2-Exo-siSTIL on gastric cancer proliferation and metastasis in vivo. Anti-HER-2-Exo-siSTIL was able to enter SGC-7901 cells and inhibit STIL expression, significantly suppressing the growth of SGC-7901 xenograft tumors. By downregulating STIL and the anti-apoptotic protein Bcl-2, and upregulating the pro-apoptotic proteins Bax, Caspase-3, and Caspase-9, Anti-HER-2-Exo-siSTIL effectively induced apoptosis in tumor cells. Furthermore, Anti-HER-2-Exo-siSTIL selectively inhibited lung metastasis of SGC-7901 cells via hematogenous dissemination. In summary, Anti-HER-2-Exo-siSTIL specifically targets and suppresses gastric cancer proliferation and lung metastasis, demonstrating its significant translational potential for gastric cancer therapy.
To develop and validate a contrast-enhanced computed tomography (CT)-based radiomics nomogram for the preoperative prediction of Ki-67 expression status and its prognostic significance in patients with hepatocellular carcinoma (HCC). This retrospective study enrolled 167 HCC patients who underwent curative surgical resection. Preoperative arterial-phase CT images were manually segmented, and 851 radiomics features were extracted. Features with high inter-observer agreement were retained and subsequently selected via least absolute shrinkage and selection operator (LASSO) regression to construct a radiomics signature (Rad-score). Clinical predictors were identified through univariate and multivariate logistic regression. A radiomics nomogram was developed by integrating independent clinical predictors with the Rad-score. The discriminatory performance was assessed using the area under the receiver operating characteristic curve (AUC). Calibration and clinical utility were evaluated with calibration curves and decision curve analysis (DCA), respectively. Kaplan-Meier survival analysis was performed to assess the prognostic stratification ability based on the nomogram-predicted Ki-67 status. Tumor size was independent clinical predictor of high Ki-67 expression. The Rad-score, derived from 10 selected features, was significantly higher in the high Ki-67 group. The radiomics nomogram demonstrated the best predictive performance, with AUCs of 0.869 (training cohort) and 0.798 (validation cohort), outperforming the clinical model (AUCs: 0.722 and 0.673) and the Rad-score alone (AUCs: 0.835 and 0.793). DCA confirmed its superior clinical net benefit. The nomogram effectively stratified patients into groups with significantly different overall survival, correlating with pathological Ki-67 status. The CT-based radiomics nomogram noninvasively and accurately predicts Ki-67 expression in HCC preoperatively and effectively stratifies patient prognosis. This tool integrates imaging phenotypes with clinical variable, offering a practical framework for individualized risk assessment and treatment optimization.
Epigenetic age acceleration/deceleration (EAA/EAD), measured using DNA methylation, is an emerging biomarker of biological aging and has been linked to adverse outcomes in various cancers. However, its prognostic role across diverse molecular subtypes of breast cancer (BC), particularly in the aggressive triple-negative breast cancer (TNBC) subtype, requires further investigation. This study aimed to investigate the association between EAA/EAD and clinical outcomes in BC. In total, 1,674 BC samples with Illumina 450 k or EPIC array data were collected for epigenetic age (epiAge) and EAA/EAD estimation. EpiAge and EAA/EAD were computed utilizing four different clocks (Horvath2013, PhenoAge, ZhangQ2019, and EpiTOC) and compared among different BC subtypes: Luminal A/B, HER2 + , Normal-like, and TNBC. Cox regression analysis and the log-rank test were employed to assess the association of EAA/EAD with BC survival. Epigenetic age alterations were observed across all BC subtypes; notably, EAD was most pronounced in the TNBC subtype. Multivariate analysis revealed that EAD (indicating a younger epiAge than chronological age) was significantly associated with a higher hazard ratio (HR = 2.03, 95
Multimodal prehabilitation has been increasingly used to enhance perioperative resilience in patients undergoing elective surgery for gastric cancer (GC). However, its effects on postoperative morbidity and recovery outcomes remain inconsistent. This systematic review and meta-analysis aimed to evaluate the impact of multimodal prehabilitation on postoperative outcomes after elective gastrectomy for GC. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to February 28, 2026. Randomized controlled trials comparing multimodal prehabilitation with standard care or ERAS-based care in adults scheduled for elective gastrectomy for GC were eligible. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the Cochrane Risk of Bias 2.0 tool. Pooled odds ratios (ORs) or mean differences (MDs) with 95
As laparoscopic techniques continue to advance, intraoperative tissue visualization has become increasingly important. In gynecological oncology, sentinel lymph node (SLN) mapping remains a critical procedure for assessing lymph node metastasis and guiding lymphadenectomy. Meanwhile, iatrogenic ureteral injury, although rare, can have severe consequences. Thus, achieving rapid, reliable, and cost-effective intraoperative visualization of both SLNs and the ureters during laparoscopy poses a significant clinical challenge. Near-infrared fluorescence (NIRF) imaging has emerged as a promising solution, using various fluorophores such as methylene blue (MB), indocyanine green (ICG), and technetium-99m (99mTc) to enable clear visualization of living tissues. However, a comprehensive summary of the advantages and limitations of these fluorophores is lacking. This article reviews the efficacy of different fluorophores for SLN and ureteral mapping and discusses recent advances in domestic fluorescence laparoscopic systems.
The incremental survival value of higher lymph node yield (LNY) or extended pelvic lymph node dissection (PLND) during radical cystectomy in the systemic therapy era remains uncertain. Because LNY is a postoperative count rather than a direct measure of anatomical dissection boundaries, we evaluated LNY-threshold and anatomical-template evidence separately and explored whether their survival associations differed according to neoadjuvant or induction systemic therapy exposure. This PROSPERO-registered systematic review and meta-analysis (CRD420261398389) was reported according to PRISMA 2020. PubMed/MEDLINE, Web of Science, Embase, ClinicalTrials.gov, and reference tracking were searched. Six studies were included in the quantitative synthesis. GRADE certainty was very low for all comparisons. Prespecified DerSimonian-Laird random-effects models were supplemented by restricted maximum-likelihood models with Hartung-Knapp adjustment. In LNY-threshold studies, higher LNY was associated with better overall survival (OS) in no-neoadjuvant-chemotherapy cohorts (three studies; HR 0.723, 95
Mucinous adenocarcinoma (MAC) exhibits aggressive clinicopathological features, yet its prognostic significance in stage II colon cancer remains controversial, and current guidelines do not regard mucinous histology as a high-risk feature (HRF). We compared mucinous and non-mucinous (NMAC) stage II colon adenocarcinomas with respect to clinicopathological characteristics and cumulative HRF burden. In this retrospective single-center cohort, patients who underwent curative resection for stage II colon cancer between January 2023 and October 2025 were included. MAC was defined as greater than 50
Breast cancer liver metastasis (BCLM) represents a critical stage of disease progression and is associated with poor survival outcomes. Molecular subtype discordance between primary tumors and metastatic lesions has been increasingly recognized; however, the relationships among subtype conversion, time to liver metastasis (TTLM), metastatic patterns, and survival outcomes remain insufficiently understood. Molecular subtypes of both primary tumors and liver metastases were classified as Luminal A, Luminal B, HER2+, or triple-negative breast cancer (TNBC). Logistic regression models were used to identify factors associated with subtype conversion and primary liver metastasis. Linear regression models were applied to explore factors related to TTLM. Overall survival (OS) was analyzed using Kaplan–Meier curves and Cox proportional hazards models. Among 205 patients with paired subtype information, the overall subtype conversion rate between primary tumors and liver metastases was 42.9
Quality of life (QoL) and psychological distress are critical yet under-evaluated dimensions of head and neck squamous cell carcinoma (HNSCC) management. While clinical staging is a primary determinant of survival, the influence of the socio-economic “safety net” in low- and middle-income countries remains under-researched. We aimed to identify independent socio-clinical predictors of QoL and develop an exploratory socio-clinical scoring chart to visualize baseline vulnerabilities. This prospective observational study of 2,458 patients at the Regional Cancer Centre, Trivandrum (2000–2004) evaluated primary HNSCC at clinical entry using the FACT-HN instrument. Multivariable regression was used to identify independent predictors among clinical TNM staging and socio-demographic variables, including literacy and family structure. A predictive nomogram was developed by normalizing regression coefficients to a 100-point scale. Multivariable Ordinary Least Squares (OLS) linear regression was utilized as the primary framework to construct the nomogram, supplemented by secondary binary logistic regression for descriptive risk stratification. The mean FACT-HN score was 103.16 ± 20.21. QoL declined significantly with advancing clinical stage (p < 0.001). Multivariable analysis revealed that socio-economic factors exerted an impact comparable to clinical stage. Multivariable continuous analysis revealed substantial baseline score penalties for patient illiteracy (-8.84 points) and spousal illiteracy (-9.75 points), matching or exceeding the impact of advanced oncological stage. Spousal literacy and adult child support emerged as primary moderators of well-being. In Indian patients with HNSCC, the “social net” (literacy and family structure) is as critical as oncological staging in determining QoL. Our exploratory nomogram provides a standardized structural map of baseline socio-demographic vulnerabilities at clinical entry, emphasizing the value of caregiver-inclusive supportive care in low-resource settings.
Prostate cancer (PCa) ranks among leading causes of male cancer mortality, but PSA screening lacks specificity. Metabolic dysregulation drives PCa pathogenesis; however, composite metabolic indices remain underexplored. The ZJU index—integrating BMI, fasting glucose, triglycerides, and liver enzymes—may enable novel risk stratification. We evaluated the ZJU index in the NHANES population cohort (N = 3,482) and a biopsy-confirmed clinical PCa cohort (N = 246) from The Second Affiliated Hospital of Nanchang University. Multivariable logistic regression, restricted cubic splines, Boruta feature selection, and Cox proportional hazards models assessed associations with PSA-defined high-risk status for PCa, PSA levels, and all-cause mortality. Elevated ZJU index independently predicted reduced PSA-defined High-risk PCa. In NHANES, each unit increment lowered high-risk PCa odds by 3
Lung cancer resection is usually associated with surgical stress and systemic immune-metabolic shifts. Existing prognostic tools largely depend on static parameters. We aimed to characterize early perioperative Systemic Immune-Inflammation Index (SII) response patterns and construct a predictive nomogram to risk-stratify patients undergoing lung cancer resection. We selected patients with malignant lung neoplasms who underwent resection and had complete perioperative laboratory records from the INSPIRE database (2011–2020). Gaussian finite-mixture modeling within an LCGA framework was applied to classify early SII response patterns from baseline to 24 h postoperatively. Primary and secondary endpoints were overall survival (OS) and intensive care unit (ICU) length of stay, respectively. A perioperative immune-metabolic stress index (PIMSI) nomogram via multivariable logistic regression was established to predict the high-risk Severe Surge response pattern and was internally validated using bootstrap resampling. A total of 2,186 patients were included and classified into three early perioperative SII response patterns: Class 1 (Stable; 57.4
