Spleen-preserving station No. 10 lymphadenectomy is technically demanding because the splenic hilar branches and pancreatic tail occupy a deep, confined field. We present a plane-first “Sandwich” sequence that organizes established anatomical planes and vessel-oriented maneuvers into a structured teaching workflow. A 50-year-old man (170 cm, 55 kg) with poorly differentiated gastric adenocarcinoma, staged cT3N+M0, received three cycles of neoadjuvant SOX plus camrelizumab. Endoscopy placed the esophagogastric junction at approximately 40 cm and the infiltrative lesion at 45–53 cm from the incisors. After multidisciplinary review and endoscopic carbon-nanoparticle marking, total gastrectomy was selected to secure an oncologically appropriate proximal margin. Station No. 10 dissection was an individualized decision based on the pretreatment tumor extent, posterior gastric-body involvement toward the greater-curvature side, radiographic nodal risk, planned total gastrectomy, and team experience. The upper and lower exposure planes were established before vessel-oriented removal of the intervening splenic hilar lymphoadipose layer. Operative time was 257 min, estimated blood loss was 100 mL, and no conversion, transfusion, pancreatic injury, splenic injury, or major vascular injury occurred. Permanent paraffin pathology showed residual moderately-to-poorly differentiated adenocarcinoma with negative margins, modified Ryan tumor regression score 2, and 2/41 metastatic lymph nodes (station No. 3, 1/2; station No. 5, 1/6; station No. 10, 0/3), yielding ypT3N1M0, post-neoadjuvant stage II. A postoperative pulmonary infectious episode requiring continued antibiotics and respiratory therapy was classified as Clavien–Dindo grade II. At approximately 51 months, the patient was alive with no reported recurrence. In this patient, the plane-first Sandwich sequence enabled completion of spleen-preserving No. 10 dissection with defined anatomical landmarks and completion criteria. Its principal contribution is a structured operative sequence and visual teaching framework for selected patients undergoing hilar lymphadenectomy. Not applicable.
To compare perioperative, oncological, and functional outcomes between intrafascial (IF) and extrafascial (EF) techniques in Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) performed beyond the learning curve. This retrospective study analyzed 188 patients with localized prostate cancer (LPCa) who underwent RS-RARP between May 2021 and July 2023 at the urology departments of the Chinese PLA General Hospital. Patients were stratified into an IF group (n = 72) and an EF group (n = 116) based on the clinical T stage of the tumor and patient preference. All surgeries were performed by experienced surgeons (> 100 RS-RARP cases). Perioperative outcomes, positive surgical margin (PSM) rates, biochemical progression-free survival (bPFS), urinary continence (UC) recovery, and the EPIC-26 urinary incontinence and sexual scores were analyzed. No significant differences were observed in operative time, estimated blood loss, postoperative length of hospital stay, or complication rates (all P > 0.05). Regarding oncological outcomes, after multivariable adjustment, EF RS-RARP was associated with a lower hazard of biochemical recurrence (HR = 0.12, 95
Despite curative-intent surgery, recurrence remains a major cause of mortality in gastric cancer, while conventional clinicopathological staging provides limited accuracy for postoperative risk stratification. Circulating tumor DNA (ctDNA), a promising biomarker of molecular residual disease (MRD), has emerged as a potential tool for identifying occult residual disease and guiding personalized postoperative management. However, the prognostic value of ctDNA across different clinical contexts and assay strategies remains incompletely defined. A systematic review and meta-analysis was conducted in accordance with PRISMA guidelines. PubMed, Embase, and Web of Science were searched for eligible studies published between January 2019 and May 2025. Studies evaluating ctDNA or broader cfDNA-based biomarkers as prognostic markers in gastric cancer and reporting hazard ratios (HRs) for survival outcomes were included. Pooled HRs with 95
Colorectal signet-ring cell carcinoma (SRCC) is rare, often advanced at diagnosis, and associated with poor survival. We assessed whether the association between SRCC and advanced presentation differed across diagnosis eras and quantified the timing of survival loss in early-onset disease. We analyzed SEER Research records of stage I–IV colorectal adenocarcinoma diagnosed at ages 20–49 years during 2000–2023. Baseline-covariate and stage-conditional survival models, competing-risk analyses, sequential tumor-burden adjustment, and crude and stage-standardized landmark restricted mean survival time (RMST) compared SRCC with conventional and mucinous adenocarcinoma. Among 66,916 diagnosis records from 65,595 patients, 1,230 (1.8
This randomized controlled trial aims to evaluate whether adjuvant gemcitabine plus cisplatin improves overall survival compared to gemcitabine monotherapy in patients with resected cholangiocarcinoma (CCA). Secondary outcomes include assessment of disease-free survival, treatment safety, and adherence. This phase III, multicenter, open-label randomized controlled trial planned to enroll 320 patients with resected CCA. Eighty patients were randomized to receive either gemcitabine plus cisplatin or gemcitabine monotherapy (40 per group). Recruitment was terminated prematurely because of slow accrual and the absence of a clear benefit signal in preliminary efficacy data. Outcomes including overall survival, disease-free survival, and safety were assessed. At a median follow-up of 83.5 months (95
