INTRODUCTION:In 2020, the American College of Surgeons introduced Operative Standard 5.8 mandating that lymph nodes be sampled from 1 hilar (N1) station and 3 separate mediastinal (N2) stations for all lung resections with curative intent. Though lymph node assessment is necessary for staging, there is limited data to define the number of lymph nodes or the extent of dissection. We seek to clarify modern trends in mediastinal lymph node sampling. METHODS:The SEER database was queried for patients who underwent surgery, 18 years and older, between 2018 and 2020 with non-small cell lung cancer. Demographics, stage, histology, and cause-of-death were compared. RESULTS:Of 17927 NSCLC patients, 16 431 (91.7%) underwent MLNS. Percentages increased over time 91% (2018), 92% (2019), and 93% (2020). MLNS was associated with more average harvested nodes (13.5 vs. 8.2), although the number of positive lymph nodes was similar. Death from any cause and lung cancer-specific death was higher in patients that did not receive MLNS (12.2% vs 9.1% and 7.8% vs 5.3%). CONCLUSION:MLNS is performed in more than 91% of anatomic resections. It is not known if each satisfied the 3N2 + 1N1 threshold with evidence strong enough to demand it. Operative Standard 5.8 mandates a solution for a problem that may not exist. Threatening hospitals with loss of accreditation distracts the surgeon agency with non-clinical considerations and compromises safe choices.
BACKGROUND:Neoadjuvant radiotherapy (RT) has been the standard of care for locally advanced rectal cancer (LARC) for over two decades. Adjuvant RT use in LARC represents a deviation from standard care and warrants further investigation. OBJECTIVES:To identify factors associated with adjuvant RT utilization. We hypothesized that sociodemographic determinants contribute to differences in the sequence of radiation treatment among patients with rectal cancer. METHODS:This retrospective cohort study utilized the National Cancer Database (2015-2022) to identify adults with clinical stage II-III rectal adenocarcinoma undergoing surgery and RT. Patients were categorized by RT sequence (neoadjuvant vs. adjuvant). Multivariable logistic regression identified factors associated with use of adjuvant RT. RESULTS:Of the included 48 452 patients, 6.9% received adjuvant RT. Compared with the neoadjuvant group, adjuvant RT recipients exhibited higher rates of pathologic upstaging (20.5% vs. 10.3%), positive margins (14.7% vs. 6.3%), and lymphovascular invasion (17.4% vs. 11.3%; all p < 0.001). On multivariable analysis, positive margins (aOR 1.78, 95% CI 1.43-2.22), lymphovascular invasion (aOR 1.96, 95% CI 1.66-2.31), upstaging (aOR 1.63, 1.31-2.02) were independently associated with adjuvant RT. CONCLUSIONS:Adjuvant RT appeared to be used in patients who were found to have high-risk tumor pathology postoperatively.
AIM:Standard treatment for muscle-invasive bladder cancer (MIBC) includes radical cystectomy (RC), a highly invasive procedure. We evaluated the utility of the Geriatric-8 (G8) screening tool in guiding treatment and whether the survival benefit of RC differs by G8 score. METHODS:We retrospectively reviewed patients with non-metastatic MIBC who underwent G8 assessment (2020-2024). Patients were grouped by G8: low (<11), intermediate (11-14), and high (>14). Treatment patterns and the effectiveness of RC were evaluated. RESULTS:A total of 152 patients were included (high: n = 55, intermediate: n = 67, low: n = 30). RC was performed in 124 patients (81.6%). Lower G8 was linked to older age, poorer performance status, and dependent instrumental activities of daily living (p < 0.01). Neoadjuvant chemotherapy followed by RC was more frequently planned in the high G8 group (81.8% vs. 53.7% vs. 26.7%, p < 0.0001), while immediate RC was a more common plan in the low G8 group (14.5% vs. 41.8% vs. 53.3%, p = 0.0003). RC was associated with significantly improved overall survival, and the benefit persisted after propensity score matching (p = 0.0013). Inverse probability of treatment weighting, which retained the whole cohort, gave a consistent estimate (hazard ratio [HR] 0.17, 95% confidence interval [CI] 0.08-0.39). Subgroup estimates were less precise in the low G8 group (HR 0.57, 95% CI 0.12-2.73) than in the intermediate (HR 0.14, 95% CI 0.06-0.33) and high (HR 0.10, 95% CI 0.02-0.39) groups. In sliding window analysis, HR estimates were higher at G8 < 9, with wide CIs. Similar results were observed for cancer-specific survival. CONCLUSIONS:RC was associated with a survival benefit in patients with intermediate and high G8 scores, whereas the evidence in the low G8 group was limited and inconclusive; careful risk-benefit evaluation remains warranted in this group.
BACKGROUND:Glossectomy for oral cancer can lead to significant concerns regarding speech and swallowing function. This study aims to assess the impact of age on post-glossectomy functional recovery and quality of life. METHODS:We conducted a retrospective analysis of patients who underwent glossectomy for primary oral cavity cancer involving the oral tongue from 2016 to 2024. Patients were stratified into three cohorts: < 60, 60-70, and > 70 years. Functional outcomes were assessed using speech-language pathology evaluations at 1 month, 6 months, 1 year, and 2 years postoperatively. Patient-reported quality of life was assessed using FACE-Q scores. RESULTS:206 patients were included, with 92 patients under 60, 61 patients aged 60-70, and 53 patients over 70. Primary closure was performed in 80 patients (39%), and free flap reconstruction in 109 (53%). One month postoperatively, patients over 70 demonstrated significantly higher rates of moderate to severe reductions in labial ROM and strength (p < 0.05). At 1 and 2 years, most functional differences had resolved, but deficits in labial ROM and strength persisted at 2 years (p = 0.048). FACE-Q scores, gastrostomy tube and tracheostomy dependence, length of stay, readmission, reoperation, and revision rates did not differ across cohorts. When adjusting for comorbidities, glossectomy type and age were significant predictors of long-term functional outcomes. CONCLUSION:Older patients undergoing glossectomy may experience initial delays in functional recovery, but long-term clinically meaningful functional outcomes are comparable across age groups. However, older patients may experience decreased patient-reported satisfaction in key domains, emphasizing the need for careful patient selection and shared decision-making when considering glossectomy in older adults.
Hepatocellular carcinoma (HCC) poses significant therapeutic challenges due to its high heterogeneity and immunosuppressive tumor microenvironment (TME). Immunogenic cell death (ICD) represents a promising strategy in cancer therapy by eliciting antitumor immune responses through the controlled release of damage-associated molecular patterns (DAMPs). However, its therapeutic efficacy remains substantially limited by the immunosuppressive TME and the lack of selective targeting of conventional ICD-inducing agents. MicroRNAs (miRNAs) regulate immune checkpoints (e.g., PD-L1), TME populations (e.g., tumor-associated macrophages and regulatory T cells), and DAMPs-related pathways, positioning them to both enhance ICD and relieve its constraints. Clinical translation, however, is hindered by delivery and off-target effects. Emerging nanotechnologies, including pH-responsive and photoresponsive carriers, enable spatiotemporal co-delivery of ICD inducers (e.g., oxaliplatin) and miRNA modulators (e.g., anti-miR-21), thereby augmenting DAMP release, reprogramming the TME, and targeting competing endogenous RNA networks (e.g., lncRNA H19) to overcoming resistance. In this Review, with a focus on clinical translation, we argue that combining ICD, immune checkpoint blockade, and miRNA modulation offers a coherent framework to turn cold HCC tumors into responsive ones, thereby increasing treatment precision and sustaining benefit.
INTRODUCTION:SMA-first-approach in pancreaticooduodenectomy (PD) was found to be associated with better oncological outcomes as compared to the standard approach both in our pilot study and a few retrospective studies. Hence, we performed a randomized controlled trial to compare these two approaches in terms of resection margins, lymph node-retrieval, and long-term survival. METHODS:Between January 2014 to December 2018, all the consecutive patients undergoing PD for periampullary cancer at the Department of Gastrointestinal Surgery, AIIMS, New Delhi were assessed for randomization. Primary outcomes were R0 resection rate and number of lymph nodes retrieved. The secondary outcomes were operating time, blood loss, postoperative complications, recurrence free and overall survival. RESULTS:Of 299 patients assessed, 203 were randomized and 183 analyzed (20: excluded after randomization, 90: patients-SMA, 93: patients-classical). The median age of the study population was 56 (14-78) years, with predominantly male (138, 68%) and with periampullary tumors (89%). The demographic profile, preoperative clinical and laboratory parameters were comparable. The blood loss was significantly higher in SMA first group (675 vs 600 ml, p = 0.02), however the operating time and the need for blood transfusion were comparable in both groups. ISGPS Grade B/C pancreatojejunostomy leak (20 vs 24.7%, p = 0.68), post-pancreatectomy hemorrhage (8.8 vs 14%, p = 0.38), delayed gastric emptying (37.8 vs 40.9%, p = 0.67) and Clavien-Dindo grade ≥III complications(27.7 vs 31.2, p = 0.85) were similar in both the groups. The R0 resection rates (82.2 vs 78.5%, p = 0.53) and total lymphnodes retrieved (18 vs 17, p = 0.63) were similar between the two groups. Both groups were comparable in terms of median recurrence free (48 vs 44 months, p = 0.85) and overall survival (53 vs 51 months, p = 0.69). CONCLUSIONS:'Posterior (SMA-first) approach' and 'Standard approach' for pancreatoduodenectomy for periampullary cancer yielded equivalent results in terms of R0 resection rate, number of lymph nodes retrieved, recurrence-free and overall-survival.
INTRODUCTION:Neoadjuvant therapy for pancreatic adenocarcinoma (PDAC) has evolved from single-agent to multi-agent approaches, largely informed by metastatic disease studies demonstrating improved survival; albeit at the price of increased toxicity. It remains unclear how response to varied neoadjuvant regimens impact survival. We hypothesized that tumor response to different neoadjuvant approaches reflects underlying tumor biology, and achieving a pathologic complete response (pCR) with single-agent neoadjuvant may signal favorable biology. METHODS:Adult PDAC patients (2010-2021) who received neoadjuvant therapy were identified in the National Cancer Database. Tumor response was categorized as pCR (pT0N0), moderate (≥ 2 T-stage reduction), or minimal/no response (≤ 1 T-stage reduction). Patients with stage IV disease, margin positive, or nodal involvement on final pathology were excluded; sensitivity analyses including these patients were performed. Neoadjuvant regimens were classified as single-agent, multi-agent, or multi-agent therapy plus adjuvant chemotherapy. RESULTS:Of 1923 patients, 9.8% achieved pCR, 19.1% had moderate response and 71.1% had minimal/no response. The 3-year overall survival (OS) was 74% [68-81] for pCR, 56% [51-62] for moderate, and 50% [47-52] for minimal/no response. Notably, 11% of pCR patients received single-agent therapy and had a 3-year OS comparable to those who received more intensive regimens, even after adjusting for confounders. Conversely, single-agent therapy in moderate or minimal/no responders was associated with significantly worse survival. Sensitivity analyses including patients with nodal metastasis and positive margins demonstrated consistent trends. CONCLUSIONS:Most PDAC patients benefit from multi-agent neoadjuvant, although a small subset achieve pCR with single-agent therapy and experience excellent outcomes. Response to varied neoadjuvant approaches merits further investigation in biomarker-driven studies and may inform opportunities for therapy personalization in appropriately selected PDAC patients.
BACKGROUND AND OBJECTIVES:Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is established for peritoneal surface malignancies, but its use in older patients is debated. We assessed CRS-HIPEC morbidity and mortality in patients aged ≥ 70 years using a cohort of younger patients as a comparator. METHODS:We retrospectively reviewed consecutive patients aged ≥ 70 and < 70 undergoing CRS-HIPEC for peritoneal carcinomatosis at two centers (2017-2026). Peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CC), complications (Clavien-Dindo), and mortality were analyzed. RESULTS:Ninety-five patients were included (53 female; mean age 74.7 years; 10 [10.5%] aged ≥ 80; 70 [73.7%] ASA III-IV). Commonest primaries: colorectal (40), gastric (14), ovarian (12). Mean PCI was 15.6; complete cytoreduction (CC-0) was achieved in 58.9%. Complications were Clavien-Dindo grade III-IV in 11.6%, and grade V in 3.2%; major morbidity (≥ III) was 14.7%. Longer operative time (p = 0.013) and intraoperative transfusion (p = 0.027) were associated with major morbidity in the elderly cohort, whereas age was not (p = 0.161). Overall mortality was 12/95 (12.6%). CONCLUSIONS:In selected patients aged ≥ 70 years, CRS-HIPEC achieved morbidity and mortality comparable to the younger group, with most complications low-grade. Advanced age alone should not preclude CRS-HIPEC; candidacy depends on comorbidity, performance status, and the likelihood of complete cytoreduction.
OBJECTIVE:This single-center retrospective cohort study aimed to evaluate the efficacy of auricular acupressure combined with heat-sensitive moxibustion in promoting gastrointestinal functional recovery and regulating gastrointestinal hormone levels in patients who underwent laparoscopic colorectal cancer surgery. METHODS:A total of 68 patients with colorectal cancer who underwent laparoscopic radical resection at Ningde Municipal Hospital affiliated to Ningde Normal University from January to December 2022 were retrospectively enrolled. According to the postoperative intervention measures received, the patients were divided into an intervention group (n = 34, standard postoperative care plus auricular acupressure combined with heat-sensitive moxibustion) and a control group (n = 34, only standard postoperative care). The primary outcome indicators included the time to first flatus, time to recovery of bowel sounds, and time to first defecation after surgery. The secondary outcome indicators included the incidence and severity of postoperative abdominal distension, abdominal distension scores and bowel sound scores at 12, 24, 48 and 72 h after surgery, and the levels of gastrointestinal hormones (gastrin [GAS], motilin [MTL], gastric inhibitory polypeptide [GIP]) detected by radioimmunoassay before surgery and 5 days after surgery. The clinical data of the two groups were collected and statistically analyzed to compare the differences in each outcome indicator. RESULTS:There were no statistically significant differences in baseline demographic data, clinical characteristics and operative variables between the two groups (p > 0.05), with good comparability. The time to first flatus, time to recovery of bowel sounds and time to first defecation in the intervention group were significantly shorter than those in the control group (all p < 0.05). At 72 h after surgery, the incidence of abdominal distension in the intervention group (67.65%) was significantly lower than that in the control group (88.24%), and the severity of abdominal distension in the intervention group was milder than that in the control group (p < 0.05). The abdominal distension scores and bowel sound scores of the intervention group at 12, 24, 48 and 72 h after surgery were significantly lower than those of the control group (all p < 0.05). There were no significant differences in the levels of GAS, MTL and GIP between the two groups before surgery (p > 0.05). At 5 days after surgery, the levels of the three gastrointestinal hormones in both groups were changed compared with those before surgery, and the levels of GAS, MTL and GIP in the intervention group were significantly higher than those in the control group (all p < 0.05). CONCLUSION:Auricular acupressure combined with heat-sensitive moxibustion can effectively shorten the recovery time of gastrointestinal function, reduce the incidence and severity of postoperative abdominal distension, and effectively regulate the levels of gastrointestinal hormones in patients after laparoscopic colorectal cancer surgery. It is a safe and effective non-pharmacological adjuvant therapy for postoperative clinical management, and is worthy of clinical promotion and application.
BACKGROUND:Text-based pathology reports inadequately communicate complex three-dimensional (3D) relationships in musculoskeletal oncology, potentially contributing to errors in re-resection and adjuvant treatment planning. While our prior 7-case pilot study established technical feasibility, the scalability of this workflow and its utility as a platform for further innovation have not been demonstrated. METHODS:We conducted a prospective implementation study of 36 musculoskeletal oncology specimens at a tertiary sarcoma center between April 2023 and November 2025. Specimens underwent ex vivo 3D scanning using a structured light scanner, followed by virtual annotation using computer-aided design software to mirror the standard-of-care grossing process and create visual pathology reports (VPRs). The primary outcome was systematic implementation without disrupting standard processing. Secondary outcomes included platform-derived applications: augmented reality (AR)-guided re-resection, 3D margin heat maps, and 3D wound-bed scans. RESULTS:All 36 specimens were scanned and mapped (21 soft tissue, 13 bone, 2 metastatic; median greatest specimen dimension 12.7 cm). Positive margins occurred in 13.9% (N = 5) of cases. VPRs were presented in multidisciplinary tumor boards in three of these five cases. AR guidance was implemented in eight staged-resection cases (N = 4 for positive margin re-resection, N = 4 for pre-reconstruction planning), 3D heat maps were created for eight cases, and intraoperative wound bed scanning was piloted once. DISCUSSION/CONCLUSION:3D specimen scanning and virtual mapping are scalable workflows providing a permanent visual record of resected specimens and functioning as a foundational platform for novel interventions. AR-guided surgery and 3D heat mapping demonstrate potential paradigm shifts from static reporting to dynamic, visual pathologic reporting and surgical guidance.
BACKGROUND:The quality of mesorectal excision completeness is a key determinant of oncologic outcomes in rectal cancer; however, it is unclear how surgical margin status influences the survival impact of mesorectal excision quality. The present study aimed to assess the survival outcomes of incomplete total mesorectal excision (TME) in patients with locally advanced rectal cancer, according to surgical margin status. METHODS:Using a contemporary (2022-2023) cohort from the US National Cancer Database, adult patients with clinical stage II-III rectal adenocarcinoma who underwent proctectomy were included. Complete and near-complete TME were analyzed as a single group and compared with incomplete TME. Multivariable logistic regression was used to identify predictors of incomplete TME. Kaplan-Meier statistics and multivariable Cox proportional hazard analysis were used to assess 3-year overall survival (OS), stratified by margin, stage, and neoadjuvant chemoradiation therapy (nCRT). RESULTS:Among 4889 patients (61.6% males), 12.6% had an incomplete TME. Incomplete TME was associated with higher rates of positive CRM (37.5% vs. 11.1%) and positive margins (39.7% vs. 12.5%). Incomplete TME was associated with reduced 3-year OS (82.0% vs. 87.9%, p < 0.001). This survival decrement was more notable in patients with positive CRM (71.0% vs. 81.2%) than in patients with negative CRM (87.9% vs. 88.6%). The adverse survival effect of incomplete TME was strongest in patients who did not receive nCRT. Incomplete TME was not independently associated with reduced OS after adjustment for confounders (HR: 1.583, 95% CI: 0.892-2.807, p = 0.116). CONCLUSIONS:Incomplete TME was not independently associated with significantly reduced OS. However, it may have an adverse survival effect in patients with positive CRM or who did not receive nCRT. Margin status was found to be a critical modifier of the TME-survival relationship.
PURPOSE:This study investigated the prognostic value of the preoperative tumor-to-blood pool standardized uptake value ratio (TBR) on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in patients undergoing pancreatoduodenectomy (PD) for distal bile duct and ampullary cancers. METHODS:We retrospectively reviewed 100 patients who underwent PD between January 2011 and December 2024. TBR was calculated as tumor SUVmax divided by the SUV of the descending aorta. The optimal cutoff for overall survival (OS) was determined using time-dependent ROC curve analysis. Survival outcomes were evaluated using Kaplan-Meier and multivariable Cox regression analyses. RESULTS:A TBR cutoff of 2.30 was identified. Patients with high TBR (≥ 2.30) had significantly higher preoperative bilirubin, C-reactive protein, and CA19-9 levels, more frequent lymph node metastasis, poorer differentiation, and longer operation time than those with low TBR. High TBR was associated with worse OS and recurrence-free survival (RFS) (both p < 0.001). Multivariate Cox regression confirmed high TBR as an independent predictor of poor OS (Hazard Ratio: 2.88, p = 0.044). CONCLUSIONS:Preoperative TBR on FDG-PET/CT was associated with adverse pathological features and inferior survival in patients undergoing PD for distal bile duct and ampullary cancers. These findings suggest that TBR may be useful as an adjunctive PET-derived marker for preoperative risk stratification.
Liver transplantation (LT) is the definitive treatment for early hepatocellular carcinoma (HCC), based on established criteria. Pre-transplant imaging occasionally underestimates the tumor burden or biological aggressiveness, leading to explant pathology that exceeds the projection criteria, such as Milan. This paper aims to review the incidence, prognostic implications, post-transplant management, and outcomes of explant pathology in patients with HCC beyond Milan. We conducted a narrative review of the literature focusing on imaging-pathology discrepancies, recurrence risk stratification, immunosuppression strategies, surveillance, and adjuvant therapeutic considerations. A significant proportion of LT recipients had explant findings that exceeded the predicted criteria. These patients are at higher risk of recurrence, particularly those with microvascular invasion and poor differentiation. Currently, no standard adjuvant therapy exists; however, individualized surveillance and immunosuppression optimization, including sirolimus-based regimens, are reasonable strategies. Prospective studies are needed to define the optimal post-transplant pathways. Explant-beyond-criteria HCC represents a distinct high-risk population that requires individualized post-transplant management. While no validated adjuvant therapy exists, risk stratification using tools such as the RETREAT score, immunosuppression optimization with mammalian target of rapamycin (mTOR) inhibitors, and intensified surveillance may improve outcomes. Prospective studies are needed to define the optimal management strategies for this challenging population.
BACKGROUND AND OBJECTIVES:Failure to rescue (FTR), defined as death following a postoperative complication, is an established quality metric; however, national data after pulmonary resection remain limited. We aim to identify patient-, procedural-, and hospital-level factors associated with FTR after pulmonary resection for lung cancer and evaluate related outcomes. METHODS:The National Inpatient Sample (2016-2022) was used to identify adults undergoing elective pulmonary resection for lung cancer who developed ≥ 1 major complication. FTR was defined as in-hospital mortality. Multivariable logistic regression identified predictors. Secondary outcomes included length of stay, costs, and discharge disposition. RESULTS:Among 14,575 patients with major complications, FTR occurred in 2.6%. Frailty (OR 3.44, 95% CI 2.73-4.35) and comorbidity burden (Elixhauser ≥ 2: OR 4.87, 1.54-15.43) were the strongest predictors. Pneumonectomy (OR 2.78, 1.82-4.23), age ≥ 75 years (OR 2.21, 1.47-3.32), and open approach (OR 1.78, 1.41-2.24) were also associated, while female sex and private insurance were protective. No hospital factors were independently associated. CONCLUSIONS:FTR is driven by patient vulnerability and procedural complexity rather than hospital characteristics. These findings emphasize preoperative risk stratification and complication management in high-risk patients but do not support regionalization to high-volume centers as a strategy to reduce FTR.
INTRODUCTION:In liver transplantation (LT) with a caval sparing (CS) approach, the presence of complete encirclement of inferior vena cava (IVC-E) by hypertrophic segment 1 increases the technical complexity of hepatectomy. Thus, in LT for hepatocellular carcinoma (HCC), It may be suspected that the resulting greater liver manipulation and delayed vascular exclusion might increase the risk of intraoperative dissemination of tumor cells. METHODS:A multicenter, retrospective study was performed to assess the association between IVC-E and the risk of post-transplant tumor recurrence in a cohort of 537 HCC patients treated with CS-LT, between 2010 and 2021. IVC-E was defined on preoperative imaging. RESULTS:IVC-E (n = 150) and no-IVC-E (n = 387) groups were comparable in terms of severity of underlying liver disease, recipient characteristics, morphological and biological features of HCC. Recipient hepatectomy was significantly longer in IVC-E group (IVC-E vs. no-IVC-E, 144 min [110-180] versus 120 min [90-150], p < 0.001) and was associated with higher blood transfusion requirements (no transfusion cases, 15.3% vs. 25.8%, p = 0.034). The cumulative incidence of HCC recurrence at 1, 3, and 5-year, accounting for the competing risk of death unrelated to tumor recurrence, was significantly higher in IVC-E group (8.1%, 18.5%, and 20.1% vs. 3.9%, 8.4%, and 11.3%, p = 0.001, respectively). CONCLUSIONS:The technical complexity associated with IVC-E during CS hepatectomy not only increases intraoperative morbidity but may also trigger the risk of post-transplant tumor recurrence in LT for HCC.
BACKGROUND/OBJECTIVE:This study aimed to compare extreme oncoplastic surgery (EO-partial breast reconstruction for tumors > 5 cm or multicentric lesions) with extreme reconstruction (ER-mastectomy with reconstruction for tumors >5 cm or multicentric lesions). METHODS:This retrospective cohort study evaluated clinical and pathological parameters, complications, recurrence, survival, and aesthetic outcomes in 276 women, with large or multicentric breast carcinoma who underwent breast reconstruction between March 2004 and September 2025 at a private oncoplastic practice and two tertiary hospitals in Goiânia, Brazil. Data were analyzed using SPSS (version 15.0), with statistical significance set at p < 0.05. RESULTS:Mean follow-up was 44 months for EO and 57 months for ER (p = 0.03). Clinical tumor size before chemotherapy was 60 mm in both groups; after neoadjuvant chemotherapy, tumors were smaller in EO (37 mm vs. 44.5 mm, p = 0.02). EO required fewer procedures, with 74% completed in a single surgery, while ER more often required multiple operations (p < 0.01). No significant differences were found between groups regarding margin status or re-excision rates. In the ER group, 51.40% of patients developed complications, with 18.60% requiring reoperation due to severe events (p < 0.01). Five-year overall survival was similar (94.40% EO vs. 97.50% ER, p = 0.53), as was locoregional recurrence-free survival (97%). Patient-reported outcomes and physician assessments demonstrated superior satisfaction and aesthetic results in EO. CONCLUSIONS:EO provides equivalent oncologic safety to ER, with fewer surgeries, lower complication rates, and improved aesthetic and psychosocial outcomes. These findings support EO as a valid alternative to mastectomy with reconstruction in selected patients with large or multicentric breast cancer.
Robotic surgery has transformed head and neck cancer (HNC) treatment. This scoping review synthesizes evidence on transoral robotic surgery (TORS), focusing on applications, limitations, and future directions. Following PRISMA-ScR guidelines, this review used the PCC framework (Population: HNC patients; Concept: technological advancements; Context: any clinical setting). A systematic search of five databases and gray literature was conducted. Two independent reviewers screened records and extracted data from clinical trials and reviews. From 5411 records, 21 studies were included. Evidence confirms TORS provides excellent local disease control and functional benefits (e.g., shorter hospitalization, improved swallowing) over open surgery, albeit with a distinct complication profile (e.g., hemorrhage). A significant finding is the scarcity of high-quality randomized trials comparing TORS to radiotherapy or open surgery. Technologically, evolution from multiport to single-port and flexible systems has improved access, though limitations like absent haptic feedback persist. Emerging trends focus on AI integration for precision and developing smaller instruments. Robotic surgery is a viable, evolving approach for HNC with demonstrable functional advantages. Its future depends on overcoming technological limits, establishing cost-effectiveness, and validating efficacy through robust comparative studies. AI integration is a promising frontier for enhancing surgical precision and personalization.
BACKGROUND:ACS-NSQIP began capturing operative approach in 2022. With increased adoption of minimally invasive (MIS) techniques for malignancy, a contemporary review of benchmark outcomes for open, laparoscopic and robotic gastrectomy is warranted. METHODS:We performed a retrospective cohort study of adults in ACS-NSQIP (2022-2024) undergoing partial or total gastrectomy (CPT 43631-4 and 43620-2) for cancer. Outcomes included operative time, length of stay (LOS), unplanned conversion-to-open, and 30-day morbidity, mortality, and readmission. Multivariable logistic regression evaluated patient and operative factors associated with morbidity. RESULTS:Among 1,459 patients (median age 66, 60.4% male), 66.8% underwent partial gastrectomy and 33.2% total gastrectomy. Approaches were 61.2% open, 19.5% laparoscopic, and 19.3% robotic. Thirty-day mortality (1.8%), major complications (18.2%), and readmissions (10.3%) did not differ by approach. Unplanned conversion-to-open occurred in 14.0% of MIS. Robotic had longer median operative time of +1.2 and +1.7 h than laparoscopic and open and median -1 and -2 days shorter LOS respectively (p < 0.001). Hypoalbuminemia (OR 3.10), CKD ≥ 3 (OR 1.75), and anemia (OR 1.48) were independently associated with major complications (p < 0.05). CONCLUSION:Operative approach influences operative time and LOS but not short-term morbidity and mortality. The newly available ACS-NSQIP operative approach variable enables approach-specific benchmarks for cancer-related gastrectomy.
BACKGROUND:The publication of SARC028 in late 2017 revolutionized soft tissue sarcoma (STS) treatment by demonstrating promising response to anti-PD1 immunotherapy in undifferentiated pleomorphic sarcoma (UPS) and dedifferentiated liposarcoma (DDLPS). Data on immunotherapy efficacy and outcomes in larger cohorts and with longer follow-up remain limited. METHODS:31 672 cases of UPS, DDLPS, alveolar soft part sarcoma, and myxofibrosarcoma were extracted from the NCDB. Factors associated with the use of immunotherapy were evaluated using logistic regression, and survival analysis was performed with Kaplan-Meier curves and Cox proportional hazards models. RESULTS:Patients diagnosed with STS after 2017 were 3.67 times more likely to receive immunotherapy. Immunotherapy was associated with an approximately 20% reduction in mortality in stage IV STS, which was driven by cases of UPS. This survival benefit was observed in male, but not female, patients. There was no survival benefit in stage III STS. DISCUSSION:These data are consistent with a survival benefit with immunotherapy in stage IV STS, predominantly in UPS, supporting the findings of SARC028. Benefit in stage III STS was not observed, limiting concordance with later trials like SARC032. Further prospective data on long-term outcomes and immunotherapy efficacy according to histology and sex are needed.
