Traditional American Joint Committee on Cancer (AJCC) staging exhibits critical limitations when assessing oral squamous cell carcinoma (OSCC) treated with neoadjuvant immunochemotherapy (NICT). This study proposed using the percentage of residual viable tumor (
Surgical resection is the standard for early-stage lung adenocarcinoma (LUAD), but recurrence remains a risk for patients with epidermal growth factor receptor (EGFR) mutations. The efficacy of adjuvant EGFR tyrosine kinase inhibitors (EGFR-TKIs) in stage IA LUAD is currently controversial. This retrospective study evaluated 456 patients with stage IA EGFR-mutant LUAD. We compared survival outcomes between patients receiving adjuvant EGFR-TKIs (n = 60) and an observation group (n = 396). Subgroup analyses identified specific clinical features associated with treatment benefit. With a median follow-up of 75.87 months, exploratory analysis suggested a favorable trend toward improved 7-year disease-free survival (DFS) in the EGFR-TKI group compared with the observation group (92.2
Robotic pancreatoduodenectomy demands precise orientation during uncinate/mesopancreatic dissection around the superior mesenteric artery (SMA)/vein (SMV) axis, where neural and lymphatic plexus dissection is technically and oncologically important.1,2In this deep field, small pancreatic head arterial branches and jejunal mesenteric arteries are useful landmarks but are difficult to recognize under the limited tactile feedback of robotic surgery. This video demonstrates indocyanine green (ICG) fluorescence-guided navigation at two demanding steps of robotic pancreatoduodenectomy using the da Vinci Xi Firefly system, with low-dose boluses (1.25–2.5 mg) followed by a rapid 10–20-mL saline flush.3 ICG was applied during uncinate/mesopancreatic dissection oriented to the peri-SMA nerve plexus (PL-phII) and during jejunal mobilization.4,5,6 In the presented case, ICG provided clear real-time confirmation of pancreatic head arterial landmarks—including the inferior pancreaticoduodenal artery (IPDA) and the dorsal pancreatic artery (DPA) right branch—in the deep uncinate and mesopancreatic field. The DPA right branch, running superficial to the PL-phII division plane, served as a representative orientation marker around the SMA/SMV axis.5,6 In the jejunal mesentery, fluorescence visualized the first and second jejunal arterial (J1A/J2A) branching, facilitating selection of the intended mesenteric division line.4 ICG fluorescence may offer useful real-time anatomical confirmation during these two demanding steps. It should be regarded as an adjunct to preoperative imaging and surgical anatomy, not as evidence of improved perioperative or oncologic outcomes.
A timely, high-quality biopsy is essential for the accurate staging and prompt treatment of invasive cutaneous melanoma. While excisional biopsies are considered to be the gold standard, biopsy techniques vary. In parallel, the proportion of Advanced Practice Providers (APPs) in dermatologic practice has increased. We aimed to evaluate the relationship between biopsy type, deep margin status, and pathologic T (pT) category upstaging on an individual patient level as well as regional biopsy trends stratified by provider credentials. Medical records of patients referred to our academic center for invasive melanoma treatment from 2017 to 2022 were retrospectively reviewed. Shave biopsies (67
This video demonstrates a robotic distal pancreatectomy with partial splenectomy for a pseudopapillary neoplasm located at the splenic hilum. Total splenectomy during distal pancreatectomy carries a lifelong risk of overwhelming post-splenectomy infection. Although splenic preservation is preferred, tumors adjacent to the splenic hilum often preclude standard vessel-sparing techniques. A 38-year-old woman presented with an incidentally discovered asymptomatic 4-cm pancreatic tail mass during abdominal imaging. Further investigations with endoscopic ultrasound demonstrated a 33-mm pancreatic tail lesion, and fine-needle aspirate cytology was consistent with a pseudopapillary neoplasm. Due to the splenic-artery small-vessel branching, a splenic vessel-sparing Kimura technique was not feasible. A robotic approach using the da Vinci X platform was used. This involved division of the pancreas, ligation of the splenic vessels, and a partial splenectomy. Indocyanine green fluorescence imaging was used to confirm robust perfusion of the preserved splenic segment. The robotic approach allowed for excellent visualization and precise dissection of the splenic hilum. The patient tolerated the procedure well and experienced an uneventful postoperative recovery. Final pathologic assessment confirmed a pseudopapillary neoplasm with negative margins. Robotic spleen-preserving distal pancreatectomy with partial splenectomy is a safe and feasible approach for select pancreatic tail lesions near the splenic hilum. This technique achieves oncologic resection and maximizes splenic function when standard vessel-sparing techniques are inappropriate1.
In patients with synchronous liver-metastatic low-grade (WHO grade 1/2) gastro-entero-pancreatic neuroendocrine tumors (GEPNETs), resection of primary and liver metastases is associated with improved overall survival (OS). The benefit of surgical resection in metastatic well-differentiated grade 3 GEPNETs, a recently defined tumor grade, remains unclear. We aimed to define survival benefit from primary resection and liver metastasectomy in patients with well-differentiated WHO grade (G) 3 GEPNETs. Patients diagnosed with well-differentiated WHO grade 1—3 synchronous liver-metastatic GEPNETs between 2018–2021 were identified from the National Cancer Database (NCDB). Kaplan-Meier and multivariable Cox proportional hazards modeling were utilized to evaluate the association of primary tumor and liver resection with OS. Among 3,198 patients (G1: n=1434; G2: n=1113; G3: n=651), surgical intervention decreased with higher grade (G1: 67.3
Resection of the celiac artery (CA) during surgery for locally advanced pancreatic cancer (LAPC) carries a significant risk of hepatic and gastric ischemia.1,2 In addition, in the current context, where patients undergo intensive chemotherapy before surgery, a new complication has emerged: post-pancreatectomy liver injury (PPLI).3 A 59-year-old patient with biopsy-confirmed locally advanced pancreatic cancer arising from the pancreatic body (Video and Fig. 1) underwent extended neoadjuvant FOLFIRINOX (folinic acid [leucovorin], fluorouracil, irinotecan, and oxaliplatin). The patient was restaged using the A-B-C criteria,4 adding the target approach for anatomical feasibility,5 metabolic imaging, and survival prediction.6 The patient underwent extended pancreatosplenectomy, including resection of the left adrenal gland and the CA (Mayo Clinic class Ia), divestment of the superior mesenteric artery, and portal-superior mesenteric vein reconstruction using a left renal vein graft interposition. Arterial reconstruction was initially deemed unnecessary, as proper hepatic artery flow was maintained—albeit dampened—via the gastroduodenal artery, confirmed by visual inspection and Doppler ultrasound. Postoperatively, the course was notable for a rapid rise in alanine aminotransferase levels without overt clinical or radiological deterioration (Fig. 2). Emergency re-exploration was undertaken with the objective of hepatic arterial revascularization (Fig. 3). We hypothesized that, in the setting of underlying metabolic dysfunction–associated steatotic liver disease, arterial inflow was insufficient to meet the demands of an already vulnerable parenchyma, with increased intrahepatic resistance further compounding ischemic liver injury consistent with clinically relevant (CR)-PPLI. Liver biopsy confirmed acute steatohepatitis and extensive ischemic necrosis. Early postoperative recognition and grading of CR-PPLI is critical to prevent liver failure, as static imaging may fail to reflect dynamic hepatic perfusion. A disproportionate rise in alanine aminotransferase within 48 h is a key warning sign. Prospective multicenter studies are needed to better define the incidence, risk factors, and optimal management of CR-PPLI.
