The current training paradigm in Complex General Surgical Oncology (CGSO) fellowship was established when most graduates pursued traditional academic careers. However, contemporary workforce data suggest increasing misalignment between fellowship selection criteria, training requirements, and eventual career outcomes. Fellowship selection remains heavily influenced by research productivity, leading many applicants to undertake prolonged dedicated research experiences during residency despite substantial financial and institutional costs. Recent studies demonstrate that while most CGSO fellows complete dedicated research time, only a small minority subsequently achieve sustained academic productivity or extramural funding. By contrast, most graduates devote the majority of their professional effort to clinical practice. This discrepancy raises concerns regarding the efficiency and equity of a training model that broadly emphasizes research achievement despite producing a predominantly clinically focused workforce. Simultaneously, increasing demand for cancer care and evolving workforce needs underscore the importance of optimizing training pathways. We propose a differentiated fellowship model consisting of clinically intensive and research-intensive tracks that better align trainee goals with workforce demands. Such an approach would allow more targeted allocation of educational and research resources while preserving pathways for future surgeon-scientists. A corresponding reassessment of fellowship selection metrics is also warranted, emphasizing clinical performance, leadership, professionalism, and holistic applicant evaluation. Aligning selection processes and training structures with contemporary practice realities may improve efficiency, promote equity, and better prepare the future surgical oncology workforce.
Neoadjuvant chemo-immunotherapy has transformed the treatment landscape for resectable non-small-cell lung cancer (NSCLC). However, real-world surgical data from nationwide European cohorts remain limited. This study evaluated surgical outcomes and practice patterns during the first year of nationwide implementation of neoadjuvant chemo-immunotherapy with nivolumab in the Czech Republic. This prospective, multicenter, observational cohort study included all consecutive patients with resectable programmed cell death ligand-1(PD-L1) ≥ 1% NSCLC treated according to the CheckMate 816 protocol (platinum-based chemotherapy plus nivolumab) at all eight accredited thoracic oncology centers in the Czech Republic between August 2023 and August 2024. Surgical and pathological outcomes were assessed. Sixty-four patients initiated neoadjuvant therapy and 56 (87.5%) underwent resection. Minimally invasive surgery was attempted in 46.4% of cases, with an 11.5% conversion rate. Clavien-Dindo grade ≥ III complications occurred in 14.3%, with grade IIIb representing the highest severity. 30-day mortality was 0%. Although 90-day mortality was 5.4%, none of the deaths were directly attributable to surgery. R0 resection was achieved in 98.2%. In the intention-to-treat population, pathological complete response and major pathological response rates were 40.6% and 48.4%, respectively. Pathological complete response was significantly higher in squamous than in non-squamous NSCLC (66.7% vs. 27.6%; p = 0.003). In this first nationwide cohort from a European country, early adoption of neoadjuvant chemo-immunotherapy with nivolumab in patients with resectable PD-L1 ≥ 1% NSCLC was associated with acceptable perioperative outcomes, high R0 resection rates, and substantial pathological response. These results demonstrate the successful adoption of a novel NSCLC treatment modality across a nationwide healthcare system.
Surgery is the cornerstone for locally contained lung cancer; however, intraoperative challenges include accurate lesion localization and assessment of surgical margins. Intraoperative molecular imaging (IMI) using near-infrared fluorescence-guided surgery is a real-time tumor-targeted optical imaging technique. A multicenter phase II clinical trial evaluated abenacianine (VGT-309), a cathepsin-targeted near-infrared (NIR) IMI agent for visualization of pulmonary nodules and margins during surgery. The primary objective was to assess the efficacy of abenacianine. At six sites, patients scheduled to undergo surgery for known or suspected cancer in the lung received intravenous abenacianine 0.32 mg/kg 12-36 h before surgery. Efficacy was measured by the proportion of clinically significant events, defined as localization of lesions not found by standard surgical techniques, identification of additional cancers, identification of inadequate surgical margins confirmed by histology, and detection of cancerous lymph nodes. Of 89 patients who received abenacianine and surgical resection, 40 (45%) had at least one clinically significant event. Abenacianine with NIR imaging identified lesions not found by standard methods in 33 (37%) patients, synchronous and occult cancers not found by preoperative imaging in three (3%) patients, margins within 10 mm of the closest staple line in eight (9%) patients, and cancerous lymph nodes in one (1%) patient. Abenacianine was safe and well-tolerated in this study; there were no drug-related serious adverse events. IMI with abenacianine during standard-of-care lung cancer surgery improved intraoperative localization, identification of occult lesions, margin assessment, and lymph node detection, enabling a more complete oncologic resection.
Robot-assisted distal pancreatectomy is increasingly recognized as an important minimally invasive option for lesions of the pancreatic body and tail. Given the technical complexity inherent to distal pancreatectomy, including deep operative planes, vascular dissection, splenic vessel management, and the persistent risk of postoperative pancreatic fistula, robotic systems may offer specific advantages in selected settings. However, although the number of relevant publications has continued to rise, the overall research landscape and thematic development of this field remain insufficiently and unsystematically characterized. The present study was designed to assess the global research status, knowledge structure, and evolving hotspots in the field of robot-assisted distal pancreatectomy through bibliometric and visualization analysis. A total of 254 eligible publications indexed in the Web of Science Core Collection between January 1, 2007 and December 31, 2025, including 210 articles and 44 reviews, were analyzed using Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica. The yearly publication output demonstrated a general increasing pattern, with more marked growth from the mid-2010s onward and the highest output recorded in 2025. Italy together with the United States remained the principal contributors across much of the study period, while China showed sustained growth in recent years. The United States ranked first in citation impact. Several institutions, including the University of Amsterdam, University of Verona, and University of Pisa, emerged as major contributors. Among the leading publication venues were Surgical Endoscopy and Other Interventional Techniques, Annals of Surgical Oncology, and Journal of Robotic Surgery. Citation and co-citation analyses showed that the intellectual structure of the field has been shaped mainly by studies focusing on surgical technique, perioperative outcomes, and comparisons with laparoscopic distal pancreatectomy. Keyword analysis indicated that spleen preservation, pancreatic fistula, laparoscopic comparison, learning curve, clinical outcomes, and multicenter evaluation are among the main research themes, with recent attention increasingly directed toward preservation strategies, outcome assessment, and more refined clinical application. In conclusion, research on robot-assisted distal pancreatectomy has expanded steadily and is moving from early feasibility-focused exploration toward a more specialized and clinically oriented stage. Future progress in this field will likely depend on stronger multicenter collaboration, more indication-specific evaluation, and more standardized evidence generation.
Intraductal papillary mucinous neoplasm (IPMN) is a typical precursor lesion of pancreatic cancer, but differential diagnosis and grading of IPMN is often difficult. Currently, grading of diagnosis is based mainly on imaging examinations, but these methods are invasive, and the accuracy is unsatisfactory. Therefore, the current study aimed to determine the usefulness of urine cell-free DNA (cfDNA) as a liquid biopsy, which the authors suggest has potential as a less invasive diagnostic tool for IPMN. Preoperative plasma and urine samples were collected from 33 patients with a preoperative diagnosis of IPMN. From their plasma and urine, cfDNA was extracted. Analysis of GNAS and KRAS mutations in the cfDNA was performed using droplet digital polymerase chain reaction. The final diagnosis was IPMN in 31 of the 33 cases according to the resected specimens. The positivity rate of GNAS mutations in these 31 patients was 10 % (3/31) in plasma cfDNA, and 32 % (10/31) in urine cfDNA. The positivity rate of KRAS mutations was 19 % (6/31) in plasma cfDNA and 58 % (18/31) in urine cfDNA. In the multivariate analysis of the malignancy diagnosis, the main pancreatic duct diameter was ≥10 mm, and the positivity of both GNAS and KRAS mutations in urine cfDNA were significantly associated with IPMN malignancy (odds ratio [OR], 12.70; P = 0.0200; OR, 8.10; P = 0.0269). Urine cfDNA involves a less invasive liquid biopsy and seems to be useful in the diagnosis of IPMN.
Incidence of appendiceal cancer is increasing, with one-third of patients diagnosed before age 50 years. Fertility preservation (FP) is important for patients who have not completed childbearing; however, the safety of oocyte and embryo banking remains unclear due to concerns for ovarian metastases. This study evaluates incidence of ovarian metastases at cytoreductive surgery (CRS) and describes FP practices and outcomes among reproductive-aged women with appendiceal cancer. A retrospective review was conducted of female patients aged 18-45 years treated for appendiceal cancer at MD Anderson Cancer Center from January 2020 to January 2025. Clinical, surgical, pathologic, and fertility-related variables were collected. Descriptive statistics assessed rates and laterality of ovarian metastases, FP practices, and reproductive outcomes. A total of 100 reproductive-aged women (median age 35.9 years, range 19-44 years) with histology-confirmed appendiceal cancer were identified, of whom 47 underwent CRS. Ovarian metastases were documented in 89.4% (42/47), with bilateral involvement in 71.4% (30/42) and unilateral involvement in 28.6% (12/42). Fertility-sparing surgery included retention of one ovary in 25.5% (12/47) and uterine preservation in 19.1% (9/47). Among patients retaining an ovary, 60% developed amenorrhea after adjuvant therapy. Desire for FP was documented in 23.4% (11/47), all were referred for oncofertility consultation. Five patients underwent oocyte or embryo cryopreservation before CRS, including three with confirmed ovarian involvement. Reproductive-aged women with appendiceal cancer have a high and often bilateral incidence of ovarian metastases, with important implications for FP safety. Individualized fertility counseling prior to CRS is essential to optimize reproductive outcomes while maintaining oncologic safety.
Perioperative therapies for gastric and gastroesophageal junction (GEJ) adenocarcinoma have improved significantly in recent years, especially for mismatch-repair deficient (dMMR/MSI-H) tumors. Pathologic complete response (pCR) rates are now established which has raised the question as to whether surgery can be omitted. This article summarizes the debate between two gastric cancer experts supporting each side of the argument on the possibility of omitting surgery. Total, proximal, and esophagogastrectomy remain highly morbid procedures that still carry significant risk of mortality, particularly in older patients and at low-volume centers. Patients with dMMR/MSI-H gastric and GEJ adenocarcinoma have a pCR rate to neoadjuvant immunotherapy of 60% and those with mismatch repair intact (MMR-intact) tumors experience pCR to neoadjuvant chemo-immunotherapy with a rate of approximately 20%. The ability to assess for clinical complete response in gastric and GEJ adenocarcinoma has limitations, however, and there is a lack of long-term data to support omission of surgery. pCR rates are established and durable in gastric and GEJ adenocarcinoma. Omission of surgery is a consideration in patients with dMMR/MSI-H tumors with cCR to immunotherapy. Surgery remains the standard-of-care for patients with MMR-intact tumors but patients should be counseled about the possibility of pCR in shared decision making.
Early recurrence after curative resection for cT3 esophageal squamous cell carcinoma (ESCC) is strongly associated with poor long-term survival. Identifying patients at high risk of early recurrence may improve postoperative risk stratification and inform tailored surveillance or adjuvant therapy. We retrospectively analyzed patients who underwent en bloc esophagectomy with three-field lymphadenectomy. The log odds of positive lymph nodes (LODDS) were calculated as log([number of positive nodes + 0.5]/[number of negative nodes + 0.5]). Early recurrence was defined using maximally selected rank statistics. Independent risk factors for early recurrence were identified using multivariable Firth logistic regression, followed by decision tree analysis to establish hierarchical risk stratification. Among 121 patients, 109 (90.1%) achieved R0 resection. The median numbers of dissected and metastatic lymph nodes were 67.0 and 2.0, respectively, with a median LODDS of - 3.46. Early recurrence was defined as recurrence within 16.6 months after surgery. Multivariable analysis identified higher LODDS, upper thoracic location, and resectability status (resectable or borderline resectable) as independent predictors of early recurrence. In the complementary tree-based analysis, early recurrence risk was primarily stratified by LODDS using a cut-off of - 2.69. Patients with LODDS > - 2.69 had significantly worse 5-year overall survival than those with LODDS ≤ -2.69 (30.0% versus 66.1%, p < 0.001). Among patients with LODDS ≤ - 2.69, tumor location further refined risk stratification. LODDS provides a robust and clinically applicable metric for postoperative risk stratification of early recurrence in patients undergoing radical esophagectomy for cT3 ESCC.
Primary inferior vena cava leiomyosarcoma (PIVCLS) is a mesenchymal tumor originating from the smooth muscle cells of the vascular intima.1 Owing to the absence of characteristic clinical manifestations in early stages, PIVCLS often evades timely diagnosis, resulting in generally unfavorable prognosis.2 En bloc surgical resection with concomitant IVC reconstruction has emerged as the standard therapeutic approach for this disease entity.3 The established efficacy of laparoscopic vascular replacement is pivotal in accelerating postoperative recovery. This video demonstrates a minimally invasive approach to the resection of a primary inferior vena cava (IVC) leiomyosarcoma with synchronous vascular reconstruction. The case involves a 69-year-old male patient presenting with an asymptomatic infrarenal IVC tumor. A minimally invasive approach was employed to achieve complete resection of the tumor while preserving vascular integrity through precise laparoscopic vascular reconstruction techniques. The video highlights key steps, including tumor mobilization and prosthetic graft placement, offering a detailed visual guide for this complex procedure (Fig. 1). Fig. 1 The operative field after prosthetic vascular reconstruction RESULTS: Following a 6-h operation without complications, graft patency was confirmed by CT imaging on the second postoperative day, and the patient was subsequently discharged on day 7. Histopathology confirmed a poorly differentiated epithelioid leiomyosarcoma. Total laparoscopy offers superior exposure and minimal invasiveness over open surgery. Given the confined tumor, we completed the inferior vena cava reconstruction entirely laparoscopically. This procedure, while demanding, is feasible when a specialized team selects suitable cases, and vascular reconstruction is essential to maintain physiological circulatory function.
Radical salvage surgery offers the only chance of cure for patients with locally recurrent rectal cancer (LRRC), yet up to 50% develop disease recurrence after surgery. Identification of those at highest risk of disease recurrence may improve selection for surgery and intensification of neoadjuvant treatment. This scoping review aimed to identify molecular determinants of oncologic outcomes following surgery for LRRC. This study was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. MEDLINE, Embase, CENTRAL, and Scopus databases were searched for articles published between 2005 and 2025 that reported associations between blood, tissue, or other molecular factors and postoperative oncologic outcomes (recurrence and survival) in patients undergoing treatment for LRRC. The search identified 2799 articles, of which 17 were included. Sample size varied from 21 to 213 patients. Locoregional recurrence rates after surgery ranged from 15% to 52% (various timepoints between 3 and 5 years), while 5-year overall survival ranged from 22% to 53%. Elevated carcinoembryonic antigen (CEA) was associated with shorter overall survival in 11 studies, and poorer relapse-free survival in 1 study. Elevated serum carbohydrate antigen 19-9 (CA19-9) was associated with shorter overall survival and disease-specific survival in two studies. No studies evaluating contemporary biomarkers (mutational profile, microsatellite instability, or circulating-tumour DNA) were identified. Evidence evaluating molecular biomarkers in LRRC is limited and has focused on traditional serum biomarkers such as CEA and CA19-9. Contemporary colorectal cancer biomarkers including mutational profile and ctDNA are yet to be studied in this population.
This study aimed to determine the rates and predictors of residual tumor and pathologic upstaging among patients undergoing a second transurethral resection of bladder tumors (TURBT). This retrospective study investigated patients who underwent a second TURBT within 2-6 weeks after an initial complete TURBT for non-muscle-invasive bladder cancer. A second TURBT was performed in cases of T1 tumors, high-grade Ta tumors, and absence of the detrusor muscle in the initial specimen. Patients were initially categorized by the presence of residual tumor, and those with residual disease were further stratified according to their pathologic upstaging status. Potential predictors, including patient demographics, tumor characteristics, surgical team consistency, and complications, were analyzed using logistic regression. Among 728 patients who underwent TURBT, 284 met the inclusion criteria and were included in the analysis. Residual tumor was detected in 144 patients (50.7%). Multivariable analysis showed that multifocality, tumor size ≥ 3 cm, resection from both the primary and additional sites, complications, and female sex were independently associated with residual tumor (all p < 0.05). Pathologic upstaging was observed in 20 (13.9%) of the 144 patients with residual tumor. Primary tumor morphology was the only independent predictor of pathologic upstaging, with solid (odds ratio [OR], 7.72; p = 0.013) and papillosolid (OR, 4.07; p = 0.020) morphologies associated with a higher risk than papillary morphology. A second TURBT remains an important reassessment step for residual tumor and upstaging. Risk assessment for patients undergoing a second TURBT should incorporate initial pathology, tumor burden, endoscopic appearance, and tumor morphology.
Robotic gastrectomy may improve precision during radical lymphadenectomy, but its prognostic relevance in advanced gastric cancer remains uncertain. The authors hypothesized that robotic surgery may influence outcomes through improved recovery and oncologic control. A prospectively maintained registry included 426 curative-intent minimally invasive gastrectomies from 2017 to 2025 (laparoscopic, n = 176; robotic, n = 250). Propensity score-matching yielded 154 pairs. Endpoints included severe morbidity (Clavien-Dindo grade ≥ III), postoperative inflammation, adjuvant chemotherapy delivery, recurrence patterns, overall survival (OS), and relapse-free survival (RFS). Robotic gastrectomy independently reduced severe complications in the entire cohort (odds ratio, 0.31; 95% confidence interval [CI] 0.13-0.73; P = 0.007). After matching, the results showed that robotic surgery reduced both severe complications (2.6% [4/154] vs. 9.7% [15/154]; P = 0.016) and C-reactive protein levels (day 1, P = 0.001; day 3, P = 0.007; maximum, P = 0.005). In matched pStages II and III disease, robotic surgery improved chemotherapy completion (63.6% vs. 40.5%; P = 0.026), showed numerically fewer nodal and peritoneal recurrences, and was associated with higher estimated 5-year OS (71.7% vs. 52.0%; P = 0.046). After pStage II or III distal gastrectomy, the estimated 5-year OS was 78.9% vs. 53.4% (P = 0.004), and the estimated RFS was 79.2% vs. 53.4% (P = 0.050). An exploratory analysis of T4 distal gastrectomy showed a favorable OS signal (68.0% vs. 40.4%; P = 0.029). Robotic gastrectomy may have prognostic relevance through two complementary pathways: a recovery pathway characterized by reduced morbidity, attenuated inflammation, and improved adjuvant chemotherapy delivery and an oncologic-control pathway characterized by precise lymphadenectomy and gentler tumor-handling. However, survival and recurrence findings remain exploratory and require prospective validation.
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Postoperative complications after gastrectomy for gastric cancer (GC) increase mortality and delay recovery. Simple, objective tools for preoperative risk stratification using routine data remain limited. This study aimed to develop a clinically practical risk score to predict postoperative complications from standard preoperative laboratory tests. The study analyzed the data of 490 patients who underwent curative gastrectomy for GC between January 2017 and September 2025. Preoperative hematologic and biochemical parameters were systematically screened to predict postoperative complications of Clavien-Dindo grade II or higher. A composite predictive scoring system was developed, and model performance was assessed using multivariate logistic regression analysis and bootstrap internal validation. Postoperative complications of Clavien-Dindo grade II or higher occurred for 89 patients (18%). Based on discriminative performance, the C-reactive protein level, monocyte count, serum albumin level, and prothrombin time-international normalized ratio were identified as independent predictors of postoperative complications. An 8-point scoring system, termed the G-CMAP score, was constructed using odds ratio-based weighting. The G-CMAP score demonstrated modest predictive ability (area under the curve, 0.68) and remained an independent predictor in multivariate analysis (odds ratio, 3.42; 95% confidence interval, 2.08-5.61; P < 0.001). Finally, bootstrap internal validation confirmed good discrimination and calibration, with minimal overfitting. The G-CMAP score is a simple and objective blood-based tool that enables modest preoperative prediction of postoperative complications after gastrectomy for GC.
In colorectal liver metastases deemed unresectable, advances in chemotherapy and venous reconstruction techniques have enabled resection in selected patients.1-3 However, data on long-term venous stenosis after reconstruction remain limited. We experienced a case of late stenosis in a reconstructed hepatic vein that had remained patent for 8 years. To further investigate this issue, we analyzed the causes and timing of venous stenosis in 72 reconstructed veins from 66 cases performed at our institution between 2004 and 2025. A 49-year-old woman with initially unresectable rectal cancer and multiple liver metastases involving all three major hepatic veins underwent extended hepatectomy with triple hepatic vein resection and reconstruction after chemotherapy, and 8 years later, severe stenosis of the reconstructed right hepatic vein (RHV) was detected without definitive evidence of recurrence on imaging. Redo RHV resection and reconstruction using a right internal jugular vein graft were performed, and pathological examination confirmed tumor recurrence. Among the 72 reconstructed veins, stenosis occurred in 19, with 14 being due to technical factors unrelated to tumor and 5 associated with tumor recurrence. All technical stenoses occurred within 6 months, while all late stenoses were attributable to tumor recurrence. Late venous stenosis after hepatic vein reconstruction should raise suspicion of tumor recurrence. Redo reconstruction is feasible in selected patients.
Recent studies suggest that selective omission of sentinel lymph node biopsy (SLNB) in early-stage breast cancer may reduce morbidity without compromising oncologic outcomes. The impact of SLNB omission on eligibility for adjuvant therapies, including CDK4/6 inhibitors and partial breast irradiation (PBI), remains unclear, as both depend on nodal status. Using a single-institution registry (2012-2024), we identified women with cT1N0, ER+/HER2-, grade 1-2 breast cancer who would have been candidates for SLNB omission. Pathologic nodal status and eligibility for CDK4/6 inhibitors and PBI were assessed. Among 1,194 patients, 130 (10.9%) had ≥1 positive sentinel lymph nodes, including five (0.4%) with ≥4 positive nodes. Nodal positivity decreased with age (18% <50 years vs. 7.4% ≥70 years (p < 0.001). Nodal positivity increased with tumor size (6.2% (cT1a), 6.6% (cT1b), 14.4% (cT1c); p < 0.001) and with tumor grade (8.5% (grade 1) vs. 12.4% (grade 2); p = 0.03). In women aged 50-59 years with cT1a/b tumors, nodal positivity did not differ by grade (6.8% grade 1 vs. 11.1% grade 2; p = 0.43). In women aged ≥60 years with cT1a/b tumors, rates were 3.1 and 2.1%, respectively (p = 1.00). Under current guidelines, SLNB omission would have excluded 18% of women <50 and 8.8% of women ≥50 from consideration for CDK4/6 inhibitors and PBI. Sentinel lymph node biopsy omission is unlikely to affect adjuvant treatment selection in carefully selected older women with small, low-grade tumors, particularly those aged ≥60 years with grade 1 cT1a/b disease, in whom occult nodal positivity was only 2.1%. In contrast, younger patients, those with cT1c tumors, and those with higher-grade disease demonstrated substantially higher rates of nodal involvement, suggesting that SLNB continues to provide clinically actionable information that may influence eligibility for CDK4/6 inhibitors and partial breast irradiation. These findings support a risk-adapted rather than universal approach to SLNB omission.
Robotic liver surgery enables precise, parenchyma-sparing resection of centrally located hepatic tumors involving critical hilar structures. Focal nodular hyperplasia (FNH), although benign, may require resection in symptomatic or enlarging lesions. A 24-year-old woman with biopsy-proven FNH presented with progressive right epigastric pain and tumor growth from 4.4 cm to 7.0 cm. Preoperative imaging demonstrated a centrally located lesion abutting the right anterior Glissonean pedicle without evidence of major vascular invasion, making preservation of uninvolved hepatic parenchyma a principal operative objective. She underwent robotic partial central hepatectomy (segments 4A, 4B, 5, and 8) with cholecystectomy, with intraoperative indocyanine green (ICG) cholangiography used to delineate biliary anatomy near the Glissonean pedicles. The robotic approach was selected to facilitate stable hilar exposure, meticulous juxta-hilar dissection, and controlled parenchymal transection adjacent to the biliary bifurcation while avoiding unnecessary extended hepatectomy. Selective vascular stapling was utilized only for isolated segmental inflow and outflow structures encountered during transection, while preserving the major hilar vasculature and surrounding functional liver parenchyma. The procedure was completed in 3 h with 100 cc estimated blood loss and no complications. She was discharged on postoperative day 3. Final pathology confirmed complete resection, and at 1-year follow-up, she remained symptom-free with no evidence of recurrence. This case highlights the feasibility of robotic central parenchyma-sparing hepatectomy for lesions in close proximity to critical hilar structures, demonstrating how enhanced robotic dexterity, stable visualization, and fluorescence guidance can facilitate safe dissection and excellent perioperative outcomes in anatomically challenging tumors.
Large language models (LLMs) are increasingly used in health information seeking, but their performance in testicular cancer education remains unclear. This study evaluated the validity, reliability, and readability of responses generated by four widely used artificial intelligence (AI) chatbots. Four AI chatbots (ChatGPT 5.2, Copilot 2025, DeepSeek V3.2, and Gemini 2.5 Pro) were assessed. Structured clinical-knowledge accuracy was evaluated using 250 testicular cancer-related multiple choice questions across five domains, each administered to each model three times. The information quality of patient-facing responses was assessed using 12 patient-oriented questions derived from Google Trends queries and refined based on clinical experience, with responses rated using DISCERN, Ensuring Quality Information for Patients (EQIP), Global Quality Scale (GQS), and Journal of the American Medical Association (JAMA) benchmark criteria. Readability was measured using six standard readability indices and compared with the sixth-grade level recommended by the American Medical Association and the National Institutes of Health. All four chatbots demonstrated high structured clinical-knowledge accuracy, with overall multiple choice question accuracy exceeding 96%. ChatGPT 5.2 achieved the highest accuracy (98.40%), followed by Gemini 2.5 Pro (97.20%), DeepSeek V3.2 (97.07%), and Copilot 2025 (96.93%). Overall accuracy differed significantly among models (p = 0.026), and only ChatGPT 5.2 significantly outperformed Gemini 2.5 Pro after Bonferroni correction. ChatGPT 5.2 also achieved the highest information-quality scores on DISCERN, EQIP, and GQS, whereas JAMA scores were uniformly low across all models. DeepSeek V3.2 generated the most readable responses overall. However, none of the chatbots met recommended readability thresholds, and all significantly deviated from sixth-grade readability benchmarks. AI chatbots showed high validity in answering testicular cancer-related questions, but important differences remained in information quality and readability. ChatGPT 5.2 provided the most reliable responses, whereas DeepSeek V3.2 produced the most readable content. These tools may support patient education, but they cannot yet replace clinician-guided and evidence-based communication.