The rising global cancer burden underscores the need for a skilled cancer surgical workforce. Education in the principles of cancer surgery is essential to ensuring a competent cancer surgical workforce. In response, the Society of Surgical Oncology and the European Society of Surgical Oncology jointly published the first Global Curriculum in Surgical Oncology in 2016 to provide a structured framework for the education of cancer surgeons. The updated version of the original curriculum incorporates advances in cancer surgical care from the intervening period, while maintaining the original vision of a globally relevant educational framework. The global curriculum committees of the Society of Surgical Oncology and the European Society of Surgical Oncology convened a series of meetings to review, revise, and develop the updated global curriculum in surgical oncology. The second edition of the global curriculum in surgical oncology incorporates key advances in cancer surgical care that have occurred since the publication of the original curriculum. The curriculum retains the foundational principles of the first edition, such as: (a) ensuring that the curriculum is resource-stratified, (b) applicability across diverse geographical regions worldwide, and (c) provision of a flexible and modular, foundational framework that can be adapted to local training needs. The second edition of the global curriculum in surgical oncology provides resource-stratified, geographically agnostic foundational scaffolding for training the global cancer surgical workforce. Implementation of this curriculum can be instrumental in building a competent surgical oncology workforce capable of addressing the rising global cancer burden.
Team dynamics influence team performance and patient outcomes in surgery, yet data on resident-led teams are scarce. This study aimed to compare patient outcomes across resident-led teams in complex surgical oncology. We hypothesized that patient outcomes would vary by team assignment. This was a retrospective cohort study of resident-led teams who contributed more than 10 surgical oncology operations (colectomy, hepatectomy, pancreatectomy, or thyroidectomy) to the National Surgical Quality Improvement Project registry at a single university-based hospital (2018-2025). The primary outcome was presence of any adverse event, including mortality and postoperative complications. Length of stay and 30-day readmissions were also examined. Mixed-effects regression estimated expected outcome probabilities for each patient. For each team, observed-minus-expected (O-E) outcome rates were calculated to assess performance. In total, 145 teams cared for a median of 22 patients (interquartile interval 16- 27; n = 2919). Five teams demonstrated poor performance based on risk-adjusted adverse event rates (O-E rates: 6.9% and 22.3%). A total of 13 teams had significantly longer risk-adjusted length of stays than expected (O-E between 0.4 and 3.5 days), and seven teams had shorter risk-adjusted length of stays than expected (O-E between -1.1 and -0.7 days). Three teams had higher risk-adjusted readmission rates than expected (O-E between 4.9% and 6.8%). Two teams performed poorly across all three outcomes. Variation in team performance can be measured using valid and reliable risk-adjusted patient outcomes in complex surgical oncology. This may provide meaningful feedback with benchmarking to identify teams that require more supervision.
While neoadjuvant immunochemotherapy has improved outcomes of resectable nonsmall cell lung cancer (NSCLC), treatment-induced tissue changes can increase surgical complexity. This study aimed to identify preoperative predictors of technically challenging surgery following neoadjuvant immunochemotherapy. This multicenter retrospective analysis included 114 patients who underwent surgery after neoadjuvant nivolumab plus platinum-based chemotherapy at 29 institutions between March 2023 and July 2024. Challenging surgery was defined as one requiring bronchoplasty, pulmonary artery angioplasty, or pneumonectomy. Logistic regression was used to identify preoperative predictors for surgical complexity. Twenty-one patients (18.4%) required challenging surgeries, including bronchoplasty (n = 13), pulmonary artery angioplasty (n = 1), double-sleeve resection (n = 4), and pneumonectomy (n = 3). These cases had longer operative times (340 ± 118 vs. 267 ± 98 min, p < 0.001) and more frequently required open thoracotomy (90.5% vs. 44.1%, p < 0.001). Conventional predictive factors (T/N status, programmed cell death ligand expression, radiological response, and treatment-to-surgery interval) showed no association with surgical complexity. Post-treatment extranodal extension (ENE) after neoadjuvant therapy and before surgery was the strongest predictor of challenging surgery (univariable odds ratio [OR] 7.06, 95% confidence interval [CI]: 1.45-34.41, p = 0.009). Post-treatment ENE demonstrated a higher predictive accuracy for challenging surgery (positive predictive value [PPV] 50.0%) than that of pathological ENE metastasis (PPV 14.3%); thus, positivity reflects treatment-induced anatomical changes rather than residual tumor invasion. Unlike conventional predictors, post-treatment ENE may predict surgical complexity after neoadjuvant immunochemotherapy. ENE may be a potential marker of treatment-induced anatomical complexity rather than residual tumor burden, enabling evidence-based surgical planning in the immunotherapy era.
The management of intraductal papillary mucinous neoplasms (IPMNs) has evolved through successive International Association of Pancreatology guidelines, aiming to refine surgical indications and improve cancer prevention. With broader adoption of surveillance, the oncologic outcomes of patients resected after follow-up-and the effectiveness of current strategies in preventing malignancy-remain unclear. This study examined how evolving management has influenced surgical selection and cancer prevention, particularly by comparing patients resected at diagnosis versus after surveillance. Patients with presumed IPMN across four International Association of Pancreatology guideline periods (pre-2006, 2006-2012 [Sendai], 2012-2017 [Fukuoka], and 2017-2024 [Fukuoka revisions]) were analysed by clinical trajectory: follow-up without surgery, upfront surgery (resection within 12 months of diagnosis), and post-surveillance resection (PR). Endpoints included surgical indications and rates of low-grade dysplasia (LGD), high-grade dysplasia (HGD), and invasive carcinoma (IC). Across guideline periods, patients managed with surveillance increased from 172 before 2006 to 828 in 2006-2012, 1,572 in 2012-2017, and 1,193 after 2017, while PR increased from 11 to 29, 60, and 204, respectively. Overall, among 3,304 patients, 2,452 (74%) were managed with surveillance, 548 (17%) underwent upfront surgery, and 304 (9%) had PR. In the PR group, resections for a single high-risk stigmata (HRS) increased from 9% to 48%, and those with multiple HRS up to 20% after 2017. At pathology, LGD decreased from 46% to 17%, whereas HGD and IC increased from 18 to 28% and from 36 to 45%, respectively. In the upfront surgery group, LGD decreased from 49% to 26%. Development of HRS during follow-up was associated with a higher risk of HGD/IC (odds ratio 2.18, p = 0.008). While evolving IPMN management has reduced rates of LGD and increased detection of HGD, invasive carcinoma remains frequent at resection after surveillance, as surgery is often delayed until HRS emerge. Improved tools are needed to optimize timing and define appropriate oncologic outcomes.
Anatomic segmentectomy 8 of the liver is among the most technically demanding procedures, primarily because of the deep intraparenchymal location and marked anatomic variability of the segment 8 Glissonean pedicle (G8) and the inherently curved configuration of the intersegmental planes. The cranial hepatic vein-guided approach (HVGA) combined with indocyanine green (ICG) fluorescence imaging offers a rational and reproducible strategy for achieving accurate anatomic resection. The authors performed robotic anatomic segmentectomy 8 using a stepwise strategy integrating three complementary elements: (1) cranial root-side exposure of the middle hepatic vein (MHV) to establish a stable anatomic axis, (2) intersegmental vein (ISV)-guided localization of G8 exploiting the consistent anatomic relationship between the ISV between segments 5 and 8 and the G8 root, and (3) ICG-negative staining for real-time delineation of the segment 8 portal territory. The operative time was 180 min, with an estimated blood loss of 10 mL. No intraoperative transfusion was required. The Pringle maneuver was applied intermittently for a cumulative duration of 45 min. A 30-mm hepatocellular carcinoma was resected with a clear surgical margin of 11 mm. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. Robotic anatomic segmentectomy 8 using a cranial HVGA integrated with ICG fluorescence imaging enables precise identification of G8 and accurate navigation along the curved intersegmental planes of S8. This three-element integrated strategy provides an anatomically grounded, reproducible framework for safe and complex robotic anatomic segmentectomy.
Primary retroperitoneal germ cell tumors (GCTs) are rare and often present as large masses with close anatomical relationships to adjacent organs and vessels, which can complicate surgical management. Indications for neoadjuvant chemotherapy are guided by pathological features and serum alpha-fetoprotein (AFP) levels; however, these levels may be difficult to interpret in infants. While some tumors respond to neoadjuvant chemotherapy, others may progress during treatment, making surgical resection even more challenging. This study aimed to evaluate the management and outcomes of retroperitoneal GCTs within a national multicenter cohort. This national retrospective study included pediatric patients with primary retroperitoneal GCTs who underwent surgical resection between 2000 and 2022. Data were identified through the French Very Rare Tumors Committee (FRACTURE) database, the TGM-2013 study, and the Groupe des Chirurgiens Pédiatres Opérant des Tumeurs (GCPOT) collaborative group. A total of 24 children were included (17 girls). The median age and weight at diagnosis were 5.2 months (range 1.6-44 months) and 7.4 kg (range 4-14 kg), respectively. Five patients (29%) had a prenatal diagnosis. The median tumor volume was 563 cm3 (range 280-986 cm3), and 17 patients (71%) initially presented with vascular risk factors. AFP levels were elevated for age in eight patients (33%), including four infants under 1 year old, with a median level of 7500 ng/mL (range 1775-70,860 ng/mL). Eight patients (33%) received neoadjuvant chemotherapy, six of whom had age-elevated AFP. Following chemotherapy, tumor volume decreased in three cases, while five patients experienced tumor progression. Complete (R0) resection was achieved in 18 cases (75%). Histological analysis revealed 11 mature teratomas (46.0%), 9 immature teratomas (37.5%)-including 5 grade 1, 2 grade 2, and 2 grade 3-and 4 malignant GCTs with a yolk sac tumor (YST) component (16.5%). One patient with perioperative tumor capsular rupture and metastatic YST received adjuvant chemotherapy. Major complications (Clavien-Dindo ≥ 3) occurred in five cases (21%). Two deaths were recorded: one postoperatively due to mesenteric ischemia and one due to local and metastatic YST progression. After a median follow-up of 7.1 years (range 2.7-12.3 years), 22 patients (91.6%) are alive with no evidence of recurrence. This study confirms the favorable oncological prognosis of primary retroperitoneal GCTs in children. Neoadjuvant chemotherapy should be approached with caution, as its impact on tumor volume may be limited. Furthermore, it carries a potential risk of growing teratoma syndrome, which can ultimately lead to even more challenging surgical procedures.
Locally advanced thymic epithelial tumors (TETs) may extend into the adjacent brachiocephalic vein (BCV), creating major technical challenges for resection. While BCV reconstruction is traditionally considered after tumor removal, its true clinical value compared with simple transection remains unclear. Consecutive patients with TETs involving the BCV who underwent surgical resection at Shanghai Pulmonary Hospital between January 2013 and March 2023 were retrospectively analyzed. Perioperative details, 30-day morbidity, and long-term outcomes were systematically assessed. Inverse probability of treatment weighting (IPTW) was applied to improve baseline comparability between groups. A total of 51 patients were enrolled in the final cohort and were categorized into the transection group (n = 22) or the reconstruction group (n = 29), according to the surgical management of BCV. Compared with the reconstruction group, the transection group had a significantly lower transfusion rate (9.1% versus 37.9%, P = 0.025). However, both 30-day morbidity (40.9% versus 48.3%, P = 0.601) and long-term morbidity (22.7% versus 27.6%, P = 0.693) showed no significant differences. Similarly, recurrence-free survival and overall survival did not differ significantly between the two groups (P = 0.731 and P = 0.882, respectively). After IPTW adjustment, transfusion rates remained significantly higher in the reconstruction group (37.3% versus 5.9%, P = 0.005), whereas no other short- or long-term outcomes differed significantly between the groups. Despite its technical complexity, BCV reconstruction did not confer additional short- or long-term benefits compared with transection. Therefore, BCV transection may be a more practical surgical approach for selected patients with locally advanced TETs.
Renal cell carcinoma (RCC) is the most common type of kidney cancer and significant patient population experiences relapse and metastasis, resulting in poor survival outcomes. Therefore, there is a need to identify novel biomarkers and therapeutic targets to monitor RCC progression and improve patient outcomes. MicroRNAs (miRNAs) are small non-coding RNAs that regulate post-transcriptional gene expression and have been implicated in tumor progression. We analysed publicly available datasets to identify differentially expressed miRNAs and their putative targets were identified using miRDB and Starbase ENCORI database. Further, We analysed the expression levels of identified miRNAs and their selected target mRNAs by qRT-PCR. Diagnostic potential of miRNAs were analysed by ROC analysis.  Cox regression analysis were performed with target mRNAs to evaluate the potential prognostic utility and their association with clinical outcomes in ccRCC patients. hsa-miR-200b-3p, hsa-miR-320a-3p were downregulated and hsa-miR-34c-5p was upregulated in ccRCC patients. The target genes of identified miRNAs are critical regulators of the OXPHOS, cell death, and inflammatory pathways, involved in the progression of ccRCC. hsa-miR-200b-3p has an AUC of 0.7273 (p < 0.05; cutoff 3.870, LR+ 4.77). Univariable and multivariable cox regression analysis showed low expression of NDUFS1 independently associated with poor survival outcome (p < 0.001) in ccRCC patients. Our study demonstrated, downregulation of hsa-miR-200b-3p in ccRCC holds promise as a potential diagnostic biomarker and its identified target NDUFS1 as an independent prognostic biomarker for patients with ccRCC. These findings need to be validated in a large cohort of patients with RCC.
Patients with gastric cancer and isolated positive peritoneal cytology have stage IV disease. The clinical significance of cytologic conversion is poorly understood. Our objectives are to (1) describe the clinicopathologic characteristics of patients with gastric cancer and isolated positive peritoneal cytology and their association with survival, (2) evaluate patients who underwent second cytologic evaluation for assessment of cytologic conversion, and (3) describe recurrence patterns in patients with cytologic conversion who underwent resection. Patients with gastric adenocarcinoma and isolated positive peritoneal cytology were identified from a prospectively maintained institutional database from 1996 to 2020 for this cohort study. Patients were characterized by selection for second cytologic evaluation following chemotherapy, cytologic conversion, and selection for surgical resection. Factors associated with overall survival (OS) were evaluated by time-dependent multivariable Cox regression models. Overall, 174 patients were identified, 62 (35.6%) were selected for second cytologic evaluation, 43 (69.4%) were cytologic converters, and 32 (74.4, 18.4% overall) underwent resection. Selection for second cytologic evaluation was associated with improved OS (hazard ratio [HR] 0.56, 95% CI 0.37-0.86), and among those patients, cytologic conversion was associated with improved OS (HR 0.17, 95% CI 0.08-0.35). Ten patients (31.3%) had no evidence of recurrence following resection during the study period. The peritoneum was the most common site of recurrence (n = 17, 53.1%). Among patients with gastric cancer and isolated positive peritoneal cytology, second cytologic evaluation can provide prognostic information and inform treatment decisions. Cytologic conversion was documented in 25% of patients, with rare instances of long-term disease control.
This study aimed to investigate the pathologic and clinical features of local recurrence after partial nephrectomy (PN) for renal cell carcinoma (RCC), with particular emphasis on recurrence location and its association with pathologic upstaging and salvage surgical management. The study retrospectively analyzed 55 patients who experienced ipsilateral local recurrence after PN and subsequently underwent secondary surgical treatment between January 2014 and March 2025. Based on imaging, intraoperative findings, and gross pathology, recurrences were classified as original-site recurrence (tumor bed or resection margin) or non-original-site recurrence (distant ipsilateral renal parenchyma). Baseline characteristics, perioperative variables, pathologic findings at secondary surgery, and renal functional outcomes were compared between the two groups. Pathologic upstaging was defined as a higher pathologic T stage of the recurrent tumor compared with the primary tumor. Of the 55 patients, 32 (58.2 %) had original-site recurrence, and 23 (41.8 %) had non-original-site recurrence. Baseline demographic and perioperative characteristics at initial surgery were comparable between the groups. However, original-site recurrence was significantly associated with pathologic upstaging compared with non-original-site recurrence (84.3 % vs 21.7 %; p < 0.001). Recurrent tumors in the original-site group also showed more advanced pathologic stage at secondary surgery (p < 0.001). This difference influenced salvage treatment selection (p = 0.003): radical nephrectomy was more frequently performed in the original-site group (81.2 % vs 47.8 %), whereas repeat partial nephrectomy was more common in the non-original-site group (47.8 % vs 9.4 %). Cancer-specific mortality and secondary recurrence were numerically higher in the original-site group, although the differences were not statistically significant. Long-term renal functional outcomes were similar between the groups. Local recurrence after PN is biologically heterogeneous. Original-site recurrence is strongly associated with pathologic upstaging and more aggressive disease, often requiring radical salvage surgery. In contrast, non-original-site recurrence tends to show less aggressive pathology and may be more suitable for repeat nephron-sparing surgery. Recurrence location may therefore be an important factor in postoperative risk stratification and secondary surgical decision-making.
Peritoneal metastasis (PM) following curative resection for colorectal cancer (CRC) remains difficult to detect and is associated with limited therapeutic options. This study aimed to assess recurrence patterns of PM after curative CRC surgery and to identify associated risk factors. A retrospective cohort study included 4695 patients with pathologically confirmed T3 or T4 CRC who underwent curative resection at a tertiary center from January 2012 to December 2020. Recurrence site distribution, cumulative incidence of recurrence, cumulative incidence of peritoneal metastasis (CIPM), and risk factors for PM were analyzed by T stage. Of 4,695 patients, 749 had T4 CRC, with a higher recurrence rate than T3 cases (30.6% vs. 11.9%). In T4 CRC, PM was the most common recurrence site (10.9%), surpassing lung (9.6%) and liver (7.1%) metastases. Peritoneal metastasis rates were highest in right-sided T4 colon cancers (15.7%). The 5-year CIPM was significantly higher in T4 than in T3 (11.5% vs. 1.8%, p < 0.001). Stratified analysis showed a higher cumulative incidence of PM in T4N0 disease compared with T3N+ disease (7.4% vs. 2.9%, p < 0.001). Independent risk factors for PM included T4 stage (hazard ratio 4.47; 95% confidence interval 3.15-6.35), nodal positivity (hazard ratio 2.41; 95% confidence interval 1.60-3.63), advanced age, preoperative obstruction, right-sided cancer, signet ring cell carcinoma, and perineural invasion. Pathologic T4 CRC exhibits a distinct recurrence pattern characterized by a predominance of peritoneal metastasis. These findings may inform future surveillance protocols and treatment planning.
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The optimal extent of gastrectomy after neoadjuvant therapy for Siewert II/III gastric adenocarcinoma remains unclear. The objective of this study was to compare survival after proximal versus total gastrectomy and to assess the prognostic impact of distal nodal station metastasis (nos. 4d, 5, 6, and 12a). We retrospectively analyzed 824 patients with Siewert II/III gastric adenocarcinoma who received neoadjuvant chemotherapy and underwent proximal gastrectomy (PG) or total gastrectomy (TG) at three Chinese centers (2010-2025). Following propensity score matching, survival analysis was performed on a balanced cohort of 518 patients. Overall survival (OS) and progression-free survival (PFS) were assessed using Kaplan-Meier analysis and Cox regression. PG and TG achieved comparable OS and PFS (OS P = 0.54; PFS P = 0.86), with consistent findings across Siewert subtype, pathologic T stage, and TNM stage strata. No significant differences were observed in N0 or N+ subgroups. Survival remained similar between procedures regardless of neoadjuvant response or immunotherapy exposure. Metastasis to distal lymph node stations increased with advancing ypTNM stage, particularly in stage III disease. In multivariable analyses, gastrectomy type was not an independent prognostic factor (P = 0.117), whereas advanced pathological stage independently predicted worse survival (all P < 0.05). Other clinicopathologic variables were not independently associated with outcome. PG provides survival comparable to TG after neoadjuvant therapy. The distal key station exhibits a significantly higher metastatic incidence in patients with stage III gastric cancer.
Active surveillance (AS) is the first-line approach for desmoid-type fibromatosis (DTF). However, 30 % of patients require active treatment. Identifying these patients will help upfront to define a personalized treatment approach. This study assessed whether radiomics can predict AS failure in patients with DTF. This multicenter study included data from the Netherlands (NL), Italy (ITA), and Canada (CAN). The study included patients with extra-abdominal DTF initially managed with AS and baseline MRI. Tumors were segmented using a minimally interactive deep-learning method, and radiomics features were extracted from T1-weighted (T1W) and T2-weighted (T2W) MRI scans. Prediction models to predict AS failure versus no failure were created using various machine-learning approaches. Both an internal cross-validation using all available data and an external leave-one-country-out cross-validation were used to assess model performance. The cohort included 200 patients (72 NL, 62 ITA, 66 CAN), with AS failing for 26 % of the patients. Internal validation of the T1W+T2W imaging model resulted in an overall area under the curve (AUC) of 0.69 (95 % confidence interval [CI] 0.60-0.79). External validation resulted in an AUC of 0.58 (95 % CI 0.42-0.74) in the Dutch cohort, 0.76 (95 % CI 0.60-0.91) in the Italian cohort, and 0.77 (95 % CI 0.65-0.89) in the Canadian cohort. Adding clinical features did not improve the models' performance. Predicting AS failure with radiomics showed reasonable performance and generalized well to the Italian and Canadian cohorts. Pending improvements to the model or patient selection, the authors' model shows potential to better identify which DTF patients will benefit from AS and which will not.
The oncologic impact of lymph node dissection (LND) for intrahepatic cholangiocarcinoma (iCCA) remains unclear. We hypothesized that the prognostic relevance of LND may vary according to tumor burden. Therefore, this study sought to evaluate the interaction between tumor burden and adequate LND among patients who underwent curative-intent resection for iCCA. Patients who underwent curative-intent liver resection for iCCA were identified from a large international multi-institutional database. Overall survival (OS) was evaluated using multivariable Cox regression models that included an interaction term between tumor burden score (TBS) and adequate LND. Among 1,558 patients, 872 (56.0%) underwent LND and 322 (20.7%) underwent adequate LND, defined as retrieval of at least six lymph nodes. The median TBS was 6.1 (interquartile range [IQR] 4.1-8.6). On multivariable Cox regression analysis, a significant interaction was observed between TBS and adequate LND (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.87-0.95, p < 0.001). Among 542 (34.8%) patients with TBS < 5.0, adjusted OS did not differ according to adequate LND status (HR 1.23, 95% CI 0.86-1.76, p = 0.265). In contrast, among 1,016 (65.2%) patients with TBS ≥ 5.0, adequate LND was associated with improved adjusted OS (HR 0.65, 95% CI 0.51-0.82, p < 0.001). Similar findings were observed for recurrence-free survival (RFS). The prognostic relevance of adequate LND in patients undergoing curative-intent resection for iCCA appears to vary according to tumor burden. Adequate LND was associated with improved OS and RFS among patients with high TBS, but not among those with low TBS.
Adjuvant treatment decisions in ER+/HER2- breast cancer depend on accurate distinction between pN1 and pN2/3 disease. As sentinel lymph node biopsy (SLNB) increasingly replaces axillary lymph node dissection (ALND), patients with apparent pN1 disease may be understaged. We evaluated preoperative imaging and developed a composite risk score to identify patients for whom completion ALND might be omitted. We retrospectively analyzed 160 ER+/HER2- patients with 1-3 positive sentinel nodes who underwent completion ALND after upfront surgery. Four imaging modalities were assessed for pN2/3 (≥4 positive nodes). A five-item composite score (SLN ≥ 2, lymphovascular invasion, tumor ≥2 cm, Ki-67 ≥20%, multifocality; range 0-5) underwent bootstrap validation and decision curve analysis (DCA). All four preoperative imaging modalities failed to predict pN2/3 under-staging (NPV 80-86%; all p ≥ 0.885). Overall, 17.5% harbored true pN2/3 on completion ALND. Low-risk patients (score ≤1; 32% of cohort) had a pN2/3 rate of only 3.9% (NPV 96.1%; sensitivity 92.9%) versus 23.9% in high-risk patients (p = 0.0015). DCA showed net benefit over a treat-all strategy across clinically relevant thresholds, corresponding to ~14 fewer unnecessary ALNDs per 100 patients. Preoperative imaging showed limited sensitivity for pN2/3 under-staging and should not alone guide omission of completion ALND. A five-item composite score identified a low-risk subgroup (NPV 96.1%) in whom completion ALND might be omitted without compromising monarchE or RxPONDER decisions; prospective external validation is required before routine adoption.
This study aimed to compare functional and oncologic outcomes between high-intensity focused ultrasound (HIFU) and robot-assisted radical prostatectomy (RARP) for patients with localized prostate cancer (LPCa). Four databases (Embase, PubMed, Cochrane Library, Web of Science) were systematically searched from inception to December 2025. The review followed PRISMA 2020 and AMSTAR 2 guidelines. Pooled effect estimates were calculated using Stata 17. Random-effects models were applied when I2 was 50 % or higher or the P value was lower than 0.10. Five cohort studies (n = 2123) were included. In this review, HIFU was associated with significantly higher International Index of Etile Function (IIEF)-5 scores at 6 months (effect, 3.41; 95 % confidence interval [Cl], 1.88-4.94; P < 0.05), 12 months (effect, 3.75; 95% Cl 3.00-4.49; P < 0.05), and 24 months (effect, 2.72; 95% Cl 0.59-4.85; P < 0.05). Urinary continence overy also favored HIFU (odds ratio [OR], 0.40; 95% Cl 0.27-0.59; P < 0.05) for pad-free rates at baseline and at 6 and 12 months (all P < 0.05). No significant differences were observed in International Prostate Symptom Score (IPSS) or salvage therapy rates. For patients with localized prostate cancer, HIFU offers better etile function and urinary continence overy than RARP, with comparable complication and salvage therapy rates. Long-term oncologic outcomes remain to be confirmed.
Detailed longitudinal data on symptom recovery after pancreatectomy and determinants of delayed recovery remain limited. This study prospectively characterized symptom trajectories and defined symptom-based recovery using patient-reported outcomes. The study included 185 patients who underwent pancreatectomy between October 2020 and September 2025 (pancreatoduodenectomy [n = 106], distal pancreatectomy [n = 79]). Of the 185 patients, 121 (65%) underwent a robotic approach. The MD Anderson Symptom Inventory (MDASI) was completed preoperatively at seven postoperative time points through postoperative month (POM) 6. The top five symptoms and top three interference items were identified using mean postoperative day 3 scores. Composite symptom and interference scores were defined as the mean scores of those top items for each. Recovery was defined when both composite scores achieved ≤ 3 of 10 points. Cumulative recovery rates were compared by surgery type and approach, and cluster analysis was performed to identify patients with delayed recovery and contributing factors. The top symptoms were pain, fatigue, sleep disturbance, drowsiness, and bloating, and the top interference items were general activity, working, and walking. Symptom recovery followed three phases: acute improvement (POD 3 to 14), a plateau (POD 14 to POM 1), and persistent recovery extending to POM 6. Fatigue persisted longest. Overall cumulative recovery rates were 68.1% on POM 1, 78.6% on POM 3, and 86.9% on POM 6. In cluster analysis, postoperative complications predicted delayed recovery, whereas surgery type and approach did not. Early symptom burden improved over time, with changes varying by time point, but fatigue often persisted. Prevention of postoperative complications appears to be a key strategy for improving symptom recovery regardless of surgical approach.
Locally advanced gastroesophageal junction (GEJ) tumors are surgically challenging, requiring balance between R0 resection and preserving quality of life.1 Total gastrectomy has been the standard approach, but function-preserving strategies are increasingly used to mitigate the nutritional and hormonal consequences associated with complete stomach removal.2Proximal gastrectomy (PG) with esophagogastric anastomosis preserves gastric volume but is frequently complicated by severe reflux and anastomotic strictures.3 Double-tract reconstruction (DTR) has emerged as an alternative. Recent meta-analyses have demonstrated that DTR reduces reflux and stricture rates compared with esophagogastric anastomosis while maintaining 5-year overall survival comparable with total gastrectomy.4,5 Fig. 1 Port placement and external retraction for robotic proximal gastrectomy METHODS: This study demonstrated robotic PG-DTR and en bloc distal pancreatectomy with splenectomy (DPS) for a 70-year-old man with Siewert type II GEJ adenocarcinoma. After a favorable response to neoadjuvant FOLFOX chemotherapy, the patient underwent resection. The case was completed in less than 6 h. Pathology showed a 6.3-cm, moderately differentiated T4bN2 adenocarcinoma. Despite advanced-stage disease and indications of peritoneal spread, the patient had prompt recovery (Fig. 1). Key considerations included careful patient selection after preoperative chemotherapy and achievement of R0 resection with meticulous mediastinal and oncologic lymph node dissection. For optimal functional outcomes and prevention of internal hernias, the authors perform hand-sewn esophagojejunostomy, appropriate spacing between the esophagojejunostomy and gastrojejunostomy, upright fixation of the remnant stomach, and closure of the hiatal, mesenteric, and Petersen defects. This case demonstrates that PG-DTR and en bloc DPS are feasible and may provide functional benefits for select patients who have locally advanced GEJ tumors with direct pancreatic invasion. The robotic approach may enhance postoperative recovery, supporting early resumption of systemic therapy.