BACKGROUND AND OBJECTIVES: We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. METHODS: This single-center retrospec...BACKGROUND AND OBJECTIVES: We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. METHODS: This single-center retrospective cohort study included patients aged ≥ 75 years with pathological stage I-III disease after R0 resection who underwent surgery within September 2012-2022, stratified by CFS score. Univariate and multivariate analyses assessed risk factors for postoperative complications. Cox proportional hazards models identified prognostic factors for overall survival (OS) and disease-specific survival (DSS). RESULTS: Among 109 patients (median age: 78 [interquartile range, 76-82]; 65.1% male), the CFS 5-7 group (n = 17) had a higher stoma creation rate (70.6% vs. 43.5%; p = 0.063) than the CFS 1-4 group (n = 92), and none in this group underwent lateral pelvic lymph node dissection. No independent risk factors were identified for postoperative complications with Clavien-Dindo grade ≥ II. CFS 5-7 was independently associated with worse OS (hazard ratio [HR] = 10.073; p < 0.001) and DSS (HR = 9.135; p = 0.003), and 3-year OS (63.6% vs. 85.6%, p < 0.001) and DSS (74.3% vs. 90.7%, p = 0.035) were significantly poorer. CONCLUSIONS: CFS provides a simple and effective preoperative assessment tool for evaluating patient frailty that significantly influences long-term outcomes in patients undergoing minimally invasive rectal cancer surgery.
BACKGROUND: Hepatic artery infusion chemotherapy (HAIC) has become an important strategy for treating patients with unresectable hepatocellular carcinoma (uHCC). The mainstream FOLFOX regimen seriously affects the treatm...BACKGROUND: Hepatic artery infusion chemotherapy (HAIC) has become an important strategy for treating patients with unresectable hepatocellular carcinoma (uHCC). The mainstream FOLFOX regimen seriously affects the treatment experience of patients due to the need for continuous drug pumping for a long time. CapeOx regimen with oral capecitabine instead of continuous intravenous infusion of 5 - fluorouracil, is expected to be on the premise of not reduce the curative effect of treatment of convenience. METHODS: This study retrospectively analyzed 127 patients with uHCC who were treated with HAIC combined with tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs), including 31 cases in the CapeOx-HAIC group and 96 cases in the FOLFOX-HAIC group. The baseline differences were balanced through propensity score matching (PSM), and the differences in efficacy and safety between the two groups were compared. RESULTS: The CapeOx-HAIC group was slightly superior to the FOLFOX-HAIC group in terms of objective response rate (61.6% vs 46.1%) and disease control rate (88.5% vs 80.8%), but there was no significant statistical difference. Notably, the CapeOx-HAIC regimen was associated with significantly shorter durations of both chemotherapy and hospitalization, while maintaining a comparable safety profile to the FOLFOX-HAIC regimen. CONCLUSIONS: The CapeOx-HAIC regimen offers comparable efficacy and safety to FOLFOX-HAIC but with superior convenience due to shorter treatment and hospitalization. It represents a valuable "subtractive optimization" that is especially beneficial for frail patients, thereby simplifying clinical management and strengthening the basis for treatment plan selection.
OBJECTIVE: Salvage laryngectomy is associated with significant reconstructive challenges related to pharyngocutaneous fistula (PCF) formation and need for secondary reconstruction. This retrospective study evaluates thes...OBJECTIVE: Salvage laryngectomy is associated with significant reconstructive challenges related to pharyngocutaneous fistula (PCF) formation and need for secondary reconstruction. This retrospective study evaluates these surgical outcomes by comparing free flap onlay technique with pedicled muscle and fascial flap onlay technique. METHODS: All patients underwent chemoradiation therapy with recommendations for salvage laryngectomy after being diagnosed with recurrent or persistent laryngeal malignant disease. Patients were excluded if the surgical defect required interposed flap tissue for pharyngeal closure. Subgroup analysis was performed to compare overall rates of fistula and need for secondary reconstructive surgery. RESULTS: A significant overall association (p = 0.014) between flap reconstruction type and presence of PCF was found. The odds of fistula formation was 55% lower in the pedicled pectoralis/latissimus muscle flap group and 70% lower for the free flap reconstruction group compared to the reference group that underwent only primary pharyngeal closure, without flap onlay (odds ratio = 0.3, p = 0.004). CONCLUSION: PCF rates and need for secondary reconstructive efforts are decreased when free tissue onlay is employed to reinforce the pharyngeal closure line compared to pedicled flaps.
OBJECTIVE: To evaluate apoptotic markers in tumor cells from hyperthermic intraperitoneal chemotherapy (HIPEC) effluent as a biomarker of treatment effectiveness. BACKGROUND: Cytoreductive surgery (CRS) combined with HIP...OBJECTIVE: To evaluate apoptotic markers in tumor cells from hyperthermic intraperitoneal chemotherapy (HIPEC) effluent as a biomarker of treatment effectiveness. BACKGROUND: Cytoreductive surgery (CRS) combined with HIPEC is used to treat peritoneal surface malignancies (PSM), yet no validated method exists to assess HIPEC efficacy in real time. We explored whether apoptosis in residual tumor cells present in post-HIPEC effluent correlates with oncologic outcomes. METHODS: Forty-four patients undergoing CRS-HIPEC were prospectively enrolled. CD45⁻ cells were stained for Annexin-PI by flow cytometry before and after HIPEC. The apoptotic response (Δapop) was defined as the increase in apoptosis post-HIPEC. Clinical and procedural variables were correlated with peritoneal disease-free survival (pDFS). RESULTS: Tumor histologies included colorectal (50%), appendiceal (18.2%), ovarian (15.9%), and gastric (11.4%) primaries. Complete cytoreduction was achieved in 81.8% of patients. Median Δapop = 8.5% (IQR: 0%-37%). Responders had significantly prolonged pDFS (median not reached vs. 16 months; p = 0.04). On multivariable analysis, apoptotic response remained a significant predictor of pDFS (HR = 0.22; 95% CI: 0.05-0.87; p = 0.03), independent of PCI and CCR. CONCLUSIONS: In this pilot study, apoptotic markers in HIPEC effluent are a histology-agnostic assay that correlates with recurrence risk. This biomarker may improve patient selection for adjuvant therapies.
Acker RC, Hwang J, Williams S
… +4 more, Sharpe J, Wachtel H, Karakousis GC, Kelz RR
J Surg Oncol
· 2026 Mar · PMID 41774551
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INTRODUCTION: Malignant obstructions are associated with morbidity, mortality, and impaired quality of life with limited population-based data on practice patterns. We characterized the association between prior cancer-r...INTRODUCTION: Malignant obstructions are associated with morbidity, mortality, and impaired quality of life with limited population-based data on practice patterns. We characterized the association between prior cancer-related hospitalizations and receipt of operative treatment for obstruction. METHODS: We performed a retrospective cohort study of patients hospitalized with malignant gastrointestinal obstructions from colorectal, gynecologic (GYN), and hepato-pancreatico-biliary (HPB) cancers in 12 states using the Healthcare Cost and Utilization Project State Inpatient Database, 2016-2020. The primary exposure was the number of cancer-related hospitalizations in the year prior to the first hospitalization for an obstruction. Risk-adjusted use of operative treatment during the index hospitalization, enrollment in hospice, length of stay, and inpatient mortality were examined using regression. RESULTS: Of 8665 patients, the median age was 67 years [Interquartile Range: 58,76]. There were 3789 patients with colorectal (43.7%), 2593 patients with GYN (29.9%), and 2337 patients (26.9%) with HPB cancers. The operative rate was 24.1%. Patients with prior hospitalizations were less likely to undergo operative treatment than those who were not previously hospitalized (operative rate difference: -7.8%, p < 0.001). Operative treatment was associated with longer median length of stay ( + 8.6 days, p < 0.001), lower rates of hospice enrollment (-3.0%, p = 0.002) and lower rates of inpatient mortality (operative rate difference -2.3%, p < 0.001). The time between readmissions also decreased with each recurrent obstruction in colorectal and GYN cancers. CONCLUSION: A greater number of previous cancer-related hospitalizations was associated with lower rates of operative treatment during the first hospitalization for a malignant obstruction. These data provide insight into the treatment trends for patients with malignant obstructions and may be helpful when counseling patients about the natural course of their disease.
BACKGROUND AND OBJECTIVES: The survival difference between recurrent pancreatic cancer (Rec-PC) and primary metastatic PC (PM-PC) remains inadequately understood. METHODS: Eligible participants received combination chemo...BACKGROUND AND OBJECTIVES: The survival difference between recurrent pancreatic cancer (Rec-PC) and primary metastatic PC (PM-PC) remains inadequately understood. METHODS: Eligible participants received combination chemotherapy with either gemcitabine plus nab-paclitaxel (GnP) or FOLFIRINOX. Overall survival (OS) was compared between patients with Rec-PC and those with PM-PC. RESULTS: Data from 147 participants (84 male and 63 female) were retrospectively analyzed. The Rec-PC group demonstrated significantly longer OS (median: 12.7 months) than the PM-PC group (median: 8.4 months) (p = 0.03). On multivariate analysis, Rec-PC (hazard ratio [HR]: 0.51; 95% confidence interval [CI]: 0.31-0.84; p < 0.01), presence of peritoneal dissemination (HR: 2.29; 95% CI: 1.42-3.69; p < 0.01), receipt of second-line chemotherapy (HR: 0.34; 95% CI: 0.21-0.55; p < 0.01), receipt of any local therapy (HR: 0.42; 95% CI: 0.23-0.77; p < 0.01), and prognostic nutritional index < 40 (HR: 2.50; 95% CI: 1.55-4.04; p < 0.01) were identified as independent prognostic factors. CONCLUSIONS: Rec-PC was identified as a favorable prognostic factor after adjusting for established prognostic indicators (registration number: NCT06921252).
BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer worldwide with high mortality and recurrence rates. We aimed to report survival and recurrence rates following ablation as the first treatment using real-worl...BACKGROUND: Hepatocellular carcinoma (HCC) is a common cancer worldwide with high mortality and recurrence rates. We aimed to report survival and recurrence rates following ablation as the first treatment using real-world data. METHODS: This study was based on data from a database and medical records. Variables associated with survival were investigated using the Kaplan-Meier estimator and Cox regression, and for recurrence with the Aalen-Johansen estimator and cause-specific Cox regression. RESULTS: From 2013 to 2023, 395 patients were included. Among them, 80% were men, the median age was 66 years, and 91% had cirrhosis. A complete ablation response was achieved in 86.1% of cases. Median survival was 3.4 years, and the five-year survival rate was 37.3%. Adjusted analysis showed a worse prognosis in patients with a tumor diameter ≥3 cm compared to <3 cm, performance status 1 and ≥ 2 compared to 0, and a percutaneous approach compared to open. Two-thirds developed recurrence, of whom 40.5% had de novo HCC, and 18% had local recurrence. Adjusted analysis showed that diameter ≥3 cm compared to <3 cm and three or more tumors had a higher recurrence risk. CONCLUSION: Recurrence remains challenging, particularly for patients with larger and multiple tumors, and studies investigating the treatment of recurrence are warranted. CLINICAL TRIALS REGISTER: NCT05498779.
BACKGROUND: Giant cell tumor (GCT) of bone is locally aggressive with a high recurrence rate following intralesional curettage. This study assessed early outcomes of Technetium (Tc-99 m) guided intraoperative gamma-camer...BACKGROUND: Giant cell tumor (GCT) of bone is locally aggressive with a high recurrence rate following intralesional curettage. This study assessed early outcomes of Technetium (Tc-99 m) guided intraoperative gamma-camera margin mapping for the detection of residual tumor in GCT around the knee. METHODS: This prospective study included twenty consecutive patients with histologically confirmed GCT of the distal femur (n = 11), proximal tibia (n = 9) treated with extended curettage and cementing. Tc-99 m MIBI (10 mCi) was administered 2-4 h preoperatively. Sequential gamma-camera readings (R1-R5) were obtained from baseline to post-curettage using grid sampling. Curettage was continued until final activity was <1.5 × baseline, confirming tumor clearance. The mean follow-up was 16.5 months (6-30). RESULTS: The mean patient age was 30 years (17-61), with equal gender distribution. The mean tumor size was 6.49 cm (3.1-9.7 cm). Serial intraoperative metabolic readings demonstrated a progressive decline, with mean values of 13.7 (R1:baseline), 84.9 (R2), 98.8 (R3), 93.7 (R4), 29.3 (R5), and 19.1 at final assessment. The mean R5 Final/R1 ratio was 1.46 (SD 0.33; range, 0.94-2.40), reflecting effective tumor clearance. No perioperative or postoperative complications were observed. Local recurrence occurred in 2 patients (10%) at 7,10 months following primary surgery. CONCLUSION: Salunke technique of radionuclide -guided gamma-camera margin mapping provides objective intraoperative guidance supplementing conventional visual and tactile assessment during intralesional curettage surgery. Larger prospective studies are needed to define its role in contemporary orthopaedic oncologic practice.
BACKGROUND: Total mesorectal excision (TME) with bilateral lateral lymph node dissection (BLLND) is a standard surgical approach for low advanced rectal cancer (LARC) in Eastern countries. Although robotic surgery has be...BACKGROUND: Total mesorectal excision (TME) with bilateral lateral lymph node dissection (BLLND) is a standard surgical approach for low advanced rectal cancer (LARC) in Eastern countries. Although robotic surgery has been increasingly adopted for rectal cancer, its impact on lateral lymph node recurrence (LLNR) after BLLND remains unclear. METHODS: We retrospectively reviewed 180 patients with pathological stage II/III LARC who underwent TME with BLLND between 2009 and 2019. Of these, 149 patients underwent open surgery and 31 underwent robotic surgery. Perioperative outcomes, long-term oncological outcomes, and patterns of LLNR were compared between the two groups. RESULTS: Robotic surgery was associated with a significantly longer operative time but resulted in markedly reduced blood loss, lower rates of wound infection and anastomotic leakage, and a shorter postoperative hospital stay compared with open surgery (p < 0.0001, p < 0.0001, p < 0.0001, p = 0.02, and p = 0.003, respectively). There were no significant differences between the two groups in 5-year overall survival or disease-free survival (p = 0.25 and p = 0.11, respectively). Notably, LLNR was observed exclusively in the open surgery group (16 patients), whereas no cases of LLNR occurred in the robotic surgery group. Recurrence sites in the open group were predominantly located in the distal internal iliac region (263D), followed by the proximal internal iliac (263P) and obturator (283) regions. CONCLUSION: Robotic TME with BLLND demonstrated favorable short-term outcomes and technical feasibility; however, definitive oncological superiority could not be established.
Effective communication is crucial in surgical oncology. This scoping review synthesizes literature on patient perspectives of communication in surgical oncology, reporting findings from 15 primary sources across six dom...Effective communication is crucial in surgical oncology. This scoping review synthesizes literature on patient perspectives of communication in surgical oncology, reporting findings from 15 primary sources across six domains: (1) emotional support, optimism, and surgeon demeanor, (2) patient expectations and expectation setting, (3) communication aids or tools, (4) shared decision-making, (5) prognosis and oncologic outcomes, and (6) appearances and office setting.
OBJECTIVE: Virtual Surgical Planning (VSP) for tongue reconstruction promises patient-specific optimizations, but its utility is limited by the difficulty of translating a digital plan to a deformable organ. This study e...OBJECTIVE: Virtual Surgical Planning (VSP) for tongue reconstruction promises patient-specific optimizations, but its utility is limited by the difficulty of translating a digital plan to a deformable organ. This study evaluated the feasibility and anatomical accuracy of a patient-specific, additively manufactured surgical toolkit through benchtop experiments on soft-tissue phantoms. METHOD: Four distinct hemiglossectomy reconstruction cases were planned using VSP and executed on patient-specific silicone tongue phantoms. The guided workflow, performed by an independent surgeon, incorporated: (1) resection marking guide, (2) intraoperative volume inspection guide, (3) donor flap harvesting guide with decoupled planar and volumetric control, and (4) marker-guided flap insetting. High-resolution 3D surface scans were used to quantify anatomical fidelity by measuring the surface deviation between the pre- and post-procedure scans. RESULTS: All four guided reconstructions were successfully completed. Mean surface deviation was 0.76-1.26 mm, and the 99th percentile (robust maximum) ranged 3.37-4.13 mm. This accuracy is comparable to that reported for established patient-specific osseous reconstructions. The operating surgeon found the toolkit intuitive, the workflow sequencing clear, and the volumetric inspection step practical. CONCLUSION: This benchtop study demonstrates that a patient-specific, guided surgical toolkit can feasibly and reliably translate tongue VSP into accurate reconstructions on soft-tissue phantoms. By introducing a volume feedback mechanism and decoupling the flap's planar shape from its volume, the system provides adaptive guidance that is both geometry- and volume-aware. These findings support progression to cadaveric studies and early clinical validation to evaluate overbulking strategies, intraoperative adaptability, and correlation with functional outcomes.
BACKGROUND: Pancreatoduodenectomy is a high-risk operation. National cancer registry data can estimate trends in 90-day outcome measures but are not always included in surgical discussions. We aimed to study national tre...BACKGROUND: Pancreatoduodenectomy is a high-risk operation. National cancer registry data can estimate trends in 90-day outcome measures but are not always included in surgical discussions. We aimed to study national trends in patient selection and postoperative outcomes to better guide shared decision-making between patients and surgeons. METHODS: Patients ≥18 years who underwent pancreatoduodenectomy between 2004 and 2020 were abstracted from the National Cancer Database. Primary outcome was 90-day mortality. Mortality was tabulated by year and stratified by tumor histology: adenocarcinoma, neuroendocrine neoplasm, or other (adenocarcinoma in the setting intraductal papillary mucinous neoplasm, colloid carcinoma, sarcomas, etc.). Multivariable logistic regression determined independent predictors of mortality and survival. RESULTS: A total of 63,283 patients were included. 51.7% were male, with median age of 66 (IQR 59, 73) years. The number of pancreatoduodenectomies per year more than doubled over time from 2219 in 2004 to 4613 in 2020. Tumors were categorized as adenocarcinoma in 91.0%, neuroendocrine in 6.6%, and other malignancies in 2.4%. Change in 90-day mortality over time differed by histology. For patients with pancreatic ductal adenocarcinoma, 90-day mortality decreased from 8.0% in 2004 to 5.3% in 2020 (p < 0.001); for neuroendocrine neoplasm mortality decreased from 8.6% to 3.4% (p < 0.001); for other tumors mortality decreased from 8.7% to 7.2% (N.S). Older age (p < 0.001) and Charlson-Deyo Score ≥3 (p < 0.001) were significant predictors of both 30- and 90-day mortality. CONCLUSIONS: 90-day mortality following pancreatoduodenectomy continues to decrease significantly. Case volume more than doubled over this 16-year period. Continued improvements in patient selection, optimization, and refinement in operative technique may contribute to improving outcomes over time.
INTRODUCTION: Soft tissue sarcoma (STS) resections of the thigh have high rates of wound complications, but the effect of tumor depth and surrounding tissue composition on wound risk is not fully understood. We aimed to...INTRODUCTION: Soft tissue sarcoma (STS) resections of the thigh have high rates of wound complications, but the effect of tumor depth and surrounding tissue composition on wound risk is not fully understood. We aimed to determine whether skin-to-tumor distance and regional thigh adiposity independently predict postoperative wound complications. METHODS: We retrospectively reviewed 125 patients who underwent thigh STS resection from 2013 to 2025. Preoperative MRI or CT was used to measure (1) the shortest skin-to-tumor distance in the quadrant with the greatest tumor burden and (2) average thigh adiposity across the remaining quadrants. The primary endpoint was a composite of wound dehiscence, infection, or return to the operating room within 90 days. Multivariable logistic regression was used, adjusting for demographic, treatment, and tumor variables. RESULTS: Composite wound complications occurred in 34 patients (27%). Each 1-cm increase in skin-to-tumor distance reduced the odds of complication by approximately 80% (OR = 0.21, 95%-CI: 0.07-0.61, p = 0.004), while each 1-cm increase in average thigh adiposity nearly doubled the risk (OR = 1.92, 95%-CI: 1.08-3.41, p = 0.025). Findings were consistent for wound dehiscence, with similar trends observed for infection. CONCLUSION: Both superficial tumor location and increased thigh adiposity independently predict postoperative wound complications. Incorporating radiographic measures of local coverage and regional tissue quality may enhance preoperative risk assessment and assist in reconstructive planning for extremity soft tissue sarcoma surgery.
INTRODUCTION: Malignant bowel obstruction is common in colorectal cancer and may require high-risk emergency surgery. A structured four-stage obstruction protocol may improve outcomes through early decompression and opti...INTRODUCTION: Malignant bowel obstruction is common in colorectal cancer and may require high-risk emergency surgery. A structured four-stage obstruction protocol may improve outcomes through early decompression and optimisation, thereby preventing deterioration, reducing acute resections and stoma formation, and minimising morbidity and mortality. This study evaluated clinical outcomes of this protocol. METHODS: The protocol categorises patients by symptom severity and colonic distension, with stage-specific management and routine reassessment for improvement or deterioration. Deterioration was defined as worsening of symptoms requiring escalation to a higher stage and more intensive care. This retrospective study included patients treated between 2018 and 2024. RESULTS: Of 319 patients, 236 received curative and 83 palliative treatment. Stage distribution (curative/palliative): stage 1 (184/59), stage 2 (19/11), stage 3 (20/6), stage 4 (13/7). (Semi-)acute resections occurred more frequently in higher stages: 1% (stage 1), 6% (stage 2), 25% (stage 3), 15% (stage 4) (p < 0.001). Overall, 6% of curative patients deteriorated: 3% (stage 1), 5% (stage 2), 30% (stage 3), and 8% (stage 4). In curative stage 3, acute resection was avoided in 75% treated with stenting or nasogastric decompression. In the palliative group, all stage 3-4 patients received a stent or stoma without deterioration. CONCLUSION: The four-stage obstruction protocol effectively manages colorectal cancer-related obstruction. In 94% of curative patients, deterioration was prevented, avoiding emergency surgery and its risks. While emergency resection was previously considered standard in stage 3, the protocol avoided this in most patients. Accurate staging and close monitoring remain essential to prevent deterioration.
Rottoli M, Calini G, Castagna G
… +13 more, Gori A, Cardelli S, Spinelli A, Pellino G, Bianconi A, Fiore M, Rosati R, Morino M, de Manzini N, Pietrabissa A, Boni L, Poggioli G, COVID‐CRC Study Group
J Surg Oncol
· 2026 Apr · PMID 41723819
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BACKGROUND: Colorectal cancer screening mainly targets a population between 50 and 70 years of age; however, it is inconsistently implemented in people over 70. The aim of this study was to analyze the association betwee...BACKGROUND: Colorectal cancer screening mainly targets a population between 50 and 70 years of age; however, it is inconsistently implemented in people over 70. The aim of this study was to analyze the association between colorectal cancer (CRC) screening, postoperative mortality, and perioperative and oncologic outcomes in a large population of patients over 70 years of age who underwent surgery for CRC. METHODS: Data regarding people over 70 who underwent CRC surgery were retrieved from a nationally validated retrospective database, including four consecutive years (2018-2021) and 81 centers. The patients were divided into two groups according to their participation in the CRC screening program: Screening versus No Screening. The outcomes of the study were 30-day mortality; urgent, palliative and minimally invasive surgery rates; Clavien-Dindo ≥ III; advanced oncologic stage; R0 resection and length of hospital stay (LOS). Logistic regression analysis was carried out and adjusted for multiple confounders. RESULTS: Of the 10,346 patients over 70,676 were in the screening group, and 9670 were in the no screening group. At logistic regression, CRC screening was significantly associated with a reduction in 30-day mortality (OR 0.41, 95% CI 0.18-0.92, p = 0.032), urgent surgery (OR 0.06, 95% CI 0.02-0.14, p < 0.001), palliative surgery (OR 0.32, 95% CI 0.19-0.54, p < 0.001), Clavien-Dindo ≥ III complications (OR 0.69, 95% CI 0.51-0.93, p = 0.016) and advanced oncologic stage (OR 0.53, 95% CI 0.45-0.62, p < 0.001), and a significant increase in R0 resections (OR 3.15, 95% CI 1.67-5.94, p < 0.001) and laparoscopic surgery (OR 1.93, 95% CI 1.57-2.38, p < 0.001). The crude and adjusted Odds Ratio similarity confirmed this correlation, regardless of the comorbidities and confounders. CONCLUSIONS: Adherence to CRC screening should be further encouraged and standardized for people over 70.
Scheipner L, Morra S, Baudo A
… +16 more, Jannello LMI, Siech C, de Angelis M, Goyal JA, Tian Z, Saad F, Shariat SF, Briganti A, Chun FKH, Longo N, Carmignani L, De Cobelli O, Seles M, Mischinger J, Ahyai S, Karakiewicz PI
PURPOSE: To test the effect of laterality on the risk of intraoperative complications (ICs) in a contemporary cohort of adrenalectomy patients. METHODS: Within the Nationwide Inpatient Sample (NIS) database (2015-2019),...PURPOSE: To test the effect of laterality on the risk of intraoperative complications (ICs) in a contemporary cohort of adrenalectomy patients. METHODS: Within the Nationwide Inpatient Sample (NIS) database (2015-2019), we identified patients who underwent either minimal-invasive or open adrenalectomy. Multivariable logistic regression models tested for the association of laterality and IC. Additionally, this association was further tested in specific subgroups, namely patients with elevated body mass index (BMI) ≥ 30, patients who underwent minimal-invasive adrenalectomy, and patients who underwent open adrenalectomy. RESULTS: Overall, we identified 4887 patients who underwent adrenalectomy. Of those, 2143 (44%) were right-sided, and 2744 (56%) left-sided. An IC was recorded in 90 (1.8%) patients. Right-sided adrenalectomy had significantly more IC compared to left-sided adrenalectomy (2.6% vs. 1.3%, p < 0.001). After multivariable adjustment, right side emerged as an independent predictor for IC (OR 1.9, p = 0.007). In subgroup analysis, right-side remained an independent predictor for IC in patients with BMI ≥ 30 (OR 4.08 p = 0.003) and minimal-invasive adrenalectomy (OR 2.3 p = 0.01) patients. CONCLUSION: ICs in adrenalectomy are rare, but are associated with high morbidity. Right-sided adrenalectomy carries an increased risk for IC. Conversely, surgeons should exercise particular caution when approaching the right adrenal gland to mitigate the associated risks and enhance patient outcomes.
PURPOSE: Immunohistochemistry (IHC) is a crucial step in the diagnostic and therapeutic management of colorectal carcinoma (CRC). This study aimed to explore the feasibility and diagnostic accuracy of general-purpose vis...PURPOSE: Immunohistochemistry (IHC) is a crucial step in the diagnostic and therapeutic management of colorectal carcinoma (CRC). This study aimed to explore the feasibility and diagnostic accuracy of general-purpose vision-language models (VLMs), specifically Gemini (2.5 Pro) and ChatGPT-4.0, for the automated classification of MMR status using immunohistochemical whole-slide images (WSIs). METHODS: A retrospective cohort of 50 CRC cases, stratified by reference MMR phenotype, was analyzed, with models performing a dual assessment: individual IHC evaluation and an overall result (Proficient Mismatch Repair, pMMR, or Deficient Mismatch Repair, dMMR). RESULTS: The AI models achieved 100% specificity in correctly classifying cases with retention of all four MMR proteins as pMMR (20/20 cases). However, the overall sensitivity for detecting dMMR cases was 65% (13/20 cases), with lower concordance observed for MSH2/MSH6 loss (60%) compared to MLH1/PMS2 loss (70%). CONCLUSIONS: This drop in sensitivity was attributed to the models' reluctance to confirm true protein loss, often categorizing the result as "Indeterminate" or "Inadequate". Crucially, the diagnostic certainty of the AI models increased dramatically only when a clear Internal Positive Control (IPC) was visible in the image, establishing the IPC as an indispensable feature for robust dMMR identification and differentiating true biological loss from technical artifacts.