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Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging...
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Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 31 January 2026 | Viewed by 9777

Special Issue Editors

Dr. Salvatore Sorrenti

E-Mail Website
Guest Editor
Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy
Interests: thyroid cancer; breast cancer; surgical oncology
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Luigi Marano

E-Mail Website
Guest Editor
1. Department of Medicine, Academy of Applied Medical and Social Sciences, 2 Lotnicza Street, 82-300 Elblag, Poland
2. Department of General Surgery and Surgical Oncology, Saint Wojciech Hospital, Nicolaus Copernicus Health Center, 50 Jana Pawła II Street, 80-462 Gdansk, Poland
Interests: gastric cancer; robotic surgery; Surgical oncology; colorectal surgery; gastrointestinal surgery; minimally invasive surgery; histopathological aspects; signet ring cells; lymphadenectomy; molecular classifications; peritoneal spreading; neoadjuvant chemotherapy; esophageal cancer; achalasia; gastro-esophageal reflux disease; immunonutrition in cancer patients; textbook outcomes and volumes in surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Fabio Medas

E-Mail Website
Guest Editor
Department of Surgical Sciences, University of Cagliari, 09124 Cagliari, Italy
Interests: endocrine surgery; thyroid; parathyroid; mini-invasive surgery
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Angela Gurrado

E-Mail Website
Guest Editor
Department of Precision and Regenerative Medicine and Ionian Area, Aldo Moro University, Bari, Italy
Interests: surgical oncology

Special Issue Information

Dear Colleagues,

Cancer remains one of the most formidable challenges in modern medicine, with its multifaceted nature requiring a comprehensive and multidisciplinary approach for effective management. Among the various modalities employed in cancer treatment, surgery stands as a cornerstone, offering curative potential, symptom relief, and palliation across a wide spectrum of malignancies. The intricate interplay between surgical techniques, technological advancements, and evolving treatment paradigms underscores the critical role of surgical oncology in the continuum of cancer care. The landscape of surgical oncology has witnessed remarkable transformations in recent years, driven by a confluence of scientific breakthroughs, technological innovations, and refined surgical strategies. This evolution has not only expanded the repertoire of surgical interventions, but has also revolutionized our understanding of cancer biology, tumor behavior, and treatment outcomes. From minimally invasive approaches to precision oncology-guided surgeries, the field of surgical oncology has embraced a paradigm shift towards personalized and tailored cancer therapies. The importance of surgical advances in cancer treatment cannot be overstated. Surgical resection remains the primary curative option for many solid tumors, offering the potential for the complete eradication of localized disease. Moreover, surgical interventions play a pivotal role in achieving local control, debulking tumors, and facilitating the integration of other treatment modalities, such as chemotherapy, radiation therapy, and immunotherapy. Beyond its curative intent, surgery also holds significance in the realm of palliative care, alleviating symptoms, improving individuals’ quality of life, and prolonging the survival of patients with advanced or metastatic disease. 

We are pleased to invite colleagues and experts from across the globe to join us in this research adventure by contributing their insights, research findings, and clinical experiences to this Special Issue.

Furthermore, we are pleased to propose this Special Issue under the umbrella of the highly esteemed Italian College of Associate Professors of Surgery. As a society exclusively composed of associate professors of surgery, the College collects a wealth of expertise and experience in surgical oncology. Partnering with such a recognized institution will undoubtedly enhance the credibility and relevance of this Special Issue. 

This Special Issue aims to achieve the following:

  • Showcase cutting-edge surgical techniques: Highlighting innovative surgical approaches and technologies employed in the treatment of various cancer types.
  • Explore interdisciplinary collaborations: Examining the synergies between surgery, oncology, radiology, pathology, and other specialties to optimize patient outcomes.
  • Provide a comprehensive overview: Offering insights into surgical interventions across different anatomical regions and cancer types, from gastrointestinal to skin cancer and beyond.
  • Foster research on clinical outcomes: Encouraging studies that evaluate the effectiveness, safety, and long-term outcomes of novel surgical interventions in cancer care.
  • Promote personalized cancer therapies: Investigating the role of precision medicine and tailored surgical approaches in optimizing treatment strategies for individual patients.
  • Enhance knowledge dissemination: Facilitating the exchange of scientific knowledge, best practices, and emerging trends in surgical oncology among researchers, clinicians, and policymakers.
  • Address challenges and controversies: Addressing current debates and challenges in cancer surgery, such as minimally invasive versus open procedures, organ preservation, and surgical margins.
  • Advance the field of surgical oncology: Contributing to the advancement of surgical techniques, patient care standards, and interdisciplinary collaboration in the fight against cancer.

In this Special Issue, original research articles and reviews are welcome. Research areas may include (but are not limited to) the following:

  1. Innovative Surgical Techniques: Exploration of novel surgical approaches and methodologies aimed at improving the efficacy, safety, and precision of cancer surgeries.
  2. Technological Advancements: Investigation of cutting-edge technologies such as robotics, image-guided surgery, and augmented reality in enhancing surgical outcomes and patient recovery.
  3. Interdisciplinary Collaborations: Examination of collaborative efforts between surgeons, oncologists, radiologists, pathologists, and other healthcare professionals to optimize multidisciplinary cancer care pathways.
  4. Clinical Outcomes Research: Evaluation of surgical interventions' short-term and long-term outcomes, including survival rates, recurrence rates, functional outcomes, and quality of life measures.
  5. Personalized Medicine in Surgery: Study of personalized treatment strategies, including patient-specific surgical planning, genomic profiling, and targeted therapies tailored to individual tumor biology and patient characteristics.
  6. Minimally Invasive Surgery: Assessment of minimally invasive surgical techniques, including laparoscopic, robotic-assisted, and endoscopic procedures, in the context of cancer treatment.
  7. Surgical Oncology in Special Populations: Investigation of surgical considerations and outcomes in special patient populations, such as elderly patients, pediatric patients, and those with comorbidities or rare cancers.
  8. Quality Improvement and Patient Safety: Initiatives aimed at enhancing the quality of cancer surgical care, including protocols for surgical safety, standardized practices, and quality metrics assessment.
  9. Health Economics and Healthcare Policy: Studies examining the cost-effectiveness of surgical interventions, healthcare resource utilization, and policy implications for optimizing cancer surgical care delivery.
  10. Surgical Education and Training: Innovations in surgical education, simulation-based training, and competency assessment for aspiring and practicing surgical oncologists.
  11. Ethical and Societal Considerations: Exploration of ethical dilemmas, patient-centered decision-making, and societal implications of emerging surgical technologies and treatment modalities in cancer care.
  12. Global Perspectives on Surgical Oncology: Insights into the challenges, opportunities, and disparities in the delivery of cancer surgical care across different regions and healthcare systems worldwide. 

We look forward to your valuable contributions and to the collective impact we can achieve in advancing research on cancer. 

Dr. Salvatore Sorrenti
Prof. Dr. Luigi Marano
Dr. Fabio Medas
Prof. Dr. Angela Gurrado
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • surgical oncology
  • surgical innovation
  • image-guided surgery
  • robotic-assisted surgery
  • multidisciplinary oncology
  • surgical outcomes research
  • precision surgery
  • healthcare economics
  • surgical training and simulation

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  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • e-Book format: Special Issues with more than 10 articles can be published as dedicated e-books, ensuring wide and rapid dissemination.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (12 papers)

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12 pages, 247 KiB  
Article
External Lymphatic Fistula After Radical Surgery for Colorectal Cancer: A Case Series
by Vincenzo Tondolo, Luca Emanuele Amodio, Federica Marzi, Giada Livadoti, Giuseppe Quero and Gianluca Rizzo
Cancers 2025, 17(9), 1416; https://doi.org/10.3390/cancers17091416 - 23 Apr 2025
Abstract
Background: The incidence of external lymphatic fistula (ELF) represents a relatively rare complication after surgery for colorectal cancer, especially in Western countries. However, the rate of this complication is progressively increasing following the introduction of complete mesocolic excision and central vascular ligation with [...] Read more.
Background: The incidence of external lymphatic fistula (ELF) represents a relatively rare complication after surgery for colorectal cancer, especially in Western countries. However, the rate of this complication is progressively increasing following the introduction of complete mesocolic excision and central vascular ligation with consequent extensive lymphadenectomy. There are no guidelines for the management of ELF, with therapeutic options varying from conservative procedures to more invasive surgeries. The aim of this study was to retrospectively quantify the rate of ELF after surgery for colorectal cancer, to describe its management, and to evaluate its clinical impact on early postoperative outcomes in a tertiary referral European centre. Methods: Data on all patients who underwent surgery for colorectal cancer at our institution between July 2022 and December 2024 were entered into a database. Preoperative, perioperative, and early (within 30 days) postoperative data were recorded. Results: A total of 279 patients underwent elective surgery for colorectal cancer (205 colon and 74 rectum). No postoperative deaths occurred within 30 days after surgery, and the rates of overall and major (grade ≥ 3) postoperative morbidity were 34.7% and 7.1%, respectively. The anastomotic leakage and reoperation rates were 2.8% and 5.3%, respectively. ELFs occurred in 15 patients (5.3%). In all patients, conservative treatment (based on fasting, total parenteral nutrition (TPN), and a prolonged medium-chain triglyceride (MCT) diet) was administered successfully. A recurrent ELF (after the first oral feeding resumption) occurred in four (26.6%) patients, but all were successfully treated with a conservative approach. The occurrence of an ELF prolonged the postoperative length of stay which was 12 days, a length higher than that recorded in patients without ELF. Conclusions: The occurrence of an ELF was found to be a relatively frequent complication after surgery for colorectal cancer and appears to negatively influence only the postoperative length of stay. Conservative management appeared to be a successful treatment. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
19 pages, 1405 KiB  
Article
Assessing Surgical Approaches and Postoperative Complications for Thoracic Schwannomas: A Multicenter Retrospective Observational Analysis of 106 Cases
by Giuseppe Corazzelli, Antonio Bocchetti, Marco Filippelli, Maria Marvulli, Sergio Corvino, Valentina Cioffi, Vincenzo Meglio, Settimio Leonetti, Ciro Mastantuoni, Maria Rosaria Scala, Alberto de Bellis, Alessandra Alfieri, Roberto Tafuto, Francesco Ricciardi, Salvatore Di Colandrea, Alessandro D’Elia, Luigi Sigona, Mauro Mormile, Pasqualino De Marinis, Sergio Paolini, Vincenzo Esposito, Alfonso Fiorelli, Gualtiero Innocenzi and Raffaele de Falcoadd Show full author list remove Hide full author list
Cancers 2025, 17(7), 1177; https://doi.org/10.3390/cancers17071177 - 31 Mar 2025
Viewed by 158
Abstract
Background: Thoracic schwannomas are benign nerve sheath tumors that can cause neurological and respiratory symptoms depending on their location and extension. The optimal surgical approach remains debated, particularly regarding resection extent, complication rates, and postoperative morbidity. Methods: This retrospective multicenter study analyzed 106 [...] Read more.
Background: Thoracic schwannomas are benign nerve sheath tumors that can cause neurological and respiratory symptoms depending on their location and extension. The optimal surgical approach remains debated, particularly regarding resection extent, complication rates, and postoperative morbidity. Methods: This retrospective multicenter study analyzed 106 patients treated between 2011 and 2024, classifying tumors according to the Eden system and comparing surgical strategies. Surgical variables, including operative time, blood loss, resection extent, recurrence rates, and complications classified by Clavien–Dindo, were analyzed. Results: Eden I and II schwannomas were treated with laminectomy (LCT) or hemilaminectomy (HLCT) and transpedicular approaches (TPD), achieving high gross total resection (GTR) rates with minimal complications. Eden III dumbbell tumors benefited from a combined neurosurgical–thoracic approach (LCT + VATS), which resulted in higher GTR rates (100% vs. 62%, p < 0.01) and lower dural complications compared to neurosurgical resection alone. Eden IV extraforaminal schwannomas were best managed with VATS, which was associated with lower intraoperative blood loss (p = 0.018), shorter surgical duration (p = 0.027), and reduced postoperative complications compared to open thoracotomy. Our findings confirm that minimally invasive techniques, particularly VATS and combined neurosurgical–thoracic approaches, optimize tumor resection while reducing morbidity. However, feasibility depends on institutional resources and multidisciplinary collaboration. Conclusions: This study provides a stratified comparison of surgical approaches tailored to Eden classification, aiming to identify the most effective and least morbid strategies for each lesion type. Future prospective studies should validate these findings, integrating preoperative functional assessments and long-term follow-up to better stratify surgical risk, personalize operative planning, and refine surgical decision making for thoracic schwannomas. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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12 pages, 2413 KiB  
Article
Management of Cutaneous Squamous Cell Carcinoma of the Scalp in Kidney Transplant Recipients
by Lucia Romano, Chiara Caponio, Fabio Vistoli, Ettore Lupi, Maria Concetta Fargnoli, Maria Esposito, Laura Lancione, Manuela Bellobono, Tarek Hassan, Elisabetta Iacobelli, Luca Semproni and Alessandra Panarese
Cancers 2025, 17(7), 1113; https://doi.org/10.3390/cancers17071113 - 26 Mar 2025
Viewed by 265
Abstract
Background: Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3–8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, [...] Read more.
Background: Organ transplant recipients are at a significantly higher risk of developing skin cancer compared to the general population, particularly cutaneous squamous cell carcinoma. Approximately 3–8% of these carcinomas are located on the scalp. Scalp reconstruction is particularly challenging, especially for large excisions, due to the thickness of the scalp, the inelastic aponeurosis of the galea, and the integrity of the hair-bearing scalp. Additionally, in organ transplant recipients, the presence of numerous comorbidities and the increased risk of infection due to immunosuppressive therapy make management more complex. Based on our experience and the existing literature, we aim to describe possible reconstruction methods and discuss the combined management of medical and immunosuppressive therapy. Method: We present our experience with seven kidney transplant patients who underwent excision of cutaneous squamous cell carcinoma with a diameter larger than 3 cm. The crane technique involves three key steps. First, the tumor is excised with wide margins of disease-free tissue. Next, a pericranial flap is rotated and positioned to cover the exposed cranial bone. Finally, a bilayer dermal substitute is applied to create a microenvironment that supports skin graft implantation. Results: The crane technique was used for six patients. In one case, an O-Z rotation flap was used. All patients modified their immunosuppressive therapy, with those receiving antiproliferative therapy switching everolimus after surgery. Conclusions: When combined with a post-operative modification of the immunosuppressive regimen, the crane technique could be considered a feasible, safe, and effective approach to managing large cSCC of the scalp in fragile patients. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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13 pages, 2535 KiB  
Article
Segmentectomy Versus Wedge Resection for Stage IA Lung Adenocarcinoma—A Population-Based Study
by Xu-Heng Chiang, Chih-Fu Wei, Ching-Chun Lin, Mong-Wei Lin, Chun-Ju Chiang, Wen-Chung Lee, Jin-Shing Chen and Pau-Chung Chen
Cancers 2025, 17(6), 936; https://doi.org/10.3390/cancers17060936 - 10 Mar 2025
Viewed by 677
Abstract
Background: Sublobar resection (SLR), including segmentectomy and wedge resection (WR), is an alternative to lobectomy for early-stage lung cancer due to its potential benefits in preserving lung function. However, the comparative outcomes between segmentectomy and WR for stage IA lung adenocarcinoma are equivocal. [...] Read more.
Background: Sublobar resection (SLR), including segmentectomy and wedge resection (WR), is an alternative to lobectomy for early-stage lung cancer due to its potential benefits in preserving lung function. However, the comparative outcomes between segmentectomy and WR for stage IA lung adenocarcinoma are equivocal. This population-based study aimed to compare overall survival between segmentectomy and WR. Methods: Data on patients with clinical stage IA lung adenocarcinoma were collected from the Taiwan Cancer Registry between 2011 and 2018. The primary endpoint was overall survival. Further subgroup survival analyses were conducted based on tumor size. Propensity score matching (PSM) was used to balance baseline differences such as age and tumor stage between the two groups. Predictors of survival other than the surgical procedure were analyzed using a Cox regression model. Results: In total, 6598 patients with stage IA lung adenocarcinoma undergoing SLR between 2011 and 2018 were enrolled, including 2061 and 4537 receiving segmentectomy and WR, respectively. The mean age was 60.3 ± 11.7 years, 66.2% were female, and 81.5% never smoked. After PSM, segmentectomy was associated with significantly better overall survival than WR (p = 0.019), especially for tumors larger than 2 cm (p < 0.001). Aside from segmentectomy, age ≤ 75 years, well-differentiated tumors, small tumor size, and the absence of nodal metastasis were associated with better overall survival. Conclusions: Segmentectomy offered superior overall survival for patients with tumors larger than 2 cm. For tumors smaller than 2 cm, the outcomes of segmentectomy and WR were comparable, offering flexibility in surgical decision-making. These findings highlight the need for individualized surgical approaches based on tumor characteristics. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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10 pages, 418 KiB  
Article
Evaluating Tumor Size to Ki67 Proliferation Index Ratio for Optimizing Surgical Axillary Treatment Decisions in Breast Cancer Patients
by Marco Pellicciaro, Marco Materazzo, Alice Bertolo, Federico Tacconi, Sebastiano Angelo Bastone, Francesco Calicchia, Denisa Eskiu, Enrica Toscano, Amir Sadri, Michele Treglia, Massimiliano Berretta, Benedetto Longo, Valerio Cervelli, Oreste Claudio Buonomo and Gianluca Vanni
Cancers 2025, 17(5), 798; https://doi.org/10.3390/cancers17050798 - 26 Feb 2025
Viewed by 484
Abstract
Despite advancements in breast cancer surgery, the decision-making process for axillary treatment remains complex, necessitating new predictors like the tumor size to Ki67 proliferation index ratio. Intraoperative examination of the sentinel lymph node is performed to reduce the risk of a secondary surgery. [...] Read more.
Despite advancements in breast cancer surgery, the decision-making process for axillary treatment remains complex, necessitating new predictors like the tumor size to Ki67 proliferation index ratio. Intraoperative examination of the sentinel lymph node is performed to reduce the risk of a secondary surgery. Several studies have demonstrated that even in the presence of moderate nodal involvement, local disease control can be achieved by omitting axillary lymph node dissection (ALND). The aim of our retrospective study is to compare patients subjected to sentinel lymph node biopsy (SNLB) with or without intraoperative evaluation. This study included patients with breast cancer who underwent breast-conserving surgery and SNLB. Of the 551 patients, 333 (60.4%) underwent an SNLB intraoperative evaluation (SLNB-IE), while 218 (39.6%) underwent sentinel lymph node dissection diagnostic evaluation (SLNB-DE). Our analysis revealed that the tumor size to Ki67 ratio is an independent predictive factor for axillary tumor burden, suggesting its utility in surgical decision-making. A secondary ALND was performed in 2 (0.6%) vs. 7 (2.8%), p = 0.032, and in 1 (0.4%) vs. 4 (2.1%), p = 0.171, excluding patients with T ≥ 2. Surgical time was significantly shorter (p > 0.001) in the SLNB-DE group. According to a multivariate analysis, lesion dimension (OR 1.678; 95%CI 1.019–2.145; WALD:7.588; p = 0.006) and the ratio of lesion dimension to the Ki67 proliferation index (OR 0.08; 95%CI 0.011–0.141; WALD:11.004 p = 0.001) were both predictive factors for a higher axillary tumor burden. A value of 0.425, which is the ratio of tumor dimension to the Ki67 proliferation index, was identified as a predictor of tumor burden in the axilla (sensitivity, 78%; specificity, 87.5%). Intraoperative evaluation of SNLB may be omitted but could be considered in potential candidates for cyclin inhibitor and cN0 therapy with a higher ratio of tumor dimension to the Ki67 proliferation index in order to avoid secondary surgery. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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9 pages, 3095 KiB  
Article
Comparing Outcomes of Open and Robot-Assisted Inguinal Lymphadenectomy for the Treatment of cN2 Squamous Cell Carcinoma of the Penis: A Retrospective Single-Center Analysis
by Aldo Brassetti, Rigoberto Pallares-Mendez, Alfredo M. Bove, Leonardo Misuraca, Umberto Anceschi, Gabriele Tuderti, Riccardo Mastroianni, Leslie C. Licari, Eugenio Bologna, Silvia Cartolano, Simone D’Annunzio, Mariaconsiglia Ferriero, Rocco S. Flammia, Flavia Proietti, Costantino Leonardo and Giuseppe Simone
Cancers 2024, 16(23), 3921; https://doi.org/10.3390/cancers16233921 - 22 Nov 2024
Cited by 1 | Viewed by 961
Abstract
Background: Inguinal lymph node (LN) dissection (iLND) is mandatory in cN2 penile squamous cell carcinoma (PSCC). Open iLND (OIL) is often omitted due to the high rate of complications. A minimally invasive approach may reduce morbidity; however, evidence supporting its role to treat [...] Read more.
Background: Inguinal lymph node (LN) dissection (iLND) is mandatory in cN2 penile squamous cell carcinoma (PSCC). Open iLND (OIL) is often omitted due to the high rate of complications. A minimally invasive approach may reduce morbidity; however, evidence supporting its role to treat bulky nodes is limited. This study aimed to present the outcomes of the largest European single-center series of robot-assisted iLND (RAIL) for the treatment of cN2 PSCC and to compare the surgical and survival outcomes of this approach with the standard of care. Methods: A retrospective analysis was conducted on men with cT1-4N2M0 PSCC undergone either OIL or RAIL at our institution from January 2014 onwards. Baseline demographics, perioperative data, and oncologic outcomes were analyzed. Results: Overall, 47 patients were included; 38 (81%) underwent OIL. Median age was 59 years, with 23 men (48%) presenting with a ≥4 Charlson comorbidity index. Operation time was significantly longer in the robotic cohort (212 min vs. 145 min; p < 0.001), while the length of stay (p = 0.09) and time to inguinal drainage removal (p = 0.08) were not. Estimated blood loss favored the robotic approach (60 mL vs. 300 mL; p < 0.001). Post-operative complications rates were comparable in the two groups (25% vs. 47%; p = 0.17): four major complications were observed overall, and these were all in the OIL cohort. Median LN yield was comparable between the two groups (18 vs. 25; p = 0.05). Final pathology reports showed no significant differences in tumor stage distribution between the cohorts (p = 0.54). Kaplan–Meier analysis did not reveal any significant differences in RFS probabilities between the two treatment groups (Log Rank = 0.99). Conclusions: RAIL demonstrated comparable perioperative and oncologic outcomes to OIL for cN2 PSCC, with the benefit of reduced estimated blood loss. RAIL is a feasible option for cases where a minimally invasive approach is preferred, offering comparable perioperative safety and oncological outcomes. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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11 pages, 2546 KiB  
Article
Survival after Lung Metastasectomy from Urothelial Carcinoma: A Multi-Institutional Database Study
by Yoshikane Yamauchi, Masaaki Sato, Takekazu Iwata, Makoto Endo, Norihiko Ikeda, Hiroshi Hashimoto, Tai Hato, Hidemi Suzuki, Haruhisa Matsuguma, Yasushi Shintani, Haruhiko Kondo, Takahiko Oyama, Yoko Azuma, Tomohiko Iida, Noriaki Sakakura, Mingyon Mun, Keisuke Asakura, Takashi Ohtsuka, Hirofumi Uehara and Yukinori Sakao
Cancers 2024, 16(19), 3333; https://doi.org/10.3390/cancers16193333 - 29 Sep 2024
Viewed by 1108
Abstract
Background/objectives: The efficacy of lung metastasectomy in patients with urothelial carcinoma remains inconclusive, as there is only limited evidence from small studies. In this study, we aimed to assess the prognostic outcomes of excising pulmonary metastases from urothelial carcinoma. Methods: In this study, [...] Read more.
Background/objectives: The efficacy of lung metastasectomy in patients with urothelial carcinoma remains inconclusive, as there is only limited evidence from small studies. In this study, we aimed to assess the prognostic outcomes of excising pulmonary metastases from urothelial carcinoma. Methods: In this study, we utilized data from the Metastatic Lung Tumor Study Group of Japan database, a multi-institutional prospective database of pulmonary metastasectomies. We examined the data of patients who had undergone pulmonary metastasectomy for urothelial carcinoma between 1985 and 2021. Exclusion criteria included insufficient clinical information and follow-up of <3 months. Results: The study cohort comprised 100 patients (63 bladder cancer, 37 renal pelvic and ureteral cancer), with a median follow-up of 34 months. There were 70 male and 30 female patients of average age 66.5 ± 10.4 years at lung metastasectomy. The median interval from treatment of the primary lesion to metastasectomy was 19 months and the maximum tumor diameter was 21 ± 15 mm. Three- and five-year overall survival rates were 69% and 59%, respectively. Three- and five-year disease-free survival rates were 56% and 46%, respectively. Multivariate analysis identified larger tumor diameter (hazard ratio: 1.62, 95% confidence interval: 1.21–2.17) and distant metastases at the time of treatment of the primary cancer (hazard ratio: 4.23; 95% confidence interval: 1.54–11.6) as significant adverse prognostic factors for overall survival. Conclusions: To our knowledge, this is the largest published case series of pulmonary resection for metastatic urothelial carcinoma, providing benchmark data for the assessment of long-term outcomes of this rare entity. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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10 pages, 722 KiB  
Article
Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) for Gastric Cancer Peritoneal Metastases: Results from the Lithuanian PIPAC Program
by Martynas Luksta, Augustinas Bausys, Neda Gendvilaite, Klaudija Bickaite, Rokas Rackauskas, Marius Paskonis, Raminta Luksaite-Lukste, Anastasija Ranceva, Rokas Stulpinas, Birute Brasiuniene, Edita Baltruskeviciene, Nadezda Lachej, Juste Bausiene, Tomas Poskus, Rimantas Bausys, Skaiste Tulyte and Kestutis Strupas
Cancers 2024, 16(17), 2992; https://doi.org/10.3390/cancers16172992 - 28 Aug 2024
Viewed by 1181
Abstract
Background: Peritoneal metastases (PM) of gastric cancer (GC) are considered a terminal condition, with reported median survival ranging from 2 to 9 months. Standard treatment typically involves systemic chemotherapy alone or combined with targeted therapy or immunotherapy, though efficacy is limited. Pressurized intraperitoneal [...] Read more.
Background: Peritoneal metastases (PM) of gastric cancer (GC) are considered a terminal condition, with reported median survival ranging from 2 to 9 months. Standard treatment typically involves systemic chemotherapy alone or combined with targeted therapy or immunotherapy, though efficacy is limited. Pressurized intraperitoneal aerosol chemotherapy (PIPAC) has emerged as a novel technique for treating GC PM, although it remains an experimental treatment under investigation. This study aimed to summarize the outcomes of GC PM treatment with PIPAC from the Lithuanian PIPAC program. Methods: All patients who underwent PIPAC for GC PM at Vilnius University Hospital Santaros Klinikos between 2015 and 2022 were included in this retrospective study. The safety of PIPAC was assessed by postoperative complications according to the Clavien–Dindo classification. Efficacy was evaluated based on the peritoneal carcinomatosis index (PCI), ascites dynamics throughout the treatment, and long-term outcomes. Results: In total, 32 patients underwent 71 PIPAC procedures. Intraoperative and postoperative morbidity related to PIPAC occurred after three (4.2%) procedures. Following PIPAC, there was a tendency towards a decrease in median PCI from 10 (Q1 3; Q3 13) to 7 (Q1 2; Q3 12), p = 0.75, and a decrease in median ascites volume from 1300 mL (Q1 500; Q3 3600) at the first PIPAC to 700 mL (Q1 250; Q3 4750) at the last PIPAC, p = 0.56; however, these differences were not statistically significant. The median overall survival after PM diagnosis was 12.5 months (95% CI 10–17), and the median survival after the first PIPAC procedure was 5 months (95% CI 4–10). Conclusions: PIPAC is a safe and feasible treatment option for GC PM; however, well-designed prospective studies are needed to fully assess its efficacy. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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15 pages, 1063 KiB  
Article
Predicting Postoperative Length of Stay in Patients Undergoing Laparoscopic Right Hemicolectomy for Colon Cancer: A Machine Learning Approach Using SICE (Società Italiana di Chirurgia Endoscopica) CoDIG Data
by Gabriele Anania, Matteo Chiozza, Emma Pedarzani, Giuseppe Resta, Alberto Campagnaro, Sabrina Pedon, Giorgia Valpiani, Gianfranco Silecchia, Pietro Mascagni, Diego Cuccurullo, Rossella Reddavid, Danila Azzolina and On behalf of SICE CoDIG (ColonDx Italian Group)
Cancers 2024, 16(16), 2857; https://doi.org/10.3390/cancers16162857 - 16 Aug 2024
Viewed by 1300
Abstract
The evolution of laparoscopic right hemicolectomy, particularly with complete mesocolic excision (CME) and central vascular ligation (CVL), represents a significant advancement in colon cancer surgery. The CoDIG 1 and CoDIG 2 studies highlighted Italy’s progressive approach, providing useful findings for optimizing patient outcomes [...] Read more.
The evolution of laparoscopic right hemicolectomy, particularly with complete mesocolic excision (CME) and central vascular ligation (CVL), represents a significant advancement in colon cancer surgery. The CoDIG 1 and CoDIG 2 studies highlighted Italy’s progressive approach, providing useful findings for optimizing patient outcomes and procedural efficiency. Within this context, accurately predicting postoperative length of stay (LoS) is crucial for improving resource allocation and patient care, yet its determination through machine learning techniques (MLTs) remains underexplored. This study aimed to harness MLTs to forecast the LoS for patients undergoing right hemicolectomy for colon cancer, using data from the CoDIG 1 (1224 patients) and CoDIG 2 (788 patients) studies. Multiple MLT algorithms, including random forest (RF) and support vector machine (SVM), were trained to predict LoS, with CoDIG 1 data used for internal validation and CoDIG 2 data for external validation. The RF algorithm showed a strong internal validation performance, achieving the best performances and a 0.92 ROC in predicting long-term stays (more than 5 days). External validation using the SVM model demonstrated 75% ROC values. Factors such as fast-track protocols, anastomosis, and drainage emerged as key predictors of LoS. Integrating MLTs into predicting postoperative LOS in colon cancer surgery offers a promising avenue for personalized patient care and improved surgical management. Using intraoperative features in the algorithm enables the profiling of a patient’s stay based on the planned intervention. This issue is important for tailoring postoperative care to individual patients and for hospitals to effectively plan and manage long-term stays for more critical procedures. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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11 pages, 929 KiB  
Article
A Monocentric Analysis of Implantable Ports in Cancer Treatment: Five-Year Efficacy and Safety Evaluation
by Adel Abou-Mrad, Luigi Marano and Rodolfo J. Oviedo
Cancers 2024, 16(16), 2802; https://doi.org/10.3390/cancers16162802 - 9 Aug 2024
Viewed by 2055
Abstract
Background: Daily clinical practice requires repeated and prolonged venous access for delivering chemotherapy, antibiotics, antivirals, parenteral nutrition, or blood transfusions. This study aimed to investigate the performance and the safety of totally implantable vascular access devices (TIVADs) over a 5-year follow-up period through [...] Read more.
Background: Daily clinical practice requires repeated and prolonged venous access for delivering chemotherapy, antibiotics, antivirals, parenteral nutrition, or blood transfusions. This study aimed to investigate the performance and the safety of totally implantable vascular access devices (TIVADs) over a 5-year follow-up period through a standardized well-trained surgical technique and patient management under local anesthesia. Methods: In a retrospective, observational, and monocentric study, 70 patients receiving POLYSITE® TIVADs for chemotherapy were included. The safety endpoints focused on the rate of perioperative, short-term, and long-term complications. The performance endpoints included vein identification for device insertion and procedural success rate. Results: The study demonstrated no perioperative or short-term complications related to the TIVADs. One (1.4%) complication related to device manipulation was identified as catheter flipping, which led to catheter adjustment 56 days post-placement. Moreover, one (1.4%) infection due to usage conditions was observed, leading to TIVAD removal 3 years and 4 months post-surgery. Catheter placement occurred in cephalic veins (71.4%), subclavian veins (20%), and internal jugular veins (8.6%). The procedural success rate was 100%. Overall, the implantable ports typically remained in place for an average of 22.4 months. Conclusions: This study confirmed the TIVADs’ performance and safety, underscored by low complication rates compared to published data, thereby emphasizing its potential and compelling significance for enhancing routine clinical practice using a standardized well-trained surgical technique and patient management. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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Review

Jump to: Research

20 pages, 1361 KiB  
Review
Uncertain Resection in Lung Cancer: A Comprehensive Review of the International Association for the Study of Lung Cancer Classification
by Xavier Cansouline, Abdelhakim Elmraki, Béatrice Lipan, Damien Sizaret, Mathieu Sordet, Anne Tallet, Christophe Vandier, Delphine Carmier, Myriam Ammi and Antoine Legras
Cancers 2025, 17(9), 1386; https://doi.org/10.3390/cancers17091386 - 22 Apr 2025
Abstract
Objective: We explored the impact of uncertain resection in lung cancer on overall survival and disease-free survival. Methods: We performed an exhaustive literature review of all studies comparing prognosis after resection according to the IASLC classification, from the PubMed, Cochrane, MEDLINE, [...] Read more.
Objective: We explored the impact of uncertain resection in lung cancer on overall survival and disease-free survival. Methods: We performed an exhaustive literature review of all studies comparing prognosis after resection according to the IASLC classification, from the PubMed, Cochrane, MEDLINE, and Google Scholar databases. Results: Overall, 68 original studies were included, of which 67 were retrospective and 1 was prospective, with 81 785 patients included over 46 years. R(un) reclassification was mostly caused by a lack of hilar or mediastinal node dissection, or because of metastasis in the highest node. R(un) is a strong factor for higher recurrence and mortality, while its effects seem limited in early stages. Carcinoma in situ at bronchial margin resection (CIS BRM) does not show an effect on survival, while positive pleural cytology (Cy+) and positive highest mediastinal lymph node (HMLN+) appear to be highly predictive of recurrence and death. Discussion: The R(un) classification of the IASLC appears highly relevant, especially in locally advanced stages IIb-IIIA, and helps to discriminate patients with poor prognosis despite being classified as R0 in the UICC classification. Conclusions: The use of this more precise classification would allow for better stratification of recurrence risk and more effective use of adjuvant therapies. Cy+ patients should receive adjuvant chemotherapy, while CIS BRM patients could likely benefit from endoscopic surveillance to detect local recurrences. HMLN+ patients should be considered at high risk of recurrence, and adjuvant radio-chemotherapy should be considered. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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17 pages, 524 KiB  
Review
Surgical Techniques for Non-Small-Cell Lung Cancer After Neoadjuvant Chemo-Immunotherapy: State of Art and Review of the Literature
by Beatrice Trabalza Marinucci, Massimiliano Mancini, Alessandra Siciliani, Fabiana Messa, Giorgia Piccioni, Antonio D’Andrilli, Giulio Maurizi, Anna Maria Ciccone, Cecilia Menna, Camilla Vanni, Matteo Tiracorrendo, Erino Angelo Rendina and Mohsen Ibrahim
Cancers 2025, 17(4), 638; https://doi.org/10.3390/cancers17040638 - 14 Feb 2025
Viewed by 688
Abstract
Non-small-cell lung cancer (NSCLC) accounts for 80–85% of all lung cancers. Approximately 20% of patients with NSCLC are diagnosed with stage IIIA–IIIB disease, for which the optimal treatment remains unclear. Meta-analyses reveal that neoadjuvant/perioperative ICI–chemotherapy significantly improves pathological complete response (pCR), overall survival [...] Read more.
Non-small-cell lung cancer (NSCLC) accounts for 80–85% of all lung cancers. Approximately 20% of patients with NSCLC are diagnosed with stage IIIA–IIIB disease, for which the optimal treatment remains unclear. Meta-analyses reveal that neoadjuvant/perioperative ICI–chemotherapy significantly improves pathological complete response (pCR), overall survival (OS), major pathological response (MPR), and R0 rate compared to standard neoadjuvant chemotherapy. Resectability is achieved when R0 resection can be performed after surgery. Radiographic downstaging often does not correspond to surgical downstaging. In fact, intra-operative fibrosis due to chemo-immunotherapy (synonymous with ICI–chemotherapy) can create adhesions and consequent difficult planes for dissection. Thus, pneumonectomy cannot be avoided. Even the suspicion of N2 after neoadjuvant treatment is considered a limitation of upfront surgery because of the risk of pneumonectomy. The aim of this review is to explore the literature on the technical strategies for surgical excision of NSCLC after chemo-immunotherapy, addressing even the most challenging scenarios. Full article
(This article belongs to the Special Issue Surgical Advances in Cancer Treatments: Exploring Innovative Approaches and Emerging Perspectives by the Italian College of Associate Professors of Surgery)
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