Search Results (7,936)

Background/Objectives: Lidocaine has demonstrated immunomodulatory properties and promising antitumor effects in experimental models, but its impact on long-term outcomes following oncologic surgery remains unclear. This study aimed to compare the impact of intraoperative lidocaine versus remifentanil on long-term cancer outcomes after primary lung cancer surgery. Methods: This is a post hoc analysis of a randomized controlled trial (NCT03905837, EudraCT 2016-004271-52). From 154 patients who underwent elective lung resection via video-assisted thoracoscopic surgery (VATS) between January 2019 and June 2021 and were randomized to receive intraoperative lidocaine (intravenous or paravertebral) or remifentanil, we analyzed data from patients with confirmed primary lung cancer in the surgery specimen. Overall survival (OS) and disease-free survival (DFS) were assessed through May 2025. Survival outcomes were analyzed using Kaplan–Meier curves and log-rank tests. A multivariate Cox proportional hazards model was used to adjust for potential confounders. Results: Among the 97 patients with primary lung cancer finally included in the analysis, those in the lidocaine group exhibited improved OS compared with those who received intravenous remifentanil (log-rank p = 0.022). This association remained significant in the multivariate Cox regression analysis (HR 2.59, 95% CI 1.13–5.96, p = 0.025). No significant differences were observed in DFS overall (log-rank p = 0.283) or in DFS limited to recurrences of cancers present at the time of surgery, either the resected primary tumor or a prior malignancy (log-rank p = 0.080). Conclusions: In this post hoc analysis, lidocaine administration during oncologic lung resection was associated with improved OS in primary lung cancer patients. No differences in DFS were observed between groups; however, a non-significant trend toward improved DFS in lidocaine patients was noted when focusing on recurrences of cancers present at the time of surgery. Further investigation in larger prospective studies is warranted. Full article

Cancer is a leading cause of cancer-related death. Liver metastases develop in over one-third of patients and are associated with worse prognosis. The evolution in the field of interventional oncology/radiology over the past two decades has expanded image-guided locoregional therapies for colorectal liver metastases (CLM). Historically, hepatic resection was considered the only possible cure for selected patients with CLM. Current evidence supports thermal ablation (TA) as another locally curative treatment modality for small CLM that can be ablated with adequate margins. Other non-thermal ablative treatment options include Yttrium-90 (⁹⁰Y) radiation segmentectomy (RS), irreversible electroporation (IRE), and histotripsy, with an evolving role in the treatment of CLM. More extensive disease that is not amenable to resection or ablation can be treated with intra-arterial therapies (⁹⁰Y trans-arterial radioembolization (TARE) and trans-arterial chemoembolization (TACE)). This comprehensive review describes the evolution of interventional oncology treatments for CLM and examines the appropriate indications for each treatment modality. Full article

Introduction: The elbow is a rare site for bone tumors, and for this reason, the literature provides little data on the epidemiology of metastatic lesions involving the distal humerus, proximal ulna, and radius. Before performing surgery of the metastatic bone, it is first necessary to consider both patients’ and metastatic lesions’ features in order to better choose the best possible treatment. This systematic review aims to collect data on elbow metastases, delineate primary tumors leading to such metastases, guide surgical treatment decisions, and evaluate reconstructive techniques and associated complications. Material and Methods: A systematic literature review was conducted in April 2024, searching the PubMed, MEDLINE, and Cochrane Library databases using specific search terms related to elbow metastases. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) was followed. Eligible studies reported at least one patient with metastatic bone disease involving the elbow region and specified the undertaken treatment. For studies reporting multiple skeletal sites, only elbow-specific data were extracted. We excluded recurrences of primary elbow tumors. The methodological quality of included studies was assessed with the modified Coleman Methodology Score (mCMS). Results: In total, 28 articles (103 patients) were included. The studies were predominantly case reports (68%), with a mean mCMS of 31. Gender was reported for only 41 patients: 71% were male and 29% female. The mean age at diagnosis of elbow metastatic lesion was 55 years old. Renal cell carcinoma was the most common primary tumor (28%), followed by breast (9%) and lung cancer (6%). The distal humerus was the most frequently affected site (85%). A surgical approach was adopted in 90% of cases, whereas 10% of patients were managed conservatively. Forty-five patients underwent wide tumor resection followed by reconstructive surgery while forty-eight patients received a surgical treatment for either pathological fractures or impending fractures. Conclusions: When treating elbow metastasis, a thorough evaluation of the patient is crucial, considering the patient’s functional status, pain management needs, and overall prognosis; all these features influence the treatment of choice. The selected treatment should aim to provide optimal functional outcomes and minimize complications. For patients with pathological or impending fractures, single or double plate fixation is typically the preferred approach. For patients with severe, symptomatic lesions unresponsive to conservative therapy, resection followed by the implantation of a modular prosthesis usually offers the best clinical and functional outcomes. Full article

Primary retroperitoneal mucinous cystadenocarcinoma (PRMC) is an uncommon malignant neoplasm with few reported cases, particularly among male patients. Currently, only nine documented cases have been reported worldwide, including the present case. The present case report describes the incidental detection of PRMC in an 86-year-old male patient. Despite being offered surgical intervention, the patient initially opted against treatment. Consequently, follow-up imaging examinations were performed for 3 subsequent years. The tumor, initially measuring 31 × 32 × 31 mm, gradually increased to 58 × 60 × 59 mm. Subsequently, the patient underwent laparoscopic retroperitoneal tumor resection. Histopathological examination revealed adenocarcinoma characterized by intestinal differentiation. The patient has exhibited no evidence of disease for 1 year postoperatively. The present case is noteworthy, as this disease rarely occurs in men, thereby offering significant potential for educational and scientific contributions. Notably, the patient’s age, longitudinal observation of tumor progression through imaging over a period of 3 years, and complete surgical excision of the tumor are salient features of this case. These findings may prove useful in the diagnosis and treatment strategy for male patients with PRMC. Full article

Introduction: Small Bowel Obstruction (SBO) accounts for 15% of emergency department (ED) admissions. While conservative management is recommended, surgery becomes necessary when strangulation is suspected. Identifying which patients need surgery remains a challenge, as traditional imaging lacks sufficient sensitivity and specificity. This study aimed to explore radiomic features to identify potential predictors of strangulation. Methods: This retrospective study included patients admitted to a tertiary referral hospital ED between 2019 and 2023, diagnosed with Adhesion Small Bowel Obstruction (aSBO) via contrast-enhanced abdominal CT scans. Two patient groups were examined: those who underwent surgery with bowel resection and ischemic changes confirmed histologically (operative management—OM) and those successfully treated with conservative management (CM). All CT scans were reviewed blindly by a general surgeon and an experienced radiologist. Pre-obstructive loop segmentation was performed using 3D Slicer software, with slice-by-slice contouring of intestinal borders on images of suspected strangulated bowel. Radiomic features were extracted, followed by univariate and multivariate regression analysis. Results: A total of 55 patients were included: 27 CM and 28 OM. Significant differences emerged in GLCM (Gray Level Co-occurrence Matrix), GLDM (Gray Level Dependence Matrix), GLRLM (Gray Level Run Length Matrix), and GLSZM (Gray Level Size Zone Matrix), particularly involving entropy and uniformity. These metrics reflect subtle variations in gray levels not visible to the naked eye. Conclusions: Differences in entropy, uniformity, and energy align with imaging and histopathological findings, supporting the development of radiomic models and future AI-based prediction tools. Full article

Background/Objectives: Resection arthroplasty is well established in treating bone defects following tumor resection, with the distal femur and proximal tibia being its most common localizations. The aim of this study was to analyze the functional outcomes and quality of life following endoprosthetic reconstruction for malignant bone tumors of the knee joint. Methods: We retrospectively included all patients treated with an endoprosthetic reconstruction following resection of a malignant bone tumor of the knee at our institution. Functional outcomes (KOOS, OKS, MSTS, and KSS) and health-related quality of life scores [QoL] (SF-36, Karnofsky Index) were evaluated. Chi-square and Fisher’s exact test was used for categorical variables, T-test and Whitney U-Mann tests for continuous variables. Survival was calculated using the Kaplan–Meier curves. Results: 32 patients were included. A total of 12 patients had died at the time of follow-up. Among the remaining 20 patients (m:w 17:3), mean follow-up was 8.1 years (range, 8.12 ± 6.8). Mean age at the time of tumor diagnosis was 50 ± 23.3 (10–83) years. According to age, patients were divided into two groups (group C1: <29 years, group C2: >29 years). Group C1 showed significantly better results regarding functional outcome (p < 0.05). The anatomic location of the replacement and a revision surgery did not influence the functional outcome (p > 0.05). QoL showed no significant differences in subgroup analysis (p > 0.05). Primary bone tumors had a significantly better survival (primary tumor: 216.90 months [168.42–265.83]; secondary tumor: 37.03 months [11.71–62.35] p = 0.01). Furthermore, pathologic fractures were associated with significantly worse survival (pathologic fracture: 50.24 months [0.00–102.43]; pathologic fracture 190.63 moths [139.28–241.45]; p = 0.007). Conclusions: Knee resection arthroplasty can offer meaningful long-term functional outcomes and acceptable quality of life in selected patients with musculoskeletal tumors. While the rarity and heterogeneity of such cases remain a challenge, our findings contribute to the growing evidence supporting this complex but limb-sparing surgical option. Full article

Background/Objectives: Gastric cancer remains a leading cause of cancer-related mortality, with over 50% of cases diagnosed at a locally advanced or metastatic stage. High-quality surgical resection within the embryological mesogastric layer is critical for achieving optimal oncological outcomes but is often complicated by anatomical distortion in advanced tumors. This study aimed to develop and validate a system of topographic and anatomical navigation landmarks for embryologically guided laparoscopic gastrectomy, leveraging 3D modeling to enhance precision and safety. Methods: A single-center study was conducted, analyzing 78 patients undergoing emergency laparoscopic gastrectomy for locally advanced gastric cancer. Preoperative 3D models were generated from CT data annotations to map the stomach, tumor, vascular structures, and mesogastric adipose tissue. Thirty biomodels were used to refine dissection techniques. Surgical procedures adhered to embryological principles, with lymphadenectomy guided by predefined landmarks. Histopathological validation assessed resection margins and tumor infiltration in resected specimens. Statistical analysis compared outcomes between patients with and without 3D planning. Results: The 3D models demonstrated 100% concordance with intraoperative vascular anatomy. Radiologically dense adipose tissue, resected as potentially tumor-infiltrated, showed histopathological invasion in 74% of cases. R0 resection was achieved in 74.4% of patients. Operative time decreased from 300 to 250 min after technical optimization, with a 7.7% conversion rate (primarily due to vascular injury or tumor fixation). Postoperative mortality was 5.1%, attributed to comorbidities. Patients with 3D planning had significantly higher lymph node yields (p < 0.00001) and R0 rates (p = 0.045). Conclusions: The integration of embryologically based topographic landmarks and 3D navigation improves the safety and standardization of laparoscopic gastrectomy for locally advanced gastric cancer. This approach enhances oncological radicality, reduces operative time, and mitigates risks in anatomically distorted fields. Further validation in larger cohorts is warranted. Full article

Background and Objectives: The term “oncoplastic breast surgery” (OBS) incorporates plastic and oncologic concepts. Through the application of diverse mammoplasty approaches, the remaining breast tissue can be reconstructed, thereby enabling more extensive resections to be achieved with oncologically safe, margin-free outcomes. This study aims to assess the efficacy of the single incision lateral mammoplasty (SILM) technique as an oncoplastic approach for managing breast cancer located in the outer quadrant, in comparison with the matrix rotation flap (MRF) technique. Materials and Methods: This prospective randomized controlled study comprised 68 patients, who were randomized into two groups scheduled to undergo breast surgery: Group A constitutes the matrix rotation flap MRF group and Group B represents the single incision lateral sulcus mammoplasty (SLIM) group. A follow-up was planned for postoperative complications and esthetic outcomes. Results: The mean age of patients in Group A was 51.4 ± 9.4 years, compared with 52.6 ± 8.1 years in Group B. A total of 14.7% and 11.8% of patients in Group A reported a hematoma or seroma, respectively, which were higher than what was reported in Group B, where a hematoma and seroma were reported in 5.9% of patients. Additionally, 32.4% and 50% of patients in Groups A and B, respectively, reported excellent satisfaction. The evaluation with the Vancouver Scar Scale (VSS) revealed that esthetic outcomes were significantly better in Group B. Conclusions: Compared to the MRF procedure, the SLIM results in a much lower rate of postoperative hematoma, minor seroma, minimum blood loss, reduced areolar deviation, and improved breast symmetry. Both the MRF and SLIM techniques yield acceptable cosmetic outcomes. However, a longer-term follow-up is necessary to establish the definitive oncological equivalence between techniques. Full article

Neuroendocrine tumors of unknown primary (CUP-NET) present a diagnostic challenge when conventional imaging fails to localize the primary tumor. This study aimed to evaluate the diagnostic value of concurrent [⁶⁸Ga]Ga-DOTA-TOC and [¹⁸F]FDG PET/CT imaging in localizing primary tumors in patients with histologically confirmed CUP-NET. Thirty-four patients underwent both imaging modalities as part of a prospective imaging protocol after negative conventional imaging or [¹¹¹In]In-octreotide scintigraphy. Primary tumor detection rates were assessed, and imaging characteristics compared between the two modalities. The overall localization rate was 58.9% (20/34). Of these, 90% (18/20) of primary tumors were identified solely by [⁶⁸Ga]Ga-DOTA-TOC PET/CT, with the remaining two visualized by both modalities. [¹⁸F]FDG PET/CT did not independently localize any primary tumors. Identified primaries were limited to grade 1 (60%) or grade 2 (40%) tumors, predominantly in the small intestine (95%). Among localized cases, 45% (9/20) underwent surgical resection and 15% (3/20) became eligible for peptide receptor radionuclide therapy. [⁶⁸Ga]Ga-DOTA-TOC PET/CT demonstrated superior detection of metastatic lesions compared to [¹⁸F]FDG PET/CT (97.1% vs. 70.6%, p = 0.006). No significant survival differences were observed between patients with localized versus non-localized primaries. These findings support the value of [⁶⁸Ga]Ga-DOTA-TOC PET/CT for identifying primary tumors in CUP-NET. Further research is warranted to explore the role of [¹⁸F]FDG PET/CT in high-grade NETs. Full article

Objectives: To investigate the correlation between intraoperative conventional ultrasound, SWE, and SMI ultrasound manifestations of glioma and the expression of immunohistochemical markers. Methods: Patients with single superficial supratentorial glioma scheduled for brain tumor resection in our neurosurgery department from October 2020 to October 2022 were prospectively included. High-grade glioma (HGG) and low-grade glioma (LGG) were classified by pathological histological grading, and the differences in conventional ultrasound, SWE Young’s modulus, and SMI intratumoral and peritumoral blood flow architecture between HGG and LGG were analyzed, and the SWE diagnostic cut-off value was calculated by the Youdon index. Logistic regression models were used to analyze the independent predictive ultrasound signs associated with the diagnosis of HGG. HGG and LGG were classified by pathological histological grading. IDH1 expression was measured by immunohistochemical methods to analyze the correlation between IDH1 expression in glioma and clinical and ultrasound characteristics. Results: Forty-eight patients with glioma admitted to our hospital from October 2020 to October 2022 were included in this study, including 30 (62.5%) with HGG and 18 (37.5%) with LGG. For conventional ultrasound, HGG was often associated with severe peritumoral edema compared with LGG (p = 0.048). The sensitivity of HGG was 88.9%, the specificity was 86.7%, and the AUC was 0.855 (95% confidence interval: 0.741–0.968, p = 0.001) using Young’s mode 13.90 kPa as the threshold. Logistic analysis showed that SWE Young’s modulus values, and peritumoral and intratumoral SMI blood flow structures, were associated with the diagnosis of HGG. Among the 48 gliomas, 22 (45.8%) were IDH1-positive and 26 (54.2%) were IDH1-negative, with no statistical difference in age between the two groups and a statistical difference in histological grading (p < 0.05). There was a statistical difference between IDH1 mutant and wild type in terms of peritumoral edema and SMI intratumoral and peritumoral tissue vascular architecture. Logistic regression models showed that intratumoral and peritumoral tissue SMI vascular architecture was a valid predictor of IDH1 positivity, with a classification accuracy of 81.3%, sensitivity of 90.9%, and specificity of 73.1%. Further group analysis of mutant Young’s modulus values in LGG were higher than wild-type Young’s modulus values (p = 0.031). Conclusions: Peritumoral and intratumoral tissue SMI vascular architecture was a valid predictor of IDH1 positivity. Based on intraoperative ultrasound multimodality images, we can preoperatively determine the expression of molecular markers of lesions, which is of clinical significance for optimizing surgical strategies and predicting prognosis. Full article

Objective: The simultaneous occurrence of brain aneurysms and brain tumors creates a complicated clinical scenario requiring extensive surgical planning. The study seeks to illuminate the safety, effectiveness, and prospective advantages of combination surgical intervention. Materials and Methods: We analyzed 10 patients concurrently diagnosed with both cerebral aneurysm and meningioma who received simultaneous microsurgical intervention. Clinical and demographic data, encompassing lesion characteristics, surgical specifics, complications, and outcomes, was extracted. The Karnofsky Performance Status Scale (KPS) was utilized to assess functional status preoperatively, after discharge, and during the final follow-up. Descriptive statistics and visualizations were produced via Python tools and libraries. Results: The predominant demographic was female (90%), with a median surgical age of 58 years. All patients presented with WHO Grade 1 meningiomas and predominantly incidental aneurysms, typically situated in the middle cerebral artery. At a median follow-up of 27 months, functional results demonstrated improvement, with 10% of patients reporting tumor recurrence or necessitating resurgery, while the total death rate was 20%. Conclusion: The simultaneous occurrence of intracranial aneurysms and brain tumors is infrequent. This study demonstrates that simultaneous aneurysm clipping and tumor resection with the same method is both viable and secure. A comprehensive evaluation of the patient and an extensively devised surgical plan are essential for the effective management of these complex cases. Full article

Brain metastases are a significant complication of non-small-cell lung cancer (NSCLC), contributing to high morbidity and mortality rates. The introduction of immune checkpoint inhibitors (ICIs) has opened new therapeutic avenues for patients with NSCLC, including those with brain metastases. However, the distinct microenvironment of the brain presents unique challenges to the effectiveness of these treatments. This review examines the mechanisms by which ICIs impact brain metastases from NSCLC, with particular focus on immune cell trafficking across the blood–brain barrier (BBB), tumor microenvironment modulation, and transcriptomic evolution of brain-tropic tumor clones. Unlike prior reviews, we integrate emerging data from single-cell and spatial transcriptomic studies, BBB disruption mechanisms, and the tumor-supportive role of brain-resident glia. We also critically evaluate key clinical trials and real-world evidence, highlighting differences in ICI efficacy across patient subgroups and therapeutic contexts. Additionally, we address the evolving role of surgical resection, stereotactic radiosurgery, and cerebrospinal-fluid-based biomarkers in optimizing ICI-based treatment strategies. This synthesis provides a comprehensive, mechanistic, and clinically relevant framework for improving outcomes in patients with NSCLC brain metastases treated with immunotherapy. Full article

Ependymomas are a heterogeneous group of central nervous system tumors originating from ependymal cells, exhibiting significant variability in clinical behavior, prognosis, and treatment response based on anatomical location and molecular profile. Historically, diagnosis and grading relied on histopathological features, often failing to predict outcomes accurately across tumor subtypes. With the integration of molecular and epigenetic profiling, the classification and management of ependymomas have undergone a significant transformation, culminating in the updated 2021 World Health Organization Classification of Tumors of the Central Nervous System. This molecularly driven system emphasizes the relevance of DNA methylation patterns and fusion oncogenes, offering a more biologically accurate stratification of disease. These insights enhanced diagnostic accuracy and informed prognostic assessments, paving the way for new targeted therapies. Although conventional treatment primarily consists of surgical resection and radiotherapy, emerging preclinical and early-phase clinical studies suggest a potential for molecularly guided interventions targeting specific oncogenic pathways. Despite these advances, effective targeted therapies remain limited, highlighting the need for further research and molecular stratification in clinical trial design. Additionally, the practical implementation of molecular diagnostics in standard-of-care settings is challenged by cost, accessibility, and institutional variability, which may impede equitable integration. This review summarizes the evolution of ependymoma classification, current molecular subtypes, gaps in clinical application and their implications for personalized therapy and future clinical research. Full article

Histiocytic sarcoma (HS) is an ultra-rare hematopoietic neoplasm that frequently occurs in extranodal sites of adults. Clinically, HS demonstrates aggressive behavior and can arise de novo or in association with other hematological neoplasms. The median overall survival from the time of diagnosis is approximately six months. Histologically, HS is composed of sheets of large, round to oval cells with abundant eosinophilic cytoplasm and can be confused with a variety of benign and malignant conditions. Immunohistochemistry plays a crucial role in the diagnosis of HS, showing expression of CD163, CD68, lysozyme, and PU.1 and negative staining with follicular dendritic cell markers and myeloid cell markers. Recent studies have demonstrated a high rate of PD-L1 expression, suggesting a potential therapeutic target. Several genomic alterations have been identified in HS, including mutations involving the RAS/MAPK and PI3K/AKT/mTOR signaling pathways, CDKN2A mutations/deletions, and TP53 mutations. There is no standard protocol for the management of HS. Surgical resection with or without radiotherapy is the most common first-line treatment for unifocal/localized disease. The systemic treatment options for multifocal/disseminated disease are very limited. This review provides an overview of the current knowledge on the clinicoradiological features, histopathology, pathogenesis, and management of HS. Full article

The application of predictive and explainable artificial intelligence to bioinformatics data such as single nucleotide polymorphism (SNP) information is attracting rising attention in the diagnosis of various diseases. However, there are few reviews available on the recent progress of genetic artificial intelligence for the early diagnosis of gastrointestinal disease (GID). The purpose of this study is to complete a systematic review on the recent progress of genetic artificial intelligence in GID. The source of data was ten original studies from PubMed. The ten original studies were eligible according to the following criteria: (participants) the dependent variable of GID or associated disease; (interventions/comparisons) artificial intelligence; (outcomes) accuracy, the area under the curve (AUC), and/or variable importance; a publication year of 2010 or later; and the publication language of English. The performance outcomes reported varied within 79–100 for accuracy (%) and 63–98 for the AUC (%). Random forest was the best approach (AUC 98%) for the classification of inflammatory bowel disease with 13 single nucleotide polymorphisms (SNPs). Similarly, random forest was the best method (R-square 99%) for the regression of the gut microbiome SNP saturation number. The following SNPs were discovered to be major variables for the prediction of GID or associated disease: rs2295778, rs13337626, rs2296188, rs2114039 (esophageal adenocarcinoma); rs28785174, rs60532570, rs13056955, rs7660164 (Crohn’s disease early intestinal resection); rs4945943 (Crohn’s disease); rs316115020, rs316420452 (calcium metabolism); rs738409_G, rs2642438_A, rs58542926_T, rs72613567_TA (steatotic liver disease); rs148710154, rs75146099 (esophageal squamous cell carcinoma). The following demographic and health-related variables were found to be important predictors of GID or associated disease besides SNPs: age, body mass index, disease behavior, immune cell type, intestinal microbiome, MARCKS protein, smoking, and SNP density/number. No deep learning study was found even though deep learning was used as a search term together with machine learning. Genetic artificial intelligence is effective and non-invasive as a decision support system for GID. Full article