Search Results (4,018)

Background: Chronological age remains deeply embedded in perioperative risk assessment because it is readily available and intuitively associated with adverse outcomes. In clinical practice, however, patients of similar age frequently experience markedly different postoperative trajectories, suggesting that physiological reserve may more accurately reflect vulnerability to surgical stress than years lived alone. We therefore investigated whether age-based stratification inadequately captures perioperative vulnerability when compared with functional phenotyping based on frailty status and baseline handgrip strength (HGS). Methods: We conducted a prospective multicenter observational cohort study including 223 adults undergoing elective abdominal surgery between January 2023 and June 2025. Chronological age was evaluated both continuously and using a conventional threshold (<70 vs. ≥70 years). Physiological reserve was characterized using a phenotype-based frailty model (fit, pre-frail, frail) and baseline HGS measured at hospital admission. Prolonged hospitalization, defined a priori as length of stay (LOS) >10 days, was used as a pragmatic clinical benchmark. Cross-classification analyses, logistic regression, and receiver operating characteristic (ROC) curve analyses were performed to compare the discriminatory performance of chronological age, frailty phenotype, and HGS. Results: Substantial discordance was observed between chronological age and frailty phenotype. Among patients younger than 70 years, 7.7% met criteria for frailty, whereas 58.0% of patients aged ≥70 years were classified as fit or pre-frail. Prolonged hospitalization occurred in 48 patients (21.5%) and varied markedly according to frailty status within each age group. Frail patients younger than 70 years demonstrated higher rates of prolonged LOS than fit older patients (40.0% vs. 10.5%). Chronological age demonstrated limited discrimination for prolonged hospitalization (AUC 0.579), while the ≥70-year threshold showed poor discriminatory performance (AUC 0.541). Frailty phenotype demonstrated improved discrimination (AUC 0.679), whereas the combined multivariable model integrating age, frailty, HGS, sex, and oncologic indication achieved good discriminatory performance (AUC 0.810). In multivariable analyses, frailty remained independently associated with prolonged LOS, whereas chronological age did not. Conclusions: Chronological age alone demonstrated limited discriminatory performance for perioperative risk stratification. Functional phenotyping based primarily on frailty status, complemented by objective functional measures such as HGS, may better capture physiological reserve and support more individualized, function-centered perioperative assessment in abdominal surgery. Full article

Objective: The aim of this study was to evaluate the expression of PD-L1, PD-1, CD3, CD4, and CD8 in tumor tissues of patients with head and neck squamous cell carcinoma from southern Poland, and to assess their prognostic value in relation to disease-free survival (DFS), taking into account HPV16 status and other clinical, pathological, and demographic factors. Material/Methods: This study included 155 unselected patients with head and neck squamous cell carcinoma (HNSCC) from the southern Poland region, who underwent diagnostic evaluation and surgical treatment. Formalin-fixed, paraffin-embedded (FFPE) tissue blocks were obtained from these centers. The patients were treated at the Maria Skłodowska-Curie National Research Institute of Oncology, Kraków Branch, between 1991 and 2014, with treatment approaches including induction therapy (preoperative), adjuvant therapy (postoperative), or definitive chemoradiotherapy with cisplatin. Protein expression was assessed using immunohistochemistry and quantified (TPS, CPS, H-score). Relationships between expression levels and epidemiological, clinical, and histopathological features were analyzed. Results: The results show that PD-L1 overexpression was associated with worse DFS, whereas overexpression of PD-1, CD3, CD4, and CD8 correlated with improved DFS. These associations were statistically significant in the HPV16-negative subgroup, while no such correlations were found in HPV16-positive patients. In multivariate analysis, independent prognostic factors associated with improved DFS included HPV16 infection, absence of PD-L1 overexpression, overexpression of CD4 and CD8, and combined chemoradiotherapy with cisplatin. Conclusions: These findings confirm the prognostic relevance of PD-L1, PD-1, and T-cell markers in HNSCC, particularly in HPV16-negative patients, and support further research into the use of these biomarkers in personalized treatment strategies. Full article

Esophageal cancer remains a global challenge, with poor overall survival despite advances in multimodal therapy. Surgical resection continues to be the main curative treatment, yet esophagectomy is among the most technically challenging oncological procedures due to the esophagus’s location within the densely packed mediastinal corridor. Critical vascular, neural, and lymphatic structures surround the esophagus, and their frequent anatomical variations pose significant risks during mobilization, lymphadenectomy, and reconstruction. This review synthesizes current evidence on the anatomical variability in the vessels, nerves, lymphatics, and fascial compartments relevant to esophageal surgery. Particular emphasis is placed on aberrant arterial and venous patterns, recurrent and non-recurrent laryngeal nerve pathways, thoracic duct variants and atypical courses, and the fascial planes that are used to define surgical boundaries. By shifting the surgical paradigm from standardized anatomical assumptions to patient-specific structural mapping, we highlight how understanding these variations is driving the field of personalized surgical medicine. By integrating these anatomical insights with surgical approaches—including right and left transthoracic, transhiatal, and transcervical techniques—we highlight the implications of variations for intraoperative safety and postoperative outcomes. A thorough understanding of these relationships is essential for surgical planning, minimizing morbidity, and achieving oncological outcomes. Ultimately, a thorough understanding of these relationships is essential for patient-tailored surgical planning. Full article

Perineal urethrostomy (PU) involves the creation of a urethral meatus at the perineal level. Traditionally, it was regarded as a last-resort therapeutic option or the outcome of failed previous reconstructive attempts. Currently, this perspective has evolved, and PU is increasingly considered a primary indication in complex cases or in patients with significant comorbidities. PU can be performed either as a definitive procedure—in patients with extensive, recurrent strictures or in those with comorbidities that preclude formal reconstruction—or as a temporary measure to facilitate healing and optimize conditions prior to definitive reconstructive surgery. In oncologic cases associated with total penectomy, PU serves as the definitive form of urinary diversion, and the same reconstructive principles should be applied to its design. A key requirement for PU is preserved sphincteric continence and the absence of proximal urethral stenosis. Advances in surgical techniques, including the use of flap mobilization and grafting, have enabled the creation of wide, functional meatuses, reducing the rate of stricture recurrence. Additionally, non-transecting variants aim to preserve the vascularization of the dorsal urethral surface. Following these surgical principles, high success rates can be achieved. Despite representing a significant alteration of anatomy and voiding habits, patient satisfaction is generally high. PU should not be viewed merely as a palliative alternative but rather as a versatile reconstructive option capable of providing comfortable and durable voiding in selected patients. Appropriate patient selection and meticulous surgical execution remain essential pillars of contemporary urethral surgery. Full article

Neuroendocrine tumors (NETs) are a heterogeneous group of neoplasms with increasing incidence, particularly within the gastroenteropancreatic (GEP) system. The liver represents the most common site of metastasis, and neuroendocrine liver metastases (NELMs) significantly impact prognosis, symptom burden, and therapeutic decision-making. Surgical management remains a cornerstone in the treatment of NELMs and encompasses a spectrum of strategies, including curative liver resection, cytoreductive surgery, and, in selected cases, liver transplantation (LT). Hepatic resection, although potentially curative when technically feasible, is applicable only to a highly selected subset of patients, and its benefits in terms of long-term survival and symptom control remain limited by recurrence rates and patient-related factors. Cytoreductive surgery has emerged as a valuable alternative in patients with unresectable disease, with increasing evidence supporting a ≥70% debulking threshold as sufficient to achieve meaningful clinical benefit. This approach may improve survival and quality of life, notably in symptomatic patients, and can be combined with parenchymal-sparing techniques and locoregional therapies. Liver transplantation represents a radical but potentially curative strategy for highly selected patients with liver-only disease, favorable tumor biology, and stable disease. Outcomes are strongly dependent on strict selection criteria, and appropriate patient selection remains critical. The incorporation of systemic treatments, such as somatostatin analogues, targeted therapies, and peptide receptor radionuclide therapy (PRRT), has broadened the available therapeutic options and contributed to redefining current treatment strategies. Overall, the management of NELMs requires a multidisciplinary, individualized approach guided by tumor biology, disease distribution, and patient-specific factors, with the goal of optimizing survival outcomes and preserving quality of life. Full article

In oncology, body composition (BC) provides clinically meaningful information beyond body mass index, capturing muscle and adipose tissue alterations associated with survival, treatment tolerance, surgical complications and quality of life. Although routine oncologic imaging is widely available, BC assessment remains poorly integrated into daily clinical practice, largely because conventional imaging-based approaches require time-consuming manual analyses, dedicated software and specialized expertise. Artificial intelligence (AI), particularly deep learning-based image segmentation, may automate BC analysis and generate rapid, reproducible, and scalable estimates from routinely acquired imaging, without increasing clinical workload. This opinion paper aims to examine AI-based BC analysis as a potential strategy to integrate BC into routine oncology workflows, outlining its potential clinical benefits and the aspects that need to be addressed before widespread implementation. AI-based BC analysis may improve nutritional assessment, refine clinical and nutritional risk stratification, and help identify patients at increased risk of treatment-related toxicity. In perspective, BC data may also support more personalized nutritional and physical activity interventions and contribute to muscle mass-informed anticancer treatment dosing strategies. Several gaps still limit its clinical implementation, including the need of robust external validation, standardized acquisition and analytical protocols, clinically meaningful cut-offs and ethical, and regulatory and data governance frameworks. AI-based BC analysis is therefore a promising but still evolving approach that may help translate BC from a prognostic marker into a clinically actionable tool in oncology. Full article

Introduction: Subcortical motor mapping thresholds are routinely used during glioblastoma resection to reduce the risk of permanent neurological injury, but their association with survival is not well established. We evaluated whether the final subcortical motor mapping threshold recorded at the end of resection is associated with overall survival (OS) in patients undergoing mapping-guided resection of motor-eloquent glioblastoma, including exploratory evaluation by residual fluorescence adjacent to the motor pathway. Methods: We performed a retrospective single-center cohort study of consecutive adults with newly diagnosed IDH-wild-type glioblastoma (2018–2024) who underwent motor mapping-guided resection with a documented final subcortical stimulation threshold and received adjuvant oncological therapy. The prespecified exposure was stimulation threshold ≤ 5 mA versus >5 mA. OS was analyzed using Kaplan–Meier estimates and Cox regression. To reduce overfitting, the primary adjusted Cox model included stimulation threshold, age, and temozolomide exposure; a fully adjusted model including age, sex, extent of resection, radiotherapy regimen, and temozolomide was established for sensitivity analysis. Because proportional hazards assumptions were not fully satisfied, restricted mean survival time (RMST) differences were also estimated at prespecified horizons. Results: Among 36 patients, stimulation threshold ≤ 5 mA was associated with shorter OS compared with >5 mA (log-rank p = 0.001). In the primary adjusted Cox model, stimulation threshold > 5 mA remained associated with lower mortality risk (HR 0.35, 95% CI 0.15–0.82, p = 0.016); results were directionally consistent in the fully adjusted model (HR 0.24, 95% CI 0.089–0.643, p = 0.0046). RMST analyses favored the >5 mA group at 12, 18, and 24 months. In exploratory analyses, the association appeared most evident in patients without residual fluorescence adjacent to the motor pathway. Conclusions: Lower final subcortical stimulation thresholds were associated with shorter overall survival after mapping-guided resection of motor-eloquent glioblastoma. These findings suggest that the final intraoperative stimulation threshold was associated with overall survival in adjusted exploratory models and may provide prognostic information in addition to its established role in surgical safety; however, prospective validation in larger cohorts is warranted. Full article

Background: Large language models (LLMs) are emerging as clinical decision-support tools in oncology, yet their ability to generate reliable treatment recommendations in real-world multidisciplinary tumor board (MTB) settings remains uncertain, particularly for complex colorectal cancer (CRC). Methods: In this retrospective study, 300 consecutive adult CRC cases discussed at a tertiary MTB were evaluated. Standardized de-identified case summaries were independently submitted to Gemini 2.5 (general-purpose, guideline-integrated) and MedGemma 27B (domain-specialized; T = 0.0 and T = 1.0). Concordance with MTB decisions was assessed using weighted Cohen’s kappa (κ), accuracy, F1 score, and recall. Safety was adjudicated by blinded senior MTB members using a three-tier risk framework. Importantly, Gemini 2.5 was evaluated in a guideline-integrated setting, whereas MedGemma operated without external guideline retrieval, introducing a predefined asymmetry in knowledge augmentation. Results: Gemini 2.5 demonstrated substantial agreement (κ = 0.792, p < 0.001), the highest exact concordance (85.0%), and a clinical safety rate of 83.7%, significantly outperforming MedGemma (p < 0.001). MedGemma showed moderate agreement at T = 0.0 (κ = 0.566; accuracy = 70.3%) and modest improvement at T = 1.0 (κ = 0.610; accuracy = 73.5%; p = 0.038), with lower safety rates (62.3% and 62.7%; p < 0.001). Discordance predominantly occurred in clinically complex scenarios, including surgical/interventional planning, active surveillance, recurrent disease management, and patients with compromised performance status. Conclusions: A guideline-integrated general-purpose LLM demonstrated superior concordance and safety compared with a domain-specialized model operating without external retrieval, supporting its adjunctive use within MTBs while preserving expert clinical judgment. Full article

Cancer-associated thrombosis (CAT) is a leading cause of morbidity and mortality in patients with malignancy, yet its imaging manifestations extend far beyond the conventional diagnosis of deep vein thrombosis and pulmonary embolism. This comprehensive review examines the full spectrum of CAT as encountered by radiologists, from routine venous thromboembolism to unusual-site thromboses, arterial thromboembolic events, catheter-related complications, and endovascular management strategies. Patients with cancer face a four- to seven-fold increased risk of venous thromboembolism compared with the general population, and arterial thromboembolism occurs at more than twice the expected rate, particularly within the first six months following cancer diagnosis. The radiologist’s role spans detection, characterization, and therapeutic guidance across multiple vascular territories. Key diagnostic challenges addressed include the distinction between bland and tumor thrombus—a determination with direct implications for TNM staging, surgical planning, and systemic therapy selection—and the recognition of incidental thromboembolism, which carries prognostic weight equivalent to symptomatic events and warrants similar clinical management. Emerging applications of diffusion-weighted MRI, contrast-enhanced ultrasound, and FDG-PET/CT provide a multiparametric toolkit for thrombus characterization, while artificial intelligence and machine learning show promise for improving patient selection and reducing unnecessary imaging. The expanding recognition of cancer-associated arterial disease, including cerebrovascular, coronary, and peripheral arterial events, requires that cardiovascular structures receive systematic attention on routine oncologic imaging. Interventional radiology contributes actively to CAT management through inferior vena cava filtration, catheter-directed thrombolysis, and thrombolytic-sparing mechanical thrombectomy, the latter being particularly relevant in oncology patients with elevated bleeding risk. Conclusions: Realizing the full potential of imaging in CAT requires not only technical proficiency with individual modalities but a synthesized, oncology-informed interpretive approach that incorporates the patient’s treatment history, biomarker status, and thrombotic risk profile at the time of image interpretation, positioning the radiologist as a central rather than peripheral figure in oncologic care. Full article

Background/Objectives: Ki-67 is widely used as an immunohistochemical marker of tumor proliferation in hormone receptor-positive (HR-positive), HER2-negative breast cancer, but its interpretation is limited by variability and uncertain concordance with genomic assays. The Oncotype DX^® Recurrence Score (RS) is a validated multigene assay with established prognostic and predictive utility. This study evaluated the relationship between Ki-67 and RS in clinical practice. Methods: We retrospectively analyzed women in Greece with early-stage estrogen receptor-positive, HER2-negative breast cancer without distant metastasis (pM0) who underwent Oncotype DX testing between 2020 and 2023. Eligible patients were node-negative or postmenopausal with node-positive disease. RS was categorized as low (0–25) or high (>25). Ki-67 was assessed using binary (<20% vs. ≥20%) and three-tier (≤5%, >5–<30%, ≥30%) classifications. Associations were analyzed using correlation, concordance, and non-parametric methods. Results: Among 2967 patients, the median RS was 16, with similar distributions across nodal subgroups. Ki-67 and RS demonstrated a modest positive correlation as continuous variables (R = 0.30, p < 0.001). After stratification, associations with RS were observed only in tumors with high Ki-67 expression, whereas no correlation was detected in low or intermediate groups. RS distributions differed significantly across Ki-67 strata. Overall concordance between Ki-67-based proliferation categories and RS-based genomic risk was 56.2%, with discordant cases in both directions. Conclusions: Ki-67 shows a modest association with Oncotype DX RS, but substantial discordance indicates Ki-67 should not substitute genomic testing in HR-positive/HER2-negative early breast cancer. Full article

Adrenal tumors are increasingly diagnosed due to widespread use of cross-sectional imaging and an aging population, making adrenalectomy a progressively more common surgical procedure. Over the past three decades, adrenal surgery has undergone a paradigm shift from open adrenalectomy to minimally invasive (MI) techniques, with laparoscopic adrenalectomy becoming the standard approach for most benign and selected malignant adrenal tumors. More recently, retroperitoneoscopic and robotic approaches have expanded the armamentarium available to adrenal surgeons, allowing for tailored, patient-specific surgical strategies. This review summarizes current evidence on MI adrenalectomy techniques, including transperitoneal and retroperitoneal laparoscopic approaches, hand-assisted adrenalectomy, and robotic adrenalectomy, with particular emphasis on their role in pheochromocytoma and adrenocortical carcinoma. In addition, evolving ancillary technologies such as laparoscopic ultrasound, indocyanine green fluorescence imaging, artificial intelligence, and virtual and augmented reality are reviewed, highlighting their potential to enhance intraoperative decision-making, safety, and surgical precision. Current controversies, including the role of preoperative alpha-blockade, partial versus total adrenalectomy in hereditary pheochromocytoma, the oncologic adequacy of MI surgery for adrenocortical carcinoma, and the selective use of lymph node dissection, are discussed. Available evidence supports MI adrenalectomy as a safe and effective approach in carefully selected patients when performed by experienced surgeons in high-volume centers. Technological innovations continue to refine surgical planning, execution, and training, suggesting that the future of adrenal surgery will increasingly rely on precision-guided, personalized, and data-driven strategies. This review offers a timely and comprehensive synthesis of the evolving landscape of MI adrenalectomy, uniquely integrating current evidence across the full spectrum of surgical techniques with a critical appraisal of emerging ancillary technologies while addressing unresolved clinical controversies relevant to contemporary surgical practice. Full article

Aim: The purpose of this study was to investigate the safety, efficacy, and clinical outcomes of the vaginal natural orifice transluminal endoscopic surgery (vNOTES) technique in patients suffering from gynecological cancer. Methods: A systematic review of the literature was conducted from inception to October 2025 following the PRISMA guidelines. PubMed, Google Scholar, and the Cochrane Library were searched for studies investigating vNOTES in gynecological malignancies. Study quality was evaluated using the Newcastle–Ottawa Scale, the National Institute of Health and the Joanna Briggs Institute critical appraisal tools. Results: The search identified 11 observational cohort studies, 28 case series, and 22 case reports. A total of 926 patients with suspected or confirmed gynecologic malignancies underwent surgery via vNOTES approach. The combination of hysterectomy, bilateral salpingo-oophorectomy, and sentinel lymph node biopsy represented the most commonly performed surgical procedure. Endometrial cancer was the most frequent oncological indication. The included studies evaluated the perioperative outcomes, including operative time, estimated blood loss, lymph node assessment, conversion rates and complications. Conclusions: The vNOTES approach appeared to be feasible and at least non-inferior to standard surgical treatments for patients with early-stage gynecologic malignancies. However, the small sample sizes and heterogeneity among studies limit the strength of the evidence and preclude definitive conclusions. Full article

Background: Immune dysregulation and clinical immunosuppression are biologically plausible contributors to thoracic aortic wall vulnerability through endothelial injury, protease-mediated extracellular matrix remodeling, vascular smooth muscle cell dysfunction, and impaired vascular repair. Yet, the clinical relevance of immunomodulated states to thoracic aortic aneurysm (TAA) incidence or growth and acute aortic syndromes remains undefined. Methods: This comprehensive review synthesizes clinical and translation evidence linking immunomodulated states in solid organ transplantation, autoimmune disease (predominantly systemic lupus erythematosus), HIV, and oncologic therapies to thoracic aortic dilation, aneurysmal progression, and acute aortic events. Principal Findings: Across transplant, autoimmune, and HIV cohorts, recurring themes include chronic immune dysregulation, endothelial dysfunction, proteolytic matrix remodeling, and impaired vascular repair capacity, although thoracic segment-specific longitudinal growth data remain limited and are often embedded within analyses of multiple vascular beds. In oncologic cohorts, aggregate analyses generally do not demonstrate uniform acceleration of aneurysm growth with malignancy or chemotherapy exposure, although agent-level models suggest that regimen-specific effects may be obscured in pooled estimates. Two studies most directly addressed our question in thoracic-relevant contexts reported (1) very low mean annual ascending aortic aneurysm growth (0.18 ± 0.64 mm/year) with no detectable association with chemotherapy or radiotherapy and (2) prior immunosuppressive/cytostatic chemotherapy exposure to be common in a proximal TAA surgical cohort (39.3%) without a clear difference in thoracic phenotype at presentation or postoperative outcomes. In HIV cohorts, available evidence supports modest but reproducible proximal aortic remodeling and a clinically meaningful aneurysm burden across vascular beds, yet definitive thoracic segment-specific natural history data remain limited. Conclusions: The available literature supports clinical vigilance and exposure-aware surveillance, while suggesting that thoracic aortic risk is unlikely to be uniform across immunosuppressive and cytotoxic therapies. Standardized, segment-specific longitudinal imaging with granular agent-level exposure characterization (dose, duration, sequencing, and combination regimens), consistent definitions of baseline diameter and growth, careful adjustment for key confounders, and prospective ascertainment of dissection/rupture and operative endpoints are needed to translate immunobiology into actionable risk stratification and long-term management strategies. Full article

Background/Objective: MicroRNA-21 (miR-21) is one of the most widely studied oncogenic microRNAs and has been implicated in breast cancer progression, therapy resistance, and metastatic potential. However, its utility as a long-term prognostic biomarker in patients undergoing mastectomy remains insufficiently clarified. This study evaluated the prognostic significance of miR-21 expression in predicting overall and disease-free survival. Methods: A retrospective cohort of 426 breast cancer patients who underwent mastectomy between 2010 and 2017 was analyzed. Tumor miR-21 expression was measured using quantitative real-time PCR and categorized as high or low based on cohort-derived thresholds. Long-term outcomes were assessed over a median follow-up of 112 months. Kaplan–Meier survival curves, log-rank tests, and multivariable Cox proportional hazards models were used to estimate associations between miR-21 levels and survival outcomes. Results: High miR-21 expression was identified in 48.8% of cases. Patients with high miR-21 demonstrated significantly poorer overall survival (10-year OS: 61.4% vs. 82.7%; log-rank p < 0.001) and disease-free survival (10-year DFS: 54.9% vs. 78.3%; log-rank p < 0.001). In multivariable analysis, high miR-21 remained an independent predictor of decreased OS (HR = 2.18; 95% CI: 1.56–3.04) and DFS (HR = 2.44; 95% CI: 1.78–3.33). Conclusions: Elevated miR-21 expression is a significant independent biomarker of adverse long-term prognosis in breast cancer patients undergoing mastectomy. Integrating miR-21 into postoperative risk stratification may improve individualized management strategies. Full article