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AbstractPurposeMethodsResultsConclusion\nIMPLICATIONS FOR REHABILITATION(1) To assess the feasibility of a blended intervention, combining a smartphone app for self-monitoring of physical activity and protein intake with coaching from a physiotherapist and dietician after hospitalization and (2) to evaluate the associated study procedures.A single-arm feasibility study was performed with adult patients scheduled for curative intent gastrointestinal or lung cancer surgery. Patients were provided with a smartphone app and accelerometer one week before surgery, which they used for six weeks following discharge. In addition, patients received coaching from a physiotherapist and dietician. Feasibility was assessed by evaluating participation and completion rates, user adherence, system usability score (SUS), as well as experiences and safety, based on predefined criteria.In total, 32 patients were included, with participation and completion rates of 69 and 75%, respectively. User adherence to wearing the accelerometer was deemed satisfactory (91%), while user adherence to protein intake was suboptimal (59%). The mean SUS was acceptable (73.5). Patient experiences were predominantly positive, although some patients mentioned a lack of options in the protein registration tool.The intervention is feasible for implementation in a larger study. To improve adherence, modifications are needed regarding self-recording of protein intake. Study procedures require minor modifications. Patients after oncological surgery are positive about an intervention that combines a smartphone app for self-monitoring of physical activity and protein intake with coaching by a physiotherapist and dietician after hospitalization.Although the effect on functional recovery has yet to be examined in a randomized controlled trial, the blended Optimal Physical Recovery After Hospitalization (OPRAH) intervention seems to contribute to the self-management of patients, since there was a substantial increase in physical activity and most patients achieved their protein requirements.Patients after oncological surgery are positive about an intervention that combines a smartphone app for self-monitoring of physical activity and protein intake with coaching by a physiotherapist and dietician after hospitalization.Although the effect on functional recovery has yet to be examined in a randomized controlled trial, the blended Optimal Physical Recovery After Hospitalization (OPRAH) intervention seems to contribute to the self-management of patients, since there was a substantial increase in physical activity and most patients achieved their protein requirements. [ABSTRACT FROM AUTHOR]

Up to 30% of adrenocortical carcinoma (ACC) patients have metastasised disease upon initial presentation, and systemic treatments currently fail to sufficiently improve survival. Palliative primary tumour resection can be considered for symptomatic relief, but its potential survival benefit remains a topic of debate. This systematic review therefore aims to assess the effect of primary tumour resection on overall survival in patients with metastatic ACC. A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Relevant databases were searched from 2000 to 2024 for studies on primary tumour resection in metastatic ACC. Overall survival data were analysed. A total of 13 studies on primary tumour resection for metastatic ACC were included. All studies were retrospective and assessed as having a high risk of bias. Data regarding adequate patient characteristics and indications for surgery were missing in all studies. Hence, the current literature is hampered by both indication and selection biases to draw any conclusions on the survival benefit of primary tumour resection in patients with metastasised ACC. However, 12 out of 13 studies (92%) demonstrated longer overall survival after primary tumour resection compared to no surgery. Whereas this is in line with retrospective data on other cancers, randomised controlled trials in other tumours, such as breast and colorectal cancers, have failed to display survival benefits of primary tumour resection. These cancers are, however, relatively chemo-sensitive, unlike ACC. Primary tumour resection could therefore only be considered on an individual patient basis. [ABSTRACT FROM AUTHOR]

Background: Chylothorax is a rare but potentially life-threatening complication after esophageal cancer resection. This study aims to investigate the impact of a strategy combining preoperative three-dimensional (3D) reconstruction of contrast-enhanced chest CT with olive oil ingestion on the incidence of chylothorax following esophageal cancer resection. Methods: We retrospectively analyzed the clinical data of 357 patients who underwent esophageal cancer resection in the Department of Thoracic Surgery at Gansu Provincial People's Hospital from January 2019 to June 2024. Among them, 179 patients who underwent preoperative 3D reconstruction of contrast-enhanced chest CT combined with oral olive oil administration were assigned to the 3D reconstruction group, while 158 patients who did not receive these interventions served as the control group. The primary outcome measures included the incidence of chylous leakage and related perioperative outcomes. Results: All patients in both groups underwent surgeries successfully without any perioperative deaths. Compared to the control group, the 3D reconstruction group exhibited a significant decrease in the incidence of postoperative chylothorax (0% versus 8.2%, P < 0.001). The visualization rate of the thoracic duct during surgery was higher in the 3D reconstruction group compared to the control group (93.85% vs. 48.73%). Furthermore, patients in the 3D reconstruction group had less intraoperative bleeding (P = 0.003), shorter postoperative hospital stays (P = 0.003), and reduced chest drainage in the first three postoperative days (P < 0.001). Conclusion: This study reveals that preoperative three-dimensional reconstruction of chest using enhanced CT allows for the anticipation of thoracic duct anatomy. Additionally, the combination of preoperative oral olive oil administration significantly enhances the intraoperative visualization of the thoracic duct. This integrated strategy effectively reduces the incidence of postoperative chylothorax, demonstrating promising clinical application prospects. [ABSTRACT FROM AUTHOR]

The treatment of multimorbid patients in oncological surgery of the upper gastrointestinal tract requires a differentiated consideration of every single risk factor in order to provide a holistic assessment. This article focuses on pre-existing diseases that are particularly relevant for elective esophageal and gastric surgery and have practical clinical consequences. In this way a differtiation is made between metabolic, vascular, cardiopulmonary and organ-specific risks. The aim of this work is to provide practical guidelines for complex and multimorbid cases. Given the multifactorial interrelationships, the importance of a thorough preoperative evaluation and interdisciplinary management cannot be overemphasized. [ABSTRACT FROM AUTHOR]

Introduction Prehabilitation seeks to enhance functional capacity and preparedness before surgery with the aim of improving outcomes; it is generally based on exercise, diet and psychological interventions. While there is obvious appeal to this approach in terms of patient experience and resource use, the interventions are complex and the evidence base for prehabilitation before cancer surgery is heterogeneous. Prehabilitation requires patient understanding and motivation as well as commitment of resources. Programmes are challenging to design and implement, and can generate 'intervention-based inequalities' based on the capacity of patients to engage. We present a narrative reviewon the inequalities andchallenges of prehabilitation before cancer surgery. Methods We searched databases of peer-reviewed research to identify appropriate articles. We used the results in combination with iterative searches based on citation tracking, grey literature (e.g. patient information resources) and articles from personal libraries, to develop our discussion. Results We describe the uncertainties in the evidence base for prehabilitation before cancer surgery, and the challenges and barriers for healthcare providers, systems and patients. Key findings include that prehabilitation is under-researched in many cancers and that people with lower health literacy, from minority ethnic groups and socio-economically disadvantaged backgrounds, are less likely to engage, despite often having worse peri-operative outcomes. Discussion Prehabilitation must be implemented carefully to avoid widening inequalities. More research is needed, both in terms of the impact of interventions and to understand how prehabilitation should account for the social determinants of health. [ABSTRACT FROM AUTHOR]

We conducted a trial of limited versus extended pelvic lymph node dissection (PLND) during radical prostatectomy for localized prostate cancer in a cohort of 1500 patients. Although the biochemical recurrence rates were comparable between the groups, we found that extended PLND had a protective effect against metastasis. Lymph node dissection (LND) has been standard in cancer surgery for more than a century, yet evidence from randomized trials showing a benefit is scarce. We conducted a clinically integrated randomized trial comparing limited versus extended pelvic LND (PLND) during radical prostatectomy and previously reported comparable biochemical recurrence (BCR) rates. We report updated BCR rates and compare rates of metastasis between the study arms. Between October 2011 and March 2017, 1432 patients undergoing radical prostatectomy were enrolled at a single center. Surgeons were cluster randomized to perform limited (external iliac nodes) or extended PLND (external iliac, obturator, and hypogastric nodes) with crossover for 3-mo periods. Cox proportional-hazards regression with robust standard errors clustered by surgeon was used to assess whether the PLND template affected BCR or distant or locoregional metastasis. There were 452 BCR events at median follow-up of 4.2 yr for participants who did not develop BCR. The results confirm our previous finding of comparable BCR rates between the arms (hazard ratio [HR] 1.05, 95% confidence interval [CI] 0.97–1.13; p = 0.3). However, with 123 metastasis events and median follow-up of 5.4 yr for patients without metastasis, we found a clinically and statistically significant protective effect of extended PLND against metastasis (any metastasis: HR 0.82, 95% CI 0.71–0.93; p = 0.003; distant metastasis: HR 0.75, 95% CI 0.64–0.88; p < 0.001). Patients undergoing radical prostatectomy should receive extended PLND that includes the external iliac, obturator, and hypogastric nodes. Further research should examine biological mechanisms regarding the anatomic location of affected nodes. Trials of LND for other cancers are warranted and should consider our clinically integrated design. This trial is registered on ClinicalTrials.gov as NCT01407263. [ABSTRACT FROM AUTHOR]

Gallbladder cancer is a malignancy with a highly dismal prognosis, requiring optimal surgical strategies to achieve effective outcomes. We aimed to evaluate the outcomes of our algorithm-based decision-making approach based on image T-factors and intraoperative pathology of regional lymph node metastases and the bile duct stumps in patients undergoing gallbladder cancer resection. A prospectively maintained database of patients who underwent gallbladder cancer resection between April 2001 and June 2022 was reviewed. Our approach included the decision on the extent of local lymph node dissection based on image T-factors and intraoperative rapid pathological diagnosis. The need for extra bile duct resection was decided according to the intraoperative rapid pathological diagnosis of the cystic or bile duct stump. Overall, 148 patients underwent gallbladder cancer resection and were assessed to evaluate the efficacy of an institutional algorithm-based surgical strategy. Oncologically acceptable surgery rate was 98.6 and 96.9 % in terms of decision-making on the extents of lymph node dissection and bile duct resection, respectively. Our step-by-step decision-making approach based on image T-factors and intraoperative pathology for gallbladder cancer resection was effective in achieving oncologically acceptable surgeries. [ABSTRACT FROM AUTHOR]

Reconstructive surgeons often use a free radial forearm flap for nasal reconstruction when a forehead flap is not an option, but this flap has drawbacks. This article presents a series of patients with complex defects who underwent reconstruction with an anterolateral thigh (ALT) flap. Severe burns and cancer resection may lead to the loss of multiple anatomical units, including the entire nose and nearby structures. Multiple materials are required for reconstruction in those with complex total nasal defects involving adjacent areas. In this series of patients, a chimeric ALT flap was harvested and thinned to recreate the three-dimensional nasal structure and cover the adjacent area. Cartilage and alloplastic materials were used as the nasal framework, and the skin flap was folded for the mucosal lining. The results were good with an excellent contour, and no complications or airway obstruction were observed during follow-up. By thinning the ALT flap, this flap can be an alternative for complex reconstructions that require a facial or three-dimensional nasal structure. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine the optimal natural orifice specimen extraction (NOSE) method for robotic-assisted mid-rectal cancer resection in women. Methods: This retrospective propensity score-matched (PSM) study was to analyze the clinical data prospectively collected from female rectal cancer patients who underwent either robotic-assisted transvaginal specimen extraction (RATV) or robotic-assisted transanal specimen extraction (RATA) at our center between June 2016 and December 2022. The main outcome measures were urinary, anal, and sexual function. Disease-free survival (DFS), and overall survival (OS) were also included. Results: Anal function, assessed by the Wexner score, was better in the RATV group than in the RATA group (P = 0.034). Additionally, pre-menopausal women in RATV group exhibited superior anal function over those in RATA group (P = 0.031). There was no statistically significant difference in urinary function between the groups for both pre-menopausal and peri-menopausal patients (P = 0.711, P = 0.106). No difference was observed in sexual function between the two groups (P = 0.351); however, pre-menopausal patients in RATA group had better sexual function than those in RATV group (P = 0.045). Univariate logistic regression analysis showed surgical procedure was not a significant factor for the occurrence of sexual dysfunction. There were no significant difference in DFS (P = 0.845)and OS (P = 0.642) between the two groups. Conclusion: Though the postoperative efficacy of the RATA and RATV was equivalent on urinary and sexual function, RATV is an optimal natural orifice specimen extraction for robotic middle rectal cancer resection in women based on anal function. [ABSTRACT FROM AUTHOR]

Purpose: Patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been noted to face increased cancer incidence. Yet, the impact of concomitant renal dysfunction on acute outcomes following elective surgery for cancer remains to be elucidated. Methods: All adult hospitalizations entailing elective resection for lung, esophageal, gastric, pancreatic, hepatic, or colon cancer were identified in the 2016–2020 National Inpatient Sample. Based on stage of renal dysfunction, CKD patients were sub-classified as CKD1-3, CKD4-5, or ESRD (others: Non-CKD). Multivariable regression models were developed to assess the association of comorbid CKD/ESRD with in-hospital mortality, perioperative complications, and resource utilization. Results: Of ~515,145 patients, 32,195 (6.2%) had CKD (5.1% CKD1-3, 0.7% CKD4-5, 0.5% ESRD). The incidence of CKD among patients undergoing cancer resection increased from 5.3% in 2016 to 7.3% in 2020 (P<0.001). Following risk adjustment, CKD1-3 and CKD4-5 remained linked with similar likelihood of mortality and hospitalization costs, but greater need for blood transfusion (CKD1-3 AOR 1.21, CI 1.09–1.35; CKD4-5 AOR 1.73 CI 1.38–2.18). CKD4-5 was also associated with greater odds of infection (AOR 1.88, CI 1.34–2.62) and respiratory sequelae (AOR 1.36, CI 1.05–1.77). Further, ESRD was linked with greater odds of in-hospital mortality (AOR 2.74, CI 1.69–4.45), infection (AOR 2.31, CI 1.62–3.30) and respiratory complications (AOR 1.72, CI 1.31–2.26), as well as greater resource utilization, relative to Non-CKD. Conclusion: Comorbid renal dysfunction was linked with inferior clinical and financial outcomes following elective cancer resection. Future work is needed to develop optimal management strategies and recovery pathways for this complex cohort. [ABSTRACT FROM AUTHOR]

Purpose: Neuroendocrine neoplasms of the appendix (aNET) are rare tumors that are often diagnosed by pathology as an incidental finding after appendectomy for acute appendicitis. Several guidelines proposed risk criteria to indicate oncological completion surgery after appendectomy. The aim of this study was to evaluate the reliability of proposed criteria for completion surgery of aNET. Methods: Patients with aNET treated at ENETS center of excellence Marburg between 2002 and 2022 were retrieved from a prospective data base. Demographic data, histopathological findings, including formerly proposed criteria to indicate oncological completion surgery, histological results of the completion resection and disease-free survival were evaluated. Results: 82 patients with a median age of 35 (range 8–82) years were analysed. 72 (88%) patients underwent an emergency appendectomy because of acute appendicitis. 11 (13%) patients received an ileocecal resection or right hemicolectomy. Seven (8.5%) patients had lymph node metastases and three (3.6%) patients had distant metastases at the initial operation. 27 (33%) patients underwent completion surgery by right hemicolectomy according to guideline criteria, but postoperative histology detected lymph node and distant metastases in only six (22%) and zero patients resulting in an overtreatment of 21 (75%) patients. A tumor size of > 2 cm was the only significant criterion which was associated with lymph node metastases (p < 0.05). After a median follow-up of 62 months (range 2-264) 76 (96%) of the patients in stages I to III were alive with no evidence of disease. Conclusion: aNET have an excellent prognosis in stages I-III and distant metastases are rare. Formerly proposed criteria for oncological completion surgery have to be adopted and discussed for every patient, as they might result in an overtreatment in at least 75% of patients. [ABSTRACT FROM AUTHOR]

Background: Nutritional management in patients after gastrointestinal cancer surgery has changed throughout the 2000s. However, its evolution has not been formally studied. This study aimed to evaluate changes in nutritional management using real-world data. Methods: Patient data from 2011 to 2022 were extracted from a nationwide medical claims database. Patients were divided into four groups based on their year of hospital admission: period I, 2011–2013; II, 2014–2016; III, 2017–2019; IV, 2020–2022. For each period, feeding routes in all patients and prescribed doses of parenteral energy and amino acids in fasting patients during postoperative days (POD) 1–7 were determined. The results of the four different periods were compared using statistical trend tests. Results: The study cohort was comprised of 365,125 patients. During POD 1–3, the proportion of patients administered any oral intake increased over time (I, 40.3%; II, 47.1%; III, 49.4%; IV, 54.2%; P < 0.001), while that of patients receiving parenteral nutrition (PN) decreased (I, 60.1%; II, 55.0%; III, 50.3%; IV, 45.5%; P < 0.001). Of 19,661 patients with PN alone (i.e., neither oral intake nor enteral nutrition) during POD 1–7, the median (interquartile range) prescribed doses on POD 7 of energy (kcal/kg) [I, 15.3 (10.3–21.9); II, 13.9 (8.4–20.0); III, 13.2 (7.7–19.2); IV, 12.9 (7.0–18.7); P < 0.001] and amino acids (g/kg) [I, 0.65 (0.30–0.94); II, 0.58 (0.24–0.89); III, 0.56 (0.00–0.86); IV, 0.56 (0.00–0.87); P < 0.001] both decreased over time. Conclusion: From 2011 to 2022, more patients who underwent gastrointestinal cancer surgery in Japan were administered early oral intake, while fewer patients were administered early PN. Overall, the energy and amino acid doses prescribed in PN were far below the guideline recommendations. [ABSTRACT FROM AUTHOR]

Objectives: Recently, sarcopenia has been linked to unfavorable outcomes in various surgical procedures, including lung cancer surgery. This study aimed to investigate the impact of respiratory sarcopenia (RS) on postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery. Methods: This retrospective study included patients aged 70 years and older who underwent lobectomy with curative intent for lung cancer between 2017 and 2019. RS was defined as having values below the median for both the L3 skeletal muscle index, measured from preoperative PET-CT images, and peak expiratory flow (PEF). An inverse probability of treatment weighting (IPTW) approach was applied to balance covariates between the RS and non-RS groups. Baseline characteristics and postoperative outcomes were compared between groups using t-tests and chi-square tests. Kaplan–Meier curves and log-rank tests were used to compare overall and recurrence-free survival. Multivariable logistic regression analysis incorporating IPTW weights was performed to assess the impact of RS on respiratory complications. Results: A total of 509 patients were included, of whom 123 (24.2%) had RS. After IPTW adjustment, baseline characteristics, including pulmonary function, were similar between the RS and non-RS groups. All patients underwent lobectomy, with 78.8% of the RS group and 80.9% of the non-RS group undergoing minimally invasive surgery. The RS group had a significantly higher rate of respiratory complications compared to the non-RS group (14.5% vs. 7.7%, p = 0.041). Multivariable logistic regression analysis showed that male sex (odds ratio = 15.2, p < 0.01) and lower DLCO (odds ratio = 0.96, p < 0.01) were significantly associated with respiratory complications, whereas RS did not show a significant association (p = 0.05). No significant differences were found in overall survival (p = 0.11) or recurrence-free survival (p = 0.51) between the groups. Conclusions: In this study, RS had a limited impact on both postoperative and long-term outcomes in elderly patients undergoing lung cancer surgery. These findings suggest that other factors, such as DLCO and male sex, may play a more prominent role in predicting respiratory complications. [ABSTRACT FROM AUTHOR]

Simple Summary: Vulvar tumors are uncommon and have a considerable impact on the functional and aesthetic well-being of those affected. Their treatment necessitates a comprehensive, multidisciplinary approach at various levels, highlighting the importance of having standardized recommendations that are aligned with the latest scientific findings. Are scientific guidelines aligning with the advancements made in this field of oncology, spanning from diagnosis to palliative care at various levels? To address this, we conducted a systematic comparison of the main European and American guidelines for vulvar cancer management to assess their current status of update. From our comparisons, many divergences emerged in management strategies. Among them, lack of reference to the most up-to-date diagnostic classification systems, indication for an integrated gyneco-oncologic and plastic surgical approach to postoperative management with the most modern advanced dressing devices and palliative setting with the use of immuno- and electrochemotherapy. Background: Vulvar carcinoma is an uncommon gynecological tumor primarily affecting older women. Its treatment significantly impacts the quality of life and, not least, aesthetics because of the mutilating surgery it requires. Objectives: The management requires a multidisciplinary team of specialists who know how to care for the patient in her entirety, not neglecting psychological aspects and reconstructive surgery. How do the guidelines address multidisciplinarity, team surgical management, passing through preoperative diagnosis, and follow-up in such a challenging rare tumor to treat? Methods: To answer these questions, we compared the main scientific recommendations to identify similarities and differences in diagnostic and therapeutic management to provide an overview of the gaps that there are currently in European and American international recommendations in providing management guidance in a cancer that is both among the rarest and most difficult to manage. In this way, we aim to encourage an update in practices based on the latest scientific evidence. Results: A review of various international guidelines, some dating back to 2014, shows significant variation in approaches, ranging from initial diagnostic procedures to managing relapses. The most recent guidelines also lacked references to the latest literature, indicating that more robust scientific evidence is needed before new treatments, such as electrochemotherapy for palliation and reconstructive surgery post exenteration, can be widely adopted. Conclusions: From the systematic comparison of the main international guidelines, a strong heterogeneity emerged in the diagnostic and therapeutic recommendations as well as for the multidisciplinary approach that today is essential. Our work certainly stimulated an update of the main guidelines. [ABSTRACT FROM AUTHOR]

Background: As colorectal cancers are histopathologically and molecularly highly heterogeneous tumors, it is necessary to consider the tumor's microenvironment as well as its cellular characteristics in order to determine the biological behavior of the tumor. This study included 100 patients who underwent resection for colorectal cancer. We aimed to investigate the relationships between the expression status of the HIF-1α, LOX and ITGA5 proteins and clinicopathologic parameters. Methods: HIF-1α, LOX and ITGA5 antibodies were applied immunohistochemically to tissue microarrays prepared from tumor samples. Expression status in the tumor microenvironment were evaluated using a combined scoring system based on staining intensity and the percentage of positively stained cells. Nuclear HIF-1α expression in tumor cells was quantified, with >1% considered positive. The staining of HIF-1α, ITGA5 and LOX was analyzed in relation to prognostic and molecular features. Results: The staining of HIF-1α, ITGA5 and LOX in the tumor microenvironment demonstrated a positive correlation with one another and with HIF-1α and LOX expression in tumor cells. In patients with KRAS, NRAS or BRAF mutation and the moderate to strong expression of all three of these proteins in the tumor microenvironment, the number of metastatic lymph nodes was higher than in other patients. Stage IV patients with the moderate to strong expression of HIF-1α, ITGA5 or LOX in the microenvironment had lower progression-free survival than those with weak expression (p < 0.05). In addition, female gender; moderate to strong HIF-1α, LOX and ITGA5 stromal expression; and metastatic first line chemotherapy only were found to be independently associated with an increased risk of progression. Conclusions: These markers may be useful in predicting treatment responses and may also guide the development of alternative or combined treatments that specifically target molecules such as HIF and LOX. Our study should be supported by more comprehensive studies addressing the tumor stroma and its prognostic importance. [ABSTRACT FROM AUTHOR]

Background: Oncological surgery during the COVID-19 pandemic was performed only in carefully selected cases, due to variation in the allocation of resources. The purpose of this study was to highlight the impact of the pandemic lockdown on the presentation, diagnosis, and surgical management of colorectal cancers as well as the post-pandemic changes in this area. Material and methods: This single center, retrospective comparative study contained 1687 patients, divided into three groups with equal time frames of two years, consisting of a pre-pandemic, pandemic, and post-pandemic period, in which preoperative and perioperative as well as postoperative parameters were compared. Results: Statistically significant differences regarding environment, type of admission, and ASA score, as well as a more advanced tumoral stage, increased number of important postoperative complications, and a lower minimally invasive surgical approach, were highlighted within the pandemic group. Statistically significant differences regarding emergency diagnosis as well as late diagnosis were highlighted. There were no significant differences regarding the tumor location, postoperative 30-day mortality, or hospitalization duration. Conclusions: COVID-19 significantly impacted the surgical timing in colorectal cancer, as well as addressability for the rural population, with a marked decrease in elective cases as well as an increased number of cases diagnosed in an emergency setting, with locally advanced tumors. However, no significant changes in postoperative mortality or hospitalization duration were highlighted. In addition, most of the changes highlighted were reverted in the post-pandemic period. Further studies are required to observe the long-term effects in terms of morbidity and mortality, regarding the delay of diagnosis and oncological treatment. [ABSTRACT FROM AUTHOR]

Tumor drainage lymph node imaging during oncological surgery is crucial to reduce recurrence. The fluorescent metal–organic framework Zn-TCPP was prepared by carrying out a solution reaction between tetra(4-carboxyphenyl)porphine and Zn(BDC)(H2O)2. Zn-TCPP migrated into sentinel lymph nodes quickly and could be identified by the naked eye under ultraviolet excitation. [ABSTRACT FROM AUTHOR]

Background: Patients with rectal cancer often experience adverse effects on urinary, sexual, and digestive functions. Despite recognised impacts and available treatments, they are not fully integrated into follow-up protocols, thereby hindering appropriate interventions. The aim of the study was to discern the activities conducted in our routine clinical practice outside of clinical trials. Methods: This multicentre, retrospective cohort study included consecutive patients undergoing rectal cancer surgery between January 2016 and January 2020 at six tertiary Spanish hospitals. Results: A total of 787 patients were included. Two years post surgery, gastrointestinal evaluation was performed in 86% of patients. However, bowel movements per day were only recorded in 242 patients (46.4%), and the values of the Low Anterior Resection Syndrome (LARS) questionnaire were recorded in 106 patients (20.3%); 146 patients received a diagnosis of fecal incontinence (28.2%), while 124 patients were diagnosed with low anterior resection syndrome (23.8%). Urogenital evaluation was recorded in 21.1% of patients. Thirty-seven patients (5.1%) were detected to have urinary dysfunction, while 40 patients (5.5%) were detected to have sexual dysfunction. A total of 320 patients (43.9%) had their quality of life evaluated 2 years after surgery, and only 0.8% completed the Quality of Life questionnaire. Medication was the most used treatment for sequelae (26.9%) followed by referral to other specialists (15.1%). Conclusions: There is a significant deficit in clinical follow-ups regarding the functional assessment of patients undergoing rectal cancer surgery. It is crucial to implement a postoperative functional follow-up protocol and to utilize technologies such as Patient-Reported Outcome Measures (PROMs) to enhance the evaluation and treatment of these sequelae, thereby ensuring an improved quality of life for patients. [ABSTRACT FROM AUTHOR]

Continuous monitoring on the general ward leads to more and earlier interventions to prevent clinical deterioration. These clinical actions influence outcomes and may serve as an indicator of impending deterioration. This study aims to correlate clinical actions with clinical endpoints and deviating vital signs. Methods: This cohort study prospectively charted all patients undergoing continuous vital sign monitoring on a gastro-intestinal and oncological surgery, and an internal ward of an academic hospital in The Netherlands from 1 August 2018 till 31 July 2019 (METC 2018-4330, NCT04189653). Clinical actions recorded in electronic medical records were analyzed to assess correlations with patient outcomes, hospital length of stay, and alarming monitoring minutes. Results: A total of 1529 patients were included, of which 68 patients had a negative clinical endpoint. There were 2749 clinical actions recorded. Clinical actions correlated to negative clinical endpoints (ρ = 0.259; p < 0.001, OR: 3.4 to 79.5) and to the length of stay (ρ = 0.560; p < 0.001). Vital sign deviations correlated with clinical actions (ρ = 0.025–0.056; p < 0.001–p = 0.018). In the last 72 h before a clinical endpoint, for alarming minutes, this correlation with clinical actions was more pronounced (ρ = 0.340, p < 0.001). Conclusions: Predefined clinical actions performed on admitted general ward patients correlated with negative endpoints, an increased length of stay, and with deviating vital signs, especially in the period directly preceding severe deterioration. Clinical actions have potential as an intermediate measurement of deterioration. [ABSTRACT FROM AUTHOR]

Background: Postoperative physiotherapy is a cornerstone of Enhanced Recovery After Surgery (ERAS) programs, especially following lung resection. Despite its importance, the literature lacks clear recommendations and guidelines, particularly regarding the role of incentive spirometry (IS). This study aims to determine whether incentive spirometry offers additional benefits over early ambulation alone in patients undergoing lung resection for primary lung cancer. Methods: We conducted a retrospective case–control study at the European Institute of Oncology (IEO) involving patients who underwent lung resection from June 2020 to June 2022. Patients were divided into two cohorts: early ambulation alone (control group) and early ambulation with IS (IS group). The primary endpoint was the rate of postoperative pulmonary complications. Secondary endpoints included length of hospital stay and time to chest drain removal. A propensity score-matched analysis was performed based on age, sex, and BMI. Data were compared using Chi-squared and Student's t-tests as appropriate. Results: A total of 304 patients were included, with 153 in the intervention group and 151 in the control group. After propensity-score matching, 52 patients from each cohort were compared. No significant differences were found between the groups regarding postoperative oxygen requirement, fever, atelectasis, residual pleural space, need for bronchoscopy toilette, and re-hospitalization rate. IS group showed trends toward shorter hospital stays and lower time to chest drain removal, though without reaching statistical significance. Conclusions: IS did not significantly improve postoperative outcomes compared to early ambulation alone in patients undergoing lung resection for primary lung cancer. More extensive, prospective, randomized trials are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Simple Summary: Hypnosis sedation has been used for anesthesia in breast oncologic surgery. This manuscript reports the results of a multicentric, prospective non-randomized study evaluating three different modalities of anesthesia for breast cancer surgery: general anesthesia, general anesthesia preceded by virtual reality with a hypnorelaxation session and hypnosis sedation exclusively in place of general anesthesia. Local anesthesia was systematically administered in all patients. Some benefits of hypnosis sedation, a decrease in pain and the consumption of non-steroidal anti-inflammatory drugs are correlated with a significant reduction in the inflammatory reaction in the perioperative process. Background: Hypnosis sedation has recently been used for anesthesia in breast oncologic surgery. Methods: Between January 2017 and October 2019, 284 patients from our Breast Clinic (Cliniques Universitaires Saint-Luc, Université Catholique de Louvain) and from the Jolimont Hospital were prospectively included in an interventional non-randomized study approved by our two local ethics committees and registered on clinicaltrials.gov (NCT03330117). Ninety-three consecutive patients underwent surgery while on general anesthesia (GA group). Ninety-two consecutive patients underwent surgery while on general anesthesia preceded by a hypnorelaxation session (GAVRH group). Ninety-five consecutive patients underwent surgery while exclusively on hypnosis sedation (HYPS group). Clinical parameters (pain score, anxiety and distress score) were measured on days 0, 1 and 8 for all patients. All evaluable patients underwent NLR (neutrophil-to-lymphocyte ratio) and CRP (C-reactive protein) dosage on days 0, 1 and 8. Results: Pain scores and anxiety scores were statistically lower in the HYPS group on days 1 and 8, as was the duration of NSAID consumption. NLR and CRP values were significantly inferior on day 1 for all patients who benefited from hypnosis sedation. Conclusions: Some benefits of hypnosis sedation (reduction in postoperative pain, decrease in NSAID consumption) are correlated with a significant reduction in inflammatory parameters in the perioperative process. [ABSTRACT FROM AUTHOR]

(1) Background: Suspicious adnexal masses should be referred to gynecological oncology units. However, when surgery waiting lists are prolonged, these patients usually suffer from a delay in surgery. This could have a negative impact on their prognosis when the final diagnosis is ovarian cancer (OC). The primary aim of this study was to investigate the impact of surgery delay on the oncological results of early-stage ovarian cancer patients. (2) Methods: We retrospectively reviewed the records of early-stage OC patients who underwent surgery in the 1st Department of Obstetrics and Gynecology from 2012 to 2019. Time to surgery was defined as the time interval from the day of first examination to the day of surgery. (3) Results: A total of 72 patients were categorized into two groups, with a cut-off point of 5 weeks: 32 were treated ≤ 5 weeks (group A), and 40 > 5 weeks (group B). Concerning age, BMI or comorbidities, no differences were found between the two groups. Furthermore, no differences were presented in the post-operative complications rate, hospital stay, ICU admittance, or in disease-free (p = 0.48) and overall survival rates (p = 0.703). (4) Conclusions: Suspicious adnexal masses should undergo careful differential diagnosis to avoid delays in the "wait and see" period when the final diagnosis is positive for malignancy. However, the time to surgery for early-stage OC over 5 weeks seems to be relatively safe, with no impact on the mortality, morbidity, or recurrence rate. [ABSTRACT FROM AUTHOR]

Ambient ionization mass spectrometry was proved to be a powerful tool for oncological surgery. Still, it remains a translational technique on the way from laboratory to clinic. Brain surgery is the most sensitive to resection accuracy field since the balance between completeness of resection and minimization of nerve fiber damage determines patient outcome and quality of life. In this review, we summarize efforts made to develop various intraoperative support techniques for oncological neurosurgery and discuss difficulties arising on the way to clinical implementation of mass spectrometry‐guided brain surgery. [ABSTRACT FROM AUTHOR]

Background Pancreatic cancer remains highly lethal, and resection represents the only chance for cure. Although patients are counseled regarding short-term (0-3 months) mortality, little is known about mortality 3-6 months (intermediate-term) following surgery. We assessed predictors of intermediate-term mortality, evaluated hospital-level variation, and developed a nomogram to predict intermediate-term mortality risk. Methods Patients undergoing pancreatic cancer resection were identified from the National Cancer Database (2010-2020). Multivariable logistic regression identified predictors of intermediate-term mortality and assessed differences between short-term and intermediate-term mortality. Multinomial regression grouped by intermediate-term mortality quartiles evaluated hospital-level variation. A neural network model was constructed to predict intermediate-term mortality risk. All statistical tests were 2-sided. Results Of 45 297 patients, 3974 (8.9%) died within 6 months of surgery of which 2216 (5.1%) were intermediate-term. Intermediate-term mortality was associated with increasing T category, positive nodes, lack of systemic therapy, and positive margins (all P < .05) compared with survival beyond 6 months. Compared with short-term mortality, intermediate-term mortality was associated with treatment at high-volume hospitals, positive nodes, neoadjuvant systemic therapy, adjuvant radiotherapy, and positive margins (all P  < .05). Median intermediate-term mortality rate per hospital was 4.5% (interquartile range [IQR] = 2.6-6.5). Highest quartile hospitals had decreased odds of treatment with neoadjuvant systemic therapy, neoadjuvant radiotherapy, and adjuvant radiotherapy (all P < .05). The neural network nomogram was highly accurate (accuracy = 0.9499; area under the receiver operating characteristics curve = 0.7531) in predicting individualized intermediate-term mortality risk. Conclusion Nearly 10% of patients undergoing pancreatectomy for cancer died within 6 months, of which one-half occurred in the intermediate term. These data have real-world implications to improve shared decision making when discussing curative-intent pancreatectomy. [ABSTRACT FROM AUTHOR]

Objective: Esophageal cancer lacks a standard surgical approach, and opinions differ regarding the extent of lymphadenectomy. This study aimed to assess the correlation between the extent of lymphadenectomy, patient and tumor characteristics, and survival of esophageal cancer. Methods: Data of 101 patients who underwent surgery for esophageal cancer between 1990 and 2022 were retrospectively analyzed. The mean survival and 1, 3, 5, and 10 year overall survival (OS) rates were examined. Overall survival rates for adenocarcinoma and squamous cell carcinoma were separately evaluated. The relationships among gender, age, tumor size, stage, total number of harvested lymph nodes, and survival were analyzed. Results: Among 101 patients, 34 (33.7%) were female, and 67 (66.3%) were male, with a mean age of 61.01±12.01 years. Among the included patients, 82 (81.2%) had squamous cell carcinoma and 16 (15.8%) had adenocarcinoma. The mean follow-up was 61.2 months, and the OS averaged 61.01±12.01 months. Only the total harvested lymph node count had a statistically significant impact on survival (p=0.17). Conclusion: There was a clear association between the total number of harvested lymph nodes and OS. In squamous cell cancers, the extent of lymph node dissection improves long-term survival. However, the routine use of extended lymphadenectomy for distal cancer remains a topic of debate. [ABSTRACT FROM AUTHOR]

The term cholangiocarcinoma (CCA) includes a group of malignant tumors that develop in the efferent bile ducts and are characterized by a high degree of heterogeneity. These differences between intrahepatic, perihilar and distal CCAs run through all aspects of the disease including the etiology, pathogenesis, symptoms, diagnostics and treatment. This review article presents the current developments in this field of diseases. We highlight surgical innovations in the clinical routine and the application of new systemic forms of treatment to augment the oncological radicality of surgery. [ABSTRACT FROM AUTHOR]

Introduction: Artificial Intelligence (AI) has emerged as a promising tool in the delivery of health care. ChatGPT-4.0 (OpenAI, San Francisco, California) and Llama 2 (Meta, Menlo Park, CA) have each gained attention for their use in various medical applications. Objective: This study aims to evaluate and compare the effectiveness of ChatGPT-4.0 and Llama 2 in assisting with complex clinical decision making in the diagnosis and treatment of thyroid carcinoma. Participants: We reviewed the National Comprehensive Cancer Network® (NCCN) Clinical Practice Guidelines for the management of thyroid carcinoma and formulated up to 3 complex clinical questions for each decision-making page. ChatGPT-4.0 and Llama 2 were queried in a reproducible manner. The answers were scored on a Likert scale: 5) Correct; 4) correct, with missing information requiring clarification; 3) correct, but unable to complete answer; 2) partially incorrect; 1) absolutely incorrect. Score frequencies were compared, and subgroup analysis was conducted on Correctness (defined as scores 1-2 vs 3-5) and Accuracy (scores 1-3 vs 4-5). Results: In total, 58 pages of the NCCN Guidelines® were analyzed, generating 167 unique questions. There was no statistically significant difference between ChatGPT-4.0 and Llama 2 in terms of overall score (Mann-Whitney U-test; Mean Rank = 160.53 vs 174.47, P = 0.123), Correctness (P = 0.177), or Accuracy (P = 0.891). Conclusion: ChatGPT-4.0 and Llama 2 demonstrate a limited but substantial capacity to assist with complex clinical decision making relating to the management of thyroid carcinoma, with no significant difference in their effectiveness. [ABSTRACT FROM AUTHOR]

Background: Frailty is increasingly recognized as a perioperative risk for numerous surgical diseases. We applied the modified frailty index (mFI-11) to the National Inpatient Sample (NIS) for patients undergoing surgery for colorectal cancer (CRC). Methods: We performed a retrospective analysis of the NIS (2015-2019) including CRC patients undergoing surgery. We classified patients into frail (ie, mFI ≥0.27) and robust (ie, mFI <0.27) categories. Primary outcomes were in-hospital postoperative morbidity and mortality. The secondary outcomes included system-specific postoperative morbidity and length of stay (LOS). Multivariable regression models were fit. Results: Within the 53,652 identified patients undergoing surgery for CRC, 19.1% were frail. Frail patients were at higher risk of postoperative mortality (3.1% vs 1.0%, odds ratio [OR] 1.96, 95% confidence intervals [CIs] 1.68-2.30, P < 0.001), morbidity (41.3 % vs 23.1%, OR 1.75, 95% CI 1.66-1.83, P < 0.001), and LOS (mean difference [MD] 1.46, 95% CI 0.29-1.62, P < 0.001). Significant differences existed between groups in system-specific postoperative morbidity, with the largest effect estimates seen in cardiovascular morbidities (OR 4.07, 95% CI 3.36-4.93, P = 0.001), followed by respiratory (OR 1.75, 95% CI 1.66-1.83, P = 0.001). Conclusion: Frail patients undergoing CRC surgery are at risk of increased postoperative complications. Preoperative frailty screening may allow for individualized preoperative counseling. [ABSTRACT FROM AUTHOR]

Purpose: There is few evidence regarding the optimal salvage treatment options for loco-reginal recurrence of esophageal cancer. This study aimed to evaluate the clinical outcomes of salvage radiotherapy (RT) in patients with loco-regional recurrence (LRR) after surgery for esophageal cancer. Materials and Methods: We retrospectively reviewed 147 esophageal cancer patients who received salvage RT for loco-regional recurrence between 1996 and December 2019. A total dose of 60 Gy in 20 fractions was used for RT alone and 60-70 Gy in 30-35 fractions for concurrent chemoradiotherapy (CCRT). Results: The patients' median age was 65 years (range, 41 to 86 years). The median disease-free interval was 13.5 months (1.0 to 97.4 months). After a median 18.8 months follow-up, the 2-year overall survival (OS) and progression-free survival (PFS) rates were 38.1% and 25.9%, respectively. The median OS and PFS were 18.8 and 8.4 months, respectively. The CCRT could not improve OS compared to RT (p=0.336), but there was a trend of better PFS in the CCRT group. Regarding toxicities, the rate of grade 3 or higher toxicity was 10.9% occurring in 16 patients, and it was higher in patients who received CCRT than in the RT alone group (19.6% vs. 6.3%, p=0.023). Conclusion: Salvage RT alone as well as CCRT could be effective in patients with locoregionally recurrent esophageal cancer. [ABSTRACT FROM AUTHOR]

Purpose: Atherosclerosis and cancer may progress through common pathological factors. This study was performed to investigate the association between the abdominal aortic calcification (AAC) volume and outcomes following surgical treatment for pancreatic cancer. Methods: The subjects of this retrospective study were 194 patients who underwent pancreatic cancer surgery between 2007 and 2020. The AAC volume was assessed through routine preoperative computed tomography. Univariate and multivariate analyses were performed to evaluate the impact of the AAC volume on oncological outcomes. Results: A higher AAC volume (≥ 312 mm3) was identified in 66 (34%) patients, who were significantly older and had a higher prevalence of diabetes and sarcopenia. Univariate analysis revealed several risk factors for overall survival (OS), including male sex, an AAC volume ≥ 312 mm3, elevated carbohydrate antigen 19–9, prolonged operation time, increased intraoperative bleeding, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy. Multivariate analysis identified an AAC volume ≥ 312 mm3, prolonged operation time, lymph node metastasis, poor differentiation, and absence of adjuvant chemotherapy as independent OS risk factors. The OS rate was significantly lower in the high AAC group than in the low AAC group. Conclusion: The AAC volume may serve as a preoperative prognostic indicator for patients with pancreatic cancer. [ABSTRACT FROM AUTHOR]

The association between chronic obstructive pulmonary disease (COPD) and risk for postoperative complications after pancreatic surgery has not been clarified. The aim of this study was to investigate if COPD is associated with increased risk for postoperative complications after pancreatoduodenectomy. All patients aged ≥18 years undergoing pancreatoduodenectomy from 2008 to 2019 at a high-volume tertiary centre for pancreatic cancer surgery were included. COPD was defined as an established diagnosis according to the International Statistical Classification of Diseases. The primary outcome was Clavien-Dindo-score (CD)≥ IIIa. Out of 1009 available patients, 57 (5.6 %) had a diagnosis of COPD. There was no association between COPD and CD≥ IIIa (25.5 % vs. 29.8 % p-value 0.471). COPD was associated with an increased risk for postoperative pancreatic fistula (POPF) (odds ratio [OR] 3.06, 95 % confidence interval 1.62–5.89; p < 0.001). The 12 months mortality rate was higher among patients with COPD compared to patients without COPD, although not statistically significant (28.07 % vs., 18.17 %, p-value = 0.063). COPD was associated with increased risk for POPF. These results imply that among patients deemed fit enough to undergo surgery, COPD should be thoroughly evaluated in the risk stratification. [ABSTRACT FROM AUTHOR]

Over the past several years, there has been a trend of decreasing screening or diagnostic fluoroscopic examinations ordered by clinical teams, particularly double contrast gastrointestinal studies. The underlying reason is due to increasing number of endoscopic procedures performed by Gastroenterology and Urology and usage of other imaging modalities, which are either more sensitive and/or offer the ability to obtain tissue for confirmation. Many fluoroscopic studies are now tailored toward patients who have undergone gastrointestinal or genitourinary oncologic surgeries, providing both functional and anatomic information, which are important tools for patient management. Some of these surgeries are very complex and an understanding of the postoperative anatomy and potential pitfalls is important to accurately evaluate for complications. The purpose of this article is to describe techniques and indications for common post-operative fluoroscopic procedures in gastrointestinal and genitourinary oncology while reviewing normal appearances. Complications, with emphasis on postoperative leaks, will be highlighted. Familiarity with the various types of gastrointestinal surgeries and urinary diversion techniques and knowledge of the expected postsurgical appearance is essential for achieving an accurate and prompt diagnosis of complications to allow for adequate treatment and management. [ABSTRACT FROM AUTHOR]

This case series aimed to assess the clinical outcomes of oncologic patients rehabilitated with a zygomatic implant-supported prosthesis. Ten oncologic patients who underwent upper jaw resections due to cancer were enrolled in the study. Zygomatic implants were utilized for rehabilitation according to specified inclusion criteria. Surgical and prosthetic procedures were standardized, and implant and prosthetic survival rates, along with complications, were evaluated. The study cohort comprised 10 patients with a mean age of 66.5 years. A total of 35 implants were placed, with a survival rate of 94.29% at the mean follow-up of 5.78 years. Biological complications affected 40% of patients, while prosthetic complications occurred in 40% of patients, necessitating modifications but with no outright failures. Zygomatic implants offer a viable solution for oncologic patient rehabilitation, particularly in cases where bone grafting is contraindicated or impractical. However, they present medium-to long-term complications that warrant careful consideration. Future research should focus on larger studies and meta-analyses to provide more robust evidence. [ABSTRACT FROM AUTHOR]

Objective: The Commission on Cancer (CoC) recently introduced a quality metric to optimize time between major head and neck surgery and adjuvant treatment (TAT) ≤6 weeks, as TAT delay adversely impacts patient survival. This study evaluates whether enhanced recovery after surgery (ERAS) for this population reduces the rate of postoperative complications, length of stay (LOS), and TAT. Methods: Patients undergoing larynx or oral cavity resection with free flap reconstruction, ERAS, and adjuvant treatment after 2018 were compared to a historical pre‐ERAS cohort. Patients underwent surgery at a single‐institution tertiary referral center for complex head and neck oncology. Differences between groups were compared by chi‐square, Fisher's exact, or Wilcoxon rank‐sum test. TAT >6 weeks was evaluated with univariate and multivariable logistic regression. Results: Thirty‐nine pre‐ERAS patients were compared to 39 ERAS patients. No demographic differences existed between groups. LOS was improved with ERAS (p = 0.005). ERAS patients were discharged to home and returned to their activities of daily living (ADL) earlier (p = 0.004, 0.001). ADL recovery was associated with on‐time TAT ≤42 days on univariate analysis (OR 1.36, 95% CI 1.13–1.63, p = 0.001). TAT delay was less frequent with ERAS (51.3% vs. 69.2%), but this was not significant after multivariable logistic regression (p = 0.11). Conclusion: ERAS decreases LOS and returns advanced head and neck cancer patients to their ADL sooner. Postoperative ADL recovery independently predicts on‐time adjuvant treatment. Still, compliance beyond 50% with the TAT ≤6 weeks CoC quality metric remains a major treatment barrier. [ABSTRACT FROM AUTHOR]

Copyright of Saudi Medical Journal is the property of Saudi Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Skin cancer is the world's fifth most diagnosed malignancy and is increasingly occurring in young adults. The elevated morbidity and mortality of skin cancer are known to be highly correlated with its frequent recurrence after tumor excision. Although regimens such as chemotherapy and/or immunotherapy are often administered following surgical treatments, the patients may suffer from severe side effects, drug resistance, and/or high cost during treatments, indicating that the development of an effective and safe modality for skin cancer after surgery is still highly demanded nowadays. In this study, an injectable and thermoresponsive hyaluronic acid/hexamethylene diisocyanate-Pluronic F127 block copolymer crosslinking composite hydrogel loaded with indocyanine green (ICG) and camptothecin (CPT), called ICHHPG, was developed for photochemotherapy of skin cancer after surgery. ICHHPG can be self-gelationed at 37 °C and stabilizes ICG in the gel matrix. Upon NIR exposure, ICHHPG can generate hyperthermia and consequently provide photothermal therapy when the ICG dosage is >5 μM. Furthermore, ICHHPG may provide a remarkably enhanced cancericidal effect compared to the equal concentration of free ICG (≤10 μM) or CPT (≤1000 μM) alone, and more than 95% of cancer cells can be destroyed as the intra-gel doses of ICG/CPT were elevated to 10/800 μM. Given the confirmed cytotoxicity together with its fluidic and thermoresponsive characteristics which are foreseeably favorable for wound coverage, the developed ICHHPG is highly applicable for use in skin cancer treatment after surgical excision. [ABSTRACT FROM AUTHOR]

Background/Objectives: Oral cancer ranks among the top ten cancers globally, with a five-year survival rate below 50%. This study aimed to evaluate the effectiveness of autofluorescence-guided surgery compared to standard surgical methods in identifying tumor-free margins and ensuring complete excision. Methods: A prospective cohort of 80 patients was randomized into two groups: the control group underwent excision with a 10 mm margin based on clinical judgment, while the experimental group used autofluorescence guidance with a 5 mm margin beyond fluorescence visualization loss. Autofluorescence imaging was performed using the OralID device, which employs a 405 nm excitation laser to detect abnormal tissue. Ethical approval was obtained from the "Spitalul Clinic Municipal de Urgență Timișoara" Ethics Committee (approval number 08/26.02.2021), and the trial was registered at the University of Medicine and Pharmacy Timisoara (trial no. 59/25.11.2021). A double analysis was conducted: a primary analysis of the full cohort and a subgroup analysis focusing on squamous cell carcinoma (control: n = 19; experimental: n = 24). Histopathological analysis was the gold standard for margin evaluation, with margins coded as tumor-free margins (0), close (1), or infiltrated (2). Results: Statistically significant differences were observed in tumor-free margins between the control (73.17%) and experimental (97%) groups (p = 0.003). Subgroup analysis for SCC showed no significant difference (control: 84.21%; experimental: 95.83%; p = 0.306). Tumor location also differed significantly (p = 0.011), while other baseline variables, such as tumor type and patient characteristics, showed no significant differences. Conclusions: Autofluorescence-guided surgery improves the detection of tumor-free margins and may serve as an effective adjunct in oral cancer management. Larger studies are recommended to confirm these findings. [ABSTRACT FROM AUTHOR]

Sodium-glucose cotransporter 2 inhibitors are gaining widespread acceptance in managing diabetic patients due to their favorable cardiac and renal protective effects. However, these drugs can cause a lethal complication described as sodium-glucose cotransporter 2 inhibitor-associated perioperative ketoacidosis (SAPKA) if they are continued until surgery. The FDA recommends stopping these medications at least 4–6 days before surgery to avoid the risk of euglycemic ketoacidosis, which can present a diagnostic challenge for perioperative physicians. We present three patients undergoing colorectal cancer surgeries who on SGLT2 inhibitors developed perioperative SGLT2i-associated perioperative ketoacidosis. [ABSTRACT FROM AUTHOR]

Copyright of HNO is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Accurate staging of malignancies often requires comprehensive evaluation of lymph nodes. However, finding these lymph nodes during oncological surgery is a daunting and time-consuming task, which increases the risk of missed lymph nodes and complications. Near-infrared (NIR) fluorescence imaging with the experimental fluorescent contrast agent PanLN800(-Forte) could provide real-time identification of lymph nodes and may solve this longstanding problem. In the current study we performed the preclinical toxicology evaluation of PanLN800(-Forte) towards its clinical translation for intraoperative pan lymph node imaging in thoracic surgery. A single extended dose toxicology study was conducted to determine the safety and potential toxicity of PanLN800(-Forte) after administration of a single intravenous dose to Wistar Han rats. The study included a control group and two treatment groups (5.0 mg/kg and 15.0 mg/kg PanLN800(-Forte)), each consisting of 10 male and 10 female rats. Experimental endpoints included moribundity/mortality, clinical signs, body weights, body weight gains, clinical pathology, toxicity, and gross necropsy observations. Unexpected acute mortality was observed after administration of 5.0 mg/kg PanLN800(-Forte) to rats. No clear cause of sudden death was found after gross necropsy and pathology observations. To understand the mechanism of toxicity of PanLN800(-Forte), several additional tests were performed. By elimination, acute cardiac toxicity appears to be the cause of acute mortality in rats, in which PanLN800(-Forte) was found to be a potent inotrope acting as a cardiac calcium sensitizer. PanLN800(-Forte) is not a viable fluorescent contrast agent for lymph node imaging in surgery because of cardiac calcium sensitization but may be a novel treatment for heart failure. [Display omitted] • NIR fluorescence imaging with PanLN800(-Forte) enables real-time pan lymph node mapping in mice. • PanLN800(-Forte) is not viable for lymph node imaging in humans due to cardiac toxicity. • PanLN800(-Forte) is a potent inotrope representing a new class of cardiac calcium sensitizers. [ABSTRACT FROM AUTHOR]

• TORS shows growing potential in supraglottic laryngeal cancer surgery. • Indirect comparisons between surgical techniques pose a high risk of selection bias. • TORS vs. TOLM conclusions risk misinterpretation, especially with superficial reading. [ABSTRACT FROM AUTHOR]

Liver cancer seriously threatens the health of human beings. Studies have found that esterase is overexpressed in liver cancer cells. Therefore, esterase can be one of the biomarkers of liver cancer. Previous literature studies have shown that the structures of fluorescent probe detection groups significantly impact the probes themselves and enzyme detection. In this paper, three "off–on" esterase-activated fluorescent probes ( RHO-1 , RHO-2 and RHO-3) with different length of the carbon chains of the detection groups were designed and synthesized. Density functional theory (DFT) calculation and Michaelis-Menten equations were applied to study the optical properties and affinity with esterase of the probes. Compared with RHO-1 and RHO-2 , RHO-3 showed superior optical properties and affinity with esterase. Subsequently, RHO-3 was further used to detect esterase activity in vitro and in vivo. RHO-3 was the first esterase-activated fluorescent probe applied to image-guided diagnosis and surgical resection of liver cancer. It was expected to be a promising molecular imaging diagnostic tool in clinical applications. [Display omitted] • The effect of detection group chain length on esterase detection ability was studied. • Esterase-activated fluorescent probe was used to diagnose early liver cancer. • An esterase-activated fluorescent probe is first time used to guide liver cancer resection. [ABSTRACT FROM AUTHOR]

To explore the value of amide proton transfer (APT) imaging in assessing parametrial invasion (PMI) and lymph-vascular space invasion (LVSI) of cervical cancer. We retrospectively analyzed the clinical and imaging data of cervical cancer patients diagnosed pathologically at our hospital from January 2021 to June 2024. All patients underwent routine magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and APT imaging before treatment. Apparent diffusion coefficient (ADC) and APT values were measured. Based on the pathological results, patients were categorized into LVSI (+) and LVSI (−) groups, and PMI (+) and PMI (−) groups. Independent sample t -tests were used to compare the ADC and APT values between these groups. Receiver operating characteristic (ROC) curves were used to assess the sensitivity, specificity, and area under the curve (AUC) of ADC, APT, and ADC + APT in predicting PMI and LVSI. The Delong test was employed to compare the diagnostic performance among these measures. A total of 83 patients were included, with 56 in the LVSI (−) group, 27 in the LVSI (+) group, 35 in the PMI (−) group, and 16 in the PMI (+) group. The ADC values for the LVSI (+) and PMI (+) groups were significantly lower than those for the LVSI (−) and PMI (−) groups (P < 0.01). The APT values for the LVSI (+) and PMI (+) groups were significantly higher than those for the LVSI (−) and PMI (−) groups (P < 0.01). The AUC values for ADC, APT, and the combination of ADC + APT in predicting LVSI were 0.839, 0.788, and 0.880, respectively, and in predicting PMI were 0.770, 0.764, and 0.796, respectively. There were no statistically significant differences in the diagnostic performance of ADC, APT, and ADC + APT in predicting PMI. However, the diagnostic performance of ADC + APT in predicting LVSI was significantly better than that of ADC and APT alone (P < 0.01). APT imaging can predict LVSI and PMI status in cervical cancer before surgery. When combined with ADC, its diagnostic accuracy for predicting LVSI is higher than that of APT or ADC alone. This suggests a novel approach for assessing LVSI in cervical cancer. [ABSTRACT FROM AUTHOR]

The article discusses a case study of a 66-year-old woman who underwent surgical resection for sigmoid cancer and later experienced regression of a laterally spreading tumor (LST) following chemotherapy. The LST transitioned from a mixed-nodular to a flat morphology after chemotherapy, highlighting the potential for chemotherapy to alter the histology of colorectal adenomas. The study emphasizes the importance of considering post-chemotherapy polyp treatment in colorectal cancer patients. [Extracted from the article]