Molecularly defined oligodendrogliomas are rare tumors whose prognosis has improved over time because of more effective treatments. However, several aspects of management are still controversial, and studies with long-term follow-up are needed. The main aim of this study was to analyze and compare the natural history and management of patients with OG2 and OG3 and define which factors have the strongest effect on outcome. We reviewed an institutional retrospective cohort (1996-2024) of patients with molecularly defined OG2 and OG3 according to World Health Organization 2021. We retrieved information on baseline clinical features, MRI characteristics (i.e., presence and pattern of contrast enhancement), extent of resection, initial treatment modalities after surgery, and management at progression. The relationships of these factors with progression-free survival (PFS) and overall survival (OS) were studied with univariate and multivariate analyses. Among 240 patients with IDH-mutant 1p/19q-codeleted oligodendrogliomas, grade 2 tumors were 149 (62.1%) and grade 3 were 91 (37.9%) with a median age of 42 and 44 years, respectively. Male/female ratio was 73/76 (49%/51%). Among patients with OG3, 70/91 (77%) exhibited a diffuse grade 3 histology (OG3d), whereas 21/91 (23%) had focal grade 3 areas only (OG3f). Overall, patients with OG2 and OG3 had similar median PFS (57.6 months, CI 53.2-61.9, vs 59.8 months, CI 41.9-77.6, p = 0.25), and prolonged median OS (274 months vs not reached). However, patients with OG3 exhibited a shorter time to radiotherapy at progression and their survival probability declined more rapidly within the first decade after surgery. The extent of resection was the only factor that significantly affected both PFS and OS in a multivariate analysis (for PFS, hazard ratio [HR] 0.90, 0.62-0.99, p = 0.026; for OS, HR 0.29, 0.13-0.79, p = 0.016), whereas tumor grade did not. Temozolomide alone as initial treatment of high-risk OG2 and OG3 with large residual tumor after surgery was not detrimental for survival. The same was true for observation in a small group of young patients with nonenhancing OG3 who have undergone complete resection and with only focal areas of malignancy (OG3f). This large retrospective cohort of IDH-mutant 1p/19q-codeleted oligodendrogliomas receiving standard treatments could serve as a benchmark for comparison with new IDH inhibitors in future clinical studies.

OBJECTIVE Extent of resection (EOR) has previously been demonstrated to have an impact on survival in patients with glioblastoma (GBM). However, with the World Health Organization (WHO) 2021 reclassification of GBMs based on IDH-mutation status, patients with "IDH-mutant GBMs," who typically survive long term, were reclassified as WHO grade 4 IDH-mutant astrocytomas and removed from the GBM taxonomy. Therefore, it is unknown whether the previously reported impact of resection on survival was a false-positive result due to the inclusion of the less aggressive IDH-mutant tumors in previous datasets. This study aimed to determine the extent to which EOR remains an independent predictor of survival in patients with WHO 2021 GBM after the reclassification of IDH-mutant grade 4 astrocytomas. METHODS All cases of GBM tumors (based on the pre-2021 GBM classification) that were newly diagnosed between 2005 and 2021 were identified in our institutional database and subsequently reclassified based on the updated WHO 2021 criteria using IDH status. Multivariable statistical analyses of demographic information, survival time, and EOR based on volumetric MRI were performed to determine the independent predictors of survival for the whole group of patients and for IDH-wildtype GBM patients exclusively. Additional analyses were performed to identify an EOR threshold for improvement in survival. RESULTS Of the 523 tumors classified as GBM based on the pre-2021 taxonomy, 52 (9.9%) cases were reclassified as WHO grade 4 IDH-mutant astrocytomas, and the median survival of patients in this group was 7.9 years, whereas median survival of the IDH-wildtype GBM patients was 1.4 years. Multivariate analyses of the whole group demonstrated that IDH-mutant astrocytomas were associated with reduced hazard of death. In both the whole group (n = 523) and in IDH-wildtype GBMs (n = 471), higher EOR of the contrast-enhancing (CE) tumor was associated with reduced hazard of death, whereas older age or male sex was associated with increased hazard of death. Because most patients (90%) had high EOR values (> 81%), a statistically meaningful EOR threshold could not be established. CONCLUSIONS These analyses demonstrated that EOR of the CE tumor is an independent predictor of survival and that greater EOR is associated with improved survival in WHO 2021 IDH-wildtype GBMs even after excluding grade 4 IDH-mutant astrocytomas. However, an absolute EOR threshold below which resection did not improve survival could not be established, raising concerns about prior cutoff assessments.

Preoperative systemic immune-inflammation index predicts seizure outcomes after anterior temporal lobectomy in drug-resistant temporal lobe epilepsy.

Minimally Invasive/Robotic Surgery for Gastric Cancer.

Extent of liver resection for incidental gallbladder cancer: Anatomic versus nonanatomic approaches in T2-T3 disease.

Lobar vs Sublobar Lung Resection for Early-Stage Epidermal Growth Factor Receptor-Mutant Non-Small Cell Lung Cancer.

European experience on oncological outcomes of patients with early-stage non-small cell lung cancer and any prior cancer following lobectomy or segmentectomy.

Thalamic gliomas (TGs) remain a formidable clinical challenge for accurate diagnosis and effective therapy. This study aims to refine molecular diagnosis and surgical management of TGs by integrating clinicopathological and multi-omics data. We analyzed 106 TGs, comprising 65 diffuse midline glioma (DMG) and 41 non-DMG, using genomic profiling, single-cell RNA sequencing, and orthogonal assays. Surgical outcomes were evaluated using rigorous causal inference frameworks, including propensity score matching and difference-in-differences analyses. Genomic profiling revealed striking mutual exclusivity between H3F3A mutations and CDKN2A/B (9p21) loss. Single-cell and orthogonal assays validated that 9p21 loss emerged as a highly specific adjunctive marker favoring non-DMG over DMG. Causal inference analyses consistently demonstrated that microsurgical third ventriculostomy (mTV) confers profound protection against postoperative hydrocephalus (risk reduction > 60%). Multivariate analysis identified the transfrontal approach as an independent predictor of postoperative motor deficits. Survival analysis showed that the median overall survival of this cohort following surgical resection was 21.0 months. Extent of resection and tumor mutational burden emerged as the principal independent determinants of prognosis, whereas postoperative KPS showed survival stratification in univariable/subgroup analyses but was not independently significant in multivariable model. In this 106-patient cohort study, we delineated the somatic mutational landscape of thalamic glioma and showed that 9p21 loss is mutually exclusive with H3F3A mutations, providing a highly specific adjunctive marker for thalamic glioma. We further demonstrated that maximal surgical resection confers a survival benefit and intraoperative mTV serves as a standardized treatment workflow to optimize care for thalamic glioma.

Characterization of response-adapted surgery following neoadjuvant systemic therapy in oral cavity cancer.

This study aimed to determine the parameters that should be taken into consideration to predict the development of postoperative complications in patients aged 80 years and over (octogenarians) who underwent lung resection. The data of 49 octogenarian patients who underwent lung resection between January 2016 and June 2025 were retrospectively analyzed. Patient demographics, operative parameters, and predictive indices and scores for postoperative complications (Charlson Comorbidity Index (CCI), Simplified Comorbidity Index (SCI), American Society of Anesthesiologists (ASA), Glasgow Prognostic Score (GPS), The Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) and Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM)) were calculated. Postoperative complications were recorded according to the Clavien-Dindo classification. The mean age of the patients, 79.6% of whom were male, was 81.98 ± 2.07 years. Statistically significantly fewer complications were observed in those who underwent sublobar resection compared to lobar resection (38.9% vs. 76.9%, p = 0.019). No correlation was found between CCI, SCI, ASA, and GPS scores and the development of complications (p = 0.170, p = 0.246, p = 0.774, p = 0.158, respectively), while ARISCAT and POSSUM scores were found to be predictive of complication development (p < 0.001, p < 0.001). In the multivariate analysis, while the extent of resection lost its status as an independent risk factor (p = 0.222), the classified ARISCAT score and the POSSUM score grouped according to the cut-off value determined by ROC analysis remained independent factors in predicting the development of complications. Patients in the high-risk group according to the ARISCAT score (OR = 16.482, 95% CI = 1.376-197.339, p = 0.027) and those with a POSSUM score above 31.100 (OR = 36.308, 95% CI = 3.889-338.952, p = 0.002) had a significantly higher incidence of postoperative complications. In this single-centre study, higher ARISCAT and POSSUM scores were associated with the development of postoperative complications in octogenarians. Given the limited sample size, the wide confidence intervals, and the predominance of minor (Clavien-Dindo grade I-II) complications, these scores should be regarded as promising adjuncts for risk stratification that require validation in larger, prospective, multicentre studies before being applied to patient selection.

Extent of resection (EOR) predicts local freedom from recurrence (LFFR) for meningiomas and is a key clinical trial design parameter. Simpson grade (SG) defines EOR based on intraoperative assessment of tumor removal, but MRI-based methods represent promising alternatives. The aim of this study was to compare the prognostic performance of SG vs MRI-based EOR paradigms for predicting recurrence and survival across histomolecular subgroups. International multicenter, retrospective cohort study included 475 meningiomas, resected between 1983 and 2024, which were classified by World Health Organization grade and molecular subgroups (DNA methylation, gene expression, and integrated grade). Area under the curve (AUC) was calculated for LFFR and overall survival (OS) from Cox models with a histomolecular subgroup and an EOR paradigm. Delta AUC (ΔAUC) compared EOR predictive performance within each subgroup, and log-rank comparisons of LFFR and OS were performed. MRI-defined gross total resection was associated with significantly longer LFFR and OS when compared with subtotal resection across most histomolecular subgroups. SG1-3 vs 4 distinguished differences in LFFR across several subgroups, but there were no consistent differences in outcomes when comparing degrees of dural treatment. Multivariable Cox including gene expression groups revealed that volumetric EOR (%) had a significantly higher AUC than SG (ΔAUC 0.07, P = .036) for 5-year OS; otherwise, there were no other differences between MRI-based or SG EOR paradigms for 5-year LFFR or OS. Additional significant differences for predicting 10-year LFFR all favored MRI-based EOR paradigms. Although SG and MRI-based EOR paradigms provide similar prognostic performance for predicting LFFR and OS in the era of molecular classification, MRI-based definitions may be preferred for future clinical trial inclusion criteria.

Chordoid gliomas are rare World Health Organization Grade II neoplasms of the third ventricle. While Gross Total Resection (GTR) has traditionally been the primary surgical objective, the intimate adherence to the hypothalamus and optic apparatus of these tumors creates a therapeutic dilemma for balancing oncological control against the risk of severe neurological and endocrine morbidity. This study aims to guide optimal management by bridging the evidence gap with the largest systematic review to date, analyzing clinical characteristics, surgical outcomes, and survival data.A systematic review was conducted according to PRISMA 2020 guidelines, searching Web of Science, PubMed, Scopus, and Embase for studies from database inception to November 2025. Data included patient demographics, clinical presentation, radiological phenotypes, surgical techniques, molecular profiles, and follow-up outcomes. Kaplan-Meier survival estimates and log-rank tests were used to assess survival outcomes by extent of resection. All analyses were performed using R-software (version 4.3.1).The cohort (N = 198; mean age 41.8 years; female-to-male ratio 2:1) predominantly presented with headache (51.3%), visual disturbances (37.5%), and cognitive deficits (24.4%). GTR was achieved in 56% of patients, while 32% underwent Subtotal Resection (STR), and 10% biopsy only. Kaplan-Meier analysis revealed a significant survival advantage for GTR, with a stable 5-year survival rate of 91.9% compared to 54.7% for STR (p = 0.0089). Molecular profiling identified PRKCA D463H as the predominant driver mutation, with BRAF V600E observed in a minority of cases.GTR is associated with superior long-term survival in the literature and may be considered when anatomically feasible. However, because this association may be confounded by tumor adherence and surgical selection, resection strategies must be strictly individualized to balance tumor control against hypothalamic morbidity.

Due to the complex anatomical structure, high variability of vasculature, and substantial controversies regarding treatment decision-making in left-sided colon cancer, standardized diagnosis and treatment has remained a research focus in the field of colorectal surgery. This article systematically reviews the core advances and clinical standards in the surgical management of left-sided colon cancer. The discussion encompasses the definition of the left colon and its special anatomical significance, the principles of surgical dissection of the left colonic mesentery, fascia, and interfascial spaces under the framework of membrane anatomy, the indications and technical essentials of totally intracorporeal digestive tract reconstruction, and the indications, extent, and nerve-sparing strategies for dissection of No. 223 and No. 253 central lymph nodes. A decision-making pathway for individualized bowel resection extent based on tumor location is proposed. The clinical value of the sequential "colonic stent for obstruction--neoadjuvant chemotherapy--radical surgery" treatment paradigm for obstructive left-sided colon cancer, as well as the indications and oncological benefits of multivisceral resection for cT4b left-sided colon cancer, are clarified. Targeted recommendations are also provided for special clinical scenarios, including additional radical surgery after endoscopic resection of early-stage cancer and the management of synchronous multiple primary tumors. This review aims to summarize the current progress and consensus in the diagnosis and treatment of left-sided colon cancer, offering a reference for establishing a comprehensive, standardized clinical system covering anatomical cognition, surgical techniques, and complex case management, with the goal of achieving a balance between oncological radicality and organ function preservation, thereby improving patients' long-term survival and quality of life.

Brain metastases affect 10-20% of cancer patients, yet the perioperative factors most strongly governing recurrence after surgical resection remain poorly characterised. This study aims to identify the perioperative determinants of recurrence of brain metastases. We conducted a retrospective cohort study of patients undergoing resection of histologically confirmed brain metastases between January 2010 and June 2024. Eligible patients were ≥ 18 years who survived to discharge and had complete surgical outcome records. Data were collected at patient and lesion levels, capturing demographics, tumour characteristics, extent of resection, resection technique, and capsule status. Outcomes were stratified by primary tumour origin using Kaplan-Meier and log-rank analysis, followed by clustered multivariable Cox proportional hazards regression to identify independent predictors of progression-free survival (PFS). 172 patients were included (361 total lesions, 247 resected). The three most common primary origins were lung (n = 70), breast (n = 42), and renal cell carcinoma (RCC, n = 31). RCC demonstrated significantly shorter time to recurrence than lung cancer (p = 0.0298) and melanoma (p = 0.0441), while lung cancer was associated with fewer minor complications than breast (p = 0.0329) and colon cancer (p = 0.0471). No significant differences in overall survival were observed. On multivariable Cox regression, younger age (HR = 0.97 per year), lesion size (HR = 1.03 per mm), piecemeal resection (HR = 2.22), and subtotal resection (HR = 2.21) independently predicted worse PFS. Breast cancer origin (HR = 0.54) and radiotherapy were significantly protective (HR = 0.37). Intraoperative capsule breach was the most influential modifiable predictor (HR = 2.70). Capsule integrity and resection technique are key modifiable determinants of recurrence following brain metastasis surgery, with implications for surgical planning and adjuvant therapy selection.

ABSTRACTPurposeThe optimal surgical strategy for early‐stage lung adenocarcinoma appearing as part‐solid nodules (PSN) versus pure solid nodules (SPN) remains debated. This study directly compares their clinicopathological features, surgical outcomes, and recurrence patterns to inform personalized management based on CT characteristics.MethodsThis retrospective study analyzed 710 surgical patients with clinical stage IA lung adenocarcinoma. Nodules were categorized as PSN or SPN by the presence of a GGO component on preoperative CT. Interaction‐effect analysis assessed CT‐attenuation dynamics in solid components. Propensity‐score matching balanced intergroup confounders, and Cox regression identified recurrence risk factors for each type.ResultsMean CT‐solid value (−13.2 Hu vs. 22.2 Hu, p < 0.001) and the trend of change in CT‐solid value during follow‐up (Interaction effect Index: −0.011078, p < 0.001) were significantly different between PSN and SPN. Upon histological examination, PSN had significantly lower incidences of visceral pleural invasion (11.7% vs. 30.4%, p < 0.001) and lymph node metastasis (11.2% vs. 20.6%, p = 0.008) than SPN. After propensity‐score matching, patients with PSN had significantly better recurrence‐free survival (86.8% vs. 70.7%, p < 0.001) than those with SPN. In Cox regression analysis, sublobar resection and lymph node sampling‐only were associated with increased risk of loco‐regional recurrence in SPN, but not in PSN.ConclusionPSN and SPN show distinct clinicopathological features and prognostic profiles, suggesting potentially different biological behaviors. CT features need to be incorporated with clinical tumor stage in deciding surgical strategies on resection extent and lymph node examination for early‐stage lung adenocarcinoma.

Refined risk stratification before randomization is clinically important for reducing prognostic imbalance across study arms when evaluating novel therapies for glioblastoma. However, current artificial intelligence-assisted prognostic models are often limited by complex computational pipelines, limited bedside applicability, and insufficient biological interpretability. This study aimed to develop a prognostic model, supported by an online-accessible platform, for individualized risk stratification of glioblastoma using MRI-based intratumoral heterogeneity and routinely available clinical features, and to investigate the biological meaning of model-driven risk stratification. This retrospective multicenter study included 836 patients with isocitrate dehydrogenase-wildtype glioblastoma from six centers between October 1996 and May 2025. The habitat risk score (HRS) for each patient was derived from a proposed intratumoral heterogeneity index and quantitative metrics extracted from three-dimensional preoperative MRI-based vascular habitat mappings. Independent predictors of overall survival (OS) were identified using Cox proportional hazards regression analysis, and three prognostic models (HRS model, clinical model, and radio-clinical model) were developed and validated in spatial and temporal external sets. Model interpretability was assessed using time-stratified Shapley additive explanations (SHAP) analysis. A web-based interactive platform was implemented for rapid individualized risk assessment. The biological meaning of model-driven risk stratification was explored using transcriptomic and histologic profiling. HRS, Karnofsky performance status (KPS), O6-methylguanine-DNA methyltransferase promoter methylation status, and extent of resection were identified as independent predictors of OS, with KPS and HRS contributing most strongly to survival prediction in SHAP analysis. The radio-clinical model demonstrated good predictive performance and outperformed the clinical model and the HRS model, with C-indexes of 0.74 and 0.77 in the spatial and temporal validation sets, respectively. It also effectively stratified patients into low- and high-risk groups regardless of first-line therapeutic regimen (log-rank, P < 0.05). Mechanistically, high-risk tumors showed increased tumor stemness and expanded HIF1α-positive regions, whereas low-risk tumors exhibited an immune-stimulatory phenotype. The deployed web-based platform enabled rapid patient-specific risk estimation to support bedside application. This study establishes an interpretable and clinically deployable framework for glioblastoma risk stratification by integrating imaging-derived intratumoral heterogeneity with routine clinical features, without requiring complex computational infrastructure. The model also provides biologically grounded insights into model-driven risk stratification.

Glioblastoma (GB) is the most aggressive primary brain tumor in adults. Tumor-associated epilepsy at diagnosis (TAE) is common, yet its prognostic significance remains unclear. We analyzed a retrospective multicenter test cohort of 855 GB patients (Aachen, Hamburg, Bielefeld) and validated findings in a prospectively collected cohort of 344 patients (Erlangen). Survival was assessed using multivariable Cox regression, propensity score matching, and interaction modeling of TAE and extent of resection (EOR). Molecular profiling included methylation-based classification, epigenetic deconvolution, and spatial transcriptomics. TAE was independently associated with improved survival (HR 0.81, 95% CI 0.69-0.99, P = .036, absolute survival advantage ∼4-5 months). This effect was validated in the independent cohort (C-index 0.68 (95% CI 0.62-0.74) and persisted in propensity-matched analyses (HR 0.74, 95% CI 0.56-0.96, P = .027). Interaction modeling revealed that gross total resection (GTR) improved survival in both groups but particularly in patients with TAE (EOR interaction HR 0.69, 95% CI 0.49-0.99, P = .041). In this subgroup, partial resection provided no significant advantage over biopsy, whereas patients without seizures benefited incrementally from both partial resection and GTR. Molecular analysis demonstrated enrichment of the RTK II subtype, differentiated cell states, and an inflammatory microenvironment in glioblastoma with TAE; tumors without seizures displayed neuronal and stem-like features. Functional validation using Electrogenomics showed that glioblastoma cortical slices with increased inflammatory score exhibited synchronization of action potentials characteristic for seizure-like epileptiform activity. TAE at diagnosis is a favorable prognostic marker in GB, defining a biologically distinct subgroup. Seizure status modifies the prognostic effect of surgical resection, underscoring the importance of GTR particularly in patients presenting with TAE.

The purpose of this study was to review the assessment of residual tumor, analyze surgical factors associated with incomplete resection, determine the risk of neurological sequelae for reoperation, and assess the impact of second surgeries on survival. Patients 0-21 years old with nonmetastatic intracranial ependymoma treated within the prospective multicenter E-HIT2000 trial were included. Prospective central neuroradiological review of pre- and postoperative imaging was performed. The 291 patients included in the E-HIT2000 trial underwent surgery at 71 centers in Germany, Austria, and Switzerland. Timely central review of postoperative imaging of sufficient quality was performed in 206 patients, and extent of resection was classified as gross-total resection (GTR) in 137 (67%) patients and incomplete with residual disease (RD) in 69 (33%) patients. Surgeons erroneously reported GTR in 11/40 patients with RD and available surgical reports; adhesions in the rhomboid fossa and/or brainstem were the most common reasons for intentional RD. Twenty-three of the 69 patients with RD underwent a second surgery as part of their primary treatment, 11 before and 12 after the start of adjuvant therapy; in 11/23 patients, GTR was achieved after a maximum of 3 procedures. The frequency of postoperative neurological deficits in the patients with second surgery did not differ from that in patients with primary GTR. Ten-year overall survival with GTR was 69.8% ± 4.4% versus 51.2% ± 7.1% with RD (p = 0.002). A second surgery significantly improved progression-free survival (42.4% ± 11.5% vs 22.2% ± 6.5% without second surgery, p = 0.004). Second surgery was not associated with an increased frequency of neurological sequelae and conferred an advantage in survival overall. The authors strongly recommend early central neuroradiological review to evaluate postoperative residual tumor and discuss reoperation. Further studies are needed to outline a tailored risk assessment for each patient based on molecular and clinical aspects.

Insular gliomas- white fiber tract based topography and focused surgical strategy- analysis of 69 surgically treated cases.

To systematically review the published literature on minimally invasive spine surgery (MISS) approaches for intramedullary spinal cord tumor (IMSCT) resection and summarize surgical techniques, perioperative outcomes, neurological results, and complications. A PRISMA-guided search of PubMed, CINAHL, Cochrane Trials, and Scopus was performed from inception through November 19, 2025. Studies reporting MISS techniques for IMSCT resection with operative details and perioperative outcomes were included. Out of a total of 482 studies identified, 11 were included that reported on a total of 222 patients (Age range: 11-72; 52.9% male population). 64% of included studies (n=7 of 11) were retrospective case series whereas 36% (n=4 of 11) were case reports. Posterior tubular retractor-based approaches were most commonly reported, with fewer studies describing non-tubular, muscle- and bone-preserving laminotomy techniques. Tumors most frequently involved the cervical (33.2%; n=74 of the 223 tumors), and thoracic spine segments (30.9%; n=69 of the 223 tumors). Ependymoma (41.3%; n=92 of the 223 tumors), astrocytoma (32.3%; n=72 of the 223 or tumors), and hemangioblastoma (16.6%; n=37 of the 223 or tumors) were the most common histologies. Estimated blood loss was reported in 7 of 11 studies (63.6%) and was uniformly low (under 200 mL); length of hospital stay was reported in 7 of 11 studies (63.6%) and was generally short (3 to 6 days); and extent of resection was reported in all included studies (11/11, 100%), with high rates of gross total resection (87.4%; n=195 of the 223 tumors). Postoperative neurological outcomes were most often stable or improved relative to baseline. Complications and recurrences were uncommon, though follow-up duration was variable. MISS approaches for IMSCT resection are feasible in select cases and can be performed using posterior muscle- and bone-sparing techniques, with generally minimal complications and stable or improved postoperative neurological function. Favorable outcomes likely reflect both technical advantages and selection of tumors with anatomical and histological characteristics suited to MISS. Such variables should be controlled for in future comparative studies.