Background: the phenomenon of cancer not only attacks the physical, but also the psychological. One of the actions to deal with physical problems is through elective oncology surgery, which often causes anxiety for patients. This anxiety cannot be considered a small thing because it can have an impact on delaying and even canceling oncology surgery. Objective: this study aims to describe the anxiety level of preoperative patients of elective oncology surgery. Methods: this study employed a descriptive observational study with a cross-sectional approach. Respondents were selected using a purposive sampling technique with specific inclusion and exclusion criteria. Data were collected through the distribution of demographic questionnaires and the Depression Anxiety Stress Scale-21 (DASS-21) questionnaire and analyzed by descriptive statistics. Results: respondents in this study totaled 106, with 56 respondents who did not experience anxiety (52.8%), 27 respondents who experienced moderate anxiety (25.5%), 12 respondents who experienced severe anxiety (11.3%), 11 respondents who experienced mild anxiety (10.4%), and no one experienced panic attacks. Conclusion: most respondents did not experience anxiety, and almost half of the respondent’s experienced anxiety from low to severe levels. Nurses are expected to innovate in providing counseling, information, and education with digital media and technology related to reducing anxiety before oncology surgery, both in the inpatient and outpatient rooms.

Background Gynaecological cancers constitute a major cancer burden globally. So the service demand in gynaecology oncology is increasing day by day. The gynecological cancers where surgical intervention may be needed are cervical, uterine or endometrial, ovarian, vulvar, and vaginal cancers and the procedures may range from staging, debulking surgeries involving multiple visceral organs resections, total/radical hysterectomy, lymphadenectomy, vulvectomy and vaginectomy. Due to the complexity of these surgeries and patient-related factors, complications are common. This study evaluates intraoperative and postoperative complications in gynecological cancer surgeries at Purbanchal Cancer Hospital, Birtamode. Methods This prospective study was conducted in the Department of Gynecology Oncology at Purbanchal Cancer Hospital from July 2023 to January 2025. A total of 70 patients diagnosed with or suspected of having gynecological cancer were included. Data were collected from the hospital electronic medical records regarding patients profile, surgery type, operative time, intraoperative events, blood loss, complications, and hospital stay. The primary outcomes were intraoperative and postoperative morbidity, measured through the Clavien-Dindo classification of surgical complications. The secondary outcome were patient profile, average hospital stay and blood loss. Results Among the 70 surgeries performed, the most common were staging laparotomies (34), debulking surgeries (17), and radical hysterectomies (11). The average patient age was 51-60 years, with 88% being parous and 60% menopausal. The mean operative time was 270 minutes, with majority (38.5%) of patients experiencing blood loss between 200-300 ml. Clavin Dindo scoring for surgical complications stratification was done and 68% of the patients had CD score 1 followed by CD 2 which constituted 32%. Intraoperative complications included bowel injury (7.1%), bladder injury (5.5%), and vessel injury (1.3%). Postoperative complications included urinary tract infections (5.5%), paralytic ileus (2.6%), chest infections (4.2%), chyluria (1.3%) and secondary haemorrhage (1.3%). The average hospital stay was 8 days. Conclusion Gynecological oncology surgeries are complex, with notable intraoperative and postoperative complications. Multidisciplinary care, prehabilitation, and proper postoperative management are essential in reducing morbidity and improving outcomes. The surgical complication rates in this study are consistent with similar large studies.

Treatment of spinal tumors is complex and resource-intensive. The LACE+ index is a validated tool for predicting postoperative readmission and mortality. It incorporates length of stay, acuity of admission, comorbidity (Charlson index), and emergency visits and age, sex, and previous admissions (LACE+). This study assessed whether the LACE+ index has predictive value in patients undergoing spinal tumor surgery. Data on patients undergoing spinal oncology surgery (n = 757) with preoperative LACE+ index were collected. Most patients underwent posterior instrumented aiming for gross total resection. Coarsened exact matching was used to account for confounding variables and assess the predictive value of LACE+. Patients with a LACE+ score in the top 50% of the study cohort (score >58, n = 169) were compared with matched patients in the bottom 50% (score ≤58, n = 169). Outcomes assessed included 30- and 90-day emergency department visits, readmissions, reoperations, nonhome discharges, and mortality. The cohort included primary (42.8%), metastatic (56.0%), and unknown spinal tumors (1.2%), with a mean age of 58 years (range 18-88). There were 386 patients with LACE+ ≤58 (51%) and 371 patients with LACE+ >58 (49%). Patients with high LACE+ scores were significantly more likely to be readmitted 30 (Odds ratios [OR] 1.91 [1.13, 3.19], P = .0169) and 90 days (OR 1.86 [1.17, 2.94], P = .0097) after surgery when compared with otherwise matched patients with a low LACE+ score. High LACE+ score patients were also more likely to require postacute care after discharge (OR 2.33 [1.48, 3.66], P = .0001) and have higher mortality rates at 90 days (OR 3.4 [1.25, 9.215], P = .0169). There were no differences in postoperative emergency department visits or reoperations. The LACE+ index can prospectively predict readmission, nonhome discharge, and mortality for spinal oncology patients after surgery. Application of the LACE+ index may help risk stratify and guide management of spinal tumor patients in the perioperative setting.

Abstract Endometrial cancer is the most frequent gynecologic malignancy in developed countries, with increasing incidence in Latin America. Minimally invasive approaches have become the standard for early-stage disease, with robotic surgery offering enhanced ergonomics and precision. Sentinel lymph node (SLN) mapping using radioguided techniques is a validated strategy to reduce the morbidity associated with systematic lymphadenectomy while maintaining accurate staging. We report the case of a 60-year-old woman diagnosed with endometrioid adenocarcinoma FIGO grade 1 who underwent robotic radical hysterectomy with radioguided sentinel lymph node mapping. This is the first reported case in Ecuador combining robotic surgery with nuclear medicine-guided sentinel node detection.

BACKGROUNDThe vascular endothelial glycocalyx (VEG) plays a critical role in maintaining vascular barrier integrity, regulating inflammation, and ensuring microcirculatory homeostasis. Surgical stress and systemic inflammation can disrupt the glycocalyx, leading to endothelial dysfunction, impaired microcirculation, and adverse postoperative outcomes. dexmedetomidine (DEX), an α2-adrenergic agonist with anti-inflammatory and organ-protective properties, has been suggested in preclinical and clinical studies to mitigate glycocalyx degradation, yet evidence in gastrointestinal cancer surgery remains limited.AIMTo determine whether perioperative DEX attenuates surgical inflammation-induced VEG degradation and preserves endothelial barrier function in patients undergoing gastrointestinal cancer resection.METHODSThis was a prospective, single-center, randomized, double-blind, placebo-controlled trial conducted at the First Affiliated Hospital of University of Science and Technology of China. A total of 110 patients undergoing elective gastric or colorectal tumor resection were randomly assigned (1:1) to receive intraoperative DEX or saline placebo. Anesthesia and analgesia were standardized across groups. The primary outcome was plasma syndecan-1 concentration, a marker of endothelial glycocalyx injury, measured at four perioperative timepoints (T0-T3). Secondary outcomes included inflammatory biomarkers [interleukin-6 (IL-6), tumor necrosis factor-alpha, C-reactive protein, heparan sulfate], microcirculatory parameters [perfused vessel density (PVD), flow index, P(v-a)CO2, lactate], and clinical endpoints [extubation time, opioid use, Visual Analog Scale (VAS) scores, Quality of Recovery-15 Questionnaire (QoR-15), length of stay, and 30-day complications]. Postoperative complications were defined by Clavien-Dindo criteria and adjudicated by blinded investigators. The trial was registered prospectively (ChiCTR2500109633) and powered to detect a clinically meaningful difference in syndecan-1 levels.RESULTSA total of 110 patients were randomized equally to the DEX or control group, with well-balanced baseline characteristics. Compared with controls, DEX significantly reduced postoperative infections (7% vs 16%) and intensive care unit admissions (7% vs 13%), shortened extubation time (13.1 ± 3.0 minutes vs 18.4 ± 4.0 minutes; P < 0.001), and decreased opioid use (23.1 ± 5.0 mg vs 27.3 ± 6.0 mg; P = 0.004) and VAS pain scores (P = 0.002). At abdominal closure, DEX attenuated endothelial glycocalyx injury, as evidenced by lower plasma syndecan-1 (44.72 ± 7.10 ng/mL vs 48.73 ± 6.26 ng/mL; P = 0.002) and heparan sulfate levels (P = 0.001). IL-6 was significantly reduced at 24 hours (110.77 ± 29.72 pg/mL vs 138.86 ± 35.95 pg/mL; P < 0.0001) and positively correlated with syndecan-1 (r = 0.71). Microcirculatory function improved with DEX, including higher PVD (21.40 ± 3.50 mm/mm² vs 19.94 ± 2.93 mm/mm²; P = 0.019), increased flow index, lower P(v-a)CO2 (P < 0.001), and reduced lactate (P = 0.003). DEX also improved recovery outcomes, with higher QoR-15 scores (P = 0.001), shorter hospital stays (6.49 ± 1.29 days vs 7.29 ± 1.59 days; P = 0.005), and fewer overall 30-day complications (12.7% vs 30.9%; P = 0.036). Receiver operating characteristic analysis identified syndecan-1 > 45 ng/mL at abdominal closure as a potential predictor of postoperative complications (area under the curve = 0.68, 95%CI: 0.59-0.76), and multivariable analysis showed a near-significant association (OR = 2.88, P = 0.057). Subgroup analyses demonstrated consistent anti-inflammatory and endothelial-protective effects of DEX across age and surgical approach strata.CONCLUSIONPerioperative administration of DEX confers significant endothelial-protective effects by mitigating glycocalyx degradation, suppressing systemic inflammation, and promoting enhanced postoperative recovery. These findings support its clinical utility as a valuable adjunctive therapy in the perioperative management of patients undergoing oncologic gastrointestinal surgery.

Craniofacial surgery requires synthesis of complex, multidisciplinary knowledge, yet specialty-specific decision support tools are lacking. Retrieval-augmented generation (RAG) offers an opportunity to create transparent, evidence-based artificial intelligence (AI) systems tailored to surgical practice. The authors developed CASPER, a domain-specific, multimodal RAG system with text and image analysis capabilities, built with RAPTOR hierarchical architecture and a knowledge base of 8561 open-access craniofacial surgery articles (2000-2025). The system retrieved and synthesized peer-reviewed literature in response to 25 clinical questions spanning craniofacial subspecialties. Performance was evaluated using semantic similarity (SEM-eval) to retrieved documents, manual content coverage review, and manual citation accuracy verification. CASPER achieved strong alignment with supporting literature (mean SEM-eval 0.89±0.04; range: 0.81-0.96), integrating an average of 7.8 sources per query. Highest performance was observed in pediatric airway (0.93), facial trauma (0.93), and oncologic surgery (0.95), with top scores for Pierre-Robin mandibular distraction (0.96) and orbital floor fracture management (0.95). Lower scores occurred in complex or emerging domains such as Le Fort III contraindications (0.81) and facial feminization planning (0.81). Manual review confirmed that CASPER maintained high content coverage across scenarios, with citations consistently accurate and directly supportive of system outputs. CASPER is the first citation-enabled AI system for craniofacial surgery and demonstrates expert-comparable reasoning across diverse clinical scenarios. By delivering transparent, evidence-grounded recommendations, CASPER has the potential to enhance surgical planning, improve decision-making consistency, and accelerate knowledge translation in both clinical practice and surgical education.

Bone metastasis from lung cancer is one of the common complications in patients with advanced lung cancer, which can lead to pathological fractures, spinal cord compression, bone surgery, bone radiotherapy, and other skeletal related events (SREs), severely affecting the quality of life and prognosis of patients. The Non-Small Cell Lung Cancer Committee of the Chinese Society of Clinical Oncology convened a multidisciplinary expert panel comprising specialists from respiratory medicine, oncology, orthopedics, radiation oncology, nuclear medicine, radiology, and oral and maxillofacial surgery to develop this consensus. It is based on domestic and international evidence-based medicine and clinical practice experience, and was formulated through repeated consultations and thorough discussions. The consensus provides nine recommendations from six perspectives: diagnosis, screening, treatment strategies, bone-targeted drug treatment strategies and management of adverse reactions, local treatment, and efficacy evaluation. These recommendations are intended for reference and used by relevant medical personnel. The development of this consensus aims to provide scientific and practical guidance for clinicians, with the expectation of improving the quality of life and prognosis of patients.

Real-time fluorescence-guided surgery has become an increasingly important intraoperative tool in abdominal oncologic surgery, providing surgeons with dynamic visual information that supports critical decision-making during complex procedures. This review analyzes current evidence on fluorescence-guided imaging techniques, with particular emphasis on near-infrared fluorescence using indocyanine green and tumor-targeted probes, and explores their potential integration with assistive surgical technologies such as exoskeleton-based support systems. The available literature demonstrates that fluorescence guidance plays a central role in margin refinement, perfusion assessment, identification of critical anatomy, and detection of occult disease, thereby enhancing intraoperative precision and safety. Furthermore, recent studies highlight the importance of visualization workflows and interface design, underscoring the need to consider how surgeons interpret and act upon fluorescence-derived information in real time. From a workflow-oriented perspective, the combination of advanced imaging and biomechanical support may contribute to more consistent execution of fluorescence-informed decisions, particularly during prolonged and technically demanding oncologic procedures. This review contextualizes these findings within international surgical practice, with specific relevance to educational and clinical settings in Mexico, Colombia, and Ecuador. Overall, the evidence supports a holistic view of precision surgery in which fluorescence-guided imaging and assistive technologies function synergistically to enhance surgical performance, decision-making, and training in abdominal oncologic surgery.

Pediatric musculoskeletal and cancer surgeries often lead to significant postoperative pain. Augmented reality (AR), a non-pharmacological approach to pain modulation, has been insufficiently studied for its potential role in reducing opioid use following major surgery in children. In this pilot trial, we randomly assigned pediatric patients undergoing major surgery, in a 1:1 ratio, to an AR versus non-AR scavenging game postoperatively. Randomization was stratified according to the study site. The primary endpoint was the rate of persistent opioid use measured at 90 days after hospital discharge. Secondary endpoints included pain intensity, opioid use, inpatient ambulation or "out of bed", movement, length of stay, and adverse events. We considered the trial a success if the rate of opioid use at 90 days postoperatively was significantly lower in the AR arm than in the non-AR arm. A total of 66 patients underwent randomization (n = 33 in each arm). The median age of each group was 12 years old. There were more females (72.7%) in the AR group than in the non-AR group (48.5%). Most patients (80%) had undergone oncological surgeries. The primary endpoint was met in over 95% of the patients. The overall rate of opioid use was low in both groups of patients (AR: 6.1% and non-AR: 9.7%) and did not reach statistical significance (p = 0.667). There were no statistically significant differences in secondary outcomes. In conclusion, this pilot study does not support the use of AR aimed at reducing the rate of persistent opioid use following pediatric surgery.

A set of preclinical trials was conducted to study the biomedical properties of personalized model implants based on aluminum oxide in the reconstruction of facial skeletal defects and to substantiate the advantages of their use. The study involved cell cultures and laboratory animals, including at least 30 small-sized laboratory animals (mice or rats) and at least 20 medium-sized laboratory animals (rabbits). The advantages of model implants based on aluminum oxide and titanium aluminum for facial skeletal reconstruction are demonstrated. On their basis, the relevance of integrating the discussed approach into conventional surgical treatment for the majority of patients requiring reconstruction is substantiated.

Robotics has gained popularity in abdominal and pelvic oncological surgery, showing advantages such as reduced blood loss and postoperative pain, and shorter hospital stays. Its use has expanded to resect retroperitoneal Nerve Sheath Tumors (NSTs), allowing for minimally invasive excision of larger tumors within a complex anatomic setting. In this study, we present our initial experience with robotic resection of a retroperitoneal NSTs and conduct a systematic review of the literature, with a focus on intraoperative performance and long-term outcomes. At our institution, 2 patients underwent robot-assisted resection of benign retroperitoneal NSTs. Intraoperative neuromonitoring was used to ensure safe and complete tumor excision. The procedures were completed with a mean operative time of 98 minutes and a blood loss of 100 mL. A systematic review was then conducted, identifying 62 additional cases of retroperitoneal NSTs treated with robotic surgery, to assess its efficacy and clinical outcomes. Robotic-assisted surgery has been performed on 64 cases of retroperitoneal NSTs. The mean surgical time was 1.95 hours (range: 0.27-6.28 hours), with an average blood loss of 57.03 mL (range: 10-600 mL). After surgery, temporary neurological impairments occurred in 12.7% of cases, while persistent neurological deficits were observed in 5.4% of patients. Average postoperative hospital stay was 3.39 days (range: 1-9 days). Robotic resection of retroperitoneal NSTs has shown potential advantages, including reduced blood loss, shorter operative time, and decreased hospital stay. However, the high initial costs and inherent learning curve remain significant barriers to its widespread adoption in routine clinical practice.

Cancer burden is rising in sub-Saharan Africa, where late presentation is common. Surgical oncology is pivotal for diagnosis, curative-intent management, and palliation, yet its contribution to hospital surgical activity in Benin remains undocumented. This study aimed to assess the contribution of surgical oncology to the overall surgical workload in tertiary hospitals in the Littoral Department of Benin and to describe the epidemiological profile, case distribution, and early outcomes of operated patients. We conducted a retrospective, hospital-based cross-sectional study across three tertiary referral hospitals. Retrospective data were extracted from operative logs, anesthesia records, and surgical ward files for all surgical procedures performed from January 1 to December 31, 2023.Cancer-related operations were identified and analyzed. Descriptive statistics were used to summarize the characteristics of the patients and surgeries performed. Additionally, 30-day postoperative survival was estimated using Kaplan-Meier methods. Of the 7,902 surgical procedures performed in 2023, 155 were cancer-related, accounting for 1.96% of the overall surgical volume. The most common cancer sites were breast (n = 36; 23.2%), prostate (n = 24; 15.5%), stomach (n = 16; 10.3%), colon (n = 16; 10.3%), and rectum (n = 10; 6.5%). Most patients presented with advanced disease, with 53.5% diagnosed at stage III-IV (stage III: n = 47; 30.3%; stage IV: n = 36; 23.2%). Open surgery was the predominant surgical approach (n = 125; 80.6%). Postoperative complications occurred in 23 patients (19.7% of the 117 patients with available data). Among the 114 patients with follow-up data suitable for survival analysis, seven patients had died, corresponding to a crude postoperative mortality rate of 6.1% (n = 7). At 30 days postoperatively, the estimated 30-day survival probability was 94% (95% CI: 89-99%). In 2023, oncologic surgeries represented a small fraction of surgical operations performed in the three tertiary hospitals located in the Littoral Department of Benin. Most surgical cases corresponded to advanced-stage tumors, reflecting the severity of disease among patients reaching surgical management.

Informed consent is fundamental to oncological surgery, but communication is often hindered by medical terminology, inconsistent explanations and variation in patient understanding. Large language models may improve accessibility by generating simplified consent information. This study assessed whether four leading artificial intelligence (AI) chatbots, ChatGPT (GPT-4), Gemini (2.5 Flash), DeepSeek (R1) and Grok (3) could generate information understandable to patients and comprehensive enough to support informed consent for six common oncological operations. Standardised patient-style prompts were applied, and chatbot outputs were evaluated for readability using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL) and Gunning Fog Index (GF). Quality and completeness, including coverage of procedure details, risks, benefits, alternatives and consequences of no treatment, were assessed by three consultant surgeons using a modified DISCERN instrument. Gemini produced the highest quality information (mean DISCERN 72.3 ± 3.0), followed by Grok (63.0 ± 1.8), whereas ChatGPT (48.0 ± 4.7) and DeepSeek (47.1 ± 1.8) performed less well. DeepSeek generated the most readable content (FKGL 9.7; GF 10.8), although no model achieved the recommended sixth-grade level. Common limitations included the lack of systematic referencing (except Gemini), occasional factual inaccuracies, reliance on predominantly US-based resources, and failure to assess patient understanding. Overall, AI chatbots can provide structured, accessible information to support surgical consent, but current limitations restrict their use as standalone tools. Gemini demonstrated the strongest balance of readability and quality, yet all models require refinement to improve reliability, equity, and patient safety. At present, AI should complement, rather than replace, clinician-led consent discussions.

ObjectivesNeuropathic pain (NP) is a common and challenging complication following thoracic oncology surgery, characterized by complex etiological factors. However, effective predictive models for identifying high-risk patients are currently lacking. This study aims to determine the incidence and key risk factors associated with neuropathic pain following thoracic oncology surgery, and to construct and validate a series of machine learning-based risk prediction models, providing a scientific foundation for clinical decision-making.MethodsThis study involved 647 patients who underwent thoracic oncology surgery at a specialized cancer hospital in Sichuan Province, China (November 2022 to December 2023). An information survey was designed to collect general demographic data and influencing factors. Outcome indicators were assessed using the Numeric Rating Scale (NRS) for postoperative acute pain and the Douleur Neuropathique 4 Questionnaire (DN4) for neuropathic pain evaluation. Using stratified sampling, the patients were divided into training (80%) and testing (20%) datasets. Univariate analysis and LASSO regression were employed to identify independent risk factors for postoperative neuropathic pain, resulting in the selection of seven factors for model inclusion. Subsequently, six machine learning models were developed using Python 3.11: logistic regression (LR), K-nearest neighbors (K-NN), random forest (RF), support vector machine (SVM), XGBoost, and LightGBM (LGBM). To enhance model accuracy, parameter tuning and ten-fold cross-validation were employed, and performance was evaluated using the testing set with the Area Under the Curve (AUC) metric. A visualization analysis of the model’s variable features was conducted, and the Shapley Additive Explanations (SHAP) values of the predictive models were calculated to identify the significant influencing factors and their respective impact levels on postoperative neuropathic pain in thoracic oncology.ResultsThe incidence of postoperative NP was 24.26%. The random forest model demonstrated the highest predictive performance (AUC = 0.86). SHAP value analysis revealed that the primary determinants for the onset of neuropathic pain include the surgical approach, the surgeon’s expertise, the quantity of thoracic drainage tubes, the duration of thoracic drainage tube placement, postoperative acute pain, and C-reactive protein (CRP).ConclusionsThe random forest model effectively predicts neuropathic pain following thoracic oncology surgery, facilitating early screening and targeted interventions to improve outcomes.

Robotic-assisted surgery has revolutionised the landscape of minimally invasive surgical oncology by enabling enhanced precision, dexterity, and visualisation, especially in anatomically complex regions. The integration of robotic platforms into oncological surgery offers a distinct advantage in achieving oncological safety with minimal morbidity. This case series demonstrates the feasibility, safety, and adaptability of robotic techniques in challenging cervicothoracic and head–neck oncologic procedures. It includes three patients who underwent complex robotic surgeries: A robotic oesophagectomy in a frail patient with poor pulmonary function, salvage transoral robotic surgery (TORS) after dual radiation exposure, and a robotic thyroidectomy using the bilateral axillo-breast approach (BABA). Each case was planned and executed after multidisciplinary evaluation, with emphasis on patient selection, surgical planning, and intraoperative considerations. All procedures were successfully completed using robotic platforms without intraoperative complications. Patients demonstrated satisfactory postoperative recovery with minimal morbidity and excellent cosmetic and functional outcomes. Histopathological evaluation confirmed negative margins in all cases. Robotic-assisted surgery offers significant advantages in precision dissection, access to deep anatomical spaces, and improved postoperative recovery in carefully selected oncologic cases. This series highlights the versatility of robotic platforms in addressing surgical challenges across the cervicothoracic and head–neck regions. Further studies with larger cohorts and long-term follow-up are warranted to establish oncologic equivalence and cost-effectiveness.

Background: The importance of integrating enhanced recovery after surgery protocols in gynecologic oncology has been proven in numerous studies. However, the actual adherence to protocol among institutions remains inconsistent in clinical practice, particularly among those without prior structured implementation. This pragmatic multicenter study provides a preliminary report from the ongoing ERGO (Enhanced Recovery in Gynecologic Oncology) cohort study (ClinicalTrials.gov: NCT06655506) and aims to evaluate adherence to enhanced recovery protocols during the early phases of its adoption as well as identify factors that determine low uptake. Methods: Overall, 300 consecutive patients undergoing gynecologic oncology surgery across five institutions were included in the present study. Adherence to preoperative, intraoperative, and postoperative enhanced recovery elements was documented using standardized forms. Optimal adherence was predetermined as fulfillment of more than 70% of the enhanced recovery components included in the pathway. Multinomial analysis was used to identify predictors of adherence. Results: Overall, 70.3% of patients achieved optimal adherence; however, rates varied across centers (26.9-84.4%), reflecting the limited institutional familiarity with enhanced recovery pathways in most participating centers. The actual volume of cases handled was an important determinant of adherence, with high-volume units consistently demonstrating substantially higher compliance compared with lower-volume hospitals. Routine preoperative items demonstrated high uptake, whereas several intraoperative and early postoperative components showed low and heterogeneous implementation, which might be the result of anesthesiology-driven practices. Higher surgical complexity and poorer performance status independently predicted reduced adherence. Visual mapping confirmed that complex procedures resulted in lower adherence. Conclusions: The significant variability in enhanced recovery protocol adherence that was observed in our study indicates the need to institute structured workflows that help increase team familiarization, particularly in high-complexity cases and centers new to these elements.

Implant-based reconstruction is the most frequent procedure after mastectomy. Effective preoperative counseling and a thorough informed consent process are crucial for informing patients about oncologic surgery, reconstruction options, and expected cosmetic outcomes. Recent studies indicate that a multimedia video-assisted informed consent procedure may enhance patient information retention compared to traditional methods. This study aims to compare the conventional informed consent process, supplemented with a written informational brochure, to a multimedia video-assisted approach. From January to June 2024, 265 consecutive breast cancer patients scheduled for mastectomy and implant-based reconstruction at the European Institute of Oncology in Milan, Italy, were enrolled in this controlled randomized prospective study. Of these, 200 patients completed evaluation questionnaires assessing information retention and anxiety. A six-minute video featuring simple schematic illustrations and automated text-to-speech narration in Italian was developed to enhance understanding of the risks, benefits, and alternatives of the surgical treatment. Patients were randomly assigned to two groups: Group A received the video presentation along with evaluation questionnaires via email, while Group B received only the questionnaires. Patients in the multimedia video-assisted group demonstrated significantly higher overall comprehension compared to those in the control group. Although scores from the Spielberger State/Trait Anxiety Inventory (STAI) and the Decisional Conflict Scale (DCS) indicated greater anxiety and decisional conflict in the standard group, these differences were not statistically significant. The multimedia video-assisted informed consent process is an effective tool for enhancing patient knowledge and awareness regarding implant-based breast reconstruction. This method improves information uptake and retention, suggesting its superiority over traditional communication techniques in preoperative counseling. These findings support the integration of multimedia resources in patient education to facilitate better-informed decision-making. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The role of nipple-areola complex tattooing in breast cancer psycho-physical rehabilitation: An updated review.

Pheochromocytoma is a rare neuroendocrine tumor that originates from the chromaffin cells of the adrenal medulla and is capable of synthesizing catecholamines. In this regard, pheochromocytoma leads to the development of significant disorders of the cardiovascular system, primarily causing significant increases in blood pressure, being an urgent problem for pediatric oncologists and surgeons. The prevalence of pheochromocytoma (together with paraganglioma) is 1 case per 300,000, with children and adolescents accounting for 20% of cases. Adrenalectomy is the “gold standard” treatment for patients with pheochromocytoma. Surgical treatment includes both traditional open techniques and minimally invasive ones, such as laparoscopy and robotic surgery. One of the main factors limiting the use of minimally invasive surgery is the large size of the tumor. However, modern researchers from around the world are increasingly using minimally invasive techniques. The article presents a clinical case of successful use of robotic adrenalectomy in a 12-year-old patient with a giant pheochromocytoma. The described clinical case demonstrates the effectiveness and safety of robotic adrenalectomy in a patient with a giant pheochromocytoma, highlighting the need for further research and exploration of the possibilities of minimally invasive surgery in pediatric oncology.

ASO Author Reflections: Improving Lymphedema Outcomes After Head and Neck Oncologic Surgery.