Oncologic Outcomes Research Articles

Proximal Gastrectomy Is Associated with Lower Incidence of Anemia and Vitamin B12 Deficiency Compared to Total Gastrectomy in Patients with Upper Gastric Cancer.

Proximal gastrectomy is an alternative to total gastrectomy (TG) for early gastric cancer (EGC) treatment in the upper stomach. However, its benefits in terms of perioperative and long-term outcomes remain controversial. The aim of this study was to compare the perioperative, body compositional, nutritional, and survival outcomes of patients undergoing proximal gastrectomy with double-tract reconstruction (PG-DTR) and TG for pathological stage I gastric cancer in upper stomach. The study included 506 patients who underwent gastrectomy for pathological stage I gastric cancer in the upper stomach between 2015 and 2019. Clinicopathological, perioperative, body compositional, nutritional, and survival outcomes were compared between the PG-DTR and TG groups. The PG-DTR and TG groups included 197 (38.9%) and 309 (61.1%) patients, respectively. The PG-DTR group had a lower rate of early complications (p=0.041), lower diagnosis rate of anemia and vitamin B12 deficiency (all p < 0.001), and lower replacement rate of iron and vitamin B12 compared to TG group (all p < 0.001). The PG-DTR group showed reduced incidence of sarcopenia at 6-months postoperatively, preserved higher amount of visceral fat after surgery (p=0.032 and p=0.040, respectively), and showed a higher hemoglobin level (p=0.007). Oncologic outcomes were comparable between the groups. The PG-DTR for EGC located in the upper stomach offered advantages of fewer complications, lower incidence of anemia and vitamin B12 deficiency, less decrease in visceral fat volume, and similar survival compared to TG. Consequently, PG-DTR may be considered a superior alternative treatment option to TG.

Preliminary experience and learning curve of endoscopic nipple-areolar-complex sparing total mastectomy: A single-center retrospective study.

In this study, the preliminary experience of endoscopic nipple-areolar-complex (NAC) sparing total mastectomy were analyzed and reported. The medical records of the patients who underwent Endoscopic NAC sparing total mastectomy from November 2019 to June 2022 in a single institute were collected and analyzed. The medical records of their clinicopathologic characteristics, perioperative parameters, postoperative complications, oncologic results were collected retrospectively. The learning curve was evaluated using univariable and multivariable analyses and analyzed using the CUSUM method. A total of 56 surgeries from 53 patients were analyzed. The mean total operation time was 272.50±66.74 minutes while mean oncologic mastectomy was 155.61±43.21 minutes. The mean postoperative hospital days were 9.85±4.70 days. In CUSUM analysis, the cases needed to decrease operation time were 10th. The overall complication rate related to implant was 15.09%. There were one locoregional recurrence patient and one distant metastasis and mortality patient observed during median follow-up of 19.12±12.01 months. According to our preliminary study, endoscopic NAC sparing total mastectomy is a safe procedure, and the operation time can be reduced with accumulated surgical experience.

Benefit and Harms of Radical Nephroureterectomy as Part of a Multimodal Treatment Strategy for Upper Tract Urothelial Carcinoma Patients Presenting with Clinical Evidence of Regional Lymph Node Metastasis: A Systematic Review and Meta-analysis by the European Association of Urology Guidelines.

Given the uncertainty regarding the role of radical nephroureterectomy (RNU) as part of a multimodal treatment strategy for upper tract urothelial carcinoma (UTUC) patients with cN+ disease, we aimed to perform a systematic review and meta-analysis of the corresponding literature. Using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we identified 17 observational comparative and noncomparative studies, published between January 2000 and September 2024, evaluating UTUC patients with cTanyN+M0 disease (P) who received RNU as part of a multimodal treatment strategy (I), as compared with any treatment strategy if applicable (C), to assess oncological or postoperative outcomes (O). Meta-analyses were further performed, as appropriate. Overall, 15 studies evaluated the effectiveness of adding chemotherapy to RNU in the perioperative setting without specifying the exact timing of delivery (n=1), in the induction setting (n=14), or in the adjuvant setting (n=5), while two studies evaluated the effectiveness of adding RNU to chemotherapy. Meta-analyses showed that the use of induction chemotherapy plus RNU versus RNU alone was associated with greater odds of pathological downstaging (risk ratio [RR]=3.06; 95% confidence interval [CI]=[2.48-3.77]; p<0.001; I2=0%; p=0.44) and pathological complete nodal response (RR=2.80; 95% CI=[2.03-3.86]; p<0.001; I2=0%; p=0.47) as well as prolonged overall survival (HR=0.52; 95% CI=[0.42-0.64]; p<0.001; I2=14%; p=0.33) without any significant impact on the risk of overall (RR=1.14; 95% CI=[0.79-1.64]; p=0.48; I2=0%; p=0.76) and major (RR=0.48; 95% CI=[0.18-1.24]; p=0.13; I2=0%; p=0.87) postoperative complications. In addition, the use of induction chemotherapy plus RNU versus RNU plus adjuvant chemotherapy (HR=0.58; 95% CI=[0.38-0.89]; p=0.01) or chemotherapy alone (HR=0.49; 95% CI=[0.32-0.76]; p=0.001; I2=46%; p=0.17) was associated with prolonged overall survival. Limitations include the observational design of all included studies. The use of RNU could provide the greatest oncological benefits without any significant harm in selected UTUC patients with fit general condition and resectable cN+ disease responding to induction chemotherapy. In this report, we looked at the outcomes of radical surgery in combination with systemic chemotherapy for upper tract urothelial carcinoma with clinical evidence of dissemination to the surrounding lymph nodes. We observed that the use of radical surgery was associated with the greatest oncological benefits without any increased risk of postoperative complications in patients with fit general condition and resectable disease responding to induction chemotherapy. We conclude that the use of induction chemotherapy plus radical surgery could be the best multimodal treatment strategy for these patients.

Oncological surgical outcomes for colorectal cancer surgery with loco-regional anesthesia: A feasibility study.

To evaluate the pathological outcomes of colorectal cancer (CRC) patients who were unsuitable for general anesthesia and underwent regional anesthesia in terms of their suitability for oncological surgery. A total of 53 patients who underwent mesocolicormesorectal surgery under regional anesthesia at Ankara Bilkent City Hospital, Ankara, Turkey, between May 2019 and May 2023 were retrospectively examined. The negative margins of the proximal, distal, and circumferential margins of specimens, as well as the number of lymph nodes removed, were analyzed. All the patients had clear proximal, distal, and circumferential surgical margins. The median number of lymph nodes removed was 23.45 (min-max: 3-97). When patients (n=24) who received neoadjuvant therapy were excluded, an insufficient number (<12) of lymph nodes were removed in 3 (7.69%) patients. A total of 3 patients died postsurgery, resulting in a 30-day mortality rate of 5.6%. For elderly and comorbid individuals with CRC, regional anesthesia can be used to carry out surgery with oncological principles.

Oncologic and fertility outcomes in patients with juvenile granulosa cell tumor - a retrospective single centre analysis

BackgroundGranulosa cell tumors (GCTs) are rare neoplasia that account for less than 5 % of all the ovarian tumors. Juvenile GCT histotype is generally observed in adolescent and young women, representing a very rare disease, so only a paucity of data are present in literature. The aim of this study is to analyse the oncologic and fertility outcome in our case series of juvenile GCTs. MethodsClinicopathological data were retrospectively collected and analysed from a cohort of 30 patients ovarian juvenile GCTs treated at IRCCS San Gerardo dei Tintori Hospital, Monza, between 1980 and 2024. ResultsThe median age of disease onset was 21.5. Among patients enrolled in the study, 80.0 % (24/30) were stage I (16/26, 1/26 and 7/26 of stage IA, IB and IC, respectively), 6.7 % (2/30) were stage II and 13.3 % stage III (4/30). In 86.7 % (26/30) of patients, a fertility-sparing surgery was carried out, while 13.3.% (4/30) of patients underwent radical surgery. Adjuvant chemotherapy was administered in 20.0 % (6/30) of cases, while 80.0 % (24/30) were followed only with surveillance. Three patients in thirty (10.0 %) relapsed and died of disease despite multi-therapeutic approaches. All of them had advanced stages of disease at time of diagnosis. ConclusionsJuvenile GCT appears to have a good prognosis at stage I disease. However, advanced stage represents a hard challenge for clinicians, showing a high rate of relapse and mortality.

13 Oncological and functional outcomes of robot-assisted radical prostatectomy in low-riskprostate cancer patients eligible for active surveillance

13 Oncological and functional outcomes of robot-assisted radical prostatectomy in low-riskprostate cancer patients eligible for active surveillance

Correspondence on “Oncologic outcomes based on lymphovascular space invasion in node- negative FIGO 2009 stage I endometrioid endometrial adenocarcinoma: a multicenter retrospective cohort study” by Dagher et al

Correspondence on “Oncologic outcomes based on lymphovascular space invasion in node- negative FIGO 2009 stage I endometrioid endometrial adenocarcinoma: a multicenter retrospective cohort study” by Dagher et al

The role of hyperaccuracy CT three-dimensional reconstruction technology in partial nephrectomy for completely endophytic renal cell carcinoma: A retrospective propensity-matched cohort study.

To compare the clinicopathological, perioperative, functional, and oncological outcomes of completely endophytic renal cell carcinoma (RCC) patients who underwent partial nephrectomy (PN) with or without preoperative hyperaccuracy CT three-dimensional (HACT3D) reconstruction. A retrospective cohort study was conducted on 154 completely endophytic RCC patients treated with PN at our medical center from January 2018 to December 2023. Patients were divided into two groups based on whether they received preoperative HACT3D reconstruction. To control for selection bias, we implemented 1:1 propensity score matching based on baseline characteristics. In the original cohort, 47 patients in the HACT3D group had higher RENAL scores (P=0.014) and PADUA scores (P=0.012). After matching, each group contained 47 RCC patients with no significant baseline differences (P>0.05). In the matched cohort, patients in the HACT3D group had significantly shorter warm ischemia time (WIT) (22.3 vs. 26.7min, p<0.001), shorter total length of hospital stay (LOS) (10.0 vs. 11.6 days, p=0.012), shorter postoperative LOS (5.8 vs. 7.3 days, p=0.003), and higher trifecta achievement rate (83.0% vs. 36.2%, p<0.001). Among functional variables, patients in the HACT3D group exhibited a smaller increase in postoperative serum creatinine (SCR) (7.5 vs. 16.5μmol/L, p=0.012), and a smaller decrease in postoperative estimated Glomerular Filtration Rate (eGFR) (-6.9 vs. -14.1mL/min/1.73m2, p=0.011). No significant differences were found in pathological outcomes and prognosis between the two groups (p>0.05). For completely endophytic RCC patients, HACT3D reconstruction can assist clinicians in performing precise parameter measurements, designing personalized surgical approaches, and providing intraoperative image guidance.

Planning and performing simultaneous bariatric surgery and robotic hysterectomy in a super-obese patient with endometrial cancer.

Endometrial cancer (EC) is the most common gynecological malignancy in developed countries, and endometrial intraepithelial neoplasia (EIN) is the defined precancerous lesion. Obesity is considered a risk factor for both EC and EIN. On the other hand, mortality is often attributed to obesity-related conditions in patients with early-stage EC. Bariatric surgery has been shown to improve oncological outcomes and obesity-related morbidity and mortality in patients with EC. Therefore, combination surgery addressing both uterine disease and obesity is a very recent point of interest. Here, we present a video article to demonstrate the crucial surgical steps for a simultaneous robotic-assisted total laparoscopic hysterectomy and sleeve gastrectomy in a patient with super obesity and EIN. A patient in her 40s with a body mass index of 62.4 kg/m² and a diagnosis of EIN was scheduled for combo surgery. The operation started with sleeve gastrectomy in the reverse Trendelenburg position. The da Vinci Xi Surgical System™ (Intuitive Surgical Inc., Sunnyvale, CA, USA) with left-side docking was used for surgery. After the mobilization of the stomach, gastric resection was performed using a stapler. Following sleeve gastrectomy, the patient was positioned in the Trendelenburg position, and the robotic system was positioned for hysterectomy. Hysterectomy and salpingectomy were performed. The excised stomach and hysterectomy material were removed through the vagina. A frozen examination revealed EC below 2 cm with superficial invasion, and bilateral oophorectomy was performed. The whole surgery took approximately 4 hours. No postoperative complications occurred, and the patient was discharged on the 3rd day.

Current Role of Intraoperative Ultrasonography in Hepatectomy

Introduction: In the past decade, hepatectomy was associated with a high mortality rate due to insufficient surgical techniques, excessive intraoperative blood loss, errors in assessing liver function reserves, and various postoperative complications. Intraoperative ultrasonography (IOUS) offers real-time insights into the tumor’s quantity, size, location, and the vascular structure of the portal and hepatic veins. It assists the surgeon in identifying resection planes, contributing to improved surgical outcomes. This study aims to evaluate the current role of IOUS in hepatectomy. Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Teaching Hospital, Nepal, from March 2022 to March 2024. Twenty-three patients undergoing various hepatectomy procedures, primarily for colorectal liver metastasis and hepatocellular carcinoma, were included. Intraoperative IOUS complemented preoperative triphasic CT scans and. data analysis was performed using SPSS Statistics version 16. Results: Out of 23 patients, 14 (60.8%) patients underwent segmentectomy, five (21.7%) right hemihepatectomy, two (8.6%) left hemihepatectomy, one (4.3%) left lateral sectionectomy and one (4.3%) right posterior sectionectomy. In seven patients (30.4%), IOUS provided additional information beyond what was seen on triphasic CT, resulting in a change in the surgical approach for four of them (17%). In all four patients, the change in surgical approach was proved to be correct based on the histological results. Notably, IOUS facilitated detailed anatomical mapping in 43% of cases, aiding in precise tumor localization relative to critical vascular structures. Conclusions: IOUS provides information on the hepatic anatomy in addition to supporting the final decision regarding which portion to resect. It is a safe technique that ensures favorable oncologic outcomes, especially in ultrasoundguided parenchyma-sparing surgeries for colorectal liver metastases.

Laparoscopy-assisted versus open surgery for low rectal cancer (LASRE): 3-year survival outcomes of a multicentre, randomised, controlled, non-inferiority trial

Laparoscopic surgery is increasingly used for rectal cancer, but the long-term oncological outcomes for low rectal cancer have not been fully established. We aimed to evaluate the 3-year survival outcomes of laparoscopic surgery versus open surgery in the treatment of low rectal cancer. This multicentre, randomised, controlled, non-inferiority trial was conducted at 22 tertiary hospitals in China. Individuals aged 18-75 years with histologically confirmed cT1-2N0, cT3-4aN0, or cT1-4aN1-2 rectal adenocarcinoma within 5 cm from the dentate line were eligible for inclusion. Participants were randomly assigned (2:1) to undergo laparoscopic surgery or open surgery. Central randomisation was conducted using a web response system, and was stratified by clinical stage, age, sex, BMI, and American Society of Anesthesiologists classification. Investigators, patients and statisticians were not masked to group allocation. The primary outcome was 3-year disease-free survival, defined as the time from the date of surgery to the date of locoregional recurrence, distant metastasis, or death from any cause, whichever occurred first. Non-inferiority was defined as a lower limit of one-sided 97·5% CI for group difference (laparoscopic surgery group minus open surgery group) of greater than -10%. The primary analyses were performed in the modified intention-to-treat population, which excluded patients with distant metastasis discovered during surgery and those who did not undergo surgery or underwent local resection only. The trial is registered with ClinicalTrials.gov, NCT01899547, and has been completed. Between Nov 12, 2013, and June 6, 2018, 1070 patients were enrolled and randomly assigned to treatment. 1039 patients (685 in the laparoscopic surgery group and 354 in the open surgery group; median age 57 years, IQR 50 to 64; 620 [60%] male and 419 [40%] women) were included in the modified intention-to-treat analysis. 3-year disease-free survival was 81·4% (95% CI 78·2 to 84·1) in the laparoscopic surgery group and 79·8% (75·2 to 83·6) in the open surgery group (hazard ratio [HR] 0·92, 95% CI 0·69 to 1·23; p=0·56). The difference between groups was 1·60% (one-sided 97·5% CI -3·34 to ∞, p<0·0001 for non-inferiority). 3-year overall survival was 91·7% (95% CI 89·3 to 93·5) in the laparoscopic surgery group and 93·7% (90·6 to 95·8) in the open surgery group (HR 1·34, 95% CI 0·82 to 2·19; p=0·24). 3-year locoregional recurrence was 3·7% (95% CI 2·5 to 5·3) and 2·3% (1·1 to 4·3), respectively (HR 1·64, 95% CI 0·74 to 3·63; p=0·22). 5-year overall survival was 84·6% (95% CI 81·5 to 87·1) and 86·6% (82·5 to 89·8) in the open group (HR 1·16, 95% CI 0·82 to 1·64; p=0·41). Laparoscopic surgery performed by experienced surgeons is non-inferior to open surgery for 3-year disease-free survival among patients with low rectal cancer. These results support the use of laparoscopic surgery for low rectal cancer. The Key Clinical Specialty Discipline Construction Program of the National Health and Family Planning Commission of China; Minimally Invasive Medical Center Construction Program, Fujian Province, China; and Joint Funds for the Innovation of Science and Technology, Fujian Province, China.

Oncological outcomes of the facial artery musculomucosal flap for oral cavity reconstruction.

Facial artery musculomucosal (FAMM) flaps are used for reconstruction of oral cavity squamous cell carcinoma (OCSCC). This study evaluates the oncologic safety of the FAMM flaps for OCSCC reconstruction, given the need to preserve the facial artery and vein during elective neck dissection. Retrospective single surgeon case series of all patients undergoing FAMM flap reconstruction for OCSCC from 2016 through 2023. Case analysis included tumor location, classification and staging, surgical details, and post-operative outcomes including locoregional and overall disease control. Twenty-one patients underwent FAMM reconstruction after resection for OCSCC. Age ranged from 40 to 85years old (mean 61), 15 (71%) were male. Sixteen (76%) patients underwent neck dissection. Follow-up ranged from 0 to 81months (mean 28). One patient (5%) recurred in ipsilateral neck level IV, one (5%) had a second primary tumor, and three patients (14%) developed distant metastases. FAMM flap represents a safe and reliable option for reconstruction after OCSCC. In our series there was no significant increased risk of locoregional recurrence.

Short-term outcomes after robot-assisted versus open radical cystectomy for bladder cancer in patients with diabetes mellitus: an analysis of the United States Nationwide Inpatient Sample of 2005-2018.

Introduction: Diabetes mellitus (DM) is associated with worse surgical outcomes, and is a risk factor for bladder cancer and subsequent oncological outcomes. This study evaluated outcomes robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) in patients with DM. Materials and Methods: Data of adults ≥ 18 years old with DM who underwent radical cystectomy were extracted from the United States National Inpatient Sample database 2005-2018. The outcomes were in-hospital mortality, prolonged length of stay (LOS), and postoperative complications. Results: Data of 2,765 patients were analyzed. Patients who received RARC had a significantly lower odds of prolonged LOS (adjusted odd ratio (aOR) = 0.56, 95% CI: 0.45, 0.71), unfavorable discharge (aOR = 0.74, 95% CI: 0.56, 0.97), urinary complications (aOR = 0.75, 95% CI: 0.57, 0.98) and wound and device-related complications (aOR = 0.59, 95% CI: 0.41, 0.86) than ORC. Of patients < 70 years old, RARC was significantly associated with decreased odds for urinary complications (aOR = 0.59, 95% CI: 0.41, 0.84) and wound and device-related complications (aOR = 0.55, 95% CI: 0.32, 0.94) compared to ORC. In patients with a Charlson Comorbidity Index score of 0-1, RARC was associated with a lower risk of urinary complications (aOR = 0.74, 95% CI: 0.56, 0.98) and wound and device-related complications (aOR = 0.63, 95% CI: 0.43, 0.93) compared to ORC. Conclusions: In patients with DM and bladder cancer, RARC appears to be associated with better short-term outcomes in terms of reduced risks of prolonged LOS, unfavorable discharge, urinary complications, and wound and device-related complications compared to ORC.

The prognostic significance of circulating tumor DNA in patients with positive lymph node disease after robotic-assisted radical cystectomy: A contemporary analysis

Background and objectiveNeoadjuvant therapy followed by radical cystectomy with lymphadenectomy remains the gold standard of treatment in patients with muscle-invasive bladder cancer. Pathologically positive lymph node (pN+) disease is known to convey a poor prognosis. Tumor-informed circulating tumor DNA (ctDNA) has emerged as a possible novel prognostic biomarker in the field. We seek to assess recurrence-free survival (RFS) for patients undergoing robotic-assisted radical cystectomy (RARC) with extended pelvic lymphadenectomy (ePLND) and to assess whether ctDNA status can be a prognostic marker for RFS outcomes in patients with pN+ disease. MethodsPatients who underwent RARC + ePLND during 2015 to 2023 were included. A sub-group analysis (n = 109) of patients who had prospectively collected serial-longitudinal tumor-informed ctDNA analyses during 2021-2023 was performed. Survival analysis and Cox-regression models were conducted. ResultsIncluded were 458 patients with a median age of 69 (IQR 63–76), and a median follow-up time of 20 months (IQR 10-37). RFS for pN0 (n = 353) and pN+ (n = 105) at 12, 24 and 36 months were 87% vs. 54%, 80% vs. 39%, and 74% vs. 35%, respectively (log-rank, P < 0.0001). On Cox multivariate analysis ≥pT3 disease (Hazzard ratio [HR] = 3.36 [2.18–5.18], P < 0.001), pN+ disease (HR = 2.39 [1.55–3.7], P < 0.001), and recipients of neoadjuvant treatment (HR = 1.61 [1.11–2.34], P = 0.013) were predictive of disease relapse. Patients with pN+ disease and undetectable precystectomy or postcystectomy ctDNA status had similar RFS to patients with pN0 with undetectable ctDNA. On Cox-regression multivariate sub-group analysis, detectable precystectomy ctDNA status (HR = 3.89 [1.32–11.4], P = 0.014), detectable ctDNA status in the minimal residual disease window ([MRD], HR = 2.89 [1.12–7.47], P = 0.028), and having ≥pT3 with pN+ disease (HR = 4.2 [1.43–12.3], P = 0.009) were predictive of disease relapse. ConclusionsPatients with pN+ .after RARC had worse oncological outcomes than patients with pN0 disease. Undetectable ctDNA status was informative of RFS regardless of nodal status at both the precystectomy and the MRD window. Patients with undetectable ctDNA status and pN+ disease may benefit from treatment de-escalation.

Function Preserving Gastrectomy and Quality of Life.

Advances in gastric cancer screening have enabled earlier detection, shifting the focus of treatment toward preserving patients' quality of life (QoL). Function-preserving gastrectomy (FPG), including pylorus-preserving gastrectomy, proximal gastrectomy, and sentinel node navigation surgery, represents a paradigm shift in the surgical management of early gastric cancer. These techniques aim to balance oncological safety with the preservation of gastric function, mitigating postgastrectomy syndromes such as dumping syndrome, bile reflux, and nutritional deficiencies. QoL assessment tools, including EORTC QLQ-STO22, KOQUSS-40, and PGSAS-45, have become integral for evaluating patient-reported outcomes, providing insights into physical, emotional, and functional recovery. Although current evidence underscores the benefits of FPG, most studies are limited to East Asia, highlighting the need for multinational trials to validate these findings globally. FPG has demonstrated comparable short- and long-term oncological outcomes to conventional gastrectomy. Enhanced nutritional recovery and reduced gastrointestinal sequelae make FPG increasingly attractive. However, its widespread adoption is challenged by technical complexity, resource intensity, and the need for adequate surgical experience. The integration of advanced technologies, such as robotic surgery and artificial intelligence, coupled with personalized approaches, is expected to further optimize FPG outcomes. This review underscores the critical role of standardized QoL assessments, collaborative research, and technological innovations in advancing FPG as a cornerstone of patient-centered gastric cancer care.

Clinical outcomes of stage IIA/IIB seminoma treated with radiotherapy and chemotherapy: should regional therapy be considered the preferred treatment approach?

The optimal management of patients with de novo clinical stage IIA/B (CSIIA/B) or relapsed CSIIA/B (Rel-CSIIA/B) seminoma remains debated due to a lack of randomized evidence. Herein, we sought to evaluate outcomes following radiotherapy and chemotherapy in this setting. A prospectively maintained single-institutional database was retrospectively queried for patients diagnosed between 1995-2016 with de novo or Rel-CSIIA/B. Patients with Rel-CSIIA/B were managed similarly to de novo CSIIA/B. All patients were reviewed by the multidisciplinary team. While the preferred management policy was radiotherapy, the treatment decision was individualized at the physician/patient level. There were 153 patients: 67 had de novo CSIIA/B (IIA-32, IIB-35) and 86 patients had Rel-CSIIA/B seminoma (IIA-51, IIB-35). Of the total, 120 patients (78%) received radiotherapy (IIA-78, IIB-42) and 33 (22%) received platinum-based chemotherapy (IIA-5, IIB-28). Median follow-up was 7.1 years (IQR 4.3-9.9). Eleven patients (IIA- 9/78, IIB- 2/42) relapsed following radiotherapy and 1 patient (IIB) relapsed following chemotherapy, corresponding to 5-year relapse rates of 10% (95% CI 6-18%) for radiotherapy and 3% (95% CI 0-23%) for chemotherapy. All 12 patients who relapsed were treated with subsequent chemotherapy. Radiotherapy and chemotherapy result in excellent oncologic outcomes for patients with de novo or Rel-CSIIA/B seminoma. All patients should be informed about both management options. However, radiotherapy with its favourable acute toxicity profile, could be considered the treatment of choice in most patients.

19 Optimizing oncologic outcomes in high-grade non-muscle invasive bladder cancer: Theimpact of a surgeon-led treatment pathway

19 Optimizing oncologic outcomes in high-grade non-muscle invasive bladder cancer: Theimpact of a surgeon-led treatment pathway

A Prospective Observational Cohort Study Comparing High-Complexity Against Conventional Pelvic Exenteration Surgery.

Background: Conventional pelvic exenteration (PE) comprises the removal of all or most central pelvic organs and is established in clinical practise. Previously, tumours involving bone or lateral sidewall structures were deemed inoperable due to associated morbidity, mortality, and poor oncological outcomes. Recently however high-complexity PE is increasingly described and is defined as encompassing conventional PE with the additional resection of bone or pelvic sidewall structures. This observational cohort study aimed to assess surgical outcomes, health-related quality of life (HrQoL), decision regret, and costs of high-complexity PE for more advanced tumours not treatable with conventional PE. Methods: High-complexity PE data were retrieved from a prospectively maintained quaternary database. The primary outcome was overall survival. Secondary outcomes were perioperative mortality, disease control, major morbidity, HrQoL, and health resource use. For cost-utility analysis, a no-PE group was extrapolated from the literature. Results: In total, 319 cases were included, with 64 conventional and 255 high-complexity PE, and the overall survival was equivalent, with medians of 10.5 and 9.8 years (p = 0.52), respectively. Local control (p = 0.30); 90-day mortality (0.0% vs. 1.2%, p = 1.00); R0-resection rate (87% vs. 83%, p = 0.08); 12-month HrQoL (p = 0.51); and decision regret (p = 0.90) were comparable. High-complexity PE significantly increased overall major morbidity (16% vs. 31%, p = 0.02); and perioperative costs (GBP 37,271 vs. GBP 45,733, p < 0.001). When modelled against no surgery, both groups appeared cost-effective with incremental cost-effectiveness ratios of GBP 2446 and GBP 5061. Conclusions: High-complexity PE is safe and feasible, offering comparable survival outcomes and HrQoL to conventional PE, but with greater morbidity and resource use. Despite this, it appears cost-effective when compared to no surgery and palliation.

Oncological outcomes, safety, efficacy in high BMI patients, attitude, and cost of robotic surgery for endometrial cancer management: a systematic review

Oncological outcomes, safety, efficacy in high BMI patients, attitude, and cost of robotic surgery for endometrial cancer management: a systematic review

Advances in Robotic and Laparoscopic Gastrectomy for Gastric Cancer: A Comparative Review of Surgical Outcomes and Techniques

The comparison between robotic and laparoscopic gastrectomy in gastric cancer treatment has sparked considerable interest due to the unique benefits and limitations of each technique. Both approaches aim to provide minimally invasive alternatives to open surgery to reduce morbidity and enhance recovery. Robotic surgery offers enhanced precision and three-dimensional visualization, potentially improving oncological outcomes, particularly in complex cases. However, it also incurs higher costs and longer operative times, which may impact accessibility and resource allocation, especially in lower-resource settings. In contrast, laparoscopic gastrectomy remains a widely adopted, cost-effective approach with established efficacy in early-stage tumors but may be limited in more advanced cases requiring extensive lymphadenectomy. This review evaluates critical factors such as operative duration, oncological radicality, cost-effectiveness and long-term survival while exploring the potential role of artificial intelligence in robotic surgery. We address the challenges of implementing robotic systems in low- and middle-income countries and examine the psychological impact of surgical choice on patient outcomes. Although both techniques have demonstrated favorable short-term outcomes, there remains a need for long-term, large-scale studies to determine their comparative effectiveness in survival and recurrence. Comprehensive guidelines tailored to tumor staging and patient characteristics are essential to optimize the surgical approach. This review highlights the current knowledge gaps and suggests directions for future research to advance minimally invasive surgical options for gastric cancer.