Oncologic Procedures Research Articles

The Effects of Nasocomial SARS-CoV-2 Infection after Elective Gastrointestinal Oncologic Procedures: Single Center 30-day Follow-up Results.

Although there is extensive debate for the best treatment strategies, limited studies, which reflect the effects of postoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on mortality and hospital stay after elective gastrointestinal oncologic procedures were published. In order to contribute to the existing literature, a single-center, retrospective, cross-sectional study, including 301 patients who underwent elective gastrointestinal oncological procedures was planned. Patients' data on sex, age, diagnosis, types of procedures, hospital stay, mortality, and SARS-CoV-2 preoperative screening tests were recorded. Four of them were postponed due to positive preoperative screening for SARS-CoV-2. 395 procedures were performed due to cancer originating from colon (105), rectum (91), stomach (74), periampullar region (16), distal pancreas (4), esophagus (3), retroperitoneum (2), ovary (2), endometrium (1), spleen (1) and small bowel (2). Laparoscopy was the approach of choice for 44 patients (14.7% vs. 85.3%). In the postoperative period, two patients were infected with SARS-CoV-2 and one of them died in the intensive care unit (n=1/2, 50% mortality). Two patients died due to surgical complications unrelated to SARS-CoV-2 (n=2/299, 0.67% mortality) (p<0.01). The mean hospital stay was longer in patients with SARS-CoV-2 infection (21.5 ± 9.1 - 8.2 ± 5.2 days, respectively, p<0.01). 298 patients were safely discharged (99%). During the pandemic elective gastrointestinal oncologic procedures may be safely performed; however, preoperative testing, precautions to minimize contamination should be performed strictly to reduce in-hospital infection rates, since the mortality rate due to SARS-CoV-2 in this setting is particularly high and hospital stay is also significantly increased.

Realistic 3D printed CT imaging tumor phantoms for validation of image processing algorithms

Medical imaging phantoms are widely used for validation and verification of imaging systems and algorithms in surgical guidance and radiation oncology procedures. Especially, for the performance evaluation of new algorithms in the field of medical imaging, manufactured phantoms need to replicate specific properties of the human body, e.g., tissue morphology and radiological properties. Additive manufacturing (AM) technology provides an inexpensive opportunity for accurate anatomical replication with customization capabilities. In this study, we proposed a simple and cheap protocol using Fused Deposition Modeling (FDM) technology to manufacture realistic tumor phantoms based on the filament 3D printing technology. Tumor phantoms with both homogenous and heterogeneous radiodensity were fabricated. The radiodensity similarity between the printed tumor models and real tumor data from CT images of lung cancer patients was evaluated. Additionally, it was investigated whether a heterogeneity in the 3D printed tumor phantoms as observed in the tumor patient data had an influence on the validation of image registration algorithms.A radiodensity range between −217 to 226 HUs was achieved for 3D printed phantoms using different filament materials; this range of radiation attenuation is also observed in the human lung tumor tissue. The resulted HU range could serve as a lookup-table for researchers and phantom manufactures to create realistic CT tumor phantoms with the desired range of radiodensities. The 3D printed tumor phantoms also precisely replicated real lung tumor patient data regarding morphology and could also include life-like heterogeneity of the radiodensity inside the tumor models. An influence of the heterogeneity on accuracy and robustness of the image registration algorithms was not found.

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable. In this document, the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis aims to provide useful practice guidance in the management of antithrombotic agents and thrombocytopenia around the time of common procedures in patients with cancer.

ВОЗМОЖНОСТИ И ПЕРСПЕКТИВЫ СОЗДАНИЯ ПЭТ-ЦЕНТРОВ В РОССИИ НА ОСНОВЕ ГЕНЕРАТОРНЫХ РАДИОНУКЛИДОВ

An assessment of the capabilities of generator radionuclides and a list of generator pairs of radionuclides whose daughter isotope has the potential to be used in medicine for PET research is given. A list of typical 68Ga-based PET radiopharmaceuticals for oncology studied in preclinical and clinical studies is provided. Data on the use of the 82Sr/82Rb generator in clinical diagnostics are presented. The assessment of the existing situation with PET centers in Russia is given. A strategy for the development of a network of clinical PET centers and an overview of the state of generator technologies in Russia are proposed. This article concludes that the use of generators makes it possible to significantly expand the range of clinical institutions capable of providing PET diagnostics and conducting PET studies, having only 1 or several PET scanners in the clinic. It is concluded that due to a serious reduction in capital investments (by 1.5 times) and a noticeable reduction in the cost of operation (by 1.5‒2 times), the use of generator systems will significantly reduce the cost of many PET diagnostic procedures in oncology and cardiology, make this method more accessible to a wide range of the country’s population.

Clinical Hypnosis for Procedural Pain and Distress in Children: A Scoping Review.

Pain and distress are common in children undergoing medical procedures, exposing them to acute and chronic biopsychosocial impairments if inadequately treated. Clinical hypnosis has emerged as a potentially beneficial treatment for children's procedural pain and distress due to evidence of effectiveness and potential superiority to other psychological interventions. However, systematic reviews of clinical hypnosis for children's procedural pain and distress have been predominantly conducted in children undergoing oncology and needle procedures and are lacking in broader pediatric contexts. This scoping review maps the evidence of clinical hypnosis for children's procedural pain and distress across broad pediatric contexts while highlighting knowledge gaps and areas requiring further investigation. Published databases (PubMed, Cochrane Library, PsycINFO, Embase, CINAHL, Scopus, and Web of Science) and grey literature were searched in addition to hand-searching reference lists and key journals (up to May 2022). Two independent reviewers screened the titles and abstracts of search results followed by a full-text review against eligibility criteria. Articles were included if they involved a clinical hypnosis intervention comprising an induction followed by therapeutic suggestions for pain and distress in children undergoing medical procedures. This review followed the Arksey and O'Malley (2005) methodology and incorporated additional scoping review recommendations by the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A total of 38 eligible studies involving 2,205 children were included after 4,775 articles were screened. Research on clinical hypnosis for children's procedural pain and distress was marked by a lack of fidelity measures and qualitative data as well as by inadequate intervention reporting and high attrition rates. Evidence regarding the safety of clinical hypnosis, pain unpleasantness outcomes, factors influencing outcomes, as well as barriers and facilitators to implementing hypnosis and study procedures was also lacking. Clinical hypnosis has potential benefits for children's procedural pain and distress based on evidence of superiority to control conditions and nonpharmacological interventions (e.g., distraction, acupressure) with moderate to large effect sizes as reported in 76% of studies. However, heterogeneous interventions, contexts, study designs, and populations were identified, and the certainty of the evidence was not evaluated. The review suggests potential benefits of clinical hypnosis for children's procedural pain and distress and thus provides a precursor for further systematic reviews and trials investigating the effectiveness of clinical hypnosis. The review also indicates the need to further explore the feasibility, acceptability, implementation, and safety of clinical hypnosis in children undergoing painful procedures. Based on the review, researchers implementing clinical hypnosis should adequately report interventions or use treatment manuals, follow recommended research guidelines, and assess the fidelity of intervention delivery to promote replicating and comparing interventions. The review also highlights common methodological shortcomings of published trials to avoid, such as the lack of implementation frameworks, small sample sizes, inadequate reporting of standard care or control conditions, and limited evidence on pain unpleasantness outcomes.

Applications of Indocyanine Green-Guided Near-Infrared Fluorescence Imaging in Pediatric Minimally Invasive Surgery Urology: A Narrative Review.

Background: Indocyanine green (ICG) is a fluorescent dye used for several indications in adult surgery, and, more recently, adopted also in the pediatric patients. This study aimed to review the literature published on the use of ICG near-infrared fluorescence (NIRF) in pediatric urology, to address its shortcomings and disadvantages and to detect the future perspectives. Materials and Methods: An electronic literature search of PubMed on all studies reporting use of ICG-NIRF in pediatrics was performed. We included only studies reporting ICG-NIRF application in minimally invasive surgery (MIS) for pediatric urology indications. Results: Forty-two articles reporting MIS procedures performed using ICG-NIRF in children were obtained, but only 15 studies that focused on urological applications of ICG-NIRF in children were included in this review. The included studies described use of ICG-NIRF for kidney malformations such as duplex system, kidney tumors, renal cysts, ureteral pathology, bladder malformations, varicocele, and lymph node sampling in tumors. The pediatric urological applications in which ICG-NIRF provided significant advantages included partial nephrectomy, lymphatics sparing varicocele repair, and oncological procedures. The ICG-NIRF use was clinically safe, without reported adverse systemic reactions in all pediatric series. The main drawback of this technology is the need of specific laparoscopic equipment such as camera system, light sources, and telescopes or the da Vinci Xi Robot, with the software for ICG-NIRF, Firefly®, already integrated within. Conclusions: ICG-enhanced fluorescence-guided surgery is gaining growing popularity among pediatric surgeons due to the excellent results that have been published until now. ICG-NIRF technology has proven to be safe, easy to use, not time-consuming, cheap, and very effective to improve intraoperative view and surgical ability. Nonetheless, further evidence, including larger series, longer follow-up, and more specific assessments, is necessary to confirm the preliminary results and enlarge the applications.

Extracorporeal membrane oxygenation support in oncological thoracic surgery.

The use of extracorporeal lung support (ECLS) during thoracic surgery is a recent concept that has been gaining increasing approval. Firstly introduced for lung transplantation, this technique is now increasingly adopted also in oncological thoracic surgical procedures. In this review, we focus on the cutting-edge application of extracorporeal membrane oxygenation (ECMO) during oncological thoracic surgery. Therefore, we report the most common surgical procedures in oncological thoracic surgery that can benefit from the use of ECMO. They will be classified and discussed according to the aim of ECMO application. In particular, the use of ECMO is usually limited to certain lung surgery procedures that can be resumed such as in procedures in which an adequate ventilation is not possible such as in single lung patients, procedures where conventional ventilation can cause conflict with the surgical field such as tracheal or carinal surgery, and conventional procedures requiring both ventilators and hemodynamic support. So far, all available evidence comes from centers with large experience in ECMO and major thoracic surgery procedures.

Modern view on the treatment of oncological diseases by endovascular methods

In recent decades, the multidisciplinary development of medicine has led to an improved understanding of the molecular mechanisms of the development of oncological diseases. The idea of malignant neoplasms as heterogeneous objects containing cells with different genetic backgrounds made it possible to explain the selective effectiveness of one type of treatment for a certain part of the tumor cells in a patient. Numerous targeted therapies have formed the cornerstone in the treatment of various malignancies, alone or in combination with other treatments such as chemotherapy, radiation therapy, surgery and interventional radiology.Interventional oncology covers both diagnostics and treatment. Its methods are minimally invasive and highly specific to the patient. Currently, personalized procedures are actively develop and allow to detect cancer cells, selectively contact and treat them. Another important problems is to evaluate drug delivery and uptake in order to make adjustments to the treatment based on the received data from the procedures and, ultimately, to predict the response. Here we will consider such interventional oncological procedures and innovative methods that are under development as transarterial chemoembolization (TACE), oily transarterial chemoembolization (cTACE), catheter intra-arterial delivery of nanoparticles etc. Thus, interventional oncology has unique opportunities for selective impact on tumor lesions not only for diagnostic purposes, but also for a wide range of minimally invasive percutaneous treatments.

Optimizing the Timeliness of Surgical Therapy in Patients with Breast Cancer Undergoing Immediate Breast Reconstruction.

In breast cancer, coordination of surgical therapy with immediate breast reconstruction (IBR) has been found to significantly delay surgical therapy, which in turn can have an adverse effect on patient survival. The objective of this study was to investigate factors that impact the timeliness of surgical therapy in this setting, which may help to optimize the care of patients with breast cancer. Patients with breast cancer undergoing surgical therapy for breast cancer and immediate reconstruction were reviewed. Patients were divided into two groups: those who underwent surgery ≤ 30 days (group A) and > 30 days (group B) after diagnosis. Multivariate statistical analysis of demographic, disease, surgical, and process of care factors was performed. A total of 348 cases met inclusion criteria, of which 255 (73.2%) were in group A and 93 (26.7%) were in group B. No significant differences were identified in clinical stage, oncologic procedure, or type of reconstruction. On multivariate analysis, an increased likelihood of undergoing surgery ≤ 30 days of diagnosis was observed, with shorter time intervals between surgical oncologist and plastic surgeon consultations [odds ratio (OR) 1.3; 95% confidence interval (CI) 1.1-1.6, p = 0.011]. The number of operating days in common between the surgical oncologist and plastic surgeon nor having the same clinic day impacted timeliness. Patients may undergo both breast conservation surgery and mastectomy with all major types of immediate reconstruction in a timely manner. Early initiation of plastic surgery referrals and surgeon flexibility to work outside the parameters of institutional schedules may help facilitate the timeliness of surgery.

Association Between Cancer Center Accreditation and Compliance With Price Disclosure of Common Oncologic Surgical Procedures.

Cancer center accreditation status is predicated on several factors that measure high-value healthcare. However, price transparency, which is critical in healthcare decisions, is not a quality measure included for accreditation. We reported the rates of price disclosure of surgical procedures for 5 cancers (breast, lung, cutaneous melanoma, colon, and prostate) among hospitals ranked by the American College of Surgeon's Commission on Cancer (ACS-CoC). We identified nonfederal, adult, and noncritical access ACS-CoC accredited hospitals and used the commercial Turquoise Health database to perform a cross-sectional analysis of hospital price disclosures for 5 common oncologic procedures (mastectomy, lobectomy, wide local excision for cutaneous melanoma, partial colectomy, prostatectomy). Publicly available financial reporting data were used to compile facility-specific features, including bed size, teaching status, Centers for Medicare & Medicaid wage index, and patient revenues. Modified Poisson regression evaluated the association between price disclosure and ACS-CoC accreditation after adjusting for hospital financial performance. Of 1,075 total ACS-CoC accredited hospitals, 544 (50.6%) did not disclose prices for any of the surgical procedures and only 313 (29.1%) hospitals reported prices for all 5 procedures. Of the 5 oncologic procedures, prostatectomy and lobectomy had the lowest price disclosure rates. Disclosing and nondisclosing hospitals significantly differed in ACS-CoC accreditation, ownership type, and teaching status. Hospitals that disclosed prices were more likely to receive Medicaid disproportionate share hospital payments, have lower average charge to cost ratios (4.53 vs 5.15; P<.001), and have lower net hospital margins (-2.03 vs 0.44; P=.005). After adjustment, a 1-point increase in markup was associated with a 4.8% (95% CI, 2.2%-7.4%; P<.001) higher likelihood of nondisclosure. More than half of the hospitals did not disclose prices for any of the 5 most common oncologic procedures despite ACS-CoC accreditation. It remains difficult to obtain price transparency for common oncologic procedures even at centers of excellence, signaling a discordance between quality measures visible to patients.

8525 Efficacy and Safety of Single Port Robotic Hysterectomy with Concomitant Urogynecologic and Gynecologic Oncology Procedures

<h3>Study Objective</h3> To assess the feasibility of the DaVinciâ Single Port (SP) robotic platform for urogynecologic and gynecologic oncology surgical procedures. <h3>Design</h3> Retrospective cohort analysis. <h3>Setting</h3> The first SP robotic procedures performed as same day surgeries at an academic tertiary medical center by board certified Female Pelvic Medicine and Reconstructive Surgery and/or Gynecologic Oncology surgeons from December 2021-April 2022. <h3>Patients or Participants</h3> 15 patients underwent SP robotic hysterectomy (RH) and either bilateral salpingectomy (BS) or salpingo-oophorectomy (BSO) with or without concomitant procedures. <h3>Interventions</h3> SP RH and concomitant procedures were performed using a 1.5 cm umbilical incision, the Access Port ä (Intuitive Surgical) and the SP platform robotic camera and instruments. <h3>Measurements and Main Results</h3> Our primary outcome was conversion to a multiport procedure and intraoperative complications. Perioperative details were abstracted from the chart including operative time, estimated blood loss (EBL), and intraoperative complications, PACU length of stay (LOS) and pain scores POD#1 Surgical Pain Scale (SPS) scores. Indications for the 15 SP RH with BS or BSO included prolapse (N=10), risk reduction (N=2,) endometrial cancer (N=1), cervical (N=1), and endometrial (N=1) intraepithelial neoplasia. Concomitant procedures included: 10 (67%) SP sacrocolpopexies, 9 (60%) midurethral slings, 2 (13%) SP sentinel lymph node mapping, and 1 breast reconstruction. There was no conversion to a multiport procedure, intraoperative or immediate postoperative complications with a mean EBL of 66.7 ± 26.1 cc. Mean operative time and PACU LOS were 182 ± 53 and 216 ± 57 min. Median PACU pain scores were low (2, IQR 4) and only one patient required a single dose of postoperative tramadol. Similarly, median POD#1 SPS scores were low for pain at rest and with activity (3 (IQR 4) and 3 (IQR 4.75)) and for the worst pain 5.5 (IQR 4,25). <h3>Conclusion</h3> SP robotic approach for urogynecologic and gynecologic oncology hysterectomy with concomitant procedures performed by sub-specialty surgeons is safe and feasible.

Glomerular hyperfiltration is a predictor of adverse outcomes following major urologic oncology surgery.

Glomerular hyperfiltration (GHF) has been associated with cardiovascular disease and all-cause mortality. We aimed to evaluate whether preoperative GHF is associated with 30-day complications following major urologic oncology procedures. We conducted a retrospective cohort study using subjects from the 2006 to 2019 American College of Surgeons National Surgical Quality Improvement Program database who underwent prostatectomy, cystectomy, or nephrectomy. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. Patients were classified as having either low, normal, or high eGFR based on the 5th and 95th percentiles of age- and sex-specific quintiles for eGFR. Using multivariable logistic regression, we evaluated GHF as an independent predictor of postoperative complications. A total of 120,013 patients were eligible for analysis, of which 1706 (1.4%) were identified as having GHF, with a median eGFR of 105.37ml/min per 1.73 m2 (IQR 94.84-116.77). Compared to patients with normal eGFR, patients with GHF were older (68years, [IQR 60-71], p < 0.001), had a lower BMI (27.52kg/m2 [IQR 23.71-31.95], p < 0.001), and greater 5-item modified frailty index scores (≥ 1, 70.6%, p < 0.001). Multivariable logistic regression demonstrated that GHF was associated with greater odds of any complication (OR 1.23, 95% CI 1.08-1.40, p = 0.002), non-home discharge (OR 1.86, 95% CI 1.50-2.30, p < 0.001), and prolonged LOS (OR 1.33, 95% CI 1.18-1.51, p < 0.001). GHF is associated with greater odds of 30-day complications following major urologic oncology surgery.

Radiotherapy of an Isolated Port-Site Metastases after Laparoscopic Surgery for Endometrial Cancer: A Case Report

Port-site metastases after gynecologic oncology procedures have a reported incidence of 1-2% and in the 95% of cases had simultaneous carcinomatosis or metastases to other sites at the time of port-site metastasis detection suggesting that the presence of port site implantation is a surrogate for advanced disease. At the moment, only poor cases of isolated port-site metastasis after endometrial cancer have been reported in literature, we reported one of this cases

Evaluating the pandemic’s impact on surgical site infections after abdominal surgery in Italy

Abstract Background The COVID-19 pandemic led to important disruptions in surgical activity. The aim of this study was to evaluate the impact of COVID-19 on abdominal surgery outcomes in the region of Piedmont, in northern Italy. Methods Data were gathered from 42 hospitals participating in the regional surveillance network from 2018 to 2020. SSI, overall mortality and case fatality rates (CFR) were calculated, comparing 2020 to mean 2018-19 data. Chi-squared tests were used to assess both the differences among the proportion of urgent and oncological procedures (based on ICD-9-CM codes) and rates between the two periods. Subgroup analyses on 2020 data were carried out comparing urgent vs. elective and oncological vs. non-oncological procedures using chi-squared tests. Analyses were performed using SPSS v. 28.0.1.0. Results 5407 procedures were recorded in 2018-19; 310 SSIs and 120 deaths were observed. The mean proportions of urgent and oncological operations were, respectively, 21.90% and 43.24%. In 2020, 1057 procedures were recorded, along with 44 SSIs and 29 deaths. 34.44% of procedures were urgent and 39.74% oncological. The mean 2018-2019 SSI rate was 5.73%, with an overall mortality of 2.22% and a CFR of 7.42%. The SSI rate in 2020 was 4.16%, with an overall mortality of 2.74% and a CFR of 9.09%. The proportion of urgent procedures significantly differed between the two periods (p &amp;lt; 0.001), as did the proportion of oncological procedures and SSI rates (both p = 0.05). Considering 2020, significant differences were found comparing overall mortality between urgent vs. elective procedures (4.95% vs. 1.59%, p = 0.002) and comparing SSI rates between oncological vs. non-oncological patients (3.57% vs. 2.20%, p = 0.02). Conclusions During the pandemic, patients undergoing surgical procedures significantly differed, reflecting public health decisions. Even though these differences did not reach statistical significance, overall mortality and CFR increased in 2020. Key messages

Variation in Price-Negotiated Rate by Private Insurers for Cancer Operation

INTRODUCTION: On January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Price Transparency Rule which requires hospitals to publicly report on their website the insurer-specific negotiated prices for 70 CMS-specified, high-volume common services. The variation in price-negotiated rate for oncologic surgical procedures across private health insurers is unknown. METHODS: Hospital websites were systematically scanned for prices listed by insurer CPT code by Turquoise Health, a third-party search engine that aggregates the information weekly into a searchable database. On February 22, 2022, we queried the database to obtain payer-specific prices for these CPT codes for pancreas, lung, esophagus, colon and rectal resection. To account for appropriate variation in price (eg cost of living), each amount was standardized using the CMS area wage index. Price for each procedure was compared across the 5 largest insurers: United Healthcare, Blue Cross Blue Shield, Cigna, Humana, and Aetna. RESULTS: Payer-specific negotiated price was reported by 942 hospitals performing these procedures and demonstrated wide variation within and across insurers. For example, the median rate for a video-assisted thoracic surgery wedge resection across the 5 major insurers varied 2.1-fold ($2,948 to $1,841). For Cigna, the interquartile range of rates for the Whipple varied 3.5-fold ($2,076 to $7,321). Similar patterns were observed for each of the procedures evaluated (Figure).FigureCONCLUSION: Negotiated prices for surgical oncology procedures reported by hospitals vary greatly within and across individual private insurers. These findings suggest that Hospital Price Transparency Rule may identify unwarranted variation in private-payer prices for operation.

Trends in Reimbursement for Index Surgical Oncology Procedures in Contemporary Practice: Declining Reimbursement for Surgical Oncology Procedures-How Low Do We Go?

BackgroundComprehensive trends in Medicare reimbursement, increasingly relevant to current and future surgical oncology practice, have not been well studied.ObjectiveThe aim of this study was to analyze Medicare reimbursement for index surgical oncology procedures between 2007 and 2021.MethodsUsing the Physician Fee Schedule Look-Up Tool from the Centers for Medicare and Medicaid Services, reimbursement data from 2007 to 2021 were obtained for 23 index surgical oncology procedures. Total change in Medicare reimbursement, yearly rates of change, and compound annual growth rate were then calculated. All data were corrected for inflation using the consumer price index. Subset analysis was performed to assess the most recent 5-year trends.ResultsOverall reimbursement for the index surgical oncology procedures increased by an average of 21.6% from 2007 to 2021. After correcting for inflation, average reimbursement decreased to − 8.6%, with the greatest decline seen for thyroid surgery (− 16.9%). Breast surgery was the only category to experience an increase in adjusted reimbursement (9.0%). The average compound annual growth rate for all procedures was − 0.68% from 2007 to 2021. In the most recent 5-year subanalysis, the yearly decrease in inflation-adjusted Medicare reimbursement averaged − 2.47% per year, in comparison with the − 0.60% overall rate of yearly decline (p < 0.005).ConclusionAdjusted Medicare reimbursement for surgical oncology procedures decreased steadily from 2007 to 2021, with an accelerating trend over the last 5 years. As the Medicare population increases, surgical oncologists need to understand these trends so they may consider practice implications, advocate for proper reimbursement models, and preserve access to surgical oncology services.

Impact of an inpatient advanced practice provider on hospital length of stay after major urologic oncology procedures.

Although timely hospital discharge is a complex and multifactorial process, this metric is consistently a focus for hospitals and health care systems. It also has been a long practice that the American Urological Association (AUA) supports the use of advanced practice providers (APPs) as an integral member of the urological care team. Here, we performed a preliminary evaluation of the effectiveness of an inpatient APP in reducing hospital length of stay (LOS) following major urologic oncology procedures. Surgical outcomes, surgeon data, and LOS for open and minimally invasive urologic oncology procedures, including radical prostatectomy, partial or radical nephrectomy, and radical cystectomy, were compiled over a 4-year period (pre-APP: 2014-2016 and post-APP: 2018-2020). Univariate descriptive statistics analyzed the association of an inpatient APP in with reducing hospital LOS over time. Average LOS decreased in all surgical procedures and for all surgeons in the post-APP setting, irrespective of surgical approach (P< 0.05). An inpatient APP was associated with a decrease of hospital LOS for urologic oncology patients over time. Such observations underscore the likely economic benefit to the health care system and potential improved coordination of care and satisfaction for patients undergoing major urologic oncology procedures.

Leveraging robotics, artificial intelligence, and machine learning for enhanced disease diagnosis and treatment: Advanced integrative approaches for precision medicine

The ever-growing burden of disease necessitates a paradigm shift in healthcare towards a more precise and data-driven approach. This paper delves into the transformative potential of integrating robotics, artificial intelligence (AI), and machine learning (ML) to revolutionize disease diagnosis and treatment. We explore advanced integrative approaches that synergistically combine robotic automation, AI-powered diagnostic tools, and ML-based predictive models to usher in the era of precision medicine. The realm of robotic systems for surgical intervention is experiencing a significant renaissance. We discuss the development and application of next-generation robotic surgical platforms. These platforms boast enhanced dexterity, improved visualization through high-definition 3D cameras, and tremor filtration capabilities, leading to minimally invasive procedures with superior precision, reduced blood loss, and faster patient recovery. We delve into the integration of haptic feedback technology that allows surgeons to experience realistic tissue manipulation, further enhancing surgical control and decision-making. Additionally, the paper explores the burgeoning field of robotic-assisted microsurgery, where miniature robots provide unparalleled access and manipulation at the cellular level, paving the way for groundbreaking advancements in areas like neurosurgery and ophthalmology. Artificial intelligence (AI) is rapidly transforming the landscape of disease diagnosis. We investigate the application of AI algorithms, particularly deep learning architectures like convolutional neural networks (CNNs), in analysing medical images for Computer-Aided Diagnosis (CAD). These algorithms, trained on vast datasets of medical scans, can achieve near-human or even superhuman levels of accuracy in identifying subtle anomalies and disease signatures within radiology images, mammograms, and pathology slides. We discuss the potential of AI-powered CAD systems to support radiologists in early disease detection, improve diagnostic accuracy, and streamline workflow efficiency. Furthermore, the paper explores the promise of AI-driven natural language processing (NLP) for analysing electronic health records (EHRs) to uncover hidden patterns and identify patients at high risk for specific diseases. This allows for proactive intervention and preventative measures tailored to individual patient needs. Machine learning (ML) plays a pivotal role in enabling personalized treatment plans. We delve into the development of robust ML models that leverage large-scale, heterogeneous healthcare datasets. These datasets encompass patient demographics, medical history, genetic information, treatment response data, and real-world clinical outcomes. By analysing such complex datasets, ML algorithms can uncover intricate relationships between patient characteristics, disease progression, and treatment efficacy. This empowers clinicians to generate personalized treatment plans that optimize therapeutic response and minimize side effects. We also discuss the potential of ML for predicting patient response to specific medications and therapies, allowing for the implementation of stratified medicine approaches. This ensures that patients receive the most effective treatment based on their unique biological makeup and disease profile. The paper underscores the importance of real-world applications and case studies in validating the transformative potential of this integrated approach. We present case studies demonstrating the successful utilization of robotic surgery in complex oncological procedures, leading to improved patient outcomes and reduced healthcare costs. Additionally, we showcase the efficacy of AI-powered CAD systems in detecting early-stage cancers, enabling timely intervention and potentially life-saving outcomes. We emphasize the need for robust data collection and standardized protocols to ensure the generalizability and scalability of these novel technologies. The impact of this integrative approach on patient outcomes and healthcare efficiency is meticulously examined. We highlight the potential for robotic surgery to minimize surgical complications, reduce hospitalization times, and improve patient recovery rates. Additionally, AI-powered diagnostic tools can facilitate faster and more accurate diagnoses, enabling earlier intervention and potentially leading to better long-term health outcomes for patients. Furthermore, ML-driven predictive models promote personalized treatments, potentially leading to improved treatment efficacy and cost savings through reduced unnecessary interventions. This paper comprehensively analyses the transformative potential of integrating robotics, AI, and ML to revolutionize disease diagnosis and treatment. By leveraging these advanced technologies, we can usher in a new era of precision medicine, characterized by personalized treatment plans, improved patient outcomes, and enhanced healthcare efficiency. However, this paradigm shift necessitates addressing challenges like data privacy, regulatory frameworks, and equitable access to these technologies. By fostering interdisciplinary collaboration between engineers, clinicians, and data scientists, we can ensure the responsible and ethical development of these powerful tools, ultimately paving the way for a healthier future for all.

Highly specialized Breast Centers did not experience delay of care during COVID-19 pandemic in Italy: the Senonetwork experience.

Aim of the studyThe study aims to evaluate the performance of selected, high-volume, highly specialized, Italian Breast Centers at the time of COVID-19 pandemic (year 2020), compared to pre-pandemic time (year 2019), highlighting differences in terms of clinical presentation of breast cancer (BC) and therapeutic strategies.MethodsPatients’ data were provided by the Senonetwork data warehouse Senonet. In order to examine changes in the surgical and oncological management of BC patients during different phases of COVID-19 pandemic, we took advantage of a selection quality indicators (QIs). We performed the analyses in two time-frames, from July to September (Jul-Sep) (2019 versus 2020) and from October to December (Oct-Dec) (2019 versus 2020).ResultsOur analysis did not show any statistically significant difference in terms of diagnosis, surgical, oncological and radiation therapy procedures between the two trimesters 2019 and 2020. Nevertheless, we observed statistically significant differences, favoring 2020, when analyzing time-to surgery and time-to radiotherapy. On the other hand, we observed a significant reduction of neoadjuvant chemotherapy and we did not recollect any data on a major use of neoadjuvant endocrine therapy.ConclusionsIn Italian Breast Centers, partners of Senonetwork, we could not observe any treatment delay or change in standard clinical practice for BC care during the 2020 pandemic year, compared to 2019 pre-pandemic year. This finding is in contrast with the globally reported decrease in the performance of the Italian Breast Centers due to the COVID-19 pandemic, and has to be linked to the sharp selection of Senonetwork Breast Centers.

Quality of superior mesenteric and hepatic artery dissection in robotic pancreatoduodenectomy for pancreatic cancer.

This video manuscript by Ikoma and colleagues demonstrates their approach to the superior mesenteric artery and hepatic artery periadventitial dissection. The quality of superior mesenteric artery and hepatic artery dissections should be maintained in robotic pancreatoduodenectomy when performed for pancreatic cancer, to provide the best possible oncological outcomes.