Tumor Resection Surgery Research Articles

Optimizing registration uncertainty visualization to support intraoperative decision-making during brain tumor resection.

Neurosurgeons need to precisely localize and resect tumors without damaging critical brain tissue. However, deformation of the brain (i.e., 'brain shift') and other factors introduce uncertainty during image-guided surgery. We present a new visualization software that supports qualitative and quantitative exploration of the effectiveness of a broad range of methods for communicating uncertainty. We expect that the ability to visualize uncertainty during surgery will help surgeons better understand uncertainty in neuronavigation and make more informed decisions. We developed UVisExplore, a software module for exploring various visualization techniques for understanding the spatial distribution of uncertainty in image registration. UVisExplore incorporates multiple classic uncertainty visualization techniques and introduces two novel paradigms appropriate for surgical environments. We also introduce a novel game-based approach to evaluate visualization effectiveness before surgery. The game scenario emulates the cognitive decision-making process during tumor resection allowing quantitative evaluation of visualization effectiveness in a non-threatening environment while training neurosurgeons to better understand uncertainty. Six clinicians and three computer scientists participated in a study using our game. Participants explored different uncertainty visualization techniques in a tumor resection task and provided feedback. Surgeon-participants preferred surgeon-centric approaches, which emphasize uncertainty near the surgical probe. They also preferred explicit numerical measures of uncertainty displayed in millimeters. The game provided valuable insights into uncertainty visualization preferences and interpretation. We provide an open-source 3D Slicer module for visualizing registration uncertainty and a game that allows users to explore uncertainty visualization for tumor resection surgery. UVisExplore provides a platform for exploring and comparing various uncertainty visualization techniques while simulating the decision-making process during surgery. The visualization module and the game proved to be a valuable communication tool and helped narrow the field of candidate visualizations that we plan to test during surgical procedures in the next phase of our research.

Investigating Clinical Significance of 3D Single-hole Thoracoscopy Surgery for Mediastinal Tumor Resection With Artificial Pneumothorax

AIM: This study aims to analyze and compare the clinical efficacy and safety between single-hole approach and two-hole video-assisted thoracoscopic surgery (VATS) for mediastinal tumor resection. METHODS: This study included 62 patients who received VATS mediastinal tumor resection in the Thoracic Department of the Affiliated Hospital of Xuzhou Medical University, between March 2020 and March 2022. Patients were divided into a single-hole VATS group (27 cases) and a two-hole VATS group (35 cases). The two groups were compared for their clinical characteristics (such as age, gender, tumor size, body mass index (BMI), comorbidities, and pathological findings), postoperative outcomes (such as operation time, intraoperative bleeding, transfer to open surgery, drainage volume, extubating time, and hospital stay), postoperative complications, and pain score. RESULTS: There were no significant differences in operation time, introperative bleeding volume, and postoperative complication rates between the two groups (p > 0.05). However, extubating time and hospital stay were significantly shorter in the single-hole VATS group than the two-hole VATS group (p < 0.05). Moreover, drainage volume was decreased in the single-hole VATS group compared to the two-hole VATS group (p < 0.05). The pain score was significantly lower on days 1 and 3 post-surgery in the single-hole VATS group than in the two-hole VATS group (p < 0.05). CONCLUSIONS: In conclusion, 3D single-hole VATS mediastinal tumor resection is a safe and feasible option for treating mediastinal tumors compared to the traditional approach. Furthermore, it significantly reduces postoperative pain, lowers drainage duration and volume, as well as extubating time, promotes faster recovery, and reduces hospital stays.

Identification of Major Bleeding Events in Postoperative Patients With Malignant Tumors in Chinese Electronic Medical Records: Algorithm Development and Validation.

Postoperative bleeding is a serious complication following abdominal tumor surgery, but it is often not clearly diagnosed and documented in clinical practice in China. Previous studies have relied on manual interpretation of medical records to determine the presence of postoperative bleeding in patients, which is time-consuming and laborious. More critically, this manual approach severely hinders the efficient analysis of large volumes of medical data, impeding in-depth research into the incidence patterns and risk factors of postoperative bleeding. It remains unclear whether machine learning can play a role in processing large volumes of medical text to identify postoperative bleeding effectively. This study aimed to develop a machine learning model tool for identifying postoperative patients with major bleeding based on the electronic medical record system. This study used data from the available information in the National Health and Medical Big Data (Eastern) Center in Jiangsu Province of China. We randomly selected the medical records of 2,000 patients who underwent in-hospital tumor resection surgery between January 2018 and December 2021 from the database. Physicians manually classified each note as present or absent for a major bleeding event during the postoperative hospital stay. Feature engineering involved bleeding expressions, high-frequency related expressions, and quantitative logical judgment, resulting in 270 features. Logistic regression (LR), K-nearest neighbor (KNN), and convolutional neural network (CNN) models were developed and trained using the 1600-note training set. The main outcomes were accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each model. Major bleeding was present in 4.31% (69/1600) of the training set and 4.75% (19/400) of the test set. In the test set, the LR method achieved an accuracy of 0.8275, a sensitivity of 0.8947, a specificity of 0.8241, a PPV of 0.2024, an NPV of 0.9937, and an F1-score of 0.3301. The CNN method demonstrated an accuracy of 0.8900, sensitivity of 0.8421, specificity of 0.8924, PPV of 0.2807, NPV of 0.9913, and an F1-score of 0.4211. While the KNN method showed a high specificity of 0.9948 and an accuracy of 0.9575 in the test set, its sensitivity was notably low at 0.2105. The C-statistic for the LR method was 0.9018 and for the CNN method was 0.8830. Both the LR and CNN methods demonstrate good performance in identifying major bleeding in patients with postoperative malignant tumors from electronic medical records, exhibiting high sensitivity and specificity. Given the higher sensitivity of the LR method (89.47%) and the higher specificity of the CNN method (89.24%) in the test set, both models hold promise for practical application, depending on specific clinical priorities.

A HClO-activated BODIPY based ratiometric fluorescent probe with dual near-infrared channels for differentiating cancerous cells from normal cells and surgical guidance of tumor resection.

A HClO-activated BODIPY based ratiometric fluorescent probe with dual near-infrared channels for differentiating cancerous cells from normal cells and surgical guidance of tumor resection.

Fluorescein-distribution in confocal laser endomicroscopy allows for discrimination between primary brain tumours and metastases.

Emerging digital biopsy technologies, such as confocal laser endomicroscopy (CLE), have shown how neuro-oncological surgery can be revolutionised with the help of rapid, intraoperative tissue assessment which offers a high diagnostic accuracy. For in vivo CLE of cerebral neoplasia, there is only one existing staining agent-Sodium-Fluorescein (SF)-approved for intravenous application. The staining characteristics of SF yet remain unclear. In order to understand the dyeing behaviour of SF, we initiated a pilot study, comparing the staining pattern when incubating established tumour cell lines with SF in vitro to the distribution of intravenously applied SF in situ-examined with CLE ex vivo as well in vivo. In vitro, the cell lines showed a hyperbolic, time-dependent cellular accumulation of SF. Carcinoma cell lines showed significantly more intracellular SF than glioma cell lines. This phenomenon could be observed when applying SF intravenously before tumour resection surgery. In gliomas and meningiomas, SF could only be detected in 14.3% and 16.1% of images per case, while in carcinoma metastases, SF would accumulate in 68.1% of images per case. The concordant results from in vitro, ex vivo and in vivo investigations could show that the cellular accumulation of the staining agent SF varies depending on the tumour entity. While primary brain tumours rarely show intracellular SF accumulation, carcinoma metastases display SF intracellularly more frequently. Therefore, SF allows for a better discrimination between brain tumours and brain metastases when performing CLE in vivo.

Abstract 1978: Circulating rare events as a biomarker of anti-tumoral effect of ketamine therapy in non-small cell lung cancer

Abstract Non-small cell lung cancer (NSCLC) remains one of the leading causes of cancer-related mortality worldwide, with surgical resection (with or without adjuvant chemotherapy) often being the recommended treatment for resectable localized disease. However, even with curative-intent resections, 30% to 55% of localized NSCLC patients experience recurrence and will die from the disease. Tumor-associated cells detected in peripheral blood, referred to here as circulating rare events, are believed to play a key role in metastatic dissemination, underscoring their potential as indicators of treatment response and recurrence risk. Recent retrospective analyses have revealed that the use of intraoperative Ketamine (Ket) during primary tumor resection surgery is associated with a lower recurrence rate, suggesting a potential utility in cancer treatment beyond its approved indication as an adjunct anesthetic. The study presented here investigates the effects of different anesthetic protocols on circulating rare events in NSCLC patients, specifically comparing Ket and dexmedetomidine (Dex) (also commonly employed as an adjunct anesthetic), to assess whether Ket exhibits anti-tumor effects and modulates the systemic tumor environment. Peripheral blood samples (n=60) were collected from 22 early-stage NSCLC patients undergoing primary tumor resection, with samples taken preoperatively (before surgical incision and after surgical closure) and at a three-week follow-up. Circulating rare events were identified through advanced imaging and phenotypic analysis and validated by comparison to blood samples from normal donors, which served as controls. Results indicated no significant differences between the anesthetic agents in pre- and post-surgery samples; however, at the three-week follow-up, Ket was associated with a higher incidence of circulating rare events and an increase in a specific cellular phenotype consistent with endothelial cells. These findings suggest that Ket may influence tumor vasculature and enhance tumor shedding, which could lead to a better prognosis after tumor resection in lung cancer patients. This highlights the potential of Ket as a perioperative agent that modulates tumor biology, as demonstrated by increased rare cell detection, and supports further investigation into a possibly expanded role in surgical oncology for potential to improve long-term outcomes in NSCLC patients. Citation Format: Anya Shah, Stephanie Shishido, Jeremy Mason, George W. Fischer, David Amar, Dawn Desiderio, Joseph R. Scarpa, David R. Jones, Amitabh Gulati, Alessia Pedoto, Alessandro De Camilli, Cosmin Guaran, Jacob C. Jackson, Alexandra Lewis, Michelle Zanone, Lucy Nystrom, Howard Scher, Ethan Barnett, Joshua Mincer, Peter Kuhn. Circulating rare events as a biomarker of anti-tumoral effect of ketamine therapy in non-small cell lung cancer. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 1978.

Comparison of open and minimally invasive nephrectomy for Wilms tumor: a systematic review and meta-analysis from the International Society of Pediatric Surgical Oncology.

To compare the risks, complications, and feasibility of minimally invasive and open surgery for resection of Wilms tumor, we systematically reviewed comparative studies assessing the oncologic outcomes of minimally invasive (MIS) versus open surgery and performed both a meta-analysis and a critical assessment of the MIS surgical landscape in the field of pediatric urology.A systematic review of current literature was performed using PubMed, EMBASE, Google Scholar, Cochrane Collection, and Web of Science databases.Of 310 articles screened, a total of 9 studies (5 retrospective, 2 prospective, and 2 database/population-level retrospective reviews) were included in the meta-analysis. Heterogeneity was considered minimal between studies, and adjustments were made when necessary. Rates of intra-operative tumor spillage, positive margins, complications, recurrence, and survival were similar between MIS and classical open surgery. Mean length of hospital stay and operative times were significantly lower in MIS, with a mean difference of.96 days and 22.48 min, respectively (p < 0.001). The mean number of retrieved lymph nodes was significantly lower in MIS vs open surgery, with a difference of 3 nodes recorded (p = 0.003).Although lymph-node retrieval sampling was found to be reduced in MIS Wilms tumor resection, there were no differences in complications or post-operative outcomes when comparing MIS vs classical open surgery. We conclude that outcome metrics are considered equivalent in MIS and classical open surgery, though operative surgical times and total hospital stay are shorter with MIS resection. Further evidence-based prospective studies and quality reporting of lymph-node retrieval are crucially warranted as MIS becomes increasingly adopted.

Innovative Thermosensitive Composite Materials: Merging Poloxamer PF‐127 and Polysaccharides for Enhanced Functional Properties

AbstractCurrently, new cancer treatment options are being developed following tumor resection surgery, with a focus on minimizing invasiveness and reducing systemic toxicity to lower the risk of recurrence. In this context, the thermosensitive poloxamer Pluronic Acid F‐127 (PF‐127) is modified by incorporating polysaccharides with varying structures—xanthan gum (XG), alginate (ALG), gellan gum (GG), and levan (LEV). Hydrogels are synthesized using different ratios of polysaccharides and PF‐127. Rheological results reveal that adding polysaccharides to the hydrogel matrix increases storage moduli from 8 to 11–18 kPa and viscosity from 4.5 to 6.1–7.1 Pa s. Additionally, the micellar aggregation capacity (MAC) and gelation temperature shift from 34 °C to between 22 and 31 °C. Studies on 5‐fluorouracil (5‐FU) release from these composites indicate that enhanced MAC prolongs drug release 4 times longer compared to the hydrogel made with PF‐127 alone. A mathematical model is applied to analyze these experimental results, taking into account polymer chain release. Hydrogel's degradation rate and viscosity are primary determinants of drug release duration. Thus, by modifying the hydrogel composition, MAC, thermosensitivity, and drug release profile can be finely controlled based on the polysaccharide used.

Fluorescence Endoscopy with Second Window Indocyanine Green for Surgical Resection of Malignant Brain Tumors.

This study aimed to validate the clinical feasibility, safety, and effectiveness of using the fluorescence endoscopy with second window indocyanine green (FESWICG) technique for resection of malignant brain tumors. Twenty-two patients undergoing surgery for malignant brain tumor resection were examined. Intravenous ICG (250mg) was administered within 24hours prior to surgery. All procedures were performed under endoscopic guidance. The fluorescence intensity of the tumors was monitored using fluorescence mode endoscopy. Specimens including resection margins were harvested and submitted for histopathological analysis. The sensitivity and specificity of FESWICG were validated using contrast-enhanced cranial magnetic resonance imaging performed within 24hours of surgery and histopathology. The Karnofsky performance scale was used to assess overall functional status before and after surgery. The tumor diagnoses were as follows: glioma (n= 14), ependymoma (n= 1), metastasis (n= 5), lymphoma (n= 1), and choroid plexus papilloma (n= 1). Intraoperative tumor fluorescence was strong in 20 patients and weak in 2. Postoperative contrast-enhanced imaging revealed complete tumor resection in 18 patients (81.82%). Sixty-four tumor specimens were collected, including 42 obtained from tumor margins. Using histopathology as the reference, the sensitivity, specificity, positive predictive value, and negative predictive value of FESWICG for detection of malignant brain tumors were 91.42%, 41.38%, 65.31%, and 80%, respectively. The median Karnofsky performance scale score was 85 before surgery and 93 at the 3-month follow-up. SWICG notably enhanced intraoperative visualization of malignant brain tumors, particularly the delineation between tumor and normal brain. Its utility for margin detection is promising. When utilized in conjunction with a full endoscopic system, the visual acuity and overall effectiveness of surgical procedures can be substantially enhanced. However, ICG remains a low-specificity technique.

1331 Validation of a New Therapeutic Target Using Tissues From Tumour Resection Surgery to Re-Establish Cell Cycle Checkpoint Response in Glioblastoma

1331 Validation of a New Therapeutic Target Using Tissues From Tumour Resection Surgery to Re-Establish Cell Cycle Checkpoint Response in Glioblastoma

AB-084. A more cost effective method to register the spinal D Wave during intraspinal tumor resection surgeries

AB-084. A more cost effective method to register the spinal D Wave during intraspinal tumor resection surgeries

High Plasma Alpha-Fetoprotein Level Is Associated With Early Postoperative Complications in Patients With Hepatocellular Carcinoma in Southern Vietnam During 2018-2023: A Cross-Sectional Study.

Liver tumor resection surgery for HCC treatment causes postoperative complications that affect long-term outcomes and the patient's quality of life. We performed this study to determine the early complication rate and predictive value of plasma AFP for early postoperative complications in HCC patients. We performed a cross-sectional, longitudinal descriptive study on 98 HCC patients treated with radical surgery from March 2018 to March 2023. We included all patients > 16 years old, indicated and undergoing liver resection using the Ton That Tung method, had HCC histopathology results, and agreed to participate in the study group. Pregnant or breastfeeding females, having portal vein thrombosis, or not meeting the study criteria were excluded from this study. The main complications were collected during the postoperative stay. All patients were divided into two groups: Group 1 (n = 26) was the group with complications, Group 2 (n = 72) was the group without complications. There were 26 patients (26.5%) who had complications after surgery, of which liver function failure accounted for 4.1% (4 patients) and ascites accounted for 12.3% (12 patients). Alcoholism, hepatitis virus infection, low platelets, increased plasma AFP, and high Child-Pugh score were independent factors related to the complications after surgery, p < 0.05. ALBI index, Child-Pugh score, and plasma AFP concentration predicted postoperative complications with AUC of 0.677, 0.777, and 0.834, respectively (p < 0.01). The rate of complications after surgery was 26.5%. Plasma AFP concentration was a good predictor of postoperative complications.

Extension patterns of giant lipomas arising from the brachial plexus: giant lipomas from brachial plexus.

Benign adipose tumors in close proximity to the major nerves are termed troublesome lipomas and are indicated for resection because of neurological impairment. Until now, however, limited cases of giant lipoma arising from the brachial plexus region have been reported. We discussed our experience with cases of giant lipomas arising from the brachial plexus region. We reviewed six cases treated in our hospital. There were four males and two females with the mean age of 55years. On its greatest dimension, the size of the giant tumor ranged from 14 to 30cm with an average of 21.6cm. Based on MRI findings, the tumor extension patterns were divided, (1) lateral type, (2) posterior type and (3) inferior type. The symptoms were characteristic according to extension patterns of the tumor. Five patients who underwent tumor resection showed improvement in subjective symptoms early after surgery. An asymptomatic case with inferior type underwent only open biopsy. The histopathology in all cases confirmed ordinary lipomas. There was no local recurrence postoperatively. Brachial plexus lipoma has potential to grow unexpectedly large due to repetitive microtrauma. The indication for tumor resection surgery should be considered in each type of tumor extension. The lateral type, which directly causes neurological symptoms, is the most indicative for tumor resection, while the posterior type is more suitable for surgery due to stubborn shoulder stiffness and symptom with thoracic outlet syndrome. In the case with inferior extension type, the patient was asymptomatic and the operative indication should be less.

Clinical application of 4N-enhanced recovery after surgery in retroperitoneal laparoscopic resection of adrenal tumors.

Enhanced recovery after surgery (ERAS) has been widely applied in various surgical fields to improve postoperative recovery and reduce complications. However, its application in retroperitoneal laparoscopic resection of adrenal tumors remains limited. This study aimed to evaluate the effect and value of the 4N-ERAS protocol, which includes no Foley catheter, no drainage, no antibiotics, and "no pain" management for the postoperative recovery of patients undergoing retroperitoneal laparoscopic adrenal tumors resection. We retrospectively analyzed data from 85 patients with adrenal tumors who were treated in the Urology Department of The University of Hong Kong-Shenzhen Hospital from January 2019 to December 2023. Of them, 42 patients were treated with the 4N-ERAS protocol (4N-ERAS group) and 43 patients received traditional treatment (control group). We compared clinical characteristics, such as sex, age, mean body mass index (BMI), preoperative diagnosis, tumor size, tumor location, and postoperative outcomes, including time to first flatus, time to first ambulation, time to Foley catheter removal, time to retroperitoneal drainage tube removal, postoperative pain score [Numeric Rating Scale (NRS)], length of hospital stay, total hospitalization costs, and postoperative complications between the two groups. There were no significant differences in terms of clinical characteristics between the two groups. Compared to the control group, the 4N-ERAS group exhibited shorter times for first flatus, first ambulation, Foley catheter removal, retroperitoneal drainage tube removal, lower postoperative pain scores (NRS), and shorter hospital stays (P<0.05). Furthermore, compared to the control group, the total hospitalization cost was significantly lower in the 4N-ERAS group (P<0.05). There were no significant differences in terms of postoperative complications between the two groups (P=0.19). The 4N-ERAS protocol for retroperitoneal laparoscopic resection of adrenal tumors may expedite postoperative recovery, reduce pain, and lower overall hospital costs. This preliminary study demonstrated the safety and feasibility of the 4N-ERAS protocol for retroperitoneal laparoscopic resection of adrenal tumors, warranting future multicenter prospective, randomized, controlled trials in this field.

Collagen IV-Targeted Nanoparticles for Cardiac Tumor Drug Delivery

Patients with cardiac tumors have a limited prognosis and the only available treatments are tumor resection surgery, radiation and chemotherapy, with poor expected outcomes. Therefore, it is necessary to identify promising therapeutical strategies for targeting dysregulated molecules in the extracellular matrix characteristic of cardiac tumors. Collagen IV is a promising target for cardiac tumor treatment, due to its high expression in cardiac vasculature, fibrotic cardiac tissue, and the tumor stroma. We aim to synthesize collagen IV-targeted nanoparticles (Col-NPs) as a novel drug delivery system in cardiac tumors. Lipid NPs containing the phospholipids DOPG, POPC and Mal-PEG-DSPE were synthesized using the reverse-phase evaporation technique. The obtained lipid NPs were coupled on their surface with collagen IV-binding peptides via a maleimide-cysteine bond. Col-NPs were characterized for their hydrodynamic diameter and Zeta potential. The biocompatibility and accumulation of Col-NPs in the heart were assessed in a mouse model with increased collagen IV expression in cardiac tissue. The mice were injected intravenously with fluorescently labeled Col-NPs to investigate their localization in organs using an IVIS Spectrum Caliper 200 Imaging System. For the safety evaluation of Col-NPs, biochemical plasma parameters (cholesterol, triglycerides, urea, creatinine, transaminases) were assessed with commercial kits. Organ tissues were analyzed histopathologically using hematoxylin-eosin staining. Col-NPs have a hydrodynamic diameter of ~ 140 nm and a Zeta potential of ~ -35 mV. After intravenous administration, both Col-NPs and untargeted NPs (Scr-NPs) primarily accumulated in the liver and spleen of the mice. When examining the hearts of mice, a greater accumulation of Col-NPs compared to Scr-NPs was observed. There was no evidence of renal or hepatic toxicity, and Col-NPs were found to be biocompatible. Additionally, no pathological lesions were detected in the liver, lung, spleen, and kidney of mice injected with Col-NPs. This targeted approach has the potential to not only improve therapeutic efficacy by facilitating the accumulation of the drug at the tumor site in sufficient concentrations to exert its effects but also to reduce the required dosage, thereby minimizing systemic toxicity.

Comparation of tumor-free margin or intralesional spondylectomy for chondrosarcoma in mobile spine: a retrospective study of surgery management, complications and prognosis

Study designRetrospective Cohort Study.ObjectivesChondrosarcoma of mobile spine is a rare aggressive malignant tumor and postsurgical local recurrence rates remain high. En bloc resection is currently the preferred treatment. Resection that achieves tumor-free margin removal of the tumor may enable more complete removal of tumor tissue but significantly increases the complexity and risk of surgery and results in more postoperative complications. We sought to compare surgical outcomes, complications, and prognoses between patients who underwent en bloc resection with and without intralesional removal of the tumor.MethodsWe reviewed 56 patients with spinal chondrosarcoma who underwent en bloc tumor resection and reconstructive surgery at our center between 2000 and 2024 with a minimum postoperative follow-up of 1 year. We collected and analyzed data regarding surgical procedures, complication characteristics, and local tumor control and recurrence.ResultsWe included 56 patients. Of these, 36 patients underwent the first surgery, and 20 experienced recurrences. All patients underwent en bloc tumor resection; 36 and 20 underwent intralesional and tumor-free margin resections, respectively. We recorded 83 complications; the incidence and the number of major complications were significantly higher in the tumor-free margin surgery group. Thirty patients experienced tumor recurrence and 26 patients died. Tumor-free margin en bloc resection and conventional-type chondrosarcoma were predictive factors for reduced long-term postoperative recurrence and mortality risk.ConclusionsTumor-free margin resection carries higher risks and is associated with a greater number of perioperative complications, but reduces the risk of local tumor recurrence and prolongs recurrence-free survival and overall survival, providing patients with better prognoses.

Long-Term Bladder, Bowel, and Ambulatory Function After Sacrectomy Surgery

Study Design. Retrospective cohort study. Objective. To assess 5-year bladder, bowel, and ambulatory function in patients receiving sacral tumor resection surgery. Summary of Background Data. Sacral tumors are rare and slow growing, often leading to late diagnoses and large tumor size. Surgical resection is the standard of care, and frequently involves nerve root sacrifice. These structures are important for bladder, bowel, and ambulatory function, and previous studies have limited follow-up. Hence, little is known regarding how sacral nerve function changes over time after sacrectomy surgery. Methods. We conducted a retrospective analysis of 43 patients who received surgery at our institution. Patients were stratified into groups based on osteotomy level (intralesional, low, mid, and high). Descriptive statistics were calculated with point estimates. Kruskal-Wallis tests were used to compare oncologic, surgical, and functional outcomes across sacrectomy groups. Cumulative link mixed models (CLMMs) were used to assess functional trends over time. Results. There were significant differences in preoperative and 1-year bladder, bowel, and ambulatory function (P&lt;0.05). However, there were no significant differences between 1-year and 5-year bladder, bowel, and ambulatory function (P=0.99, P=0.80, and P=0.72). At 5-years, bladder function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group (P=0.04 and P=0.002). At 5-years, bowel function was significantly better in the intralesional and low sacrectomy versus the mid sacrectomy group (P=0.01 and P=0.01). At 5-years, ambulatory function was significantly better in the low sacrectomy versus the high sacrectomy group (P=0.006). Conclusion. As expected, higher osteotomy level was associated with poorer function. Bladder, bowel, and ambulatory function was shown to stabilize at 1-year postoperatively. This can serve as an assessment point for long-term function and can help set patient expectations after surgery. Level of Evidence. Level III, cohort study.

Vascularized fibular epiphyseal transfer for biological reconstruction of bone defects following resection in children with proximal humeral sarcoma

BackgroundThe functional reconstruction of bone defects following resection of proximal humerus tumors in children poses a significant challenge. This study utilized vascularized fibular epiphyseal transfer for proximal humerus reconstruction to evaluate the outcome, complications, and survival rates.MethodsIn this study, we conducted a retrospective analysis of 13 pediatric patients who underwent vascularized fibular epiphyseal transfer for biological reconstruction following oncologic resection of the proximal humerus between 2019 and 2021. All patients received adequate preoperative preparation and evaluation, and complications were meticulously recorded. Regular functional follow-ups and imaging evaluations were performed.ResultsA total of 13 patients with an average age of 9.8 years were included in this study. The average length of the humerus defect after surgical resection was 13.7 cm (9.4–17.8 cm). Delayed wound healing was observed in 2 patients, and one patient experienced brief common peroneal nerve palsy. There were 3 cases of graft fracture, all of which occurred within 1 year after operation. These cases were successfully managed through the application of draping plaster or brace fixation. The mean follow-up period was 39.8 months (ranging from 19 to 57 months). The mean Musculoskeletal Tumor Society (MSTS) score was 21.5 (18–24). All patients reported no persistent pain.ConclusionIn conclusion, we assert that vascularized fibular epiphyseal transfer provides a reliable and promising option for reconstruction in pediatric patients undergoing proximal humerus tumor resection surgery. Graft fractures were the most prevalent complication, emphasizing the importance of cautionary measures to prevent falls or trauma. However, further validation through increased case numbers and extended follow-up periods is necessary.

Multicenter retrospective analysis of transoral robotic surgery for parapharyngeal space neoplasm

Objective: To investigate the efficacy and feasibility of transoral robotic surgery (TORS) for resection of tumors in the parapharyngeal spaces. Methods: The clinical data of 57 patients who underwent TORS for parapharyngeal space tumors from September 2018 to February 2024 were retrospectively analyzed. These patients were treated at five medical institutions: The First Affiliated Hospital of China Medical University, Eye & ENT Hospital of Fudan University, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, and Sun Yat-sen University Cancer Center. The patients were 28 males and 29 females, aged 17-77 years (median age, 47 years). The pathological types, locations, and sizes of the tumors, operation time, intraoperative bleeding volumes, postoperative hospital stays, and postoperative complications were evaluated. The data were analyzed using SPSS 27.0 software. Results: Postoperative pathological examination revealed 11 types of benign tumors. Among 57 cases, 27 cases had their tumors in the prestyloid spaces, predominantly with pleomorphic adenoma (n=17), and 30 cases in the retrostyloid spaces, predominantly with schwannoma (n=22). The tumor volumes ranged from 0.6 to 130.1 cm³, the intraoperative bleeding volumes ranged from 5 to 1 000 ml, the operation time ranged from 20 to 390 min, and the postoperative hospital stays ranged from 2 to 25 days. The total costs for individual cases were 36 000-100 000 yuan, with the highest cost in the case suffering from cerebrovascular accident. Four patients(7.0%) had tracheotomy and 36(63.2%) had nasogastric tube placement. Among the 57 patients, 5 had postoperative cavity effusion, 2 had wound dehiscence, 2 had cerebrovascular accidents, 1 had Horner syndrome, and 2 had other complications. The patients were followed up for 1-67 months, with only 1 patient with intracranial and extracranial communication relapsed. Conclusion: TORS is a safe and feasible approach for treating parapharyngeal space tumors, offering advantages such as minimal invasiveness, reduced blood loss, and faster recovery. It is suitable for parapharyngeal space tumors of various pathological types and locations. The postoperative complications are manageable, with favorable long-term follow-up results and low recurrence rates.

Aggressive resection of non-contrast-enhanced tumor provides varying benefits to glioblastoma, IDH-wildtype patients based on different clinical characteristics.

Aggressive resection of non-contrast-enhanced tumor provides varying benefits to glioblastoma, IDH-wildtype patients based on different clinical characteristics.