Tumor Resection Research Articles

Objective: To assess the clinicopathological characteristics of non-muscle-invasive bladder cancers (NMIBC) with high expression of human epidermal growth factor receptor 2 (HER2) and to examine the prognostic values of HER2 expression in NMIBC patients with intravesical anthracycline instillation. Methods: A total of 221 NMIBC samples diagnosed between January 1, 2017 and April 15, 2024 were collected. Their clinical, diagnostic and treatment features were analyzed. The expression of HER2 protein and the Ki-67 proliferation index were assessed using immunohistochemistry (IHC). For the patients with HER2 high-expression (IHC 3+), the clinical pathological features (age, gender, tumor grade, Ki-67 expression level, tumor size, and tumor number) were compared with those without (i.e., HER2 IHC 0/1+/2+). The impact of HER2 expression on the recurrence-free survival (RFS) of patients with intravesical anthracycline (epirubicin or pirarubicin) instillation after transurethral resection of bladder tumor (TURBT) was evaluated. Results: Among the 221 NMIBC patients, 30 (13.6%) were HER2 IHC 3+, 142 (64.3%) HER 2+, 46 (20.8%) HER2 1+, and 3 (1.4%) HER2 IHC 0. The proportion of high-grade tumors in patients with HER2 high-expression was higher than that in patients without (83.3% versus 44.5%, P<0.001). Additionally, a high Ki-67 index (≥20%) was more commonly noted in HER2 high-expression tumors (P=0.003). In the patients treated with intravesical anthracycline instillation, HER2 high-expression was associated with a shorter RFS (P<0.001). Conclusion: HER2 high-expression seems to be not only associated with worse clinicopathological features of NMIBC but also a poor RFS in NMIBC patients treated with anthracycline instillation after TURBT.

Severe cranial defects caused by trauma, tumor resection, or congenital anomalies remain challenging to repair. Conventional cranioplasty using autografts or metal/polymer plates carries risks of donor-site morbidity, infection, and suboptimal contour. Patient-specific 3D-printed “living” implant, biodegradable scaffolds seeded with autologous cells, offer precise anatomical fit and active bone regeneration. Early clinical applications in countries including South Korea, Egypt, and Brazil demonstrate improved cosmetic outcomes, accelerated bone formation, and reduced operative time. Integrating tissue engineering with additive manufacturing represents a shift in neurosurgical reconstruction, providing biologically active solutions that restore both form and function. Ongoing research focuses on vascularization, cell viability, and clinical translation. Living 3D-printed cranial implants have the potential to redefine standards of care, emphasizing regenerative repair over inert prosthetic replacement.

Investigating the impact of circadian syndrome (CircS) on the prognosis of NMIBC, identifying potential indicators affecting prognosis, and explaining NMIBC prognosis from the perspective of circadian rhythm disruption to provide a preventable risk factor. A total of 438 patients with non-muscle-invasive bladder cancer (NMIBC) who received intravesical Bacillus Calmette-Guérin (BCG) immunotherapy after transurethral resection of bladder tumor (TURBT) were selected for retrospective analysis by retrieving medical records. The primary outcomes were recurrence-free survival (RFS) and progression-free survival (PFS). The secondary endpoints were safety parameters. Least absolute shrinkage and selection operator (LASSO) regression was used to screen variables for COX regression. Subgroup analysis and sensitivity analyses were used to validate the robustness of the results. Bootstrap and K-fold cross-validations were used to validate the robustness of the models. All adverse events (AEs) were further quantified for association strength using a logistic regression analysis. This retrospective study screened 406 patients who met the inclusion criteria for further analysis. Survival analysis demonstrated significantly lower RFS in patients with CircS compared to the non-CircS cohort (Log-rank P=0.018; HR=1.58, 95% CI: 1.08-2.31). Multivariable analysis of LASSO-selected variables identified CircS (HR=1.72, 95% CI: 1.09-2.73, P=0.021), male gender (HR=2.04, 95% CI: 1.12-3.72, P=0.02), recurrence history (HR=1.79, 95% CI: 1.17-2.73, P=0.007), and tumor diameter >3cm (HR=1.88, 95% CI: 1.24-2.87, P=0.003) as independent predictors of inferior RFS in NMIBC. Notably, elevated serum albumin levels exhibited protective effects (HR=0.91, 95% CI: 0.85-0.98, P=0.008). The prognostic significance of CircS remained robust across multiple RFS validation models, though no significant association was observed with PFS. In the analysis of AEs, patients with CircS showed significantly higher odds, such as lower urinary tract symptoms (LUTS) (OR=1.64, 95% CI: 1.02-2.63, P=0.041), hematuria (OR=2.94, 95% CI: 1.55-5.50, P<0.001), dysuria (OR=4.26, 95% CI: 1.67-11.08, P=0.002), lower abdominal pain (OR=4.28, 95% CI: 1.59-11.73, P=0.004), fatigue (OR=3.86, 95% CI: 1.60-9.34, P=0.002) and arthralgia or flu-like symptoms (OR=7.30, 95% CI: 1.40-53.31, P=0.023). CircS may serve as a potential risk factor affecting the prognosis of NMIBC, manifesting as worse RFS and AEs. Along with gender, tumor size, and recurrence history, it constitutes a high-risk factor for RFS. This finding provides clues for exploring potential causal relationships between clinical syndromes caused by circadian rhythm disruption and bladder tumor prognosis, while also reshaping the understanding of connections between chronic non-neoplastic diseases and neoplastic diseases.

This study aims to assess the surgical characteristics and prognostic factors for survival outcomes of pineal region tumors (PRTs). This was a retrospective cohort study for pediatric PRTs undergoing tumor resection at Children's Hospital 2 between 2017 and 2023. Modified Rankin Scale (mRS) and Kaplan-Meier estimation were used for analyzing functional and survival outcomes. A total of 50 PRT patients were included with a median follow-up (FU) time of 34.5 months (interquartile range [IQR] 16-54.3). Histopathologies included 28% mature teratomas, 22% malignant non-germinomatous germ cell tumors (NGGCTs), 28% pineal parenchymal tumors (PPTs), and 22% gliomas. Gross-total resection (GTR) was achieved in 100% of mature teratomas compared to only 45.5% of gliomas (p = 0.02). Favorable functional outcome was 84% at 3-month and 66% at final FU. Progression-free survival (PFS) was 78% at 1 year and 54% at 5 years. Overall survival (OS) was 86% at 1 year and 76% at 5 years. Histopathology and permanent morbidity significantly influenced survival outcomes (PFS, p < 0.001; OS, p = 0.03; p < 0.001), while the extent of resection (EOR) had no substantial impact on these (PFS, p = 0.45; OS, p = 0.46). Surgical resection plays a crucial role in certain pediatric PRTs with acceptable morbidity and mortality. A higher GTR rate can be achieved in benign lesions, particularly in mature teratomas. Functional outcome improves favorably but declines thereafter due to the progression of malignant diseases. Prognostic factors for survival outcomes include histopathology and permanent morbidity regardless of EOR.

Background: Infective endocarditis (IE) due to Gemella species is extremely rare and typically associated with dental disease, mucosal disruption, or valvular pathology. To our knowledge, this is the first reported case of Gemella morbillorum IE involving a transcatheter aortic valve replacement (TAVR) prosthesis. This case underscores the importance of recognizing uncommon pathogens in prosthetic valve endocarditis (PVE), even in the absence of typical infection sources. Case: A 70-year-old man with a remote history of lymphoma (treated with abdominal tumor resection and radiation) and severe aortic stenosis status post-TAVR presented with a 1.2 cm vegetation on the bioprosthetic valve. One month prior, he had Gemella bacteremia, treated with IV vancomycin and oral minocycline. Although clinically improved, repeat transesophageal echocardiography (TEE) revealed a new valve vegetation (Figure 1A). Blood cultures were negative, and he remained afebrile and hemodynamically stable. He denied recent dental work. Maxillofacial CT showed no dental infection. Abdominal imaging revealed a stable soft tissue mass in the posterior mediastinum, consistent with residual changes from his prior lymphoma. His abdominal surgery and radiation likely led to long-term mucosal barrier injury, predisposing to translocation of Gemella, a GI tract commensal. With recent bacteremia, a new valve vegetation, and a prosthetic valve, PVE was diagnosed. He received six weeks of IV vancomycin and ultimately underwent surgical TAVR explant and valve replacement (Figure 1B). Discussion: TAVR-related PVE is rare (0.5–1.5% annually) and typically involves Staphylococcus or Enterococcus. Gemella morbillorum is an exceptionally uncommon cause, with only isolated reports of IE involving surgically implanted valves and none in TAVR recipients. Misidentification as viridans streptococci may delay diagnosis. TAVR imaging is also challenging due to prosthetic shadowing. This case is unique in its presentation of culture-negative TAVR PVE caused by Gemella morbillorum. The patient's prior oncologic treatment likely disrupted mucosal integrity, enabling bacterial translocation. This report highlights the need to consider rare pathogens like Gemella morbillorum in PVE, particularly in patients with prior mucosal compromise or immunosuppression.

Abstract Objectives Combined bone and soft tissue injuries and defects pose a challenge for the interdisciplinary orthoplastic surgical team. These conditions are not only encountered in young, healthy patients, but, due to various causes ranging from trauma over chronic osteomyelitis to tumor resection, also in patients with pre-existing vascular disease and even many years after the initial trauma. Methods An efficient interdisciplinary treatment approach by orthopedic/trauma surgeons and plastic surgeons, and if necessary, vascular surgeons, who develop a joint strategy as early as possible is crucial for optimal functional restoration of form and function. Results The goal of this orthoplastic approach is early definitive fracture stabilization or bony reconstruction combined with adequate soft tissue coverage and reconstruction of other injured structures such as vessels, nerves, and tendons, in order to begin rehabilitation as early as possible. Conclusions The different steps of the orthoplastic surgical approach for interdisciplinary extremity reconstruction is described in the following manuscript and should encourage and provide a guideline for other orthoplastic teams, possibly leading to establishing specialized extremity reconstruction centers.

Postoperative cognitive impairment is common among patients undergoing brain tumor resection. Neurofeedback (NF) represents a promising adjunctive intervention for cognitive rehabilitation, though its clinical application in neuro-oncology remains largely unexplored. This prospective case series enrolled seven inpatients (5 women, 2 men; aged 46-76years) with cognitive deficits following brain tumor surgery. Each underwent 15 sessions of EEG-based NF (35min/session, five times per week for three weeks) in parallel with daily motor rehabilitation. Baseline and post-intervention assessments included quantitative EEG (qEEG), a comprehensive neuropsychological battery, and functional measures. All patients completed the NF protocol without adverse events. qEEG analyses revealed heterogeneous but measurable modulations in absolute power and spectral ratios, with several patients showing normalization of pathological delta/beta activity. Reliable Change Index analyses indicated cognitive improvements in all patients, particularly in domains of memory, executive function, and language. Secondary benefits were also observed in mood, motor performance, and activities of daily living, though these varied across individuals. Intensive NF training combined with motor rehabilitation was feasible and well tolerated in this heterogeneous cohort. Preliminary results suggest that NF may promote postoperative cognitive recovery, with additional gains in functional and affective domains. Larger controlled studies are required to validate these exploratory findings.

Background/Objective: Endoprosthetic proximal femoral replacement is a reconstructive procedure for preserving ambulatory function following tumor resection. Different prosthetic systems for endoprosthetic proximal femoral replacement may result in different stem placement techniques, especially regarding the anteversion angle of the stem. The aim of this study was to evaluate femoral rotation and stem anteversion following endoprosthetic proximal femoral replacement using two different prosthetic systems, and to investigate their influence on postoperative quality of life. Methods: We retrospectively reviewed 30 patients who underwent endoprosthetic proximal femoral replacement at our institution between 2008 and 2022. The evaluated parameters included patient demographics, anatomical and functional stem anteversion, femoral rotation, femoral resection length, implant type, and Musculoskeletal Tumor Society score. Results: The cohort comprised 16 males and 14 females with a mean age of 65.2 ± 13.5 years. Twenty patients received the Global Modular Replacement System implants and 10 received the Kyocera Modular Limb Salvage System implants. The mean anatomical stem anteversion was 17.0 ± 17.7°, and the mean femoral rotation was 14.4 ± 22.6°. The Global Modular Replacement System implants demonstrated less variability in anatomical stem anteversion (11.7 ± 15.2°) compared to the Kyocera Modular Limb Salvage System (27.6 ± 18.4°, p = 0.02). A significant negative correlation was found between anatomical stem anteversion and femoral rotation (r = −0.78, p &lt; 0.01), and a positive correlation between femoral rotation and functional stem anteversion (r = 0.62, p &lt; 0.01). Musculoskeletal Tumor Society scores were available in 14 patients and correlated significantly with functional stem anteversion (r = −0.62, p = 0.02) and femoral resection length (r = −0.61, p = 0.02), but not with anatomical stem anteversion or femoral rotation alone. Conclusions: This study demonstrated that stem placement angles differ between prosthetic systems. These differences are attributable to variations in surgical implantation techniques and prosthesis design philosophies. In particular, the Global Modular Replacement System incorporates built-in anteversion, and when using such prostheses, referencing the linea aspera enables more stable restoration of the anatomical stem anteversion. Excessive reduction in anatomical stem anteversion is not recommended to avoid excessive external femoral rotation.

Adrenocortical oncocytic neoplasms (ACONs) are very rare in adrenal cortical tumors. One case was reported in this paper. During the physical examination, a soft tissue density shadow was about 6 cm × 5.7 cm in the right adrenal gland. A preoperative diagnosis was adrenal pheochromocytoma with concurrent laparoscopic resection of the right adrenal tumor. Postoperative pathological results rewarded the adrenal cortical oncocytic neoplasms ACONs. After 11-months of postoperative follow-up, the patient had no signs of tumor recurrence and related complications.

Post-endoscopic submucosal dissection electrocoagulation syndrome (PEECS) is a critical complication following endoscopic resection of gastric gastrointestinal stromal tumors (gGISTs). However, validated tools for predicting PEECS risk remain limited. This study aimed to develop and validate a scoring system to stratify PEECS risk in patients undergoing endoscopic submucosal dissection (ESD). A multicenter retrospective analysis included 618 patients with gGISTs treated with ESD between January 2011 and December 2024. Cohorts were stratified into a training cohort (TC, N = 346), an internal validation cohort (IVC, N = 148), and an external validation cohort (EVC, N = 124). Univariate and multivariate logistic regression analyses identified independent risk factors, which were weighted by regression coefficients to construct a scoring system. Performance metrics, including area under the curve (AUC), sensitivity, specificity, and predictive values, were evaluated across cohorts. PEECS occurred in 89 cases (14.4%). Multivariate analysis confirmed that circumferential tumor location, severe intraoperative bleeding, and prolonged procedure time as independent predictors. The scoring system assigned points as follows: anterior wall location (2 points), occurrence of severe intraoperative bleeding (3 points), and procedure time ≥ 60min (1 point). The scoring system demonstrated robust discrimination, with AUCs of 0.838 (IVC) and 0.842 (EVC), and high negative predictive values (NPV: 95.6% and 92.1%, respectively). PEECS incidence escalated with risk strata: low-risk (score 0-1: 4.8% TC, 4.4% IVC, 5.5% EVC), intermediate-risk (score 2-3: 21.6% TC, 21.6% IVC, 25.0% EVC), and high-risk (score 4-6: 92.3% TC, 100.0% IVC/EVC). This innovative scoring system, integrating tumor location, intraoperative bleeding, and procedure duration, provides a practical tool for predicting PEECS risk. Its robust validation across cohorts underscores its potential utility in guiding perioperative management and improving patient outcomes. Clinicians may use this tool to identify high-risk patients and implement preventive strategies proactively.

To evaluate the relationship between cumulative smoking exposure, measured in pack-years, and pathologic progression in patients with transitional cell carcinoma (TCC) of the bladder staged as high-grade T1 (HG-T1). We conducted a retrospective cohort study of patients diagnosed with HG-T1 urothelial carcinoma between 2020 and 2024. Clinical and pathological data were extracted, including age, gender, BMI, comorbidities, tumor size/location, completeness of resection, and presence of variant histology. Pathologic progression was defined based on worsening histology or stage on follow-up restaging transurethral resection of bladder tumor (TURBT). A pearson correlation and multivariate logistic regression were used to assess associations. Among the 80 patients analyzed, increasing cumulative smoking exposure, measured in pack-years, demonstrated a weak negative correlation with favorable pathology outcomes (r = -0.13). Neither tumor size nor completeness of resection showed a significant association with pathology change. Pathologic worsening was observed in 29.0% of smokers compared to 5.6% of non-smokers, with this difference approaching statistical significance (p = 0.057; OR = 7.0). When comparing non-smokers specifically to heavy smokers (⩾30 pack-years), the difference was statistically significant, with 34.4% of heavy smokers experiencing pathologic progression versus 5.6% of non-smokers (p = 0.036; OR = 8.9), indicating a strong association between heavy smoking exposure and adverse pathology. Cumulative smoking exposure is an independent predictor of pathologic progression in patients with HG-T1 bladder cancer. These findings support the incorporation of smoking history into risk stratification models and underscore the importance of smoking cessation counseling in this population.

Propensity score-matched systematic review and meta-analysis: Robotic versus laparoscopic limited liver resections for tumors in the posterosuperior segments.

Periostin is involved in airway remodeling, salivary tumors, and various otolaryngological diseases. D-β-aspartic acid is the major isomer of D-aspartic acid found in the tissues of elderly individuals. In this study, we investigated the expression and role of D-β-aspartic acid and periostin in the formation of benign parotid tumors. The data of 36 patients (16 male and 20 female) who underwent parotid tumor resection between April 2017 and March 2022 and were clinically and pathologically diagnosed as having benign parotid tumors were included in this study. The mean age of the patients was 59.2 (range 26-82) years. Tumors were histologically classified as pleomorphic adenomas, Warthin's tumors, basal cell adenomas, oncocytomas, and myoepitheliomas. Increased D-β-aspartic acid expression was observed in the epithelium and stroma of benign parotid tumors. In the epithelium, D-β-aspartic acid was found in 35 of 38 samples (92.1%). In the stroma, it was found in 19 of 38 samples (50.0%). In the stroma of benign parotid tumors, increased expression of periostin was found in 32 of 38 samples (84.2%). Four periostin expression patterns were observed in benign parotid tumors: negative, superficial, infiltrative, and diffuse. Statistically significant differences were found between the expression pattern of D-β-aspartic acid in the stroma and the histological classification of benign parotid gland tumors. In addition, a statistically significant difference was found between the expression patterns of D-β-aspartic acid and periostin in the stroma. Our results suggest that D-β-aspartic acid and periostin may be involved in the pathogenesis of benign parotid gland tumors.

Abstract Traditional surgical training has significant limitations, lacking objectivity and standardization. Deploying AI tools with conventional expert-mediated teaching may uncover areas where AI could complement experts and enhance surgical training through real-time performance assessment and feedback alongside risk mitigation. This randomized crossover trial assessed learning outcomes in two training sessions involving in-person expert instruction and real-time AI feedback using previously validated tumor resection simulations. Receiving expert feedback before real-time AI instruction led to greater performance improvement in trainee performance scores compared to the opposite order, with a mean difference of 0.67 95%CI [0.43–0.91], p &lt; 0.001. Diminishing returns were observed with human expert feedback, which were not seen with AI feedback, such as increased injury and bleeding risk. In surgical procedural training, AI feedback may efficiently maintain peak performance after an initial learning phase led by human experts. AI-integrated surgical curricula should consider the relative benefits of both AI and expert feedback.

ABSTRACT Introduction Cerebral air embolism accompanied by right‐to‐left shunt through the venous system during Robot‐assisted partial nephrectomy (RAPN) is regarded as a rare occurrence, with a high mortality rate. Case Presentation A case of a 77‐year‐old man with renal cell carcinoma who developed cerebral air embolism during right retroperitoneal RAPN using AirSeal. Intraoperatively, a sudden drop in end‐tidal CO 2 was observed during tumor resection. Postoperatively, the patient developed seizures, and imaging revealed cerebral air embolization. Despite hyperbaric oxygen therapy and intensive care, he progressed to fatal cerebral infarction. Conclusion This case highlights the risk of serious brain stroke during RAPN. The pathways of air entry into the cerebral circulation occasionally remain unclear and are difficult to fully exclude preoperatively. Renal vein clamping and adequate insufflation pressure are recommended when the tumor is entirely endophytic or close to the renal vein, especially when performing a right retroperitoneal approach.

A 30-year-old female patient with a benign tumor in the superficial lobe of the left parotid gland underwent tumor resection via a 5 cm intra-hairline incision, using the da Vinci Xi surgical robot combined with the NIM-Response 3.0 facial nerve monitoring system. During the operation, facial nerve branches were located and protected through facial nerve monitoring, and the robotic arms were used for precise tumor dissection. Postoperatively, the facial nerve function, incision healing, and tumor recurrence were observed. duration of the procedure was 120 minutes, and the tumor（2.0 cm×1.5 cm） was completely resected. Postoperative pathological examination indicated a pleomorphic adenoma. During the 3-month postoperative follow-up, the patient's facial nerve function remained normal, no salivary fistula occurred, the incision was hidden within the hairline, no tumor recurrence was found in the ultrasound reexamination, and the patient was highly satisfied with the appearance. The surgical approach of robot-assisted resection of benign parotid gland tumor via a hairline incision under facial nerve monitoring has significant advantages in facial nerve protection and cosmetic effect, and is suitable for patients with benign parotid gland tumors meeting specific conditions.

This study investigates the morphometric characteristics of the sphenopalatine foramen (SPF) using cone beam computed tomography (CBCT) in adult individuals to support surgical planning and improve outcomes in oral and maxillofacial procedures. A total of 120 adult patients underwent CBCT imaging for detailed analysis of the SPF. Measurements included the length and width of the foramen, as well as its spatial relationship to key anatomical landmarks. Statistical comparisons were performed to assess gender-based differences in these parameters. The results demonstrated that male subjects had significantly larger SPF dimensions compared to females across all measured variables, with high statistical significance (p &lt; 0.001). These findings provide crucial anatomical insights that are directly applicable to various clinical procedures, including posterior epistaxis management, tumor resections, dental implant placement, and Le Fort I osteotomies. The anatomical variability observed reinforces the need for personalized preoperative assessment to enhance surgical precision and reduce the risk of complications. Additionally, the study’s implications extend to neuromodulation techniques such as sphenopalatine ganglion blocks for managing cluster headaches. In conclusion, this research emphasizes the value of CBCT-based morphometric analysis of the SPF in achieving optimal diagnostic and therapeutic outcomes, advocating for its integration into routine planning for craniofacial surgical interventions.

Evaluation of the results of combined free vascularized fibular graft and pasteurized tumor segment for the reconstruction of intercalary femoral defects following tumor resection

Repeat TURBT for Ta and T1 bladder cancer: An updated review.

Clinical outcomes of autogenous fibular reconstruction after en bloc resection for aggressive giant cell tumors of the distal radius: A three-year follow-up study.