Clin. Pract., Volume 16, Issue 9 (September 2026) – 13 articles

Background/Objectives: Subtle facial and interactional cues may prompt clinicians to explore possible anxiety, confusion or hesitation, but they do not establish a patient’s internal state. The Micro-Expression Decoder (MED) links cue recognition with tentative interpretation, direct checking and communication adaptation. Methods: This preliminary, uncontrolled, single-group pre–post convergent mixed-methods evaluation involved 60 final-year medical students from three London medical schools. Ten groups of six completed a 270 min simulation-based programme comprising conceptual teaching, video observation, standardised-patient encounters, feedback and reflection. Study-specific self-ratings and a parallel-form recognition task were completed before teaching and immediately after the instructional and simulation components, before the final debrief. Standardised-patient ratings were obtained during the first and final simulated encounters. There was no control group or follow-up. Results: Recognition confidence increased from 2.7 to 4.3 (mean change 1.6, 95% CI 1.39–1.81; dz = 1.98), interpretation confidence from 3.0 to 4.5 (dz = 2.01), standardised-patient-rated attentiveness from 3.2 to 4.6 (dz = 2.02), and satisfaction from 3.5 to 4.8 (dz = 1.94). Anxiety recognition increased from 25/60 (41.7%) to 55/60 (91.7%), and confusion recognition from 29/60 (48.3%) to 52/60 (86.7%). Qualitative accounts described earlier noticing, clarification and checking, alongside difficulty distinguishing cues, distraction, cultural variation and over-interpretation. Nineteen students increased confidence without categorical improvement in anxiety or confusion recognition. Conclusions: MED was associated with immediate improvement across study-specific outcomes in simulation. The uncontrolled design, immediate assessment, investigator-developed measures, expectancy effects and ceiling in post-training satisfaction preclude conclusions about causality, retention, real-patient benefit, empathy or clinical competence. Full article

Background/Objectives: Breast cancer is the most common malignancy among women worldwide and poses a significant burden on healthcare systems. Despite evidence that treatment type is associated with hospital length of stay (LOS), current Germany-wide data on this topic are lacking. The present study aims to identify clinical and procedural factors associated with prolonged hospitalisation in women hospitalised for breast cancer in Germany. Methods: This multicentre cross-sectional study analysed anonymised inpatient data from 38 German hospitals (IQVIA database), including 16,062 female breast cancer hospitalisation episodes (inpatient cases; patient-level linkage was not possible due to anonymisation, so these may not represent 16,062 distinct women) treated between January 2019 and December 2024. The primary outcome was LOS; prolonged hospitalisation was defined as LOS > 7 days (75th percentile). Comorbidities were assessed using individual comorbidity categories defined according to the Elixhauser classification (retained at ≥1% prevalence). The primary multivariable analysis was restricted to characteristics documented independently of the in-hospital course (age, tumour site, metastatic status, chronic comorbidities). In-hospital complications, procedures, and diagnoses of ambiguous timing were analysed separately as secondary, descriptive associations. LOS was modelled using negative binomial regression (Poisson regression as a sensitivity analysis) and prolonged LOS using logistic regression, both with hospital-clustered robust (sandwich) standard errors. Results: The overall median LOS was 4 days (IQR 3–7); 19.3% of hospitalisation episodes were prolonged. In the primary analysis, longer LOS was associated with age > 70 years (RR 1.14; 95% CI 1.08–1.20), distant metastases (RR 1.76; 95% CI 1.51–2.04), lymph node metastases (RR 1.09; 95% CI 1.05–1.12), congestive heart failure (RR 1.44; 95% CI 1.31–1.59), anaemia (RR 1.41; 95% CI 1.14–1.75) and depression (RR 1.14; 95% CI 1.03–1.26). In the secondary descriptive analysis, in-hospital complications showed the strongest associations with longer LOS, particularly postoperative infection (RR 2.28), wound disruption (RR 1.92) and pneumonia (RR 1.45). Breast-conserving surgery and partial breast resection were associated with shorter LOS, while mastectomy, blood transfusions, and complex intensive care were associated with prolonged stays; the small inpatient radiotherapy subgroup (1.9%) most likely reflects a highly selected, predominantly palliative population rather than an association attributable to radiotherapy itself. Conclusions: Prolonged hospitalisation was associated with older age, documented lymph node and distant metastases, and chronic somatic comorbidities including congestive heart failure, anaemia, chronic kidney disease and depression, and, in secondary descriptive analyses, with perioperative complications and intensive procedures. The strongest correlates of prolonged stay—in-hospital complications and intensive procedures—are documented during rather than before the hospitalisation and therefore cannot themselves support early risk identification; however, the baseline characteristics documented independently of the in-hospital course (age, metastatic disease, chronic comorbidity burden) may usefully inform structured perioperative management and discharge planning in Germany. Full article

Background: Pleomorphic adenoma is the most common benign salivary-gland neoplasm and frequently affects the minor salivary glands of the palate. Although surgical excision is generally curative, incomplete encapsulation, pseudopod-like extensions, and microscopic tumor deposits may contribute to recurrence, which can occur many years after initial treatment. Recurrent palatal pleomorphic adenoma is uncommon and may present diagnostic and reconstructive challenges. Case Presentation: A 64-year-old man was referred with a painless, slowly enlarging recurrent mass of the right posterior hard palate, six years after excision of a pleomorphic adenoma at another institution. Magnetic resonance imaging and contrast-enhanced computed tomography demonstrated a well-defined enhancing palatal lesion measuring approximately 2.1 × 1.9 × 1.9 cm on MRI and 1.8 × 2.2 × 1.9 on CT, without adjacent maxillary bone destruction or cervical lymphadenopathy. An incisional biopsy was consistent with pleomorphic adenoma. Wide local excision was performed, including the tumor, surrounding palatal soft tissue, and underlying periosteum. The resulting defect was reconstructed using a facial artery musculomucosal flap. The postoperative course was uneventful, with satisfactory flap healing and preservation of speech and swallowing. At six months of follow-up, there was no clinical evidence of recurrence or functional impairment. Conclusions: Recurrent pleomorphic adenoma of the palate may develop several years after primary treatment. Complete surgical excision with tumor-free margins and appropriate reconstruction is essential. Long-term clinical follow-up is recommended because late recurrence and, rarely, malignant transformation may occur. Full article

Background/Objectives: Subarachnoid analgesia (SA) is increasingly used as an adjunct to general anesthesia in robotic ERAS pathways, but the contribution of the intrathecal local anesthetic, as distinct from that of the intrathecal opioids, has not been isolated. Methods: This study comprised a single-center retrospective cohort of adults undergoing elective robotic surgery (May 2024–July 2025). The exposure was the intrathecal regimen, serving as mutually exclusive categories. The primary outcome was intraoperative opioid exposure (model-derived area under the concentration–time curve per hour, AUC/h); secondary outcomes were standardized intraoperative fluid administration and a stringent pain-free 48 h course (NRS = 0 throughout). Multivariable Gamma and logistic models were supplemented by provider-adjusted mixed-effects analyses, E-values, and a model-free robustness analysis. Results: Of 207 patients, 83.1% received SA; all were given intrathecal morphine and 62.3% levobupivacaine. Compared with no SA, morphine alone was not associated with AUC/h (+14.0%; 95% CI, −0.9 to +31.1), whereas all levobupivacaine-containing regimens were: −36.4% (IM + L5), −24.3% (IM + L5 + S3), and −44.8% (IM + L10 + S3); overall p < 0.001. Algebraically equivalent component reparameterization attributed this to levobupivacaine dose (−44.3% at 5 mg; −59.3% at 10 mg). Remifentanil was used in 98.7%, 88.6%, and 10.0% of patients receiving 0, 5, and 10 mg, respectively. Fluid administration was lower with IM + L5 (−24.9%) and IM + L10 + S3 (−31.0%) after adjustment, but was not with levobupivacaine-graded unadjustment. SA was associated with a pain-free course (adjusted OR, 3.33; 95% CI, 1.06–11.79), an estimate not robust to minimal unmeasured confounding. Conclusions: Levobupivacaine-containing regimens were consistently associated with lower intraoperative opioid exposure, but regimen and opioid strategy were chosen jointly by the same clinician; therefore, these associations between strategies are specific to the delivery context of this study. The fluid and pain-free findings are hypothesis-generating. Trials should vary the local anesthetic dose independently of intrathecal opioids. Full article

Introduction: Medications with sedative and hypnotic properties, such as benzodiazepines, the so-called ‘Z-drugs’, and hydroxyzine, are used in primary care. However, data regarding their prescribing patterns, particularly in the context of seasonality, remain limited. Aim: This review aims to assess the current knowledge regarding primary care prescribing patterns for medications with potential sedative and hypnotic effects, with particular emphasis on benzodiazepines, ‘Z-drugs’, and hydroxyzine. Material and Methods: The systematic review was conducted following the PRISMA guidelines. The PubMed, Web of Science and Scopus databases were searched. Fourteen original English-language publications from 2015 to 2026, which focused on the primary care prescription of selected groups of medications with hypnotic properties, were included. Results: Most of the studies included concerned benzodiazepines, with inconsistent prescribing patterns. Some studies reported a decrease in the rate of their prescription, whilst others indicated an increase, particularly among older people and patients with multimorbidity. Data concerning ‘Z-drugs’ were less extensive and showed heterogeneous prescribing trends across countries and study periods. Overall, the findings indicate substantial international variability in hypnotic prescribing in primary care. Evidence regarding hydroxyzine prescribing was particularly limited, with only one study specifically examining its prescribing patterns in primary care. Data on the seasonal prescribing patterns for all groups of medications were limited. Conclusions: Prescription of medications with sedative and hypnotic properties remains an important part of primary healthcare practice. Yet, significant research gaps remain regarding hydroxyzine prescribing and the seasonal variation in hypnotic and sedative prescribing. Full article

Background: Quality assurance (QA) is a cornerstone of safe and effective postgraduate training in gynecological laparoscopic surgery, where clinical outcomes depend on procedural complexity, equipment sophistication, and the coordinated competence of an entire surgical team. This article is a narrative review of the conceptual, professional, and regulatory foundations of QA in healthcare education, complemented by a structured synthesis of the collective teaching and clinical experience of the author group. It is not an empirical study, and the sections that follow present a conceptual mapping supported by expert perspective rather than original outcome data. Methods: Sources were identified through targeted searches of PubMed/MEDLINE and Google Scholar, supplemented by hand-searching of policy and curriculum documents issued by professional bodies and by backward citation tracking, without date restriction. Approximately 480 records were screened at title and abstract level, 112 were assessed as full text, and 41 sources were retained against predefined inclusion and exclusion criteria, with five further sources added during peer review. In a second and separate step, the ten co-authors, who hold teaching and supervisory roles in gynecological laparoscopy across academic centers in Romania and Germany, each completed the same six-item written prompt on training provision, trainer development, trainee assessment, and institutional QA practice; responses were coded thematically by two authors independently and consolidated into explicit points of convergence and divergence. Results: We describe how QA principles, originally articulated in general quality-management and health-promotion literature, have been adapted by professional and regulatory bodies, including the European Board and College of Obstetrics and Gynecology (EBCOG), European Society for Gynecological Endoscopy (ESGE), American Society for Gastrointestinal Endoscopy (ASGE), and the UK General Medical Council, into concrete standards for training providers, trainers, and trainees. We outline the structures used to monitor and audit training quality, including Kirkpatrick’s four-level evaluation model and periodic institutional review cycles, alongside documentation and certification pathways such as the Gynecological Endoscopic Surgical Education and Assessment (GESEA) program, with governance and financing as cross-cutting determinants of sustainability. The author synthesis converged on a consistent gap between documented standards and their routine enforcement and diverged on whether external review and formal certification should become mandatory. Conclusions: The conceptual architecture of QA in gynecological laparoscopy is coherent and broadly fit for purpose, but we identified no study linking the implementation of a specific QA standard to measurable gains in trainee competency or patient outcomes in this field. Proposals for harmonized, outcome-oriented, and where appropriate, mandatory external review should therefore be read as reasoned positions awaiting prospective evaluation rather than as evidence-based recommendations; generating that evidence, with the trainee’s own perspective collected rather than inferred, is the principal task for future research. Full article

Background: Cardiac amyloidosis is characterized by progressive myocardial infiltration leading to ventricular dysfunction. While left ventricular strain assessment is well established, evaluation of right ventricular (RV) mechanics remains challenging because of the ventricle’s complex geometry and limitations of conventional speckle-tracking methods. We aimed to evaluate an alternative approach for RV strain assessment based on a continuous biventricular tracking pathway within the apical four-chamber view. Methods: We retrospectively studied 32 patients with cardiac amyloidosis and 32 age-, sex-, rhythm-, and ejection fraction–matched controls. RV free-wall longitudinal strain was measured using a novel investigational biventricular tracking approach from the basal RV free wall through the apex to the basal lateral left ventricular wall and compared with conventional RV strain. Investigational biventricular strain (BVS) was also obtained automatically as a surrogate marker of global ventricular function. Reproducibility was assessed in a subset of 20 patients using intraclass correlation coefficients (ICC), coefficient of variation (CV), and Bland–Altman analysis. Results: Investigational RV free-wall strain was significantly reduced in patients with cardiac amyloidosis compared with controls (−15.3 ± 4.1% vs. −21.2 ± 5.4%, p < 0.001). Compared with conventional RV strain, the investigational biventricular tracking approach yielded more negative global RV strain values in both patients with amyloidosis (−15.3 ± 4.1% vs. −13.8 ± 4.8%, p = 0.003) and controls (−21.2 ± 5.4% vs. −17.4 ± 5.8%, p < 0.001). The greatest differences were observed at the apical RV segment. Bland–Altman analysis demonstrated a mean bias of −2.64 percentage points with 95% limits of agreement from −8.41 to +3.12 percentage points. A significant regional deformation pattern along the investigational tracking contour was observed in patients with cardiac amyloidosis (p < 0.001), whereas no significant regional variation was observed in controls. BVS correlated strongly with LV global longitudinal strain (r = 0.83 in amyloidosis; r = 0.58 in controls; r = 0.84 overall; all p < 0.001). Inter- and intra-observer reproducibility of investigational RV free-wall strain was excellent (ICC 0.976 and 0.985, respectively). Conclusions: The investigational biventricular tracking approach is a feasible and highly reproducible method for assessing ventricular longitudinal deformation using a single continuous contour. It provides complementary information while remaining an exploratory investigational technique. Further studies are required to validate its anatomical specificity, clinical applicability, and prognostic value. Full article

Background/Objectives: Caries adjacent to restorations or sealants (CARS) is among the most frequent biological causes of composite restoration failure, resulting from the interplay between the patient’s cariogenic risk and restoration-related factors such as marginal adaptation. The study aimed to investigate whether cariogenic risk modifies the effect of marginal adaptation on the occurrence of caries adjacent to posterior composite restorations (CARS), using risk-stratified univariate analysis and a clustering-adjusted approach, to identify associated clinical, socio-demographic, and local risk factors. Methods: This retrospective cross-sectional study evaluated 453 posterior direct composite resin restorations (Class I, Class II) in 88 patients at the Faculty of Dental Medicine, “Grigore T. Popa” University, Iași, Romania. CARS and marginal adaptation were assessed using FDI Criteria. Patients were classified as high or low cariogenic risk using a multifactorial institutional protocol. Univariate analysis and Generalized Estimating Equations (GEE) accounting for within-patient clustering were performed. Results: CARS prevalence was 27.9% in high cariogenic risk patients versus 3.15% in low cariogenic risk patients. Univariate analysis identified high cariogenic risk (OR = 11.904), deficient marginal adaptation (OR = 25.929–69.475), restoration age of 3–5 years (OR = 3.045), and Class II configuration (OR = 2.597) as significant risk factors. GEE analysis, adjusted for clustering of restorations within patients, confirmed high cariogenic risk (OR = 12.597) and deficient marginal adaptation (OR = 121.320) as independent correlates of CARS. A significant interaction between the two (p < 0.001) showed that marginal adaptation remained the dominant local risk factor in low cariogenic risk patients, while its association with CARS was largely attenuated in high-risk patients. Conclusions: GEE analysis confirmed high cariogenic risk and deficient marginal adaptation as independent correlates of CARS, with marginal adaptation acting as the dominant local risk factor only in low-risk patients. Full article

Background: Peyronie’s Disease (PD) is a complex andrological condition that severely compromises patients’ quality of life. While a novel formulation of hyaluronic acid (HA) has recently gained traction for treating the acute inflammatory phase, clinical evidence regarding its role in stable-phase (chronic) PD is lacking. We aimed to assess the therapeutic outcomes and safety profile of Perovial^®, a specialized HA formulation, in patients with stable disease. Methods: A cohort of 47 patients with stable-phase PD was treated at a single andrological center between June and December 2025. The treatment protocol consisted of eight weekly injections targeted around the tunica albuginea plaque. Clinical efficacy was assessed 3 months post-treatment by comparing baseline data with the following outcome measures: change in penile curvature (Δ°), the international index of erectile function (IIEF-5) score, Peyronie’s Disease Questionnaire (PDQ) and Global Assessment of Peyronie’s Disease (GAPD). Results: At the 3-month follow-up visit, a statistically significant improvement in penile curvature was registered in 35 out of 47 patients (Δ° − 16) (p < 0.001). All patients had a significant improvement from baseline in terms of IIEF (20 vs. 24; p < 0.001) and in all PDQ domains. No major adverse events or complications were observed during the study period. At the GAPD questionnaire, 43 patients (91.2%) reported subjective improvement of penile curvature. Conclusions: Perilesional injection of Perovial^® seems a promising intervention in patients with stable-phase PD in terms of penile curvature reduction and patient-reported quality of life improvement. Full article

Background/Objectives: Osteosarcoma is a rare malignancy and the most common primary malignant bone tumor. Metastases commonly affect the lungs and are associated with reduced life expectancy. Calcifications can be present within a metastatic nodule at baseline or can appear during follow-up. We aimed to assess the clinical significance of calcifications in lung metastases, particularly in relation to radiological pattern, histopathological subtype, and treatment response. Methods: A retrospective cohort of patients with osteosarcoma and lung metastases at diagnosis was evaluated for the period 2000–2018. The presence of calcifications inside pulmonary lesions on baseline lung CT and/or follow-up was assessed and recorded. Radiological data were then checked against histopathological data (i.e., osteosarcoma subtypes and chemotherapy response with necrosis percentage) and the radiological pattern of the primary tumor (i.e., osteolytic, sclerotic, or mixed pattern). Results: Of a cohort of 92 patients, 14 were excluded due to having no baseline or follow-up chest CT. Of the 78 patients with an osteosarcoma diagnosis, lung metastases at diagnosis, and chest CT who were enrolled (42 men and 36 women; mean age: 23.8 years [range, 6–73 years]), 70 (89.7%) had a baseline imaging study of the primary tumor (osteosarcoma). The presence of calcifications in lung metastases at both baseline and follow-up was significantly associated with the radiological pattern of the primary lesion (p < 0.0001). Calcifications were not present in the lung metastases of any of the 18 patients (0%) with a lytic radiological pattern at any stage, whereas all 32 patients (100%) with a purely sclerotic pattern had calcifications within lung metastases at baseline or during follow-up; of the 20 patients with a mixed radiological pattern, 11 (55%) had no calcifications and 9 (45.0%) had detectable calcifications. No statistically significant association was found between histopathological subtype and calcification. Osteoblastic osteosarcoma was more frequently associated with calcification (66.0%). During induction chemotherapy, five poor responders and three good responders (necrosis > 90%) developed calcifications (p = 0.72; OR = 0.67; 95% CI, 0.10–3.86). Conclusions: In patients with osteosarcoma, calcifications within pulmonary metastases are strongly associated with the radiological pattern of the primary tumor, and this association is greatest for a pure sclerotic pattern, followed by the mixed one. We found no statistically significant association between the occurrence of calcifications during follow-up and chemotherapy response measured by necrosis percentage of the surgical specimen in our limited cohort; further research is needed. Full article

Behavioural management strategies used in paediatric dentistry have neurobiological effects. This scoping review aimed to map the existing literature on the neurobiological effects of non-invasive behavioural management strategies used in paediatric dentistry. The study protocol was registered on the Open Science Framework (registration number: OSF.IO/9EZVT). A search was conducted on PubMed, Web of Science, Scopus, Google Scholar, and African Journals Online (AJOL) for studies published up to May 2025. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Studies were included if they assessed non-invasive behavioural strategies in children aged 0–17 years undergoing dental procedures and reported at least one neurobiological or physiological outcome. The data were summarised descriptively, and key findings were thematically synthesised to identify trends in behavioural strategy types and neurobiological outcomes measured. Out of 1720 records retrieved, 35 studies met the inclusion criteria. These included randomised and non-randomised controlled trials and observational studies conducted in 13 countries on five continents involving 2919 children. The behaviour management strategies identified were 18 in number, with distraction (n = 19) and tell–show–do (n = 17) being the most frequently applied. The neurobiological outcomes assessed included anxiety (n = 36), pain perception (n = 8), fear (n = 7), and stress response (n = 1). Their physiological regulation was assessed using heart rate (n = 26), oxygen saturation (n = 10), blood pressure (n = 8), pulse rate (n = 6), cortisol (n = 4), respiratory rate (n = 1), and oxytocin (n = 1). Behavioural assessment tools used were classified into Child-Reported Anxiety and Fear Instruments (n = 23), Pain Perception Instruments (n = 9), Clinician/Observer-Rated Behavioural and Anxiety Scales (n = 18), and Parental and Proxy Reports (n = 2). This review underscores the emerging evidence that non-invasive behavioural strategies may be linked to neurobiology in paediatric dentistry. More studies are needed in new countries to be able to map the possible impact of context and culture on study findings. Full article

Background: Italy exhibits a socioeconomic divide between its northern and southern regions, which extends into healthcare delivery and biomedical research. Medical oncology is particularly affected by this structural imbalance. This paper examines geographic disparities in clinical trial scientific publication output, citation impact, research funding, and collaboration networks in medical oncology between northern and southern Italy. Methods: A narrative bibliometric analysis was conducted using data from PubMed and other institutional databases of Italian Scientific Institutes for Hospitalization and Care. Data from the Italian National Agency for the Evaluation of Universities and Research Institutes, the Alliance Against Cancer, and the Italian Association for Cancer Research were also reviewed. Regional output was compared across two macro-areas, namely north and south Italy. Results: Northern Italian institutions account for a disproportionate share of publications, high-impact citations, and funded research projects. Northern Italy produces an estimated four to six times more medical oncology papers than southern Italy, driven by a higher concentration of cancer institutes, better-funded university hospitals, and stronger multidisciplinary infrastructure than in the south. Clinical trial density is highest in the north compared to the south (0.53 versus 0.02 per 100,000 inhabitants). Conclusions: The north–south divide in Italian oncology research productivity is real, multi-factorial, and persistent. The analysis reveals a substantial gap in research productivity, institutional capacity, and access to clinical trials between the two macro-regions. Targeted policy interventions, including decentralized trial models, dedicated funding streams for southern institutions, and stronger infrastructure for inter-regional collaboration, are urgently needed to ensure representativeness in oncology evidence generation and equitable scientific progress. Full article

Background: Right-sided metastatic colon cancer represents a clinically distinct subgroup with inferior outcomes and uncertain optimal biologic treatment selection, even among patients with RAS wild-type disease. Real-world data focusing specifically on right-sided RAS wild-type metastatic colon cancer remain limited. This study aimed to describe clinicopathologic characteristics, metastatic patterns, treatment approaches, and survival outcomes in this population using a national multicenter registry. Methods: This retrospective multicenter cohort study was conducted using data from the ONKO-KOLON Türkiye registry. Patients with pathologically confirmed KRAS/NRAS wild-type metastatic colorectal cancer and available primary tumor localization were evaluated. The main analytic cohort included patients with right-sided metastatic colon cancer, defined as right colon or transverse colon tumors. Left-sided colon cancer patients were used as a contextual comparator, while rectal cancer patients were excluded from sidedness-based colon comparisons. Survival outcomes were estimated using the Kaplan–Meier method, and prognostic factors were evaluated using Cox regression analyses. Results: Among 1079 patients in the source cohort, primary tumor localization was available in 1065 patients. Of these, 213 had right-sided colon cancer, 464 had left-sided colon cancer, and 388 had rectal cancer. In the right-sided cohort, median age was 61.5 years, 64.3% were male, and 66.7% had synchronous/de novo metastatic disease. Liver metastasis was the most common metastatic site (63.4%), followed by lymph node (31.0%), lung (21.1%), and peritoneal metastases (15.5%). First-line anti-VEGF-based treatment was used in 46.0% of patients, while anti-EGFR-based treatment was used in 40.8%. Among evaluable patients, the objective response rate was 46.8% and the disease control rate was 79.2%. Median progression-free survival was 10.0 months, and median overall survival was 24.0 months. In unadjusted exploratory analysis, median OS was 27.0 months with anti-EGFR-based treatment and 17.0 months with anti-VEGF-based treatment (log-rank p = 0.022), whereas median PFS was 10.0 months in both groups. In an extended covariate-adjusted multiple-imputation sensitivity model, the anti-EGFR OS estimate did not meet statistical significance (adjusted HR 0.66, 95% CI 0.43–1.00; p = 0.051). In a secondary contextual comparison, median overall survival was shorter in the right-sided than in the left-sided colon cancer group (24.0 vs. 28.0 months; HR 1.47, 95% CI 1.19–1.82; p < 0.001), whereas progression-free survival did not differ significantly. Conclusions: This study provides a descriptive account of metastatic patterns, treatment approaches, and outcomes in a dedicated right-sided RAS wild-type metastatic colon cancer cohort. The unadjusted OS difference between biological treatment groups was not confirmed after measured covariate adjustment and should not be interpreted as evidence of comparative treatment effectiveness. Because molecular profiling was incomplete, this study cannot identify biomarker-defined treatment subgroups. Prospective studies with complete, predefined molecular characterization are needed before molecularly informed treatment selection hypotheses can be evaluated in this population. Full article