Search Results (1,276)

The management strategies in resectable non-small cell lung cancer (NSCLC) have changed over the last few years. Despite advancements in surgical techniques and conventional chemotherapy, patients with resectable NSCLC remained at high risk of future recurrence. Clinical trials have demonstrated improvements in response rates, pathological outcomes, and survival with the perioperative approach. Considering the findings of these landmark trials, there is a pressing need to contextualize and incorporate these global developments into the national practice framework. This review outlines key developments from recent clinical trials, with a focus on perioperative strategies in early-stage operable NSCLC from a Canadian perspective. We discuss the integration of checkpoint inhibitors in the perioperative setting for patients without actionable genomic alterations, adjuvant targeted therapies for EGFR and ALK mutant disease, and emerging tools such as ctDNA based minimal residual disease monitoring. The article also addresses the practical challenges of implementing these advances within the Canadian healthcare system, including systemic therapy approvals, barriers, and importance of multidisciplinary care to guide clinicians in optimizing patient outcomes. Full article

Background and Objectives: Surgical stress during robotic-assisted radical prostatectomy (RARP) elicits a measurable systemic inflammatory response despite the minimally invasive approach. Intravenous lidocaine has been increasingly investigated for its potential anti-inflammatory, analgesic, and immunomodulatory benefits, but evidence in robotic urologic oncology remains limited. This study aimed to evaluate whether intraoperative lidocaine infusion attenuates postoperative inflammation, improves analgesic outcomes, and accelerates early recovery following RARP. Materials and Methods: This prospective non-randomized observational study included 80 patients undergoing elective RARP, divided into a Lidocaine Group (n = 40) receiving an intraoperative bolus and continuous infusion, and a Control Group (n = 40) receiving standard anesthesia without lidocaine. Serum IL-6, TNF-α, CRP, and fibrinogen were measured at baseline, end of surgery, and 24 h postoperatively. Postoperative pain scores, opioid consumption, gastrointestinal recovery, ambulation, and length of stay were recorded. Statistical analyses included repeated-measures ANOVA, correlation testing, and between-group comparisons. Results: Baseline characteristics were similar between groups. At 24 h postoperatively, lidocaine administration was associated with a significantly attenuated inflammatory response, with lower levels of IL-6 (45.7 ± 10.8 vs. 68.9 ± 12.6 pg/mL, p < 0.01) and TNF-α (20.5 ± 5.1 vs. 27.2 ± 6.4 pg/mL, p < 0.01) compared with controls. Patients receiving lidocaine reported lower postoperative pain scores and required significantly less opioid analgesia, with a total 24 h consumption of 8.9 ± 3.4 vs. 14.8 ± 5.2 mg morphine milligram equivalents (p < 0.001). Lidocaine was also associated with faster recovery, including earlier oral intake and a shorter length of hospital stay (2.9 ± 0.7 vs. 3.6 ± 0.9 days, p = 0.003). No lidocaine-related adverse events were observed. Conclusions: In this prospective observational study, intraoperative intravenous lidocaine was associated with attenuated early postoperative inflammation, improved analgesic outcomes, and enhanced early recovery following RARP. These findings support the potential role of intravenous lidocaine as a safe adjunct in multimodal perioperative management; however, given the non-randomized observational design, causal inferences should be interpreted with caution. Further randomized controlled trials are warranted to confirm causality and to validate long-term clinical and mechanistic effects. Potential residual confounding inherent to the observational design should be considered when interpreting these findings. Full article

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy with poor long-term survival despite advances in surgical techniques, systemic therapies, and perioperative management. High rates of systemic recurrence following curative-intent resection suggest that many patients harbor minimal residual disease (MRD), microscopic tumor burden that persists postoperatively and remains undetectable by conventional diagnostic tools. Recent advances in liquid biopsy technologies, particularly circulating tumor DNA (ctDNA) analysis, alongside detailed characterization of the PDAC mutational landscape, offer a promising non-invasive approach for MRD detection. Emerging evidence indicates that MRD status can serve as a sensitive prognostic biomarker, identify patients at high risk of relapse, and guide personalized perioperative therapy, including optimization of adjuvant treatment. This review summarizes current knowledge on the biology and detection of MRD in PDAC, its implications for perioperative risk stratification and treatment decision-making, and discusses future directions for integrating MRD assessment into clinical practice to enable more precise, individualized patient management. Full article

Background: Adult scoliosis following spinal fusion and subsequent hardware removal presents complex challenges, especially when deformity progresses in both the sagittal and coronal planes. Revision surgery is often recommended but it entails considerable risks. Conservative approaches, including Schroth-based physiotherapy and bracing, offer promising alternatives for select patients, particularly older adults with comorbidities or those who decline further surgery. Case Presentation: A woman with adolescent idiopathic scoliosis (diagnosed at age 13) underwent spinal fusion with Harrington rod instrumentation and costoplasty at age 24. She was de-instrumented two years later due to infection and developed progressive thoracic hyperkyphosis, coronal imbalance, and 12 cm loss of height over two decades. At age 47, she chose conservative management instead of revision surgery. Methods: She completed a 28-month program combining Schroth-based physiotherapy supervised by a certified therapist and part-time bracing. Outcomes included radiographs, inclinometry, spirometry, spinal-muscle ultrasound, height/posture measures, and SRS-22 and ODI scores. Results: Substantial clinical improvements were observed. Thoracic kyphosis decreased from 80° to 45° (44%) and the coronal thoracic curve was reduced from 48° to 32° (33%). Lumbar lordosis increased by 6°, standing height rose by 4 cm, and forced vital capacity improved by 900 mL (33%). The Oswestry Disability Index (ODI) score improved from 4% to 0%, and SRS-22 domains (pain, function, self-image, mental health, satisfaction) showed meaningful gains. The patient returned to full physical activity and avoided further surgery. Conclusion: This case highlights the potential of Schroth-based physiotherapy with bracing to reverse postural and functional decline in complex post-fusion scoliosis. It offers a viable non-surgical option when revision surgery poses a high risk or is declined and aligns with modern rehabilitative goals focused on long-term quality of life. Full article

Background: Osteoarthritis (OA) is a prevalent degenerative joint disease and a major cause of disability in the aging population. Total knee arthroplasty (TKA) is a common intervention for advanced OA, yet postoperative outcomes may vary, particularly among individuals with obesity. Elevated body mass index (BMI) is a recognized risk factor for the development and progression of OA and may influence perioperative and postoperative complication rates. Objective: This literature review evaluates whether a specific BMI threshold should guide eligibility for primary TKA, with particular emphasis on the impact of BMI on surgical risk, implant outcomes, and functional recovery. Methods: A systematic search was conducted across PubMed (MEDLINE), Cochrane Library, EMBASE, and Google Scholar to identify peer-reviewed studies from the past two decades examining the relationship between BMI and clinical outcomes following primary TKA. Findings: Higher BMI—especially ≥40 kg/m²—is consistently associated with increased perioperative and postoperative complications, including wound issues, infection, thromboembolic events, longer hospital stay, and higher revision risk. Despite these elevated risks, evidence demonstrates that obese and morbidly obese patients experience substantial improvements in pain, mobility, and function that are comparable in magnitude to those seen in non-obese individuals. The literature does not support a universally applicable BMI cutoff for determining surgical eligibility. Conclusions: BMI is an important modifier of surgical risk but should not be used as an absolute criterion for excluding patients from TKA. Instead, a personalized approach is recommended—one that considers BMI within the context of comorbidities, functional limitation, patient motivation, and opportunities for preoperative optimization. With appropriate patient selection and risk-mitigation strategies, TKA remains a clinically valuable and justified intervention across all BMI categories. Full article

Background and Objective: Changes in female sex hormone levels are closely linked to the development and progression of uterine fibroids (UFs). Clinical approaches to fibroid management vary according to guidelines and depend on patient symptoms, fibroid size, and clinician judgment. Despite available diagnostic tools, surgical decisions remain largely subjective. With the advancement of artificial intelligence (AI) and clinical decision support technologies, clinical experience can now be transferred into data-driven computational models trained with hormone-based parameters. To develop a clinical decision support algorithm that predicts surgical necessity for uterine fibroids by integrating fibroid characteristics and female sex hormone levels. Methods: This multicenter study included 618 women with UFs who presented to three hospitals; 238 underwent surgery. Statistical analyses and artificial intelligence-based modeling were performed to compare surgical and non-surgical groups. Training was conducted with each hormone—follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen (E2), prolactin (PRL), and anti-Müllerian hormone (AMH)—and with 126 input combinations including hormonal and morphological variables. Five supervised learning algorithms—support vector machine, decision tree, random forest, and k-nearest neighbors—were applied, resulting in 630 trained models. In addition to this retrospective development phase, a prospective validation was conducted in which 20 independent clinical cases were evaluated in real time by a gynecologist blinded to both the model predictions and the surgical outcomes. Agreement between the clinician’s assessments and the model outputs was measured. Results: FSH, LH, and PRL levels were significantly lower in the surgery group (p < 0.001, 0.009, and <0.001, respectively), while E2 and AMH were higher (p = 0.012 and 0.001). Fibroid volume was also greater among surgical cases (90.8 cc vs. 73.1 cc, p < 0.001). The random forest model using LH, FSH, E2, and AMH achieved the highest accuracy of 91 percent. In the external validation phase, the model’s predictions matched the blinded gynecologist’s decisions in 18 of 20 cases, corresponding to a 90% concordance rate. The two discordant cases were later identified as borderline scenarios with clinically ambiguous surgical indications. Conclusions: The decision support algorithm integrating hormonal and fibroid parameters offers an objective and data-driven approach to predicting surgical necessity in women with UFs. Beyond its strong internal performance metrics, the model demonstrated a high level of clinical concordance during external validation, achieving a 90% agreement rate with an independent, blinded gynecologist. This alignment underscores the model’s practical reliability and its potential to reduce subjective variability in surgical decision-making. By providing a reproducible and clinically consistent framework, the proposed AI-based system represents a meaningful advancement toward the validated integration of computational decision tools into routine gynecological practice. Full article

Background: Intracranial atherosclerotic disease (ICAD) remains a major global cause of ischemic stroke—particularly in Asian, Black, and Hispanic populations—and is characterized by high recurrence rates despite advances in intensive medical management. Objectives: This review synthesizes current evidence on surgical and endovascular approaches for ICAD, including extracranial–intracranial bypass, encephaloduroarteriosynangiosis, angioplasty, and hybrid revascularization strategies. Methods: We performed a structured narrative literature search of PubMed and Scopus. Searches were conducted up to 1 October 2025 using combinations of subject headings and keywords, including “intracranial atherosclerotic disease”, “ICAD”, “intracranial stenosis”, “bypass”, “encephaloduroarteriosynangiosis”, “angioplasty”, “stenting”, “revascularization”, and “stroke”. We also scanned reference lists of key articles and relevant reviews. Non-English language articles were excluded. Results: While randomized trials such as SAMMPRIS, VISSIT, and CASSISS reaffirm intensive medical management as first-line therapy, emerging data suggest that surgical revascularization may benefit select patients with hemodynamic compromise refractory to medical therapy. Recent studies incorporating physiologic imaging—such as PET, SPECT, and perfusion MRI—have refined patient selection, reducing perioperative risk and improving long-term outcomes. Innovations in indirect revascularization, hybrid procedures, and intraoperative imaging continue to expand therapeutic possibilities. However, evidence remains heterogeneous, underscoring the need for well-powered randomized trials integrating modern surgical techniques, objective hemodynamic endpoints, and AI-enhanced imaging analytics. Conclusions: While intensive medical management remains the first-line standard of care, select patients with refractory, hemodynamically significant ICAD may benefit from direct, indirect, or hybrid surgical revascularization. Future directions emphasize personalized, physiology-based management frameworks that combine medical, surgical, and technological advances to optimize stroke prevention and long-term vascular outcomes in ICAD. Full article

Background/Objective: The standard approach for managing suspected basal cell carcinoma (BCC) involves performing a biopsy to confirm the diagnosis before treatment. This process often leads to multiple visits and increased healthcare costs. We aimed to evaluate the effectiveness of direct surgical excision of BCCs diagnosed clinically and dermoscopically, without the need for prior biopsy. Methods: We conducted a retrospective case–control study at a tertiary cancer center. Lesions suspected to be BCC, based on clinical and dermoscopic criteria, were divided into two groups: (1) a streamlined treatment group (cases), in which lesions were treated without a confirmatory biopsy (either excised with a 4 mm margin or managed with curettage and electrodesiccation); (2) and a biopsied group (controls). Clinical and histopathological data were analyzed and compared between groups to assess diagnostic accuracy, margin status, and treatment outcomes. Results: Of 389 BCCs, 167 (42.9%) were streamlined, while 222 (57.1%) underwent a biopsy before definitive treatment. The streamlined group demonstrated higher diagnostic accuracy, with 94.6% of excised lesions confirmed as BCC, compared with 73.4% in the biopsy group (p < 0.001). Among lesions excised with 4 mm margins, 97.9% achieved clear margins with the streamlined approach. Margin involvement was associated with high-risk BCC (p = 0.048), particularly with recurrent BCCs (p = 0.023). Conclusions: Streamlined management of BCC through direct excision without prior biopsy is an efficient and cost-effective strategy that reduces patient visits, costs, and waiting times, particularly for low-risk BCCs and older patients. Advances in dermoscopy and non-invasive tools support their accuracy, making it a feasible option in resource-limited settings. Full article

Background/Objectives: Benign bone tumors and tumor-like conditions are commonly encountered in the pediatric population, often discovered incidentally during radiographic evaluation or presenting with symptoms such as pain, swelling, or pathologic fractures. Despite their benign nature, these lesions can significantly impact bone integrity and function. The objective of this study was to characterize the epidemiology, histopathological spectrum and management of benign bone tumors in a pediatric population. Methods: We conducted a retrospective observational single-center study of pediatric patients diagnosed with benign bone tumors or tumor-like lesions between 2013 and 2023. Clinical presentations, radiological findings, histopathological diagnoses, and treatment modalities were reviewed. Biopsy results and surgical indications were analyzed to assess diagnostic yield and therapeutic strategies. Results: Among the 253 biopsies performed, 220 cases (86.6%) were diagnosed as benign tumors, with osteochondromas being the most common (62.3%). The majority of cases involved the appendicular skeleton, with a male predominance. Simple bone cysts, aneurysmal bone cysts, and nonossifying fibromas were also frequently observed. Pathological fractures were documented in 5.45% of cases. Surgical intervention was indicated in patients with symptomatic lesions, pathological fractures, or radiological signs of structural instability. Conclusions: Benign bone tumors and tumor-like lesions in pediatric patients, although non-malignant, may lead to significant skeletal complications. Our findings highlight the importance of structured diagnostic evaluation and individualized treatment planning based on lesion type, location and clinical presentation. Early radiological assessment combined with histopathological confirmation plays a key role in preventing complications and optimizing outcomes. A multidisciplinary approach remains essential in the comprehensive management of these conditions. Full article

Colorectal cancer (CRC) remains one of the leading causes of cancer-related morbidity and mortality worldwide, representing a major public health challenge. Despite advances in screening strategies, surgical techniques, and systemic therapies, patient prognosis is often compromised by late diagnosis, tumor heterogeneity, and therapeutic resistance. In recent years, the integration of advanced imaging analytics and artificial intelligence (AI) has opened new avenues for precision oncology. Radiomics, defined as the high-throughput extraction of quantitative features from medical images, has emerged as a promising tool to capture intratumoral heterogeneity and predict clinical outcomes in a non-invasive manner. When combined with AI, particularly machine learning and deep learning approaches, radiomics enables the development of predictive and prognostic models that may support treatment personalization. This narrative review provides a comprehensive overview of CRC epidemiology and risk factors, summarizes current diagnostic and clinical management strategies, and focuses extensively on radiomics and AI applications in CRC, including workflow standardization, feature extraction, clinical applications, and challenges for implementation in daily practice. Full article

Background: Recent trials, including JCOG0802/WJOG4607L and CALGB140503, have confirmed the oncological adequacy of segmentectomy for early-stage non-small-cell lung cancer (NSCLC). This shift emphasizes the preservation of pulmonary function and minimal invasiveness. Robot-assisted thoracic surgery (RATS) offers enhanced anatomical precision and potentially improves segmentectomy outcomes. Methods: We reviewed the current evidence comparing sublobar resection and lobectomy for early-stage NSCLC, focusing on RATS segmentectomy. Clinical trials, perioperative and long-term outcomes, technical innovations, and patient selection criteria were analyzed. Comparative data among RATS, video-assisted thoracoscopic surgery (VATS), and open approaches were synthesized, including the emerging roles of AI and 3D imaging. Results: Segmentectomy yields survival outcomes equivalent or superior to lobectomy for stage IA peripheral NSCLC ≤2 cm, with better pulmonary function despite higher locoregional recurrence. RATS enhances visualization, dexterity, and ergonomics, thereby enabling precise dissection and lymph node assessment. Compared to VATS and open surgery, RATS shows lower conversion rates, reduced pain, and comparable oncological control. Innovations, such as indocyanine green imaging, 3D modeling, and AI-guided navigation, support margin accuracy and personalized care. Conclusions: Segmentectomy has redefined the surgical standards for early-stage NSCLC. RATS maximizes the minimally invasive benefits by combining oncological safety and functional preservation. Its technical precision facilitates complex resections and integration with digital planning tools to advance personalized thoracic surgery. RATS represents the next evolution of minimally invasive thoracic surgery, redefining the balance between oncological safety and functional preservation in early-stage NSCLC. Full article

Background: Femoral neck fractures in the elderly often necessitate hemiarthroplasty, but the optimal surgical approach remains a highly debated topic. The postero-lateral and direct lateral approaches are commonly employed, each with benefits and drawbacks. Despite their widespread use, robust, long-term comparative studies on definitive outcomes, including pain, functional recovery, and complication rates, are notably lacking. This systematic review and meta-analysis aim to address this critical gap by meticulously comparing these approaches with long-term follow-up. Methods: A systematic literature search was performed, including only comparative studies with a minimum 1-year follow-up. A meta-analysis was performed for the primary outcome measures: operative time, dislocations, infections, perioperative fractures and reoperations. Secondary outcomes included a qualitative synthesis of patient-reported outcomes (quality of life, pain, and satisfaction). Methodological quality was assessed using RoB 2.0 for randomized controlled trials and MINORS criteria for cohort studies. Results: Our meta-analysis provides robust quantitative evidence. The direct lateral approach is associated with a significantly lower risk of post-operative dislocations (I² = 58%; OR = 2.86, 95% CI: 2.53 to 3.22; p < 0.00001) and a significantly lower rate of reoperation (I² = 0%; OR = 1.25, 95% CI: 1.12 to 1.40; p = 0.0001) compared to postero-lateral approach. Operative time, infection, and perioperative fracture rates were found to be statistically comparable. However, patient-reported outcomes yielded inconsistent results across studies, often becoming non-significant after adjusting for confounders. Conclusions: This meta-analysis shows that the direct lateral approach is associated with lower rates of dislocation and reoperation compared with the postero-lateral approach, while patient-reported outcomes remain variable across studies. Further high-quality comparative trials are needed to confirm these associations and guide surgical decision-making. Full article

Background: The impact of cytoreductive surgery on survival in patients with FIGO stage IVB endometrial cancer remains controversial. This study aimed to evaluate the independent effect of surgery within contemporary multimodal treatment strategies using a large population-based registry. Patients and methods: We conducted a multicenter retrospective analysis of 6582 patients with endometrial cancer recorded in the Saxony-Anhalt cancer registry between 2000 and 2020. After exclusions, 294 patients with FIGO stage IVB disease were included. Disease-free survival (DFS) was the primary outcome and overall survival (OS) the secondary outcome. Patients were initially categorized into three treatment groups: surgery only, non-surgical therapy, and combined multimodal therapy. To address potential selection bias, a propensity score-based inverse probability of treatment weighting (IPTW) analysis was performed to compare surgery versus no surgery. Time-period subgroup analysis was conducted for 2000–2010 and 2011–2019. Results: The median follow-up was 68 months (range 0–265 months). Combination therapy resulted in significantly improved median DFS and OS compared to surgery or non-surgical therapy alone. After IPTW adjustment, surgery was independently associated with improved OS (HR 0.64, 95% CI 0.53–0.78, p < 0.01) and DFS (HR 0.67, 95% CI 0.48–0.94, p = 0.02). Subgroup analysis demonstrated a significant survival benefit of surgery in the contemporary period (2011–2019), whereas the effect was weaker and not statistically significant in the earlier period (2000–2010). Conclusions: Cytoreductive surgery is independently associated with improved survival in patients with FIGO stage IVB endometrial cancer, particularly within modern therapeutic eras. These findings support the integration of surgery as part of a multimodal approach in selected patients while highlighting the importance of refined patient selection in the context of evolving systemic therapies. Full article

Background and Objectives: Pelvic organ prolapse (POP) is a prevalent pelvic floor disorder affecting a large proportion of parous and aging women worldwide. While surgical intervention is generally reserved for advanced prolapse, conservative approaches remain essential for the management of early-stage disease. Flat magnetic stimulation (FMS), a novel non-invasive modality, has shown promising results in pelvic floor rehabilitation for urinary incontinence, but its role in prolapse treatment remains insufficiently investigated. This study aimed to evaluate anatomical and patient-reported outcomes in women with mild POP undergoing FMS therapy. Materials and Methods: This retrospective observational study included 87 women with stage ≤ 2 POP, classified according to the Pelvic Organ Prolapse Quantification (POP-Q) system. Participants underwent eight FMS sessions, each lasting 25 min, over four weeks using the Dr. Arnold device (DEKA, Calenzano, Italy). Pre- and post-treatment evaluations included standardized POP-Q measurements and the Patient Global Impression of Improvement (PGI-I) questionnaire. Statistical analyses were performed using paired t-tests, with significance set at p < 0.05. Results: Statistically significant improvements were observed in the anterior vaginal compartment, with mean Aa values improving from −0.3 ± 1.2 to −0.7 ± 1.3 (mean difference −0.4 cm; 95% CI −0.8 to −0.03; p = 0.03; Cohen’s d = 0.31) and mean Ba values from −0.3 ± 1.3 to −0.7 ± 1.3 (mean difference −0.4 cm; 95% CI −0.8 to −0.02; p = 0.04; Cohen’s d = 0.30). No significant changes were found at other POP-Q landmarks. According to PGI-I results, 90.8% of participants reported symptom improvements, and 37.9% described their condition as “very much improved” or “much improved.” No adverse events occurred, and treatment compliance was 100%. Conclusions: FMS seems to be a safe, well-tolerated, and potentially effective conservative therapy strategy for mild POP, offering both objective anatomical benefits and high subjective satisfaction. Further randomized controlled trials with longer follow-up are required to validate these findings and clarify the long-term role of FMS in the management of pelvic floor dysfunction. Full article

Persistent postoperative opioid use (PPOU) is an emerging challenge in pediatric perioperative care, with rates as high as 4.7% in opioid-naive adolescents. Despite advances in multimodal analgesia, current protocols often fail to prevent long-term opioid exposure, particularly after high-risk surgeries such as spinal fusions. While multiple strategies exist to reduce PPOU in children, including regional anesthesia and non-opioid analgesics, this review specifically focuses on methadone and pharmacogenomic-guided opioid prescribing as promising approaches. Methadone, a long-acting opioid with mu-opioid agonism, NMDA antagonism, and monoamine reuptake inhibition, has shown encouraging outcomes in adult and emerging pediatric studies but remains underutilized due to concerns over safety, variability, and familiarity. This narrative review explores the intersection of methadone pharmacology, pharmacogenomic (PGx)-guided opioid prescribing, and their potential to reduce PPOU and optimize perioperative pain control in children. We examine methadone’s unique pharmacokinetic profile, extended half-life, and ability to reduce central sensitization and opioid tolerance. Data from pediatric trials in cardiac, spinal, and major abdominal surgeries are reviewed, highlighting methadone’s potential to lower total opioid use, stabilize postoperative pain trajectories, and improve recovery. The review also discusses the role of PGx testing, particularly CYP2D6, CYP3A4, UGT2B7, and OPRM1 variants, in tailoring methadone dosing to individual metabolic profiles, reducing adverse effects, and improving analgesic efficacy. There are no well accepted generalizable perioperative methadone dose, number of doses and dosing intervals due to limited large multicenter studies in children. We outline challenges, including QTc prolongation, dosing variability, lack of pediatric-specific PGx guidelines, and ethical considerations around genetic testing in minors. The review calls for multidisciplinary perioperative teams, expanded PGx implementation, and real-world data from registries and AI-integrated models to support precision opioid strategies. Preventing PPOU in children is critical. Integration of methadone-based multimodal analgesia in high-risk painful in-patient procedures and future integration of PGx represent positive steps toward personalized, effective, and safer pain management in pediatric surgical patients, an urgent need as opioid stewardship becomes a clinical and public health imperative. Full article