Search Results (1,633)

Background: Anterior ischemic optic neuropathy (AION) is a potentially vision threatening disorder that affects middle-aged and elderly individuals. The pathogenesis of the disease remains incompletely understood. However, the most universally accepted hypothesis suggests that a transient reduction in optic nerve head (ONH) perfusion, secondary to hypovolemia, nocturnal hypotension, or small-vessel disease, results in ischemic infarction of the anterior portion of the optic nerve. Case presentation: We present the case of a 61-year-old male patient with a history of arterial hypertension, type II diabetes mellitus, generalized atheromatosis, femoral bypass and stent implantation for chronic ischemia in his left leg, followed by brachial artery dissection that needed a prompt vascular intervention; he presented visual acuity loss in both eyes (BE), with the left eye (LE) being more affected than the right eye (RE). A complete ophthalmologic check-up was performed, and it revealed best-corrected visual acuity (BCVA) RE 0.5 Snellen, LE light perception, normal intraocular pressure (IOP), BE papillary edema and arteriovenous abnormalities. Visual field (VF) examination revealed RE inferior altitudinal defect and LE preabsolute scotoma. The diagnosis of BE anterior ischemic optic neuropathy and hypertensive retinopathy stage II was formulated. Following the aforementioned surgical procedures meant optimizing the patient’s critical vascular status, subsequent management of NA-AION systemic risk factors, along with implementing important lifestyle changes. No further cardiovascular events occurred, and visual field parameters remained stable at the three-year follow-up. Conclusions: Non-arteritic anterior ischemic optic neuropathy (NA-AION) remains a topic of interest for both ophthalmologists and neurologists worldwide. When confronted with a high-risk cardiovascular patient, a rapid and thorough systemic evaluation may prove beneficial. This management strategy could potentially contribute to maintaining a stable systemic outcome, despite major cardiovascular threats. Full article

Globally, approximately three hundred million individuals undergo non-cardiac surgery each year. Perioperative mortality results from a complex interplay between patient-related factors and procedural variables, including both surgical and anesthetic aspects. Although cardiac surgery has a well-established risk profile for acute cardiovascular events, major non-cardiac surgery also carries significant—yet often underrecognized—cardiovascular risks. Approximately half of postoperative deaths following non-cardiac procedures are attributable to cardiovascular complications. Surgical and anesthetic stress responses may induce myocardial injury through several pathophysiological mechanisms. However, the absence of a universally accepted definition of perioperative myocardial injury complicates both diagnosis and management. Furthermore, these injuries frequently occur without symptoms, making them clinically silent and often undetected. Consequently, unexpected postoperative deaths may occur and may lead to allegations of medical malpractice. We conducted a narrative review of existing literature on perioperative myocardial injury and its implications for forensic investigation and medico-legal assessment. This paper highlights the importance of a comprehensive forensic evaluation of perioperative deaths, integrating clinical documentation, autopsy findings, histopathological evidence and ancillary investigations to support accurate medico-legal assessment, recognizing that no single element is sufficient to establish the cause of death in all cases. Four illustrative case studies are presented to demonstrate the medico-legal challenges associated with these events. A structured forensic investigation is essential for accurately determining the cause of death and for distinguishing preventable medical errors from unavoidable adverse outcomes within the context of complex perioperative care. Full article

The Myval balloon-expandable transcatheter heart valve was developed for transcatheter aortic valve implantation, but its broad 20–32 mm size matrix and controlled deployment have prompted use in non-aortic landing zones. This narrative review critically synthesizes Myval-specific case reports, case series, and observational cohorts, together with relevant platform-level evidence, addressing device design, anatomical selection, imaging, procedural strategy, clinical outcomes, and evidence gaps. Reported applications include mitral valve-in-valve, valve-in-ring, and valve-in-mitral annular calcification; tricuspid valve-in-valve and valve-in-ring; and pulmonary implantation in conduits, surgical bioprostheses, and selected native or patched right ventricular outflow tracts. Outcomes appear most predictable within circular stented surgical bioprostheses, whereas non-circular rings, severe mitral annular calcification, and compliant or aneurysmal outflow tracts present greater risks of inadequate anchoring, paravalvular regurgitation, embolization, frame deformation, left ventricular outflow tract obstruction, and coronary compression. Intermediate and extra-large diameters increase the available nominal sizing options; however, no clinical evidence demonstrates that this reduces embolization, paravalvular regurgitation, residual gradients, or reintervention. The available data document procedural feasibility in anatomically selected patients but are predominantly observational, with limited independent adjudication and follow-up. These procedures are generally off-label and should remain individualized Heart Team decisions; prospective multicenter studies are required to define comparative safety, antithrombotic management, durability, and lifetime reintervention strategies. Full article

Background/Objectives: Chronic low back pain (CLBP) is the leading global cause of years lived with disability, but long-term real-world evidence for non-surgical management remains scarce, particularly in low- and middle-income countries. This study aimed to describe 5-year trajectories of pain, disability, healthcare utilization, patient satisfaction, and surgical conversion among patients with non-specific CLBP initially managed non-surgically at a tertiary spine center in Northwest China. We also compared long-term outcomes between unimodal therapy and multidisciplinary biopsychosocial care and examined baseline demographic, clinical, and psychosocial predictors of treatment success and conversion to surgery. Methods: We conducted a 5-year retrospective cohort study of consecutive patients with non-specific CLBP at a tertiary spine center in Northwest China. Of 485 consecutive patients screened for eligibility, 420 were enrolled and were compared on the basis of unimodal therapy with multidisciplinary biopsychosocial care. Primary outcomes were pain (Numerical Pain Rating Scale, NPRS) and disability (Oswestry Disability Index, ODI), analyzed using linear mixed-effects models; predictors of surgical conversion were identified via multivariable Cox regression. Results: Of the 420 patients, 352 (83.8% retention) completed the 5-year follow-up. Both pain and disability improved substantially during the first 12 months. Thereafter, pain intensity increased slightly (NPRS from 4.8 to 5.4), whereas functional disability continued to improve (ODI from 31.7 to 26.5). Early multidisciplinary care was associated with sustained superior outcomes (adjusted functional disability (ODI) difference: −8.2 points at 5 years) and a 42% lower observed risk of surgery (HR = 0.58). The cumulative 5-year surgical rate was 14.2%, with high pain catastrophizing as the strongest independent predictor (HR = 3.10). Conclusions: In patients with non-specific CLBP, non-surgical management yields substantial 12-month gains; function continues to improve through 5 years, while pain shows partial recurrence. Early multidisciplinary biopsychosocial care was associated with more durable outcomes and lower surgical conversion; because treatment was not randomized, these associations warrant confirmation in pragmatic trials and support routine psychosocial screening and stratified care. Full article

Background/Objectives: Kidney transplantation is the most effective treatment for pediatric patients with end-stage renal disease (ESRD), offering superior survival rates and quality of life compared to dialysis. However, long-term graft survival remains a complex clinical and surgical challenge. This systematic review aims to evaluate short- and long-term graft outcomes and comprehensively analyze the primary clinical, immunological, and procedural risk factors driving pediatric graft failure. Methods: A comprehensive search was conducted across the PubMed database, yielding 289 initial records. Following duplicate removal and systematic title and abstract screening, 108 full-text articles were evaluated for eligibility. Ultimately, 35 high-quality studies met the full inclusion criteria and were selected for final data synthesis and analysis. Results: Synthesized data revealed high short-term outcomes, with a 1-year graft survival rate of 94.60%. However, survival experienced a steady decline over time, dropping to 59.50% at the 10-year mark. Acute rejection episodes and delayed graft function (DGF) were identified as the primary immunological primary risk factors. Furthermore, specific donor characteristics, early surgical complications (such as vascular thrombosis), post-transplant infections affecting nearly 45% of patients, and adolescent non-adherence to immunosuppressive regimens were heavily associated with accelerated graft failure. Conclusions: While short-term success in pediatric kidney transplantation is highly encouraging, long-term graft longevity requires targeted clinical interventions. Optimizing outcomes necessitates precise, lifelong management strategies specifically focused on mitigating chronic rejection, preventing post-operative infections, and implementing multidisciplinary support systems to enhance patient adherence to immunosuppressive therapy. Full article

Background and Objectives: Presurgical infant orthopedics aims to reduce cleft severity and facilitate primary surgical repair during the early neonatal period, when increased tissue plasticity enhances molding. Nasoalveolar molding is widely used but requires intraoral appliances, laboratory support, specialized training, and frequent follow-up visits, which may limit accessibility and adherence. This case series reports the clinical application of presurgical lip–alveolus–nose approximation (PLANA), an extraoral technique for early presurgical cleft management, and describes the clinical changes observed during treatment in four infants. Materials and Methods: A prospective case series conducted in neonates with non-syndromic unilateral or bilateral cleft lip and/or palate referred within the first 10 days of life to the Alabama Cleft Center. Treatment consisted of a prefabricated silicone nasal aligner combined with hydrocolloid lip adhesive taping. No intraoral plates or dental impressions were used. Devices were worn 20 to 22 h daily. Follow up occurred every 2 to 4 weeks, with remote monitoring used when appropriate. Qualitative clinical observations focused on apparent changes in nasal symmetry, columellar length, septal alignment, nasal tip projection, premaxillary position, nostril dimensions, alar base width, cleft width, and lip approximation, as well as feeding tolerance, skin tolerance, and treatment adherence. These observations were assessed qualitatively through serial clinical examinations and clinical photographs; no standardized quantitative morphometric measurements were performed. Results: Four infants with complete unilateral or bilateral cleft lip and palate received PLANA treatment. Serial clinical examinations and photographs documented qualitative changes in nasolabial morphology over the course of treatment in all four patients. Qualitative clinical assessment of serial photographs and examinations suggested greater apparent nasal symmetry, apparent columellar elongation, more central-appearing nasal alignment, increased apparent nasal tip projection, apparent cleft-width reduction, and progressive lip approximation. In unilateral clefts, changes were observed in both the cleft and non-cleft nasal sides, while bilateral clefts demonstrated changes in nasal morphology bilaterally. No device-related complications or clinically significant skin intolerance were documented during the reported treatment periods. Parent-reported device wear was approximately 20–22 h per day. Conclusions: In this four-patient prospective descriptive case series, PLANA was applied clinically, with no clinically significant treatment-related complications documented during the reported treatment periods. Serial clinical observations suggested changes in nasolabial morphology during treatment. Given the small sample size, absence of a contemporaneous control group, and qualitative nature of the assessments, these findings should be interpreted as preliminary and hypothesis-generating rather than as evidence of treatment efficacy or comparative effectiveness. Larger prospective, multicenter comparative studies incorporating standardized quantitative measurements, objective adherence assessment, and long-term surgical and aesthetic outcomes are needed to evaluate the effectiveness, reproducibility, and clinical applicability of the PLANA approach. Full article

Background: Adoption of surgical robotic systems is accelerating globally, driven by advances in clinical capability, ergonomics, and workflow efficiency. However, robotic surgery programs introduce complex organizational challenges related to patient safety, workforce capability, infrastructure readiness, governance, vendor dependency, procurement, and long-term sustainability. Hospitals often lack structured, leadership-oriented frameworks to support systematic, context-appropriate evaluation, adoption, and governance of these technologies. Objective: To develop a multidisciplinary, consensus-based framework to support leadership-level evaluation, organizational readiness assessment, adoption, and governance of surgical robotic systems. Methods: A two-round modified Delphi study was conducted at Singapore General Hospital involving eleven stakeholder groups spanning clinical, perioperative, technical, operational, governance, and executive domains. Department-level consensus responses were generated. In Round 1, stakeholders completed role-specific questionnaires comprising Likert-scale items and open-ended questions. Items rated as low importance were excluded, while items of moderate importance were refined through thematic analysis. In Round 2, refined and newly generated items were re-evaluated. Items achieving ≥70% agreement for high importance within each stakeholder group were retained. Results: A total of 417 consensus-derived items were identified and organized into nine thematic domains encompassing patient safety and risk management, technical capability and surgical performance, workflow integration, training and credentialing, governance and sustainability, vendor support, infrastructure, logistics, and operational readiness. The framework was operationalized through category-specific interpretive scoring rubrics and three domain-weighted decision models reflecting clinician, safety, and procurement perspectives. Conclusions: This study presents a leadership-oriented, multi-stakeholder framework to support the risk-aware evaluation, adoption, implementation, and governance of surgical robotic systems. By integrating considerations across institutional readiness, comparative robotic platform assessment, and program governance, the framework provides a structured approach to decision-making throughout the robotic surgery lifecycle. While it may serve as a useful starting point for institutions seeking to establish or expand robotic surgery programs, the framework was developed and evaluated within a single academic tertiary healthcare institution. Further validation across diverse healthcare settings, including community hospitals, non-academic institutions, specialty centers, and resource-constrained environments, is required before broader adoption can be recommended. Full article

Background/Objectives: Liver metastasis develops in approximately 50% of patients with colorectal cancer. Invasion of the biliary tract from colorectal liver metastasis (CRLM) is rarely reported. Preoperative diagnosis remains elusive, prohibiting optimal surgical management. The objective of this systematic review was to summarize the clinical, radiological, pathological, and treatment characteristics of ibCRLM and describe the reported outcomes. Methods: A systematic literature search of the Medline, Embase, Web of Science, CENTRAL, and CINAHL databases was undertaken for studies reporting clinical outcomes of patients with ibCRLM, up to May 2026. An individual patient data analysis approach was utilized. Results: Thirty-eight case reports and 10 case-series, incorporating 228 patients with biliary involvement from CRLM, were identified. Mean age was 62.4 ± 10.9 years, with a male-to-female ratio of 3.2:1. The majority of metastatic lesions were metachronous in 71.1% and solitary in 59.1% of patients. Surgical treatment was implemented in 89.2% of patients. Major hepatectomy was the most common procedure, being performed in 46.2% of patients, followed by minor hepatectomy in 38.7% and pancreatoduodenectomy in 4.3%. After a median follow-up of 52.5 months (range 2–164 months), the survival rate was 60.5%. Non-survivors were found to have significantly more synchronous CRLM (50% versus 0, p = 0.008), while a single patient did not receive any curative-intent treatment and died 20 days following CRLM presentation. Conclusions: IbCRLM is a distinct clinicopathological presentation of CRLM with characteristic radiological and pathological features. The available evidence suggests that selected patients may achieve favorable long-term outcomes following complete surgical resection, although these findings should be interpreted with caution given the limitations of the available literature. Full article

Background and Objective: Prolonged mechanical ventilation (PMV) after cardiac surgery is a common complication associated with increased morbidity, mortality and intensive care resource utilization. Our aim was to determine predictors of PMV > 48 h in patients undergoing coronary artery bypass grafting (CABG). Methods: This was a single-center retrospective observational study including adult patients who underwent CABG between January 2011 and December 2024. The primary outcome was PMV. Results: From 2083 patients, 241 had PMV (11.6%). Compared with patients without PMV, those with PMV had lower hemoglobin levels (12.6 ± 2.1 vs. 13.4 ± 1.9 g/dL, p < 0.001) and worse estimated Glomerular Filtration Rate (67.1 ± 26.9 vs. 78.1 ± 22.6 mL/min, p < 0.001). The model with preoperative variables predicted the risk of PMV (with an area under the receiver operating characteristic curve [AUROC] of 0.789). The prediction improved with the addition of intraoperative variables (AUROC 0.832) and with the further addition of early postoperative re-exploration for bleeding (AUROC 0.847). A simplified preoperative score showed good discrimination (AUROC 0.78; 95% CI 0.749–0.81) and stratified patients into clinically meaningful risk categories. Restricted cubic spline analysis showed a non-linear association between cardiopulmonary bypass duration and PMV, with risk increasing progressively after 120 min. Conclusions: PMV after CABG can be predicted using simple preoperative variables. This prediction has relevant implications for clinical management, intensive care resource allocation, and surgical scheduling. Preoperative anemia. Preoperative anemia was independently associated with PMV and represents a potentially modifiable perioperative risk factor. Full article

Systolic anterior motion (SAM) of the mitral valve can occur either in association with or in the absence of hypertrophic obstructive cardiomyopathy (HOCM). SAM induces dynamic left ventricular outflow tract obstruction (LVOTO) and, in the majority of cases, is associated with a substantial degree of mitral regurgitation (MR) that significantly impacts patient morbidity and mortality. This narrative review explores the contemporary understanding of the pathophysiology, diagnosis, and management of SAM, focusing particularly on surgical strategies and the novel therapeutic class of cardiac myosin inhibitors. Extended septal myectomy remains the gold-standard treatment for HOCM-related SAM, yielding superior long-term outcomes compared to alcohol septal ablation (ASA). Advanced imaging modalities, including three-dimensional transesophageal echocardiography (3D-TEE), enable precise pre-operative characterization of the mitral valve apparatus. Some patients may benefit from septal reduction strategies while concomitant mitral valve interventions are generally reserved for highly selected cases with intrinsic valve pathology or persistent residual SAM, thereby avoiding unnecessary valvular manipulation and its potential hemodynamic risks. Mavacamten, a selective cardiac myosin inhibitor, represents an important advance in pharmacological management, achieving a mean LVOT gradient reduction of 37.2 mmHg in symptomatic patients. Furthermore, data from the MARVEL registry confirm the real-world clinical efficacy of mavacamten in obstructive hypertrophic cardiomyopathy, with 86% of patients successfully down-staged to NYHA functional class I–II. Although ASA serves as a viable alternative to surgery, it entails a higher risk of conduction abnormalities requiring permanent pacemaker implantation and subsequent re-intervention. Beyond classical hypertrophic SAM, this review addresses the diagnosis and management of post-mitral repair complications and non-hypertrophic variants. Optimal management and risk stratification remain an evolving field requiring a multidisciplinary Heart Team approach, leverage of advanced imaging, and adoption of novel medical therapies. Interventional strategies must be carefully tailored to maximize the efficacy-to-safety profile on an individualized patient basis. Full article

Background: Breast implant illness (BII) is a constellation of non-specific systemic and local symptoms—including fatigue, joint pain, cognitive dysfunction, and autoimmune-like manifestations—attributed to silicone breast implants. Although BII remains a controversial clinical entity, accumulating evidence suggests symptom improvement following implant removal; however, causal mechanisms and optimal surgical strategies remain uncertain. Objective: The objective was to evaluate the prevalence of BII symptoms and the effect of explantation with en bloc total capsulectomy on symptom resolution in affected women. Methods: A prospective case series of 50 women who underwent explantation with total capsulectomy between 2023 and 2025 was conducted (Level IV evidence). The BII Questionnaire of the American Society for Aesthetic Plastic Surgery (ASAPS) was administered to assess preoperative and one-year postoperative symptom burden. Perioperative data—including implant characteristics, capsular findings, and imaging results—were analyzed. Symptom changes were assessed using descriptive statistics and nonparametric tests. Results: The mean age at explantation was 43 years, with a mean age at implantation of 31 years. Implants were predominantly placed in the retropectoral plane (80%). Intraoperative rupture was identified in 34 patients (68%). At one-year follow-up, a statistically significant reduction in symptom burden was observed, with an 81.7% decrease in mean symptom frequency (preoperative mean: 10.79 vs. postoperative: 1.97; p < 0.001). The most pronounced improvements were noted in chronic fatigue, cognitive impairment, and delayed wound healing. No surgical complications were recorded, and aesthetic outcomes were satisfactory among patients who underwent single-stage mastopexy. Conclusions: Explantation with en bloc total capsulectomy is associated with substantial symptom improvement in women presenting with BII. Although the precise pathophysiology of BII remains elusive, these findings support a patient-centered approach incorporating thorough preoperative evaluation and shared decision-making. Future research should prioritize the development of standardized diagnostic criteria, biomarker validation, and patient subgroup stratification to optimize clinical management and further advance the understanding of BII. Limitations: The absence of a control group precludes causal inference. Objective clinical and immunological assessments were not performed. Patient-reported symptoms were not corroborated by formal clinical evaluation. Most patients were self-referred, introducing referral and expectation bias. The sample size was small. Full article

Background/Objectives: Ulnar nerve neuropathy at the elbow (UNE) is the second most common focal neuropathy of the upper extremity and often results from entrapment of the ulnar nerve as it traverses the elbow with insidious onset and gradual progression. This study describes the clinical, electrodiagnostic (EDX), and ultrasound (US) findings in a cohort of patients presenting with acute UNE. Methods: This is a review of 103 patients with clinical features of UNE with acute onset who underwent EDX and US studies over a 25-year period (2010–2026) at our Neurodiagnostic Center. Results: Of the 103 patients with acute UNE, all experienced paresthesia in the ulnar nerve distribution. A total of 27 (26.2%) patients had elbow pain, and 99 (96.1%) had decreased pinprick sensation in the ulnar nerve distribution. Weakness of the following muscles was detected: abductor digiti minimi (ADM) (94 [91.3%]), FDI (first dorsal interosseous) (91 [88.3%]), and FDPu (flexor digitorum profundus—ulnar) (76 [73.8%]). Most patients had a clinical grade of 3 (severe: sensory and motor abnormalities as well as atrophy of the FDI and ADM muscles) (93 [90.3%]). Perioperative injuries were the most common etiology of acute UNE, consisting of 65 (63.1%) patients. The perioperative injury was noted after surgical procedures at varied locations, most frequently at the shoulder in 23 (35.4%) followed by coronary artery bypass in 9 (13.8%) and knee joint surgery in 8 (12.3%). Non-iatrogenic injuries affected 11 (10.7%) patients. The US study revealed cysts and tumors such as a Schwannoma in 14/76 (18.4%) patients. Focal demyelination was observed by EDX studies in 95 (92.2%) patients, and a conduction block was detected in 24 (23.3%). Motor and sensory axonal involvement was identified in 81 (78.6%) and 86 (83.5%) patients, respectively. Of the 76 patients who underwent an US study, 68 (90.6%) had an increase in the cross-sectional area of the ulnar nerve and 51 (68.0%) had a hypoechoic ulnar nerve at the elbow. Conclusions: In this study, the most common cause of acute UNE was periprocedural injury, most frequently following shoulder surgery. Acute UNE may also occur without a history of antecedent trauma or a surgical procedure. EDX and US studies provide complementary data to determine the severity and the etiology of acute UNE and guide further management. Full article

Background and Objectives: Few cases of spontaneous evisceration through umbilical hernia (UH) in adult patients have been reported in the literature. Although uncommon, it is a potentially life-threatening surgical emergency. This scoping review aimed to map the published cases and summarize the reported clinical settings, precipitating factors, pathophysiologic mechanisms, management strategies, and outcomes. Materials and Methods: A scoping review was conducted in accordance with the PRISMA-ScR guidelines. The search was conducted through PubMed/MEDLINE and Scopus using the strings (“spontaneous evisceration” OR “spontaneous bowel evisceration” OR “umbilical hernia rupture” OR “umbilical hernia evisceration” OR “bowel evisceration umbilical” OR “umbilical evisceration” OR “bowel evisceration” OR “umbilical eventration”). Reports describing spontaneous evisceration of abdominal content through an UH in adult patients were included, whereas pediatric cases, non-umbilical eviscerations, traumatic eviscerations, animal studies, duplicates, and reports without extractable clinical data were excluded. Results: From the initial 2623 records identified, after thorough screening and reference tracking of the selected publications, 47 relevant reports for a total of 49 patients were identified. Cirrhosis was reported in 26 patients (53%), umbilical skin changes before the evisceration in 33 (67%), and death in 10 (20%). Conclusions: The available evidence suggests that spontaneous evisceration through UH is a surgical emergency that should be viewed not merely as a local mechanical event, but as the result of a multistep process involving chronic pressure overload, tissue fragility, and systemic decompensation, frequently in the setting of cirrhosis with ascites. Urgent repair is usually required, but the role of mesh reinforcement remains unclear and should be individualized according to contamination, defect size, patient condition, and ascites control. Full article

Background: Immune checkpoint inhibitors (ICIs) have moved from the metastatic setting into neoadjuvant, adjuvant, and fully perioperative strategies across several solid tumors. This shift has created a new clinical interface between medical oncology, surgery, anesthesia, pathology and postoperative care because immune activation may improve pathological response and survival while also generating immune-related adverse events (irAEs) that mimic or aggravate perioperative complications. Methods: We conducted a scoping review according to PRISMA-ScR. PubMed/MEDLINE and Web of Science were searched for studies published between 2016 and 2026 that evaluated adult patients with solid tumors receiving ICIs in relation to surgery. Thirty-three studies were included and synthesized descriptively across surgical feasibility, perioperative safety, irAEs, anesthetic considerations, and oncological outcomes. Results: The strongest evidence was found in resectable non-small-cell lung cancer, where neoadjuvant or perioperative ICI-based regimens improved pathological response and, in several trials, event-free or overall survival. Evidence in triple-negative breast, bladder, gastric/gastroesophageal junction, and ovarian cancers supported broader applicability but remained heterogeneous, with variable efficacy across tumor types and treatment regimens. Surgery following ICI exposure was generally feasible, without a consistent increase in postoperative mortality. However, pneumonitis, myocarditis, endocrinopathies, hepatitis, colitis, and cytokine release syndrome may mimic conventional postoperative complications. Direct evidence comparing anesthetic or perioperative management strategies was scarce. Conclusions: Perioperative ICI-based therapy is no longer an experimental concept, but its safe implementation requires structured preoperative screening, individualized surgical timing, organ-specific toxicity surveillance, careful corticosteroid decision-making, and close multidisciplinary communication. Future prospective studies should integrate standardized perioperative endpoints, anesthesia-related variables, biomarker-driven risk stratification, and long-term oncological outcomes. Full article

Brain metastases represent a major clinical challenge in the management of non-small-cell lung cancer, particularly in patients with epidermal growth factor receptor mutations, constituting a leading cause of morbidity and mortality. In recent years, significant advancements have been made in both local therapies and systemic treatments. Nevertheless, managing central nervous system disease remains complex, encompassing challenges such as optimal therapy sequencing, resistance mechanisms, oligoprogression, the role of the blood–brain barrier, diagnostic strategies, and the influence of the brain tumor microenvironment. Despite advances, brain metastases in non-small-cell lung cancer remain an unmet need. Local treatments like radiotherapy are effective but carry risks of long-term neurological side effects, while the number and burden of brain metastases remain key prognostic factors. Surgical resection may be considered even in patients with multiple brain metastases to improve clinical status, enable further therapy, and enhance survival and quality of life. With the extension of survival afforded by systemic therapies, optimizing the balance between treatment efficacy and quality of life has become critical. Integrating patient perspectives is essential in navigating these complex clinical decisions. Full article