Search Results (8)

Background: Neoadjuvant chemoimmunotherapy is now a standard approach for resectable stage II–III non-small cell lung cancer (NSCLC), demonstrating improved pathological response and survival. However, its safety in physiologically high-risk surgical patients is unclear, as these groups are underrepresented in trials. This study compares 30-day and 90-day mortality and oncological outcomes of neoadjuvant chemoimmunotherapy followed by surgery versus upfront surgery within a high-risk multidisciplinary team (MDT) cohort. Methods: A retrospective single-centre study was performed, including consecutive high-risk MDT patients undergoing resection for stage II -III NSCLC between January 2022 and December 2025. High-risk status was defined by established physiological, cardiopulmonary, and comorbidity criteria. Patients were stratified into neoadjuvant chemoimmunotherapy followed by surgery (Chemo-IO; n = 33) or upfront surgery (n = 57). The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, R0 resection rate, and length of hospital stay. Inverse probability of treatment weighting (IPTW) based on propensity scores was used to balance baseline differences between groups. Results: Ninety patients were included. Patients receiving neoadjuvant therapy had a greater comorbidity burden (Charlson Comorbidity Index 3.2 ± 1.5 vs. 1.4 ± 1.7, p < 0.001) and more advanced disease (stage III: 57.6% vs. 29.8%, p = 0.014). Thirty-day mortality was 0% in the Chemo-IO group and 1.8% following upfront surgery. After IPTW adjustment, neoadjuvant therapy was not associated with increased perioperative mortality. Ninety-day mortality was similar between groups (3.0% vs. 3.5%; IPTW OR 0.91, 95% CI 0.05–15.39, p = 0.948). R0 resection rates were numerically higher following Chemo-IO (87.9% vs. 78.9%; IPTW OR 3.42, 95% CI 0.71–16.59, p = 0.127). Median hospital stay was identical in both cohorts (6 days), with no significant difference after weighting (p = 0.722). Conclusions: Neoadjuvant chemoimmunotherapy appears safe and feasible in carefully selected high-risk patients with resectable stage II–III NSCLC. Despite greater comorbidity burden and more advanced disease, short-term perioperative outcomes were not compromised, while a trend towards improved R0 resection rates was observed. These findings support the consideration of multimodal treatment strategies within high-risk MDT pathways. Full article

Background: The integration of neoadjuvant and perioperative chemo-immunotherapy (CT-IO) has significantly reshaped the treatment of resectable non-small-cell lung cancer (NSCLC), improving pathological response and survival outcomes. However, its impact on surgical management—particularly robotic-assisted thoracic surgery (RATS)—remains incompletely defined. This review provides a practical overview of current evidence and technical considerations for robotic lung resection following neoadjuvant chemo-immunotherapy. Methods: A narrative review of the literature was performed, focusing on phase III trials, meta-analyses, and surgical series reporting perioperative, oncological, and technical outcomes of minimally invasive—especially robotic—approaches after neoadjuvant or perioperative chemo-immunotherapy. Results: Randomized trials have established CT-IO as a standard treatment option for selected patients with resectable stage II–III NSCLC—although the specific standard varies according to stage, molecular and PD-L1 status, and regulatory approval—significantly improving pathological complete response and event-free survival. However, immune-related fibrosis, nodal scarring, and altered tissue planes increase surgical complexity and intra-postoperative complications. Available evidence, largely retrospective and derived from selected patient populations treated at experienced centers, suggest that RATS is feasible and safe, offering enhanced visualization and dexterity that may facilitate dissection in challenging post-induction settings. Vascular management and lymph node dissection remain critical technical aspects, and early conversion to open surgery, when required, should be regarded as an appropriate safety strategy rather than a complication. Conclusions: RATS after neoadjuvant chemo-immunotherapy appears feasible and promising in selected patients treated at experienced centers, but current evidence does not yet establish it as the preferred approach for all patients. Careful patient selection, adherence to oncological principles, and surgeon experience are essential. Prospective data are needed to define optimal surgical timing and standardize techniques. Full article

Background/Objectives: Immunotherapy (IO) has demonstrated survival benefits in metastatic gastroesophageal cancers, and current data supports perioperative IO in localized adenocarcinomas. Radiation may further enhance IO response through immunologic priming. This study evaluates the feasibility, safety, and preliminary efficacy of incorporating IO into a chemoradiation-based perioperative strategy for resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma. Methods: This single-arm, phase I/II study enrolled adults with untreated, locally advanced, resectable gastric or GEJ adenocarcinoma between February 2019 and June 2023. The treatment protocol consisted of induction chemotherapy (oxaliplatin + 5-fluorouracil), induction IO (nivolumab + ipilimumab), concurrent immune-chemoradiation (nivolumab, 5-fluorouracil, and 45 Gy IMRT/VMAT), surgical resection, and adjuvant nivolumab for residual disease. Primary endpoints were safety and feasibility; secondary endpoints included the pathologic complete response (pCR), R0 resection rate, disease-free survival (DFS), overall survival (OS), and biomarker analysis. Results: In total, 30 patients were enrolled, and 23 underwent resection. Grade 4 treatment-related toxicities occurred in three patients (10%), including acute kidney injury, myocarditis/myositis/myasthenia gravis overlap syndrome, and neutropenia. Among surgical patients, the pCR rate was 39.1% (95% CI: 19.7–61.5%), and the intention-to-treat pCR rate was 30% (95% CI: 14.7–49.4%). R0 resection was achieved in 87% of cases. Median DFS among resected patients was 40.2 months (95% CI: 21.6–NE). Median OS was 43.7 months (95% CI: 30.7–NE), with 2-, 3-, and 5-year OS rates of 73.3%, 57.5%, and 47.9%, respectively. Conclusions: This multimodality approach incorporating IO with chemotherapy and chemoradiation demonstrated a manageable safety profile and an encouraging pCR rate, supporting further evaluation. Full article

Background: Perioperative bleeding from cancellous bone remains a clinically relevant challenge in orthopaedic surgery. Bone wax has long been used as a simple and inexpensive mechanical hemostatic agent, but previous reviews have focused mainly on total joint arthroplasty or on the material history of bone wax and its substitutes. The broader clinical evidence across orthopaedic subspecialties has not been comprehensively mapped. Methods: This scoping review followed the Arksey and O’Malley framework, with methodological refinements proposed by Levac et al., and was reported in accordance with PRISMA-ScR. Five electronic sources and grey literature were searched through May 2025. Clinical studies evaluating bone wax in orthopaedic surgery were eligible regardless of study design; a relevant clinical trial registry record with sufficient methodological detail was also retained to map ongoing evidence. Preclinical and purely material-based studies were excluded. The protocol was registered in the Open Science Framework (DOI: 10.17605/OSF.IO/K3ZAV). Results: Of 486 identified records, 15 met the inclusion criteria. Eight records concerned joint replacement, two spinal surgery, three excision of abnormal bony structures, and two sealing applications. The strongest comparative evidence came from arthroplasty, where bone wax was generally associated with reduced intraoperative or perioperative blood loss without clear evidence of adverse effects on early postoperative recovery outcomes reported in the included studies. Evidence for spinal and nontraditional applications was more heterogeneous and was derived mainly from small observational studies, case series, technical reports, or a trial registry record. Complications such as foreign-body reaction and chronic inflammation were described primarily in spine-related reports of retained nonabsorbable wax. Conclusions: Bone wax remains a useful and inexpensive adjunct for hemostasis in orthopaedic surgery. The strongest clinical evidence is concentrated in arthroplasty, whereas spinal and nontraditional applications remain supported by limited and heterogeneous data. Future research should clarify indication-specific benefits and risks and evaluate the safety and effectiveness of bioresorbable alternatives in well-designed clinical studies. Full article

Background/Objectives: Recent advancements in immunotherapy have significantly reduced recurrence rates and improved distant outcomes of patients with non-small cell lung cancer. This review synthesizes literature from 2020 to 2025, concentrating on preoperative immunotherapy outcomes. Methods: We analyzed treatment regimens, focusing on primary endpoints, the percentage of patients who underwent initial surgery, type of surgery, R0 rate, immune-related adverse events and chemotherapy-related toxicities as well as the rate of surgery delays and cancelations. Results: Our findings emphasize the importance of optimizing patient selection, effectively managing adverse events, and implementing strategies to minimize surgical delays and cancelations. Conclusions: We defined areas for improvement, such as increasing the implementation of minimally invasive surgeries and avoiding pneumonectomies. These priorities are essential for increasing the efficacy of immunotherapy in surgical settings for NSCLC, and improving patient outcomes. Full article

Background/Objectives: Perioperative chemo-immunotherapy (CHT-IO) has emerged as a standard treatment strategy for resectable stage II–IIIB NSCLC. However, data regarding surgical feasibility, mini-invasive surgery rates, perioperative outcomes, and postoperative complications in real-world single-center experiences remain limited. Methods: A retrospective single-center analysis was performed including consecutive patients with locally advanced NSCLC treated with perioperative chemo-immunotherapy between March 2024 and March 2026. Patients received platinum-based chemotherapy combined with pembrolizumab or durvalumab, followed by surgical resection with curative intent. Surgical, pathological, and postoperative outcomes were analyzed. Results: Thirty patients received neoadjuvant CHT-IO, of which 25 (83.3%) underwent surgical resection. Reasons for failure to proceed to surgery included treatment-related toxicity or deterioration in performance status (n = 3), disease progression (n = 1), and patient refusal (n = 1). Lobectomy was the most performed procedure (64%), while a minimally invasive approach (uniportal VATS) was adopted in 44% of cases. Moderate-to-severe pleural adhesions (64%) and hilar fibrosis (60%) were observed intraoperatively. Despite these technical challenges, conversion to thoracotomy was required in only one case (4%), no intraoperative complications occurred, and complete (R0) resection was achieved in 96% of patients. Pathological complete response and major pathological response were observed in 36% and 52% of cases, respectively. Postoperative complications occurred in 56% of patients, although most were Clavien–Dindo grade I–II. The presence of comorbidities was the only factor associated with an increased risk of postoperative complications (OR 10.00, 95% CI 0.99–100.46; p = 0.05). Median length of hospital stay was 5.65 ± 2.04 days. One postoperative death due to septic complications was recorded. Conclusions: In this real-world monocentric experience, the combination of perioperative CH-ICIs and surgical resection (including mini-invasive approach) was safe and feasible in patients with locally advanced NSCLC. High rates of complete (R0) resection and encouraging pathological responses were observed, consistent with outcomes reported in randomized trials. Although surgery was overall frequently technically demanding, these changes did not appear to compromise perioperative safety or oncological radicality, even when minimally invasive approaches were adopted. Larger studies with longer follow-up are needed to better define long-term oncological outcomes. Full article

This detailed narrative review focuses on the current understanding of unique alterations in GM colonization and subsequent complications following surgery for significant childhood conditions, such as necrotizing enterocolitis (NEC), Hirschsprung’s disease (HD), inflammatory bowel disease (IBD), and short bowel syndrome (SBS). Surgical interventions can alter the diversity and structure of the GM and potentially cause post-surgical complications. Although the data are well-established in adults, there is a lack of pediatric-specific data on post-surgical GM dysbiosis and its complications, including surgical infections, intestinal obstructions (IO), and anastomotic leak (AL). This gap constitutes both a clinical risk and an important therapeutic opportunity. Therefore, research on how to modulate the GM perioperatively in children is needed. Current research provides an initial understanding of the possible post-surgical implications for outcomes of these intestinal disorders. Future studies could clarify GM alterations associated with various pediatric intestinal surgical procedures and their complications, which may influence the evaluation of GM-targeted treatments. Full article

Background: Immunotherapy (IO)-based strategies have been demonstrated to significantly prolong survival in the perioperative setting of non-oncogene-addicted non-small cell lung cancer (NSCLC). The adoption of such strategies in clinical practice depends on heterogeneous regulatory approvals and on the agreement between medical oncologists and thoracic surgeons on patients’ selection. Methods: An Expert Panel Meeting of medical oncologists and thoracic surgeons was held virtually by the Italian Association of Thoracic Oncology (AIOT) to discuss results of pivotal clinical trials with perioperative chemo-immunotherapy and reach agreement on open issues for the topic, formulating specific statements based on initially proposed discussion questions. Results: Overall, panelists found agreement on seven statements. With regard to tissue and biomarker analysis, the role of increasing PD-L1 expression in predicting IO efficacy was recognized, whereas ctDNA and pCR were mainly attributed a prognostic role, in the absence of dedicated studies. The panelists acknowledged direct relationship between the benefit of neoadjuvant chemo-immunotherapy approaches and the local burden of disease/mediastinal node involvement, supporting the inclusion of these factors, together with PD-L1, in selecting upfront surgery or induction treatment. The panelists agreed that the current literature data do not answer the issue of assessing the role of the adjuvant phase within a perioperative treatment strategy. Surgical considerations on the role of pneumonectomy and other approaches were also discussed. Conclusions: This experience highlights the importance of a synergistic approach between oncologists and surgeons to leverage the unmet needs in translating results of IO-perioperative clinical trials into clinical practice in patients with resectable NSCLC. Full article