Search Results (442)

Background: Megaprosthetic reconstruction is the standard of care for limb salvage after tumor resection around the knee, but the full burden of unplanned revision surgery is rarely reported as a structured composite outcome. We evaluated 241 consecutive patients over 21 years at a tertiary orthopedic oncology center. Methods: This retrospective cohort included 241 patients (160 distal femur, 78 proximal tibia, three combined) treated between 2003 and 2024. Revision-free survival (RFS, composite of any unplanned revision or amputation) and amputation-free survival were estimated by Kaplan–Meier analysis; independent predictors were identified by Cox regression. A pre-specified major-event composite (amputation, implant removal, or recurrence resection) was used for sensitivity analysis. Results: Mean age was 34.9 ± 19.5 years; mean follow-up was 120.2 months. Negative resection margin (R0) was achieved in 85.5% (206/241). Unplanned revision was required in 25 patients (10.4%); overall limb salvage was 92.9%. Five-year RFS was 73.8% (distal femur) vs. 65.0% (proximal tibia; p = 0.084), and 5-year limb salvage was 88.9% vs. 84.3% (p = 0.081). Surgical margin was strongly associated with outcome: 5-year RFS 75.4% (R0) vs. 48.7% (R1/R2; p < 0.001); 5-year limb salvage 90.6% vs. 71.5% (p = 0.003). On exploratory multivariate Cox analysis, proximal tibia site and positive margin were associated with worse revision-free survival; within the proximal tibia subgroup, absence of gastrocnemius flap coverage was also associated with worse outcome (interpreted with caution given the small flap subgroup, n = 11, and limited event count). Conclusions: In this single-center series, megaprosthetic reconstruction around the knee achieved acceptable revision-free survival and limb salvage. Surgical margin status was the strongest independent predictor of both endpoints, reinforcing the well-established importance of oncologic margin quality and site-specific soft tissue strategies. Full article

Introduction: Giant retroperitoneal liposarcomas (GRPLs) are rare tumors that often reach considerable size before diagnosis due to their indolent growth and deep anatomical location. Surgery represents the only potentially curative treatment, yet recurrence rates remain high. While histological subtype is a recognized predictor of recurrence, the prognostic role of tumor size, particularly in giant tumors, remains controversial. This study evaluates the impact of tumor size and histological subtype on recurrence risk in a literature-based retrospective cohort. Materials and Methods: Data were extracted from a literature-based database of GRLPs published between 2004 and 2023. Only tumors >20 cm treated without positive surgical margins were included; patients receiving adjuvant therapy or with missing follow-up were excluded. Histological subtype (well-differentiated vs. other) was the main variable of interest. Recurrence-free survival (RFS) was defined as the primary endpoint and estimated using the Kaplan–Meier method. The association between histological subtype and recurrence risk was evaluated using a Cox proportional hazards model. A sensitivity analysis was performed to explore the potential interaction between tumor size and histological subtype. Results: Our final cohort yielded a total of 81 patients, of whom 47 (58%) had a well-differentiated GRLPs. The median tumor size was 38 cm and median follow-up was 16 months, with 24 recurrences observed. At 24 months, RFS was higher in well-differentiated tumors than in other histological subtypes (81% vs. 41%). In multivariable Cox analysis, histology was independently associated with recurrence risk (HR 3.2, 95% CI 1.28–8.17, p = 0.01), whereas tumor size showed no association with recurrence. Interaction analysis confirmed no differential effect of tumor size across histological subtypes. Conclusions: In this literature-based cohort of GRLPs treated with surgery, histological subtype independently predicted recurrence, whereas tumor size showed no prognostic value, either overall or within individual histological subtypes. Full article

Background: Robot-assisted partial nephrectomy (RAPN) is an established nephron-sparing technique for localized renal tumors. It is performed using on-clamp (temporary renal artery clamping) or off-clamp (without hilar clamping) strategies. Comparative real-world evidence remains limited and is often confounded by non-randomized treatment allocation. Methods: This retrospective single-center study included 146 consecutive patients undergoing RAPN between 2020 and 2025. Patients were allocated to on-clamp (n = 108) or off-clamp (n = 38) groups based on tumor characteristics and intraoperative surgeon judgment. Perioperative, functional, and early oncological outcomes were analyzed. Tumor complexity was assessed using the RENAL nephrometry score. Surgical quality was evaluated using the Trifecta outcome (negative margins, warm ischemia time ≤25 min, and absence of Clavien–Dindo ≥III complications). Results: Off-clamp RAPN was more frequently applied in smaller tumors (p = 0.008), while RENAL scores were comparable between groups. Estimated blood loss was higher in the off-clamp group (260 ± 62 vs. 110 ± 35 mL; p < 0.0001), whereas transfusion rates and overall complication rates did not differ significantly. Trifecta achievement was similar between on-clamp and off-clamp RAPN (91.0% vs. 96.8%; p = 0.45). No significant differences were observed in early postoperative renal function (creatinine, hemoglobin, eGFR) or positive surgical margin rates. Conclusions: In this retrospective cohort, both on-clamp and off-clamp RAPN demonstrated comparable perioperative safety, functional outcomes, and early oncological efficacy. Differences in baseline tumor characteristics reflect selection bias rather than treatment effect. These findings support the feasibility of both techniques in appropriately selected patients, while highlighting the need for prospective comparative studies with adjustment for confounding factors. Full article

Dental implant placement has evolved from conventional freehand techniques toward digitally guided workflows integrating cone-beam computed tomography (CBCT), computer-aided design/computer-aided manufacturing (CAD/CAM), and dynamic navigation systems. Although guided surgery improves positional accuracy, its clinical relevance compared with freehand placement remains debated. This narrative review, based on a systematic and structured literature search following predefined selection criteria, analyzes studies published between 2000 and 2025 comparing guided and freehand implant placement regarding accuracy, survival, complications, biological outcomes, and workflow efficiency. Searches of PubMed/MEDLINE, Embase, and Web of Science identified 40 eligible human clinical studies for qualitative synthesis. Guided placement consistently demonstrated greater positional accuracy, with angular deviations of approximately 2–4° versus 5–9° for freehand placement and linear deviations reduced by about 1 mm. Nevertheless, implant survival rates were high and comparable for both techniques, generally exceeding 95% across short- and medium-term follow-up. Overall complication rates were low; guided approaches reduced anatomical risk and improved prosthetic predictability in complex or multi-implant cases, while freehand placement allowed greater intraoperative flexibility and tactile feedback, potentially optimizing primary stability in variable bone conditions. Marginal bone loss and peri-implant tissue outcomes were similar between approaches. Guided workflows required additional planning time and costs but enhanced reproducibility in complex rehabilitations. Guided and freehand implant placement should therefore be considered complementary strategies, with optimal outcomes depending on case selection, surgical expertise, and the balanced integration of digital technologies into contemporary implant practice. Full article

Background and Objectives: Papillary thyroid microcarcinoma (PTMC) is generally indolent; however, a subset exhibits aggressive features, reflecting biological heterogeneity. In the era of treatment de-escalation and active surveillance, accurate risk stratification is essential. We aimed to evaluate recurrence, identify factors associated with recurrence, determine predictors of lymph node metastasis (LNM) at diagnosis, and assess management strategies at our center. Materials and Methods: This retrospective study included 302 patients with PTMC. Associations between clinicopathological variables and outcomes were evaluated using chi-square test, Spearman correlation, and univariate and multivariate logistic regression analyses. Results: The cohort included 240 females (79.5%) and 62 males (20.5%), with a median age of 47 years. Total thyroidectomy was performed in 97.7%, and radioactive iodine (RAI) in 64.2%. LNM was identified in 26 patients (8.6%). Recurrence occurred in 4 patients (1.3%), and 98.0% were alive at last follow-up. Recurrence was associated with LNM at diagnosis, higher ATA risk categories, and positive surgical margins (p < 0.005). Younger age, larger tumor size, and vascular invasion independently predicted LNM (all p < 0.05), while autoimmune thyroiditis was associated with a reduced risk (p = 0.020). Conclusions: PTMC demonstrates clinically relevant heterogeneity, particularly in patients with LNM. However, given the limited number of recurrence events, recurrence-related findings should be interpreted cautiously and considered exploratory. These findings support risk-adapted management and careful patient selection in the era of treatment de-escalation. Full article

Objective: To evaluate the early oncological outcomes of patients treated with robot-assisted radical prostatectomy for prostate cancer with multiple PIRADS lesions at baseline mpMRI in a tertiary referral center. Methods: Data of consecutive patients undergoing robot-assisted radical prostatectomy between 2020 and 2022 at a high-volume tertiary referral center were prospectively collected. mpMRI data was evaluated by two expert uro-radiologists at our center. All patients received an MRI–ultrasound fusion biopsy. Results: Overall, 286 patients with multiple PIRADS lesions treated with robot-assisted radical prostatectomy at a tertiary referral center were included. Unilateral and bilateral nerve-sparing were achieved in 63 (22.3%) and 124 (43.1%) patients, respectively. Median age was 69 years (IQR: 64–72), while median Charlson Comorbidity Index was 3 (IQR: 2–4). The presence of two PIRADS lesions was found in the 81.8% of cases, while 18.2% presented with three or more. Bilateral lesions were observed in 67.4% of cases. The dominant lesion was PIRADS 4 in 57.3% and PIRADS 5 in 32.3% of cases, with a median diameter of 12 mm (IQR: 10–17). Pathological upstaging to pT3 occurred in 61% of patients. Overall, 9.8% of cases exhibited positive surgical margins (PSMs), most of them single and limited in extent. Postoperative major complications were recorded in 6.3% of patients. At a median follow-up of 18 months (IQR: 6–29), biochemical recurrence (BCR) occurred in 8% of patients. Patients with PIRADS 5 lesions experienced shorter BCR-free survival compared to those with PIRADS 3–4. On multivariable Cox regression, PIRADS 5 independently predicted biochemical recurrence (HR: 2.52; 95% CI: 1.10–5.80; p = 0.029), after adjustment for age, number of lesions, and nerve-sparing status, with the performance of nerve-sparing not associated with an increased risk of recurrence, including in patients with multifocal disease. Conclusions: Nerve-Sparing Robot-Assisted Radical Prostatectomy in patients with multiple PIRADS lesions achieves encouraging short-term oncologic outcomes, with biochemical recurrence-free survival exceeding 84% at 3 years, despite high rates of multifocality and pathological upstaging. Full article

Phyllodes tumours (PTs) of the breast are rare fibroepithelial neoplasms with potentially aggressive behaviour, characterised by rapid growth, a significant risk of local recurrence, and occasional metastatic spread. Optimal management remains controversial, particularly regarding surgical margins, adjuvant radiotherapy, and the relevance of molecular markers in predicting tumour behaviour. A PRISMA 2020-guided qualitative systematic review was conducted of studies published between January 2000 and December 2024 in PubMed/MEDLINE, Scopus, and Web of Science. Eligible studies included malignant PTs of the breast and addressed at least one of the following domains: molecular pathology, surgical margins and local recurrence, adjuvant radiotherapy, or predictors of recurrence and metastasis. A clinical case of malignant PT treated at our institution is presented as an illustrative study. Thirty-four studies met the inclusion criteria. Evidence suggests that margin status, stromal proliferative activity, and selected molecular markers influence recurrence risk. Several retrospective studies suggest that adjuvant radiotherapy may improve local control in selected high-risk malignant PTs, although the evidence remains heterogeneous, retrospective, and potentially affected by treatment-selection bias, and no consistent survival benefit has been demonstrated. Molecular alterations, including MED12 mutations, TERT promoter mutations, TP53 alterations, and increased Ki-67 expression, have been associated with tumour progression and aggressive behaviour. A 44-year-old woman presented with a 2.4 cm left breast mass on radiological examination. Lumpectomy revealed a malignant PT with stromal hypercellularity, nuclear atypia, and a mitotic index of 20/10 HPF with close margins. Immunohistochemistry showed positivity for CD99, Bcl-2, and CD34 with a Ki-67 proliferation index of 20%. The patient underwent wide local re-excision followed by adjuvant radiotherapy (60 Gy), and at 24-month follow-up, the patient remained disease-free. Evidence synthesis highlights the importance of complete surgical excision, multidisciplinary management, and consideration of adjuvant radiotherapy in selected malignant PTs. Emerging molecular profiling may contribute to improved biological understanding and future risk stratification of malignant PTs, although its routine clinical utility remains to be validated in prospective studies. Full article

Background: The optimal role of induction chemotherapy (IC) in the management of oral cavity squamous cell carcinoma (OCSCC) remains controversial. This study compared oncologic outcomes between IC followed by surgery and concurrent chemoradiotherapy (CCRT) and upfront surgery followed by adjuvant CCRT. Methods: We retrospectively analyzed 98 patients with OCSCC treated between 2011 and 2017. Overall survival (OS), cancer-specific survival (CSS), and local control (LC) were evaluated using Kaplan–Meier survival analysis and Cox proportional hazards models to identify prognostic factors. Results: Fifty patients received IC and 48 underwent upfront surgery. With a median follow-up of 77.8 months, no significant differences in OS, CSS, or LC were observed between treatment groups (OS: HR 1.31, p = 0.415; CSS: HR 1.36, p = 0.421; LC: HR 1.29, p = 0.475). Positive surgical margins independently predicted inferior OS, CSS, and LC, while extracapsular spread was independently associated with inferior CSS. Although tumor downstaging was frequently observed after IC, it did not translate into survival benefit. Conclusions: IC followed by surgery was associated with no statistically significant differences in oncologic outcomes compared with upfront surgery followed by adjuvant CCRT. Prognosis was primarily determined by pathological risk factors rather than treatment sequence. Full article

Background/Objectives: In periarticular knee surgery, such as osteotomies, ligament reconstruction, and fracture fixation, surgeons face a dilemma: ensuring the safety of the popliteal artery (PA) while securing adequate surgical access to the bone. While macroscopic anatomical studies suggest knee flexion protects the PA, they often fail to account for physiological muscle tension in living knees. This study aimed to quantitatively evaluate the dynamic positional changes in the PA and the vastus medialis and lateralis muscles (VM and VL, respectively) using Open Magnetic Resonance Imaging (MRI) to determine the optimal limb position for each surgical step. Methods: Twenty-three living knees were evaluated using Open MRI. The shortest perpendicular distances from the posterior aspect of the femur and tibia to the PA, and from the femoral cortex to the posterior border of the VM and VL, were measured at 10° knee-flexed position (representing the extended position) and 90° knee-flexed position. Results: The PA shifted significantly away from the bone in 90° knee-flexed position compared to extension at the distal femur (0 and 1 cm proximal to the intercondylar line (Blumensaat’s line)) and the proximal tibia (0, 1, and 2 cm distal to the joint line) (Q < 0.05). Conversely, both the VM and VL moved significantly closer to the femur in flexion at all measured levels (0–4 cm) (Q < 0.05), often causing the muscles to compress tightly against the bone. Conclusions: The vascular safety margin is maximized in flexion, whereas surgical exposure for the distal femur is optimized in extension due to vastus muscle relaxation. We suggest performing superficial exposure and femoral plate insertion in extension, and surgical maneuvers involving the posterior cortex in flexion to minimize neurovascular and soft tissue complications. Full article

Background/Objectives: Optimal surgical margin management in penile squamous cell carcinoma remains debated because organ-preserving surgery must balance oncological control with functional preservation. Historically, wide excision margins have been recommended; however, subsequent evidence has challenged this threshold, shifting practice towards narrower margins without a demonstrated increase in local recurrence. We evaluated whether invasive positive surgical margins and minimal negative margin widths were associated with local recurrence and survival after surgery for penile squamous cell carcinoma. Methods: We retrospectively analysed 157 consecutive men who underwent surgical treatment at a single centre between 2011 and 2024. Time-to-event analyses were performed in 131 patients with invasive non-metastatic disease after excluding those with penile intraepithelial neoplasia (PeIN)-only lesions (n = 23) and distant metastases (n = 3) at diagnosis. The margins were classified as either invasive-negative or invasive-positive. Among histologically negative-margin cases, minimal margin width was grouped a priori as <2 mm, 2–5 mm, and >5 mm. Results: The median follow-up was 25 months (interquartile range [IQR], 10–52). In the invasive (M0) cohort, 101/131 patients had invasive-negative margins and 30/131 had invasive-positive margins; local recurrence occurred in 42/131 patients. Margin status was not independently associated with recurrence-free, overall, or cancer-specific survival rates. Non-sparing surgery was associated with a lower hazard of local recurrence, whereas grade 3 (G3) histology independently predicted worse recurrence-free, overall, and cancer-specific survival. Advanced stage according to the Tumour, Node, Metastasis (TNM) classification independently predicted worse cancer-specific survival. Conclusions: Among patients with histologically negative margins, outcomes did not differ significantly across the predefined margin-width categories. These findings support tissue-preserving surgery aimed at histologically negative margins within a structured surveillance framework. Full article

Background/Objectives: While robot-assisted radical cystectomy (RARC) is widely adopted, its long-term survival impact relative to open radical cystectomy (ORC) remains uncertain. We compared survival outcomes between ORC and RARC using a propensity score-matched multicenter cohort. Methods: We retrospectively analyzed 3972 radical cystectomy patients from 11 Korean tertiary centers between 2003 and 2024. After stratifying by surgical approach (ORC vs. RARC), 1:1 propensity score matching (PSM) mitigated baseline imbalances. Overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) were evaluated using Kaplan–Meier and multivariable Cox analyses. Results: PSM yielded 473 well-balanced patients per group. Compared to ORC, RARC was associated with a longer operative time but demonstrated a superior perioperative profile, including reduced estimated blood loss, lower intraoperative transfusion rates, shorter hospital stays, higher lymph node yields, and lower positive margin rates. RARC significantly improved OS (5-year: 75.4% vs. 56.1%; 10-year: 68.3% vs. 44.5%; p < 0.001) and CSS (5-year: 88.1% vs. 71.6%; 10-year: 82.7% vs. 67.7%; p < 0.001), with comparable RFS (5-year: 59.6% vs. 54.8%; 10-year: 51.1% vs. 47.4%; p = 0.155). Multivariable analyses confirmed RARC as an independent predictor of improved OS (hazard ratio [HR] 0.564, p < 0.001) and CSS (HR 0.474, p < 0.001). Conclusions: RARC demonstrated superior perioperative outcomes and favorable survival trends compared to ORC, with no difference in RFS. Although RARC appears to be an oncologically safe alternative, these exploratory survival benefits require cautious interpretation due to potential residual confounding. Further prospective validation is warranted. Full article

Background/Objectives: Lower eyelid malposition is a recognized complication following eyelid tumor excision, trauma, or degenerative changes, and is frequently associated with laxity or disruption of the canthal ligaments. Conventional reconstruction techniques using autologous grafts such as fascia lata or auricular cartilage are effective but are associated with donor-site morbidity and increased surgical complexity. This study aimed to evaluate the feasibility and early outcomes of a novel technique for reconstruction and reinforcement of the lower eyelid canthal ligaments using a barbed suture system. Methods: A single-institution retrospective case series was conducted, including consecutive patients who required lower eyelid canthal ligament reconstruction or horizontal support reinforcement from April 2025 to November 2025. Margin reflex distance 2 (MRD-2) was measured from standardized photographs preoperatively and at final follow-up. Munk scale scores, surgically induced astigmatism (SIA), and postoperative complications were recorded. Results: Seven patients (median age 72 years; range 38–86) underwent the procedure. Indications included post-oncological eyelid reconstruction (n = 2), cicatricial ectropion (n = 2), paralytic ectropion (n = 1), involutional ectropion (n = 1), and cicatricial entropion (n = 1). The median follow-up was 189 days (range 105–280). MRD-2 at final follow-up was 5.4 mm in Case 1 (preoperative: 5.7 mm) and 4.1 mm in Case 2 (preoperative: 4.2 mm), indicating maintained eyelid position. Munk scale scores improved in four of five evaluated patients. No recurrence of ectropion or entropion was observed during follow-up. Transient linear skin indentation along the suture pathway was observed in all cases and resolved spontaneously in all patients by 3 months postoperatively. One patient experienced transient postoperative diplopia that resolved with conservative management. Conclusions: This study demonstrates the feasibility of lower eyelid canthal ligament reconstruction using a barbed suture system in a heterogeneous cohort of seven patients. Short-term results are encouraging, with maintained eyelid position and no recurrence of malposition observed during the follow-up period. These preliminary findings warrant further evaluation in larger, prospective, controlled studies with longer follow-up. Full article

Background: Surgery and the perioperative management for periampullary carcinomas are translated from the more frequent ductal adenocarcinoma of the pancreatic head (hPDAC). After implementation of the pathological circumferential resection margin (CRM), true margin negativity dropped dramatically for hPDAC patients. The frequent infiltration of the mesopancreas (MP) is a causative factor for incomplete resection. It remains unknown if the oncological relevance of the MP remains exclusive for the hPDAC or if it can be translated into the operative management for periampullary carcinomas as well. Material and methods: Patients who received oncological pancreatoduodenectomies (PD) for dCCAs and ACs from 2015 to 2025 at our department were included in this study (n =100). The MP status was retrieved from the histopathological reporting. Results: MP infiltration was evident in 36.4% and 62.2% of the AC and dCCA patients respectively (p = 0.015). Across both tumour entities, mesopancreatic involvement emerged as a marker of significantly worse overall survival (AC: p = 0.002; dCCA: p = 0.013). Conclusion: Distal cholangiocarcinomas presented with a frequent infiltration into the mesopancreas. A positive infiltration status of the MP significantly correlated with incomplete resection status in ampullary carcinoma. In addition, MP infiltration proved to be an adverse prognostic factor for overall survival in periampullary carcinoma patients, underscoring its potential role in perioperative staging and its possible relevance for surgical decision-making. This is the first study revealing insights into the infiltrative prevalence of the MP in periampullary carcinomas. Mesopancreatic involvement may not be exclusive to pancreatic cancer and warrants further investigation in other periampullary malignancies. Full article

The management of deep subgingival carious lesions presents significant challenges for achieving durable adhesive restorations due to limited access, moisture control, and proximity to periodontal tissues. Two main approaches are currently adopted to manage these cases: Deep Margin Elevation (DME) and Surgical Crown Lengthening (SCL). This systematic review (PROSPERO registration CRD420250654262) aimed to compare the performance and survival of restorations placed following DME versus SCL in teeth with deep subgingival margins. A comprehensive literature search was conducted in PubMed, B-ON, and the Cochrane Library for studies published between 2014 and 2025. Following PRISMA guidelines, six studies were included. Methodological quality and risk of bias were assessed using ROBINS-I, RoB 2, and the CARE guidelines. The available evidence indicates that both DME and SCL provide satisfactory periodontal stability, high restoration survival rates, and a low incidence of recurrent caries. DME emerged as a minimally invasive strategy that facilitates adhesive procedures by relocating deep margins to more accessible positions, potentially improving marginal integrity while preserving tooth structure and gingival architecture, particularly in patients with a thick gingival biotype. The choice between DME and SCL should be individualized. Further long-term clinical studies are required to clarify their impact on adhesive interface durability in subgingival environments. Full article

Background: Pancreatic neuroendocrine neoplasms (PanNENs) represent a heterogeneous tumor entity with a steadily rising incidence, mainly due to advances in imaging and growing diagnostic awareness. In pancreatic ductal adenocarcinoma (PDAC), the mesopancreas (MP) has been identified as a frequent site of microscopic tumor spread and a key determinant of circumferential resection margin (CRM) status, leading to the concept of standardized mesopancreatic excision (MPE). While its oncological relevance in PDAC is increasingly recognized, the role of the mesopancreas in PanNENs remains unclear. This study aimed to systematically evaluate mesopancreatic infiltration in PanNENs and to identify associated clinicopathological predictors. Methods: Consecutive patients undergoing oncological pancreatoduodenectomy, spleen-preserving distal pancreatectomy, or distal splenopancreatectomy for PanNENs and PanNECs were included. The mesopancreas was histopathologically examined for tumor infiltration within CRM assessment. Results: MP infiltration was detected in 60% of patients. It was associated with higher Ki-67 index, larger tumor size, lymph node involvement, venous invasion, and positive CRM status. A Ki-67 index ≥ 5% and tumor size ≥ 21.5 mm were identified as predictors of MP infiltration. Higher T stage predicted reduced overall survival (OS), whereas MP infiltration, lymphatic (L1) and venous (V1) invasion, and Ki-67 ≥ 5% were associated with impaired disease-free survival (DFS). Conclusions: Mesopancreatic infiltration is frequently present in PanNENs and correlates with aggressive tumor characteristics. Given its association with CRM positivity and reduced DFS, consideration of the mesopancreas in staging and surgical strategies appears oncologically justified. Larger studies are required to validate these findings. Full article