Search Results (10,843)

Background: Skeletal-related events (SREs), including pathological fractures, spinal cord compression, radiotherapy to bone, and bone surgery, substantially worsen quality of life in breast cancer with bone metastases. Denosumab, a monoclonal antibody targeting RANKL, mechanistically differs from bisphosphonates and is not renally cleared, offering potential clinical advantages. In practice, an increasing number of patients transition from bisphosphonates to denosumab. However, the comparative effectiveness of sequential therapy versus initial denosumab remains unclear. Methods: We retrospectively analyzed 165 patients with breast cancer and radiologically confirmed bone metastases treated between 1 January 2019 and 30 April 2024 at a tertiary center in China. Patients were categorized into an initial denosumab group (n = 67) or a sequential bisphosphonate-to-denosumab group (n = 98). The primary endpoint was time to first on-treatment SRE; the 12-month first on-treatment SRE rate was also reported as a descriptive summary measure. Secondary endpoints included cumulative SRE incidence and safety. Kaplan–Meier and log-rank tests compared SRE-free survival; Cox regression explored prognostic factors. Results: The median age at bone-metastasis diagnosis was 54.7 years. Median time from diagnosis to bone-targeted agents (BTAs) initiation was 0.9 months in both groups; median follow-up was longer in the sequential group (22.5 vs. 11.3 months). At diagnosis, 46 of 165 patients (27.9%) presented with synchronous SREs, more frequent in the initial denosumab group (37.3% vs. 21.4%; p = 0.040). During follow-up, 31 patients (18.8%) developed SREs: 25 of 98 (25.5%) in the sequential group versus 6 of 67 (9.0%) in the initial denosumab group (p = 0.008). After BTA initiation, on-treatment SREs occurred in 28 of 165 patients (17.0%): 25 of 98 (25.5%) in the sequential group versus 3 of 67 (4.7%) in the initial denosumab group (p < 0.001). The 12-month first on-treatment SRE rate was 15.7% (95% CI 8.1–22.7) for sequential therapy and 5.9% (0–12.3) for initial denosumab. In Cox analysis, second-line systemic therapy increased SRE risk (HR = 2.651, p = 0.021). Safety outcomes were generally manageable and consistent with known class effects, with no clear exposure-adjusted safety advantage of one strategy over another. Conclusions: Initial denosumab was associated with fewer and delayed SREs compared with sequential bisphosphonate-to-denosumab therapy, supporting early denosumab initiation as a potentially preferable BTA strategy. Prospective studies are warranted to confirm these findings. Full article

Background: Artificial intelligence (AI) is increasingly applied in pulmonary endoscopy, including diagnostic bronchoscopy, interventional pulmonology and endobronchial imaging. Advances in computer vision, machine learning and robotic systems have expanded the potential for automated lesion detection, navigation to peripheral pulmonary lesions, and real-time procedural support. However, the current evidence base remains heterogeneous, and translational challenges persist. Methods: This review summarizes current applications and developments of AI across white-light bronchoscopy (WLB), image-enhanced bronchoscopy (e.g., narrow-band imaging and autofluorescence imaging), endobronchial ultrasound (EBUS), virtual and robotic bronchoscopies, and workflow optimization and training. The authors also examine the methodological limitations, regulatory considerations, and implementation barriers that affect translation into routine practice. Results: Reported developments include deep learning-based models for mucosal abnormality detection, lymph-node characterization during EBUS-guided transbronchial needle aspiration (EBUS-TBNA), improved lesion localization, and reduction in operator-dependent variability. Additionally, AI-assisted simulation platforms and decision-support tools are reshaping training paradigms. Nevertheless, most studies remain retrospective or single-center, with limited external validation, dataset heterogeneity, unclear model explainability, and incomplete integration into clinical workflows. Conclusions: AI has the potential to support lesion detection, navigation, and training in pulmonary endoscopy. However, robust prospective validation, standardized datasets, transparent model reporting, robust data governance, multidisciplinary collaboration, and careful integration into clinical practice are required before widespread adoption. Full article

Background: The role of systemic fibrinolysis in patients with intermediate-risk pulmonary embolism (PE) remains controversial because of the uncertain balance between potential benefits and bleeding risk. This study evaluated the association between systemic fibrinolysis and clinical outcomes in a real-world cohort of patients with symptomatic intermediate-risk PE. Methods: This prospective observational study included consecutive patients with symptomatic intermediate-risk PE from 2009 to 2019 at a tertiary hospital. Patients receiving systemic fibrinolysis were compared with those treated with anticoagulation alone. The primary outcome was 30-day all-cause mortality. Secondary outcomes included major bleeding, and recurrent venous thromboembolism. Multivariable Cox proportional hazards regression models were used to adjust for potential confounders. Results: A total of 560 patients with symptomatic intermediate-risk PE were included, of whom 54 (9.6%) received systemic fibrinolysis. Patients receiving fibrinolysis were younger than those treated with anticoagulation alone (median age 58 vs. 73 years; p < 0.001). Thirty-day mortality occurred in 1.8% and 3.3% of patients, respectively (p = 1). After adjustment, fibrinolysis was not associated with reduced 30-day mortality (aHR 1.5; 95% CI 0.1–17.9), nor with a significant increase in 30-day major bleeding (aHR 2.6; 95% CI 0.8–8.3). Intracranial hemorrhage and VTE recurrences were rare. Conclusions: In this real-world cohort, systemic fibrinolysis was not associated with improved survival compared with anticoagulation alone, consistent with current guideline recommendations against routine fibrinolysis in intermediate-risk PE. Full article

Interest in classical psychedelics as potential treatments for ADHD has grown alongside broader psychiatric psychedelic research, but ADHD-specific evidence remains limited. This systematic review examined prospective and experimental studies on whether classical psychedelics, including microdosing-like use and retreat-based exposure, are associated with changes in adult ADHD symptoms and related functioning. A PRISMA-guided systematic review was conducted using a PECO/PICO framework focused on adults (≥18 years) with diagnosed ADHD and/or elevated ADHD symptomatology who were exposed to a classical psychedelic and assessed prospectively with quantitative ADHD outcomes. Major databases were searched, with reference screening and targeted checks for recent or registered trials. Risk of bias was assessed using RoB 2 for the RCT and ROBINS-I for non-randomized studies. Because of heterogeneity and the small number of studies, findings were synthesized narratively. Five studies met the inclusion criteria. Five prospective/experimental studies were included: three naturalistic online microdosing cohorts, one randomized double-blind placebo-controlled phase 2A trial of low-dose LSD, and one pre-post ayahuasca retreat pilot. In uncontrolled naturalistic microdosing studies, participants reported short-term reductions in ADHD symptom ratings together with improvements in well-being and affect-related functioning; however, these studies were highly vulnerable to self-selection, expectancy, attrition, and non-standardized exposure. In contrast, the only randomized placebo-controlled ADHD trial found improvement in both LSD and placebo groups, with no statistically significant advantage for LSD on clinician-rated or self-reported ADHD outcomes. Objective cognitive findings were limited and inconsistent, and safety data outside the supervised trial context were sparse. Naturalistic studies provide, at most, low-certainty signals of perceived short-term improvement, but the strongest controlled evidence does not demonstrate drug-specific efficacy of repeated low-dose LSD for core ADHD symptoms. Current evidence therefore does not allow separation of pharmacological effects from expectancy, setting, self-monitoring, and broader experiential/contextual influences, and is insufficient to support psychedelics as an evidence-based treatment for ADHD. Full article

This study investigates the effective translation of complex biological principles into viable engineering solutions within the field of biomimetic design. A critical challenge in current research is the “fuzzy front end” bridging initial biological observations and practical engineering applications. This gap primarily stems from the lack of intermediary models capable of abstracting complex biomechanical data into manufacturable mechanical paradigms. To address this, we propose a systematic biomimetic translation framework that redefines traditional crafts as “Empirically Optimized Biological Analogues” (EOBAs), serving as a logical bridge between biological inspiration and engineering realization. This study contributes by integrating the Analytic Hierarchy Process (AHP) with the Fuzzy Comprehensive Evaluation (FCE) method to construct a quantitative assessment system. This system evaluates translation feasibility, engineering innovation potential, semantic interaction characteristics, and prototype manufacturability. Applying this framework to four intangible cultural heritages in Guangdong, combined with comprehensive expert and public evaluations, revealed that the Guangdong Lion Dance exhibits the highest biomimetic translation potential in terms of morphological clarity and dynamic behavioral characteristics. Consequently, we extracted the core principle of “embodied kinematics for communication” and developed a conceptual multi-segment biomimetic robotic prototype designated as “Kine-Lion”. Ultimately, this research provides a structured methodological reference for biomimetic robotic design, demonstrating that culturally abstracted biological behaviors can be systematically decoded into functional robotic structures. These findings indicate broad application prospects in the domains of human–robot interaction and biomimetic engineering. Full article

Background/Objectives: Metabolic alterations, including dyslipidemia, may influence tumor biology and treatment outcomes in neuroendocrine tumors. However, the clinical relevance of dyslipidemia and lipid-lowering therapy in bronchopulmonary neuroendocrine tumors (BP-NETs) treated with somatostatin analogues (SSAs) remains poorly defined. This translational proof-of-concept study evaluated progression-free survival (PFS) in patients with advanced BP-NETs receiving SSAs according to dyslipidemia and statin therapy and explored the effects of statin-SSA combination treatment in vitro. Methods: We retrospectively analyzed 24 patients with advanced well-differentiated BP-NETs treated with SSAs as first-line therapy. Fourteen patients (58.3%) had dyslipidemia, and 11 of them were receiving statins. In parallel, NCI-H727 cells were treated with atorvastatin (10 µM), lanreotide (5 or 10 µM), or their combination for 48–72 h. Cell viability, proliferation, cell death, apoptosis, DNA damage, and ATP production were assessed. Results: Median PFS was 22.5 months overall. A trend toward longer PFS was observed in non-dyslipidemic vs. dyslipidemic patients (70 vs. 36 months, p = 0.08). Among dyslipidemic patients, statin therapy was associated with a non-significant trend toward longer PFS compared with no statin therapy (36 vs. 18 months, p = 0.30). In vitro, combined atorvastatin–lanreotide treatment reduced cell viability and proliferation, increased cell death, enhanced cleaved caspase-3 and p-γH2AX expression, and reduced ATP production. Conclusions: These findings support the potential relevance of lipid metabolism modulation as an adjunct strategy in advanced BP-NETs while highlighting the need for larger prospective studies and dedicated biochemical investigation of the underlying lipid-related pathways. Full article

Impaired wound healing is a major cause of morbidity among patients with diabetes. Human α1-antitrypsin (hAAT) promotes the resolution of injured tissues. In hyperglycemic conditions, circulating hAAT is likely to undergo glycation, yet it is unknown whether its reparative properties are preserved. We hypothesized that clinical-grade hAAT treatment, but not deliberately glycated hAAT (gly-hAAT), would promote wound repair under hyperglycemic conditions. Mice were rendered hyperglycemic, excisional wounding was performed, and wounds were treated with topical albumin or hAAT every three days. The wound area was assessed, and samples were collected for histology and gene expression analysis. Gly-hAAT was generated from clinical-grade hAAT, after which in vitro RAW 264.7 macrophage responses and re-epithelialization of A549 cells were assessed. Gap closure was further assessed using sera from a human cohort (prospective samples from 10 patients with poorly controlled diabetes at Soroka University Medical Center, Beer-Sheva, Israel, 2018). Group comparisons were performed using one-way ANOVA with Tukey’s post hoc test. hAAT accelerated in vivo wound closure and in vitro A549 cell gap closure, accompanied by an anti-inflammatory IL-1Ra/IL-1β gene expression profile. In contrast, gly-hAAT inhibited normoglycemic mouse wound closure, evoked an inflammatory response in macrophages, and interfered with A549 cell gap closure; concomitant hAAT treatment improved gap closure. Similarly, patient serum inhibited A549 gap closure, and concomitant hAAT treatment improved gap closure. Importantly, inferential statistical analysis was not performed on this outcome due to the small and heterogeneous human cohort. In conclusion, hAAT accelerated wound closure in hyperglycemic mice and in A549 cells, whereas gly-hAAT promoted inflammatory responses and impaired wound closure, a trend reversed by native hAAT. These findings support the concept that glycation undermines the beneficial functions of circulating hAAT and provides a mechanistic insight into the pathophysiology of diabetic wound healing. Further studies are warranted to evaluate clinical-grade hAAT as a potential therapeutic for hyperglycemia-associated impaired wound healing. Full article

Background: Evidence on the presence of an association between epicardial adipose tissue (EAT) and myocardial perfusion imaging (MPI) as assessed by positron emission tomography (PET) has been reported. This systematic review aimed to synthesize the existing literature investigating this topic. Methods: A comprehensive and systematic search of the PubMed/MEDLINE, Scopus, and Embase databases was performed to identify published studies investigating the association between EAT and myocardial perfusion assessed by PET imaging. Eligible studies included original research articles evaluating EAT and reporting PET MPI outcomes. Data regarding the study design, patient characteristics, imaging protocols, and main findings were extracted and qualitatively analyzed. Results: Ten studies were included in the final analysis. Overall, most studies demonstrated a significant association between increased EAT and impaired myocardial perfusion on PET imaging. In several studies, EAT remained an independent predictor of abnormal PET MPI after adjustment for traditional clinical risk factors. Nonetheless, important methodological differences among studies were observed, including heterogeneity in EAT measurement techniques, quantification methods, and PET tracers used for MPI evaluation, which limit the generalizability of these findings. Conclusions: This systematic review seems to suggest a potential association between increased EAT and impaired myocardial perfusion, as assessed by PET. However, significant methodological heterogeneity across the available studies—including differences in EAT quantification, PET protocols, and tracer selection—limits the strength of this conclusion. Standardized imaging protocols and larger, prospective, multicenter studies are required to validate this relationship, determine its incremental prognostic value, and evaluate its potential for integration into routine clinical risk stratification pathways. Full article

Background/Objectives: Pediatric malnutrition is associated with loss of muscle mass and impaired physical function. While anthropometric measurements are widely used for diagnosis, functional indicators that reflect early changes in nutritional status are limited in children. Handgrip strength has been proposed as a simple and objective marker of muscle function; however, pediatric data remain scarce. Methods: In this prospective controlled study, 55 children aged 3–17 years diagnosed with malnutrition and 50 age- and sex-matched healthy controls were evaluated. Anthropometric measurements and muscle strength assessments, including handgrip and pinch grip strength, were performed in both groups. Muscle strength values were additionally converted to age- and sex-adjusted standard deviation scores (SDS). In the malnutrition group, measurements were repeated at 2 and 8 weeks following individualized nutritional therapy to assess treatment response. Results: Children with malnutrition had significantly lower body weight, body mass index, mid-upper arm circumference, triceps skinfold thickness, and lean body mass compared with controls (p < 0.05 for all). Both dominant and non-dominant handgrip strength values were also significantly reduced in the malnutrition group. When adjusted for age and sex, handgrip strength SDS values remained significantly lower in children with malnutrition, whereas pinch grip strength SDS values did not differ significantly between groups. During follow-up, nutritional therapy was associated with significant improvements in anthropometric parameters and absolute muscle strength measurements. However, SDS-based analyses demonstrated that these changes were not uniform across all parameters, suggesting that observed improvements may only partly exceed expected physiological growth. Conclusions: Handgrip strength appears to reflect nutritional status in children, and its association with malnutrition persists after adjustment for growth-related factors. These findings support its potential role as a complementary functional marker. However, longitudinal changes in standardized scores indicate that recovery is variable, and interpretation should consider the influence of normal growth and development. Further large-scale, age-standardized studies are needed to better define their role in clinical practice. Full article

Background and Objectives: Pancreatic ductal adenocarcinoma (PDAC) is one of the leading causes of cancer-related mortality, largely due to late-stage diagnosis and the absence of effective population-based screening. Intrapancreatic fat deposition (IPFD) has emerged as a potential risk phenotype. This narrative review critically appraises the clinical, metabolic, epidemiologic, and mechanistic evidence linking IPFD to PDAC and discusses its implications for risk stratification and prevention. Materials and Methods: A structured literature search was conducted in PubMed/MEDLINE and Scopus for studies published between 2007 and 2025 using predefined terms related to pancreatic steatosis and pancreatic cancer. After duplicate removal and screening according to predefined inclusion and exclusion criteria, 42 articles were included. Evidence was synthesized focusing on epidemiologic associations, mechanistic pathways, and imaging-based quantification methods. Results: A strong association between IPFD and PDAC was found. Although definitive causality remains unproven, some studies support temporal correlation between IPFD and PDAC, suggesting that IPFD precedes PDAC. A possible pathophysiological explanation to this correlation has been advanced in experimental models indicating IPFD as a pro-inflammatory factor cooperating with oncogenic KRAS to facilitate neoplastic progression. Finally, variability in IPFD definitions and heterogeneity in imaging assessment limit interpretability. Conclusions: Current evidence links IPFD to PDAC risk, suggesting a strong suspicion that pancreatic steatosis may represent an independent risk factor for PDAC. Still robust causal inference remains unproven. Well-designed prospective studies, standardized imaging protocols, and mechanistic investigations are required to clarify causality and determine whether pancreatic steatosis can be incorporated into risk-based screening and preventive strategies. Full article

This study examines institutional processes in digital justice through a mixed conceptual approach that integrates bibliometric analysis and technology-adoption modeling, incorporating artificial intelligence (AI) as a projected component rather than an implemented system. A corpus of approximately 200 Scopus-indexed documents (2003–2024) was analyzed, identifying five dominant thematic clusters: advanced technologies, institutional justice, digital government, judicial information management, and digital criminal justice. The results reveal persistent gaps in the literature, particularly in rural and underserved communities, where connectivity barriers and the limited application of adoption models hinder inclusive digital transformation. As an institutional contribution, the study presents the conceptual design of the digital solution “Travel Permits—Accessible Justice”, developed under a Service-Oriented Architecture (SOA) and projected for future integration with AI-supported components to automate judicial authorizations through biometric validation, electronic signatures, and digital delivery. To evaluate its potential acceptance, the Technology Acceptance Model (TAM) is analytically adapted and extended to the community-based judicial context, framing institutional learning processes as a prospective form of learning analytics focused on user interaction, perceived usefulness, perceived ease of use, and behavioral intention. Taken together, the integration of bibliometric evidence with an extended TAM, along with the projected incorporation of AI-supported institutional learning processes, offers a coherent foundation for future studies on inclusive digital innovation in justice environments. Full article

Endometriosis and endometrial cancer are distinct gynecological conditions that share overlapping biological mechanisms with implications for clinical management. Endometriosis is a chronic, benign disorder characterized by the ectopic implantation of functional tissue lining the uterus, primarily affecting women of reproductive age. It commonly causes chronic pelvic pain, dysmenorrhea, dyspareunia, and infertility. The disease is marked by persistent inflammation, hormonal dysregulation, and alterations in cellular signaling, which mirror some neoplastic processes despite lacking malignant potential. Endometrial cancer is a malignant tumor of the uterine lining, most frequently diagnosed in postmenopausal women. Its incidence is rising due to aging, obesity, and prolonged estrogen exposure. Epidemiological studies suggest a modest increase in endometrial cancer risk among women with endometriosis. However, detection bias and metabolic confounders may influence this association. Both conditions share estrogen dependence, chronic inflammatory microenvironments, and dysregulated pathways such as PI3K/AKT/mTOR. Somatic mutations in genes, including PTEN and ARID1A, further underline molecular intersections. Clinical management is tailored to disease type and severity. Endometriosis therapy emphasizes stepwise hormonal treatment, multidisciplinary pain management, and surgery when indicated. Endometrial cancer management relies on staging, with particular emphasis on molecular classification and histopathology to guide surgery, radiotherapy, chemotherapy, hormone therapy, and immunotherapy in advanced cases. Emerging noninvasive biomarkers and precision medicine strategies may enhance diagnosis, monitoring, and targeted treatment in both conditions. Understanding their shared and divergent mechanisms aids risk stratification, individualized therapy, and improved quality of life. Further prospective studies are needed to optimize patient-specific management and translate mechanistic insights into clinical practice. Full article

Objective: The fetal-to-neonatal transition is marked by profound cardio-respiratory changes. Infections emerging within the first 48 h after birth may influence early cardiovascular adaptation. We aimed to evaluate the association between early infection/inflammation markers and vital parameters in neonates during the first 15 min after birth. Methods: This is a secondary outcome parameter post-hoc analysis of data derived from a prospective observation study. Preterm and term neonates with cerebral oxygen saturation (crSO2) monitoring (INVOS 5100C) during the first 15 min after birth and available inflammatory markers (C-reactive protein [CRP], leukocytes, immature-to-total neutrophils ratio [IT ratio]) within 48 h after birth were included. Heart rate (HR) and arterial oxygen saturation (SpO₂) were continuously recorded during the first 15 min. Inflammatory markers obtained at 16–24 and 24–48 h after birth were correlated with crSO₂, SpO₂, and HR at minute 5, 10 and 15. Results: Sixty-eight neonates were included (median (IQR) gestational age 34.0 (32.0; 35.9) weeks, birth weight 1900 (1488; 2542) grams). CRP within the first 24 h correlated negatively with crSO₂ (r = −0.314; p = 0.011) and with SpO₂ (r = −0.393; p = 0.001) at minute 15. IT ratio within 24 h correlated negatively with crSO₂ at minute 5 (r = −0.367; p = 0.005), 10 (r = −0.273; p = 0.035), and 15 (r = −0.306; p = 0.013), and with SpO₂ at minute 5 (r = −0.327; p = 0.008). IT ratio at 24–48 h correlated negatively with crSO₂ at minute 15 (r = −0.384, p = 0.012). No significant correlations were observed with HR. Leukocytes within the first 24 h after birth correlated negatively with crSO2 at minute 5 (r = −0.265; p = 0.046). Conclusions: Early inflammatory markers, particularly CRP and the IT ratio, are associated with cerebral and systemic oxygenation during immediate postnatal transition. These findings suggest a potential association between early inflammatory activation and oxygenation dynamics; however, given the observational design and modest correlation strength, the results should be interpreted cautiously and do not allow conclusions regarding causality or underlying mechanisms. Full article

Patellar maltracking is among the most common causes of anterior knee pain after total knee arthroplasty (TKA), underscoring the need for accurate prevention and treatment. Therefore, the purpose of this narrative review is to provide a comprehensive overview of current evidence on post-TKA tracking, focusing on component alignment, preoperative patient assessment, and revision treatment options. A PubMed database search was performed, leveraging the literature from the last 20 years, and the results were qualitatively synthesized. According to current studies, several precautions should be taken to prevent patellofemoral stress and, consequently, patellar maltracking, such as avoiding internal rotation, valgus alignment, and excessive flexion of the femoral component and internal rotation of the tibial component. Regarding alignment strategies, kinematic alignment appears to offer potential benefits over mechanical alignment in certain functional outcomes and patient satisfaction scores. However, these differences should be interpreted cautiously as they may not always exceed the minimal clinically important difference. Furthermore, recent evidence indicates that quadriceps biomechanics influence TKA outcomes, potentially suggesting that conventional surgical approaches may need to be individualized, though these preliminary findings require prospective validation. Currently, robotic-assisted surgery represents a developmental direction for patient-tailored interventions and offers great promise for better prosthesis customization to the individual patient. Integration of imaging data with dynamic soft-tissue assessment enables more predictable reconstruction of joint kinematics. Regarding surgical treatment, the selection of specific methods requires a prior clinical and radiographic assessment. Indications range from patellar maltracking direction and component malrotation to patient preferences and rehabilitation potential. Ultimately, the future of TKA relies on personalized interventions to prevent complications and improve patient outcomes. This evolution is driven by the shift from mechanical alignment to kinematic alignment, alongside quadriceps tendon assessment and intraoperative robotic-assisted measurement, all aimed at optimizing the accuracy of implant positioning. Full article

Background: Isolated adrenal metastases may occur in several solid malignancies, and surgical resection has been associated with improved local control and potential survival benefit in carefully selected patients. Open adrenalectomy has traditionally been considered the standard approach, while laparoscopic adrenalectomy has progressively gained acceptance as a minimally invasive alternative. More recently, robotic adrenalectomy has been introduced. However, its role in the management of adrenal metastases remains incompletely defined. Methods: This retrospective comparative study analyzed a prospectively maintained database including patients who underwent adrenalectomy for isolated adrenal metastasis between January 2001 and December 2025 at two academic centers. Patients were stratified according to surgical approach into open, laparoscopic, and robotic groups. Perioperative outcomes, postoperative morbidity, resection margin status, and oncological adequacy of the resection were compared among groups. Results: A total of 89 patients underwent adrenalectomy for isolated adrenal metastasis (robotic n = 27, laparoscopic n = 28, open n = 34). Metastasis size was larger in the robotic group compared with the laparoscopic group (51.4 vs. 44.2 mm, p = 0.043). Laparoscopy showed the shortest operative time, with respect to both robotic (p = 0.042) and open surgery (p = 0.045). Estimated blood loss was significantly higher in the open group (263 mL) than in the robotic (117 mL) and laparoscopic groups (106 mL) (p = 0.042 and 0.040, respectively). R0 resection rates were comparable across approaches (96%, 89%, and 94%, respectively). Hospital stay was shorter after both robotic and laparoscopic surgery with respect to open surgery (2.5–3.1 vs. 5.6 days, p = 0.043 and 0.046, respectively). Conclusions: Open, laparoscopic, and robotic adrenalectomy are all feasible surgical options for isolated adrenal metastases with acceptable perioperative outcomes. Robotic adrenalectomy may represent a potential extension of the applicability of minimally invasive surgery. Full article