Search Results (10,225)

Background: Colorectal cancer (CRC) remains a leading cause of cancer-related morbidity and mortality worldwide. While established molecular biomarkers such as microsatellite instability (MSI), KRAS, and BRAF are routinely used in clinical practice, the prognostic relevance of tumor suppressor proteins p53 and PTEN remains incompletely defined, particularly when assessed using immunohistochemistry. Objective: The primary aim of this study was to evaluate the prognostic significance of p53 expression and PTEN deficiency in colorectal adenocarcinoma. Secondary aims included assessment of their association with clinicopathological characteristics. Methods: This retrospective cohort study included 103 consecutive patients who underwent surgical resection for colorectal adenocarcinoma. Immunohistochemical analysis of formalin-fixed paraffin-embedded (FFPE) tumor samples was performed to assess aberrant p53 expression and PTEN deficiency. Associations with clinicopathological variables were evaluated, and overall survival was analyzed using Kaplan–Meier curves and Cox proportional hazards regression models. Results: Aberrant p53 expression and PTEN deficiency were both associated with shorter overall survival in univariate analyses. Patients with concurrent aberrant p53 expression and PTEN deficiency demonstrated the poorest survival outcomes. However, in multivariate Cox regression analysis, only nodal status and age remained independent predictors of overall survival, while p53 and PTEN did not retain independent prognostic significance after adjustment for clinicopathological variables. Conclusions: Aberrant p53 expression and PTEN deficiency are associated with reduced overall survival in colorectal cancer; however, their prognostic impact appears secondary to established clinicopathological factors. The combined presence of these alterations may identify a biologically aggressive subgroup of patients with particularly unfavorable outcomes, although this observation should be considered exploratory. Further validation in larger, independent cohorts is required. Full article

Background/Objectives: The uniform application of total neoadjuvant therapy (TNT) for locally advanced rectal cancer (LARC) risks overtreatment and surgical complications. We evaluated a novel tailor-made therapy that personalizes radiotherapy and chemotherapy to balance oncological safety with organ preservation. Methods: We retrospectively analyzed 38 patients with cStage II–III LARC treated between 2023 and 2025. Patients were stratified by sphincter preservation feasibility and high systemic risk (cN2, extramural vascular invasion, lateral lymph node enlargement). Group A (sphincter-preserving, n = 20) received induction chemotherapy; long-course chemoradiotherapy (LCCRT) was omitted in favorable responders but added if MRF-positive or to aim for non-operative management (NOM) in exceptional responders. Group B (non-sphincter-preserving, low systemic risk, n = 8) received LCCRT plus consolidation chemotherapy. Group C (non-sphincter-preserving, high systemic risk, n = 10) received short-course radiotherapy plus consolidation chemotherapy. Results: Over a median observation period of 20 months (range, 6–37), NOM was initiated in 7 patients (18% overall; Group A: 10%, Group B: 50%, Group C: 10%), with one local regrowth observed to date, resulting in 6 of 7 patients (85.7%) successfully maintaining NOM. Preoperative radiotherapy was safely omitted in 32% of the total cohort, and notably in 60% of patients in Group A. Surgery was performed in 28 patients (74%), achieving an R0 resection rate of 100% across all groups. Distant metastasis recurrence during preoperative treatment occurred in 5 patients (13%). Risk-stratified, tailor-made therapy for LARC facilitates the highly customized application or omission of radiotherapy. Conclusions: Risk-stratified, tailor-made therapy facilitates the safe omission or targeted application of radiotherapy in LARC. This personalized approach prevents overtreatment, maintains complete surgical curability, and achieves successful organ preservation in appropriately selected patients. Full article

Background: The impact of long-term residence in uranium legacy-affected areas on surgical outcomes in patients with lower extremity artery disease (LEAD) remains insufficiently studied. Objectives: This study aimed to compare early postoperative dynamics of chronic lower limb ischemia (CLLI) in patients with LEAD residing in uranium legacy-affected areas and those living outside the zone of potential technogenic exposure. Methods: The study included 70 patients with LEAD (CLLI stages IIB–IV according to the Fontaine classification). The study group (n = 35) consisted of patients who had resided for at least 5 years within a radius of less than 20 km from uranium tailings storage facilities (Stepnogorsk area, Akmola region, Kazakhstan). The control group (n = 35) comprised patients with the same diagnosis living outside this zone. Results: The distribution of Fontaine stages was compared between groups before surgery and at 1 month postoperatively. Statistical analysis was performed using Pearson’s chi-squared test. Before surgery, no statistically significant intergroup differences were found in the distribution of CLLI stages (χ² = 3.688, df = 2, and p = 0.158). At 1 month after surgery, the control group demonstrated significantly better regression of ischemia stages: mild stages (I–IIa) were observed in 51.4% of control patients versus 8.6% in the study group, while severe stages (III–IV) persisted in 62.8% of the study group versus 22.9% of the control group (χ² = 17.547, df = 4, and p = 0.002). Complete regression to stage I occurred only in the control group (2 patients, 5.7%). Conclusions: Patients with LEAD residing long-term in uranium legacy-affected areas showed less favorable early postoperative dynamics compared to patients living outside the zone of potential technogenic exposure. The observed association requires cautious interpretation, and further prospective studies with individual exposure assessment are warranted. Full article

Gastric adenocarcinomas with yolk sac tumor (YST) differentiation represent an exceptionally rare and poorly understood phenotype, characterized by the emergence of extraembryonic features within an epithelial malignancy. Their histogenesis remains debated, with increasing evidence supporting somatic lineage plasticity rather than germ cell origin. Here, we performed an integrated histopathologic and genomic characterization of three gastric adenocarcinomas with YST differentiation surgically treated at a tertiary cancer center. Histologically, all tumors showed a predominant adenocarcinoma component associated with variable YST differentiation, displaying reticular/microcystic and papillary patterns and expression of oncofetal markers, including alpha-fetoprotein (AFP) and Glypican-3. Targeted next-generation sequencing using a 523-gene panel revealed microsatellite-stable profiles with intermediate tumor mutational burden and substantial intertumoral heterogeneity. Despite gene-level variability, the detected alterations involved signaling pathways commonly implicated in epithelial tumorigenesis, including PI3K-AKT and RTK/RAS-MAPK signaling. Several recurrent alterations were identified across cases, including CCND3 variants and MDM2 copy number gains; however, their biological significance requires validation in larger cohorts. Functional enrichment analysis identified alterations involving developmental and proliferative signaling programs. Overall, these findings suggest that YST differentiation may represent a phenotypic manifestation of epithelial tumor plasticity arising within gastric adenocarcinoma and is associated with epithelial-related oncogenic programs, although broader genomic and comparative studies are required to clarify its histogenesis. This study provides preliminary molecular and histopathologic insights into this rare entity and supports the integration of molecular profiling into its diagnostic and translational management. Full article

Background/Objectives: Pelvic organ prolapse (POP) is increasingly recognized as a localized extracellular matrix (ECM) remodeling disorder. Conventional clinical predictors do not fully explain interindividual variation in tissue quality or surgical durability. This study aimed to characterize the ECM failure phenotype in surgically obtained pelvic support tissue and to derive an exploratory tissue-based ECM Vulnerability (ECM-V) score. Methods: This single-center exploratory translational biomarker derivation study included 121 women: 60 undergoing primary reconstructive surgery for POP with or without concomitant stress urinary incontinence, and 61 benign gynecological controls. Standardized intraoperative anterior vaginal wall biopsies and preoperative plasma samples were obtained. Seven ECM biomarkers (COL1, COL3, ELN, MMP1, MMP2, MMP3, MMP9) were quantified in both compartments. Receiver operating characteristics (ROC) analysis adjusted logistic regression and stratified 10-fold cross-validation were performed. An exploratory integer-weighted ECM-V score was derived from COL3, MMP2 and MMP9 tissue values. Results: Tissue biomarkers demonstrated substantially stronger discrimination than plasma biomarkers. Surgical cases showed reduced COL1 (AUC 0.898) and ELN (AUC 0.846), elevated COL3 (AUC 0.818), MMP2 (AUC 0.958) and MMP9 (AUC 0.977) (all p < 0.001). The compact COL3-MMP2-MMP9 tissue model achieved a cross-validated AUC of 0.986 ± 0.035, substantially outperforming the best plasma model (AUC 0.719). The ECM-V score demonstrated derivation-level AUC of 0.995, sensitivity of 0.967 and specificity of 0.967. Tissue MMP9 and MMP2 correlated strongly with POP-Q severity and validated symptom scores (rho up to 0.806, p < 0.001). Conclusions: Women undergoing primary POP surgery demonstrate a distinct localized ECM failure phenotype. The exploratory COL3-MMP2-MMP9 framework provides a biologically coherent basis for the ECM-V score requiring prospective validation with longitudinal recurrence outcomes. Full article

Background/Objectives: Artificial intelligence (AI) is increasingly being integrated into vascular surgery, particularly in diagnostic imaging, perioperative planning, intraoperative guidance, and postoperative surveillance. This literature review evaluates the current applications of artificial intelligence in vascular surgery and endovascular practice, with a particular focus on imaging technologies and their role in improving diagnostic precision, workflow efficiency, and patient outcomes. In addition, the review examines emerging AI applications in operative workflow optimization, endovascular navigation, postoperative surveillance, training platforms, and AI-assisted clinical decision support. Methods: A literature review was conducted using PubMed and Scopus with the search terms: (artificial intelligence OR AI OR neural network) AND (vascular surgery) AND (diagnosis OR treatment). Reference lists of included studies were manually screened, and additional recent studies were identified from relevant journals. Articles published in English up to April 2026 were included. Studies were assessed for their applications in vascular diagnostics, plaque characterization, endovascular workflow optimization, and postoperative surveillance. Results: AI demonstrated strong diagnostic performance across multiple imaging modalities. Deep learning systems achieved a sensitivity of 91.3% and specificity of 95.2% in peripheral arterial stenosis classification, while plaque characterization models showed accuracies up to 96% and substantial agreement with expert imaging interpretation. AI-assisted operative systems improved procedural efficiency through reductions in operative duration, radiation exposure, and contrast utilization. However, many studies were retrospective, single-center, and based on relatively small cohorts with heterogeneous endpoints. Conclusions: AI has significant potential to improve vascular surgical practice through enhanced image interpretation, procedural guidance, and individualized treatment planning. Despite promising outcomes, current evidence remains limited by methodological heterogeneity and insufficient external validation. Prospective multicenter studies and standardized evaluation frameworks are required before widespread clinical implementation can be achieved. Full article

Background: Costal cartilage is the preferred structural material for augmentation rhinoplasty when robust and durable tip support is required. However, conventional full-thickness harvest is associated with significant donor-site morbidity, and commonly employed rigid fixation strategies—such as the septal extension graft—substantially restrict postoperative nasal tip compliance. The present study introduces a novel two-component technique combining a half-harvest costal cartilage procurement method with a pyramidal-shaped columellar strut graft anchored on the floating-tip principle, with the objective of maintaining postoperative nasal tip flexibility while providing structural support following augmentation rhinoplasty. Methods: A retrospective review was performed of consecutive patients who underwent primary or revision augmentation rhinoplasty using the pyramidal costal cartilage columellar strut graft technique by a single surgeon between June 2018 and February 2026. The medial half of the conjoined costal cartilage at the seventh, eighth, or ninth rib was procured via a half-harvest approach, preserving the lateral cortex and perichondrium to minimize donor-site morbidity and potential cartilage regeneration was considered a theoretical benefit. The harvested cartilage was carved into a pyramidal columellar strut and secured to the anterior nasal spine using a floating fixation construct; the inferior base of the strut was rigidly fixed to the nasal septum and anterior nasal spine with a minimum of three PDS 5-0 sutures, while the superior portion remained free to preserve physiologic nasal tip mobility. Adjunctive cap and shield grafts, perichondrial wrapping, and dermal fat grafts were employed as indicated. Primary outcomes included nasal tip projection, postoperative tip mobility, donor-site morbidity, and surgical complication rates. Results: Favorable clinical observations of maintained tip projection were noted throughout follow-up. Manual postoperative examination suggested preservation of tip flexibility in most patients; however, no validated objective mobility assessment tool was available. The revision rate for clinically significant tip deviation was low. No major donor-site adverse events—including pneumothorax or rib fracture—were encountered. Postoperative chest wall pain was minimal and transient, with most patients resuming daily activities within one week of surgery. Conclusions: The pyramidal-shaped costal cartilage columellar strut graft with half-harvest technique is a novel, biomechanically informed, and technically reproducible approach to augmentation rhinoplasty that was developed to address donor-site morbidity and postoperative tip rigidity, two commonly recognized limitations of conventional costal cartilage rhinoplasty: donor-site morbidity and postoperative nasal tip rigidity. Preservation of the lateral cortex and perichondrium during procurement may contribute to reduced postoperative donor-site discomfort, accelerates functional recovery, and may promote endogenous cartilage regeneration over time. The anatomically derived pyramidal strut geometry, combined with floating fixation to the anterior nasal spine, was designed to approximate the native columellar architecture, enabling consistent preservation of physiologic nasal tip mobility. The present series demonstrated a favorable safety profile with a low overall complication rate and an absence of major donor-site adverse events. Prospective studies with validated objective outcome measures are required to confirm these findings, to delineate the optimal patient selection criteria, and to establish evidence-based long-term outcome benchmarks for this technique. Full article

Background: Hemorrhagic wounds pose significant clinical challenges, with approximately 20% associated with surgical site infections and an increased mortality risk. Despite growing interest in natural product-based medicines, the molecular targets and bioactive phytochemicals of Musa acuminata peel relevant to hemorrhagic wound healing are insufficiently established. Methods: This study employed an integrative in silico approach to identify bioactive phytochemicals from the ethyl acetate extract of Musa acuminata peel as potential wound healing agents. Liquid chromatography-high resolution mass spectrometry (LC-HRMS) profiling was performed for phytochemical characterization, followed by drug-likeness and toxicity screening via OSIRIS DataWarrior. Network pharmacology, molecular docking, molecular dynamics (MD), binding free energy calculation, pharmacokinetic properties prediction, and density functional theory (DFT) analysis were subsequently conducted. Results: LC–HRMS profiling identified 211 compounds across 21 chemical classes, of which 18 met drug-likeness criteria. Network pharmacology revealed five key protein targets. Molecular docking demonstrated that Compound 16 (−9.34 kcal/mol) and Compound 17 (−9.26 kcal/mol) exhibited stronger binding affinity toward VEGFR2 than Axitinib (−9.15 kcal/mol), with key interactions at glutamic acid-917 (GLU917) and cysteine-919 (CYS919). MD simulations over 100 ns confirmed complex stability, with BP16 showing superior binding stability and favorable MM/PBSA free energy. Pharmacokinetics and DFT analysis further supported BP16 as the most promising lead compound, exhibiting favorable pharmacokinetic properties, low predicted toxicity, and enhanced electronic stability. Conclusions: BP16 and BP17 are identified as potential VEGFR2-targeting candidates, providing a rational mechanistic foundation for future experimental validation as natural hemorrhagic wound healing therapeutics. Full article

Accurate monocular depth estimation (MDE) is a foundational task in endoscopic surgery, critical for augmenting depth perception and aiding surgical navigation. While diffusion-based and discriminative depth estimators demonstrate complementary strengths, they also exhibit asymmetric errors: discriminative models yield precise geometric boundaries but struggle in homogeneous or saturated areas, whereas diffusion models recover fine textures at the cost of occasional structural incoherence. To systematically exploit this complementarity, we present CoDepth, a novel framework that leverages confidence-guided fusion to harmonize the outputs of these heterogeneous estimators. Its core components include a complementary map extractor that identifies structured disparity disagreements, a cross-attention module for context-aware feature integration, and a probabilistic confidence network that generates spatially adaptive fusion weights. Extensive evaluations on the SCARED dataset show that CoDepth achieves improved overall performance relative to strong single-model baselines, with the most consistent gains observed in Abs Rel and $\delta$-based accuracy, while changes in some other error metrics are more modest. Furthermore, CoDepth exhibits encouraging cross-domain generalization. When a model trained on SCARED is directly evaluated on SERV-CT, Hamlyn, and C3VD without fine-tuning, it achieves competitive performance and improves several key metrics across datasets. The framework also demonstrates enhanced robustness against common synthetic corruptions like low-light conditions, Gaussian noise, and impulse noise, underscoring its practical utility in complex clinical settings. These results suggest that confidence-guided complementary fusion provides a practical integration-level paradigm for combining heterogeneous endoscopic depth estimators. Full article

Introduction: Pituitary carcinoma (PC) is a rare, aggressive endocrine neoplasm characterized by metastasis and challenging clinical management. The transformation from pituitary adenoma (PA) to PC is poorly understood, and predictors of metastasis remain elusive. This study evaluates the clinical course, surgical outcomes, and molecular characteristics of PC. Methods: We retrospectively reviewed patients with PC treated at the M. D. Anderson Cancer Center between 1993 and 2023. Primary outcomes included metastasis-free survival and overall survival (OS). Clinical features, radiographic findings, surgical strategies and outcomes, immunohistochemical profiles, and MIB-1 were analyzed. Results: The cohort (n = 20) had a median age at PA and PC diagnosis of 33.9 and 43.3 years, respectively. The median metastasis-free interval was 7.4 years. GH- and ACTH-secreting tumors showed shorter times to PC diagnosis, while nonfunctioning PAs had longer metastasis-free survival. PAs with MIB-1 > 10% had shorter survival. Dura was the most common site of metastasis within the CNS, and bone was the most common outside the CNS. Leptomeningeal disease was seen in six patients. PAs became aggressive > five years after initial surgical resection (n = 13) or metastasized early within the first five years (n = 7). Median OS from PA diagnosis was 13.7 years, and 8.6 years from PC diagnosis. A total of 102 neurosurgical procedures were performed, with a median of five per patient; the median was similar in patients surviving longer than five years vs. those whose survival was shorter (5.0 vs. 4.5 procedures, p = 0.661). Most surgical interventions post-PC diagnosis were for optic decompression or metastasectomy. All long-term survivors (at least five years after PC diagnosis) received temozolomide-based therapy, with most also receiving radiotherapy. Conclusions: PC shows a variable clinical course, with some PAs progressing to PC after years, while others transform rapidly. All long-term survivors received temozolomide-based therapy, most in combination with radiotherapy and repeated surgical intervention, suggesting that aggressive multimodal management may be associated with prolonged survival. Future research will focus on identifying reliable predictors of metastasis at different time points in the complex clinical evolution of these tumors. Full article

Large congenital melanocytic nevi (LCMN) of the face can pose significant functional, esthetic, and psychosocial challenges in childhood. In selected patients, staged excision offers a practical reconstructive strategy when primary closure is not feasible without distortion of nearby facial landmarks. We report the management of a child with a facial LCMN using a planned multistage surgical approach aimed at lesion removal while preserving contour and minimizing scar burden. The lesion was excised sequentially over three procedures, with careful attention given to relaxed skin tension lines and facial esthetic units. When required, adjunctive reconstruction was performed to optimize closure and support tissue healing. This approach allowed a gradual reduction in the nevus, improved tissue accommodation, and avoidance of excessive tension on the surrounding skin. Postoperative recovery was uncomplicated, and the final esthetic outcome was satisfactory for both the patient and parents. Staged excision was selected over tissue expansion and skin grafting because it allowed progressive lesion reduction while preserving adjacent facial landmarks and minimizing donor-site morbidity. This technical case highlights the importance of individualized surgical planning, preservation of facial esthetic units, and staged scar placement when managing large facial congenital melanocytic nevi in pediatric patients. The educational value of the report lies in illustrating the decision-making process used to balance lesion removal, esthetic outcomes, and long-term surveillance in a challenging facial location. Full article

Objectives: Catamenial pneumothorax (CP) is a rare but clinically relevant cause of spontaneous pneumothorax (SP) in women and is associated with high recurrence rates. We hypothesized that CP is underrecognized in routine surgical practice due to an incomplete clinical assessment rather than an absence of characteristic intraoperative findings. Methods: We conducted a retrospective single-center analysis of all patients undergoing surgical treatment for pneumothorax between 2000 and 2025. Female patients with SP and no structural lung disease were identified and systematically evaluated for features suggestive of CP. Demographic, clinical, intraoperative, and outcome data were compared between patients with and without CP. Results: Among 4581 surgically treated pneumothoraces, 1253 (27.4%) occurred in women. Of these, 211 cases of SP without structural lung disease were analyzed. CP was identified in 15 cases among 14 patients (7.1%). Patients with CP were older at initial diagnosis (median 39 vs. 32 years; p = 0.0264) and exhibited higher recurrence rates (92.9% vs. 42.4%; p = 0.0003). A temporal association with menstruation was documented in 57.1% of CP cases, while in 35.7% no such assessment had been performed. Intraoperative findings suggestive of thoracic endometriosis were present in 85.7% of CP patients, whereas histological confirmation was achieved in only 14.3%. Conclusions: CP is likely underdiagnosed in surgical cohorts of women with SP. The principal diagnostic limitation appears to be incomplete history-taking rather than lack of intraoperative evidence. Given the high recurrence risk and limited efficacy of surgery alone, systematic assessment of menstrual association and interdisciplinary management are essential to optimize outcomes. Full article

Background/Objectives: Postoperative remodeling and positional deviations of the mandibular coronoid process (CP) after orthognathic surgery remain insufficiently characterized, particularly in three-dimensional analyses. The aim of this study was to evaluate qualitative and quantitative CP changes following bimaxillary orthognathic surgery using a deep learning-assisted three-dimensional workflow. Methods: This retrospective study included 75 patients treated with combined orthodontic–surgical therapy, including 25 patients with skeletal Class II malocclusion and 50 patients with skeletal Class III malocclusion. Preoperative and 6-month postoperative computed tomography scans were analyzed. Automatic segmentation and three-dimensional reconstruction were performed using a convolutional neural network based on the nnU-Net architecture. Qualitative assessment included evaluation of CP displacement patterns and visualization of local surface differences using heat maps. Quantitative analysis included volumetric assessment of preoperative and postoperative CP models, calculation of apposition-compatible (Vapo) and resorption-compatible (Vres) volumetric changes, and mixed-effects modeling accounting for within-patient correlations. Results: Medial displacement of the CP predominated in both skeletal classes and was more frequent in Class III patients. Qualitative surface analysis demonstrated a consistent location-dependent remodeling pattern, characterized by predominant apposition-compatible changes on the lateral and medial surfaces and predominant resorption-compatible changes along the anterior border. Quantitative analyses revealed an overall positive remodeling balance, although substantial inter-individual variability was observed. Mixed-effects analyses demonstrated no significant overall effects of side or skeletal class on volumetric remodeling; however, a significant interaction between side and skeletal class was identified for net remodeling balance. A significant random patient effect indicated considerable variability in remodeling response among individuals. Conclusions: AI-assisted three-dimensional analysis enables a reproducible assessment of postoperative CP remodeling following orthognathic surgery. Coronoid process remodeling is characterized by heterogeneous, location-dependent surface changes and substantial inter-individual variability. The observed remodeling patterns are compatible with adaptive responses to altered postoperative biomechanical conditions, although the underlying biological mechanisms remain to be clarified. Full article

Background/Objectives: Medication-related osteonecrosis of the jaw (MRONJ) is a severe complication of antiresorptive and antiangiogenic therapies, and identifying specific risk factors for recurrence remains a significant clinical challenge. This study aimed to evaluate the clinical characteristics and independent risk factors for recurrence in a large-scale cohort of MRONJ patients. Methods: This single-center retrospective study analyzed 812 patients diagnosed with MRONJ according to the 2022 AAOMS criteria at Chosun University Dental Hospital between 2020 and 2024. Demographic, clinical, radiographic, and medication-related variables were collected. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors associated with recurrence. Results: The majority of patients were female (89.9%), with a mean age of 72.9 years, and mandibular involvement was most frequent (70.8%). Tooth extraction was the most common local precipitating factor (47.0%). The overall recurrence rate was 10.1%. Multivariate analysis identified bilateral jaw involvement (OR = 4.555, p = 0.006), mandibular ramus involvement (OR = 8.222, p = 0.008), and systemic liver disease (OR = 3.703, p = 0.037) as significant independent risk factors. Conversely, routes of prior antiresorptive medication administration involving intravenous-only or combined oral/intravenous therapy, as well as hyperlipidemia and a history of dental implant surgery, were associated with lower recurrence rates. Conclusions: Anatomical complexity and systemic health status are critical predictors of MRONJ recurrence. Patients presenting with bilateral or mandibular ramus involvement, or with compromised liver function, require more aggressive surgical debridement and individualized treatment planning to reduce the risk of recurrence. Given the small affected subgroups, the effect sizes for mandibular ramus involvement and liver disease should be interpreted with caution. Full article

Background/Objectives: Recurrent uterine leiomyosarcoma (ULMS) frequently poses a surgical question because systemic options remain limited and recurrence patterns are heterogeneous. We reviewed the published evidence on repeated and extended cytoreductive surgery for recurrent ULMS, focusing on selection criteria, operative boundaries, and the role of multivisceral, thoracic, and peritoneal-directed procedures. Methods: This narrative review synthesizes peer-reviewed literature on surgically managed recurrent or metastatic ULMS, prioritizing contemporary guidelines, retrospective cohorts, pooled analyses, selected systematic reviews when directly relevant to the surgical question, and published illustrative reports. The search covered records available from database inception through 14 May 2026 and used PubMed/MEDLINE, Web of Science Core Collection, Scopus, Google Scholar, selected publisher databases, and citation-linked records. No new patient-level or institution-specific clinical data are presented. Results: The available evidence is entirely retrospective and strongly affected by selection bias, yet it consistently suggests that the best outcomes are observed when complete gross resection is feasible. Across published series, favorable features include isolated or limited recurrence, longer time to relapse, compartmentalized disease, lung-only metastases, and preserved performance status. Contemporary reports also show that repeat surgery may evolve into extensive multivisceral procedures involving bowel resection, upper-abdominal dissection, urinary tract reconstruction, diaphragmatic resection, and thoracic surgery. Peritoneal-directed CRS/HIPEC-type strategies remain supported mainly by small heterogeneous studies and a ULMS-specific systematic review, reinforcing feasibility but not routine use. Published illustrative reports confirm that serial metastasectomies can occasionally support prolonged survival in exceptional patients, but they cannot establish effectiveness. Conclusions: In highly selected patients, repeated and even extensive cytoreductive surgery may remain a rational disease-control strategy for recurrent ULMS. The central unmet need is not proof that surgery can work in exceptional cases, but better criteria to identify who benefits from iterative resection and when escalation to multivisceral or thoracoabdominal surgery is justified. Full article