Search Results (3,569)

Background/Objectives: Sentinel lymph node biopsy is central to axillary staging in breast cancer, but conventional mapping often relies on radioisotopes and/or blue dye. Indocyanine green fluorescence has emerged as an alternative, although evidence for its use as a sole tracer in routine practice remains limited. This study evaluated the technical feasibility, lymph node yield, nodal metastasis detection, and short-term clinical outcomes of indocyanine green used as the only tracer for axillary staging in a consecutive single-centre cohort. Methods: This retrospective observational cohort study included 260 patients with histologically confirmed breast cancer who underwent axillary surgery at University Hospital Kaspela between 2024 and 2025 under an institutional protocol using indocyanine green as the sole tracer. Indocyanine green-guided mapping was attempted in all patients. For node-focused statistical analyses, a predefined complete-case–cohort of 230 patients was used. Descriptive analyses assessed axillary procedure distribution, lymph node yield, nodal metastasis, and postoperative outcomes. Exploratory multivariable logistic regression was performed to evaluate predictors of nodal metastasis. Results: Mapping was successful in 259/260 patients (99.6%). In the complete-case–cohort, sentinel lymph node biopsy was performed in 166/230 patients (72.2%), targeted axillary dissection in 4/230 (1.7%), and axillary lymph node dissection in 60/230 (26.1%). Median overall lymph node yield was 4 (IQR 3–7), but this pooled value reflected heterogeneous axillary procedures and should not be interpreted as sentinel node yield alone. In the clinically node-negative upfront SLNB subgroup, median lymph node yield was 4 (IQR 2.75–5), and nodal metastasis was identified in 22/112 patients (19.6%). Overall, nodal metastasis was identified in 58/230 patients (25.2%), with a median of 2 metastatic nodes (IQR 1–3) among nodal-positive cases. Reoperation for axillary lymph node dissection occurred in 14/230 patients (6.1%). In exploratory multivariable analysis, suspicious biopsied-positive nodes (OR 12.85, 95% CI 3.98–41.52), suspicious non-biopsied nodes (OR 15.58, 95% CI 3.44–70.59), and neoadjuvant therapy (OR 0.31, 95% CI 0.11–0.87) were associated with nodal metastasis; these findings should be interpreted cautiously given the expected clinical relationship between preoperative nodal suspicion and nodal positivity, and the limited number of nodal-positive events. Conclusions: Indocyanine green used as a sole tracer demonstrated high technical feasibility within a heterogeneous real-world axillary staging workflow in this single-centre cohort. These findings should be interpreted as implementation-focused feasibility data rather than formal diagnostic validation, given the retrospective design, heterogeneous case mix, and absence of an internal comparator. Full article

Background: Molecular classification has transformed risk stratification in endometrial cancer, providing prognostic information beyond traditional clinicopathologic features. However, the relationship between molecular subtype, nodal involvement, and recurrence risk remains incompletely defined. This study aimed to compare lymph node metastasis rates across molecular subgroups and evaluate survival outcomes and prognostic factors for recurrence. Methods: We conducted a retrospective study including 158 patients with a preoperative diagnosis of presumed early-stage endometrial carcinoma treated surgically between 2021 and 2024. Molecular classification was performed according to WHO criteria, including POLE-ultramutated, mismatch repair deficient (MMRd), p53-abnormal (p53-abn), and no specific molecular profile (NSMP). Sentinel lymph node biopsy (SLNB) was the primary method for nodal staging. Survival outcomes were assessed using a Kaplan–Meier analysis, and logistic regression was used to identify prognostic factors for recurrence. Results: NSMP was the most frequent molecular subtype (44.3%), followed by MMRd (29.1%), p53-abn (20.9%), and POLE-mutated tumors (5.7%). Overall, 11.4% of patients had nodal metastases, most commonly in the p53-abn subgroup, which showed significantly higher rates of positive sentinel lymph nodes (p = 0.010). Prognosis differed significantly across molecular subtypes. POLE-mutated and NSMP tumors demonstrated the most favorable outcomes, while p53-abn tumors showed the poorest overall survival and progression-free survival. In a univariate analysis, grade, lymphovascular space invasion (LVSI), myometrial invasion, FIGO stage, and molecular classification were associated with recurrence. Stratified analyses suggested LVSI as the most relevant prognostic factor within the MMRd subgroup. Conclusions: Molecular classification is strongly associated with nodal involvement and survival outcomes in early-stage endometrial cancer. Integrating molecular subtype with clinicopathologic factors may improve recurrence risk stratification and guide individualized surgical and adjuvant treatment strategies. Full article

Tumor hypoxia has been implicated in treatment resistance and disease progression in esophageal squamous cell carcinoma (ESCC), yet its relationship with post-neoadjuvant pathological staging remains unclear. This study evaluated the association between hypoxia-inducible factor-1α (HIF-1α) expression and pathological stage following neoadjuvant concurrent chemoradiotherapy (CCRT). We retrospectively analyzed 55 patients with ESCC treated with standardized neoadjuvant CCRT followed by curative esophagectomy. Immunohistochemical staining was performed on surgical specimens to assess tumor (HIF-T%) and stromal (HIF-N%) HIF-1α expression, and correlations with postoperative pathological stage were analyzed. Tumor HIF-1α expression was significantly higher in patients with pathological stage III disease compared with stage I–II disease (40% vs. 15%, p = 0.023). Increasing trends in tumor HIF-T% were observed across higher T and N classifications, although these did not reach statistical significance. Stromal HIF-1α expression was not associated with pathological stage. These findings demonstrate that elevated tumor HIF-1α expression is associated with advanced pathological stage following neoadjuvant CCRT in ESCC, supporting the role of hypoxia-related signaling in treatment resistance. HIF-1α may serve as a clinically relevant biomarker of residual disease burden, although further validation in larger cohorts is warranted. Full article

Intraoperative fluorescence-guided surgery is an important adjunct to brain tumor resection. However, fluorescent probe performance varies across molecularly and histopathologically distinct entities, including IDH-wildtype glioblastoma, metastatic brain tumors (MBTs), and primary central nervous system lymphoma (PCNSL), and the mechanisms underlying this variability remain poorly understood. We propose a mechanistic framework integrating biomechanical constraints, molecular barrier heterogeneity, and probe-specific pharmacokinetics to explain cross-tumor differences in fluorescence signal. Probe performance is conceptualized through three sequential bottlenecks: extravasation (blood–brain barrier/blood–tumor barrier permeability and transcytosis), interstitial penetration (extracellular matrix density and hydraulic resistance), and retention/clearance (efflux transporters and metabolic processing). An overlying optical layer, including tissue absorption, scattering, and autofluorescence, further modulates the detected signal. Tumor-specific molecular heterogeneity critically shapes these processes. In IDH-wildtype glioblastoma and legacy high-grade glioma cohorts, heterogeneous expression of ATP-binding cassette transporters has been associated with reduced intracellular accumulation of protoporphyrin IX after 5-aminolevulinic acid administration and may contribute to false-negative fluorescence in selected tumor regions. In MBTs, stage-dependent blood–tumor barrier integrity and vascular programs influence probe delivery, whereas in PCNSL, corticosteroid-sensitive restoration of endothelial barrier function may compromise the performance of leakage-dependent tracers. Together, this framework highlights how tumor biology, barrier function, and probe pharmacology jointly shape fluorescence contrast. Rational probe selection informed by tumor-specific transport and barrier constraints may improve intraoperative visualization of brain tumors and optimize surgical decision-making. Full article

The convergence of artificial intelligence and robotic surgery is redefining the management of genitourinary cancers by enhancing diagnostic accuracy, surgical precision, and training efficiency. This narrative review explores recent advancements in artificial intelligence applications across the cancer care continuum, with a focus on prostate, kidney, and bladder malignancies. Artificial intelligence tools, particularly those based on machine learning and deep learning, have demonstrated strong performance in analyzing imaging data, segmenting tumors, predicting pathological features, and supporting clinical decision-making. Intraoperatively, artificial intelligence enables skill assessment, personalized feedback, and real-time navigation by processing data from surgical videos and robotic system sensors. Augmented reality and intraoperative modeling further enhance visualization and margin control during complex procedures. The review also discusses emerging technologies such as single-port robotic platforms, which offer advantages in confined anatomical spaces and support less invasive approaches. Additionally, the growing field of telesurgery is addressed, highlighting its feasibility for complex urologic operations across vast distances. While many of these innovations are still in early stages of clinical validation, their integration into practice has the potential to improve oncologic and functional outcomes, expand access to expert care, and foster the development of next-generation surgical strategies in urologic oncology. Full article

Objectives: Endometrial carcinoma (EC), the most common gynecological malignancy, is associated with unfavorable survival in advanced stages. Treatment strategies now include cytoreductive surgery (CRS) and (neo)adjuvant chemotherapy, but survival rates remain limited. This study evaluates overall survival (OS) and surgical outcomes, including outcomes of CRS and surgical complications, over a 20-year period at the Erasmus MC. Methods: This retrospective cohort study includes women diagnosed with FIGO stage III or IV EC between 2000 and 2020 who received treatment at the Erasmus MC. Data were collected from the Netherlands Comprehensive Cancer Organization and supplemented by medical record reviews. Statistical analyses were conducted to evaluate differences in OS based on FIGO stage, histological type, molecular characteristics, CRS outcome, and type of CRS. Results: A total of 188 patients were included, with a median age of 66 years. Most patients received surgery and additional chemotherapy and radiotherapy. A total of 64 patients (59.3%) underwent primary CRS, and 44 patients (40.7%) underwent interval CRS. Patients with complete CRS had a significant survival advantage over patients with optimal and incomplete CRS (HR 0.56; 95% CI 0.33–0.96, p = 0.036). Comparison between primary and interval CRS revealed no significant difference in OS (HR 1.42; 95% CI 0.82–2.44, p = 0.207). Surgical complications occurred in 33.1% of patients, with infections most common. Two patients died from severe complications. Conclusions: This study highlights the predominant role of surgery in the management of advanced EC. Complete CRS is often achievable and offers significant survival advantage. However, approximately one-third of patients experience surgical complications. Full article

Soft tissue sarcomas (STS) are locally invasive and aggressive tumors that occur spontaneously in humans, dogs, and cats. High-intensity focused ultrasound (HIFU) is a non-invasive ablation technology that has been explored in canine but not feline STS. The objective of this pilot study was to determine the in vivo safety and feasibility of HIFU ablation for feline STS and to investigate the impact of HIFU on the acute immunological response. Client-owned cats diagnosed with spontaneous STS were recruited. Computed tomography (CT) scans of the chest, abdomen, and tumor were performed prior to treatment for staging and treatment planning. A commercially available HIFU unit (Echopulse, Theraclion, Malakoff, France) was used to target portions of solid tumors before standard-of-care surgical resection. Ablation efficacy and local immunological response were characterized using histopathological and immunohistochemical assessments. Acute safety was monitored with physical examinations, owner reports, and CBC/serum biochemistry. Multiplex serum cytokine levels were used to evaluate the systemic immune response. A total of three cats diagnosed with STS were recruited and treated. No significant adverse events attributed to HIFU treatment were noted in this pilot study. In treated areas, hemorrhage as well as coagulative and lytic necrosis were observed microscopically and were more extensive than in untreated tissues. There was a statistically significant difference in the level of serum MCP-1 after HIFU treatment, but no significant changes in any other analytes. No differences in the infiltration of CD3-, CD79a-, or IBA1-positive cells were noted between treated and untreated samples. Overall, findings suggested that HIFU may offer a viable alternative to conventional therapies for feline STS, with pilot results showing effective tumor ablation in cats with STS without significant adverse events. Some preliminary evidence of immunomodulation following treatment was observed, but HIFU as an immunotherapeutic treatment option needs to be further investigated. Full article

Background and Clinical Significance: Osteoblastomas are rare, benign but locally aggressive bone tumors with a predilection for the posterior elements of the spine. Their clinical, radiological and histopathological presentation often overlaps with that of osteoid osteomas, leading to diagnostic and therapeutic challenges—particularly in atypical locations such as the anterior thoracic spine. Case Presentation: We report two cases of young female patients (aged 35 and 30 years) presenting with persistent thoracic back pain unresponsive to NSAIDs. In the first case, imaging revealed a lesion at the right T7 pedicle initially attributed to osteoid osteoma; CT-guided thermoablation was declined due to proximity to neural structures. At this stage, we chose percutaneous transpedicular ablation by drilling through the centrum of the lesion (Nidus) surgically. After this transpedicular resection with initial symptom improvement, the patient developed recurrence with lesion progression into both anterior and posterior columns, requiring a second, open, surgical intervention. In the second case, a lesion at the left T11 pedicle and transverse process was identified directly as osteoblastoma due to size and radiological morphology; initial biopsy was non-diagnostic due to specimen fragmentation. In both cases, histopathology was inconclusive or misleading, while clinical and radiological features—including NSAID unresponsiveness, lesion size, and anatomical extent—favored osteoblastoma. Both patients underwent surgical resection via posterior costotransversectomy, partial hemivertebrectomy, expandable cage placement, and posterior instrumentation (T5–T8 and T10–T12, respectively). The postoperative courses were complicated by thoracic events—hemothorax in the first case and pulmonary embolism in the second—both of which were managed successfully. At follow-up, both patients were neurologically intact and pain-free. Conclusions: These cases emphasize the diagnostic overlap between osteoid osteoma and osteoblastoma and highlight the importance of clinical and radiographic correlation when histopathology is inconclusive. A posterior-only approach with costotransversectomy may be a valid strategy in selected cases of thoracic spinal tumors, although specific complications such as hemothorax must be considered. Full article

Intrabody cage augmentation has emerged as a minimally invasive technique for anterior column reconstruction in Kümmell disease and osteoporotic burst fractures. These osteoporotic conditions lead to progressive vertebral collapse, kyphosis, and instability. While cement augmentation provides rapid pain relief, it often fails to reliably restore sagittal balance or ensure biological integration in advanced stages of collapse. Although conventional anterior corpectomy with long-segment posterior fusion can achieve satisfactory deformity correction, these procedures are associated with substantial surgical morbidity. In contrast, screw fixation alone often fails to withstand anterior loading, resulting in loss of correction or hardware failure. By adapting standard interbody devices for off-label intravertebral use, this technique utilizes the intravertebral cleft as a natural cavity to restore vertebral height and sagittal alignment while preserving adjacent intervertebral discs and reducing stress on posterior instrumentation. The surgical technique involves transpedicular access, meticulous curettage of necrotic tissue, and insertion of a cage packed with osteoinductive material. This approach minimizes surgical trauma and operative time compared with conventional corpectomy procedures. Reported outcomes from retrospective series suggest promising pain relief, maintenance of correction, and low complication rates. Collectively, current evidence suggests that intrabody cage augmentation may serve as a potential, less invasive surgical option, acting as an intermediate approach between cement augmentation and corpectomy. However, as the existing evidence remains preliminary, high-quality prospective comparative studies are required to establish definitive indications and long-term efficacy. Full article

Introduction: Pancreatic ductal adenocarcinoma (PDAC) remains a leading cause of cancer-related mortality. Radiological distinctions between borderline resectable (BR) and locally advanced disease (LA) are increasingly recognised as imperfect when considered without dynamic assessment. Neoadjuvant therapy (NAT) improves outcomes through tumour downstaging and early treatment of occult metastatic disease, but the optimal NAT strategy, particularly in BR disease, remains uncertain. Published data evaluating combined systemic anti-cancer therapies (SACT) with or without chemoradiation (CRT) are limited and heterogeneous. Methods: This is a single-centre retrospective analysis of 44 patients with BR PDAC and a comparator cohort of 121 patients with LA PDAC treated with a total neoadjuvant approach of SACT with or without CRT and surgical resection between June 2017 and September 2022. Results: Median overall survival (OS) did not differ significantly between BR and LA disease (18 vs. 16 months, p = 0.14). Following NAT, 47.7% of BR and 18.1% of LA patients were anatomically suitable for surgical resection. Among unresected BR and LA patients, those treated with CRT in addition to SACT had a median OS of 18 and 21 months respectively. In the resected subgroup, resection margin status was the primary factor associated with survival; with R0 resection conferring a substantial OS advantage over R1, irrespective of initial BR/LA classification as diagnosis (47 vs. 22 months, p < 0.001). Conclusions: Despite anatomical differences at diagnosis, BR and LA PDAC demonstrated comparable survival outcomes when treated with total neoadjuvant strategies in this cohort. These findings challenge traditional radiological staging-based treatment paradigms and confirm that a margin-negative surgical resection offered the greatest opportunity for long-term survival for BR/LA PDAC patients. Full article

Background/Objectives: The main objective of the study was to determine the frequency of patients who underwent breast-conserving surgery (BCS) and those with modified radical mastectomy and to compare the clinical–paraclinical parameters between these groups. Methods: We conducted an observational, retrospective study, which included 101 patients diagnosed with breast cancer that had surgical interventions between January 2024 and April 2025. Results: The BCS category was represented by 36.6% cases, while 63.4% were in the mastectomy subgroup. Hemoglobin at the time of admission had an average of 13 g/dL, the difference between the two categories of patients being statistically significant. (13.7 vs. 12.7, p = 0.010). Conclusions: Although it has been a hotly debated topic in recent years, the choice of surgical technique for breast tumors still presents novelties and remains a subject of interest within surgical specialties. Selection criteria such as disease stage, histopathological subtype, and the intervention chosen by the surgeon may vary and oncological results may be comparable. Full article

Spinal infections in general, and infectious spondylodiscitis in particular, are increasingly diagnosed in the Western world, in recent decades. This rise in incidence is associated with an ageing population and with an increased availability of accurate diagnostic modalities. Even so, due to the non-specific nature of clinical manifestations, and of the implicated blood and serum markers, there is a risk of underdiagnosis or misdiagnosis of the disease in its initial stages. Ionizing radiation methods, such as plain radiography (X-ray) and computed tomography (CT), are also not reliable in the early stages of the diseases, and the golden standard of imagistic diagnosis, magnetic resonance imaging (MRI), is not always available or requested. Still, MRI remains the most reliable method in most cases where there is a need for differential diagnosis with other pathologies, namely Andersson lesions, destructive spondyloarthropathy, erosive osteochondritis, micro-crystalline spondylitis, Modic 1 lesion, Charcot spinal arthropathy, osteoporotic fractures, SAPHO syndrome with spinal involvement, and Schmorl’s nodes. Infectious spondylodiscitis is caused by bacteria, and, less frequently, by fungi. Rare cases of parasitic causes have also been reported in the literature. Infectious spondylodiscitis of bacterial causes may be pyogenic, more frequently caused by Staphylococcus spp. or Streptococcus spp., or granulomatous, usually caused by Mycobacterium tuberculosis complex (MTBC) or from classical brucellosis. In all these cases, therapy may be conservative, with antibiotics, or surgical, when the former fails or in patients with significant spinal instability or other neurological manifestations. There are various surgical approaches, each with its own drawbacks, and usually used according to the preference of the attending physician. Even in cases of surgical treatment, antibiotic administration is prolonged, and it is important for a proper scheme to be selected based on antimicrobial susceptibility testing. However, given that in many cases, the causative agent cannot be identified, empirical treatment must be initiated. Finally, newer approaches, including the incorporation of antimicrobial substances, may offer better solutions for improving treatment and rehabilitation outcomes. Full article

Introduction: Magnetic resonance imaging (MRI) is the reference imaging modality for locoregional staging and restaging of rectal cancer (RC). However, its agreement with surgical pathology in real-world practice is limited. We aimed to assess the agreement and diagnostic performance of preoperative MRI for dichotomized T and N staging in RC. Secondarily, we explored the direction of MRI misclassification and potential preoperative factors associated with discordance. Methods: We conducted a retrospective real-world study on 152 consecutive patients with pathologically confirmed RC who underwent surgery between September 2019 and June 2025 in our institution. Two cohorts were analyzed separately: patients treated without neoadjuvant therapy (non-NAT, n = 70) and patients treated with NAT followed by restaging MRI and surgery (NAT, n = 82). The main staging outcomes were dichotomized into T0-T2 vs. ≥T3 and N0 vs. N+, using final pathology as the reference standard. Agreement, Cohen’s kappa, sensitivity, specificity, predictive values, McNemar’s test, and exploratory regression analyses for misclassification were performed. Results: In the overall cohort, agreement was 72.4% for T staging and 73.0% for N staging, with moderate agreement for T (kappa = 0.452) and fair-to-moderate agreement for N (kappa = 0.349). Sensitivity and specificity were 80.3% and 67.0% for T staging and 54.5% and 80.6% for N staging, respectively. T-stage errors were mainly associated with overstaging. In NAT-treated patients, baseline MRI showed markedly poorer agreement with final pathology than restaging MRI, particularly for T stage (45.1% vs. 72.0%). Exploratory analyses did not identify strong or reproducible predictors of misclassification. Conclusions: This real-world study provides a contemporary estimate of MRI-pathology agreement for dichotomized T and N staging in routine RC care. Agreement was moderate, and performance was more consistent for advanced T-category assessment than for nodal staging. These findings support MRI as a practical tool for multidisciplinary risk stratification and highlight the need for continued monitoring of MRI usage and performance in clinical practice. Full article

Background: Gallbladder carcinoma (GBC) represents one of the most aggressive malignancies of the hepatobiliary system, evolving along a continuum from chronic inflammation to preneoplastic lesions and invasive cancer. This progression is frequently associated with gallstones and chronic cholecystitis and shares common pathogenic mechanisms with systemic inflammatory and metabolic disorders. Despite its relatively low incidence, GBC is characterized by poor prognosis, largely due to late-stage diagnosis and limited understanding of its molecular underpinnings. Methods: We conducted an observational study including 60 adult patients with radiologically suspected gallbladder cancer (GBC). Patients with disseminated disease, ongoing oncologic treatment, or synchronous malignancies were excluded. Fasting venous blood samples were collected to evaluate tumor markers and biochemical parameters, including carcinoembryonic antigen (CEA) and carbohydrate antigen CA 19-9. Surgical specimens were analyzed histopathologically and staged according to the European Society for Medical Oncology TNM classification system. Statistical analysis was performed using SPSS software (version 26.0), with appropriate parametric or non-parametric tests applied based on data distribution, and a p-value < 0.05 considered statistically significant. Results: Based on histological findings, patients were stratified into benign gallbladder disease (GBD) and GBC groups. CA 19-9 demonstrated higher mean serum levels with lower variability compared to CEA, suggesting superior sensitivity and diagnostic stability for gallbladder adenocarcinoma. In contrast, CEA levels exhibited greater fluctuation, limiting its reliability as a standalone biomarker. Importantly, the combined use of CA 19-9 and CEA improved diagnostic accuracy, supporting a multimarker approach for better clinical stratification. Our findings highlight the diagnostic value of CA 19-9 as a robust biomarker in GBC and support the integration of combined biomarker panels. Beyond tumor markers, the study identified a strong interplay between systemic inflammation and metabolic comorbidities, with obesity and hypertension significantly associated with chronic gallbladder pathology, and diabetes mellitus contributing to increased risk of acute inflammatory episodes. Elevated inflammatory markers, leukocytosis, and cholestatic enzyme alterations further supported the presence of a systemic inflammatory milieu. Multivariate analysis revealed that C-reactive protein (CRP), as a marker of systemic inflammation, was significantly influenced by a combination of clinical and biochemical variables, including age, hemoglobin, hypertension, amylase, CA 19-9, and CEA, explaining over 50% of its variability and up to 85% in advanced fibrotic changes. Additionally, platelet counts were significantly reduced in adenocarcinoma and correlated specifically with CA 19-9 levels, suggesting a potential link between tumor burden, inflammation, and platelet dynamics. Conclusions: Therefore, the observed associations between chronic inflammation, metabolic dysregulation, and tumor marker expression suggest a potential link between gallbladder carcinogenesis and systemic cardiometabolic pathways, opening new perspectives for early detection and targeted therapeutic strategies. Full article

Background: Breast augmentation is traditionally performed under general anesthesia, but tumescent local anesthesia (TLA) offers advantages in terms of rapid recovery and reduced risks. This study presents the largest European series on the use of TLA for breast augmentation, analyzing the cumulative results of 16 years of experience. Methods: A multicenter retrospective analysis was conducted on 1644 consecutive patients (982 subglandular and 662 subpectoral) between 2008 and 2024. All procedures were performed under TLA with conscious sedation without the use of general anesthesia. The tumescent solution consisted of 25 mL of 2% lidocaine, 8 mEq of sodium bicarbonate, and 1 mL of epinephrine (1 mg/1 mL) in 1000 mL of 0.9% saline solution. Infiltration protocols differed between groups: the subglandular approach utilized a single-plane technique (mean 589 mL per breast), whereas the subpectoral approach required a two-stage process (pre-fascial and retromuscular) with a higher mean volume (770 mL per breast). Intraoperative parameters, complication rates, and patient-reported outcomes (BREAST-Q) were analyzed. Statistical comparisons between the two surgical planes were performed using Independent Samples T-tests. Results: The procedure was successfully completed under TLA in 100% of cases, with no conversions to GA. The subpectoral approach was associated with significantly higher mean operating times (141 ± 11.2 min vs. 90.3 ± 11 min; p < 0.001) and TLA solution volumes (770 ± 16.1 mL vs. 589 ± 53.6 mL; p < 0.001). The overall major complication rate was 4.74%, with a significantly higher incidence of hematoma in the subpectoral group compared to the subglandular group (3.51% vs. 1.83%; p = 0.015). Regarding severe capsular contracture (Baker III–IV), although a slightly higher incidence was observed in the subpectoral cohort compared to the subglandular group (2.11% vs. 1.22%), this difference was not statistically significant (p = 0.155). Patient satisfaction via Breast-Q was high, with dissatisfaction exclusively linked to implant dislocation. Conclusions: This 16-year cumulative analysis validates TLA as a safe, effective, and reproducible alternative to general anesthesia for both subglandular and subpectoral breast augmentation. While the subpectoral plane entails longer surgical times and a slightly higher risk of minor complications, the TLA protocol ensures excellent pharmacological safety and rapid functional recovery, supporting its use in modern outpatient surgical settings. Full article