Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 49 appraisals
The American journal of pathology
An Integrated Machine Learning and Genomic Framework for Precise Detection of Gastric Cancer
This study presents a novel integrative approach for the analysis of high-dimensional gene expression data, leveraging the complementary strengths of unsupervised clustering and supervised classification. Using K-means clustering, the data set is stratified into three distinct clusters, revealing intrinsic biological patterns and relationships. The resulting cluster assignments are subsequently used as pseudolabels to train machine learning models, including support vector machines, random forest, and a stacking ensemble classifier. To validate and enhance the robustness of clustering, complementary methods, such as hierarchical clustering and density-based spatial clustering of applications with noise (DBSCAN), are used, with results visualized through principal component analysis-driven dimensionality reduction. The high predictive accuracy achieved by the classifiers underlines the separability and reliability of the identified clusters. Furthermore, feature importance analysis highlighted key genetic determinants within each cluster, offering actionable insights into potential biomarkers and critical genomic features. This framework bridges the gap between exploratory unsupervised learning and predictive supervised modeling, providing a scalable and interpretable method for analyzing complex genomic data sets. Its applicability extends to biomarker discovery, patient stratification, and other precision medicine applications, emphasizing its utility in advancing genomic research and clinical practice.
3 Aug 2026
Read appraisal →Clinical & translational oncology : official publication of the Federation of Spanish Oncology Societies and of the National Cancer Institute of Mexico
Research progress of machine learning applications in gastric cancer diagnosis and therapy
Gastric cancer (GC), a malignant neoplasm originating from the gastric mucosal epithelium, represents one of the most prevalent cancers worldwide. Early detection is critical for improving treatment outcomes and patient prognosis. Recent advances in artificial intelligence (AI), particularly in machine learning, have introduced powerful computational and analytical capabilities that are increasingly being applied in GC research. Machine learning algorithms have shown considerable promise in enhancing the accuracy of GC diagnosis and optimizing therapeutic strategies. This review provides a concise overview of progress in machine learning applications within oncology, examines their current role and clinical utility in GC diagnosis and treatment, and highlights the transformative potential of machine learning in advancing GC management and patient care.
2 Aug 2026
Read appraisal →Journal of robotic surgery
From robot assistance to surgical intelligence: global research trends and emerging frontiers of artificial intelligence-enhanced robotic surgery in urology.
To systematically characterize global publication trends, collaboration patterns, intellectual foundations, research hotspots, and emerging frontiers in artificial intelligence (AI)-enhanced robotic and robot-assisted surgery in urology. Publications were retrieved from the Web of Science Core Collection (WoSCC) using a topic search strategy that included three keyword groups: robot-assisted surgery, urologic diseases or procedures, and AI-related technologies. English-language articles and reviews were included. Meeting abstracts, conference proceedings, editorials, letters, non-English publications, studies unrelated to urologic robotic surgery, and studies without substantive AI or intelligent algorithmic content were excluded. RStudio was used for descriptive statistics and annual publication trend visualization. VOSviewer was used for auxiliary bibliometric network construction and visualization. CiteSpace was used to construct collaboration networks, co-citation networks, keyword co-occurrence maps, cluster maps, timeline and time-zone maps, and citation burst maps. A total of 401 records were initially retrieved, and 253 publications were finally included after screening by document type, language, and topical relevance. These comprised 199 articles (78.66%) and 54 reviews (21.34%). Publications in this field began in 2004 and increased rapidly after 2018, reaching a peak of 53 publications in 2025. Because 2026 was an incomplete retrieval year, only 23 publications were recorded. Italy, the United States, the Netherlands, China, and Japan were the leading contributing countries. The University of Turin, Azienda Ospedaliero-Universitaria San Luigi Gonzaga, IRCCS Fondazione del Piemonte per l'Oncologia, the Netherlands Cancer Institute, and Leiden University Medical Center were the most productive institutions. Keyword clustering showed that the major research hotspots included renal cell carcinoma, augmented reality, image-guided surgery, indocyanine green, machine learning, registration, deep learning, and bladder cancer. AI-enhanced robotic surgery in urology has evolved from early research on registration, navigation, and image-guided surgery toward a surgical intelligence stage characterized by augmented reality, three-dimensional reconstruction, machine learning-based prediction, deep learning-based segmentation, surgical video understanding, and skill assessment. Future studies should prioritize multicenter standardized datasets, sharing of intraoperative video and robotic platform data, model interpretability, prospective validation, and integration into real-world clinical workflows.
27 July 2026
Read appraisal →Journal of robotic surgery
Perioperative outcomes and nodal station assessment after robotic-assisted versus video-assisted thoracoscopic segmentectomy for early-stage NSCLC: a systematic review and meta-analysis
The relative benefits of Robotic-assisted thoracoscopic segmentectomy (RATS) versus video-assisted thoracoscopic segmentectomy (VATS) for early-stage NSCLC remain uncertain. This meta-analysis compared perioperative outcomes, lymph node assessment, and postoperative safety between the two approaches. PubMed, Cochrane Library, Embase, and Web of Science were searched from inception to April 2026. Comparative studies of RATS versus VATS segmentectomy for early-stage NSCLC were included. Outcomes were pooled as weighted mean differences or odds ratios with 95% confidence intervals. Random-effects models were used for substantial heterogeneity (I² >50% or P < 0.05); otherwise, fixed-effects models were applied. Leave-one-out sensitivity plots are provided in the supplementary materials. Nine retrospective comparative studies involving 19,805 patients were included. Robotic-assisted segmentectomy was associated with a greater number of lymph node stations examined (WMD = 1.16, 95% CI: 0.51, 1.81, P < 0.001) and a shorter length of hospital stay (WMD = - 0.75, 95% CI: -1.36, - 0.15, P = 0.015). No significant differences were observed in operative time (WMD = 1.86, 95% CI: -8.80, 12.52, P = 0.732), duration of drainage (WMD = - 0.37, 95% CI: -0.79, 0.06, P = 0.090), overall complications (OR = 0.94, 95% CI: 0.67, 1.34, P = 0.745), air leak (OR = 1.02, 95% CI: 0.54, 1.91, P = 0.949), pneumonia (OR = 1.33, 95% CI: 0.89, 1.99, P = 0.170), or 30-day readmission (OR = 1.09, 95% CI: 0.94, 1.26, P = 0.257). Current retrospective evidence suggests that RATS may offer more examined lymph node stations and shorter hospital stay without increased morbidity, but these findings are limited by risk of bias and should not be interpreted as evidence of oncologic superiority.
22 July 2026
Read appraisal →Journal of robotic surgery
Robotic versus laparoscopic and open surgery for endometrial cancer: a systematic review of randomized trials and pooled analysis of conversion rates
To summarize randomized evidence assessing robotic surgery in relation to conventional laparoscopic and open abdominal approaches for endometrial cancer treatment, with particular attention to perioperative outcomes and conversion to open surgery. Randomized controlled trials evaluating robot-assisted surgical treatment of endometrial cancer were identified across major biomedical databases up to December 2025. Eligible studies compared the robotic approach against laparoscopic or open abdominal surgery. Quantitative pooling was undertaken only when outcome reporting was sufficiently consistent across studies. Eight randomized trials including 647 patients met the inclusion criteria. Overall, 322 patients underwent robotic surgery, 244 conventional laparoscopy, and 81 laparotomy. Most perioperative endpoints were reported heterogeneously, limiting formal pooling. Operative time varied across trials when robotics was compared with laparoscopy and was generally longer than laparotomy. Intraoperative blood loss and postoperative hospitalization did not show consistent differences between the two minimally invasive approaches. Compared with laparotomy, the robotic approach was linked to reduced postoperative stay. Conversion to laparotomy occurred less frequently after robotic surgery than after laparoscopy (0.7% vs. 8.4%; OR 0.17; p = .03). Complication reporting was inconsistent, although trials comparing robotics with laparotomy generally favored the robotic approach. Direct procedural costs were higher for robotics, whereas indirect costs favored robotics in the single study evaluating them. The robotic approach resulted in a lower need for open conversion compared with conventional laparoscopy. Other perioperative outcomes appeared broadly comparable between the two minimally invasive approaches, while comparisons with laparotomy suggested shorter hospital stay and fewer postoperative complications, although these findings should be interpreted cautiously because of the limited and heterogeneous randomized evidence.
21 July 2026
Read appraisal →Journal of robotic surgery
Transperitoneal versus retroperitoneal single-port robot-assisted partial nephrectomy: systematic review and meta-analysis of perioperative and functional outcomes
To systematically compare the safety and efficacy of the transperitoneal (TP) and retroperitoneal (RP) approaches in single-port robot-assisted partial nephrectomy (SP-RAPN). PubMed, Web of Science, and Embase were searched for comparative studies published before October 2025. The primary evaluated outcomes were grouped as Perioperative Outcomes (operative time, blood loss, ischemia time, positive surgical margin, postoperative eGFR, and hospital stay) and Surgical Safety (complication rate). Study inclusion and exclusion standards followed the PICOS guidelines. Four comparative studies with 384 patients (188 TP and 196 RP) were analyzed. Compared with the RP group, the TP group had higher intraoperative blood loss (WMD = 27.95 mL, 95% CI = 4.90-51.02, p = 0.018), longer hospital stay (WMD = 0.56 days, 95% CI = 0.34-0.78, p < 0.001), and higher absolute postoperative eGFR (WMD = 6.87, 95% CI = 2.65-11.10, p = 0.001). Operative time did not differ significantly in the main analysis (p = 0.356); an exploratory sensitivity analysis suggested a possible small difference (≈ 12 min) that requires confirmation. Warm ischemia time, positive surgical margin rate, and complication rate showed no significant differences between the two groups. Sensitivity analysis confirms the robustness of these findings, with overall low heterogeneity. Both transperitoneal and retroperitoneal SP RAPN are safe and feasible based on this limited evidence. Preliminary findings suggest the RP approach may offer advantages in blood loss, hospital stay, and renal preservation, but these results are hypothesis generating. Importantly, tumor location strongly influenced approach selection, and observed differences may be attributable to tumor location rather than the approach itself; causal inference is not possible from this observational data. Validation in larger, prospective, and preferably randomized studies is required.
21 July 2026
Read appraisal →Journal of robotic surgery
Safety and feasibility of robotic telesurgery in urological procedures: a systematic review and meta-analysis of clinical data
Robotic telesurgery has emerged as a potential solution to expand access to specialized surgical care; however, clinical evidence remains fragmented across procedures and robotic platforms. We conducted this meta-analysis to assess the feasibility and safety of robotic telesurgery across urological procedures. An electronic search was conducted on PubMed, Scopus, Web of Science (WoS) and the Cochrane Library from inception through April 2026 according to PRISMA guidelines. Clinical studies reporting robotic telesurgery in urology were included regardless of study design. The primary outcome of interest was procedural success, defined as completion without conversion to a local surgeon or an alternative surgical approach. Secondary outcomes included complication rates and round-trip latency (RTL). Nineteen studies involving 164 patients were included. The pooled procedural success rate was 0.92 (95% CI: 0.86-0.96). No conversions to open or laparoscopic surgery were reported across the included studies. The pooled complication rate was 0.12 (95% CI: 0.07-0.20), with events occurring in a limited number of studies. RTL data were available from 14 studies, with a pooled mean latency of 123.30 milliseconds (ms) (95% CI: 81.76-164.83) demonstrating substantial heterogeneity (I² = 99.99%). Robotic telesurgery in urology demonstrates excellent technical feasibility and a favorable short-term safety profile in carefully selected cases. However, variability in network performance and procedure-specific requirements remain important considerations. Further prospective studies with standardized reporting and long-term outcome assessment are needed before widespread clinical adoption can be recommended.
21 July 2026
Read appraisal →Journal of robotic surgery
Technical advancements in robot-assisted radical prostatectomy: systematic review and bibliometric analysis
Robot-assisted radical prostatectomy has transformed the surgical management of localized prostate cancer, yet its research landscape remains incompletely mapped. We conducted a systematic review and bibliometric analysis of 578 articles and conference papers from Scopus and Web of Science (2005-2026), following PRISMA guidelines, and analyzed publication trends, geographic and institutional distribution, author networks, journal output, keyword co-occurrence, and thematic evolution. The results reveal exponential growth in research, with an inflection around 2015-2016 and accelerated momentum after 2020, reflecting the widespread adoption and maturation of robotic programs. The United States leads in publication volume, followed by Italy and the rapidly growing contribution of China, while The University of Turin (Italy) emerges as the most productive institution due to its pioneering Retzius-sparing approach; the Journal of Robotic Surgery remains the leading publication venue. Thematic analysis demonstrates a progression from early feasibility studies to the standardization of nerve-sparing and continence-preserving techniques, advancing toward single-port surgery, augmented reality navigation, and AI-assisted intraoperative decision-making. Emerging technologies such as augmented reality, the NeuroSAFE protocol, and deep learning models for outcome prediction are particularly transformative, and geographic disparities are highlighted as critical priorities for future research.
21 July 2026
Read appraisal →Breast cancer research and treatment
Extended applications of chest wall perforator flaps in breast surgery: case series and systematic literature review
PURPOSE: Chest wall perforator flaps (CWPFs) are integral to modern oncoplastic breast surgery, offering volume replacement without muscle sacrifice. While their role in partial breast reconstruction is established, data on extended and non-conventional applications remain limited. This study aims to synthesize current clinical experience and delineate the extended applications of chest wall perforator flaps beyond conventional oncoplastic contexts. METHODS: This study combined a prospective institutional case series from two tertiary centers (Singapore and UK) with a systematic literature review of PubMed, Embase, Web of Science, and Cochrane databases. Eligible studies described CWPF use for extended oncologic, reconstructive, or aesthetic indications. Data were synthesized descriptively according to PRISMA guidelines. RESULTS: Six women underwent LICAP-based reconstruction for complex indications including skin-replacing excisions, implant salvage, chronic sinus closure, and total autologous reconstruction with adjunct lipofilling. All flaps were fully viable with good contour restoration and symmetry, and adjuvant therapy proceeded without delay. The systematic review identified 38 studies (≈ 324 patients, 349 flaps). CWPFs, most commonly LICAP, LTAP, and TDAP, were used for defects following oncologic resection, radiotherapy injury, implant failure, or post-bariatric contour correction. Overall flap success exceeded 95%, with major complications under 5%. Donor-site morbidity was minimal, with high aesthetic satisfaction (> 90%). CONCLUSIONS: CWPFs represent muscle-sparing reconstructive options whose utility may extend beyond conventional oncoplastic indications; this descriptive series supports their feasibility and short-term outcomes across a range of selected clinical settings, suggesting that CWPFs warrant further consideration in the management of complex breast and chest wall defects.
17 July 2026
Read appraisal →Nutricion hospitalaria
Immunonutrition in surgical patients with colorectal cancer: a systematic review
Introduction: surgery in patients with colorectal cancer often leads to complications, affecting recovery, prolonging hospital stay, and impacting quality of life. Immunonutrition plays an important role by modulating the immune system and may contribute to the reduction of these complications. Objective: to assess the effect of immunonutrient supplementation on complications in surgical patients with colorectal cancer. Materials and methods: a literature search was conducted in PubMed, Web of Science, Embase, and Cochrane, following the PRISMA model. A total of 20 clinical trials and two observational studies published between 2000 and 2025 were selected, analyzing postoperative complications, physical or nutritional status, immune response, and length of hospital stay. Results: a reduction in postoperative complications was observed with combined immunonutrient supplementation (arginine, omega-3 fatty acids, nucleotides, L-alanine, and L-glutamine), particularly in wound infections. No benefits were found with isolated supplementation. Conclusion: combined immunonutrient administration may improve postoperative complications, especially wound infections, although results regarding hospital stay are inconsistent. Isolated supplementation with omega-3 fatty acids shows no benefit. Introducción: la cirugía en pacientes con cáncer colorrectal conlleva complicaciones, alterando la recuperación, alargando la estancia hospitalaria y afectando a la calidad de vida. La inmunonutrición ejerce una acción importante al modular el sistema inmunológico y podría mejorar estas complicaciones. Objetivo: evaluar el efecto de la suplementación con inmunonutrientes en las complicaciones en pacientes quirúrgicos por cáncer colorrectal. Material y métodos: se realizó una búsqueda bibliográfica en PubMed, Web of Science, Embase y Cochrane, siguiendo el modelo PRISMA. Se seleccionaron 20 ensayos clínicos y dos observaciones, publicados entre 2000 y 2025, que analizaron complicaciones posoperatorias, el estado físico o nutricional, la respuesta inmune y la duración de estancia hospitalaria. Resultados: se halló una reducción de las complicaciones posoperatorias con una suplementación combinada de inmunonutrientes como arginina, ácidos grasos omega-3, nucleótidos, L-alanina y L-glutamina, especialmente en infecciones de herida, sin beneficios en la administración aislada. Conclusión: la administración combinada podría mejorar las complicaciones posquirúrgicas, especialmente de la infección de la herida, con resultados contradictorios para estancia hospitalaria. La suplementación aislada de ácidos grasos n-3 no aporta beneficios.
15 July 2026
Read appraisal →Hernia : the journal of hernias and abdominal wall surgery
Clinical outcomes in abdominal wall autologous flap reconstruction: a systematic review
PURPOSE: Complex abdominal wall defects present major reconstructive challenges when restoration of fascial continuity must be combined with durable soft-tissuecoverage, visceral protection, and, in selected cases, functional repair. Although autologous flap reconstruction is well established for selected indications, its overall role across defect types has yet to be established. METHODS: A systematic review was performed in accordance with PRISMA guidelines (PROSPERO: CRD42023491916). PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar were searched from inception to April 2026 for studies reporting adult autologous flap-based abdominal wall reconstruction. Given substantial clinical and methodological heterogeneity, data were analysed descriptively. RESULTS: 172 studies comprising 4,421 patients were included. Pedicled flaps predominated (n=4,095, 92.6%), with free flaps used in 146 patients (3.3%) and mixed approaches in 180 (4.1%). Hernia-related pathology was the commonest indication (n=3751, 84.8%), followed by malignancy (n=470, 10.6%). Frequently used flap categories included anterolateral thigh, tensor fascia lata, rectus-based, and latissimus dorsi-based flaps. Flap selection was primarily defect-driven: fascia-bearing regional and turnover techniques were used mainly for structurally focused hernia repair, whereas composite flaps were used more often for oncologic, fistulating, traumatic, contaminated, or full-thickness defects. Common short-term complications include seroma, surgical site infection, and wound dehiscence. Flap failure and reported long term hernia recurrence were low. Free flaps were used more often for larger defects weighted mean 401 cm² vs 250 cm² for pedicled flaps), although size ranges overlapped. CONCLUSIONS: Autologous flap reconstruction is a durable and versatile option for selected complex abdominal wall defects. Reconstructive strategy should be guided primarily by defect composition.
10 July 2026
Read appraisal →Journal of gastrointestinal cancer
Tumour-Associated Neutrophils in Colorectal Cancer: a Systematic Review, Meta-analysis, and Comprehensive Literature Review
PURPOSE: Neutrophils are at the forefront of innate immune response. The prognostic impact of tumour-associated neutrophils (TANs) remains unclear. This study aimed to evaluate the prognostic role of TANs in colorectal cancer (CRC). METHODS: A systematic review and meta-analysis were conducted using PubMed, Embase, and Scopus to identify studies correlating TANs with time-to-event survival analysis in patients with stages I-IV CRC from the date of inception until April 2024. Articles were included if they involved the identification of TANs through hematoxylin-eosin (HE) or immunohistochemistry (IHC) and reported survival analysis. Data was collected from the tumour core (TC) and invasive margin (IM). The hazard ratios (HRs) were extracted from the study results. Heterogeneity was evaluated using Cochran's Q and I². Primary and secondary endpoints were overall survival (OS) and disease-free survival (DFS). RESULTS: Of 4,292 citations found, 18 studies fulfilled eligibility criteria, encompassing 7,406 patients. IHC was used to identify TANs in 12 trials, while six performed HE. Five studies included patients with disease stages I-III, and 13 had stages I-IV. High TANs at the IM were associated with improved OS (HR = 0.64, 95% Confidence Interval [CI] 0.50-0.81, I2 = 48%) and DFS (HR = 0.47, 95% CI 0.25-0.88, I2 = 32%). At the TC, high TANs showed a trend towards better OS (HR = 0.82, 95% CI 0.61-1.10, I2 = 83%) and DFS (HR = 0.48, 95% CI 0.21-1.07, I2 = 93%), although not statistically significant and with high heterogeneity. CONCLUSION: In this systematic review and meta-analysis, high TANs at the invasive margin (IM), the tumour-host interface, was associated with improved prognosis in CRC. In contrast, no statistically significant association was observed for high TANs at the tumour core (TC).
9 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Patients' expectations and barriers towards postoperative telehealth follow-up after oncologic breast surgery in France
BACKGROUND: Surgery is the most frequent treatment for breast cancer and requires postoperative follow-up to detect complications and monitor patient recovery. Postoperative telemonitoring has demonstrated benefits in improving rehabilitation and psychological well-being. However, patient expectations of and barriers to telehealth follow-up after oncologic breast surgery remain insufficiently explored. METHODS: A prospective survey was conducted among adult patients attending pre- or postoperative follow-up appointments for breast cancer in the Department of Breast and Reconstructive Surgery at the Civil Hospitals of Colmar between March and August 2025. The questionnaire comprised four sections: demographic data, treatments received, telemedicine accessibility and acceptability, and patient expectations of and barriers to telemonitoring. RESULTS: A total of 124 questionnaires were analyzed. Results demonstrated high accessibility to digital tools among participants. Although patients recognized several advantages of telemonitoring, most expressed a strong preference for in-person follow-up visits. The most expected features included the ability to report postoperative complications and to monitor recovery and pain. The main barrier was the fear of reduced human contact. Retired status was associated with lower acceptance of postoperative telemonitoring. CONCLUSION: These findings support the implementation of a hybrid follow-up model combining early postoperative telemonitoring with later in-person consultations, which could help reassure patients and shorten hospital stays while maintaining personalized care. The monocentric design may limit the external validity of the findings. Future studies should explore patients' perceptions following repeated use of telemonitoring tools and incorporate healthcare professionals' perspectives on their integration into clinical practice.
7 July 2026
Read appraisal →World journal of surgical oncology
Robotic-assisted versus conventional nipple-sparing mastectomy with immediate implant-based breast reconstruction: a GRADE-assessed systematic review and meta-analysis of prospective studies
BACKGROUND: Robotic nipple-sparing mastectomy with immediate implant-based reconstruction is increasingly adopted to improve cosmetic outcomes and patient experience; however, its comparative perioperative value against conventional or open nipple-sparing mastectomy remains uncertain when restricted to prospective evidence. METHODS: We performed a PRISMA-aligned systematic review and random-effects meta-analysis of prospective comparative studies and randomized trials comparing robotic versus conventional or open nipple-sparing mastectomy with immediate implant-based reconstruction. The primary outcome was the total operative time, and the secondary outcomes were major complications, nipple-areolar complex ischemia or necrosis, and length of hospital stay. The risk of bias was assessed using RoB 2 for randomized data and ROBINS-I for nonrandomized data. Leave-one-out sensitivity analyses were conducted for outcomes with substantial heterogeneity, and the certainty of the evidence was graded using GRADE. RESULTS: Three prospective studies were included. Robotic surgery was associated with a significantly longer total operative time (mean difference 64.01 min, 95% confidence interval 8.54-119.47). Major complications did not differ between the approaches (risk ratio 0.63, 95% confidence interval 0.27-1.47), nor did nipple areolar complex ischemia or necrosis (risk ratio 0.56, 95% confidence interval 0.28-1.11) or length of hospital stay (mean difference 0.22 days, 95% confidence interval - 0.26 to 0.70). Heterogeneity was high for operative time and moderate to substantial for length of stay. The certainty of the evidence was low overall, driven by imprecision, heterogeneity, and limitations of the non-randomized design. CONCLUSIONS: Robotic nipple-sparing mastectomy is associated with a longer operative time than conventional or open approaches. No statistically significant differences were observed in major complications or nipple-areolar complex viability; however, the current prospective evidence base is limited, heterogeneous, and imprecise, and clinically important differences cannot be excluded. In experienced centers, robotic nipple-sparing mastectomy may be considered for carefully selected patients who prioritize scar concealment and minimally invasive access; however, its broader role in routine practice remains uncertain pending stronger prospective data on safety, patient-reported outcomes, and resource use.
26 June 2026
Read appraisal →Journal of robotic surgery
Emerging robotic platforms in gynecologic surgery: a systematic review.
Robotic innovation in gynecologic surgery has expanded beyond established multiport ecosystems toward single-port, modular multi-arm, transvaginal, AI-enabled, and teleoperated platforms. However, available evidence remains fragmented and unsuitable for quantitative synthesis. This systematic review evaluated emerging robotic platforms in gynecologic surgery, focusing on procedure types, outcomes, costs, and learning curves. The review was prospectively registered in PROSPERO (CRD420261360389). Eligible studies included clinical studies evaluating emerging robotic platforms in gynecologic surgery. PubMed, Scopus, and Web of Science were searched on 4 April 2026. After duplicate removal, 408 records were screened, 160 full texts assessed, and 92 studies included. Data extraction and risk of bias assessment were performed independently in duplicate. The 92 studies covered 13 platforms and were mainly retrospective single-center studies. Evidence was most extensive for da Vinci SP and HUGO RAS, with more limited but informative data for Senhance, Versius, hinotori, and KANGDUO. Evidence for other systems consisted mainly of first-in-human, pilot, or feasibility studies. Hysterectomy and sacrocolpopexy were the most frequently reported procedures. Overall, perioperative outcomes and short-term safety appeared favorable, despite limited follow-up and heterogeneous outcome definitions. Cost data were mainly available for Senhance and KANGDUO. Learning-curve evidence was strongest for da Vinci SP and HUGO RAS. Risk-of-bias was predominantly moderate. Emerging robotic platforms have demonstrated broad technical feasibility and generally acceptable short-term perioperative safety in selected gynecologic procedures, but current evidence is heterogeneous, observational, and methodologically limited. Rigorous prospective studies, standardized economic analyses, longer follow-up, and learning-curve evaluations are needed before comparative conclusions can be drawn.
23 June 2026
Read appraisal →Journal of robotic surgery
A focused systematic review and meta-analysis of robot-assisted inguinal lymphadenectomy versus open inguinal lymph node dissection in penile cancer
This focused systematic review and meta-analysis evaluated robot-assisted inguinal lymphadenectomy (RAIL) versus open inguinal lymph node dissection (OILND) in penile cancer, aiming to provide robot-specific comparative estimates rather than a broad minimally invasive synthesis. PubMed, EMBASE, Web of Science, and the Cochrane Library were searched through December 2025 for comparative studies. All meta-analyses were conducted using STATA 18, employing random-effects modeling. Binary outcomes were summarized using odds ratios (ORs), and continuous outcomes were presented as weighted mean differences (WMDs), with all estimates accompanied by 95% confidence intervals (CIs). Risk of bias in the included non-randomized comparative studies was assessed using the ROBINS-I tool. Four retrospective comparative studies involving 276 patients were included, and no randomized controlled trials were identified. A lower odds of total postoperative complications was observed with RAIL (OR = 0.52, 95% CI: 0.27, 0.97; P = 0.047), but this borderline finding should be interpreted cautiously given the small number of retrospective studies and potential residual confounding. Across individual studies, operative time generally tended to be longer with RAIL, whereas findings for estimated blood loss and drainage-related outcomes were inconsistent. Lymph node yield, skin-related complications, minor complications, and groins with positive nodes did not differ significantly between approaches. According to the GRADE assessment, the certainty of evidence was low for most pooled outcomes and very low for skin-related complications and lower-limb edema/lymphedema. RAIL may be associated with lower overall postoperative complications than open surgery, but the evidence remains low certainty and insufficient to establish a definitive morbidity-reduction benefit. In addition, several continuous perioperative variables showed extreme between-study heterogeneity and were not clinically interpretable as reliable pooled effects.
22 June 2026
Read appraisal →Journal of robotic surgery
Rethinking health technology assessment in robotic surgery: an EFISDS-TROGSS position paper. Official position paper of the European Federation - International Society for Digestive Surgery (EFISDS) and The Robotic Global Surgical Society (TROGSS).
Robotic-assisted surgery (RAS) has evolved from a procedural innovation into an increasingly integrated component of contemporary digital surgical ecosystems. Nevertheless, most current Health Technology Assessment (HTA) frameworks continue to evaluate robotic systems primarily through comparator-based models focused on isolated perioperative and oncological outcomes. In this EFISDS-TROGSS position paper, we critically examine the methodological limitations of conventional HTA paradigms when applied to robotic surgical platforms, using the recent Italian AGENAS appraisal as a representative case study. While the AGENAS document represents one of the most comprehensive national evaluations of RAS performed to date, its heterogeneous recommendations across procedures highlight unresolved tensions regarding perioperative benefit, real-world implementation, learning curves, organizational impact, and long-term healthcare value. We argue that RAS should increasingly be interpreted not simply as a surgical device, but as a platform technology interacting with simulation-based training, digital infrastructure, surgical data science, artificial intelligence, telecommunication systems, and institutional organization. Rather than a surgical device alone, RAS should be interpreted and regarded as a combination of technological advances and approaches that integrate various degrees of artificial intelligence autonomy, image navigation, telesurgery, and other benefits to empower the surgical team. Conventional HTA models, originally developed for relatively discrete therapeutic interventions, may incompletely capture the multidimensional interaction between robotic technologies and modern healthcare systems. Particular attention is dedicated to real-world evidence, implementation maturity, reimbursement limitations, and the growing mismatch between current Diagnosis-Related Group (DRG) structures and technologically integrated surgical care. Finally, we propose more flexible and multidimensional assessment frameworks integrating procedural outcomes with organizational sustainability, digital interoperability, workforce implications, and longitudinal healthcare value.
20 June 2026
Read appraisal →Journal of robotic surgery
Transoral robotic surgery using the da Vinci single-port system: current evidence and clinical indications - a systematic review and meta-analysis
The DaVinci Single-Port (SP) transoral robotic surgery (TORS) platform was developed to overcome spatial constraints and instrument collisions encountered with multiport systems in head and neck surgery. We systematically reviewed and meta-analyzed perioperative performance, safety, functional recovery, and oncologic outcomes of SP TORS. Following PRISMA 2020, we searched PubMed/MEDLINE, Embase, Cochrane Library, Web of Science, and the first 25 pages of Google Scholar through January 1, 2026. Peer-reviewed English-language clinical and cadaveric studies evaluating SP TORS were included. Three reviewers screened studies and extracted data. Random-effects meta-analyses were performed where appropriate. Fourteen studies (2019-2025) including 479 patients met inclusion criteria. Patient-level evidence was concentrated in oncologic cohorts, with additional smaller clinical applications in obstructive sleep apnoea-related tongue-base surgery (37 patients), hypopharyngeal foreign body removal (1 patient), parapharyngeal space surgery (2 patients), and SP-assisted reconstruction (3 patients), as well as preclinical feasibility studies. No study reported intraoperative conversion to multiport or open surgery. Pooled estimates were console time 60.04 min (95% CI 29.56-90.51; I² = 99.1%), docking time 10.13 min (0.47-19.79; I² = 97.9%), operative time 57.72 min (37.23-78.21; I² = 0.0%), length of stay 10.63 days (2.43-18.82; I² = 99.8%), and blood loss 24.16 mL (- 6.95 to 55.27; I² = 86.8%). Bleeding was the most consistently reported surgical complication, with major bleeding requiring operative management reported in larger cohorts but remaining uncommon. Functional recovery suggested early oral intake, although timing was inconsistently reported. Margin status was predominantly R0 in several oncologic cohorts, although one matched cohort reported a lower R0 rate. SP TORS appears feasible across indications, but current evidence is limited by nonrandomized designs, inconsistent long-term reporting, and between-study heterogeneity.
14 June 2026
Read appraisal →Med (New York, N.Y.)
Neoadjuvant mFOLFOXIRI with or without cadonilimab versus mFOLFOX6 in locally advanced colorectal cancer: A randomized phase 2 trial (OPTICAL-2)
BACKGROUND: The efficacy of neoadjuvant chemotherapy combined with dual immune checkpoint blockade in proficient mismatch repair/microsatellite-stable (pMMR/MSS) locally advanced colorectal cancer (LACRC) remains uncertain. METHODS: In this open-label, randomized phase 2 trial (ClinicalTrials.gov: NCT05571644), eligible patients were randomly assigned (1:1:1) to receive 6 cycles of neoadjuvant mFOLFOXIRI plus cadonilimab, mFOLFOXIRI, or mFOLFOX6, followed by surgery and adjuvant chemotherapy. The primary endpoint was pathological complete response (pCR) in the intention-to-treat population. Secondary endpoints included major pathological response (MPR), safety, locoregional recurrence, disease-free survival, and overall survival. FINDINGS: Between July 2023 and August 2024, 123 patients were randomly assigned (41 per group). Neoadjuvant mFOLFOXIRI plus cadonilimab significantly improved pCR compared with mFOLFOX6 (26.8% versus 9.8%; odds ratio [OR], 3.4; 95% confidence interval [CI], 1.04 to 13.24; p = 0.046), whereas mFOLFOXIRI alone did not (14.6% versus 9.8%; OR, 1.6; 95% CI, 0.4 to 6.7; p = 0.50). MPR rates were 68.3%, 46.3%, and 43.9%, respectively, and were significantly higher with mFOLFOXIRI plus cadonilimab than with mFOLFOX6 (p = 0.026). Downstaging to ypStage 0-I occurred in 66%, 45%, and 41% of patients in the three groups, respectively, and was significantly higher in the mFOLFOXIRI plus cadonilimab group (p = 0.027). Grade ≥3 adverse events were manageable, with liver enzyme elevation and neutropenia being the most common. CONCLUSIONS: Neoadjuvant mFOLFOXIRI plus cadonilimab significantly improved pCR compared with mFOLFOX6 in LACRC, with a manageable safety profile, supporting further investigation. FUNDING: This work was funded by the National Science Fund for Distinguished Young Scholars (82425045) and the National Natural Science Foundation of China (82272800).
14 June 2026
Read appraisal →Techniques in coloproctology
Robotic versus laparoscopic TME for rectal cancer: meta-analysis of pathological quality indicators
BACKGROUND: Total mesorectal excision (TME) quality is a key determinant of oncological outcomes in rectal cancer. While robotic surgery offers technical advantages over laparoscopy in the confined pelvis, its superiority regarding pathological outcomes remains debated. We conducted a meta-analysis comparing robotic and laparoscopic TME focusing on quality indicators of TME and risk factors for incomplete TME. METHODS: A PROSPERO-registered systematic search of PubMed and EMBASE up to May 2025. Comparative studies reporting pathological outcomes of robotic versus laparoscopic TME were included. Primary endpoints were TME completeness, circumferential resection margin (CRM) positivity and distal resection margin (DRM) positivity. Secondary analysis included baseline characteristics (male gender, BMI, bulky tumours, distance to anal verge, neoadjuvant radiotherapy) and local recurrence rate. RESULTS: Fifty-six studies (27,648 patients; robotic 10,629, laparoscopic 17,019) were included. Robotic surgery was associated with significantly more complete TME specimens (OR 1.50, 95% CI 1.23-1.82, p < 0.001) and fewer positive DRMs (OR 0.68, 95% CI 0.48-0.97, p = 0.031). CRM positivity was comparable between groups (OR 0.93, 95% CI 0.77-1.12, p = 0.44). In random-effects analysis, there was a non-significant trend towards fewer local recurrences after robotic TME (OR 0.75, 95% CI 0.54-1.05, p = 0.09). Robotic cohorts more frequently included male patients, distal tumours and neoadjuvant chemoradiotherapy, suggesting preferential selection of technically challenging cases. CONCLUSIONS: Robotic TME is associated with higher specimen completeness and lower DRM positivity compared with laparoscopic TME, while CRM positivity and local recurrence rates appear broadly similar. These data support the use of robotics as a primary minimally invasive option for mid-low rectal cancer; however, as a result of low certainty of evidence, these findings should be interpreted cautiously. SYNOPSIS: This meta-analysis provides the most up-to-date synthesis of pathological outcomes comparing robotic and laparoscopic TME for rectal cancer, incorporating data from 56 studies including the recent REAL and COLRAR randomized trials. Unlike previous reviews, it exclusively analyses total mesorectal excision procedures, excluding partial or high anterior resections, thereby eliminating a major source of heterogeneity. The findings demonstrate that robotic TME is associated with higher specimen completeness and fewer positive distal margins, even in technically demanding mid- and low-rectal cancers, supporting the role of robotics as the preferred minimally invasive approach in mid-low, difficult tumours.
1 June 2026
Read appraisal →Journal of gastrointestinal cancer
Durable Survival Outcomes After Liver Transplantation for Colorectal Liver Metastases: A Systematic Review and Single-arm Meta-analysis of Prospective Clinical Trials
BACKGROUND: Liver transplantation (LT) has emerged as a potential treatment option for selected patients with colorectal liver metastases (CRLM), but existing meta-analyses are limited by heterogeneous populations and mixed treatment modalities. METHODS: A systematic review and single-arm meta-analysis were conducted in accordance with PRISMA guidelines. Studies reporting outcomes following LT for CRLM were included. Primary outcomes were overall survival (OS) and progression-free survival (PFS) at predefined time points. Secondary outcomes included adverse events. Pooled proportions were calculated using random-effects models with logit transformation and Hartung-Knapp adjustment. Heterogeneity was assessed using the I² statistic. RESULTS: Four prospective studies (1 RCT, 3 prospective cohorts) comprising 118 patients were included. Studies were conducted in Norway (SECA-I, n = 21; SECA-II, n = 15), the United Kingdom (n = 50), and a European multicentre RCT (TransMet, n = 32). Median age ranged from 55 to 58 years; all patients had liver-only metastases with resected primary tumors and had received pre-transplant chemotherapy. The pooled 3-year OS was 69% (95% CI, 52-82%; I² = 0.0%), and the pooled 5-year OS was 62% (95% CI, 36-83%; I² = 14.6%). The pooled 3-year PFS was 33% (95% CI, 7-76%), with substantial heterogeneity (I² = 62.8%). The pooled incidence of adverse events was 41% (95% CI, 25-60%; I² = 0.0%). Sensitivity analyses confirmed the robustness of pooled estimates. The retrospective literature also supported the finding that LT can achieve meaningful long-term survival in carefully selected patients. CONCLUSIONS: In carefully selected patients with CRLM, LT is associated with durable long-term survival and an acceptable safety profile, supporting further prospective evaluation and refinement of selection criteria.
31 May 2026
Read appraisal →Journal of robotic surgery
Comparative efficacy and safety of open, laparoscopic, and robot-assisted radical cystectomy: a systematic review and network meta-analysis
The most appropriate surgical strategy for radical cystectomy in bladder cancer remains to be established. This study performed a network meta-analysis of randomized controlled trials to evaluate open, laparoscopic, and robot-assisted approaches. Outcomes were systematically classified into intraoperative metrics, postoperative recovery, perioperative safety, and oncological efficacy. A random effects model was employed, and treatment hierarchy was determined using the surface under the cumulative ranking curve. Eleven studies comprising 1270 patients met the inclusion criteria. Compared with open surgery, minimally invasive techniques were associated with reduced intraoperative blood loss and lower transfusion rates, although they required longer operative time. Among these, laparoscopic surgery was associated with a potentially greater likelihood of enhanced postoperative recovery and fewer complications, although these findings should be interpreted with caution given the sparse network and substantial heterogeneity in some outcomes. Robot-assisted procedures did not demonstrate consistent superiority over laparoscopy in perioperative measures. Oncological outcomes were similar across all modalities. Overall, minimally invasive approaches confer perioperative benefits and appear comparable to open surgery with respect to short-term surrogate oncological endpoints, although long-term outcomes remain to be determined.
31 May 2026
Read appraisal →The New England journal of medicine
Zanidatamab with and without Tislelizumab in HER2-Positive Gastroesophageal Cancer
BACKGROUND: Zanidatamab, a dual human epidermal growth factor receptor 2 (HER2)-targeted bispecific antibody, plus chemotherapy both with and without tislelizumab (anti-programmed death 1), showed encouraging efficacy and safety as first-line therapy in phase 2 studies involving patients with HER2-positive gastroesophageal adenocarcinoma. METHODS: In an open-label, phase 3 trial, we randomly assigned, in a 1:1:1 ratio, patients with previously untreated, centrally confirmed HER2-positive advanced gastroesophageal adenocarcinoma to receive zanidatamab and tislelizumab plus chemotherapy, zanidatamab plus chemotherapy, or trastuzumab plus chemotherapy. The two primary end points were progression-free survival and overall survival. RESULTS: At a median follow-up of 25.9 months, progression-free survival was longer with zanidatamab-tislelizumab-chemotherapy (median among 302 patients, 12.4 months) and zanidatamab-chemotherapy (median among 304 patients, 12.4 months) than with trastuzumab-chemotherapy (median among 308 patients, 8.1 months) (hazard ratio for progression or death with zanidatamab-tislelizumab-chemotherapy, 0.63 [95% confidence interval {CI}, 0.51 to 0.78]; hazard ratio with zanidatamab-chemotherapy, 0.65 [95% CI, 0.52 to 0.81]; P<0.001 for both comparisons). Overall survival was longer with zanidatamab-tislelizumab-chemotherapy than with trastuzumab-chemotherapy (median, 26.4 vs. 19.2 months; hazard ratio for death, 0.72; 95% CI, 0.57 to 0.90; P = 0.004). At this interim analysis, overall survival did not differ significantly between zanidatamab-chemotherapy (median, 24.4 months) and trastuzumab-chemotherapy (hazard ratio, 0.80; 95% CI, 0.64 to 1.01; P = 0.06). The incidence of grade 3 or higher adverse events was 83.3% with zanidatamab-tislelizumab-chemotherapy, 73.8% with zanidatamab-chemotherapy, and 74.5% with trastuzumab-chemotherapy; diarrhea was the most common such event, in 24.8%, 20.0%, and 12.9% of patients, respectively. CONCLUSIONS: Zanidatamab plus chemotherapy, both with and without tislelizumab, led to longer progression-free survival than trastuzumab plus chemotherapy among patients with HER2-positive advanced gastroesophageal adenocarcinoma. At this interim analysis, overall survival was longer with zanidatamab-tislelizumab-chemotherapy than with trastuzumab-chemotherapy; further analyses are planned to assess zanidatamab-chemotherapy. Diarrhea was a common adverse event. (Funded by Jazz Pharmaceuticals and others; HERIZON-GEA-01 ClinicalTrials.gov number, NCT05152147.).
29 May 2026
Read appraisal →JBJS reviews
Reconstruction of the Proximal Tibia and Extensor Mechanism After Tumor Resection: A Systematic Review and Meta-Analysis
BACKGROUND: Proximal tibia reconstruction after tumor resection is technically challenging due to the dual requirement of skeletal stability and extensor mechanism restoration. Multiple reconstruction methods exist, but comparative data on complications, survival, and functional outcomes remain limited. This study aimed to compare complication rates and implant survival across different proximal tibia reconstruction methods (megaprostheses, osteoarticular allografts [OAs], intercalary allografts [ICAs], and allograft-prosthetic composites [APCs]) and to evaluate how extensor mechanism reconstruction technique influences functional outcomes. METHODS: A systematic review and meta-analysis was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Embase databases were searched through September 2025. Studies reporting outcomes of proximal tibia and/or extensor mechanism reconstruction for oncologic indications were included. Complications were classified using the Henderson system. Random-effects meta-analysis was performed for complication rates, implant survival, and extension lag. Subgroup analyses were performed by reconstruction type. RESULTS: Seventy-eight studies including 2,825 patients were analyzed (mean age 25.9 years, mean follow-up 84.7 months). Prosthetic reconstruction demonstrated the lowest overall complication rate (39.2%, 95% confidence interval [CI] 32%-45%) compared with OAs (69.6%, 95% CI 55%-82%), APCs (52.7%, 95% CI 32%-73%), and ICAs (53.4%, 95% CI 34%-70%) (p = 0.004). Biological reconstructions had significantly higher structural failure rates (OA 31.0%, ICA 24.5% vs. prosthesis 5.5%, p < 0.001). Five-year implant survival showed no significant differences between prosthesis (75.3%), OA (67.4%), and APC (74.3%). At 10 years, survival rates converged across all methods (63%-71%). Extensor mechanism reconstruction technique significantly influenced extension lag: direct tendon-to-metal reattachment (11.0°) resulted in worse outcomes than synthetic augmentation (5.7°), allograft reattachment (4.6°), or autograft reconstruction (2.3°) (p < 0.001). CONCLUSION: While prosthetic reconstruction offers lower short-term complication rates, long-term implant survival is comparable across reconstruction methods. Extensor mechanism reconstruction technique is a critical determinant of functional outcome. Surgeons should consider techniques beyond simple direct reattachment, particularly synthetic augmentation or biological reconstruction, when feasible to optimize extension function. Individual patient factors should guide selection between prosthetic and biological reconstruction. LEVEL OF EVIDENCE: Level IV. See Instructions for Authors for a complete description of levels of evidence.
27 May 2026
Read appraisal →Clinical and experimental dermatology
The role of dermoscopy in optimizing surgical margins for keratinocyte cancers: updated evidence from a systematic review and meta-analysis
BACKGROUND: Keratinocyte cancer (KC) is the most common malignancy worldwide. Surgical excision is the primary treatment, with clear margin delineation critical for oncological and cosmetic outcomes. Dermoscopy, well established for diagnosis, has recently been included in updated British guidelines as an alternative method for surgical margin planning and may offer improved border visualization. OBJECTIVES: To update the existing evidence on dermoscopy-guided excision of KC, focusing on margin control and recurrence risk and incorporating newly published studies and re-evaluating its use considering evolving guideline recommendations. METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, EMBASE and CENTRAL were searched to October 2024. Eligible studies compared dermoscopy-guided with conventional surgical excision of histologically confirmed KC. The primary outcome was the incomplete excision rate. Risk of bias was assessed using ROBINS-I, and meta-analysis was conducted using a DerSimonian-Laird random-effects model. RESULTS: Ten studies (1151 patients; 1186 lesions) were included; 4 contributed to meta-analysis. Most focused on basal cell carcinoma; squamous cell carcinoma data were limited. Dermoscopy was associated with improved surgical precision and reduced incomplete excision (pooled odds ratio 0.30, 95% confidence intervals 0.27-0.34, P < 0.001; I² = 0%, P > 0.99), although all studies were observational and at moderate to serious risk of bias. Narrower margins were often achieved without compromising recurrence outcomes. CONCLUSIONS: Dermoscopy may enhance preoperative planning in KC excision, but evidence remains limited by methodological constraints. These findings support further high-quality trials to confirm clinical utility and define its role in future surgical guidelines.
27 May 2026
Read appraisal →Journal of robotic surgery
Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for resectable esophageal cancer: a systematic review and meta-analysis
Robot-assisted minimally invasive esophagectomy (RAMIE) has emerged as an alternative to conventional minimally invasive esophagectomy (MIE) for esophageal cancer, but its short-term perioperative advantages remain uncertain. To compare early postoperative outcomes of RAMIE and MIE in patients with resectable esophageal cancer, this systematic review and meta-analysis was conducted according to PRISMA 2020 guidelines. PubMed was searched for randomized controlled trials, propensity score-matched studies, and retrospective comparative studies published between January 2005 and December 2024. Adult patients undergoing RAMIE or conventional MIE for resectable esophageal cancer were included. Random-effects models were used to pool standardized mean differences and odds ratios with 95% confidence intervals. Study quality was assessed using the MINORS criteria and Cochrane RoB 2 tool. In addition, a post hoc GRADE assessment was carried out for key outcomes to evaluate the certainty of evidence. Forty-one studies involving 13,321 patients were included, of whom 4,327 underwent RAMIE and 8,994 underwent MIE. Compared with MIE, RAMIE was associated with lower blood loss, reduced conversion to open surgery, higher total lymph node yield, greater left recurrent laryngeal nerve lymph node harvest, fewer pulmonary complications, and lower overall postoperative morbidity. ICU stay and hospital stay were also e shorter after RAMIE, whereas operative time was longer. No significant differences were observed in R0 resection, anastomotic leak, recurrent laryngeal nerve palsy, cardiac complications, chyle leak, surgical site infection, or 30- and 90-day mortality. Post hoc GRADE assessment showed that the certainty of evidence was very low across key outcomes, mainly because of the predominance of non-randomized studies, substantial heterogeneity across several pooled analyses, and outcome-specific concerns regarding imprecision and publication bias. RAMIE is safe and may offer some short-term perioperative advantages over conventional MIE without clear evidence of increased major morbidity or short-term mortality. However, the certainty of evidence across key outcomes was very low, and the predominance of nonrandomized studies and substantial heterogeneity across several analyses warrant cautious interpretation. Further adequately powered randomized trials are required.
25 May 2026
Read appraisal →Journal of robotic surgery
Emerging robotic platforms in partial nephrectomy: a comparative systematic review and network meta-analysis
Robotic-assisted partial nephrectomy (RAPN) is the preferred minimally invasive nephron-sparing technique, with outcomes comparable to open and laparoscopic surgery. While most evidence derives from the da Vinci system, newer robotic platforms such as Hugo, Hinotori, KangDuo and MP1000 are emerging. This systematic review and network meta-analysis evaluated perioperative outcomes across available RAPN platforms. A systematic search of PubMed, Cochrane Library, CINAHL, and Scopus identified studies reporting RAPN outcomes across available robotic platforms. Eligible studies included randomized and observational cohorts. Risk of bias was assessed with ROBINS-I. Outcomes included in the analysis operative time (OT), estimated blood loss (EBL), and length of hospital stay (LOS). A frequentist NMA using the "netmeta" R package generated standardized mean differences (SMD) with 95% CIs, and P-scores ranked platform performance. The review was registered on PROSPERO (ID: CRD420251032233). This review was conducted in accordance with PRISMA guidelines. Thirteen studies (n = 2,450) were included. Under fixed-effects model, da Vinci SP (SMD - 0.63, 95% CI - 0.87 to - 0.40) and Xi (-0.52, 95% CI - 0.67 to - 0.38) revealed shorter operative times; however, under random-effects models these differences were not statically significant due to substantial heterogeneity. Heterogeneity (I² ≈ 84%) attenuated these effects. For ischemia time, Hugo RAS (-0.88, 95% CI - 1.45 to - 0.30) and Xi (-0.58, 95% CI - 0.73 to - 0.44) outperformed Si, though differences lost significance under random-effects (I² >90%). No significant differences were found for length of stay, blood loss, or R.E.N.A.L. nephrometry scores, although ranking differences were observed. Preoperative outcomes were revealed a comparable outcome using emerging robotic system with the established system. Favourable trends in operative and ischemia times were showed in some platforms; however, these differences were not vigorous under random-effects models and are limited by substantial heterogeneity. This raised the need for long-term, comparative follow-up studies, as the current evidence remains elementary.
22 May 2026
Read appraisal →Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Randomized Phase II/III Trial Comparing Hepatectomy, Followed by mFOLFOX6 With Hepatectomy Alone for Liver Metastasis From Colorectal Cancer: Long-Term Results of JCOG0603
JCOG0603 demonstrated improved disease-free survival (DFS) with adjuvant mFOLFOX6 after hepatectomy compared with hepatectomy alone in colorectal liver-only metastasis (CRLM), but the overall survival (OS) data were immature. Here, we report OS after long-term follow-up. Eligible patients with colorectal adenocarcinoma and an unlimited number of liver metastases were randomized to adjuvant mFOLFOX6 or hepatectomy alone. DFS was the primary endpoint, and OS was a secondary endpoint. Between March 2007 and January 2019, 151 and 149 patients were randomized to adjuvant chemotherapy and hepatectomy alone, respectively. At a median follow-up of 7.7 years for disease-free surviving patients, 54 (35.8%) and 51 (34.2%) patients had died in the respective arms, (hazard ratio [HR], 1.07 [95% CI, 0.73 to 1.57]). Five-year OS was 73.4% (95% CI, 65.5 to 79.7) and 80.1% (95% CI, 72.6 to 85.7) and 7-year OS was 69.4% (95% CI, 61.2 to 76.2) and 72.4% (95% CI, 64.2 to 79.1), respectively. One patient in the adjuvant chemotherapy arm possibly died of protocol treatment-related toxicity, and one in the hepatectomy-alone arm died of post-protocol treatment complications. Five-year DFS was respectively 49.7% (95% CI, 41.5 to 57.3) and 40.5% (95% CI, 32.5 to 48.3) in the adjuvant chemotherapy and hepatectomy-alone arms (HR, 0.72 [95% CI, 0.54 to 0.97]). Long-term OS did not differ with adjuvant mFOLFOX6 compared with hepatectomy alone in resectable CRLM. Adjuvant mFOLFOX6 may delay recurrence but did not improve long-term survival.
20 May 2026
Read appraisal →The British journal of dermatology
Evaluation and enhancement of the prognostic ability of the eighth edition of TNM staging in cutaneous malignant melanoma: a population-based study, using machine learning, of 111 871 patients
BACKGROUND: Melanoma is the fifth most common cancer in the USA and the UK, with global incidence on the rise. The TNM staging system guides treatment decisions and predicts patients' outcomes. OBJECTIVES: To evaluate the prognostic ability of the eighth edition TNM (TNM-8) staging system to predict overall (OS) and melanoma-specific survival (MSS) in cutaneous malignant melanoma (CMM), and to explore the potential of machine learning (ML) methods to enhance melanoma prognostication. METHODS: The records of adult patients diagnosed with CMM from 2018 to 2022 were extracted from the Surveillance, Epidemiology, and End Results (SEER) Program database. TNM-8 was evaluated using Kaplan-Meier plots and OS and MSS probabilities. Fine-Gray competing risk and accelerated failure time (AFT) models evaluated factors affecting MSS and OS, respectively. ML models were used to evaluate the predictive ability of TNM stages for OS and MSS, compared with that of multiple clinically important prognostic variables. RESULTS: Altogether, 111 871 patients with CMM were included in the analysis, with OS and MSS as survival endpoints. Most T (tumour), N (node), M (metastasis) and TNM-8 stage categories had distinct MSS and OS probabilities, except in the N1 and N2 stages at 12 months and in OS for TNM-8 stages 2 and 3 at 12, 36, 48 and 59 months. Fine-Gray and AFT models showed that age, sex, race/origin, tumour site, histological type, ulceration, Breslow thickness, mitotic rate, number of positive lymph nodes and M stage were important prognostic variables for MSS and OS. ML models showed that TNM had a higher predictive prognostic ability for MSS than OS and that including clinically important prognostic variables in addition to TNM stage has higher discriminative prognostic ability for OS and MSS (testing C-indices range 0.84-0.85 and 0.89-0.92, respectively) than using TNM staging alone (testing C-indices range 0.67-0.72 and 0.82-0.87, respectively). CONCLUSIONS: This proof-of-concept study demonstrated that although TNM staging retains prognostic value, adding important prognostic variables and using ML could improve prognostication for patients with melanoma. ML could be used to develop interactive clinical decision-support tools to improve the prognostication of individuals with melanoma. Cutaneous malignant melanoma is a common type of skin cancer. A guide called the ‘TNM’ is often used to decide what treatment patients should get. It also helps doctors decide how long patients need specialist care for. The guide is also used to help determine what the outlook for a patient might be. Lots of factors can affect the outcome for a person with the disease. These include a person’s age, sex and race. They also include factors related to the tumour, whether lymph glands are involved and whether the cancer has spread to other organs. Not all these factors are included in the current TNM guide. An accurate staging system is important. It will ensure that patients are followed-up and treated appropriately. This will help avoid unnecessary treatment or surveillance. In this study, we used a type of artificial intelligence (AI) to test how well the latest edition of the TNM can determine what the outlook for patients with melanoma is. We also used it to see if adding other important factors could improve its ability to predict the outlook for these patients. We included over 100,000 patients with melanoma from a large database called SEER. We found that using AI in addition to the current TNM guide could enhance the prediction of outcomes for patients with melanoma. The findings suggest that AI could be useful in helping health professionals predict outcomes for patients with melanoma.
20 May 2026
Read appraisal →Current oncology reports
Impact of 18-FDG PET/CT on Multidisciplinary Decision-Making and Management in Abdominal Malignancies: A Systematic Review and Meta-Analysis
PURPOSE: To systematically review and assess the impact of 18 F-FDG PET/CT on multidisciplinary team (MDT) decision-making and management in adults with abdominal malignancies. MATERIALS & METHODS: We searched Ovid MEDLINE, Ovid Epub, Cochrane CENTRAL, EMBASE, and Scopus upto August 31, 2024, for studies including 18-FDG PET/CT and MDT management in abdominal malignancies in adult patients and describing pre- and post-PET/CT treatment plans or MDT decisions. Data extraction followed by independent two reviewer assessment using ROBINS-I framework. A random-effects meta-analysis of proportions was performed for studies reporting management change attributable to PET/CT. RESULTS: Fourteen studies met inclusion criteria, of which seven provided sufficient quantitative data for meta-analysis. A random-effects meta-analysis of the seven eligible quantitative studies showed that 21.8% of patients (95% CI: 10.6%-33.0%, p < 0.001; range: 8-36%) experienced a management change directly attributable to PET-based imaging. Between-study heterogeneity was substantial (I² ≈ 85%, p < 0.001). Reported management changes included cancellation or addition of planned surgery, modification of surgical extent, change in treatment intent between curative and palliative strategies, and alteration of systemic therapy or radiotherapy plans. Evidence on downstream outcomes such as survival, quality of life, and cost-effectiveness was limited and heterogeneous, precluding quantitative synthesis. CONCLUSION: PET/CT leads to a change in MDT management in roughly one in five patients with abdominal malignancies, often through re-staging and identification of occult metastases that alter treatment intent or surgical strategy. The magnitude of impact varies widely by clinical context and tumor type. 1. PET/CT identifies occult metastases and clarifies disease extent, allowing MDTs to avoid futile surgeries and appropriately shift between curative and palliative strategies. 2. Approximately one in five patients experience a meaningful change in management after PET/CT, demonstrating its significant influence on real-world treatment planning. 3. Incorporating PET/CT into MDT discussions enhances diagnostic confidence and supports more coordinated, evidence-based care across surgical, oncologic, and radiologic teams. By highlighting which patients benefit most, the findings support more efficient use of PET/CT, emphasizing the need for standardized outcome measures and prospective data to refine patient selection.
19 May 2026
Read appraisal →Techniques in coloproctology
Bridging the gap: a systematic literature review and meta-analysis on the management of rectal wall defect after transanal excision
BACKGROUND: Transanal resection techniques have gained considerable importance in the treatment of benign and malignant rectal neoplasms. However, there is no definitive consensus on whether the rectal defect should be closed or left open after excision. We sought to provide an updated pooled analysis of the management of rectal wall defect after transanal excision. METHODS: In accordance with PRISMA and Cochrane guidelines, this meta-analysis was performed using the PubMed (MEDLINE), Cochrane Central Register of Controlled Trials, and Google Scholar databases to identify studies comparing perioperative outcomes after rectal defect closure versus leaving the defect open following full-thickness (FT) excision. Odds ratios (ORs) and standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated. Heterogeneity was assessed using Cochrane's Q test. Risk of bias and certainty of evidence were judged by ROBINS-I and GRADE, respectively. RESULTS: Six comparative studies meeting the inclusion criteria were included in the final analysis. Closing the rectal defect was associated with significantly reduced rectal bleeding (OR = 0.57, 95% CI: 0.35-0.94, p = 0.03; I2 = 26%) and re-admission rates (OR = 0.34, 95% CI: 0.16-0.76, p = 0.008; I2 = 0%) compared with the open group, while other outcomes were not significantly different. A prolonged operative time was noted when the rectal wall defect was sutured (SMD = 0.15, 95% CI: 0.03-0.28, p = 0.02; I2 = 44%). CONCLUSIONS: The present analysis revealed that both approaches are safe and technically feasible; however, closing the rectal wall defect after FT excision of rectal neoplasms was associated with lower bleeding and re-admission rates. Nevertheless, randomized studies with homogeneous protocols and consistent long-term outcome data are still needed to provide definitive answers.
17 May 2026
Read appraisal →Journal of robotic surgery
Robotic versus laparoscopic low anterior resection for rectal cancer: an updated systematic review and meta-analysis
Robotic surgery has increasingly been adopted for the treatment of rectal cancer. However, most previous meta-analyses included heterogeneous rectal procedures, limiting conclusions specific to low anterior resection. The present study aimed to provide an updated systematic review and meta-analysis comparing robotic versus laparoscopic low anterior resection for rectal cancer. This systematic review and meta-analysis was conducted according to PRISMA guidelines and recommendations from the Cochrane Handbook. PubMed, Scopus, and the Cochrane Library were systematically searched from inception to the most recent date. Comparative studies evaluating robotic low anterior resection (R-LAR) versus laparoscopic low anterior resection (L-LAR) for rectal cancer were included. Risk of bias was assessed using RoB 2 for randomized trials and ROBINS-I for non-randomized studies. Certainty of evidence was evaluated using the GRADE approach. Thirty-three studies including 82,149 patients were analyzed (R-LAR: 56,290; L-LAR: 25,859). R-LAR was associated with a significantly lower conversion rate (OR 0.45, 95% CI 0.40-0.51, p < 0.00001, I²=28%), lower 30-day reoperation rate (OR 0.86, 95% CI 0.77-0.96, p = 0.01, I²=0%), reduced 30-day mortality (OR 0.65, 95% CI 0.52-0.82, p = 0.002, I²=0%), and higher rate of complete total mesorectal excision (OR 2.71, 95% CI 1.38-5.33, p = 0.01, I²=72%). Operative time was significantly longer in the robotic group (MD + 30.58 min, 95% CI 13.71-47.45, p = 0.001, I²=97%). No significant differences were observed for estimated blood loss, overall complications, major complications, anastomotic leakage, postoperative ileus, recovery parameters, length of hospital stay, readmission, circumferential margin positivity, lymph node yield, local recurrence, diverting ileostomy formation, disease-free survival, or overall survival. Robotic LAR may reduce conversion, reoperation, and short-term mortality and may improve completeness of total mesorectal excision, although operative time is longer. These findings suggest potential technical advantages of R-LAR, but high-quality randomized trials are required to determine whether these translate into meaningful clinical benefit.PROSPERO: CRD420261326600.
15 May 2026
Read appraisal →PloS one
A remote monitoring system based on deep learning for real-time assessment of free flaps
PURPOSE: Venous congestion is a major cause of postoperative free flap compromise, and early detection is crucial for improving flap salvage rates and patient outcomes. This study aimed to develop and validate a deep learning (DL)-integrated remote monitoring system with a smartphone application for real-time, quantitative assessment of free flaps, with a specific focus on the early detection of venous congestion. METHODS: This diagnostic study was conducted at our institution. Patients aged 18-60 years who underwent free flap reconstruction between January 2019 and June 2025 were included. The study was divided into three phases: a 5-month model training phase for DL model development and internal validation, a 5-month external validation and clinical application phase, and a 4-month clinical comparison phase. The DL model was developed using TensorFlow Lite and a Flap Segmentation Network (FS-Net). Performance was evaluated through accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC), and clinical outcomes including time to detection and flap survival. RESULTS: A total of 1649 photographs from 615 patients were analyzed in the development and validation of the DL classification model between January 2019 and February 2025. During model development, the model achieved an accuracy of 86.8%, sensitivity of 92.4%, specificity of 79.7%, and AUC of 0.88. Internal validation improved these metrics to 87.6%, 95.0%, 81.1%, and 0.92, respectively. External validation demonstrated the model's generalizability, with an accuracy of 89.3%, sensitivity of 96.2%, specificity of 84.9%, and AUC of 0.93. The clinical application phase showed that the system had an overall accuracy of 92.16%, sensitivity of 95.18%, false-positive rate of 2.62%, and false-negative rate of 4.82%. A total of 113 patients were included in clinical comparison between March 2025 and June 2025. The remote monitoring group exhibited a trend towards a shorter mean time to congestion detection, higher flap survival rate, and shorter mean time to re-exploration, although these differences were not statistically significant. CONCLUSIONS: The DL-integrated remote monitoring system demonstrated high accuracy and reliability in detecting venous congestion. It provided an objective and real-time tool that may help reduce clinical burden and support timely intervention in free flap management. However, its impact on definitive clinical outcomes required further validation in larger studies.
13 May 2026
Read appraisal →Pediatric surgery international
Development of a machine learning-based prognostic prediction model and a web-based tool for pediatric hepatoblastoma: a Surveillance, Epidemiology, and End Results (SEER) database study
BACKGROUND: Prognostic evaluation of pediatric hepatoblastoma (HB) remains challenging due to the low accuracy of traditional risk stratification models. This study aims to leverage the U.S. Surveillance, Epidemiology, and End Results (SEER) database to develop and compare several machine learning-based survival models and create an online prediction tool for individualized survival probability estimation in children with HB. METHODS: A total of 614 pediatric HB patients diagnosed from 2000 to 2021 in the SEER database were identified and randomly split (7:3 ratio) into a training set (n = 429) and an internal hold-out validation cohort (n = 185). This split was selected to retain sufficient data for model development while preserving an adequate validation cohort for performance assessment. Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used for feature selection, and three prognostic prediction models (Cox regression, random survival forest (RSF), and a deep learning-based survival (DeepSurv) neural network) were developed using the training data. Model performance was evaluated by Harrell's concordance index (C-index), time-dependent area under the receiver operating characteristic (ROC) curve (AUC) at 1, 3, and 5 years, and decision curve analysis (DCA). We also used SHapley Additive exPlanations (SHAP) analysis to interpret the RSF model. Based on RSF-derived risk scores, patients were classified into high-, intermediate-, and low-risk groups for survival analysis. Ultimately, a web-based tool was developed to enable real-time prediction of 1-, 3-, and 5-year survival probabilities using individual patient characteristics. RESULTS: In the validation cohort, the RSF model achieved the highest C-index (0.745), outperforming the DeepSurv (0.720) and Cox regression models (0.709). The RSF also yielded favorable 1-year, 3-year, and 5-year AUC values, and DCA indicated a greater net benefit across clinically relevant threshold probabilities. SHAP analysis highlighted distant-stage disease, surgical treatment status, and tumor extent as key factors influencing survival predictions. Kaplan-Meier curves stratified by the RSF risk groups showed significantly different survival outcomes among high-, intermediate-, and low-risk patients (log-rank P < 0.001 for all comparisons). The finalized online tool allows users to input patient characteristics and obtain estimated 1-year, 3-year, and 5-year survival probabilities, which may assist individualized prognostic assessment as an adjunctive reference. CONCLUSION: The RSF-based prognostic model showed favorable predictive performance compared with the Cox and DeepSurv models in this retrospective SEER-based cohort of pediatric HB. With interpretable model outputs and an accessible web-based interface, the model may serve as an adjunctive tool for individualized risk assessment. However, external validation and prospective evaluation are required before routine clinical implementation.
13 May 2026
Read appraisal →Signal transduction and targeted therapy
Total neoadjuvant chemotherapy combined with PD‑1 blockade and IL‑2 in MSS/pMMR locally advanced rectal cancer: short-term results of a prospective, single-arm phase II study
Neoadjuvant therapy has become a cornerstone in the management of locally advanced rectal cancer (LARC). In this single-arm, open-label phase II study, we evaluated the efficacy and safety of total neoadjuvant chemotherapy (TNT) using a CapOX regimen combined with a programmed cell death protein 1 (PD‑1) antibody (sintilimab) and interleukin‑2 (IL‑2) in patients with microsatellite stable (MSS)/defining proficient mismatch repair (pMMR) LARC. A total of 33 patients, aged 18-75 years, with rectal tumors located within 12 cm from the anal verge and staged as cT3/4N_anyM0 or cT_anyN⁺M0, were enrolled. Patients received a regimen consisting of oxaliplatin, sintilimab, capecitabine, and IL‑2 administered in a three‑week cycle, with response evaluations performed after every two cycles. Following six cycles of treatment, 33 patients underwent radical surgery, achieving a 100% R0 resection rate. The pathological complete response (pCR) rate was 42.4% (95% CI: 25.68-59.16%) while the remaining 19 patients (57.6%, 95% CI: 41.07-74.09%) were assessed as having a partial response. The tumor regression grades (TRG) were, TRG1: 3 cases (9.1%, 95% CI: 1.90-25.97%), TRG2: 14 cases (42.4%, 95% CI: 26.27-60.38%), and TRG3: 2 cases (6.1%, 95% CI: 0.73-20.37%), respectively. Surgical safety reported as no cases of grade B/C anastomotic leakage or bowel obstruction. Adverse events (AEs) were manageable, with a 21.2% incidence of grade 3 events and no grade IV/V events or treatment‑related deaths. With a median follow‑up of 25.5 weeks, no recurrences were observed. Analysis of blood and tissue samples from patients with different treatment outcomes revealed significant activation of CD8+ T cells, NK cells, and M1 macrophage subsets in the tumor microenvironment of patients achieving pCR. These compelling data demonstrate promising efficacy with a favorable safety profile in MSS/pMMR LARC. These findings warrant studies to validate this regimen as a novel treatment paradigm for rectal cancer. ClinicalTrials.gov registration: NCT06108596.
10 May 2026
Read appraisal →Cancer medicine
Predicting Prognosis for Gastric Cancer Patients Receiving Neoadjuvant Treatment With Body Composition-Based Deep Learning
BACKGROUND: This study sought to develop an innovative body composition (BC)-based deep learning (DL) model to precisely evaluate survival in gastric cancer (GC) patients undergoing neoadjuvant treatment (NT). MATERIALS AND METHODS: This retrospective study included GC patients undergoing NT from two centers. CT images both pre-NT and post-NT were preprocessed, focusing on the automatic segmentation of subcutaneous fat, visceral fat, and skeletal muscle regions using TotalSegmentator. Delta Radiomics features were extracted using Pyradiomics. After feature fusion and selection, the optimal model is Naive Bayes (Rad model). A hybrid DL model was developed by combining ResNet18 and Transformer networks for feature extraction. The Clinic_Rad_DL model was constructed by combining clinical features, radiomic signatures, and DL signatures. The ExtraTree classifier was used for the Clinic_Rad_DL model, while a separate Cox regression model was developed for survival analysis using the same features. RESULTS: A total of 356 patients (mean age, 59 ± 10 years; 264 males [74.2%]) were enrolled and divided into training, validation, and test sets in a 7:2:1 ratio. The DL model outperformed the Rad model. The Clinic_Rad_DL model outperformed both Rad model and DL model, with AUC of 0.915, 0.890, and 0.890 in training, validation, and test sets, respectively. The Cox proportional hazards model showed C-index of 0.806, 0.803, and 0.819, effectively stratifying patients into high- and low-risk groups with significant survival differences. CONCLUSION: The study developed and validated a BC-based DL model to predict survival in GC patients undergoing NT, offering potential for personalized treatment strategies in clinical practice.
5 May 2026
Read appraisal →Journal of the European Academy of Dermatology and Venereology : JEADV
A deep learning-clinical nomogram hybrid for predicting sentinel lymph node metastasis in melanoma
BACKGROUND: Melanoma is a life-threatening skin malignancy, with sentinel lymph node metastasis (SLNM) serving as a critical prognostic factor. While machine and deep learning models using histopathology have focused on melanoma diagnosis, limited efforts have aimed to predict SLNM. OBJECTIVES: This study aimed to develop a collaborative machine and deep learning model that integrates histopathological patches and clinical data to predict SLNM in patients with invasive melanoma, thereby aiding decision-making regarding sentinel lymph node biopsy. METHODS: A total of 78 invasive cutaneous melanoma cases (43 SLNM-positive and 35 SLNM-negative) from the University of Yamanashi Hospital (2007-2022) were divided into training (n = 60) and test (n = 18) datasets. A clustering-constrained attention multiple-instance learning (CLAM) model was developed using haematoxylin and eosin-stained whole-slide images. Among the four CLAM variants, the model using a ResNet50trunc encoder trained on whole-tissue regions (CLAM-R50) demonstrated the best performance and was further integrated with a clinical nomogram. Hybrid modelling was performed using logistic regression, a support vector machine and gradient boosting. RESULTS: CLAM-R50 achieved an area under the receiver operating characteristic curve (AUROC) of 0.875, while the clinical nomogram achieved an AUROC of 0.826 on the test set. The gradient boosting hybrid model, termed the Melanoma Indicative Scorer for Sentinel Lymph node Evaluation (MISSLE), demonstrated the highest AUROC of 0.950 (95% bootstrapped confidence interval (CI): 0.933-1.00) on the test set. CLAM-R50 attention maps identified pale cytoplasm and plasma cell-like tumour cells as predictors of positive SLNM, whereas dense melanin deposition and lymphocyte-like tumour cells predicted negative SLNM. CONCLUSIONS: MISSLE integrates histopathological and clinical data to predict SLNM with high AUROC, surpassing the previous reports and offering a tool for clinical decision-making. Limitations include the single-centre design and predominantly Japanese cohort, limiting generalizability. The code and models are publicly available for external validation.
5 May 2026
Read appraisal →Abdominal radiology (New York)
A CT-based 2.5D deep learning model for preoperative T-staging in gastric cancer: a retrospective multicenter study
PURPOSE: To develop and validate a 2.5D multi-angle deep learning (MADL) model for preoperative T-staging in patients with gastric cancer (GC) and to explore the predictive potential for survival outcome. MATERIALS AND METHODS: In this retrospective study, GC datasets from four centers were used to develop a quaternary for preoperative T-staging model by integrating CT images with nine 2D slicers and three angles (0°, + 45°, -45°) from transverse, sagittal, and coronal views. Diagnostic performance (accuracy, sensitivity, specificity, F1-score) were compared between the 2.5D MADL and radiologists. The prognostic potential of 2.5D MADL-derived features was evaluated using Kaplan-Meier analysis and multivariate Cox regression. RESULTS: A total of 433 patients were divided into the training (n = 346, mean age, 64.8 years ± 10.5 [SD]; 95 female) and the internal validation (n = 87, mean age, 63.0 years ± 11.9; 23 female) sets from Centers 1-3, and 41 patients (mean age, 64.6 years ± 8.9; 10 female) formed the external testing set from Center 4. The 2.5D MADL model exhibited excellent diagnostic performance for T-staging in external testing set (AUCs of T1-T4: 0.962, 0.722, 0.913, 0.962). For T1 staging, it outperformed radiologists in accuracy (95% vs. 83%), sensitivity (75% vs. 12%), and F1 score (86% vs. 22%) in external testing set. Survival analysis showed significant overall survival differences between high- and low-risk groups stratified (P < 0.001), with high-risk patients having shorter survival (HR = 1.632, 95% CI:1.239-2.150). CONCLUSION: The 2.5D MADL model achieves accurate and reliable preoperative T staging of gastric cancer, with performance comparable to radiologists and superior accuracy for early-stage disease.
5 May 2026
Read appraisal →Journal of clinical ultrasound : JCU
Deep Learning Radiomics Model Based on Ultrasound Images Predicts Myometrial Infiltration of Endometrial Cancer
OBJECTIVE: This study aims to develop and validate a deep learning radiomics (DLR) model based on ultrasound images for non-invasively distinguishing the myometrial infiltration (MI) of patients with endometrial cancer (EC). METHODS: We retrospectively collected 310 patients with EC who underwent surgical resection from center 1 from September 2017 to January 2025, forming a training group and a validation group. An external testing group was comprised of 80 patients from center 2. We extracted deep learning (DL) features and radiomics features from ultrasound images, establishing a DLR model after dimensionality reduction. The receiver operating characteristic analysis was used to evaluate the practicality of the proposed model. The utility of the proposed model was evaluated using receiver operating characteristic, calibration, and decision curve analysis. RESULTS: A total of 390 EC patients were included in the study. In the validation set, the AUC of the radiomics model was 0.874 (0.774-0.949), and in the testing group, the AUC of the DL model was 0.844 (0.699-0.957). The DLR model was superior to radiomics models and DL models in interpreting images, and also outperformed the diagnostic performance of advanced ultrasound physicians. CONCLUSION: The DLR model based on ultrasound images can accurately and non-invasively distinguish the MI depth of EC patients, assisting doctors in formulating more favorable treatment plans for patients.
5 May 2026
Read appraisal →European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology
Machine learning identifies a 10-gene signature predicting hepatocellular carcinoma recurrence and immune-metabolic reprogramming
BACKGROUND: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality, with frequent recurrence after curative treatment. Conventional clinicopathological prognostic systems fail to capture the molecular heterogeneity underlying recurrence, highlighting the need for biologically informed biomarkers. METHODS: We developed a transcriptome-based prognostic model for HCC recurrence using a machine learning-guided feature selection strategy designed to reduce survival-time bias. LASSO-based gene selection was integrated with multivariable Cox regression, and model performance was assessed through stratified cross-validation and independent external validation. RESULTS: Analysis of the TCGA-LIHC cohort (n = 344) identified a stable 38-gene recurrence-associated signature (AUC: 0.715-0.847), which was distilled into a reproducible 10-gene classifier combined with tumor stage. This integrated model effectively stratified patients into high- and low-risk groups (log-rank P < 0.0001) and was independently validated in the HCCDB25 cohort (n = 158; P = 0.031). High-risk tumors exhibited an immune-excluded phenotype with reduced cytotoxic immune infiltration. Gene set enrichment analyses revealed progressive activation of proliferative signaling, metabolic dysregulation, and immune evasion pathways. CONCLUSIONS: The integrated 10-gene-plus-stage classifier is a robust and generalizable predictor of HCC recurrence, providing mechanistic insights into immune-metabolic reprogramming and highlighting potential implications for risk-informed patient stratification in future studies.
4 May 2026
Read appraisal →Biomedical physics & engineering express
Kali MC: an open-source toolkit for intraoperative electron radiation therapy treatment planning
Intraoperative electron radiation therapy (IOERT) is commonly delivered without intraoperative imaging, limiting patient-specific planning and requiring fast, reliable treatment calculations in the operating room. As a result, monitor unit (MU) calculations are often performed using spreadsheets and static look-up tables derived from measurements in water. We present Kali MC, an open source, Python-based software developed to streamline IOERT absorbed dose visualization, MU calculation and report generation for treatments delivered with the Liac HWL mobile accelerator. The software provides a graphical interface to visualize precomputed Monte Carlo absorbed dose distributions in water and performs MU calculations using experimentally determined output factors. Optional atmospheric pressure correction and predefined rescaling factors are supported to improve consistency of dose delivery and target coverage with the prescription isodose. Kali MC also generates customizable PDF treatment reports and exports DICOM RT Plan objects to facilitate integration with record-and-verify systems. By integrating validated dosimetric data, correction methods, and 3D dose visualization into a transparent platform, Kali MC supports efficient intraoperative decision-making; however, its use should be locally commissioned and evaluated according to institution-specific procedures and equipment characteristics.
28 Apr 2026
Read appraisal →JAMA
Tumor Debulking in Combination With Chemotherapy in Multiorgan Metastatic Colorectal Cancer: The ORCHESTRA Randomized Clinical Trial
IMPORTANCE: Local therapy, including surgery, radiation, and ablation, is increasingly used in patients with multiorgan metastatic colorectal cancer (mCRC). However, prospective evidence for a survival benefit of tumor debulking is lacking. OBJECTIVE: To investigate whether tumor debulking added to palliative chemotherapy improves survival of patients with multiorgan mCRC. DESIGN, SETTING, AND PARTICIPANTS: This investigator-initiated, open-label, multicenter, randomized clinical trial enrolled patients with multiorgan mCRC between May 2013 and May 2023. The last date of follow-up was April 4, 2024. Patients were enrolled in 27 hospitals in the Netherlands and 1 in the UK. Adult patients with multiorgan mCRC were considered eligible if more than 80% tumor debulking was deemed feasible by resection, radiotherapy, and/or thermal ablation prior to starting first-line palliative chemotherapy. INTERVENTIONS: After achieving objective tumor response or stable disease after 3 cycles of capecitabine and oxaliplatin or 4 cycles of 5-fluorouracil and oxaliplatin with or without bevacizumab, patients were randomized 1:1 to receive chemotherapy alone (standard care group) or tumor debulking followed by chemotherapy. MAIN OUTCOMES AND MEASURES: The primary end point was overall survival. Secondary end points included progression-free survival and serious adverse events. These outcomes were analyzed in the intention-to-treat population, applicable from randomization. A prespecified interim analysis performed after the initial 100 participants were enrolled revealed that the trial was both safe and feasible to proceed. RESULTS: A total of 382 of 454 enrolled patients were randomized: 192 in the chemotherapy alone group (133 [69%] male) and 190 in the chemotherapy plus tumor debulking group (127 [67%] male). The median age was 64 years in both groups. After a median follow-up of 32.3 months, median overall survival in the chemotherapy alone group was 27.5 months vs 30.0 months in the chemotherapy plus tumor debulking group (adjusted hazard ratio, 0.88 [95% CI, 0.70-1.10]; P = .26). Median progression-free survival in the chemotherapy alone group was 10.4 months vs 10.5 months in the chemotherapy plus tumor debulking group (adjusted hazard ratio, 0.83 [95% CI, 0.67-1.02]; P = .08). More patients in the chemotherapy plus tumor debulking vs chemotherapy alone group had any serious adverse events (101 [53%] vs 74 [39%]; P = .006). CONCLUSIONS AND RELEVANCE: Tumor debulking in addition to first-line palliative systemic treatment failed to improve overall survival compared with systemic treatment alone for patients with multiorgan mCRC and should not be considered standard care. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01792934.
23 Apr 2026
Read appraisal →Journal of gastrointestinal cancer
Effect of Probiotics on the Clinical Outcome and Inflammatory Response in Gastric Cancer Surgery: A Double Blinded Randomized Control Trial
BACKGROUND AND AIM: Gut dysbiosis contributes to postoperative complications and worsens the inflammatory and immune dysfunction in gastric cancer (GC) patients. Probiotics may mitigate these effects by modulating gut microbiota. This study aimed to evaluate the effect of probiotics on the length of hospital stay, other post-operative clinical outcomes, nutritional status, inflammatory and immune markers in patients undergoing gastrectomy for gastric cancer. METHODS: This was a single-centred, prospective, double blinded, placebo-controlled trial. Participants were patients who underwent open gastrectomy for gastric cancer. Participants were randomized to receive probiotics or placebo for 10 days starting on postoperative day (POD) 1. Blood samples were collected preoperatively and POD 10 to assess haemoglobin, total counts, albumin, IL6, TNFα, and IgA. Clinical outcomes including time to first flatus, first passage of stools, oral diet resumption and length of hospital stay (LOHS). Postoperative complications were monitored for 30 days and classified using the Clavien-Dindo system. RESULTS: Of 42 participants (22 probiotic, 20 placebo), baseline characteristics were comparable. The probiotic group had a significantly shorter median LOHS (9 vs. 12 days, p<0.05), earlier time to first passage of flatus (2.6 vs. 4.3 days, p<0.05), earlier time to first passage of stools (3.6 vs. 5.7 days, p<0.05), and oral diet resumption (3.6 vs. 5.7 days, p<0.05). No significant differences were observed in inflammatory markers (TLC, IL-6, TNF-α), immune markers (IgA), nutritional status (albumin, haemoglobin), or postoperative complications (p>0.05). CONCLUSION: Postoperative probiotic supplementation reduced LOHS and improved gastrointestinal recovery in GC patients undergoing gastrectomy, but did not significantly affect inflammatory, immune, or nutritional markers.
20 Apr 2026
Read appraisal →BMJ open
Indocyanine green fluorescence for intraoperative detection of liver tumours in minimally invasive surgery: protocol for the LIVERGREEN phase IV multicentre clinical trial
INTRODUCTION: Liver tumours are a leading cause of global morbidity and mortality. Current diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS), have limitations in detecting liver neoplasms. Indocyanine green (ICG) has emerged as a promising tool for improving liver tumour detection. This study aims to assess the impact of preoperative ICG on intraoperative tumour detection in minimally invasive surgery and develop a machine-learning algorithm to enhance tumour detection using ICG fluorescence. METHODS AND ANALYSIS: This prospective, multicentre, phase IV clinical trial adheres to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Patients with liver tumours eligible for minimally invasive surgery and a preoperative imaging test will be included. ICG will be administered intravenously 24 hours before surgery. Intraoperative procedures will include IOUS, ICG mapping and photographic documentation. Patients will be followed for 90 days to assess tumour progression, morbidity and mortality. The photographic analysis will enable the development of an artificial intelligence algorithm using machine learning and neural networks to identify lesions based on ICG fluorescence. The estimated sample size is 173 patients and the trial is predicted to accrue in 3 years. ETHICS AND DISSEMINATION: The trial will be conducted in accordance with the Declaration of Helsinki and the Spanish Agency of Medicines and Medical Devices (AEMPS) guidelines. Approved by the local institutional Ethics Committee and the AEMPS, the results will be shared with the scientific community through publications and conferences. EUDRACT NUMBER: 2023-5 08 316-27-00. TRIAL REGISTRATION NUMBER: NCT06398028. PROTOCOL VERSION: V.12, 18 March 2025.
18 Apr 2026
Read appraisal →Clinical cancer research : an official journal of the American Association for Cancer Research
Neoadjuvant Nivolumab with or without Ipilimumab for Cisplatin-Ineligible Patients with Muscle-Invasive Bladder Cancer
PURPOSE: Many patients with muscle-invasive bladder cancer (MIBC) are ineligible for cisplatin-based therapy. We conducted a phase II trial of neoadjuvant nivolumab ± ipilimumab for cisplatin-ineligible patients. PATIENTS AND METHODS: Patients with MIBC were enrolled in two consecutive cohorts: (i) nivolumab alone and (ii) ipilimumab/nivolumab. A third cohort with alternative dosing was planned. The primary endpoint was eligibility for cystectomy ≤60 days after last treatment. Correlative analyses were performed, with the PURE-01 trial used as an independent dataset. RESULTS: Fifteen patients enrolled onto each cohort. In cohorts 1 and 2, 12 of 15 and eight of 15 were eligible for cystectomy within 60 days, respectively. Due to cohort 2's failure to meet the primary endpoint, cohort 3 was not initiated. With nivolumab alone, four patients achieved <ypT2ypN0 (26%), with two pathologic complete responses (pCR; 13%). With ipilimumab/nivolumab, three achieved <ypT2ypN0 (20%), with one pCR (7%). One patient after nivolumab and two after ipilimumab/nivolumab had durable clinical complete responses (CR) without cystectomy. Twelve-month recurrence-free survival (RFS) was 79% with nivolumab [95% confidence interval (CI), 61-100] and 61% with ipilimumab/nivolumab (95% CI, 39-95). Sequencing analyses suggest that NCOR1 alterations may be associated with improved clinical outcomes. Gene expression profiling indicated a potential association between tumor-infiltrating immune cells and longer RFS (log-rank P = 0.18); this was also observed in PURE-01 (P = 0.022). CONCLUSIONS: Among cisplatin-ineligible patients with MIBC, nivolumab alone was well tolerated. Ipilimumab/nivolumab caused toxicity that delayed cystectomy. Cases of progression before cystectomy indicated insufficient efficacy of pure neoadjuvant immunotherapy for unselected patients. Despite low response rates, some patients experienced sustained clinical CR without cystectomy.
16 Apr 2026
Read appraisal →Annals of plastic surgery
Immediate Lymphatic Reconstruction to Prevent Postmastectomy Lymphedema: A National Analysis of Outcomes and Regional Trends
BACKGROUND: Lymphedema is a chronic disease characterized by swelling, inflammation, adipose deposition, and fibrosis. In the United States, lymphedema occurs most frequently as a sequela of oncologic lymphadenectomy. Axillary lymph node dissection (ALND) for breast cancer has been associated with a 5%-40% incidence of upper limb lymphedema. In immediate lymphatic reconstruction (ILR), surgeons perform lymphovenous anastomosis (LVA) with ALND to prevent the development of future lymphedema. Although early evidence supports a protective effect of ILR, there have been few large-scale studies on the topic. We leveraged a large claims database to better characterize the outcomes of ILR and national trends related to its adoption. METHODS: Adult female patients with breast cancer who underwent axillary lymph node dissection (ALND) between 2007 and 2022 were identified within the Merative MarketScan Research Databases and stratified according to whether they underwent ILR. Adjusted odds of undergoing ILR, both overall and regionally, and of experiencing postmastectomy lymphedema syndrome (PMLS) were calculated. RESULTS: Of all patients undergoing mastectomy and ALND, 1.3% received ILR. ILR was associated with decreased odds of developing PMLS (OR, 0.81; P = 0.02). The frequency of ILR procedures increased in all regions between 2017 and 2022, most dramatically in the Midwest and East US. More recent surgery year, younger age, complete mastectomy, and delayed ALND elevated the odds of undergoing ILR ( P ≤ 0.01). CONCLUSIONS: The popularity of ILR has grown rapidly since 2017, with significant regional variability. Patients with breast cancer who undergo ILR at the time of ALND are significantly less likely to develop lymphedema.
13 Apr 2026
Read appraisal →Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Neoadjuvant Chemotherapy With CAPOX Versus Chemoradiation for Locally Advanced Rectal Cancer With Uninvolved Mesorectal Fascia (CONVERT): Final Results of a Phase III Trial
PURPOSE: The neoadjuvant chemoradiotherapy (nCRT) might accentuate surgical complications and toxicity in the treatment of locally advanced rectal cancer (LARC) while neoadjuvant chemotherapy (nCT) alone shows promise as an alternative treatment. However, which patients deserve most from the nCT need further clarify. This trial aimed to assess the non-inferiority of nCT with capecitabine plus oxaliplatin (CAPOX) versus nCRT with capecitabine in LARC with uninvolved mesorectal fascia (MRF). METHODS: Patients with LARC within 12 cm from the anal verge and uninvolved MRF were randomly assigned to receive 4 cycles of CAPOX chemotherapy alone (nCT group) or CRT with concurrent Capecitabine (nCRT group). The primary end point is 3-year locoregional recurrence-free survival (LRRFS). Secondary end points, such as 3-year disease-free survival (DFS), 3-year overall survival (OS), and adverse events (AEs), were also reported. RESULTS: A total of 663 patients were enrolled and 589 patients received the allocated treatment (nCT, n = 300; nCRT, n = 289). LRRFS was analyzed with a median follow-up of 48 months. 3-year LRRFS was 97.4% (95% CI, 95.5 to 99.3) in the nCRT group and 96.3% (95% CI, 94.0 to 98.6) in the nCT group, resulting in a hazard ratio (HR) of 1.40 (95% CI, 0.53 to 3.68). The nCT and nCRT achieved similar 3-year DFS (89.2% v 87.9%; HR, 0.88 [95% CI, 0.54 to 1.44]) and 3-year OS (95.0% v 94.1%; HR, 0.86 [95% CI, 0.42 to 1.76]). The nCT group showed a lower incidence of grade 2 to 4 long-term AEs (16.0% v 26.3%, P = 0.002) and proctitis (33.6% v 41.7%, P = 0.049) compared with nCRT group. CONCLUSIONS: The non-inferiority of nCT was not confirmed with a very low incidence of local recurrence in both group. But nCT offers comparable DFS and OS while mitigating the burden of toxicity as compared to nCRT. These insights shed light on a potential paradigm shift in the treatment for LARC with uninvolved MRF.
10 Apr 2026
Read appraisal →The New England journal of medicine
Perioperative Enfortumab Vedotin and Pembrolizumab in Bladder Cancer
BACKGROUND: Patients with muscle-invasive bladder cancer who are ineligible for cisplatin-based chemotherapy proceed directly to radical cystectomy with pelvic lymph-node dissection. Perioperative therapy may improve outcomes in this population. METHODS: In this phase 3, open-label trial, participants with muscle-invasive bladder cancer who were ineligible for or declined cisplatin-based chemotherapy were randomly assigned to perioperative (neoadjuvant and adjuvant) enfortumab vedotin, an antibody-drug conjugate directed at nectin-4, plus pembrolizumab and surgery (9 total cycles of enfortumab vedotin [1.25 mg per kilogram of body weight on days 1 and 8] plus 17 total cycles of pembrolizumab [200 mg on day 1 every 3 weeks], with surgery after 3 cycles) or surgery alone (control). The primary end point was event-free survival. Key secondary end points were overall survival and pathological complete response (absence of viable tumor after surgical resection). Other secondary end points included safety. RESULTS: A total of 344 participants underwent randomization (170 in the enfortumab vedotin-pembrolizumab group and 174 in the control group). At data cutoff, median follow-up was 25.6 months (range, 11.8 to 53.7). Surgery was performed in 87.6% of participants in the enfortumab vedotin-pembrolizumab group and in 89.7% in the control group. At 2 years, estimated event-free survival was 74.7% in the enfortumab vedotin-pembrolizumab group and 39.4% in the control group (hazard ratio for an event or death, 0.40; 95% confidence interval [CI], 0.28 to 0.57; two-sided P<0.001); estimated overall survival was 79.7% and 63.1% (hazard ratio for death, 0.50; 95% CI, 0.33 to 0.74; two-sided P<0.001). A pathological complete response had occurred in 57.1% and 8.6% of the participants (estimated difference, 48.3 percentage points; 95% CI, 39.5 to 56.5; two-sided P<0.001). Adverse events occurred in all participants in the enfortumab vedotin-pembrolizumab group (grade ≥3, 71.3%; grade ≥3 drug-related, 45.5%) and in 64.8% in the control group (grade ≥3, 45.9%). CONCLUSIONS: Perioperative enfortumab vedotin plus pembrolizumab and surgery led to significantly better event-free and overall survival outcomes and a greater percentage of participants with pathological complete response than surgery alone in a predominantly cisplatin-ineligible population with muscle-invasive bladder cancer. Safety was also assessed. (Funded by Merck Sharp and Dohme, a subsidiary of Merck [Rahway, NJ]; KEYNOTE-905 ClinicalTrials.gov number, NCT03924895.).
4 Apr 2026
Read appraisal →Cancer Res
Artificial Intelligence and Multimodality Data Integration Decipher Tertiary Lymphoid Structure Maturity in Gastric Cancer
UNLABELLED: Tertiary lymphoid structures (TLS) are critical components of the tumor microenvironment in gastric cancer, but clinical assessment of TLSs is challenging. The development of automated annotation tools for histopathologic slide analysis could facilitate the identification of TLSs and enhance our understanding of the mechanisms driving TLS maturation. In this study, we generated a transformer-based deep learning model that enables quantitative characterization of TLS maturity from whole-slide images. Application of the model to a large gastric cancer cohort (n = 253) showed that higher TLS maturity correlated with improved patient survival. Integration of single-cell RNA sequencing data from 17 patients with gastric cancer combined with multiplex IHC, flow cytometry, and functional coculture assays identified a key immune circuit in mature TLSs involving CD8+ tissue-resident memory T cells, which recruit activated B cells via the CXCL13-CXCR5 axis to enhance tissue-resident memory T-cell cytotoxicity through granzyme B upregulation. Overall, this study established a clinically applicable artificial intelligence tool and uncovered key immune interactions that regulate TLS maturation and antitumor immunity in gastric cancer. SIGNIFICANCE: A deep learning model demonstrates that higher tertiary lymphoid structure maturity predicts improved gastric cancer patient survival and identifies a key immune circuit, offering a clinically applicable tool that could guide treatment. This article is part of a special series: Driving Cancer Discoveries with Computational Research, Data Science, and Machine Learning/AI.
1 Dec 2025
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