World Journal of Surgical Oncology最新文献

Background: Robotic-assisted navigation systems for the localization of nonvisible and nonpalpable pulmonary nodules have demonstrated feasibility and safety in preclinical animal studies; however, clinical evidence supporting their practical application remains limited. This study aims to evaluate the safety and feasibility of using a robotic-assisted system for computed tomography (CT)-guided percutaneous localization of lung nodules.

Methods: A total of 137 consecutive patients with 155 nodules were included in the final analysis, all of whom underwent percutaneous hook-wire localization using a novel robotic-assisted optical navigation system. The baseline characteristics of patients and nodules, localization procedure findings, and exploratory outcomes of the correlations between pulmonary nodule features and localization procedure findings were analyzed.

Results: The localization success rate was 100%. With the assistance of the robotic-assisted optical navigation system, the median number of needle adjustments per target was 0 (ranging from 0 to 2) in this study, with a mean deviation of 1.49 ± 1.93 mm. The mean intervention time was 8.24 ± 1.77 min during the robotic-assisted process. Notably, there was no significant change in the accuracy influenced by the location, type, size of nodules, distance to pleura, and decubitus positions. Localization-related complications occurred in 13 (8.39%) out of 155 targets, including 3 (1.94%) minor hemorrhages and 10 (6.45%) minor pneumothoraxes, and no dislodgement was observed in any of the cases. All surgeries were successfully performed with a mean time interval between nodule localization and surgery of 133.67 ± 103.36 min.

Conclusions: This prospective, single-center, single-arm clinical study suggests both feasibility and safety of an innovative robotic-assisted optical navigation system for the CT-guided percutaneous localization of pulmonary nodules using hook-wire technique, as well as satisfactory accuracy during the needle placement.

Background: Anorectal melanoma is rare and has a poor prognosis. Symptoms are often non-specific, such as bloody diarrhea, anal pain or bowel habit changes. Diagnosis requires tissue sample with immunohistochemistry because of the difficulty of clinical differentiation from other tumor entities since many lesions are amelanotic. Many patients are diagnosed at an advanced stage, precluding surgical treatment. Owing to the rareness of the disease and the lack of data there are no clear treatment guidelines available. A 90-year-old female sought emergency care due to rectal bleeding and changes in bowel habits. A CT scan revealed a substantial rectal tumor with nearby lymph node involvement and suspected liver and adrenal gland metastases. Endoscopy revealed a semicircular lesion, which was identified as a necrotic amelanotic tumor expressing Melan-A and S-100; immunohistochemically confirming malignant melanoma. Given the patients' overall condition, the tumor board recommended best supportive care. Recurrent severe bleeding necessitated transfusions, but surgical intervention for symptom control was not feasible due to her general health. Thus, palliative endovascular coil embolization of the tumor -supplying arteries was successfully performed for bleeding control. However, the patient died from disease progression three months later without further bleeding.

Conclusion: The diagnosis of this rare manifestation of melanoma is technically challenging and rectal melanomas are often clinically misinterpreted as conditions such as hemorrhoidal disease. To date, there is no standardized therapy, but surgical intervention should be considered for local control. The role of adjuvant radiotherapy, chemotherapy, or immunotherapy in this disease has not yet been determined. Coil embolization can be a viable palliative treatment alternative for recurrent bleeding in patients unfit for surgery, which, has not been reported specifically for rectal melanoma.

Background: Gastric outlet obstruction (GOO) complicates unresectable gastric and pancreatic cancers. Conventional gastrojejunostomy (CGJ) is standard but frequently leads to delayed gastric emptying. Stomach-partitioning gastrojejunostomy (SPGJ) mitigates this problem and improves outcomes.

Methods: We conducted a meta-analysis of SPGJ versus CGJ for GOO, searching databases through 25 November 2025. Outcomes were delayed gastric emptying (DGE), major complications, reintervention, 30-day mortality, operative time, Gastric Outlet Obstruction Scoring System (GOOS) scores, length of stay, chemotherapy adherence, and survival. Continuous variables were pooled as mean differences (MD) with 95% CIs; dichotomous variables as relative risks (RR) with 95% CIs. Survival was analyzed using individual patient data reconstructed from Kaplan-Meier curves.

Results: A total of 11 studies comprising 456 patients were included. SPGJ was associated with significantly reduced DGE (RR = 0.24, 95% CI: 0.12-0.47) and postoperative major complications (RR = 0.26, 95% CI: 0.12-0.54) compared to CGJ. No significant differences were found in the need for reintervention (RR = 0.59, 95% CI: 0.21-1.64), short-term mortality (RR = 0.99, 95% CI: 0.42-2.33), or LOS (MD = -1.47 days, 95% CI: -3.10 to 0.16). GOOS scores were comparable between groups. Overall survival was also similar between SPGJ and CGJ (HR = 1.06, 95% CI: 0.66-1.70).

Conclusions: Our meta-analysis shows that SPGJ offers important clinical advantages over CGJ by significantly reducing delayed gastric emptying and postoperative major complications, while demonstrating comparable GOOS scores, length of stay, reintervention rates, and short- and long-term survival. These findings support SPGJ as a viable and potentially preferable option for managing malignant GOO, although high-quality randomized trials are still needed.