A 69-year-old female underwent remote right upper lobectomy by a surgical team located >8000 km away to evaluate the feasibility and safety of real-time transcontinental uniportal robotic thoracic surgery using a 5G-enabled serpentine robotic system. The procedure utilized a single-port robotic platform connected via a dedicated 5G network. and completed in 58 minutes with network latency consistently below 150 milliseconds. No intraoperative complications occurred. The patient was discharged on postoperative day 3 without adverse events. This study demonstrates the technical feasibility and safety of transcontinental single-port robotic thoracic surgery under 150 milliseconds latency constraints, supporting its potential to expand global surgical access.

To evaluate the feasibility of single-port (SP) robotic pulmonary resection after neoadjuvant chemoimmunotherapy for non-small-cell lung cancer (NSCLC).

We retrospectively reviewed data from patients who underwent SP robotic or SP video-assisted thoracic surgery (VATS) pulmonary resection after neoadjuvant chemoimmunotherapy at Korea University Guro Hospital between March 2018 and November 2025 and compared baseline characteristics, intraoperative and perioperative outcomes, and postoperative complications between the 2 groups.

Twenty-four patients were included: 10 in the SP robotic group and 14 in the SP VATS group. Baseline characteristics were comparable, except for histologic type (P = .033) and immunotherapy type (P = .011). One pneumonectomy was performed in the SP VATS group (7%). R0 resection rates were 90% in the SP robotic group and 93% in the SP VATS group (P = 1.000). The conversion rate to thoracotomy was 10% in the SP robotic group and 29% in the SP video-assisted group (P = .358). Other perioperative outcomes, including operative time, lymph node yield, drainage volume, hospital stay length, postoperative complications, and postoperative pain, were comparable between groups. One patient in the SP video-assisted group died of myocardial infarction.

Single-port robotic pulmonary resection after neoadjuvant chemoimmunotherapy is technically feasible and can be performed safely with acceptable perioperative results. Our findings suggest that SP approaches, including robotic and VATS techniques, can serve as viable minimally invasive surgical alternatives for appropriately selected patients with NSCLC.

This case series aims to evaluate the incidence, mechanisms, and management of bronchopleural fistula (BPF) following transbronchial microwave ablation (TMWA) for lung tumours and to explore innovative strategies for prevention and treatment.

A retrospective review was conducted on 173 patients who underwent 209 sessions of TMWA from March 2019 to May 2025 at a single centre. Four cases of BPF confirmed by imaging and clinical presentation were analysed. Data collected included procedural details, mechanisms of BPF formation, management strategies, and patient outcomes. Techniques such as intraoperative fibrin glue injection and endobronchial valve placement were documented.

BPF occurred in 4 patients (1.9%) and was associated with mechanisms including extensive ablation zone with cavitation, tissue contraction, and inadvertent pleural puncture. Treatments varied from conservative drainage and antibiotics to targeted endobronchial interventions, with all BPF successfully resolved. The use of innovative techniques, such as intraoperative fibrin glue injection, demonstrated promising results with minimal invasiveness. Patients with BPF experienced longer hospital stays compared to those without complications.

Although rare, BPF is a significant complication after TMWA, often requiring individualized management. Early recognition through vigilant monitoring and advanced imaging facilitates prompt intervention. Further prospective studies are needed to refine prevention and management strategies for this serious complication.

This study aims to evaluate the safety and feasibility of uniportal robot-assisted thoracic surgery for sleeve lobectomy and to analyse the impact of induction therapy on perioperative outcomes.

Between January 2022 and June 2025, 134 consecutive patients who underwent uniportal robot-assisted thoracic surgery sleeve lobectomy using the da Vinci Xi system were enrolled from a prospective database. Perioperative variables, including patient characteristics, surgical details, pathologic outcomes, and 30-day complications, were analysed. Statistical comparisons were performed between patients who received induction therapy and those who did not.

The cohort had a median age of 62 years, with 72.3% having a smoking history. Squamous cell carcinoma was predominant (68.6%), and 55.2% of patients received induction therapy, primarily chemoimmunotherapy. The left upper lobe was the most common resection site (35.1%). R0 resection was achieved in 97.8% of cases. The median operative time was 185 min, and median hospital stay was 6 days. Patients underwent induction therapy was associated with longer operative time (202.5 vs 172.5 min, P = .005) and hospital stay (7 vs 6 days, P < .001) but did not significantly affect blood loss, conversion rate (9.5% vs 6.7%, P = .687), major complications (23.0% vs 26.7%, P = .622), or 30-day readmission (1.4% vs 3.3%, P = .441). There were no 30-day deaths.

Uniportal robot-assisted thoracic surgery sleeve lobectomy is technically safe and feasible, with high R0 rates and acceptable morbidity. Induction therapy prolongs operative time and hospitalization but does not significantly increase perioperative risk. These findings support the adoption of uniportal robot-assisted thoracic surgery for complex sleeve lobectomy, including patients after induction treatment.

The use of the deep inspiration breath-hold (DIBH) technique reduces cardiac and lung radiation exposure during left breast cancer radiotherapy. However, the optimal beam delivery technique and the effects of patient adaptation during DIBH remain incompletely understood.

In this study, the dosimetric differences between continuous semi-arc and tangent-arc plans in stage I left-sided breast cancer patients using DIBH were compared, and the treatment session duration was descriptively analyzed to characterize treatment-time trends during routine DIBH delivery.

Twenty patients treated at our hospital from 01/05/2022-31/05/2023 were retrospectively selected from the institutional database for exploratory dosimetric analysis. Two radiotherapy plans were created on the basis of each patient's computed tomography (CT) images. Dosimetric parameters for the planning target volume (PTV) and organs at risk (OARs), and beam-on and total treatment times, were compared.

The conformity index (CI) for the PTV was significantly better with the continuous semi-arc plan (P < 0.05), whereas the other PTV parameters did not significantly differ between the plans (P > 0.05). The doses and beam-on time for all OARs (except the left ventricle) were significantly lower for the tangent-arc plan (P < 0.05). Treatment time tended to stabilize across fractions, with a significant difference between the 15th and 16th sessions (P < 0.05).

With the tangent-arc plan, the beam-on time and radiation exposure to OARs were observed to be lower, while adequate PTV coverage was maintained in patients with stage I left-sided breast cancer using DIBH. Treatment times tended to stabilize with increasing treatment fractions. This observation suggests gradual patient adaptation during routine DIBH rather than a predefined training effect. Given the exploratory nature of these findings and the limited sample size from a single institution, these findings should be interpreted with caution and warrant further investigation in larger, multicenter studies.

Intrahepatic cholangiocarcinoma (iCCA) is an aggressive malignancy with limited therapeutic options and a poor prognosis. Opisthorchis viverrini (OV) infection is a major risk factor in endemic regions, particularly in Southeast Asia. However, the molecular mechanisms underlying iCCA development and progression remain incompletely understood. This study, as it is, is observational and demonstrates association rather than causation. This study aimed to characterize genetic alterations in key germline variants associated with cancer risk and prognosis, as well as components of the oxidative stress pathway, and to evaluate their associations with clinicopathological features in Thai iCCA patients. A cohort study was conducted involving 112 iCCA patients, 60 OV-infected individuals, and 156 healthy controls. Genetic alterations in TP53, CREBBP, KRAS (codons 12 and 13), CDKN2A, IDH1, and GZMB were analyzed by PCR and sequencing. Gene polymorphic co-occurrence and burden were assessed. Additionally, polymorphisms in the KEAP1-NFE2L2 oxidative stress pathway (KEAP1 rs11085735; NFE2L2 rs6726395, rs6721961, rs4893819) were analyzed in 50 iCCA patients. Associations with clinicopathological parameters, including metastatic status, tumor size, and tumor markers (CEA and CA 19-9), were evaluated using odds ratios (OR) and statistical analyses. CREBBP polymorphisms were significantly more frequent in iCCA patients (50.0%) than in OV-infected individuals (30.0%) and healthy controls (30.8%) (P = 0.003), with homozygous mutations conferring the highest cancer risk (OR = 6.43, 95% CI: 1.70-24.31). KRAS codon 13 polymorphisms were detected exclusively in iCCA patients (21.4%) and were absent in OV-infected individuals. In contrast, TP53 polymorphisms were highly prevalent across all groups, with no significant differences, suggesting these variants may represent background genetic variation rather than tumor-specific drivers. Co-polymorphism analysis revealed that TP53 and CREBBP alterations were the dominant genetic events, with most tumors harboring one or two mutations (mean gene polymorphism burden: 1.46 ± 0.86). Further statistical modeling revealed significant clinicopathological associations. Binary logistic regression identified tumor size (P = 0.029) and TP53 mutation status (P = 0.037) as significant predictors of metastasis. Notably, TP53 wild-type status demonstrated a protective effect against metastasis (OR = 0.083, 95% CI: 0.007-0.950, P = 0.045), and multivariable analysis confirmed TP53 as an independent predictor of metastasis (P = 0.037) after adjusting for sex, age, and sex-by-age interaction. Furthermore, ordinal regression identified metastasis as the primary predictor of advancing tumor stage (P < 0.001), with tumor size showing a trending association (P = 0.068). Evaluation of CDKN2A was limited by quasi-complete separation (adjusted OR = 0.000, P = 1.000) due to sample size constraints. Analysis of the KEAP1-NFE2L2 pathway revealed limited genetic diversity in KEAP1 but substantial polymorphic variation in NFE2L2. These polymorphisms showed minimal associations with clinicopathological features, suggesting a complex role of oxidative stress regulation in iCCA pathogenesis. The study identifies CREBBP and KRAS codon 13 polymorphisms as key genetic alterations enriched in iCCA, supporting their role as candidate germline variants and potential therapeutic targets. Polymorphism co-occurrence patterns indicate a relatively low mutational burden, with epigenetic dysregulation and oncogenic signaling representing central mechanisms in iCCA development. Further large-scale studies integrating tissue and circulating DNA analyses are warranted to validate these findings and identify clinically actionable biomarkers in iCCA.

Pediatric cancer is an emerging public health priority in Africa, where survival rates remain critically low compared to high-income regions. Malnutrition; specifically wasting and cachexia; is the most prevalent, yet modifiable comorbidity that compromises treatment tolerance and increases mortality. Recent primary studies from 2025 indicate a significant discrepancy between wasting diagnosed via clinical assessment versus anthropometrically defined wasting, suggesting a "hidden burden" of malnutrition in African oncology wards. However, no comprehensive synthesis of data exists regarding the prevalence of wasting across the continent using modern assessment standards, nor its specific impact on clinical outcomes in the current treatment era.

We will conduct a systematic review and meta-analysis of observational studies (cross-sectional, cohort, and case-control) published from January 1, 2000, to the present. Data sources will include PubMed/MEDLINE, EMBASE, Web of Science and CINAHL. We will include studies involving children and adolescents (0-19 years) diagnosed with malignancies in African healthcare settings. Two independent reviewers will screen studies, extract data, and assess risk of bias using Covidence systematic review software. The risk of bias will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The primary outcome will be the pooled prevalence of wasting/cachexia. Secondary outcomes will include diagnostic accuracy of assessment methods (such as Mid-Upper Arm Circumference [MUAC] vs. Weight-for-Height vs. clinical assessment) and associations with adverse clinical events (neutropenia, sepsis, treatment abandonment, and mortality). A random-effects meta-analysis will be performed using R software. Heterogeneity will be assessed using the I2 statistic and explored via subgroup analyses (region, tumor type, and assessment tool).

Ethical approval is not required as this study relies on secondary data. Findings will be disseminated through a peer-reviewed publication and conference presentations to inform nutritional guidelines for pediatric oncology in resource-limited settings.

Registration Number: CRD420251237859.

Minimal residual disease (MRD) monitoring is a cornerstone of risk stratification in pediatric acute myeloid leukemia (AML), with a threshold of 0.1% conventionally defining positivity by flow cytometry. Advances in flow cytometric technologies, enabling detection of leukemic cells with higher sensitivity and specificity, warrant a reevaluation of whether a lower threshold improves prognostic accuracy.

We conducted a retrospective cohort study using data from the Therapeutically Applicable Research to Generate Effective Treatments (TARGET)-AML initiative. The study population comprised 1,205 pediatric patients with de novo AML treated across Children's Oncology Group (COG) clinical trial centers. Patients were enrolled between September 1996 and December 2016, with a median follow-up of 6.2 years (range: 0.5-20.1 years). The primary objective was to compare the prognostic performance of the traditional MRD threshold (≥0.1%) with a lower threshold (≥0.05%) after induction courses 1 and 2. The main outcome measure was 5-year event-free survival (EFS). Analyses included Kaplan-Meier survival estimates, Cox proportional hazards models to calculate hazard ratios (HR) with 95% confidence intervals (CI), receiver operating characteristic (ROC) curves, and net reclassification improvement (NRI). The optimal threshold for predicting 5-year EFS, determined by ROC analysis, was 0.05% after both induction course 1 (AUC: 0.840, 95%CI[0.76,0.88]) and course 2 (AUC: 0.854, 95%CI[0.78,0.89]). The 0.05% threshold demonstrated higher HR for the first event than the 0.1% threshold (after course 1: HR = 2.8, 95%CI[2.3,3.3]; P < 0.001; after course 2: HR = 3.7, 95%CI[3.0,4.6]; P < 0.001). NRI analysis confirmed significant improvement in risk classification with the 0.05% threshold (overall NRI: 0.15 after course 1, 0.18 after course 2). The main limitation of this study is its retrospective design using historical data from trials conducted over 20 years, which may limit generalizability to contemporary treatments.

A lower MRD threshold of 0.05% provides superior prognostic discrimination compared to the conventional 0.1% threshold in pediatric AML treated in previous COG trials. These findings support testing this more sensitive threshold in future clinical trial designs for improved risk-adapted therapy.

Childhood cancer presents lasting challenges beyond primary treatment, affecting multiple aspects of daily life. This mixed-methods study examines the impact of childhood cancer on activities and participation within the first five years after treatment. It mainly focuses on the interplay of factors influencing participation. Further, qualitative interviews provide contextual insights and experiential perspectives from affected families to complement the quantitative findings.

The study combines qualitative interviews with 30 parents and quantitative survey data from 256 parents. The survey included self-developed items based on the International Classification of Functioning, Disability and Health (ICF). A correlation-based network analysis examined relationships among factors affecting children's activities and participation.

Survivors experience impairments in school activities, social interactions, and daily functioning. Network analysis highlights the interconnections among ICF-coded aspects, revealing that learning, communication, and participation in major life areas strongly influence overall activity and participation.

While many survivors reintegrate into everyday life, hidden challenges can significantly impact their participation. This study underscores the need for a holistic, multidisciplinary approach addressing medical, educational, and psychosocial challenges, including struggles beyond visible limitations.

Interventions should prioritize comprehensive support, particularly in learning, communication, and participation in school activity. Educating healthcare providers and caregivers about the interdisciplinary links between these domains is essential for a coordinated, holistic approach.

The integration of multi-omics data holds great promise for identifying robust and clinically relevant biomarkers, yet the increasing complexity of computational methods raises questions about their practical utility. In this study, we present a comprehensive benchmarking framework that evaluates 27 feature selection strategies and 11 predictive models across three real-world disease cohorts: Alzheimer's disease, progressive supranuclear palsy, and breast cancer. We compare traditional machine learning, ensemble-based methods, and state-of-the-art deep learning models in terms of predictive performance, stability, and biological interpretability. Our results reveal that ensemble feature selection consistently improves robustness and accuracy, particularly for compact biomarker panels. Surprisingly, deep learning models did not outperform simpler classifiers such as logistic regression (L.Regression), support vector machines, or multilayer perceptrons, which often achieved comparable or superior results with lower computational cost and greater interpretability. Triple-omics yielded the highest validation, followed by dual-omics and then single-omics (Triple > Dual > Single). Biological validation against five independent databases confirmed the clinical relevance of the identified biomarkers, including both well-established and novel candidates. To support reproducibility and community adoption, we provide a web-based tool for applying our benchmarking pipeline. Our findings advocate for a pragmatic approach to biomarker discovery-prioritizing methodological transparency, reproducibility, and biological insight over algorithmic complexity.