Robotic pancreaticoduodenectomy with venous resection and reconstruction (RPD-VR) is one of the most technically challenging procedures in hepatopancreaticobiliary surgery. While acceptance of robotic pancreaticoduodenectomy is growing, the safety, feasibility, and oncologic adequacy of combined portal vein (PV) and/or superior mesenteric vein (SMV) resection remain incompletely defined. A systematic review was conducted following PRISMA guidelines. PubMed/MEDLINE, Scopus and the Cochrane Library were searched from inception of the databases to June 2026. The Newcastle-Ottawa Scale was used to evaluate methodological quality. Twelve retrospective studies involving 202 patients undergoing RPD-VR were included. Indications were predominantly pancreatic ductal adenocarcinoma, but other periampullary and pancreatic malignancies were included. The venous reconstruction techniques were primary venorrhaphy, patch venoplasty, end-to-end anastomosis and interposition graft reconstruction. The conversion rates ranged from 0% to 36.4%. Major postoperative complications (Clavien-Dindo ≥ III) were 0% to 40%, postoperative pancreatic fistula 0% to 20% and mortality 0% to 14.3%. R0 resection rates ranged from 69.2 to 100% and lymph node harvest from 14.3 ± 6.7 to 60.0 ± 13.9 nodes. Limited long-term data suggested vascular patency rates exceeding 90% in the studies reporting follow-up imaging. Overall survival, disease-free survival and recurrence outcomes were, however, reported to a limited extent and heterogeneously across studies. Existing data suggest RPD-VR is technically feasible and may be associated with acceptable perioperative, vascular, and oncologic outcomes in carefully selected patients treated at experienced centers. However, the currently available evidence is limited by the retrospective study designs, small sample sizes, and lack of long-term oncologic follow-up. Standardised reporting and solid long-term outcome assessment in prospective multicenter studies are needed to better define the role of RPD-VR in contemporary pancreatic surgery. Prospero ID: CRD420261417822.

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.

To investigate real-world demographics, clinical characteristics, treatment patterns, and outcomes in US patients with ≥ 1 line of therapy (LOT) for hormone receptor-positive (HR+) HER2-low metastatic breast cancer (mBC).

This retrospective cohort study used a US-based electronic health record-derived de-identified database of patients with mBC diagnosed in 2018-2023. Patient demographics, clinical characteristics at date of mBC diagnosis, treatment patterns, and real-world overall survival (rwOS) and progression-free survival (rwPFS) were analyzed.

Of 2662 patients, 49.4% had recurrent mBC. The median (Q1-Q3) number of LOTs was 2 (1-3). Endocrine therapy (ET) plus a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) was the most common first-line, second-line, and third-line therapy. In LOT1, 86.2% of patients received ET-containing regimens; consecutive use of ET-containing regimens in subsequent lines constituted 66.0%, 46.0%, 28.3%, and 19.3% of patients in LOT2-5, respectively. Of 830 patients who received chemotherapy, a median (Q1-Q3) of 1 (0-2) prior lines of ET-containing regimens were received. Median (95% CI) rwOS from mBC diagnosis was 42.4 (40.7, 45.0) months; 5-year survival was 36.9%. Median (95% CI) rwPFS decreased from 16.3 (15.2, 17.3) months in LOT1 to 9.1 (8.3, 10.0), 6.2 (5.6, 7.2), 5.3 (4.6, 6.1), and 3.8 (3.3, 4.9) months in LOT2-5, respectively.

Treatment of HR+, HER2-low mBC was characterized by progressive endocrine exhaustion followed by later lines of chemotherapy, with outcomes worsening at each subsequent treatment line. Data highlight the need for new, effective treatment options in this setting.

This study reports the first clinical comparison of the novel modular Carina robotic platform with the established da Vinci system for robot-assisted radical prostatectomy (RARP), including 6-month outcomes. This single-center study included a prospective cohort of 32 patients undergoing Carina RARP and a retrospective cohort of 105 patients treated with da Vinci RARP. Pre-, intra-, and postoperative data were analyzed. Groups were matched 1:2 using propensity scores based on preoperative characteristics. All patients underwent 6-month follow-up assessing feasibility, safety, oncological outcomes, and urinary continence. Following matching, 32 Carina patients were compared with 64 da Vinci patients. Baseline characteristics were largely well balanced after matching. Total operative time was modestly longer in the Carina group than in the da Vinci group (median 138 vs. 130 min), whereas console time (91 vs. 85 min) and docking time (5 min for both) were comparable between systems. Operative time decreased as platform-specific experience accumulated in later Carina cases. At 6 weeks, the satisfactory biochemical response rate (PSA < 0.1 ng/mL) was identical between groups (90.6%). Urinary continence rates at 1 week, 3 months, and 6 months were 34.4%, 81.3%, and 90.6% for Carina versus 31.3%, 76.6%, and 87.5% for da Vinci, with no significant differences. The Carina system appears safe and feasible for RARP, with early oncological and continence outcomes similar to those observed with the da Vinci system in this pilot matched cohort.

Robot-assisted radical prostatectomy (RARP) has become an increasingly discussed surgical option for patients with high-risk or locally advanced prostate cancer. Nevertheless, how publications, knowledge structures, and research priorities have developed in this area remains insufficiently clarified. This study aimed to characterize the bibliometric profile and clinically oriented evidence domains of RARP for this patient population, with emphasis on oncologic safety, functional outcomes, lymph-node management, and multimodal treatment. Publications were retrieved from the Web of Science Core Collection. Eligible records included English-language original articles and reviews with official publication years up to 2025. After database filtering and manual screening, 643 records were retained, including 596 original articles and 47 review articles. Bibliometric assessment, data processing, and graphical visualization were performed using R, Bibliometrix, VOSviewer, CiteSpace, and Scimago Graphica. We analyzed publication trajectories, geographic and institutional contributions, author activity, journal distribution, citation links, reference co-citation patterns, keyword networks, thematic clusters, burst keywords, and longitudinal topic changes. Scientific output increased progressively from 2003 to 2025, with publication activity becoming more pronounced in the most recent period. In terms of national contribution, the United States showed the strongest overall performance in both publication output and citation impact, whereas Italy, the Netherlands, Japan, China, and several other countries also made substantial contributions. At the institutional level, the Netherlands Cancer Institute, Vita-Salute San Raffaele University, and the University of Verona represented major contributors. BJU International, European Urology, World Journal of Urology, Journal of Endourology, and Journal of Robotic Surgery were identified as key journals for disseminating research in this area. Keyword and co-citation findings indicated a gradual transition from early surgical experience, learning-curve assessment, and technical feasibility toward research on oncologic outcomes, lymph-node management, functional recovery, and multimodal treatment, alongside increasing attention to magnetic resonance imaging, pathological grading, and predictive factors. Research activity concerning robot-assisted radical prostatectomy for high-risk and locally advanced prostate cancer has expanded consistently over the past 20 years and has progressively shifted toward an integrated clinical research framework centered on oncologic safety, functional outcomes, lymph-node management, and multimodal treatment. Diagnostic and risk-assessment themes have increasingly supported patient selection, staging, and treatment planning within this framework. Future investigations incorporating harmonized definitions, longer follow-up, prospective multicenter designs, and consistent reporting of oncologic, functional, nodal, and treatment-sequencing outcomes are needed to define more precisely the clinical role of RARP in this patient population.

Robot-assisted thoracoscopic surgery has emerged as a new option for lung cancer surgery. This study aimed to compare the short-term perioperative outcomes of Multi-Arm Uniportal Robotic-Assisted Thoracic Surgery (M-URATS) and uniportal video-assisted thoracoscopic surgery (UVATS) in patients undergoing segmentectomy for stage IA non-small cell lung cancer. Clinical data of 179 patients who underwent M-URATS or Uniportal video-assisted thoracoscopic surgery (UVATS) segmentectomy and were pathologically confirmed as non-small cell lung cancer (NSCLC) were retrospectively reviewed. Propensity scores were estimated using available baseline clinicopathological variables, and 1:1 optimal propensity score matching without replacement was performed within exact T-stage strata to reduce baseline imbalance. A total of 170 patients (65 M-URATS, 105 UVATS) were enrolled according to the exclusion criteria. After propensity score matching, 46 patients remained in each group. After matching, compared with the UVATS group, the M-URATS group had a greater recorded number of assessed nodal stations and retrieved lymph nodes. The M-URATS group also showed more favorable short-term perioperative outcomes, including shorter operative time, less intraoperative blood loss, shorter drainage duration, lower drainage volume, and shorter postoperative length of stay after matching. No significant differences were observed in postoperative white blood cell change, hemoglobin change, albumin change, conversion to open surgery, or postoperative complications; however, the matched cohort was limited in size and was underpowered for uncommon safety outcomes. In addition, the total hospitalization cost remained higher in the M-URATS group than in the UVATS group (9560 ± 1310 USD vs. 7280 ± 1040 USD, P < 0.001). M-URATS appears to be a feasible option for selected patients undergoing segmentectomy for stage IA NSCLC and may be associated with more favorable short-term perioperative outcomes, particularly in recorded nodal assessment, blood loss control, chest drainage, and early postoperative recovery. UVATS remains a mature clinical alternative, and surgical approach should be individualized according to patient, tumor, anatomical, institutional, and economic factors. The findings should not be interpreted as evidence of safety equivalence, pain superiority, or long-term oncologic superiority.

To update the comparative evidence on robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN) for patients with cT1-cT2 renal tumors, with emphasis on cancer control, perioperative recovery, and postoperative kidney function. Four databases were queried for English-language comparative studies published between January 30, 2016 and March 1, 2026. Eligible reports enrolled adults with localized renal tumors treated with RAPN or LPN and provided extractable oncological, perioperative, or renal functional data. Two reviewers performed study selection, extraction, and quality appraisal. Treatment effects were calculated as odds ratios for binary variables and mean differences for continuous variables. Heterogeneity, sensitivity, small-study effects, subgroup patterns, and evidence certainty were explored where data allowed. Twenty-two studies with 6,202 participants were analyzed. Surgical margin positivity and recurrence did not differ materially between RAPN and LPN (OR 0.83, 95% CI 0.49-1.42; and OR 1.32, 95% CI 0.43-4.02, respectively). RAPN was associated with fewer overall complications (OR 0.72, 95% CI 0.55-0.93), lower transfusion requirement (OR 0.49, 95% CI 0.25-0.94), less blood loss (MD -27.88 mL, 95% CI -40.28 to -15.47), shorter warm ischemia (MD -3.54 min, 95% CI -4.65 to -2.44), smaller eGFR reduction (MD -3.05 mL/min/1.73 m², 95% CI -4.30 to -1.80), and reduced new-onset CKD (OR 0.61, 95% CI 0.42-0.88). However, the certainty of evidence was low or very low for all outcomes, and these findings should be interpreted as associations rather than proof of definitive superiority. In contemporary comparative studies, RAPN appeared oncologically comparable with LPN and was associated with favorable estimates for selected perioperative and renal functional outcomes. Because the certainty of evidence was low or very low, the clinical implications should be interpreted cautiously and may be most relevant for complex tumors and patients in whom renal preservation is particularly important.

To assess feasibility and oncological results of subxiphoid robotic thymectomy by comparing perioperative and survival outcomes between large (≥ 5 cm) and small (< 5 cm) thymic epithelial tumors (TETs). This retrospective research contained 145 patients with TETs undergoing subxiphoid robotic thymectomy between September 2016 and November 2022. Patients were assigned into large and small tumor group according to maximum diameter on chest CT. The large and small tumor groups included 51 and 94 patients respectively. All patients underwent R0 resection. Patients with large tumor group had prolonged surgical time (135 vs. 120 min, p = 0.005). Other characteristics including pathology, length of hospital stay, TNM stage and tumor invasion were not significantly different between groups. Median follow-up was 65 months. 62.8% of patients completed 5 years of follow-up. Five-year FFR (85.2% vs. 93.4%, p = 0.18), OS (92.6% vs. 95.5%, p = 0.75), and DFS (85.2% vs. 89.9%, p = 0.61) were comparable between large and small tumor groups. In contrast, FFR differed significantly by histotype (p = 0.0001). Among patients undergoing subxiphoid robotic thymectomy, there is no significant differences in survival outcomes over 5 years between large and small tumors.

Neoadjuvant immunochemotherapy (NAIC) has been confirmed to achieve greater tumor regression and better potential survival benefits than neoadjuvant chemotherapy alone. However, for locally advanced gastric cancer after NAIC, existing evidence comparing robotic gastrectomy (RG) and laparoscopic gastrectomy (LG) remains limited. This research included 305 patients in total, among which 196 underwent LG and 109 underwent RG. After propensity score matching (PSM), 90 patients were retained in each cohort. Compared with LG, RG was associated with shorter operative duration (205.49 ± 48.49 min versus 243.27 ± 66.42 min, P < 0.001), higher total number of harvested lymph nodes (31.78 ± 12.86 versus 26.83 ± 10.71, P = 0.006), lower intraoperative blood loss (median: 20 ml versus 30 ml, P = 0.004), and lower incidence of postoperative complications (18.89% versus 37.78%, P = 0.005). Regarding survival outcomes, RG significantly improved the 3-year disease-free survival (DFS) rate (81.1% versus 66.6%, P = 0.029), while no statistically significant between-group difference was observed in 3-year overall survival (OS) (91.1% versus 83.3%, P = 0.136). In conclusion, compared with LG, RG shows clear advantages in short-term postoperative outcomes and 3-year DFS, with no significant difference in 3-year OS.

To characterize clinical and molecular characteristics and prognosis among patients with metastatic breast cancer (MBC) who undergo brain metastasis (BM) resection.

We retrospectively identified patients with MBC who underwent BM resection from 2006 to 2024 at a single center. Chart abstraction was utilized to identify key demographic, treatment, and outcome data. Median real-world overall survival (mrwOS) was estimated with the Kaplan-Meier method; the Cox proportional hazards model evaluated factors associated with mrwOS.

107 patients were identified with the following MBC subtypes: hormone receptor-positive (HR+), HER2-negative (HER2-) (n = 26, 24.3%), HER2+ (n = 45, 42.1%), and triple-negative (TNBC; n = 36, 33.6%). At time of initial BM surgical resection, 55 patients (51.4%) had CNS-only disease and 63 patients (58.9%) had a single BM. Most patients received systemic therapy after BM resection (n = 83/95 with available systemic therapy records, 87.4%) and postoperative radiation (n = 92/103 with available post-operative radiation records, 89.3%). Among patients with available BM receptor status (n = 92), 25 (27.2%) had receptor discordance between BM and peripheral tissue testing, mostly loss of BM HR-positivity (n = 20/92, 21.7%). Among patients with available BM NGS testing (n = 40), the most common pathogenic alterations were TP53 mutation (n = 28, 70.0%), ERBB2 amplification (n = 15, 37.5%), and PIK3CA mutation (n = 9, 22.5%); 31 patients (77.5%) had therapeutically targetable mutations. mrwOS from BM resection was longer for patients with HR+/HER2- and HER2+ MBC vs. TNBC (40.3 and 37.8 months vs. 12.6 months, p = 0.04 and p = 0.02 respectively). On multivariate analysis, receipt of systemic therapy (HR 0.09, CI 0.04-0.21, p < 0.01) and stereotactic radiosurgery (SRS) (HR 0.41, CI 0.18-0.97, p = 0.04) post-operatively were associated with longer mrwOS. Extracranial disease at time of resection (HR 4.60, CI 2.52-8.39, p < 0.01) and development of leptomeningeal disease (LMD) (HR 6.08, CI 3.00-12.31, p < 0.01) were associated with shorter mrwOS.

Survival after BM resection was ~3 years in patients with HR+/HER2- and HER2+ MBC and ~1 year in patients with TNBC. Extracranial disease at time of BM resection and development of LMD were associated with worse prognosis. Loss of HR-positivity and targetable mutations were present in ~22% and ~75% of resected BMs, respectively, supporting the utility of molecular analysis of resected BMs to guide management.