Zolbetuximab plus chemotherapy is standard first-line therapy for HER2-negative, CLDN18.2-positive advanced gastric or gastroesophageal junction cancer (GC/GEJC), but the incidence, course, and clinical correlations of zolbetuximab-related gastric mucosal injury and hypoalbuminemia remain unclear. We thus evaluated these relationships and the clinical course in real-world practice.

We retrospectively analyzed 38 patients with HER2-negative, CLDN18.2-positive, advanced GC/GEJC treated with zolbetuximab plus chemotherapy at a single center. Associations between endoscopic findings and albumin changes from baseline were analyzed.

Median albumin decreased from 3.7 to 2.6 g/dL. The median albumin decline was greater in patients without gastrectomy (- 1.0 g/dL) or with partial gastrectomy (- 1.1 g/dL) than in those with total gastrectomy (- 0.3 g/dL; P = 0.009 and 0.007). Albumin levels fell rapidly at weeks 1-3 and recovered toward baseline by weeks 19-27. Upper gastrointestinal endoscopies were performed in patients with a remaining stomach, showing peak abnormalities within 7-12 weeks; no cases with grade ≥ 2 gastric mucosal injury were observed after week 25. White exudate was associated with albumin decline (- 0.9 vs. -0.4 g/dL, P = 0.023).

The presence of white exudate demonstrated a significant association with a marked decrease in serum albumin levels. The risk of hypoalbuminemia appeared to be lower in patients after total gastrectomy. Serum albumin levels decreased after treatment initiation and subsequently showed a tendency to recover over time. Gastric mucosal abnormalities were most frequently observed during the early phase of treatment and were less common in examinations performed after week 25.

Lung cancer is the leading cause of cancer death in the United States and disproportionately affects Black adults. Lung cancer screening (LCS) remains narrowly focused on cigarette smoking, often excluding other tobacco use, and low provider referral rates continue to limit screening uptake. Addressing these gaps is critical to advancing screening equity.

We surveyed 100 Black adults (aged 50 + years) with a 20 + year history of tobacco use who either currently used or had quit within the past 15 years. The survey assessed tobacco use characteristics, cessation intentions, tobacco product harm perceptions, LCS-related quit motivations, and LCS knowledge and beliefs. We compared characteristics, beliefs, and experiences by LCS status (56% screened) using a quasi case-control approach.

LCS uptake varied by insurance status (p = 0.03), tobacco risk perceptions (p = 0.037), past-year quit attempts (p = 0.005), and lung cancer beliefs, including early detection knowledge (p < 0.001). Screening experiences were associated with health care discrimination and LCS-related risk perceptions. Among adults reporting past-year use of combustible tobacco products other than cigarettes, unscreened adults were more likely than screened adults to report current use (22.7% vs. 5.4%; p = 0.01). Participants most identified social media (48.0%), followed by magazines/newspapers (31.0%) and local news (29.0%), as trusted sources of information on early lung cancer detection.

Expanding LCS eligibility to include non-cigarette combustible tobacco use-while addressing structural barriers, provider recommendations, gaps in screening knowledge, risk perception, and culturally responsive communication-are essential for improving the reach, implementation, and equity of LCS in Black communities.

Young adults diagnosed with cancer face complex challenges related to identity, body perception, and psychosocial adjustment during survivorship. Nature-based rehabilitation programs have been proposed as potential supportive interventions, yet little is known about how participants construct meaning from these experiences. This study explored how young adult cancer survivors narrated the impact of participation in the Desert Journey program, a multi-day desert trek for young adults coping with cancer.

In-depth semi-structured interviews were conducted with 21 young adult cancer survivors after participating in the program. Data were analyzed through a dual analytic strategy combining narrative analysis to reconstruct individual accounts as evolving plots and cross-narrative thematic analysis to identify shared patterns of change.

Three interconnected themes emerged: (1) the body that tells a story-a shift from experiencing the body as fragile and medically controlled to perceiving it as resilient and capable; (2) rewriting identity-movement from a survival-focused self-definition toward renewed authenticity and belonging; (3) the day after-varying experiences of integrating journey insights into everyday life, with some participants sustaining personal growth and others reporting challenges maintaining changes without continued support.

Nature-based group programs may provide an important context for psychosocial recovery among young adult cancer survivors. The findings highlight the potential value of such interventions within supportive cancer care and emphasize the importance of ongoing psychosocial and peer support to sustain their benefits.

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.

Robot-assisted partial nephrectomy (RAPN) enables the management of complex localized renal masses while preserving renal function. However, the adoption of institutionalized same-day discharge (SDD) pathways remains limited. Herein, we report the safety and feasibility of SDD RAPN at an ambulatory surgery center (ASC) at our institution. We performed a retrospective observational study of patients who underwent SDD RAPN at a freestanding ASC at our institution during 2022-2025. Patients were eligible for the SDD pathway if they had a good performance status (ECOG 0-1), localized renal masses amenable to partial resection, reliable post-discharge communication, and travel time < 2 h from their residence to the hospital. A total of 63 patients underwent 65 SDD RAPNs at our ASC during 2022-2025. Patients had a median age at surgery of 62 years (interquartile range 51-71 years), and most were male (73%), non-Hispanic (63%), White (70%), and overweight (54%). Most patients had an American Society of Anesthesiologists score of III (60%), were never-smokers (63%), and had clinical stage T1 disease (92%). Most procedures were for lesions of moderate complexity (46%). All surgical specimens revealed negative surgical margins (100%), with the most common histology being clear cell carcinoma (63%). Overall, 4/65 (6%) procedures led to any-grade Clavien-Dindo complications and 2/65 (3%) required readmissions. No deaths or local or distant recurrence were observed at a median follow-up of 1.1 years. Overall, we found that SDD is safe and feasible for appropriately selected patients undergoing RAPN, with promising perioperative outcomes and low morbidity rates.

AL amyloidosis is characterized by extracellular deposition of immunoglobulin light-chain fibrils, frequently leading to kidney involvement and progressive organ dysfunction. We report a case of kidney AL amyloidosis secondary to multiple myeloma in which daratumumab-based chemotherapy combined with autologous peripheral blood stem cell transplantation resulted in marked improvement, as confirmed by sequential kidney biopsy. The initial biopsy revealed vascular-dominant amyloid deposition, whereas the second biopsy obtained 2 years later demonstrated a marked reduction in amyloid burden, particularly within the vascular compartments. This histopathological improvement corresponded with hematologic remission and stabilization of kidney function. The observed reduction in tissue amyloid deposits was presumed to result from suppression of amyloidogenic light chains, leading to inhibition of new fibril formation and subsequent tissue remodeling. Our findings provide direct pathological evidence that daratumumab-based combination therapy, through immune-mediated plasma cell depletion, may indirectly promote the regression of amyloid deposits and contribute to functional recovery.

Post-robot-assisted radical prostatectomy (RARP) urinary incontinence (PPI) represents the functional complication with the greatest negative impact on the patient's global quality of life (QoL). Although the role of Pelvic Floor Muscle Training (PFMT) is widely established in perioperative clinical management, it is mostly delivered on demand after surgery. This study primarily assesses the clinical efficacy of pelvic prehabilitation when systematically implemented compared with usual care. This is a prospective, non-randomized, quasi-experimental (before-and-after) study comparing all consecutive patients undergoing RARP prior to the implementation of the PFMT program with an equally sized cohort of consecutive patients exposed to PFMT before RARP. PFMT consisted of a standardized 60-minute group session delivered by dedicated pelvic physiotherapists, including pelvic floor anatomy education, supervised proprioceptive and contraction exercises, and prescription of a structured home-based training program. The primary endpoint was post-operative continence, defined as no need for pads after surgery. Functional outcomes were also assessed using the UCLA-PCI and SF-36 questionnaires at 1, 3, and 6 months after surgery, and the recourse to post-operative PFMT. Additionally, a composite variable named "True Clinical Need" was defined as no incontinence at 6 months plus a moderate/severe subjective bother (score 3 or 4 on question Q5 of the UCLA-PCI). Finally, a cost-avoidance analysis on preoperative PFMT was performed. Overall, 214 consecutive subjects were recruited: 107 per our standard pathway (no-PFMT group) and 107 who received PFMT before RARP (PFMT group). Patient-reported satisfaction and adherence to the home-based program were high (both > 8/10 on a Likert scale). Demographic, oncological, and surgical features were comparable between the two groups. The PFMT group demonstrated significantly better 6-month continence rates (82.0% vs. 66.7%, p = 0.025) and urinary function scores (57.9 vs. 51.7, p = 0.045) compared with the NO-PFMT group. The recourse to individual postoperative cycles was similar between groups (no-PFMT 3.7% vs. PFMT 5.6%), as well the true clinical need (no-PFMT 16.1% vs. PFMT 11.2%). A cost-avoidance analysis showed that prehabilitation would yield an estimated net saving of €165 per patient. A single PFMT session could significantly improve continence recovery at 6 months after RARP within economic sustainability.

Postoperative erectile dysfunction remains a highly debilitating complication following robot assisted radical prostatectomy for localized prostate cancer. Traditional risk stratification heavily relies on anatomical and oncological parameters utilizing simple linear regression algorithms, frequently failing to capture the complex multifaceted physiological and psychological dynamics that govern functional sexual recovery. To engineer and robustly validate an advanced machine learning architecture utilizing a LightGBM framework coupled with SHapley Additive exPlanations to accurately predict postoperative erectile dysfunction by integrating conventional surgical metrics with novel psychosocial and systemic immunological indices. This multicenter retrospective cohort study analyzed 824 patients with strictly localized prostate cancer who underwent robot assisted radical prostatectomy across two independent medical institutions. The primary outcome was functional erectile impairment systematically assessed utilizing validated questionnaires following a minimum six month postoperative observation period. To isolate the optimal prognostic variables, a rigorous two step dimensionality reduction strategy was executed. This approach incorporated Least Absolute Shrinkage and Selection Operator regression alongside a Random Forest feature importance algorithm. The dimensionality reduction pipeline successfully identified seven core independent predictors: the Patient Health Questionnaire 9 score, patient age, the HALP score, baseline serum testosterone, clinical stage, preoperative biopsy Gleason score, and prostate volume. The LightGBM algorithm demonstrated unparalleled predictive superiority in the independent validation cohort, achieving an area under the receiver operating characteristic curve of 0.946, an overall accuracy of 0.927, a sensitivity of 0.775, and a specificity of 0.956. The SHapley Additive exPlanations analysis provided transparent clinical interpretability, unequivocally revealing the Patient Health Questionnaire 9 score as the dominant predictive determinant. Severe baseline depressive symptoms were independently associated with a significantly elevated risk of functional impairment, whereas robust systemic nutritional immunological health and adequate baseline testosterone levels emerged as potential protective factors. This multicenter study developed a LightGBM prognostic framework that incorporates preoperative psychological and systemic physiological metrics to predict erectile dysfunction after robot assisted radical prostatectomy. The integration of these variables provides a more comprehensive approach to risk assessment than traditional physiological models. While further independent external validation remains necessary, this framework may assist urologists in personalized risk stratification and early rehabilitation planning for patients with localized prostate cancer.

Robotic total mesorectal excision (TME) now rests on an evidence base that has accumulated layer by layer: randomized trials, meta-analyses, registry cohorts, and dedicated functional-outcomes studies. The publication of the long-term results of the REAL trial (2025) marked a turning point. We propose a hierarchical evidence framework in which the REAL trial functions as confirmatory apex rather than foundational basis. It provided the first randomized evidence of better locoregional control and disease-free survival with robotic surgery compared to laparoscopy (3-year locoregional recurrence 1.6% vs. 4.0%; absolute risk reduction 2.4%; HR 0.45). This narrative review synthesizes the current evidence comparing robotic TME with laparoscopic TME, framing the most recent randomized data within the broader context of the accumulated literature. Across multiple study designs, robotic TME is consistently associated with lower conversion rates, better circumferential resection margin negativity in selected subgroups, and better preservation of urinary and sexual function. These advantages are amplified in male patients, those with obesity, post-neoadjuvant fibrosis, and lower rectal tumors. Important caveats remain: REAL was conducted exclusively at high-volume Chinese centers, an overall survival benefit has not yet been demonstrated, and cost and access barriers continue to shape global adoption. Evidence in 2026 supports robotic TME as the preferred minimally invasive approach for mid-to-low rectal cancer in centers with established expertise, adequate infrastructure, and case volume. When these conditions are not met, expert laparoscopic TME retains its place. Five-year data and validation across diverse healthcare systems are needed before a universal recommendation can be made.

Endoscopic thyroid surgery is increasingly used for papillary thyroid carcinoma (PTC), but whether robotic bilateral axillo-breast approach (BABA) offers meaningful perioperative advantages over endoscopic contralateral axillo-bilateral-breast approach (CABBA) for unilateral lobectomy with ipsilateral central lymph node dissection (CLND) is unclear. This retrospective cohort study at Shanghai Sixth People's Hospital (2021-2025) aimed to compare outcomes between robotic BABA and endoscopic CABBA after lobectomy plus ipsilateral CLND for PTC, stratified by body mass index (BMI: <24 vs. ≥ 24 kg/m²). Propensity score matching was applied within each BMI stratum. Among 116 non-overweight patients (BMI < 24; median age 33.0 years; 87.1% female), operative time (150.0 vs. 137.5 min; median diff 12.0 min; 95% CI 0 to 24; P = 0.087) and central lymph node yield (7.0 vs. 6.0; median diff - 1.0; 95% CI - 3 to 1; P = 0.435) were comparable between robotic BABA and endoscopic CABBA. Robotic BABA was associated with significantly higher cost (median ¥51,394 vs. ¥22,043; median diff ¥29,351; 95% CI ¥26,100-¥32,600; P < 0.001) and longer incision length (median 4.00 vs. 2.80 cm; median diff - 1.20 cm; 95% CI - 1.20 to - 1.20; P < 0.001). Among 32 overweight/obese patients (BMI ≥ 24; median age 32.0 vs. 31.0 years; 56.3% female), robotic BABA achieved higher central lymph node yield (6.5 vs. 2.5; median diff - 4.0; 95% CI - 8 to - 1; P = 0.003), with comparable operative time (142.5 vs. 140.0 min; median diff - 5.0; 95% CI - 20 to 10; P = 0.595) and hospital stay (3.0 vs. 3.0 days; median diff 0; 95% CI 0 to 1; P = 0.147). Endoscopic CABBA retained cost and cosmetic advantages in both strata (both P < 0.001). In non‑overweight patients undergoing lobectomy with ipsilateral CLND for PTC, robotic BABA provides no perioperative advantage over endoscopic CABBA and is less cost‑effective. In overweight/obese patients, robotic BABA improves central lymph node clearance. These findings support BMI‑based patient selection for robotic thyroidectomy.