Hip arthroplasty is rarely required before skeletal maturity. However, it is appropriate after resection of a proximal femoral bone tumour. This retrospective single-centre cohort study was conducted to evaluate how age and choice of articulation affects modes of implant failure and revision-free survival, and to understand the longer-term outcomes following inevitable revision.

Between January 1982 and April 2023, 60 patients aged between two and 16 years underwent excision of a malignant bone tumour and proximal femoral endoprosthetic reconstruction (PFEPR) combined with either a hemiarthroplasty (HA) or total hip arthroplasty (THA) articulation. The median follow-up was 12.6 years (IQR 4 to 21).

There were 41 HAs and 19 THAs. Revision-free survival was poor in pre-adolescent patients (age ≤ 12 years) regardless of articulation (54% at five years (95% CI 38 to 77) and 21% at ten years (95% CI 8 to 54)). Adolescent patients (age > 12 years) undergoing THA (n = 12) had better median, five-year, and ten-year revision-free implant survival (21.9 years (IQR 11.9 to 22.7), 89% (95% CI 71 to 100), and 78% (55 to 100), respectively) than similarly aged patients undergoing HA (n = 15); (7.1 years (IQR 4.9 to 13.5), 68% (95% CI 46 to 100), 39% (18 to 82); p = 0.048), respectively). The leading indication for revision across all ages was an acetabular complication. HA subluxation occurred exclusively in the pre-adolescent cohort (14/26) at a median 2.8 years (IQR 2 to 8). Chondrolysis occurred in the adolescent cohort (8/27) at a median 7.1 years (IQR 2 to 12). Revision THA after failed HA (n = 35) survived well (85% (95% CI 71 to 100) and 77% (60 to 100) at five and ten years) although an early postoperative dislocation rate of 12% (n = 4) was observed, all of which were managed by closed reduction.

Very young patients continue have a high risk of further surgery in the first decade after PFEPR. THA combined with PFEPR appears to improve revision-free implant survival in adolescent patients when compared with HA; however, it may introduce a risk of early postoperative dislocation. Following HA, there is a different mode of failure in pre-adolescent compared with adolescent patients, and revision to THA in either circumstance is durable.

Over the past two decades, focal therapy for localized prostate cancer has evolved from an experimental approach into a structured treatment option within the framework of risk-adapted prostate cancer management. The aim of this article is to provide a critical appraisal of the current role of focal therapy in light of contemporary guidelines, available evidence, and health-economic considerations. The introduction of multiparametric MRI and MRI-targeted fusion biopsy has substantially improved the accurate identification of clinically significant index lesions, thereby establishing the technical foundation for selective ablative approaches. Despite these advances, the evidence base remains heterogeneous, and large randomized comparative trials are still lacking. The largest comparative study to date (HIFI trial) demonstrated oncological non-inferiority compared with radical prostatectomy, albeit with important methodological limitations, while achieving superior functional outcomes. Initial randomized data from the FARP trial has so far been presented only in abstract format at scientific meetings, and a full peer-reviewed publication is pending. Within the contemporary therapeutic landscape, active surveillance, focal therapy, and radical treatments should not be viewed as strictly competing strategies but rather as components of a risk-adapted continuum. While active surveillance remains the standard of care for patients with low-risk disease, focal therapy may represent a suitable option for carefully selected patients with a clearly localized, biologically relevant index lesion and a strong preference for functional preservation. Optimal outcomes depend on rigorous patient selection using modern imaging, fusion biopsy techniques, and structured follow-up protocols. At the same time, considerable structural disincentives persist: pretherapeutic precision diagnostics are frequently inadequately reimbursed, and hospital reimbursement for focal procedures remains substantially lower than for radical standard treatments. In summary, focal therapy should no longer be regarded primarily as an experimental approach but as a selective component of a differentiated precision oncology concept. Its appropriate application remains indication-dependent and requires further high-quality prospective studies as well as supportive structural and economic frameworks.

Non-small cell lung cancer (NSCLC) staging relies on accurate assessment of mediastinal lymph nodes. This study investigates the utility of radiomic features derived from contrast-enhanced thoracic CT scans in predicting malignancy in clinically positive (cN+) mediastinal lymph nodes.

A retrospective cohort of 110 NSCLC patients with cN + who underwent surgical resection was analyzed. 3D segmentations of up to three lymph nodes per patient were performed. Radiomic features, encompassing heterogeneity measures, were extracted. A radiomics model was constructed using a random forest and XGboost algorithm. To ensure robustness and minimize bias, 100 iterations of data splitting were conducted to create distinct training and test sets for reproducibility and statistical reliability.

The radiomics model achieved an area under the curve (AUC) of 0.703 for Forest model and 063 for XGboost model. Three recurrent features in the radiomic signatures, "RootMeanSquared", "Grey Level Co-Occurrence Matrix Imc2", and "Grey Level Run Length Matrix RunEntropy", highlighted the importance of nodal heterogeneity features in the model.

Radiomic features extracted from contrast-enhanced thoracic CT scans could predict malignancy in cN+ mediastinal lymph nodes of NSCLC patients (AUC = 0.703). Three features of heterogeneity were recurrent in radiomic signature, emphasizing the potential importance of incorporating nodal heterogeneity criteria in addition to size assessment.

Mobile phone-based surveys are increasingly used for data collection in global contexts - and although the strengths and limitations of this methodology in high-income countries are well-documented, less is known about using this approach (particularly for longitudinal data collection) in low- and middle-income countries, where mobile phone ownership has expanded rapidly. In this paper, we leverage data from a parent study about cervical cancer prevention to understand the features associated with retention and loss to follow-up in repeated random-digit dialed mobile phone-based surveys over time in Kenya. From a cohort of 1405 people surveyed in 2022, 1167 were found again in 2024 (83.1%) and 1106 completed the 2024 survey (78.7%). Survey re-completion was significantly associated with older age (versus 17-32 year olds: OR 1.63 [95% CI 1.21-2.20] for 33-38 year olds, OR 1.65 [95% CI 1.22-2.22] for 39-45 year olds, and OR 2.62 [95% CI 1.84-3.72] for ≥46 year olds), male gender (OR 1.44 [95% CI 1.14-1.83]), and household income. Only age was significantly associated with our secondary outcome of being retained in the sample for follow-up (regardless of survey re-completion). This study's high follow-up rate was not substantially different across these aforementioned groups, suggesting that mobile phone-based data collection is a promising approach, even for longitudinal surveys, in diverse global settings. We encourage more research about, and using, this methodology so researchers can better understand, and improve, follow-up and its determinants.

The aim of this systematic review and meta-analysis is to evaluate whether neoadjuvant radiotherapy or chemoradiotherapy, combined with immune checkpoint inhibitors for adults with resectable solid tumors, increases the risk of severe treatment-related toxicity and organ-specific adverse events compared with radiotherapy or chemoradiotherapy alone.

A systematic review and meta-analysis will be performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We will identify eligible studies published in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials from January 2015 through March 2026. Clinical trial registries and major oncology conference proceedings will be searched, and references of included studies and relevant prior systematic reviews will be reviewed. Eligible studies will include randomized and observational cohorts of adults with resectable solid tumors receiving neoadjuvant radiotherapy or chemoradiotherapy combined with immune checkpoint inhibitors and reporting at least one prespecified safety outcome. Outcomes of interest include grade ≥ 3 treatment-related adverse events, grade ≥ 3 immune-related adverse events (overall and by organ system), treatment discontinuation, treatment-related death, requirement for systemic immunosuppression, radiotherapy site toxicities, and 90-day perioperative complications after surgery. Where appropriate, comparative data will be pooled using random-effects models and explored in subgroup analyses by tumor site, fractionation approach, and timing of immune checkpoint inhibitor delivery relative to radiotherapy. The protocol has been registered on the International Prospective Register for Systematic Reviews (PROSPERO CRD420261322883).

Neoadjuvant radiotherapy and chemoradiotherapy are established components of curative-intent care across multiple solid tumors, and immune checkpoint inhibitors are increasingly used perioperatively. However, safety data for combined neoadjuvant radio-immunotherapy are fragmented across tumor sites and treatment schedules, limiting clear estimates of severe and organ-specific toxicity. This study will synthesize the available evidence on toxicity and perioperative complications and clarify safety risks, identify settings where toxicity may be concentrated, and highlight evidence gaps that should be addressed in future prospective comparative trials.

Superficial gastrointestinal (GI) neoplasms pose a significant global health burden, with endoscopic submucosal dissection (ESD) as the gold standard for curative resection. However, conventional ESD (C-ESD) is technically challenging, with prolonged procedure times and higher complication risks. Robotic-assisted ESD (R-ESD) offers enhanced precision and safety, but evidence is limited. To evaluate the efficacy and safety of R-ESD using a Bayesian single-arm Meta-analysis. Systematic review and Bayesian single-arm meta-analysis. Following PRISMA guidelines and PROSPERO registration (CRD420251273787), we conducted a systematic review and Bayesian single-arm meta-analysis of randomized/nonrandomized comparative and single-arm studies on R-ESD for superficial GI neoplasms. Searches spanned MEDLINE, Embase, Scopus, and others through December 2025. Primary outcomes: en-bloc and R0 resection rates. Secondary outcomes: procedure time, perforation, bleeding. Bayesian random-effects models used non-informative priors; analyses in R with the brms package. Risk of bias was assessed via RoB 2 and NOS; certainty via GRADE. Five studies (183 lesions) were included. Frequentist pooled en-bloc resection rate: 98.2% (95% CI: 0.916-0.996, I2 = 0%); R0: 96.8% (95% CI: 0.759-0.997, I2 = 47.8%). Bayesian medians: en-bloc 93.4% (95% CrI: 0.856-0.971); R0 90.0% (95% CrI: 0.798-0.957). 77.6 min (95% CI: 45.0-110.3, I2 = 99%); perforation: 1.2% (95% CI: 0.002-0.077, I2 = 0%); bleeding: 10.6% (95% CI: 0.019-0.416, I2 = 30.8%). Evidence certainty:low. R-ESD demonstrates promising efficacy and safety, but current evidence is limited to small, mostly non-comparative studies. Larger comparative trials are required before definitive conclusions can be made.

To assess the long-term cost-effectiveness of robot-assisted radical prostatectomy (RARP) versus open radical prostatectomy (ORP) for localized prostate cancer from the perspective of the French public healthcare system using real-world data. This nationwide comparative cohort study used the French National Health Data System including men undergoing first prostatectomy between 2012 and 2015 with up to eight years follow-up. Patients were allocated to RARP or ORP based on hospital equipment. Inverse probability weighting using a high-dimensional propensity score adjusted for confounding. Outcomes included progression-free survival and direct medical costs. Incremental cost-effectiveness ratios were estimated with bootstrapping and acceptability curves. Sensitivity analyses incorporated additional robotic costs, and hospital volume. Among 27,951 patients, 10,040 underwent RARP and 17,911 ORP; median follow-up was 6.7 years. RARP was associated with lower total costs (€44,631 vs. €47,434) and slightly longer progression-free survival (+0.10 years), yielding a dominant profile. Cost savings reached €3,623 overall and were greatest in highvolume centers. The probability of cost-effectiveness exceeded 90% across thresholds. When robotic costs were included, RARP remained cost-effective, with incremental cost-effectiveness ratios around €19,000-€25,000 per progression-free year depending on volume. RARP provides improved progression-free survival with reduced healthcare expenditures compared with ORP in France, resulting in a robust dominant or highly cost-effective profile over the long term. Findings were consistent across hospital volumes and sensitivity analyses. These real-world results support reassessment of reimbursement policies and suggest that wider adoption of RARP may deliver sustained clinical and economic value for the healthcare system overall.

To assess the feasibility of robot-assisted right colectomy (RRC) for right-sided colon cancer by comparing its short-term surgical outcomes with those of laparoscopic right colectomy (LRC). We retrospectively reviewed consecutive patients undergoing elective right colectomy for stage I-III colon adenocarcinoma (LRC, n = 75; RRC, n = 50). The primary endpoint was overall 30-day postoperative morbidity; overall survival (OS), relapse-free survival (RFS), and other perioperative measures were secondary. A pre-specified exploratory analysis measured anastomotic time on intraoperative video in patients receiving an intracorporeal anastomosis (IA; robotic, n = 10; laparoscopic, n = 3). Median follow-up was 22.6 months. Baseline characteristics were balanced. Blood loss was lower with RRC (median 5 vs. 10 mL, p = 0.005), a clinically irrelevant difference, while operative time was longer (290 vs. 251 min, p = 0.05); setup and docking took a median of 24.5 min and console time 211.5 min. IA was used far more often in RRC (88.0% vs. 6.7%, p < 0.001). Morbidity, Clavien-Dindo grade ≥ III events, leakage, and hospital stay were similar. Robotic IA (n = 10) was faster than laparoscopic IA (n = 3; 33.4 vs. 40.7 min, p = 0.049), though underpowered. Neither OS nor RFS differed (log-rank p = 0.12 and 0.13). RRC was as safe as LRC perioperatively, with no difference in early OS or RFS, although the study was not powered for equivalence. The shorter robotic anastomotic time, observed despite greater institutional experience with laparoscopic IA, is hypothesis-generating and merits confirmation in adequately powered studies.

Telesurgery may help overcome geographic disparities in access to specialized surgical care. Although recent studies confirm the technical feasibility of robotic thoracic telesurgery, most reports originate from highly controlled settings, and practical implementation within public healthcare systems remains scarce. We describe the development and preliminary clinical application of a robotic thoracic telesurgery program in a middle-income country, reported as a proof-of-implementation case series rather than a statistically validated model. A robotic thoracic telesurgery program was developed connecting the University of São Paulo Medical School (FMUSP) and University Hospital (HU-USP), approximately 10 km apart, using the Toumai® platform over the institutional fiber-optic network. Development included infrastructure deployment, preclinical network validation (28 robotic surgeons), safety-protocol development, and team training, culminating in two remotely performed procedures under a pre-defined, manufacturer-limited case allocation. A robotic wedge resection for pulmonary metastasis and a robotic left upper trisegmentectomy with systematic lymphadenectomy were completed entirely under remote control, with the surgeon at FMUSP and the patient at HU-USP. Neither procedure had communication interruptions, packet loss, conversion events, or intraoperative complications; maximum latency did not exceed 12 milliseconds. Chest tubes were removed on postoperative day 1 in both patients, with discharge on day 1 and 2, respectively. This early experience supports the technical feasibility of introducing robotic thoracic telesurgery within a public healthcare system through a structured implementation pathway. Given the small sample, conclusions remain preliminary; the model's value lies not in extending distance, but in outlining a reproducible process for expanding access to specialized surgical expertise.

Resection-line planning during robot-assisted partial nephrectomy (RAPN) requires accurate tumor localization while preserving normal renal parenchyma. We developed a three-dimensional image-guided (3D-IG) system that displays a patient-specific 3D kidney model together with the real-time position of the surgical instrument tip. This retrospective comparative study evaluated the initial clinical implementation of 3D-IG in RAPN. Ten consecutive patients with moderate- to high-complexity renal tumors who underwent RAPN using 3D-IG between February and June 2025 were compared with ten randomly selected historical controls with a matching R.E.N.A.L. (R = tumor radius, E = exophytic/endophytic properties, N = nearness of tumor to the collecting system or sinus, A = anterior/posterior, L = location relative to polar line) nephrometry score range who underwent conventional ultrasound (US)-guided RAPN in 2024. Resection-line marking time was significantly shorter in the 3D-IG group than in the US group (77 vs. 282 s, p < 0.001), as was resection-line localization time (25 vs. 125 s, p < 0.001). Electrocautery activation events during marking were also fewer in the 3D-IG group (16 vs. 39, p < 0.001). Even after including routine US confirmation performed for safety in the 3D-IG group, total planning time remained comparable between groups (207 vs. 282 s, p = 0.226). Pathological margin width did not differ significantly between groups, no positive surgical margins were observed, and perioperative and renal functional outcomes showed no apparent adverse signal. The 3D-IG system improved the efficiency of resection-line marking during RAPN while maintaining acceptable short-term surgical outcomes.