Abstract: Background/Objectives: Single port laparoscopy (SPL) represents an evolution in mi-nimally invasive surgical techniques aimed at reducing access trauma and improving cosmetic outcomes. This meta-analysis examines the benefits, limitations, and evolutio-nary trajectory of SPL across surgical specialties to provide a comprehensive understan-ding of its clinical utility. Methods: A systematic search of electronic databases (PubMed/MEDLINE, Embase, Cochrane Library, Web of Science) was conducted for studies published between January 2000 and October 2023 comparing SPL with conventional laparoscopy. The PRISMA guidelines were followed for study selection and data extraction. Randomized controlled trials and prospective comparative studies were included. Outcomes of interest included operative metrics, postoperative recovery, complications, and patient-reported outcomes. Meta-analyses were performed using random-effects models with heterogeneity explored through subgroup analyses and meta-regression. Results: Analysis of 43 randomized controlled trials (5,807 patients) demonstrated that SPL was associated with longer operative times (WMD: +10.5 minutes; p< 0.001), superior cosmetic satisfaction (SMD: +0.61; p< 0.001), and reduced postoperative pain within 24 hours (SMD: -0.58; p=0.002). No significant differences were observed in overall com-plication rates (RR: 0.94; p=0.31), though heterogeneity was substantial across outcomes (I²: 29-83%). Subgroup analyses revealed surgeon experience, access device type, patient selection, and procedural complexity as significant moderators of between-study varia-tions. Conclusions: SPL can be performed safely across various surgical disciplines when conducted by appropriately trained surgeons, with its primary advantage being cosmetic outcomes. While significant technical challenges remain, including instrument crowding, compromised triangulation, and increased costs, ongoing technological innovations continue to address these limitations. The selective application of SPL to appropriate procedures and patient populations represents the most balanced approach to maximizing benefits while mitigating limitations.

Abstract: Background/Objectives: Cervical spondylotic myelopathy (CDM) is the leading cause of functional disability of spinal origin in people over 50 years old. The objective of the present study was to establish a multiparametric weighted scoring system, easy to use in daily practice, based on the most significant MRI signs and correlated as strongly as possible with the clinical presentation (mJOA) – the SIMS for Severity on Imaging Myelopathy Score. Methods: 99 patients who underwent clinical and radiological evaluation by mJOA and MRI between January 2015 and March 2021 were retrospectively included. The variables included in the score were the Fujiwara ratio, the T2-weighted intramedullary hyperintensity, the aspect of the perimedullary fluidcisterns, the Torg-Pavlov ratio, the local kyphosis and the number of stenotic levels. Each variable was first correlated to the mJOA score for each patient, making possible at the end to construct the final SIMS, and validate it by comparison with mJOA scores. Results: The variables significantly correlated were the T2-weighted intramedullary hyperintensity, the reduction of perimedullary fluid spaces and the number of stenotic levels (p &lt; 0.05). Then points were assigned to each variable according to their relative importance and made it possible to construct the definitive SIMS. The final correlation coefficient between SIMS and mJOA score was -0.747. Conclusions: This work showed that this new multi-parametric MRI-based scoring system represents a consistent mean to characterize the degree of severity of the degenerative cervical myelopathy.

Abstract: The first web space of the hand plays a fundamental role in daily hand function, facili-tating crucial movements such as pinching, grasping, and opposition. Structural anom-alies and acquired defects of this anatomical region, whether congenital or secondary to trauma, burns, or surgical resections, necessitate meticulous reconstructive strategies to ensure both functional restoration and aesthetic integrity. Given the complexity and variability of first web defects, a broad spectrum of reconstructive techniques has been developed, ranging from skin grafting and local flap reconstructions to advanced mi-crosurgical approaches. This review comprehensively examines the existing literature on first web reconstruction techniques, analyzing their indications, advantages, and limi-tations. Additionally, it explores innovative techniques and emerging trends in the field, such as tissue engineering, regenerative medicine, and composite tissue allotransplan-tation, which may revolutionize future reconstructive strategies. The primary objective is to provide clinicians with an evidence-based guide to selecting the most appropriate reconstructive strategy tailored to individual patient needs. Furthermore, we incorporate our institutional experience in managing first web defects, highlighting key surgical principles, patient outcomes, and challenges encountered. Through this analysis, we aim to refine the understanding of first web reconstruction and contribute to the ongoing evolution of hand surgery techniques.

Abstract: The TMJ prosthesis is a valuable and effective tool in different clinical conditions. This study aims to uncover the variables related to the success of the intervention. A retrospective study was conducted on patients who underwent joint replacement surgery utilizing a customized alloplastic system between 2018 and 2023, comprising subjects with complete records for both the planning and follow-up phases. The Student's t-test was applied with a significance threshold of p &lt; 0.05. Forty-eight subjects were admitted for initial analysis, and 31 subjects were evaluated with a minimum follow-up of 1 year and a maximum of 7 years with a mean age of 36.37  15.53. The TMJ diagnosis was mainly with degenerative TMJ disease followed by ankylosis and craniofacial syndromes, and an average of 2.1  1.2 previous surgeries were noted. Degenerative joint disease correlated with increased pain (p=0.0001) and a higher prevalence of prior joint surgery (p=0.0001). Thirty-one subjects were followed up with 47 prostheses installed; 74.4% underwent complementary surgery with other facial osteotomies. Significant improvements (p&lt;0.0001) were observed when comparing pain levels pre- and postoperatively, with a decrease from 5.5 ( 2.3) to 2.2 ( 0.4). Concerning the interincisal opening, there was a significant increase (p&lt;0001) from 25.85 ( 10.2) mm to 35.93 (± 4.2) mm in mouth opening. TMJ replacement treatment is efficient and effective, demonstrating stability in follow-up assessments for up to 7 years. The indications for replacement are diverse and may benefit patients who have not yet progressed to end-stage TMJ disease.

Abstract: Background: The treatment of varicosities originating from popliteal fossa perforating vein (PFPV) is challenging due to their proximity to nerve structures and unique morphology. Limited data exists on the use of endovenous laser ablation (EVLA) for these cases. Methods: This retrospective, single-center study reviewed all primary surgeries from May 2021 to December 2024. Only primary PFPV varicosis cases with CEAP stage C2s or higher were included. Recurrent cases and those with primary truncal insufficiency were excluded. Treatments were performed with 1470 nm radial emitting laser catheters. Ablation targeted the proximal source of reflux and the downstream varicose segments. Tumescent solution was used to protect nerve structures and skin. The primary outcome was ablation success, assessed with duplex ultrasonography. The secondary outcome was complication incidence. Results: Of 2375 limbs treated for primary varicose veins, 44 (1.9%) involved PFPV. The cohort included 16 males (36%) and 28 females (64%), with a mean age of 54 years. The median follow-up was 14 days. Technical success was achieved in 41 of 44 cases (93.2%). Foam sclerotherapy was performed in 8 patients (18.2%) exclusively for superficial residual varicosities and never simultaneously with EVLA. Three treatment failures required re-operation, two of which were successfully re-treated. Minor postoperative complications occurred in two patients (4.5%). No nerve injuries or thrombotic events were observed. Conclusion: EVLA using a 1470 nm diode laser demonstrates promising early outcomes with low morbidity for treating PFPV varicosis. By eliminating the central reflux source, EVLA creates a hemodynamic condition that either leads to the regression of superficial varicosities or facilitates their treatment with foam therapy. Early redo procedures in cases of treatment failure can further improve long-term success.

Abstract: Background: Postoperative neck hematoma is an uncommon but potentially fatal complication following thyroid surgery. The main aim of this study was to evaluate the impact of direct oral anticoagulants on the occurrence of this complication. Methods: Patients who underwent thyroidectomy, between January 2020 and December 2022, in nine high-volume thyroid surgery centers in Europe, were retrospectively evaluated. Based on taking direct oral anticoagulants, patients were divided in two groups: DOAC Group and Control Group. Propensity score matching 1:1 was performed between the two groups, which were then compared through univariate analysis. Results: Patients enrolled based on inclusion/exclusion criteria were 8985. Following propensity score matching, the study population consisted of 316 patients: 158 in DOAC Group and 158 in Control Group. In DOAC Group, the overall incidence of neck hematoma was 5.70% (4.43% for neck hematomas managed conservatively, and 1.27% for those that required surgical revision of hemostasis). No statistically significant difference was found between the two groups in terms of incidence of this complication. Readmission for neck hematoma was not observed in any patient. No statistically significant difference was found between the two groups in terms of timing of onset of neck hematomas that required surgical revision of hemostasis. Conclusions: This study showed that, in the field of thyroid surgery, direct oral anticoagulants have no impact on the occurrence of postoperative neck hematoma. Therefore, based on our findings, it can be concluded that thyroidectomy can be safely performed in patients taking this class of drugs.

Abstract: Background/Objectives: Fractures of the atrophic mandible still nowadays present significant challenges due to reduced bone volume, poor blood supply, and the absence of teeth as anatomical guides. This case report discusses the use of CAD-CAM (Computer-Aided Design and Manufacturing) technology for the secondary reconstruction of a severely atrophic mandible following the failure of a previous surgical procedure with load-sharing intent. Methods: A 75-year-old female patient with a bifocal mandible fracture after a car accident underwent initial open reduction and internal fixation (ORIF) with miniplates. However, the patient experienced non-union and displacement of the mandibular fragments, necessitating a secondary reconstructive approach. A personalized, patient-specific titanium plate was designed using Virtual Surgical Planning (VSP) and 3D printing, considering the patient’s specific anatomy and the need for rigid fixation. Results: The reconstructive surgery resulted in the restoration of mandibular function, including labial competence and improved kinetics, without complications such as nerve injury or malunion. Implant rehabilitation was completed with the positioning of 2 5-mm implants in the symphyseal segment and an overdenture. Psychological symptoms, including anxiety and PTSD, were also addressed and solved through psychotherapeutic intervention. Postoperative radiologic evaluations and volumetric analysis confirmed optimal positioning and fixation of the plate. Conclusions: This case highlights the effectiveness of CAD-CAM technology in complex mandibular reconstructions, offering improved precision, stability, and patient-specific solutions for challenging fractures in edentulous and atrophic mandibles. The integration of CAD-CAM and VSP represents a promising advancement in maxillofacial surgery, providing significant benefits for both functional and aesthetic recovery.

Abstract: Background: The COVID-19 pandemic has significantly disrupted healthcare systems, including the management of emergency general surgery. Even though the pandemic ended, the new variants are continuously emerging, making it necessary to standardized the management protocols of emergency general surgery in COVID patients. Objective: This meta-analysis aims to evaluate the outcomes of emergency general surgery in COVID-19 patients compared to non-COVID-19 patients, focusing on mortality, postoperative complications, mechanical ventilation, and ICU admissions. Methods: A systematic search of PubMed, Embase, Cochrane Library, Scopus, and Web of Science databases was conducted, including studies published between December 2019 and the present. Observational studies, cohort studies, case-control studies, and randomized controlled trials reporting outcomes of emergency general surgery in adult patients with and without COVID-19 were included. A random-effects meta-analysis model was employed, and heterogeneity was assessed using the I² statistic. Publication bias was evaluated using funnel plot. Results: The analysis included 10 studies encompassing 7559 patients (3118 COVID19 group, 4441 non-COVID19 group). COVID-19 group patients demonstrated significantly higher mortality having odds ratio (OR) of 3.0036 (95% CI: 2.4263, 3.7184) and risk ratio (RR) of 2.8333 (95% Cl: 2.3127, 3.4712). Conclusion: Emergency general surgery in COVID-19 patients is associated with worse outcomes, including increased mortality, higher complication rates, and increased ICU admissions. These findings highlight the need for tailored perioperative strategies for COVID patients to mitigate risks.

Abstract: Facial reconstruction presents complex challenges due to the intricate nature of craniofacial anatomy and the necessity for individualized treatment. Conventional reconstructive methods—such as autologous bone grafts and prefabricated alloplastic implants—pose limitations, including donor site morbidity, implant rejection, and suboptimal aesthetic results. The emergence of 3D printing technology has introduced patient-specific implants (PSIs) that enhance anatomical fit, functional restoration, and biocompatibility. This review outlines the evolution of 3D-printed implants, key materials, computer-assisted design (CAD), and their applications across trauma, oncology, congenital conditions, and aesthetics. It also addresses current challenges and explores future directions such as bioprinting, smart implants, and drug-eluting coatings.

Abstract: Background/Objectives: Fast-track (FT) protocols have been developed to reduce the surgical burden and enhance recovery, but they still need to be established for carotid endarterectomy (CEA). In this scenario, carotid stenting has gained momentum by answering the need for a less invasive treatment, despite a still debated clinical advantage. We aim to propose a FT protocol for CEA, along with the analysis of its clinical impact. Methods: This retrospective, monocentric study enrolled consecutive patients who underwent CEA for asymptomatic carotid stenosis using a FT protocol between January 2016 and December 2024. Patients undergoing CEA for symptomatic carotid stenosis, carotid bypass procedures, and combined interventions were excluded. Our FT protocol comprises same-day hospital admission, exclusive use of local anesthesia, non-invasive assessment of cardiac and neurological status, and selective utilization of cervical drainage. Discharge criteria were goal-directed and included the absence of pain, electrocardiographic abnormalities, hemodynamic instability, neck hematoma, or cranial nerve injury, with a structured plan for rapid readmission if required.Postoperative pain was assessed using the Numerical Rating Scale (NRS), administered to all patients. The perioperative clinical impact of the protocol was evaluated based on complication rates, pain control, length of hospital stay, and early readmission rates. Results: Among 1051 patients who underwent CEA, 853 met the inclusion criteria. General anesthesia was required in 17 cases (2%), while a cervical drain was placed in 83 patients (10%). The eversion technique was employed in 765 cases (90%). Postoperative intensive care unit (ICU) monitoring was necessary for 7 patients (1%). The mean length of hospital stay was 1.17 days.Postoperatively, 17 patients (2%) required surgical revision. Minor stroke occurred in 3 patients (0.4%), and acute myocardial infarction requiring angioplasty in 2 patients (0.2%). Inadequate postoperative pain control (NRS >4) was reported by 5 patients (0.6%). Hospital readmission was required for one patient due to a neck hematoma. Conclusions: Our fast-track protocol for elective carotid surgery, designed to mitigate operative stress, demonstrated effectiveness in optimizing the quality of care, yielding significantly favorable outcomes in patients' clinical courses.

Abstract: Complex ventral hernia repairs pose unique challenges in high-risk patients with impaired tissue quality or contaminated fields. While traditional synthetic meshes are effective, their use in these scenarios carries an increased risk of chronic inflammation and infection. Biologic and bioabsorbable meshes are alternative options designed to provide a temporary scaffolding that supports tissue healing while minimizing foreign body reactions. This paper explores the strengths and limitations of biologic, bioabsorbable, and hybrid meshes, particularly in contaminated or high-risk settings. Biologic meshes, though costly, offer temporary reinforcement and promote tissue integration, while absorbable meshes present a viable alternative with promising safety data. Hybrid meshes, which combine durability with biocompatibility, represent a promising class of materials, particularly for patients with impaired wound healing. As the field advances, further research and comparative studies will be critical to optimizing mesh selection and improving long-term outcomes in complex ventral hernia repair.

Abstract: Introduction: Catheter phlebitis is a multifactorial issue with a variety of associated risk factors. This study aimed to evaluate the impact of peripheral venous catheter maintenance on treatment management in patients with specific comorbidities, depending on age and sex. Materials and Methods. This retrospective study included 232 patients hospitalized in the Plastic Surgery Department with catheter phlebitis at various stages of severity, among whom 134 patients required surgical intervention. Results and Discussion: In this study, we analyzed factors that influence the development of catheter phlebitis. One-way ANOVA analysis of variance showed that there was a significant difference between comorbidities and age (F = 39.39, p ≤.001). A two-tailed t-test for independent samples showed that the difference between females and males related to branula maintenance was statistically significant, t(131.97) = -2.9, p = 0.004, 95% confidence interval [-0.65, -0.12]. The two-way ANOVA test showed that there was a significant statistical difference between treatment and branula maintenance p=< .001, and that there was no correlation between the sex and treatment concerning the branula maintenance p=1. Conclusions: Prevention strategies include screening high-risk patients and developing specific therapeutic interventions according to the identified risk factors.

Abstract: BACKGROUND This study aimed to analyze the morbidity, mortality, and survival outcomes in patients with peritoneal surface malignancies who were initially considered candidates for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) but were found to have unresectable disease, resulting in non-therapeutic exploratory laparotomy. PATIENTS AND METHODS We evaluated data from our referral center for the treatment of peritoneal surface malignancies between January 2008 and December 2022. Adverse events following non-therapeutic laparotomy were classified using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0. RESULTS Among a cohort of 486 patients with peritoneal surface malignancies initially considered candidates for CRS + HIPEC, 46 cases (9.4%) were aborted due to the disease being deemed unresectable during exploratory laparotomy. The primary reasons for unresectability included extensive disease spread, observed in 28 patients, with massive small intestine involvement detected in 13 of these cases. The median duration of surgery was 90 minutes (range: 60–180 minutes). Postoperative complications occurred in 10 patients (22%), with a mortality rate of 4.3% (2 patients). Survival was significantly lower in patients who did not receive adjuvant systemic chemotherapy with palliative intent (4 months vs. 15 months, p < 0.01). CONCLUSION Exploratory laparotomy in patients with peritoneal surface malignancies considered for CRS with HIPEC carries a substantial risk of complications. Improved preoperative staging using advanced technologies such as radiomics and laparoscopy is expected to reduce the number of patients undergoing non-therapeutic laparotomy.

Abstract: Advances in artificial intelligence (AI), multi-omics profiling, and sophisticated imag-ing technologies have significantly advanced personalized medicine in gastrointestinal surgical oncology. These technological innovations enable precise patient stratification, tailored surgical strategies, and individualized therapeutic approaches, thereby signif-icantly enhancing clinical outcomes. Despite remarkable progress, challenges persist, including standardization and integration of diverse data types, ethical concerns re-garding patient privacy, and rigorous clinical validation of predictive models. Ad-dressing these challenges requires establishing international standards for data in-teroperability, such as Fast Healthcare Interoperability Resources, and adopting ad-vanced security methods, such as homomorphic encryption, to facilitate secure mul-ti-institutional data sharing. Moreover, ensuring model transparency and explainabil-ity through techniques such as explainable AI is critical for fostering trust among clini-cians and patients. The successful integration of these advanced technologies necessi-tates strong multidisciplinary collaboration among surgeons, radiologists, geneticists, pathologists, and oncologists. Ultimately, the continued development and effective implementation of these personalized medical strategies complemented by human expertise promise a transformative shift toward patient-centered care, improving long-term outcomes for patients with gastrointestinal cancer.

Abstract: Background: There is some evidence to suggest that general anaesthesia may influence oncological outcomes, such as survival and disease-free recurrence, in addition to surgical outcomes. This study compares clinico-oncological outcomes of pancreatic cancer patients who had pylorus-preserved pancreaticoduodenectomy (PPPD) under epidural anaesthesia without endotracheal intubation (EA) and those who received general anaesthesia (GA). Methods: A retrospective cohort investigation of a prospective maintained database comparing pancreatic cancer patients with PPPD under GA and EA. The procedure's feasibility and 30-day clinical-pathological outcomes were evaluated between groups. Results: The ratio of males to females was 16:5. The mean age was 51 years (range 27–74 years). The median hospital stay was 12 days (range 7–60). In the GA group, 13 patients had PPPD, and one patient received total pancreatectomy with splenectomy (TPS). On the other hand, in the EA group, six patients received PPPD, and two patients underwent TPS. The two groups had similar preoperative demographics, including ASA classification. Seven EA patients underwent successful surgery without GA conversion. Due to respiratory acidosis, one TPS patient was converted to GA before abdominal closure. Neither group had mortality or major cardiopulmonary issues, with the exception of one case in the GA group who acquired COVID-19 while hospitalised and was ventilated for 10 days until completely recovering. Surgical complications occurred as follows: Two GA patients had pancreatic fistula type B, and one EA patient had a biliary leak, all treated conservatively. One GA patient needed a revision laparoscopy after an iatrogenic bowel Perforation during IR-drain insertion for chylous ascites on postoperative day 30. All cases had an R0 resection. The histological tumour stage was similar in both groups. The EA group has significantly more harvested lymph nodes and a higher number of lymph node metastases (p=0.022 and p=0.005, respectively). Conclusions: Pancreaticoduodenectomy with just epidural anaesthesia and without endotracheal intubation can be performed safely in selected cases. It may decrease surgical complications without affecting oncological outcomes. Additional research is necessary to comprehend its actual advantages. Portions of the data reported herein were previously shared as an oral presentation at the International Surgical Week in Kuala Lumpur, August 2024.

Abstract: We aim to assess endoscopic surgical correction of recti diastasis (RD), showing a novel approach for mini-abdominoplasty minimally invasive (MAMI) abdominal contouring. Ideas: Regarding European Hernia Society (EHS) classification of RD, a widening greater than 2 centimeters of the linea alba is typically considered for surgical correction. The latest trends MILA and SCOLA approach for RD are indicated for patients with a body mass index (BMI) up to 28, considering only height and weight. Nevertheless, some may find this insufficient for certain types of patients. Despite advancements in skin retraction, there is still no evidence of how the devices may affect postoperative outcomes when added to these procedures. Consequently, thin patients with skin flaccidity and a clinical or imaging diagnosis of RD could benefit from a Mini Abdominoplasty with Minimally Invasive Approach (MAMI). Discussion: The main purpose of this study is to address a possible misfit indication for endoscopic surgical correction of RD, based on the common presentation of this condition. Regarding our experience, Mini Abdominoplasty with a Minimally Invasive Approach (MAMI) has the potential to enhance outcomes, reducing pain and bulging after surgery for patients requiring RD correction with skin laxity. Conclusion: MAMI surgery has been shown to be a safe and reproducible approach for selected women who wish to restore the feminine characteristics of the body after childbirth and have a rapid recovery. It produces better aesthetic results than the traditional full abdominoplasty due to the minimized scar and due to the muscle plication that provides definition of the body contour.

Abstract: Pelvic organ prolapse (POP) is a common, multifactorial condition where pelvic organs descend into or through the vaginal canal, often compromising quality of life. Despite multiple conservative and surgical options, recurrence rates remain significant, and controversies persist regarding the optimal use of mesh, surgical techniques, and the definition of “successful” outcomes. Discrepancies in patient anatomy, tissue properties, and symptom severity underscore the limitations of a “one-size-fits-all” treatment paradigm and highlight the need for truly personalized care. Computational modeling, particularly finite element analysis (FEA), has attracted increasing attention for its ability to simulate patient-specific biomechanical forces, identify high-risk zones for surgical failure, and inform the design of innovative repair strategies. However, the literature features substantial variability in defining functional versus anatomical success, as well as inconsistent imaging methods and limited in vivo data on tissue properties, all of which make it challenging to establish uniform best practices. In this evolving context yet with too heterogeneous studies, this review summarizes in a critical way the actual methodological gaps, emphasizing the importance of standardized definitions, validated clinical endpoints for patients, and more comprehensive biomechanical characterization as the critical bases for the genesis of an effective computational surgical planning system. Emerging technologies—including machine learning, augmented reality, and multi-omics—promise to enhance diagnostic accuracy and treatment planning, fostering a paradigm shift toward truly individualized, function-oriented management. Bridging mechanical insights, patient-centered metrics, and clinical decision-making may transform POP management, reducing recurrence rates and enabling truly individualized care in gynecological practice.

Abstract: (1) Background: Meningioma-related epilepsy (MRE) is observed in approximately 30% of patients. Although studies focus on identifying risk factors related to pre- and postoperative MRE, there is no clear evidence regarding the timing for discontinuing antiseizure medications (ASM) after surgical resection. (2) Methods: We retrospectively collected data from a series of naïve supratentorial meningiomas treated with surgical resection. Preoperative MRI was used to calculate the meningioma and peritumoral edema (PE) volumes through a voxel-based system. We analyzed the frequency of pre-and postoperative epilepsy in the group of meningiomas with and without perile-sional edema (PE > 1 cm3 as the cut-off); (3) Results: From a clinical series of 507 patients, we included 128 who underwent surgical resection in our Center, between January 2020 and December 2022, with a mean follow-up of 30.1 ± 19.8 months. Surgical treatment had a curative effect on MRE (41.4% pre- vs. 19.5% postoperative; p=0.0001). We observed a statistically significant reduction in the seizure rate in cases with preoperative PE (45.3% pre- vs. 18.9% postoperative; p=0.0002) and a non-statistically significant reduction in cases without PE (32.5% pre- vs. 21.4% postoperative; p=0.24). We observed ASM con-tinuation in 37.8% of Engel IA patients; (4) Conclusions: PE increases the likelihood of MRE resolution with surgery. Our results show that surgical resection directly impacts MRE and ASM discontinuation in the presence of preoperative PE. The PE is a reas-suring factor in decision-making regarding the timing of ASM discontinuation after surgery.

Abstract: Objectives: Overall survival (OS) of patients with stage 0 adenocarcinoma in situ (AIS) of the lung is not well characterized in the U.S. Specifically, there are a lack of data regarding the OS of patients with stage 0 AIS who do not receive treatment. We compared OS among stage 0 AIS patients who received surgery and those who received no treatment. Methods: OS of patients with stage 0 (TIS, N0, M0) AIS of the lung who received surgery versus no treatment from 2010-2018 in the National Cancer Data Base was evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis. Predictors of surgery were evaluated using multivariable logistic regression. Survival outcomes based on surgical approach were evaluated in a propensity score-matched subgroup analysis. Results: Of the 897 patients who were diagnosed with stage 0 AIS, 716 (79.8%) underwent surgical resection. A propensity score-matched analysis of 134 patients who received no treatment and 134 patients who underwent surgery showed that the surgical group had a significantly improved OS at five-years 85.8% (95% CI: 74.2-92.4%) compared to the group who received no treatment 62.8% (95% CI: 50.1-72.7%) (log-rank, p <0.0001). Subgroup propensity score-matched analysis showed no significant differences in OS at five-years in the surgical group who underwent a wedge resection 90.8% (95% CI: 83.8-94.8) compared to a lobectomy 94.9% (95% CI: 89.9-97.4%) (log-rank, p=0.19). Conclusions: In this national analysis, stage 0 AIS patients who underwent surgery had significantly better OS when compared to patients who did not receive treatment.

Abstract: Objective: We aimed to explore the relevance of uncertain resection in lung cancer. Methods: We performed an exhaustive literature review of all studies comparing prognosis after resection according to IASLC classification. Results: Systematic review led to select 68 original studies included in this review. R(un) reclassification was mostly caused by a lack of hilar or mediastinal node dissection, or because of metasta-sis in the highest node. R(un) is a strong factor for higher recurrence and mortality, while its effects seem limited in early stages. Carcinoma in situ at bronchial margin resection (CIS BRM) does not show effect on survival, while positive pleural cytology (Cy+) and positive highest mediastinal lymph node (HMLN+) appear to be highly pre-dictive of recurrence and death. Conclusion: The R(un) classification of the IASLC 2005 appears highly relevant, espe-cially in locally advanced stages IIb-IIIA, and helps to discriminate patients with poor prognosis despite being classified as R0 according to UICC classification. The use of this more precise classification would allow for better stratification of recurrence risk and more effective use of adjuvant therapies. Cy+ patients should receive adjuvant chemotherapy, while CIS BRM patients could likely benefit from endoscopic surveil-lance to detect local recurrences. HMLN+ patients should be considered at high risk of recurrence, and adjuvant radiochemotherapy should be considered.