Shugo Yajima

Background Adrenal metastasectomy for non–small cell lung cancer (NSCLC) has been reported mainly in historical series, and the ESTRO-EORTC oligometastatic classification has rarely been applied to surgical cohorts. We evaluated contemporary outcomes and applied this classification to a surgical adrenal cohort. Methods Consecutive patients who underwent adrenal metastasectomy for NSCLC at a single institution between 2011 and 2025 were retrospectively reviewed; small cell carcinoma and non-lung primary tumors were excluded. Overall, cancer-specific, recurrence-free, and post-recurrence survival were estimated by the Kaplan–Meier method. Each patient was assigned an ESTRO-EORTC category, and post-recurrence systemic therapy was recorded. Results Twenty-eight patients were analyzed (adenocarcinoma 79%; 61% operated in 2020 or later). Surgery was minimally invasive in 86%, with one Clavien–Dindo grade II event (blood transfusion), no grade ≥ III complication, and no 30-day mortality. Three-year overall survival was 60% and three-year cancer-specific survival 66%, whereas median recurrence-free survival was 5.6 months (2-year 25%) with recurrence in 75%; median post-recurrence survival was 32.1 months. Among 21 patients with recurrence, 18 (86%) received post-recurrence systemic therapy. In an exploratory comparison, oligorecurrence (n = 16) was associated with longer recurrence-free survival than all other ESTRO-EORTC states combined (n = 12; median 15.1 vs 3.7 months; hazard ratio 0.29, 95% confidence interval 0.12–0.71; log-rank p = 0.004). Conclusions Adrenal metastasectomy for NSCLC was safe and, despite frequent recurrence, was followed by prolonged survival in a highly selected cohort with frequent use of contemporary post-recurrence systemic therapy. Oligorecurrence was associated with longer recurrence-free survival than the other ESTRO-EORTC states combined.

Introduction: Situs inversus totalis complicates minimally invasive surgery, and simultaneous robotic surgery for tumors of different organs is particularly challenging. Case Presentation: A 72‐year‐old man with situs inversus totalis receiving androgen blockade for prostate cancer developed a 40‐mm muscle‐invasive bladder tumor undetected on magnetic resonance imaging 7 months earlier; synchronous gastric cancer was also diagnosed. After four chemotherapy cycles, robot‐assisted distal gastrectomy and radical cystectomy with an ileal conduit were performed in one session, sharing four of eight ports and lasting 10 h 27 min. The bladder showed no residual carcinoma (ypT0N0) and the gastric cancer ypT2N3aM0; he died 27 months postoperatively. Conclusion: Two major robotic resections were completed in one session, to our knowledge for the first time. Port sharing avoided a second set of incisions and a second port map, although the robot was undocked and redocked. The surgery was prolonged and followed by suspected non‐occlusive mesenteric ischemia.

Objectives: Perioperative treatment with enfortumab vedotin (EV) plus pembrolizumab has demonstrated a high pathological complete response (pCR) rate in patients with cisplatin‐ineligible muscle‐invasive bladder cancer (MIBC). However, whether this therapeutic benefit reflects true pharmacologic synergy or can be explained by independent drug action (IDA) remains uncertain. Methods: We analyzed data from EV‐103 cohort H (EV monotherapy), the cisplatin‐ineligible subset of PURE‐01 (pembrolizumab monotherapy), and KEYNOTE‐905/EV‐303 (EV plus pembrolizumab). An IDA model incorporating a Gaussian copula was applied to estimate the predicted pCR rate of the combination therapy. The primary analysis assumed weak positive dependence between drug responses (correlation coefficient ρ = 0.24). Sensitivity analyses evaluated the observed‐minus‐IDA‐predicted pCR difference across a continuous range of dependence assumptions ( ρ = 0.00–0.99). Results: The predicted pCR rate for EV plus pembrolizumab was 53.5%, consisting of 21.4% EV‐only responders, 17.1% pembrolizumab‐only responders, and 15.0% dual responders. The observed pCR rate in the KEYNOTE‐905/EV‐303 trial was 57.1%, corresponding to an absolute difference of 3.6 percentage points compared with the model prediction. In sensitivity analyses, the posterior median observed‐minus‐predicted difference increased with stronger positive dependence, but the 95% credible intervals were wide and included zero across a broad range of dependence assumptions. Conclusions: Although modest pharmacologic synergy cannot be excluded given the uncertainty in the available data, substantial population‐level pharmacologic synergy is not required to explain the high pCR observed with the combination.

Aim: Standard treatment for muscle‐invasive bladder cancer (MIBC) includes radical cystectomy (RC), a highly invasive procedure. We evaluated the utility of the Geriatric‐8 (G8) screening tool in guiding treatment and whether the survival benefit of RC differs by G8 score. Methods: We retrospectively reviewed patients with non‐metastatic MIBC who underwent G8 assessment (2020–2024). Patients were grouped by G8: low (14). Treatment patterns and the effectiveness of RC were evaluated. Results: A total of 152 patients were included (high: n = 55, intermediate: n = 67, low: n = 30). RC was performed in 124 patients (81.6%). Lower G8 was linked to older age, poorer performance status, and dependent instrumental activities of daily living ( p < 0.01). Neoadjuvant chemotherapy followed by RC was more frequently planned in the high G8 group (81.8% vs. 53.7% vs. 26.7%, p < 0.0001), while immediate RC was a more common plan in the low G8 group (14.5% vs. 41.8% vs. 53.3%, p = 0.0003). RC was associated with significantly improved overall survival, and the benefit persisted after propensity score matching ( p = 0.0013). Inverse probability of treatment weighting, which retained the whole cohort, gave a consistent estimate (hazard ratio [HR] 0.17, 95% confidence interval [CI] 0.08–0.39). Subgroup estimates were less precise in the low G8 group (HR 0.57, 95% CI 0.12–2.73) than in the intermediate (HR 0.14, 95% CI 0.06–0.33) and high (HR 0.10, 95% CI 0.02–0.39) groups. In sliding window analysis, HR estimates were higher at G8 < 9, with wide CIs. Similar results were observed for cancer‐specific survival. Conclusions: RC was associated with a survival benefit in patients with intermediate and high G8 scores, whereas the evidence in the low G8 group was limited and inconclusive; careful risk–benefit evaluation remains warranted in this group.