Rohan Dureja

Introduction: Immunotherapy has revolutionized the treatment for locally advanced resectable non-small-cell lung cancer (NSCLC). In clinical trials, the combination of neoadjuvant immunotherapy and chemotherapy has resulted in a higher rate of pathologic complete response in comparison with neoadjuvant chemotherapy alone. Our study aims to describe surgical and oncological outcomes after neoadjuvant chemoimmunotherapy and lung resection at our academic center outside clinical trials. Methods: We retrospectively analyzed 54 patients who received neoadjuvant chemoimmunotherapy and underwent surgical resection from 2018 to 2024. Demographics, pre-operative systemic treatment, surgical approach and postoperative outcomes were evaluated. Results: The median age was 65 years, 46% were female, and 67% of patients had a non-squamous histology, chiefly adenocarcinoma. The most common clinical stage was IIIA (54%). Major findings include a 41% pathologic complete response (pCR) and 52% major pathologic response (MPR) rate. Neoadjuvant chemoimmunotherapy resulted in downstaging in 78% (n = 42) of patients. Most patients (83%) had their operation completed robotically. R0 resection was achieved in 96%. Median length of stay was significantly shorter after robotic operations, with no significant difference in complications compared to the open group. At a median follow up of 16 months, 24 months of recurrence-free survival was estimated at 76% (95% CI: 61–94) and overall survival, 93% (CI: 84–100). Conclusion: At our medical center, induction chemoimmunotherapy followed by anatomic lung resection has resulted in a high rate of complete pathologic response, overall survival and recurrence-free survival. The robotic approach after induction chemoimmunotherapy is safe and associated with shorter length of stay and faster recovery time.

Purpose: During vasectomy, technical errors such as difficulty identifying and transecting the vas deferens may occur. Pathology reports indicating an incompletely transected vas may create uncertainty regarding procedural success. However, there is a paucity of large cohort studies investigating this correlation. To address this gap, we explored the relationship between abnormal pathology reports and vasectomy failure rates to determine whether such reports should impact clinical decision making. Methods: We retrospectively reviewed charts of men aged ≥18 who underwent vasectomy between 2004–2024. Abnormal pathology reports failed to identify complete vas deferens cross sections. Vasectomy failure was defined as presence of motile sperm or ≥100,000 nonmotile sperm on postvasectomy semen analysis (PVSA) ≥3 months. Results: Of 2446 vasectomies with pathology reports, 2399 (98.1%) reports were normal, 1330 returned for PVSA, and 55 were failures (4.1%). Conversely, 47 (1.9%) had an abnormal report. Of these, 31 patients returned for PVSA, 87.1% ( n = 27) were successes with failure rate of 9.7% ( n = 3), and one patient had sperm on PVSA Conclusions: Outcomes from a large cohort over two decades suggests although pathology provides early feedback, abnormal reports do not reliably predict vasectomy failure. Pathology should not independently guide clinical decision making without confirmatory semen analysis, which remains the marker of success. Future research could investigate outcomes of patients with abnormal pathology who did not follow up for semen analysis.