Abdelrhman H. Mohamed

Background: Indocyanine green (ICG) near-infrared fluorescence is increasingly used to guide lymphadenectomy during laparoscopic gastrectomy for gastric cancer, but its impact on oncologic outcomes and perioperative safety compared with conventional surgery remains unclear. This systematic review and meta-analysis evaluates whether ICG guidance improves long-term outcomes and surgical quality in adults undergoing laparoscopic radical gastrectomy for resectable gastric adenocarcinoma. Methods: We systematically searched PubMed, Scopus, Web of Science, and the Cochrane Library through October 2025 for randomized trials and comparative cohort studies comparing ICG-guided lymphadenectomy with conventional laparoscopic gastrectomy without ICG. Random-effects models were used to pool effect estimates, with subgroup analyses, meta-regression, sensitivity analyses, and trial sequential analysis employed to explore heterogeneity and assess robustness. Results: From 1457 records, 28 studies were included, of which 25 contributed to the meta-analysis. ICG guidance significantly increased total lymph node retrieval [mean difference (MD): 6.57 nodes; 95% confidence interval (CI): 5.09–8.04; P < 0.0001] without increasing metastatic lymph node yield (MD: 0.01; 95% CI: −0.53 to 0.56; P = 0.958). No significant differences emerged in 5-year overall survival [risk ratio (RR): 0.99; 95% CI: 0.87–1.12], 2-year overall survival (RR: 1.03; 95% CI: 0.95–1.12), or 30-day mortality (RR: 1.19; 95% CI: 0.34–4.25). ICG-guided surgery showed modest reductions in operative time (MD: −8.67 min), blood loss (MD: −11.84 mL), and hospital stay (MD: −0.54 days), though heterogeneity was substantial for several perioperative outcomes. No significant reductions were seen in overall complications, Clavien–Dindo grade-specific complications, time to first flatus or oral intake or affected resection margins. Conclusion: ICG fluorescence–guided lymphadenectomy provides meaningful technical benefits during laparoscopic gastrectomy, increasing lymph node yield and modestly improving perioperative efficiency without compromising survival or increasing harm. These findings support ICG as a safe, effective adjunct to standard gastrectomy, though standardized protocols and further large, high-quality trials are needed to confirm long-term oncologic benefit.

From the 8th International Cancer Congress

From the 8th International Cancer Congress

From the 8th International Cancer Congress

Background Colorectal cancer (CRC) is a leading cause of cancer-related morbidity and mortality in the United States. It can coexist with diabetes mellitus (DM) as they share metabolic, inflammatory, and lifestyle risk factors. Despite the clinical significance, national trends in CRC-related mortality among adults with DM remain unexplored. Methods We performed a retrospective analysis using U.S. national mortality data (1999–2025) to identify deaths with CRC (ICD-10: C18-C20) among diabetics (E10-E14) aged ≥ 45 years. Age-adjusted mortality rates (AAMR) and crude mortality rates (CMR) were calculated per 1,000,000. Trends were assessed using joinpoint regression to estimate annual percent change (APC) and average annual percent change (AAPC), with 95% confidence intervals (CIs). Forecasting analyses estimated future mortality trends through 2040 using time-series projection methods. Results A total of 103,289 deaths were attributed to CRC and DM among adults aged ≥ 45 years (1999–2025). Overall mortality showed a non-significant decline (AAMR: 18.95 to 16.77; AAPC: -0.6; 95% CI: -1.3 to 0.09; P = 0.09). Men showed higher AAMRs (24.4 in 1999 to 22.1 in 2025) when compared to women (15.27 to 12.47). Older adults aged ≥ 65 years carried the greatest mortality burden, with CMR decreasing from 83.08 in 1999 to 63.96 in 2025 (AAPC: -1.2; 95% CI: -1.9 to -0.4; P = 0.002). Racially, NH Blacks had the highest AAMR (31.66 to 24.08). Regionally, the greatest mortality was observed in the South with AAMRs (16.11 to 20.12). The decedent’s home carried the most common place of death (37.5%). Forecasts project overall AAMR to reach 11.98 by 2040. Conclusion CRC and DM-related mortality demonstrated an overall declining trend and is projected to continue declining through 2040. Disparities among men, NH Blacks and older adults require refined strategies to improve outcomes.

Background: Tobacco use is a major risk factor for ischemic heart disease (IHD), substantially increasing the likelihood of myocardial infarction, stroke, and premature mortality. This study examined U.S. trends in IHD mortality with documented tobacco use disorder from 1999 to 2023. Methods: CDC mortality data for adults aged ≥ 25 years with IHD (ICD-10 codes: I20–I25) and documented tobacco use (ICD-10 code: F17) listed as contributing causes of death were analyzed. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC). Results: From 1999 to 2023, 1,497,919 deaths were reported. The AAMR rose from 3.90 to 32.37 (AAPC: 10.71; p < 0.01). Males had a higher AAMR (39.68; AAPC: 10.72) than females (14.05; AAPC: 10.77). Non-Hispanic (NH) Whites had the highest AAMR (26.86), followed by American Indians (25.43), NH Blacks (19.77), and Hispanics (10.38). The Midwest had the highest regional AAMR (32.96). Most deaths occurred in inpatient facilities (27.9%). Adults aged ≥ 65 years had the highest mortality rate (CMR: 92.16). Rural areas exceeded urban (35.73 vs. 22.95). Conclusion: IHD mortality with documented tobacco use has risen sharply, disproportionately affecting older adults, males, rural areas, the Midwest, and NH Whites.

Objective This study evaluated local tumor control and morbidity following chemoradiotherapy and MRI-based image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. Methods This prospective, single-center cohort study enrolled patients between January 2019 and December 2024. Eligible patients had biopsy-proven cervical carcinoma, FIGO stage IB3–IVA or stage IVB limited to para-aortic lymph node metastasis, and ECOG performance status < 2. Treatment comprised concurrent chemoradiotherapy (weekly cisplatin 40 mg/m², 45–50 Gy EBRT) followed by MRI-based IGABT (28 Gy in 4 fractions, cobalt-60), per GEC-ESTRO recommendations. Primary endpoints were local control and late morbidity; secondary endpoints were progression-free and overall survival. (ClinicalTrials.gov: NCT04767425). Results Sixty patients were enrolled (median age 55.5 years); squamous cell carcinoma predominated (95%), with stage IIB most common (33.3%). Mean D90% CTV-HR was 95.17 ± 7.76 Gy (EQD2₁₀). Organ-at-risk doses were within acceptable limits: bladder D2cc 81.35 ± 9.97 Gy, rectum D2cc 64.61 ± 7.62 Gy, sigmoid D2cc 55.79 ± 8.91 Gy. Complete response was achieved in 90% with minimal toxicity (1.7% Grade III vaginal). Local control was 96.7% at 17 months and 91.1% at 27 months. Disease-free survival was 75% at 40 months and 55% at 60 months; overall survival was 80% and 65% respectively. Distant metastasis (11.7%) was the predominant failure pattern. Conclusion As the first MRI-guided adaptive brachytherapy program in Upper Egypt, this study demonstrates that advanced image-guided techniques can be successfully implemented in resource-limited settings, achieving excellent local control with minimal toxicity. The predominance of distant failure suggests systemic therapy intensification warrants investigation in future trials.

Background: Cardiogenic shock (CS) complicated by sepsis is a life-threatening condition marked by circulatory collapse and systemic inflammation, with persistently high mortality despite critical care advances. National trends and disparities remain unclear. This study aimed to evaluate temporal mortality trends from 1999 to 2025 and project rates through 2040. Methods: We conducted a population-based study using U.S. mortality data (1999–2025) from the CDC WONDER database. Deaths among adults aged ≥25 years with CS and sepsis were identified using ICD-10 codes. Age-adjusted mortality rates (AAMRs) per 100,000 were calculated. Joinpoint regression estimated annual percent change (APC) and average annual percent change (AAPC). Forecasting models projected mortality trends through 2040. Results: From 1999 to 2025, 71,726 deaths occurred; 97.09% in medical facilities. Overall, AAMR rose from 0.65 to 2.16 (AAPC 5.01%, p < 0.001) and is projected to reach 3.62 by 2040. Men had higher mortality than women (2025: 2.78 vs 1.65; AAPC 5.06% vs 4.91%). In 2025, AAMR was 3.75 among NH Black individuals, 1.98 among NH White individuals, and 2.01 among Hispanic individuals. Adults ≥65 years had the highest CMR (7.50 in 2025; AAPC 4.63%), with the largest relative increase in ages 25–44 (AAPC 7.19%). Conclusion: CS with sepsis mortality increased significantly from 1999 to 2025, particularly among men, NH Black individuals, and adults ≥65 years. Although recent trends have stabilized, projections indicate continued increases through 2040, highlighting persistent and widening demographic disparities in the mortality burden.

Background: Colorectal cancer (CRC) remains a leading cause of cancer-related mortality in the United States despite advances in screening and treatment. Prior national studies have documented long-term declines in CRC mortality; however, emerging demographic and disparities warrant updated evaluation. Methods: We conducted a retrospective, population-based analysis of CRC mortality in the United States from 1999 to 2023 using the CDC WONDER database. Adults aged ≥25 years with CRC were identified using ICD-10 codes C18–C20. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated. Trends were assessed using Joinpoint regression. Results: From 1999 to 2023, a total of 1,551,550 CRC deaths were recorded among U.S. adults aged ≥25. The overall AAMR declined from 38.23 per 100,000 in 1999 to 22.93 in 2023 (AAPC: –2.14; 95% CI: –2.39 to –1.88; p < 0.001). Overall, the AAMR declined in both sexes between 1999 and 2023; 31.98 to 19.09 (AAPC: -2.16; p < 0.01) among women, as compared to 47.46 to 27.43 (AAPC: -2.31; p < 0.01) among men. Racial disparities persisted, with non-Hispanic Black individuals showing the highest overall AAMR (37.34). Regionally, the Midwest has the highest overall AAMR (30.05). Urban–rural comparisons (1999–2020) showed higher AAMRs in rural areas (32.08) than in metropolitan areas (27.81). Older adults (≥65 years) accounted for most deaths. The most common place of death was home (40.7%). Conclusions: CRC mortality in the U.S. has declined substantially over the past 25 years; however, significant disparities persist by race, geography, and age.