Eli Dario Zuleta Zabala

Multivisceral pelvic surgery represents a complex therapeutic strategy for patients with locally advanced or recurrent pelvic malignancies in whom conventional organ-specific resection may be insufficient to achieve adequate oncological clearance. This study aimed to analyze the relationship between surgical radicality, urinary tract preservation or reconstruction, postoperative morbidity, oncological control, and quality of life. An integrative review guided by the Scientific Method was conducted using evidence from PubMed/MEDLINE, Scopus, Web of Science, and Embase, focusing on contemporary studies published between 2015 and 2026. The analysis incorporated oncological, urological, surgical, and patient-centered outcomes. Contemporary PelvEx data demonstrated an increase in R0 resection rates from 79.8% to 84.8% in locally advanced rectal cancer and from 55.4% to 71.7% in locally recurrent disease, despite a greater frequency of extended resections. Major complication rates decreased from 37.8% to 23.1% in locally advanced disease and from 32.1% to 23.9% in recurrent disease. Urinary reconstruction remained heterogeneous, and comparative evidence showed similar rates of grade III–IV complications between continent and non-continent diversion, at 42.9% and 42.3%, respectively, with urinary complication rates of 15.9% and 16.7%. Longitudinal quality-of-life data showed early postoperative deterioration in some functional domains followed by progressive recovery, with overall quality-of-life scores returning toward or exceeding baseline during follow-up in many patients. These findings indicate that contemporary multivisceral pelvic surgery can achieve high rates of complete oncological resection while maintaining acceptable functional outcomes when performed in appropriately selected patients within specialized multidisciplinary centers. Surgical success should therefore be defined through the integrated assessment of R0 resection, urinary preservation or individualized reconstruction, perioperative safety, and long-term quality of life.

Advanced thyroid cancer remains a significant clinical challenge despite major advances in endocrine oncology. Although conventional management based on surgery and radioactive iodine therapy continues to provide favorable outcomes for many patients, locally advanced, recurrent, metastatic, and radioiodine-refractory disease often require more complex therapeutic approaches. The objective of this review was to analyze contemporary surgical innovations, molecular-targeted therapies, and nuclear medicine strategies used in the management of advanced thyroid cancer throughout the Americas. A narrative literature review was conducted using the Scientific Method as the methodological framework. Scientific evidence was retrieved from PubMed, Scopus, Web of Science, ScienceDirect, Cochrane Library, and Google Scholar, focusing on studies published between 2014 and 2026. The findings demonstrated that molecularly targeted therapies have become a central component of treatment, particularly in tumors harboring BRAF, RET, and NTRK alterations. Lenvatinib, sorafenib, cabozantinib, selpercatinib, pralsetinib, and dabrafenib-trametinib have significantly expanded therapeutic options for patients with advanced disease. Surgical intervention remains essential for local disease control and management of recurrent or invasive tumors, while nuclear medicine continues to play a critical role through radioactive iodine therapy, PET/CT, SPECT/CT, and emerging redifferentiation strategies. The review also identified important challenges related to molecular testing accessibility, targeted therapy availability, specialized surgical services, and nuclear medicine infrastructure across different healthcare systems. Overall, the evidence supports a transition toward precision medicine and multidisciplinary management as the foundation of contemporary advanced thyroid cancer care. Continued efforts to improve access to innovative technologies and specialized treatment resources will be necessary to optimize patient outcomes throughout the American continent.

Hepatobiliary surgery remains one of the most technically demanding areas of modern surgical practice due to the complexity of hepatic and biliary anatomy, the need for precise lesion localization, and the risk of major intraoperative complications. In recent years, advances in artificial intelligence (AI), intraoperative imaging, and radiological navigation technologies have introduced new opportunities to improve surgical planning, procedural accuracy, and patient safety. This review analyzes the current evidence regarding the integration of AI-assisted technologies and intraoperative radiological navigation in hepatobiliary surgery. A narrative literature review was conducted using scientific publications retrieved from major international databases, including PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, SpringerLink, Wiley Online Library, and Google Scholar. The reviewed literature demonstrated a substantial increase in research activity during the last decade, particularly in areas involving machine learning, deep learning, computer vision, three-dimensional reconstruction, fluorescence-guided imaging, augmented reality, robotic-assisted surgery, and intelligent navigation systems. The findings indicate that these technologies contribute to improved preoperative planning, enhanced anatomical visualization, greater intraoperative precision, and more effective decision-making. Furthermore, increasing integration among artificial intelligence platforms, advanced imaging modalities, and robotic technologies suggests the emergence of comprehensive digital surgical ecosystems designed to support precision surgery. Although challenges related to implementation costs, technological accessibility, infrastructure, and clinical validation remain, current evidence supports the growing incorporation of these innovations into hepatobiliary surgical practice. Continued research and international collaboration will be essential for optimizing their clinical application and expanding access to advanced surgical technologies worldwide.

Modern warfare has generated increasingly complex patterns of injury characterized by massive hemorrhage, traumatic brain injury, blast-related trauma, vascular damage, and multisystem injuries, creating significant challenges for military and civilian healthcare systems. Continuous advances in tactical medicine, combat casualty care, neurocritical care, radiological imaging, and damage control strategies have substantially improved the management of these injuries and reduced preventable mortality in combat environments. This review analyzes current innovations in war trauma management, emphasizing developments in hemorrhage control, traumatic brain injury management, advanced radiological technologies, damage control surgery, damage control resuscitation, and multidisciplinary trauma systems. A structured narrative review was conducted using the Scientific Method and PRISMA-based review principles. Scientific evidence was identified through PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, SpringerLink, Wiley Online Library, Cochrane Library, and Google Scholar, including peer-reviewed articles, clinical guidelines, systematic reviews, meta-analyses, and consensus statements published between 2005 and 2025. The available evidence demonstrates that Tactical Combat Casualty Care protocols, modern tourniquet systems, hemostatic dressings, balanced transfusion strategies, advanced neurocritical care, and innovative imaging techniques have significantly improved survival, neurological preservation, diagnostic accuracy, and long-term functional recovery among combat casualties. Furthermore, multidisciplinary trauma systems integrating tactical medicine, surgery, radiology, intensive care, and rehabilitation have strengthened continuity of care and enhanced patient outcomes throughout the recovery process. These advances have also influenced civilian trauma systems by improving emergency preparedness, disaster response, and management of severe traumatic injuries. Although important progress has been achieved, continued research remains necessary to optimize neuroprotective therapies, expand access to advanced technologies, improve rehabilitation strategies, and address the evolving challenges associated with modern warfare. Contemporary war trauma management has become a highly specialized, multidisciplinary, and evidence-based field whose innovations continue to shape the future of military and civilian trauma care worldwide.

Precision medicine has progressively transformed anesthesiology by promoting individualized perioperative management based on biological, physiological, and technological information. Within this context, biomarker-guided anesthesia and real-time metabolic monitoring have emerged as promising approaches for improving patient safety, optimizing anesthetic interventions, and enhancing clinical outcomes in surgical and critically ill populations. This review analyzed current scientific evidence regarding the role of biomarkers, advanced physiological monitoring technologies, pharmacogenomics, artificial intelligence, and metabolic surveillance systems in precision anesthesia. A comprehensive review of the literature published between 2009 and 2025 was conducted using major biomedical databases, including PubMed/MEDLINE, Scopus, Web of Science, ScienceDirect, SpringerLink, Wiley Online Library, and the Cochrane Library. The findings demonstrated increasing utilization of cardiovascular and metabolic biomarkers, electroencephalographic monitoring, near-infrared spectroscopy, continuous glucose monitoring, lactate surveillance, advanced hemodynamic assessment, and artificial intelligence-supported decision systems. Collectively, these technologies contributed to improved risk stratification, earlier detection of physiological deterioration, optimization of anesthetic drug administration, enhanced postoperative recovery, and reduction of perioperative complications. The evidence also indicated that multimodal monitoring strategies consistently outperform isolated monitoring approaches by providing a more comprehensive representation of patient physiology. Furthermore, artificial intelligence and automated monitoring platforms showed significant potential for improving predictive accuracy and individualized clinical decision-making. Overall, biomarker-guided precision anesthesia and real-time metabolic monitoring represent transformative developments in perioperative and critical care medicine. The integration of biological indicators, advanced monitoring technologies, and data-driven clinical strategies supports a more personalized approach to anesthetic management and may contribute to safer, more effective, and outcome-oriented patient care. Continued research and technological standardization will be essential to facilitate broader implementation of precision anesthesia within future healthcare systems.