Ana Milena Murgas Acevedo

Liquid biopsy has rapidly emerged as one of the most promising innovations in precision oncology by providing minimally invasive access to tumor-derived biomarkers throughout the clinical course of cancer. This review analyzes the current evidence regarding the clinical applications of liquid biopsy beyond early cancer detection, emphasizing its role in molecular profiling, therapeutic selection, treatment monitoring, minimal residual disease assessment, identification of resistance mechanisms, and evaluation of tumor heterogeneity in patients with solid tumors. A comprehensive literature review was conducted using major biomedical databases, selecting high-quality publications focused on circulating tumor DNA, circulating tumor cells, extracellular vesicles, circulating RNA, and other emerging biomarkers. The available evidence demonstrates that circulating tumor DNA currently represents the most clinically validated biomarker because of its high analytical performance and increasing incorporation into precision oncology protocols. Liquid biopsy has shown particular utility in lung, colorectal, breast, and prostate cancers, where molecular information directly contributes to personalized treatment decisions. Nevertheless, several barriers continue to limit universal implementation, including high costs, limited molecular infrastructure, methodological variability, and unequal access to advanced genomic technologies, particularly in developing countries. Ongoing technological improvements, international collaboration, and methodological standardization are expected to further expand the clinical applications of liquid biopsy and facilitate its incorporation into routine oncology practice. Overall, liquid biopsy represents a transformative strategy that complements conventional tissue biopsy and supports more personalized, dynamic, and evidence-based management of solid tumors.

Damage control surgery (DCS) has evolved from a trauma-focused strategy into an essential component of modern emergency general surgery for selected patients with non-traumatic abdominal emergencies. This review aimed to analyze the current scientific evidence regarding the expanding indications, physiological rationale, perioperative management, and clinical outcomes associated with DCS in conditions such as abdominal sepsis, acute mesenteric ischemia, severe acute pancreatitis, massive gastrointestinal hemorrhage, abdominal compartment syndrome, and vascular emergencies. A structured narrative literature review was conducted using the scientific method. Relevant publications were identified through PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar, prioritizing systematic reviews, meta-analyses, clinical guidelines, international consensus statements, and high-quality observational studies. The reviewed evidence demonstrated that DCS is primarily indicated in patients with profound physiological instability characterized by hemodynamic compromise, metabolic acidosis, coagulopathy, hypothermia, severe intra-abdominal contamination, or uncertain bowel viability. Across the analyzed studies, the staged approach consisting of abbreviated surgery, temporary abdominal closure when required, intensive care resuscitation, planned re-exploration, and delayed definitive reconstruction was consistently associated with improved physiological recovery in carefully selected patients. However, postoperative complications including surgical-site infection, respiratory dysfunction, ventral hernia, and enteroatmospheric fistula remain important challenges requiring multidisciplinary management. Although current evidence supports the expanding role of DCS in non-traumatic emergencies, additional prospective multicenter studies are needed to standardize patient selection criteria and optimize clinical protocols. Overall, damage control surgery represents a physiology-guided strategy that has broadened therapeutic possibilities in emergency abdominal surgery while emphasizing individualized clinical decision-making and coordinated multidisciplinary care.

Enhanced Recovery After Surgery (ERAS) has become a fundamental approach in contemporary perioperative medicine by integrating multidisciplinary, evidence-based interventions designed to reduce surgical stress, accelerate functional recovery, and improve clinical outcomes. This review analyzed current scientific evidence regarding the physiological foundations, perioperative components, clinical effectiveness, and international implementation of ERAS protocols across different surgical specialties. Relevant literature was examined from major biomedical databases and international clinical guidelines, prioritizing clinical practice guidelines, systematic reviews, meta-analyses, clinical studies, and consensus documents addressing enhanced recovery and perioperative care. The evidence reviewed indicates that ERAS pathways are associated with reductions in postoperative complications and hospital length of stay, earlier restoration of gastrointestinal function and mobility, decreased opioid requirements, and more efficient utilization of healthcare resources. Favorable outcomes were observed across colorectal, hepatobiliary, pancreatic, thoracic, gynecologic, urologic, orthopedic, and other surgical fields, although their magnitude varied according to procedure complexity, patient characteristics, institutional resources, and protocol adherence. Greater compliance with ERAS components was consistently associated with better postoperative outcomes, emphasizing the importance of multidisciplinary collaboration, standardized clinical pathways, professional education, and continuous quality improvement. Despite persistent implementation barriers, particularly in resource-constrained healthcare systems, the principles of enhanced recovery can be adapted to different institutional environments, including those in Latin America. ERAS therefore represents an evolving model of evidence-based surgical care capable of improving patient safety, functional recovery, and healthcare efficiency. Future developments involving personalized perioperative medicine, digital monitoring, predictive analytics, and emerging technologies may further strengthen enhanced recovery pathways and support their broader implementation worldwide.

Chimeric antigen receptor T-cell (CAR-T) therapy has emerged as one of the most significant advances in contemporary oncology, representing a transformative approach within the field of personalized cancer immunotherapy. By genetically engineering T lymphocytes to recognize and eliminate malignant cells through specific antigen-targeting mechanisms, CAR-T therapy has demonstrated remarkable clinical efficacy in several hematological malignancies, including acute lymphoblastic leukemia, diffuse large B-cell lymphoma, mantle cell lymphoma, and multiple myeloma. This review analyzes the biological foundations, clinical applications, therapeutic outcomes, safety considerations, and future perspectives associated with CAR-T technology. The available evidence indicates that CAR-T therapy has achieved unprecedented response rates in patients with relapsed or refractory disease, significantly improving treatment possibilities for populations with historically poor prognoses. However, important challenges remain regarding treatment-related toxicities, manufacturing complexity, economic sustainability, accessibility, and limited effectiveness in solid tumors. Recent advances in genetic engineering, synthetic biology, biomarker discovery, and precision medicine are driving the development of next-generation CAR-T platforms designed to enhance efficacy, safety, and applicability across a broader spectrum of cancers. Furthermore, growing interest in Latin America, particularly in Mexico, Colombia, and Ecuador, reflects increasing efforts to expand access to advanced cellular therapies through academic collaboration, translational research, and healthcare innovation. The findings suggest that CAR-T therapy will continue to play a central role in the evolution of precision oncology and may serve as a model for future individualized therapeutic strategies in cancer management.

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.