Organ- or function-preservation surgery is recommended, but who is a candidate?

The impact of nerve-sparing robotic-assisted radical prostatectomy on positive surgical margins: Uncertainty

“…In fact, this concept of using the strict criteria to select a certain population of any cancer patients for minimally invasive surgery and/or less radical surgery to minimize the risk of therapy-related toxicity is of paramount importance. [2][3][4] However, we are confused about some of their descriptions, and we hope to see their response.…”

Neoadjuvant therapy

“…NAT not only plays an important role as part of multimodal therapies for many kinds of malignant-like or malignant diseases, such as endometrial cancer, endometriosis, cervical cancer, rectal cancer, pancreatic cancer, and esophagus cancer, etc, but also serve as a very good predictor for outcomes. 1,3,4,8,[17][18][19][20] 20 The study found that achieving surgical resection after NAT was associated with improved survival for patients with potentially resectable (median 38.5 vs 13.3 months), borderline resectable (32.3 vs 13.9 months), and locally advanced (30.0 vs 14.6 months) cancers, respectively, 20 suggesting that NAT indeed and dramatically offer a better chance to total eradication of cancers. Additionally, Dr. Brown also found rates of surgical resection after NAT vary based on anatomical stage.…”

“…1 Life-saving is the most critical issue for cancer treatment; however, the patients not only wish to be cured from the diseases but also want to have a good to excellent posttreatment recovery as well as had better have their organ-preservation or complete return of the function to maintain good quality of life (QoL) in their remaining life, and these wishes now have become an optimal therapeutic goal for both physicians and patients. [2][3][4] An accurate and precise pretherapy evaluation and an appropriate and personalized therapeutic plan for these cancer or critically ill patients through the far-advanced development of new technology or therapeutic strategy, such as a minimally traumatic organ-preservation approach and a method for maintenance of physiological and morphological function of targeted lesions can minimize the risk of overtreatment and subsequently avoid the development of severe posttherapy sequelae without compromising the therapeutic efficacy. [5][6][7] To reach this goal, it is still challengeable.…”

A trend to minimize the radicality of surgery

“…have been reported to effectively assist in maintaining the basic or alternative function of damaged organs and/or tissue. 11 However, if an accurate and precise evaluation and the following appropriate therapeutic plan can be guided before the initiation of treatment, particularly for those who are candidates suitable for surgical intervention, a minimally traumatic and/or sparing organ strategy as well as an establishment of the physiological and morphological function of damaged tissues and/or organs should be conducted to minimize the risk of overtreatment-related subsequent AEs and severe sequelae. 11 Sometimes, no need for extra cost from new technology can be achieved, 11 contributing to the refreshing or reminding of our thoughts while we do more but may lose more.” 12 The recent publication in the current issue of the Journal of the Chinese Medical Association entitled “Effects of nerve-sparing procedures on surgical margins after robot-assisted radical prostatectomy” attempted to discuss the highly debated issue, 13 since these cancer patients not only wish to be managed successfully (cure) to save their lives but also look eagerly forward to having preservation of function of the targeted organs and/or surrounding organs after cancer treatment.…”

“…have been reported to effectively assist in maintaining the basic or alternative function of damaged organs and/or tissue. 11 However, if an accurate and precise evaluation and the following appropriate therapeutic plan can be guided before the initiation of treatment, particularly for those who are candidates suitable for surgical intervention, a minimally traumatic and/or sparing organ strategy as well as an establishment of the physiological and morphological function of damaged tissues and/or organs should be conducted to minimize the risk of overtreatmentrelated subsequent AEs and severe sequelae. 11 Sometimes, no need for extra cost from new technology can be achieved, 11 contributing to the refreshing or reminding of our thoughts while we do more but may lose more."…”