The mainstay of treatment for primary retroperitoneal sarcoma (RPS) is surgery. However, whether multiple visceral resection (MVR) affects patients’ quality of life compared with simple tumor resection has not been reported. Patients with primary RPS who underwent radical resection between 2009 and 2021 were included. Patients who were alive at the last follow-up were asked to complete the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). The primary endpoint of the study was the global health (GH) score. A total of 161 patients were included, including 77 in the MVR group and 84 in the non-MVR group. When comparing EORTC scores on functional domains and symptom scales between MVR and non-MVR groups, only constipation scores differed (p = 0.011). Comparing GH scores within 6 months after surgery between the two groups, GH was better in non-MVR patients (58.3 vs. 76.4, p = 0.082). However, patients with longer postoperative intervals in the MVR group had higher scores (p < 0.001), and patients with postoperative intervals of more than one year scored similar to those in the non-MVR group (64.7 vs. 59.2, p = 0.522). As the postoperative interval increased, there was an improvement in all indicators in MVR patients, while there was no significant improvement in non-MVR patients. Aggressive surgical approaches impair quality of life within 6 months postoperatively, but the long-term quality of life is similar to that of patients undergoing simple tumor resection. This should be factored into RPS treatment decisions.

Rationale: Biliary system anomalies, such as duplicated gallbladders, are rare congenital conditions that present significant diagnostic challenges. Dr. Boyden’s classification system, especially the H-type anomaly, offers vital insight into these variations. Failure to detect these anomalies preoperatively can increase the risk of surgical complications, making early identification crucial for surgical planning. Patient concern: A 42-year-old male, asymptomatic, was incidentally found to have a gallbladder mass during routine imaging. An upper abdominal magnetic resonance imaging showed gallbladder wall thickening, gallstones, and a liver lesion. Despite the absence of symptoms, a laparoscopic cholecystectomy revealed an atrophied gallbladder with a cystic duct cyst, which was identified as an H-type double gallbladder anomaly. The surgery was completed without complications, and pathology confirmed the presence of gallstones and inflammation. Diagnoses: The patient was diagnosed with a duplicated gallbladder, classified as an H-type anomaly, following laparoscopic cholecystectomy. Preoperative imaging identified gallbladder wall thickening and gallstones, and further investigation during surgery confirmed the congenital anomaly. Interventions: The patient underwent laparoscopic cholecystectomy for the removal of the gallbladder, and during the procedure, an H-type double gallbladder anomaly was discovered. The surgery proceeded without incident, ensuring the complete excision of the gallbladders. Outcomes: The case highlights the diagnostic difficulty of identifying duplicated gallbladders and the importance of advanced imaging techniques in detecting atypical anatomical variations. The successful laparoscopic removal of both gallbladders illustrates the current capabilities of minimally invasive surgery. Postoperative recovery was uneventful, and the pathology confirmed gallstones and inflammation. Lessons: This case emphasizes the importance of recognizing biliary anomalies such as duplicated gallbladders to avoid complications during surgery. Preoperative identification, aided by imaging, and careful surgical planning are key to managing these rare conditions. The case contributes to the growing body of knowledge about biliary system anomalies and reinforces the need for comprehensive management strategies to ensure optimal patient outcomes.

The first recurring message is that operative quality begins before the incision. Zheng et al. developed an ultrasonography-based model and simplified score to distinguish retroperitoneal ganglioneuroma from schwannoma in 74 patients. Optimism-corrected areas under the curve were 0.930 and 0.917, respectively, but the authors appropriately called for external validation and recalibration before routine use. In a cohort of 28 adults with primary retroperitoneal lymphangioma, Li et al. described characteristic multiloculated cystic imaging features, complete resection in all patients, and no recurrence or disease-specific death during a median follow-up of 76 months. Yang et al. similarly showed how pathology can resolve the marked clinical heterogeneity of pelvic solitary fibrous tumors: three patients underwent individualized open, robot-assisted, or laparoscopic R0 resection, with nuclear STAT6 supporting diagnosis. These series are small, but they illustrate how imaging, operative anatomy, and pathology should be interpreted as one continuous diagnostic process.Moving beyond pairwise discrimination, Feng et al. developed REMIND, an end-to-end deep learning model for contrast-enhanced computed tomography, using data from 12 Chinese centers. The model was trained in 606 patients, externally validated in 736, and prospectively evaluated in 188; it combined seven-class diagnosis with tumor segmentation and, in a reader study, achieved a top-1 accuracy comparable to senior radiologists while improving the performance of less-experienced readers (1). This work suggests that artificial intelligence may become a useful decision-support layer for rare, heterogeneous retroperitoneal neoplasms. Before such systems influence biopsy or operative strategy, however, their calibration, failure modes, and transportability should be tested prospectively in other populations and clinical workflows.Complex anatomy also benefits from explicit reconstruction. In a case of ganglioneuroma involving an ectopic inferior vena cava, Xu et al. used three-dimensional reconstruction to plan robot-assisted resection. Such tools should not be treated as decorative imaging. Their value lies in defining displacement, encasement, collateral pathways, and the likely need for vascular control before committing to an approach.Several reports show why apparent natural history or an unusual syndrome must not replace tissue diagnosis. Spontaneous radiological regression did not exclude malignancy in a Bosniak IV cystic renal lesion, which proved to be clear cell renal cell carcinoma after partial nephrectomy. In an adolescent with a large renal mass and a pathogenic TSC2 variant, malignant perivascular epithelioid cell tumor was distinguished from angiomyolipoma only after histopathological and molecular assessment. Adult pelvic fibrosarcoma presenting with bowel obstruction required an exclusionary pathological workup, while refractory mucocutaneous disease in a patient with retroperitoneal dedifferentiated liposarcoma was ultimately recognized as paraneoplastic pemphigus.The limits of inference from isolated PEComa cases are clarified by the TARPSWG study of Mor et al., which included 77 patients with primary extra-visceral retroperitoneal or abdominopelvic PEComas from 13 centers. Among 59 patients treated with curative intent, 24 recurred; outcomes differed by histological subtype, with PEComa not otherwise specified showing the highest recurrence and mortality, sclerosing PEComa an intermediate course, and angiomyolipoma predominantly indolent behavior (2). This pattern supports expert pathology review, biopsy-informed classification, and subtype-adapted surveillance rather than risk assessment based on tumor size alone. Together with the cases in this collection, it argues for early multidisciplinary review whenever symptoms, imaging, pathology, and presumed biology do not align.The second message is not maximal surgery, but appropriately scaled surgery. For dedifferentiated liposarcoma with true colonic infiltration, tumor resection with right hemicolectomy addressed contiguous disease and achieved short-term control. For advanced low-grade serous ovarian carcinoma extending to the iliac vessels and paraspinal region, coordinated gynecologic, orthopedic, plastic, and gastrointestinal surgery enabled R0 resection, femoral vein repair, and flap reconstruction. The proposed "Four Surgical Limits" frameworkanatomical, oncological, functional, and interdisciplinary -offers a useful language for determining when apparent technical limits can be crossed safely.The same principle applies to severe benign disease. A giant uterine leiomyoma complicated by pleural and ascitic effusions, venous thromboembolism, hernia, and pelvic organ prolapse was treated through staged stabilization followed by tumor resection. Conversely, intravenous leiomyomatosis extending through the inferior vena cava into the right atrium demonstrated that even successful en bloc removal does not end perioperative risk; postoperative pulmonary embolism demanded rapid recognition and treatment. These reports emphasize that resectability is not simply an anatomical label. It is a team judgment that includes physiological reserve, thrombotic risk, reconstructive options, and rescue capacity.Quantifying that risk may make perioperative planning more transparent. In 319 patients undergoing resection of primary retroperitoneal sarcoma, Zhuang et al. developed an internally validated morbidity nomogram incorporating age, tumor burden and location, operative time, the number and weighted score of resected organs, estimated blood loss, and packed red-cell transfusion. The model had a concordance index of 0.795 (95% confidence interval 0.746-0.844) (3). It offers a structured basis for risk stratification, counselling, and postoperative vigilance, but several inputs become known only during surgery. A clinically mature pathway will therefore need separately...