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Background: Pancreatic ductal adenocarcinoma (PDAC) represents a challenging disease for the surgeon, oncologist, and radiation oncologist in both diagnostic and therapeutic settings. Surgery is currently the gold standard treatment, but the role of neoadjuvant treatment (NAD) is constantly evolving and gaining importance in resectable PDACs. The aim of this narrative review is to report the state of the art and future perspectives of neoadjuvant therapy in patients with PDAC. Methods: A PubMed database search of articles published up to September 2022 was carried out. Results: Many studies showed that FOLFIRINOX or Gemcitabine-nab-paclitaxel in a neoadjuvant setting had a relevant impact on overall survival (OS) for patients with locally advanced and borderline resectable PDAC without increasing post-operative complications. To date, there have not been many published multicentre randomised trials comparing upfront surgery with NAD in resectable PDAC patients, but the results obtained are promising. NAD in resectable PDAC showed long-term effective benefits in terms of median OS (5-year OS rate 20.5% in NAD group vs. 6.5% in upfront surgery). NAD could play a role in the treatment of micro-metastatic disease and lymph nodal involvement. In this scenario, given the low sensitivity and specificity for lymph-node metastases of radiological investigations, CA 19-9 could be an additional tool in the decision-making process. Conclusions: The future challenge could be to identify only selected patients who will really benefit from upfront surgery despite a combination of NAD and surgery.

Immunoglobulin G4-related disease (IgG4-RD) is a systemic, immune-mediated condition characterized by fibroinflammatory lesions affecting multiple organs. When localized in the retroperitoneum, it may mimic malignancy and often leads to surgical intervention. We report the case of a 21-year-old male with retroperitoneal IgG4-RD and review the relevant literature, emphasizing the diagnostic challenges and importance of differential diagnosis. A case report of a 21-year-old man with retroperitoneal IgG4-RD is presented. A literature review was conducted via Scopus, Embase, and Medline through December 2024, selecting studies with immunohistochemically confirmed retroperitoneal IgG4-RD. Data were independently extracted and analyzed using SPSS software. Of 74 articles retrieved, 22 met the inclusion criteria, totaling 23 patients including our case. The mean age was 62 years, with a male predominance (65%). The left ureter was most commonly involved (52%). Frequent symptoms included localized abdominal pain (61%) and hydronephrosis (96%). Imaging often suggested malignancy, leading 74% of patients to undergo surgery. Histopathology confirmed IgG4-RD in all cases, though only 30% showed IgG4 immunohistochemical positivity. Retroperitoneal IgG4-RD closely mimics malignancy, posing significant diagnostic challenges. Elevated serum IgG4 levels and tissue biopsy are critical for accurate diagnosis. IgG4-RD should be considered in patients with unexplained retroperitoneal masses to avoid unnecessary surgery and ensure appropriate treatment.

Background: The outcomes of patients with peritoneal metastases from gastric cancer (GCPMs) remain dismal, with an overall survival (OS) of less than 1 year. Approaches reported from East Asia include normothermic intraperitoneal systemic chemotherapy, aimed at downstaging the disease, allowing an R0 resection. This is the first Western study evaluating a bidirectional regimen in a neoadjuvant setting of GCPMs. This phase II study evaluates the tolerability, efficacy and conversion surgery rate. Methods: Patients with PCI < 13 without ascites or HER2 overexpression and no extraperitoneal spread were enrolled starting in January 2018. After staging laparoscopy combined with PIPAC (cisplatin + doxorubicin), NIPS began following Yonemura’s schedule: cisplatin (30 mg/m²) + docetaxel (30 mg/m²), intraperitoneally (day 1); capecitabine 1000 mg/m², orally (days 2–15); and cisplatin (30 mg/m²) + docetaxel (30 mg/m²), intravenous (day 8). After three cycles, patients with no progressive disease and negative peritoneal cytology underwent cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Three additional NIPS cycles were reserved for patients who underwent surgery. Results: Among the 25 treated patients with 17.3-month (95%CI: 10.4; NA) OS, no adverse events (CTCAE) ≥ G3 arose. With a 52% conversion surgery rate, 13 patients underwent CRS combined with HIPEC (cisplatin 100 mg/m²), 10 with CC0 status 3 with CC experienced no operative mortality, and major complications rated Clavien–Dindo IIIB occurred in 2 patients (15.4%). The median OS for patients undergoing surgery was 26 (95%CI: 23.1; NA) months, with progression-free survival of 20 (95%CI: 16.7–NA) months. Conclusions: NIPS is safe and effective. The conversion rate in our Western patients is comparable to that reported in Eastern Asian countries.

Background: With the advancement of AI-powered online tools, patients are increasingly turning to AI for guidance on healthcare-related issues. Methods: Acting as patients, we posed eight direct questions concerning a common clinical condition—liver cysts—to four AI chatbots: ChatGPT, Perplexity, Copilot, and Gemini. The responses were collected and compared both among the chatbots and with the current literature, including the most recent guidelines. Results: Overall, the responses from the four chatbots were generally consistent with the literature, with only a few inaccuracies noted. For questions addressing “grey areas” in clinical research, all chatbots provided generalized answers. ChatGPT, Copilot, and Gemini highlighted the lack of conclusive evidence in the literature, while Perplexity offered speculative correlations not supported by data. Importantly, all chatbots recommended consulting a healthcare professional. While Perplexity, Copilot, and Gemini included references in their responses, not all cited sources were academic or of medium/high evidence quality. An analysis of Flesch Readability Ease Scores and Estimated Reading Grade Levels indicated that ChatGPT and Gemini provided the most readable and comprehensible responses. Conclusions: The integration of chatbots into real-world healthcare scenarios requires thorough testing to prevent potentially serious consequences from misuse. While undeniably innovative, this technology presents significant risks if implemented improperly.