Background: Preoperative optimization has emerged as a critical strategy in enhancing surgical outcomes, particularly for oncological patients. By addressing modifiable risk factors before surgery, healthcare providers aim to improve postoperative outcomes. The aim of this study was to evaluate the impact of a preoperative optimization program on postoperative outcomes and improvements in modifiable risk factors (anemia, malnutrition, smoking, and endocrine management) among oncology patients undergoing elective surgery. Methods: A retrospective pretest–posttest study was conducted including all oncology patients who underwent elective general surgery at King Hussein Cancer Center between January 2020 and December 2021. The preoperative optimization program was launched in May 2020 and fully implemented by December 2020. Program elements included anemia management, nutritional support, smoking cessation, and glycemic control. Patients were divided into pre-implementation and post-implementation cohorts, and outcomes were assessed at baseline, immediately preoperatively, and 30 days postoperatively. Results: The sample included 503 individuals, 53.9% had preoperative anemia, 15.5% had malnutrition, 40.6% were smokers, and 41.6% had uncontrolled DM. The optimized group demonstrated significant improvements in hemoglobin, albumin, and smoking cessation rates. In contrast, the control group showed worsening hemoglobin and albumin levels over the same period. Serious complications (Clavien–Dindo III–IV) were significantly more frequent in the control group (p = 0.006). The likelihood of postoperative complications among the control group was significantly higher than the optimized group (OR: 2.2, 95%CI: 1.5–3.2, p < 0.001). Conclusions: Implementation of a comprehensive preoperative optimization program significantly improved modifiable risk factors and reduced serious postoperative complications, highlighting its value for adoption in oncology surgical care.

Background: The prognostic utility of inflammatory and tumor biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and carcinoembryonic antigen (CEA), in rectal cancer has been increasingly studied, but results remain inconsistent. This study evaluates the prognostic significance of pre- and post-chemoradiotherapy (CRT) levels and dynamic changes in NLR, PLR, and CEA for predicting overall survival (OS) and disease-free survival (DFS) in locally advanced rectal cancer (LARC). Methods: This retrospective study included 261 LARC patients treated with neoadjuvant CRT followed by curative surgery. Pre- and post-CRT NLR, PLR, and CEA were collected. Survival analyses were performed using Kaplan–Meier curves and Cox proportional hazards models. ROC curves assessed predictive performance, and patients were stratified by cut-offs and biomarker changes (delta values). Results: The cohort had a mean age of 55.5 years; 55.9% were male, and 93.5% had clinical stage III disease. Post-CRT NLR (HR: 1.05, p = 0.007) and CEA (HR: 1.00, p < 0.001) were independently associated with OS, while post-CRT CEA and AJCC stage III were predictors of DFS (HR: 4.12, p = 0.009). ROC analysis showed improved accuracy when combining NLR (AUC = 0.66) and CEA (AUC = 0.70), yielding a combined AUC of 0.84 for OS. Patients with decreases in both NLR and CEA had the most favorable outcomes, whereas increases in both markers indicated poor prognosis (OS p < 0.0001; DFS p = 0.00019). Conclusions: Post-CRT levels and dynamic changes in NLR and CEA are independent prognostic markers in rectal cancer. Their combined assessment enhances survival prediction and may guide personalized postoperative surveillance and treatment strategies.

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype with limited targeted treatment options. Immunotherapy has recently emerged as a potential strategy. The addition of pembrolizumab to neoadjuvant chemotherapy, as established in the KEYNOTE-522 trial, represents a major advancement in targeted immunotherapy for TNBC. However, real-world data validating its feasibility and outcomes remain limited. This study aims to evaluate, in real-life settings, the impact of adding pembrolizumab to neoadjuvant chemotherapy on complete pathological response (pCR), recurrence-free survival (RFS), and overall survival (OS) in patients with non-metastatic TNBC. Methods: This retrospective cohort study included patients treated at King Hussein Cancer Center (KHCC) between 2015 and 2022. Among 8523 breast cancer cases, 761 were TNBC. Eligible patients had non-metastatic TNBC, received neoadjuvant therapy, and underwent surgery. The immunotherapy group included patients treated with neoadjuvant pembrolizumab (2019–2022); the no-immunotherapy group received standard neoadjuvant chemotherapy (2015–2022). Propensity score matching (1:1, nearest neighbor) was performed based on pre-treatment covariates including age, BMI, clinical stage, comorbidities, smoking, and histopathology. Pathological response, complication rates, RFS, and OS were analyzed using logistic regression and Kaplan–Meier curves with log-rank testing. Results: The matched cohort included 130 patients (65 per group). The study groups’ baseline characteristics were well-balanced between the two groups. Postoperative complication rates were similar across groups, with no significant increase in adverse events observed in the immunotherapy group. The mean lymph node positivity ratio was significantly lower in the immunotherapy group (2.2 ± 7.7 vs. 24.3 ± 33.1, p < 0.001), indicating reduced nodal burden. Pathologic complete response (pCR) was markedly higher with immunotherapy (66.2% vs. 9.2%, p < 0.001). However, survival outcomes were significantly improved with immunotherapy. At three years, RFS was markedly higher in the immunotherapy group (91.8%; 95% CI: 85.0–99.0%) compared to the no-immunotherapy group (53.8%; 95% CI: 42.8–67.8%), with a log-rank p < 0.001. Overall survival also significantly favored the immunotherapy group, with three-year OS of 87.2% versus 67.8% in no-immunotherapy group (p = 0.0015). Conclusions: Neoadjuvant pembrolizumab significantly enhances pathological response, reduces nodal involvement, and provides durable RFS and OS benefits in non-metastatic TNBC without increasing perioperative complications. This study supports incorporating immunotherapy into standard neoadjuvant regimens for TNBC patients and provides real-world evidence from a Middle Eastern tertiary cancer center.

Background: Achieving breast symmetry is an important aesthetic goal following reconstruction post-mastectomy; however, little is known about women’s awareness, attitudes, and barriers regarding Contralateral Breast Symmetry Procedures (CBSP) in Jordan. Objectives: To assess awareness, perceptions, and barriers toward contralateral breast symmetry procedures among breast cancer survivors who underwent reconstruction at King Hussein Cancer Center. Methods: A cross-sectional study was conducted from July to Oct 2025 at KHCC, among 314 women diagnosed with breast cancer who had post-breast reconstruction. Data were collected using a structured Arabic questionnaire, which was developed based on existing literature, validated by an expert panel, and piloted on 10 women for clarity and reliability. The final tool demonstrated acceptable internal-consistency (Cronbach’s α = 0.712). The questionnaire captured sociodemographic and clinical data and detailed knowledge, attitudes, and barriers related to CBSP. Descriptive statistics summarized the data. Results: Participants’ mean age was 45.8 years; the majority were married (83.8%) and held university degrees (65.6%). Most reconstructions used silicone implants (94.6%). Only 6.4% had undergone CBSP, primarily delayed breast augmentation or mastopexy, with 75% reporting satisfaction. Awareness of CBSP was limited (37.9%), and less than one-third had discussed CBSP options with their surgeon or knew about insurance coverage. While 82.5% valued symmetry for body image, 31.5% viewed it as unnecessary after cancer recovery. Main barriers included satisfaction with current appearance (48.1%), fear of additional surgery (32.2%), financial constraints (37.3%), and lack of physician counseling (27.1%). Trust in medical team recommendations was high (89.2%). Conclusions: Contralateral breast symmetry procedures are under-recognized and infrequently pursued, primarily due to limited awareness, financial concerns, and insufficient counseling. Focused education and enhanced surgeon–patient communication are essential to support women’s aesthetic and psychological needs after reconstruction in Jordan.

Background: Artificial intelligence (AI) and large language models such as ChatGPT are increasingly applied in surgical education and practice. Successful integration requires healthcare professionals to have adequate literacy, perceived knowledge, and agreement in using these tools, alongside awareness of ethical considerations. Evidence on AI and ChatGPT literacy among surgical trainees and specialists remains limited. Objectives: This study aimed to evaluate AI and ChatGPT literacy, perceived knowledge, agreement in clinical application, attitudes, perceived barriers, and perceived clinical utility among surgical medical students, residents, and specialists. Methods: A cross-sectional survey was conducted among medical students (clinical years), surgical residents, and consultants/specialists in Jordan to assess AI literacy, ChatGPT literacy, attitudes, and barriers toward AI integration in surgical practice. Stratified random sampling with proportional allocation ensured representative participation across professional strata. A structured online questionnaire, including the Meta-AI Literacy Scale, ChatGPT literacy items, an AI exposure subscale, and attitude measures, was used. Subscale and overall scores were calculated, and internal consistency was high across all measures (Cronbach's α 0.846–0.930). Data were analyzed using R, with ANOVA or Kruskal–Wallis tests for group comparisons, chi-square tests for categorical associations, and significance set at p < 0.05. Results: Most participants lacked formal AI training (93.2%), but 80.9% had prior ChatGPT experience. AI exposure and perceived literacy scores were highest among students and residents, while consultants reported lower familiarity. Residents showed greater agreement in clinical AI application (MAIL_Use&Apply: 19.5 ± 5.2 vs. 17.4 ± 5.4; p = 0.014) and AI detection (MAIL_AI_Detect:9.0 ± 2.7 vs. 8.5 ± 2.2; p = 0.033) compared with consultants. Ethical awareness was high across all groups (MAIL_AI_Ethics:10.8 ± 2.9). AI was perceived as most useful for surgical planning, diagnostics, and robotic-assisted surgery, with trainees rating utility relatively higher than consultants ( p < 0.01). Barriers included lack of training, cost, ethical concerns, and limited infrastructure. Conclusions: AI and ChatGPT literacy varies across professions, with younger trainees reporting relatively higher exposure, agreement, and perceived utility. Ethical awareness is generally high, and attitudes toward AI adoption are positive. Integrating structured AI education and addressing barriers are critical to safe, effective, and ethical adoption of AI in surgical education and practice.