The immune microenvironment plays a critical role in pathogenesis and treatment response of cervical cancer. This review comprehensively examines the cellular and molecular components of the tumor immune microenvironment (TIME) in cervical cancer, encompassing patterns of immune cell infiltration (T cells, B cells, NK cells, DCs, TAMs), immune checkpoint molecules, and cytokine/chemokine networks. We emphasize recent advances in understanding TIME heterogeneity, enabled by high-resolution spatial mapping and single-cell sequencing technologies, focusing specifically on differences across disease stages and treatment approaches. The review systematically evaluates immunotherapeutic strategies, such as immune checkpoint inhibitors, adoptive cell therapies, and therapeutic vaccines, discussing their mechanisms of action, clinical efficacy, and challenges. By synthesizing insights from both preclinical and clinical studies, our aim is to offer a translational perspective on targeting the TIME to enhance outcomes for cervical cancer patients.

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers worldwide. The role of macrophage receptor with collagenous structure (MARCO), a scavenger receptor class-A protein expressed on macrophage surface, in PDAC progression remains unclear. Here, we identified a subset of MARCO-expressing macrophages with strong immunosuppressive signatures that were markedly increased in PDAC patients. Analysis of MARCO^hi PDAC samples displayed reduced proportion of CD8⁺ T cells and NK cells, accompanied by an increased proportion of regulatory T cells (Tregs). In vitro, co-culture with multiple PDAC cell lines potently induced MARCO expression on both human and murine macrophages, driving them to a pro-tumorigenic polarization phenotype. Cell-cell interaction analyses further indicated that vascular endothelial growth factor (VEGF) selectively targets MARCO⁺ macrophages, and VEGF stimulation significantly upregulates MARCO expression in vitro. Notably, genetic ablation of Marco markedly suppressed tumor growth in a murine PDAC model, at least partly through enhanced proportion of NK and T cells. Furthermore, MARCO⁺ macrophages were also enriched across several other cancer types, suggesting a potential pan-cancer relevance. Collectively, our findings uncover a critical role of MARCO⁺ macrophages in PDAC progression and highlight MARCO as a promising therapeutic target with potential applicability across multiple malignancies.

Objective: Recurrent vulvar cancer after radiotherapy is a devastating condition that severely impairs patients’ quality of life. Although radical vulvectomy can improve survival and quality of life in primary cases, patients with post-radiation recurrence are at high risk for severe wound-related complications. To address this challenge, our team adopted a combined approach of radical vulvectomy and rectus abdominis flap reconstruction, which has yielded favorable therapeutic outcomes. Methods: This retrospective study enrolled patients with radiotherapy-recurrent vulvar cancer who underwent radical vulvectomy combined with rectus abdominis flap reconstruction between 2023 and 2024. The primary endpoint was the change in quality of life, assessed using the EORTC QLQ-C30 and QLQ-VU34 questionnaires. Results: Eleven patients underwent radical vulvectomy with rectus abdominis flap reconstruction. The median patient age was 67 years, and the median BMI was 28.98. The median operative time and intraoperative blood loss were 210 minutes and 400 mL, respectively. All patients achieved R0 resection. Nine patients experienced only minor complications (Clavien - Dindo grade II), while two patients developed complications requiring intervention under local anesthesia (grade IIIa). No wound infections, wound dehiscence, or donor-site complications were observed. Postoperatively, a significant improvement in quality of life was evident across all patients, particularly in the domains of physical functioning, pain reduction, and overall global health status (all P < 0.05). Conclusions: Radical vulvectomy combined with rectus abdominis flap reconstruction significantly improves quality of life and oncological outcomes in patients with radiotherapy-recurrent vulvar cancer. This combined approach represents a valuable and safe treatment option that merits broader clinical implementation, preferably within a multidisciplinary team setting.

BACKGROUND: Primary tumor resection with simultaneous para-aortic lymph node dissection has curative potential in selected patients with isolated infrarenal para-aortic lymph node metastasis secondary to colorectal cancer. However, para-aortic lymph node dissection is technically challenging, and en bloc resection is difficult. Traditional piecemeal removal may increase the risk of missing lymphatic tissue and contribute to local recurrence. IMPACT OF INNOVATION: A modified "lawn-mowing" technique is introduced for en bloc para-aortic lymph node dissection that simplifies this complex procedure. By initially identifying anatomical boundaries and then systematically removing lymph nodes in a sequential "lawn-mowing" manner, this approach maximizes lymphatic clearance and facilitates appropriate vessel ligation, potentially reducing recurrence and complications. TECHNOLOGY MATERIALS AND METHODS: There are 2 steps in the technique: (1) Identification of boundaries: establishing the left (left ureter, gonadal vessels and psoas), distal (left common iliac vein level), right (right ureter, gonadal vessels and psoas), and proximal (left renal vein) boundaries. (2) En bloc resection: sequential dissection from distal to proximal and right to left in a "lawn-mowing" pattern, collecting all para-aortic lymph nodes up to the left renal vein and ligating the main lymphatic vessels, superior and inferior to the left renal artery. Key considerations include preserving the sympathetic ganglia and avoiding injury to hemorrhage-prone veins. PRELIMINARY RESULTS: Successful en bloc para-aortic lymph node resection was achieved in a 26-year-old female with sigmoid colon cancer and para-aortic metastasis. Duration of surgery was 380 min, with 100 mL of blood loss. The patient was discharged without complications. Histopathological examination revealed 2/23 positive para-aortic lymph nodes. At the nine-month follow-up, there was no recurrence or formation of lymphocysts. CONCLUSIONS AND FUTURE DIRECTIONS: En bloc para-aortic lymph node resection using the "lawn-mowing" technique, after identification of boundaries, is feasible and reproducible. This simplified approach reduces the risk of lymphatic residue. Further evaluation in a larger series is required to assess oncological and functional outcomes. See New Technology Report Video.

A 35-year-old woman presented with a local recurrence at the stoma site three months after Hartmann’s procedure for sigmoid colon cancer. In the subsequent months, the tumor exhibited rapid progression, with direct invasion into the abdominal wall. Her clinical course was characterized by persistent pain, fever, foul odor, and defecation disorder. The substantial disease burden ​​confined her to bed, leaving her unable to care for her two young children​​. Following a multidisciplinary team (MDT) evaluation, she was deemed a candidate for reoperative surgery. The procedure comprised en bloc resection of the recurrent tumor, followed by restoration of bowel continuity with a primary colorectal anastomosis and immediate abdominal wall reconstruction. The patient’s postoperative recovery was uneventful, with a marked improvement in quality of life. This case highlights the critical role of flap-based reconstruction in managing complex abdominal wall defects.