Rodrigo Arrangoiz MS, MD, FACS, FSSO

12/15/2025

12/15/2025

The Anastomoses of the Recurrent Laryngeal Nerve in the Larynx

The vagus nerve: Also known as the 10th cranial nerve Gives rise to the superior laryngeal nerve (SLN) and recurrent laryngeal nerve (RLN) in the neck After descending toward the larynx: The SLN di…

12/12/2025

Vascular anatomy relevant to the surgical approach to the external branch of the superior laryngeal nerve (EBSLN)

The true prevalence of iatrogenic injury to the EBSLN during thyroid surgery remains difficult to quantify, largely due to underdiagnosis and variability in clinical presentation. – The patho…

11/30/2025

✅ Re**al Cancer Radiotherapy 2025 Update

Re**al Cancer Radiotherapy — 2025 Update (Cancer Radiother): What Really Changes in Daily Practice

The new 2025 update on re**al cancer radiotherapy reflects a truly mature, European-style integration of TNT, short-course RT, long-course chemoradiotherapy, and organ-preservation strategies.
Rather than offering a rigid algorithm, it highlights a shift toward individualized, biology-driven and logistics-aware care.

🔷 Total Neoadjuvant Therapy (TNT)
TNT is now the preferred framework for most locally advanced re**al cancers, particularly in high-risk disease (CRM+, EMVI+, N2).
It improves systemic control, increases response rates, and creates real opportunities for organ preservation.
But the review also stresses the uncertainties: long-term toxicity of intensified regimens and unresolved questions about optimal sequencing (induction vs consolidation).

🔷 SCRT vs LCRT — “Equivalence with context”
Short-course RT (5×5 Gy) is no longer the second option.
Within TNT, SCRT is fully equivalent to LCRT regarding oncologic outcomes — and often superior in logistics and treatment efficiency.
Still, LCRT retains strategic value for very distal tumors where maximal downsizing is required for sphincter preservation.

🔷 Organ Preservation / Watch-and-Wait
Watch-and-wait is now a validated pathway for patients achieving a true clinical complete response.
Evidence shows more local regrowth but excellent salvage outcomes and no compromise in survival — if the center can maintain high-quality MRI, endoscopy and strict surveillance.
This is not “watch & wait”; this is “watch & work.”

🔷 A distinctly European perspective
The document reflects a flexible, principle-based approach:

choose TNT when systemic risk is high,

choose SCRT or LCRT based on anatomy and resources,

offer organ preservation only within structured programs with reliable follow-up.

Overall, the 2025 update brings re**al cancer radiotherapy closer to a modern, personalized, organ-preserving model — one that aligns biology, technology, and real-world feasibility.

11/30/2025

Biomarkers in Colore**al Cancer

Right-Sided Colon Cancer (proximal colon)
• More likely to have MSI-High (microsatellite instability)
• Higher frequency of KRAS mutations
• More likely to have BRAF mutations
• More common in patients with Lynch Syndrome (HNPCC)

Left-Sided Colore**al Cancer (distal colon & re**um)
• Associated with HER2 amplification
• More common in patients with Familial Adenomatous Polyposis (FAP)