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MicroRNA; Genetic profiling; Tumor resection; Personalized surgery; Cancer genomics

Surgical decision-making in cancer treatment has historically been based on anatomical considerations, tumor size, location, and histopathological analysis. However, with the rise of molecular medicine, more precise strategies are emerging through the integration of microRNA (miRNA) expression and genetic profiling. miRNAs are small, non-coding RNAs that regulate gene expression at the post-transcriptional level, and they have been implicated in tumorigenesis, metastasis, and chemotherapy resistance. Similarly, genetic profiling identifies mutations and alterations in DNA that can influence a tumor's behavior and response to treatment. These molecular insights allow surgeons to make better-informed decisions regarding tumor resection, particularly in complex or metastatic cancers. By incorporating genetic and miRNA data into the preoperative planning process, surgical strategies can be tailored to individual patients, enhancing both surgical precision and patient outcomes [1][2].

MicroRNA and Genetic Profiling in Cancer Surgery

MicroRNAs (miRNAs) are small RNA molecules that play crucial roles in regulating gene expression, influencing cell proliferation, apoptosis, and differentiation. In cancer, miRNAs have been found to be frequently dysregulated, either overexpressed or underexpressed, contributing to tumorigenesis, metastasis, and resistance to therapies. Profiling miRNA expression in tumors can provide valuable insights into the molecular characteristics of the cancer, including its aggressiveness and potential for recurrence. These molecular signatures are becoming increasingly important in guiding surgical decisions, particularly in identifying tumors that are more likely to invade surrounding tissues or metastasize. Genetic profiling, which typically involves the sequencing of a tumor’s DNA, provides a comprehensive analysis of mutations, copy number variations, and other genomic alterations present in cancer cells. These alterations often correlate with tumor behavior and can help predict patient response to certain therapies. By incorporating genetic profiling into surgical planning, surgeons can better understand the tumor's biological behavior, allowing them to make more informed decisions regarding the extent of resection and the use of adjunctive therapies such as chemotherapy or targeted treatments. Both miRNA and genetic profiling are pivotal in understanding the tumor’s molecular signature and determining the most appropriate surgical approach. For example, tumors with certain genetic mutations, such as those in the EGFR or KRAS genes, may require different surgical strategies or adjuvant therapies than those without these mutations [3][4].

Applications of miRNA Profiling in Surgical Decision-Making

MiRNA profiling has emerged as a powerful tool in cancer diagnosis, prognosis, and treatment selection. By examining the expression patterns of specific miRNAs, clinicians can gain insights into the tumor’s biological behavior, including its potential for aggression, recurrence, and metastasis. For example, miRNAs such as miR-21, miR-155, and miR-34a have been associated with poor prognosis in various cancers, including lung, breast, and colorectal cancer. Conversely, the loss of certain miRNAs, such as miR-143, has been linked to tumor progression and metastasis [5]. In the context of surgical decision-making, miRNA profiling can help guide tumor resection by identifying aggressive tumors that may require more extensive surgery or closer postoperative monitoring. For instance, in pancreatic cancer, where tumors are often diagnosed at an advanced stage, miRNA profiling has been shown to predict the tumor's likelihood of spreading to nearby lymph nodes or distant organs. This information can help surgeons determine the need for more extensive resection or the addition of neoadjuvant therapies to shrink the tumor before surgery [6]. In addition, miRNA profiling can provide guidance on the likelihood of surgical complications or recurrence. For example, high expression of certain miRNAs has been associated with poor responses to treatment and higher risks of postoperative recurrence. Surgeons can use this information to tailor their surgical approach, offering patients a more personalized treatment plan that accounts for both tumor biology and individual risk factors [7].

Genetic Profiling and Tumor Resection Strategy

Genetic profiling has become a cornerstone of personalized medicine, particularly in cancer treatment. Tumors often harbor specific genetic mutations that can influence their growth and behavior. Genetic profiling, especially the use of next-generation sequencing (NGS), enables the identification of these mutations and provides important information on how a tumor is likely to respond to various treatments. For example, mutations in the TP53 gene are common in many cancers and often indicate a more aggressive tumor with a higher likelihood of metastasis. Identifying such mutations preoperatively can inform the surgeon's strategy, possibly leading to more aggressive resections or adjuvant therapies such as chemotherapy or radiation [8][9]. In addition to assessing the primary tumor, genetic profiling can also be used to assess circulating tumor DNA (ctDNA), which can provide insights into the genetic landscape of metastatic disease. This is particularly useful for cancers that have already spread beyond the primary tumor, as genetic profiling of ctDNA can help identify the presence of occult metastases. Surgeons can use this information to decide whether to perform lymph node dissections or pursue a more aggressive approach to ensure all cancerous tissue is removed [10]. Genetic profiling also plays a crucial role in identifying patients who are likely to benefit from targeted therapies. For example, the identification of HER2-positive breast cancer patients can guide the use of HER2-targeted therapies such as trastuzumab (Herceptin). In colorectal cancer, genetic mutations in the KRAS gene can predict resistance to EGFR-targeted therapies, allowing surgeons to tailor treatment strategies accordingly. Thus, genetic profiling helps ensure that patients receive the most appropriate therapies based on the molecular characteristics of their cancer.

Integrating miRNA and Genetic Profiling into Surgical Planning

The integration of miRNA and genetic profiling into surgical planning has the potential to revolutionize the way surgeons approach cancer surgery. By providing a more detailed understanding of the tumor’s molecular characteristics, these profiling techniques help surgeons make more informed decisions regarding the extent of surgery, the choice of adjuvant therapies, and the need for postoperative surveillance. For example, in breast cancer, genetic profiling of tumors can help determine the need for lymph node dissection, based on the presence of specific mutations or genetic signatures that predict lymph node involvement. Similarly, miRNA profiling can help assess the likelihood of local recurrence or distant metastasis, which may influence the decision to pursue more aggressive surgical options or neoadjuvant therapies. In some cases, miRNA and genetic profiling may even reveal the presence of genetic mutations that make the tumor susceptible to targeted therapies, allowing surgeons to adjust their treatment plans accordingly. Furthermore, by combining miRNA and genetic profiling with advanced imaging techniques such as PET scans or MRI, surgeons can obtain a comprehensive view of the tumor's location, size, and molecular behavior. This multi-modal approach improves tumor resection accuracy and reduces the risk of leaving behind residual cancerous tissue. Personalized treatment plans based on both molecular profiling and imaging data are more likely to result in better patient outcomes, reduced recurrence rates, and improved overall survival.

Challenges and Limitations

While miRNA and genetic profiling offer significant advantages in guiding surgical decisions, several challenges remain. One of the main obstacles is the complexity and cost of genetic sequencing technologies. Next-generation sequencing (NGS) is still relatively expensive, and not all healthcare institutions have the resources to routinely perform comprehensive genetic and miRNA profiling. Furthermore, the interpretation of these profiling results requires specialized knowledge and expertise, and the integration of these findings into clinical practice can be challenging. Additionally, while miRNA and genetic profiling can provide valuable insights, they do not offer a complete picture of tumor behavior. Tumor heterogeneity, in which different areas of a tumor exhibit different genetic or molecular characteristics, can complicate the interpretation of these profiles. The dynamic nature of cancer also means that tumor genetics can evolve over time, which may limit the predictive power of genetic profiling and miRNA analysis.

Conclusion

MicroRNA and genetic profiling are increasingly being used to guide surgical decisions in cancer treatment. These molecular tools provide critical insights into the biological behavior of tumors, including their aggressiveness, potential for metastasis, and response to therapies. By incorporating miRNA and genetic profiling into surgical planning, surgeons can offer more personalized and precise treatment strategies, leading to improved patient outcomes. Although challenges such as cost, accessibility, and interpretation remain, the integration of these technologies holds great promise for advancing the field of precision oncology and improving the overall effectiveness of cancer surgery.

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