Liu M, Seier K, Gonen M
… +7 more, Wei AC, Drebin J, Balachandran V, Kingham TP, Soares K, Jarnagin WR, D'Angelica M
Ann Surg Oncol
· 2026 Jun · PMID 42360648
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BACKGROUND: We aimed to characterize the outcomes of patients undergoing resection of solitary colorectal liver metastases (CLM), including patterns of recurrence and usage of salvage therapy. METHODS: A retrospective an...BACKGROUND: We aimed to characterize the outcomes of patients undergoing resection of solitary colorectal liver metastases (CLM), including patterns of recurrence and usage of salvage therapy. METHODS: A retrospective analysis of 535 consecutive patients who underwent resection of solitary CLM between 1999 and 2021 was performed from an institutional database. Extrahepatic disease and prior liver-directed therapy were excluded. Salvage therapy consisted of repeat resection, ablation, or radiation of all sites of recurrence. Outcomes, overall survival (OS), recurrence-free survival, and hepatic recurrence-free survival were analyzed using time-to-event methods. RESULTS: The median OS of the whole cohort was 10 years. At a median follow-up of 8.6 years, 52% had recurred at 3 years, 73% of which were at a single site. Salvage therapy was performed in 51% of recurrences and associated with prolonged OS (5.89 [95% confidence interval (CI) 4.68-6.64] years vs. 2.24 [95% CI 1.92-2.41] years; p<0.001). Of those who received salvage therapy, 58% were alive 5 years after recurrence. On multivariate analysis, worse OS was associated with more than three positive lymph nodes in the colon primary (hazard ratio [HR] 2.19 [95% CI 1.56-3.08], p<0.001), tumor size (HR 1.07 [95% CI 1.04-1.1]; p<0.001), and positive margins (HR 1.90 [95% CI 1.07-3.37]; p=0.028). Use of adjuvant hepatic artery infusion chemotherapy was associated with improved OS (HR 0.74 [95% CI 0.54-0.99]; p=0.043) and reduced liver recurrence (HR 0.53 [95% CI 0.37-0.76]; p<0.001). CONCLUSIONS: Patients with resected solitary CLM have excellent long-term survival, with half remaining free of recurrence after initial surgery. In the event of recurrence, repeat salvage treatment is feasible and associated with improved survival.
Ann Surg Oncol
· 2026 Jun · PMID 42360647
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BACKGROUND: For breast cancer patients with clinically node-positive (cN+) and residual disease after neoadjuvant chemotherapy (NAC), axillary lymph node dissection (ALND) remains the standard of care, though alternative...BACKGROUND: For breast cancer patients with clinically node-positive (cN+) and residual disease after neoadjuvant chemotherapy (NAC), axillary lymph node dissection (ALND) remains the standard of care, though alternative strategies may be selected by multidisciplinary teams in certain cases. This study evaluated factors associated with omission of ALND for cN+ patients who were pathologically node-positive after NAC (ypN+). METHODS: In this retrospective observational study, the National Cancer Database was queried for patients with clinical T1-T4, N1-N3 breast cancer from 2016 to 2021 who received NAC and were subsequently ypN+. Axillary procedures were categorized as sentinel lymph node biopsy (SLNB) alone, SLNB followed by ALND (SLNB + ALND), or ALND alone. Logistic regression identified factors associated with omission of ALND after SLNB, adjusting for sociodemographic, geographic, and clinical variables. RESULTS: Among 38,559 patients, axillary interventions were SLNB alone (n = 7,131, 18.49%), SLNB+ALND (n = 14,247, 36.95%), and ALND alone (n = 17,179, 44.55%). Over the study period, SLNB alone and SLNB + ALND increased while ALND alone decreased. Compared with academic programs, patients treated at comprehensive community, integrated network, and community programs had greater odds of SLNB alone compared with SLNB+ALND (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.22-1.43; OR 1.17, 95% CI 1.07-1.27; OR 1.54, 95% CI 1.33-1.78, respectively). CONCLUSIONS: There has been de-escalation of ALND after initial SLNB for cN+ breast cancer patients found to be ypN+. This suggests that providers may be extrapolating evidence supporting SLNB alone to populations in which it has not yet been thoroughly studied or are omitting ALND in anticipation of ongoing clinical trial results.
Ann Surg Oncol
· 2026 Jun · PMID 42360644
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BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced melanoma. SWOG S1801 demonstrated improved event-free survival (EFS) with neoadjuvant pembrolizumab compared with adjuvant th...BACKGROUND: Immune checkpoint inhibitors (ICIs) have revolutionized the management of advanced melanoma. SWOG S1801 demonstrated improved event-free survival (EFS) with neoadjuvant pembrolizumab compared with adjuvant therapy alone in resectable stage III/IV melanoma patients. Similarly, the NADINA trial demonstrated improved EFS by using neoadjuvant ipilimumab plus nivolumab compared to adjuvant nivolumab. We conducted a retrospective study to evaluate outcomes associated with neoadjuvant versus adjuvant ICI in real-world patients with stage III/IV melanoma. METHODS: We reviewed records from our prospectively-maintained IRB-approved institutional database from January 2020 to December 2024 to identify consented patients with clinically detectable stage IIIB to IIID or oligometastatic stage IVA to IVC melanoma who had intended curative-intent surgery and received ICI preoperatively (neoadjuvant) and postoperatively (adjuvant) or only adjuvantly. The patients had to have at least 12 months of follow-up or an event to be included. The primary endpoint was EFS, defined as time from diagnosis of stage III or IV melanoma to recurrence, progression, or death. Secondary endpoints included pathological response in the neoadjuvant group. RESULTS: A total of 159 patients met the inclusion criteria: 102 received neoadjuvant ICI, and 57 received only adjuvant ICI. In a landmark analysis, EFS at 1 year was 79.2% (95% confidence interval [CI] 71.6-87.5) in the neoadjuvant group and 54.7% (95% CI 43.2-69.3) in the adjuvant-only group. The EFS at 2 years was 68.9% (95% CI 59.9-79.2) in the neoadjuvant group and 46.3% (95% CI 34.7-61.8) in the adjuvant only group (p = 0.05). The median follow-up was 28.7 months (IQR 18.5-41.3) in the neoadjuvant group and 30.1 months (IQR 19.5-41.8) in the adjuvant group. Major pathologic response was observed in 56 (54.9%) patients, partial pathologic response in 11 (10.8%), no response in 23 (22.5%), and progression in 12 (11.8%) patients treated with neoadjuvant ICI. CONCLUSIONS: In this single-academic institution analysis, neoadjuvant ICI was associated with improved 2-year EFS compared with adjuvant ICI in patients with advanced melanoma, consistent with prospective data from SWOG 1801 and NADINA. This evidence validated the integration of neoadjuvant ICI therapy into clinical practice and underscores the importance of real-world validation.
Zhang Z, Dai H, Wu Y
… +4 more, Wang Y, Zhou X, Liu R, Luo J
Ann Surg Oncol
· 2026 Jun · PMID 42348150
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BACKGROUND: Active surveillance is increasingly adopted for low-risk papillary thyroid microcarcinoma (PTMC ≤1 cm). However, a subset of tumors exhibit tracheal or recurrent laryngeal nerve (RLN) invasion, resulting in u...BACKGROUND: Active surveillance is increasingly adopted for low-risk papillary thyroid microcarcinoma (PTMC ≤1 cm). However, a subset of tumors exhibit tracheal or recurrent laryngeal nerve (RLN) invasion, resulting in upstaging and functional morbidity. Reliable preoperative predictors are needed to optimize patient selection. METHODS: This retrospective study analyzed 10,112 consecutive PTMC patients (mean age, 44.7 years; 73.8% female) who underwent surgery at a high-volume center between June 2021 and February 2025. Preoperative high-resolution ultrasonography was performed for all the patients. The shortest distances from the tumor to the trachea and posterior thyroid capsule were measured and categorized. Tracheal and RLN invasion were confirmed intraoperatively. Odds ratios (ORs) were calculated across risk groups. RESULTS: Tracheal invasion occurred in 1.5% of the patients and was not observed when the tumor-trachea distance exceeded 3 mm. Among tumors ≤1 mm from the trachea, invasion rates increased with tumor-trachea angle (acute 7.6%, right 11.3%, obtuse 17.2%), corresponding to a 47.9-fold higher risk (95% confidence interval, 29.5-77.7) compared with tumors larger than 1 mm. Recurrent laryngeal nerve invasion occurred in 2.3% of the patients and was rare when the tumor-capsule distance exceeded 3 mm (0.05%). Tumors ≤2 mm from the posterior capsule with capsular disruption showed a 34.6% invasion rate, including 9.8% clinically significant RLN invasion, with significantly increased risks of any RLN invasion (OR 45.6) and clinically significant RLN invasion (OR, 66.2). CONCLUSION: Preoperative ultrasound assessment of tumor proximity and interface with adjacent structures robustly predicts tracheal and RLN invasion in PTMC. These parameters may improve selection for active surveillance and guide surgical decision-making.
Remy M, Albouys J, Birnbaum DJ
… +5 more, Gaujoux S, Védie AL, Descourvières C, Gonzalez JM, Lorenzo D
Ann Surg Oncol
· 2026 Jun · PMID 42342971
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BACKGROUND: Managing branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging, as guideline criteria (worrisome features/high-risk stigmata) and nomograms often leave uncertainty. Next-generati...BACKGROUND: Managing branch-duct intraductal papillary mucinous neoplasms (BD-IPMNs) remains challenging, as guideline criteria (worrisome features/high-risk stigmata) and nomograms often leave uncertainty. Next-generation sequencing (NGS) may provide actionable molecular information that influences clinical decision-making. METHODS: We conducted a national, vignette-based decision-impact study involving 132 clinicians (gastroenterologists and surgeons). Four complex BD-IPMN vignettes (each with two to four worrisome features) were evaluated twice: pre-NGS and post-NGS after disclosure of either a high-risk mutation (positive) or its absence (negative). The primary endpoint was the within-physician change in management in the NGS-concordant direction (NGS+ surveillance to surgery; NGS- surgery to surveillance) assessed using McNemar's test and mixed-effects logistic regression. Secondary endpoints included change in decision confidence, inter-physician agreement (Fleiss' κappa), and practitioner factors. RESULTS: NGS significantly changed management in all vignettes (all p < 0.001): with NGS-, surgical plans shifted to surveillance (43% in distal pancreatectomy; 61% in pancreatoduodenectomy scenarios); with NGS+, surveillance shifted to surgery (90% and 72%, respectively; both p < 0.001). In mixed-model, post-NGS reduced surgery in NGS- cases (odd ratio [OR] 0.30, 95%confidence interval [CI] 0.16-0.57) and the post-NGS effect was strongly amplified in NGS+ cases (interaction OR 76.51, 95%CI 26.47-221.13). Population-averaged probabilities of choosing surgery shifted from 20% to 7% (NGS-) and 42% to 94% (NGS+). Decision confidence increased (proportional-odds OR 4.66, 95%CI 3.62-6.02, p < 0.0001). Inter-physician agreement rose from κ = 0.044 (95%CI 0.033-0.055) pre-NGS to κ = 0.590 (95%CI 0.580-0.601) post-NGS (p < 2×10). After NGS, practitioner characteristics no longer explained decision patterns. CONCLUSIONS: In complex BD-IPMN scenarios, NGS significantly influences clinician decision-making and reduces inter-physician variability. These findings support its role as a decision-support tool.
Laude E, Guyon C, Diaz LM
… +11 more, Cabel L, Pierga JY, Ramtohul T, Loap P, Mahiou K, Bonneau C, Djerroudi L, Sabah J, Didelot H, Laas E, Gaillard T
Ann Surg Oncol
· 2026 Jun · PMID 42334720
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BACKGROUND: The optimal management of the axilla in patients with de novo metastatic breast cancer (MBC) undergoing breast surgery remains unclear. This study aimed to evaluate the association between axillary surgical m...BACKGROUND: The optimal management of the axilla in patients with de novo metastatic breast cancer (MBC) undergoing breast surgery remains unclear. This study aimed to evaluate the association between axillary surgical management and survival outcomes for patients with de novo MBC. METHODS: This retrospective single-center cohort study included patients with de novo extra-nodal MBC treated at Institut Curie between 2008 and 2019 and registered in the ESME database. Patients were categorized according to axillary management: axillary lymph node dissection (ALND) versus sentinel lymph node biopsy (SLNB) or no axillary surgery. Progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods. Inverse probability of treatment-weighting (IPTW) based on a propensity score was used to reduce selection bias. RESULTS: The study included 246 patients including 182 (74%) who underwent ALND, 54 (21%) who received SLNB, and 10 (4%) who had no axillary surgery. After a median follow-up period of 60.3 months (95% confidence interval [CI], 55.9-64 months), axillary surgical management was not associated with survival outcomes. In IPTW-weighted analyses, ALND was not associated with better PFS than SLNB or no axillary surgery (hazard ratio [HR], 0.82; 95% CI, 0.53-1.25; p = 0.4), nor with improved OS (HR, 1.19; 95% CI, 0.64-2.25; p = 0.6). Patterns of disease progression were similar between the groups, with no increased nodal progression observed in the SLNB group. CONCLUSION: For patients with de novo MBC undergoing breast surgery, ALND was not associated with improved survival. These findings support a more conservative axillary approach for this population given the limited therapeutic benefit and potential morbidity of extensive axillary surgery.
Ann Surg Oncol
· 2026 Jun · PMID 42334718
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BACKGROUND: Postoperative pancreatic fistula (POPF) is a major contributor to morbidity and mortality after pancreaticoduodenectomy (PD). Externalized pancreatic stents decrease the incidence and severity of POPF after P...BACKGROUND: Postoperative pancreatic fistula (POPF) is a major contributor to morbidity and mortality after pancreaticoduodenectomy (PD). Externalized pancreatic stents decrease the incidence and severity of POPF after PD, but their feasibility has not been demonstrated in robotic PD. We present our method of externalized pancreatic stent placement during robotic PD and report our initial experience. METHODS: This video demonstrates our technique of using an externalized pancreatic stent during robotic PD. We conducted a retrospective review of patients who underwent robotic PD with externalized pancreatic duct stent placement at a single academic institution. Fistula risk was graded using the Fistula Risk Score (FRS) and the Alternative FRS, and postoperative outcomes were recorded. RESULTS: Of 67 consecutive patients, 44.8% were female and the median age was 68 years. The most common indication for PD was pancreatic ductal adenocarcinoma (PDAC) (47.8%), followed by cystic neoplasms (22.4%) and neuroendocrine tumors (11.9%); 75% of patients with PDAC received neoadjuvant chemotherapy for borderline resectable disease, and 21.9% underwent preoperative radiation. Most (70.1%) had an intermediate risk of POPF using FRS, and 19.4% were classified as high risk based on the Alternative FRS. The overall POPF rate was 17.9% (biochemical leak 16.4%; grade B 1.5%; grade C 0%). The median length of stay was 5 days, and the 90-day readmission rate was 22.4%. Stents were removed, on average, at 29 days postoperatively. CONCLUSIONS: We report the placement of an externalized pancreatic stent during robotic PD, which has not been previously described in robotic surgery. This method is technically feasible and is associated with very low rates of fistula-related complications.