Ann Surg Oncol
· 2026 Jun · PMID 42329563
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BACKGROUND: Esophageal cancer is associated with substantial morbidity and mortality worldwide and is frequently diagnosed at advanced stages, leading patients and their relatives to seek health-related information beyon...BACKGROUND: Esophageal cancer is associated with substantial morbidity and mortality worldwide and is frequently diagnosed at advanced stages, leading patients and their relatives to seek health-related information beyond traditional clinical encounters. In recent years, YouTube has become a popular source of medical information. Nevertheless, questions persist regarding the accuracy, credibility, and overall reliability of the content available on the platform. METHODS: This cross-sectional study evaluated publicly available YouTube videos related to esophageal cancer. Data were collected on December 3, 2025, using a browser without a user login to minimize algorithm-driven bias. Viewer engagement metrics (views, likes, and comments), source categories, and country of origin were recorded for each video. Content quality and reliability were assessed using the DISCERN instrument, Journal of the American Medical Association (JAMA) benchmark criteria, and Global Quality Score (GQS). Non-parametric statistical analyses were used to compare quality outcomes across source categories and evaluate the correlations between the engagement metrics and quality scores. RESULTS: A total of 78 videos met the inclusion criteria, most of which originated in the USA (83.3%). Health-related channels constituted the largest source category (35.9%), followed by patient experience-based videos (23.1%), and private institutions (20.5%). Viewer engagement metrics (views, likes, and comments) did not differ significantly among source types (p > 0.05). In contrast, the content quality varied substantially. Videos produced by public institutions achieved the highest DISCERN, JAMA, and GQS values, whereas patient-experience-based videos demonstrated significantly lower quality and reliability (p < 0.001). Engagement metrics were strongly intercorrelated but showed no association with quality scores. CONCLUSION: YouTube videos related to esophageal cancer frequently exhibit moderate informational quality, and popularity metrics do not reflect content reliability. Source credibility plays a critical role in determining video quality, underscoring the need for greater involvement of healthcare professionals and public institutions in digital health content production.
Lorentzen EH, Reich AJ, Nguyen K
… +1 more, Minami CA
Ann Surg Oncol
· 2026 Jun · PMID 42329562
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PURPOSE: The American Society of Clinical Oncology recommends integration of geriatric-specific screening tools in the evaluation of older adults undergoing systemic therapy. How these data affect surgical oncology care...PURPOSE: The American Society of Clinical Oncology recommends integration of geriatric-specific screening tools in the evaluation of older adults undergoing systemic therapy. How these data affect surgical oncology care is underexplored. We evaluated the effect of these data on preoperative surgical decision-making and communication. METHODS: Patients ≥ 70 years, who presented to a breast surgical oncology clinic from October 2021 to May 2024 were screened for frailty using the Geriatric-8 (G8) and limited life expectancy using the Schonberg Index. Surgeons received the results prior to consultation with the patient. Post-visit surveys assessed whether the tools influenced treatment decisions or conversations. Semistructured interviews were conducted pre- and postimplementation to capture surgeon perspectives. Survey data were analyzed descriptively; interviews were analyzed by using a thematic analysis approach. RESULTS: Thirteen surgeons participated; 92% were fellowship-trained. Among 233 patient encounters, results altered treatment plans a minority of the time (G8: 4%, Schonberg Index: 4%). However, approximately 30% of surgeons stated the results shifted discussion, and 10% discussed results explicitly with patients. Three themes emerged in interviews: (1) the tools often reinforced providers' subjective assessments and were most valuable in "borderline" cases; (2) surgeons desired better language to discuss frailty and life expectancy; and (3) structural factors affect tool utilization. CONCLUSIONS: Routine frailty and limited life expectancy screening in an academic breast surgery clinic infrequently altered clinical management but did have the potential to inform conversations regarding tailoring locoregional therapy in older adults. Continued work on supporting surgeons in the integration of these tools into treatment conversations, and disseminating similar efforts in different clinical environments, is needed.
Aydogdu C, Wang B, McSweeney S
… +5 more, Pieretti A, Weight CJ, Autorino R, Kaouk J, Bukavina L
Ann Surg Oncol
· 2026 Jun · PMID 42324366
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BACKGROUND: This study aimed to evaluate whether pre-surgical tumor-informed circulating tumor DNA (ctDNA) predicts pathologic nodal status at radical cystectomy and its potential role in risk stratification for future b...BACKGROUND: This study aimed to evaluate whether pre-surgical tumor-informed circulating tumor DNA (ctDNA) predicts pathologic nodal status at radical cystectomy and its potential role in risk stratification for future biomarker-guided surgical strategies. METHODS: The study prospectively analyzed 40 patients with non-muscle-invasive and muscle-invasive bladder cancer who underwent radical cystectomy with pelvic lymph node dissection (LND) and pre-surgical tumor-informed ctDNA testing. Compared with pathologic nodal findings, ctDNA status was classified as positive or negative. Diagnostic performance metrics with 95 % confidence intervals (CIs) were calculated. To assess reproducibility, data from a published cohort meeting comparable inclusion criteria were integrated for pooled descriptive analysis. RESULTS: Of 40 patients, 27 (68 %) were ctDNA-negative and 13 (32 %) were ctDNA-positive before cystectomy. Pathologic nodal metastases were identified in seven patients (18 %). For nodal metastases, ctDNA demonstrated a sensitivity of 86 % (95 % CI, 49-97 %), a specificity of 79 % (95 % CI, 62-89 %), and negative predictive value of 96 % (95 % CI, 82-99 %). In pooled descriptive analysis including 149 patients, the negative predictive value remained high at 92 % (95 % CI, 84-97 %). A simulated ctDNA-guided omission strategy may have avoided LND for 27 patients (68 %), with one false-negative case (3.7 %) that subsequently had recurrence. CONCLUSION: Pre-surgical tumor-informed ctDNA showed high negative predictive value for nodal metastases at radical cystectomy. These findings supported prospective validation of ctDNA as a biomarker to identify patients at low risk of nodal metastases and inform future trials of biomarker-guided surgical strategies.
Morando L, Millochau JC, Nos C
… +4 more, Couturaud B, Sanchez AM, Sarfati I, Clough KB
Ann Surg Oncol
· 2026 Jun · PMID 42323460
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BACKGROUND: Chest wall perforator flaps (CWPF) are emerging as a versatile and safe oncoplastic technique for breast-conserving surgery, particularly in small to medium breasts and challenging tumor locations. Despite pr...BACKGROUND: Chest wall perforator flaps (CWPF) are emerging as a versatile and safe oncoplastic technique for breast-conserving surgery, particularly in small to medium breasts and challenging tumor locations. Despite proven benefits, their adoption remains limited by the lack of long-term real-world data. METHODS: A single-institution retrospective analysis was conducted to assess CWPF outcomes in 157 patients with early-stage breast cancer treated at the Paris Breast Center between 2005 and 2024. Primary outcomes were complication rates, re-excision, and conversion to mastectomy rates. Secondary outcomes included local and distant recurrence, and overall survival with median follow-up exceeding 4 years. RESULTS: The median age was 60 years; most tumors were cT1-T2 with median size 14.4 mm. CWPF types were anterior intercostal artery perforator (AICAP; 70.7%), lateral intercostal artery perforator (LICAP; 18.5%), LICAP + lateral thoracic artery perforator (LTAP; 6.4%), and LTAP (4.5%). Early complications (grade ≥II) occurred in 5.1% with no partial or total flap loss. The rate of re-excision was 5.7% and of completion mastectomy was 0.6%. The median follow-up was 48 months; local recurrence occurred in 2.5% and distant recurrence in 6.4%, with no deaths. CONCLUSIONS: CWPF reinforces the evolving role of oncoplastic surgery in safely extending breast-conserving opportunities, including neoadjuvant systemic therapy and re-operative settings. Prospective, multicentric studies including patient-reported outcomes are warranted to further validate these findings.
Feng L, Gao W, Yin G
… +6 more, Zhong Q, Chen X, Fang J, Huang Z, Guo W, Zhang Y
Ann Surg Oncol
· 2026 Jun · PMID 42323459
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BACKGROUND: Neoadjuvant immunotherapy combined with chemotherapy (NICT) improves tumor downstaging in locally advanced hypopharyngeal squamous cell carcinoma (LA-HSCC), but the effect of response-adapted surgery on outco...BACKGROUND: Neoadjuvant immunotherapy combined with chemotherapy (NICT) improves tumor downstaging in locally advanced hypopharyngeal squamous cell carcinoma (LA-HSCC), but the effect of response-adapted surgery on outcomes is unclear. This study evaluated the efficacy and safety of NICT and compared minimally invasive versus open surgery on the basis of treatment response. PATIENTS AND METHODS: We retrospectively analyzed 79 patients with stage III-IVB HSCC who received NICT. Treatment response was assessed per RECIST 1.1, and surgery was tailored accordingly. The objective response rate was 84.81%, and the pathological complete response rate was 59.49%. Grade ≥ 3 treatment-related adverse events occurred in 11.39% of patients. RESULTS: Following NICT, 73.4% of patients underwent transoral minimally invasive surgery, 17.7% partial laryngectomy, and 8.8% total laryngectomy, resulting in a laryngeal preservation rate of 91.14%. With a median follow-up of 15 months, there were no significant differences in progression-free or overall survival between surgical groups. However, the minimally invasive group had significantly better 1-year respiratory (89.66% versus 35.71%, p < 0.001) and phonatory (70.69% versus 0%, p < 0.001) function preservation compared to the open surgery group. CONCLUSIONS: Multivariate analysis confirmed that minimally invasive surgery independently predicted improved respiratory function. NICT enables high response and organ preservation in LA-HSCC, and minimally invasive surgery achieves comparable survival with superior functional outcomes, supporting its use in a personalized treatment approach.
Campbell S, Ahmed O, Cullinan D
… +4 more, Vachharajani N, Khan AS, Chapman WC, Doyle MBM
Ann Surg Oncol
· 2026 Jun · PMID 42323458
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BACKGROUND: In carefully selected patients, liver transplantation (LT) has provided encouraging outcomes for unresectable biliary tract cancers (BTC), including biphenotypic (cHCC-CC), perihilar (pCC), and intrahepatic c...BACKGROUND: In carefully selected patients, liver transplantation (LT) has provided encouraging outcomes for unresectable biliary tract cancers (BTC), including biphenotypic (cHCC-CC), perihilar (pCC), and intrahepatic cholangiocarcinoma (iCCA). This study aimed to characterize diagnostic discrepancies, recurrence patterns, and oncologic metrics in this unique LT population. PATIENTS AND METHODS: Patients with BTC receiving LT within a single academic transplant center were included (n = 98 from 2007 to 2025). Survival and recurrence outcomes were analyzed by tumor histotype using Kaplan-Meier and log-rank tests. Univariate and multivariate Cox proportional hazards regression was performed. RESULTS: The most common transplanted subtype was pCC (n = 54, 55.1%), followed by cHCC-CC (n = 28, 28.6%) and iCCA (n = 16, 16.3%). Pretransplant diagnoses frequently differed from final explant pathology in 26 patients (26.5%). Recurrence occurred in 40 (40.8%) patients with a median time to recurrence of 16 months (interquartile range 1-160 months). Estimated 1-, 3-, and 5-year overall survival rates for the entire cohort were 88%, 68%, and 58%, respectively. On multivariate analysis, lymph node positivity (hazard ratio [3.27, p = 0.010), iCCA subtype (HR 2.94, p = 0.030), and explant tumor size (HR 1.22 per cm, p = 0.005) were independent predictors of recurrence. CONCLUSIONS: This is, to our knowledge, the largest single-center analysis of liver transplant recipients with BTC. Lymph node positivity, iCCA subtype, and tumor size are independent predictors of recurrence following LT for BTC. Despite the diagnostic challenges and high disease recurrence, LT is a promising option for unresectable BTC when no other surgical option exists.
Xie Z, Xiu Z, Lin Y
… +5 more, Gong N, Peng F, Zhang W, Wang R, Wang W
Ann Surg Oncol
· 2026 Jun · PMID 42323452
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PURPOSE: Evidence for adjuvant immunotherapy after neoadjuvant chemoimmunotherapy (NCIT) remains limited. This study aims to assess survival benefits of adjuvant immunotherapy in esophageal squamous cell carcinoma (ESCC)...PURPOSE: Evidence for adjuvant immunotherapy after neoadjuvant chemoimmunotherapy (NCIT) remains limited. This study aims to assess survival benefits of adjuvant immunotherapy in esophageal squamous cell carcinoma (ESCC) patients treated with NCIT. METHODS: This multicenter retrospective study analyzed 398 esophageal cancer patients who underwent NCIT followed by R0 resection (2019-2023). Postoperatively, 147 received immunotherapy (ICIs group) and 251 did not (non-ICIs group). After propensity score matching (PSM), 143 patients were included in each group. The primary endpoints were 2-year overall survival (OS) and disease-free (DFS) rates. RESULTS: Before matching, adjuvant immunotherapy showed no significant OS (hazard ratio [HR] 0.68, p = 0.14) or DFS (HR = 0.75, p = 0.161) benefit versus non-ICIs in ESCC patients. Post-PSM, however, ICIs demonstrated significantly improved 2-year DFS (HR = 0.57, p = 0.013) and OS (HR = 0.47, p = 0.008). Subgroup analyses revealed that ≤65 years, male, lower location, cT3-4, cN1, ypT3-4, ypN2-3, ypIIIB-IVA stage, non-pCR, and non-MPR were significantly associated with survival benefits from adjuvant immunotherapy. Both before and after matching, pCR patients did not benefit from immunotherapy, whereas non-pCR patients exhibited significantly improved DFS (HR = 0.54, p = 0.007) and OS (HR = 0.48, p = 0.01) after matching. Multivariate Cox analysis showed that adjuvant chemoimmunotherapy was the only regimen independently improving both DFS and OS compared to no adjuvant therapy, while immunotherapy alone did not demonstrate significant survival improvement. CONCLUSIONS: Adjuvant immunotherapy enhanced survival in NCIT-treated ESCC patients overall, although no survival benefit was observed with adjuvant immunotherapy in pCR patients. Whereas non-pCR patients may benefit from adjuvant immunotherapy, with chemoimmunotherapy may be the optimal strategy. These findings are exploratory. Further validation in longer follow-up time, larger cohorts or prospective studies are needed.
Ann Surg Oncol
· 2026 Jun · PMID 42319590
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BACKGROUND: Robotic surgical platforms have demonstrated functional advantages in complex abdominal surgeries. However, they are rarely employed in cytoreductive surgery (CRS). The da Vinci SP platform may overcome the l...BACKGROUND: Robotic surgical platforms have demonstrated functional advantages in complex abdominal surgeries. However, they are rarely employed in cytoreductive surgery (CRS). The da Vinci SP platform may overcome the limitations of multi-port approaches with encouraging postoperative outcomes. We present a case of peritoneal metastases from colon cancer, which was treated with neoadjuvant chemotherapy and CRS using the da Vinci SP system. METHODS: A 61-year-old female patient with colon cancer exhibited ovarian and multiple peritoneal metastases 14 months after undergoing laparoscopic right hemicolectomy for colon cancer. The patient was referred to our institution for further management after bilateral salpingo-oophorectomy. After seven cycles of neoadjuvant chemotherapy, CRS was planned, including hysterectomy, rectal resection, left lower abdominal wall mass excision, greater omentectomy, cholecystectomy (gallbladder polyps), and hyperthermic intraperitoneal chemotherapy. The procedures were deemed feasible using the da Vinci SP system, and informed consent was obtained from the patient. A single port was introduced through a 4.5-cm umbilical incision. The peritoneal carcinomatosis index score was 7, and all procedures were completed, achieving complete cytoreduction (CC-0). RESULTS: The entire procedure lasted 501 min, with an estimated blood loss of 150 mL. The patient had a maximum pain numerical rating score of 3 and was discharged without complications on day 9. Adjuvant chemotherapy was administered, and the patient has remained recurrence-free for ≥ 6 months at the time of reporting. CONCLUSIONS: Single-port robotic CRS using the da Vinci SP appears feasible for highly selected cases with limited peritoneal metastases. This approach facilitates multi-quadrant dissection through a single incision, minimizes abdominal wall trauma, and potentially enhances postoperative recovery.
Zhang R, Huang Y, Hu X
… +11 more, Wang Y, Guan W, Yan B, Zhang B, Chen X, Zheng Q, Dong X, Rehman FUL, Zhang Q, Zhuo S, Yan J
Ann Surg Oncol
· 2026 Jun · PMID 42319589
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BACKGROUND: Low anterior resection syndrome (LARS) is common after neoadjuvant chemoradiotherapy (nCRT) and sphincter-preserving surgery for rectal cancer and is associated with poor quality of life. However, reliable to...BACKGROUND: Low anterior resection syndrome (LARS) is common after neoadjuvant chemoradiotherapy (nCRT) and sphincter-preserving surgery for rectal cancer and is associated with poor quality of life. However, reliable tools to identify patients at high risk remain limited. This study aims to develop and validate a prediction model for major LARS in patients with rectal cancer after nCRT and sphincter-preserving surgery. PATIENTS AND METHODS: A total of 315 consecutive patients between 2019 and 2021 were retrospectively enrolled (training cohort: 213; independent validation cohort: 102). A distal resection margin collagen score (CS) was derived from multiphoton imaging using least absolute shrinkage and selection operator (LASSO) logistic regression. A prediction nomogram incorporating CS and clinicopathologic factors was developed and evaluated for discrimination, calibration, and clinical utility. RESULTS: The CS was developed on the basis of eight features. Multivariable analysis revealed that the CS (odds ratio [OR] 3.57, 95% confidence interval [CI] 2.56-5.37), tumor distance from the anal verge, and time to stoma closure were independent predictors of major LARS. The CS-integrated nomogram showed good discrimination in the training cohort (area under the receiver operating characteristic curve [AUROC], 0.914, 95% CI 0.863-0.957) and validation cohort (AUROC 0.922, 95% CI 0.851-0.976). Compared with the traditional model, incorporating CS significantly improved discrimination in both the training cohort (AUROC 0.914 versus 0.631; p < 0.001) and validation cohort (AUROC, 0.922 versus 0.619; p < 0.001). CONCLUSIONS: The CS was associated with major LARS after nCRT and sphincter-preserving surgery. The CS-integrated model may support postoperative risk stratification for major LARS in patients with rectal cancer.