Eur J Surg Oncol [JOURNAL]
Sun
200 papers
Navigating the complexities of rectal cancer management: Shared decision-making and patient perspectives in critical choices.
De Roo AC, Neuman HB
Eur J Surg Oncol · 2026 Jul · PMID 41820181 · Publisher ↗
Patients with rectal cancer now may face several potential pathways for treatment, including options to avoid major surgery, omit radiation, or maintain bowel continuity. In preference studies, clinicians often prioritiz...
Patients with rectal cancer now may face several potential pathways for treatment, including options to avoid major surgery, omit radiation, or maintain bowel continuity. In preference studies, clinicians often prioritize cancer outcomes, while many patients prefer to avoid an ostomy, surgery, or otherwise maintain quality of life. Treatment morbidity remains high, including major bowel, bladder, and sexual dysfunction, with variable effects on quality of life. Clinicians and patients should work together to incorporate quality of life goals when devising treatment plans. Future research into predictive tools, information needs and delivery, and optimal non-operative management surveillance strategies may make this process less complex for future patients and clinicians.
Microwave ablation versus surgical resection for hepatocellular carcinoma within Milan criteria: A propensity score-based analysis.
Qi X, Zhang P, Huang M … +9 more , Li Y, Ding F, Wang X, Deng Y, Han X, An C, Wang X, Zhao X, Wang G
Eur J Surg Oncol · 2026 May · PMID 41819052 · Publisher ↗
OBJECTIVES: Microwave ablation (MWA) has emerged as an important local treatment option for patients with hepatocellular carcinoma (HCC) within the Milan criteria. This study aimed to compare the recurrence beyond the Mi...
OBJECTIVES: Microwave ablation (MWA) has emerged as an important local treatment option for patients with hepatocellular carcinoma (HCC) within the Milan criteria. This study aimed to compare the recurrence beyond the Milan criteria (RBM) rates between MWA and surgical resection (SR) in HCC patients. METHODS: This retrospective multicenter study included 668 patients with Milan criteria HCC who underwent initial treatment with either MWA or SR between January 2010 and December 2023. Baseline characteristics were balanced using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). RBM, overall survival (OS), and recurrence-free survival (RFS) were compared between the two groups using the log-rank test. RESULTS: A total of 668 patients (mean age, 60.1 ± 9.6 years; 532 male) were included. After PSM (n = 187 in each group), the 1-, 3-, and 5-year RBM rates were 26.5%, 40.9%, and 56.5% in the MWA group, and 18.1%, 42.7%, and 61.7% in the SR group, respectively (hazard ratio [HR] = 0.95, 95% confidence interval [CI] 0.70-1.29; P = 0.751). The corresponding OS rates were 92.9%, 81.0%, and 66.9% in the MWA group, and 95.1%, 85.6%, and 70.1% in the SR group (HR = 1.08, 95% CI 0.71-1.63; P = 0.727). The 1-, 3-, and 5-year RFS rates were 69.2%, 42.3%, and 27.8% in the MWA group, compared with 75.0%, 46.3%, and 27.3% in the SR group (HR = 1.08, 95% CI 0.83-1.39; P = 0.579). After IPTW adjustment, no significant differences were observed between the two groups in RBM (HR = 1.01, 95% CI 0.75-1.35; P = 0.969), OS (HR = 0.84, 95% CI 0.57-1.23; P = 0.372), or RFS (HR = 1.04, 95% CI 0.82-1.32; P = 0.733). In the PSM cohort, the MWA group had significantly fewer postoperative complications than the SR group (24.6% vs. 35.3%; P = 0.032) and a shorter length of hospital stay (median, 4 [IQR, 3-5.5] vs. 8 [IQR, 5-10] days; P < 0.001). CONCLUSION: MWA demonstrated comparable RBM, OS, and RFS outcomes to SR in HCC patients within Milan criteria. Given its lower morbidity and shorter hospitalization, MWA represents an effective local treatment alternative in this patient population.
Factors influencing surgical decision-making in breast cancer: A multicenter study in Japan.
Seki H, Komiya T, Sowa Y … +5 more , Kato M, Nishida Y, Takano J, Saiga M, Collaborative Study Group of Scientific Research of the Japan Oncoplastic Breast Surgery Society
Eur J Surg Oncol · 2026 May · PMID 41812477 · Publisher ↗
BACKGROUND: Recent advances in cancer treatment and improvements in prognosis have led to increasing recognition of the critical role of shared decision-making (SDM) between patients and healthcare providers in determini...
BACKGROUND: Recent advances in cancer treatment and improvements in prognosis have led to increasing recognition of the critical role of shared decision-making (SDM) between patients and healthcare providers in determining treatment strategies. SDM requires not only information on surgery-related outcomes and health-related quality of life, but also consideration of patient-specific factors such as the social background. However, determinants of surgical choice among Japanese patients remain unclear, and this study aimed to identify the influencing factors. METHODS: This multicenter, cross-sectional study evaluated patient-reported outcomes in 577 Japanese patients who underwent mastectomy (MT), breast-conserving surgery (BCS), or immediate breast reconstruction (IBR). Participants completed questionnaires to assess the factors influencing surgical decision-making, including sociodemographic, psychosocial, and healthcare provider-related factors. Clinical data were obtained from the medical records, and multivariate analyses were conducted to identify the factors associated with the selection of surgical procedures. RESULTS: The most frequently cited factor was the surgeon's opinion (92.2%), followed by fear of recurrence (43.8%) and partner's opinion (35.5%). Partner's opinion was significantly more influential in BCS and IBR selection than in MT selection (P = 0.012), whereas concern about recurrence was the main factor influencing MT selection (P = 0.002). Multivariate analysis suggested the nurse's opinion was significantly associated with IBR, while concern about recurrence was inversely related. CONCLUSIONS: Considering that the factors influencing decision-making vary by surgical procedure, it is essential to tailor surgical choices to each patient's values and lifestyle. Strengthening decision-support systems by involving the entire healthcare team will be an important priority moving forward.
The utility of large language models in oncological multidisciplinary team meetings: A systematic review.
Prabhakaran S, Bell S, Lee JC … +1 more , Kong JCH
Eur J Surg Oncol · 2026 May · PMID 41812476 · Publisher ↗
Large language models (LLMs) have emerged in recent years as innovative artificial intelligence systems with early potential in clinical decision-making. This is the first systematic review to evaluate LLMs' oncological...
Large language models (LLMs) have emerged in recent years as innovative artificial intelligence systems with early potential in clinical decision-making. This is the first systematic review to evaluate LLMs' oncological decision-making and compare their treatment recommendations to "gold standard" oncological multi-disciplinary team (MDT) decision-making. PubMed, EMBASE and Medline databases were last searched on 20th January in line with PRISMA guidelines. All relevant peer-reviewed publications comparing LLM and MDT treatment recommendations in patients with cancer were included. Studies using fictional cases, case reports, and conference proceedings were excluded. Modified QUADAS-2 tool was used for bias assessment. The primary outcome was the concordance between LLM and MDT treatment recommendations. 34 publications met the inclusion criteria with a total of 3513 patient cases included in this review. Studies were highly heterogenous with regards to study design, sample size, cancers studied, and LLM models evaluated, among others. Concordance rates ranged from 16 to 100% across all studies. Highest concordance rates were noted in prostate cancer cases, where the LLM was directed to incorporate established international guidelines in decision-making. One third of studies exhibited a high level of bias. Limitations to LLM decision-making include overtreatment of frail patients, lack of reproducibility, insufficient niche knowledge, occasional life-threatening recommendations, and medico-legal issues including privacy and confidentiality. LLMs may be capable of generating appropriate oncological treatment recommendations, but early outcomes are inconsistent, and conflicting across the various studies with regards to safety. Robust prospective comparative studies are yet needed to better determine their utility in this setting.
Global burden, trends, and attributable risk factors of women's cancers with projection to 2050: Results from the GLOBOCAN 2022 and global burden of disease study 2021.
Wei T, Li Y, Zhang Z … +9 more , Xu Y, Huang H, Huang Y, Li J, Gong Z, Hu Z, Wang Y, Zhang A, Li F
Eur J Surg Oncol · 2026 May · PMID 41812475 · Publisher ↗
BACKGROUND: The global burden of women's cancers has changed in recent decades; however, a comprehensive epidemiological analysis is still absent. This study aims to estimate the burden, trends, and associated risk facto...
BACKGROUND: The global burden of women's cancers has changed in recent decades; however, a comprehensive epidemiological analysis is still absent. This study aims to estimate the burden, trends, and associated risk factors of women's cancers. METHODS: Data on the incidence and mortality of women's cancers, including breast, cervical, uterine, and ovarian cancers, were retrieved from GLOBOCAN 2022 and the Global Burden of Disease 2021. The estimated annual percent change was calculated to assess trends from 1990 to 2021, and Bayesian age-period-cohort models were used to project the incidence and mortality trends to 2050. Cross-country inequalities in women's cancers were analyzed based on data from 204 countries. RESULTS: In 2022, there were 3.7 million new cases and 1.3 million deaths from women's cancers globally. Breast cancer represented the highest proportion, with 2,295,720 incident cases and 665,675 deaths, followed by cervical, uterine, and ovarian cancers. The age-standardized incidence rate of women's cancers has risen in recent decades and is projected to reach 83.7 per 100,000 by 2050. The age-standardized mortality rate for women's cancers has shown a downward trend since 1990 and is expected to decline further, reaching 25.3 per 100,000 by 2050. High socio-demographic index (SDI) level regions bore a greater burden of breast, uterine, and ovarian cancers, while cervical cancer was more prevalent in low-SDI regions. Additionally, the cancer burden was higher among elderly women. Unsafe sexual practices are the leading risk factor for cervical cancer, dietary risks for breast cancer, and high body mass index for uterine and ovarian cancers. CONCLUSION: Women's cancers pose a significant global health burden, with pronounced geographical and age-related disparities. Targeting modifiable risk factors and enhancing healthcare access, especially in low-SDI regions, is essential to reducing the worldwide burden of women's cancers.
A pre-operative two-week very low-calorie diet to reduce steatosis before liver resection (RESOLVE): A multi-centre randomised controlled feasibility trial.
Chynoweth J, Sorrell L, Neilens H … +11 more , MacCormick A, Allgar V, Aspinall PJ, Parkin T, Murphy P, Takhar AS, Fenwick SW, Frampton AE, Dhakshinammorthy V, Puckett M, Aroori S
Eur J Surg Oncol · 2026 Apr · PMID 41797062 · Publisher ↗
BACKGROUND: Liver surgery (LS) remains the main curative option for liver metastases and primary liver tumours. Low-calorie and very low-calorie diets (VLCDs) are routinely used for 2-4 weeks prior to bariatric and gallb...
BACKGROUND: Liver surgery (LS) remains the main curative option for liver metastases and primary liver tumours. Low-calorie and very low-calorie diets (VLCDs) are routinely used for 2-4 weeks prior to bariatric and gallbladder surgery to reduce liver size and abdominal adiposity, thereby improving surgical safety. This study aimed to evaluate the feasibility of a VLCD in patients undergoing LS with hepatic steatosis (HS). METHODS: In this randomised controlled feasibility trial, 29 participants were randomised to either the intervention group (VLCD providing 800 kcal and 80 g protein for 2 weeks before LS; n = 14) or treatment as usual (n = 15). Feasibility and clinical outcomes, including operating time, blood loss, ease of surgery, length of hospital stay, readmission and mortality, were assessed. RESULTS: There was no indication of a between-group difference. There was no mortality within 90 days. In the intervention group, 11 participants initiated VLCD and 6 adhered to it for at least 10 days. DISCUSSION: Although this feasibility study did not demonstrate a clinical benefit due to the small sample size, a definitive trial is needed to evaluate whether a VLCD administered 2 weeks before LS reduces HS during the preoperative period. TRIAL REGISTRATION: ISRCTN Number 19701345. Date registered: 20/032023. URL: https://www.isrctn.com/ISRCTN19701345.
Tumour localization and oncological outcomes in nonuterine leiomyosarcoma of the abdomen and pelvis.
Spasojevic M, Mariathasan AB, Stoldt S … +3 more , Larsen SG, Hompland I, Boye K
Eur J Surg Oncol · 2026 May · PMID 41797032 · Publisher ↗
BACKGROUND: Leiomyosarcoma is an aggressive soft tissue sarcoma. While some evidence supports different biological behaviour between uterine and non-uterine LMS (NULMS), outcome data for NULMS according to tumour localiz...
BACKGROUND: Leiomyosarcoma is an aggressive soft tissue sarcoma. While some evidence supports different biological behaviour between uterine and non-uterine LMS (NULMS), outcome data for NULMS according to tumour localization are limited. We evaluated the impact of tumour localization on oncological outcomes in abdominal and pelvic NULMS. METHODS: Patients with abdominal or pelvic NULMS diagnosed between 2005 and 2022 were identified from an institutional sarcoma database. Non-operated patients, uterine LMS, and cases with incomplete data were excluded. Patients were grouped by primary tumour location: visceral, retroperitoneal, or pelvic. RESULTS: A total of 120 patients (median age 61 years) were included: 47 retroperitoneal, 35 visceral, and 38 pelvic tumours. Median tumour size was 8 cm, with larger tumours in the retroperitoneal group (10.0 vs. 6.5 cm, p = 0.002). Complete resection was achieved in 67.5% of patients and was less common in retroperitoneal and pelvic tumours. Survival analyses of 104 patients (median follow-up 83 months) showed a median OS of 111 months, with 5- and 10-year OS rates of 65% and 46%. Median DFS was 65 months. Recurrence occurred in 39% of patients, mainly as distant metastases. Retroperitoneal LMS and especially suprahepatic IVC involvement were associated with poor OS. On multivariable analysis, retroperitoneal location, R1 resection, and high tumour grade independently predicted inferior OS. CONCLUSIONS: Retroperitoneal LMS demonstrates significantly poorer survival than visceral LMS, while pelvic LMS shows intermediate outcomes. Suprahepatic IVC involvement confers a poor prognosis, underscoring the importance of treatment decision-making by a multidisciplinary team.
Efficacy and safety of electrochemotherapy in the treatment of cutaneous and sub-cutaneous recurrence from breast cancer: A single-center cohort study.
Sena G, Amaddeo A, Iannello A … +4 more , Renne M, Orsini V, Currò G, Rizzuto A
Eur J Surg Oncol · 2026 Apr · PMID 41795433 · Publisher ↗
BACKGROUND: Cutaneous and subcutaneous recurrence of breast cancer represents a challenging clinical scenario, particularly in patients previously treated with surgery, radiotherapy, and systemic therapies. Electrochemot...
BACKGROUND: Cutaneous and subcutaneous recurrence of breast cancer represents a challenging clinical scenario, particularly in patients previously treated with surgery, radiotherapy, and systemic therapies. Electrochemotherapy (ECT) combines electroporation with cytotoxic drug administration and has shown promising local control rates; however, evidence in breast cancer remains limited. This study aimed to evaluate the safety and efficacy of ECT in patients with breast cancer skin recurrence. METHODS: We conducted a single-center retrospective cohort study including patients with histologically confirmed breast cancer who developed cutaneous recurrence and were treated with ECT between January 2015 and December 2023. Tumor response was assessed according to RECIST 1.1 criteria. Overall survival (OS) was calculated from the date of the first ECT session to death or last follow-up. Survival analysis compared responders (complete or partial response) and non-responders (no response or progressive disease). Cox regression was used to identify prognostic factors. RESULTS: Nineteen patients were included. Eleven (57.9%) achieved a complete or partial response. Median OS for the entire cohort was 19 months. Responders had significantly longer OS compared to non-responders (20 vs 12 months; log-rank p = 0.002). Lack of response to ECT was the strongest negative prognostic factor (HR 6.59, 95% CI 1.72-25.29, p = 0.006). HER2 positivity was also associated with poorer survival (HR 10.67, 95% CI 1.32-86.30, p = 0.026). No grade ≥3 adverse events were observed. CONCLUSION: ECT appears to be a safe and effective local treatment for cutaneous breast cancer recurrence, providing meaningful local control and a potential survival benefit in responders. Larger prospective studies are warranted to confirm these findings.
Targeting the liver: Insights from a tertiary center on post-operative hepatic arterial oxaliplatin for metastatic colorectal cancer.
Sarti K, El-Rawadi E, Gelli M … +16 more , Beunon P, Bonnet B, Tselikas L, Camilleri GM, Fernandez De Sevilla E, Denèche I, Smolenschi C, Valéry M, Fuerea A, Malka D, Pudlarz T, Tarabay A, Hollebecque A, Ducreux M, Boige V, Boilève A
Eur J Surg Oncol · 2026 Apr · PMID 41795432 · Publisher ↗
BACKGROUND: As the liver is the most common site of metastasis in colorectal cancer (CRC), and metastatic recurrence frequently occurs after resection of colorectal liver metastases (CRLM), hepatic arterial infusion chem...
BACKGROUND: As the liver is the most common site of metastasis in colorectal cancer (CRC), and metastatic recurrence frequently occurs after resection of colorectal liver metastases (CRLM), hepatic arterial infusion chemotherapy (HAIC) has emerged as a promising treatment approach. This study investigates the feasibility, safety, and efficacy of postoperative HAIC with oxaliplatin following curative-intent resection of CRLM. METHODS: A retrospective analysis was conducted on all patients with resected CRLM who received postoperative HAIC with oxaliplatin between 2008 and 2022 at a tertiary cancer center. The primary study endpoint were disease-free-survival (DFS) and overall survival (OS). RESULTS: Overall, 119 patients (median age, 56 years; synchronous metastatic disease, 82%) received postoperative HAIC with oxaliplatin after complete resection of their CRLM (median number of metastases resected, 7). They received a median number of 6 HAIC cycles (range, 1-12), mostly combined with intravenous chemotherapy with 5-fluorouracil/leucovorin (n = 118, 99%) and irinotecan (n = 41, 34%). The median DFS was 10.2 months (95% CI 9-12.4) and the median intrahepatic DFS was 18.4 months (95% CI 12.4-29.7,12 months DFS rate, 60%). The median OS reached 55.5 months (95% CI, 50.0-86.6; 5-year OS rate, 46%). Grade 3-4 toxicities occurred in 45% of patients (neutropenia, 38%; peripheral neuropathy, 9%); 54% of patients experienced pain (mostly mild to moderate) during oxaliplatin infusion. HAI catheter-related complications included extrahepatic perfusion (30%) and catheter occlusion (11%). CONCLUSIONS: HAIC with oxaliplatin is an effective, safe and feasible treatment option after resection/ablation of CRLM. These findings support the therapeutic relevance of postoperative HAIC in liver-limited metastatic CRC.
Multi-omic and immune landscapes of HPV-negative versus HPV-positive cervical cancer reveal implications for immunotherapy.
Zhang G, Zhang X, Li H … +2 more , Du X, Wang J
Eur J Surg Oncol · 2026 Apr · PMID 41795431 · Publisher ↗
BACKGROUND: HPV-negative cervical cancer (3-8% of cases) presents distinct clinical challenges and poorer prognosis compared to HPV-positive disease. We aimed to conduct an exploratory study to characterize its unique tu...
BACKGROUND: HPV-negative cervical cancer (3-8% of cases) presents distinct clinical challenges and poorer prognosis compared to HPV-positive disease. We aimed to conduct an exploratory study to characterize its unique tumor immune microenvironment (TIME) and molecular drivers to inform immunotherapy development. METHODS: We analyzed 70 cervical cancer patients (50 HPV-positive/HPV-A, 20 HPV-negative/HPV-I) using targeted next-generation sequencing and multiplex immunofluorescence. Clinical features, mutational profiles, immune cell infiltrates, and prognostic factors were compared between groups. Strict FDR correction and effect size analysis (Cliff's Delta) were applied to statistical comparisons. RESULTS: HPV-I tumors showed significant association with gastric-type adenocarcinoma (p < 0.001) and higher CA125 levels (p = 0.011). Molecularly, HPV-I tumors were substantially enriched for TP53 mutations (46.2% vs 2.2%, OR = 0.030, p < 0.001), while PIK3CA mutations predominated in HPV-A tumors (41.3% vs 7.7%, OR = 7.78, p = 0.047), suggesting notable mutual exclusivity. Immunologically, HPV-A tumors showed substantially higher stromal M2 macrophage density (Cliff's Delta = -0.51, Large Effect), while HPV-I tumors displayed significantly higher stromal immune cell ratios: M1/M2 (5.34 vs 0.87, p = 0.003), CD8+/M2 (13.65 vs 2.66, p = 0.004), and NK/M2 (8.43 vs 0.59, p = 0.012), revealing the paradox of favorable immune balance coexisting with immune exclusion. In HPV-I subgroup analysis, high CD8+/M2 ratio was associated with superior progression-free survival (16.7% vs 71.4% event rates, p = 0.014). CONCLUSIONS: HPV-negative and HPV-positive cervical cancers represent distinct entities with unique molecular and immunological profiles. Our exploratory findings suggest that HPV-I tumors exhibit the paradox of favorable stromal immune cell ratios coexisting with immune-excluded phenotype, while HPV-A tumors show higher M2 macrophage infiltration. The prognostic significance of CD8+/M2 ratio in HPV-I patients may provide a valuable biomarker and suggest specific therapeutic strategies targeting immune exclusion and macrophage polarization based on HPV status.
A prediction model for disease-free survival following R0/R1 rectal cancer resection: A retrospective longitudinal study based on the Norwegian and Danish colorectal cancer quality registries.
Martinez Bravo JJ, Gögenur M, Gögenur I … +3 more , Kiran RP, Šaltytė Benth J, Augestad KM
Eur J Surg Oncol · 2026 Apr · PMID 41795430 · Publisher ↗
BACKGROUND: Prediction models may assist clinicians in communicating prognostic outcomes to cancer survivors. The Norwegian and Danish colorectal cancer registers (NCCR and DCCG) are valuable data sources for developing...
BACKGROUND: Prediction models may assist clinicians in communicating prognostic outcomes to cancer survivors. The Norwegian and Danish colorectal cancer registers (NCCR and DCCG) are valuable data sources for developing such models. Although few models exist for rectal cancer, their development and validation remain limited. METHODS: We assessed data from 21,116 stage I-III rectal cancer patients who underwent R0/R1 surgery. The assessment included clinicopathological predictors of DFS, with the index date being the date of the pathological report. A multivariable Cox regression model with inverse probability weighting was estimated for DFS, as outcome, defined as the time from diagnosis to death, recurrence or end of follow-up with at least 90-day follow-up. RESULTS: The analysis included 10,234 NCCR and 6691 DCCG patients, with 40·3% and 38·3% being female, mean age of 67·9 (11·7) and 67·9 (10·6) years, median follow-up times of 93·4 (95% CI (91·0-96·0)) and 79·1 (77·4-80·6) months, and 5-year DFS of 29·9% and 24·3%. Sex, age, pathological stage, circumferential resection margin, lymph node yield, malignant lymph nodes, and surgical procedures were significant predictors. The C-index was 0·69 (R 0·24), and 0·65 (R 0·07) for the external validation cohort. The calibration slope was 1·22 (SE 0·05). Predicted probabilities for the NCCR and DCCG cohorts closely matched the observed probabilities. CONCLUSION: Accessible through RECTI.net, the model predicts disease-free survival for up to 12·5 years after surgery, aiding clinicians to provide prognostic outcomes to rectal cancer survivors. To improve the generalisability of the model, further validation in other populations is needed.
Readmission rates and predictive factors in older patients undergoing colorectal cancer surgery: A multicenter European retrospective study.
Scardino A, Wolthuis A, Taffurelli G … +7 more , Dileo C, Ghignone F, Bislenghi G, Fagard K, Ugolini G, D'Hoore A, Montroni I
Eur J Surg Oncol · 2026 Apr · PMID 41795429 · Publisher ↗
PURPOSE: In the era of enhanced recovery pathways, hospital readmission after colorectal surgery remains a relevant issue in older patients and may reflect suboptimal perioperative management. This multicenter retrospect...
PURPOSE: In the era of enhanced recovery pathways, hospital readmission after colorectal surgery remains a relevant issue in older patients and may reflect suboptimal perioperative management. This multicenter retrospective study aimed to identify risk factors for 30-day readmission following elective colorectal cancer surgery in patients aged ≥70 years. METHODS: Clinical records from three European high-volume centers were retrospectively analyzed. A total of 1126 patients aged ≥70 years undergoing elective colorectal cancer surgery were included; urgent and emergency procedures were excluded. Preoperative assessment comprised ASA class, ECOG status, Age-Adjusted Charlson Comorbidity Index (ACCI), functional status, and frailty evaluation using the Flemish Triage Risk Screening Tool (fTRST) and G8 score. Surgical variables included operative approach and procedure type. Postoperative outcomes included Clavien-Dindo complications, Comprehensive Complication Index (CCI), anastomotic leak, and length of stay. Univariable and multivariable logistic regression analyses were performed to identify predictors of 30-day readmission. RESULTS: The cohort included 1126 patients (51.1% male) with a mean age of 79 ± 5.6 years. The 30-day readmission rate was 6.9%. On univariable analysis, male sex, ACCI >6, ASA >2, fTRST >2, and stoma presence were associated with readmission. Multivariable analysis identified male sex (OR 1.79), fTRST >2 (OR 1.87), and ileostomy (OR 2.08) as independent predictors. Mean length of stay was 8 ± 7.6 days, mean CCI 12.2 ± 9.8, and anastomotic leak rate 9.2%. CONCLUSION: Male sex, preoperative frailty, and ileostomy independently predict 30-day readmission after colorectal cancer surgery in older patients. Tailored perioperative care pathways beyond standard enhanced recovery protocols reduce readmission rates and improve outcomes in this vulnerable population.
Enhanced recovery after surgery for gastric cancer with HIPEC: feasibility and outcomes in a complex setting.
Casella F, Geroin C, Meloni F … +4 more , Bencivenga M, Mattioni E, Camozzi S, Weindelmayer J
Eur J Surg Oncol · 2026 Apr · PMID 41793858 · Publisher ↗
BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways improve outcomes following gastrectomy, but their applicability to procedures involving hyperthermic intraperitoneal chemotherapy (HIPEC) remains uncertain. MET...
BACKGROUND: Enhanced Recovery After Surgery (ERAS) pathways improve outcomes following gastrectomy, but their applicability to procedures involving hyperthermic intraperitoneal chemotherapy (HIPEC) remains uncertain. METHODS: All patients undergoing total or subtotal gastrectomy for gastric cancer at our center between January 2017 and June 2024 were included. The institutional ERAS protocol, originally designed for standard gastrectomy, was prospectively applied to patients undergoing concomitant cisplatin-based HIPEC (CB-HIPEC). Twelve ERAS items were assessed, and adherence ≥70% was considered optimal. Clinical and perioperative outcomes were analyzed retrospectively. RESULTS: Among 670 patients, 44 underwent gastrectomy with CB-HIPEC and 626 underwent gastrectomy alone. HIPEC patients were younger (median age 55 vs. 68 years, p < 0.001) and had more advanced disease. Overall ERAS compliance ≥70% was achieved in 75% of the standard group but only 25% of the HIPEC group (p < 0.001). Major deviations involved delayed removal of the nasogastric tube (77% retained postoperatively vs. 18%, p < 0.001) and urinary catheter (98% vs. 28%, p < 0.001), as well as slower progression to oral intake (liquids by POD 1: 52% vs. 88%; soft diet by POD 3: 36% vs. 76%, p < 0.001). Despite reduced adherence, rates of active ambulation by POD 2 were comparable (82% vs. 88%). Overall complication rates were higher after CB-HIPEC (54.5% vs. 38%, p = 0.039), but CB-HIPEC itself was not an independent predictor of morbidity. CONCLUSIONS: HIPEC substantially impairs ERAS adherence, mainly due to delayed gastrointestinal and urinary recovery, without directly increasing postoperative morbidity. Procedure-specific ERAS adaptations are warranted for gastrectomy with CB-HIPEC.
Defining the role of minimally invasive surgical thermal ablation in liver malignancies: A systematic review and meta-analysis of outcomes and reporting standards.
Scotton G, Notte F, Pommergaard HC … +6 more , Tschuor C, Al-Saffar HA, Bale R, Meijerink MR, Gomez F, Stättner S
Eur J Surg Oncol · 2026 Apr · PMID 41793857 · Publisher ↗
Malignant liver tumors are increasingly treated with thermal ablation. Minimally invasive surgical thermal ablation (MITA) may offer advantages over the percutaneous approach for lesions near critical structures. This sy...
Malignant liver tumors are increasingly treated with thermal ablation. Minimally invasive surgical thermal ablation (MITA) may offer advantages over the percutaneous approach for lesions near critical structures. This systematic review and meta-analysis evaluated the safety, technical success, and long-term oncological outcomes of laparoscopic and robotic MITA, synthesizing data from 28 studies encompassing 3983 patients and 7033 treated lesions. Overall, 3959 procedures were carried out laparoscopically, while 24 were performed with a robotic approach. The primary analysis demonstrated a pooled technical failure rate of 2% (95% CI 1-4%), with a significant improvement to 1% in studies published after 2017, reflecting progressive technical refinement. Major complications (Clavien-Dindo ≥ 3a) occurred in 2.2% of cases (95% CI 1.4-3.5%), with a 30-day mortality of 0.25% (95% CI 0.08-0.75%). The aggregated incidence rate of local tumor progression was 6.13 events per 100 person-years, highlighting a discrepancy between immediate technical success and durable local control. For hepatocellular carcinoma, 1-, 3-, and 5-year OS were 90%, 69%, and 45%, with DFS of 74%, 48%, and 29%. For colorectal liver metastases, 1-, 3-, and 5-year OS were 90%, 60%, and 43%, and DFS were 66%, 60%, and 43%. MITA is a safe option for tumors unsuitable for percutaneous treatment, with very low procedure-related morbidity and mortality. However, high technical success does not always translate into durable local control, and current evidence is limited by heterogeneous reporting standards. Multicenter RCTs and standardized outcome definitions are needed to strengthen the evidence base and refine clinical guidelines.
The oncovascular surgeon in modern surgical oncology: A literature review.
Todorov AS, Dimova MP
Eur J Surg Oncol · 2026 Apr · PMID 41793856 · Publisher ↗
BACKGROUND: Involvement of major vascular structures by malignant tumors has historically been considered a contraindication to curative surgical resection. Advances in vascular reconstruction, perioperative management,...
BACKGROUND: Involvement of major vascular structures by malignant tumors has historically been considered a contraindication to curative surgical resection. Advances in vascular reconstruction, perioperative management, and multimodal oncologic therapy have challenged this paradigm. Oncovascular surgery has emerged as a specialized field integrating radical oncologic resection with arterial and/or venous reconstruction, thereby expanding surgical resectability. Despite increasing evidence, the role of the oncovascular surgeon remains variably defined. METHODS: A narrative literature review was performed using PubMed/MEDLINE, Embase, and Scopus databases. Studies reporting oncologic resections involving major vascular ligation or reconstruction were included, focusing on soft tissue and retroperitoneal sarcomas, pancreatic cancer, hepatobiliary malignancies, pelvic and colorectal tumors, and renal cell carcinoma with caval involvement. Outcomes included perioperative morbidity and mortality, oncologic margins, survival, and contribution of the oncovascular surgeon. RESULTS: Across multiple tumor types, en bloc resection with vascular reconstruction is feasible and can be performed with acceptable perioperative risk in selected patients. Oncologic outcomes are primarily driven by tumor biology and margin status rather than vascular reconstruction. Early involvement of the oncovascular surgeon improves planning and facilitates safe execution of complex resections. However, these procedures remain concentrated in high-volume centers and underutilized in routine practice. CONCLUSION: Major vascular involvement should no longer be viewed as an absolute contraindication to curative cancer surgery. The oncovascular surgeon plays a pivotal role in redefining resectability and enabling margin-negative resections within a multidisciplinary framework. Broader integration of oncovascular expertise and structured training pathways is needed to improve outcomes in locally advanced malignancies.
Ten-year of French multicentric experience in the management of peritoneal mesothelioma with 924 patients.
Noiret B, Lenne X, Piessen G … +4 more , Sgarbura O, Bruandet A, Kepenekian V, Eveno C
Eur J Surg Oncol · 2026 Apr · PMID 41785549 · Publisher ↗
BACKGROUND: Diffuse malignant peritoneal mesothelioma (DMPM) is a rare disease for which only selected patients are eligible for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). The aim...
BACKGROUND: Diffuse malignant peritoneal mesothelioma (DMPM) is a rare disease for which only selected patients are eligible for cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of our study was to evaluate oncologic outcomes of different treatments patterns of DMPM at national level. METHODS: All patients treated for DMPM between 2012 and 2021 in France were extracted through a national administrative database. Perioperative outcomes were analyzed into 3 groups: upfront-resectable, borderline-resectable (B-R) and inoperable patients. Survival outcomes were performed by Kaplan-Meier method. A multivariate logistic model was used to identify factors affecting survival. RESULTS: Of 924 patients, 270, 117 and 537 were identified as upfront-resectable, B-R and inoperable patients. The median age was 53 years with a mean Elixhauser comorbidity index of 3.2. Patients treated with CRS-HIPEC were younger with less comorbidities and had more exploratory laparoscopy compared to inoperable patients (p < 0.001). Majority of surgical patients were mostly treated in expert centers (97.7%). 90-day postoperative mortality (POM) was 2.1%. Major morbidity (MM) occurred in 50.9% with a failure-to-rescue (FTR) rate of 4.1%. Upfront-resectable patients had significantly better 5-year survival compared to B-R and inoperable patients (84.6% vs 55% vs 12.9%, p < 0.0001). After multivariate analysis, male gender (p < 0.0001), age (p = 0.005), B-R group (p < 0.0001), MM (p = 0.003) and adjuvant chemotherapy (p = 0.01) were independently associated with decrease 5-year survival. CONCLUSION: CRS and HIPEC is a safe procedure with a low 90-day POM and FTR. Patients should be address to expert centers to evaluate patients that could benefit from curative strategy.
Characteristics and management of women with a new breast cancer diagnosis after previous breast cancer in Australia and New Zealand.
Shepherdson M, Edwards S, Bochner M
Eur J Surg Oncol · 2026 Apr · PMID 41785548 · Publisher ↗
INTRODUCTION: Women previously treated for breast cancer are at higher risk of developing second primary breast cancer. This study investigates the diagnosis method, demographics, tumour characteristics and management of...
INTRODUCTION: Women previously treated for breast cancer are at higher risk of developing second primary breast cancer. This study investigates the diagnosis method, demographics, tumour characteristics and management of women who developed a subsequent breast cancer after previous primary breast cancer treatment. MATERIALS & METHODS: Australian and New Zealand women diagnosed with breast cancer between June 2023 and December 2024 were identified using the BreastSurgANZ Quality Audit database. A multivariable Poisson model with robust error variance was performed to compare the two groups (previous breast cancer and no previous breast cancer) versus a number of a priori predictors: age at diagnosis and detection method, invasive breast cancer tumour size, histological grade and node positivity, Sentinel Lymph Node biopsy, referral source, axillary surgery as well as type of surgery, reconstruction type and use of adjuvant radiotherapy. RESULTS: 11,474 women were diagnosed with breast cancer between June 2023 to December 2024. 13.9% had undergone previous breast cancer surgery. Second primary breast cancers were smaller (p < 0.001), more likely to be node negative (p < 0.002) and asymptomatic (p < 0.001). Women with no previous breast cancer surgery were more likely to undergo breast conservation than mastectomy (70.58% vs 29.42%). Patient subgroups that opted for immediate reconstruction were highest in those presenting with their first breast cancer (27% vs 21%)). CONCLUSIONS: Second primary breast cancers diagnosed after previous breast cancer are commonly smaller, asymptomatic and node negative. There is a need for an evidence based personal surveillance approach for women who have had previous breast cancer based on known risk factors.
External validation of a predictive system from the Swedish colorectal cancer registry to predict the risk of permanent stoma after rectal cancer surgery: A multicenter study in Spain.
Planellas P, Fernandes-Montes N, Alonso-Gonçalves S … +7 more , Golda T, Gil J, Elorza G, Kreisler E, Abad-Camacho MR, Cornejo L, Marinello F
Eur J Surg Oncol · 2026 Apr · PMID 41780407 · Publisher ↗
BACKGROUND: Sphincter-preserving surgery in rectal cancer aims to avoid permanent stoma formation, yet this remains a frequent outcome. Although several predictive models for permanent stoma have been proposed, few have...
BACKGROUND: Sphincter-preserving surgery in rectal cancer aims to avoid permanent stoma formation, yet this remains a frequent outcome. Although several predictive models for permanent stoma have been proposed, few have undergone external validation. This study aimed to externally validate a Swedish registry-based model for predicting permanent stoma in patients undergoing anterior rectal resection. METHODS: This multicentre retrospective study included six high-volume colorectal surgery units in Spain. A total of 837 patients who underwent sphincter-preserving resection for rectal cancer between January 2016 and January 2020 were initially assessed. Of these, 549 patients met the inclusion criteria defined in the original prediction study. Discriminative ability of the online risk calculator was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Among the 549 included patients, 57 (10.4%) had a permanent stoma two years after surgery. In accordance with the original study, male sex, low tumour height, and synchronous metastases were identified as preoperative factors associated with permanent stoma. When the online risk calculator was applied to our cohort, the model showed an AUC of 0.6345 (95% CI: 0.559-0.709; p < 0.001). CONCLUSION: External validation of a Swedish registry-based prediction model showed limited discriminative ability in predicting permanent stoma. These results highlight the need for improved, patient-centred predictive tools. Better-performing models could support shared decision-making by providing individualized risk estimates and help clinicians and patients weigh surgical options with greater confidence, ultimately contributing to improved long-term quality of life.
Perioperative trajectories of acute-phase proteins and their association with major postoperative complications in advanced ovarian cancer.
Hunde D, Kofoed NG, Ul Hassan M … +4 more , Wedin M, Kannisto P, Asp M, Salehi S
Eur J Surg Oncol · 2026 Apr · PMID 41774978 · Publisher ↗
BACKGROUND: Acute-phase proteins (APPs) reflect systemic inflammation and nutritional status, yet their perioperative trajectories and clinical utility as biomarkers of outcome in advanced ovarian cancer (aEOC) remain un...
BACKGROUND: Acute-phase proteins (APPs) reflect systemic inflammation and nutritional status, yet their perioperative trajectories and clinical utility as biomarkers of outcome in advanced ovarian cancer (aEOC) remain unclear. We aimed to characterise perioperative APP fluctuations and assess their associations with postoperative complications. METHODS: This observational study included patients undergoing cytoreductive surgery for aEOC across two prospective studies (n = 274). Serial serum albumin, transthyretin, C-reactive protein (CRP), fibrinogen, and procalcitonin were measured preoperatively and on postoperative days (PoD) 1, 3, and 5. Associations between APP levels and major postoperative complications, classified by Clavien-Dindo (CD ≥ III), were examined using multivariable logistic regression. Length of stay (LOS) was evaluated for biomarkers showing significant associations. Predictive thresholds were derived by ROC analysis. RESULTS: Positive APPs peaked postoperatively (CRP and fibrinogen on PoD 3; procalcitonin on PoD 1), while negative APPs reached nadirs on PoD 3. Neither preoperative albumin (>35 g/L) nor transthyretin (>0.2 g/L) predicted major postoperative complications. In contrast, elevated CRP measured on PoD 3 was associated with both major postoperative complications, OR 2.78 (95% CI 1.45-5.48) and prolonged LOS (>7 days) OR 3.0 (95% CI 1.67-5.47), with optimal cut-offs of ≥287 mg/L and ≥322 mg/L respectively (AUC 0.80). CONCLUSION: Preoperative APPs were not associated with postoperative outcomes in this cohort. CRP measured on postoperative day 3 was the most informative biomarker associated with major postoperative complications and prolonged hospital stay after cytoreductive surgery for advanced ovarian cancer and may support postoperative surveillance and recovery assessment when interpreted alongside clinical findings.
Unexpected proximal tumor extension as a predictor of poor survival after distal gastrectomy for locally advanced gastric cancer.
Ri M, Ohashi M, Hayami M … +3 more , Irino T, Sano T, Nunobe S
Eur J Surg Oncol · 2026 Apr · PMID 41774977 · Publisher ↗
BACKGROUND: Unexpected horizontal tumor extension, quantified as the discrepancy between gross and pathological proximal margins (ΔPM), has been reported as a prognostic indicator in total and proximal gastrectomy, but i...
BACKGROUND: Unexpected horizontal tumor extension, quantified as the discrepancy between gross and pathological proximal margins (ΔPM), has been reported as a prognostic indicator in total and proximal gastrectomy, but its relevance in distal gastrectomy remains unclear. METHODS: Patients who underwent upfront distal gastrectomy with R0 resection for locally advanced gastric cancer at the Cancer Institute Hospital between 2015 and 2019 were retrospectively analyzed. ΔPM was calculated as the difference between gross and pathological proximal margin lengths. Optimal cutoff values were determined using ROC analyses. Overall (OS) and recurrence-free survivals (RFS) were assessed using Kaplan-Meier methods, and prognostic factors were evaluated through multivariate Cox regression and subgroup analyses. RESULTS: A total of 427 patients were included. ΔPM ≥7 mm was significantly associated with poorer 5-year OS (68.5% vs. 88.5%, p < 0.001) and RFS (61.8% vs. 84.9%, p < 0.001) compared with ΔPM <7 mm. In multivariate analysis, ΔPM ≥7 mm remained an independent predictor of OS (HR 2.15, 95% CI 1.27-3.64) and RFS (HR 2.01, 95% CI 1.23-3.29). Subgroup analyses showed a more pronounced adverse effect of ΔPM ≥7 mm in patients with cN-positive disease. CONCLUSIONS: A longer ΔPM is associated with substantially worse long-term outcomes after distal gastrectomy and serves as an independent indicator of aggressive tumor biology. This effect is particularly notable in cN-positive disease, suggesting potential value in guiding intraoperative management.
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