Eur J Surg Oncol [JOURNAL]
Sun
200 papers
Bridging prediction and reality: AI-based external validation of predictive models for lymph node metastasis in gastric cancer.
Santos LL, Finamore AC, Gisbertz S … +25 more , Romario UF, Kielan W, Rosati R, Kołodziejczyk P, Wijnhoven B, Gockel I, Giacopuzzi S, Polkowski WP, Davies A, Morgagni P, Hoelscher A, Allum W, D'ugo D, Hartgrink H, Bencivenga M, Viganò J, Pera M, Reim D, Schneider PM, Mönig S, De Manzoni G, Baiocchi GL, Antunes C, Matos da Costa P, GASTRODATA Consortium (European Chapter of International Gastric Cancer Association)
Eur J Surg Oncol · 2026 Jun · PMID 42341441 · Publisher ↗
INTRODUCTION: The optimal extent of lymphadenectomy in gastric cancer surgery remains a subject of ongoing debate. Our previous modelling work indicated that identifying at least 26 lymph nodes may reveal occult nodal me...
INTRODUCTION: The optimal extent of lymphadenectomy in gastric cancer surgery remains a subject of ongoing debate. Our previous modelling work indicated that identifying at least 26 lymph nodes may reveal occult nodal metastases in patients undergoing more limited dissections, thereby reducing the risk of under-staging. However, those analyses were population-based and lacked individual-level validation of clinical outcomes, including disease-free and overall survival. This study sought to externally validate, using artificial intelligence (AI)-driven modelling, the predicted risk of pN upstaging associated with simulated increases in retrieved lymph node counts. MATERIALS AND METHODS: The PT cohort comprised 209 patients with gastric adenocarcinoma who underwent curative-intent gastrectomy between 2004 and 2022, all with fewer than 26 examined lymph nodes, pN + status, and M0 disease. External validation was conducted using the European GASTRODATA (GD) cohort, which included 392 patients from a multinational registry (2019-2022). Patients in both cohorts met identical eligibility criteria. Cohort comparability was assessed using a combination of AI-trained regression models, Random Forest algorithms with cross-validation, and multidimensional projection analysis, ensuring robust evaluation of dataset equivalence. Proportional and exponential simulation models were subsequently applied to the combined dataset (n = 601) to explore different assumptions regarding nodal yield scaling. RESULTS: The two cohorts were statistically comparable across key clinicopathological variables, supporting their suitability for external validation. Simulations predicted increases of 21% (proportional model) and 16% (exponential model) in the number of metastatic lymph nodes, indicating a clinically meaningful risk of under-staging when lymphadenectomy yield falls below recommended thresholds. CONCLUSION: These findings externally validate, in a larger multicentre cohort, the previously developed simulation models and reinforce the recommendation that harvesting at least 26 lymph nodes during gastrectomy is essential to optimise staging accuracy and prognostic assessment in gastric cancer, regardless of institutional setting.
National United Kingdom study of the management of breast cancer locoregional recurrence (MARECA) study: Analysis of disease presentation and patient management.
Morgan JL, Hubbard T, Herbert E … +22 more , Hartup S, Cheng V, Barry PA, Copson E, Cutress RI, Dave R, Elsberger B, Fairbrother P, Hogan B, Horgan K, Hughes TA, Kirwan CC, Mannu G, McIntosh SA, O'Connell RL, Patani N, Potter S, Rattay T, Sheehan L, Wyld L, Kim B, MARECA study research collaborative
Eur J Surg Oncol · 2026 Jun · PMID 42335799 · Publisher ↗
BACKGROUND: Despite improvements in primary breast cancer treatment, 10-year cumulative locoregional recurrence (LRR) incidence is around 8%. This study aimed to examine the management of patients diagnosed with LRR. MET...
BACKGROUND: Despite improvements in primary breast cancer treatment, 10-year cumulative locoregional recurrence (LRR) incidence is around 8%. This study aimed to examine the management of patients diagnosed with LRR. METHODS: Patients previously treated for breast cancer and diagnosed with LRR were prospectively identified at breast MDT meetings and clinics. Data collection included tumour pathology, imaging results, surgical treatment, and adjunct therapy for the original and recurrent cancer. RESULTS: Data were analysed for 742 patients recruited from 50 UK hospitals (2022-2023). Median ages at original cancer (OC) and LRR diagnosis were 53 and 67 years old respectively; median disease-free interval (DFI) 8.9 years. For the OC and LRR, ER + PR + HER2-receptor profile was most prevalent. Breast conserving surgery (BCS) was predominantly performed for the OC (75.3%; 559/742). Concomitant distant metastases (DM) rate was 9.3% (69/742) with higher incidence seen in node positive LRR, HER2+ LRR, and shorter DFI (<5 years). Of 622 patients receiving LRR resection, commonest procedures were mastectomy (62.9%; 391/622), wide excision of chest wall/skin flap LRR (20.6%; 128/622), and repeat BCS (10.9%; 68/622). For patients receiving axillary surgery, node positivity rate was 25.3% (140/554) for OC and 21.3% (86/403) for LRR. Radiotherapy (67.8% OC vs. 18.8% LRR) and chemotherapy (33.1% OC vs. 23.9% LRR) utilisation rates were lower for LRR. Endocrine therapy utilisation rate was higher for LRR (63.5% OC and 70.5% LRR). CONCLUSION: Routine radiological staging investigation is advocated for invasive LRR. Majority of LRR were resectable, with nodal positivity rate comparable to the original cancer.
Incidence and outcomes of metachronous peritoneal metastasis in the setting of obstructing colon cancer: a systematic review.
O'Connell LV, McCafferty J, Udayasiri D … +4 more , Flood M, Mohan HM, Heriot AG, Warrier SK
Eur J Surg Oncol · 2026 Jun · PMID 42335798 · Publisher ↗
BACKGROUND: Colorectal peritoneal metastases are challenging to diagnose and confer a poorer prognosis than disease recurrence at other sites. Obstruction at presentation in colonic carcinoma is associated with worse sur...
BACKGROUND: Colorectal peritoneal metastases are challenging to diagnose and confer a poorer prognosis than disease recurrence at other sites. Obstruction at presentation in colonic carcinoma is associated with worse survival outcomes. There is little data on its specific influence on the incidence of peritoneal recurrence, including by the varying strategies employed to address the obstruction. METHODS: A systematic review of the literature was performed to investigate rates of peritoneal recurrence in obstructing colon cancer. The study was pre-registered in the PROSPERO database. The MEDLINE/PubMed, EMBASE, Scopus, Web of Science, and CENTRAL databases were searched for relevant records. Articles published from inception to November 2025 were retrieved and assessed by two independent reviewers. RESULTS: Of the initial 187 studies retrieved, seven were deemed eligible for inclusion, with a total number of 6578 patients. All were retrospective cohort studies. Reported rates of metachronous peritoneal metastases ranged from 7 to 21%, compared to 2-4% in unselected colorectal cancer populations. Peritoneal recurrence conferred a significantly abbreviated prognosis, with 3-year survival rates of 48-56% compared to 77-85% in those without peritoneal disease. CONCLUSION: Colonic obstruction at presentation is a risk factor for peritoneal recurrence, which is challenging to diagnose and is associated with poorer survival outcomes than metastatic disease at non-peritoneal locations. Prospective randomised trials investigating strategies to mitigate this risk are warranted.
Short and Long-term mortality following new-onset atrial fibrillation in patients post oesophageal surgery.
Essa H, Balu A, Stephens N … +2 more , Lip GYH, Welters I
Eur J Surg Oncol · 2026 Jun · PMID 42335797 · Publisher ↗
INTRODUCTION: Oesophageal cancer is a highly aggressive malignancy that exerts a disproportionate impact on mortality: it is the 11th most common cancer worldwide, yet the 7th leading cause of cancer death. Operative man...
INTRODUCTION: Oesophageal cancer is a highly aggressive malignancy that exerts a disproportionate impact on mortality: it is the 11th most common cancer worldwide, yet the 7th leading cause of cancer death. Operative management is the gold standard for a curative approach. New-onset atrial fibrillation (NOAF) is a common complication after esophagectomy. It is unclear if NOAF post-esophagectomy influences long-term mortality. METHODS: We conducted a retrospective cohort analysis of all patients undergoing esophagectomy for oesophageal cancer at a tertiary UK centre between September 2016 and February 2025. Patients with benign oesophageal disease or prior AF were excluded. Baseline characteristics, perioperative complications, and survival outcomes were extracted from electronic medical records. RESULTS: A total of 385 patients (mean age 65.1 ± 9.7 years; 20.7% female) were included, of whom 114 (29.6%) developed new-onset atrial fibrillation (NOAF). Patients with NOAF were older than controls (67.8 ± 7.2 vs 63.7 ± 10 years, p < 0.001), with no other significant baseline differences. NOAF was strongly associated with pneumonia (66.7% vs 42.4%, p < 0.001), anastomotic leak (20.2% vs 5.9%, p < 0.001), longer ICU stay (6.9 vs 5.2 days, p < 0.001), higher in-hospital mortality (13.2% vs 1.1%, p < 0.001) and twelve-month mortality (17.5% vs 9.9%, p = 0.047). Survival analysis demonstrated significantly worse outcomes (HR 19.58, 95% CI 2.45-156.52, p = 0.005), with no difference beyond 30 days. CONCLUSION: NOAF is implicated in nearly 30% of esophagectomy patients and is a significant marker of increased perioperative morbidity and early mortality. NOAF is associated with postoperative complications, in particular pneumonia and anastomotic leak. This affects short-term outcomes but appears to have limited long-term effect.
Systematic review and Bayesian network meta-analysis comparing multiple anastomotic techniques after total mesorectal excision in rectal cancer.
Kitaguchi D, Forgione A, Serra-Aracil X … +5 more , Innocenzi C, Yang Y, Giménez M, Oda T, Marescaux J
Eur J Surg Oncol · 2026 Jun · PMID 42330709 · Publisher ↗
BACKGROUND: Although several studies have performed pairwise comparisons of individual anastomotic techniques after total mesorectal excision (TME) for rectal cancer, there is a lack of comprehensive analyses, which simu...
BACKGROUND: Although several studies have performed pairwise comparisons of individual anastomotic techniques after total mesorectal excision (TME) for rectal cancer, there is a lack of comprehensive analyses, which simultaneously evaluate multiple techniques. This study aims to perform a systematic review and Bayesian network meta-analysis to compare the various anastomotic methods used after TME. METHODS: This systematic review and Bayesian network meta-analysis included both randomized controlled trials (RCTs) and non-RCTs which evaluated outcomes of various anastomotic techniques in patients with rectal cancer undergoing TME. The techniques assessed included immediate handsewn anastomosis, delayed Turnbull-Cutait anastomosis (TCA), double-stapling technique (DST), and transanal transection and single-stapled (TTSS) anastomosis. The primary outcome was the proportion of anastomotic leakage (AL). Secondary outcomes included overall postoperative morbidity and postoperative anorectal function. RESULTS: A total of 13 studies were included, comprising two RCTs and 11 non-RCTs, with a combined total of 2710 patients. TTSS was associated with a lower proportion of AL as compared to both the DST group (RR: 0.43, 95% CrI: 0.21-0.87) and the immediate handsewn group (RR: 0.35, 95% CrI: 0.13-0.74). TCA was also associated with a significantly lower proportion of AL as compared to the immediate handsewn group (RR: 0.42, 95% CrI: 0.21-0.80). No statistically significant differences were observed between groups regarding overall postoperative morbidity or anorectal function. CONCLUSIONS: The findings of this study suggest that TTSS may be associated with a lower risk of postoperative AL after TME for rectal cancer; however, the certainty of evidence was low, and the findings should be interpreted with caution.
Factors influencing women's preferences and decision making regarding the extent of axillary surgery in breast cancer: A systematic review.
Cooke R, Baxter P, Wyld L … +1 more , Morgan J
Eur J Surg Oncol · 2026 Jun · PMID 42330708 · Publisher ↗
Axillary surgery in early-stage breast cancer is increasingly de-escalated. However, variation in practice persists, and the patient level factors influencing treatment decisions remain unclear. This systematic review sy...
Axillary surgery in early-stage breast cancer is increasingly de-escalated. However, variation in practice persists, and the patient level factors influencing treatment decisions remain unclear. This systematic review synthesised evidence on the psychological, clinical, and contextual factors shaping women's preferences and decision making regarding the extent of axillary surgery they receive. A PRISMA-guided search of Ovid MEDLINE, Embase and Cochrane databases was conducted in December 2025. Ten studies involving 861 women were included, comprising observational, qualitative, and mixed methods designs. Quantitative evidence was limited and heterogeneous, with no consistent clinical or demographic predictors of treatment choice identified. Qualitative findings demonstrated that fear of undertreatment, desire for prognostic reassurance, and trust in clinician recommendation were dominant drivers of decision making. Patients frequently valued additional staging information despite limited survival benefit, and misunderstandings regarding the purpose of axillary procedures were common. No widely implemented, formally validated patient decision aid specific to axillary management was identified. Axillary treatment decisions are primarily driven by patient values and risk perception rather than objective clinical factors. Psychological influences, particularly fear of recurrence and desire for reassurance, may contribute to overtreatment despite increasing evidence supporting de-escalation. Development of validated decision support tools and consistent clinical communication are required to better align surgical care with patient preferences and current evidence.
Beyond non-anatomical resections: Is minimally invasive parenchyma-sparing anatomical hepatectomy the next chapter?
Schwab M, Miller E, Kassem A … +9 more , Bopp L, Nasir N, Rasbach E, Heil J, Sturm D, Müssle B, Kornmann M, Rahbari NN, Birgin E
Eur J Surg Oncol · 2026 Jun · PMID 42330707 · Publisher ↗
BACKGROUND: Parenchyma-sparing hepatectomy using minimally invasive techniques is typically performed for peripheral liver lesions by means of non-anatomic liver resection. However, anatomical hepatectomies may be requir...
BACKGROUND: Parenchyma-sparing hepatectomy using minimally invasive techniques is typically performed for peripheral liver lesions by means of non-anatomic liver resection. However, anatomical hepatectomies may be required for technical and biological reasons and can still be performed in a parenchyma-sparing approach such as (sub)segmentectomies or sectionectomies. Given limited evidence regarding outcomes of minimally invasive anatomical liver resections, the aim of the study was to compare parenchyma-sparing (PAR) with non-parenchyma-sparing (NPAR) anatomical liver resection. METHODS: From 2020 to 2025 we identified consecutive patients who had minimally invasive anatomical liver resections at our institution. Perioperative outcomes were compared using univariate and multivariate analyses. A propensity-score analysis was performed to match PAR and NPAR groups. RESULTS: Of 228 patients with minimally invasive anatomical liver resections, a total of 158 patients underwent parenchyma sparing and 70 patients a non-parenchyma sparing liver resection. The PAR group showed a shorter median operating time (213 vs. 280 min, P = 0.002), lower median blood loss (400 vs. 500 ml, P = 0.003), and a shorter median hospital stay (5 vs. 6 days, P = 0.004) compared to the NPAR group. There were no differences in posthepatectomy bile leakage, posthepatectomy hemorrhage and posthepatectomy liver failure between the two groups, however, there were less severe complications in the PAR group (12% vs. 30%, P = 0.024). CONCLUSIONS: Minimally invasive parenchyma-sparing anatomical hepatectomy is associated with improved perioperative outcomes compared to non-parenchyma-sparing resections.
Telerobotic partial nephrectomy and radical prostatectomy using a hybrid network: A single-center prospective experience.
Gaurab P, Yu S, Zheng H … +8 more , Tao J, Cui J, Liu Y, Fan Y, Zhan Y, Dong B, Zhu Z, Zhang X
Eur J Surg Oncol · 2026 Jun · PMID 42322709 · Publisher ↗
INTRODUCTION: Advances in robotics and telecommunications have catalyzed resurgence of telerobotic surgery (TRS). This study aims to evaluate safety, feasibility, and clinical outcomes of TRS in partial nephrectomy (PN)...
INTRODUCTION: Advances in robotics and telecommunications have catalyzed resurgence of telerobotic surgery (TRS). This study aims to evaluate safety, feasibility, and clinical outcomes of TRS in partial nephrectomy (PN) and radical prostatectomy (RP), using a hybrid network. METHODS: A prospective, single-center study was conducted with 13 patients (7 PN, 6 RP) using Toumai® robotic system over 5G and fiber-optic networks. Surgeries were performed remotely, with surgeon operating 25 km away. Primary outcomes included successful completion of surgeries without conversion or reoperation within 24 h. Secondary outcomes included intraoperative outcomes (operative time, warm ischemia time, blood loss), network performance (latency, packet loss), and short-term functional recovery at three month follow-up. RESULTS: All procedures were successfully completed with minimal delay and no major network disruptions. Median latency was 12 ms for fiber-optic and 46 ms for 5G network. For PN, median operative time was 69 min, with 9 min of warm ischemia time and 50 ml of blood loss. For RP, median operative time was 130.5 min with 25 ml blood loss. Postoperative renal function remained stable in PN cases and early continence was achieved in majority of patients at three months. No conversions or major perioperative complications were observed. CONCLUSIONS: This study provides early clinical evidence suggesting the feasibility and short-term safety of telerobotic urological surgery performed over a hybrid network. Successful completion of all procedures without major complications and stable intraoperative communication support further clinical evaluation.
Changes in liver resections and associated outcomes over thirty years: a nationwide analysis using a machine learning approach.
Verdonschot KHM, Vissers PAJ, van den Boezem PB … +5 more , Overduin CG, Fütterer JJ, de Wilt JHW, Nagtegaal ID, Stommel MWJ
Eur J Surg Oncol · 2026 Jun · PMID 42322708 · Publisher ↗
BACKGROUND: In contrast to three decades ago, liver resection (LR) is now an increasingly common procedure. This study aims to evaluate changes in the number and indications of liver resections for malignancy over the pa...
BACKGROUND: In contrast to three decades ago, liver resection (LR) is now an increasingly common procedure. This study aims to evaluate changes in the number and indications of liver resections for malignancy over the past 30 years in the Netherlands and the associated survival outcomes. METHOD: All records of surgical resections for liver tumors performed between 1991 and 2020 were extracted from the Dutch nationwide pathology network database. Resection and tumor characteristics were extracted using a machine-learning algorithm. Survival data was acquired through the Dutch Center for Family History. Patient, resection, and tumor characteristics and survival for hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) were assessed across decades. RESULTS: Between 1991 and 2020, 19.022 LRs were performed. The annual number of LRs increased from 113 in 1991 to 1.178 in 2020. Liver metastases accounted for 84% of resections, of which 85% were CRLM, while of primary liver tumors 59% were HCC. The annual number of liver resections for colorectal metastases decreased since 2015. Over the decades patients undergoing liver resections were older, with more often multifocal liver tumors and re-resections. Five-year survival rate for CRLM decreased from 44% (1991-2000) to 33% (2011-2020), p < 0.001. Five-year survival rate for HCC patients was stable: 57% (1991-2000), 50% (2001-2010), and 50% (2011-2020), p = 0.681. CONCLUSION: The number of liver resections for malignancies in the Netherlands has sharply increased over the past three decades with expansion of indications. Survival after liver resection for CRLM showed a declining trend, potentially reflecting less stringent patient and tumor characteristics.
An algorithmic approach to implant based immediate breast reconstruction.
Gui G, Rusby JE, Tasoulis MK
Eur J Surg Oncol · 2026 Jun · PMID 42320220 · Publisher ↗
Implant based breast reconstruction (IBR) remains the most commonly performed reconstructive approach following mastectomy. Contemporary practice has evolved significantly through advances in implant technology, availabi...
Implant based breast reconstruction (IBR) remains the most commonly performed reconstructive approach following mastectomy. Contemporary practice has evolved significantly through advances in implant technology, availability of biological and synthetic meshes, and the establishment of prepectoral IBR as an alternative to the traditional subpectoral technique. Patient selection and operative planning remain complex, particularly in the setting of varying breast anatomy, ptosis, skin quality, nipple preservation, and anticipated adjuvant therapies. The aim of the presented algorithm is to support decision-making in IBR providing a structured approach based on four principal considerations: nipple-versus skin-sparing mastectomy, the use of acellular dermal matrix (ADM), one-stage versus two-stage reconstruction, and the requirement for nipple-areola complex repositioning or skin reduction. Patients are stratified into four reconstructive categories according to breast size, degree of ptosis, and extent of skin adjustment required. For each category, tailored reconstructive pathways are proposed, incorporating considerations of pocket stability, skin quality, use of tissue expansion, and the role of different ADM-assisted techniques. This structured framework aims to facilitate consistent patient selection, optimise aesthetic and oncologic outcomes, and support shared decision-making between surgeons and patients.
Association of multidisciplinary team management with clinical outcomes in hepatobiliary and pancreatic malignancies: A systematic review and meta-analysis.
Shao S, Xue K, Guo Q … +3 more , Xia N, Wang L, Tian B
Eur J Surg Oncol · 2026 Jun · PMID 42314305 · Publisher ↗
BACKGROUND: Multidisciplinary team (MDT) management is widely endorsed for complex hepatobiliary and pancreatic (HBP) malignancies. However, robust systematic evidence evaluating its survival benefits and heterogeneity a...
BACKGROUND: Multidisciplinary team (MDT) management is widely endorsed for complex hepatobiliary and pancreatic (HBP) malignancies. However, robust systematic evidence evaluating its survival benefits and heterogeneity across distinct anatomical sites remains limited. METHODS: Our study systematically searched four databases from their inception through Dec 17, 2025, for studies comparing MDT versus non-MDT care in HBP malignancies. The primary outcome was overall survival or mortality risk. Secondary outcomes included the rates of neoadjuvant therapy administration and overall treatment receipt, as well as perioperative outcomes. To mitigate clinical heterogeneity, analyses were stratified into pancreatic/ampullary and hepatobiliary cohorts. RESULTS: Our study included 23 studies comprising 70,294 patients. In the pancreatic and ampullary tumour cohort, MDT management was associated with a significantly reduced risk of mortality (HR 0.74 [95% CI 0.68-0.82]; I = 35.8%). Furthermore, MDT intervention significantly increased the rate of neoadjuvant therapy administration (RR 1.51 [1.48-1.58]; I = 0%) and decreased the risk of clinically relevant postoperative pancreatic fistula (CR-POPF ≥ grade B; RR 0.51 [0.31-0.84]; I = 0%). Similarly, in the hepatobiliary cohort, MDT management correlated with a significant reduction in mortality risk (HR 0.58 [0.41-0.82]; I = 95.3%). In sensitivity analyses, the exclusion of a single study reduced heterogeneity (I = 63.2%) while suggesting the protective trend persisted (HR 0.53 [0.43-0.65]). Descriptive analysis indicated that MDT evaluation modified diagnosis or treatment strategies in approximately 26% of cases. CONCLUSION: These findings support the clinical value of routine MDT evaluation in optimising therapeutic strategies for complex HBP malignancies. Nevertheless, due to substantial inter-study variability and pathological differences, the overall survival benefit should be interpreted with caution.
Extended hepatectomy is associated with improved five- and ten-year survival rates in perihilar cholangiocarcinoma: a population-based analysis of the SEER database (2010-2022).
Amer M, El Youzouri H, Pession U … +4 more , Heise M, Benkö T, Wiegering A, Koca F
Eur J Surg Oncol · 2026 Jun · PMID 42314304 · Publisher ↗
BACKGROUND: The prognostic factors for long-term survival after resection of perihilar cholangiocarcinoma (pCCA) remain controversial, especially concerning the impact of an extended hepatectomy. This study aimed to iden...
BACKGROUND: The prognostic factors for long-term survival after resection of perihilar cholangiocarcinoma (pCCA) remain controversial, especially concerning the impact of an extended hepatectomy. This study aimed to identify those affecting five- and ten-year survival rates after pCCA resection. METHODS: This retrospective analysis examined patients undergoing pCCA resection from the SEER database between 2010 and 2022. The study included patients who underwent a wedge or segmental resection, only bile duct resection, hemi-hepatectomy, and extended hepatectomy. The inclusion criteria were as follows: no distant metastases, at least three months of available follow-up, and death due to biliary cancer or alive at follow-up. After identifying the predictors via univariable analysis, a multivariable binary logistic regression analysis was performed. RESULTS: A total of 1134 patients were included in the study. The following factors were all associated with a higher five-year survival rate in the multivariable analysis: lower age (less than 54 years), OR: 1.6 (95% CI: 1.1-2.5, p = 0.016); female sex, OR: 1.4 (95% CI: 1.0-1.9, p = 0.040); undergoing an extended hepatectomy, OR: 1.7 (95% CI: 1.3-2.4, p < 0.001); resecting more than three lymph nodes or none, OR: 1.7 (95% CI: 1.2-2.5, p = 0.005); and nodal negative disease, OR: 3.3 (95% CI: 2.3-4.8, p < 0.001). Higher predictors of a ten-year survival rate were undergoing an extended hepatectomy (OR: 2.1, 95% CI: 1.1-3.9, p = 0.019) and nodal negative disease (OR: 3.5 (95% CI: 1.5-8.1), p = 0.003. CONCLUSION: Patients undergoing an extended hepatectomy for a pCCA resection have higher five- and ten-year survival rates.
Early postoperative intraperitoneal chemotherapy for pseudomyxoma peritoneii: A state of the art review.
Yu Y, Vaska A, Ahmadi N … +2 more , Liauw W, Morris D
Eur J Surg Oncol · 2026 Jun · PMID 42308725 · Publisher ↗
BACKGROUND: Cytoreductive surgery (CRS) followed by heated intraperitoneal chemotherapy (HIPEC) remains the mainstay of treatment for patients with pseudomyxoma peritonei (PMP). CRS and intraperitoneal chemotherapy (IPC)...
BACKGROUND: Cytoreductive surgery (CRS) followed by heated intraperitoneal chemotherapy (HIPEC) remains the mainstay of treatment for patients with pseudomyxoma peritonei (PMP). CRS and intraperitoneal chemotherapy (IPC) was first proposed by Sugarbaker in the 1980s for peritoneal malignancies of various origins. This approach, as described by Sugarbaker, included CRS aiming for complete cytoreduction intraoperative intraperitoneal chemotherapy utilising heated Mitomycin C, and 5 consecutive days of intraperitoneal 5-fluorouracil (early postoperative intraperitoneal chemotherapy, EPIC)(1). Currently, the use of EPIC for PMP has fallen out of favour due to concerns regarding complications and uncertainty regarding its oncological benefit. This narrative review explores the history and rationale behind the conception of EPIC, describes past and current evidence for EPIC, and attempts to establish a future role and direction for its use in the treatment of PMP. CONTENT: We conducted a systematic search in Pubmed and OVID according to the PRISMA guidelines and included all studies published before 25th April 2025 comparing EPIC to HIPEC. Our search found 102 studies and after excluding non-relevant studies, a total of 12 retrospective studies were identified. The literature suggests EPIC may improve survival without increasing major morbidity but can increase hospital length of stay. CONCLUSION: The role of EPIC for PMP remains unanswered. However, the literature appears to support a survival benefit with EPIC for PMP without an increase in morbidity risk despite an increase in hospital length of stay.
Female sex is associated with improved outcomes after surgery for pancreatic neuroendocrine neoplasms.
Bechtiger FA, Kaiser J, Rompen IF … +7 more , Hinz U, Lewosinska M, Leonhardt CS, Al-Saeedi M, Loos M, Büchler MW, Hank T
Eur J Surg Oncol · 2026 Jun · PMID 42302634 · Publisher ↗
BACKGROUND: Sex-related differences in oncologic outcomes are well established in pancreatic adenocarcinoma, but evidence in pancreatic neuroendocrine neoplasms (pNEN) remains limited. This study analyses the association...
BACKGROUND: Sex-related differences in oncologic outcomes are well established in pancreatic adenocarcinoma, but evidence in pancreatic neuroendocrine neoplasms (pNEN) remains limited. This study analyses the association of female sex and pre-menopausal status with perioperative outcomes and long-term survival after resection of non-functioning pNEN. METHODS: Patients who underwent pancreatic surgery for pNEN at Heidelberg University Hospital between 2001 and 2023 were analyzed. Outcomes included perioperative morbidity, disease-free survival (DFS) and overall survival (OS). Subgroups were stratified by age (<50, 50-65, >65 years) as a surrogate for menopausal status. Survival was estimated by Kaplan-Meier analysis and Cox regression was used to evaluate associations with OS. RESULTS: A total of 591 patients were included, of whom 257 (43.5%) were female. Age and ASA class were similar between sexes, while females had a lower BMI (24.6 vs 26.3 kg/m, p < 0.001). Resection types did not differ, but operative time was shorter in females (240 vs 265 min, p = 0.003). Major complications were comparable (CDC ≥3a: 30.7% vs 34.1%, p = 0.426), whereas severe complications (CDC ≥3b) occurred less often in females (9.7% vs 15.3%, p = 0.048). TNM stage was similar, although males had more G3 tumors (15.9% vs 8.2%, p = 0.019). Females had longer DFS (129.4 vs 75.5 months, p = 0.006) and increased OS (5-year: 85.7% vs 70.5%; 10-year: 72.2% vs 61.1%; p = 0.002). This effect was driven by patients <50 years, indicating a pre-menopausal survival advantage, as females had markedly better outcomes than age-matched males (p = 0.022). On multivariable cox-regression analysis, female sex, age, grading and M-status remained independently associated with OS. CONCLUSIONS: Female sex is associated with improved perioperative outcomes and increased long-term survival after resection in non-functioning pNEN. The survival benefit was largely determined by pre-menopausal patients, highlighting sex and menopausal status as relevant prognostic factors.
Impact of adjuvant chemotherapy among pathologic complete responders with pancreatic ductal adenocarcinoma.
Elmankabadi S, Ashraf AG, Foroutani L … +7 more , Li TM, Corvera C, Hirose K, Kirkwood K, Nakakura E, Alseidi A, Adam M
Eur J Surg Oncol · 2026 Jun · PMID 42302633 · Publisher ↗
INTRODUCTION: Achievement of pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC) is associated with improved overall survival (OS). However...
INTRODUCTION: Achievement of pathologic complete response (pCR) following neoadjuvant chemotherapy (NAC) in patients with pancreatic ductal adenocarcinoma (PDAC) is associated with improved overall survival (OS). However, the role of adjuvant chemotherapy (AC) in this population remains unclear. This study aimed to evaluate whether AC confers additional OS benefit in patients with PDAC who achieve pCR. MATERIALS AND METHODS: Patients who received NAC, underwent surgical resection, and achieved pCR were identified from National Cancer Database (2012-2020). Patients were stratified based on receipt of AC and survival duration. Kaplan-Meier survival curves and multivariable Cox proportional hazards models were used to assess the association between AC and OS. RESULTS: Among 7973 patients, only 3.1% achieved pCR and had significantly improved OS compared to non-pCR patients (median 87.8 vs. 24.9 months, p < 0.001). Among pCR patients, only 18.6% received AC. AC was associated with significantly improved OS (median not reached vs. 80.3 months, p = 0.019) and remained independently associated with improved survival on multivariable analysis (HR 0.39, 95% CI 0.19-0.77; p = 0.007). AC was also associated with long-term survival (≥5 years) (unadjusted 28% vs. 14%, p = 0.005) and after adjustment (OR 2.54; 95% CI 1.23-5.37; p = 0.013). CONCLUSIONS: In PDAC patients achieving pCR following NAC and pancreatectomy, AC is associated with significantly improved OS and long-term survival, supporting the continued role of systemic therapy even in the setting of complete pathologic response.
Prognostic value and spatial transcriptomic landscape of histopathological growth patterns in synchronous colorectal liver metastases.
Lin Z, Li X, Yi T … +5 more , Hua H, Jin H, Liang Y, Wan Y, Li G
Eur J Surg Oncol · 2026 Jun · PMID 42296573 · Publisher ↗
BACKGROUND: Histopathological growth patterns (HGPs) are critical prognostic biomarkers in colorectal liver metastases (CRLM), yet their molecular drivers remain unclear. This study aims to validate the prognostic value...
BACKGROUND: Histopathological growth patterns (HGPs) are critical prognostic biomarkers in colorectal liver metastases (CRLM), yet their molecular drivers remain unclear. This study aims to validate the prognostic value of HGPs in synchronous CRLM and explore their spatial transcriptomic underpinnings. METHODS: Clinicopathological data from 182 patients with surgically resected synchronous CRLM were analyzed. HGPs were classified as desmoplastic (dHGP) or non-desmoplastic (ndHGP). Overall survival (OS) and disease-free survival (DFS) were evaluated via Kaplan-Meier curves and Cox regression. Public spatial transcriptomics datasets were integrated to characterize malignant epithelial programs across distinct HGPs using non-negative matrix factorization (NMF). RESULTS: Clinical evaluation established ndHGP as an independent risk factor for mortality (adjusted Hazard Ratio [HR]: 1.91) and recurrence (adjusted HR: 1.62), showing significant associations with KRAS mutations and advanced nodal stage. Spatial transcriptomics revealed two divergent molecular strategies: desmoplastic-type tumors displayed hypoxia-driven angiogenesis and fibrotic confinement, supported by a fibrosis-related partial epithelial-mesenchymal transition (EMT) that formed a dense desmoplastic barrier. In contrast, replacement-type tumors showed enhanced proliferation and a distinctive hepatocyte mimicry metabolic phenotype, enabling metabolic co-option of the hepatic microenvironment to drive invasion. CONCLUSIONS: This study validates HGPs as versatile prognostic biomarkers for synchronous CRLM, and highlights two distinct transcriptomic adaptive strategies-angiogenic confinement versus metabolic co-option-as potential key determinants of clinical outcomes. These findings provide a morphological-molecular basis for precision risk stratification and targeted therapeutic development, justifying routine HGPs assessment in pathology reports.
One-stage hepatectomy may be a safe and feasible alternative to ALPPS for hepatocellular carcinoma with liver fibrosis or cirrhosis and FLR/SLV ratio of 30% - 40% - A multicenter study.
Yang H, Gao J, Mo S … +6 more , Zhan G, Huang J, Lu Z, Gong W, Peng T, Xiang B
Eur J Surg Oncol · 2026 Jun · PMID 42296572 · Publisher ↗
OBJECTIVE AND BACKGROUND: The optimal surgical strategy for patients with hepatocellular carcinoma (HCC) and liver fibrosis/cirrhosis presenting with a future liver remnant to standard liver volume (FLR/SLV) ratio of 30%...
OBJECTIVE AND BACKGROUND: The optimal surgical strategy for patients with hepatocellular carcinoma (HCC) and liver fibrosis/cirrhosis presenting with a future liver remnant to standard liver volume (FLR/SLV) ratio of 30%-40% remains a subject of clinical controversy. This study aimed to evaluate the safety and efficacy of one-stage hepatectomy (OSH) versus Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) and to validate the feasibility of OSH by benchmarking it against the standard safety criterion (FLR/SLV ≥40%). METHODS: We conducted a retrospective analysis of 219 patients with HBV-related HCC and liver fibrosis/cirrhosis who underwent right hemihepatectomy. Patients were stratified into three groups: the OSH group (FLR/SLV 30%-40%, n = 62), the ALPPS group (FLR/SLV 30%-40%, n = 20), and the standard control group (FLR/SLV ≥40% undergoing OSH, n = 137). Perioperative outcomes, including post-hepatectomy liver failure (PHLF) and complications, as well as long-term overall survival (OS) and disease-free survival (DFS), were compared. RESULTS: In the 30%-40% cohort, the incidence of severe PHLF (ISGLS Grade B or C) in the ALPPS group was comparable to that of the one-stage hepatectomy group (P = 0.128), and no 90-day mortality was observed in either group. However, in terms of severe postoperative complications (Clavien-Dindo grade ≥ IIIa), the ALPPS group demonstrated a higher incidence rate compared to the one-stage hepatectomy group, although the difference did not reach statistical significance (P = 0.082). Long-term oncological outcomes, including OS and DFS, were comparable between the OSH and ALPPS groups (p > 0.05). Furthermore, benchmarking analysis revealed preliminary observations that patients in the OSH group (30%-40%) achieved perioperative and long-term outcomes comparable to those in the standard control group (≥40%) (p > 0.05). CONCLUSIONS: For selected HCC patients with liver fibrosis/cirrhosis and FLR/SLV ratio of 30%-40% undergoing standardized right hemihepatectomy, one-stage hepatectomy might serve as a safe and feasible alternative to ALPPS, though large-scale prospective validation is warranted.
Global curriculum in surgical oncology: 2nd edition, 2026.
Are C, Stattner S, Leiphrakpam P … +4 more , Pitzl T, Audisio RA, Rubio IT, Berman RS
Eur J Surg Oncol · 2026 May · PMID 42290632 · Publisher ↗
BACKGROUND: The rising global cancer burden underscores the need for a skilled cancer surgical workforce. Education in the principles of cancer surgery is essential to ensuring a competent cancer surgical workforce. In r...
BACKGROUND: The rising global cancer burden underscores the need for a skilled cancer surgical workforce. Education in the principles of cancer surgery is essential to ensuring a competent cancer surgical workforce. In response, the Society of Surgical Oncology and the European Society of Surgical Oncology jointly published the first Global Curriculum in Surgical Oncology in 2016 to provide a structured framework for the education of cancer surgeons. The updated version of the original curriculum incorporates advances in cancer surgical care from the intervening period, while maintaining the original vision of a globally relevant educational framework. MATERIAL AND METHODS: The global curriculum committees of the Society of Surgical Oncology and the European Society of Surgical Oncology convened a series of meetings to review, revise, and develop the updated global curriculum in surgical oncology. RESULTS: The second edition of the global curriculum in surgical oncology incorporates key advances in cancer surgical care that have occurred since the publication of the original curriculum. The curriculum retains the foundational principles of the first edition, such as: (a) ensuring that the curriculum is resource-stratified, (b) applicability across diverse geographical regions worldwide, and (c) provision of a flexible and modular, foundational framework that can be adapted to local training needs. CONCLUSIONS: The second edition of the global curriculum in surgical oncology provides resource-stratified, geographically agnostic foundational scaffolding for training the global cancer surgical workforce. Implementation of this curriculum can be instrumental in building a competent surgical oncology workforce capable of addressing the rising global cancer burden.
Immunotherapy and surgical decision-making in Lynch syndrome-associated colorectal cancer: Implications for personalized management and guideline revision.
Rafii S, Mukherji D, Chamseddine AN … +2 more , Al-Shamsi HO, Jamali F
Eur J Surg Oncol · 2026 Jun · PMID 42288005 · Publisher ↗
Lynch syndrome (LS), the most common hereditary colorectal cancer (CRC) syndrome, confers a lifetime CRC risk of 40-80%. Historically, most guidelines have recommended subtotal colectomy at diagnosis to reduce metachrono...
Lynch syndrome (LS), the most common hereditary colorectal cancer (CRC) syndrome, confers a lifetime CRC risk of 40-80%. Historically, most guidelines have recommended subtotal colectomy at diagnosis to reduce metachronous cancer risk. However, the immune checkpoint inhibitors (ICIs) have fundamentally transformed the therapeutic landscape of microsatellite instability-high (MSI-H)/mismatch repair-deficient (dMMR) CRC. Recent clinical trials have shown unprecedented pathological complete response (pCR) ranging from 60 to 100% in MSI-H/dMMR CRC treated with ICIs. Multiple studies, including the landmark NICHE trials and case reports of LS patients with metastatic disease achieving pCR after immunotherapy challenge the necessity of extensive prophylactic surgery. This narrative review comprehensively synthesizes evidence from neoadjuvant immunotherapy trials, metastatic disease outcomes, contemporary metachronous risk studies, and current guideline recommendations. While acknowledging constraints such as limited cohort, long term follow-up, and substantial variation in global access to immunotherapy, the convergence of remarkable immunotherapy efficacy and lack of survival benefit from extended colectomy warrants reassessment of surgical management strategies. We propose that international guidelines reassess their recommendations to reflect this evolving therapeutic landscape by shifting from routine subtotal colectomy recommendations toward an individualized, biology-informed recommendation.
Unplanned readmission after surgery for spinal metastases: The influence of data source on a surgical oncology quality indicator - A systematic review and descriptive meta-analysis.
Li YC, Li CY, Huang SH … +5 more , Wang HK, Chen KH, Hsu PW, Kang YP, Lu YJ
Eur J Surg Oncol · 2026 Jun · PMID 42275924 · Publisher ↗
Surgery for spinal metastases represents a complex intervention at the intersection of oncology, neurosurgery, and orthopaedics, performed in patients with advanced systemic disease and limited physiological reserve. Unp...
Surgery for spinal metastases represents a complex intervention at the intersection of oncology, neurosurgery, and orthopaedics, performed in patients with advanced systemic disease and limited physiological reserve. Unplanned hospital readmission has emerged as an important quality indicator in surgical oncology, reflecting both perioperative care quality and the trajectory of underlying malignancy. We conducted the first systematic review and descriptive meta-analysis of readmission incidence and risk factors in this population. Five databases were searched (January 2010-March 2026); 14 cohort studies (8132 patients for 30-day analysis; 22,198 for 90-day analysis) met inclusion criteria. Given anticipated heterogeneity between institutional cohorts and national administrative databases, a stratified analytical framework was pre-specified. The exploratory pooled 30-day readmission incidence was 16.0% (95% CI: 12.2-20.3%; 95% prediction interval: 5.3-30.8%; I = 93.2%). Stratification revealed homogeneous estimates from single-centre studies (13.9%; I = 0%; k = 5) versus higher rates from administrative databases (20.4%; k = 2; p < 0.001), indicating that the data source is a principal driver of the observed heterogeneity. Pooled 90-day incidence was 31.2% (95% CI: 26.9-35.6%; k = 7). Comorbidity burden, prior spinal radiation, and poor functional status were the most consistently identified risk factors, although effect-measure heterogeneity precluded quantitative pooling. Evidence certainty was very low (GRADE). Approximately one in six cancer patients experiences unplanned readmission within 30 days of spinal metastasis surgery, with the wide prediction interval underscoring substantial setting-dependent variability. These findings support the integration of readmission tracking into spinal metastasis surgery quality programmes and prospective validation of risk-stratified perioperative pathways.
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