Eur J Surg Oncol [JOURNAL]
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200 papers
Sex-specific divergence in global urological cancer trajectories to 2050: A dual-model projection analysis based on GLOBOCAN and GBD databases.
Guo Q, Li L, Beeraka NM … +5 more , Zhang Y, Xu R, Cui X, Nikolenko VN, Liu J
Eur J Surg Oncol · 2026 Jun · PMID 42275923 · Publisher ↗
BACKGROUND & AIMS: Urological malignancies are major contributors to the global cancer burden. This study aims to provide a comprehensive, sex-stratified assessment of the 2022 baseline and project trajectories to 2050 f...
BACKGROUND & AIMS: Urological malignancies are major contributors to the global cancer burden. This study aims to provide a comprehensive, sex-stratified assessment of the 2022 baseline and project trajectories to 2050 for prostate, bladder, and kidney cancers to inform long-term surgical oncology and healthcare planning. METHODS: Baseline estimates for 185 countries were retrieved from GLOBOCAN 2022, with longitudinal trends from GBD 2021. We employed a dual-modeling framework: demographic forecasting for absolute case volumes and Bayesian Age-Period-Cohort (BAPC) models for age-standardized risk trends (ASIR/ASMR), including 95% uncertainty intervals (UI). RESULTS: In 2022, urological cancers accounted for 2.52 million new cases and 773,968 deaths globally. While prostate cancer dominated male burden, bladder and kidney cancers posed a notable clinical demand in both sexes. Higher HDI correlated with higher ASIR but lower mortality-to-incidence (M:I) ratios. A critical sex-specific divergence was observed: BAPC models predicted risk declines in females, but stable or modestly rising risks in males through 2050, likely driven by escalating metabolic factors. Paradoxically, the absolute global burden is projected to increase by 92.5%, reaching 4.85 million cases and 1.74 million deaths annually by 2050. The sharpest relative increases (>100%) are expected in low-to-medium HDI regions, where mortality growth is projected to outpace incidence. CONCLUSION: The urological cancer landscape faces a dual challenge of population aging and stagnating male-specific risks. Our findings describe an urgent need to expand urological surgical capacity and infrastructure, particularly in transitioning economies, to accommodate the inevitable surge in operative demand despite favorable risk trends in specific populations.
What outcomes can be expected after surgical treatment of primary pelvic bone sarcomas in children at referral centers?
Albergo JI, Principe F, Aponte-Tinao LA … +6 more , Farfalli GL, Lozano-Calderon S, Houdek MT, Jeys L, Shreemal B, Laitinen M
Eur J Surg Oncol · 2026 Jun · PMID 42269334 · Publisher ↗
BACKGROUND: Primary pelvic bone sarcomas in children are rare and associated with poor outcomes, but large-volume, multicenter data are lacking. QUESTIONS/PURPOSES: We asked: What is the overall survival of pediatric pat...
BACKGROUND: Primary pelvic bone sarcomas in children are rare and associated with poor outcomes, but large-volume, multicenter data are lacking. QUESTIONS/PURPOSES: We asked: What is the overall survival of pediatric patients with primary pelvic bone sarcomas following surgical treatment? What are the rates of local recurrence and postoperative complications? Which factors are associated with these outcomes? METHODS: We retrospectively reviewed 119 patients younger than 16 years treated surgically for primary pelvic sarcoma at five referral centers between 1990 and 2023. Survival was estimated with Kaplan-Meier methods, and recurrence and complications with competing risk models. Prognostic factors were analyzed with Cox regression. RESULTS: Estimated survival was 59% at 5-years and 55% at 10-years. Local recurrence occurred in 19% of patients, most within 2 years. Positive margins and poor response to chemotherapy were associated with worse survival and recurrence (p < 0.01), while radiotherapy showed a non-significant trend toward reduced recurrence (p = 0.054). Complications developed in 47% of patients at 5-years, most often wound dehiscence and deep infections. Reconstruction was not significantly associated with complications (p = 0.379). CONCLUSION: Pediatric pelvic sarcomas remain challenging, with poor long-term survival, high recurrence, and frequent complications. Negative margins and good chemotherapy response are the most important prognostic factors. Radiotherapy, particularly in the preoperative setting, may have an expanding role when clear wide margins are not achievable. Multicenter collaboration is essential to optimize treatment strategies and improve outcomes in rare diseases like pelvic bone sarcomas in the pediatric population. LEVEL OF EVIDENCE: Type 3 multicentric study.
A combined preoperative cardiorespiratory fitness and body composition phenotype is associated with major complications after pancreatoduodenectomy, independent of postoperative pancreatic fistula risk.
Hildebrand ND, Alhulaili ZM, Driessens H … +7 more , Hoeijmakers LSM, Bongers BC, van Dijk DPJ, Rensen SSM, den Dulk M, Klaase JM, Olde Damink SWM
Eur J Surg Oncol · 2026 May · PMID 42269333 · Publisher ↗
INTRODUCTION: Major complication rates after pancreatoduodenectomy (PD) are high. Cardiorespiratory fitness and body composition are considered important determinants of postoperative outcomes. This study evaluated the a...
INTRODUCTION: Major complication rates after pancreatoduodenectomy (PD) are high. Cardiorespiratory fitness and body composition are considered important determinants of postoperative outcomes. This study evaluated the association between a multimodal preoperative assessment of cardiorespiratory fitness and body composition as core patient phenotypes and the occurrence of major complications following PD. METHODS: In this two-center retrospective cohort study (2022-2024), patients undergoing PD were included. Preoperative cardiorespiratory fitness was assessed using cardiopulmonary exercise testing (CPET) or the modified steep ramp test (mSRT). Poor cardiorespiratory fitness was defined as an oxygen uptake (VO) at the ventilatory anaerobic threshold (AT) < 11.0 mL/kg/min or VO at peak exercise (VO) < 18.0 mL/kg/min during CPET, or a work rate at peak exercise <2.1W/kg at the mSRT. Preoperative body composition parameters were derived from abdominal computed tomography scans. Low muscle mass based on skeletal muscle index (SMI) and myosteatosis (defined as low skeletal muscle radiation attenuation, SM-RA) were assessed. The primary outcome was 30-day major complications (Clavien-Dindo ≥ III). Logistic regression analyses identified predictors. RESULTS: Among 175 eligible patients (mean ± SD age 69.1 ± 8.2 years, 44.6% female), 34.9% were unfit; 54.9% had low muscle mass and 35.4% had myosteatosis. Major complications occurred in 37.7% and 8.0% required unplanned intensive care unit (ICU) admission. Preoperative cardiorespiratory fitness correlated moderately with SM-RA (ρ = 0.36-0.47; all p < 0.001). Poor cardiorespiratory fitness was associated with major complications in multivariable analysis (adjusted odds ratio [aOR] 2.54, 95% CI 1.17-5.54, p=0.02). Combined myosteatosis and poor cardiorespiratory fitness (n = 28, 16.0%) was associated with both major complications (aOR 3.40, 95% CI 1.25-9.28, p = 0.02) and unplanned ICU admission (aOR 4.62, 95% CI 1.06-20.16, p = 0.04). CONCLUSION: Myosteatosis correlates with lower cardiorespiratory fitness. The combination of preoperative myosteatosis and poor cardiorespiratory fitness is associated with major complications and postoperative ICU admission. In future preoperative assessment, these patient phenotypes may help to refine personalized risk assessment and guide inclusions for trials on targeted preventive interventions.
Continuous skeletal muscle gauge enhances preoperative risk stratification in intrahepatic cholangiocarcinoma: A multicenter study.
Shen L, Wu D, Lai J … +9 more , He G, Li G, Pan J, Huang M, Zhang C, Wang L, Tian Y, Huang L, Chen S
Eur J Surg Oncol · 2026 Jun · PMID 42269332 · Publisher ↗
BACKGROUND: Sarcopenia-related skeletal muscle abnormalities have been established as prognostic indicators in intrahepatic cholangiocarcinoma (ICC); however, the most appropriate CT-derived skeletal muscle parameter for...
BACKGROUND: Sarcopenia-related skeletal muscle abnormalities have been established as prognostic indicators in intrahepatic cholangiocarcinoma (ICC); however, the most appropriate CT-derived skeletal muscle parameter for its assessment remains uncertain. The skeletal muscle gauge (SMG), a composite measure combining both muscle quantity and quality (SMG = SMI × SMD), has yet to be systematically evaluated in ICC. METHODS: In this multicenter retrospective study, 760 patients with ICC who underwent curative resection between 2015 and 2021 at seven hepatobiliary centers were analyzed. Preoperative computed tomography (CT) scans were used to quantify skeletal muscle index (SMI), skeletal muscle density (SMD), and SMG. Independent prognostic factors were determined via Cox proportional hazards regression. Five predictive models were generated and compared, after which the best-performing model was used to develop nomograms. Model performance was evaluated using time-dependent ROC curves, calibration plots, and decision curve analysis (DCA). RESULTS: Continuous SMG was independently associated with both overall survival (OS) (P < 0.001) and recurrence-free survival (RFS) (P < 0.001). The continuous SMG-based model showed higher performance (OS: C-index 0.756, AUC 0.917; RFS: C-index 0.728, AUC 0.935) than cut-off-based and alternative models. The resulting nomograms displayed good calibration and discrimination and suggested potential utility as prognostic assessment tools in both the training and validation cohorts. CONCLUSIONS: Continuous SMG serves as an independent prognostic indicator for ICC. The SMG-based nomogram suggests potential clinical utility as an adjunct for individualized prognostic assessment and risk evaluation.
International consensus on axillary staging after neoadjuvant chemotherapy in node-positive breast cancer.
Lucocq J, Karakatsanis A, Kirwan C … +14 more , Boughey J, Tseng J, Sun SX, Gentilini OD, Barber M, Chagla L, Buccimazza I, Dick L, Masannat Y, Dixon JM, Kühn T, Benson J, Elder K, NAC-AX Collaborative Group
Eur J Surg Oncol · 2026 Apr · PMID 42259722 · Publisher ↗
INTRODUCTION: There is a lack of consensus on the eligibility thresholds and technical standards of minimally invasive axillary staging techniques including targeted axillary dissection (TAD), marked lymph node biopsy (M...
INTRODUCTION: There is a lack of consensus on the eligibility thresholds and technical standards of minimally invasive axillary staging techniques including targeted axillary dissection (TAD), marked lymph node biopsy (MLNB) and sentinel lymph node biopsy (SLNB) in node-positive breast cancer responding to neoadjuvant chemotherapy (NAC). METHODS: Consultant breast surgical oncologists from OECD countries were invited to participate. Statements developed from the literature, guidelines, and steering-committee were distributed to the panellists and consensus was investigated (≥70% agreement). Latent class analysis investigated the association between surgeon characteristics and axillary de-escalation. RESULTS: Of 574 surgeons (97.7% with access to axillary marking/localisation), 471 (82.1%) completed Round 2. The preferred axillary approach in cN1 (82.5% agreement) and cN2a (77.4%) patients converting to ycN0 was TAD, in preference to MLNB or SLNB. Eligibility for TAD was agreed for three or fewer involved nodes pre-NAC (84.1%) but was not agreed for four or more nodes (40.1%). Consensus supported marking only a single pathological node (≥78%), before NAC (93.8%), with localisation (87.3%) and intra-operative confirmation (93.6%). TAD should include resection of all SLNs (91.9%), all abnormal palpable nodes (91.9%) and at least one SLN is required (86.2%). Single-tracer with TAD (66.7%) and the retrieval of the marked node without SLNs (62.0%) did not reach consensus as sufficient staging. ALND was not required for isolated tumour cells in the TAD specimen (76.0%). There was significant geographic variation in axillary de-escalation. Surgeons with ≥20years experience (OR, 0.29, p = 0.005) and those working in centres with ≥300 breast cancers annually (OR, 0.30, p = 0.017) were more likely to de-escalate surgery. CONCLUSION: International consensus supports TAD as the preferred technique for cN1 patients responding to NAC, with agreement on essential procedural steps. Precise eligibility criteria for TAD and the omission of ALND require further investigation.
Comparison of long-term survival between primary and interval cytoreductive surgery in advanced ovarian cancer: A ten-year real-world cohort study.
Duan X, Tan S, Wang C … +3 more , Liu J, Huang L, Zhang Y
Eur J Surg Oncol · 2026 Jun · PMID 42258952 · Publisher ↗
OBJECTIVES: To compare long-term survival outcomes between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in patients with advanced ovarian cancer. METHODS:...
OBJECTIVES: To compare long-term survival outcomes between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in patients with advanced ovarian cancer. METHODS: We conducted a retrospective cohort study of 400 patients with FIGO stage III-IV epithelial ovarian cancer between 2013 and 2024. Propensity score matching (PSM) was employed to balance baseline characteristics, resulting in 124 patients in each treatment group. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints. RESULTS: In the matched cohort, PDS was associated with improved survival outcomes compared to NACT-IDS. Median PFS was 31.6 months for PDS versus 20.17 months for NACT-IDS (HR 0.6503, 95%CI 0.4734-0.8932, P = 0.0071). Median OS was 49.67 months for PDS versus 40.5 months for NACT-IDS (HR 0.6333, 95%CI 0.4425-0.9064, P = 0.0124). In multivariable analysis, NACT-IDS remained independently associated with poorer PFS (adjusted HR 1.59, 95% CI 1.14-2.22; P = 0.006) and OS (adjusted HR 1.62, 95% CI 1.11-2.37; P = 0.013). In the subgroup analysis, CC0/R0 resection was significantly associated with improved survival. CONCLUSIONS: In conclusion, in this single-institution retrospective real-world cohort, PDS was associated with longer PFS and OS than NACT-IDS after adjustment for measured baseline characteristics. Regardless of treatment strategy, CC0/R0 resection was associated with improved survival outcomes, highlighting the importance of individualized treatment selection aimed at achieving safe complete cytoreduction whenever feasible.
Multi-omic biomarkers of neoadjuvant treatment response in rectal cancer: A narrative review.
Maerten P, Wolthuis A, D'Hoore A … +11 more , Bislenghi G, De Hertogh G, Sagaert X, Dresen R, Broeckhoven V, Rasschaert G, Tejpar S, Van Herpe F, Van Cutsem E, Dekervel J, Haustermans K
Eur J Surg Oncol · 2026 Jun · PMID 42250371 · Publisher ↗
BACKGROUND: Neoadjuvant treatment response in rectal cancer is highly heterogeneous, complicating patient selection for organ-preservation strategies. Robust biomarkers capable of accurately predicting treatment response...
BACKGROUND: Neoadjuvant treatment response in rectal cancer is highly heterogeneous, complicating patient selection for organ-preservation strategies. Robust biomarkers capable of accurately predicting treatment response are needed to improve personalized treatment decisions. METHODS: We conducted a narrative review of studies published since 2015 evaluating predictors of response to neoadjuvant therapy in rectal cancer. A comprehensive PubMed/MEDLINE search identified evidence across six domains: (1) genomic and molecular biomarkers, (2) imaging-based biomarkers, (3) histopathological and digital pathology biomarkers, (4) liquid biopsy biomarkers (cfDNA and ctDNA), (5) patient-derived tumor models and (6) microbiome-associated biomarkers. RESULTS: Treatment response in rectal cancer reflects a complex interplay between tumor-intrinsic, immune microenvironment and stromal features. Immune-enriched tumors, characterized by high intratumoral CD8 T-cell infiltration, CMS1/iCMS3 subtype and high Immunoscore, consistently demonstrate higher rates of pathological and clinical complete response. Conversely, KRAS, TP53, BRAF and SMAD4 mutations, fibroblast activation, TGFβ signaling, inflammatory cancer-associated fibroblasts and epithelial-mesenchymal transition programs are associated with treatment resistance. Artificial intelligence applied to MRI, endoscopy and digital pathology enables accurate response prediction, particularly when incorporating longitudinal features. Emerging technologies including ctDNA monitoring, patient-derived tumor models and microbiome profiling provide additional insight into treatment sensitivity and show promise for predicting treatment response. CONCLUSIONS: Neoadjuvant treatment response in rectal cancer is dependent on genomic alterations, immune activation and stromal interactions. AI-driven biomarkers hold promise for personalized treatment and organ-preservation. Prospective, multicenter validation is essential to enable further clinical implementation.
Young onset rectal cancer (YORC): a descriptive tertiary center analysis.
Schraepen C, Rasschaert G, Maerten P … +14 more , Bislenghi G, De Hertogh G, Debrun L, Dresen R, Leclercq P, Sagaert X, Tejpar S, Van Herpe F, Dekervel J, Haustermans K, Van Cutsem E, Coeckelberghs E, D'Hoore A, Wolthuis A
Eur J Surg Oncol · 2026 Jun · PMID 42247965 · Publisher ↗
BACKGROUND: The incidence of colorectal cancer (CRC) in adults under 50 is increasing worldwide, with young-onset rectal cancer (YORC) projected to represent up to 25% of rectal cancers by 2030. This study compared clini...
BACKGROUND: The incidence of colorectal cancer (CRC) in adults under 50 is increasing worldwide, with young-onset rectal cancer (YORC) projected to represent up to 25% of rectal cancers by 2030. This study compared clinical presentation, tumor characteristics, and staging between YORC and late-onset rectal cancer (LORC) in a tertiary referral center. The primary objective was to assess differences in baseline disease stage, with secondary outcomes including short-term oncological endpoints. METHODS: All patients diagnosed with rectal adenocarcinoma between 2017 and 2024 were retrospectively analyzed and classified as YORC (<50 years) or LORC (≥50 years). Clinical, pathological, and radiologic staging features were compared. Mismatch repair (MMR) status was determined by immunohistochemistry, with MSI testing for MMR-deficient tumors. Overall survival (OS) and disease-free survival (DFS) in non-metastatic patients were calculated using Kaplan-Meier analysis. Median potential follow-up was estimated using the reverse Kaplan-Meier method. RESULTS: Of 705 patients, 86 (12.2%) were YORC and 619 (87.8%) LORC. YORC patients more often presented with symptoms (91.9% vs 70.9%; p < 0.001), had better WHO performance status (score 0: 98.8% vs 82.5%; p = 0.002), and more frequently showed dMMR/MSI tumors (7.0% vs 1.3%; p = 0.001). Younger patients had higher rates of metastatic disease (22.1% vs 11.6%; p = 0.007), lymph-node involvement (73.8% vs 60.7%; p = 0.020), and extramural vascular invasion (40.1% vs 26.0%; p = 0.004), with no significant differences in T-stage or mesorectal fascia involvement. At the first MDT, YORC patients were more often selected for total neoadjuvant therapy or chemotherapy alone. Among non-metastatic patients, 3-year OS (93.6% vs 87.1%; p = 0.259) and DFS (77.8% vs 77.2%; p = 0.923) was not statistically different with a median potential follow-up of 3.85 years. CONCLUSION: YORC presents more often with symptoms and advanced disease (M+, N+, EMVI+), yet short-term survival in non-metastatic patients tended to parallel that of older individuals. These findings underscore the need for earlier diagnosis, tailored management, and increased clinical awareness.
Optimizing breast conservative surgery for ductal carcinoma in situ: Comparative outcomes of intraoperative ultrasound and wire localization in achieving negative margins.
Esgueva A, Pitoni L, Regueira F … +10 more , Rodríguez-Spiteri N, Olartecoechea B, Sobrido C, Pina L, Elizalde A, Cambeiro M, Gimeno-Morales M, Iscar T, Abengozar M, Rubio IT
Eur J Surg Oncol · 2026 Jun · PMID 42247964 · Publisher ↗
BACKGROUND: Intraoperative ultrasound-guided surgery (IOUS) is an effective technique for invasive breast cancer, offering advantages over wire localization (WL), such as smaller resection volumes, lower rates of involve...
BACKGROUND: Intraoperative ultrasound-guided surgery (IOUS) is an effective technique for invasive breast cancer, offering advantages over wire localization (WL), such as smaller resection volumes, lower rates of involved margins, and better patient satisfaction. However, evidence for ductal carcinoma in situ (DCIS) is limited. This study aimed to compare specimen margins and excision volume in DCIS treated with IOUS versus WL. MATERIAL AND METHODS: From February 2018 to December 2023, women diagnosed with DCIS and eligible for breast-conserving surgery guided by IOUS or WL were prospectively recorded. For IOUS, a US-visible clip was placed at the biopsy site. During surgery, the distance between the clip and the end of mammographic microcalcifications was measured to guide excision. A specimen mammogram confirmed complete removal. Margin status, need for re-excision, and volume of excess healthy tissue-estimated through the calculated resection ratio (CRR)-were compared. RESULTS: A total of 188 patients were included: 55 (29.25%) in the IOUS group and 133 (70.75%) in the WL group. IOUS patients were younger (p = 0.01). Tumor size (p = 0.11) and grade (p = 0.46) were similar between groups. IOUS achieved higher rates of negative margins (>2mm, p = 0.005) and fewer close margins (0.1-2mm, p = 0.03). Surgical volumes did not differ (p = 0.39). Re-excision rates were lower with IOUS (p = 0.05). Multivariate analysis showed IOUS significantly reduced re-excisions (OR 0.1; 95% CI 0.01-0.6) and close/positive margins (OR 0.1; 95% CI 0.02-0.5). Disease-free survival was similar between groups. CONCLUSIONS: IOUS is an accurate localization method for DCIS surgery, reducing re-excisions by increasing rates of negative margins compared with WL.
Rates of adjacent organ invasion in non-metastatic renal cell carcinoma: a population-based study.
Filzmayer M, Quarta L, Petix M … +11 more , Orlandi F, Goyal JA, Briganti A, Carmignani L, Micali S, Shariat SF, Kosiba M, Humke C, Saad F, Chun FK, Karakiewicz PI
Eur J Surg Oncol · 2026 Jun · PMID 42247963 · Publisher ↗
INTRODUCTION: Pathological T4 (pT4) renal cell carcinoma (RCC) is defined by adjacent organ invasion. The rate of pT4 and its associated clinicopathological characteristics received little attention in non-metastatic (M0...
INTRODUCTION: Pathological T4 (pT4) renal cell carcinoma (RCC) is defined by adjacent organ invasion. The rate of pT4 and its associated clinicopathological characteristics received little attention in non-metastatic (M0) RCC. METHODS: Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2022), we identified M0 RCC nephrectomy patients and assessed pT4 rates. RESULTS: Of 129,075 M0 RCC nephrectomy patients, 733 (0.6%) harbored pT4 stage. Annual pT4 rates decreased from 1.4% in 2004 to 0.4% in 2022 (p < 0.001). According to tumor size, the pT4 rate was 0.1% in tumors <7 cm and increased from 0.7% in 7-7.9 cm tumors to 6.4% in ≥15 cm tumors (p < 0.001). In patients undergoing radical nephrectomy for tumors ≥7 cm, pT4 rate was 2.5% (578/22,981). According to histology, pT4 rates were 2.3% (376/16,703) in clear-cell RCC, 3.0% (81/2682) in papillary RCC, 1.2% (27/2274) in chromophobe RCC, 6.7% (75/1119) in sarcomatoid dedifferentiated tumors, 13.2% (7/53) in collecting duct carcinomas, and 8.0% (12/150) in other variant histologies (p < 0.001). Compared to pT2-3 patients, pT4 patients more frequently underwent lymphadenectomy (63.3% [366/578] vs. 30.0% [6724/22,403], p < 0.001). Among patients who underwent lymphadenectomy, lymph node invasion was more common in pT4 than in pT2-3 stage (83.6% [298/366] vs. 54.8% [3901/6724], p < 0.001). CONCLUSION: In M0 RCC, pT4 is rare. It is virtually non-existent in tumors <7 cm. The highest pT4 rates are observed in variant histologies. Compared to pT2-3, pT4 is associated with higher lymphadenectomy use and lymph node invasion rates. Collectively, these findings provide descriptive population-level benchmarks.
Quality of life in patients with pseudomyxoma peritonei treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy and implications for ERAS-informed rehabilitation.
Wang SL, Cui YR, Ma R … +4 more , Li CH, Fang L, Wang YJ, Li Y
Eur J Surg Oncol · 2026 May · PMID 42247962 · Publisher ↗
INTRODUCTION: Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is the standard of care for pseudomyxoma peritonei (PMP) but is associated with substantial perioperative burden and prolon...
INTRODUCTION: Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is the standard of care for pseudomyxoma peritonei (PMP) but is associated with substantial perioperative burden and prolonged recovery. Contemporary data on health-related quality of life (HRQoL) trajectories after CRS + HIPEC remain limited, as does their integration into perioperative and rehabilitation planning. We aimed to characterize short- and mid-term HRQoL changes after CRS + HIPEC in PMP and to identify ERAS-informed rehabilitation priorities based on postoperative symptom and function trajectories. METHODS: We screened 273 patients from our institutional PMP CRS + HIPEC database and included 111 adults who had adequate EORTC QLQ-C30 data for longitudinal analysis. HRQoL was assessed using the EORTC QLQ-C30 at baseline and 1 week, 1, 3, 6, 9 and 12 months postoperatively. Longitudinal changes were summarized descriptively, and mean differences versus baseline were interpreted using established minimally important difference thresholds (≥10 points). RESULTS: At 1 week postoperatively, physical, role, emotional, cognitive and social functioning and global QoL declined by 22.9, 41.6, 13.3, 19.7, 20.5 and 28.4 points, respectively, all exceeding the threshold for clinically meaningful deterioration. Fatigue, pain, dyspnoea, insomnia, appetite loss and financial difficulties showed peak or near-peak worsening at 1 week, whereas constipation and diarrhea peaked at 3 months. Overall QoL was worst around 1 month postoperatively and then improved steadily; by 12 months, most functional scales and symptoms had returned to or approached baseline (e.g. global QoL -1.1 points vs. preoperative), although mild residual cognitive and bowel disturbances persisted in some patients. DISCUSSION: CRS + HIPEC for PMP imposes a pronounced but largely transient HRQoL burden, characterized by a sharp early decline, mid-term recovery and near-restoration of baseline QoL within 6-12 months. Our findings support an ERAS-informed rehabilitation framework that prioritizes pain control, respiratory recovery, nutrition, sleep, and psychological support. These elements should be interpreted as clinically informed rehabilitation priorities rather than as a validated intervention package directly derived from this observational dataset. These findings inform preoperative counseling and the timing of follow-up after CRS + HIPEC.
99mTc GSA scintigraphy predicts post-hepatectomy liver failure in biliary tract cancer.
Akita M, Yanagimoto H, Sofue K … +7 more , Ishida J, Nanno Y, Urade T, Fukushima K, Komatsu S, Kido M, Fukumoto T
Eur J Surg Oncol · 2026 May · PMID 42247961 · Publisher ↗
BACKGROUND: Technetium-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) scintigraphy is a useful method for assessing liver function and its heterogeneity. We evaluated its predictive u...
BACKGROUND: Technetium-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) scintigraphy is a useful method for assessing liver function and its heterogeneity. We evaluated its predictive usefulness for post-hepatectomy liver failure (PHLF) in liver resection for biliary tract cancer. METHODS: Between 2013 and 2024, 95 patients underwent major hepatectomy with bile duct resection for biliary tract cancer and had preoperative 99mTc-GSA scintigraphy. The GSA-K value was defined using established reduction formulas of indocyanine green plasma clearance rate (ICG-K) values based on LHL15 value (99mTc-GSA uptake ratio of the liver to the liver plus heart at 15 min) from 99mTc-GSA scintigraphy. Functional remnant liver volume (f-RLV) ratio was estimated by dividing scintillation counts of the future remnant liver by total counts of the whole liver. We compared volumetric (ICG-Krem: ICG-K x RLV ratio) and functional (GSA-Krem: GSA-K x f-RLV ratio) assessment methods of the future remnant liver for predicting PHLF. RESULTS: PHLF was observed in 34 patients (35.8%) and a receiver operating characteristic curve revealed cut-off values for predicting PHLF of 0.088 for ICG-Krem and 0.086 for GSA-Krem. Positive predictive values for PHLF were 53.2% (ICG-Krem) and 87.6% (GSA-Krem). In patients with portal vein embolization (PVE), GSA-Krem showed 89.1% of positive predictive value for PHLF, and ICG-Krem was very low (53.3%). The multivariate analysis identified GSA-Krem as one of independent predictors of PHLF. CONCLUSIONS: GSA-Krem derived from 99mTc-GSA scintigraphy is a valuable predictor of PHLF.
Preoperative three-dimensional reconstruction facilitates robot-assisted radical nephrectomy and inferior vena cava thrombectomy for renal cell carcinoma: Insights from a Chinese high-volume center.
Hong P, Yu L, Duan P … +4 more , Zhang F, Deng S, Wang G, Zhang S
Eur J Surg Oncol · 2026 Jun · PMID 42247960 · Publisher ↗
OBJECTIVE: Three-dimensional (3D) reconstruction model is an emerging technology that significantly enhanced perioperative metrics. This work aimed to delineate the contribution of preoperative 3D reconstruction model to...
OBJECTIVE: Three-dimensional (3D) reconstruction model is an emerging technology that significantly enhanced perioperative metrics. This work aimed to delineate the contribution of preoperative 3D reconstruction model to robot-assisted radical nephrectomy (RARN) and IVC thrombectomy. METHODS: A retrospective cohort study was conducted on consecutive patients with RCC and IVC tumor thrombus (Mayo level 1-3) who underwent robotic surgery by a single surgeon (January 2023-January 2026). Preoperative computed tomography urography (CTU) images were used to generate 3D reconstruction models, enabling detailed visualization of tumor-vessel relationships and quantitative measurement of tumor parameters. The primary oncological endpoint was recurrence-free survival (RFS); overall survival (OS) was also evaluated as a secondary endpoint. Postoperative complications were graded using Clavien-Dindo (≥III defined as major), and renal function was assessed by eGFR. A two-sided p value < 0.05 was considered significant. RESULTS: Among 71 patients, those with preoperative 3D reconstruction (n = 27) versus without (n = 44) showed significantly shorter postoperative hospital stay (8.0 vs 10.0 days, P = 0.04) and higher postoperative estimated glomerular filtration rate (eGFR) (76.0 vs 60.0, P = 0.01). Other perioperative benefits (blood transfusion, major complications) were not statistically significant. RFS and OS did not differ significantly between groups. CONCLUSIONS: Preoperative 3D reconstruction helps facilitate RARN and IVC thrombectomy and improves perioperative outcomes. This technique holds promise for broader application in complex urological surgery.
Comparison of the effectiveness of neoadjuvant chemotherapy versus upfront surgery for osteosarcoma: A target trial emulation study.
Zhong G, Gu H, Huo Z … +6 more , Zhu M, Gingold JA, Lee DF, Huang G, Shen J, Tu J
Eur J Surg Oncol · 2026 Jun · PMID 42242069 · Publisher ↗
INTRODUCTION: Most studies recommend a treatment sequence involving neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy (NAC first) for osteosarcoma, yet direct comparisons with upfront surgery (surger...
INTRODUCTION: Most studies recommend a treatment sequence involving neoadjuvant chemotherapy followed by surgery and adjuvant chemotherapy (NAC first) for osteosarcoma, yet direct comparisons with upfront surgery (surgery first) are lacking, and previous comparative analyses revealed no significant difference in overall survival (OS) between the two strategies. MATERIALS AND METHODS: Using the target trial emulation (TTE) framework and the Surveillance, Epidemiology, and End Results (SEER) database, we compared NAC first versus surgery first in patients with osteosarcoma. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were employed to control for baseline confounding. The primary analysis aimed to estimate the intention-to-treat (ITT) effect to evaluate the comparative effectiveness of which initial treatment strategy is associated with a better prognosis. RESULTS: Among 831 eligible patients, 152 were assigned to the surgery-first group, and 679 were assigned to the NAC-first group. After PSM (121 pairs), the NAC-first group had significantly higher 5-year OS (77.7% [95% CI: 70.6%-85.5%] versus 61.3% [95% CI: 53.0%-70.8%], p = 0.006) and an increased risk of death in the surgery-first group (HR = 1.907, 95% CI: 1.172-3.103; p = 0.009). ITT and per-protocol (PP) analyses consistently corroborated these findings. IPTW analysis of the entire cohort showed a non-significant trend toward improved survival with NAC first (HR = 1.084, 95% CI: 0.992-1.186; p = 0.076). CONCLUSION: This study is the first to employ the TTE framework to compare treatment sequences for osteosarcoma. Our findings suggest that initiating treatment with NAC is associated with increased OS rates compared with initiating treatment with upfront surgery, providing empirical evidence that aligns with current recommendation in the National Comprehensive Cancer Network (NCCN) guidelines.
Surgical extent and its association with major postoperative complications in advanced ovarian cancer: initial validation of the Karolinska surgical extent and complexity score (K-SECS).
Hunde D, Kofoed NG, Kannisto P … +3 more , Asp M, Hassan MU, Salehi S
Eur J Surg Oncol · 2026 May · PMID 42242068 · Publisher ↗
BACKGROUND: Cytoreductive surgery is central to the management of advanced ovarian cancer. As the extent of surgery varies widely, assessment of postoperative risk is challenging. The Karolinska Surgical Extent and Compl...
BACKGROUND: Cytoreductive surgery is central to the management of advanced ovarian cancer. As the extent of surgery varies widely, assessment of postoperative risk is challenging. The Karolinska Surgical Extent and Complexity Score (K-SECS) was developed to quantify surgical extent and has previously been associated with survival. This study evaluated whether K-SECS is also associated with major postoperative complications (MPC). METHODS: We conducted an observational study using two Swedish databases (2009-2023) including women with FIGO stage III-IV ovarian cancer undergoing cytoreductive surgery. K-SECS was classified as Intermediate (0-9), High (10-18), or Very High (≥19). The primary outcome was MPC (Clavien-Dindo grade ≥ III). Multivariable logistic regression adjusted for relevant covariates was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: A total of 399 patients were included; 25% experienced an MPC. The risk of MPC increased with increasing surgical extent: 15% (Intermediate), 33% (High), and 52% (Very High). Compared with Intermediate scores, High (OR 2.69, 95% CI 1.62-4.52) and Very High K-SECS (OR 5.92, 95% CI 2.03-18.3) were associated with higher odds of MPC. Absolute adjusted risk differences confirmed a clinically meaningful stepwise increase in morbidity across K-SECS categories, with a 34% higher risk in the Very High versus Intermediate group (95% CI 11-57). CONCLUSION: K-SECS is associated with MPC. When considered alongside its previously demonstrated association with survival, K-SECS may support a more structured assessment of the balance between oncologic benefit and surgical risk in advanced ovarian cancer.
Robotic-assisted surgery versus conventional laparoscopy in endometrial cancer: a systematic review and meta-analysis.
Kalas N, Lintner B, Sebők B … +7 more , Vida B, Lőczi L, Merkely P, Bánhidy F, Ács N, Tóth R, Keszthelyi M
Eur J Surg Oncol · 2026 May · PMID 42235434 · Publisher ↗
BACKGROUND: Endometrial cancer is the sixth most common malignancy in women worldwide, and surgery remains the cornerstone of its treatment. Minimally invasive approaches, including conventional laparoscopy and robotic-a...
BACKGROUND: Endometrial cancer is the sixth most common malignancy in women worldwide, and surgery remains the cornerstone of its treatment. Minimally invasive approaches, including conventional laparoscopy and robotic-assisted surgery are widely used; however, their relative oncologic effectiveness remains debated. This systematic review and meta-analysis compared oncologic and perioperative outcomes of robotic-assisted hysterectomy and conventional laparoscopic hysterectomy in patients with endometrial cancer. METHODS: A systematic literature search was performed in PubMed/MEDLINE, Scopus, Embase, Cochrane and Web of Science according to PRISMA 2020 guidelines. Comparative studies evaluating robotic assisted versus laparoscopic surgery for endometrial cancer were included. Outcomes assessed included lymph node yield, recurrence, progression-free survival (PFS), overall survival (OS), and perioperative variables, including estimated blood loss (EBL), conversion to open surgery, operative time, and intraoperative complications. Random-effects meta-analyses with heterogeneity and sensitivity analyses were conducted. RESULTS: Forty-two studies, including 91,151 patients, were analyzed. Robotic-assisted and laparoscopic surgery demonstrated equivalent oncologic outcomes, with no significant differences in recurrence, PFS, or OS. Lymph node yields were similar between approaches. Robotic surgery was associated with reduced EBL and lower conversion to open surgery, while other perioperative outcomes were comparable. Intraoperative complications were slightly more frequent in the robotic group. CONCLUSIONS: Robotic-assisted and conventional laparoscopic hysterectomy provide equivalent oncologic and survival outcomes. Perioperative differences are modest and mainly reflect technical characteristics. Surgical platform choice may therefore be guided by institutional resources, surgeon expertise, and patient-specific factors. PROSPERO REGISTRATION NUMBER: CRD420251274986 (registered on December 29, 2025).
Long-term outcomes of total versus distal gastrectomy in the older population with early gastric cancer: A propensity score-matched analysis.
Yoo J, Seo DH, Seong BO … +8 more , Yook JH, Yoo MW, Kim BS, Lee IS, Gong CS, Min SH, Lee JB, Ko CS
Eur J Surg Oncol · 2026 May · PMID 42235433 · Publisher ↗
INTRODUCTION: Total gastrectomy (TG) is associated with comparable survival outcomes but poorer short-term postoperative outcomes than distal gastrectomy (DG) in the general population with gastric cancer. However, evide...
INTRODUCTION: Total gastrectomy (TG) is associated with comparable survival outcomes but poorer short-term postoperative outcomes than distal gastrectomy (DG) in the general population with gastric cancer. However, evidence regarding these outcomes in the older population with early gastric cancer remains limited. This study compared long-term treatment outcomes after TG and DG, including longitudinal nutritional indicators, in this cohort. MATERIALS AND METHODS: Patients aged ≥75 years with pathologically confirmed stage I gastric cancer were included. Among the 534 enrolled patients, 450 underwent DG and 84 underwent TG. Propensity score matching was performed to minimize baseline differences between the two groups. RESULTS: After 1:1 matching, 84 patients were included in each treatment group. Surgical outcomes, including hospital days and readmission rates, did not show significant differences. The overall complication rate was higher in the TG group (34.5% vs. 25.0%), although not significantly. 5-year overall survival rates were 79.8% in the DG group and 69.9% in the TG group. Body weights and hemoglobin levels declined more significantly in the TG group over time. CONCLUSION: TG showed a numerically lower 5-year overall survival than DG, and was accompanied by less favorable longitudinal nutritional outcomes, although postoperative complication rates did not differ significantly between the two groups. The oncological benefit of TG may be expected primarily in disease-specific rather than overall survival in this age group, where non-cancer mortality contributes substantially. These observations may suggest that, in older adults with early gastric cancer at relatively low oncological risk, surgical strategies that minimize functional loss without compromising oncological adequacy deserve further investigation. Our findings could indirectly support stomach-preserving approaches in selected older patients with early gastric cancer.
Analysis of lymph node metastasis distribution patterns and dissection efficacy in thoracic esophageal cancer.
Li Z, Dong K, Lv H … +7 more , Li X, Li J, Liu Z, Sun B, Zhu Z, Wen S, Tian Z
Eur J Surg Oncol · 2026 May · PMID 42235432 · Publisher ↗
OBJECTIVE: To investigate the distribution patterns and dissection efficacy of lymph node metastasis in thoracic esophageal cancer, providing a theoretical basis for standardized lymphadenectomy during esophageal cancer...
OBJECTIVE: To investigate the distribution patterns and dissection efficacy of lymph node metastasis in thoracic esophageal cancer, providing a theoretical basis for standardized lymphadenectomy during esophageal cancer surgery. METHODS: A total of 703 patients who underwent radical resection for thoracic esophageal cancer via the right thoracic approach at the Fourth Hospital of Hebei Medical University between January 2014 and March 2023 were analyzed. According to tumor location, patients were classified into upper, middle, and lower thoracic groups. Lymph nodes were categorized anatomically into three regions: upper mediastinum, lower mediastinum, and upper abdomen. Stratified analyses were performed according to tumor invasion depth (T stage) and histological differentiation grade. Metastasis rates and efficacy index (EI) values were calculated for each lymph node station to clarify correlations between tumor characteristics and nodal involvement and to assess the impact of metastatic stations on patient survival. RESULTS: Overall metastasis rates to the upper mediastinal, lower mediastinal, and upper abdominal lymph nodes were 37.55%, 18.07%, and 23.33%, respectively. Among all stations, the right recurrent laryngeal nerve lymph nodes (Station 106recR) exhibited the highest metastasis rate (22.62%) and EI (11.22). Metastasis to lymph nodes along the hepatic artery (Station 8a), celiac axis (Station 9), and proximal splenic artery (Station 11p) was extremely low (≤0.85%). Stratified analysis showed that in upper and middle thoracic cancers, metastasis was most frequent at Station 106recR, with both the metastasis rates and EI increasing with greater tumor invasion invasion (T3-T4 vs. T1-T2) and poorer differentiation. For example, in upper thoracic cancer with T3-T4 poorly differentiated tumors, Station 106recR had a metastasis rate of 44.44% and an EI of 22.22. In lower thoracic cancers, perigastric lymph nodes (Stations 1-4) had the highest metastasis rate (24.71%) and EI (10.08). Among T1-T2 tumors, moderately-to-well differentiated cases metastasized predominantly to Station 106recR (7.69%, EI 5.13), whereas poorly differentiated tumors primarily involved the left gastric artery nodes (Station 7; 33.33%, EI 12.50). In T3-T4 poorly differentiated lower thoracic tumors, perigastric nodes showed the highest metastasis (59.46%, EI 22.31). CONCLUSION: Lymph node metastasis in thoracic esophageal cancer exhibits distinct, site-specific patterns. Upper and middle thoracic tumors predominantly metastasize upward to recurrent laryngeal nerve nodes, whereas lower thoracic tumors primarily involve the perigastric region. The risk and extent of lymph node metastasis-including the number of involved nodes, nodal stations, and EI values-increase with deeper invasion and poorer differentiation. Although distant lymph node metastasis occurs frequently in advanced disease, an EI of zero indicates no survival benefit from extended lymphadenectomy. Surgical lymphadenectomy should therefore be individualized based on tumor location, invasion depth, differentiation, and nodal metastatic patterns.
Effect of three-dimensional virtual modeling on surgical outcomes in robot-assisted partial nephrectomy for localized renal tumors: A propensity-matched analysis.
Nguyen TT, Thai MS, Tiong HY … +10 more , Chau QT, Hoang KC, Thai KL, Vu DH, Tran TT, Nguyen NH, Nguyen HQ, Pham TT, Ho TKC, Ngo XT
Eur J Surg Oncol · 2026 Jun · PMID 42235431 · Publisher ↗
BACKGROUND: Three-dimensional virtual modeling (3DVM) is increasingly used in robot-assisted partial nephrectomy (RAPN), yet its true clinical utility remains uncertain because prior studies rarely accounted for surgeon...
BACKGROUND: Three-dimensional virtual modeling (3DVM) is increasingly used in robot-assisted partial nephrectomy (RAPN), yet its true clinical utility remains uncertain because prior studies rarely accounted for surgeon experience or relied on unmatched cohorts. This study aimed to evaluate the association of 3DVM with Trifecta achievement and perioperative performance after accounting for tumor complexity and surgeon experience. METHODS: We retrospectively analyzed 80 RAPN cases (27 with 3DVM). Propensity-score matching (1:1) was performed using demographic and anatomical variables, while surgeon-related confounding was addressed using mixed-effects regression with surgeon included as a random effect. The primary endpoint was Trifecta (negative margin, warm ischemia time ≤25 min, and no 30-day complications). Mixed-effects logistic regression was used to evaluate independent predictors. RESULTS: Propensity score matching was used to balance patient and tumor characteristics between groups, while surgeon-related effects were further addressed using mixed-effects regression models. In the matched cohort, 3DVM use resulted in significantly shorter warm ischemia time (20.3 ± 9.3 vs 28.5 ± 7.1 min; p = 0.001) and more frequent arterial-only clamping (81.5% vs 18.5%; p < 0.001). Trifecta was achieved more often with 3DVM (74.1% vs 37.0%; p = 0.014). In mixed-effects logistic regression analyses accounting for surgeon-level random effects and continuous surgeon experience, the association between 3D virtual modeling and trifecta achievement was not statistically significant (OR 2.25, 95% CI 0.44-11.45, p = 0.33). CONCLUSIONS: These findings suggest that while 3D virtual modeling is associated with improved perioperative outcomes in matched comparisons, its independent effect on trifecta achievement remains uncertain after accounting for surgeon-level heterogeneity.
Preoperative MRI-based scoring system for prediction of microvascular invasion in intrahepatic mass-forming cholangiocarcinoma ≤5 cm: A multicenter study.
Yan Y, Si J, Shu J … +9 more , Shi F, Xu Q, Hu S, Li J, Wang L, Wang W, Jia N, Feng Z, Zhang L
Eur J Surg Oncol · 2026 May · PMID 42235430 · Publisher ↗
OBJECTIVES: To establish and externally validate a preoperative MRI-based risk scoring system for MVI prediction in IMCC≤5 cm, and to evaluate its prognostic value. METHODS: This multicenter retrospective study enrolled...
OBJECTIVES: To establish and externally validate a preoperative MRI-based risk scoring system for MVI prediction in IMCC≤5 cm, and to evaluate its prognostic value. METHODS: This multicenter retrospective study enrolled 171 patients with pathologically confirmed IMCC (≤5 cm) from four institutions who underwent curative surgical resection. Patients were divided into training (n = 122) and external validation (n = 49) cohorts. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of MVI. A scoring system was established by incorporating the independent predictors based on logistic regression coefficients. According to this scoring system, patients were stratified into low- and high-risk MVI groups and disease-free survival (DFS) was analyzed by Kaplan-Meier survival analysis. RESULTS: In the multivariable analysis, non-smooth tumor margin (OR = 4.140; p = 0.005), arterial phase (AP) peritumoral enhancement (OR = 6.589; p < 0.001), and arterial edge enhancement ratio (AEER; OR = 0.916; p < 0.001) were included as independent predictors of MVI. The scoring system demonstrated high predictive accuracy, with AUCs of 0.837 in the training cohort and 0.813 in the external validation cohort. IMCC patients at high risk exhibited significantly shorter DFS compared to those at low risk for MVI in both cohorts (p < 0.05). CONCLUSION: The preoperative MRI-based scoring system incorporating tumor margin, AP peritumoral enhancement, and AEER can effectively predict MVI in patients with IMCC ≤5 cm, providing a valuable predictive tool for risk stratification and prognosis assessment.
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