Eur J Surg Oncol [JOURNAL]
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200 papers
Prognostic impact of close margins on Loco-regional recurrence in ductal carcinoma in situ treated with breast-conserving surgery and radiotherapy.
Kang J, Lee S, Jung S … +6 more , Yoon Y, Oh JH, Koh HW, Yoon KH, Shin HC, Kim EK
Eur J Surg Oncol · 2026 May · PMID 42229166 · Publisher ↗
INTRODUCTION: Current guidelines recommend achieving negative margins ≥2 mm for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and radiotherapy (RT). However, the need for re-excision in cas...
INTRODUCTION: Current guidelines recommend achieving negative margins ≥2 mm for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and radiotherapy (RT). However, the need for re-excision in cases with close (<2 mm), but negative margins remain controversial. We evaluated the prognostic impact of close margins on locoregional recurrence (LRR) and identified factors associated with recurrence. MATERIAL AND METHODS: We retrospectively analyzed 672 patients with pure DCIS who underwent BCS and adjuvant RT between 2004 and 2020. Patients were categorized into negative- and close-margin groups (n = 611 and 61, respectively). A subgroup analysis was performed on 175 patients with microinvasive carcinoma. Predictors of LRR were assessed using Cox proportional hazards models, and survival outcomes were compared using Kaplan-Meier analysis. RESULTS: During a median follow-up of 88 months, 12 patients (1.8%) developed LRR. In pure DCIS, margin status was not significantly associated with recurrence. Younger age (≤50 years) and omission of hormonal therapy were risk factors for LRR. However, in microinvasive carcinoma, close margins were significantly associated with shorter LRR-free survival. On ultrasonography, lesion size ≥2 cm and non-mass-like appearance were associated with close margin status. CONCLUSION: Close margins were not associated with an increased risk of LRR in pure DCIS patients treated with BCS and RT, suggesting that routine re-excision may be unnecessary. However, in microinvasive carcinoma, close margins were associated with a higher recurrence risk, indicating the need for wider excision. Ultrasonographic features may help to predict close margins and assist in preoperative surgical planning.
Impact of cytoreductive surgery with HIPEC in the treatment of pancreatic cancer with peritoneal carcinomatosis: A systematic review.
Ribeiro T, Rebelo P, Rangelova E … +2 more , Ferreira-da-Silva R, Bouça-Machado T
Eur J Surg Oncol · 2026 May · PMID 42229165 · Publisher ↗
Pancreatic cancer with peritoneal metastases is associated with a particularly poor prognosis under standard systemic therapy. This systematic review evaluates the role of cytoreductive surgery (CRS) and hyperthermic int...
Pancreatic cancer with peritoneal metastases is associated with a particularly poor prognosis under standard systemic therapy. This systematic review evaluates the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in this patient population, focusing on survival, recurrence, and treatment-related morbidity and mortality. Following PRISMA guidelines, a systematic search was conducted across MEDLINE, Web of Science, and SCOPUS. Study quality was assessed using the Methodological Index for Non-randomised Studies (MINORS). Three retrospective studies met the inclusion criteria. Median overall survival ranged from 12 to 26 months. In the only comparative study, median overall survival from diagnosis was 41 months in the CRS-HIPEC group versus 19 months in the control group (systemic chemotherapy). Complete cytoreduction (CC-0) was consistently associated with better outcomes, with a median progression-free survival of 17 months after CC-0 compared with 5 months after CC-1 resection. Major complication rates ranged from 20% to 43%, and perioperative mortality ranged from 0% to 16.7%, although estimates were imprecise owing to small sample sizes. Overall, outcomes appeared highly contingent on careful patient selection based on biological criteria. CRS-HIPEC represents a potential therapeutic strategy for a carefully selected subgroup of pancreatic cancer patients with peritoneal metastasis. However, current evidence is limited to small cohorts. Adequately powered clinical trials are required before definitive clinical recommendations can be established.
Two-stage anastomotic reconstruction after pancreatectomy (TARP procedure) - A single-center retrospective case series.
Uzunoglu FG, van Rüth V, Gehrisch F … +5 more , Götz MR, Meißner K, Nießen A, Nickel F, Hackert T
Eur J Surg Oncol · 2026 May · PMID 42229164 · Publisher ↗
BACKGROUND: Venous congestion and small bowel edema after venous reconstruction during pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) may compromise anastomotic safety. A two-stage approach with d...
BACKGROUND: Venous congestion and small bowel edema after venous reconstruction during pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) may compromise anastomotic safety. A two-stage approach with delayed gastrointestinal reconstruction may offer a protective strategy. We refer to this concept as the TARP procedure (Two-stage Anastomotic Reconstruction after Pancreatectomy). MATERIALS AND METHODS: This retrospective single-center study analyzed all consecutive patients who underwent TARP between February 2023 and February 2025. Tumor resection and venous reconstruction were completed in an initial operation, followed by deferred reconstruction within 24-72 h. Baseline characteristics and perioperative outcomes were analyzed descriptively. RESULTS: Nine patients underwent TARP during the study period. The median age was 72 years and the primary indication for a two-stage reconstruction was small bowel edema due to venous congestion. Median operation time was 401 min, median ICU stay 9 days, and median hospital stay 28 days. No patient developed an anastomotic leak or clinically relevant postoperative pancreatic fistula. Six patients (66.7%) experienced Clavien-Dindo grade ≥ IIIb complications. One patient (11.1%) died within 30 days. CONCLUSIONS: Two-stage PD with delayed reconstruction appears to be a feasible approach in selected patients with intraoperative risk factors such as bowel edema or instability. Avoiding anastomosis under unfavorable conditions may reduce early morbidity.
Promising treatment options for cerebellopontine angle meningiomas: a longitudinal retrospective cohort study.
He WB, Tang LS, Chen ZH … +8 more , Hou JX, Zheng DT, Chen YC, Zheng Y, Chen RL, Liu ZY, Hu Y, Xu JG
Eur J Surg Oncol · 2026 Jul · PMID 42229145 · Publisher ↗
BACKGROUND: Although gross total resection (GTR) is the standard treatment for meningiomas, its application in the cerebellopontine angle (CPA) remains controversial. Previous studies have not systematically compared lon...
BACKGROUND: Although gross total resection (GTR) is the standard treatment for meningiomas, its application in the cerebellopontine angle (CPA) remains controversial. Previous studies have not systematically compared long-term tumor control and functional outcomes between surgical resection and Gamma Knife radiosurgery (GKRS) for CPA meningiomas. MATERIALS AND METHODS: CPA meningioma cases were extracted from a cohort of 10,392 patients diagnosed with meningiomas. Two strategies were used: a tumor-free approach (GTR) to ensure complete tumor resection, and a tumor-reduced approach (upfront GKRS or subtotal resection plus adjuvant GKRS) to reduce tumor burden. Outcomes were assessed by progression-free survival, Karnofsky Performance Status (KPS) scores, and neurological function recovery. RESULTS: This study followed 158 patients for a median of 85.4 months. The tumor-free group had a progression rate of 5.7%, significantly lower than the 22.7% (p = 0.002) in the tumor-reduced group. Kaplan-Meier analysis showed significantly better tumor control in the tumor-free group (p = 0.043), especially in posterior tumors (p = 0.008). Regarding functional outcomes, the overall cranial nerve improvement rate was 54.2%, with a neurological deterioration rate of 7.6%. ΔKPS indicated better functional recovery in the tumor-reduced group (+12.95 vs. tumor-free group: +7.57, p = 0.005), especially for anterior tumors (+14.76 vs. +0.71, p < 0.001). CONCLUSION: For posterior CPA meningiomas, prioritizing surgical GTR may lead to optimal tumor control. For anterior meningiomas, a tumor-reduced approach (either upfront GKRS or STR followed by adjuvant GKRS) may be preferred to achieve a better functional outcome. The selection between upfront GKRS and STR + GKRS should be guided by tumor size and the presence of neural compression symptoms.
Surgeon's treatment outcome prediction: accuracy and communication.
Vlug L, de Lange EC, Kruiswijk AA … +5 more , Pieterse AH, Schrage YM, van de Sande MAJ, van Bodegom-Vos L, VALUE-PERSARC research group
Eur J Surg Oncol · 2026 May · PMID 42217951 · Publisher ↗
INTRODUCTION: Achieving clear surgical margins is essential for treating soft tissue sarcomas (STS), as expected margins influence both prognosis and treatment decisions. When prognostic tools such as the Personalized Sa...
INTRODUCTION: Achieving clear surgical margins is essential for treating soft tissue sarcomas (STS), as expected margins influence both prognosis and treatment decisions. When prognostic tools such as the Personalized Sarcoma Care (PERSARC) app are used for treatment planning, a preoperative estimate of expected surgical margins is required. The accuracy of these margin predictions and how margin uncertainty is communicated remain unclear. METHODS: We conducted a retrospective secondary analysis using PERSARC app data, electronic patient records, and audio-recorded treatment decision-making consultations. Preoperative margin predictions were compared with postoperative histopathology in 134 patients. Communication of uncertainty was analyzed in a subset of 37 consultations. RESULTS: Predicted and observed margins differed for 42/134 patients, resulting in a sensitivity of 2.3% for predicting positive margins. Prediction accuracy was not associated with patient and tumor characteristics. Inaccurate margin predictions substantially altered PERSARC-based estimations for overall survival, local recurrence, and distant metastasis. During consultations, the possibility of positive margins was discussed with 22/37 patients. When discussed, surgeons frequently expressed high confidence in achieving negative margins. Communication of margin uncertainty did not differ between patients with negative versus positive postoperative margins. CONCLUSION: Preoperative margin prediction in STS patients shows low accuracy for positive margins and is often accompanied by high expressed confidence and limited discussion of uncertainty. Treatment decisions were unlikely to be affected in this cohort, however inaccurate margin predictions may affect prognostic counseling. Increasing awareness of prediction limitations and transparent communication of uncertainty may support more realistic patient expectations and better informed decision making.
Beyond margin length: Integrating tumour biology into the extent of gastrectomy.
Polkowski WP
Eur J Surg Oncol · 2026 May · PMID 42214946 · Publisher ↗
Recent surgical studies have renewed interest in the oncological relevance of proximal resection margin length in gastric and oesophagogastric junction cancer. While some data suggest that the absolute length of a negati...
Recent surgical studies have renewed interest in the oncological relevance of proximal resection margin length in gastric and oesophagogastric junction cancer. While some data suggest that the absolute length of a negative proximal margin does not independently influence survival, other observations indicate that unexpected microscopic proximal tumour extension may predict adverse outcomes despite margin negativity. These findings challenge a purely distance-based surgical doctrine and suggest that horizontal intramural spread may reflect tumour biology rather than technical inadequacy. Alterations in adhesion molecules such as E-cadherin and CD44v6 have been associated with infiltrative growth and nodal dissemination and may partly explain unpredictable microscopic extension. In parallel, evolving perioperative strategies and increasing response rates further question a strictly anatomy-driven approach to resection planning. Integrating biological and response-based considerations into surgical decision-making may represent a logical next step in refining the extent of gastrectomy.
The incidence of low volume metastases according to Silva pattern in cervical adenocarcinoma undergoing sentinel lymph node biopsy.
Bizzarri N, Schivardi G, Casarin J … +15 more , Di Martino G, Buda A, Antonacci A, Querleu D, Pedone Anchora L, Fedele C, Carbone V, Certelli C, Multinu F, Landoni F, Fruscio R, Scaglione G, Arciuolo D, Fagotti A, Fanfani F
Eur J Surg Oncol · 2026 Jul · PMID 42214903 · Publisher ↗
OBJECTIVE: Silva pattern is associated with higher risk of lymph node metastasis in cervical adenocarcinoma. However, no study specifically assessed the correlation between Silva pattern and sentinel lymph node (SLN) met...
OBJECTIVE: Silva pattern is associated with higher risk of lymph node metastasis in cervical adenocarcinoma. However, no study specifically assessed the correlation between Silva pattern and sentinel lymph node (SLN) metastasis after ultrastaging. The primary aim of this study was to assess the incidence of low volume metastases in SLN of patients undergoing primary surgery with SLN biopsy for cervical adenocarcinoma, according to Silva pattern. Secondary aims were to assess risk factors for lymph node metastasis and prognosis. METHODS: Retrospective, multi-center study. Patients with cervical adenocarcinoma clinical FIGO stage IA1 to IIA2, treated with primary surgery between 04/2015 and 12/2023 and undergoing SLN mapping attempt, were included. Low volume metastases were defined as any tumor deposit ≤2 mm (ITC as <0.2 mm, micro-metastasis as 0.2-2 mm). Appropriate statistical analysis was performed to assess study endpoints. RESULTS: 153 patients were included. Bilateral SLN mapping was achieved in 133 (86.9%) women. Silva pattern A was present in 47 (30.7%), B in 51 (33.3%) and C in 55 (35.9%) patients. 14 (9.1%) patients had metastatic SLN and 2 (1.4%) had metastatic non-SLN. The incidence of low-volume metastasis was 10/133 (7.5%) in patients with bilateral SLN mapping: 7 (5.3%) in Silva C, 1 (0.7%) in Silva B, and 2 (1.5%) in Silva A, while macro-metastases occurred in 4/133 (3.0%): 3 (2.2%), 0 and 1 (0.7%) cases, respectively (p = 0.027). Silva pattern C was the only factor independently associated to lymph node metastasis at multivariable analysis (OR: 9.724; 95%CI: 1.468-64.402; p = 0.018). No difference in disease-free survival and overall survival was evident when comparing Silva patterns (p = 0.210 versus p = 0.305, respectively). CONCLUSION: Low-volume metastases are more frequent than macro-metastases in patients with cervical adenocarcinoma undergoing SLN biopsy. Silva pattern C was associated with higher incidence of low volume lymph node metastasis, and it was the only factor independently associated with lymph node metastasis. Lymph node macro- and low-volume metastases were found also in Silva pattern A and B, highlighting the potential need for nodal assessment by SLN biopsy also in these sub-groups of patients.
Functional surgery for invasive nail apparatus melanoma: A cohort study and systematic review.
Lee ES, Park JH, Lee DY … +2 more , Mun GH, Lee KT
Eur J Surg Oncol · 2026 Jul · PMID 42208343 · Publisher ↗
BACKGROUND: Surgical management of nail apparatus melanoma (NAM) has evolved from amputation to digit-preserving functional surgery, supported by oncologic safety in non-invasive disease. However, indications and outcome...
BACKGROUND: Surgical management of nail apparatus melanoma (NAM) has evolved from amputation to digit-preserving functional surgery, supported by oncologic safety in non-invasive disease. However, indications and outcomes in invasive melanoma remain unclear. We evaluated a standardized institutional protocol for functional surgery in invasive NAM and performed a systematic review of the literature. METHODS: Patients with primary invasive NAM treated between 2021 and 2025 were reviewed. Preoperative MRI was used to assess bone involvement. Functional surgery was performed when no bone invasion was identified, across a range of Breslow thicknesses. Oncologic outcomes were analyzed. A systematic review of studies reporting functional surgery for invasive NAM was also conducted. RESULTS: Twenty-seven patients were included (median Breslow thickness, 1.8 mm). Tumor stages were T1 (n = 9), T2 (n = 7), T3 (n = 6), and T4 (n = 5); three patients had nodal metastasis. Pathology confirmed absence of bone invasion in all cases, yielding an MRI negative predictive value of 100%. Median tumor-to-bone distance was 1.75 mm and showed no correlation with Breslow thickness. Over a median follow-up of 18 months, three recurrences occurred (one regional lymph node, two distant), all distant recurrences in node-positive patients. No local recurrence was observed. The estimated two-year locoregional recurrence-free survival rate was 94.4%. The systematic review identified no study defining clear indications of functional surgery for invasive lesions. CONCLUSIONS: Functional surgery appears oncologically safe for invasive NAM without radiologic bone involvement across a range of tumor thicknesses. Preoperative MRI may aid patient selection. Larger studies with longer follow-up are warranted.
Not all guidelines are created equal: Rigour, evidence, and the case for transparent adaptation in papillary thyroid cancer guidance.
Bekker J, Nixon I, Wreesmann V
Eur J Surg Oncol · 2026 Jul · PMID 42202708 · Publisher ↗
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Interpretable and non-linear machine learning models for quantitative ICG perfusion assessment in colorectal cancer anastomosis: A feasibility study.
Daniluk-Marsy P, Castelein J, Polom K … +1 more , Borra RJH
Eur J Surg Oncol · 2026 Jul · PMID 42202707 · Publisher ↗
BACKGROUND: Anastomotic leakage (AL) remains a major complication after colorectal cancer surgery (CCS). Intraoperative indocyanine green (ICG) fluorescence angiography is widely used to assess bowel perfusion, but inter...
BACKGROUND: Anastomotic leakage (AL) remains a major complication after colorectal cancer surgery (CCS). Intraoperative indocyanine green (ICG) fluorescence angiography is widely used to assess bowel perfusion, but interpretation is largely subjective. Quantitative analysis of fluorescence kinetics combined with machine learning (ML) may enable more objective, physiology-based risk stratification. MATERIALS AND METHODS: In this single-centre retrospective feasibility study, 81 patients undergoing colorectal cancer resection with ICG perfusion assessment were analysed. Intraoperative fluorescence videos were post-processed to extract four quantitative perfusion metrics. Eight clinical variables with plausible relevance to microvascular health were included. Intraoperative hypoperfusion (n = 12, 15%) was defined by delayed fluorescence propagation judged by the operating surgeon. Logistic regression with elastic-net regularisation and three non-linear algorithms (random forest, XGBoost, support vector machine) were trained using perfusion metrics-only, clinical variables-only, and combined feature sets. Performance was evaluated with repeated stratified 5-fold cross-validation and bootstrap confidence intervals. RESULTS: Using perfusion-only features, elastic-net logistic regression achieved a ROC-AUC of 0.76 (95% CI 0.62-0.88). Clinical-only models reached a ROC-AUC of 0.77 (95% CI 0.59-0.93) with random forest. The combined model (perfusion + clinical) yielded the highest discrimination (ROC-AUC 0.81, 95% CI 0.63-0.94) with good calibration (Brier score 0.14). SHAP analysis identified increased latency and lower plateau intensity ratio (PIR) as the strongest predictors of hypoperfusion. CONCLUSION: Quantitative ICG perfusion indices, particularly latency and PIR, combined with interpretable ML models, can predict surgeon-assessed intraoperative hypoperfusion during colorectal cancer surgery with good discrimination. These findings support further development of explainable, perfusion-guided decision-support tools to reduce anastomotic risk.
CT-derived body composition and clinical outcomes in ovarian cancer patients: A scoping review.
Ohm N, Møller Andersen M, Oreskov JO … +2 more , Høgdall C, Henrichsen Schnack T
Eur J Surg Oncol · 2026 Jul · PMID 42184663 · Publisher ↗
INTRODUCTION: Epithelial ovarian cancer (EOC) is associated with poor prognosis. Computed tomography (CT)-derived body composition, encompassing muscle and adipose tissue metrics, has emerged as a potential biomarker for...
INTRODUCTION: Epithelial ovarian cancer (EOC) is associated with poor prognosis. Computed tomography (CT)-derived body composition, encompassing muscle and adipose tissue metrics, has emerged as a potential biomarker for prognosis and treatment guidance. This scoping review maps current evidence on associations between CT-derived body composition and clinical outcomes in EOC, with attention to methodological variation and research gaps. METHODS: The review protocol was prospectively registered in the Open Science Framework on December 11, 2024: https://osf.io/4p5u6. A comprehensive literature search was conducted in Medline (via PubMed), Embase (via Ovid), and Web of Science, following JBI methodology for scoping reviews and PRISMA-ScR guidelines. Eligible studies assessed CT-derived body composition in relation to clinical outcomes among EOC patients. RESULTS: 50 studies were included, 47 retrospective. Muscle and fat quantities were measured as cross-sectional areas or volumetric estimates, while muscle quality was assessed as skeletal muscle radiodensity in Hounsfield Units (HU). Considerable heterogeneity was observed in measurement techniques, anatomical landmarks, and cut-off definitions for sarcopenia and adiposity. Outcomes investigated included survival, chemotherapy-related, and surgical endpoints. Muscle quality, joint fat-muscle measures, and treatment-related muscle loss were more consistently predictive of survival than muscle mass or adipose tissue alone. Associations with chemotherapy-related and surgical outcomes were less consistent. CONCLUSION: CT-derived body composition may have prognostic relevance in EOC; however, associations remain inconsistent and is largely based on retrospective studies. Findings should therefore be considered hypothesis-generating. Methodological inconsistencies limit clinical applicability and highlight the need for standardized measurement techniques, consensus cut-offs, and prospective validation.
Propensity matched comparison between one-stage and two-stage hepatectomy after portal vein embolization for bilateral colorectal liver metastases.
Reese T, Engstrand J, Björk D … +16 more , Ottestad AM, Kiim KS, Evers M, Larsen PN, Schultz NA, Røsok BI, Carling U, Holmquist F, Lindell G, Sandström P, Böcker J, Gilg S, Sturesson C, Oldhafer KJ, Björnsson B, Sparrelid E
Eur J Surg Oncol · 2026 Jul · PMID 42176617 · Publisher ↗
BACKGROUND: Bilobar colorectal liver metastases present significant surgical challenges. Portal vein embolization followed by one-stage hepatectomy (PVE-OSH), omitting prior future liver remnant clearance, has been propo...
BACKGROUND: Bilobar colorectal liver metastases present significant surgical challenges. Portal vein embolization followed by one-stage hepatectomy (PVE-OSH), omitting prior future liver remnant clearance, has been proposed as an alternative to two-stage hepatectomy with PVE (TSH-PVE). This study used propensity matching to address selection bias. METHODS: Propensity scores were estimated using a probit model including demographic, clinical, and disease-related variables. Nearest-neighbour matching (up to 3 controls per treated patient) was performed. The primary outcome was successful resection, defined as completion without 90-day mortality. RESULTS: Following matching, 52 TSH-PVE and 75 PVE-OSH patients were analysed with well-balanced characteristics (SMD 0.1). Successful resection rates were comparable (76% TSH-PVE vs 82% PVE-OSH, p = 0.683). The chemotherapy-to-major-surgery interval was longer for TSH-PVE. Logistic regression demonstrated that metastasis size and number, rather than resection strategy, predominantly influenced successful resection. Rescue-ALPPS requirement was significantly higher for TSH-PVE (24% vs 7%, p = 0.006), and time to completion was shorter for PVE-OSH. Overall survival showed no significant differences between groups. CONCLUSION: PVE-OSH is comparable to TSH-PVE regarding complications, completion rates, and survival while reducing the chemotherapy-free interval. Metastasis size and number, rather than resection strategy, determine resection success and overall survival, demonstrating PVE-OSH as a feasible alternative to TSH-PVE.
Assessment of the Scandinavian guidelines on papillary thyroid cancer using the AGREE II instrument.
Sonesson O'Neill M, Areklätt T, Rygård SL … +5 more , Shakir B, Brauckhoff K, Londero S, Tjellaug EV, Almquist M
Eur J Surg Oncol · 2026 May · PMID 42173704 · Publisher ↗
BACKGROUND: Clinical practice guidelines are intended to help with decision-making. However, their quality differs. Guidelines of low quality are a waste of resources and can cause patient harm. We compared the quality o...
BACKGROUND: Clinical practice guidelines are intended to help with decision-making. However, their quality differs. Guidelines of low quality are a waste of resources and can cause patient harm. We compared the quality of the Danish, Norwegian, and Swedish guidelines on papillary thyroid cancer (PTC) with those of the American Thyroid Association (ATA, 2015 version). METHODS: Three pairs of appraisers independently rated the guidelines using the AGREE II instrument, a validated tool for assessing the quality of guidelines. Furthermore, recommendations on the extent of surgery in low-risk PTC, prophylactic lymph node dissection, thyroxine suppression, radioiodine treatment, active surveillance, and the length of follow-up after treatment, along with the evidence cited to support these recommendations, were compared across the four guidelines. RESULTS: Overall, the ATA guidelines had the highest quality, with a score of over 70 % in four domains, and the highest score in five of six domains. The Danish and Swedish guidelines each reached a score of over 70 % in only one domain, while the Norwegian guidelines did not reach that score in any domain. The overall score was 83 % for the ATA guidelines, 50 % for the Danish, 44 % for the Swedish, and 28 % for the Norwegian. Recommendations varied widely, particularly regarding extent of surgery and indications for radioiodine treatment. The ATA guidelines had the highest number of references supporting the recommendations. CONCLUSION: The quality of clinical practice guidelines and recommendations on treatment for PTC differed between the Scandinavian countries and the ATA, with the ATA having the highest quality.
Prognostic factors and the role of GnRHa in premenopausal HR+/HER2+ breast cancer achieving pathologic complete response after neoadjuvant chemotherapy.
Lee SM, Nam SJ, Kim SW … +8 more , Lee JE, Yu J, Chae BJ, Ryu JM, Park WK, Jung JJ, Lee SB, Lee SK
Eur J Surg Oncol · 2026 Jul · PMID 42173037 · Publisher ↗
BACKGROUND: Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) generally have favorable outcomes. Ho...
BACKGROUND: Patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer who achieve a pathologic complete response (pCR) after neoadjuvant chemotherapy (NAC) generally have favorable outcomes. However, in the hormone receptor-positive/HER2-positive (HR+/HER2+) subtype, prognostic heterogeneity may persist even after pCR. In particular, the role of gonadotropin-releasing hormone agonist (GnRHa) for ovarian function suppression in premenopausal patients remains unclear. We aimed to identify prognostic factors and evaluate the clinical impact of GnRHa in this population. METHODS: We performed a retrospective analysis of prospectively collected cohorts from Samsung Medical Center and Asan Medical Center. A total of 332 premenopausal patients with HR+/HER2+ breast cancer who achieved pCR after anti-HER2 containing NAC (2008 - 2021) were included. Patients were categorized according to GnRHa use during adjuvant endocrine therapy. The primary endpoints were disease-free survival (DFS) and distant metastasis-free survival (DMFS), analyzed using Cox proportional hazards regression and the Kaplan-Meier method. RESULTS: Among 332 patients, 218 (65.7%) did not receive GnRHa and 114 (34.3%) did. With a median follow-up of 65.8 months, clinical nodal stage (cN3) was identified as an independent adverse prognostic factor for both DFS (HR 5.92, p < 0.001) and DMFS (HR 13.60, p < 0.001). In contrast, GnRHa use was not significantly associated with survival outcomes. Patients with cN3 disease showed significantly worse outcomes than those with cN0-2 (5-year DFS: 80.0%% vs 96.2%; DMFS: 87.5% vs 97.9%). No clear survival differences were observed according to GnRHa use. Subgroup analyses showed no significant association between GnRHa and survival, although a trend toward improved outcomes was observed in the cN3 subgroup. CONCLUSION: Prognostic heterogeneity persists among premenopausal HR+/HER2+ patients achieving pCR, with baseline nodal status as a key determinant of outcomes. GnRHa was not associated with improved survival overall, although a potential benefit in high-risk subgroups cannot be excluded. These findings support a risk-adapted approach to adjuvant endocrine therapy rather than uniform intensification.
AGO Breast Committee recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2026.
Banys-Paluchowski M, Solbach C, Kühn T … +45 more , Müller V, Ditsch N, Fehm T, Albert US, Bartsch R, Bauerfeind I, Blohmer JU, Budach W, Dall P, Fallenberg EM, Fasching PA, Friedrich M, Gluz O, Harbeck N, Hartkopf A, Heil J, Hörner-Rieber J, Huober J, Janni W, Kreipe HH, Krug D, Kümmel S, Loibl S, Lüftner D, Lux MP, Maass N, van Mackelenbergh MT, Mundhenke C, Park-Simon TW, Reinisch M, Rhiem K, Rody A, Schmidt M, Schneeweiss A, Schütz F, Sinn HP, Solomayer EF, Stickeler E, Untch M, Witzel I, Wöckel A, Wuerstlein R, Reimer T, Bjelic-Radisic V, Thill M
Eur J Surg Oncol · 2026 Jul · PMID 42173036 · Publisher ↗
The German Guideline Committee (AGO: Working Group on Gynecologic Cancers) updated its yearly recommendations on the diagnosis and treatment of breast cancer in March 2026. Chapters on oncological and oncoplastic-reconst...
The German Guideline Committee (AGO: Working Group on Gynecologic Cancers) updated its yearly recommendations on the diagnosis and treatment of breast cancer in March 2026. Chapters on oncological and oncoplastic-reconstructive surgery are coordinated with the Working Group for Plastic, Aesthetic, and Reconstructive Surgery in Gynecology (AWOgyn). The most important changes include the ommission of sentinel lymph node biopsy (SLNB) and preffered axillary staging in patients with node-positive breast cancer undergoing neoadjuvant chemotherapy (NACT). Targeted axillary dissection (TAD) is endorsed as the method of choice [AGO ++] in patients converting from cN + to ycN0 status, and other de-escalated techniques (SLNB, target lymph node biopsy [TLNB]) are also possible options [AGO +]. Following NACT, ALND is indicated only when macrometastatic disease is detected in the sentinel and/or in the target lymph node.
Characteristics and outcome of intra-abdominal desmoid-type fibromatosis.
Penel N, Toulmonde M, Wallet J … +15 more , LE Cesne A, Bonvalot S, Corradini N, Valentin T, Chaigneau L, Bertucci F, Guillemet C, Bay JO, Dubray-Longeras P, Kurtz JE, Salas S, Bozec L, Thery J, Le Deley MC, Blay JY
Eur J Surg Oncol · 2026 Jul · PMID 42173035 · Publisher ↗
INTRODUCTION: Data about intra-abdominal desmoid-type fibromatosis (IA-DTFs) are limited. METHODS: We examined patients with IA-DTFs enrolled in the ALTITUDES study (NCT02867033). We compared their characteristics with t...
INTRODUCTION: Data about intra-abdominal desmoid-type fibromatosis (IA-DTFs) are limited. METHODS: We examined patients with IA-DTFs enrolled in the ALTITUDES study (NCT02867033). We compared their characteristics with those of other locations using chi-square and Wilcoxon tests, as appropriate, and assessed their outcomes using event-free survival (EFS). Association between primary location and EFS was determined using a Cox univariate model. Subgroup analysis was performed for patients initially managed with active surveillance (AS). RESULTS: 95/610 tumors (15.5%) enrolled in ALTITUDES were intra-abdominal. Compared with other locations, patients with IA-DTFs were older (p < 0.001), more often men (p < 0.001), had more frequently a history of polyposis (p = 0.001), larger tumors (p = 0.003), different CTNNB1 mutation profiles (p = 0.004), and a diagnosis established more frequently on surgical specimens (p < 0.001). These patients reported less pain (p = 0.01) and fewer emotional difficulties (p = 0.001), but more constipation (p = 0.004). Surgery was the most common first-line approach (51.6%); AS accounted for the management of only 29.5%. Overall, we observed no significant difference between IA-DTFs and other locations in terms of EFS (hazard ratio, HR = 0.84; 95%CI, 0.56-1.26) and overall survival (HR = 1.84; 0.50-6.80). Among patients managed by AS, EFS was similar between both groups (HR = 1.05; 0.55-2.00). CONCLUSION: One third of IA-DTFs patients were managed using AS, and their outcome was similar to those of patients with other locations. These observational data may help to discuss SA as a first-line approach in the management of IA-DTFs patients.
International practice patterns and perceptions of pressurised intraperitoneal aerosol chemotherapy for management of gastric cancer: A global clinician survey.
Kaur H, Silva TN, Wright JA … +5 more , Woods SL, Price T, Hewett P, Trochsler M, PIPAC Collaborative Group
Eur J Surg Oncol · 2026 Jul · PMID 42173034 · Publisher ↗
BACKGROUND: Gastric cancer with peritoneal metastases remains a major clinical challenge, with poor prognosis and limited benefit from systemic therapy. PIPAC is an emerging locoregional option used mainly in the palliat...
BACKGROUND: Gastric cancer with peritoneal metastases remains a major clinical challenge, with poor prognosis and limited benefit from systemic therapy. PIPAC is an emerging locoregional option used mainly in the palliative setting, however international practice remains heterogenous, particularly with respect to patient selection, chemotherapy regimens, and response assessment. This study aimed to capture international practice patterns and identify areas of consistency, variation and evidence gaps in the use of PIPAC for gastric cancer. METHODS: A 44-question online survey was distributed electronically via the International Society for the Study of Pleura and Peritoneum (ISSPP) and directly to expert clinicians involved in the use of PIPAC for gastric cancer management. The survey examined clinician and centre-level practices pertaining to patient selection, intraperitoneal chemotherapy protocols and perceived utility and limitations of this approach in managing gastric cancer. RESULTS: Complete responses were obtained from 80 clinicians representing 62 centres across 28 countries. Marked international variability was observed in patient selection, treatment intent, and response assessment. However, several areas of consistencies were identified, including predominant use of cisplatin/doxorubicin-based regimens, similar procedural approaches, and reliance on intraoperative, radiological, and pathological regression grading to assess treatment response. Lack of high-quality prospective evidence was consistently identified as the principal barrier to broader adoption and standardisation. CONCLUSION: This international survey provides comprehensive insight into clinician decision making in the use of PIPAC for gastric cancer. The findings demonstrate heterogeneity and emerging areas of practice convergence, and may inform pathway development, priorities for prospective research and future standardisation efforts.
Using agile development methodology to develop a decision aid for complex rectal cancer.
Williams A, Woods F, O'Neill C … +12 more , Hutchings H, Quyn A, Gilbert A, Duff M, Jenkins JI, Taylor C, Griffiths B, Drew P, Gill N, Harris D, Evans M, Harji D
Eur J Surg Oncol · 2026 Jul · PMID 42173033 · Publisher ↗
INTRODUCTION: Approximately 5-10% of rectal cancer diagnoses are locally advanced (LARC) at presentation and between 4 and 8% recur locally after initial treatment, locally recurrent rectal cancer (LRRC). For patients di...
INTRODUCTION: Approximately 5-10% of rectal cancer diagnoses are locally advanced (LARC) at presentation and between 4 and 8% recur locally after initial treatment, locally recurrent rectal cancer (LRRC). For patients diagnosed with LARC/LRRC pelvic exenteration (PE) may be potentially curative, but is likely to impact on subsequent quality of life (QoL). To make optimal decisions about their treatment options patients need high quality detailed comprehensible information. To date there are no validated patient decision aids (PtDA) to facilitate the process of shared decision making (SDM) for PE patients. The aim of this study was to develop a PtDA in line with international minimum standards. METHODS AND ANALYSIS: A national, multi-centre mixed methods study was designed in keeping with guidance from the International Patient Decision Aids Standard (IPDAS). Ethical approval was obtained. A PtDA was developed by a multidisciplinary committee of clinicians and patient advocates using Agile Cycle Development (ADM). Content was informed by literature review and qualitative patient and clinician interviews. Face validity and field testing were undertaken using mixed-methods of interviews and questionnaires; QQ-10, EORTC PATSAT-C33 and Preparation for Decision-Making Scale (Prep-DM). RESULTS: Six sprint cycles were used to develop the content of the PtDA. Qualitative interviews were undertaken with 19 patients and 9 clinicians resulting in 50 changes. Mean scores for value and burden were 89% (SD = 12.1) and 8% (SD = 8.5), respectively, suggesting high value and low burden for most patients. PtDA use resulted in improved satisfaction in all domains (p < 0.05). Pre and post implementation Prep-DM score was 66.8% (SD = 11.8) and 91.5% (SD = 8.9%), respectively (p < 0.001). DISCUSSION: This validated PtDA supports SDM for patients considering PE. A future study on implementation once the PtDA is used in routine practice will determine any further barriers to implementation.
Wide resection margin fails to demonstrate improved survival outcomes in early-stage hepatocellular carcinoma following anatomical resection: A propensity score-matched analysis from two tertiary centers.
Yang H, Yang Y, Shen S … +4 more , Wu S, Chen H, Zhang K, Xiang B
Eur J Surg Oncol · 2026 Jul · PMID 42150294 · Publisher ↗
BACKGROUND: The influence of wide resection margins (RM) on long-term outcomes in hepatocellular carcinoma (HCC) patients undergoing anatomical resection (AR) remains underexplored. This study aims to comprehensively eva...
BACKGROUND: The influence of wide resection margins (RM) on long-term outcomes in hepatocellular carcinoma (HCC) patients undergoing anatomical resection (AR) remains underexplored. This study aims to comprehensively evaluate the clinical implications of wide versus narrow resection margins by analyzing multiple prognostic indicators. PATIENTS AND METHODS: A multicenter database identified HCC patients who had undergone AR.Early recurrence rates, recurrence patterns, postoperative complications,90-day mortality, overall survival(OS),disease-free survival(DFS),and potential risk factors were analyzed in HCC patients using propensity score matching(PSM),COX regression analysis and subgroup analysis. RESULTS: The study cohort comprised 538 HCC patients, stratified into wide (n = 217) and narrow (n = 321) resection margin groups. PSM analysis revealed comparable OS and DFS outcomes between the two groups (both p > 0.05). Comparative analysis showed no statistically significant differences in early recurrence rates, recurrence patterns (intrahepatic, extrahepatic, or combined), or 90-day mortality rates, either before or after PSM adjustment (all P > 0.05). However, analysis of postoperative complications revealed significantly higher rates of post-hepatectomy liver failure (PHLF) and ascites in the wide resection margin group compared to the narrow margin group, consistent across both pre-PSM and post-PSM analyses (all P < 0.05). Multivariate Cox regression analysis showed that neither microvascular invasion (MVI) status nor resection margin width independently predicted improved OS or DFS. In subgroup analyses, wide RM improved DFS in HCC patients at intermediate stage (BCLC stage B), but not in those at early stage (BCLC stage 0/A). CONCLUSIONS: Wide RM may benefit HCC patients at intermediate stage (BCLC stage B), but not those at early stage (BCLC stage 0/A) undergoing AR.
Ultrasound-guided preoperative progressive pneumoperitoneum to facilitate pressurized intraperitoneal aerosol chemotherapy in inoperable peritoneal carcinomatosis.
Pardo-Garcia C, Abadal JM, Galvez-Gonzalez E … +2 more , Echegaray N, Cortes-Guiral D
Eur J Surg Oncol · 2026 Jul · PMID 42143795 · Publisher ↗
INTRODUCTION: Approximately 5% of patients with peritoneal carcinomatosis are excluded from pressurized intraperitoneal aerosol chemotherapy (PIPAC) due to a "non-accessible abdomen" caused by extensive adhesions. Preope...
INTRODUCTION: Approximately 5% of patients with peritoneal carcinomatosis are excluded from pressurized intraperitoneal aerosol chemotherapy (PIPAC) due to a "non-accessible abdomen" caused by extensive adhesions. Preoperative progressive pneumoperitoneum (PPP) is traditionally used in complex hernia repair but has not been applied to facilitate PIPAC. This study evaluates the feasibility and safety of ultrasound-guided PPP to overcome this technical barrier. MATERIALS AND METHODS: A prospective study was conducted in five patients with histologically confirmed inoperable peritoneal carcinomatosis and a pre-established non-accessible abdomen. PPP was performed using controlled, intermittent air insufflation via a percutaneous catheter placed under ultrasound guidance with hydrodissection. Pre-PIPAC computed tomography confirmed adequate intra-abdominal volume for safe laparoscopic access. Primary outcomes were technical success (successful laparoscopic access and PIPAC delivery) and safety (complications and 30-day mortality). RESULTS: The combined PPP-PIPAC approach achieved 100% technical and clinical success. All five patients underwent successful transformation of non-accessible abdomens to accessible ones, enabling safe laparoscopic PIPAC or electrostatic PIPAC (ePIPAC) delivery. No procedure-related complications or adverse events occurred during the 30-day post-procedure period. High clinical tolerability was observed across repeated treatment cycles. CONCLUSION: Ultrasound-guided PPP with hydrodissection successfully transforms non-accessible abdomens into accessible ones, enabling safe PIPAC delivery in previously excluded patients. This novel, reproducible approach provides a practical solution to a common technical limitation in surgical oncology, potentially expanding treatment eligibility by approximately 5% for patients with peritoneal carcinomatosis.
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