Eur J Surg Oncol [JOURNAL]
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200 papers
Thromboprophylaxis, pain and organization: How do expert centers manage PIPAC's perioperative care? An international survey.
Fawaz J, Hübner M, Ezanno AC … +7 more , Taibi A, Kepenekian V, Eveno C, Alyami MS, Malgras B, Pocard M, Collaborative Authorship Group
Eur J Surg Oncol · 2026 Jul · PMID 42143535 · Publisher ↗
INTRODUCTION: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is an emerging therapeutic option for peritoneal carcinomatosis, offering improved drug distribution and tissue penetration. Although clinical outcom...
INTRODUCTION: Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) is an emerging therapeutic option for peritoneal carcinomatosis, offering improved drug distribution and tissue penetration. Although clinical outcomes have been encouraging, international guidelines for perioperative management - including pain control and thromboprophylaxis - are still lacking. MATERIALS AND METHODS: A global online survey was distributed to PIPAC practitioners to corresponding authors of published PIPAC studies and members of the International Society for the Study of Pleura and Peritoneum (ISSPP). The questionnaire consisted of 24 closed-ended questions covering five domains: institutional experience, perioperative organization, thromboprophylaxis, biological monitoring, and postoperative pain management. Consensus was defined as ≥70% agreement among respondents. RESULTS: Out of 300 contacted experts, 125 responded (42% overall response rate), representing 68 centers across 27 countries (71.2% from Europe). Consensus was reached for four items: performing a surgical or oncological consultation before each PIPAC procedure (74.59%), conducting pre and postoperative laboratory tests (89.43% and 70.73% respectively) and the non-use of non-medicated thromboprophylaxis (70.97%). Pharmacological thromboprophylaxis was prescribed in 63.71% of centers, mainly low-molecular-weight heparin, up to 7 days in 33% of centers, up to 21 days in 33%, and limited to the in-hospital stay in 22%. Otherwise, anesthetic consultations were systematically performed in 57.26% of centers. Outpatient procedures (<24 h) were performed in 11.29%, while 41.94% and 34.68% of patients were hospitalized for one and two days respectively. Paracetamol was the first-line analgesic and was used in more than 80% of cases on postoperative day 1. A significant difference was observed regarding the use of morphine PCA, which was more frequently prescribed after oxaliplatin-based PIPAC (p = 0.013). DISCUSSION: This international survey highlights substantial heterogeneity in perioperative care practices. Although PIPAC and cytoreductive surgery are performed for peritoneal metastases, pharmacological thromboprophylaxis appears to be less frequently prescribed in the PIPAC settings. Pre-PIPAC consultation and perioperative biological monitoring are more standardized, although noteworthy variations persist. These findings underscore the need for evidence-based international guidelines to harmonize perioperative management and improve patient outcomes in PIPAC.
Extent of liver resection for incidental gallbladder cancer: Anatomic versus nonanatomic approaches in T2-T3 disease.
Saboor F, Min G, Lu J
Eur J Surg Oncol · 2026 Jul · PMID 42143534 · Publisher ↗
BACKGROUND: Incidental gallbladder cancer (IGBC) is increasingly diagnosed after cholecystectomy performed for presumed benign disease. For T2 and selected T3 tumors, completion radical re-resection with liver resection...
BACKGROUND: Incidental gallbladder cancer (IGBC) is increasingly diagnosed after cholecystectomy performed for presumed benign disease. For T2 and selected T3 tumors, completion radical re-resection with liver resection and regional lymphadenectomy is recommended, but the optimal hepatic extent-nonanatomic wedge resection versus anatomic segment IVb/V resection-remains debated. METHODS: This narrative review summarizes evidence from IGBC-specific series and registries, international multicenter cohorts, meta-analyses, and contemporary consensus guidelines comparing wedge resection and segment IVb/V resection for T2-T3 gallbladder cancer, with emphasis on oncologic outcomes, perioperative morbidity, and the evolving role of systemic therapy. RESULTS: Across contemporary cohort studies and meta-analyses, margin-negative wedge resection appears to provide long-term oncologic outcomes comparable to segment IVb/V resection for T2 disease, while segment IVb/V is consistently associated with higher perioperative morbidity. Tumor location (T2a vs T2b) may correlate with prognosis, but does not independently mandate greater liver volume when nodal and margin status are considered. In IGBC, outcomes are driven primarily by nodal involvement, residual disease, and margin status rather than by the specific hepatic volume removed. For T3 and other high-risk presentations, large international datasets suggest limited incremental benefit from escalation to major hepatectomy or routine extrahepatic bile duct resection, although bile duct resection is indicated when the cystic duct margin is positive. Neoadjuvant systemic therapy is increasingly considered in selected borderline-resectable or node-positive disease to enable biologic selection and improve the likelihood of achieving an R0 resection with limited hepatic excision. CONCLUSIONS: For T2 IGBC, a parenchyma-sparing, margin-negative wedge resection of the gallbladder bed combined with high-quality regional lymphadenectomy appears to provide oncologic outcomes comparable to segment IVb/V resection in most patients. Current evidence does not demonstrate a consistent survival advantage for routine segment IVb/V resection. In T3 and high-risk disease, surgical strategy should prioritize biologic selection and integration of systemic therapy, with hepatic extent tailored to margin requirements rather than routine escalation.
Perioperative and oncologic outcomes of vascular resection after neoadjuvant therapy in intrahepatic cholangiocarcinoma.
Dong Y, Pereyra D, Li Z … +10 more , Podrascanin V, Santol J, Ammann M, Kankeu Fonkoua LA, Graham RP, Conboy CB, Tran NH, Warner SG, Smoot RL, Starlinger PP
Eur J Surg Oncol · 2026 Jul · PMID 42143533 · Publisher ↗
BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA) with major vascular involvement is a technically challenging and biologically aggressive clinical scenario. Although vascular resection (VR) can be performed at experien...
BACKGROUND: Intrahepatic cholangiocarcinoma (iCCA) with major vascular involvement is a technically challenging and biologically aggressive clinical scenario. Although vascular resection (VR) can be performed at experienced centers, the oncologic value of this approach depends on appropriate patient selection. We evaluated whether neoadjuvant therapy (NAT) may improve selection and outcomes among patients undergoing hepatectomy with concomitant VR. METHODS: A single-institution cohort study of 349 patients who underwent resection for histologically confirmed iCCA between 2000 and 2024 was performed. Patients were stratified by VR status and, within the VR cohort, by receipt of NAT. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier methods and Cox regression, including an interaction term between NAT and VR. RESULTS: Twenty-eight patients (8.0%) underwent major VR, including 11 who received NAT. Compared with patients without VR, those undergoing VR had higher-risk disease and higher 90-day mortality, but similar long-term survival. Within the VR cohort, NAT-treated patients had more adverse baseline clinicopathologic features, yet recurrence occurred less frequently than after upfront VR (27% vs. 82%; p = 0.006). In adjusted analyses restricted to the VR cohort, NAT was associated with improved RFS (HR 0.21; p = 0.041). In the full cohort, the NAT×VR interaction was borderline significant (HR 0.27; p = 0.050), suggesting a potential concentration of the NAT-associated RFS benefit among patients requiring VR. CONCLUSIONS: In patients with iCCA requiring major vascular resection, NAT may improve biologic selection and may be associated with more favorable recurrence-free outcomes despite adverse baseline disease features. Given the small NAT + VR subgroup, these results should be interpreted as hypothesis-generating and warrant validation in larger prospective multicenter cohorts.
Subcentimeter thyroid nodules: Diagnostic challenges, risk stratification and management in contemporary surgical oncology practice.
Bekker J, Repanos C, Nixon I … +1 more , Wreesmann V
Eur J Surg Oncol · 2026 Jul · PMID 42140030 · Publisher ↗
Subcentimeter thyroid nodules, defined as those measuring less than 10 mm in maximum diameter, represent a growing diagnostic and surgical oncology challenge. The proliferation of neck ultrasonography has dramatically in...
Subcentimeter thyroid nodules, defined as those measuring less than 10 mm in maximum diameter, represent a growing diagnostic and surgical oncology challenge. The proliferation of neck ultrasonography has dramatically increased their incidental detection, yet existing risk stratification systems were validated predominantly in larger nodule cohorts. This is a narrative review of contemporary evidence, incorporating data from the ElaTION randomised controlled trial, the recent 2026 BTA/BAETS Joint Consensus Statement, and service-level analyses from a single UK centre, to evaluate the diagnostic performance, risk stratification and optimal management of subcentimeter thyroid nodules. Paradoxically, referred nodules under 10 mm carry a malignancy rate of 38.3% - exceeding larger nodules - reflecting selection enrichment in the investigated cohort. Nevertheless, the majority of thyroid microcarcinomas are clinically indolent, and former BTA guidance has driven disproportionate fine-needle aspiration cytology (FNAC) and surgical activity without commensurate diagnostic yield. The 2026 BTA/BAETS consensus introduces size-stratified FNAC thresholds and removes vascularity as a primary risk stratification feature, aligning UK practice with international TIRADS approaches.
Defining disease recurrence after curative treatment of esophageal cancer: a literature review.
Huizer TJ, Schulte JB, Beerepoot LV … +8 more , Mohammad NH, Jeene PM, Kouwenhoven EA, Meijer SL, Pouw RE, Verhoeven RHA, Wijnhoven BPL, Dutch Upper GI Cancer Group (DUCG)
Eur J Surg Oncol · 2026 Jul · PMID 42134281 · Publisher ↗
BACKGROUND: Despite aggressive multimodal treatment, disease recurs in 30-40% of patients with esophageal cancer. In selected patients with isolated locoregional recurrence (LRR), radical treatment may lead to long-term...
BACKGROUND: Despite aggressive multimodal treatment, disease recurs in 30-40% of patients with esophageal cancer. In selected patients with isolated locoregional recurrence (LRR), radical treatment may lead to long-term survival. Lack of consensus on the definition of LRR complicates the selection of optimal treatment strategies. This study aimed to review the literature on the definition of LRR. METHODS: A systematic search of Embase and Medline Ovid databases was conducted to identify studies reporting on LRR after curative treatment for advanced esophageal cancer. Data on the definition of LRR, the staging system used, and the treatment strategies were extracted and tabulated. The primary outcome was the definition of LRR by anatomical site and the staging system used. Secondary outcomes included treatment strategies and outcomes for LRR. RESULTS: In total, 2856 studies on LRR after esophageal cancer treatment were identified, of which 44 were included and assessed. There was substantial variation in the anatomical location of LRR, with only six studies referring to TNM staging manuals for defining recurrence. Treatment and outcome for LRR were infrequently reported with considerable variation. CONCLUSION: Definitions of LRR after curative treatment for esophageal cancer are inconsistent. Standardization of LRR is needed to improve comparability across studies and guide clinical management.
Contemporary short-term post-operative outcomes after resection of entero-pancreatic NETs: a population-based study.
Meloche-Dumas L, Singh S, Law C … +4 more , Chan WC, Ding A, Armah J, Hallet J
Eur J Surg Oncol · 2026 Jul · PMID 42134280 · Publisher ↗
BACKGROUND: Surgery is a cornerstone of management for neuroendocrine tumors (NETs), but outcomes vary. It is critical to understand the real-world morbidity profile of surgery to optimize patient selection and outcomes....
BACKGROUND: Surgery is a cornerstone of management for neuroendocrine tumors (NETs), but outcomes vary. It is critical to understand the real-world morbidity profile of surgery to optimize patient selection and outcomes. We examined short-term outcomes after resection for entero-pancreatic NETs. METHODS: We performed a population-based retrospective cohort study of adults with entero-pancreatic NETs (2000-2023). The outcome was 90-day major morbidity (Clavien-Dindo 3-5) and 90-day days-at-home after surgery (90-DAH). Logistic regression examined factors associated with outcomes for each type of surgery. RESULTS: Of 3699 surgeries for entero-pancreatic NETs, 30.5% involved a pancreatic primary, and 58.6% had metastases. 90-day major morbidity was 24.4% after all surgeries, including 26.9% after hepatectomy, 30.3% after pancreatectomy, 21.3% after enterectomy, and 30.4% after combined resection. 90-day mortality was 3.4% overall, with 4.0%, 1.7%, and 4.1% after hepatectomy, pancreatectomy, and enterectomy, respectively. Combined resection (OR 1.44; 95%CI 1.08-1.94) and pancreatoduodenectomy (OR 2.35; 95%CI 1.77-3.12), as well as age (OR 1.21; 95%CI 1.14-1.29) and higher comorbidity burden (OR 1.56; 95%CI 1.20-2.01) were independently associated with increased odds of 90-day major morbidity. Median DAH-90 was 82 (IQR: 77-84) overall and did not differ by surgery type. Combined hepatectomy, pancreatoduodenectomy, and higher comorbidity were independently associated with fewer 90-DAH. CONCLUSION: Approximately 1 out of 4 patients experienced 90-day major morbidity after surgery for NETs and mortality below 5%. Most patients spent most of the time at home after surgery for NETs. This information is important to counsel patients, inform discussions about treatment options, and set expectations for post-operative recovery.
Robotic-assisted gastrectomy for 700 gastric cancer patients: A comparative analysis between specialized centers in Italy and Korea.
Carbone L, Cho YS, Kang MK … +22 more , Park K, Fortuna L, Giuliani G, Andreucci E, Wang S, Kim C, Kim SH, Kim J, Coratti F, Guerra F, Visani A, Kwak Y, Lee HS, Suh YS, Kong SH, Yang HK, Cianchi F, Coratti A, Roviello F, Lee HJ, Marrelli D, Park DJ
Eur J Surg Oncol · 2026 Jul · PMID 42127609 · Publisher ↗
INTRODUCTION: Robotic surgery is a safe approach for gastric cancer. Most available evidence originates from East Asia, while data from European centers remain limited. This study aims to compare surgical and oncological...
INTRODUCTION: Robotic surgery is a safe approach for gastric cancer. Most available evidence originates from East Asia, while data from European centers remain limited. This study aims to compare surgical and oncological outcomes between different countries, focusing on the number of lymph node retrieved. MATERIALS AND METHODS: We included adult patients who underwent curative-intent distal or total robotic gastrectomy for gastric cancer between 2017 and 2024 at specialized centers in Tuscany (Italy) and the Seoul National University Hospital (South Korea). RESULTS: A total of 700 patients were enrolled, including 232 Italian and 468 Korean patients. Western patients were older, had a higher comorbidity burden, and had more advanced disease (64.7% vs. 28.6%). Neoadjuvant chemotherapy and D2 lymphadenectomy were more frequently performed in Western centers, whereas D1+ was preferred in Eastern centers (p < 0.001). Median node retrieved was 34 (West 38 vs. East 33 nodes), exceeding oncological thresholds (>15) across all pathological stages. Lymph node retrieved increased with pT stage and was independent of age, while higher BMI was associated with lower nodal retrieval (31 vs. 35 nodes). Postoperative surgical complications were higher in the Western cohort (13.4% vs. 8.1%, p = 0.029), with an increased rate of anastomotic leakage (p < 0.001). Length of stay and perioperative mortality were comparable between centers. CONCLUSION: Robotic gastrectomy ensures adequate lymphadenectomy and acceptable perioperative outcomes in both Italian and Korean centers. Observed differences in operative efficiency, morbidity, and survival mainly reflect variations in patient selection and disease stage rather than surgical quality, supporting centralization and earlier diagnosis at Western populations.
Prognostic value of the SENTIREC-endo algorithm integrating sentinel lymph node and FDG-PET/CT in staging high-risk endometrial cancer.
Holm J, Bjørnholt SM, Gerke O … +9 more , Vilstrup MH, Loft A, Dias AH, Schledermann D, Mejlgaard E, Sponholtz SE, Jochumsen KM, Hildebrandt MG, Jensen PT
Eur J Surg Oncol · 2026 Jul · PMID 42127608 · Publisher ↗
INTRODUCTION: Lymph node metastasis is a significant negative prognostic factor in women with high-risk endometrial cancer. The SENTIREC-endo algorithm, combining sentinel lymph node mapping and FDG-PET/CT for targeted p...
INTRODUCTION: Lymph node metastasis is a significant negative prognostic factor in women with high-risk endometrial cancer. The SENTIREC-endo algorithm, combining sentinel lymph node mapping and FDG-PET/CT for targeted pelvic and paraaortic lymph node dissection has shown high diagnostic accuracy. This study investigated whether the SENTIREC-endo algorithm showed similar prognostic discrimination to systematic lymphadenectomy within the same cohort. METHODS: In a prospective national non-randomized cohort (2017-2023), women with high-risk endometrial cancer underwent the SENTIREC-endo algorithm, including sentinel node mapping, resection of suspicious and/or FDG-PET-positive nodes, followed by systematic lymph node dissection. Within the cohort, we compared time to progression and mortality between node-positive and node-negative groups, as defined by the algorithm versus systematic dissection. We also assessed the prognostic value and diagnostic accuracy of lymphovascular space invasion (LVSI) and evaluated associated prognostic variables. RESULTS: The SENTIREC-endo algorithm demonstrated significant discrimination in survival outcomes (p = 0.001), with Kaplan-Meier curves paralleling systematic lymphadenectomy, supporting its prognostic performance. LVSI showed a strong prognostic association (p = 0.0004) but low sensitivity for detection of nodal metastasis (38%, 95% CI 24-54%), suggesting prognostic independence from lymph node status. FDG-PET/CT combined with LVSI lacked sufficient prognostic accuracy to replace surgical staging. CONCLUSION: The SENTIREC-endo algorithm showed similar prognostic discrimination as systematic lymphadenectomy within the same cohort of high-risk endometrial cancer. LVSI remained an essential prognostic marker but was unsuitable for predicting nodal metastasis. Our findings support surgical lymph node dissection with validated targeted dissection should remain part of standard staging of women with high-risk endometrial cancer.
Identifying patients with apparent early-stage ovarian cancer at very low risk of lymph node metastasis: a multicenter preoperative prediction model.
Descargues P, Selfort L, Maucort Boulch D … +20 more , Del M, Lecointre L, Valery C, Azais H, Duong C, Delvallée J, Costaz H, Lien Tran P, Campan V, Deluche E, Garcia P, Scattarelli A, Montero-Macias R, Poirier L, Perrin M, Chanudet L, Camilli H, Péron J, Gertych W, Bolze PA
Eur J Surg Oncol · 2026 Jul · PMID 42127607 · Publisher ↗
OBJECTIVE: Systematic pelvic and para-aortic lymphadenectomy is recommended for surgical staging in presumed early-stage epithelial ovarian cancer, although lymph node metastases occur in only a minority of patients and...
OBJECTIVE: Systematic pelvic and para-aortic lymphadenectomy is recommended for surgical staging in presumed early-stage epithelial ovarian cancer, although lymph node metastases occur in only a minority of patients and the procedure is associated with significant morbidity. We aimed to develop and validate a predictive model based on variables available prior to lymphadenectomy within a two-step surgical strategy for identifying patients at very low risk of lymph node metastasis. METHODS: We conducted a multicenter retrospective study including patients with presumed early-stage high-grade epithelial ovarian cancer treated in 12 French centers between January 2018 and December 2023. All patients underwent comprehensive surgical staging including systematic pelvic and para-aortic lymphadenectomy. Three prediction algorithms were evaluated: logistic regression, random forest, and extreme gradient boosting (XGBoost). Model performance was assessed using repeated stratified 5 × 5 cross-validation. A predefined probability threshold of 0.98 defined very low risk of nodal metastasis (≤2%). RESULTS: A total of 219 patients were included. Lymph node metastases were identified in 26 patients (12%). Among the evaluated algorithms, XGBoost achieved the best trade-off between safety and clinical applicability. The final model included five preoperative variables: cytology, bilateral ovarian involvement, age ≥60 years, BMI ≥25, and CA-125 ≥ 100 IU/mL. Using the predefined threshold, the model classified 42% of patients as very low risk of lymph node metastasis with only one false-negative prediction. CONCLUSIONS: This multicenter study supports the feasibility of a simple preoperative model to identify a substantial subgroup of patients with apparent early-stage ovarian cancer at very low risk of lymph node metastasis. If externally validated, this approach may help refine patient selection and reduce unnecessary lymphadenectomy.
Evaluating adherence to literature-derived systemic therapy standards for resectable intrahepatic cholangiocarcinoma: A systematic review and cohort study.
Russell B, Philips P, Scoggins CR … +3 more , Egger M, McMasters K, Martin RCG
Eur J Surg Oncol · 2026 Jul · PMID 42127606 · Publisher ↗
IMPORTANCE: Intrahepatic cholangiocarcinoma (iCCA) is frequently grouped with other biliary tract cancers (BTC) in studies evaluating neoadjuvant and adjuvant systemic therapies, despite known biologic and clinical heter...
IMPORTANCE: Intrahepatic cholangiocarcinoma (iCCA) is frequently grouped with other biliary tract cancers (BTC) in studies evaluating neoadjuvant and adjuvant systemic therapies, despite known biologic and clinical heterogeneity. As a result, treatment paradigms for resectable iCCA are largely extrapolated from mixed BTC populations, and iCCA-specific randomized data remain limited. OBJECTIVE: To evaluate whether receipt of systemic therapy consistent with literature-derived standards is associated with overall survival (OS) among patients undergoing resection or ablation for iCCA at a single institution. DESIGN: A systematic review of the literature was performed to identify studies informing systemic therapy regimens and treatment duration relevant to iCCA. Based on trial design and treatment exposure across these studies, thresholds for therapy adequacy were defined as ≥2 months of neoadjuvant therapy and ≥6 months of adjuvant therapy using gemcitabine-based regimens or capecitabine. These definitions were applied retrospectively to a prospectively maintained institutional database of patients treated for iCCA between April 1997 and June 2025. OS was compared between patients receiving adequate versus inadequate therapy in both the neoadjuvant and adjuvant settings. RESULTS: Eighty-two patients underwent resection or ablation for iCCA, with a median OS of 53.6 months (95% CI 33.9-84.6). Among patients with evaluable neoadjuvant treatment data (n = 34), those receiving ≥2 months of therapy demonstrated a numerically longer median OS compared with those receiving shorter or no therapy (77.6 vs. 38.1 months), though this difference did not reach statistical significance. Among patients with evaluable adjuvant treatment data (n = 38), receipt of ≥6 months of adjuvant therapy was associated with longer median OS compared with inadequate or no adjuvant therapy (93.6 vs. 48.4 months). CONCLUSIONS: In this single-institution cohort, receipt of systemic therapy consistent with literature-derived standards was associated with prolonged overall survival following surgical treatment of iCCA, particularly in the adjuvant setting. These findings support continued adherence to established adjuvant treatment durations and suggest a potential role for neoadjuvant therapy in select patients with resectable iCCA. Prospective, iCCA-specific trials are needed to define optimal perioperative systemic treatment strategies.
CT assessment of body composition and liver fat fraction predicts prognosis in gastric cancer.
Xiao GL, Huang ZN, Wang Y … +10 more , Wu DZ, Liu R, Luo SK, Tu RH, Lin GT, Lin M, Xie JW, Huang CM, Lin JX, Zheng CH
Eur J Surg Oncol · 2026 Jul · PMID 42127605 · Publisher ↗
BACKGROUND: Prognosis in gastric cancer (GC) is closely linked to patients' nutritional and metabolic status. Although CT can evaluate body composition at different sites, few studies have combined these indicators for p...
BACKGROUND: Prognosis in gastric cancer (GC) is closely linked to patients' nutritional and metabolic status. Although CT can evaluate body composition at different sites, few studies have combined these indicators for prognostic prediction. METHODS: We retrospectively analyzed GC patients who underwent radical gastrectomy at two medical centers. Patients were randomly divided into a training cohort and a validation cohort at a 7:3 ratio. Preoperative CT images were used to quantify body composition and liver fat content. Cox regression identified prognostic indicators, and a combined score was constructed. A prognostic model integrating the combined score and clinicopathological factors was then constructed and compared with the pTNM staging system. RESULTS: A total of 696 patients were included. Skeletal muscle density (SMD) and CT-derived liver fat fraction (LFF) were identified as independent prognostic factors. A combined score (SMD-LFF) was developed, stratifying patients into low-, intermediate-, and high-risk groups, with 5-year overall survival rates of 86.6%, 67.6%, and 42.3%, respectively (P < 0.001). Consistent stratification was observed in the validation cohort. Multivariable analysis identified SMD-LFF, postoperative chemotherapy, lymphovascular invasion, pT stage, and pN stage as independent predictors, which were incorporated into a nomogram. The nomogram showed superior predictive performance and clinical net benefit compared with the pTNM staging system. CONCLUSION: The SMD-LFF score, combining skeletal muscle density and liver fat content, is an independent prognostic factor for GC patients. The nomogram integrating this score with clinicopathological variables outperforms the pTNM staging system in predicting postoperative survival and recurrence risk.
Hepatocellular carcinoma in the immunotherapy Era: A SEER-based era comparison across the U.S. FDA transition.
Lv TR, Huang W, Bukhari RZ … +3 more , Jin YW, Hu HJ, Li FY
Eur J Surg Oncol · 2026 Jul · PMID 42119196 · Publisher ↗
BACKGROUND: In 2020, immunotherapy entered first-line care for hepatocellular carcinoma (HCC). It remained uncertain whether population-level survival improved thereafter and whether adding immunotherapy to chemotherapy...
BACKGROUND: In 2020, immunotherapy entered first-line care for hepatocellular carcinoma (HCC). It remained uncertain whether population-level survival improved thereafter and whether adding immunotherapy to chemotherapy in routine practice was associated with additional benefit. METHODS: A population-based SEER analysis was performed among HCC diagnosed in 2018-2022. Comparative analyses were performed between cases in the immunotherapy era (IEC) versus cases in the pre-immunotherapy era (PIEC). A prespecified chemotherapy subset compared chemotherapy + immunotherapy with chemotherapy alone. Competing-risks methods (Gray's test; Fine-Gray) were applied with cancer-related death (CRD) as the event. RESULTS: In total, 12056 patients were included (PIEC 7291; IEC 4765). After matching (n = 8796), better survival was observed in IEC versus PIEC (HR 0.905, 95% CI 0.846-0.968; P = 0.004). In the matched cohort, a lower CRD risk was also observed for IEC (sHR 0.807, 95% CI 0.750-0.868; P = 7.33 × 10) with a matched-strata Gray's P = 0.0105. In the chemotherapy subset (n = 3381; PSM n = 1884), the addition of immunotherapy was not associated with a statistically significant OS advantage after adjustment (HR 0.917; P = 0.166) or after matching (HR 0.914; P = 0.218), a pattern that remained consistent in the non-surgical subgroup (matched HR 0.885; P = 0.106). The matched CRD comparison was not significant (Gray's P = 0.96), whereas an unmatched Fine-Gray model suggested a protective association (sHR 0.803, 95% CI 0.701-0.919; P ≈ 0.001). CONCLUSIONS: Diagnosis in the post-approval immunotherapy era was associated with modestly improved OS and lower CRD at the population level. However, because this was an era-based rather than regimen-level comparison, the observed association cannot be attributed solely to immunotherapy uptake.
Limited clinical utility of mutation-based circulating tumor DNA detection in pseudomyxoma peritonei.
Torgunrud A, Davidson B, Nilsen TA … +4 more , Nitschke Marcussen IK, Dagenborg VJ, Lund-Andersen C, Flatmark K
Eur J Surg Oncol · 2026 Jul · PMID 42119195 · Publisher ↗
Pseudomyxoma peritonei (PMP) is a rare abdominal cancer where curative treatment involves cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Postoperative surveillance relies on radiological imaging and...
Pseudomyxoma peritonei (PMP) is a rare abdominal cancer where curative treatment involves cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Postoperative surveillance relies on radiological imaging and blood tumor markers, which lack sensitivity and specificity. Circulating tumor DNA (ctDNA) analysis could offer a non-invasive alternative, but evidence in PMP is limited. Plasma samples from 95 PMP patients carrying KRAS and/or GNAS tumor mutations were analyzed using droplet digital PCR. Clinicopathological parameters and outcome were assessed, and disease-free survival (DFS) was analyzed using Cox regression. ctDNA was detected in 8 of 95 patients (8%), with low (median 0.1) mutated allele frequency with four positive cases at baseline, three at the time of recurrence, and one follow-up sample. Appendix tumor histology, high-grade peritoneal disease, and elevated baseline CA19-9 were independently associated with inferior DFS. Currently, mutation-based ctDNA detection cannot replace conventional postoperative surveillance for PMP patients.
Reporting of baseline characteristics in gastrointestinal cancer: A systematic review of surgical randomised controlled trials.
Bahri S, Walshaw J, Bishop L … +5 more , Stocken DD, Smith A, Lee MJ, Blencowe NS, Pathak S
Eur J Surg Oncol · 2026 Jul · PMID 42119194 · Publisher ↗
BACKGROUND: Randomised controlled trials (RCTs) underpin surgical practice, but external validity depends on transparent reporting of participant characteristics. In gastrointestinal (GI) cancer surgery, socio-demographi...
BACKGROUND: Randomised controlled trials (RCTs) underpin surgical practice, but external validity depends on transparent reporting of participant characteristics. In gastrointestinal (GI) cancer surgery, socio-demographic factors influence outcomes, yet the extent to which these are reported in surgical RCTs remains unclear. This review evaluated reporting of baseline characteristics and equality, diversity, and inclusion (EDI) considerations in contemporary trials. METHODS: Systematic searches of MEDLINE, EMBASE, and CENTRAL identified RCTs of surgical interventions for GI malignancies published in journals with an impact factor ≥7.5. Two reviewers independently screened studies and extracted data. Reporting of eligibility criteria, baseline characteristics, and equality, diversity, and inclusion (EDI)-related statements was narratively synthesised. RESULTS: Thirty-two RCTs including 9370 patients were analysed. Age and sex were reported in 93.8% of trials, and body mass index in 65.6%. No trial reported disability status, pregnancy status, ethnicity, socioeconomic status, or sexual orientation. Exclusions relating to older adults (≥80 years) and pregnancy were common, but explanations were infrequently reported. Only 40.6% of trials discussed generalisability. CONCLUSION: Reporting of participant characteristics in GI cancer surgery RCTs remains limited. Despite journal-level EDI guidance, demographic reporting beyond age and sex is uncommon, constraining assessment of external validity.
Major wound complications after conventional preoperative radiotherapy in STS patients: incidence, predictors, and timing.
Foppele GF, Duursma SL, Wiltink LM … +8 more , Lansu J, Schrage Y, van Houdt WJ, Scholten AN, Hamming-Vrieze O, Post SF, Fiocco M, Haas RL
Eur J Surg Oncol · 2026 Jul · PMID 42114423 · Publisher ↗
In 2002, a major wound complication rate (MWC) of 35% was reported in the Canadian SR-2 trial after preoperative radiotherapy (RT) in soft-tissue sarcomas (STS). Recent literature reports a lower incidence of MWC. This s...
In 2002, a major wound complication rate (MWC) of 35% was reported in the Canadian SR-2 trial after preoperative radiotherapy (RT) in soft-tissue sarcomas (STS). Recent literature reports a lower incidence of MWC. This study aims to evaluate the incidence, potential predictors, and duration of MWC over the last two decades. Data was collected from patients treated between October 2003 and October 2024, in curative setting, in a regimen of 25 fractions of 2 Gy, followed by surgery. Data was collected until 120 days post-surgery. In total, 164 patients were analyzed. The median interval between the last fraction of RT and surgery was 45 days (range 8-111). Patients had a mean age of 60.4 years (SD ± 14.0). STS were most commonly at the lower extremities (75.0%), had a mean tumor size of 9.2 cm (SD ± 5.1), and intermediate or high grade in 79.3% of the cases. The cohort was divided into subgroups: prior to 2020 and from 2020 onwards, due to the implementation of Volumetric Modulated Arc Therapy (VMAT) from 2020 onwards. MWC occurred in 26.2% of all patients, in 30.6% of patients treated before 2020, and in 17.9% of patients treated from 2020 onwards. In multivariate Cox proportional hazard regression model, treatment before 2020 (HR: 4.41, CI: 1.50-12.97), smoking (HR: 6.06, CI: 2.82-13.06), adiposity (HR: 2.73, CI: 1.27-5.89), and plastic reconstruction (HR: 2.45, CI: 1.18-5.11) were significantly associated with MWC. This study reports a lower incidence of MWC of 26.2% than historically reported. Patients treated before 2020, with adiposity, current smoking, or plastic reconstructions were at a higher risk of MWC.
Distal margin length after neoadjuvant chemoradiotherapy has no prognostic impact in low rectal cancer once the margin is microscopically negative: A multicentre equivalence analysis.
Wang X, Jiang W, Sun Y … +4 more , Tang Y, Huang Y, Chi P, LASRE Study Group
Eur J Surg Oncol · 2026 Jun · PMID 42114353 · Publisher ↗
BACKGROUND: Although neoadjuvant Chemoradiotherapy (NCRT) has been used to shorten the distal resection margin (DRM) and enable sphincter preservation, the hypothesis that-once the margin is microscopically clear-DRM len...
BACKGROUND: Although neoadjuvant Chemoradiotherapy (NCRT) has been used to shorten the distal resection margin (DRM) and enable sphincter preservation, the hypothesis that-once the margin is microscopically clear-DRM length itself no longer affects prognosis has never been tested in an equivalence trial. We examined whether any negative DRM length yields equivalent oncological outcomes. METHODS: A total of 453 patients treated at 22 Chinese centres between 2013 and 2018 were included in this post-hoc study of the multicentre LASRE trial. All patients had clinical stage II-III low rectal adenocarcinoma (≤5 cm from dentate line), completed NCRT and underwent curative-intent sphincter-preserving resection. Fresh-specimen DRM was prospectively measured to the nearest millimetre. PRIMARY ENDPOINT: 3-year disease-free survival (DFS). Equivalence margins: HR 0.90-1.11. Two one-sided tests (TOST) used α = 0.05. RESULTS: After exclusion of 5 patients with positive DRM, 73 (16.3 %) had DRM ≤1 cm, 160 (35.7 %) 1-2 cm and 215 (48.0 %) >2 cm. Three-year DFS (log-rank P = 0.155), locoregional recurrence (P = 0.386) and overall survival (P = 0.127) were comparable across groups. Adjusted HRs for DRM were 1.00 (95 % CI 0.98-1.01) for DFS, 0.98 (0.95-1.01) for OS and 1.00 (0.95 to 1.05) for local recurrence; all estimates lay within equivalence margins (TOST P < 0.05). CONCLUSION: Once the DRM is microscopically negative after NCRT, its length does not influence prognosis; sphincter-preserving surgery need not be deferred solely to obtain a longer margin. TRIAL REGISTRATION: Parent trial: ClinicalTrials.gov NCT01899547; distal margin length analysis protocol preregistered at Open Science Framework (Doi: osf.io/z8uab).
Comparative survival in gastric cancer: Mucosa-confined with extensive nodal metastases versus serosal invasion without nodal spread.
Li J, Liu L, Wu D … +7 more , Wang H, Xue F, Zhao B, Gu M, Dai B, Wen M, Wang X
Eur J Surg Oncol · 2026 Jul · PMID 42107169 · Publisher ↗
BACKGROUND: The TNM staging system classifies both pTNM and pTNM gastric cancers as stage ⅡB, despite their distinct profiles of local invasion versus lymphatic spread. This study compares their survival outcomes to asse...
BACKGROUND: The TNM staging system classifies both pTNM and pTNM gastric cancers as stage ⅡB, despite their distinct profiles of local invasion versus lymphatic spread. This study compares their survival outcomes to assess the differential prognostic impact of these two patterns. METHODS: A total of 235 patients with pTNM or pTNM gastric cancer diagnosed between October 2005 and July 2022 were included. Propensity score matching (PSM) was applied to balance baseline characteristics between the groups. Survival outcomes were analyzed using the Kaplan-Meier method, with 3- and 5-year disease-free survival (DFS) and overall survival (OS) rates compared. Univariate and multivariate Cox regression analyses were performed to identify prognostic factors. RESULTS: This study enrolled 197 gastric cancer patients: 31 with pTNM and 166 with pTNM. Significant differences were observed between groups in gender and tumor location. After PSM (1:3), pathological analysis revealed higher neural invasion in T4aN0 group (26.9% vs. 3.2%, p = 0.005) compared to T1N3a group, which showed more frequent lymphatic invasion (41.9% vs. 16.1%, p = 0.003). The T1N3a group predominantly exhibited signet ring cell carcinoma (SRCC, 64.5%), with the highest lymph node metastasis rate at No. 3 (77.4%). Survival analysis indicated worse OS in the T1N3a group (3-year OS: HR = 2.495, 95% CI: 0.99,6.24, p = 0.0115; 5-year OS: HR = 1.993, 95% CI: 0.85, 4.68, p = 0.0384). Subgroup analysis showed that in patients with SRCC, the T1N3a subgroup had poorer 3-year OS (HR = 2.761, 95% CI: 0.95,8.06, p = 0.0424). While N stage was an independent prognostic factor for 3-year OS (HR = 3.1, 95% CI: 1.4,6.7, p = 0.004), this association did not persist at 5 years. Notably, an Eastern Cooperative Oncology Group (ECOG) score of 2 consistently predicted higher mortality at both 3 and 5 years (3-year HR = 4.8, p = 0.013; 5-year HR = 4.1, p = 0.008). CONCLUSION: Patients with pTNM gastric cancer have a poorer prognosis than those with pTNM. Among SRCC patients, the T1N3a subgroup exhibits histology-driven intrastage heterogeneity. Future risk stratification models should account for the interaction between histological subtype and anatomical stage, with more intensive follow-up and adjuvant therapy for these high-risk patients.
Prediction of recurrent laryngeal nerve lymph node metastasis in esophageal squamous cell carcinoma based on CT radiomics model: A multicenter study.
Yao Y, Zhao Y, Yuan Q … +12 more , Li X, Chen S, Jian L, Li H, Chen S, Lai B, Xu Z, Zhang S, Bu J, Li Y, Lin D, Mo X
Eur J Surg Oncol · 2026 Jul · PMID 42107168 · Publisher ↗
OBJECTIVE: Recurrent laryngeal nerve lymph nodes (RLNLN) dissection in resectable esophageal squamous cell carcinoma (ESCC) is challenging due to increased post-operative complications and unfavorable outcomes. We aimed...
OBJECTIVE: Recurrent laryngeal nerve lymph nodes (RLNLN) dissection in resectable esophageal squamous cell carcinoma (ESCC) is challenging due to increased post-operative complications and unfavorable outcomes. We aimed to develop and validate a CT-based radiomic model to predict RLNLN metastasis in ESCC patients to optimize treatment strategies. METHODS: We retrospectively enrolled 645 ESCC patients from four centers (2015-2022) with pathologically confirmed RLNLN status, stratified into a training cohort, an internal validation cohort, and two external validation cohorts to ensure model generalizability. The radiomics model was built from both non-contrast and contrast-enhanced CT images. The CT-based combined model was developed by integrating the radiomic model with clinicopathological factors (including T/N stage, tumor location, and lymph node size) through multivariate logistic regression. The model's performance was evaluated for discriminative ability, calibration, and clinical usefulness. RESULTS: Incorporating ten features, the radiomics model effectively distinguished ESCC patients with RLNLN metastasis from those without, achieving AUCs of 0.819 in training, 0.708 in internal validation, and 0.806 and 0.635 in the two external validation cohorts. The combined model demonstrated strong discriminative ability, achieving AUCs of 0.866 in the training cohort, 0.749 in the internal validation cohort, and 0.710 and 0.694 in the two external validation cohorts. Decision curve analysis validated the clinical utility of the combined model across various threshold probabilities, highlighting its potential to inform treatment decisions in ESCC patients. CONCLUSION: The CT-based combined model demonstrated robust predictive performance for RLNLN metastasis in resectable ESCC across multiple centers, providing clinically actionable support for personalized therapeutic decision-making.
AJCC staging evolution and its clinical impact on resectable oral cancers: A decade-based cohort analysis.
Kaur A, Singh R, Afreen A … +2 more , Bhave D, Dandekar M
Eur J Surg Oncol · 2026 Jul · PMID 42107167 · Publisher ↗
PURPOSE: To assess clinical impact of American Joint Committee on Cancer (AJCC) 7th, 8th, and 9th edition transitions and staging patterns on resectable oral squamous cell carcinoma (SCC). METHODOLOGY: A decade-long coho...
PURPOSE: To assess clinical impact of American Joint Committee on Cancer (AJCC) 7th, 8th, and 9th edition transitions and staging patterns on resectable oral squamous cell carcinoma (SCC). METHODOLOGY: A decade-long cohort (2014-2025) was analyzed across three AJCC editions. Depth of Invasion (DOI)'s prognostic value was assessed using chi-square tests, while vermillion lip reclassification in the 9th edition was evaluated using risk ratios. Stage migration and treatment-impacting transitions were quantified using transition matrices and heatmaps. Kaplan-Meier curves with risk tables were generated to assess overall survival for the AJCC 8th and 9th editions. RESULTS: Out of a sample size of 532 (M:F = 7:1; mean age 50.9 years, buccal mucosa (65%), tongue/floor of mouth (32.2%), and lip (2.8%), 96.8% were treatment-naïve. DOI-driven upstaging occurred in 29.3% of cases (McNemar's p < 0.001), prompting treatment escalation. Vermillion lip cancers demonstrated lower nodal metastatic risk than other oral subsites {RR 1.39 (95% CI: 0.47-4.11)}. Furthermore, regrouping vermillion lip within cutaneous malignancy demonstrated a 4- fold difference in propensity for nodal metastases between early and advanced T stage (RR = 4.0, 95% CI: 0.66-24.3; OR = 10.0, 95% CI: 0.94-106.5) endorsing its inclusion within cutaneous malignancy. The 7th-8th edition transition caused significant upstaging and treatment escalation, while the 9th edition remained stable except for marked lip tumor reclassification (p < 0.001). Kaplan-Meier analysis showed comparable overall survival, with a modest late advantage for the AJCC 9th edition. CONCLUSION: AJCC staging evolution has progressively improved risk stratification in oral cancers. The 8th edition introduced clinically meaningful refinements, while the 9th edition maintained staging stability and optimized lip cancer classification.
Volumetric discordance predicts post-hepatectomy liver failure after major hepatectomy: the false security of measured volumetry.
Ding S, Tong H, Xu Z … +7 more , Gao YL, Jin L, Shen GL, Liu J, Huang J, Yao W, Xiao ZQ
Eur J Surg Oncol · 2026 Jul · PMID 42107166 · Publisher ↗
BACKGROUND: Standard total liver volume (STLV) equations derived from Western populations may not perform well in Chinese patients. We developed a China-specific STLV equation and evaluated whether discordance between st...
BACKGROUND: Standard total liver volume (STLV) equations derived from Western populations may not perform well in Chinese patients. We developed a China-specific STLV equation and evaluated whether discordance between standardized and measured FLR ratios is associated with post-hepatectomy liver failure (PHLF) after major hepatectomy. METHODS: In this retrospective study (March 2017-June 2025), we derived an STLV equation in patients with a normal liver background and internally validated it against the Vauthey equation. In the major hepatectomy cohort, volumetry was obtained from preoperative MRI and postoperative CT. Volumetric discordance was defined as the difference between standardized and measured FLR ratios (Δ), with Δ ≈ 0.08 used for stratified analyses. RESULTS: Among 971 patients, overall PHLF was higher in the abnormal-background group, while grade B/C PHLF was similar between groups. The China-specific STLV equation showed lower error and reduced systematic bias versus the Vauthey equation. In the major hepatectomy cohort (Group A n = 65; Group B n = 185; Group C n = 118), overall PHLF occurred in 27.4% and was most frequent in Group A. After adjustment for Child-Pugh grade and ICGR15, the discordance pattern Δ > 0.08 with sFLRV < mFLRV (Group A) remained associated with PHLF (OR 2.54, 95% CI 1.41-4.57). Δ alone had limited discrimination, but performance improved when combined with liver function variables in a multivariable model. CONCLUSIONS: A locally calibrated STLV equation reduces bias in volume standardization. Discordance where standardized FLRV is lower than measured FLRV is associated with higher PHLF risk after major hepatectomy and may refine preoperative risk stratification alongside functional markers.
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