Eur J Surg Oncol [JOURNAL]
Sun
200 papers
Defining surgical excellence in gallbladder cancer: A meta-analysis validating the 6-node threshold and extended D2 lymphadenectomy across all T-Stages.
Pandey M, Chakraborty S, Hansalia D … +2 more , Dixit R, Kumar T
Eur J Surg Oncol · 2026 Jun · PMID 42105721 · Publisher ↗
INTRODUCTION: The surgical management of gallbladder cancer (GBC) is complicated by aggressive lymphatic spread, leading to ongoing debate regarding the optimal extent of lymphadenectomy. This study aims to evaluate the...
INTRODUCTION: The surgical management of gallbladder cancer (GBC) is complicated by aggressive lymphatic spread, leading to ongoing debate regarding the optimal extent of lymphadenectomy. This study aims to evaluate the stage-specific association between nodal harvest volume, anatomical templates, and survival outcomes. METHODS: A systematic review and meta-analysis of 27 studies (1999-2025) were conducted. Utilizing random-effects models and meta-regression, we evaluated Overall Survival (OS) and Disease-Free Survival (DFS) across pathological T-stages. RESULTS: Regional lymphadenectomy was associated with a significant overall survival benefit (HR 0.77, 95% CI: 0.62-0.96). Subgroup analysis and meta-regression (p = 0.768) suggested this association remains consistent across the T-stage spectrum (T1b-T4). Achieving a harvest of ≥6 nodes was identified as a critical quality benchmark (HR 0.68, 95% CI: 0.57-0.81). For T2 and T3 disease, D2 dissection (including retropancreatic and celiac stations) was associated with superior outcomes compared to D1 clearance (HR 0.68, 95% CI: 0.57-0.82). Secondary analysis of DFS similarly favored thorough nodal removal (HR 0.63, 95% CI: 0.48-0.83). CONCLUSION: Systematic lymphadenectomy of at least six nodes, incorporating the retropancreatic and celiac stations, is a critical quality metric associated with improved regional control and survival in resectable GBC. While these findings support a standardized approach, the retrospective nature of the evidence necessitates cautious application, particularly in early-stage (T1b) disease.
The Inflammatory Biomarkers Prognostic Index (IBPI) obtained from standard preoperative blood tests predicts postoperative complications in patients undergoing pelvic exenteration for locally recurrent rectal cancer.
Scardino A, Fiore M, Cavalleri T … +8 more , Rausa E, Taffurelli G, Ljevar S, Miceli R, Callegaro D, Pietrantonio F, Gronchi A, Montroni I
Eur J Surg Oncol · 2026 Jun · PMID 42105720 · Publisher ↗
PURPOSE: Pelvic exenteration (PE) for local recurrent rectal cancer (LRRC) is associated with high morbidity and mortality rates. Recent interest has focused on the relationship between the inflammatory response and outc...
PURPOSE: Pelvic exenteration (PE) for local recurrent rectal cancer (LRRC) is associated with high morbidity and mortality rates. Recent interest has focused on the relationship between the inflammatory response and outcomes in surgical oncology. The Inflammatory Biomarkers Prognostic Index (IBPI) was calculated and validated in retroperitoneal sarcoma (RPS) as a useful predictive tool for overall survival (OS) and postoperative complications. METHODS: The study included all consecutive patients with LRRC who underwent surgery with curative intent between January 2009 and December 2025 at a tertiary cancer center. The primary outcome is the correlation between the IBPI and 30-day postoperative complications measured with the Comprehensive Complications Index (CCI). The secondary outcomes were the correlation between the IBPI and 30-, 90-day or 1-year mortality, readmission or reoperation within 30 days after discharge and overall survival (OS). RESULTS: Sixty-six consecutive patients treated with PE for LRRC met the inclusion criteria and were analyzed. IBPI is highly predictive of postoperative complications (Coeff: 7.89, p = 0.008, 95% CI 2.14-13.63). The correlation between IBPI and complications is even more significant when considering only severe complications (CCI >42.3%: OR 3.33, p = 0.006, 95% CI 1.40-7.90), particularly when IBPI>2 (OR 6.00, p = 0.003, 95% CI 1.82-19.80). CONCLUSION: The IBPI is an easily available score and can very well predict the occurrence of complications after pelvic exenteration for LRRC. Differently from RPS, IBPI did not demonstrate a prognostic role in terms of OS.
Neoadjuvant docetaxel, cisplatin, and capecitabine in borderline-inoperable locally advanced oral cavity squamous cell carcinoma: A prospective observational study.
Singh A, Malhotra M, Sehrawat A … +7 more , Priya M, Bhardwaj A, Joyson Antony X, Prasath R, Chawra DS, Vetrivel G, Choudhary J
Eur J Surg Oncol · 2026 Jul · PMID 42105650 · Publisher ↗
INTRODUCTION: Borderline-inoperable locally advanced oral cavity squamous cell carcinoma (LAOSCC) represents a therapeutic grey zone in which upfront surgery is technically feasible but oncologically uncertain. In such c...
INTRODUCTION: Borderline-inoperable locally advanced oral cavity squamous cell carcinoma (LAOSCC) represents a therapeutic grey zone in which upfront surgery is technically feasible but oncologically uncertain. In such cases, neoadjuvant chemotherapy (NACT) is employed to enable reassessment of operability rather than to confer a survival advantage. Evidence regarding optimal induction regimens in this setting remains limited. MATERIALS AND METHODS: This prospective observational study included treatment-naïve patients with borderline-inoperable stage III-IV oral cavity squamous cell carcinoma. Patients received neoadjuvant chemotherapy with Docetaxel, Cisplatin, and Capecitabine (TPX). Tumour response was assessed using RECIST version 1.1, and treatment-related toxicity was graded according to CTCAE version 5.0. Following NACT, operability was reassessed by a multidisciplinary team. Surgical and immediate postoperative outcomes were documented for patients undergoing resection. RESULTS: Forty-five patients were enrolled, the majority presenting with advanced T-stage disease. An objective response rate of 53.3% was observed following NACT. Conversion to operability was achieved in 13 patients (28.9%), all of whom proceeded to definitive surgery. Margin-negative (R) resection was achieved in all operated cases. Severe (grade 3-4) treatment-related toxicities occurred in a minority of patients, and chemotherapy discontinuation due to toxicity was infrequent. CONCLUSION: Neoadjuvant chemotherapy with Docetaxel, Cisplatin, and Capecitabine is a feasible and well-tolerated induction strategy in selected patients with borderline-inoperable LAOSCC. TPX was associated with meaningful tumour response and conversion to operability, enabling margin-negative surgical resection without unacceptable toxicity. These findings suggest that TPX as a pragmatic neoadjuvant option in carefully selected patients.
Laparoscopic versus open surgery for locally advanced gastric gastrointestinal stromal tumors following neoadjuvant imatinib therapy: a multicenter propensity-weighted cohort study.
Cai Z, Chen J, Xu Z … +8 more , Lin H, Lin L, Su X, Hong S, Song W, Chen X, Yang Z, Zhou Y
Eur J Surg Oncol · 2026 Jul · PMID 42105649 · Publisher ↗
BACKGROUND: Neoadjuvant imatinib therapy (NIT) is the standard of care for gastric locally advanced gastrointestinal stromal tumors (LA-GIST), yet the optimal surgical approach following treatment remains undefined. This...
BACKGROUND: Neoadjuvant imatinib therapy (NIT) is the standard of care for gastric locally advanced gastrointestinal stromal tumors (LA-GIST), yet the optimal surgical approach following treatment remains undefined. This multicenter study compared the safety and long-term efficacy of laparoscopic surgery versus open surgery in this patient population. METHODS: We retrospectively analyzed 76 patients from four Chinese centers using inverse probability weighting (IPW) to balance baseline covariates. Primary endpoints were 5-year disease-free survival (DFS) and overall survival (OS); secondary endpoints included perioperative outcomes and complications. RESULTS: After IPW adjustment, the laparoscopic (n = 42) and open surgery (n = 34) groups were well-balanced. Laparoscopic surgery was associated with significantly reduced intraoperative blood loss, lower intraoperative transfusion rates, and shorter postoperative hospital stays. No significant differences were found in operative time, R0 resection rates, or complications. In exploratory subgroup analyses, the reduction in intraoperative blood loss associated with laparoscopic surgery did not reach statistical significance in patients aged ≥60 years, those with tumors ≥10 cm, or those undergoing combined organ resection, and no statistically significant interactions were detected between surgical approach and these factors. In terms of long-term outcomes, no statistically significant differences were observed in 5-year DFS (HR = 0.73, P = 0.499) or 5-year OS (HR = 0.86, P = 0.842) between the two approaches. CONCLUSIONS: Laparoscopic surgery for gastric LA-GIST following NIT was associated with improved perioperative outcomes and showed no statistically significant differences in long-term survival compared with open surgery. In complex cases, including elderly patients, patients with large tumors, or those requiring combined organ resection, surgical decision-making should remain individualized.
Diagnostic accuracy of magnifying Image-enhanced endoscopy for predicting the invasion depth of superficial esophageal neoplasm: a meta-analysis.
Jiang W, Huang Y, Pang J … +2 more , Yang S, Chen R
Eur J Surg Oncol · 2026 Jun · PMID 42097052 · Publisher ↗
PURPOSE: The aim of this study was to assess the accuracy of magnifying image-enhanced endoscopy (IEE) for predicting the invasion depth of superficial esophageal neoplasm (SEN). METHODS: We searched PubMed, Embase, the...
PURPOSE: The aim of this study was to assess the accuracy of magnifying image-enhanced endoscopy (IEE) for predicting the invasion depth of superficial esophageal neoplasm (SEN). METHODS: We searched PubMed, Embase, the Cochrane Library. The sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds radio (DOR) with 95% confidence interval (CI) were calculated by bivariate mixed effect model, the summary receiver operating characteristic (SROC) curve was drawn and the area under the curve (AUC) was calculated to comprehensively evaluate the diagnostic value of magnifying IEE for the invasion depth of SEN. RESULTS: Twelve literatures were included. The combined effect size of magnifying IEE in the diagnosis of carcinoma in situ (Tis) or tumor infiltrating lamina propria mucosae (LPM) were: sensitivity: 0.88(95%CI 0.83-0.92), specificity: 0.85(95%CI 0.76-0.91), PLR: 5.8(95%CI 3.6-9.3), NLR: 0.14(95%CI 0.09-0.20), DOR: 42 (95%CI 23-76), AUC: 0.93(95%CI 0.91-0.95); The combined effect size of magnifying IEE in the diagnosis of tumor infiltrating muscularis mucosae (MM) or tumor infiltrating the upper third of the submucosal layer (SM1) were: sensitivity: 0.72(95%CI 0.63-0.80), specificity: 0.86(95%CI 0.79-0.90), PLR: 5.0(95%CI 3.5-7.2), NLR: 0.32(95%CI 0.24-0.44), DOR: 15(95%CI 9-26), AUC: 0.86(95%CI 0.83-0.89); The combined effect size of magnifying IEE in the diagnosis of tumor infiltrating the middle third of the submucosal layer (SM2) or deeper were: sensitivity: 0.52(95%CI 0.40-0.64), specificity: 0.99(95%CI 0.98-0.99), PLR: 37.0(95%CI 24.5-55.9), NLR: 0.49(95%CI 0.38-0.63), DOR: 76(95%CI 45-127), AUC: 0.98(95%CI 0.96-0.99). CONCLUSION: Magnifying IEE shows good overall diagnostic performance for assessing the invasion depth of SEN, with excellent diagnostic efficacy for superficial lesions, while the diagnostic sensitivity for deep lesions is relatively low. It can provide helpful evidence for selecting appropriate clinical treatments.
Preoperative MRI features for predicting response to postoperative adjuvant anti-PD-1 therapy in hepatocellular carcinoma.
He X, Wang S, Ye Z … +4 more , Zhan J, Sun Y, Hu S, Peng Z
Eur J Surg Oncol · 2026 Jul · PMID 42097011 · Publisher ↗
RATIONALE AND OBJECTIVES: Biomarkers for predicting survival benefit of postoperative adjuvant anti-PD-1 therapy (PA-PD-1) in hepatocellular carcinoma (HCC) are scare and lack of clinical evidence currently. This study a...
RATIONALE AND OBJECTIVES: Biomarkers for predicting survival benefit of postoperative adjuvant anti-PD-1 therapy (PA-PD-1) in hepatocellular carcinoma (HCC) are scare and lack of clinical evidence currently. This study aimed to identify the value of preoperative MRI features for predicting response to PA-PD-1 in HCC. MATERIALS AND METHODS: Between January 2020 and June 2023, consecutive eligible patients after curative hepatectomy were retrospectively enrolled and prospectively followed-up. MRI features were independently reviewed by two radiologists. Overall survival (OS) and recurrence-free survival (RFS) were compared between subgroups. Independent prognostic risk factors for OS and RFS were confirmed by Cox regression analysis. RESULTS: Fifty-eight patients (54 years ± 12; 56 men) with PA-PD-1 and 110 patients (52 years ± 12; 101 men) without PA-PD-1 were analyzed after propensity-score matching. Patients with PA-PD-1 had significantly longer RFS than those without PA-PD-1 (29.50 versus 10.97 months, p = .005). Absence of hypointense halos (HR = 1.635; 95% CI: 1.066-2.510; p = .024) and irregular rim-like hyper enhancement (HR = 0.566; 95% CI: 0.379-0.845; p = .005) were identified as independent predictors for RFS. Subgroup analysis indicated that patients with absence of hypointense halos and irregular rim-like hyper enhancement achieved significantly longer RFS after PA-PD-1 compared with those without PA-PD-1. CONCLUSION: Preoperative MRI features of absence of hypointense halos and irregular rim-like hyper enhancement were significantly associated with recurrence and potential predictors for response to PA-PD-1 in HCC.
Usefulness of routine clinical follow-up after oral cavity cancer treatment: a single-center retrospective study.
Guibert A, Vergez S, Dupret-Bories A … +7 more , Vairel B, Sarini J, Rivière LD, Modesto A, Piram L, Morisseau M, Chabrillac E
Eur J Surg Oncol · 2026 Jul · PMID 42097010 · Publisher ↗
INTRODUCTION: Follow-up for Oral Cavity Squamous Cell Carcinoma (OCSCC) imposes a heavy financial burden on healthcare systems. The survival benefits of recommended clinical monitoring models remains unproven. This study...
INTRODUCTION: Follow-up for Oral Cavity Squamous Cell Carcinoma (OCSCC) imposes a heavy financial burden on healthcare systems. The survival benefits of recommended clinical monitoring models remains unproven. This study aimed to determine whether the mode of detection for locoregional recurrences or head and neck second primary tumors (SPT) influences tumor stages and survival outcomes. METHODS: This single-center retrospective study included 351 patients surgically treated for primary OCSCC between 2015 and 2022. The primary endpoint was the occurrence of a Head and Neck Event (HNE), defined as locoregional recurrence or head and neck SPT. Post-Event Survival (PES) was analyzed using a lead-time bias correction. We calculated the Number Needed to See (NNS) to detect one asymptomatic HNE, and the average cost of a routine follow-up visit. RESULTS: HNEs occurred in 92 (26.2%) patients. They were detected during routine visits for 48 (52.7%) patients and interval visits for 43 (47.3%). Neither HNE tumor stage (p = 0.718) nor curative treatment intent (p = 0.405) was significantly associated with the type of detection visit. The median PES was 10.3 months, with no significant difference observed between routine and interval detections (p = 0.504). The average visit cost was €166. The NNS was 547 during the first two years (equivalent to €90,802), and 255 during the years two to five (equivalent to €42,330). CONCLUSION: Routine clinical follow-up is not associated with improved PES or lower tumor stage in OCSCC patients. Recommended surveillance models demonstrate a low diagnostic yield. Follow-up should transition toward risk-stratified, tailored regimens emphasizing patient empowerment and sustainability.
Capsulectomy for chronic encapsulated seroma after breast cancer surgery: prone to complications and limited efficacy.
Tamminen A, Lintunen R, Aaltonen RI
Eur J Surg Oncol · 2026 Jul · PMID 42097009 · Publisher ↗
INTRODUCTION: Chronic encapsulated seroma is a challenging complication after breast cancer surgery, and evidence guiding its optimal management is limited. Surgical excision (capsulectomy) has been proposed as a treatme...
INTRODUCTION: Chronic encapsulated seroma is a challenging complication after breast cancer surgery, and evidence guiding its optimal management is limited. Surgical excision (capsulectomy) has been proposed as a treatment option, although data on its effectiveness and associated morbidity remain scarce. METHODS: We reviewed follow-up data from 6812 breast cancer surgeries performed at a single university hospital and identified patients who underwent capsulectomy for chronic encapsulated seroma. Risk factors and long-term outcomes were analyzed. RESULTS: Chronic seroma requiring capsulectomy occurred in 1.7% (47/2736) of patients after mastectomy and in none of the patients undergoing breast-conserving surgery without axillary lymph node dissection (0/3083). Obesity was a major risk factor: 4.4% of patients with a BMI >30 kg/m who underwent mastectomy required seroma capsulectomy compared with 0.9% of those with normal BMI. Following seroma capsulectomy, 68% of patients had persistent seroma beyond three months, 46% developed surgical site infection, and 48% required reoperation. Uneventful healing with complete resolution of seroma within three months from seroma capsulectomy was observed in seven patients (14%). CONCLUSION: Chronic encapsulated seroma appears to occur predominantly in obese patients after mastectomy. Seroma capsulectomy is associated with considerable morbidity and relatively low rates of resolution. These findings should be considered when evaluating the role of surgery in clinical practice.
Trends in surgical outcomes for perihilar cholangiocarcinoma: Insights from a Western tertiary center.
De Bellis M, Alaimo L, Conci S … +9 more , Poletto E, Calderone G, Scoccati G, Cismaroiu ID, Fresu EM, Marchese A, Guglielmi A, Campagnaro T, Ruzzenente A
Eur J Surg Oncol · 2026 Jul · PMID 42097008 · Publisher ↗
INTRODUCTION: Following the aggressive surgical approach proposed by Japanese authors, the management of perihilar cholangiocarcinoma (PHCC) has evolved over time. OBJECTIVE: to assess the improvement of surgical outcome...
INTRODUCTION: Following the aggressive surgical approach proposed by Japanese authors, the management of perihilar cholangiocarcinoma (PHCC) has evolved over time. OBJECTIVE: to assess the improvement of surgical outcomes in PHCC patients in a Western tertiary center over the last three decades. METHOD: 196 PHCC patients underwent curative resection at Verona University Hospital, Italy. Perioperative data were analyzed by comparing early (1995-2004), intermediate (2005-2014), and late (2015-2024) period with the Cochran-Armitage test. RESULTS: 24, 64, and 108 patients underwent surgery in early, intermediate, and late period, respectively. An increased trend in preoperative biliary drainage (38%, 72%, 75%, p = 0.002) portal vein embolization (0%, 6%, 19%, p = 0.003), extended hepatectomies (0%, 13%, 17%, p = 0.040) and vascular resections (4%, 16%, 24%, p = 0.017) was observed. The median number of lymph nodes retrieved increased (3, 9, 9, p < 0.001) while R1 resection decreased (42%, 36%, 34%, p = 0.524). A downward trend of major complications (54%, 39%, 39%, p = 0.274) and 90-day mortality (17%, 8%, 6%, p = 0.152) was reported. Adjuvant therapy rate progressively increased (0%, 39%, 58%, p < 0.001). The 5-year survival was 13%, 29%, 50% in early, intermediate, and late period, respectively (p < 0.001). CONCLUSION: Advances in PHCC management have led to increased survival and decreased major complications and 90-day mortality.
Diffusion-weighted MRI and apparent diffusion coefficient in head and neck malignancies: practical utility for diagnosis, triage and post-treatment surveillance.
Bhardwaj S, Bekker J
Eur J Surg Oncol · 2026 Jul · PMID 42090739 · Publisher ↗
Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping is widely available on modern magnetic resonance imaging platforms and is increasingly embedded in head and neck oncological pathways. Th...
Diffusion-weighted imaging (DWI) with apparent diffusion coefficient (ADC) mapping is widely available on modern magnetic resonance imaging platforms and is increasingly embedded in head and neck oncological pathways. The technique can refine lesion characterisation, support nodal assessment, and strengthen post-treatment surveillance when it is applied to specific clinical questions. In this narrative review, we synthesise practical applications of DWI/ADC across major head and neck malignancies, including lymphoma, squamous cell carcinoma (SCC), sinonasal tumours, and salivary gland neoplasms, with emphasis on common diagnostic pitfalls and the limits of cross-study threshold transferability. We also summarise evidence relevant to treatment monitoring, adaptive radiotherapy strategies, and the technical repeatability needed for longitudinal ADC interpretation. Across the literature, markedly low ADC values favour lymphoma, whereas substantial overlap constrains benign-malignant separation in salivary and sinonasal lesions. In the post-treatment setting, meta-analytic evidence supports lower ADC values in recurrent disease than in treatment-related change, with a commonly cited recurrence threshold near 1.10 x 10-3 mm2/s. Overall, DWI is best treated as a probability-modifying biomarker that complements morphology, endoscopy, pathology, and clinical trajectory rather than replacing them.
Tumor burden score determines survival benefit of anatomic resection in hepatocellular carcinoma: A multicenter propensity-matched study.
Pang S, Shi Y, Jiang M … +9 more , Ye Q, Yan X, Sun Z, Kou X, Chen X, SiMa H, Chen Y, Yang Y, Yang N
Eur J Surg Oncol · 2026 Jun · PMID 42070541 · Publisher ↗
BACKGROUND: The survival benefit of wide-margin or anatomic resection for hepatocellular carcinoma (HCC) is debated, necessitating practical preoperative predictors. METHODS: This multicenter retrospective study analyzed...
BACKGROUND: The survival benefit of wide-margin or anatomic resection for hepatocellular carcinoma (HCC) is debated, necessitating practical preoperative predictors. METHODS: This multicenter retrospective study analyzed 635 HCC patients (2016-2023) comparing recurrence-free survival (RFS) after wide vs. narrow margin and anatomic vs. non-anatomic resections. Tumor burden score (TBS) was defined as √[(max diameter)+ (tumor number)]. Patients were stratified by TBS (high >5, low ≤5). Propensity score matching (PSM) balanced confounders in the high-TBS cohort for RFS comparison. RESULTS: Margin width did not affect RFS. Anatomic resection significantly improved RFS only in high-TBS patients (p = 0.002), not in low-TBS patients. After PSM adjusted for baseline imbalances in the high-TBS cohort, the RFS benefit of anatomic resection remained significant (p = 0.012). CONCLUSION: TBS is an effective preoperative predictor, identifying high tumor burden patients who derive significant RFS benefit from anatomic resection.
Role of staging laparoscopy in gastric cancer management: Evaluation of occult disease and its influence on clinical decision making.
Çolakoğlu MK, Pişkin E, Öter V … +4 more , Güven A, Özler İ, Keskin YY, Bostancı EB
Eur J Surg Oncol · 2026 Jun · PMID 42068699 · Publisher ↗
BACKGROUND: Accurate staging is critical in gastric cancer, as the presence of peritoneal metastasis directly influences treatment strategy and prognosis. Despite advances in cross-sectional imaging, occult peritoneal di...
BACKGROUND: Accurate staging is critical in gastric cancer, as the presence of peritoneal metastasis directly influences treatment strategy and prognosis. Despite advances in cross-sectional imaging, occult peritoneal disease may remain undetected. Staging laparoscopy has been increasingly utilized to improve diagnostic accuracy; however, its true impact on clinical decision-making and the predictive factors for occult metastasis remain areas of ongoing investigation. METHODS: This retrospective study included patients with biopsy-proven gastric adenocarcinoma who underwent staging laparoscopy between March 2019 and April 2025 at a high-volume tertiary center. Patients with radiologically metastatic disease or incomplete clinical data were excluded. All patients had clinically M0 disease on preoperative imaging. The primary outcome was the detection rate of occult stage IV disease and its impact on treatment strategy. Secondary outcomes included concordance between frozen and final cytology, postoperative outcomes, and identification of predictors for peritoneal metastasis. Multivariable logistic regression analysis was performed to determine independent risk factors. RESULTS: A total of 301 patients were included in the final analysis. Staging laparoscopy identified occult metastatic disease in 65 patients, corresponding to an upstaging rate of 21.6% (95% CI: 16.9-26.3%). Malignant cytology and peritoneal implants were detected in 13.9% and 17.3% of patients, respectively. Frozen cytology demonstrated high specificity (95%) but limited sensitivity (67%) compared to final cytology. Treatment strategy was altered in all patients with newly detected metastatic disease, avoiding non-beneficial surgical intervention. Multivariable analysis revealed that only clinical nodal stage was independently associated with positive peritoneal cytology and/or peritoneal involvement (OR 2.42, 95% CI: 1.4-4.2, p = 0.001). The procedure was associated with low morbidity (0.66%) and minimal mortality (0.33%). CONCLUSION: Staging laparoscopy provides substantial diagnostic value in detecting radiologically occult metastatic disease in gastric cancer and significantly influences treatment planning. Its routine use in appropriately selected patients improves staging accuracy and helps prevent unnecessary surgical interventions. Clinical nodal status appears to be the strongest independent predictor of occult peritoneal disease.
CT Habitat-peritumoral fusion radiomics predicts aggressiveness and prognosis in pheochromocytomas and paragangliomas to inform intensified surgical strategies: A multicenter study.
Zhou Y, Zhang Z, Zhou K … +9 more , Tan Y, Zhao J, Zhong L, Wei X, Zhu J, Li Z, Du J, Liu L, Fang L
Eur J Surg Oncol · 2026 Jun · PMID 42068698 · Publisher ↗
BACKGROUND: This study aimed to develop a dual-domain radiomics framework integrating probability-driven high-risk habitats and peritumoral microenvironmental features to accurately predict the aggressiveness of pheochro...
BACKGROUND: This study aimed to develop a dual-domain radiomics framework integrating probability-driven high-risk habitats and peritumoral microenvironmental features to accurately predict the aggressiveness of pheochromocytomas and paragangliomas (PPGLs). METHODS: This retrospective study included 356 patients with abdominal PPGLs from four institutions, who were divided into a training set (n = 182) and two external test sets (n = 70, n = 104). Radiomic features were extracted from the whole-tumor and 1-mm peritumoral regions on contrast-enhanced CT images. Probability-driven habitat analysis utilizing a Support Vector Machine and K-means clustering was implemented to segment high-risk subregions. Following rigorous cascaded feature selection, a Random Forest-based fusion model was constructed to integrate key habitat and peritumoral features for predicting aggressiveness. Additionally, SHapley Additive exPlanations (SHAP) analysis was employed to evaluate feature importance and model interpretability. RESULTS: The habitat-peritumoral fusion model demonstrated superior predictive performance and robustness compared to traditional single-modality models, achieving area under the receiver operating characteristic curve values of 0.884 and 0.854 in external test sets 1 and 2, respectively. The model maintained excellent diagnostic efficacy across both >6 cm and ≤6 cm tumor subgroups. Furthermore, the model-derived risk score successfully stratified metastasis-free survival in the overall cohort (P < 0.001) and the clinically ambiguous ≤6 cm subgroup (P = 0.003), serving as an independent prognostic factor (HR = 10.73, P = 0.028). CONCLUSION: The fusion model is a robust, non-invasive tool for preoperatively identifying high-risk PPGLs. Particularly for tumors ≤6 cm where decision-making is challenging, it provides objective evidence to individualize surgical strategies and stratify postoperative surveillance.
Digital twins in urological oncology and surgery: A review of emerging applications.
Olawade DB, Oisakede EO, Fidelis SC … +3 more , Ogunbona MA, Makanjuola BD, Daniel RIA
Eur J Surg Oncol · 2026 Jun · PMID 42068697 · Publisher ↗
BACKGROUND: Digital twin technology represents a transformative approach in healthcare, creating virtual replicas of physical entities that enable real-time data integration, predictive modelling, and personalised treatm...
BACKGROUND: Digital twin technology represents a transformative approach in healthcare, creating virtual replicas of physical entities that enable real-time data integration, predictive modelling, and personalised treatment strategies. In urology, this emerging technology offers unprecedented opportunities to optimise patient care through simulation-based decision-making. AIM: This narrative review comprehensively examines current applications of digital twin technology in urology, evaluates its clinical utility across various urological conditions, and identifies key challenges limiting its widespread implementation. METHOD: A comprehensive search was conducted across PubMed, Web of Science, and Scopus databases for literature published between January 2020 and January 2026. Search terms included digital twin, virtual twin, urology, uro-oncology, prostate cancer, renal surgery, and bladder dysfunction. Studies focusing on the development, validation, and clinical implementation of digital twins in urological practice were included. RESULTS: Digital twin technology demonstrates significant potential in uro-oncology for treatment planning, surgical navigation, and disease progression monitoring. Key applications include patient-specific tumour growth simulation in prostate cancer, three-dimensional anatomical modelling for partial nephrectomy, and bladder function prediction in outlet obstruction. Integration with artificial intelligence enhances predictive accuracy and enables real-time surgical guidance. CONCLUSION: Digital twin technology represents a paradigm shift towards precision urology, though challenges in data integration, computational requirements, validation, and ethical considerations must be addressed before routine clinical implementation. Future developments should focus on standardisation, regulatory frameworks, and prospective clinical validation studies.
Targeted axillary dissection in the primary surgery setting for node-positive breast cancer: A systematic review.
Lucocq J, Mitchell S, Potter S … +1 more , Elder K
Eur J Surg Oncol · 2026 Jun · PMID 42068696 · Publisher ↗
INTRODUCTION: Targeted axillary dissection (TAD) improves the accuracy of axillary staging in patients undergoing neoadjuvant chemotherapy but its role in patients with low volume nodal disease undergoing primary surgery...
INTRODUCTION: Targeted axillary dissection (TAD) improves the accuracy of axillary staging in patients undergoing neoadjuvant chemotherapy but its role in patients with low volume nodal disease undergoing primary surgery is unclear. This study aimed to summarise the evidence of upfront TAD in the primary surgical setting in patients with node-positive breast cancer. METHODS: Searches were performed in PubMed, Embase, and Scopus to identify studies reporting the outcomes of upfront TAD in patients with node-positive breast cancer. Primary outcomes were to report procedural technique, the rate of clip/marker retrieval, concordance with sentinel nodes and the presence of residual nodal disease in the axillary clearance specimen. RESULTS: Six observational studies (four prospective cohorts and two retrospective) were included involving 66 patients undergoing marking of pathologically involved nodes prior to excision. A single suspicious node was marked in 95.7% (45/47). All localisation markers were detected (13/13), but the tattooed node was not received in 5.3% (1/19), US-visible clips could not be identified in 25% (6/24) and nickle-titanium clips were not retrieved in 23.8% (5/21). Concordance between the marked node and sentinel nodes was 92.1% (35/38) and overall the FNR of SLNB was 0% (0/21). Four studies mandated ALND for all patients whereas two studies considered ALND omission following TAD. Across two studies, 31.6% (6/19) had axillary metastasis outside of the TAD specimen (marked node and SLNs). No complications were reported in the only study reporting complications (0/13). No studies evaluated adjuvant treatment decision or oncological outcomes following upfront TAD. CONCLUSIONS: The current evidence supporting upfront TAD is extremely limited. Consensus work and further observational studies are needed to establish eligibility criteria. Well-designed trials will then be required to determine the oncological safety of this approach.
Long-term outcomes of liver transplantation versus liver resection for combined hepatocellular-cholangiocarcinoma: An updated systematic review and meta-analysis.
Kimura J, Asassfeh A, Cooper M … +1 more , Prasad KR
Eur J Surg Oncol · 2026 Jun · PMID 42068695 · Publisher ↗
BACKGROUND: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare and aggressive primary liver cancer. Liver resection (LR) has long been the standard treatment for cHCC-CCA, but it is associated with high recu...
BACKGROUND: Combined hepatocellular cholangiocarcinoma (cHCC-CCA) is a rare and aggressive primary liver cancer. Liver resection (LR) has long been the standard treatment for cHCC-CCA, but it is associated with high recurrence rates and poor long-term prognosis. The significance of liver transplantation (LT) remains controversial. This systematic review and meta-analysis aimed to compare the long-term survival and recurrence outcomes between LT and LR for cHCC-CCA to assess the potential benefit of LT. METHODS: A systematic search of Web of Science, Medline Ovid, Scopus, and Cochrane CENTRAL was conducted using predefined terms related to cHCC-CCA. Records were screened according to PRISMA. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcome was 5-year Overall Survival (OS). Recurrence-free survival (RFS) was a secondary outcome. Meta-analysis was performed using random-effects models. RESULTS: Six retrospective studies met inclusion criteria. NOS scores ranged from 7 to 9. For OS, pooled analyses yielded ORs of 0.67 (95% CI: 0.39-1.15, p = 0.15) at 1 year, 0.70 (95% CI: 0.42-1.17, p = 0.15) at 3 years, and 0.55 (95% CI: 0.38-0.81, p = 0.002) at 5 years. For RFS, pooled analyses yielded ORs of 0.48 (95% CI: 0.30-0.78, p = 0.003) at 1 year and 0.40 (95% CI: 0.27-0.59, p < 0.001) at 5 years. CONCLUSION: LT may be associated with favorable long-term survival and recurrence outcomes compared with LR for cHCC-CCA. These findings suggest that LT could be considered in carefully selected patients.
Urological complications and renal function outcomes following total pelvic clearance: A five-year retrospective cohort study.
Abusada E, Haghdani S, Abusada LO … +4 more , Abdelrahman M, Al Haj A, Elsakka H, Oates J
Eur J Surg Oncol · 2026 Jun · PMID 42068694 · Publisher ↗
BACKGROUND: Total Pelvic Clearance (TPC) is an aggressive surgical procedure developed to manage recurrent or advanced neoplastic disease in the pelvic area. Although it provides definitive treatment, it has been associa...
BACKGROUND: Total Pelvic Clearance (TPC) is an aggressive surgical procedure developed to manage recurrent or advanced neoplastic disease in the pelvic area. Although it provides definitive treatment, it has been associated with a high rate of urological complications. METHODS: A retrospective cohort analysis was conducted at a referral oncological centre involving 92 patients who underwent total pelvic clearance (TPC) between 2019 and 2023. Data were extracted from institutional electronic medical records. Demographic, clinical, and surgical parameters were documented. Urological complications, including hydronephrosis, anastomotic leak, anastomotic stenosis, urostomy stenosis, parastomal hernia, and recurrent urinary tract infections (UTIs), and their association with various demographic, clinical, and surgical factors were evaluated. The decline in renal function was determined by the percentage reduction in postoperative estimated glomerular filtration rate (eGFR) over a one-year period. The management of complications was also reported. RESULTS: Out of 92 patients who had Total Pelvic Clearance (TPC), urological complications occurred in 43 (47.1%). The most common issues were hydronephrosis in 19 patients (20.7%) and anastomotic stenosis in 13 patients (14.1%). Anastomotic leaks and recurrent urinary tract infections each affected 6 patients (6.5%). Parastomal hernias and urostomy stenoses were less common, occurring in 2.2% and 1.1%, respectively. There was no significant association between complications and radiotherapy, chemotherapy, or disease recurrence, although hydronephrosis was more common in recurrent cases (84.2% vs. 63%, p = 0.079). The average decline in renal function was 12.9% ± 17.0% at one year. Most complications were managed conservatively or with minimally invasive procedures; only two patients required surgical revision. CONCLUSION: Hydronephrosis and anastomotic stenosis remain the most common urological complications after TPC, often leading to a decline in renal function. Most cases were successfully managed conservatively or through image-guided intervention, supporting a stepwise, minimally invasive approach that protects renal function and avoids unnecessary reoperations.
Prognostic significance of perineural invasion in esophageal squamous cell carcinoma: A large-scale propensity score matching analysis with long-term follow-up outcomes.
Yan Z, Xu T, Lu J … +4 more , Li X, Wang X, Hu Z, Guo W
Eur J Surg Oncol · 2026 Jun · PMID 42066694 · Publisher ↗
BACKGROUND: The prognostic significance of perineural invasion (PNI) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study evaluated the impact of PNI on long-term survival in a large surgical co...
BACKGROUND: The prognostic significance of perineural invasion (PNI) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study evaluated the impact of PNI on long-term survival in a large surgical cohort. METHODS: A total of 1211 consecutive patients who underwent esophagectomy with two-field lymphadenectomy for pT1-4aN0-3M0 ESCC at the Fourth Hospital of Hebei Medical University between January 2015 and December 2020 were retrospectively enrolled. PNI status was assessed by both hematoxylin and eosin staining and S100 immunohistochemistry. Propensity score matching (PSM) was employed to balance baseline clinicopathological characteristics. Logistic regression analysis was used to identify factors associated with PNI, and Cox proportional hazards models were applied to evaluate its prognostic significance. Survival outcomes were estimated using the Kaplan-Meier method and compared by log-rank test. RESULTS: PNI occurred in 23.7% of patients and was independently associated with lymphovascular invasion and advanced T stage. After PSM, 512 patients (256 per group) were included in the survival analysis. Median overall survival was significantly shorter in the PNI-positive group (29.3 months vs. 40.4 months; P < 0.05). Multivariate Cox regression confirmed PNI as an independent predictor of poorer survival (HR 1.24, 95% CI 1.01-1.53; P < 0.05). Subgroup analysis suggested that the prognostic effect of PNI was more pronounced in patients with T3-4 tumors. CONCLUSION: PNI is an independent adverse prognostic factor for long-term survival in patients with surgically resected ESCC. Routine PNI assessment may refine risk stratification and guide clinical decision-making.
Robotic-assisted versus video-assisted thoracoscopic anatomical pulmonary resection in elderly patients with lung cancer: A propensity score-matched comparison of short-term outcomes.
Huang L, Huang X, Zhou Y … +9 more , He J, Huang J, Ma Y, Pan C, Peng S, Qin J, Chen X, Wei J, Zhong Y
Eur J Surg Oncol · 2026 Jun · PMID 42061191 · Publisher ↗
OBJECTIVE: Lung cancer is a major health issue, particularly among the elderly. This study aimed to compare the short-term outcomes of robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surge...
OBJECTIVE: Lung cancer is a major health issue, particularly among the elderly. This study aimed to compare the short-term outcomes of robot-assisted thoracoscopic surgery (RATS) versus video-assisted thoracoscopic surgery (VATS) for anatomical pulmonary resection in elderly patients with lung cancer. METHODS: A retrospective analysis was performed on patients aged ≥65 years who underwent RATS or VATS. Propensity score matching (PSM) was applied to balance baseline characteristics. Demographic, clinical, and perioperative variables were compared. RESULTS: A total of 594 patients who underwent anatomical pulmonary resection for non-small cell lung cancer (NSCLC) were enrolled, with 141 patients received RATS and 453 received VATS, respectively. After matching, 117 pairs (234 patients) were created in this study, and baseline characteristics were well-balanced between groups. Compared to VATS, the RATS group had significantly shorter operative time (156 ± 51.67 vs. 214.3 ± 89.95 min, p < 0.001), lower intraoperative blood loss (44.96 ± 83.49 vs. 149.44 ± 461.51 mL, p = 0.017), shorter chest tube duration (5.93 ± 3.83 vs. 6.46 ± 4.9 days, p = 0.041), reduced total drainage volume (1149.36 ± 728.31 vs. 1501.92 ± 1662.32 mL, p = 0.037), shorter postoperative hospital stay (6.77 ± 3.46 vs. 9.66 ± 8.15 days, p = 0.001), and lower pain scores on postoperative day 3 (3.49 ± 1.46 vs. 4.09 ± 1.60, p = 0.003). The conversion rate to open surgery was lower in the RATS group (0.9% vs. 7.7%, p = 0.010). The total hospitalization costs were significant higher in RATS group (p = 0.002). No significant differences were observed in postoperative complications, lymph node dissection outcomes (p > 0.05). CONCLUSION: Compared with VATS, RATS demonstrated favorable short-term clinical outcomes in elderly lung cancer patients, including shorter operative time, diminished blood loss, reduced drainage, shorter hospital stay, and alleviated early postoperative pain, alongside higher hospitalization costs, while maintaining comparable complication rates. RATS appears to be a safe and effective minimally invasive alternative for this population.
Integrating multi-omics data for enhanced prognosis prediction in gastric cancer post-neoadjuvant therapy.
Huang ZN, Zhang HX, Chen F … +17 more , Liu ZW, Wang L, Li Y, Weng CM, He JX, Zhuang HY, Zheng CH, Li P, Wang JB, Chen QY, Cao LL, Lin M, Tu RH, Wang B, Huang CM, Lin JX, Xie JW
Eur J Surg Oncol · 2026 Jun · PMID 42054940 · Publisher ↗
BACKGROUND: Neoadjuvant therapy is crucial for locally advanced gastric cancer (LAGC), yet response varies significantly. Traditional models based on clinicopathological features often lack precision. This study aimed to...
BACKGROUND: Neoadjuvant therapy is crucial for locally advanced gastric cancer (LAGC), yet response varies significantly. Traditional models based on clinicopathological features often lack precision. This study aimed to develop and validate a comprehensive prognostic model integrating deep learning features from CT images and immune scores to improve risk assessment. METHODS: A total of 179 LAGC patients who received neoadjuvant therapy between 2019 and 2022 were divided into a development cohort (DC, n = 125) and an internal validation cohort (IVC, n = 54). Additionally, an external validation cohort (EVC) of 29 patients was included. Pre-treatment abdominal enhanced CT images were analyzed using a ResNet18-based deep learning model to extract features and generate a DeepScore via univariate Cox and LASSO regression. ImmuneScore was calculated from postoperative transcriptome data using the ESTIMATE algorithm. A multi-omics nomogram combining DeepScore, ImmuneScore, and ypTNM stage was constructed, calibrated in the development cohort, and validated. RESULTS: In the DC, 3-year DFS rates for high, medium, and low DeepScore groups were 83.3%, 71.4%, and 29.3% (P < 0.0001); in the IVC, they were 92.0%, 66.7%, and 35.7% (P = 0.0011). The integrated nomogram achieved AUCs of 0.858, 0.843, and 0.839 (1-, 2-, 3-year DFS) in the DC, and 0.844, 0.825, and 0.833 in the IVC. In the EVC, the nomogram achieved AUCs of 0.786 and 0.785 for 1- and 2-year DFS, respectively. Low-risk patients showed significantly higher 3-year DFS and OS than high-risk patients in both DC and IVC cohorts (all P < 0.001). ssGSEA revealed higher immune infiltration in the low-risk group, and GSEA indicated enrichment in immune-related pathways. CONCLUSION: The integrated model combining deep learning and immune scores enhances prognostic accuracy for LAGC patients after neoadjuvant therapy, offering valuable support for clinical decision-making.
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