Eur J Surg Oncol [JOURNAL]
Sun
200 papers
Quantifying surgical extent as a prognostic factor in advanced ovarian cancer: initial validation of the Karolinska surgical extent and complexity score.
Groes Kofoed N, Hunde D, Ul Hassan M … +2 more , Imboden S, Salehi S
Eur J Surg Oncol · 2026 Jun · PMID 42054939 · Publisher ↗
BACKGROUND: Complete macroscopic cytoreductive surgery provides the best survival outcomes in advanced ovarian cancer (aOC), yet the extent and complexity of surgery also influence prognosis. In the absence of a standard...
BACKGROUND: Complete macroscopic cytoreductive surgery provides the best survival outcomes in advanced ovarian cancer (aOC), yet the extent and complexity of surgery also influence prognosis. In the absence of a standardised contemporary instrument to quantify surgical extent, this study aimed to perform the initial validation of a new scoring system for aOC surgery. METHODS: This observational, registry-based study included all women with aOC who underwent surgery in the Stockholm Region, Sweden, between 2009 and 2018. Patient and treatment data were obtained from the Swedish Quality Registry of Gynaecologic Cancer and vital status was cross-linked with the Swedish Population Registry. Surgical extent was quantified using the Karolinska Surgical Extent and Complexity Score (K-SECS), which assigns weighted complexity scores to cytoreductive procedures. The association between K-SECS and overall survival was evaluated using proportional hazards regression adjusted for relevant covariates. RESULTS: A total of 772 patients were included. Three prognostic K-SECS categories were identified: Intermediate (0-9), High (10-18) and Very High (≥19). A Very High K-SECS increased the hazard of death by 89% (HR 1.89; 95% CI 1.24-2.88; p = 0.002), while a High K-SECS increased the hazard by 46% (HR 1.46; 95% CI 1.20-1.79; p < 0.001). Adjusted absolute survival differences were 10.3% (95% CI 3.3-17.3) for Intermediate vs High and 18.5% (95% CI 6.3-30.8) for Intermediate vs Very High. CONCLUSION: Surgical extent and complexity independently predict survival in aOC. This study provides the initial validation of K-SECS as a contemporary instrument for adjusting surgical extent when reporting oncological outcomes.
The local efficacy of microwave ablation versus surgical resection for subcapsular colorectal liver metastases.
Zhou J, Cui H, Lin Z … +6 more , Qin S, Cui R, Chen Y, Wang Y, Wan Y, Liu G
Eur J Surg Oncol · 2026 Jun · PMID 42054938 · Publisher ↗
INTRODUCTION: The effectiveness of microwave ablation (MWA) versus surgical resection (SR) for subcapsular colorectal liver metastases (CRLM) is debated, with limited clinical evidence. This study examines the local ther...
INTRODUCTION: The effectiveness of microwave ablation (MWA) versus surgical resection (SR) for subcapsular colorectal liver metastases (CRLM) is debated, with limited clinical evidence. This study examines the local therapeutic efficacy and complications of MWA and SR for treating subcapsular CRLM. MATERIALS AND METHODS: Between January 2013 and December 2020, 519 patients with subcapsular CRLM were retrospectively included. This research was conducted on 768 subcapsular CRLM (621 in the MWA group and 147 in the SR group). Propensity score matching (PSM) with a ratio of 1:2 and adjusted Cox proportional hazards regression were utilized to balance the potential bias between the two groups. Local tumor progression (LTP) rate and complication rate were compared between the two groups. RESULTS: After PSM, 363 CRLM were matched: 232 in the MWA group and 131 in the SR group. Before PSM, LTP was 13.5% and 16.3% for MWA and SR groups; after PSM, it was 18.9% and 15.2% for MWA and SR groups. No significant difference in LTPFS between the groups (multivariable analysis, p = 0.395; PSM analysis, p = 0.374). Multivariable analysis identified protrusion as a significant factor for poor LTPFS in the MWA group. In the protruding CRLM subgroup, SR resulted in superior LTPFS compared to MWA (p = 0.037). The MWA group had a significantly lower minor and major complication rate than the SR group (both p < 0.001). CONCLUSION: Compared with SR, MWA provides comparable local tumor control and lower complication rates for subcapsular CRLM. SR is preferable for protruding CRLM.
Long-term oncological outcomes in early-stage breast cancer patients who underwent upfront oncoplastic breast-conserving surgery: Results from the Turkish oncoplastic breast surgery working group (TOBSWG) database.
Dogan L, Gulcelik MA, Karanlik H … +3 more , Akinci M, Ugurlu MU, Gulluoglu BM
Eur J Surg Oncol · 2026 Jun · PMID 42048919 · Publisher ↗
INTRODUCTION: Oncoplastic breast surgery (OPBS) techniques differ in terms of incision patterns and localizations, as well as the excision volumes they allow. There is no data yet reporting disease outcomes according to...
INTRODUCTION: Oncoplastic breast surgery (OPBS) techniques differ in terms of incision patterns and localizations, as well as the excision volumes they allow. There is no data yet reporting disease outcomes according to each OPBS technique applied to patients. In this study, we aimed to present long-term local control and overall mortality rates in patients recorded in the Turkish Oncoplastic Breast Surgery Working Group Database. METHODS: Female breast cancer patients who underwent upfront OPBS for definitive treatment were included in this retrospective cohort study. Patients were grouped into 6 cohorts according to the OPBS techniques applied. Patients who underwent surgery following neoadjuvant systemic treatment were excluded. Only patients who achieved a clear margin (a minimum of no ink on the tumor) during surgery were included in the study. Primary outcome was to assess the rates of in-breast tumor recurrence (IBTR), regional recurrence (RR), BC-specific mortality (BCSM), and overall mortality (OM) in patients. Univariate and multivariate analyses were done to find the independent factors for IBTR and BCSM. RESULTS: 3174 patients were included in the study. The most commonly used techniques were Racquet mammoplasty (26.5%) and vertical pattern mammoplasty (25%). After a 102-month follow-up period, IBTR rate was 3.9%, and the rates were similar among all surgery groups. RR, BCSM, and OM rates were 1.1%, 7.5%, and 8.4%, respectively. Having tumor subtypes of HER2+ and TN, multicentric/multifocal tumors, and failure to receive WBRT were found to be the independent factors associated with IBTR. Having tumor subtypes of HER2+ and TN and failure to receive adequate ST were independent factors related to BCSM. CONCLUSION: Overall, upfront OPBS resulted in a less than 4% of IBTR rate after a 8,5 year follow-up in patients with early breast cancer, and the rates were not different according to OPBS subgroups. Independent factors related to IBTR were having non-luminal subtype cancers, multicentric/multifocal tumors, and failure to receive RT to the breast. Therefore, upfront OPBS seems to be a safe procedure in patients with early breast cancer with safe margins, independent of the technique applied.
Prognostic significance of post-neoadjuvant MRI-detected extramural venous invasion and tumour deposits in rectal cancer: a systematic review and meta-analysis.
Lal N, Cheong Chung KJN, Hodges N … +2 more , Jenkins JT, Brown G
Eur J Surg Oncol · 2026 Jun · PMID 42048918 · Publisher ↗
BACKGROUND: Extramural venous invasion (EMVI) and tumour deposits (TDs) are recognised markers of aggressive rectal cancer biology at baseline. However, their prognostic relevance when persisting on post-neoadjuvant MRI...
BACKGROUND: Extramural venous invasion (EMVI) and tumour deposits (TDs) are recognised markers of aggressive rectal cancer biology at baseline. However, their prognostic relevance when persisting on post-neoadjuvant MRI remains poorly defined. We performed a systematic review and meta-analysis to evaluate the oncologic impact of persistent MRI-detected EMVI (ymrEMVI) and tumour deposits (ymrTD) and to compare their predictive value with post-treatment nodal status. METHODS: PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to December 2025. Studies reporting post-neoadjuvant MRI assessment of EMVI and/or TDs with time-to-event outcomes were included. Random-effects meta-analyses generated pooled hazard ratios (HRs) for disease-free survival (DFS), overall survival (OS), distant metastasis-free survival, and local recurrence-free survival. RESULTS: Seventeen studies encompassing 3932 patients met inclusion criteria. Persistent ymrEMVI was strongly associated with inferior DFS (HR 2.12, 95% CI 1.75-2.56) and OS (HR 2.21, 95% CI 1.63-2.99). ymrTD positivity conferred an even greater adverse impact on DFS (HR 2.85, 95% CI 1.58-5.17) and OS (HR 2.12, 95% CI 1.20-3.74). In contrast, post-treatment nodal status demonstrated inconsistent associations with DFS across studies. These vascular invasion phenotypes showed stronger and more reproducible prognostic value than residual nodal disease. CONCLUSIONS: Persistent EMVI and tumour deposits on post-neoadjuvant MRI identify a high-risk biological subgroup with markedly inferior survival, outperforming nodal status as prognostic indicators. Incorporation of ymrEMVI and ymrTD into post-treatment risk stratification and trial design is urgently required to guide intensification strategies and personalise rectal cancer management.
Clinical characteristics and surgical management of adult gastric inflammatory myofibroblastic tumors: A systematic review and pooled individual patient data analysis.
Ben-Ishay O, Harbi A, Gilshtein H
Eur J Surg Oncol · 2026 Jun · PMID 42034576 · Publisher ↗
Adult gastric inflammatory myofibroblastic tumors (IMT) are rare mesenchymal neoplasms that often mimic gastrointestinal stromal tumors (GIST). This systematic review with pooled individual patient data aimed to define t...
Adult gastric inflammatory myofibroblastic tumors (IMT) are rare mesenchymal neoplasms that often mimic gastrointestinal stromal tumors (GIST). This systematic review with pooled individual patient data aimed to define their clinical presentation, diagnostic work-up, and surgical management. Electronic databases (PubMed/MEDLINE, Embase, Scopus, Cochrane Library) were searched for adult (≥18 years) cases of histologically confirmed gastric IMT. Individual patient data on demographics, tumor characteristics, treatment, and outcomes were extracted from eligible case reports and series. Continuous variables were summarized as means with standard deviations and categorical variables as proportions with 95% confidence intervals, with prespecified comparisons by tumor location and surgical approach. Thirty-one patients were identified, with a female predominance and a mean age of 47.7 years. Most were symptomatic, presenting with abdominal pain or upper gastrointestinal bleeding/anemia. Tumors most frequently involved the middle third of the stomach and showed wide size variability. Distal tumors were larger and predominantly associated with pain, whereas proximal tumors more often presented with hemorrhage and less pain, suggesting distinct location-dependent clinical phenotypes. Surgical resection was the mainstay of treatment. Stomach-preserving resections were feasible in most cases, and minimally invasive surgery (MIS) was increasingly used for smaller, well-circumscribed lesions, while larger or locally invasive tumors more often required open major gastrectomy. Preoperative EUS-guided biopsy with immunohistochemistry, including ALK-1, is critical to avoid misdiagnosis. Complete surgical resection offers excellent short-to mid-term outcomes, and MIS stomach-preserving techniques appear safe for tumors under 5 cm when negative margins can be achieved.
Meta-analysis of endoscopic ultrasound guided gastrojejunostomy versus surgical gastroenterostomy for the management of gastric outlet obstruction.
Dermanis AA, Thompson D, Rao PKD … +2 more , Hajibandeh S, Hajibandeh S
Eur J Surg Oncol · 2026 Jun · PMID 42034575 · Publisher ↗
AIMS: To evaluate comparative outcomes of endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) and surgical gastrojejunostomy (SGJ) for management of gastric outlet obstruction (GOO). METHODS: A systematic search of e...
AIMS: To evaluate comparative outcomes of endoscopic ultrasound guided gastrojejunostomy (EUS-GJ) and surgical gastrojejunostomy (SGJ) for management of gastric outlet obstruction (GOO). METHODS: A systematic search of electronic data sources was conducted and all comparative studies investigating outcomes of EUS-GJ and SGJ were identified and their risk of bias were evaluated. Technical success, clinical success, length of hospital stay, overall adverse events, postoperative Clavien-Dindo (C-D) ≥ III complications, time to soft intake, time to oral intake, time to initiation of chemotherapy, overall mortality, 30-day mortality, readmissions, reintervention, among other outcomes were evaluated. RESULTS: Fourteen studies reporting a total of 22,337 patients were included (5172 EUS-GJ versus 17,165 SGJ). EUS-GJ was associated with significantly higher clinical success (OR 1.85, p = 0.02) and lower risk of overall morbidity (OR 0.28, p < 0.001), postoperative C-D > III complications (OR 0.44, p = 0.006) compared with SGJ. Moreover, it significantly shortened length of stay (MD -4.38, p < 0.0001), time to oral intake (MD -2.57, p < 0.0001), time to solid intake (MD -4.28, p = 0.027) or time to chemotherapy (MD -17.9, p < 0.0001). However, SGJ had significantly higher technical success (OR 0.34, p = 0.005). There was no significant difference in 30-day mortality (OR 1.03, p = 0.91), overall mortality (OR 0.98, p = 0.89) or reintervention (OR 0.77 p = 0.67) between groups. CONCLUSIONS: Where available, EUS-GJ should be considered as the first-choice intervention for isolated GOO considering favourable clinical success and significantly lower perioperative morbidities when compared with SGJ. Surgical approach is indicated if EUS-GJ fails or in the presence of a simultaneous anatomical disturbance that requires surgical correction. Future research is needed.
Explainable machine learning integrating metabolic and inflammatory signatures for personalized prognosis in resected intrahepatic cholangiocarcinoma.
Fang J, Zhu J, Huang R … +8 more , Dai X, Gao F, Li H, Xue J, Liu C, Li Z, Zheng J, Xie K
Eur J Surg Oncol · 2026 Jun · PMID 42034574 · Publisher ↗
BACKGROUND: The precise prognostic stratification of intrahepatic cholangiocarcinoma (iCCA) remains challenging. We aimed to develop and validate interpretable machine learning (ML) models that integrate clinicopathologi...
BACKGROUND: The precise prognostic stratification of intrahepatic cholangiocarcinoma (iCCA) remains challenging. We aimed to develop and validate interpretable machine learning (ML) models that integrate clinicopathological, metabolic, and immune-inflammatory factors to personalize prognosis prediction. METHODS: We retrospectively collected data from 690 iCCA patients across five centers. Patients from four centers were assigned to training/testing sets (n = 597, 7:3 split), and another single center as an external validation set (n = 93). After feature selection, five survival models were developed and compared for predicting overall survival (OS) and disease-free survival (DFS) using the concordance index (C-index), time-dependent ROC, Kaplan-Meier, calibration and decision curves. SHapley Additive exPlanations (SHAP) interpreted predictions, and a clinically applicable web-based tool was developed. RESULTS: The survival support vector machine (SSVM) model achieved the best predictive performance for both OS and DFS prediction. The SSVM_OS model achieved a C-index of 0.754, and the SSVM_DFS model achieved a C-index of 0.709. Both models showed excellent performance in the external validation set and demonstrated good clinical utility. The models effectively stratified patients into distinct risk groups and outperformed the AJCC-TNM staging system. SHAP analysis identified gamma-glutamyl transferase, triglyceride-glucose index, lymph node metastasis, and carcinoembryonic antigen as the most influential predictors for both OS and DFS. The optimal models were deployed as an online tool to provide individualized risk estimates for death and recurrence, supporting clinical decision-making. CONCLUSIONS: We developed and externally validated explainable ML models to predict postoperative risk for iCCA patients. The best-performed SSVM models were implemented as a clinical decision-support tool to guide personalized surveillance.
Development and validation of an ensemble machine learning model to predict survival in locally advanced rectal cancer: A multicenter, retrospective study.
Pan Z, Zheng S, Zhuang Z … +8 more , Wang Y, Lu X, Peng T, Zhang Q, Ye W, Guan G, Li S, Chen B
Eur J Surg Oncol · 2026 Jun · PMID 42030696 · Publisher ↗
BACKGROUND: Patients identified with locally advanced rectal cancer (LARC) demonstrate a varied prognosis after undergoing neoadjuvant chemoradiotherapy (nCRT), highlighting the essential need for precise predictions of...
BACKGROUND: Patients identified with locally advanced rectal cancer (LARC) demonstrate a varied prognosis after undergoing neoadjuvant chemoradiotherapy (nCRT), highlighting the essential need for precise predictions of outcomes. PURPOSE: The aim of this study is to create and assess a machine learning model that is interpretable and tailored to forecasting results in individuals diagnosed with LARC. METHODS: A multicenter retrospective cohort study was carried out, incorporating 1119 instances of LARC that received radical surgery following nCRT between the years 2012 and 2022. We utilized ten feature selection machine learning algorithms to identify the optimal predictive factors. Subsequently, we developed models using the selected subset of ten features combined with ten machine learning algorithms. The models' effectiveness was assessed using two distinct cohorts and analyzed through multiple techniques, such as the time-dependent calibration curves, concordance index (C-index), decision curve analysis and time-dependent receiver operating characteristic curves. RESULTS: Following the selection of predictors, a total of ten feature subsets were created. These subsets were then paired with ten machine learning algorithms in various combinations, leading to the formation of 100 predictive models. Of all the models analyzed, the integration of Random Survival Forest with gradient boosting showed the highest level of predictive accuracy. In the training group, the C-index for GRM was recorded at 0.917 (95% CI 0.890-0.944), while in validation cohort 1, it was 0.897 (95% CI 0.850-0.924), and in validation cohort 2, it registered at 0.837 (95% CI 0.780-0.894). Moreover, a web-based tool that is accessible to the public was developed for the GRM. CONCLUSION: GRM possesses the capability to effectively determine the prognosis for patients with LARC undergoing nCRT. This can aid healthcare providers in assessing the severity of the condition, improve patient oversight, and assist in the development of supplementary treatment strategies.
Treatment evolution and stage-specific survival in extrahepatic cholangiocarcinoma: a SEER study.
Wang Z
Eur J Surg Oncol · 2026 Jun · PMID 42030695 · Publisher ↗
INTRODUCTION: Whether survival in extrahepatic cholangiocarcinoma (eCCA) has improved over time, and whether any gains reflect earlier stage at diagnosis or evolving treatment strategies, remains unclear. We evaluated te...
INTRODUCTION: Whether survival in extrahepatic cholangiocarcinoma (eCCA) has improved over time, and whether any gains reflect earlier stage at diagnosis or evolving treatment strategies, remains unclear. We evaluated temporal changes in stage, treatment patterns, overall survival (OS), and cancer-specific mortality (CSM) in eCCA. MATERIALS AND METHODS: Patients with primary extrahepatic bile duct cancer (C24.0), malignant behavior, and histology codes 8140/3 or 8160/3 diagnosed in the SEER database from 2004 to 2022 were included. Diagnostic year was grouped into 2004-2008, 2009-2013, 2014-2018, and 2019-2022. Stage was classified as localized, regional, distant, or unknown. First-course treatment was recoded as no recorded active treatment, surgery alone, non-surgical therapy, or surgery plus additional recorded therapy. Multivariable Cox and Fine-Gray models were used for OS and CSM. RESULTS: Among 11,198 patients, there was no clear shift toward earlier-stage disease over time; localized disease remained stable (17.3% vs 15.2%), while unknown stage decreased from 16.6% to 10.3%. Treatment patterns changed substantially, with no recorded active treatment decreasing from 49.2% to 37.2%, non-surgical therapy increasing from 25.0% to 33.3%, and surgery plus additional therapy increasing from 12.1% to 20.7%. Later era was associated with improved OS, with adjusted hazard ratios of 0.94, 0.89, and 0.79 across successive eras versus 2004-2008; these attenuated to 0.98, 0.95, and 0.87 after treatment adjustment. Similar patterns were observed for CSM. Survival gains varied by stage and were concentrated within 24 months after diagnosis. CONCLUSION: Survival in eCCA improved over time without a clear shift toward earlier-stage disease. The attenuation of era effects after treatment adjustment suggests that evolving treatment strategies contributed substantially to recent outcome gains.
Development and external validation of a novel online calculator for predicting long-term survival following radical hepatectomy in patients with BCLC stage 0/A hepatocellular carcinoma and clinically significant portal hypertension.
Shao T, Hu H, Li Y … +29 more , Xia F, Shen X, Huang H, Zhang Z, He S, Li D, Xiang B, Zhou C, Wang B, Li B, Liu L, Yu D, Cai C, Yang H, Jiang B, Yuan G, Li Z, Lu Z, Zou H, Zhang G, Peng Y, Han B, Xiao C, Yu J, Wang J, Liu X, Chen X, Cheng Q, Zhang Z
Eur J Surg Oncol · 2026 Jun · PMID 42019372 · Publisher ↗
BACKGROUND: Patients with hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) experience a poorer prognosis following hepatectomy (Hx). This study aimed to develop a calculator to estimat...
BACKGROUND: Patients with hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) experience a poorer prognosis following hepatectomy (Hx). This study aimed to develop a calculator to estimate the survival outcomes of the cohort. METHODS: This study collected data from patients with BCLC stage 0/A HCC and CSPH who underwent curative Hx at 12 medical centers between 2015 and 2020. Prognostic factors for overall survival (OS) were identified using the Cox proportional hazards model. The performance of the nomogram was primarily assessed through the concordance index (C-index), compared with the Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden (MELD-AFP-TBS) and Chinese University Prognostic Index (CUPI). RESULTS: The patients were split into training (n = 370) and validation (n = 157) cohorts, with well-balanced baseline characteristics (all P > 0.05). The AUC values of the nomogram for 3- and 5-year OS were 0.776 and 0.712 in the training cohort, and 0.695 and 0.732 in the validation cohort. The C-index values for the nomogram were significantly improved (training cohort: vs. MELD-AFP-TBS, 0.148 [0.091-0.204]; vs. CUPI, 0.184 [0.134-0.234]; validation cohort: vs. MELD-AFP-TBS, 0.146 [0.054-0.238]; vs. CUPI, 0.140 [0.050-0.230]; all P < 0.05). Based on the nomogram, an online calculator was developed for individualized assessment of risk level and survival outcomes. CONCLUSION: Based on multi-center data, an accessible online calculator was developed to individually forecast the survival prognosis of patients with BCLC stage 0/A HCC and CSPH undergoing Hx.
Adding pembrolizumab to standard neoadjuvant chemoradiotherapy is not associated with increased postoperative complications after esophagectomy in ESCC: a retrospective analysis from a prospective database.
Yao L, Qi WX, Li S … +5 more , Zhao H, Wang M, Li H, Chen J, Zhao S
Eur J Surg Oncol · 2026 Jun · PMID 42019371 · Publisher ↗
BACKGROUND: The current standard of care for locally advanced esophageal squamous cell carcinoma (ESCC) consists of neoadjuvant chemoradiotherapy (nCRT) followed by curative surgery. Recent single-arm trials have demonst...
BACKGROUND: The current standard of care for locally advanced esophageal squamous cell carcinoma (ESCC) consists of neoadjuvant chemoradiotherapy (nCRT) followed by curative surgery. Recent single-arm trials have demonstrated that incorporating immune checkpoint inhibitors (ICIs) into neoadjuvant regimens improves pathological complete response (pCR) rates. However, the comparative risk of postoperative complications between nCRT and neoadjuvant chemoimmunoradiotherapy (nCIRT) followed by esophagectomy in patients with ESCC remains unclear. MATERIALS AND METHODS: We retrospectively analyzed ESCC patients who underwent neoadjuvant therapy followed by esophagectomy at Ruijin Hospital (April 2019-April 2025). Postoperative complications were defined as adverse events occurring within 90 days after surgery, primarily involving the respiratory, digestive, and cardiovascular systems. Severity was assessed using the Clavien-Dindo classification (CDC), and Grade IIIA or higher levels were considered severe complications. To overcome limitations of CDC in capturing the full morbidity spectrum and burden, we further evaluated complications using the Comprehensive Complication Index (CCI). RESULTS: A total of 271 patients who underwent curative esophagectomy were enrolled, including 169 in the nCRT group and 102 in the nCIRT group. No significant differences were observed in age or gender distribution between the two groups. According to Clavien-Dindo classification, there was no significant difference in overall complication rates between the nCRT and nCIRT groups (p = 0.76). Regarding severe complications (Grade ≥ IIIA), the overall incidence was 35.50% in the nCRT group and 28.43% in the nCIRT group (p = 0.23). The CCI analysis indicated a comparable morbidity burden, with median CCI scores of 22.60 in both nCRT and nCIRT cohorts (p = 0.65). Furthermore, no statistically significant differences were observed in subgroups analyses of patients with cardiac complications, pulmonary complications, anastomotic leakage, chyle leakage and wound infections, especially in severe complications. CONCLUSIONS: In this retrospective analysis of a prospectively maintained cohort, the addition of pembrolizumab to nCRT was not associated with a statistically significant increase in postoperative complications among patients with ESCC. These findings provided preliminary evidence regarding the perioperative safety of this combination. Further studies were warranted to investigate the long-term efficacy of nCIRT for the treatment of ESCC.
Use of uterine manipulators in endometrial cancer surgery: Balancing benefits and uncertainties.
D'Indinosante M, Bruno M, Napolitano F … +7 more , Perelli F, Restaino S, Vizzielli G, Rosati A, Perrone E, Fagotti A, Fanfani F
Eur J Surg Oncol · 2026 Jun · PMID 42019370 · Publisher ↗
OBJECTIVE: Intrauterine manipulators are commonly used for minimally invasive hysterectomy for endometrial cancer yet concerns regarding tumor spillage and oncologic safety remain debated. This review aims to synthesize...
OBJECTIVE: Intrauterine manipulators are commonly used for minimally invasive hysterectomy for endometrial cancer yet concerns regarding tumor spillage and oncologic safety remain debated. This review aims to synthesize comparative evidence regarding their impact on oncologic outcomes. METHODS: A comprehensive literature review up to December 2025 identified 15 comparative studies, including randomized trials, meta-analyses, and observational cohorts. The analysis focused on peritoneal cytology, lymphovascular space invasion (LVSI), recurrence patterns, and survival outcomes in patients undergoing hysterectomy for endometrial cancer. RESULTS: Most randomized and matched evidence demonstrated no significant detriment in disease-free or overall survival for early-stage endometrioid disease attributable to manipulator use. However, recent large datasets and meta-analytic subgroups signaled modest increases in positive peritoneal cytology (adjusted OR 1.7) and LVSI among manipulator users. Additionally, specific cohorts reported increased isolated vaginal vault recurrences, although overall operative safety remained comparable. CONCLUSIONS: Current evidence suggests that a universal oncologic hazard may not be present for early-stage, low-grade tumors, though the reliance on predominantly retrospective data warrants caution. Until definitive prospective data mature, a selective, technique-conscious approach could be considered.
Long-term implications of using preoperative oral antibiotics to prevent surgical-site infections in colon surgery: a follow-up study from ORALEV RCT.
Pellino G, Martínez-López M, Rudge E … +10 more , Solís-Peña A, Kreisler E, Fraccalvieri D, Muinelo-Lorenzo M, Maseda Díaz O, García-González JM, Huguet BM, Codina-Cazador A, Biondo S, Espín-Basany E
Eur J Surg Oncol · 2026 Jun · PMID 42019369 · Publisher ↗
BACKGROUND: ORALEV-RCT demonstrated that preoperative oral antibiotics (OA) before colon surgery reduces surgical-site infections. There was concern regarding a potential risk of antibiotic resistance. AIM: To assess if...
BACKGROUND: ORALEV-RCT demonstrated that preoperative oral antibiotics (OA) before colon surgery reduces surgical-site infections. There was concern regarding a potential risk of antibiotic resistance. AIM: To assess if OA led to increased long-term infection-related complications/antibiotic resistance. METHODS: Retrospective analysis of 3-year follow-up data of ORALEV. PRIMARY OUTCOME: risk of infectious complications with vs without OA. Secondary: long-term complications, effect on COVID-19. RESULTS: 529 were included (n = 265,no OA vs n = 264,OA). Infective complications with hospital admissions (2.6% vs 2.6%, no OA vs OA), antibiotic treatment (1.9% vs 1.1%,p = 0.715), and COVID-19 (0.4% vs 1.5%,p = 0.22) did not differ. Three patients required ertapenem. Readmissions for any complication did not differ (10.9% vs 12.5%,p = 0.67). After removing COVID-19 admissions, COPD was associated with need for antibiotic treatment in the long-term (HR 5.13, 95%CI 1.28-20.54) irrespective of OA administration. Postoperative hernia (4.1% vs 1.5%,p = 0.11) and indication for repair (81.8% vs 25%,p = 0.08) were higher in non-OA group, but not statistically different. CONCLUSIONS: OA do not increase the risk of long-term infective complications and need for advanced antimicrobial treatment. COPD increased the risk of subsequent need for antibiotic treatment.
Advanced high-grade serous ovarian cancer treated with intensive cytoreductive surgery and chemotherapy: prognostic impact of lymph node involvement: analysis of the French national ESME-Unicancer database.
Le Bars S, Guerin-Charbonnel C, Martin E … +17 more , Thomas QD, Costaz H, Pomel C, Marchal F, Narducci F, Gouy S, Laas E, Rossi L, Lambaudie E, Rouzier R, Petit T, Gladieff L, De La Motte Rouge T, Bosquet L, Colombo PE, Classe JM, Loaec C
Eur J Surg Oncol · 2026 Jun · PMID 42013623 · Publisher ↗
INTRODUCTION: Benefits on survival of retroperitoneal lymph node (LN) dissection during cytoreductive surgery (CRS) for epithelial ovarian cancer are debated. However, LN involvement may be a prognostic factor especially...
INTRODUCTION: Benefits on survival of retroperitoneal lymph node (LN) dissection during cytoreductive surgery (CRS) for epithelial ovarian cancer are debated. However, LN involvement may be a prognostic factor especially in case of high-grade serous ovarian cancer (HGSOC). MATERIALS AND METHODS: In the French Epidemiological Strategy and Medical Economics - Ovarian Cancer (ESME-OC) database, we identified patients treated for advanced-stage (FIGO III-IV) HGSOC with chemotherapy and intensive CRS including retroperitoneal LN dissection. Our first objective was to identify prognostic factors in case of maximalist treatment. RESULTS: Of 13032 patients included, 485 with advanced HGSOC diagnosed between May 29, 2006 and December 16, 2019 were analyzed. Primary CRS was performed on 279 patients (57.5%). Of them, 70.3% had LN involvement. Surgery was performed after neo-adjuvant chemotherapy (NAC) in 206 patients (42.5%). Of them, 61.2% had LN involvement. LN involvement was considered major with a Lymph Node Ratio (LNR) ≥25% for 21.1% of patients who underwent primary CRS and 15.0% after NAC. In primary CRS, when adjusted to FIGO stage and BRCA1/2 deleterious mutation, LNR ≥25% vs none indicated a poorer prognosis for both overall survival (OS) (HR = 2.46 [1.25; 4.84], p = 0.009) and progression-free survival (PFS) (HR = 2.23 [1.40; 3.57], p < 0.001). After NAC, LNR ≥25% vs none was a negative prognostic factor with a stronger negative impact on PFS (HR = 2.00 [1.12; 3.57]; p = 0.018). CONCLUSION: LN involvement is a negative prognostic factor in advanced-stage HGSOC especially in case of primary CRS. LN involvement could be a target for developing new therapies.
Women in surgical oncology.
Wyld L, Rubio IT
Eur J Surg Oncol · 2026 May · PMID 42001839 · Publisher ↗
Abstract loading — click title to view on PubMed.
Survival advantage of conversion surgery following induction therapy in cT4 esophageal cancer: A systematic review and meta-analysis.
Jiang KY, Zhang LD, Zhong AL … +6 more , Hu WL, Wang JJ, Zhang JJ, Mao YY, Deng ZQ, Tian D
Eur J Surg Oncol · 2026 Jun · PMID 42001566 · Publisher ↗
BACKGROUND: cT4 esophageal cancer represents a major therapeutic challenge, with definitive chemoradiotherapy (dCRT) currently considered the standard treatment. However, survival outcomes remain unsatisfactory. CS follo...
BACKGROUND: cT4 esophageal cancer represents a major therapeutic challenge, with definitive chemoradiotherapy (dCRT) currently considered the standard treatment. However, survival outcomes remain unsatisfactory. CS following induction therapy has emerged as a potential alternative strategy, though its clinical effectiveness remains under debate. This systematic review and meta-analysis aimed to compare survival outcomes between conversion surgery (CS) and definitive therapy in patients with cT4 esophageal cancer. METHODS: Relevant literature was retrieved from PubMed, the Cochrane Library, and Embase. Patients were categorized into the CS group or the definitive therapy group. A systematic review and meta-analysis were performed to evaluate 1-, 3-, and 5-year overall survival (OS) outcomes in patients with esophageal cancer. Odds ratios, mean differences, and 95% confidence intervals were calculated using fixed-effects or random-effects models. RESULTS: Seventeen studies involving a total of 3721 patients with cT4 esophageal cancer were included. After excluding studies with high heterogeneity, CS was associated with significantly better survival compared to definitive therapy at 1-year (73.6% vs. 49.6%), 3-year (37.0% vs. 18.4%), and 5-year (26.5% vs. 11.6%) OS. A subgroup analysis of three studies including 341 patients with cT4b disease revealed a significant survival advantage for the CS group in both 1-year OS (86.4% vs. 37.6%) and 3-year OS (48.6% vs. 11.4%). CONCLUSIONS: CS following induction therapy significantly improves survival in patients with cT4 esophageal cancer. However, the survival benefit of CS for cT4b disease requires further validation in larger prospective studies.
Postoperative complications and prognosis after splenectomy during cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
Ghanipour L, Rashed M, Abraham-Nordling M … +4 more , Enblad M, Birgisson H, Graf W, Cashin P
Eur J Surg Oncol · 2026 Jun · PMID 42000406 · Publisher ↗
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for peritoneal metastases (PM) of various origins. The spleen is frequently involved in advanced d...
BACKGROUND: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is an established treatment for peritoneal metastases (PM) of various origins. The spleen is frequently involved in advanced disease, making splenectomy a common procedure in CRS. This study aimed to evaluate postoperative complications and prognosis associated with splenectomy during CRS + HIPEC. PATIENTS AND METHODS: Data from patients undergoing CRS + HIPEC from 2012 to 2022 were retrospectively collected from a prospectively maintained HIPEC registry. Postoperative complications according to Clavien-Dindo, overall survival (OS), and disease-free survival (DFS) were compared between patients undergoing splenectomy (n = 109) and the control group without splenectomy (n = 282). Cox proportional hazards models were used to identify independent prognostic factors. RESULTS: The splenectomy group had significantly higher PCI (median 25 vs. 8, p < 0.001) and more frequent diaphragmatic peritonectomy (83% vs. 70%, p < 0.001). High PCI was an independent predictor for splenectomy (adjusted OR 1.18, 95% CI 1.12-1.24). In univariable analysis, the likelihood of severe postoperative complications (Clavien-Dindo grade 3-4) was higher after splenectomy (OR 1.77, 95% CI 1.12-2.80), with increased rates of sepsis and kidney failure. In multivariable analysis, diaphragmatic resection (adjusted OR 4.81, 95% CI 1.99-11.61) was associated with severe complications, whereas splenectomy was not. Splenectomy was also not a predictor of OS and DFS after multivariable adjustment. In contrast, PCI ≥20 and synchronous liver resection were associated with worse OS. CONCLUSION: The need for splenectomy during CRS + HIPEC reflects more advanced peritoneal disease; however, splenectomy is not an independent risk factor for postoperative complications. Likewise, it does not independently affect overall or disease-free survival.
Surgical outcomes after neoadjuvant chemoimmunotherapy for resectable NSCLC: a systematic review and meta-analysis.
Bertoglio P, Gallina FT, Balzani E … +16 more , Ambrosi F, Di Federico A, Faccioli E, Facheris G, Ferrara R, Ferro A, Filipello F, Giusti R, Greco C, Mammana M, Marinelli D, Nuccio A, Pittaro A, Sepulcri M, Viscardi G, Guerrera F
Eur J Surg Oncol · 2026 Jun · PMID 42000405 · Publisher ↗
INTRODUCTION: The integration of immune checkpoint inhibitors (ICIs) into the management of resectable non-small cell lung cancer (NSCLC) has markedly improved pathological response and survival. However, the effect of I...
INTRODUCTION: The integration of immune checkpoint inhibitors (ICIs) into the management of resectable non-small cell lung cancer (NSCLC) has markedly improved pathological response and survival. However, the effect of ICI-based regimens on surgical feasibility, complexity, and perioperative safety remains uncertain. This study aimed to systematically evaluate surgical outcomes following neoadjuvant or perioperative ICI-based therapy, with or without chemotherapy. METHODS: A systematic search of PubMed, EMBASE, Scopus, Cochrane CENTRAL, and Web of Science was conducted from database inception to January 2025 according to PRISMA guidelines. Only prospective single-arm and randomized controlled trials reporting surgical outcomes after ICI-based regimens in resectable NSCLC were included. Pooled event proportions (EP) were estimated using random-effects meta-analysis with Freeman-Tukey transformation. Meta-regression analyses compared chemo-immunotherapy (CTIO) versus immunotherapy-only (IO) protocols. RESULTS: Twenty-seven eligible trials comprising 2691 patients were analyzed. The pooled EP for intraoperative complications was 0.03, postoperative complications 0.27, and postoperative mortality 0.01. Pneumonectomy was performed in 10% of cases. Minimally invasive surgery (MIS) was used in 47% of resections, with a 20% conversion rate and 9% surgical delays. Meta-regression revealed higher intraoperative complications and surgery omission with CTIO protocols, while IO regimens showed higher postoperative mortality. No significant differences were found in pneumonectomy rate, MIS utilization, or conversion. CONCLUSIONS: Surgery following ICI-based therapy is feasible and safe in appropriately selected patients but presents distinct perioperative challenges. Differing risk profiles between treatments underscore the need for multidisciplinary coordination, experienced thoracic surgeons, and treatment centralization in resectable NSCLC within the immunotherapy era.
Impact of less invasive axillary staging procedures after neoadjuvant systemic therapy on adjuvant systemic therapy indications in HER2-positive and triple-negative breast cancer.
Claassens EL, Koppert LB, van der Pol CC … +8 more , Luiten EJT, van Nijnatten TJA, Jager A, de Boer M, van Diest PJ, Smidt ML, Simons JM, RISAS study group
Eur J Surg Oncol · 2026 Jun · PMID 42000404 · Publisher ↗
OBJECTIVE: To determine how often the indication for adjuvant systemic therapy (AST) in HER2+ and TN breast cancer is based solely on residual axillary disease (ypT0N+) and to estimate the theoretical frequency with whic...
OBJECTIVE: To determine how often the indication for adjuvant systemic therapy (AST) in HER2+ and TN breast cancer is based solely on residual axillary disease (ypT0N+) and to estimate the theoretical frequency with which less invasive axillary staging procedures may fail to identify AST eligibility. BACKGROUND: HER2+ and triple-negative (TN) breast cancer patients with residual disease after neoadjuvant systemic therapy (NST) benefit from AST with trastuzumab and emtansine (T-DM1) and capecitabine improving disease-free and overall survival for HER2+ and TN patients, respectively. METHOD: This retrospective analysis of prospectively collected data from the multicenter RISAS trial included clinically node-positive (cN+) breast cancer patients treated with NST. We assessed how often ypT0N + occurred and estimated how often sentinel lymph node biopsy (SLNB), marking axillary lymph nodes with radioactive iodine seeds (MARI) or RISAS might theoretically fail to detect residual axillary disease, compared to axillary lymph node dissection (ALND). RESULTS: In 109 HER2+ (n = 64) and TN (n = 45) breast cancer patients, 63 (57.8%) had residual disease in the breast and/or axilla and were eligible for AST. Eligibility was based on ypT0N+ in 10/63 (15.9%) patients. The theoretical risk of missing AST eligibility was 3.2% (2/63) for RISAS, and 4.8% (3/63) for MARI and SLNB. CONCLUSIONS: In this cN + cohort, approximately one in six patients eligible for AST had residual disease only in the axilla. Less-invasive axillary staging procedures were associated with a low estimated theoretical risk of missed AST eligibility. However, these findings should be interpreted in light of the modest sample size.
MRI-driven multimodal deep learning approach for predicting pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer: A multicenter study.
Han K, Zhou C, Zeng L … +4 more , Lai X, Liang B, Xu Z, Yang Y
Eur J Surg Oncol · 2026 Jun · PMID 41996781 · Publisher ↗
OBJECTIVES: Achieving a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) enables organ preservation and may obviate the need for r...
OBJECTIVES: Achieving a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer (LARC) enables organ preservation and may obviate the need for radical surgery. This study aimed to develop an interpretable magnetic resonance imaging (MRI)-based clinical deep learning radiomics (DLR) model to noninvasively predict treatment response before therapy. MATERIAL AND METHODS: This retrospective cohort enrolled 180 LARC patients who received surgery following nCRT at a tertiary care center. And then they were assigned into a training cohort (Center 1, n = 92) and an external validation cohort (Centers 2 and 3, n = 88) for model development and independent evaluation. In total, 428 quantitative radiomics features and 320 deep learning (DL) features (from ResNet50, GoogLeNet, ResNet18, and VGG16) were obtained per patient from pre-nCRT and post-nCRT T2-weighted (T2WI) and diffusion-weighted imaging (DWI) sequences. The predictive performance of the model was quantified by the area under the receiver operating characteristic curve (AUC), and differences among models were statistically assessed with the DeLong test. To enhance interpretability, the Shapley Additive explanations (SHAP) analysis and Gradient-weighted Class Activation Mapping (Grad-CAM) approach were employed to validate and visualize the contribution of individual features. RESULTS: The DLR fusion model, which integrated radiomics features with ResNet50-derived deep learning features, demonstrated higher predictive performance for pCR in LARC patients after nCRT, yielding AUCs of 0.838 in the training cohort and 0.786 in the external validation cohort-surpassing the performance of other DLR models. The clinical DLR (CDLR) model achieved higher performance (AUCs: 0.923 and 0.866, respectively). SHAP analysis highlighted DL_26_T2WI_post as a key predictor of pCR. CONCLUSION: The interpretable CDLR fusion model based on pre-nCRT and post-nCRT multiparametric MRI offers a reliable, noninvasive approach for the prediction of pCR in LARC patients after receiving nCRT and shows potential for guiding individualized clinical decision-making.
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