Eur J Surg Oncol [JOURNAL]
Sun
200 papers
AGIBOT AM1000 versus da Vinci Xi systems for robot-assisted partial nephrectomy: a retrospective propensity score-matched comparative study.
Gao S, Sun J, Zhu Y … +10 more , Wang X, Wang X, Ji C, Liu G, Zhang G, Gan W, Xu M, Cheng G, Jiang B, Guo H
Eur J Surg Oncol · 2026 Jun · PMID 41996780 · Publisher ↗
INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) has become a new standard option for clinical T1 renal tumors. Whether outcomes with the AGIBOT AM1000 system are comparable to those with the da Vinci Xi platform...
INTRODUCTION: Robot-assisted partial nephrectomy (RAPN) has become a new standard option for clinical T1 renal tumors. Whether outcomes with the AGIBOT AM1000 system are comparable to those with the da Vinci Xi platform remains uncertain. MATERIALS AND METHODS: This single-center, retrospective, propensity score-matched noninferiority study included adults who underwent RAPN between December 2023 and December 2025. The primary endpoint was the operative success rate, defined as completion of the planned RAPN without conversion to laparoscopy or open surgery. The noninferiority margin was set at -10%. RESULTS: Overall, 54 patients in AGIBOT group and 521 patients in da Vinci group were enrolled. After propensity score-matching, 49 patients were matched in each group. All procedures were completed without conversion. Operative success was 100% in both groups; the risk difference was 0.0% (95% CI, -7.3% to 7.3%), meeting the noninferiority criterion. No significant difference was found in operation time, warm ischemic time (WIT), docking time, intraoperative complications, postoperative complications, serum creatinine, eGFR level, or positive surgical margin. AGIBOT AM1000 was associated with lower estimated blood loss (EBL) (median 30 vs 50 mL; p = 0.014) and a smaller hemoglobin decrease (-3.60% vs -6.02%; p = 0.017). As for the NASA task load index (NASA-TLX), significant differences were found in temporal demand and effort. CONCLUSION: The AGIBOT AM1000 system appears to be a suitable platform for RAPN, with feasibility and short-term perioperative outcomes comparable to those of the da Vinci Xi system.
Conversion surgery after repeated intraperitoneal chemotherapy in unresectable peritoneal metastatic colorectal cancer: a narrative review of the literature.
Scarton A, Kerkhoff TME, van Erning FN … +3 more , Burger JWA, Sommariva A, de Hingh IHJT
Eur J Surg Oncol · 2026 Jun · PMID 41996779 · Publisher ↗
Peritoneal metastases from colorectal cancer (CRC-PM) are known to respond poorly to systemic chemotherapy. Therefore, in patients with irresectable CRC-PM, treatments with repeated administration of intraperitoneal chem...
Peritoneal metastases from colorectal cancer (CRC-PM) are known to respond poorly to systemic chemotherapy. Therefore, in patients with irresectable CRC-PM, treatments with repeated administration of intraperitoneal chemotherapy via pressurized intraperitoneal aerosol chemotherapy (PIPAC) or catheter-based intraperitoneal chemotherapy (CBIPC) have been introduced. Currently, it is unknown whether such palliative-intent therapy may play a role in converting patients with irresectable CRC-PM into candidates for cytoreductive surgery (CRS). The current study reviewed all literature available up to 1st December 2025 investigating palliative intraperitoneal therapies in patients diagnosed with CRC-PM. Inclusion of articles was further based on the availability of conversion surgery data. Data on safety, response and survival outcomes were also collected. In total, 14 studies on PIPAC and 4 studies on CBIPC were included. Conversion to CRS rates after bidirectional treatment in retrospective studies were up to 27% with PIPAC-Oxaliplatin and to 34% with CBIPC-Paclitaxel. In clinical trials, a conversion rate of 17% and 22% were found respectively after PIPAC-Oxaliplatin monotherapy and CBIPC-Irinotecan plus systemic therapy. Outcomes after conversion surgery are rarely reported. Repetitive intraperitoneal chemotherapy was found to enable conversion to CRS in part of the patients with irresectable CRC-PM. Though promising, the current review highlights the heterogeneity of data on palliative intraperitoneal therapies in irresectable CRC-PM, hampering the intra- and across modality comparison of results. Further research is needed to indicate the optimal delivery system, intraperitoneal agent, timing of treatment initiation, number of cycles and bimodality.
Construction and validation of a prediction model for textbook outcome in distal cholangiocarcinoma undergoing pancreaticoduodenectomy based on six machine learning algorithms.
Yang SQ, Cai YL, Tian Y … +4 more , Zou RQ, Hu HJ, Jin YW, Li FY
Eur J Surg Oncol · 2026 Jun · PMID 41996778 · Publisher ↗
BACKGROUND: Textbook outcome (TO) serves as a validated composite metric for short-term surgical quality in pancreaticoduodenectomy (PD) patients. This study developed and validated a machine learning-based model to pred...
BACKGROUND: Textbook outcome (TO) serves as a validated composite metric for short-term surgical quality in pancreaticoduodenectomy (PD) patients. This study developed and validated a machine learning-based model to predict the probability of TO attainment in patients with distal cholangiocarcinoma (dCCA) undergoing PD. METHODS: Patients with dCCA who underwent PD at our institution between 2012 and 2020 were retrospectively analyzed. Candidate variables were first screened using least absolute shrinkage and selection operator (LASSO) regression, and the selected features were subsequently entered into multivariable logistic regression to identify independent predictors of TO. Six machine learning models were then constructed and evaluated, with their performance compared using the area under the receiver operating characteristic curve (AUC-ROC). SHapley Additive exPlanations (SHAP) analysis was used to elucidate the optimal model's decision-making process and quantify the contribution of each predictor. RESULTS: Among the 242 patients included in the study, 177 (73.1%) achieved TO. LASSO regression followed by multivariable logistic analysis identified five independent predictors of TO: ASA classification, lymph node metastasis, perineural invasion, BMI, and operation time. Six machine learning algorithms were constructed, among which the Gradient Boosting Machine (GBM) exhibited the best discriminative performance (AUC training set: 0.951, 95% CI 0.915-0.988; test set: 0.890, 95% CI 0.800-0.980). Calibration plots and decision curve analysis further demonstrated the strong accuracy and favorable clinical utility of the GBM-based model. CONCLUSION: The GBM-based prediction model offers accurate preoperative probability estimates of TO attainment and serves as a valuable tool to support individualized surgical planning.
The impact of MRI on real-world staging pathways and management timelines in pancreatic cancer: A systematic review.
Memon M, Chatzielefthreiou E, Kowal MR … +4 more , Shapey I, Albazaz R, Smith A, Pathak S
Eur J Surg Oncol · 2026 Jun · PMID 41996777 · Publisher ↗
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and accurate staging is crucial to avoid unnecessary surgery. MRI may improve the detection of occult liver metastases when compared with CT. The...
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, and accurate staging is crucial to avoid unnecessary surgery. MRI may improve the detection of occult liver metastases when compared with CT. The impact of adding MRI on treatment timelines and cost-effectiveness remains uncertain. This systematic review synthesises the available evidence of incorporating MRI alongside CT for pre-operative staging of pancreatic cancer. METHODS: We systematically searched MEDLINE, Embase, Web of Science, and the Cochrane Library (2005-2025) for studies comparing staging pathways using CT + MRI versus CT alone in adults with PDAC. Primary outcomes were time to treatment/pathway delays. Secondary outcomes were changes in management, detection of liver metastases, and economic implications. RESULTS: Fifteen studies (4 retrospective cohorts, 11 case series; n = 7243) were included. Cohort data showed inconsistent effects of MRI on time to surgery, ranging from a 5-day reduction to an 8-day increase (weighted mean + 5.7 days). In case series, the CT-MRI interval averaged 9.7 days and MRI-surgery interval 8.7 days. MRI identified additional liver metastases in 2-23% of CT-negative patients and in 12-45% of those with indeterminate CT findings. CONCLUSIONS: MRI improves detection of occult liver metastases and influences surgical decision-making without consistently delaying treatment. However, pathway-level evidence is heterogeneous, and cost-effectiveness remains unexplored. High-quality prospective studies are needed to define MRI's role in contemporary staging pathways.
Artificial intelligence-enhanced three-dimensional radiological analysis for predicting spread through air spaces in early-stage lung adenocarcinoma.
Amemiya R, Kudo Y, Matsubayashi J … +13 more , Ichinose A, Park J, Tanei S, Nagase W, Takada I, Ito M, Furumoto H, Hagiwara M, Kakihana M, Ohira T, Nagao T, Masumoto J, Ikeda N
Eur J Surg Oncol · 2026 Jun · PMID 41990409 · Publisher ↗
OBJECTIVES: Spread through air space (STAS) is a pathological feature that correlates with poor prognosis, especially in patients with lung adenocarcinoma undergoing sublobar resection. The microscopic nature of STAS com...
OBJECTIVES: Spread through air space (STAS) is a pathological feature that correlates with poor prognosis, especially in patients with lung adenocarcinoma undergoing sublobar resection. The microscopic nature of STAS complicates direct detection using preoperative radiological imaging. We aimed to develop an artificial intelligence (AI)-assisted three-dimensional (3D) computed tomography (CT) imaging model to preoperatively predict STAS in early-stage lung adenocarcinoma. METHODS: This retrospective study included 364 patients with stage 0-IA3 lung adenocarcinoma who underwent complete surgical resection between 2018 and 2021. Preoperative CT images were analyzed using 3D image analysis with AI. This process involved automatic quantification of pulmonary nodule volume and assessment of 22 distinct imaging characteristics of the nodules. Pathological analysis of STAS was conducted on excised specimens, and its relationship with imaging features was explored. RESULTS: STAS was identified in 107 patients. Compared with a non-STAS group (n = 257), patients with STAS had a significantly higher median standard uptake value on positron emission tomography/CT (4.5 vs. 2.0, p < 0.01). AI-driven 3D analysis showed that STAS-positive tumors exhibited a significantly greater solid component volume and percentage (1.37 cm and 68.6%, respectively) compared with STAS-negative tumors (0.38 cm and 26.0%, respectively; p < 0.01). Utilizing 22 imaging features derived from AI-driven 3D analysis, multivariate analysis identified lobulated edge (p = 0.002) or pleural hypertrophy (p = 0.022), and the absence of ground-glass opacity (p = 0.029) as independent predictive factors for STAS. CONCLUSION: AI-driven 3D imaging can enhance preoperative STAS prediction for the risk stratification of lung adenocarcinoma, potentially optimizing surgical decisions and treatment strategies.
A radiomics model for preoperative prediction of microvascular invasion as a factor in predicting prognosis of hepatocellular carcinoma after radiofrequency ablation.
Shao L, Wu K, Wang Q … +1 more , Zhang B
Eur J Surg Oncol · 2026 Jun · PMID 41985382 · Publisher ↗
OBJECTIVE: To establish a non-invasive predictive radiomics model of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) and to explore the correlation between MVI status and prognosis of HCC patients after ra...
OBJECTIVE: To establish a non-invasive predictive radiomics model of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) and to explore the correlation between MVI status and prognosis of HCC patients after radiofrequency ablation (RFA). METHODS: A total of 142 HCC patients with or without MVI were randomly allocated into the training set (n = 99) and the validation set (n = 43). After preprocessing of tri-phase contrast-enhanced MRI, 1688 radiomics features were extracted per lesion. LASSO-Logistic regression was employed for feature selection and radiomics model construction to predict MVI in HCC. The model performance was evaluated using discrimination metrics. Additionally, 58 HCC patients who underwent RFA were enrolled. Univariate and multivariate logistic regression analyses were performed to investigate the impact of MVI on post-RFA prognosis of HCC. RESULTS: The radiomics model, especially that derived from the portal venous phase, exhibited effective performance in MVI prediction, achieving an area under the curve (AUC) of 0.888 in the training set and 0.769 in the validation set. Furthermore, the radiomics score was identified as an independent risk factor for recurrence after RFA. CONCLUSIONS: This non-invasive radiomics model enables preoperative identification of MVI and prediction of post-RFA recurrence risk in HCC patients, thereby providing valuable evidence for formulating individualized treatment strategies.
Hepatobiliary surgical training in a changing educational landscape: An 18-year longitudinal analysis of a high-volume international fellowship programme.
Wettstein D, Primavesi F, Alkhatib O … +20 more , Dupré A, Tufo A, Grünhagen DJ, Kuhlmann KFD, Carrión-Álvarez L, Sarno G, van Verschuer VMT, Thomas M, Hore T, Dreyer S, den Dulk M, Stättner S, Gordon-Weeks AN, Holroyd D, Stremitzer S, Jones RP, Malik HZ, Fenwick SW, Poston GJ, Diaz-Nieto R
Eur J Surg Oncol · 2026 Jun · PMID 41980409 · Publisher ↗
BACKGROUND: Hepatobiliary (HB) surgery is increasingly complex, requiring expertise beyond general surgery training. Structured fellowship programmes aim to ensure adequate operative training, academic growth, and global...
BACKGROUND: Hepatobiliary (HB) surgery is increasingly complex, requiring expertise beyond general surgery training. Structured fellowship programmes aim to ensure adequate operative training, academic growth, and global leadership, but their outcomes are not well studied. The Liverpool Hepatobiliary Fellowship has provided international HB training in a high-volume centre in the United Kingdom for over 18 years. METHODS: We performed a cross-sectional survey of all senior fellows who completed ≥6 months of the Liverpool fellowship (2007-2025). The questionnaire covered demographics, pre-fellowship experience, operative volume, academic productivity, and subjective fellowship evaluation. Fellows self-rated their confidence (1-10 scale) in performing a right hemihepatectomy with a junior assistant before and after the fellowship. Quantitative data were analysed descriptively, and pre-post confidence changes were tested. Qualitative responses were thematically analysed. RESULTS: Eighteen of 22 eligible fellows (82%) completed the survey. Fellows reported a significant increase in operative confidence, measured subjectively as their confidence in performing a right hemihepatectomy with a junior assistant (median improvement: 2.5/10 to 9/10). Median case volume included 65 liver resections. Minimally invasive surgery (MIS) exposure increased from 10 cases overall at the beginning of the programme to over 20 in the last 5 years. Over 80% of fellows published during or after the fellowship, and 83% were appointed to consultant roles within one year. Qualitative responses emphasized strong mentorship, high case volume, and career-defining experiences. Gaps identified included robotic surgery exposure and structured academic support. CONCLUSIONS: Dedicated HB fellowship programmes significantly enhance surgical competence, operative autonomy, academic output, and leadership development. The Liverpool programme exemplifies a successful international training model, combining high-volume hands-on practice with strong mentorship. The recent incorporation of robotic-assisted surgery addresses an identified key training gap, ensuring the fellowship's continued relevance in a technologically advancing field.
Trends and future of the disease burden of malignant neoplasms of bone and articular cartilage in China from 1990 to 2023: An analysis based on the Global Burden of Disease 2023.
Zheng J, Yu W, Lou Y … +8 more , He X, He S, Zhou H, Gao X, Sun W, Fang B, Wang S, Yin M
Eur J Surg Oncol · 2026 Jun · PMID 41980408 · Publisher ↗
BACKGROUND: Malignant neoplasms of bone and articular cartilage (MNBAC) are rare but highly aggressive tumors that impose substantial health and socioeconomic burdens. This study aimed to comprehensively assess temporal...
BACKGROUND: Malignant neoplasms of bone and articular cartilage (MNBAC) are rare but highly aggressive tumors that impose substantial health and socioeconomic burdens. This study aimed to comprehensively assess temporal trends, demographic patterns, and future projections of MNBAC burden in China from 1990 to 2023. METHODS: Data were obtained from the Global Burden of Disease Study 2023. We analyzed incidence, prevalence, deaths, and disability-adjusted life years (DALYs), along with age-standardized rates. Joinpoint regression was used to estimate annual percent change (APC) and average annual percent change (AAPC). Age-period-cohort (APC) models were applied to evaluate age, period, and cohort effects. A decomposition analysis quantified the contributions of population growth, population aging, and changes in age-specific rates. Bayesian age-period-cohort (BAPC) models were used to project trends through 2040. RESULTS: From 1990 to 2023, incident cases, prevalent cases, and deaths increased approximately threefold, while DALYs increased by 1.8-fold. The age-standardized incidence rate (ASIR) and age-standardized prevalence rate (ASPR) increased by 125.71% and 134.62%, with AAPCs of 2.63% and 2.78%, respectively. In contrast, the age-standardized DALYs rate (ASDR) and age-standardized mortality rate (ASMR) increased by 59.21% and 69.64%, with comparatively lower AAPCs. APC modeling revealed strong age effects and increasing risks in later birth cohorts. Decomposition analysis indicated that changes in age-specific rates were the primary drivers of increases in incidence, prevalence, and DALYs, whereas population aging contributed most substantially to mortality growth. BAPC projections suggest continued increases in ASIR, ASPR, and ASDR through 2040, with more moderate growth in ASMR. CONCLUSION: The burden of MNBAC in China has increased substantially over the past three decades, characterized by rising incidence and prevalence alongside relatively slower mortality growth. Population aging, cohort-related risk accumulation, and evolving lifestyle and environmental exposures may underlie these trends. Strengthened early intervention and long-term management strategies are needed to mitigate the projected future burden.
Incidence trends and survival benefit of surgery in solid tumors with synchronous brain-limited metastasis at diagnosis: a population-based cohort study (2010-2022).
Li GS, He WY, Liu J … +5 more , Fu ZW, Zhou HF, Zhou QH, Huang T, Yang N
Eur J Surg Oncol · 2026 May · PMID 41980407 · Publisher ↗
OBJECTIVE: To describe temporal trends and metastatic patterns of brain metastases (BMs) and to assess the associations of primary site surgery (PSS) and metastatic site surgery (MSS) with overall survival (OS) among pat...
OBJECTIVE: To describe temporal trends and metastatic patterns of brain metastases (BMs) and to assess the associations of primary site surgery (PSS) and metastatic site surgery (MSS) with overall survival (OS) among patients with brain-limited metastases (BLMs) at diagnosis across primary cancer types. METHODS: Using SEER-17 (2010-2022), we identified 65,861 patients with BMs at diagnosis among 3,540,748 solid tumors. The analytic cohort included 23,394 patients with BLMs (no extracranial distant metastases) with known PSS/MSS status. Propensity score-based overlap weighting was used to reduce measured confounding in cancer-specific Cox models of OS. RESULTS: BMs were identified in 1.9% of solid tumors, with lung cancer accounting for 80.0% of cases. BM counts increased from 4459 (2010) to 5330 (2022), while the overall proportion among solid tumors remained at approximately 2%. BLMs accounted for 35.5% of patients with BMs. Among patients with BLMs, median OS was 7.0 months, and 5-year OS was 9.4%, varying widely by primary site (23-24 months for thyroid/prostate vs. 3 months for pancreatic/liver primaries). PSS was uncommon and declined modestly (8.5% to 7.0%), whereas MSS increased (22.1% to 29.1%). In fully adjusted overlap-weighted models, PSS and MSS were associated with lower mortality for most cancer types; in lung cancer, PSS (HR, 0.52) and MSS (HR, 0.74) were associated with lower mortality, with both associations remaining significant after Benjamini-Hochberg false discovery rate adjustment (adjusted p < .05). CONCLUSIONS: Prognosis and surgery-associated survival in BLMs vary by primary site and may help inform cancer-specific multidisciplinary decision-making and the design of future prospective studies.
Management of non-detection of the sentinel node in breast cancer: A scoping review.
Andersen LS, Jensen K, Tvedskov THF
Eur J Surg Oncol · 2026 May · PMID 41966790 · Publisher ↗
Axillary nodal status is a key prognostic factor in women with breast cancer and is most commonly assessed by sentinel lymph node biopsy (SLNB). However, non-detection of the sentinel node occurs in 1-13% of cases and re...
Axillary nodal status is a key prognostic factor in women with breast cancer and is most commonly assessed by sentinel lymph node biopsy (SLNB). However, non-detection of the sentinel node occurs in 1-13% of cases and remains insufficiently addressed in international clinical guidelines. This scoping review maps the existing evidence on axillary sampling (AS) as an alternative axillary staging strategy when the sentinel node cannot be identified. A structured literature search was conducted in PubMed to identify studies evaluating the diagnostic accuracy of AS in comparison with SLNB and axillary lymph node dissection (ALND) in clinically node-negative breast cancer. Nine studies, reported in ten publications, met the eligibility criteria. Across the included literature, AS demonstrated high sensitivity and low false-negative rates, particularly when four or more lymph nodes were removed. The diagnostic performance of AS was comparable to ALND and slightly inferior to SLNB. Overall, the available evidence suggests that AS may represent a feasible alternative for axillary staging in cases of sentinel node non-detection. However, the evidence base is limited and largely derived from older studies, highlighting the need for contemporary research to inform clinical practice and guideline development.
Preoperative MRI-based prediction and risk stratification of very early recurrence in intrahepatic cholangiocarcinoma: a multicenter study.
Shu J, Wang L, Wang W … +6 more , Liu Z, Shi F, Si J, Yan Y, Feng Z, Zhang L
Eur J Surg Oncol · 2026 May · PMID 41955848 · Publisher ↗
OBJECTIVES: To establish and validate a preoperative MRI-based model to predict very early recurrence (VER, ≤6 months) of intrahepatic mass-forming cholangiocarcinoma (IMCC) following curative resection. MATERIALS AND ME...
OBJECTIVES: To establish and validate a preoperative MRI-based model to predict very early recurrence (VER, ≤6 months) of intrahepatic mass-forming cholangiocarcinoma (IMCC) following curative resection. MATERIALS AND METHODS: This multicenter study enrolled 228 patients who underwent curative resection for IMCC between May 2019 and January 2024. Participants were randomly allocated to a training cohort (n = 160) and a validation cohort (n = 68). Independent predictors of VER were identified using Cox regression analysis and integrated into a prediction nomogram. The discriminative performance was evaluated and recurrence-free survival (RFS) between low-and high-risk groups was compared using Kaplan-Meier analysis. RESULTS: VER was observed in 52 patients (32.5%) and 28 patients (41.2%) in the training and validation cohorts. Tumor multiplicity (HR: 1.858, 95% CI: 1.017-3.394, p = 0.044), arterial edge enhancement ratio (HR: 0.012, 95% CI: 0.001-0.423; p = 0.015), and intrahepatic duct dilatation (HR: 2.367, 95% CI: 1.332-4.205; p = 0.003) were identified as independent predictors of VER. The area under the curve (AUC) of nomogram was 0.815 (95 % CI: 0.746-0.894) and 0.827 (95% CI: 0.726-0.927) in the training and validation cohorts. RFS rate was significantly lower in the high-risk group compared to the low-risk group in the training cohort (27.8% vs. 79.0%; p < 0.001) and the validation cohort (18.8% vs. 71.2%; p < 0.001). CONCLUSION: The preoperative MRI-based model, incorporating tumor multiplicity, arterial edge enhancement ratio, and intrahepatic duct dilatation can effectively predict VER with risk stratification in IMCC patients.
Long-term efficacy of radical treatment of patients with clear cell sarcoma.
Czarnecka AM, Błoński P, Chmiel P … +9 more , Zdzienicki M, Szumera-Ciećkiewicz A, Pieńkowski A, Teterycz P, Spałek MJ, Świtaj T, Falkowski S, Wągrodzki M, Rutkowski P
Eur J Surg Oncol · 2026 May · PMID 41955847 · Publisher ↗
BACKGROUND: Clear cell sarcoma (CCS) is a rare subtype of soft tissue sarcoma (STS). The objective of this analysis was to evaluate the effectiveness of multidisciplinary treatment of CCS and to identify potential factor...
BACKGROUND: Clear cell sarcoma (CCS) is a rare subtype of soft tissue sarcoma (STS). The objective of this analysis was to evaluate the effectiveness of multidisciplinary treatment of CCS and to identify potential factors that influence the outcome. METHODS: A retrospective analysis of curative-intent treatment of CCS patients between 1998 and 2024 in the sarcoma reference centre. RESULTS: The median Relapse-free Survival (RFS) and Overall Survival (OS) times were 33.1 (95% CI: 11.1-Not Reached, NR) and 55.5 (95% CI: 37.4-NR) months, respectively. One year after the surgery, the RFS was 63.5% (95% CI: 49.5-81.5), and at three and five years it was 41.8% (95% CI: 28-62.4) and 38.3% (95% CI: 24.8-59.2), respectively. Three years after the surgery 64.7% (95% CI: 50.3-83.2) of patients were alive, and at five years - 49.3% (95% CI: 34.1-71.2). Among 19 patients referred for sentinel lymph node biopsy (SLNB), it was positive in 8 (42.1%) patients, at the same time lymph node dissection (LND) was performed in 4 patients. Excluding patients undergoing electrochemotherapy and wide excision of scar, the R0 resection margins were achieved in 14 (48.3%) patients. Those patients had superior RFS compared to patients with R1/2 resection margins: 83 (95% CI: 14.8-NR) months and 11.1 (95% CI: 5.9-NR) months, respectively (p = 0.0095). We observed a similar trend for OS, where patients with R0 margins had NR (95% CI: 30-NR) compared to 37.4 (95% CI: 10.6-NR) in the case of R1/2 margins, p = 0.051. CONCLUSIONS: Consequently, SLNB and LND procedures should be offered more often to patients with this diagnosis.
Extra-hepatic cholangiocarcinoma diagnosis: from classical pathological analysis to the emerging omics tests.
Marichez A, Passand GT, Boubaddi M … +6 more , Toussaint N, Fernandez B, Laurent C, Raymond AA, Saltel F, Chiche L
Eur J Surg Oncol · 2026 May · PMID 41955846 · Publisher ↗
Extrahepatic cholangiocarcinoma (eCCA), comprising perihilar and distal cholangiocarcinoma, remains a major diagnostic challenge in the setting of an indeterminate biliary stricture. Definitive diagnosis still relies on...
Extrahepatic cholangiocarcinoma (eCCA), comprising perihilar and distal cholangiocarcinoma, remains a major diagnostic challenge in the setting of an indeterminate biliary stricture. Definitive diagnosis still relies on histopathological examination of endobiliary samples. However, the diagnostic sensitivity of biopsy and brush cytology remains limited, at approximately 50% despite high specificity. This limitation has driven the development of novel omics-based assays aimed at improving diagnostic accuracy using solid tissue sampling, as well as liquid biopsies derived from blood, bile, or urine. The primary diagnostic challenge in eCCA is to establish malignancy while avoiding misclassification of benign biliary strictures, thereby preventing unnecessary high-morbidity surgical procedures. In addition, accurate histopathological classification of periampullary tumours is critical for guiding optimal therapeutic decision-making, particularly regarding systemic chemotherapy. Although histology remains the diagnostic gold standard, next-generation sequencing (NGS) has improved the diagnostic yield of endobiliary sampling. Among all the omics techniques developed in research, genomics is currently the most advanced for clinical application whereas other omics approaches remain largely investigational and have not yet been sufficiently validated in large cohorts for routine use. Nevertheless, despite its robust performance in solid biopsy specimens, which makes its implementation in routine practice feasible, NGS still shows substantial false-negative rates ranging from 15% to 25%. Future advances will likely include the development of tissue-based omics profiling approaches focusing on molecular readouts closer to the functional consequences of the gene expression on solid biopsies, as well as the development of serum- and bile-based liquid biopsies that can be translated from bench to bedside.
Influence of body composition on short- and long-term clinical outcomes in patients undergoing laparoscopic gastrectomy.
Xu H, Hu Y, Yu J … +3 more , Han X, Qi C, Jiang H
Eur J Surg Oncol · 2026 May · PMID 41931919 · Publisher ↗
Gastric Cancer (GC) is the fifth most common malignancy and third leading cause of cancer-related deaths globally. Despite therapeutic advances, advanced GC prognosis remains suboptimal. Body composition (decreased muscl...
Gastric Cancer (GC) is the fifth most common malignancy and third leading cause of cancer-related deaths globally. Despite therapeutic advances, advanced GC prognosis remains suboptimal. Body composition (decreased muscle mass, intramuscular fat deposition, visceral obesity) has prognostic value in cancer, but the combined impact of these components on outcomes of laparoscopic gastrectomy is understudied. This retrospective cohort study included 728 GC patients who underwent laparoscopic-assisted radical gastrectomy (2018-2021). Preoperative third lumbar computed tomography (CT) quantified skeletal muscle index (SMI, indicating decreased muscle mass), skeletal muscle density (SMD, low SMD indicating intramuscular fat deposition), and visceral fat area (VFA, ≥100 cm indicating visceral obesity). Patients with decreased muscle mass, low SMD, or VFA ≥100 cm had longer stays higher costs, more complications (all P < 0.05), and worse OS (P = 0.001, P < 0.001, P = 0.039 respectively). Decreased muscle mass was an independent poor survival predictor (HR = 1.567, 95% CI:1.120-2.192, P = 0.009). All three markers correlated (P < 0.001) and exerted a cumulative adverse effect on overall survival (all positive = worst OS, P < 0.001). In conclusion, these body composition factors associate with adverse short- and long-term outcomes in GC patients post-laparoscopic gastrectomy, aiding preoperative assessment and targeted nutrition interventions.
Cutaneous angiosarcoma: Long-term outcomes and risk factors of local recurrence, metastasis and disease-specific mortality in a Danish nationwide cohort.
Abebe K, Thorsen KV, Jensen DH … +8 more , Wagenblast AL, Schmidt G, Petersen MM, Loya AC, Mentzel T, Herly M, Vester-Glowinski P, Ørholt M
Eur J Surg Oncol · 2026 May · PMID 41931918 · Publisher ↗
BACKGROUND: Cutaneous angiosarcoma is associated with a poor prognosis. Investigation of key prognostic factors is warranted, as methodological constraints and short follow-up periods limit previous studies. OBJECTIVE: T...
BACKGROUND: Cutaneous angiosarcoma is associated with a poor prognosis. Investigation of key prognostic factors is warranted, as methodological constraints and short follow-up periods limit previous studies. OBJECTIVE: To investigate the prognosis and identify risk factors in a comprehensive, nationwide population-based study of patients with cutaneous angiosarcoma. MATERIALS AND METHODS: All patients diagnosed with cutaneous angiosarcoma in Denmark between 2000 and 2023 were included. Absolute 5-year risks were estimated using multivariable cause-specific Cox regression models, treating all-cause mortality as a competing risk. RESULTS: We included 192 patients with cutaneous angiosarcoma with a median follow-up of 8 years. The 5-year risks were 40% for local recurrence, 41% for metastasis, 43% for both disease-specific mortality and overall survival, and 29% for progression-free survival. In the multivariable analysis of 5-year prognostic risk factors, poor tumor differentiation emerged as a strong predictor of local recurrence, metastasis and disease-specific mortality, whereas moderate tumor differentiation was only significant for metastasis and disease-specific mortality. Primary cutaneous angiosarcoma and invasion of the fascia and/or perineural/perivascular invasion were significant predictors of metastasis, while age >73 was associated with local recurrence. CONCLUSION: Cutaneous angiosarcoma should be considered a high-risk tumor and is associated with a poor prognosis across all outcomes. Poor and moderate tumor differentiation, primary cutaneous angiosarcoma, invasion of the fascia and/or perineural/perivascular invasion, and age >73 years were important predictors of adverse outcomes and may be considered potential high-risk features. The absence of these risk factors may therefore constitute a subgroup with a comparatively more favorable prognosis.
First preclinical evaluation of a thermogel delivering mitomycin C: sustained local release with preserved surgical safety in a large animal model.
Mouawad C, Thouvenin A, Rozenbaum P … +7 more , Pimpie C, Kaci R, Kemmel V, Eveno C, Boudy V, Mignet N, Pocard M
Eur J Surg Oncol · 2026 May · PMID 41926868 · Publisher ↗
BACKGROUND: Peritoneal recurrence remains a major concern in colorectal cancer surgery. We aimed to evaluate the safety and preliminary efficacy of a novel poloxamer-based thermogel delivering Mitomycin C (TGel-MMC) as a...
BACKGROUND: Peritoneal recurrence remains a major concern in colorectal cancer surgery. We aimed to evaluate the safety and preliminary efficacy of a novel poloxamer-based thermogel delivering Mitomycin C (TGel-MMC) as a simple prophylactic approach to reduce peritoneal carcinomatosis risk. METHODS: The cytotoxicity effect of the MMC within the thermogel was assessed over time on CT26 cells using the alamar blue assay. TGel biocompatibility and cytoreductive effect was evaluated on a murine model. Finally, TGel-MMC safety was tested in a porcine model with laparotomy and anastomoses to assess tissue reaction, adhesions, and anastomotic integrity. RESULTS: Prolonged exposure of CT26 to TGel-MMC enhanced MMC cytotoxicity at low doses in vitro. In mice, TGel alone did not cause significant adhesions or diffuse inflammation up to 63 days. The TGel-MMC group showed effective prophylactic cytoreduction comparable to MMC alone. In pigs, no anastomotic fistulae and no chemical peritonitis were observed up to day 15. Pharmacokinetic profiles showed MMC absorption highly comparable to standard HIPEC, with peak levels at 1 h and gradual decline over 6 h. CONCLUSION: This study shows the sustained release of MMC in thermogel in-vitro. It demonstrates for the first time the feasibility and short-term safety of intraperitoneal TGel-MMC administration in a large animal model with digestive sutures. These results support further investigation on TG-MMC as a prophylactic strategy to reduce peritoneal metastases in high-risk colorectal surgery.
Feedback from wearable devices accelerates recovery after breast cancer surgery.
Latif A, Al Janabi N, Joshi M … +6 more , Che Bakri NA, Kwasnicki RM, Fusari G, Shepherd L, Darzi A, Leff DR
Eur J Surg Oncol · 2026 May · PMID 41926867 · Publisher ↗
BACKGROUND: Axillary surgery for breast cancer is frequently associated with upper-limb morbidity, impacting quality of life. Structured exercise improves outcomes, but access to physiotherapy is inconsistent. Wearable d...
BACKGROUND: Axillary surgery for breast cancer is frequently associated with upper-limb morbidity, impacting quality of life. Structured exercise improves outcomes, but access to physiotherapy is inconsistent. Wearable devices offer objective post-operative monitoring and the potential for real-time rehabilitation support. This study aims to assess the impact of wearable-driven feedback on upper-limb recovery after axillary surgery, and to evaluate the usability, adherence, and acceptability of wearables during post-operative rehabilitation. METHODS: In this prospective observational cohort study, patients undergoing axillary surgery at a tertiary breast unit were equipped with wearable devices to monitor upper-limb activity. Participants were allocated to basic-feedback (BF; fixed 60-min goal) or dynamic-feedback (DF; personalised weekly clinician-adjusted goals). Recovery was defined as post-operative activity relative to pre-operative baseline. An earlier prospective no-feedback (NF) cohort served as comparator. RESULTS: Forty-nine patients were included: 10 DF, 10 BF, and 29 NF. Adherence was high (mean compliance 89.4%, SD 17.9). By postoperative day (POD) 8, DF patients exceeded baseline activity (103.2%, SD 30.6), outperforming BF (80.2%, SD 13.9) and NF (86.2%, SD 55.8). Recovery plateaued earliest in DF (POD 4), followed by BF (POD 5) and NF (POD 7). Among SLNB-only patients, DF recovered faster than NF, while BF and NF showed similar trajectories. CONCLUSIONS: Clinician-guided, wearable-driven feedback significantly accelerates upper-limb recovery following axillary surgery. These findings support further evaluation of this approach in larger randomized trials to determine clinical and cost-effectiveness.
Redefining the role of carbon nanoparticles in colorectal cancer surgery: From lymph node yield to diagnostic paradox.
Lv Y, Wang F, Shen Y … +6 more , Yin S, Jia X, Tang W, Xu J, Huang X, Dai S
Eur J Surg Oncol · 2026 May · PMID 41921381 · Publisher ↗
BACKGROUND: Accurate lymph node (LN) staging is critical in colorectal cancer (CRC). Carbon nanoparticles (CNPs), used as a tumor localization agent, incidentally stain LNs, creating uncertainty about their utility for i...
BACKGROUND: Accurate lymph node (LN) staging is critical in colorectal cancer (CRC). Carbon nanoparticles (CNPs), used as a tumor localization agent, incidentally stain LNs, creating uncertainty about their utility for improving staging and guiding oncologic resection. This study evaluates the surgical and oncologic outcomes of CNP use and determines the diagnostic accuracy of CNP staining for metastasis. METHODS: We conducted a dual-component study: a retrospective, propensity score-matched analysis of 556 patient pairs (CNP vs. control) undergoing CRC surgery between 2020 and 2024, and a prospective cohort of 119 patients in which each LN was analyzed for staining and metastatic status. RESULTS: In the matched cohort, CNP use improved surgical efficiency (shorter operative time, less blood loss) and increased total LN yield (mean, 21.5 vs. 17.7; p < 0.001). However, CNP guidance did not increase metastatic LN detection (p = 0.5) or improve 3-year survival (OS, p = 0.074; DFS, p = 0.31). The prospective analysis revealed a paradoxical finding: unstained LNs had a significantly higher rate of metastasis than stained LNs (3.7% vs. 2.1%; p = 0.02). Consequently, CNP staining was an unreliable diagnostic tool, failing to identify 67.5% of metastatic LNs. All CNP-stained extra-regional LNs (found in 23.5% of patients) were benign. DISCUSSION: CNPs have a paradoxical dual role in CRC surgery. They are a valuable localization aid that improves surgical efficiency. However, the incidental staining of lymph nodes is diagnostically unreliable and should not guide oncologic decision-making. The practice of extending dissection to pursue extra-regional black-stained nodes is not supported by evidence and should be avoided.
Biological selection explains survival differences in perihilar cholangiocarcinoma: Post-hoc application of the mayo criteria to a resection cohort.
Keshi E, Siemund F, Raschzok N … +7 more , Globke B, Haber P, Ossami Saidy RR, Hillebrandt KH, Pratschke J, Schöning W, Krenzien F
Eur J Surg Oncol · 2026 May · PMID 41921380 · Publisher ↗
INTRODUCTION: Survival differences reported across treatment strategies for perihilar cholangiocarcinoma (pCCA) may be strongly influenced by biological patient selection rather than treatment modality itself. This study...
INTRODUCTION: Survival differences reported across treatment strategies for perihilar cholangiocarcinoma (pCCA) may be strongly influenced by biological patient selection rather than treatment modality itself. This study quantified how much of survival after curative-intent liver resection for pCCA can be explained by biological selection alone, using the Mayo Clinic eligibility criteria as a validated selection framework. METHODS: A post-hoc analysis of consecutive patients undergoing liver resection for pCCA between January 2005 and December 2023 at a tertiary referral center was performed. Patients were stratified according to whether they fulfilled adapted Mayo Clinic eligibility criteria (MC). Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan-Meier estimates and Cox regression. RESULTS: A total of 305 patients were included, of whom 54 (17.7%) met MC. Patients within MC were significantly younger, had lower ASA scores and significantly lower postoperative complications compared with patients outside MC (p < 0.05). Median overall survival was 4.1 years within the MC versus 2.2 years in patients outside the MC (p = 0.004). Similarly, median recurrence-free survival was 3.6 versus 1.5 years, respectively (p = 0.005). In multivariate analysis, MC was not an independent predictor for overall survival or recurrence-free survival. Instead ASA III, renal failure, coronary artery disease, nodal involvement and positive resection margin was associated with worse survival. CONCLUSIONS: When applied to a surgical PCCA cohort, the Mayo eligibility criteria identify patients with markedly improved survival. The survival difference became smaller after adjusting for known prognostic factors. This suggests that the Mayo criteria reflect favorable tumor biology and patient health rather than directly determining outcomes.
Machine learning identifies a 10-gene signature predicting hepatocellular carcinoma recurrence and immune-metabolic reprogramming.
Bera P, Raju R, Das D
Eur J Surg Oncol · 2026 May · PMID 41921379 · Publisher ↗
BACKGROUND: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality, with frequent recurrence after curative treatment. Conventional clinicopathological prognostic systems fail to capture the mol...
BACKGROUND: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality, with frequent recurrence after curative treatment. Conventional clinicopathological prognostic systems fail to capture the molecular heterogeneity underlying recurrence, highlighting the need for biologically informed biomarkers. METHODS: We developed a transcriptome-based prognostic model for HCC recurrence using a machine learning-guided feature selection strategy designed to reduce survival-time bias. LASSO-based gene selection was integrated with multivariable Cox regression, and model performance was assessed through stratified cross-validation and independent external validation. RESULTS: Analysis of the TCGA-LIHC cohort (n = 344) identified a stable 38-gene recurrence-associated signature (AUC: 0.715-0.847), which was distilled into a reproducible 10-gene classifier combined with tumor stage. This integrated model effectively stratified patients into high- and low-risk groups (log-rank P < 0.0001) and was independently validated in the HCCDB25 cohort (n = 158; P = 0.031). High-risk tumors exhibited an immune-excluded phenotype with reduced cytotoxic immune infiltration. Gene set enrichment analyses revealed progressive activation of proliferative signaling, metabolic dysregulation, and immune evasion pathways. CONCLUSIONS: The integrated 10-gene-plus-stage classifier is a robust and generalizable predictor of HCC recurrence, providing mechanistic insights into immune-metabolic reprogramming and highlighting potential implications for risk-informed patient stratification in future studies.
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