BACKGROUND: Pregnancy-associated breast cancer (PABC), defined as breast cancer diagnosed during pregnancy or within 1 year postpartum, presents unique surgical and oncologic challenges. Management requires balancing mat...BACKGROUND: Pregnancy-associated breast cancer (PABC), defined as breast cancer diagnosed during pregnancy or within 1 year postpartum, presents unique surgical and oncologic challenges. Management requires balancing maternal outcomes with fetal safety while accounting for trimester-specific constraints and tumor biology. METHODS: We conducted a comprehensive narrative review of the literature on the management of operable PABC. Evidence was synthesized into a trimester-based clinical framework incorporating surgical approach, axillary staging, systemic therapy, tumor subtype, and reconstructive considerations. RESULTS: Surgery is safe across all trimesters and remains the cornerstone of treatment. In the first trimester, mastectomy is generally preferred given contraindications to chemotherapy and radiotherapy during organogenesis. In the second and early third trimesters, both mastectomy and breast-conserving therapy with deferred postpartum radiation are feasible, and anthracycline- and taxane-based chemotherapy can be administered. Radiation therapy, endocrine therapy, human epidermal growth factor receptor 2 (HER2)-directed therapy, and immunotherapy are contraindicated during pregnancy. Management of aggressive subtypes, including HER2-positive and triple-negative disease, requires modification of standard neoadjuvant regimens because of fetal toxicity. Sentinel lymph node biopsy with technetium-99m sulfur colloid is safe, whereas blue dye should be avoided. Immediate expander-based reconstruction may be considered in select patients but is often deferred. CONCLUSIONS: Optimal management of PABC requires trimester- and subtype-specific decision-making within a multidisciplinary framework. This review provides a practical, clinically applicable algorithm to guide management. When timely, guideline-concordant care is delivered, maternal outcomes approach those of nonpregnant patients.
BACKGROUND: Neoadjuvant chemotherapy for resectable colon cancer has emerged as a potential strategy to improve systemic treatment delivery, enhance tumor downstaging, and facilitate margin-negative resection in selected...BACKGROUND: Neoadjuvant chemotherapy for resectable colon cancer has emerged as a potential strategy to improve systemic treatment delivery, enhance tumor downstaging, and facilitate margin-negative resection in selected patients with locally advanced disease. However, its role remains controversial because radiologic staging is imperfect and long-term survival benefits have not been uniformly demonstrated. METHODS: We performed a narrative review of the contemporary evidence on neoadjuvant chemotherapy in resectable colon cancer, focusing on randomized trials, comparative studies, meta-analyses, and implementation issues. Key trials included FOxTROT, which randomized patients 2:1 to 6 weeks of preoperative oxaliplatin-fluoropyrimidine plus 18 weeks postoperative therapy versus 24 weeks postoperative therapy; OPTICAL, which evaluated 3 months of preoperative mFOLFOX6 or CAPOX followed by surgery and 3 months postoperative chemotherapy; PRODIGE 22; and the phase III NeoCol trial. A 2024 meta-analysis of seven comparative studies including 2120 patients was also reviewed. RESULTS: FOxTROT showed reduced 2-year residual or recurrent disease (16.9% vs. 21.5%; rate ratio 0.72; P = 0.037), improved downstaging, and higher complete resection rates, with fewer serious postoperative complications despite 4.3% requiring expedited surgery for obstruction. OPTICAL reported improved pathologic response and overall survival (HR 0.44; P = 0.002), although disease-free survival was not statistically significant (82.1% vs. 77.5%; HR 0.74; P = 0.08). NeoCol did not show significant DFS or OS differences. The meta-analysis suggested improved recurrence, overall survival, and incomplete resection risk without excess operative morbidity. CONCLUSIONS: Neoadjuvant chemotherapy is feasible and biologically active in selected locally advanced resectable colon cancer, but benefit depends on accurate patient selection.
BACKGROUND: Soft tissue sarcomas are rare mesenchymal tumors accounting for less than 1% of all cancers, originating intra-abdominally or retroperitoneally in 40% of cases. Leiomyosarcomas are among the most common retro...BACKGROUND: Soft tissue sarcomas are rare mesenchymal tumors accounting for less than 1% of all cancers, originating intra-abdominally or retroperitoneally in 40% of cases. Leiomyosarcomas are among the most common retroperitoneal sarcomas (RPS), with surgery as primary treatment option whenever an R0 resection is feasible. Taken into account the concept of histology-guided surgery for RPS, surgery for leiomyosarcomas often does not require wide resections, allowing preservation of adjacent organs when not directly infiltrated. Nevertheless, high-grade leiomyosarcomas of abdominal major vessels may require extendend multi-organ resections and complex reconstructions, thus requiring a multidisciplinary surgical approach. All these factors highlight the need to manage such cases in referral centers. METHODS: We present the case of a 65-year-old patient with a locally advanced leiomyosarcoma of the right external iliac vein, infiltrating the ipsilateral external iliac artery, ureter and psoas major muscle. After multidisciplinary discussion, the patient underwent surgery with removal of the mass en bloc with infiltrated structures. The reconstructive phase was carried out with the assistance of vascular surgery and urology teams. The postoperative course was complicated by a ureterovesical anastomotic leak, treated conservatively. RESULTS: This video demonstrates the step-by-step radical removal of a locally advanced vascular leiomyosarcoma, highlighting the related critical aspects of vascular control and complex reconstructions, as well as the importance of management of these cases in referral centers and with a multidisciplinary surgical approach. CONCLUSIONS: Although surgical management of locally advanced vascular leiomyosarcomas is often challenging, a multidisciplinary approach and adequate surgical expertise can reduce surgery-related risks and lead to improved outcomes.
BACKGROUND: The impact of sentinel lymph node dissection (SLND) or targeted axillary dissection (TAD) prior to axillary lymph node dissection (ALND) on the technical success of immediate lymphatic reconstruction (ILR) is...BACKGROUND: The impact of sentinel lymph node dissection (SLND) or targeted axillary dissection (TAD) prior to axillary lymph node dissection (ALND) on the technical success of immediate lymphatic reconstruction (ILR) is not well described. We aimed to determine if the technical success of ILR varies by timing of surgical axillary staging prior to ALND. METHODS: Our departmental database was queried to identify patients undergoing ALND from 2020 to 2024. Type and timing of axillary surgical staging and ILR technical details were collected by retrospective chart review. RESULTS: Among 866 patients undergoing ALND with a plan for ILR, 655 (75.6%) underwent single-stage ALND, 120 (13.9%) underwent SLND/TAD followed by ALND under the same anesthetic, and 91 (10.5%) underwent SLND/TAD followed by ALND at a separate surgery. The overall ILR technical success rate was 93.4% (612/655). Immediate lymphatic reconstruction technical success did not vary significantly between groups (p = 0.415). Groups were similar in number of reconstructed lymphatic channels (p = 0.173), with a median of 2 (IQR 1-3) channels. The most common reasons for ILR not being performed (n = 52) included failure to identify blue lymphatic channels by axillary reverse mapping (n = 21) and no suitable veins for the reconstruction (n = 11). On multivariable analysis, White race and lower body mass index were significant predictors of ILR technical success. CONCLUSIONS: In patients undergoing ALND, ILR was successfully performed in > 90% of cases, irrespective of concurrent or staged SLND/TAD procedures. Most patients (62.9%) had at least 2 lymphatic channels reconstructed. Deferring decision-making about completion ALND for final pathology from SLND/TAD does not appear to negatively impact technical success of ILR.
Liu DS, Le KDR, Cacic J
… +23 more, Ukovic B, Mellerick C, Binion B, Ishak G, Turner J, Wilson C, Johnson L, Suryanarayan N, Weinberg L, Ferguson M, Lanteri C, Brazzale D, Ma R, Dalyell A, Hall K, Watson L, Chapman B, Keong B, Mori K, Aly A, Wong D, Bigaran A, Strong for Oesophago-gastric Cancer Surgery (SOCS) study group
BACKGROUND: Esophago-gastric cancer surgery frequently results in substantial morbidity. Prehabilitation, an approach to optimize an individual's preoperative physical, nutritional, and mental health, may decrease postop...BACKGROUND: Esophago-gastric cancer surgery frequently results in substantial morbidity. Prehabilitation, an approach to optimize an individual's preoperative physical, nutritional, and mental health, may decrease postoperative complications. Here, we present perioperative and allied health findings from a multimodal prehabilitation study (ACTRN12623000183684). METHODS: This single-center observational study recruited patients with esophago-gastric cancer undergoing curative-intent treatment between 2017 and 2024. Patients who did and did not receive multimodal prehabilitation were compared. Prehabilitation involved personalized medical, physical, nutritional, and psychological optimization before surgery. The primary endpoint was the rate of postoperative respiratory complications. Secondary endpoints included other postoperative complications and allied health outcomes. RESULTS: In total, 164 participants (control n=121, prehabilitation n=43) underwent esophago-gastric cancer resection. More minimally invasive surgeries were performed in the prehabilitation group, but the baseline characteristics were otherwise similar between groups. Prehabilitation improved physical fitness and decreased malnutrition rates. Importantly, prehabilitation resulted in fewer postoperative respiratory (43.8% vs 20.9%, p=0.010), cardiac (22.3% vs 7.0%, p=0.037), hepatic (9.1% vs 0.0%, p=0.031), and renal (9.9% vs 0.0%, p=0.037) complications than in the control group. Moreover, prehabilitation was associated with diminished intensive care unit stays (median [IQR] 1 day [1.0-6.5] vs 1 day [1.0-3.0]; p=0.005) and hospital stays (14 days [9-24] vs 11 days [8-16]; p<0.001) and higher rates of adjuvant chemotherapy usage (51.0% vs 80.6%, p=0.004). Multivariate and sensitivity analyses demonstrated that prehabilitation, rather than surgical technique (laparoscopic vs open surgery), was independently associated with perioperative outcomes. CONCLUSION: This study demonstrates that multimodal prehabilitation improves perioperative outcomes for patients with esophago-gastric cancer, thus supporting routine integration of prehabilitation into perioperative care pathways.
BACKGROUND: The optimal extent of lymphadenectomy following neoadjuvant chemoimmunotherapy (nCIT) for esophageal squamous cell carcinoma (ESCC) remains unclear. Current recommendations are largely derived from neoadjuvan...BACKGROUND: The optimal extent of lymphadenectomy following neoadjuvant chemoimmunotherapy (nCIT) for esophageal squamous cell carcinoma (ESCC) remains unclear. Current recommendations are largely derived from neoadjuvant chemoradiotherapy cohorts, and their applicability in the era of immunotherapy is unclear. This study evaluated the association between lymph node dissection (LND) yield and disease-free survival (DFS) in patients with ESCC treated with nCIT. METHODS: This retrospective multicenter cohort study included 465 patients with ESCC who underwent nCIT followed by radical esophagectomy at six hospitals in China between January 2019 and December 2023. The median follow-up was 40.7 months. The total number of dissected lymph nodes was analyzed in relation to DFS. The restricted mean survival time at 5 years was estimated by using random survival Forest-based models, with subgroup analyses by posttherapy pathological stage (ypT/ypN). RESULTS: A higher lymph node yield was associated with improved DFS, although the relationship was nonlinear and varied by pathological subgroup. In patients with ypT0-2N0 disease, DFS improved with increasing LND up to approximately 20-30 lymph nodes, after which the benefit plateaued. In patients with residual nodal disease (ypN1-3), higher lymph node yields were associated with longer DFS, with greater yields observed in more advanced disease stages. Across all subgroups, lower lymph node yields were consistently associated with inferior DFS. CONCLUSIONS: In this multicenter cohort of patients with ESCC treated with nCIT, lymph node yield was associated with DFS in a stage-dependent manner, suggesting its potential role as a postoperative quality indicator for surgical lymphadenectomy after nCIT.
Zou J, Li P, Lei W
… +13 more, Han W, Zhou F, Gu Y, Hu Y, Zeng C, Li J, Fei Q, Yi J, Cheng Z, Wu F, Wang L, Liu Y, Liu W
Ann Surg Oncol
· 2026 Jun · PMID 42377697
·
Publisher ↗
OBJECTIVE: We aimed to investigate clinicopathological features and survival outcomes of patients diagnosed with primary pulmonary sarcoma (PPS) or pulmonary sarcomatoid carcinoma (PSC). METHODS: Both PPS (N = 156) and P...OBJECTIVE: We aimed to investigate clinicopathological features and survival outcomes of patients diagnosed with primary pulmonary sarcoma (PPS) or pulmonary sarcomatoid carcinoma (PSC). METHODS: Both PPS (N = 156) and PSC (N = 175) patients diagnosed in our hospital between 2015.9-2024.9 were included and retrospectively analyzed. Among them, 77 PPS patients (49.4%) and 82 PSC patients (46.9%) underwent radical resection, while patients with unresectable diseases received systemic treatment and radiotherapy. Clinical and pathological characteristics were summarized and compared. Survival analysis and multivariable cox regression were also performed using overall survival (OS) data. RESULTS: The 5-year survival rates among surgically treated patients were 42.3% for PPS and 32.2% for PSC. Among patients with PPS, the median survival was 3.44 years for those who underwent surgery and 0.52 years for those who did not. In PSC, the median survival was 2.16 years with surgery and 0.96 years without surgery. Perioperative systemic therapy-primarily chemoradiotherapy-did not confer significant survival benefits. In the unresectable population, targeted therapy and immunotherapy may offer prognostic improvement for both PPS and PSC. CONCLUSIONS: Surgical resection potentially provides PPS and PSC patients with the opportunity of long-term survival. For unresectable diseases, immunotherapy as well as targeted therapy may contribute to improved survival outcome.
Doescher J, von Witzleben A, Eberhardt N
… +10 more, Sauter C, Mlynarcik C, Peiper A, Treutlein E, Schuler PJ, Sommer F, Laban S, Beer AJ, Zenk J, Hoffmann TK
Ann Surg Oncol
· 2026 Jun · PMID 42377695
·
Publisher ↗
Zenaty N, Bachmann R, Khaled C
… +7 more, Demetter P, Sclafani F, Baldin P, Sanchez AV, Moreau M, Donckier V, Liberale G
Ann Surg Oncol
· 2026 Jun · PMID 42371324
·
Publisher ↗
BACKGROUND: Histologic growth patterns (HGPs) of both peritoneal metastasis (PM) and liver metastasis (LM) have emerged as prognostic factors for patients undergoing curative surgery for metastatic colorectal cancer (CRC...BACKGROUND: Histologic growth patterns (HGPs) of both peritoneal metastasis (PM) and liver metastasis (LM) have emerged as prognostic factors for patients undergoing curative surgery for metastatic colorectal cancer (CRC). The main objectives of the study were, first, to evaluate the correlation between PMHGP and LMHGP of CRC patients who underwent curative-intent cytoreductive surgery (CRS) and LM resection and, second, to assess the prognostic impact of HGP type. METHODS: This retrospective bicentric study included patients treated with both CRS and LM resection for metastatic CRC. Histologic growth patterns were classified as pushing (P-HGP) and infiltrating (I-HGP) for PM, and as desmoplastic HGP (D-HGP) and non-desmoplastic (ND-HGP) for LM. Correlation between PMHGP and LMHGP was assessed using the chi-square test. Overall survival (OS) and disease-free survival (DFS) were evaluated using Kaplan-Meier and Cox regression. RESULTS: The study included 44 patients. Of the 44 patients, 9 (20.5%) had P-HGP + D-HGP, 23 (52.3%) had I-HGP + ND-HGP, 5 (11.4%) had P-HGP + ND-HGP, and 7 (15.9%) had I-HGP + D-HGP. Significant correlation was observed between PMHGP and LMHGP (p = 0.0085; Φ = 0.3965). The patients with I-HGP + ND-HGP had shorter OS and DFS than those with other combinations: 34 versus 64 months (HR, 2.067; p = 0.0672) for OS, and 14 versus 25 months (hazard ratio [HR], 1.775; p = 0.1071) for DFS. CONCLUSIONS: This study highlighted a significant correlation between PMHGP and LMHGP in metastatic CRC. However, survival trends were nonsignificant.
Kanzaki R, Okami J, Tokunaga T
… +13 more, Iwasaki T, Takahama M, Sakamaki Y, Higashiyama M, Ikeda N, Takami K, Yokouchi H, Takeuchi Y, Momozane T, Kadota Y, Fujii M, Shintani Y, Thoracic Surgery Study Group of Osaka University (TSSGO)
Ann Surg Oncol
· 2026 Jun · PMID 42371323
·
Publisher ↗
BACKGROUND: Real-world evidence regarding surgery for clinical T4 (cT4) nonsmall cell lung cancer (NSCLC) is limited. We evaluated outcomes and prognostic factors of cT4 NSCLC using the 9th edition TNM classification. PA...BACKGROUND: Real-world evidence regarding surgery for clinical T4 (cT4) nonsmall cell lung cancer (NSCLC) is limited. We evaluated outcomes and prognostic factors of cT4 NSCLC using the 9th edition TNM classification. PATIENTS AND METHODS: This multi-institutional retrospective study included patients who underwent pulmonary resection for cT4N0-2bM0 NSCLC between 2010 and 2019. Prognostic factors for relapse-free survival (RFS) and overall survival (OS) were analyzed in patients who achieved R0 resection. OS was compared across cT4 subgroups and cN categories. RESULTS: Among 165 patients, 71 were classified as cT4 owing to invasion of neighboring organs. Clinical nodal status was cN0 in 97, cN1 in 40, cN2a in 21, and cN2b in 7. Preoperative therapy was administered in 44 patients. Postoperative complications occurred in 48%, with 90-day mortality of 2.4%. OS after R0 resection was significantly longer than after R1-2 resection. The 5-year RFS and OS of 149 R0-resected patients were 43 and 61%, respectively. The 5-year RFS rates were 47% for pN0-1, 28% for pN2a, and 17% for pN2b; corresponding OS rates were 63, 48, and 50%, respectively. Multivariable analysis identified pN status and preoperative therapy as independent predictors of RFS, and pN status was an independent predictor of OS. OS did not differ among cT4 subgroups (size alone, invasion alone, or both). Prognosis was similar between cT4cN0-1 and cT4cN2a, whereas cT4cN2b had significantly worse outcomes. CONCLUSIONS: Surgery for cT4 NSCLC can achieve favorable results when R0 resection is feasible. Tumors with dual T4 factors and selected cT4N2a disease may benefit from surgery-inclusive treatment.
Muttillo EM, Cherqui D, Chouillard MA
… +14 more, Golse N, Ciacio O, Pittau G, Salloum C, Azoulay D, Allard MA, Pietrasz D, Adam R, Vibert E, Hammel P, Lewin M, Pascale A, Rosmorduc O, Sa Cunha A
Ann Surg Oncol
· 2026 Jun · PMID 42371322
·
Publisher ↗
BACKGROUND AND PURPOSE: Surgery for locally advanced intrahepatic cholangiocarcinoma (LAICC) requires extended liver resections, often associated with vascular and/or biliary reconstruction. The benefits of these high-ri...BACKGROUND AND PURPOSE: Surgery for locally advanced intrahepatic cholangiocarcinoma (LAICC) requires extended liver resections, often associated with vascular and/or biliary reconstruction. The benefits of these high-risk operations are still debated. The objective of this study was to analyze short, long-term outcomes, and futility after surgery for LAICC. METHODS: A retrospective single-center study on the 2013-2024 period was conducted. LAICC was defined as mass-forming intrahepatic tumors 5 cm or more in size with hepatic vein/IVC contact or hepatic hilum contact or both and requiring extended liver resection (five segments or more). Futility was defined as deaths within 90 days or recurrence within 6 months of surgery. RESULTS: 39 consecutive patients were analyzed, including (29) 74% women with a median age of 66 years (38-83 years). In 34 (88%) patients, a trisectionectomy (H145678 or H123458) was performed. Major vascular or biliary recontruction was required in 43.5% and 67%, respectively. Overall morbidity was 56%, with severe morbidity occurring in 8 (20%). The 90-day mortality was 5%. Median overall survival and recurrence-free survival was estimated at 58 and 23 months, respectively. Overall rate of futility was 15.4%. N+ has been shown to be the main factor affecting survival (p = 0.03 for overall survival and p = 0.01 for recurrence-free survival). R1 resection had no impact of overall or recurrence-free survival. CONCLUSIONS: Our study supports an aggressive surgical approach for LAICC. Anticipated R1 resection by necessity should not be considered a contraindication to surgery.
Longoni M, Falkenbach F, Marmiroli A
… +19 more, Le QC, Nicolazzini M, Catanzaro C, Polverino F, Goyal JA, Graefen M, Musi G, Chun FKH, Palumbo C, Schiavina R, Longo N, Saad F, Shariat SF, Quarta L, Moschini M, Gandaglia G, Montorsi F, Briganti A, Karakiewicz PI
Ann Surg Oncol
· 2026 Jun · PMID 42371321
·
Publisher ↗
Fennig S, Kirshtein A, Landman Y
… +3 more, Weiner N, Fenig E, Sharon E
Ann Surg Oncol
· 2026 Jun · PMID 42371320
·
Publisher ↗
BACKGROUND: Targeted intraoperative radiation therapy (TARGIT-IORT) is a promising alternative to standard external radiation for the treatment of early-stage breast cancer. However, American Society for Radiation Oncolo...BACKGROUND: Targeted intraoperative radiation therapy (TARGIT-IORT) is a promising alternative to standard external radiation for the treatment of early-stage breast cancer. However, American Society for Radiation Oncology guidelines have limited its use. We aimed to present our long-term results with the use of TARGIT-IORT in a very restricted population. METHODS: The electronic records of a tertiary medical center were retrospectively searched for women diagnosed with invasive ductal carcinoma from 2014 to 2023. Inclusion criteria were age > 50 years, unifocal disease, tumor size < 3 cm, and clinical subtype estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-non-amplified. Those with a favorable pathology after completion of lumpectomy and sentinel lymph node biopsy (SLNB) underwent TARGIT-IORT consisting of delivery of a single high dose of radiation (20 Gy) to an applicator inserted into the tumor bed using low-energy X-rays (50 Kv) over 22-29 minutes. Follow-up consisted of clinical examination every 6 months in the first 2 years and then mammography and breast ultrasound annually. RESULTS: The cohort included 219 patients with a median age of 66 years (range 50-83). During a median follow-up of 85 months, there was one case each (0.45%) of ipsilateral breast tumor recurrence, axillary lymph node recurrence, and isolated liver metastasis. In total, 20 patients (9.1%) had minor wound complications, and three (1.4%) had fat necrosis, self-limiting in all cases, with no need for hospital readmission. CONCLUSION: TARGIT-IORT is associated with excellent local control, very high survival rates, and a very low toxicity profile for low-risk early breast cancer, consistent with the TARGIT-A trial and should be offered to patients when suitable.