Ofori KA, Smart H, Liu S
… +5 more, Bader JM, Aguirre N, Gupta P, Sharma A, Turaga K
Ann Surg Oncol
· 2026 Jun · PMID 42265516
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While circulating tumor DNA (ctDNA) may guide adjuvant therapy in stage II-III colon cancer, detection largely hinges on systemic tumor shedding. In a secondary analysis of three prospective ctDNA studies, peritoneal met...While circulating tumor DNA (ctDNA) may guide adjuvant therapy in stage II-III colon cancer, detection largely hinges on systemic tumor shedding. In a secondary analysis of three prospective ctDNA studies, peritoneal metastases occurred in up to 9.4% of patients, were predominantly isolated, and were enriched among ctDNA-negative recurrences. Molecular and clinical data demonstrate reduced ctDNA levels in peritoneum-only disease, identifying a surveillance blind spot with direct implications for high-risk patients.
Fernandez-de-Sevillaa E, Collard MK, de Rosa RV
… +17 more, Laroche S, Scoleri I, Boubaddi M, de Ponthaud C, Perinel J, Leclerc J, Bustamante R, Addeo P, Cherif R, Ayav A, Adham M, Gaujoux S, Laurent C, Truant S, Cunha AS, Sulpice L, Gelli M
Ann Surg Oncol
· 2026 Jun · PMID 42262425
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Kosumi K, Harada K, Shimogawa T
… +14 more, Tsubakihara H, Hara Y, Matsumoto C, Yamashita K, Ohuchi M, Eto K, Ogawa K, Ida S, Hiyoshi Y, Nagai Y, Baba Y, Miyamoto Y, Yoshida N, Iwatsuki M
Ann Surg Oncol
· 2026 Jun · PMID 42257783
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Rohrich RN, Soltani H, Snee I
… +3 more, Fan KL, Lesnikoski BA, De La Cruz LM
Ann Surg Oncol
· 2026 Jun · PMID 42252358
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BACKGROUND: Since our 2015 manuscript, nipple-sparing mastectomy (NSM) has been increasingly adopted in breast cancer management, though concerns regarding long-term oncologic safety persist. We provide a 10-year update...BACKGROUND: Since our 2015 manuscript, nipple-sparing mastectomy (NSM) has been increasingly adopted in breast cancer management, though concerns regarding long-term oncologic safety persist. We provide a 10-year update on oncologic outcomes following NSM, including overall survival (OS), disease-free survival (DFS), local recurrence (LR), and nipple-areolar complex recurrence (NACR). PATIENTS AND METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review identified studies reporting oncologic outcomes after NSM. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in the meta-analysis. Studies lacking comparison arms were included in pooled analyses for NSM outcomes using a random-effects model. Weighted averages and 95% confidence intervals (CI) were calculated, and studies were stratified by duration of follow-up. RESULTS: A total of 60 studies comprising 7752 NSM patients were included: 11 studies had comparison arms; 9 studies reporting OS demonstrated a significant pooled risk difference of 2.1% favoring NSM over MRM/SSM (95% CI 0.0-4.3%, p = 0.047); 7 studies reporting DFS showed a nonsignificant pooled risk difference of 4.8% favoring NSM (95% CI -0.8 to 10.3%, p = 0.093); 11 studies reporting LR demonstrated a nonsignificant pooled risk difference of -0.7% (95% CI -2.1 to 0.8%, p = 0.35). The systematic review included all 60 studies. Weighted average follow-up ranged from 25.6 to 133.4 months across groups. Among patients with 10 years of follow-up (n = 391), OS was 82.0% (80.9-93.2%), DFS 60.7% (58.8-62.7%), LR 15.1% (13.9-16.2%), and NACR 1.1% (1.0-1.1%). CONCLUSIONS: NSM is associated with excellent long-term survival and low recurrence rates comparable to SSM/MRM, with minimal NAC recurrence in appropriately selected patients, supporting its long-term oncologic safety.
Ann Surg Oncol
· 2026 Jun · PMID 42251213
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BACKGROUND: Anatomic liver resection traditionally relies on intraoperative ultrasound to identify hepatic veins as landmarks for parenchymal transection. Recently, portal territory staining with indocyanine green (ICG)...BACKGROUND: Anatomic liver resection traditionally relies on intraoperative ultrasound to identify hepatic veins as landmarks for parenchymal transection. Recently, portal territory staining with indocyanine green (ICG) has emerged as a key research focus in precision liver surgery, offering direct visualization of segmentation boundaries. However, a standardized technique for staining complex, multi-segmental tumors is lacking. This study evaluated a novel multi-subsegmental positive staining technique to achieve precise resection in such cases. METHODS: The study enrolled a 59-year-old man with a 7.5-cm hepatocellular carcinoma (HCC) occupying segments Ⅷ and Ⅳa. Preoperative three-dimensional reconstruction mandated resection of both segments for adequate margins. Informed consent was obtained from the patient and his family. Intraoperatively, under ultrasound guidance, the portal veins supplying segments Ⅷ and Ⅳa were selectively punctured. A 1:1000 diluted ICG solution was injected into each, generating a composite positive staining map to delineate the combined resection territory. This approach was termed the "jigsaw-patterned staining technique." RESULTS: The total operative time was 240 min, with the staining procedure requiring 30 min. Intraoperative blood loss was 50 mL. The fluorescent boundaries closely correlated with the subsequent ischemic planes after targeted pedicle division. Histopathology confirmed HCC with microvascular invasion and satisfied margins. At this writing, the patient has recovered without complications and has maintained a disease-free survival for more than 20 months. CONCLUSIONS: The "jigsaw-patterned" multi-subsegmental portal vein ICG staining technique is technically feasible and safe. It enables precise anatomic resection for complex HCC spanning multiple segments, optimizing oncologic margin control while sparing functional parenchyma.
Busch IM, Marinelli V, Maggioni O
… +7 more, Leardini C, Wu AW, Mazzi M, Berti L, Besselink MG, Salvia R, Rimondini M
Ann Surg Oncol
· 2026 Jun · PMID 42251210
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BACKGROUND: Transparent management and disclosure of surgical errors and adverse events (AE) are essential for patient safety and staff well-being. This systematic review synthesizes evidence on how surgical errors and A...BACKGROUND: Transparent management and disclosure of surgical errors and adverse events (AE) are essential for patient safety and staff well-being. This systematic review synthesizes evidence on how surgical errors and AE are experienced and disclosed, focusing on their psychological impact on clinicians, coping strategies, support resources, and barriers to disclosure. MATERIALS AND METHODS: A systematic search of PubMed, PsycINFO, CINAHL, and WoS Core Collection was conducted without date restrictions, using also additional sources and automatic alerts. Two reviewers independently screened studies, assessed quality, and extracted data. Findings were synthesized narratively. RESULTS: A total of 30 studies involving 11,723 participants were included. Surgical staff reported significant emotional distress following AE, with guilt (53-89%) and anxiety (45-88%) commonly reported and up to 96% experiencing some emotional impact. Coping strategies varied, while formal psychological support was rarely (1.6-7%) accessed. Reporting and disclosure practices were inconsistent, with disclosure rates ranging from 17 to 62%. Major barriers included fear of litigation, unclear institutional procedures, and hierarchical pressures. Although disclosure was widely recognized as ethically correct, individual and systemic obstacles persisted. Training interventions improved communication skills, but gaps remained. CONCLUSIONS: This systematic review highlights the substantial psychological impact of surgical errors and AE on clinicians, underscoring the need for organizational strategies that protect staff well-being. Evidence directly addressing psychological factors involved in disclosure remains limited. Clearer disclosure protocols, enhanced communication training, and accessible psychological support may reduce distress among surgical staff and promote transparent, patient-centered error management, particularly in complex surgical fields such as oncological care.
Lin JP, Hong JH, Zhuang FN
… +10 more, Chen WJ, Lin H, He H, Chen YJ, Wang P, Zhou H, Wei WW, Gao PQ, Liu SY, Wang F
Ann Surg Oncol
· 2026 Jun · PMID 42251209
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OBJECTIVES: This study evaluated the prognostic value of the 12th thoracic vertebra skeletal muscle mass index (T12-SMI) before and after neoadjuvant chemoimmunotherapy (NACI) in patients with esophageal squamous cell ca...OBJECTIVES: This study evaluated the prognostic value of the 12th thoracic vertebra skeletal muscle mass index (T12-SMI) before and after neoadjuvant chemoimmunotherapy (NACI) in patients with esophageal squamous cell carcinoma (ESCC). METHODS: We retrospectively analyzed 211 patients with ESCC who underwent NACI followed by esophagectomy between 2020 and 2022. According to their SMI at T12, the patients were divided into a muscle attenuation group (MAG) and a normal group (NG) before or after NACI. The perioperative outcomes and survival data were compared between the two groups. RESULTS: The pathological complete response (pCR) rates and major pathological response rates were comparable between the MAG and NG before and after NACI (all P > 0.05). The postoperative complication rates and 90-day mortality rates were also comparable (all P > 0.05). However, compared with the NG, the MAG had significantly worse overall survival and disease-free survival, both before and after NACI (all P < 0.05). Multivariate analyses confirmed that muscle attenuation post-NACI was an independent prognostic factor for overall survival (hazard ratio 2.977; 95% confidence interval 1.733-5.113; P < 0.001) and disease-free survival (hazard ratio 2.355; 95% confidence interval 1.339-4.142; P = 0.003). Post-NACI, the MAG had higher overall recurrence rates (41.7% vs. 21.1%, P = 0.009), particularly for distant metastases (22.2% vs. 9.1%, P = 0.024). CONCLUSION: Sarcopenia at the T12 level after NACI is an independent predictor of poor survival for patients with ESCC and is associated with increased postoperative recurrence risk, especially for distant metastases.
Sun X, Li XM, Liu WZ
… +10 more, Qu KQ, Li TH, Ding JN, Lu DF, Liu XH, Lin Y, Liang X, Shen Q, Yin YP, Tao KX
Ann Surg Oncol
· 2026 Jun · PMID 42251208
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BACKGROUND: Neoadjuvant chemoimmunotherapy (NCIT) is an important treatment strategy for locally advanced gastric cancer (LAGC). Although proton pump inhibitors (PPIs) are frequently prescribed in oncology settings, thei...BACKGROUND: Neoadjuvant chemoimmunotherapy (NCIT) is an important treatment strategy for locally advanced gastric cancer (LAGC). Although proton pump inhibitors (PPIs) are frequently prescribed in oncology settings, their impact on the efficacy of perioperative immunotherapy remains unclear. PATIENTS AND METHODS: This multicenter retrospective cohort study included 107 patients with LAGC who received NCIT followed by curative-intent gastrectomy (January 2020‒December 2023). Patients receiving potassium-competitive acid blockers were included in the PPI group. Clinicopathological characteristics, pathological response, disease-free survival (DFS), and overall survival (OS) were compared, and multivariable Cox regression models identified independent prognostic factors. RESULTS: The PPI group comprised 48 (44.9%) patients. Baseline characteristics were generally balanced between groups. PPI exposure was associated with significantly reduced nodal clearance, reflected by a lower ypN0 rate (47.9% versus 67.8%, p = 0.038). After a median follow-up of 33.0 months, DFS and OS were significantly worse in PPI-treated patients. Median DFS was 40.0 months (95% confidence interval [CI], 22.9-57.0) in the PPI group and not reached in the non-PPI group (p = 0.001). Multivariable analysis identified PPI exposure as an independent predictor of inferior DFS (hazard ratio [HR] 2.60; p = 0.033) and OS (HR 4.41; p = 0.007). CONCLUSIONS: Concomitant PPI exposure during NCIT was associated with impaired pathological nodal response and worse long-term survival in patients with LAGC. Given the retrospective design and limited data on exposure timing and duration, these findings should be considered hypothesis-generating and should not be interpreted as evidence of a duration-dependent or causal effect.
Wendelspiess SR, Sandstedt JT, Stoffel J
… +9 more, Menzi N, Burger M, Halbeisen FS, Lese I, Ismail T, Fabi A, Kouba L, Schaefer DJ, Kappos EA
Ann Surg Oncol
· 2026 Jun · PMID 42251207
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BACKGROUND: Perineal reconstruction remains challenging due to complex anatomy, high bacterial load, and frequent postoperative complications. Extensive tissue defects after oncologic resection or severe infection common...BACKGROUND: Perineal reconstruction remains challenging due to complex anatomy, high bacterial load, and frequent postoperative complications. Extensive tissue defects after oncologic resection or severe infection commonly necessitate reconstructive procedures. Although myocutaneous flaps are widely used, perforator flaps offer advantages such as muscle preservation and reduced donor-site morbidity. Given the perineal region's critical role in defecation, urination, and sexual function, evaluating patients' quality of life (QoL) after reconstructive surgery is essential. METHODS: This single-center cohort study evaluated postoperative complication rates and QoL after perineal reconstruction with perforator versus non-perforator flaps from 2013 to 2023. All participants were invited to complete a postoperative QoL survey. RESULTS: Of all the patients, 58 % received a perforator-based and 40 % a non-perforator-based reconstruction. One patient (2.3 %) underwent a combined approach. The primary indication for perineal reconstruction (68.9 %) was defect coverage after oncologic resection. Both groups had a 50 % complication rate. Donor-site morbidity was higher in the non-perforator flap group, with all complications classified as Clavien-Dindo grade III. Additional findings were exploratory: patient satisfaction was higher in the non-perforator flap group (100 % vs 66 %), although this group had a substantially longer follow-up period (4.14 vs 1.74 years). Conversely, numerically higher QoL scores were observed in the perforator flap group. CONCLUSION: Perforator flaps demonstrated a more favorable donor-site profile, representing the most robust finding of this cohort. Observed differences in complications and patient-reported outcome measures are exploratory, and QoL continues to be insufficiently addressed in oncologic perineal reconstruction, underscoring the need for enhanced interdisciplinary collaboration.
Gujarathi R, Belmont E, Rodman C
… +13 more, Bansal VV, Setia N, Alpert L, Hart J, Möller MG, Eng OS, Lee G, Chin J, Amin MA, Polite BN, Liao CY, Turaga KK, Shergill A
Ann Surg Oncol
· 2026 Jun · PMID 42251206
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BACKGROUND: The incidence of early onset (age < 50 years at diagnosis) appendiceal adenocarcinoma (EOAA) is rising alarmingly. Reported data on etiology, treatment, and outcomes is scarce. In this study, we report clinic...BACKGROUND: The incidence of early onset (age < 50 years at diagnosis) appendiceal adenocarcinoma (EOAA) is rising alarmingly. Reported data on etiology, treatment, and outcomes is scarce. In this study, we report clinical outcomes for patients with EOAA. PATIENTS AND METHODS: Patients diagnosed with appendiceal adenocarcinoma between 2013 and 24 were stratified on the basis of age at diagnosis as having either EOAA (< 50 years) or average-age onset appendiceal adenocarcinoma (AOAA; ≥ 50 years). Clinicopathological and genomic data were abstracted from electronic medical records. Baseline clinicopathologic features and survival outcomes were compared between patients with EOAA and AOAA. RESULTS: Of 181 eligible patients, 49 (27.1%) had EOAA. Median age at diagnosis for patients with EOAA was 42.1 years (interquartile range [IQR], 35.7-46). Of the 76 patients (EOAA = 23 [30.3%] + AOAA = 53 (69.7%)] who had locoregional disease at presentation, 44 (57.9%) remained disease-free for at least 2 years. Within these 44 (conditional survival), the EOAA group showed numerically shorter recurrence-free survival (RFS) and higher risk of recurrence (median RFS, EOAA = 49.5 months versus AOAA = 83.3 months; hazard ratio [HR], 4.07; 95% confidence interval [CI], 1.49-11.18; p = 0.06). Long-term recurrences (≥ 5 years) were seen in 9/15 (60%) patients during the 5-year follow-up period. Of 139 evaluable patients (EOAA = 36 [25.9%] + AOAA = 103 [74.1%]) with metastatic/recurrent disease, patients with EOAA received more non-fluorouracil (FU)-based systemic treatments, including experimental agents, in any line of treatment (8/36, 22.2% versus 6/103, 5.8%; p = 0.009). A higher proportion of patients in the EOAA group received bevacizumab in any line of treatment (24/36, 66.7% versus 49/103, 47.6%; p = 0.055) and three or more lines of systemic therapy (10/36, 27.8% versus 14/103, 13.6%; p = 0.07). There was no significant difference in OS between the EOAA and AOAA groups despite more aggressive therapy in EOAA (median OS, EOAA = 35.2 months versus AOAA = 40.6 months; HR, 0.90; 95% CI, 0.57-1.44; p = 0.66). CONCLUSIONS: Among patients who remained disease-free after initial surgical resection for locoregional disease for at least 2 years, recurrence was more frequent in patients with EOAA. Aggressive systemic therapy, including trials and non-FU based therapies were more frequent in patients with EOAA but were not associated with improved survival. EOAA may represent a unique entity within this rare disease, which warrants further exploration.