Journal Of Surgical Oncology[JOURNAL]
Sun
200 papers
Institutional Learning Curve in Esophagectomy: Technical Standardization of Gastric Conduit Formation and Conduit-Related Outcomes in 187 Consecutive Patients.
Tripathi M, Balachandran RR, Vineet K … +4 more , Vadodaria D, Kushwaha V, Ansari MI, Shukla P
J Surg Oncol · 2026 Jul · PMID 42402157 · Publisher ↗
BACKGROUND: Learning curves in esophagectomy are often described in terms of procedural volume, but institutional maturation also reflects progressive standardization of reconstruction, operative choreography, and team-b...
BACKGROUND: Learning curves in esophagectomy are often described in terms of procedural volume, but institutional maturation also reflects progressive standardization of reconstruction, operative choreography, and team-based decision-making. Gastric conduit viability remains central to safe esophageal reconstruction, with conduit ischemia, torsion, and tension contributing substantially to leak and necrosis. We examined the institutional learning curve of a high-volume esophageal cancer program, focusing on technical standardization of gastric conduit formation and conduit-related outcomes. METHODS: We retrospectively analyzed 187 consecutive patients who underwent esophagectomy for locally advanced esophageal cancer between 2019 and 2025 at a tertiary cancer center. For descriptive temporal comparisons, the cohort was divided into two pragmatic phases corresponding to institutional practice before and after routine formalization of the conduit protocol: up to 2022 (n = 101) and 2023-2025 (n = 86). During program maturation, a standardized gastric conduit protocol was formalized, emphasizing preservation of conduit vascularity, controlled conduit geometry, minimal omental bulk, cervical-first dissection, torsion-free transposition, and selective pyloric management. The primary outcome was composite major conduit-related morbidity, defined per patient as major anastomotic leak, major conduit necrosis, or conduit-related re-exploration. Secondary outcomes included overall leak, vocal cord palsy, chyle leak, Clavien-Dindo grade, 30-day mortality, R0 resection, and lymph node yield. Outcomes were interpreted within the broader context of institutional maturation rather than as a simple calendar-era comparison. RESULTS: Composite major conduit-related morbidity declined from 8.9% in the earlier phase of the program to 2.3% in the later phase. Within this composite, major conduit necrosis declined from 5% to 0%, while overall leak rates remained stable. Thirty-day mortality was 4.3%, and most complications were minor. Oncologic adequacy was preserved, with R0 resection in 94.7% and a median lymph node yield of 25. Improvements in pathological complete response and recurrence over time paralleled broader changes in neoadjuvant treatment intensity and lymphadenectomy and should not be attributed solely to conduit protocolization. CONCLUSIONS: Institutional maturation in esophagectomy was associated with transition from experience-dependent practice to reproducible technical standardization of gastric conduit formation. This learning curve coincided with disappearance of major conduit necrosis without compromising oncologic adequacy. Standardization of conduit construction may represent an important and exportable quality-improvement step in developing high-volume esophageal cancer programs, especially in resource-variable settings.
Evaluating the Accuracy of ChatGPT-4o in Addressing Complex Clinical Questions Based on NCCN Guidelines for Rectal Adenocarcinoma.
Meyer R, Bresler TE, Palmer KM … +3 more , Wilson T, Pandya S, Fujita M
J Surg Oncol · 2026 Jul · PMID 42402154 · Publisher ↗
INTRODUCTION: The management of rectal adenocarcinoma requires navigation of complex, branching guideline pathways encompassing neoadjuvant sequencing, surgical approach, organ preservation, and surveillance, yet real-wo...
INTRODUCTION: The management of rectal adenocarcinoma requires navigation of complex, branching guideline pathways encompassing neoadjuvant sequencing, surgical approach, organ preservation, and surveillance, yet real-world guideline adherence remains as low as 60-70%. The ability of current-generation large language models (LLMs) to accurately navigate these decision points has not been fully characterized. METHODS: In this cross-sectional, vignette-based study, 135 clinical questions were constructed from 45 pages of NCCN Rectal Cancer Guidelines (Version 4.2024). ChatGPT-4o was queried using standardized prompts with up to 3 clarifying questions permitted per query. Responses were independently evaluated by two physician raters on a 5-point Likert scale, with potential discrepancies adjudicated by a board-certified surgical oncologist. Primary outcomes were the proportion of responses rated Correct (score ≥ 3) and Accurate (score ≥ 4). Inter-rater reliability was assessed using Cohen's kappa, and subgroup analysis was performed across clinical domains using the Kruskal-Wallis test. RESULTS: Of 135 questions, 127 (94.1%; 95% CI, 88.7-97.0%) were Correct and 121 (89.6%; 95% CI, 83.3-93.7%) were Accurate. One hundred two responses (75.6%) were completely correct without additional prompting. Performance was consistent across clinical domains (Kruskal-Wallis H = 0.530, p = 0.767). Inter-rater agreement was perfect (κ = 1.0). Eight responses (5.9%) contained partially or wholly incorrect information, with errors concentrated in multi-step conditional treatment decision points. CONCLUSION: ChatGPT-4o demonstrates high concordance with NCCN rectal cancer guidelines across all evaluated clinical domains with notable improvement over prior ChatGPT iterations evaluated by our group. The concentration of errors in complex conditional treatment algorithms suggests that LLMs excel at discrete factual recall but may struggle with multi-step reasoning under clinical uncertainty. Prospective validation using real-world clinical data and comparison with multidisciplinary tumor board recommendations remain necessary prior to clinical integration.
Racial Differences in Breast Cancer Treatment and Information Access.
Williams T, Li MX, Fine KS … +7 more , Melnick BA, Ho KC, Joseph J, Allums J, Casas Fuentes RJ, Coles BM, Galiano RD
J Surg Oncol · 2026 Jul · PMID 42402153 · Publisher ↗
BACKGROUND AND OBJECTIVES: Persistent disparities in breast cancer (BC) care highlight the need to better understand patient experiences across diverse populations. This study examined racial differences in BC treatment,...
BACKGROUND AND OBJECTIVES: Persistent disparities in breast cancer (BC) care highlight the need to better understand patient experiences across diverse populations. This study examined racial differences in BC treatment, BR decisions, and social media use. METHODS: A web survey of 413 racially diverse breast cancer survivors collected self reported clinical data, BREAST-Q scores, and social media use. Multivariate regression examined BC treatment, BR complications, social media use, and satisfaction by race. RESULTS: Black and Hispanic women were more likely to have mastectomy and chemotherapy than white women (p < 0.01; p < 0.001), even after adjusting for stage (p = 0.368). Asian women were less likely to receive chemotherapy or radiation (p < 0.01). Despite more breast-conserving surgery (p < 0.001 vs. Black; p < 0.05 vs. Hispanic), white women reported lower breast satisfaction (p < 0.05). Black and Hispanic women relied more on social media for information (p < 0.001; p < 0.01). Younger age, tobacco use, radiation, and comorbidities increased BR complication risk. CONCLUSIONS: Women of color in this study experienced more aggressive treatment patterns and were more likely to rely on social media for information, highlighting an opportunity to address inequities in breast cancer care. Leveraging social media to deliver culturally tailored, evidence-based information may enhance understanding of treatment and surgical options, as well as complication risks, thereby promoting more equitable, patient-centered care.
Comparative Analysis of CEM and Breast MRI: A Retrospective Study.
Tomala J, Upadhyay N
J Surg Oncol · 2026 Jul · PMID 42394378 · Publisher ↗
INTRODUCTION: Breast cancer is a prevalent malignancy where accurate preoperative assessment is crucial for treatment planning. Breast MRI is a highly sensitive imaging modality for breast cancer detection. It is widely...
INTRODUCTION: Breast cancer is a prevalent malignancy where accurate preoperative assessment is crucial for treatment planning. Breast MRI is a highly sensitive imaging modality for breast cancer detection. It is widely used preoperatively and can assist with local staging, tumour size assessment, detection of additional tumour foci and assessment of treatment response in patients receiving neoadjuvant chemotherapy. Contrast-enhanced spectral mammography (CEM) is an emerging alternative with comparable diagnostic performance and shorter examination times. This study retrospectively compares CEM and MRI in measuring breast cancer extent. METHODS: In this retrospective study conducted at Imperial College Healthcare NHS Trust, 58 patients with histologically confirmed breast cancer who underwent both CEM and MRI between January 2020 and July 2023 were included. Lesion sizes were evaluated on both modalities and compared with the postoperative histopathology specimen using the Wilcoxon signed-rank test and Pearson correlation. RESULTS: There was no statistically significant difference in average tumour size between CEM and MRI (28.8 mm (SD = 22.8) on CEM and 31.8 mm (SD = 24.2) on MRI; p = 0.1058). Both imaging modalities demonstrated similar measurement precision when compared with the surgical specimen (12.9 mm vs. 12.2 mm absolute mean difference between histopathological and radiological measurement - MRI and CEM respectively). Pearson analysis demonstrated a good correlation with postoperative histopathology in size measurement, with CEM showing slightly stronger correlation (r = 0.7858, p < 0.0001, n = 45) compared with MRI (r = 0.6726, p < 0.0001, n = 46). DISCUSSION: CEM appears to be a viable alternative to MRI. This study demonstrates high sensitivity of CEM and MRI for breast cancer detection, with no statistically significant difference in maximum diameter of enhancing abnormalities. Both modalities strongly correlate with histopathology. Further studies are required to validate the role of CEM in clinical practice.
The Treatment Efficacy for Patients Undergoing Combined Transanal-Transabdominal Endoscopic Resection of Rectal Anastomosis Stenosis.
Wan T, Shi Y, Zhou Y … +10 more , Zheng H, Xie H, Ye F, Huang P, Alenzi M, Liu Z, Cai Y, Luo S, Kang L, Huang L
J Surg Oncol · 2026 Jul · PMID 42385137 · Publisher ↗
BACKGROUND: Combined transanal and transabdominal resection for anastomotic stenosis may provide an opportunity to restore bowel continuity in patients with colorectal anastomotic stenosis. This study aimed to evaluate t...
BACKGROUND: Combined transanal and transabdominal resection for anastomotic stenosis may provide an opportunity to restore bowel continuity in patients with colorectal anastomotic stenosis. This study aimed to evaluate the therapeutic efficacy of combined transanal-transabdominal resection in patients with rectal anastomotic stenosis. METHODS: We retrospectively analyzed a consecutive cohort of patients who underwent combined transanal-transabdominal endoscopic resection for rectal anastomotic stenosis between August 2019 and March 2023. Data on intraoperative variables, mortality, postoperative complications, and stoma closure were collected. Functional outcomes were evaluated using the Low Anterior Resection Syndrome (LARS) score and the Wexner incontinence score. RESULTS: A total of 54 patients, including 46 men and 8 women, met the inclusion criteria. In all patients, anastomotic stenosis developed secondary to either anastomotic leakage or preoperative radiotherapy. The median length of hospital stay was 15 days (11-24 days). No postoperative mortality occurred, and the overall morbidity rate was 15%. During a median follow-up of 48 months, stoma closure was achieved in 49 patients after a median interval of 3.8 months (2.5-11 months). At the end of follow-up, stoma closure had failed in 2 patients because of poor anastomotic functional outcomes, and 3 patients developed recurrent anastomotic stenosis. Among the 49 patients available for functional assessment, 35 (71.4%) reported no or minor LARS. The median Wexner incontinence score was 8 (0-18), and 13 patients had a score of 0. Erectile function was evaluated in 28 male patients, of whom 18 reported normal postoperative erectile function. CONCLUSIONS: Combined transanal-transabdominal endoscopic resection appears to be an effective treatment for rectal anastomotic stenosis, with a high rate of stoma closure, low morbidity, and acceptable long-term functional outcomes. CLINICAL TRIAL REGISTRATION NUMBER: NCT06036862.
"It Depends on the Situation": Variability in How Surgical Oncologists Elicit and Integrate Patient Values.
Speer JEF, Bechthold AC, Monton O … +3 more , Newcomb A, Odom JN, Kopecky KE
J Surg Oncol · 2026 Jul · PMID 42385133 · Publisher ↗
BACKGROUND: Understanding what matters most to patients is central to person-centered care, particularly in surgical oncology, where decisions often involve significant tradeoffs. We explored how surgeons elicit, integra...
BACKGROUND: Understanding what matters most to patients is central to person-centered care, particularly in surgical oncology, where decisions often involve significant tradeoffs. We explored how surgeons elicit, integrate, document, and support patient values in cancer-related decision-making. METHODS: This qualitative descriptive study involved semi-structured interviews with surgical oncologists (June-September 2025). Participants were purposively sampled from a prior international survey to ensure variation in demographics. Interviews were recorded, transcribed, and analyzed using thematic analysis. Participant characteristics were summarized descriptively. RESULTS: Fourteen surgeons participated. Most were male (71%), White (86%), and early-career (43%), practicing primarily in gastrointestinal or hepatobiliary surgery (each 43%) at academic centers (57%) in the U.S. South or Midwest (each 36%). Surgeons described various approaches to eliciting values, including inferring values from contextual clues and clarifying tradeoffs between survival and quality-of-life. Values elicitation was largely situational, occurring in high-risk or preference-sensitive contexts. When values conflicted with recommendations, surgeons adapted plans within oncologic safety. Documentation varied and was shaped by relevance, medicolegal concerns, and workflow. Barriers included time limitations, emotional distress, family dynamics, and limited training. CONCLUSIONS: Values elicitation was inconsistent and situational rather than routine. More structured, earlier approaches and system-level support may better align surgical decisions with patient values.
A Tale of Two Pathways: Same-Surgeon Versus Different-Surgeon Resection After Second Surgical Opinion.
Mevawalla A, Woldesenbet S, Sarfraz A … +5 more , Alizai Q, Angez M, Elemosho A, Chatzipanagiotou OP, Pawlik TM
J Surg Oncol · 2026 Jun · PMID 42366900 · Publisher ↗
BACKGROUND: The role of second surgical opinions (SSOs) in gastrointestinal (GI) cancer care is not well-defined. While SSOs are common, the impact may depend on whether patients ultimately undergo resection with the sam...
BACKGROUND: The role of second surgical opinions (SSOs) in gastrointestinal (GI) cancer care is not well-defined. While SSOs are common, the impact may depend on whether patients ultimately undergo resection with the same surgeon or with a different surgeon after the SSO. We sought to characterize perioperative outcomes relative to SSO among older adults with GI cancers. METHODS: Using SEER-Medicare data (2000-2019), patients aged 66-90 with primary GI were identified. Cancer-directed resections were categorized into three claims-observed pathways: surgery without SSO, SSO with same-surgeon resection, and SSO with different-surgeon resection. Multivariable regression models assessed the association between operative pathway and perioperative outcomes including complications, extended length of stay (LOS), 90-day readmission and mortality, discharge disposition, and achievement of a composite "textbook outcome." RESULTS: Among 40,603 surgical patients, 56.2% underwent surgery without SSO, 5.3% underwent SSO with same-surgeon resection, and 38.5% underwent SSO with different-surgeon resection. Compared with no SSO, SSO followed by resection with a different surgeon was associated with lower odds of 90-day readmission (aOR 0.92, 95%CI 0.88-0.97), any complications (aOR 0.90, 95%CI 0.84-0.95), extended LOS (aOR 0.93, 95%CI 0.88-0.98), and mortality (aOR 0.67, 95%CI 0.58-0.78), as well as higher discharge-home (aOR 1.05, 95%CI 1.01-1.12) and textbook outcome (aOR 1.12, 95%CI 1.07-1.17). In contrast, SSO with same-surgeon resection was associated with higher complications (aOR 1.14, 95%CI 1.01-1.29), longer LOS (aOR 1.21, 95%CI1.09-1.35), and lower home discharge (aOR 0.77, 95%CI 0.70-0.85) with no survival advantage. CONCLUSION: Among older adults undergoing GI cancer surgery, SSO followed by resection with a different surgeon was associated with improved perioperative safety and recovery, whereas SSO followed by resection with the same surgeon was not associated with similar benefit. These findings suggest that the value of SSO may lie in its role as a pathway to a different surgical team when clinically appropriate.
How I Do It: The Life and Work of a Rubber Band in Robotic Liver Parenchymal Transection.
Wang Y, Simon CJ, Cheah YL
J Surg Oncol · 2026 Jun · PMID 42332369 · Publisher ↗
Liver retraction is critical for safe and efficient robotic liver transection. Conventional methods often require additional instruments, tacking sutures or continuous bedside assistance. This "How I Do It" article prese...
Liver retraction is critical for safe and efficient robotic liver transection. Conventional methods often require additional instruments, tacking sutures or continuous bedside assistance. This "How I Do It" article presents our double rubber band technique, which enables stable, hands-free retraction during robotic liver transection. We provide a video demonstration of our standard retraction technique for hemihepatectomy and describe adaptations for complex resections.
New Paradigms of Cancer Require New Language: A Qualitative Study Exploring Language for Non-Curative Non-Palliative Cancer Surgery.
Wong BO, Farber ON, Reich AJ … +5 more , Cooper ZR, Mack JW, Clancy TE, Raut CP, Lilley EJ
J Surg Oncol · 2026 Jun · PMID 42318831 · Publisher ↗
BACKGROUND AND METHODS: Cancer interventions are traditionally described as either "curative" or "palliative," but evolving cancer biology and new treatments have transformed some cancers into chronic diseases where surg...
BACKGROUND AND METHODS: Cancer interventions are traditionally described as either "curative" or "palliative," but evolving cancer biology and new treatments have transformed some cancers into chronic diseases where surgery plays a non-curative, disease-targeted role. We conducted semi-structured interviews with cancer surgeons via purposive snowball sampling, exploring two hypothetical scenarios and discussing "disease-control" surgery as a category of neither palliative nor curative surgical intent. Interviews were thematically analyzed. RESULTS: Eighteen surgeons from 16 US institutions described how evolving cancer treatment paradigms challenge existing language for surgical intent. "Disease-control" surgery captured new adjuvant surgical roles including debulking to improve systemic therapy efficacy, resection of treatment-resistant disease, and "resetting the clock" for indolent tumors. Surgical goals are increasingly defined by individual patients' broader multidisciplinary treatment trajectory. CONCLUSIONS: Traditional "curative" versus "palliative" categories inadequately describe contemporary cancer surgery. New frameworks aligned with current understandings of cancer biology and new treatment modalities may facilitate clearer communication about surgical goals and enable developing appropriate research outcome measures. DISCUSSION: These findings highlight a need for standardized surgical intent terminology. Broader validation through multidisciplinary stakeholder engagement is needed to refine and implement this proposed framework.
Performance of Survival Prediction Tools in Patients With Gastrointestinal Stromal Tumors: A Systematic Review and Meta-Analysis.
Zhu A, Wong C, Adhikari NKJ … +5 more , Ip KY, Mahar A, Hsu AT, Hallet J, Coburn N
J Surg Oncol · 2026 Jun · PMID 42312566 · Publisher ↗
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. We conducted a systematic review and meta-analysis of studies that developed, validated, or updated clinical p...
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. We conducted a systematic review and meta-analysis of studies that developed, validated, or updated clinical prognostic tools to predict survival in adults with primary GIST, identifying 47 eligible studies (38 development and 9 validation studies). Meta-analyses were performed to assess performance in external validation cohorts. The MSKCC nomogram was most frequently validated, with a pooled C-statistic of 0.78 for recurrence-free survival.
Prognostic Factors for Patients Under 45 Undergoing Surgery for Colorectal Liver Metastases: A SEER Population-Based Study.
Grob G, Fang F, Karpov M … +4 more , Feliberti E, Hughes M, Burke R, Lo W
J Surg Oncol · 2026 Jun · PMID 42312562 · Publisher ↗
BACKGROUND AND OBJECTIVES: Colorectal cancer (CRC) has been on the rise in adults younger than 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). The a...
BACKGROUND AND OBJECTIVES: Colorectal cancer (CRC) has been on the rise in adults younger than 50. Surgical resection is a potentially curative treatment option for patients with colorectal liver metastases (CRLM). The aim of this study was to describe patient and tumor characteristics associated with disease-specific survival in young patients (< 45 years) versus older patients (≥ 45 years) with isolated CRLM. METHODS: The SEER database was queried for patients with CRLM who underwent colon and liver resection from 2010 to 2021. Patients under age 20, with metastases beyond the liver, or who had not had surgery for liver metastases were excluded. Cox regression was used to analyze demographic factors, tumor characteristics, and treatment order. RESULTS: The study group consisted of 2222 patients, with 299 patients less than 45 years old, and 1923 patients at least 45 years old. Higher nodal burden was associated with worse survival in both groups. Elevated CEA was associated with worse survival only in older patients. Younger patients experienced initial longer disease-specific survival. CONCLUSIONS: Typical prognostic factors for older patients do not have the same impact on disease-specific survival for younger patients. Further study may help describe patient and tumor selection for surgical resection of colorectal liver metastases in young patients.
Prehabilitation Prior to Colorectal Cancer Surgery: Impact and Implementation.
Lockhorst EW, Backhuijs TAM, Kerkhoff TME … +5 more , van den Braak RRJC, Ayez N, Verhoef C, Gobardhan PD, Schreinemakers JMJ
J Surg Oncol · 2026 Jun · PMID 42312561 · Publisher ↗
BACKGROUND AND OBJECTIVES: Multimodal prehabilitation aims to improve surgical outcomes and preoperative fitness in patients undergoing surgery for colorectal cancer (CRC). This study evaluated implementation of a standa...
BACKGROUND AND OBJECTIVES: Multimodal prehabilitation aims to improve surgical outcomes and preoperative fitness in patients undergoing surgery for colorectal cancer (CRC). This study evaluated implementation of a standardised prehabilitation programme for elective CRC surgery, assess its impact, and identify pitfalls and challenges during implementation. METHODS: Retrospective single-centre study, all CRC patients scheduled for resection between January 2022 and April 2024 were included. Since May 2023, standardised multimodal prehabilitation was introduced. Before, patients received physiotherapy and a dietician if indicated, although this was not routinely offered. Patients were divided into a prehabilitation and non-prehabilitation group. Clinical data, prehabilitation details, and physiotherapy results were collected from patient charts. RESULTS: Among 401 patients, 198 (49%) underwent prehabilitation. Participation increased after standardisation (40% vs. 59%, p < 0.001). Strength and physical fitness improved significantly (leg press 100 vs. 135 kg; steep ramp 160 vs. 213 W; p < 0.001). Patients in the non-standardised programme experienced a significantly longer postoperative hospital stay than those in standardised programme (4 vs. 3 days, p = 0.010). Despite more comorbidities in prehabilitated patients, complication rates were similar between patients without and with prehabilitation (28% vs. 24%, p = 0.45). CONCLUSION: Standardised prehabilitation appears beneficial and safe, improving participation, referral justification and outcomes, particularly in high-risk colorectal cancer patients.
Access to Surgical Cancer Care in the Safety-Net: A Survey of California Hospitals.
Wong P, Alseidi A, Uche A … +3 more , Victorino GP, Maker AV, Thornblade LW
J Surg Oncol · 2026 Jun · PMID 42307000 · Publisher ↗
BACKGROUND: Safety-net hospitals (SNHs) provide a substantial segment of the U.S. population with complex health needs, yet the breadth of oncologic services available at SNHs remains unclear. METHODS: A survey on cancer...
BACKGROUND: Safety-net hospitals (SNHs) provide a substantial segment of the U.S. population with complex health needs, yet the breadth of oncologic services available at SNHs remains unclear. METHODS: A survey on cancer-care delivery was distributed to oncology providers at stand-alone California SNHs. The survey queried feasibility, access, and wait times for screening exams, diagnostic tests, procedures, and specialist services for comprehensive cancer care. RESULTS: Of 15 SNHs queried, nine (60%) responded. Access to full-time surgical specialists varied considerably: 33% lacked breast surgeons and urologists, 44% lacked surgical oncologists/hepatobiliary and colorectal surgeons, 56% lacked thoracic surgeons, 67% lacked endocrine surgeons, and 89% lacked orthopedic oncologists. Most hospitals (78%) employ general surgeons to perform cancer operations. Specific procedures are performed with the following frequency: right hemicolectomy/LAR/APR 89%, gastrectomy 78%, pulmonary lobectomy 78%, pancreaticoduodenectomy 67%, melanoma surgery 67%, major hepatectomy 56%. Robotic surgery is available at two-thirds of SNHs. One hospital offered CRS/HIPEC, and no respondent site provided regional intraoperative chemotherapy techniques. CONCLUSIONS: Like the United States as a whole, much cancer surgery in respondent California SNHs is performed by general surgeons. Significant gaps in subspecialty and advanced therapies persist, potentially requiring patients to travel long distances to tertiary centers and limiting access to comprehensive cancer care.
Oncologic Outcomes After Liver Transplantation for Unresectable Colorectal Liver Metastases: A Systematic Review and Meta-Analysis of Proportions.
Pompeu BF, Aguiar LR, Melillo GD … +8 more , Nakabayashi LS, Barone GL, Delgado LM, Theis C, Grande LMD, Poli de Figueiredo SM, Formiga FB, Bressan AK
J Surg Oncol · 2026 Jun · PMID 42306995 · Publisher ↗
Liver transplantation has emerged as a therapeutic option for highly selected patients with unresectable colorectal liver metastases (CRLM). This review evaluated oncologic and perioperative outcomes in 92 patients who u...
Liver transplantation has emerged as a therapeutic option for highly selected patients with unresectable colorectal liver metastases (CRLM). This review evaluated oncologic and perioperative outcomes in 92 patients who underwent transplantation. One- and 3-year overall survival (OS) were 96.32% and 73.07%, respectively. Disease-free survival (DFS) was lower, with high rates of recurrence. Major complications occurred in 39.36%, and 90-day mortality was 1.03%. Further randomized studies are needed to better define the role of liver transplantation and optimize patient selection criteria.
Systematic Review and Meta-Analysis of Resection Sequence in Synchronous Colorectal Liver Metastasis: Primary vs. Liver First.
Mavrantonis S, El-Wafa OA, Vaghiri S … +1 more , Prassas D
J Surg Oncol · 2026 Jun · PMID 42296400 · Publisher ↗
BACKGROUND: This present systematic review and meta-analysis aims to compare overall survival (OS), disease-free survival (DFS), morbidity and mortality outcomes in patients undergoing colorectal first (CRf) versus liver...
BACKGROUND: This present systematic review and meta-analysis aims to compare overall survival (OS), disease-free survival (DFS), morbidity and mortality outcomes in patients undergoing colorectal first (CRf) versus liver first (Lf) resections with synchronous colorectal liver metastases. METHODOLOGY: A literature search was performed in PubMed, Cochrane Central trials register, and Google Scholar databases. This was conducted in line with current PRISMA guidelines. 95% confidence intervals were calculated for the primary endpoints and odds ratios for secondary endpoints. The Cochrane Q test and the measurement of inconsistency test were used to assess the degree of heterogeneity among the included studies. RESULTS: Fifteen studies were included with a total of 8611 patients from 2010 to 2025. A statistically significant survival benefit was seen in the overall 1-year survival of the CRf group compared to the Lf group, with no significant difference in 3- and 5-year follow-up. In addition, a statistically significant benefit in 1-, 3-, and 5- year DFS rates was seen in the CRf group when compared to the Lf group. No significant difference was seen in major morbidity and 90-day mortality, and failure to proceed to the second resection stage. CONCLUSION: DFS was significantly increased in the CRf group compared to the Lf group, with no difference in secondary outcomes. One-year OS was also found to be higher in the CRf group; however, this finding likely reflects the heterogeneity of the included studies and perioperative course after hepatic resections. To our knowledge, this is the first meta-analysis to demonstrate such a significant difference of one strategy over the other. However, caution should be used in the interpretation of these results due to the lack of available randomized control trials.
Classification of High- and Low-Risk Patients With Dermal Leiomyosarcoma: An Exploratory Nationwide Cohort Study.
Abebe K, Munch A, Wagenblast AL … +9 more , Schmidt G, Jensen DH, Petersen MM, Loya AC, Daugaard S, Mentzel T, Herly M, Vester-Glowinski P, Ørholt M
J Surg Oncol · 2026 Jun · PMID 42296396 · Publisher ↗
BACKGROUND: Risk factors for dermal leiomyosarcoma (dLMS) metastasis remain poorly defined because methodological constraints, small sample sizes, and short follow-up have limited previous studies. OBJECTIVES: To investi...
BACKGROUND: Risk factors for dermal leiomyosarcoma (dLMS) metastasis remain poorly defined because methodological constraints, small sample sizes, and short follow-up have limited previous studies. OBJECTIVES: To investigate risk factors for metastasis and local recurrence, and to propose a high- and low-risk classification for dLMS. METHODS: All patients diagnosed with dLMS in Denmark between 1980 and 2022 were included. Absolute 5‑year risks were estimated using the Aalen-Johansen method, treating all‑cause mortality as a competing risk. RESULTS: Among 381 patients (median age 66 years, 71% male), the 5-year risk of metastasis was 2.4% and 10% for local recurrence. The most important risk factors for metastasis were tumor necrosis, mitotic grade 3, and perineural/intravascular invasion, with 5-year absolute risks ranging between 9% and 25%. Positive surgical margins and perineural/intravascular invasion were associated with increased 5-year absolute risks of local recurrence, ranging between 26% and 50%. CONCLUSION: Although few distant metastases were observed, high-risk dLMS features may include tumor necrosis, mitotic grade 3, perineural/intravascular invasion, or positive surgical margins. Cases without these features may be classified as low-risk dLMS. We propose regular cross-sectional imaging in the follow-up of patients with high-risk dLMS, whereas follow-up for patients with low-risk dLMS could be limited to clinical examinations.
Distance to Care, Regional Context, and Survival in Early-Onset Colorectal Cancer.
Myers S, Davis ES, Ng SC … +3 more , Sachs T, Davids JS, Kenzik KM
J Surg Oncol · 2026 Jun · PMID 42296391 · Publisher ↗
BACKGROUND: Despite an overall decrease in colorectal cancer (CRC) mortality in recent decades, incidence and mortality of CRC among individuals younger than 50 (early onset CRC; EOCRC) has increased. Individual and popu...
BACKGROUND: Despite an overall decrease in colorectal cancer (CRC) mortality in recent decades, incidence and mortality of CRC among individuals younger than 50 (early onset CRC; EOCRC) has increased. Individual and population-level exposures contribute to EOCRC, but it is not clear how rurality and traveling for care impact survival. METHODS: Using the National Cancer Database (NCDB, 2010-2022), we (1) characterized and compared the EOCRC population to the average-onset (AOCRC) population, and (2) analyzed individual and population-level sociodemographic and clinical factors associated with 5-year survival. We used accelerated failure-time models; hazard ratios (HR) and 95% confidence intervals (CI) are reported. RESULTS: Among 404,440 individuals with CRC (15.7% EOCRC), more EOCRC patients were non-white (32.2% vs. 24.6%; p < 0.001), had rectal cancer (43% vs. 34%; p < 0.001), and presented at later stages compared to AOCRC patients. EOCRC patients traveled farther for care overall, and rural EOCRC patients with rectal cancer traveled farthest of any group (median 41.7 miles). In adjusted EOCRC survival models, compared to urban patients traveling for care, survival was worse for urban patients who did not travel (HR 1.09, 95% CI 1.05-1.12) and rural patients regardless of travel (rural, traveled: HR 1.12, 95% CI 1.07-1.18; rural, no travel: HR 1.16, 95% CI 1.09-1.22). CONCLUSIONS: EOCRC individuals living in urban areas experienced improved survival when traveling farther for care, though their rural counterparts did not necessarily gain the same survival benefit by traveling. Using exposures and health behaviors to guide screening beyond age-based guidelines could improve early detection and survival.
Morphology and Pathophysiology of 10 Different Types of Peritoneal Metastases.
Sugarbaker PH, Liang JJ
J Surg Oncol · 2026 Jun · PMID 42296382 · Publisher ↗
BACKGROUND: Predictions concerning the natural history of peritoneal surface malignancy may be available from the study of the sites of cancer progression on the peritoneal surface. As a first step to identify useful cli...
BACKGROUND: Predictions concerning the natural history of peritoneal surface malignancy may be available from the study of the sites of cancer progression on the peritoneal surface. As a first step to identify useful clinical and histopathological correlations the multiple morphologic types of peritoneal metastases must be identified and a meaningful nomenclature associated with each type. METHODS: The morphological types were selected from their appearance on peritoneal surfaces. Both open and laparoscopic observations and photographs were utilized. The pathophysiology that was responsible for the lesion's appearance was an important consideration in separating the numerous shapes and sizes into specific morphologic types. RESULTS: As an initial step peritoneal lesions were separated into raised types and flat types. Line drawings of each of the 10 morphologic types were constructed and a single illustrative photograph associated with each morphologic type. A description of the pathophysiology of each type was contained within the text. CONCLUSIONS: Ten morphologic types of peritoneal surface malignancies were selected, illustrated and provided with a definitive nomenclature. The pathophysiology of each type was presented. These morphologic types are considered the starting place for further study of morphology in the prediction of outcome of peritoneal metastases treatments.
The Role of Routine Staging Laparoscopy for Pancreatic Adenocarcinoma in Underserved Populations: A 14-Year Experience at a Safety-Net Hospital.
Holmes DM, Reyes JEM, Hsu C … +1 more , Silberfein EJ
J Surg Oncol · 2026 Jun · PMID 42252681 · Publisher ↗
BACKGROUND: There are no consensus guidelines for staging laparoscopy (SL) in pancreatic ductal adenocarcinoma (PDAC) and existing data largely reflect insured referral populations. Routine SL has not been studied in und...
BACKGROUND: There are no consensus guidelines for staging laparoscopy (SL) in pancreatic ductal adenocarcinoma (PDAC) and existing data largely reflect insured referral populations. Routine SL has not been studied in underserved patient populations who face disparities in cancer diagnosis and treatment. We evaluated the utility of SL for potentially operable PDAC at an urban safety-net hospital and assessed its association with survival. METHODS: A single-institution retrospective review was performed of all patients undergoing SL for potentially resectable PDAC (May 2011-May 2025). The primary outcome was detection of occult metastasis. Associated factors were assessed using multivariable logistic regression. Survival was analyzed using Kaplan-Meier methods and log-rank tests. RESULTS: Fifty-two patients underwent SL and 18 (35%) received curative-intent surgery. Median age was 58 years, 87% were non-White, 40% non-English-speaking, and 89% presented emergently. SL identified occult metastatic disease in 12 patients (23.1%), including five (41.7%) identified by cytology alone. No clinicopathologic factors were associated with occult metastasis. Median overall survival was 9.5 months with occult metastasis versus 35.7 months without (p < 0.001), and 102.5 months after curative-intent surgery versus 17.8 months without resection (p < 0.001). CONCLUSIONS: Routine SL frequently upstaged patients, often by cytology alone, thereby avoiding non-therapeutic laparotomy and supporting consideration of its more routine use in underserved PDAC populations.
Parotidectomy: 10-Year Experience in the Hands of Surgical Oncologists.
Su AY, Koness J, Calvino AS … +2 more , Somasundar P, Kwon S
J Surg Oncol · 2026 Jun · PMID 42236664 · Publisher ↗
BACKGROUND AND OBJECTIVES: Parotidectomy is the most common salivary gland surgery, but there remains a paucity of literature regarding its outcomes in the hands of surgical oncologists. METHODS: A retrospective review w...
BACKGROUND AND OBJECTIVES: Parotidectomy is the most common salivary gland surgery, but there remains a paucity of literature regarding its outcomes in the hands of surgical oncologists. METHODS: A retrospective review was conducted of all patients (n = 74) who underwent parotidectomy by surgical oncologists at a single institution over 10 years (2015-2025). Demographics, perioperative characteristics, and complications were compared. Associations between clinical factors and complications were evaluated by multivariate logistic regression. RESULTS: Most patients were White (85.1%) and male (51.4%) with a mean age of 59.9 years. The most common comorbidities were hypertension (48.6%), current smoking (40.5%), and anxiety (17.6%). Temporary facial nerve paresis occurred in 40.3% of patients by postoperative day one, with no cases of permanent facial nerve paresis. Frey's syndrome occurred in 9.0% and First Bite Syndrome (FBS) in 10.4% of tumor cases; a higher proportion of malignant cases experienced these complications in comparison to benign indications. Positive lymph node status was associated with FBS (p = 0.015), potentially reflecting more extensive surgical dissection. No significant risk factors were identified for other complications. CONCLUSIONS: This study suggests that surgical oncologists with appropriate training can perform parotidectomies with complication rates within published ranges. Larger multicenter studies are needed to validate these findings and examine associations between clinical factors and rare complications, further establishing the role of surgical oncologists in parotidectomy.
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