Journal Of Surgical Oncology[JOURNAL]
Sun
200 papers
Dynamic Prognostic Nutritional Index With Circulating Tumor DNA Predicts Survival in Localized Pancreatic Ductal Adenocarcinoma.
Horowitz A, Shen C, Vitello DJ … +7 more , Cox M, Wells A, Sridalla K, Bentrem DJ, Zhang Q, Roy I, Chawla A
J Surg Oncol · 2026 Jun · PMID 42226668 · Publisher ↗
BACKGROUND AND OBJECTIVES: To evaluate the prognostic significance of baseline and longitudinal changes in prognostic nutritional index (PNI) in localized pancreatic ductal adenocarcinoma (PDAC) and to assess the complem...
BACKGROUND AND OBJECTIVES: To evaluate the prognostic significance of baseline and longitudinal changes in prognostic nutritional index (PNI) in localized pancreatic ductal adenocarcinoma (PDAC) and to assess the complementary prognostic value of PNI with tumor burden measured by circulating tumor DNA (ctDNA). METHODS: We analyzed 127 patients with localized PDAC enrolled in a prospective biomarker study (2020-2024). Laboratory values were collected at five standardized timepoints. PNI was calculated as (10 × albumin) + (0.005 × lymphocyte count). KRAS ctDNA was assessed using digital droplet PCR. The primary endpoint was overall survival (OS), analyzed using Kaplan-Meier and Cox regression, with longitudinal changes assessed using Friedman testing. RESULTS: Low PNI (< 45) at diagnosis was associated with worse OS (p = 0.043). PNI declined significantly across treatment timepoints (p < 0.001). In multivariable analysis, decline in PNI during neoadjuvant chemotherapy independently predicted worse OS (HR 1.095, 95% CI 1.042-1.152, p < 0.001). Patients with both low PNI and ctDNA positivity had a 3.64-fold increased risk of death (HR 3.64, 95% CI 1.32-10.04, p = 0.012). CONCLUSIONS: PNI is a dynamic, clinically accessible biomarker that independently predicts survival in localized PDAC. Integration of PNI with ctDNA improves prognostic stratification by capturing both patient host vulnerability and tumor burden.
Recurrence of Giant Cell Tumor of Bone and Related Risk Factors: A Retrospective Analysis of 340 Cases From a Single Center.
Yao J, Xie Y, Gao L … +4 more , Liu G, Xu L, Zhang Y, Wang S
J Surg Oncol · 2026 Jun · PMID 42226602 · Publisher ↗
BACKGROUND: Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor, with recurrence being its major clinical complication. Surgery remains the primary treatment modality, and numerous factors may influence th...
BACKGROUND: Giant cell tumor of bone (GCTB) is a locally aggressive bone tumor, with recurrence being its major clinical complication. Surgery remains the primary treatment modality, and numerous factors may influence the risk of recurrence. This study aimed to retrospectively analyze the incidence of local recurrence of GCTB and the related risk factors in a single-center cohort. PATIENTS AND METHODS: A total of 340 patients with benign GCTB treated at our center between 2002 and March 2023 were retrospectively reviewed, including 172 males and 168 females. The mean age was 34.04 ± 12.83 years (range, 13-78 years). In 48.2% of patients, tumors were located in the distal femur or proximal tibia. Surgical procedures consisted of extended curettage and wide resection. All the patients were followed up with a minimum duration of 24 months. RESULTS: The overall recurrence rate was 20.00%, with a mean recurrence interval of 21.90 ± 14.57 months (range, 3-67 months). Multivariable Cox regression analysis demonstrated that surgical type and sex were independent risk factors for recurrence-free survival. The recurrence rate following extended curettage was 22.55%, significantly higher than that following wide resection (9.23%) (HR, 4.75; 95% CI, 2.02 to 11.19; p < 0.001). Male patients had a recurrence rate of 15.12%, significantly lower than that of female patients (25.00%) (HR, 0.53; 95% CI, 0.32 to 0.87; p = 0.01). In the extended curettage group, female sex and Campanacci grade Ⅲ were identified as recurrence risk factors. CONCLUSIONS: Tumor recurrence may develop in approximately one-fifth of the patients who underwent surgical treatment of GCTB. Extended curettage was independent risk factors for the local recurrence. Specifically, for the extended curettage group, patients with Campanacci grade III are recommended with closer follow-up.
Real‑World Experience of Circulating Tumor DNA Testing in Extended Pelvic Exenteration: A Chinese Single‑Institution Observational Study.
Lu Y, Chen J, Chen G … +2 more , Peng H, Zhang J
J Surg Oncol · 2026 Jun · PMID 42226565 · Publisher ↗
BACKGROUND: Extended pelvic exenteration (EPE) is a key therapeutic strategy for locally advanced or recurrent rectal cancer. However, conventional postoperative assessments-including histopathology, serum tumor markers,...
BACKGROUND: Extended pelvic exenteration (EPE) is a key therapeutic strategy for locally advanced or recurrent rectal cancer. However, conventional postoperative assessments-including histopathology, serum tumor markers, and standard imaging-are limited by low sensitivity and a considerable temporal lag in detecting residual disease. Detection of molecular residual disease (MRD) via circulating tumor DNA (ctDNA) may provide a reliable biomarker to enable more precise postoperative management following EPE. This study evaluates the utility of ctDNA-based MRD assessment in determining molecular R0 resection status and in monitoring disease recurrence after pelvic exenteration for rectal cancer. METHODS: Between May 2022 and October 2023, a real-world study was conducted involving 100 patients with locally advanced or recurrent rectal cancer without evidence of distant metastasis who underwent radical resection at Shanghai Changzheng Hospital. Peripheral blood samples were collected preoperatively, postoperatively, following adjuvant therapy, and at 3-month intervals thereafter. MRD status was assessed using a personalized, tumor-informed panel based on whole-exome sequencing of the primary tumor. RESULTS: The cohort comprised 52 male patients (52%), with a mean (standard deviation) age of 50.8 (13.24) years. While all patients achieved pathologically negative margins, the postoperative MRD positivity rate (MRD1) remained at 35%, increasing to 41% following adjuvant therapy (MRD2). Over a median follow-up of 745 days (95% confidence interval, 697-793 days), the 1-year and 2-year disease-free survival (DFS) rates were 85.0% and 71.9%, respectively. Positivity at the MRD1 and MRD2 timepoints conferred an 8-fold and a 60-fold increased risk of recurrence, respectively, compared with MRD-negative status. Notably, MRD positivity detected tumor recurrence or metastasis significantly earlier than radiological confirmation, with a median lead time of 361 days (interquartile range, 158.5-468 days). CONCLUSIONS: ctDNA-based MRD detection demonstrates substantial clinical utility for recurrence surveillance and prognostic stratification. Postoperative MRD status provides a more accurate reflection of molecular R0 resection than conventional pathological margin assessment. Furthermore, MRD status upon completion of initial adjuvant therapy serves as an early indicator of therapeutic efficacy and a robust predictor of long-term prognosis.
Management of Satellite Lesions in Hepatocellular Carcinoma: An Updated Review.
Tran A, Suraju MO, Tasie I … +2 more , Abdalla AK, Aziz H
J Surg Oncol · 2026 Jun · PMID 42226564 · Publisher ↗
Satellite lesions, defined as microscopic or small macroscopic tumor nodules within 2 cm of a primary hepatocellular carcinoma (HCC), represent early intrahepatic dissemination and are strongly associated with aggressive...
Satellite lesions, defined as microscopic or small macroscopic tumor nodules within 2 cm of a primary hepatocellular carcinoma (HCC), represent early intrahepatic dissemination and are strongly associated with aggressive tumor biology. This review synthesizes the current evidence regarding the biological basis, diagnostic challenges, prognostic relevance, and therapeutic approaches for managing satellite lesions in HCC. In published studies, satellite lesions were consistently linked to aggressive tumor behavior, including higher rates of microvascular invasion, multifocality, and early postoperative recurrence. Patients with satellite lesions experienced significantly reduced disease-free and overall survival compared to those with solitary tumors, although outcomes varied with tumor size, number, and liver function. In transplant-eligible cohorts, satellite lesions were associated with exceeding standard listing criteria and demonstrated increased post-transplant recurrence when identified on explant pathology. Radiologic detection showed moderate sensitivity but high specificity, influencing selection for resection, ablation, and transplant-based strategies. Satellite lesions are a critical marker of tumor aggressiveness in HCC and significantly influence surgical and transplant decision-making. Although resection may be appropriate for carefully selected patients with preserved liver function, recurrence rates remain high. The presence or suspicion of satellite lesions strongly impacts transplant candidacy, with most guidelines considering radiological satellites an indicator of advanced disease.
Enhanced Molecular Staging of Pancreatic Cancer Using Methylated DNA Markers in Peritoneal Lavage Fluid.
Mills K, Berger CK, Taylor WR … +18 more , Mahoney DW, Burger KN, Maheshwari K, Kipp BR, Delgado AM, Doering KA, Streich HM, Foote PH, Cleary SP, Grotz TE, Kendrick ML, Smoot RL, Starlinger PP, Thiels CA, Truty MJ, Warner SG, Kisiel JB, Majumder S
J Surg Oncol · 2026 Jun · PMID 42226556 · Publisher ↗
BACKGROUND AND OBJECTIVES: Occult intra-abdominal metastases are identified in approximately 20% of patients with radiographically localized pancreatic ductal adenocarcinoma (PDAC) through staging laparoscopy, as periton...
BACKGROUND AND OBJECTIVES: Occult intra-abdominal metastases are identified in approximately 20% of patients with radiographically localized pancreatic ductal adenocarcinoma (PDAC) through staging laparoscopy, as peritoneal cytology is limited in sensitivity. Methylated DNA markers (MDMs) have demonstrated high diagnostic accuracy for PDAC in tumor tissue, blood, and pancreatic secretions. This study assesses the feasibility and diagnostic performance of MDMs in peritoneal lavage fluid collected during staging laparoscopy, comparing their performance to mutant KRAS (mKRAS) detection. METHODS: DNA from peritoneal lavage fluid of PDAC patients was analyzed for mKRAS mutations (codons 12, 13, and 61) using droplet-digital PCR and for 13 MDMs and a reference gene (B3GALT6) using quantitative methylation-specific PCR. An MDM score was generated from the average signal of the 13 MDMs and evaluated for its ability to detect intra-abdominal metastases via receiver operator characteristic (ROC) analysis. RESULTS: Among 48 patients, 15 (31%) had intra-abdominal metastases. The MDM score showed 87% sensitivity and 90% specificity (AUC = 0.98), outperforming mKRAS, which showed 40% sensitivity and 85% specificity (AUC = 0.62; p < 0.0001). CONCLUSIONS: MDMs in peritoneal lavage fluid may enable highly accurate molecular staging of PDAC and warrant validation in larger studies.
Level of Vascular Ligation for Sigmoid Colon Cancer: Does It Matter? The Pina Low-T Study.
Picotto S, Seno E, Calabrò M … +5 more , Di Marzo M, Lo Moro G, Santarelli M, Delrio P, Muratore A
J Surg Oncol · 2026 May · PMID 42186358 · Publisher ↗
BACKGROUND AND METHODS: In sigmoid colon cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin (high ligation, HLG) or distal to the left colic artery bifurcation (low ligation, LLG). While hi...
BACKGROUND AND METHODS: In sigmoid colon cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin (high ligation, HLG) or distal to the left colic artery bifurcation (low ligation, LLG). While high ligation facilitates lymph node harvest and mobilization, it may compromise colonic perfusion and increase nerve injury risk. Low ligation preserves the LCA and may improve anastomotic blood supply. We conducted a retrospective multicenter study including patients who underwent sigmoidectomy for sigmoid colon cancer between January 2017 and December 2022. Short- and long-term outcomes were compared between HLG and LLG. RESULTS: A total of 185 patients were included (127 HLG, 58 LLG). Median postoperative length of stay was similar (6 vs. 5 days; p = 0.879). Anastomotic leak rates were 5.5% in HLG and 1.7% in LLG (p = 0.438). Patients undergoing LLG had a higher comorbidity burden, and more than half of the cohort was aged ≥ 70 years. Lymph node yield was higher in HLG (20 vs. 15; p < 0.001). Three-year disease-free survival (85.5% vs. 87.3%; p = 0.751) and overall survival (89.7% vs. 80.7%; p = 0.098) were comparable, with no differences in recurrence patterns. CONCLUSIONS: IMA ligation level does not significantly influence outcomes. However, in elderly or fragile patients, low ligation achieves very low leak rates without compromising oncological safety.
Venous Thromboembolism Risk and Prevention After Gastrointestinal Cancer Surgery: Real World Evidence From a Large Integrated Healthcare System.
Qi T, Liu IA, Wu YL … +3 more , Park SJ, Dehal AN, Gould MK
J Surg Oncol · 2026 May · PMID 42177803 · Publisher ↗
BACKGROUND AND METHODS: Venous thromboembolism (VTE) is common and preventable following surgery for gastrointestinal (GI) cancer. In this retrospective cohort study, we aimed to characterize VTE risk factors, prophylaxi...
BACKGROUND AND METHODS: Venous thromboembolism (VTE) is common and preventable following surgery for gastrointestinal (GI) cancer. In this retrospective cohort study, we aimed to characterize VTE risk factors, prophylaxis, and outcomes among patients who underwent surgery for GI cancer between 2019 and 2021 at Kaiser Permanente Southern California. The discrimination of the Caprini and IMPROVE risk models for predicting VTE was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Among 2702 patients, the 90-day incidence of perioperative VTE was 2.1%. VTE was associated with older age, prior VTE, thrombophilia, low serum albumin, and blood transfusion, but not procedure time or surgical approach. VTE was especially common among patients with gastric cancer (4.5%). In-hospital prophylaxis was nearly universal, but post-discharge prophylaxis was uncommonly utilized (22.9%). VTE was associated with a five-fold increase in 90-day mortality. Both Caprini (AUC 0.65, 95% CI 0.57-0.72) and IMPROVE (AUC 0.65, 95% CI 0.57-0.73) models demonstrated only fair discrimination. CONCLUSIONS: Despite adherence with recommended in-hospital prophylaxis, VTE remains an important complication following GI cancer surgery, carrying with it an increased risk of mortality. DISCUSSION: Suboptimal discrimination of risk prediction models and underutilization of post-discharge prophylaxis represent ongoing opportunities for quality improvement.
The Impact of Breast Reconstruction on Smoking Cessation Among Patients With Breast Cancer.
Hendizadeh AN, Wen A, Guidi R … +8 more , Ritz E, Rao R, Alvarado R, Perez C, Madrigrano A, Kurlander D, Shenaq D, Kokosis G
J Surg Oncol · 2026 May · PMID 42177800 · Publisher ↗
BACKGROUND AND OBJECTIVES: In this study, we aim to evaluate trends in smoking cessation among breast cancer patients, with a particular focus on the impact of breast reconstruction surgery, and to assess if breast recon...
BACKGROUND AND OBJECTIVES: In this study, we aim to evaluate trends in smoking cessation among breast cancer patients, with a particular focus on the impact of breast reconstruction surgery, and to assess if breast reconstruction surgery represents a unique opportunity for intervention. METHODS: We performed a retrospective analysis of active smokers with a new diagnosis of breast cancer who were treated with any surgical or non-surgical intervention at our institution between 2015 and 2024. Quitting was defined as continuous cessation for at least 30 days. Patients who quit were followed for at least 6 months after cessation. RESULTS: One hundred twenty-seven patients were identified. Mean age was 56 years (range 35-87). Eighty patients (63%) underwent surgery without reconstruction, 26 patients (20%) underwent surgery with reconstruction, and 21 patients (17%) received non-surgical treatment only. Overall, 26% (34/127) of patients quit smoking. Among patients undergoing surgical treatment, patients undergoing reconstruction were significantly more likely to quit smoking than those without reconstruction (50% [13/26] vs. 23% [18/80]; p = 0.007). Patients receiving reconstruction were also significantly more likely to quit preoperatively (77% [10/13] vs. 33% [12/18]; p = 0.048). Median time from initial visit with surgical oncology to surgery was longer among reconstructive patients who quit pre-operatively (90.5 days [IQR: 44-164]) than those who quit post-operatively or did not quit (45 days [IQR: 26-68]; p = 0.13). CONCLUSIONS: Patients receiving breast reconstruction are significantly more likely to quit smoking than those who do not. Longer median time to surgery among patients who quit pre-operatively emphasizes the need for targeted cessation interventions that allow for timely oncologic care.
Social and Surgical Drivers of Survival in Colorectal Liver Metastases: An NCBD Analysis.
Cummings C, Kim L, Taylor C … +6 more , Chandler J, Perez K, Dominguez V, Wiafe S, Saunders A, Eguia E
J Surg Oncol · 2026 May · PMID 42153467 · Publisher ↗
BACKGROUND AND OBJECTIVES: Among patients with colorectal cancer, the liver is the most common site of metastases and is frequently the only site of disease. Curative intent resection offers the best chance for survival;...
BACKGROUND AND OBJECTIVES: Among patients with colorectal cancer, the liver is the most common site of metastases and is frequently the only site of disease. Curative intent resection offers the best chance for survival; however, access to surgery and outcomes may be influenced by social drivers of health. METHODS: Using the 2022 National Cancer Database, we identified adults with colorectal liver metastases (CRLM) without extrahepatic spread. Patients were categorized into four surgical groups: combined primary and liver resection, liver-only resection, primary-only resection, and no surgery. Demographic, socioeconomic, and clinical factors were compared, and multivariable logistic and Cox models were used to assess predictors of surgery and overall survival and mortality risk. RESULTS: Of 40,670 patients, 49.8% received no surgery, 32.8% underwent primary-only resection, 1.6% underwent liver-only resection, and 15.8% underwent combined primary and liver resection. Combined resections were most common among younger, privately insured patients treated at academic centers in higher-income and higher-education regions (p < 0.001). Median OS differed significantly by treatment: combined resection, 59.5 months; liver-only, 41.5 months; primary-only, 28.2 months; and no surgery, 13.8 months. Adjusted mortality was higher for primary-only (HR 1.66), liver-only (HR 1.71), and no surgery (HR 3.21) compared with combined resection. CONCLUSIONS: Combined primary and liver resection was associated with the longest survival and lowest mortality among patients with CRLM. Significant disparities in surgical treatment and survival were observed across key social drivers of health, underscoring the need to address inequities in access to comprehensive, curative-intent care.
Patient Out-of-Pocket Costs and Healthcare Utilization Related to Mastectomy vs Breast Conservation: A Claims-Based Study.
Proussaloglou EM, Ren Y, Fayanju OM … +6 more , Blitzblau RC, Berger ER, Valero M, Shelley Hwang E, Wheeler SB, Greenup RA
J Surg Oncol · 2026 May · PMID 42144808 · Publisher ↗
BACKGROUND AND OBJECTIVES: Out-of-pocket (OOP) costs and healthcare utilization remain unknown for women facing breast conservation and mastectomy. METHODS: Women aged 18-64 who underwent upfront breast cancer surgery we...
BACKGROUND AND OBJECTIVES: Out-of-pocket (OOP) costs and healthcare utilization remain unknown for women facing breast conservation and mastectomy. METHODS: Women aged 18-64 who underwent upfront breast cancer surgery were identified from the IBM MarketScan Commercial Claims Database (2014-2017). Surgical groups included lumpectomy+radiation; unilateral mastectomy + /-reconstruction, and bilateral mastectomy + /-reconstruction. Cumulative OOP payments were assessed at 12-month intervals over 4 years postoperatively and adjusted to 2017 USD$. Multivariable regression identified factors associated with increased OOP costs. RESULTS: Overall, 23,159 underwent lumpectomy with radiation (60%), unilateral mastectomy with (15%) and without (6%) reconstruction, and bilateral mastectomy with (17%) and without (2.6%) reconstruction. Women undergoing bilateral mastectomy+reconstruction were younger than other surgical groups (median age 49 vs. 50-55). In the first year after diagnosis, 1.24 million outpatient visits occurred, 27% of enrollees had inpatient admissions, 23% visited an E.R., and median OOP costs were $5669 (range $0 to $132 125). Cumulative costs were significantly higher in women < 45 yo and for those with greater comorbidities. Median OOP costs declined over time (0-12 months: $3661 vs 48 months: $486). OOP costs were 12% higher (8.9%-15.1%) with mastectomy+reconstruction than lumpectomy+radiation ($6529 vs $5333). CONCLUSIONS: Out-of-pocket costs and healthcare utilization differ between equally effective surgical treatment options; mastectomy + reconstruction is costlier for patients than breast conservation.
Early Portomesenteric Thrombosis Following Pancreaticoduodenectomy: Risk Factors, Management and Outcomes.
Martinet-Kosinski F, Abdallah M, Pereira B … +8 more , Puia-Negulescu S, Bacoeur-Ouzillou O, Buc E, Antomarchi O, Aboukassem A, Perret-Boire S, Pezet D, Gagnière J
J Surg Oncol · 2026 May · PMID 42144800 · Publisher ↗
INTRODUCTION: Early portomesenteric thrombosis (ePMT) can occur following pancreaticoduodenectomy (PD) and is associated with significant postoperative morbidity and mortality. The aim of this study was to identify risk...
INTRODUCTION: Early portomesenteric thrombosis (ePMT) can occur following pancreaticoduodenectomy (PD) and is associated with significant postoperative morbidity and mortality. The aim of this study was to identify risk factors associated with early ePMT following PD. METHODS: We retrospectively analyzed data from a prospective database including all consecutive patients who underwent PD for benign or malignant tumors at our tertiary center between January 2007 and December 2019. Univariable and multivariable analysis were conducted, between the independent groups using penalized maximum likelihood logistic regression. RESULTS: 374 patients were included. Nine patients developed early ePMT. Postoperative ePMT occurred at a median of 3.5 days [0-40] after surgery. Ninety-day postoperative mortality was significantly higher in the ePMT+ group (OR = 7.1; p < 0.01). Intraoperative blood loss and body mass index (BMI) were independently associated with ePMT following PD (OR = 6.61; IC95 = [1.68;26] and OR = 4.44; IC95 = [1.09;17], respectively). Venous resection during PD and occurrence of POPF were both associated with an increased risk of ePMT, but theses associations were not statistically significant. CONCLUSION: ePMT following PD is rare but represents a severe postoperative complication associated with high mortality rate. It occurs more often in patients with increased intraoperative blood loss and higher BMI, reflecting greater intraoperative technical difficulty during surgery.
Outcomes After Intratumoral Delivery of Immunotherapy in Breast Cancer.
Baumrucker CC, Harris N, Aiello P … +7 more , Whiting J, Sun W, Soliman H, Han H, Costa R, Czerniecki BJ, Lee MC
J Surg Oncol · 2026 May · PMID 42130226 · Publisher ↗
BACKGROUND: Immunotherapy is a growing treatment option for challenging breast cancer (BC) subtypes. Systemic administration can have significant adverse events (AEs), prompting interest in intratumoral injection. We eva...
BACKGROUND: Immunotherapy is a growing treatment option for challenging breast cancer (BC) subtypes. Systemic administration can have significant adverse events (AEs), prompting interest in intratumoral injection. We evaluated the safety and feasibility of intratumoral injections at our institution. METHODS: This is an IRB-approved retrospective review of neoadjuvant patients who received intratumoral talimogene laherparepvec (TVEC) (NCT02779855) for triple negative breast cancer (TNBC), dendritic cells (DC1) for HER2+ (NCT05325632), HER2 + /ER- (NCT03387553), or TNBC (NCT05504707), or Voyager V1 virus (VV1) (NCT01042379) for high-risk lesions on ISPY2. This study outlines the safety and feasibility of intratumoral injections assessed by AEs, adherence to therapy, and ultrasound guidance. RESULTS: The study included 111 female patients (mean age 51; range 26-80). Forty-seven (42.3%) received TVEC, 62 (55.9%) received DC1, and 2 (1.8%) received VV1. Three patients missed one injection; 110 patients had ultrasound-guided injections. Mean neoadjuvant therapy length was 172 days (range 127-244). Local AEs included pain (20.7%), injection site reaction (27.9%), and hematoma (5.4%). Systemic AEs were reported more frequently, most commonly chills (52.3%), headache (39.6%), and fever (36.8%). DISCUSSION: Intratumoral IT injection is a viable treatment option that may minimize systemic exposure while maintaining therapeutic efficacy. Breast surgeons can play a role in intratumoral IT in BC.
Comparative Severe Complications After Laparoscopic Pancreatoduodenectomy in PDAC vs Non-PDAC Periampullary Cancer: A Retrospective Cohort Study.
Sun Y, Wang R, Wu D … +5 more , Tian Y, Kuang T, Zhou J, Peng B, Wu Z
J Surg Oncol · 2026 May · PMID 42108934 · Publisher ↗
INTRODUCTION: Laparoscopic pancreatoduodenectomy (LPD) offers the potentially clinical benefit for patients presenting with periampullary tumors. The aim of this study is to evaluate postoperative clinical outcomes among...
INTRODUCTION: Laparoscopic pancreatoduodenectomy (LPD) offers the potentially clinical benefit for patients presenting with periampullary tumors. The aim of this study is to evaluate postoperative clinical outcomes among patients undergoing LPD for periampullary cancer. STUDY DESIGN: We retrospectively reviewed and analyzed 574 consecutive patients received LPD for periampullary cancer at our institution between April 2011 and August 2024. Data collected included preoperative, perioperative, and postoperative information. RESULTS: Among 574 patients undergoing LPD for periampullary cancer, 311 (54.2%) pathologically diagnosed with pancreatic ductal adenocarcinoma (PDAC) and 263 (45.8%) had non-PDAC periampullary cancer. Compared with PDAC, non-PDAC patients experienced significantly higher rates of major morbidity (16.7% vs 10.9%, p = 0.043), including postoperative pancreatic fistula (p = 0.001), abdominal infection (p = 0.032), and reoperation (p = 0.021). Multivariate analysis identified age ≥ 65 years (OR 1.803, 95%CI: 1.092 ~ 2.978), prolonged operative time (OR 1.004, 95%CI: 1.001 ~ 1.006), and non-PDAC pathology (OR 1.664, 95%CI: 1.014 ~ 2.731) as independent risk factors for severe complications, while pylorus preservation was protective (OR 0.460, 95%CI: 0.264 ~ 0.803). CONCLUSION: Postoperative morbidity after LPD varies by periampullary cancer subtype, with non-PDAC patients at greater risk of severe complications. Older age, prolonged operative time, and non-PDAC pathology were independent predictors of severe complications, whereas pylorus preservation conferred a protective effect.
Pathologic Response and Outcomes After Neoadjuvant Chemotherapy in Gastric Cancer: A NCDB Analysis.
Hwang J, Sun J, Hunt A … +7 more , Papai E, Zhang L, Hasler JS, Porpiglia AS, Villano AM, Farma JM, Greco SH
J Surg Oncol · 2026 May · PMID 42108933 · Publisher ↗
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant therapy has been associated with improved survival in several malignancies, but its prognostic value in gastric cancer remains unclear. METHODS: Using the...
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant therapy has been associated with improved survival in several malignancies, but its prognostic value in gastric cancer remains unclear. METHODS: Using the National Cancer Database, we identified non-metastatic gastric adenocarcinoma patients diagnosed 2004-2021 treated with neoadjuvant chemotherapy followed by curative-intent resection. Patients receiving neoadjuvant radiation were excluded. We analyzed pCR rates, overall survival (OS), and factors associated with pCR using a generalized estimating equations model. Kaplan-Meier and Cox proportional hazards models were used to assess OS. Trends in pCR over time were evaluated with time-trend analysis. RESULTS: Among 7258 patients, 672 (9.3%) achieved pCR. Median OS was significantly higher in patients with pCR compared to those without (167.9 vs. 65.8 months, p < 0.001). Subgroup analysis of cT2N1 or higher stage patients revealed the highest survival in patients with both tumor and nodal pCR (median OS 181.8 months). Patients diagnosed after 2018 were more likely to achieve pCR (OR: 1.26, 95% CI: 1.07-1.49, p = 0.005), correlating with the adoption of the FLOT regimen. Completion of adjuvant therapy in patients who achieved pCR did not significantly improve OS. CONCLUSION: pCR is associated with significantly improved OS in gastric cancer, especially when both tumoral and nodal pCR are achieved. Increasing pCR rates in recent years may reflect the uptake of modern chemotherapy regimens, underscoring the value of neoadjuvant strategies.
Cost-Utility Analysis of Indocyanine Green Versus Methylene Blue for Sentinel Lymph Node Biopsy in Breast Cancer.
Lee SH, Kohler A, Tingen J … +5 more , King CA, Persing SM, Homsy C, Nardello S, Chatterjee A
J Surg Oncol · 2026 May · PMID 42108861 · Publisher ↗
BACKGROUND: Sentinel lymph node biopsy (SLNB) is commonly used for axillary staging in breast cancer surgery. Traditional localization methods include technetium-99m, lymphazurin, methylene blue (MB), or a combination of...
BACKGROUND: Sentinel lymph node biopsy (SLNB) is commonly used for axillary staging in breast cancer surgery. Traditional localization methods include technetium-99m, lymphazurin, methylene blue (MB), or a combination of these. Indocyanine green (ICG) is a safe and effective alternative with fewer complications. We compared the cost-effectiveness of ICG and MB for SLNB in breast cancer. METHODS: A systematic PubMed review identified the success and complication rates for MB and ICG. Costs of successful breast cancer surgeries with SLNB and related complications were estimated using Centers for Medicare & Medicaid Services (CMS) rates via Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) codes. Published utility scores were used to calculate quality-adjusted life years (QALYs). A decision tree model was developed to determine the incremental cost-effectiveness ratio (ICER). One-way (deterministic) and Monte Carlo (probabilistic) sensitivity analyses were performed to assess uncertainty. The willingness-to-pay (WTP) threshold was set to $50,000/QALY. RESULTS: SLNB using ICG cost $287 more than MB but gained 0.07 QALY, resulting in an ICER of $4,044.44, well below the WTP threshold. Sensitivity analysis showed SLNB with ICG became cost-ineffective if the probability of complication exceeded 4.9% or if ICG costs exceeded $4,190 per vial. SLNB with MB became cost-effective if the likelihood of complications dropped below 2.6%. Monte Carlo analysis indicated an 80% probability that SLNB with ICG is the more cost-effective option. CONCLUSIONS: Given lower complication rates despite higher upfront cost, ICG proved more cost-effective than MB in SLNB for breast cancer due to its improved quality-adjusted outcomes.
Comparing Tibial Osteotomy and Patellar Osteotomy to Pedicle Freezing in Proximal Tibial Malignant Bone Tumors: A Case Series Study.
Chen JJ, Tie TL, Huang CW … +6 more , Chen KL, Wang PH, Chen CM, Chen CF, Chen WM, Wu PK
J Surg Oncol · 2026 May · PMID 42108830 · Publisher ↗
BACKGROUND AND OBJECTIVES: Pedicle freezing with liquid nitrogen is a biological reconstruction method used for aggressive proximal tibial tumors. This study compared outcomes between tibial and patellar osteotomy approa...
BACKGROUND AND OBJECTIVES: Pedicle freezing with liquid nitrogen is a biological reconstruction method used for aggressive proximal tibial tumors. This study compared outcomes between tibial and patellar osteotomy approaches. METHODS: This retrospective study included 14 patients with malignant bone tumors who underwent pedicle freezing between January 2021 and March 2024. Ten patients underwent tibial osteotomy; four underwent patellar osteotomy. Surgical differences, postoperative complications, bone union, functional recovery, and oncological outcomes were analyzed. RESULTS: Tibial osteotomy required more plating, causing a greater increase in tibial diameter. Flap reconstruction was needed in six (60%) and two (50%) patients in the tibial osteotomy group and patellar osteotomy group, respectively. The bone nonunion rates were similar; median union times were 10.5 and 8.5 months. Wound complications occurred exclusively in the tibial osteotomy group (four patients), all regarding difficulties in wound closure and flap reconstruction. Tibial osteotomy resulted in more implant-related complications, whereas knee range of motion and Musculoskeletal Tumor Society scores were comparable. Tumor recurrence occurred in three cases (two tibial, one patellar), with two patients having preexisting metastases. CONCLUSIONS: Both techniques were feasible with comparable union and functional outcomes. Tibial osteotomy often requires additional plating and has more wound complications. Given the preliminary nature and limited sample size of this study, further research is required.
The Impact of Time and Place on BREAST-Q REACT: A Multi-Institutional Examination.
Kim M, Bubberman JM, Wang J … +6 more , Boe LA, Van der Hulst RRWJ, Tuinder SMH, Stern CS, Matros E, Nelson JA
J Surg Oncol · 2026 May · PMID 42108794 · Publisher ↗
BACKGROUND: Reference values provide clinically meaningful context for interpreting patient-reported outcome measures. However, these values may evolve over time with changes in reconstructive practice and may differ acr...
BACKGROUND: Reference values provide clinically meaningful context for interpreting patient-reported outcome measures. However, these values may evolve over time with changes in reconstructive practice and may differ across cultural settings. This study compares BREAST-Q scores across time periods and countries. METHOD: Patients who underwent postmastectomy breast reconstruction and completed the BREAST-Q at Memorial Sloan Kettering Cancer Center (MSKCC) and Maastricht University Medical Center (MUMC +) between 2007 and 2022 were included. BREAST-Q scores from an original MSKCC cohort (2007-2017) were compared with a recent MSKCC cohort (2018-2022) to evaluate temporal differences, and with a Dutch cohort (2013-2022) to assess geographic variation. RESULTS: A total of 7,199 MSKCC patients (3,243 original; 3,956 recent), and 444 MUMC+ patients were included. Compared with the original MSKCC cohort, the recent cohort demonstrated improved Physical Well-being of the Chest among implant-based reconstruction patients at preoperative (81 [74, 91] vs. 85 [74, 100]) and at 2-years postoperative (76 [66, 85] vs. 80 [64, 92]). Other BREAST-Q domains, on the other hand, declined in both implant-based and autologous reconstruction groups. Compared with MSKCC patients, the Dutch cohort reported lower Physical Well-being of the Chest, but higher Sexual Well-being. For example, at 2-years postoperative, MUMC+ patients scored 10 points higher on Sexual Well-being than MSKCC patients (60 [47, 72] vs. 50 [36, 66], p < 0.001). CONCLUSION: BREAST-Q reference values vary over time and across cultural contexts. Contemporary population-specific reference values may improve interpretation of patient-reported outcomes.
Assessment of Outcome in 198 Patients With Mucinous Appendiceal Adenocarcinoma and Peritoneal Metastases Over 25 Years.
Sugarbaker PH, Chang D
J Surg Oncol · 2026 May · PMID 42098056 · Publisher ↗
A prognostic assessment of mucinous appendiceal adenocarcinoma (MACA) patients with peritoneal metastases in the absence of lymph node metastases needs to be precisely defined. All patients were treated by a complete cyt...
A prognostic assessment of mucinous appendiceal adenocarcinoma (MACA) patients with peritoneal metastases in the absence of lymph node metastases needs to be precisely defined. All patients were treated by a complete cytoreductive surgery (CRS) and perioperative chemotherapy. Preoperative clinical features including tumor markers were recorded within 1 week prior to CRS. Data regarding perioperative intraperitoneal chemotherapy, histologic features and reoperative surgery were gathered after CRS. Impact on overall survival of these factors was analyzed by univariant and multivariant analysis. One hundred and ninety-eight patients with mucinous appendiceal adenocarcinoma causing pseudomyxoma peritonei were available for study. They had a median survival of 11 years. Hyperthermic intraperitoneal chemotherapy (HIPEC) with a median survival of 12.0 years was superior to early postoperative intraperitoneal chemotherapy (EPIC) with a median survival of 4.0 years (HR 2.09, p = 0.002). By histopathology, the intermediate type (MACA-Int) was associated with the longest survival and poorly differentiated (MACA-3) the poorest survival. Peritoneal cancer index and tumor marker elevations had no impact on survival. Clinical features and preoperative tumor markers had little or no prognostic value in selection of MACA patients for CRS. Intermediate histologic subtype and use of HIPEC indicated a favorable outcome.
Comparison of Proximal Tibial Endoprosthetic and Allograft-Prosthetic Reconstruction.
Ulrich MN, Mallett KE, Broida SE … +3 more , Sullivan MH, Zabtani A, Houdek MT
J Surg Oncol · 2026 May · PMID 42089397 · Publisher ↗
INTRODUCTION: The proximal tibia is a common location for bone tumors. Two contemporary reconstruction techniques for limb salvage are endoprosthetic replacement (EPR) and allograft-prosthesis composite (APC). This study...
INTRODUCTION: The proximal tibia is a common location for bone tumors. Two contemporary reconstruction techniques for limb salvage are endoprosthetic replacement (EPR) and allograft-prosthesis composite (APC). This study aimed to compare the long-term oncologic and functional outcomes of EPR and APC reconstructions. METHODS: Thirty-eight (19 APC and 19 EPR) patients underwent oncologic proximal tibia resection and reconstruction were reviewed. Patients undergoing APC reconstruction were younger than the EPR group (31 vs. 44 years, p = 0.049), and patients in the EPR group were more likely to have a diagnosis of metastatic disease (32% vs. 0%, p = 0.019). RESULTS: For all patients, the 10-year disease-specific survival was 63%. With death a competing risk, there was no difference in the 10-year cumulative risk of failure (41% vs. 26%, p = 0.171) or amputation (11% vs. 19%, p = 0.690) between APC or EPR. There was no difference comparing EPR to APC in the proportion of patients with an extensor lag > 10° (42% vs. 26%, p = 0.495) or 10-year knee society scores (85 vs. 85, p = 0.710). CONCLUSION: EPR and APC have a similar complication profile and functional outcomes following proximal tibial resection and reconstruction.
Omission of Sentinel Lymph Node Biopsy in Breast Cancer: A Real-World Validation of the Patient Populations of the SOUND and INSEMA Trials.
Puiras T, Juhanoja E, Tamminen A
J Surg Oncol · 2026 May · PMID 42089383 · Publisher ↗
BACKGROUND: Treatment guidelines recommending omission of axillary surgery in breast cancer are largely based on the SOUND and INSEMA trials. However, the extent to which their study populations represent real-world pati...
BACKGROUND: Treatment guidelines recommending omission of axillary surgery in breast cancer are largely based on the SOUND and INSEMA trials. However, the extent to which their study populations represent real-world patients remains unclear. We aimed to evaluate the real-world applicability and external validity of these trial populations. MATERIALS AND METHODS: All consecutive patients treated for early breast cancer at a single university hospital between 2010 and 2018 were included. Patients with clinically node-negative disease were identified, and eligibility according to the SOUND and INSEMA inclusion criteria was determined. Clinicopathologic characteristics were compared between trial-eligible real-world patients and published trial populations. RESULTS: A total of 2787 consecutive patients with clinically negative axilla were included; 71% (1982/2787) fulfilled the INSEMA and 52% (1461/2787) the SOUND trial eligibility criteria. Patients eligible in the SOUND trial were largely representative of real-world patients in terms of clinicopathologic characteristics. In contrast, the INSEMA trial appeared more selected, with a higher proportion of biologically favorable tumors. Both trials predominantly included patients with small (< 2 cm) luminal breast cancers. Patients with larger tumors and more aggressive subtypes were underrepresented. CONCLUSION: The SOUND and INSEMA eligibility criteria are broadly applicable to real-world patients with small luminal breast cancers. However, differences between trial populations and real-world patients highlight the need for careful consideration when applying SLNB omission beyond these lower-risk subgroups.
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