Journal Of Surgical Oncology[JOURNAL]
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200 papers
Hospital Volume and Post-Hepatectomy Liver Failure After Major Hepatectomy.
Peters XD, Brajcich BC, Ko B … +6 more , Valukas C, Janczewski LM, Ko CY, Merkow RP, Pitt HA, Bentrem DJ
J Surg Oncol · 2026 May · PMID 42089353 · Publisher ↗
BACKGROUND: Post-hepatectomy liver failure (PHLF) following major hepatectomy (MH) increases the risk of morbidity and death. The relationship between institutional MH volume, PHLF, and outcomes is not well characterized...
BACKGROUND: Post-hepatectomy liver failure (PHLF) following major hepatectomy (MH) increases the risk of morbidity and death. The relationship between institutional MH volume, PHLF, and outcomes is not well characterized. METHODS: Adults undergoing MH from 2014 to 2021 in the ACS NSQIP hepatectomy-targeted database were included. Rates of PHLF were compared based on hospital-level annual MH volume. Multivariable logistic regression evaluated the association between volume, PHLF grade, and outcomes. RESULTS: Across 11,167 patients, PHLF incidence was 3.7% in low-volume, 5.5% in low-medium volume, 6.9% in medium-high volume, 11.8% in high-volume centers (p < 0.001). The adjusted odds ratio (aOR) for morbidity in grade B/C PHLF compared to those without PHLF was elevated in both lower-volume centers (quartiles 1-3), (11.2 [7.04-17.70]) and in high-volume centers, (8.47 [6.06-11.85]). CONCLUSION: Higher annual major hepatectomy volume is associated with increased PHLF, which may be a function of complex disease treated at these institutions. PHLF precedes other adverse events affecting both high and low volume institutions. PHLF is an important target for quality improvement.
Surgical Management of Recurrent Retroperitoneal Sarcomas: Experience From a High-Volume Sarcoma Centre: Recurrent Retroperitoneal Sarcomas: Outcomes of Multiple Recurrences.
Kaderi ASA, Shah TM, Patkar S … +12 more , Sai Ram YA, Bairannavar VS, Myvizhi Kannan M, Rekhi B, Bhargav P, Gala KB, Bagwan A, Ramadwar M, Jose J, Khanna N, Laskar S, Goel M
J Surg Oncol · 2026 May · PMID 42089321 · Publisher ↗
BACKGROUND: Retroperitoneal sarcoma (RPS) is a rare and complex malignancy, requiring specialized multidisciplinary care. While a significant progress has been made in managing a primary RPS, there is a limited literatur...
BACKGROUND: Retroperitoneal sarcoma (RPS) is a rare and complex malignancy, requiring specialized multidisciplinary care. While a significant progress has been made in managing a primary RPS, there is a limited literature on the outcomes of recurrent RPS (RecRPS). This study evaluates the oncological outcomes of RecRPS at a leading sarcoma referral center in India. METHODS: A retrospective analysis was performed for patients with RecRPS who underwent surgery between January 2011 and December 2024. Clinical outcomes were analyzed using Kaplan-Meier method and compared using log-rank test. Extended Cox regression models were used to account for intra-individual correlation, in cases of multiple recurrence. Prentice, William and Peterson model (PWP) CP model (total time) and PWP Gap time (PWP-GT) models were employed to estimate predictors of multiple recurrences. RESULTS: Out of 285 patients with primary RPS, 160 (56.1%) underwent surgery for a recurrent disease. The median overall survival (OS) was 137.1 months for the entire cohort and 41.92 months in RecRPS. The median OS of patients with 1st recurrence was 38.97 months. For subsequent recurrences, the median OS were 74.94 months (2nd recurrence), 57.4 months (3rd recurrence) and 54.2 months (4th recurrence), respectively. The various clinicopathological parameter associated with multiple recurrences were R+resection or resection with unknown margins, dedifferentiated liposarcoma and leiomyosarcoma, as histopatholologic subtypes; histologic organ invasion (HOI) of the small bowel and vessels, requirement of adjuvant and neoadjuvant therapy, disease progression on neoadjuvant chemotherapy and grade IIIb and IV complications. CONCLUSION: While the best chance of cure is at the primary presentation, some patients may experience prolonged disease control even with multiple recurrence, if treated optimally.
Correction to "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection".
J Surg Oncol · 2026 May · PMID 42068574 · Publisher ↗
Abstract loading — click title to view on PubMed.
Correction to "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection".
J Surg Oncol · 2026 May · PMID 42068568 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Negative Impact of a Non-Therapeutic Laparotomy in Patients With Inoperable Colorectal Peritoneal Metastases.
Heuvel TVD, Kesteren LV, Nienhuijs S … +4 more , Burger P, Buffart T, Tuynman J, Hingh I
J Surg Oncol · 2026 Apr · PMID 42057481 · Publisher ↗
BACKGROUND: The peritoneum is the third most prevalent location for metastases of colorectal cancer. In patients with resectable disease, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS...
BACKGROUND: The peritoneum is the third most prevalent location for metastases of colorectal cancer. In patients with resectable disease, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the preferred treatment in the Netherlands, achieving median overall survival (OS) of 36-42 months. However, during explorative laparotomy, CRS-HIPEC may appear unfeasible. Evidence on how such non-therapeutic laparotomies affect prognosis is limited. METHODS: This retrospective cohort study included all non-therapeutic laparotomies performed between 01 and 01-2010 and 01-01-2022 in two Dutch tertiary HIPEC-centers. Patient, tumor and treatment characteristics, postoperative morbidity, and survival outcomes were analyzed and compared to existing literature. RESULTS: In total, 108 patients underwent a non-therapeutic laparotomy (discontinued CRS-HIPEC). The main reason was that peritoneal disease was too extensive (56%). Severe postoperative complications (Clavien-Dindo ≥ 3) occurred in 9%. Following a non-therapeutic procedure, 55% of patients received tumor-directed palliative treatment. Median OS of the entire cohort was 6.5 months (95% CI 5.1-8.0). Palliative systemic therapy was the only factor significantly associated with improved OS (12.6 vs. 2.9 months, p < 0.001). CONCLUSIONS: Non-therapeutic laparotomies are associated with decreased survival in patients with extensive peritoneal metastases. Reducing their occurrence is essential. Advances in diagnostic modalities, including MRI, FAPI-PET, artificial intelligence, and developments in bidirectional treatments, may improve preoperative selection and offer alternative therapeutic options. Further research is required.
Augmented Reality Based 3D Modelling for Sentinel Lymph Node Localization in Cutaneous Melanoma: A Pilot Study.
Adawi Q, Meiri H, Yoschpe A … +8 more , Shapira R, Grynberg S, Schachter J, Eshet Y, Eifer M, Nachmany I, Zippel D, Mor E
J Surg Oncol · 2026 Apr · PMID 42057335 · Publisher ↗
BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard for staging high-risk melanoma, but current mapping provides limited spatial guidance. This pilot study assessed whether augmented reality (AR) projected 3D model...
BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard for staging high-risk melanoma, but current mapping provides limited spatial guidance. This pilot study assessed whether augmented reality (AR) projected 3D models can improve sentinel node localization compared with the gamma probe. METHODS: In this prospective study, 10 melanoma patients undergoing SLNB at Sheba Medical Center had preoperative sentinel lymphoscintigraphy using SPECT/CT imaging segmented to generate patient-specific 3D models. Models were projected onto the patient via an AR headset before incision. Localization accuracy was measured as the deviation (mm) between AR3D-identified and gamma probe-identified sentinel lymph node positions. RESULTS: Ten patients were enrolled in this pilot study. The median age was 71 years (range 30-77). Primary tumor sites included upper limb (n = 5), trunk (n = 3), Lower Limb (n = 1), and Head and Neck (n = 1). The median Breslow thickness was 1.1 mm (range 0.8-24 mm), with ulceration in 2 cases. Model generation was successful in all patients, with each model projected onto the patient using the AR headset and evaluated by the surgeon prior to incision. The median deviation between AR3D model and the gamma probe localization was 12 mm (range 0-40 mm), with 43% of cases ≤ 10 mm. No AR-related complications occurred. CONCLUSIONS: AR-based 3D modelling was feasible and safe for SLNB localization in melanoma. Although accuracy varied, in nearly half of the cases, AR3D model was within 10 mm of the gamma probe detection. These preliminary results supported further refinement of the technique and evaluation in larger, multicenter trials.
De-Escalating Surgery for 1-2 cm Appendiceal Neuroendocrine Tumors: A North American Multi-Center Analysis.
Miller RM, Tan PH, Saleeb A … +7 more , Thompson ER, Fong ZV, Stucky CC, Bagaria SP, Gabriel EM, Grotz TE, Wasif N
J Surg Oncol · 2026 Apr · PMID 42057320 · Publisher ↗
BACKGROUND AND OBJECTIVES: NCCN guidelines recommend right hemicolectomy (RHC) for appendiceal neuroendocrine tumors (aNETs) > 2 cm and observation for < 1 cm. However, optimal surgical management of 1-2 cm tumors remain...
BACKGROUND AND OBJECTIVES: NCCN guidelines recommend right hemicolectomy (RHC) for appendiceal neuroendocrine tumors (aNETs) > 2 cm and observation for < 1 cm. However, optimal surgical management of 1-2 cm tumors remains controversial. This study compared long-term survival and recurrence between patients undergoing RHC versus appendectomy (APY) for 1-2 cm aNETs. METHODS: Patients with pathologically confirmed 1-2 cm aNETs treated at three Mayo Clinic sites (1972-2024) were included. Primary outcomes were recurrence and all-cause mortality after resection. Associations with lymph node (LN) metastasis were assessed in patients with lymphadenectomy. RESULTS: Sixty-five patients were identified: 29 (45%) underwent APY, 35 (54%) RHC, and one ileocecectomy. Median age at diagnosis was 39 years; 71% were female and 94% white. LN positivity was 15.2% for tumors with nodes examined. Tumor size > 1.5 cm, stage T3/T4, and lymphovascular invasion were not associated with nodal metastasis. No survival differences were observed between APY and RHC. LN positivity did not impact survival. No recurrences occurred during a median follow-up of 6.25 years (IQR 2.44-12.63). CONCLUSIONS: Among patients with 1-2 cm aNETs, RHC conferred no survival benefit over APY. Absence of recurrence and the limited prognostic value of nodal disease suggest APY alone may suffice for this population.
The Role of Primary Tumor Resection in De Novo Bone-Only Metastatic Breast Cancer: A Propensity Score-Matched Analysis.
Wang B, Liu S, Huang Z … +5 more , Wang J, Zhou X, Li S, Chen J, Liu H
J Surg Oncol · 2026 Apr · PMID 42057318 · Publisher ↗
OBJECTIVE: To evaluate the impact of primary tumor resection (PTR) on overall survival (OS) and cancer-specific survival (CSS) in women with de novo bone-only metastatic breast cancer (MBC). METHODS: Women diagnosed with...
OBJECTIVE: To evaluate the impact of primary tumor resection (PTR) on overall survival (OS) and cancer-specific survival (CSS) in women with de novo bone-only metastatic breast cancer (MBC). METHODS: Women diagnosed with de novo bone-only metastatic breast cancer between 2010 and 2017 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were included if they had bone metastasis at diagnosis but no lung, liver, or brain involvement. Primary tumor resection was defined as any cancer-directed breast surgery. Propensity scores were calculated using multivariable logistic regression incorporating demographics, tumor features, and treatment factors, followed by 1:1 nearest-neighbor matching (caliper = 0.2 SD). Kaplan-Meier, Cox proportional hazards, and restricted mean survival time (RMST) analyses assessed overall survival (OS) and cancer-specific survival (CSS). Time-dependent ROC curves (timeROC) evaluated model discrimination. Determinants of PTR were examined using multivariable logistic regression. RESULTS: A total of 3296 women with de novo bone-only metastatic breast cancer were included (1252 with PTR; 2044 without). After 1:1 matching, 2002 well-balanced patients remained (1001 per group). Median OS and CSS were significantly longer among patients undergoing surgery (OS: 69 vs. 39 months; CSS: 76 vs. 41 months; both p < 0.0001). PTR remained an independent predictor of improved OS (HR = 0.54, 95% CI 0.48-0.60, p < 0.001), with consistent benefit across subgroups. RMST differences (surgery - no surgery) increased with time, reaching 9.05 months for OS and 8.79 months for CSS at 60 months. Model discrimination was acceptable (AUCs for OS: 0.753, 0.734, 0.717 at 1-, 3-, and 5-years). Radiation therapy was positively associated with PTR (OR = 1.37, 95% CI 1.12-1.68, p = 0.002), whereas well/moderate grade predicted lower odds (OR = 0.80, 95% CI 0.66-0.99, p = 0.036). CONCLUSIONS: In this large SEER-based propensity-matched analysis, primary tumor resection was associated with significantly improved overall and cancer-specific survival among women with de novo bone-only metastatic breast cancer. These findings suggest that selected patients with isolated bone metastasis may benefit from locoregional surgery, warranting further prospective validation.
Ca125 KELIM as a Potential Tool for Predicting Hyperthermic Intraperitoneal Chemotherapy (HIPEC) Benefit at Interval Cytoreductive Surgery for Advanced Epithelial Ovarian Cancer-A Propensity Score-Matched Analysis.
Sinukumar S, Kazi M, Damodaran D … +5 more , Prabhu A, Piplani S, Naik S, Sankaralingam D, Bhatt A
J Surg Oncol · 2026 Apr · PMID 42045801 · Publisher ↗
OBJECTIVE: The aim of the study was to explore the role of KELIM as a potential clinical biomarker to help select patients who would benefit with the addition of Hyperthermic intraperitoneal chemotherapy(HIPEC) at interv...
OBJECTIVE: The aim of the study was to explore the role of KELIM as a potential clinical biomarker to help select patients who would benefit with the addition of Hyperthermic intraperitoneal chemotherapy(HIPEC) at interval cytoreductive surgery following neoadjuvant chemotherapy. METHODS: This was a multi-institutional, retrospective observational study of 265 patients with Stage IIIC and Stage IV A high grade serous epithelial ovarian cancer who had undergone interval cytoreductive surgery following neoadjuvant chemotherapy. Propensity score matching was performed to reduce confounding by indication for HIPEC. Matching variables were age, FIGO stage, surgical PCI, and NACT cycles. Univariable and multivariable cox-regression models were created to assess predictors of survival. Survivals were analysed using Kaplan-Meier curves. RESULTS: The median OS and median DFS of patients with Low KELIM score and who received HIPEC was 38 months and 18.9 months respectively as compared to Median OS = NR and DFS of 39.7 months respectively in patients with a high KELIM score who received HIPEC. Patients with low KELIM did worse with the addition of HIPEC (3 year OS-61%, DFS 15%) as compared to patients with High KELIM and HIPEC (3 year OS 90%, DFS- 54%). CONCLUSION: KELIM may help to identify patients who are likely to benefit from the addition of HIPEC at interval cytoreductive surgery. However, these findings require validation in larger prospective studies.
Revisiting the Intersegmental Plane in Anatomical Liver Resection: A Three-Zone Framework Beyond Hepatic Vein Exposure.
Kim JH, Son J
J Surg Oncol · 2026 Apr · PMID 42045795 · Publisher ↗
Accurate identification of the intersegmental plane is critical for anatomical liver resection (ALR), which aims to remove hepatic segments based on portal venous territories. Traditionally, hepatic veins have served as...
Accurate identification of the intersegmental plane is critical for anatomical liver resection (ALR), which aims to remove hepatic segments based on portal venous territories. Traditionally, hepatic veins have served as the primary landmark for these planes. However, advances in 3D reconstruction and indocyanine green (ICG) fluorescence imaging reveal that true portal territory boundaries often deviate from hepatic vein trajectories. We propose a three-zone classification of intersegmental planes based on their spatial relationship with the hepatic veins to guide surgical strategy. Zone 1 (Exposure Zone): The plane runs alongside a major hepatic vein, providing a clear landmark but requiring precise dissection to avoid venous injury. Zone 2 (Crossing Zone): The plane intersects a hepatic vein or its branches, creating the highest risk of bleeding due to unexpected venous crossings. Zone 3 (No Exposure Zone): The plane lies entirely within the parenchyma, away from major veins, making bleeding minimal but requiring ICG guidance to avoid disorientation. Intersegmental planes should be conceptually defined as Glissonean-free watersheds rather than solely by hepatic vein location. This zone-based classification provides a practical framework for preoperative planning and intraoperative decision-making, allowing surgeons to anticipate venous exposure and optimize dissection techniques for safer, more precise ALR.
Does Surgical Timing After Neoadjuvant Anti-HER2 Therapy Affect Pathological Complete Response and Survival in HER2-Positive Breast Cancer? A Multicenter Retrospective Cohort Study.
Birsin Z, Alkan O, Bükün HO … +14 more , Nazlı İ, Günaltılı M, Çerme E, Aliyev V, Cebeci S, Jeral S, Abbasov H, Çiçek E, Evrensel T, Papila Ç, Papila B, Wetherilt CS, Demirci NS, Alan Ö
J Surg Oncol · 2026 Apr · PMID 42024773 · Publisher ↗
BACKGROUND: The optimal timing of surgery after completion of neoadjuvant chemotherapy (NAC) remains uncertain, particularly for patients with HER2-positive breast cancer receiving targeted therapy. METHODS: This multice...
BACKGROUND: The optimal timing of surgery after completion of neoadjuvant chemotherapy (NAC) remains uncertain, particularly for patients with HER2-positive breast cancer receiving targeted therapy. METHODS: This multicenter retrospective study included 176 patients with early or locally advanced HER2-positive breast cancer who underwent surgery following neoadjuvant chemotherapy combined with anti-HER2 therapy between 2010 and 2025. The study was conducted using a previously established multicenter real-world cohort (Birsin et al. 2025). This dataset has been used in prior analyses focusing on different endpoints; however, the current study addresses a distinct research question evaluating the impact of surgical timing after neoadjuvant therapy. Patients were categorized according to the interval between the last cycle of systemic therapy and surgery into three groups: < 4 weeks, 4-8 weeks, or > 8 weeks. The primary endpoint was pathological complete response (pCR), defined as ypT0/is ypN0. Secondary endpoints were disease-free survival (DFS) and overall survival (OS). RESULTS: The median interval between completion of NAC and surgery was 8 weeks (range, 3-20 weeks). A pCR was achieved in 49% of patients. In multivariate analysis, hormone receptor negativity (OR = 2.56, p = 0.011), HER2 IHC 3+ status (OR = 0.27, p = 0.018), lower T stage (OR = 0.39, p = 0.026), and dual anti-HER2 therapy (OR = 2.47, p = 0.021) were independent predictors of pCR; however, surgical timing (< 8 weeks vs. ≥ 8 weeks; < 4 vs. 4-8 weeks; and < 4 vs. > 8 weeks) did not significantly influence pCR (p = 0.893, p = 0.171, p = 0.187). The estimated 5-year DFS rates were 87.5%, 83.5%, and 80.8%, and the OS rates were 85.2%, 82.1%, and 89.7% for the < 4-week, 4-8-week, and > 8-week groups, respectively. Neither DFS nor OS differed significantly among the groups (log-rank p = 0.828 and p = 0.778, respectively). CONCLUSIONS: In patients with early and locally advanced HER2-positive breast cancer, the interval between completion of neoadjuvant chemotherapy combined with anti-HER2 therapy and surgery did not affect pCR, DFS, or OS. Moderate delays in surgery beyond 8 weeks did not appear to adversely affect patient outcomes.
Impact of Surgical Margins in Chest Wall Chondrosarcomas: A CanSaRCC Study.
Gazendam A, Peretz Soroka H, Henning E … +19 more , Urrehman B, Trenholm R, Russo L, Michael MJ, Holloway C, Grant K, Basile G, Saade J, Cypel M, Gupta A, Griffin A, Kubik W, Ferguson P, Arteau A, Bozzo A, Monument MJ, Werier J, Ednie A, Wilson D
J Surg Oncol · 2026 Apr · PMID 42024717 · Publisher ↗
BACKGROUND: Chest wall chondrosarcoma is the most common primary malignant bone tumor of the thoracic cage. Owing to its resistance to chemotherapy and radiotherapy, complete surgical excision with negative margins remai...
BACKGROUND: Chest wall chondrosarcoma is the most common primary malignant bone tumor of the thoracic cage. Owing to its resistance to chemotherapy and radiotherapy, complete surgical excision with negative margins remains the cornerstone of treatment. However, the optimal margin width for local control and survival remains uncertain. METHODS: Data from nine Canadian sarcoma centres participating in the CanSaRCC registry were retrospectively reviewed. Patients aged ≥ 18 years with pathologically confirmed primary chest wall chondrosarcoma (2000-2024) who underwent curative-intent resection were included. Margins were defined as the minimum measured distance from tumor to resection margin, irrespective of tissue type and categorized as positive, < 4 mm, or ≥ 4 mm. Overall survival (OS), disease-free survival (DFS), and local recurrence free survival (LRFS) were analysed using Kaplan-Meier and multivariable Cox regression. RESULTS: Among 147 patients (median age 54 years (range; 21-85), 16% had positive margins, 52% < 4 mm, and 24% ≥ 4 mm. At 5 years, OS and DFS were 77% (±4.8%) and 68% (±5.2%), respectively, for the entire cohort. Independent predictors of worse overall survival included tumor size ≥ 10 cm (HR 3.23, p = 0.021) and grade 3 tumors (HR 12.40, p < 0.001) but not margin size (margin ≥ 4 mm; HR 0.70, p = 0.512). Margins ≥ 4 mm significantly reduced local recurrence (HR 0.12, p = 0.023). CONCLUSIONS: In primary chest wall chondrosarcoma, tumor biology rather than surgical margin width drives systemic outcomes. Margins ≥ 4 mm improve local control, supporting balanced resections that preserve function while maintaining oncologic safety.
Identifying Breast Cancer Risk in Patients Undergoing Gender-Affirming Chest Masculinization Surgery.
Cronin JE, Aryanpour Z, Durden JA … +7 more , Hunt SC, Arkema A, Christian NT, Kaoutzanis C, Mathes DW, Egan KG, Tevis SE
J Surg Oncol · 2026 Apr · PMID 42024716 · Publisher ↗
BACKGROUND AND OBJECTIVES: Breast cancer risk among transgender and gender-diverse individuals undergoing gender-affirming chest masculinization ("top") surgery remains poorly defined. This study aimed to characterize br...
BACKGROUND AND OBJECTIVES: Breast cancer risk among transgender and gender-diverse individuals undergoing gender-affirming chest masculinization ("top") surgery remains poorly defined. This study aimed to characterize breast cancer risk and management in this population. METHODS: We conducted retrospective chart review of patients undergoing top surgery within an academic plastic surgery practice. Variables included family and reproductive history, genetic testing, International Breast Intervention Study (IBIS) scores, and final pathology. The primary outcome was elevated breast cancer risk, defined as IBIS ≥ 20% (high risk) or 15%-19% (intermediate). Significance was set at p < 0.05. RESULTS: From April 2019 to December 2024, 284 individuals underwent top surgery. One-third reported a family history of breast cancer, and two of fifteen genetically tested patients carried pathogenic variants. IBIS scores were calculable in 79 patients, with 43% demonstrating intermediate or high risk (IBIS ≥ 15%). Seven patients were referred to breast surgical oncology and fifteen to genetics; four high-risk individuals elected risk-reducing mastectomy. One case of ductal carcinoma in situ was identified during risk-reducing mastectomy. CONCLUSION: A subset of top surgery patients exhibit elevated familial, genetic, or IBIS-based breast cancer risk. Although incidental malignancy was rare, structured risk assessment and selective referral may improve screening and management in this population.
An Interactive Preoperative Virtual Reality Intervention for Breast Cancer Patients Undergoing Oncological Surgery: A Feasibility and Pilot Randomized Clinical Trial.
El-Gabalawy R, Logan GS, Hebbard P … +10 more , Sommer JL, Reynolds K, Penner KE, Smith MSD, Mota N, Mutch WAC, Mollanji E, Maples-Keller JL, Perrin D, Arora RC
J Surg Oncol · 2026 Apr · PMID 42024710 · Publisher ↗
BACKGROUND AND OBJECTIVES: Preoperative anxiety is common before surgery and is associated with adverse outcomes, yet access to mental health support remains limited. We evaluated the feasibility and acceptability of a n...
BACKGROUND AND OBJECTIVES: Preoperative anxiety is common before surgery and is associated with adverse outcomes, yet access to mental health support remains limited. We evaluated the feasibility and acceptability of a novel preoperative virtual reality (VR) prototype designed to reduce anxiety in patients undergoing cancer surgery. METHODS: In a multi-method feasibility and pilot trial, participants were randomized to either the VR intervention or standard of care (SoC) between 2021 and 2023. VR participants completed a simulation 1-2 weeks before surgery exploring the operating room (OR) and experiencing anesthesia induction. Intervention feasibility and acceptability (primary outcomes), and preliminary trends in anxiety and distress (secondary outcomes) were explored using measures and open-ended questions administered at four perioperative timepoints. RESULTS: Of 33 interested individuals, 27 were randomized, and 23 completed the study (VR: n = 12; SoC: n = 11). No adverse VR effects occurred. Most participants reported elevated preoperative anxiety (78.3%-87%), rated the VR as helpful (M = 80.4%), enjoyable (M = 87.7%), and all viewed it as worthwhile. Six qualitative themes emerged: preparation for the OR, psychological and emotional impact, realism, interactivity, technical issues, and supporting others. Trends suggested reduced postoperative distress and anxiety for the VR group. CONCLUSION: The VR intervention was feasible and acceptable, supporting further development and advancement to a larger clinical trial. TRIAL REGISTRATION: The clinical trial was registered at clinicaltrials.gov: https://clinicaltrials.gov/study/NCT04544618 on September 10th, 2020.
RETRACTION: Hypomethylation of Mismatch Repair Genes MLH1 and MSH2 is Associated With Chemotolerance of Breast Carcinoma: Clinical Significance.
J Surg Oncol · 2026 Apr · PMID 42010783 · Publisher ↗
H. Dasgupta, S. Islam, N. Alam, A. Roy, S. Roychoudhury, and C.K. Panda, "Hypomethylation of Mismatch Repair Genes MLH1 and MSH2 is Associated With Chemotolerance of Breast Carcinoma: Clinical Significance," Journal of S...
H. Dasgupta, S. Islam, N. Alam, A. Roy, S. Roychoudhury, and C.K. Panda, "Hypomethylation of Mismatch Repair Genes MLH1 and MSH2 is Associated With Chemotolerance of Breast Carcinoma: Clinical Significance," Journal of Surgical Oncology 119, no. 1 (2019): 88-100, https://doi.org/10.1002/jso.25304. The above article, published online on November 27, 2018, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor-in-Chief, Laleh Melstrom; and John Wiley & Sons Ltd. Concerns were raised on PubPeer [1] regarding multiple duplicated images within Figures 4 and 5, and between Figure 4 and Supporting Figure S3. Additionally, the investigation revealed that multiple bands in Figure 5 were duplicated from an earlier publication by the same authors (Dasgupta et al. 2018 [https://doi.org/10.1007/s11010-018-3442-5]). The authors responded to the publisher's request for comment, but their explanation was not sufficient to resolve the concerns, and they were not able to provide the requested original data. The editor has lost confidence in the results reported, and therefore, the article must be retracted. The authors disagree with this decision. Reference: [1] G. Androsaceus and P. Patentissima, "Hypomethylation of Mismatch Repair Genes MLH1 and MSH2 is Associated with Chemotolerance of Breast Carcinoma: Clinical Significance," PubPeer, 2024, https://pubpeer.com/publications/5B2D1FA4B9252CA195CC296EB128B5.
Superficial and Functional Imaging of the Posterior Upper Arm Pathway in the Healthy Population.
Givant M, Friedman R, Fanning JE … +6 more , Chen A, Thomson S, Shillue K, Fleishman A, Ciucci JL, Singhal D
J Surg Oncol · 2026 Apr · PMID 42010368 · Publisher ↗
BACKGROUND AND OBJECTIVES: The posterior upper arm (PUA), or tricipital, pathway is a superficial lymphatic channel that has been postulated to be a compensatory pathway for lymphatic drainage of the upper extremity foll...
BACKGROUND AND OBJECTIVES: The posterior upper arm (PUA), or tricipital, pathway is a superficial lymphatic channel that has been postulated to be a compensatory pathway for lymphatic drainage of the upper extremity following axillary lymph node dissection (ALND). The PUA pathway has been characterized in the breast cancer population but not in the healthy population. METHODS: Healthy female volunteers were recruited for bilateral mapping of the upper extremities using indocyanine green (ICG) lymphography. Phenotypic variants of the PUA pathway were recorded. RESULTS: 57 volunteers underwent ICG lymphography of the bilateral arms. The PUA pathway was visualized in 100% of arms. In 46% of arms, the pathway was continuous with the forearm (long bundle phenotype), whereas in 54% of arms, the pathway had no continuity with the forearm (short bundle phenotype). CONCLUSION: The PUA pathway was universally present in healthy volunteers. However, in comparison to our prior study, which was performed in patients with breast cancer prior to ALND, healthy volunteer arms more often displayed the short bundle phenotype. Defining the incidence of PUA pathway anatomic variants in healthy subjects is important to further understand its potential role in the development of lymphedema.
Cytoreductive Surgery in Patients With Metastatic Succinate Dehydrogenase-Deficient Gastrointestinal Stromal Tumors.
Chen KY, Antkowiak M, Sharma AK … +4 more , Mallory R, Burgoyne AM, Fanta PT, Sicklick JK
J Surg Oncol · 2026 Apr · PMID 42003827 · Publisher ↗
BACKGROUND AND OBJECTIVES: Succinate dehydrogenase-deficient (SDH-deficient) gastrointestinal stromal tumors (GIST) are characterized by variable disease biology with poor responses to traditional tyrosine kinase inhibit...
BACKGROUND AND OBJECTIVES: Succinate dehydrogenase-deficient (SDH-deficient) gastrointestinal stromal tumors (GIST) are characterized by variable disease biology with poor responses to traditional tyrosine kinase inhibitors. The role of surgical intervention has been highly debated. METHODS: We performed a single-institution retrospective analysis of metastatic SDH-deficient GIST patients who underwent complete (CC-0) cytoreductive surgery (CRS) from 2017 to 2023. Pathologic-Peritoneal Cancer Index (P-PCI) and GIST Metastatectomy-Surgical Complexity Score (GM-SCS) were used to quantify complexity. Kaplan-Meier survival analysis compared time to progression on systemic therapy immediately before CRS (TTP-1L) and second to last line of systemic therapy before CRS (TTP-2L) versus time to recurrence (TTR) after CRS. RESULTS: Nine patients met inclusion criteria. The median age at CRS was 29 years (range: 17-43). Median P-PCI was 13 (IQR: 10-15) and median GM-SCS was 19 (IQR: 16-28). Clavien-Dindo grade ≥ 3 complication rate was 33.3% (3/9) within 90-days postoperatively. Median TTP-1L was unreached and median TTP-2L was 3.4 months (95% CI: 2.5-unreached), as compared to TTR at 26.1 months (95% CI: 15.2-unreached) post CRS (p ≤ 0.0001). CONCLUSIONS: Patients who underwent CC-0 CRS achieved prolonged disease control versus prior systemic therapies, suggesting that CRS may be a management option for highly selected SDH-deficient GIST patients.
Indocyanine Green-Guided Sentinel Lymph Node Biopsy in Melanoma: Assessing Clinical Value in a Cohort Over 1000 Patients.
Duarte-Bateman D, Shen A, Chen Y … +5 more , Arpi-Palacios J, Williams E, Patel V, Knackstedt R, Gastman BR
J Surg Oncol · 2026 Apr · PMID 42003043 · Publisher ↗
BACKGROUND: The sentinel lymph node biopsy (SLNB) remains the standard for identifying micrometastasis in melanoma. In this study, we utilized our prospectively maintained database to assess whether adding indocyanine gr...
BACKGROUND: The sentinel lymph node biopsy (SLNB) remains the standard for identifying micrometastasis in melanoma. In this study, we utilized our prospectively maintained database to assess whether adding indocyanine green (ICG) fluorescence imaging to radioisotope lymphoscintigraphy improved sentinel node detection and, consequently, clinical outcomes. METHODS: Consecutive patients with cutaneous melanoma who underwent dual technique SLNB by the senior author (B.R.G.) from 2012 to 2022 were enrolled. All patients with a negative SLNB result were subjected to a minimum follow-up period of 12 months. Positive and false-negative rates were calculated, and recurrence-free survival (RFS) was used as a measure of clinical outcomes. RESULTS: A total of 1267 patients were identified. The average age was 62 years, with 526 females (41.6%). The mean Breslow depth was 1.82 mm (range 0.2-24 mm). Among 3403 SLNs sampled, 358 were positive (91.1% identified by both modalities). The false-negative rate was 8.5% (25/293), and the median time to recurrence was 13.7 months (range: 2.8-60.4 months). The 12-month RFS for stages IA-IIC were 99%, 98%, 95%, 97%, and 84%, respectively (p = 0.016). CONCLUSIONS: These findings support the use of an ICG-based dual technique in SLNB for melanoma, demonstrating diagnostic precision with excellent patient outcomes.
Solid Pseudopapillary Neoplasms (SPNs) of the Pancreas: Appraisal of Contemporary Clinicopathologic Features - Clinical Implications and Surgical Outcomes of Patients Treated and Followed at a Single Institution.
Acharya S, Meredith LT, Kaplan Z … +10 more , Persaud R, Moskal D, Wummer B, Jiang W, Zheng R, Naringrekar H, Lavu H, Yeo CJ, Nevler A, Bowne WB
J Surg Oncol · 2026 Apr · PMID 41992681 · Publisher ↗
BACKGROUND: Surgeons rarely encounter solid pseudopapillary neoplasms (SPNs) of the pancreas. Contemporary clinicopathologic features, operative interventions, and oncologic outcomes remain under-reported. METHODS: We re...
BACKGROUND: Surgeons rarely encounter solid pseudopapillary neoplasms (SPNs) of the pancreas. Contemporary clinicopathologic features, operative interventions, and oncologic outcomes remain under-reported. METHODS: We reviewed clinical data and pathology from a single institution's experience of patients who underwent surgical resection with primary and recurrent SPNs treated between January 2004 and December 2023. Patient demographics, imaging results, tumor characteristics, treatment methods, genomic testing outcomes, recurrence-free survival, and survival were recorded and analyzed. RESULTS: Fifty patients comprised the study group, forty-eight were females, with a median age of 33 years (IQR:15.95, 16-53 years). Thirty patients were symptomatic, most commonly presenting with abdominal pain (n = 24). SPNs frequently demonstrated solid and cystic components and a 4.1 cm median tumor size. At a median follow-up of 53 months, three patients (6%) had recurrence of disease. Ten patient tumors underwent genomic sequencing: all containing a CTNNB1 mutation. Co-occurring PTEN and TP53 mutations were identified in two patient tumors that recurred. Treatments entailed cytoreductive surgical procedures, regional, and systemic therapies. One patient succumbed to disease progression. CONCLUSION: Patients with solid pseudopapillary neoplasms had a favorable oncologic outcome. Recurrence/metachronous metastasis occurred in older patients with larger tumors, each containing a pathogenic co-mutation, and one patient experiencing traumatic tumor rupture.
Early Complications in Mandibular Reconstruction: Analysis Using Comprehensive Complication Index.
Hidaka T, Miyamoto S, Fukunaga Y … +4 more , Oshima A, Shinozaki T, Matsuura K, Higashino T
J Surg Oncol · 2026 Apr · PMID 41992640 · Publisher ↗
BACKGROUND: Early postoperative complications after microvascular mandibular reconstruction impact outcomes in patients with advanced oral cancer. This study evaluates three reconstruction techniques: vascularized bone g...
BACKGROUND: Early postoperative complications after microvascular mandibular reconstruction impact outcomes in patients with advanced oral cancer. This study evaluates three reconstruction techniques: vascularized bone graft (VBG), mandibular reconstruction plate (MRP) with a non-osseous flap, and soft tissue flap (STF), using the Comprehensive Complication Index (CCI). METHODS: In this retrospective study of 101 patients, early postoperative complications (≤ 30 days) were assessed using the CCI, calculated from Clavien-Dindo classification grades. Differences among the three techniques were analyzed using multivariable linear regression. RESULTS: VBG was performed in younger, healthier patients. No significant differences in CCI were found among the three techniques. Multivariable analysis confirmed that non-surgical factors, such as diabetes, had greater influence on complication risks. CONCLUSIONS: Appropriate patient selection minimizes early complication risks. VBG in younger patients and technical refinements in MRP may yield complication burdens comparable to STF. TRIAL REGISTRATION: This study was registered in the UMIN Clinical Trials Registry as UMIN000056584 (http://www.umin.ac.jp/ctr).
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