Yanagimoto H, Nakachi K, Ikeda M
… +20 more, Konishi M, Ogawa G, Sano Y, Nomura T, Yanagibashi H, Shibuya K, Shirakawa H, Takahashi A, Sakamoto Y, Makino I, Hatano E, Gotohda N, Kamei K, Kobayashi S, Imaoka H, Ozaka M, Terashima T, Okusaka T, Furuse J, Ueno M
BACKGROUND AND OBJECTIVES: Postoperative early recurrence (ER) of biliary tract cancers (BTCs) leads to significant medical, psychological, social, and economic disadvantages for patients. Approximately 30% of patients w...BACKGROUND AND OBJECTIVES: Postoperative early recurrence (ER) of biliary tract cancers (BTCs) leads to significant medical, psychological, social, and economic disadvantages for patients. Approximately 30% of patients with curatively resected BTCs experience recurrence within the first 12 months after the surgery. JCOG1202 randomized phase III trial demonstrated the survival benefit of adjuvant S-1 in patients with resected BTCs. The objective of this exploratory study was to investigate the risk factors for ER in patients with resected BTCs in the JCOG1202 cohort. METHODS: Of the 440 patients enrolled in JCOG1202, 217 who underwent observation and 207 who received adjuvant S-1 were eligible in this analysis. ER was defined as recurrence or death within 12 months after enrollment. RESULTS: ER was observed in 59 and 38 patients in observation and adjuvant S-1, respectively. Multivariable logistic regression analysis identified CA19-9 levels > 37 U/ml (odds ratio (OR): 2.79, 95% confidence interval (CI): 1.26-6.17), poorly differentiation (vs. well-differentiated/papillary) (OR: 4.75, 95% CI: 1.93-11.69), moderate differentiation (vs. well-differentiated/papillary) (OR: 1.96, 95% CI: 1.07-3.57), lymph node metastases ≥ 4 (vs. 0) (OR: 3.99, 95% CI: 1.67-9.51), lymph node metastases 1-3 (vs. 0) (OR: 2.66, 95% CI: 1.47-4.81), and R1 resection (OR: 2.17, 95% CI: 1.07-4.41) as independent risk factors for ER. Adjuvant S-1 chemotherapy significantly reduced ER (OR: 0.49, 95% CI: 0.29-0.83). CONCLUSIONS: Postoperative CA19-9 levels, tumor differentiation, lymph node metastases, residual tumors, and adjuvant S-1 significantly affected ER in patients with curatively resected BTCs. Patients at high ER risk may require more intensive adjuvant therapy. TRIAL REGISTRATION: UMIN000011688.
BACKGROUND AND OBJECTIVES: Osteoid Osteoma (OO) is a painful, benign bone tumor that can be treated surgically with en bloc resection, curettage, and radiofrequency ablation (RFA). This study aims to measure recurrence r...BACKGROUND AND OBJECTIVES: Osteoid Osteoma (OO) is a painful, benign bone tumor that can be treated surgically with en bloc resection, curettage, and radiofrequency ablation (RFA). This study aims to measure recurrence rates after initial treatment by treatment type and to examine clinical factors associated with recurrence. METHODS: A retrospective review of patients with an OO diagnosis was performed using a pathology database from a tertiary pediatric hospital between November 1, 2004 and July 1, 2024. Statistical analysis examined the relationships among surgical technique, recurrence, and clinical variables. RESULTS: 24 patients met inclusion criteria with a median follow-up of 1.41 years (interquartile range, IQR 2.0) and a median age at treatment of 9.92 years (IQR 5.8-13.5). Twelve patients (50.0%) experienced symptomatic tumor recurrence, with a median time to recurrence of 0.92 years (IQR 0.1-3.0). Of those with tumor recurrence, five patients were initially treated with excision and curettage, while the remaining nine underwent RFA. There was no significant correlation between recurrence and surgical intervention (p = 0.667), age at initial surgery (p = 0.468), or patient sex (p = 0.667). CONCLUSIONS: Surgical management of pediatric OO is linked to high recurrence rates, and recurrence is not related to surgical intervention, age, or patient sex.
BACKGROUND: We assessed overall survival (OS) and cancer-specific-survival (CSS) of radical resection compared to local excision for stage 1 rectal cancer in very old patients (≥ 80 years). METHODS: This retrospective co...BACKGROUND: We assessed overall survival (OS) and cancer-specific-survival (CSS) of radical resection compared to local excision for stage 1 rectal cancer in very old patients (≥ 80 years). METHODS: This retrospective cohort study included patients aged ≥ 80 years who underwent surgery for stage 1 rectal cancer from the SEER database from 2000-2020. Patients were divided into radical resection and local excision groups, and were exact matched for T stage, tumor grade, and tumor size. The main outcome measures were OS and CSS. RESULTS: 6379 patients ≥ 80 years underwent local or radical resection of stage 1 rectal cancer; 51.9% were female and 47% had T1 tumors. After matching, 1125 patients were included in each group. The median OS was longer in patients who underwent radical resection (60 months vs. 51 months, p = 0.009), yet there were no significant differences in CSS between the two groups. When stratified by the T stage, there was no benefit for radical resection in T1 tumors (p = 0.33). In multivariate analysis, radical resection and local excision had similar hazard of mortality (HR 1.03, 95%CI 0.76-1.38). CONCLUSION: Radical resection and local excision had similar CSS in very old patients with stage 1 rectal cancer. A personalized approach considering patient status and treatment goals should be used for each patient.
Coleman-Belin JC, Zhang KK, Cohen Z
… +10 more, Cunningham L, Olla D, Khavanin N, Rubin J, Barnett J, Cracchiolo JR, Shahzad F, Nelson JA, Matros E, Allen RJ
BACKGROUND AND OBJECTIVES: Tumor involvement of the posterior mandible often requires resection of the mandibular condyle and associated soft tissue. This study explores clinical and patient-reported outcomes (PROs) asso...BACKGROUND AND OBJECTIVES: Tumor involvement of the posterior mandible often requires resection of the mandibular condyle and associated soft tissue. This study explores clinical and patient-reported outcomes (PROs) associated with condyle preservation versus resection during reconstruction. METHODS: This retrospective cohort study examined patients who underwent bony free flap reconstruction of posterolateral mandible defects from 2017 to 2021. Major clinical outcomes included length of stay (LOS), duration of follow-up, cancer recurrence, and all-cause mortality. PROs were assessed using the validated FACE-Q Head and Neck Cancer module survey for overall, short-term (0-1 year postoperatively), and long-term (> 1 year postoperatively) outcomes. The cohorts included (1) condyle preservation, (2) condyle resection with condyle autotransplantation, and (3) condyle resection without autotransplantation. RESULTS: 94 patients were included in the study. Major clinical outcomes did not significantly differ between cohorts (all p > 0.439). Compared to the condyle-resected cohort, condyle-preserved patients overall reported superior Overall Facial Appearance (p = 0.035), Eating Function (p = 0.034), Appearance/Face Distress (p = 0.020), Eating Distress (p = 0.017), and Cancer Worry (p = 0.002). Long-term assessments revealed more marked advantages for in-situ condyle preservation compared to condyle resection in Overall Facial Appearance (p = 0.022), Eating Function (p = 0.004), Smiling Function (p = 0.035), Swallowing Function (p = 0.003), Eating Distress (p = 0.006), and Cancer Worry (p = 0.011). Among condyle-resected patients, condyle autograft did not significantly improve FACE-Q scores (all p > 0.177). CONCLUSIONS: In-situ condyle preservation yielded superior PROs compared to condyle resection ± condyle autograft, particularly over 1 year postoperatively. Major clinical outcomes did not significantly differ.
Nguyen AT, Duckworth ED, Li RA
… +1 more, Galiano RD
J Surg Oncol
· 2026 Mar · PMID 41536154
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Breast cancer remains a leading cause of cancer-related mortality among women globally. Vietnamese women experience unique challenges, including sociocultural, linguistic, and systemic barriers, contributing to dispariti...Breast cancer remains a leading cause of cancer-related mortality among women globally. Vietnamese women experience unique challenges, including sociocultural, linguistic, and systemic barriers, contributing to disparities in screening utilization, late-stage diagnoses, and treatment outcomes. Despite advances in early detection and care, inequities persist. A systematic review was conducted following PRISMA guidelines, with the protocol registered on PROSPERO. PubMed, Embase, and Scopus were searched for original studies published from 2000 to 2024 examining breast cancer screening, outcomes, molecular/genetic features, and disparities in Vietnamese populations. Narrative synthesis was employed due to heterogeneity in study metrics and methodologies. Forty-one studies encompassing 39,324 Vietnamese participants (mean age 48.15 ± 7.48 years) were included. Social networks and acculturation positively influenced screening uptake, while systemic barriers such as language, cultural stigma, and lack of insurance deterred participation. Across included studies, mammography screening rates among Vietnamese women ranged widely from 26% to 83%, consistently lower than the U.S. national average of 81%, and lower than rates reported in many Asian American subgroups. Late-stage diagnoses were prevalent, occurring in 32.9% of Vietnamese women, with foreign-born Vietnamese women exhibiting higher mortality than U.S.-born counterparts. Molecular studies revealed distinct tumor subtypes, including higher HER2-positive and triple-negative breast cancer rates. Interventions, including culturally tailored education and patient navigator programs, demonstrated success in addressing screening and care disparities. Vietnamese women face significant breast cancer disparities driven by sociocultural, systemic, and biological factors. Effective solutions require integrating culturally tailored solutions to promote equitable outcomes and reduce disparities in breast cancer care.
Locally advanced breast carcinoma (LABC) is a frequent condition in Brazil and in developing countries. Neoadjuvant systemic therapy (NST) has allowed for surgical de-escalation of the breast and/or axilla, leading to in...Locally advanced breast carcinoma (LABC) is a frequent condition in Brazil and in developing countries. Neoadjuvant systemic therapy (NST) has allowed for surgical de-escalation of the breast and/or axilla, leading to increasing the rates of breast-conserving-surgery, skin/nipple preservative mastectomies and axillary preservation. There are no established quality indicators for LABC or NST. This article aimed to review the topic, highlighting Brazilian studies, identifying thirty potential quality indicators for surgical treatment.
Yosefof E, Edri N, Ritter A
… +5 more, Gendlin L, Avidor Y, Bachar G, Shpitzer T, Mizrachi A
J Surg Oncol
· 2026 Mar · PMID 41531113
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INTRODUCTION: Elective neck dissection (END) for oral tongue squamous cell carcinoma (OTSCC) typically involves level 4 due to potential metastases that may bypass levels 1-2. Our study challenges this notion and investi...INTRODUCTION: Elective neck dissection (END) for oral tongue squamous cell carcinoma (OTSCC) typically involves level 4 due to potential metastases that may bypass levels 1-2. Our study challenges this notion and investigates the necessity of level 4 inclusion in END for OTSCC. METHODS: A retrospective cohort study performed in a tertiary-care university affiliated medical center and included all OTSCC patients treated with END from 2000 to 2020, with a minimum 2-year follow-up. The study compared patients with END levels 1-3 to those with levels 1-4 regarding regional recurrence, disease-specific and disease-free survival rates. RESULTS: 120 patients with OTSCC and clinically negative neck were included. END included levels 1-4 in 33 patients (27.5%) and levels 1-3 in the remaining 87 patients (72.5%). Out of all 33 patients who underwent END of levels 1-4, only 1 patient had level 4 metastasis (3%). There was no significant difference in the regional recurrence rate (21.8% vs. 18.2%, p = 0.66) and level 4 recurrence rate (3.5% vs. 3%, p = 0.91) between the groups. No difference regarding 5-years overall, disease-specific, and disease-free survival was demonstrated between the 1-3 END and 1-4 END groups (69.3% vs. 61.1%, Log-rank p = 0.7, 82% vs. 66.2%, Log-rank p = 0.15% and 66.4% vs. 60.7%, Log-rank p = 0.54, respectively). CONCLUSION: Inclusion of level 4 in the elective neck dissection for OTSCC does not seem to improve regional control, disease-free and overall survival. Hence, elective neck dissection of levels 1-3 seems appropriate for most cases of OTSCC, as for other oral cavity subsites.
Radiomics is a growing field for diagnosis, prognostication, and therapeutic decision-making in numerous solid tumors. Despite current promising findings in pancreatic neuroendocrine tumors (PNETs), significant limitatio...Radiomics is a growing field for diagnosis, prognostication, and therapeutic decision-making in numerous solid tumors. Despite current promising findings in pancreatic neuroendocrine tumors (PNETs), significant limitations persist, including small cohorts, heterogeneous imaging protocols, and lack of external validation. This review elucidates the radiomics workflow, critically synthesizes the current evidence specifically surrounding the use of radiomics in PNETs, explicitly identifies methodological and reproducibility gaps, and outlines pragmatic research directions to bridge current drawbacks.
Mirza MB, Baechle JJ, Smith PM
… +9 more, Ali D, Dillhoff M, Poultsides G, Rocha FG, Cho CS, Winslow ER, Fields RC, Maithel SK, Idrees K
J Surg Oncol
· 2026 Feb · PMID 41520322
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INTRODUCTION: PNETs are rare pancreatic malignancies originating from islet cells and exhibit a strong co-occurrence with Diabetes Mellitus (DM), associated with worse survival outcomes. However, studies have yet to deli...INTRODUCTION: PNETs are rare pancreatic malignancies originating from islet cells and exhibit a strong co-occurrence with Diabetes Mellitus (DM), associated with worse survival outcomes. However, studies have yet to delineate the impact of insulin dependent (IDDM) and non-insulin dependent (NIDDM) on poor oncological outcomes. METHODS: Utilizing the U.S. Neuroendocrine Tumor Study Group database (1999-2016), we performed a retrospective cohort study of adult patients who underwent primary surgical resection of PNETs. Patients were categorized based on preoperative diagnosis into non-DM, NIDDM, and IDDM cohorts. We used the Kaplan-Meier method and log-rank test to study cancer-specific survival (CSS). Cox proportional Hazards models were used to assess the impact of IDDM on CSS. RESULTS: Of the 1122 patients included in the analysis, 870 (77%) were non-DM, 168 (15%) were NIDDM, and 84 (8%) were IDDM. The groups were similar in tumor stage and grade. However, they differed in sex, BMI, age, ASA class, tumor location, preoperative HbA1c, and serum glucose (p-value < 0.05). Patients with IDDM had significantly decreased 5-year CSS compared to patients without IDDM (CSS: IDDM 85%, NIDDM 94%, non-DM 93%, NIDDM + non-DM 93%; p < 0.01). On multivariate analysis, IDDM was independently associated with worse CSS (HR 2.27, 95% Confidence Interval 1.15-4.45, p = 0.02). CONCLUSION: Insulin dependence is associated with worse cancer-specific survival in PNET patients following surgical resection compared to PNET patients with NIDDM or without DM.
Hughes DL, Di Bella C, Quaratino B
… +6 more, Rigo P, Cirillo G, Sgrinzato G, Cillo U, Furian L, Marchegiani G
J Surg Oncol
· 2026 Mar · PMID 41508796
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This systematic review and meta-analysis assessed long-term outcomes following total pancreatectomy with islet autotransplantation (TPIAT). Seventeen studies including 1332 patients were analyzed. The pooled insulin inde...This systematic review and meta-analysis assessed long-term outcomes following total pancreatectomy with islet autotransplantation (TPIAT). Seventeen studies including 1332 patients were analyzed. The pooled insulin independence rate was 34%, with higher rates for non-chronic pancreatitis indications (68%) versus chronic pancreatitis (33%). TPIAT is effective in preserving endocrine function. Further studies are needed to validate outcomes across extended indications and to standardize reporting, incorporating metabolic markers and patient-reported quality-of-life endpoints over long-term follow-up.
Delgado LM, Pompeu BF, Macedo VDS
… +7 more, Martins GHA, Pasqualotto E, Araujo MR, Brunini JH, Nunes VA, Theis C, Junior SA
J Surg Oncol
· 2026 Mar · PMID 41508787
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INTRODUCTION: The management of extremity soft tissue sarcomas (STS) involving major vessels presents unique challenges, historically leading to amputation. Advances in vascular reconstruction have enabled limb-sparing s...INTRODUCTION: The management of extremity soft tissue sarcomas (STS) involving major vessels presents unique challenges, historically leading to amputation. Advances in vascular reconstruction have enabled limb-sparing surgery (LSS), but outcomes and perioperative risks remain uncertain. This systematic review and meta-analysis aimed to evaluate oncologic results following LSS with vascular reconstruction in extremity STS. METHODS: A systematic review and single-arm meta-analysis were performed according to PRISMA guidelines, with registration in PROSPERO. PubMed, Embase, and Cochrane Library were searched from inception to June 2025 for studies reporting outcomes in patients with extremity STS undergoing LSS with vascular reconstruction. Pooled analyses estimated limb salvage, survival, and complication rates using random-effects models. RESULTS: Thirty-one studies comprising 520 patients were included. Approximately 58% were male, with a mean age ranging from 29.3 to 59 years. The most common tumor localizations were the thigh (59.5%), inguinal region (15.9%), and popliteal fossa (8.6%). Liposarcoma (24.0%), synovial sarcoma (19.6%), and osteosarcoma (14.8%) were the most frequent histological subtypes. The pooled limb salvage rate was 89% (95% CI, 86%-92%), while amputation occurred in 10% (95% CI, 8%-14%). One- and 5-year overall survival rates were 89% and 62%, respectively, with disease-free survival rates of 74% and 55%. Major complications included graft thrombosis (19%), wound complications (29%), and wound infection (22%). CONCLUSIONS: Limb-sparing surgery with vascular reconstruction is effective for extremity STS involving major vessels, enabling high limb salvage and favorable long-term survival without compromising oncologic outcomes. However, substantial perioperative morbidity persists, underscoring the need for multidisciplinary care, careful patient selection, and prospective studies to refine indications and enhance quality of life.
Matias N, Naqvi A, Thomson J
… +5 more, Techache R, Avery K, Blencowe N, Macefield R, Alkhaffaf B
J Surg Oncol
· 2026 Mar · PMID 41502048
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Oesophageal carcinoma is a rising global health burden, with surgical resection and perioperative chemotherapy forming the cornerstone of curative treatment. However, uncertainty persists regarding the optimal surgical a...Oesophageal carcinoma is a rising global health burden, with surgical resection and perioperative chemotherapy forming the cornerstone of curative treatment. However, uncertainty persists regarding the optimal surgical approach, partly due to heterogeneity in outcome reporting, which hinders data synthesis and evidence-based decision-making. To address this, a core outcome set (COS) for oesophageal cancer surgery was developed through international consensus among clinicians and patients. This study systematically evaluates the uptake of these core outcomes in contemporary surgical research. A systematic review was conducted of randomised controlled trials and prospective cohort studies investigating oesophagectomy for oesophageal cancer, published between 2010 and 2024. The reporting of ten COS-recommended outcomes was assessed across eligible studies. Fifty-eight studies involving 22 260 patients were included (39 cohort studies; 19 RCTs). No study reported all 10 core outcomes. The median number of core outcomes reported was 4 (interquartile range 3-5). The frequency of individual core outcome reporting was as follows: in-hospital mortality (86%), conduit necrosis/leak (81%), respiratory complications (79%), overall survival (30%), ability to eat and drink (44%), quality of life (26%), inoperability (23%), reflux symptoms (21%), severe nutritional effects (19%), and need for reintervention (16%). No improvement in core outcome reporting was observed over the study period. Promoting COS implementation and improving methodological rigour is essential to ensure that future research reflects the priorities of both clinicians and patients, and facilitates meaningful evidence synthesis.
J Surg Oncol
· 2026 Mar · PMID 41499093
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BACKGROUND AND OBJECTIVE: Palliative surgery in oncology aims to relieve symptoms, improve quality of life, and respect patient autonomy in advanced cancer. This study aimed to develop evidence-based recommendations for...BACKGROUND AND OBJECTIVE: Palliative surgery in oncology aims to relieve symptoms, improve quality of life, and respect patient autonomy in advanced cancer. This study aimed to develop evidence-based recommendations for safely indicating and performing palliative surgeries in Brazil, considering clinical, ethical, and multidisciplinary aspects. METHODS: A modified Delphi consensus was conducted with nine experts from the Brazilian Society of Surgical Oncology, including surgical and clinical oncologists, palliative care specialists, and a psychologist. Sixteen key recommendations were formulated based on literature review and a national survey identifying gaps in training, communication, and technical safety. Consensus was defined as ≥ 80% agreement, achieved in a single round. RESULTS: Recommendations emphasize individualized patient selection based on functional status, frailty, prognosis, and symptom severity. Multidisciplinary evaluation, shared decision-making, clear communication, and consideration of minimally invasive techniques were prioritized. Palliative procedures focus on symptom control rather than survival extension, with evidence supporting improved quality of life, reduced hospital admissions, and enhanced oral intake. CONCLUSIONS: Palliative surgery should be guided by strict clinical criteria, multidisciplinary planning, and patient-centered communication. Active patient participation, ethical deliberation, and evidence-based practices ensure safe, effective, and humanized care, avoiding futile or disproportionate interventions.
Gebran A, Chopra A, Farah E
… +16 more, Hays S, Ranson K, Rojas A, Ceuppens S, Schmitz R, Liu H, Tirukkovalur NV, Talamonti M, Lee KK, Zeh HJ, Schmidt C, Boone BA, Hogg M, Zureikat AH, Polanco PM, Paniccia A
BACKGROUND AND OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) is characterized by limited survival rates, yet patients who achieve optimal CA19-9 response to neoadjuvant therapy (NAT) exhibit improved survival. This...BACKGROUND AND OBJECTIVES: Pancreatic ductal adenocarcinoma (PDAC) is characterized by limited survival rates, yet patients who achieve optimal CA19-9 response to neoadjuvant therapy (NAT) exhibit improved survival. This study examines the association between initial CA19-9 levels and survival in PDAC patients who achieved CA19-9 normalization with systemic chemotherapy. METHODS: A retrospective, multi-institutional analysis of patients with resectable/borderline-resectable PDAC, who underwent NAT and curative-intent pancreatectomy at the University of Pittsburgh Medical Center, University of Texas Southwestern Medical Center, NorthShore University, and West Virginia University To contexualize thi between 2010 and 2022, was performed. CA19-9 secretors (> 37 U/mL, with total bilirubin < 2) at diagnosis, with optimal response to NAT (normalization and > 50% drop in CA19-9) were included. A cutoff for pre-NAT CA19-9 of 400 U/mL was determined to maximize sensitivity and specificity for survival benefit, and the cohort was accordingly divided into two groups. Kaplan-Meier and Cox proportional-hazards models were used for univariate and multivariable analyses. RESULTS: A total of 134 patients were included, 32 (23.9%) had a pre-NAT CA19-9 ≥ 400U/mL. DFS and OS were considerably higher among patients with pre-NAT CA19-9 < 400U/mL (median(95%CI) in months, DFS:19.8(16.0,33.4) versus 7.8(5.0,13.0); OS:49.0(34.5,70.7) versus 23.1(13.8,50.9)). On multivariable analysis, pre-NAT CA19-9 ≥ 400 U/mL was significantly associated with reduced DFS and OS (DFS:HR = 2.4, p = 0.001; OS:HR = 1.9, p = 0.028). CONCLUSION: In this select cohort of PDAC patients with optimal NAT response, pre-NAT CA19-9 ≥ 400U/mL is strongly associated with decreased DFS and OS.
Core needle biopsy (CNB) is the preferred diagnostic method for suspected soft tissue and bone sarcoma, but nondiagnostic results remain common. To clarify the role of repeat biopsy, we conducted a systematic review of s...Core needle biopsy (CNB) is the preferred diagnostic method for suspected soft tissue and bone sarcoma, but nondiagnostic results remain common. To clarify the role of repeat biopsy, we conducted a systematic review of studies reporting repeat CNB after an initial nondiagnostic CNB, searching MEDLINE, EMBASE and PubMed. Nine studies involving nearly 9757 initial CNBs were included. Meta-analysis showed a pooled diagnostic yield of 69% (95% CI: 0.564-0.819) for repeat CNB. Subgroup analyses demonstrated a significantly higher diagnostic yield in bone sarcoma (83.1%) compared with soft tissue sarcoma (48.5%). The repeat CNB rate following a nondiagnostic initial biopsy was 5.48%. This study represents the first systematic review and meta-analysis evaluating repeat CNB in this setting, and it highlights substantial variability in diagnostic yield between sarcoma subtypes. Further research focusing on repeat biopsy across specific sarcoma subgroups is warranted to guide clinical decision-making.