Surgical Oncology[JOURNAL]
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200 papers
Retraction notice to "Effects of metastatic CRC predictors on treatment outcomes" [Surg. Oncol. 44(2022) 101835].
Smagulova KK, Kaidarova DR, Chingissova ZK … +2 more , Nasrytdinov TS, Khozhayev AA
Surg Oncol · 2026 Jun · PMID 42259006 · Publisher ↗
Abstract loading — click title to view on PubMed.
The Role of Routine Staging Laparoscopy for Pancreatic Adenocarcinoma in Underserved Populations: A 14-Year Experience at a Safety-Net Hospital.
Holmes DM, Reyes JEM, Hsu C … +1 more , Silberfein EJ
J Surg Oncol · 2026 Jun · PMID 42252681 · Publisher ↗
BACKGROUND: There are no consensus guidelines for staging laparoscopy (SL) in pancreatic ductal adenocarcinoma (PDAC) and existing data largely reflect insured referral populations. Routine SL has not been studied in und...
BACKGROUND: There are no consensus guidelines for staging laparoscopy (SL) in pancreatic ductal adenocarcinoma (PDAC) and existing data largely reflect insured referral populations. Routine SL has not been studied in underserved patient populations who face disparities in cancer diagnosis and treatment. We evaluated the utility of SL for potentially operable PDAC at an urban safety-net hospital and assessed its association with survival. METHODS: A single-institution retrospective review was performed of all patients undergoing SL for potentially resectable PDAC (May 2011-May 2025). The primary outcome was detection of occult metastasis. Associated factors were assessed using multivariable logistic regression. Survival was analyzed using Kaplan-Meier methods and log-rank tests. RESULTS: Fifty-two patients underwent SL and 18 (35%) received curative-intent surgery. Median age was 58 years, 87% were non-White, 40% non-English-speaking, and 89% presented emergently. SL identified occult metastatic disease in 12 patients (23.1%), including five (41.7%) identified by cytology alone. No clinicopathologic factors were associated with occult metastasis. Median overall survival was 9.5 months with occult metastasis versus 35.7 months without (p < 0.001), and 102.5 months after curative-intent surgery versus 17.8 months without resection (p < 0.001). CONCLUSIONS: Routine SL frequently upstaged patients, often by cytology alone, thereby avoiding non-therapeutic laparotomy and supporting consideration of its more routine use in underserved PDAC populations.
Anatomical variations and functional outcomes of the marginal mandibular nerve in neck dissection for head and neck malignancies: A prospective study.
Chakraborty S, Pathak A, Pandey M
Surg Oncol · 2026 May · PMID 42250431 · Publisher ↗
BACKGROUND: The marginal mandibular nerve (MMN) is vulnerable during neck dissection for head and neck cancer. This study documents its anatomical variations and evaluates postoperative functional and quality-of-life out...
BACKGROUND: The marginal mandibular nerve (MMN) is vulnerable during neck dissection for head and neck cancer. This study documents its anatomical variations and evaluates postoperative functional and quality-of-life outcomes. METHODS: A prospective observational study was conducted with fifty-one patients undergoing neck dissection for primary head and neck malignancy. Preoperative and postoperative assessments carried out at 1 and 3 months after surgery included clinical evaluation of lip symmetry, electromyography (EMG) of the depressor anguli oris, and quality-of-life (QoL) using FACT-H&N and Distress Inventory for Cancer (DIC) version-2 questionnaire. Intraoperative MMN anatomy was systematically recorded. RESULTS: MMN was identified in all the 51 neck dissections carried out. Mean number of branches was 1.05 ± 0.23, and mean distance from the mandibular border was 1.67 mm. Lip asymmetry was observed in over 50% of patients at 1 month, decreasing to 20% at 3 months. EMG showed complete denervation in 13 patients at 1 month, which continued till 3 months with no recovery, the branch was sacrificed in 11 of these for oncological clearance. FACT-H&N scores and DIC2 scores improved at 6 months follow-up. CONCLUSION: Meticulous identification and preservation of the MMN minimize transient dysfunction, with most patients achieving functional recovery and QOL improvement by 3 months.
Pancreas-contactless open gastrectomy for gastric cancer and postoperative pancreatic complications: A retrospective cohort study.
Fujita S, Harada H, Okuno K … +7 more , Sakuraya M, Higuchi T, Kumagai K, Naitoh T, Kumamoto Y, Yamashita K, Hiki N
Surg Oncol · 2026 May · PMID 42250430 · Publisher ↗
BACKGROUND: Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy, particularly during suprapancreatic lymph node dissection. While a pancreas-contactless technique reduces POPF in minimally...
BACKGROUND: Postoperative pancreatic fistula (POPF) is a serious complication after gastrectomy, particularly during suprapancreatic lymph node dissection. While a pancreas-contactless technique reduces POPF in minimally invasive surgery, its impact in open gastrectomy remains unclear. This study compared outcomes between pancreas-contact and pancreas-contactless techniques in open gastrectomy for gastric cancer. METHODS: Patients who underwent open gastrectomy for gastric cancer between 2015 and 2024 were retrospectively reviewed. They were classified into the contact group, in which the pancreas was compressed with gauze, and the contactless group, in which the suprapancreatic area was exposed by retracting the root of the transverse mesocolon along the inferior border of the pancreas without direct pancreatic contact. Perioperative outcomes were compared, and propensity score matching (PSM) was performed to adjust for baseline differences. RESULTS: A total of 161 patients were included (contact n = 66; contactless n = 95). Operative time was longer in the contactless group (399 vs 330 min, p < 0.001), whereas blood loss and hospital stay were similar. POPF was less frequent in the contactless group (0 vs 7.6%, p = 0.006), as was intra-abdominal abscess (3.2 vs 12.1%, p = 0.027). Body temperature on postoperative day 5 was lower before matching (p = 0.043), and on postoperative day 1 remained lower after PSM (p = 0.047). After PSM, the contactless group continued to show significantly fewer POPF and abscess cases. CONCLUSION: Pancreas-contactless open gastrectomy was associated with lower rates of POPF and intra-abdominal abscess without worsening perioperative outcomes.
Comment on "Pancreas-contactless open gastrectomy for gastric cancer and postoperative pancreatic complications: A retrospective cohort study".
Sati DM, Shinde VD, Agarwal C
Surg Oncol · 2026 Jun · PMID 42250429 · Publisher ↗
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Safety and feasibility of subtotal gastrectomy compared with completion total gastrectomy for remnant gastric cancer: A systematic review and meta-analysis.
Menegat BLRS, Menegat ALRS, Dantas CR … +1 more , de Moraes FCA
Surg Oncol · 2026 Jun · PMID 42248045 · Publisher ↗
BACKGROUND: Remnant gastric cancer is an uncommon malignancy with no established optimal surgical approach. Completion total gastrectomy remains the conventional treatment but is technically demanding with high morbidity...
BACKGROUND: Remnant gastric cancer is an uncommon malignancy with no established optimal surgical approach. Completion total gastrectomy remains the conventional treatment but is technically demanding with high morbidity. Subtotal gastrectomy has been proposed as an organ-preserving alternative, although its oncologic adequacy remains uncertain. Therefore, we performed a systematic review and meta-analysis comparing subtotal gastrectomy with completion total gastrectomy for remnant gastric cancer. METHODS: A systematic search of PubMed, Embase, and the Cochrane Library identified studies comparing subtotal gastrectomy and completion total gastrectomy in remnant gastric cancer. Meta-analyses employed a random-effects model, with pooled estimates reported as risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. Analyses were performed with R (version 4.4.1). RESULTS: Seven retrospective cohort studies including 601 patients were analyzed, of whom 120 patients (19.97%) underwent subtotal gastrectomy. Subtotal gastrectomy was associated with shorter operative time (MD -39.34 min; p < 0.01) and lower intraoperative blood loss (MD -91.22 mL; p < 0.01). No significant differences were observed in overall survival (HR 0.95; p = 0.8314), recurrence-free survival (HR 0.90; p = 0.4206), margin status (R0), tumor recurrence (9.16% vs 16.42%; RR 0.74; p = 0.34), number of lymph nodes retrieved (MD -0.85; p = 0.53), overall postoperative complications (RR 0.66; p = 0.2478), wound infection, pancreatic fistula, anastomotic leak, or length of hospital stay. CONCLUSION: Subtotal gastrectomy was associated with improved intraoperative outcomes, with no statistically significant differences observed in oncologic and postoperative outcomes. These findings suggest that subtotal gastrectomy may be a feasible organ-preserving option in selected patients, although further studies are needed.
Molecular subtypes and lymph-node metastasis in endometrial cancer: An updated systematic review and meta-analysis.
Pereira RA, Barcellos G, Tumelero M … +5 more , Francisco A, Collin B, Valagni G, Peruzzo N, Lenz G
Surg Oncol · 2026 Jun · PMID 42242033 · Publisher ↗
OBJECTIVE: Although prognostic stratification has improved with the use of molecular classification in endometrial cancer staging, it is still unclear how this will affect lymph-node metastasis in modern surgical practic...
OBJECTIVE: Although prognostic stratification has improved with the use of molecular classification in endometrial cancer staging, it is still unclear how this will affect lymph-node metastasis in modern surgical practice. The objective of this meta-analysis was to update and refine pooled estimates of lymph-node metastasis prevalence across the molecular subtypes of endometrial cancer. METHODS: We performed a systematic review and meta-analysis in accordance with PRISMA 2020 guidelines (PROSPERO: CRD420251276666). PubMed, Embase, and the Cochrane Library were searched through December 2025. Eligible studies reported lymph-node status based on TCGA/ProMisE molecular subtypes (POLE-mutated (POLEmut), mismatch repair-deficient (MMRd), no specific molecular profile (NSMP), p53-abnormal (p53abn)). RESULTS: 21 studies with 8963 patients were included. p53abn tumors showed the highest pooled lymph node metastasis rate (24%, 95% CI 17-32%), followed by MMRd (15%, 95% CI 11-20%) and NSMP tumors (10%, 95% CI 7-14%). POLEmut tumors consistently demonstrated low rates of nodal involvement (9%, 95% CI 6-14%). These findings were robust across leave-one-out sensitivity analyses. Pooled lymph-node metastasis rates were broadly similar between sentinel lymph node (SLN) and lymphadenectomy cohorts across molecular subtypes, although these comparisons should be interpreted cautiously. CONCLUSIONS: Molecular classification provides clinically meaningful information beyond traditional histopathologic factors and is closely associated with the risk of lymph-node metastasis in endometrial cancer. The consistently low nodal involvement observed in POLEmut and the high risk observed in p53abn support a more tailored approach to surgical staging.
Impact of postoperative pancreatic fistula (POPF) on long-term outcomes of patients who underwent pancreatic cancer resection: systematic review and meta-analysis.
Kyang LS, Jung J, Li S … +10 more , Daneshmand A, Pham H, Nagrial A, Wong M, Pleass H, Richardson A, Yuen L, Lam V, Pang T, Nahm CB
Surg Oncol · 2026 Jun · PMID 42242032 · Publisher ↗
INTRODUCTION: Postoperative pancreatic fistula (POPF) is a major complication resulting from pancreatic resection. The long-term oncological outcomes of patients who experience POPF after pancreatic cancer resection rema...
INTRODUCTION: Postoperative pancreatic fistula (POPF) is a major complication resulting from pancreatic resection. The long-term oncological outcomes of patients who experience POPF after pancreatic cancer resection remain inconclusive. The purpose of this study was to evaluate the impact of POPF on the long-term survival of patients undergoing pancreatic cancer resection. METHODS: A systematic review and meta-analysis were performed for studies comparing survival outcomes in patients with or without POPF following pancreatic cancer resection. RESULTS: Eighteen studies were included in the systematic review comprising a total of 7919 patients. The pooled incidences of POPF (ISGPF 2005 definition) and clinically-relevant (CR-POPF; ISGPF 2016 definition) were 20% and 14%, respectively. The presence of CR-POPF was significantly associated with worse recurrence-free survival (HR 1.60, 95% CI 1.01-2.53). In contrast, its association on overall survival was limited to grade C POPF (HR 1.81, 95% CI 1.10-2.99). Patients with POPF were also less likely to receive adjuvant chemotherapy (RR 0.76, 95% CI 0.60-0.97, p = 0.03). POPF was not associated with increased risk of locoregional (RR 1.29, 95%CI 0.77-2.17, p = 0.18) or peritoneal recurrence (RR 0.86, 95%CI 0.63-1.19, p = 0.59). CONCLUSIONS: CR-POPF is significantly associated with cancer recurrence after pancreatic resection. However, its effect on overall survival is largely confined to the most severe grade C POPF. Although POPF decreases the likelihood of receiving adjuvant chemotherapy, the association of POPF on the peritoneal or locoregional recurrence remains inconclusive due to limited studies. These findings are suggestive of the importance to prevent severe fistulas.
Parotidectomy: 10-Year Experience in the Hands of Surgical Oncologists.
Su AY, Koness J, Calvino AS … +2 more , Somasundar P, Kwon S
J Surg Oncol · 2026 Jun · PMID 42236664 · Publisher ↗
BACKGROUND AND OBJECTIVES: Parotidectomy is the most common salivary gland surgery, but there remains a paucity of literature regarding its outcomes in the hands of surgical oncologists. METHODS: A retrospective review w...
BACKGROUND AND OBJECTIVES: Parotidectomy is the most common salivary gland surgery, but there remains a paucity of literature regarding its outcomes in the hands of surgical oncologists. METHODS: A retrospective review was conducted of all patients (n = 74) who underwent parotidectomy by surgical oncologists at a single institution over 10 years (2015-2025). Demographics, perioperative characteristics, and complications were compared. Associations between clinical factors and complications were evaluated by multivariate logistic regression. RESULTS: Most patients were White (85.1%) and male (51.4%) with a mean age of 59.9 years. The most common comorbidities were hypertension (48.6%), current smoking (40.5%), and anxiety (17.6%). Temporary facial nerve paresis occurred in 40.3% of patients by postoperative day one, with no cases of permanent facial nerve paresis. Frey's syndrome occurred in 9.0% and First Bite Syndrome (FBS) in 10.4% of tumor cases; a higher proportion of malignant cases experienced these complications in comparison to benign indications. Positive lymph node status was associated with FBS (p = 0.015), potentially reflecting more extensive surgical dissection. No significant risk factors were identified for other complications. CONCLUSIONS: This study suggests that surgical oncologists with appropriate training can perform parotidectomies with complication rates within published ranges. Larger multicenter studies are needed to validate these findings and examine associations between clinical factors and rare complications, further establishing the role of surgical oncologists in parotidectomy.
Ultrasound-guided, organ-sparing robotic resection of a gastric GIST adjacent to the esophagogastric junction.
Guerra F, Matarazzo F, Lombardi A … +1 more , Coratti A
Surg Oncol · 2026 May · PMID 42235334 · Publisher ↗
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Chronic pleural effusion one year after lung cancer surgery is associated with non-cancer mortality and postoperative nutritional decline.
Tsukamoto Y, Nakada T, Watanabe Y … +6 more , Li L, Suyama Y, Nakashima M, Shibazaki T, Kinoshita T, Ohtsuka T
Surg Oncol · 2026 May · PMID 42235333 · Publisher ↗
OBJECTIVES: To evaluate the impact of postoperative chronic pleural effusion (CPE) at 1 year on long-term prognosis and host nutritional and physical status following anatomic resection for non-small cell lung cancer. ME...
OBJECTIVES: To evaluate the impact of postoperative chronic pleural effusion (CPE) at 1 year on long-term prognosis and host nutritional and physical status following anatomic resection for non-small cell lung cancer. METHODS: This single-center retrospective study included 372 patients (2017-2021). CPE was defined as pleural fluid volume ≥80 mL on computed tomography scan at 1 year postoperatively, while no pleural fluid or pleural fluid volume <80 mL was defined as non-CPE. Inverse probability of treatment weighting (IPTW) was performed to adjust for preoperative baseline confounding factors between the two groups. The primary endpoint was overall survival. Secondary endpoints included cancer-specific death and changes in nutritional/physical indicators. RESULTS: CPE was observed in 36 patients (9.7%), all of whom had demonstrated persistent effusion since 6 months postoperatively. In the IPTW-adjusted analysis, CPE was identified as an independent prognostic factor for poor OS (Hazard ratio 3.38; 95% confidence interval (CI), 1.57-7.26; p = 0.002). Competing-risk analysis revealed that CPE was a significant independent predictor of non-cancer death (Subdistribution HR 4.76; 95% CI, 1.56-14.41; p = 0.006), whereas no significant association was found with cancer-specific death. Analysis of non-cancer deaths showed that respiratory diseases, predominantly pneumonia, were the leading cause of death in the CPE group (9 of 12 patients, 75.0%). Weighted competing-risk analysis confirmed that CPE was a significant independent predictor specifically for pneumonia-related death (Subdistribution HR 5.26; 95% CI, 1.07-25.91; p = 0.041), with a 5-year weighted cumulative incidence of 11.89% in the CPE group versus 2.2% in the non-CPE group. Furthermore, patients with CPE exhibited significantly greater declines in Prognostic Nutritional Index (-4.1% vs 2.3%, p = 0.003), body weight (-5.4% vs -1.2%, p = 0.001), and Pectoralis Muscle Index (-11.5% vs -6.3%, p = 0.055) during the first postoperative year. CONCLUSIONS: Postoperative CPE was identified as an independent risk factor for non-cancer death, especially pneumonia-related death, and was associated with significant nutritional and physical deterioration. These findings suggest that CPE represents a clinical indicator of systemic wasting and physiological decline rather than merely a local fluid retention.
Long-term spectrum and outcomes of post-transplant malignancy following liver transplantation: A comprehensive single-center study.
Megaly MG, DeFor T, Luo X … +2 more , Durant JA, Matar AJ
Surg Oncol · 2026 May · PMID 42229203 · Publisher ↗
BACKGROUND: Malignancy is a leading cause of mortality after liver transplantation (LT), yet its long-term incidence and outcomes remain incompletely defined. METHODS: We performed a retrospective single-center cohort st...
BACKGROUND: Malignancy is a leading cause of mortality after liver transplantation (LT), yet its long-term incidence and outcomes remain incompletely defined. METHODS: We performed a retrospective single-center cohort study of 1841 adult LT recipients transplanted between 1990 and 2025 to characterize the spectrum, and outcomes post-transplant malignancy. Competing-risk methods accounting for non-cancer mortality were used to estimate cumulative incidence, and Fine-Gray regression identified independent predictors. RESULTS: Over a median follow-up of 10.6 years, the 25-year cumulative incidence of non-hepatocellular carcinoma (HCC) solid organ malignancy was 18%, while skin malignancy occurred in 29% of recipients. Post-transplant lymphoproliferative disorder developed in 4%, non-PTLD hematologic malignancies in 1%, and post-transplant or recurrent HCC in 18%. Malignancy related mortality accounted for 20% of deaths, second only to infection (23%). Lung, prostate, head and neck, colorectal, and renal cell carcinomas were the most common solid organ malignancies. Increasing age at transplantation independently increased solid organ malignancy risk (hazard ratio 1.22 per decade), while female sex was protective. Survival after malignancy varied substantially by cancer type, with particularly poor outcomes following solid organ malignancy and post-transplant HCC. DISCUSSION: ost-transplant malignancy represents a substantial and enduring burden after LT and is a major contributor to late mortality. These findings support the need for lifelong, risk-adapted cancer surveillance strategies tailored to individual patient risk.
Metabolomic profiling of pancreatic juice: a potential prognostic tool for pancreatic ductal adenocarcinoma.
Desiato E, Barbagallo M, Brunelli L … +8 more , Nappo G, Gavazzi F, Ridolfi C, Pagnanelli M, Luberto A, Zerbi A, Marchesi F, Capretti G
Surg Oncol · 2026 May · PMID 42229202 · Publisher ↗
BACKGROUND: Treatment for pancreatic Ductal Adenocarcinoma (PDAC) remains a major challenge despite recent advancements. Selecting biological subgroups could improve stratification and address targeted therapies. Metabol...
BACKGROUND: Treatment for pancreatic Ductal Adenocarcinoma (PDAC) remains a major challenge despite recent advancements. Selecting biological subgroups could improve stratification and address targeted therapies. Metabolomic analysis of pancreatic juice (PJ) is a promising technology to identify disease-specific profiles. The aim of this study is to evaluate the association of PJ metabolomics with PDAC patients' clinical profiles, prognostic characteristics and long-term outcomes. METHODS: Data of patients undergoing pancreatic resection for PDAC at Humanitas Research Hospital were prospectively collected. PJ samples were retrieved intraoperatively and processed through flow injection-high resolution mass spectrometry analysis (FIA-HRMS). Untargeted and targeted analysis were performed. Univariable and multivariable models assessed associations between metabolites and clinicopathologic variables. Survival analyses evaluated correlations with long-term outcomes. RESULTS: Fifty-eight patients were included; metabolomic analysis of PJ revealed three metabolic clusters with comparable demographic characteristics. Cluster 2 showed higher levels of amino acids, phospholipids, sphingomyelin and cholesteryl esters compared to Cluster 3. Cluster 2 showed higher likelihood of T3-T4 tumours (OR 10.68, CI 1.84-61.93, p = 0.01) and lymph nodal involvement (OR 14.02, CI 1.58-124.2, p = 0.02). Even though Kaplan-Meier curves did not show clear survival separation across clusters, higher cholesteryl ester concentrations were associated with improved DFS. CONCLUSION: The correlation between metabolomic clusters and cancer staging, along with the association of specific metabolites with survival outcomes, suggest that PJ composition might reflect PDAC aggressiveness. The feasibility of preoperative PJ endoscopic collection underscores its possible clinical application for patients' stratification and potential identification of therapeutic targets. Larger cohorts' analyses are needed to validate these findings.
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.
Exploring osteoporosis risk in breast cancer patients after comprehensive treatment via explainable artificial intelligence algorithms.
Zhang M, Chen D, Yang S … +11 more , Xie J, Li X, Sha Y, Yu H, Lin Z, You W, Huang Z, Hong Z, Ye R, Yuan Q, Zeng R
Surg Oncol · 2026 May · PMID 42208119 · Publisher ↗
BACKGROUND: Osteoporosis is a common complication among long-term breast cancer (BC) survivors. Assessment of osteoporosis risk of patients before therapy is essential for timely intervention and long-term health managem...
BACKGROUND: Osteoporosis is a common complication among long-term breast cancer (BC) survivors. Assessment of osteoporosis risk of patients before therapy is essential for timely intervention and long-term health management. METHODS: We included female BC patients treated between 2018 and 2022 at a tertiary hospital in China. Baseline characteristics, hematologic parameters, and pathological subtypes were collected and stratified into four molecular groups based on hormone receptor and HER2 status. Twelve machine learning (ML) algorithms were developed, and the best-performing models were interpreted using SHAP analysis. RESULTS: Among 1314 patients, 546 (41.6%) were diagnosed with osteoporosis, predominantly in HR-positive subtypes. Random Forest achieved the best performance in HR-/HER2-patients (validation AUC = 0.773), with platelet count, LDH, age, γ-GTP, uric acid, and globulin as key predictors. In HR-/HER2+ patients, Gradient Boosting performed optimally (AUC = 0.942), with hematologic and metabolic markers as major contributors. For HR+/HER2-and HR+/HER2+ groups, Boosting models reached AUCs of 0.832 and 0.771, respectively, with nodal stage, age, platelet count, uric acid, and liver/renal indices as leading predictors. SHAP dependence plots revealed critical interactions, such as age with platelet count and nodal stage with bilirubin. CONCLUSIONS: Osteoporosis risk varies substantially across molecular subtypes of BC and is shaped by both clinical and biochemical factors. ML combined with explainable AI provides accurate prediction and highlights key risk determinants, offering a potential evaluated tool for personalized bone health management in BC survivors.
Efficacy of near-infrared indocyanine green imaging in D2 lymphadenectomy for gastric cancer: A systematic review and meta-analysis comparing eastern and western cohorts.
Kruszyna B, Orzechowska D, Setlak Z … +2 more , Kruszyna T, Kenig J
Surg Oncol · 2026 May · PMID 42202594 · Publisher ↗
BACKGROUND: Accurate D2 lymphadenectomy is the cornerstone of curative gastric cancer surgery. Near-infrared indocyanine green (NIR-ICG) fluorescence imaging has emerged as an adjunctive technology that enhances lymphati...
BACKGROUND: Accurate D2 lymphadenectomy is the cornerstone of curative gastric cancer surgery. Near-infrared indocyanine green (NIR-ICG) fluorescence imaging has emerged as an adjunctive technology that enhances lymphatic visualization, potentially improving node retrieval and supporting intraoperative assessment of D2 lymphadenectomy. However, the global reproducibility of these results and their applicability across surgical settings remain uncertain. METHODS: A systematic review and meta-analysis were performed according to PRISMA guidelines (PROSPERO registration: CRD420251166824). Electronic databases and clinical trial registries were searched for studies comparing NIR-ICG-guided versus conventional D2 lymphadenectomy for gastric cancer. Random-effects models using the Knapp-Hartung adjustment were applied. Subgroup analyses assessed surgical volume and geographical region. Risk of bias was evaluated with Cochrane RoB 2 and ROBINS-I tools. RESULTS: Eleven studies were included, with seven meeting quality thresholds for the main analysis (992 patients). NIR-ICG guidance significantly increased lymph node yield compared with conventional surgery (mean difference = 9.08; 95% CI 7.70-10.46; p < 0.001) without prolonging operative time or increasing major complications. Subgroup analyses revealed greater benefits in low-volume centers (d = 0.66 vs d = 1.68; p = 0.01) and comparable outcomes between Chinese and Italian cohorts. No significant heterogeneity or publication bias was detected. CONCLUSIONS: NIR-ICG fluorescence imaging markedly improves lymph node yield and potentially supports completeness of D2 lymphadenectomy in selected settings without compromising safety. The technique demonstrates consistent efficacy across different surgical settings and may be particularly advantageous for standardization and training in lower-volume institutions. Despite promising results, findings require careful interpretation and more detailed analysis of surgical outcomes.
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