Surgical Oncology[JOURNAL]
Sun
200 papers
Appetite-preserving gastrectomy attenuates early postoperative deterioration of bone quality after surgery in esophagogastric junction cancer.
Harada H, Minoura H, Okuno K … +8 more , Kawana K, Fujita S, Higuchi T, Kumagai K, Naitoh T, Kumamoto Y, Yamashita K, Hiki N
Surg Oncol · 2026 May · PMID 42190548 · Publisher ↗
BACKGROUND: Bone loss after gastrectomy is a clinically important but often underestimated complication, particularly in elderly patients with gastric or esophagogastric junction (EGJ) cancer. Total gastrectomy (TG) has...
BACKGROUND: Bone loss after gastrectomy is a clinically important but often underestimated complication, particularly in elderly patients with gastric or esophagogastric junction (EGJ) cancer. Total gastrectomy (TG) has been associated with postoperative deterioration of bone health. Appetite-preserving gastrectomy (APG) preserves the ghrelin-secreting region of the stomach and maintains appetite and lean body mass; however, its impact on postoperative bone health remains unclear. METHODS: This retrospective observational study included 28 patients with EGJ cancer who underwent curative gastrectomy between April 2023 and October 2025 (APG, n = 22; TG, n = 6). Bone mineral content (BMC) was assessed using bioelectrical impedance analysis, and vertebral bone attenuation was evaluated using CT-based L1 Hounsfield unit (HU) measurements preoperatively and at 6 and 12 months postoperatively. Nutritional parameters, serum ghrelin levels, and body composition were analyzed. RESULTS: Baseline characteristics were comparable between groups. Changes in BMC did not differ significantly postoperatively. At 6 months, changes in L1 attenuation were similar between APG and TG. At 12 months, L1 attenuation was preserved in the APG group but declined markedly in the TG group (median ΔL1: +7.7 HU vs -30.9 HU, p = 0.0076). Postoperative serum ghrelin levels were partially preserved after APG, and postoperative reductions in body weight and lean body mass tended to be less pronounced. CONCLUSIONS: APG may attenuated early postoperative deterioration of vertebral bone quality compared with TG. Preservation of the ghrelin-secreting region may mitigate early postoperative catabolic effects on musculoskeletal tissues, supporting APG as an endocrine-preserving surgical strategy for EGJ cancer.
Level of Vascular Ligation for Sigmoid Colon Cancer: Does It Matter? The Pina Low-T Study.
Picotto S, Seno E, Calabrò M … +5 more , Di Marzo M, Lo Moro G, Santarelli M, Delrio P, Muratore A
J Surg Oncol · 2026 May · PMID 42186358 · Publisher ↗
BACKGROUND AND METHODS: In sigmoid colon cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin (high ligation, HLG) or distal to the left colic artery bifurcation (low ligation, LLG). While hi...
BACKGROUND AND METHODS: In sigmoid colon cancer surgery, the inferior mesenteric artery (IMA) can be ligated at its origin (high ligation, HLG) or distal to the left colic artery bifurcation (low ligation, LLG). While high ligation facilitates lymph node harvest and mobilization, it may compromise colonic perfusion and increase nerve injury risk. Low ligation preserves the LCA and may improve anastomotic blood supply. We conducted a retrospective multicenter study including patients who underwent sigmoidectomy for sigmoid colon cancer between January 2017 and December 2022. Short- and long-term outcomes were compared between HLG and LLG. RESULTS: A total of 185 patients were included (127 HLG, 58 LLG). Median postoperative length of stay was similar (6 vs. 5 days; p = 0.879). Anastomotic leak rates were 5.5% in HLG and 1.7% in LLG (p = 0.438). Patients undergoing LLG had a higher comorbidity burden, and more than half of the cohort was aged ≥ 70 years. Lymph node yield was higher in HLG (20 vs. 15; p < 0.001). Three-year disease-free survival (85.5% vs. 87.3%; p = 0.751) and overall survival (89.7% vs. 80.7%; p = 0.098) were comparable, with no differences in recurrence patterns. CONCLUSIONS: IMA ligation level does not significantly influence outcomes. However, in elderly or fragile patients, low ligation achieves very low leak rates without compromising oncological safety.
Venous Thromboembolism Risk and Prevention After Gastrointestinal Cancer Surgery: Real World Evidence From a Large Integrated Healthcare System.
Qi T, Liu IA, Wu YL … +3 more , Park SJ, Dehal AN, Gould MK
J Surg Oncol · 2026 May · PMID 42177803 · Publisher ↗
BACKGROUND AND METHODS: Venous thromboembolism (VTE) is common and preventable following surgery for gastrointestinal (GI) cancer. In this retrospective cohort study, we aimed to characterize VTE risk factors, prophylaxi...
BACKGROUND AND METHODS: Venous thromboembolism (VTE) is common and preventable following surgery for gastrointestinal (GI) cancer. In this retrospective cohort study, we aimed to characterize VTE risk factors, prophylaxis, and outcomes among patients who underwent surgery for GI cancer between 2019 and 2021 at Kaiser Permanente Southern California. The discrimination of the Caprini and IMPROVE risk models for predicting VTE was assessed using the area under the receiver operating characteristic curve (AUC). RESULTS: Among 2702 patients, the 90-day incidence of perioperative VTE was 2.1%. VTE was associated with older age, prior VTE, thrombophilia, low serum albumin, and blood transfusion, but not procedure time or surgical approach. VTE was especially common among patients with gastric cancer (4.5%). In-hospital prophylaxis was nearly universal, but post-discharge prophylaxis was uncommonly utilized (22.9%). VTE was associated with a five-fold increase in 90-day mortality. Both Caprini (AUC 0.65, 95% CI 0.57-0.72) and IMPROVE (AUC 0.65, 95% CI 0.57-0.73) models demonstrated only fair discrimination. CONCLUSIONS: Despite adherence with recommended in-hospital prophylaxis, VTE remains an important complication following GI cancer surgery, carrying with it an increased risk of mortality. DISCUSSION: Suboptimal discrimination of risk prediction models and underutilization of post-discharge prophylaxis represent ongoing opportunities for quality improvement.
The Impact of Breast Reconstruction on Smoking Cessation Among Patients With Breast Cancer.
Hendizadeh AN, Wen A, Guidi R … +8 more , Ritz E, Rao R, Alvarado R, Perez C, Madrigrano A, Kurlander D, Shenaq D, Kokosis G
J Surg Oncol · 2026 May · PMID 42177800 · Publisher ↗
BACKGROUND AND OBJECTIVES: In this study, we aim to evaluate trends in smoking cessation among breast cancer patients, with a particular focus on the impact of breast reconstruction surgery, and to assess if breast recon...
BACKGROUND AND OBJECTIVES: In this study, we aim to evaluate trends in smoking cessation among breast cancer patients, with a particular focus on the impact of breast reconstruction surgery, and to assess if breast reconstruction surgery represents a unique opportunity for intervention. METHODS: We performed a retrospective analysis of active smokers with a new diagnosis of breast cancer who were treated with any surgical or non-surgical intervention at our institution between 2015 and 2024. Quitting was defined as continuous cessation for at least 30 days. Patients who quit were followed for at least 6 months after cessation. RESULTS: One hundred twenty-seven patients were identified. Mean age was 56 years (range 35-87). Eighty patients (63%) underwent surgery without reconstruction, 26 patients (20%) underwent surgery with reconstruction, and 21 patients (17%) received non-surgical treatment only. Overall, 26% (34/127) of patients quit smoking. Among patients undergoing surgical treatment, patients undergoing reconstruction were significantly more likely to quit smoking than those without reconstruction (50% [13/26] vs. 23% [18/80]; p = 0.007). Patients receiving reconstruction were also significantly more likely to quit preoperatively (77% [10/13] vs. 33% [12/18]; p = 0.048). Median time from initial visit with surgical oncology to surgery was longer among reconstructive patients who quit pre-operatively (90.5 days [IQR: 44-164]) than those who quit post-operatively or did not quit (45 days [IQR: 26-68]; p = 0.13). CONCLUSIONS: Patients receiving breast reconstruction are significantly more likely to quit smoking than those who do not. Longer median time to surgery among patients who quit pre-operatively emphasizes the need for targeted cessation interventions that allow for timely oncologic care.
A preoperative ultrasound-based radiomics-clinical nomogram to assess metastasis of ipsilateral supraclavicular lymph nodes in patients with primary breast cancer: A biomarker based on breast and axillary images.
Zhou C, Qiu JJ, Wu X … +4 more , Zhao H, Yin J, Lin R, Lv Q
Surg Oncol · 2026 Jun · PMID 42172853 · Publisher ↗
BACKGROUND: Breast cancer patients with ipsilateral supraclavicular lymph node (ISLN) metastasis often experience poor prognosis. A non-invasive method for preoperative diagnosis of ISLN metastasis is warranted. METHODS:...
BACKGROUND: Breast cancer patients with ipsilateral supraclavicular lymph node (ISLN) metastasis often experience poor prognosis. A non-invasive method for preoperative diagnosis of ISLN metastasis is warranted. METHODS: This study included breast cancer patients with suspected ISLN involvement. After randomly dividing patients into training and validation groups at 3:2 ratio, radiomic models were constructed using ultrasound (US) images of the breast, axilla, and ISLN. A radiomic score (radscore) was developed using Student's t-test, Fisher's correlation coefficient, and LASSO regression, with 5-fold cross-validation (CV) applied during model construction. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves in the validation group. A nomogram combining the radscore (from the optimal radiomic model) and clinicopathological variables was developed in the training group. RESULTS: The study involved 547 ultrasound images from 186 eligible patients (112 in the training group and 74 in the validation group). The model combining radiomic features of breast and axillary ultrasound images based on LASSO regression demonstrated superior performance. A nomogram incorporating clinicopathological characteristics (including T-stage, HER-2 status and CA15-3) and radscore (comprising 10 radiomic features) was constructed. The area under the ROC curve (AUC) for ISLN diagnosis were 0.876 (95% CI 0.818-0.941, P < 0.001) and 0.837 (95% CI 0.733-0.952, P = 0.026) in the CV and validation groups, respectively. CONCLUSION: Radiomic features derived from breast and axillary US images are valuable for assessing ISLN metastasis in breast cancer patients. The preoperative US-based radiomic-clinical nomogram effectively predicts ISLN metastasis non-invasively.
Robotic thyroidectomy using Artificial Intelligence (AI) model in real-time recognizing Recurrent Laryngeal Nerves (RLN).
Wang H, Sun R, Hua S
Surg Oncol · 2026 Jun · PMID 42167959 · Publisher ↗
BACKGROUND: Robotic surgery is gaining momentum in thyroidectomy particularly among young female patients. Swallowing, voice disorders, throat discomfort and cervical scarring represent major sources of anxiety due to so...
BACKGROUND: Robotic surgery is gaining momentum in thyroidectomy particularly among young female patients. Swallowing, voice disorders, throat discomfort and cervical scarring represent major sources of anxiety due to social and occupational concerns. This has driven demand for precise and scarless approaches to improve safe and cosmetic outcomes to reduce psychological burden [1]. While endoscopic thyroidectomy has gained popularity, its technical limitations including restricted endoscopic visualization, limitation of fixed magnification, and the 'chopstick' effect of rigid instruments compromise on precision and safety during dissection along RLN. Robotic thyroidectomy emerges as a promising alternative, offering three-dimensional high-definition images, magnification, multiple forceps articulation, tremor-stabilization function and motion scale function [2]. Concurrently, advances in AI-powered intraoperative image recognition are enhancing real-time identification of critical structures like the RLN during procedures, further improving surgical precision and safety [3,4]. METHODS: The video demonstrates robotic thyroidectomy in a 42-year-old female patient with a 0.6 × 0.5 × 0.5cm irregularly shaped nodule (TI-RADS 4a) at the dorsal mid-portion of the right lobe, presenting ill-defined margins, taller-than-wide sign, and capsular invasion with multiple abnormal right central lymph nodes. Ultrasound-guided fine-needle aspiration (FNA) confirmed papillary thyroid carcinoma (Bethesda Category VI) with BRAF V600E mutation positivity. Given her strong preference against cervical scarring and expressed concerns regarding postoperative voice changes, she underwent robotic thyroidectomy with a novel AI-assisted real-time RLN navigation. RESULTS: We performed right lobectomy with isthmusectomy and concomitant right central compartment lymph nodes dissection (CCND). The AI system provided continuous real-time guidance with robust performance across diverse surgical conditions (Fig. 1). Total operative time was 120 minutes with minimal blood loss. The patient experienced no postoperative hoarseness and discharged on the third postoperative day. Final pathology confirmed papillary thyroid carcinoma (classical variant) with metastatic involvement in perithyroidal and right paratracheal lymph nodes (2/5). CONCLUSION: This video demonstrates the feasibility and safety of AI-assisted real-time recognition in dissection along RLN during robotic thyroidectomy for complex cases. This approach pioneers a robotic platform plus AI real-time navigation paradigm in conjunction with intraoperative nerve monitoring (IONM) to assist accurate identification and functional confirmation of the RLN, standardizing surgical procedures across institutions and surgeons, alleviating the fatigue and anxiety caused to the surgeon due to continuously monitoring the neural structure during the operation and shortening the learning curve for trained surgeons. It represents a pivotal transition from experience-dependent surgery to data-driven intelligent surgery, significantly advancing robotic surgery.
Curative-intent treatment for distal gastric cancer with gastric outlet obstruction: Management pathways and clinical outcomes from a Swedish multicenter cohort.
Zeyara A, Scarfone L, Hermez Chole M … +4 more , Falkenback D, Tingstedt B, Johansson J, Rouvelas I
Surg Oncol · 2026 Jun · PMID 42166873 · Publisher ↗
BACKGROUND: Distal gastric cancer with gastric outlet obstruction (GOO) poses challenges to multimodal treatment. The optimal management strategy in patients undergoing curative-intent treatment remains unclear. This stu...
BACKGROUND: Distal gastric cancer with gastric outlet obstruction (GOO) poses challenges to multimodal treatment. The optimal management strategy in patients undergoing curative-intent treatment remains unclear. This study aimed to characterize real-world management pathways and outcomes in patients with distal gastric cancer presenting with clinically significant GOO. METHODS: All consecutive patients undergoing curative-intent resection for distal gastric adenocarcinoma with GOO between 2006 and 2024 at two Swedish tertiary centers were identified from national registry and institutional databases with chart validation. Patients were categorized according to treatment strategy: neoadjuvant chemotherapy or up-front surgery. Primary outcome was overall survival. Survival was analyzed using Kaplan-Meier estimates and multivariable Cox regression adjusting for age, ASA class, clinical T stage and nodal status. RESULTS: A total of 103 patients were included; 36 (35.0%) received neoadjuvant chemotherapy and 67 (65.0%) underwent up-front surgery. Patients receiving neoadjuvant therapy were younger (median 63.7 vs 77 years, p < 0.001) and more frequently had cT3-4 and cN + disease (p < 0.001). Most patients completed planned neoadjuvant treatment. R1 resection rates were high and comparable between groups (30.6% vs 28.4%, p = 0.75). Median overall survival was 19.6 months after neoadjuvant therapy and 19.2 months after up-front surgery (log-rank p = 0.38). On multivariable analysis, treatment strategy was not independently associated with overall survival (HR 0.86, 95% CI 0.47-1.57; p = 0.63). CONCLUSION: GOO in distal gastric cancer should not be considered an absolute contraindication to neoadjuvant therapy when adequate nutritional and supportive strategies are employed. However, feasibility does not equal justification - in the absence of a survival benefit and in the context of increased severe postoperative complications, treatment decisions should be individualized through careful multidisciplinary assessment until better powered prospective studies are performed.
Social and Surgical Drivers of Survival in Colorectal Liver Metastases: An NCBD Analysis.
Cummings C, Kim L, Taylor C … +6 more , Chandler J, Perez K, Dominguez V, Wiafe S, Saunders A, Eguia E
J Surg Oncol · 2026 May · PMID 42153467 · Publisher ↗
BACKGROUND AND OBJECTIVES: Among patients with colorectal cancer, the liver is the most common site of metastases and is frequently the only site of disease. Curative intent resection offers the best chance for survival;...
BACKGROUND AND OBJECTIVES: Among patients with colorectal cancer, the liver is the most common site of metastases and is frequently the only site of disease. Curative intent resection offers the best chance for survival; however, access to surgery and outcomes may be influenced by social drivers of health. METHODS: Using the 2022 National Cancer Database, we identified adults with colorectal liver metastases (CRLM) without extrahepatic spread. Patients were categorized into four surgical groups: combined primary and liver resection, liver-only resection, primary-only resection, and no surgery. Demographic, socioeconomic, and clinical factors were compared, and multivariable logistic and Cox models were used to assess predictors of surgery and overall survival and mortality risk. RESULTS: Of 40,670 patients, 49.8% received no surgery, 32.8% underwent primary-only resection, 1.6% underwent liver-only resection, and 15.8% underwent combined primary and liver resection. Combined resections were most common among younger, privately insured patients treated at academic centers in higher-income and higher-education regions (p < 0.001). Median OS differed significantly by treatment: combined resection, 59.5 months; liver-only, 41.5 months; primary-only, 28.2 months; and no surgery, 13.8 months. Adjusted mortality was higher for primary-only (HR 1.66), liver-only (HR 1.71), and no surgery (HR 3.21) compared with combined resection. CONCLUSIONS: Combined primary and liver resection was associated with the longest survival and lowest mortality among patients with CRLM. Significant disparities in surgical treatment and survival were observed across key social drivers of health, underscoring the need to address inequities in access to comprehensive, curative-intent care.
Evaluating the utility of ICG-based NIR imaging for small intestine neuroendocrine tumors: Challenges and the need for tumor-specific tracers.
Dalmeijer SWR, Zweedijk BE, Boldewijn DF … +9 more , Galema HA, van Ginhoven TM, Franssen GJH, van Velthuysen ML, Grünhagen DJ, Verhoef C, Vahrmeijer AL, Hilling DE, Keereweer S
Surg Oncol · 2026 Jun · PMID 42150271 · Publisher ↗
PURPOSE: Accurate intraoperative localization of small intestinal neuroendocrine tumors (SI-NETs) remains a surgical challenge, with standard staging protocols frequently missing small primary or metastatic lesions. ICG...
PURPOSE: Accurate intraoperative localization of small intestinal neuroendocrine tumors (SI-NETs) remains a surgical challenge, with standard staging protocols frequently missing small primary or metastatic lesions. ICG has shown utility in other highly vascularized tumors, including pituitary and pancreatic neuroendocrine tumors and non-small cell lung cancer. We conducted a prospective feasibility study to evaluate the potential of near-infrared (NIR) fluorescence imaging (FI) using indocyanine green (ICG) to enhance intraoperative detection of SI-NETs. METHODS: The initial aim was to include at least 26 patients; however, after analysis of the first two patients, we decided to terminate the study prematurely. Therefore, we present data from two patients who underwent abdominal surgery. Each patient received 2.5 mg/kg of ICG intravenously 18 h before surgery, utilizing the second-window ICG (SWIG) technique. Intraoperative imaging was performed using the Quest Spectrum V2 camera system. The primary endpoint was fluorescence positivity of primary tumors, defined as a tumor-to-background ratio (TBR) ≥ 1.5. RESULTS: All primary tumors (n = 2) were identified via palpation and inspection, but none were fluorescence positive (median TBR 0.67, range 0.47-0.87). No occult primary or metastatic lesions were detected by fluorescence imaging. Metastatic lymph nodes and peritoneal nodules (n = 3, confirmed malignant) were also fluorescence negative. Strong non-specific background signal was observed in bowel and liver tissue, reflecting non-tumor-specific ICG uptake. Based on low tumor contrast and expert consensus, the study was terminated early without dose escalation. CONCLUSION: These findings demonstrate that ICG-based NIR FI did not enhance intraoperative detection of SI-NETs or metastases in this feasibility cohort and is limited by non-specific background fluorescence. Our data suggest that passive EPR-based accumulation may not be sufficient for reliable visualization of SI-NETs. Our results underscore the need for tumor-specific tracers targeting neuroendocrine markers to improve surgical precision in SI-NETs.
Patient Out-of-Pocket Costs and Healthcare Utilization Related to Mastectomy vs Breast Conservation: A Claims-Based Study.
Proussaloglou EM, Ren Y, Fayanju OM … +6 more , Blitzblau RC, Berger ER, Valero M, Shelley Hwang E, Wheeler SB, Greenup RA
J Surg Oncol · 2026 May · PMID 42144808 · Publisher ↗
BACKGROUND AND OBJECTIVES: Out-of-pocket (OOP) costs and healthcare utilization remain unknown for women facing breast conservation and mastectomy. METHODS: Women aged 18-64 who underwent upfront breast cancer surgery we...
BACKGROUND AND OBJECTIVES: Out-of-pocket (OOP) costs and healthcare utilization remain unknown for women facing breast conservation and mastectomy. METHODS: Women aged 18-64 who underwent upfront breast cancer surgery were identified from the IBM MarketScan Commercial Claims Database (2014-2017). Surgical groups included lumpectomy+radiation; unilateral mastectomy + /-reconstruction, and bilateral mastectomy + /-reconstruction. Cumulative OOP payments were assessed at 12-month intervals over 4 years postoperatively and adjusted to 2017 USD$. Multivariable regression identified factors associated with increased OOP costs. RESULTS: Overall, 23,159 underwent lumpectomy with radiation (60%), unilateral mastectomy with (15%) and without (6%) reconstruction, and bilateral mastectomy with (17%) and without (2.6%) reconstruction. Women undergoing bilateral mastectomy+reconstruction were younger than other surgical groups (median age 49 vs. 50-55). In the first year after diagnosis, 1.24 million outpatient visits occurred, 27% of enrollees had inpatient admissions, 23% visited an E.R., and median OOP costs were $5669 (range $0 to $132 125). Cumulative costs were significantly higher in women < 45 yo and for those with greater comorbidities. Median OOP costs declined over time (0-12 months: $3661 vs 48 months: $486). OOP costs were 12% higher (8.9%-15.1%) with mastectomy+reconstruction than lumpectomy+radiation ($6529 vs $5333). CONCLUSIONS: Out-of-pocket costs and healthcare utilization differ between equally effective surgical treatment options; mastectomy + reconstruction is costlier for patients than breast conservation.
Early Portomesenteric Thrombosis Following Pancreaticoduodenectomy: Risk Factors, Management and Outcomes.
Martinet-Kosinski F, Abdallah M, Pereira B … +8 more , Puia-Negulescu S, Bacoeur-Ouzillou O, Buc E, Antomarchi O, Aboukassem A, Perret-Boire S, Pezet D, Gagnière J
J Surg Oncol · 2026 May · PMID 42144800 · Publisher ↗
INTRODUCTION: Early portomesenteric thrombosis (ePMT) can occur following pancreaticoduodenectomy (PD) and is associated with significant postoperative morbidity and mortality. The aim of this study was to identify risk...
INTRODUCTION: Early portomesenteric thrombosis (ePMT) can occur following pancreaticoduodenectomy (PD) and is associated with significant postoperative morbidity and mortality. The aim of this study was to identify risk factors associated with early ePMT following PD. METHODS: We retrospectively analyzed data from a prospective database including all consecutive patients who underwent PD for benign or malignant tumors at our tertiary center between January 2007 and December 2019. Univariable and multivariable analysis were conducted, between the independent groups using penalized maximum likelihood logistic regression. RESULTS: 374 patients were included. Nine patients developed early ePMT. Postoperative ePMT occurred at a median of 3.5 days [0-40] after surgery. Ninety-day postoperative mortality was significantly higher in the ePMT+ group (OR = 7.1; p < 0.01). Intraoperative blood loss and body mass index (BMI) were independently associated with ePMT following PD (OR = 6.61; IC95 = [1.68;26] and OR = 4.44; IC95 = [1.09;17], respectively). Venous resection during PD and occurrence of POPF were both associated with an increased risk of ePMT, but theses associations were not statistically significant. CONCLUSION: ePMT following PD is rare but represents a severe postoperative complication associated with high mortality rate. It occurs more often in patients with increased intraoperative blood loss and higher BMI, reflecting greater intraoperative technical difficulty during surgery.
Conversion surgery for perihilar cholangiocarcinoma after immune checkpoint inhibitor-combined chemotherapy with the biliary stent-based strategy.
Kano T, Maki A, Takemura N … +13 more , Matsubara S, Asada T, Ishiyama A, Nunokawa Y, Machida H, Ikeda M, Matsudaira S, Yamamoto M, Miyata Y, Kimura A, Ninomiya R, Urahashi T, Beck Y
Surg Oncol · 2026 Jun · PMID 42144010 · Publisher ↗
BACKGROUND: Emerging immune checkpoint inhibitor (ICI)-combined chemotherapy may increase the opportunities for conversion surgery in patients with locally advanced (LA) biliary tract cancer. A major challenge in chemoth...
BACKGROUND: Emerging immune checkpoint inhibitor (ICI)-combined chemotherapy may increase the opportunities for conversion surgery in patients with locally advanced (LA) biliary tract cancer. A major challenge in chemotherapy aimed at conversion surgery for LA perihilar cholangiocarcinoma (LA PHCC) is the difficulty in accurately evaluating tumor response on contrast-enhanced computed tomography due to biliary stent-induced inflammation and artifacts. To address this issue, the biliary stent-based strategy was devised and implemented in patients undergoing gemcitabine-cisplatin (GC) with ICI therapy. To improve assessment of tumor spread, this strategy includes repeated endoscopic retrograde cholangiopancreatography during chemotherapy and intentional stent removal when functional biliary patency was achieved. We reviewed the outcomes of treatment combined with the strategy. METHODS: Patients with LA PHCC who received GC with ICI therapy with the aim of conversion surgery between 2023 and 2025 were retrospectively reviewed. Clinical course and treatment outcomes were evaluated. RESULTS: Six patients were identified. The biliary stent-based strategy was helpful in preoperative assessment of tumor spread and clinical decision making. Curative-intent resection was performed in 5 patients (83.3%) and R0 resection was achieved in all 3 patients in whom functional biliary patency was confirmed in the strategy. CONCLUSIONS: The biliary stent-based strategy may have potential clinical utility in the management of patients with LA PHCC receiving GC with ICI therapy with the aim of conversion surgery. The strategy not only facilitates preoperative assessment but also may serve as one criterion for proceeding with conversion surgery.
Impact of tumor response to neoadjuvant chemotherapy on ICG-guided lymphadenectomy quality and surgical outcomes in gastric cancer.
de Jesús-Gil Á, Morales-Conde S, Alarcón-Del Agua I … +5 more , Socas-Macías M, López-Bernal F, Pérez-Andrés MI, Padillo-Ruiz FJ, Senent-Boza A
Surg Oncol · 2026 Jun · PMID 42142425 · Publisher ↗
INTRODUCTION: Indocyanine green (ICG)-guided lymphadenectomy has been shown to be a promising tool in enhancing nodal retrieval during gastric cancer (GC) surgery. However, its efficacy in patients treated with neoadjuva...
INTRODUCTION: Indocyanine green (ICG)-guided lymphadenectomy has been shown to be a promising tool in enhancing nodal retrieval during gastric cancer (GC) surgery. However, its efficacy in patients treated with neoadjuvant chemotherapy (NAC) remains unclear. This study evaluates the impact of tumor response to NAC, based on Mandard classification, on lymphadenectomy quality and surgical outcomes in patients undergoing minimally invasive gastrectomy with ICG guidance. MATERIALS AND METHODS: We conducted a retrospective observational study including 34 patients, from a Western tertiary center, with locally advanced GC who underwent NAC followed by ICG-guided minimally invasive gastrectomy. Patients were stratified into two groups: responders (TRG 1-2) and non-responders (TRG 3-5). The primary outcome was the total number of retrieved lymph nodes. Secondary outcomes included surgical outcomes and postoperative complications. RESULTS: ICG-guided lymphadenectomy was safe in both groups, with no significant differences in surgical complications, reoperation, mortality, or hospital stay. However, non-responders had a significantly higher lymph node yield (36.29 ± 20.90 vs. 24.65 ± 7.93; p = 0.011). This trend remained across surgical types and histological subtypes. All duodenal stump leaks occurred in responders, suggesting greater fibrotic changes post-NAC. CONCLUSION: The application of ICG for lymphatic mapping in gastric cancer is both safe and feasible in patients receiving NAC. Poor tumor response is associated with higher lymph node retrieval, potentially due to preserved lymphatic architecture and better tracer diffusion. This finding supports the hypothesis that lymphatic fibrosis induced by treatment impairs tracer diffusion.
Erector spinae plane block (ESPB) versus modified pectoral plane block (PECS II) in managing post modified radical mastectomy pain: A systematic review and meta-analysis.
El-Khalifa BM, Osman ASA, Nada EA … +8 more , Ahmad J, Soliman A, Abouzkaly F, Mazy HM, Elfakharany B, Hamdy AM, Jibril NS, Qutob IA
Surg Oncol · 2026 Jun · PMID 42134219 · Publisher ↗
BACKGROUND: Breast cancer remains the most frequently diagnosed malignancy among females worldwide. Surgical management is the cornerstone of the therapeutic strategy, however associated with multiple postoperative compl...
BACKGROUND: Breast cancer remains the most frequently diagnosed malignancy among females worldwide. Surgical management is the cornerstone of the therapeutic strategy, however associated with multiple postoperative complications, particularly acute pain and shoulder mobility limitations. Regional anesthetic techniques have been proposed to counteract this phenomenon, such as the modified pectoral plane block (PECS II) and erector spinae plane block (ESPB). This systematic review and meta-analysis aims to compare between ESPB and PECS II in managing post-operative pain in modified radical mastectomy patients. METHODS: We conducted a systematic search of PubMed, Web of Science, and Scopus up to July 2025. According to our eligibility criteria, randomized controlled trials comparing PECS II and ESPB techniques in modified radical mastectomy patients were included. Our primary outcomes were post-operative analgesia duration, postoperative morphine use in the first 24 h, and postoperative pain scores. Quality assessment was conducted using the Cochrane risk of bias assessment tool 2 (RoB2). Analysis of relevant outcomes was conducted using R software Version 4.4.2. RESULTS: The literature search identified 697 studies, of which 11 trials, involving 790 patients, were analyzed. Compared to ESPB, PECS II was associated with a significantly longer analgesia duration [MD = -3.16, 95%CI (-6.11; -0.21), P = 0.0361], and fewer rescue analgesia requirement [RR = 1.37, (95%CI; 1.01, 1.87), P = 0.0437]. Pain assessment at 24 h, using the numerical rating scale (NRS) or the visual analogue scale (VAS), was comparable between the two techniques. Intraoperative fentanyl consumption was comparable, whereas postoperative morphine use in the first 24 h was significantly lower following PECS II [MD 2.96, 95%CI (2.43, 3.48), P < 0.0001]. CONCLUSION: PECS II was superior to ESPB, with a longer analgesia duration, reduced rescue analgesia requirement, and postoperative morphine consumption in the first 24 h. Overall, PECS II may offer modest analgesic advantages in modified radical mastectomy patients.
Outcomes After Intratumoral Delivery of Immunotherapy in Breast Cancer.
Baumrucker CC, Harris N, Aiello P … +7 more , Whiting J, Sun W, Soliman H, Han H, Costa R, Czerniecki BJ, Lee MC
J Surg Oncol · 2026 May · PMID 42130226 · Publisher ↗
BACKGROUND: Immunotherapy is a growing treatment option for challenging breast cancer (BC) subtypes. Systemic administration can have significant adverse events (AEs), prompting interest in intratumoral injection. We eva...
BACKGROUND: Immunotherapy is a growing treatment option for challenging breast cancer (BC) subtypes. Systemic administration can have significant adverse events (AEs), prompting interest in intratumoral injection. We evaluated the safety and feasibility of intratumoral injections at our institution. METHODS: This is an IRB-approved retrospective review of neoadjuvant patients who received intratumoral talimogene laherparepvec (TVEC) (NCT02779855) for triple negative breast cancer (TNBC), dendritic cells (DC1) for HER2+ (NCT05325632), HER2 + /ER- (NCT03387553), or TNBC (NCT05504707), or Voyager V1 virus (VV1) (NCT01042379) for high-risk lesions on ISPY2. This study outlines the safety and feasibility of intratumoral injections assessed by AEs, adherence to therapy, and ultrasound guidance. RESULTS: The study included 111 female patients (mean age 51; range 26-80). Forty-seven (42.3%) received TVEC, 62 (55.9%) received DC1, and 2 (1.8%) received VV1. Three patients missed one injection; 110 patients had ultrasound-guided injections. Mean neoadjuvant therapy length was 172 days (range 127-244). Local AEs included pain (20.7%), injection site reaction (27.9%), and hematoma (5.4%). Systemic AEs were reported more frequently, most commonly chills (52.3%), headache (39.6%), and fever (36.8%). DISCUSSION: Intratumoral IT injection is a viable treatment option that may minimize systemic exposure while maintaining therapeutic efficacy. Breast surgeons can play a role in intratumoral IT in BC.
Clinical utilisation and survival correlation of blood-based liquid biopsy in sarcoma - A systematic review and meta-analysis.
Wong CS, Rawashdeh A, Desai A … +1 more , Beggs A
Surg Oncol · 2026 Jun · PMID 42128474 · Publisher ↗
BACKGROUND: Sarcomas are rare malignant tumours of mesenchymal origin that primarily affect connective tissues (soft tissue sarcomas, STS) and bone and cartilage (bone sarcoma, BS). Owing to their marked tumour heterogen...
BACKGROUND: Sarcomas are rare malignant tumours of mesenchymal origin that primarily affect connective tissues (soft tissue sarcomas, STS) and bone and cartilage (bone sarcoma, BS). Owing to their marked tumour heterogeneity, deep anatomical location, and the practical challenges of repeated tissue sampling, blood-based liquid biopsy represents a promising minimally invasive approach for tumour detection and longitudinal monitoring, particularly in the context of disease recurrence. This systematic review aims to evaluate the current clinical applications of liquid biopsy in sarcoma and to determine its association with survival outcomes. METHOD: We performed a systematic review to evaluate the clinical utility of liquid biopsy in sarcoma. The review was conducted in accordance with the PRISMA guidelines. Relevant literature was searched from all electronic databases MEDLINE via PubMed, EMBASE, Scopus, and the Web of Science, and data extraction was performed systematically using Covidence. Meta-analysis was performed on studies reporting survival outcomes [(overall survival (OS), disease-free survival (DFS) or relapse-free survival (RFS), and progression-free survival (PFS)]. Either fixed or random effects models were used, taking into consideration heterogeneity. Publication bias was assessed using a funnel plot. RESULTS: Nine studies were included in this meta-analysis. Copy number variation is a common mutation detected in both liposarcoma and leiomyosarcoma. Circulating cell-free DNA (cfDNA) can be detected using quantitative PCR (qPCR), droplet digital PCR (ddPCR), and next-generation sequencing. Three studies reported survival outcomes. Generally, in sarcoma, detectable (or positive) cfDNA (or specifically ctDNA) is associated with poorer overall survival (pooled HR, 1.82; 95% CI, 1.29 - 2.57; p = 0.0006) and disease-free survival (HR 2.23; 95% CI 1.27 - 3.90; p = 0.005). The progression-free survival of patients with detectable cfDNA was not significantly different from those without cfDNA (HR 1.13, 95% CI 0.72 - 1.78; p = 0.60). No evidence of publication bias was detected in this study. CONCLUSIONS: The findings of this study provide the foundation for future studies that will examine the use of cfDNA in assessing the prognosis and monitoring the relapse of sarcoma.
Oncologic, pregnancy, and reproductive outcomes of fertility-sparing surgery in early-stage cervical cancer: a systematic review.
Sidonie M, Elisabete G
Surg Oncol · 2026 Jun · PMID 42114502 · Publisher ↗
BACKGROUND: Fertility-sparing surgery (FSS) is a crucial option for young patients diagnosed with early-stage cervical cancer (FIGO 2018 IA2-IB1, tumor size <2 cm). While radical trachelectomy (RT) was traditionally the...
BACKGROUND: Fertility-sparing surgery (FSS) is a crucial option for young patients diagnosed with early-stage cervical cancer (FIGO 2018 IA2-IB1, tumor size <2 cm). While radical trachelectomy (RT) was traditionally the standard, recent evidence supports less radical approaches (conization/simple trachelectomy) as oncologically safe alternatives, offering a potential reduction in surgical morbidity and improved reproductive outcomes. This systematic review compares the oncologic and reproductive outcomes between less radical FSS and RT. METHODS: We analyzed 15 studies encompassing 1487 patients, focusing on FSS outcomes reported using the FIGO 2018 staging system, and excluded studies involving neoadjuvant chemotherapy or prior staging systems. The review adhered to PRISMA 2020 guidelines and was registered with PROSPERO (CRD420251238319). A formal meta-analysis was considered but deemed unfeasible due to clinical and methodological heterogeneity across studies. RESULTS: Oncologic outcomes appeared comparable between the groups, within the limitations of indirect comparison. The recurrence rate for less radical FSS (N = 641) was 5.5%, similar to 4.9% for RT (N = 846). Seven-year overall survival rates were excellent for both: 98.9% (less radical) versus 97.8% (RT). Reproductive outcomes favored less radical procedures, with higher pregnancy rates (61.2% vs. 36.9% for RT) and live birth rates (80.9% vs. 68.4%). The preterm delivery rate was substantially lower after less radical FSS (31.1% vs. 53.8% for RT). CONCLUSION: For carefully selected low-risk patients with early-stage cervical cancer, the available retrospective evidence suggests that less radical FSS may offer comparable oncologic safety with potentially superior reproductive outcomes compared with radical trachelectomy. These findings support the consideration of surgical de-escalation within a framework of individualized patient counselling and shared decision-making, although prospective randomized data are needed to definitively establish the optimal approach.
Half of patients experience moderate to severe long-term urination dysfunction after rectal cancer surgery: a prospective cohort study.
Ágústsdóttir DH, Öberg S, Oggesen BT … +1 more , Rosenberg J
Surg Oncol · 2026 Jun · PMID 42114210 · Publisher ↗
BACKGROUND: Urination dysfunction is a known late sequela after rectal cancer surgery. Although it negatively affects the quality of life for these patients, evidence of rate is missing. METHODS: The aim was to report th...
BACKGROUND: Urination dysfunction is a known late sequela after rectal cancer surgery. Although it negatively affects the quality of life for these patients, evidence of rate is missing. METHODS: The aim was to report the rate of late urination dysfunction in patients undergoing mesorectal excision, transanal microsurgery, or abdominoperineal excision for rectal cancer. This was a prospective cohort study conducted at Herlev Hospital, Denmark. Patients with primary or recurrent rectal cancer who underwent rectal cancer operations between September 2019 and May 2023 were invited to answer an electronic questionnaire 3-12 months postoperatively. The primary outcome included urination dysfunction, incontinence, retention, and increased urinary frequency, divided by operative method. Subgroup analyses compared patient characteristics, cancer location, and operative features. RESULTS: This study included 121 mostly male patients in their sixties, with the most common procedure being robot-assisted surgery. Overall, 49% experienced urination dysfunction, more frequently in males (p = 0.02), patients undergoing oncologic therapy (p = 0.04), and those who had open surgery compared to robot-assisted or laparoscopic procedures (p = 0.01). The dysfunction was most common in patients with midrectal tumors, and symptoms did not improve over time. The extent of the tissue resection varies depending on the surgical procedures, introducing variability in the details of the pathological report. Further, there is a risk of recall bias for preoperative symptoms. CONCLUSION: Half of the rectal cancer surgery patients at our center experienced moderate to severe urinary dysfunction, particularly men and those who had oncologic therapy or open surgery.
Comparative Severe Complications After Laparoscopic Pancreatoduodenectomy in PDAC vs Non-PDAC Periampullary Cancer: A Retrospective Cohort Study.
Sun Y, Wang R, Wu D … +5 more , Tian Y, Kuang T, Zhou J, Peng B, Wu Z
J Surg Oncol · 2026 May · PMID 42108934 · Publisher ↗
INTRODUCTION: Laparoscopic pancreatoduodenectomy (LPD) offers the potentially clinical benefit for patients presenting with periampullary tumors. The aim of this study is to evaluate postoperative clinical outcomes among...
INTRODUCTION: Laparoscopic pancreatoduodenectomy (LPD) offers the potentially clinical benefit for patients presenting with periampullary tumors. The aim of this study is to evaluate postoperative clinical outcomes among patients undergoing LPD for periampullary cancer. STUDY DESIGN: We retrospectively reviewed and analyzed 574 consecutive patients received LPD for periampullary cancer at our institution between April 2011 and August 2024. Data collected included preoperative, perioperative, and postoperative information. RESULTS: Among 574 patients undergoing LPD for periampullary cancer, 311 (54.2%) pathologically diagnosed with pancreatic ductal adenocarcinoma (PDAC) and 263 (45.8%) had non-PDAC periampullary cancer. Compared with PDAC, non-PDAC patients experienced significantly higher rates of major morbidity (16.7% vs 10.9%, p = 0.043), including postoperative pancreatic fistula (p = 0.001), abdominal infection (p = 0.032), and reoperation (p = 0.021). Multivariate analysis identified age ≥ 65 years (OR 1.803, 95%CI: 1.092 ~ 2.978), prolonged operative time (OR 1.004, 95%CI: 1.001 ~ 1.006), and non-PDAC pathology (OR 1.664, 95%CI: 1.014 ~ 2.731) as independent risk factors for severe complications, while pylorus preservation was protective (OR 0.460, 95%CI: 0.264 ~ 0.803). CONCLUSION: Postoperative morbidity after LPD varies by periampullary cancer subtype, with non-PDAC patients at greater risk of severe complications. Older age, prolonged operative time, and non-PDAC pathology were independent predictors of severe complications, whereas pylorus preservation conferred a protective effect.
Pathologic Response and Outcomes After Neoadjuvant Chemotherapy in Gastric Cancer: A NCDB Analysis.
Hwang J, Sun J, Hunt A … +7 more , Papai E, Zhang L, Hasler JS, Porpiglia AS, Villano AM, Farma JM, Greco SH
J Surg Oncol · 2026 May · PMID 42108933 · Publisher ↗
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant therapy has been associated with improved survival in several malignancies, but its prognostic value in gastric cancer remains unclear. METHODS: Using the...
BACKGROUND: Pathologic complete response (pCR) after neoadjuvant therapy has been associated with improved survival in several malignancies, but its prognostic value in gastric cancer remains unclear. METHODS: Using the National Cancer Database, we identified non-metastatic gastric adenocarcinoma patients diagnosed 2004-2021 treated with neoadjuvant chemotherapy followed by curative-intent resection. Patients receiving neoadjuvant radiation were excluded. We analyzed pCR rates, overall survival (OS), and factors associated with pCR using a generalized estimating equations model. Kaplan-Meier and Cox proportional hazards models were used to assess OS. Trends in pCR over time were evaluated with time-trend analysis. RESULTS: Among 7258 patients, 672 (9.3%) achieved pCR. Median OS was significantly higher in patients with pCR compared to those without (167.9 vs. 65.8 months, p < 0.001). Subgroup analysis of cT2N1 or higher stage patients revealed the highest survival in patients with both tumor and nodal pCR (median OS 181.8 months). Patients diagnosed after 2018 were more likely to achieve pCR (OR: 1.26, 95% CI: 1.07-1.49, p = 0.005), correlating with the adoption of the FLOT regimen. Completion of adjuvant therapy in patients who achieved pCR did not significantly improve OS. CONCLUSION: pCR is associated with significantly improved OS in gastric cancer, especially when both tumoral and nodal pCR are achieved. Increasing pCR rates in recent years may reflect the uptake of modern chemotherapy regimens, underscoring the value of neoadjuvant strategies.
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