Surgical Oncology[JOURNAL]
Sun
200 papers
Cost-Utility Analysis of Indocyanine Green Versus Methylene Blue for Sentinel Lymph Node Biopsy in Breast Cancer.
Lee SH, Kohler A, Tingen J … +5 more , King CA, Persing SM, Homsy C, Nardello S, Chatterjee A
J Surg Oncol · 2026 May · PMID 42108861 · Publisher ↗
BACKGROUND: Sentinel lymph node biopsy (SLNB) is commonly used for axillary staging in breast cancer surgery. Traditional localization methods include technetium-99m, lymphazurin, methylene blue (MB), or a combination of...
BACKGROUND: Sentinel lymph node biopsy (SLNB) is commonly used for axillary staging in breast cancer surgery. Traditional localization methods include technetium-99m, lymphazurin, methylene blue (MB), or a combination of these. Indocyanine green (ICG) is a safe and effective alternative with fewer complications. We compared the cost-effectiveness of ICG and MB for SLNB in breast cancer. METHODS: A systematic PubMed review identified the success and complication rates for MB and ICG. Costs of successful breast cancer surgeries with SLNB and related complications were estimated using Centers for Medicare & Medicaid Services (CMS) rates via Current Procedural Terminology (CPT) and Diagnosis Related Group (DRG) codes. Published utility scores were used to calculate quality-adjusted life years (QALYs). A decision tree model was developed to determine the incremental cost-effectiveness ratio (ICER). One-way (deterministic) and Monte Carlo (probabilistic) sensitivity analyses were performed to assess uncertainty. The willingness-to-pay (WTP) threshold was set to $50,000/QALY. RESULTS: SLNB using ICG cost $287 more than MB but gained 0.07 QALY, resulting in an ICER of $4,044.44, well below the WTP threshold. Sensitivity analysis showed SLNB with ICG became cost-ineffective if the probability of complication exceeded 4.9% or if ICG costs exceeded $4,190 per vial. SLNB with MB became cost-effective if the likelihood of complications dropped below 2.6%. Monte Carlo analysis indicated an 80% probability that SLNB with ICG is the more cost-effective option. CONCLUSIONS: Given lower complication rates despite higher upfront cost, ICG proved more cost-effective than MB in SLNB for breast cancer due to its improved quality-adjusted outcomes.
Comparing Tibial Osteotomy and Patellar Osteotomy to Pedicle Freezing in Proximal Tibial Malignant Bone Tumors: A Case Series Study.
Chen JJ, Tie TL, Huang CW … +6 more , Chen KL, Wang PH, Chen CM, Chen CF, Chen WM, Wu PK
J Surg Oncol · 2026 May · PMID 42108830 · Publisher ↗
BACKGROUND AND OBJECTIVES: Pedicle freezing with liquid nitrogen is a biological reconstruction method used for aggressive proximal tibial tumors. This study compared outcomes between tibial and patellar osteotomy approa...
BACKGROUND AND OBJECTIVES: Pedicle freezing with liquid nitrogen is a biological reconstruction method used for aggressive proximal tibial tumors. This study compared outcomes between tibial and patellar osteotomy approaches. METHODS: This retrospective study included 14 patients with malignant bone tumors who underwent pedicle freezing between January 2021 and March 2024. Ten patients underwent tibial osteotomy; four underwent patellar osteotomy. Surgical differences, postoperative complications, bone union, functional recovery, and oncological outcomes were analyzed. RESULTS: Tibial osteotomy required more plating, causing a greater increase in tibial diameter. Flap reconstruction was needed in six (60%) and two (50%) patients in the tibial osteotomy group and patellar osteotomy group, respectively. The bone nonunion rates were similar; median union times were 10.5 and 8.5 months. Wound complications occurred exclusively in the tibial osteotomy group (four patients), all regarding difficulties in wound closure and flap reconstruction. Tibial osteotomy resulted in more implant-related complications, whereas knee range of motion and Musculoskeletal Tumor Society scores were comparable. Tumor recurrence occurred in three cases (two tibial, one patellar), with two patients having preexisting metastases. CONCLUSIONS: Both techniques were feasible with comparable union and functional outcomes. Tibial osteotomy often requires additional plating and has more wound complications. Given the preliminary nature and limited sample size of this study, further research is required.
The Impact of Time and Place on BREAST-Q REACT: A Multi-Institutional Examination.
Kim M, Bubberman JM, Wang J … +6 more , Boe LA, Van der Hulst RRWJ, Tuinder SMH, Stern CS, Matros E, Nelson JA
J Surg Oncol · 2026 May · PMID 42108794 · Publisher ↗
BACKGROUND: Reference values provide clinically meaningful context for interpreting patient-reported outcome measures. However, these values may evolve over time with changes in reconstructive practice and may differ acr...
BACKGROUND: Reference values provide clinically meaningful context for interpreting patient-reported outcome measures. However, these values may evolve over time with changes in reconstructive practice and may differ across cultural settings. This study compares BREAST-Q scores across time periods and countries. METHOD: Patients who underwent postmastectomy breast reconstruction and completed the BREAST-Q at Memorial Sloan Kettering Cancer Center (MSKCC) and Maastricht University Medical Center (MUMC +) between 2007 and 2022 were included. BREAST-Q scores from an original MSKCC cohort (2007-2017) were compared with a recent MSKCC cohort (2018-2022) to evaluate temporal differences, and with a Dutch cohort (2013-2022) to assess geographic variation. RESULTS: A total of 7,199 MSKCC patients (3,243 original; 3,956 recent), and 444 MUMC+ patients were included. Compared with the original MSKCC cohort, the recent cohort demonstrated improved Physical Well-being of the Chest among implant-based reconstruction patients at preoperative (81 [74, 91] vs. 85 [74, 100]) and at 2-years postoperative (76 [66, 85] vs. 80 [64, 92]). Other BREAST-Q domains, on the other hand, declined in both implant-based and autologous reconstruction groups. Compared with MSKCC patients, the Dutch cohort reported lower Physical Well-being of the Chest, but higher Sexual Well-being. For example, at 2-years postoperative, MUMC+ patients scored 10 points higher on Sexual Well-being than MSKCC patients (60 [47, 72] vs. 50 [36, 66], p < 0.001). CONCLUSION: BREAST-Q reference values vary over time and across cultural contexts. Contemporary population-specific reference values may improve interpretation of patient-reported outcomes.
Safety and efficacy of Enhanced Recovery after Surgery (ERAS) in pancreaticoduodenectomy combined with vascular reconstruction.
Ge X, Yin T, Xing E … +7 more , Wang Z, Zhang K, Chen Y, Wang P, Zhu J, Yao J, Xu P
Surg Oncol · 2026 Jun · PMID 42102646 · Publisher ↗
OBJECTIVE: To investigate the safety and clinical efficacy of the Enhanced Recovery After Surgery (ERAS) protocol specifically in patients undergoing pancreaticoduodenectomy (PD) combined with vascular reconstruction. PA...
OBJECTIVE: To investigate the safety and clinical efficacy of the Enhanced Recovery After Surgery (ERAS) protocol specifically in patients undergoing pancreaticoduodenectomy (PD) combined with vascular reconstruction. PATIENTS AND METHODS: A retrospective analysis was conducted on 47 patients who underwent PD with vascular reconstruction (including portal vein and superior mesenteric vein resection) between 2015 and 2024. Patients were divided into the ERAS cohort (n = 20) and the pre-ERAS control cohort (n = 27). We focused on markers of organ congestion recovery, inflammatory stress response, and specialized postoperative complications. RESULTS: The ERAS protocol was successfully implemented without increasing the incidence of major postoperative complications (such as pancreatic fistula, hemorrhage, or biliary leakage) or 30-day readmission rates. Notably, the incidence of delayed gastric emptying (DGE) was significantly lower in the ERAS group compared to the control group (5% vs. 33.3%, P < 0.05). The ERAS cohort demonstrated a significantly shorter postoperative hospital stay [17.5 (16.9,18.6) days vs. 20.4 (19.4,21.5) days, P < 0.001] and reduced medical expenses. Biochemically, the ERAS group showed a more rapid normalization of NLR and a higher maintenance of PNI during the first postoperative week (P < 0.05), reflecting mitigated inflammatory response and better-preserved immune-nutritional reserves. CONCLUSIONS: Implementation of the ERAS protocol in PD with vascular reconstruction is safe and feasible, showing preliminary evidence in mitigating surgical stress and accelerating hepatic and gastrointestinal functional recovery. The ERAS cohort experienced a significant reduction in DGE and shorter hospital stays without increasing postoperative complications. These findings support ERAS as a standardized perioperative framework even for PD with vascular reconstruction.
Assessment of Outcome in 198 Patients With Mucinous Appendiceal Adenocarcinoma and Peritoneal Metastases Over 25 Years.
Sugarbaker PH, Chang D
J Surg Oncol · 2026 May · PMID 42098056 · Publisher ↗
A prognostic assessment of mucinous appendiceal adenocarcinoma (MACA) patients with peritoneal metastases in the absence of lymph node metastases needs to be precisely defined. All patients were treated by a complete cyt...
A prognostic assessment of mucinous appendiceal adenocarcinoma (MACA) patients with peritoneal metastases in the absence of lymph node metastases needs to be precisely defined. All patients were treated by a complete cytoreductive surgery (CRS) and perioperative chemotherapy. Preoperative clinical features including tumor markers were recorded within 1 week prior to CRS. Data regarding perioperative intraperitoneal chemotherapy, histologic features and reoperative surgery were gathered after CRS. Impact on overall survival of these factors was analyzed by univariant and multivariant analysis. One hundred and ninety-eight patients with mucinous appendiceal adenocarcinoma causing pseudomyxoma peritonei were available for study. They had a median survival of 11 years. Hyperthermic intraperitoneal chemotherapy (HIPEC) with a median survival of 12.0 years was superior to early postoperative intraperitoneal chemotherapy (EPIC) with a median survival of 4.0 years (HR 2.09, p = 0.002). By histopathology, the intermediate type (MACA-Int) was associated with the longest survival and poorly differentiated (MACA-3) the poorest survival. Peritoneal cancer index and tumor marker elevations had no impact on survival. Clinical features and preoperative tumor markers had little or no prognostic value in selection of MACA patients for CRS. Intermediate histologic subtype and use of HIPEC indicated a favorable outcome.
Evolution and future perspectives of the very small remnant stomach concept in minimally invasive gastrectomy.
Hong WQ, Jiang XH, Zhang S
Surg Oncol · 2026 Jun · PMID 42096766 · Publisher ↗
BACKGROUND: Preserving a very small proximal gastric remnant (SRS), often referred to as Laparoscopic Near-Total Gastrectomy (LNTG), is an emerging function-preserving strategy for upper-third gastric cancer. This system...
BACKGROUND: Preserving a very small proximal gastric remnant (SRS), often referred to as Laparoscopic Near-Total Gastrectomy (LNTG), is an emerging function-preserving strategy for upper-third gastric cancer. This systematic review and meta-analysis evaluates its evolution, clinical outcomes, and oncological safety. METHODS: Following PRISMA guidelines (PROSPERO: CRD420251062548), we systematically searched PubMed, Embase, MEDLINE, and SCI databases up to May 2025 for observational studies on LsTG with SRS. Methodological quality was assessed using the Newcastle-Ottawa Scale. Key short-term outcomes were quantitatively synthesized using a random-effects model. RESULTS: Ten studies were included for qualitative review. Pooled analysis of non-overlapping cohorts revealed that LsTG with SRS was associated with significantly shorter operative time (Weighted Mean Difference [WMD] = -60.53 min), reduced intraoperative blood loss (WMD = -37.80 ml), and shorter postoperative hospital stay (WMD = -2.53 days) compared to conventional gastrectomies. Qualitative synthesis indicated favorable nutritional recovery and comparable short-term survival, largely attributed to fundus preservation. CONCLUSIONS: LsTG with SRS is a safe, feasible procedure offering significant short-term surgical advantages and nutritional benefits. While promising, careful patient selection is paramount; current evidence supports this approach primarily for non-infiltrative, early-stage gastric cancers, while its use in diffuse-type or signet ring cell histology remains investigational and requires extreme caution. Future research must prioritize standardizing the SRS definition (e.g., 2-3 cm stump) and validating long-term oncological safety through prospective trials.
Diagnostic value of diffusion-weighted MRI as an imaging biomarker for ovarian cancer: A systematic review and meta-analysis.
Pugliesi RA, Mansour KB, Apitzsch J … +6 more , Maalouf N, Krysiak R, Andrisani A, Billone V, Ferrero S, Gullo G
Surg Oncol · 2026 Jun · PMID 42096765 · Publisher ↗
BACKGROUND: Diffusion-weighted imaging (DWI) is a functional MRI technique reflecting tissue cellularity and water diffusivity and shows promise for evaluating malignant from benign ovarian masses. However, reported diag...
BACKGROUND: Diffusion-weighted imaging (DWI) is a functional MRI technique reflecting tissue cellularity and water diffusivity and shows promise for evaluating malignant from benign ovarian masses. However, reported diagnostic performance remains inconsistent. This systematic review and meta-analysis aimed to determine the pooled diagnostic accuracy of DWI for ovarian cancer. METHODS: A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, Cochrane Library, CINAHL, and Google Scholar from inception to October 2025. Studies reporting sensitivity and specificity of DWI for ovarian cancer were included. Two reviewers independently performed data extraction and quality assessment using the QUADAS-2 tool. Pooled sensitivity, specificity, positive and negative likelihood ratios (PLR, NLR), diagnostic odds ratio (DOR), and area under the summary receiver operating characteristic curve (AUC) were calculated using a random-effects model. Heterogeneity was assessed with the I statistic, and subgroup and meta-regression analyses explored potential sources. RESULTS: Seventeen studies comprising 1486 patients were included. Pooled sensitivity and specificity were 0.89 (95% CI: 0.86-0.91) and 0.83 (95% CI: 0.80-0.85), respectively. The pooled PLR was 5.38 (95% CI: 3.72-7.77), NLR 0.12 (95% CI: 0.07-0.20), and DOR 50.85 (95% CI: 27.33-94.61). The AUC was 0.93, indicating excellent diagnostic performance. Substantial heterogeneity was observed (I > 75%) and was not explained by study design, MRI field strength, or ADC thresholds. CONCLUSION: DWI demonstrates high pooled sensitivity and specificity for differentiating benign from malignant ovarian lesions with substantial heterogeneity across studies. Therefore, DWI should be considered a promising non-invasive, not standalone diagnostic tool.
Comparison of Proximal Tibial Endoprosthetic and Allograft-Prosthetic Reconstruction.
Ulrich MN, Mallett KE, Broida SE … +3 more , Sullivan MH, Zabtani A, Houdek MT
J Surg Oncol · 2026 May · PMID 42089397 · Publisher ↗
INTRODUCTION: The proximal tibia is a common location for bone tumors. Two contemporary reconstruction techniques for limb salvage are endoprosthetic replacement (EPR) and allograft-prosthesis composite (APC). This study...
INTRODUCTION: The proximal tibia is a common location for bone tumors. Two contemporary reconstruction techniques for limb salvage are endoprosthetic replacement (EPR) and allograft-prosthesis composite (APC). This study aimed to compare the long-term oncologic and functional outcomes of EPR and APC reconstructions. METHODS: Thirty-eight (19 APC and 19 EPR) patients underwent oncologic proximal tibia resection and reconstruction were reviewed. Patients undergoing APC reconstruction were younger than the EPR group (31 vs. 44 years, p = 0.049), and patients in the EPR group were more likely to have a diagnosis of metastatic disease (32% vs. 0%, p = 0.019). RESULTS: For all patients, the 10-year disease-specific survival was 63%. With death a competing risk, there was no difference in the 10-year cumulative risk of failure (41% vs. 26%, p = 0.171) or amputation (11% vs. 19%, p = 0.690) between APC or EPR. There was no difference comparing EPR to APC in the proportion of patients with an extensor lag > 10° (42% vs. 26%, p = 0.495) or 10-year knee society scores (85 vs. 85, p = 0.710). CONCLUSION: EPR and APC have a similar complication profile and functional outcomes following proximal tibial resection and reconstruction.
Omission of Sentinel Lymph Node Biopsy in Breast Cancer: A Real-World Validation of the Patient Populations of the SOUND and INSEMA Trials.
Puiras T, Juhanoja E, Tamminen A
J Surg Oncol · 2026 May · PMID 42089383 · Publisher ↗
BACKGROUND: Treatment guidelines recommending omission of axillary surgery in breast cancer are largely based on the SOUND and INSEMA trials. However, the extent to which their study populations represent real-world pati...
BACKGROUND: Treatment guidelines recommending omission of axillary surgery in breast cancer are largely based on the SOUND and INSEMA trials. However, the extent to which their study populations represent real-world patients remains unclear. We aimed to evaluate the real-world applicability and external validity of these trial populations. MATERIALS AND METHODS: All consecutive patients treated for early breast cancer at a single university hospital between 2010 and 2018 were included. Patients with clinically node-negative disease were identified, and eligibility according to the SOUND and INSEMA inclusion criteria was determined. Clinicopathologic characteristics were compared between trial-eligible real-world patients and published trial populations. RESULTS: A total of 2787 consecutive patients with clinically negative axilla were included; 71% (1982/2787) fulfilled the INSEMA and 52% (1461/2787) the SOUND trial eligibility criteria. Patients eligible in the SOUND trial were largely representative of real-world patients in terms of clinicopathologic characteristics. In contrast, the INSEMA trial appeared more selected, with a higher proportion of biologically favorable tumors. Both trials predominantly included patients with small (< 2 cm) luminal breast cancers. Patients with larger tumors and more aggressive subtypes were underrepresented. CONCLUSION: The SOUND and INSEMA eligibility criteria are broadly applicable to real-world patients with small luminal breast cancers. However, differences between trial populations and real-world patients highlight the need for careful consideration when applying SLNB omission beyond these lower-risk subgroups.
Hospital Volume and Post-Hepatectomy Liver Failure After Major Hepatectomy.
Peters XD, Brajcich BC, Ko B … +6 more , Valukas C, Janczewski LM, Ko CY, Merkow RP, Pitt HA, Bentrem DJ
J Surg Oncol · 2026 May · PMID 42089353 · Publisher ↗
BACKGROUND: Post-hepatectomy liver failure (PHLF) following major hepatectomy (MH) increases the risk of morbidity and death. The relationship between institutional MH volume, PHLF, and outcomes is not well characterized...
BACKGROUND: Post-hepatectomy liver failure (PHLF) following major hepatectomy (MH) increases the risk of morbidity and death. The relationship between institutional MH volume, PHLF, and outcomes is not well characterized. METHODS: Adults undergoing MH from 2014 to 2021 in the ACS NSQIP hepatectomy-targeted database were included. Rates of PHLF were compared based on hospital-level annual MH volume. Multivariable logistic regression evaluated the association between volume, PHLF grade, and outcomes. RESULTS: Across 11,167 patients, PHLF incidence was 3.7% in low-volume, 5.5% in low-medium volume, 6.9% in medium-high volume, 11.8% in high-volume centers (p < 0.001). The adjusted odds ratio (aOR) for morbidity in grade B/C PHLF compared to those without PHLF was elevated in both lower-volume centers (quartiles 1-3), (11.2 [7.04-17.70]) and in high-volume centers, (8.47 [6.06-11.85]). CONCLUSION: Higher annual major hepatectomy volume is associated with increased PHLF, which may be a function of complex disease treated at these institutions. PHLF precedes other adverse events affecting both high and low volume institutions. PHLF is an important target for quality improvement.
Surgical Management of Recurrent Retroperitoneal Sarcomas: Experience From a High-Volume Sarcoma Centre: Recurrent Retroperitoneal Sarcomas: Outcomes of Multiple Recurrences.
Kaderi ASA, Shah TM, Patkar S … +12 more , Sai Ram YA, Bairannavar VS, Myvizhi Kannan M, Rekhi B, Bhargav P, Gala KB, Bagwan A, Ramadwar M, Jose J, Khanna N, Laskar S, Goel M
J Surg Oncol · 2026 May · PMID 42089321 · Publisher ↗
BACKGROUND: Retroperitoneal sarcoma (RPS) is a rare and complex malignancy, requiring specialized multidisciplinary care. While a significant progress has been made in managing a primary RPS, there is a limited literatur...
BACKGROUND: Retroperitoneal sarcoma (RPS) is a rare and complex malignancy, requiring specialized multidisciplinary care. While a significant progress has been made in managing a primary RPS, there is a limited literature on the outcomes of recurrent RPS (RecRPS). This study evaluates the oncological outcomes of RecRPS at a leading sarcoma referral center in India. METHODS: A retrospective analysis was performed for patients with RecRPS who underwent surgery between January 2011 and December 2024. Clinical outcomes were analyzed using Kaplan-Meier method and compared using log-rank test. Extended Cox regression models were used to account for intra-individual correlation, in cases of multiple recurrence. Prentice, William and Peterson model (PWP) CP model (total time) and PWP Gap time (PWP-GT) models were employed to estimate predictors of multiple recurrences. RESULTS: Out of 285 patients with primary RPS, 160 (56.1%) underwent surgery for a recurrent disease. The median overall survival (OS) was 137.1 months for the entire cohort and 41.92 months in RecRPS. The median OS of patients with 1st recurrence was 38.97 months. For subsequent recurrences, the median OS were 74.94 months (2nd recurrence), 57.4 months (3rd recurrence) and 54.2 months (4th recurrence), respectively. The various clinicopathological parameter associated with multiple recurrences were R+resection or resection with unknown margins, dedifferentiated liposarcoma and leiomyosarcoma, as histopatholologic subtypes; histologic organ invasion (HOI) of the small bowel and vessels, requirement of adjuvant and neoadjuvant therapy, disease progression on neoadjuvant chemotherapy and grade IIIb and IV complications. CONCLUSION: While the best chance of cure is at the primary presentation, some patients may experience prolonged disease control even with multiple recurrence, if treated optimally.
Correction to "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection".
J Surg Oncol · 2026 May · PMID 42068574 · Publisher ↗
Abstract loading — click title to view on PubMed.
Correction to "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection".
J Surg Oncol · 2026 May · PMID 42068568 · Publisher ↗
Abstract loading — click title to view on PubMed.
Axillary dissection vs. non-axillary dissection in breast cancer patients with sentinel lymph node metastasis: An updated systematic review and meta-analysis of randomized clinical trials.
Castelo Branco PES, Carneiro IMC, Franco AHS … +5 more , de Oliveira AP, de Oliveira YTN, Matias FHS, Lomez ESL, Cândido EB
Surg Oncol · 2026 Jun · PMID 42066648 · Publisher ↗
OBJECTIVES: Perform an updated meta-analysis of RCTs that evaluated survival and recurrence in patients with clinically node-negative breast cancer with sentinel lymph node metastasis who underwent sentinel lymph node di...
OBJECTIVES: Perform an updated meta-analysis of RCTs that evaluated survival and recurrence in patients with clinically node-negative breast cancer with sentinel lymph node metastasis who underwent sentinel lymph node dissection (SLND) alone compared to axillary lymph node dissection (ALND). METHODS: A systematic search was conducted in PubMed, Embase, and Cochrane databases for studies on clinical T1-T3, N0, M0 primary breast cancer patients with pSLN undergoing SLND or ALND. The primary outcomes of interest are disease-free survival, overall survival, and recurrence rate; surgical adverse effects and mortality rate are evaluated as secondary outcomes. RESULTS: We included eight RCTs, in which 3952 patients underwent SLND, and 3871 underwent ALND in the presence of sentinel lymph node metastasis. We observed that overall survival and disease-free survival were non-inferior in the experimental group. When analyzing recurrence rates, axillary recurrence was the only type for which ALND appeared to have a protective effect. In contrast, local and distal recurrence were more common in the group undergoing complete axillary dissection. In terms of morbidity, patients who underwent SLND alone had fewer adverse surgical effects. The reduction in lymphedema was statistically significant only at the 5-year endpoint after randomization. However, the occurrence was lower in the experimental group at all time points analyzed in the studies. CONCLUSION: Our findings show that SLND reduces surgical complications associated with ALND and improves quality of life without decreasing local control and overall survival in patients with T1-T2/T3 breast cancer with clinically negative nodes and the presence of 1-2 pSLN.
Colorectal peritoneal metastases treated by cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Should we consider the primary tumour site?
Tidadini F, Glehen O, Sourrouille I … +18 more , Dumont F, Quesada JL, Eveno C, Marchal F, Amroun KL, Abba J, Pocard M, Kepenekian V, Fernandez de Sevilla E, Louis-Gaubert C, Foote A, Sage PY, Malgras B, Trilling B, Faucheron JL, Ezanno AC, Arvieux C, BIG Renape Group
Surg Oncol · 2026 Jun · PMID 42061941 · Publisher ↗
BACKGROUND: Several publications have shown that cancers of the colon and of the rectum are significantly different, and tumor location is a major prognostic factor for survival. However, colorectal peritoneal metastases...
BACKGROUND: Several publications have shown that cancers of the colon and of the rectum are significantly different, and tumor location is a major prognostic factor for survival. However, colorectal peritoneal metastases (CRPM) is still considered as a homogeneous and a single disease without differentiating between colonic or rectal origin. We asked whether the primary tumor location influences the survival and surgical outcomes of patients with colonic (C_PM) and rectal peritoneal metastases (R_PM) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: Between January 2013 and March 2024, data from 1237 CRS/HIPEC procedures in 1152 patients with CRPM were analysed (C_PM, n = 1129; R_PM, n = 108). Overall survival (OS), recurrence-free survival (RFS), and day-30 morbi-mortality were compared. RESULTS: The 3-year and 5-year OS rates were 68.9% and 52.5% respectively and were significantly better for C_PM than for R_PM patients: (69.8% vs 61%; p = 0.036) and (53.4% vs 43.6%; p = 0.031) respectively. Stratification according to left (LC_PM) and right colonic (RC_PM) subgroups resulted in better 3-year OS for LC_PM than for RC_PM (73.9% vs 63.2%; p ≤ 0.001). Multivariate analysis of 5-year survival identified PCI >15 (HR = 2.09), R_PM (HR = 1.46) and RC_PM (HR = 1.29) as significant risk factors of death. The C_PM group had fewer re-interventions at day-30 (17.6% vs 36.1%; p ≤ 0.001) and shorter surgery time (330 vs 390 min; p ≤ 0.001), ICU-stay (3 vs 4 days; p ≤ 0.001) and hospital length-of-stay (14 vs 17 days; p = 0.002). CONCLUSION: Patients presenting with colonic PM have significantly better OS at 3 and 5 years with fewer re-interventions at day-30 and, shorter surgery time, ICU and hospital stay than those presenting rectal PM. Left-side colonic PM has a significantly better OS at 3-years than right-side colonic PM. PCI >15, rectal and right colonic origin are linked to earlier mortality. When deciding on CRS/HIPEC treatment, designing a study, or reporting data, the CRPM primary tumour site should be taken into account.
The Negative Impact of a Non-Therapeutic Laparotomy in Patients With Inoperable Colorectal Peritoneal Metastases.
Heuvel TVD, Kesteren LV, Nienhuijs S … +4 more , Burger P, Buffart T, Tuynman J, Hingh I
J Surg Oncol · 2026 Apr · PMID 42057481 · Publisher ↗
BACKGROUND: The peritoneum is the third most prevalent location for metastases of colorectal cancer. In patients with resectable disease, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS...
BACKGROUND: The peritoneum is the third most prevalent location for metastases of colorectal cancer. In patients with resectable disease, cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) is the preferred treatment in the Netherlands, achieving median overall survival (OS) of 36-42 months. However, during explorative laparotomy, CRS-HIPEC may appear unfeasible. Evidence on how such non-therapeutic laparotomies affect prognosis is limited. METHODS: This retrospective cohort study included all non-therapeutic laparotomies performed between 01 and 01-2010 and 01-01-2022 in two Dutch tertiary HIPEC-centers. Patient, tumor and treatment characteristics, postoperative morbidity, and survival outcomes were analyzed and compared to existing literature. RESULTS: In total, 108 patients underwent a non-therapeutic laparotomy (discontinued CRS-HIPEC). The main reason was that peritoneal disease was too extensive (56%). Severe postoperative complications (Clavien-Dindo ≥ 3) occurred in 9%. Following a non-therapeutic procedure, 55% of patients received tumor-directed palliative treatment. Median OS of the entire cohort was 6.5 months (95% CI 5.1-8.0). Palliative systemic therapy was the only factor significantly associated with improved OS (12.6 vs. 2.9 months, p < 0.001). CONCLUSIONS: Non-therapeutic laparotomies are associated with decreased survival in patients with extensive peritoneal metastases. Reducing their occurrence is essential. Advances in diagnostic modalities, including MRI, FAPI-PET, artificial intelligence, and developments in bidirectional treatments, may improve preoperative selection and offer alternative therapeutic options. Further research is required.
Augmented Reality Based 3D Modelling for Sentinel Lymph Node Localization in Cutaneous Melanoma: A Pilot Study.
Adawi Q, Meiri H, Yoschpe A … +8 more , Shapira R, Grynberg S, Schachter J, Eshet Y, Eifer M, Nachmany I, Zippel D, Mor E
J Surg Oncol · 2026 Apr · PMID 42057335 · Publisher ↗
BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard for staging high-risk melanoma, but current mapping provides limited spatial guidance. This pilot study assessed whether augmented reality (AR) projected 3D model...
BACKGROUND: Sentinel lymph node biopsy (SLNB) is standard for staging high-risk melanoma, but current mapping provides limited spatial guidance. This pilot study assessed whether augmented reality (AR) projected 3D models can improve sentinel node localization compared with the gamma probe. METHODS: In this prospective study, 10 melanoma patients undergoing SLNB at Sheba Medical Center had preoperative sentinel lymphoscintigraphy using SPECT/CT imaging segmented to generate patient-specific 3D models. Models were projected onto the patient via an AR headset before incision. Localization accuracy was measured as the deviation (mm) between AR3D-identified and gamma probe-identified sentinel lymph node positions. RESULTS: Ten patients were enrolled in this pilot study. The median age was 71 years (range 30-77). Primary tumor sites included upper limb (n = 5), trunk (n = 3), Lower Limb (n = 1), and Head and Neck (n = 1). The median Breslow thickness was 1.1 mm (range 0.8-24 mm), with ulceration in 2 cases. Model generation was successful in all patients, with each model projected onto the patient using the AR headset and evaluated by the surgeon prior to incision. The median deviation between AR3D model and the gamma probe localization was 12 mm (range 0-40 mm), with 43% of cases ≤ 10 mm. No AR-related complications occurred. CONCLUSIONS: AR-based 3D modelling was feasible and safe for SLNB localization in melanoma. Although accuracy varied, in nearly half of the cases, AR3D model was within 10 mm of the gamma probe detection. These preliminary results supported further refinement of the technique and evaluation in larger, multicenter trials.
De-Escalating Surgery for 1-2 cm Appendiceal Neuroendocrine Tumors: A North American Multi-Center Analysis.
Miller RM, Tan PH, Saleeb A … +7 more , Thompson ER, Fong ZV, Stucky CC, Bagaria SP, Gabriel EM, Grotz TE, Wasif N
J Surg Oncol · 2026 Apr · PMID 42057320 · Publisher ↗
BACKGROUND AND OBJECTIVES: NCCN guidelines recommend right hemicolectomy (RHC) for appendiceal neuroendocrine tumors (aNETs) > 2 cm and observation for < 1 cm. However, optimal surgical management of 1-2 cm tumors remain...
BACKGROUND AND OBJECTIVES: NCCN guidelines recommend right hemicolectomy (RHC) for appendiceal neuroendocrine tumors (aNETs) > 2 cm and observation for < 1 cm. However, optimal surgical management of 1-2 cm tumors remains controversial. This study compared long-term survival and recurrence between patients undergoing RHC versus appendectomy (APY) for 1-2 cm aNETs. METHODS: Patients with pathologically confirmed 1-2 cm aNETs treated at three Mayo Clinic sites (1972-2024) were included. Primary outcomes were recurrence and all-cause mortality after resection. Associations with lymph node (LN) metastasis were assessed in patients with lymphadenectomy. RESULTS: Sixty-five patients were identified: 29 (45%) underwent APY, 35 (54%) RHC, and one ileocecectomy. Median age at diagnosis was 39 years; 71% were female and 94% white. LN positivity was 15.2% for tumors with nodes examined. Tumor size > 1.5 cm, stage T3/T4, and lymphovascular invasion were not associated with nodal metastasis. No survival differences were observed between APY and RHC. LN positivity did not impact survival. No recurrences occurred during a median follow-up of 6.25 years (IQR 2.44-12.63). CONCLUSIONS: Among patients with 1-2 cm aNETs, RHC conferred no survival benefit over APY. Absence of recurrence and the limited prognostic value of nodal disease suggest APY alone may suffice for this population.
The Role of Primary Tumor Resection in De Novo Bone-Only Metastatic Breast Cancer: A Propensity Score-Matched Analysis.
Wang B, Liu S, Huang Z … +5 more , Wang J, Zhou X, Li S, Chen J, Liu H
J Surg Oncol · 2026 Apr · PMID 42057318 · Publisher ↗
OBJECTIVE: To evaluate the impact of primary tumor resection (PTR) on overall survival (OS) and cancer-specific survival (CSS) in women with de novo bone-only metastatic breast cancer (MBC). METHODS: Women diagnosed with...
OBJECTIVE: To evaluate the impact of primary tumor resection (PTR) on overall survival (OS) and cancer-specific survival (CSS) in women with de novo bone-only metastatic breast cancer (MBC). METHODS: Women diagnosed with de novo bone-only metastatic breast cancer between 2010 and 2017 were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Patients were included if they had bone metastasis at diagnosis but no lung, liver, or brain involvement. Primary tumor resection was defined as any cancer-directed breast surgery. Propensity scores were calculated using multivariable logistic regression incorporating demographics, tumor features, and treatment factors, followed by 1:1 nearest-neighbor matching (caliper = 0.2 SD). Kaplan-Meier, Cox proportional hazards, and restricted mean survival time (RMST) analyses assessed overall survival (OS) and cancer-specific survival (CSS). Time-dependent ROC curves (timeROC) evaluated model discrimination. Determinants of PTR were examined using multivariable logistic regression. RESULTS: A total of 3296 women with de novo bone-only metastatic breast cancer were included (1252 with PTR; 2044 without). After 1:1 matching, 2002 well-balanced patients remained (1001 per group). Median OS and CSS were significantly longer among patients undergoing surgery (OS: 69 vs. 39 months; CSS: 76 vs. 41 months; both p < 0.0001). PTR remained an independent predictor of improved OS (HR = 0.54, 95% CI 0.48-0.60, p < 0.001), with consistent benefit across subgroups. RMST differences (surgery - no surgery) increased with time, reaching 9.05 months for OS and 8.79 months for CSS at 60 months. Model discrimination was acceptable (AUCs for OS: 0.753, 0.734, 0.717 at 1-, 3-, and 5-years). Radiation therapy was positively associated with PTR (OR = 1.37, 95% CI 1.12-1.68, p = 0.002), whereas well/moderate grade predicted lower odds (OR = 0.80, 95% CI 0.66-0.99, p = 0.036). CONCLUSIONS: In this large SEER-based propensity-matched analysis, primary tumor resection was associated with significantly improved overall and cancer-specific survival among women with de novo bone-only metastatic breast cancer. These findings suggest that selected patients with isolated bone metastasis may benefit from locoregional surgery, warranting further prospective validation.
Outcomes of minimally invasive conversion surgery after immune checkpoint inhibitors for stage IV gastric cancer.
Amada E, Kumagai K, Watanabe Y
Surg Oncol · 2026 Jun · PMID 42054777 · Publisher ↗
INTRODUCTION: Conversion surgery, enabling curative resection in initially unresectable tumors post-chemotherapy, has gained traction across various cancers. In gastric cancer, particularly HER2-negative cStage IV, integ...
INTRODUCTION: Conversion surgery, enabling curative resection in initially unresectable tumors post-chemotherapy, has gained traction across various cancers. In gastric cancer, particularly HER2-negative cStage IV, integrating immune checkpoint inhibitors (ICIs) like nivolumab with chemotherapy presents a promising strategy. This study evaluates the efficacy and safety of minimally invasive conversion surgery following ICI-combined chemotherapy for these patients. MATERIALS AND METHODS: Patients with HER2-negative cStage IV gastric cancer treated at our institution (2022-2024) were retrospectively reviewed. Diagnosis involved contrast-enhanced CT and staging laparoscopy. Treatment options included SOX + Nivo or FOLFOX + Nivo regimens for eligible candidates aged 20-80 years. Conversion surgery eligibility was assessed after initial and additional treatment cycles, guided by established diagnostic and re-staging criteria. Minimally invasive surgical techniques were applied unless contraindicated. RESULTS: Of 42 patients, 28 were cStage IV, with 18 HER2-negative. Conversion surgery was successful in 14 cases; 12 employed minimally invasive methods. The cohort comprised mainly males with a median age of 70. Post-treatment analysis showed significant improvements in performance status and nutritional markers. Grade 2 postoperative complications were minimal, with no severe events. The median postoperative hospital stay was nine days, and high rates of tumor response were observed. The 1-year relapse-free survival and 1-year overall survival were both 100.0% CONCLUSION: The study underscores the potential of ICI-combined chemotherapy to achieve control of metastatic disease and enable minimally invasive curative surgery in stage IV gastric cancer, thereby offering improved prognosis for this patient cohort. Further research is advocated to confirm long-term survival benefits.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe