Surgical Oncology[JOURNAL]
Sun
200 papers
Early Complications in Mandibular Reconstruction: Analysis Using Comprehensive Complication Index.
Hidaka T, Miyamoto S, Fukunaga Y … +4 more , Oshima A, Shinozaki T, Matsuura K, Higashino T
J Surg Oncol · 2026 Apr · PMID 41992640 · Publisher ↗
BACKGROUND: Early postoperative complications after microvascular mandibular reconstruction impact outcomes in patients with advanced oral cancer. This study evaluates three reconstruction techniques: vascularized bone g...
BACKGROUND: Early postoperative complications after microvascular mandibular reconstruction impact outcomes in patients with advanced oral cancer. This study evaluates three reconstruction techniques: vascularized bone graft (VBG), mandibular reconstruction plate (MRP) with a non-osseous flap, and soft tissue flap (STF), using the Comprehensive Complication Index (CCI). METHODS: In this retrospective study of 101 patients, early postoperative complications (≤ 30 days) were assessed using the CCI, calculated from Clavien-Dindo classification grades. Differences among the three techniques were analyzed using multivariable linear regression. RESULTS: VBG was performed in younger, healthier patients. No significant differences in CCI were found among the three techniques. Multivariable analysis confirmed that non-surgical factors, such as diabetes, had greater influence on complication risks. CONCLUSIONS: Appropriate patient selection minimizes early complication risks. VBG in younger patients and technical refinements in MRP may yield complication burdens comparable to STF. TRIAL REGISTRATION: This study was registered in the UMIN Clinical Trials Registry as UMIN000056584 (http://www.umin.ac.jp/ctr).
Mitoxantrone hydrochloride as a novel tracer for lymphatic mapping and complication reduction in thyroid cancer surgery: A single-center, randomized clinical study.
Cheng Y, Zhang S, Liu Z … +5 more , Ji W, Liu L, Wang Y, Wang Y, Gu J
Surg Oncol · 2026 Jun · PMID 41990519 · Publisher ↗
OBJECTIVES: To explore the imaging effect of the novel tracer, mitoxantrone hydrochloride injection for tracing (MHI), on cervical lymph nodes during thyroid cancer radical surgery, and its clinical value in assisting th...
OBJECTIVES: To explore the imaging effect of the novel tracer, mitoxantrone hydrochloride injection for tracing (MHI), on cervical lymph nodes during thyroid cancer radical surgery, and its clinical value in assisting the identification of parathyroid glands and recurrent laryngeal nerves. METHODS: A prospective randomized controlled study was conducted from January 2022 to March 2025, recruiting 220 thyroid cancer cases at Tianjin First Central Hospital. The CONSORT checklist was followed. Among the participants, 64 were male and 156 were female, with ages ranging from 26 to 69 years. Based on different lymph node tracing methods, the cases were divided into three groups: the MHI lymph node tracing group (MHI group, n = 100), the nanoparticle carbon lymph node tracing group (nanoparticle carbon group, n = 60), and the no lymph node tracer group (control group, n = 60). All patients underwent total thyroidectomy and regional lymph node dissection. General clinical indicators were recorded, and the number of detected lymph nodes, positive metastasis, surgical field clarity, parathyroid gland identification rate, and error excision rate were compared. Serum calcium, parathyroid hormone (PTH) levels, and complications were analyzed at different time points. Statistical analysis was conducted using one-way ANOVA, chi-square test, and two independent sample non-parametric tests. RESULTS: The MHI group and nanoparticle carbon group had significantly shorter operative times, less cervical drainage volume, and shorter hospital stays compared to the control group (P<0.05 for all). The MHI group had significantly higher staining scores, successful tracing rates, and surgical field clarity scores compared to the nanoparticle carbon group (P<0.05 for all). The MHI group had significantly more lymph nodes removed, a higher number of positive metastases, and a higher parathyroid identification rate compared to both the nanoparticle carbon and control groups. The error excision rate for the parathyroid gland in the MHI and nanoparticle carbon groups was significantly lower than in the control group (P<0.05 for all). On post-operative days 1 and 5, the MHI group had significantly higher serum calcium and PTH levels compared to both the nanoparticle carbon and control groups. However, on post-operative day 1, there was no difference in serum calcium levels between the nanoparticle carbon and control groups (P>0.05), but the PTH level in the nanoparticle carbon group was higher than that in the control group. On post-operative day 5, the nanoparticle carbon group had higher levels of both serum calcium and PTH compared to the control group (P<0.05 for all). On post-operative days 14 and 30, there was no significant difference in serum calcium and PTH levels between the MHI and nanoparticle carbon groups (P>0.05). The MHI and nanoparticle carbon groups had a lower risk of facial numbness, hand and foot convulsions, and dysphagia compared to the control group (P<0.05 for all). CONCLUSIONS: MHI can provide several advantages during radical thyroid cancer surgery, including clear lymph node tracing within the surgical field, enhanced nodal identification and pathological retrieval, and improved surgical visibility and nodal harvest. These advantages can contribute to reduce the risk of injury to the recurrent laryngeal nerve and parathyroid glands.
Prognostic impact of CRM-status on survival in patients with resected pancreatic adenocarcinoma - a dual-center cohort analysis.
Brunner M, Merkel S, Cammann S … +3 more , Vondran F, Grützmann R, Wiltberger G
Surg Oncol · 2026 Jun · PMID 41990518 · Publisher ↗
BACKGROUND: This study aimed to evaluate the impact of circumferential resection margin (CRM) status on the prognosis of patients undergoing pancreatic head resection for pancreatic adenocarcinoma (PDAC). METHODS: In thi...
BACKGROUND: This study aimed to evaluate the impact of circumferential resection margin (CRM) status on the prognosis of patients undergoing pancreatic head resection for pancreatic adenocarcinoma (PDAC). METHODS: In this dual-center retrospective cohort study, data from 413 patients who underwent curative-intent pancreatic head resection for PDAC between 2010 and 2023 at two German tertiary care centers were analyzed. CRM status was stratified into R0 wide (>1 mm), R0 narrow (≤1 mm) and R1 (tumor at margin). To account for potential confounding by tumor biology, a propensity score matching analysis was additionally performed comparing R0 wide versus R0 narrow/R1 resections. RESULTS: Among 413 patients, 208 (50%) had R0 wide, 126 (31%) R0 narrow and 79 (19%) R1 resections. Median overall survival (OS) was significantly longer in the R0 wide group (31 months) compared to R0 narrow (21 months) and R1 (20 months) (p < 0.001). Similarly, disease free survival (DFS) was significantly prolonged in R0 wide patients (21 months) versus R0 narrow (12 months) and R1 (12 months) (p < 0.001). Multivariate analysis identified CRM status as an independent prognostic factor for both OS (HR for R0 narrow: 1.4; R1: 1.5) and DFS (HR for R0 narrow: 1.4; R1: 1.4). These findings were confirmed after matching, with R0 wide resections remaining significantly associated with improved OS (HR: 1.5) and DFS (HR: 1.4). The most common localization of CRM narrow or R1 resections was the mesenteric vessel plane and dorsal margin, accounting for 64% of all positive or close margins. CONCLUSION: Achieving a margin clearance of >1 mm in resected pancreatic head adenocarcinoma is associated with significantly improved survival outcomes. The frequent involvement of the mesenteric and dorsal planes underscores the need for meticulous surgical technique and planning in these critical anatomical regions.
Nipple preservation rates of robot-assisted nipple-sparing mastectomy for breast cancer patients with different tumor-to-nipple distance categories.
Lui SA, Chu CH, Huang PC … +7 more , Ho HY, Huang JJ, Huang YT, Lin LC, Kuo YC, Chiu HH, Kuo WL
Surg Oncol · 2026 Jun · PMID 41990517 · Publisher ↗
BACKGROUND: Nipple-sparing mastectomy (NSM) offers aesthetic and psychological benefits for breast cancer patients but traditionally requires an adequate tumor-to-nipple distance (TND). Robot-assisted NSM (R-NSM) may fac...
BACKGROUND: Nipple-sparing mastectomy (NSM) offers aesthetic and psychological benefits for breast cancer patients but traditionally requires an adequate tumor-to-nipple distance (TND). Robot-assisted NSM (R-NSM) may facilitate controlled dissection under the nipple-areolar complex (NAC). This study evaluated the rates of NAC preservation and local recurrence in R-NSM patients across different TND ranges. METHODS: A retrospective study involving 173 patients who underwent 180 R-NSMs using multi-armed surgical robots was conducted. Patients were categorized into three groups based on their TND: group A (<1 cm), group B (1-2 cm), and group C (>2 cm). The nipple preservation rate, nipple necrosis rate, and local recurrence rate were compared. RESULTS: 173 patients underwent R-NSMs (n = 180) with immediate breast reconstruction, including 106 free flaps (58.9%), 54 implants (30.0%), and 20 tissue expanders (11.1%). Seven of them underwent bilateral mastectomies. The R-NSM numbers were 40 (22.2%) in group A, 72 (40.0%) in group B, and 68 (37.8%) in group C. There were 5 (2.8%) immediate nipple resections and 2 (1.11%) delayed nipple excisions. The NAC preservation rates in groups A, B, and C were 85%, 98.5%, and 98.5%, respectively (p = 0.003). During a median follow-up of 36.6 months (3.12-82.33 months), the overall NAC recurrence rate was 1.2% among patients who underwent nipple preservation. The locoregional recurrence rate was 2.8%. None of them occurred in the TND group A. Superficial nipple necrosis was noted in 23.3% of the patients, with 98.8% healed spontaneously. CONCLUSION: The nipple preservation rate with TND <1 cm was 85%, and the NAC recurrence rate was extremely low. The robotic approach increases patients' options for NSM, although long-term oncological outcomes await updates.
Pelvic MRI Following Total Neoadjuvant Therapy for Rectal Cancer Poorly Predicts a Complete Clinical Response.
Suss NR, Johnson R, Olortegui KS … +4 more , Liauw SL, Shergill A, Polite B, Shogan BD
J Surg Oncol · 2026 Apr · PMID 41987351 · Publisher ↗
BACKGROUND AND OBJECTIVE: Determining complete clinical response (cCR) after total neoadjuvant therapy (TNT) for the treatment of rectal cancer remains challenging. Post-treatment restaging can show discordant results be...
BACKGROUND AND OBJECTIVE: Determining complete clinical response (cCR) after total neoadjuvant therapy (TNT) for the treatment of rectal cancer remains challenging. Post-treatment restaging can show discordant results between endoscopy and pelvic MRI. The aim of this study was to assess the outcomes of patients that had an endoscopic cCR upon restaging, but showed continued radiographical disease. METHODS: This is a retrospective study of rectal cancer patients treated at UChicago (2015-2022). Patients who received TNT, had a cCR on restaging endoscopy, and pursued nonoperative management (NOM) were included. Outcomes between patients with residual or no residual disease on restaging MRI were compared. RESULTS: Thirty patients were endoscopically negative on restaging and entered NOM. Of these, restaging MRI showed residual disease in 12 (40%) patients and no residual disease in 18 (60%) patients. After a mean follow-up of 4.8 years, nine patients (30%) experienced regrowth. There was no difference in regrowth rates between patients with negative versus positive restaging MRI (33% vs. 27.8%; p = 0.75). After a mean of 4.0 years, 67% of patients who had an initial positive restaging MRI did not develop a regrowth. CONCLUSION: Two-thirds of endoscopically negative patients with initially positive restaging MRIs showed no regrowth after 4 years.
Tranexamic Acid in Lower Extremity Endoprosthetic Reconstruction for Oncologic Indications: A Retrospective Comparative Study of 617 Patients.
Chenard SW, Rekulapelli A, Gilbertson RS … +8 more , Charton CS, Hefley WF, Colello MJ, Halpern JL, Schwartz HS, Johnson DJ, Schoenecker JG, Lawrenz JM
J Surg Oncol · 2026 Apr · PMID 41987346 · Publisher ↗
BACKGROUND AND OBJECTIVES: While tranexamic acid (TXA) reduces blood loss in orthopedic surgery, thromboembolic concerns in cancer patients have limited adoption in orthopedic oncology. This study evaluated TXA efficacy...
BACKGROUND AND OBJECTIVES: While tranexamic acid (TXA) reduces blood loss in orthopedic surgery, thromboembolic concerns in cancer patients have limited adoption in orthopedic oncology. This study evaluated TXA efficacy and safety in patients undergoing endoprosthetic reconstruction for oncologic indications. METHODS: This retrospective single-center study included 617 patients who underwent lower extremity endoprosthetic reconstruction for oncologic indications between 2000 and 2024. Patients were stratified by perioperative TXA administration (n = 166) versus no TXA (n = 451). The primary outcome was perioperative blood loss calculated using the Mercuriali method. Secondary outcomes included perioperative packed red blood cells (pRBC) transfusion, hospital length of stay, and 90-day venous thromboembolic (VTE) complications. RESULTS: TXA was associated with a 429 mL reduction in calculated perioperative blood loss (1878 ± 1168 mL vs. 2307 ± 1442 mL; p = 0.003). TXA was not associated with reduced intraoperative pRBC transfusion rates (31% vs. 33%; RR 0.96 [95% CI: 0.74-1.25], p = 0.752) but was associated with significantly reduced postoperative transfusion requirements (17% vs. 30%; RR 0.56 [95% CI: 0.39-0.81], p = 0.003). No significant differences existed in 90-day VTE complications, reoperation rates, or mortality. CONCLUSIONS: Perioperative TXA use was associated with reduced blood loss and postoperative transfusion requirements without a detectable increase in thromboembolic complications, supporting TXA as a beneficial adjunct in musculoskeletal oncology limb salvage procedures.
Is cSCC Recurrence After Clear Margins a Sentinel Sign for Undiagnosed Immunosuppression?
Rodríguez-Jiménez P, Delgado-Jiménez Y
J Surg Oncol · 2026 Apr · PMID 41981784 · Publisher ↗
Abstract loading — click title to view on PubMed.
Safety of Pre-Operative Radiotherapy Combined With Intraoperative Radiotherapy for Retroperitoneal Sarcoma.
MacDonald M, Dougherty K, Pham V … +3 more , Yanagihara TK, Kim HJ, Spanheimer PM
J Surg Oncol · 2026 Apr · PMID 41981778 · Publisher ↗
BACKGROUND: Local recurrence in retroperitoneal sarcomas (RPS) with high-risk surgical margins remains a significant clinical challenge. Previous randomized trials have evaluated neoadjuvant external beam radiation thera...
BACKGROUND: Local recurrence in retroperitoneal sarcomas (RPS) with high-risk surgical margins remains a significant clinical challenge. Previous randomized trials have evaluated neoadjuvant external beam radiation therapy (EBRT) without intraoperative radiotherapy (IORT). Following multidisciplinary consensus, our institution employs neoadjuvant EBRT combined with IORT for the management of RPS. This study evaluates the safety and feasibility of this combined strategy. METHODS: A single-institution retrospective review was conducted of patients with RPS treated with neoadjuvant EBRT, surgical resection, and IORT between June 1, 2004, and June 30th, 2024. Postoperative complications and 90-day readmission rates were identified through electronic medical records, pathology reports, and death registries. Postoperative complications were graded by the Clavien-Dindo (CD) classification system. RESULTS: Twenty-eight patients underwent neoadjuvant EBRT followed by resection with IORT. The median age was 66 years (IQR 59.6-69.6 years) and 57% were female. Twenty-three patients (83%) were treated for primary disease, and five patients (17%) were being treated for recurrent disease, with one patient undergoing treatment for recurrence twice. Median number of neoadjuvant EBRT cycles was 25 (IQR 25). Patients received a median neoadjuvant EBRT dose of 4,500 cGy (IQR 45-4,500 cGy) and median IORT dose of 1375 cGy (IQR 1250-1500 cGy). The median tumor size was 11.9 cm (IQR 7-22.6 cm) and most commonly leiomyosarcoma (42%) and well-differentiated liposarcoma (29%). Multi-visceral resection was required in 71% of cases, most often involving the kidney (64%), adrenal gland (39%), and gallbladder (32%). Complete (R0) resection was achieved in 14 (54%) patients, while incomplete (R1) resection was achieved in 12 (46%) patients. Median hospital stay was 7 days (IQR 6-9 days). Postoperative morbidity occurred in 78% of patients, with 25% experiencing major (Clavien-Dindo III-V) complications. There was one mortality within 90 days of index operation. CONCLUSION: Neoadjuvant EBRT followed by resection with IORT is associated with frequent low-grade complications and a 25% rate of major complications, similar to neoadjuvant EBRT alone.
Laparoscopic right caudate lobectomy combined with right posterior lobectomy for hepatocellular carcinoma after neoadjuvant therapy (with video).
Yang L, Bao X, Li D … +4 more , Pan Z, Zheng H, Xu Z, Zhang W
Surg Oncol · 2026 Jun · PMID 41980503 · Publisher ↗
BACKGROUND: Tumors located at the Caudate lobe are challenging due to proximity to major vessels, increasing recurrence risk and surgical difficulty. Neoadjuvant therapy has been explored for hepatocellular carcinoma (HC...
BACKGROUND: Tumors located at the Caudate lobe are challenging due to proximity to major vessels, increasing recurrence risk and surgical difficulty. Neoadjuvant therapy has been explored for hepatocellular carcinoma (HCC) patients with higher risk of recurrence. METHODS: A 53-year-old female patient was admitted with hepatic mass detected during routine physical examination. PIVKA-II was 2143 mAU/ml and alpha-fetoprotein (AFP) was 8553 ng/ml. Contrast-enhanced magnetic resonance imaging demonstrated two discrete lesions, with tumor-related compression of the right hepatic vein and close anatomical proximity to the right portal vein trunk and posterior branch. RESULTS: Due to multiple tumors and proximity to major blood vessels with narrow margins, multidisciplinary consultation determined that neoadjuvant therapy was decided. Patient received donafenib continuously, three sessions of sintilimab and hepatic arterial infusion chemotherapy (HAIC), which resulted in marked tumor regression. Laparoscopic resection was performed. Pathological examination confirmed a diagnosis of HCC with low-grade differentiation and a major pathological response (MPR) with necrotic tumor area exceeding 70%. No evidence of recurrence was detected at the six-month's follow-up. CONCLUSION: Our findings demonstrate that laparoscopic caudate lobectomy after neoadjuvant therapy is a feasible approach for managing resectable HCC with high risk of recurrence located in the caudate lobe.
Comparative outcomes of organ-preserving surgery vs. radical resection for clinical T2N0 rectal cancer: A retrospective analysis.
Wetherell J, Zeller M, Bennett J … +5 more , Nasseri Y, Mavanur A, Solis-Pazmino P, Felton J, Wolf JH
Surg Oncol · 2026 Jun · PMID 41980502 · Publisher ↗
BACKGROUND: Radical resection is recommended for clinical T2N0 rectal cancer, yet some patients receive local excision or neoadjuvant therapy, practices traditionally excluded from national guidelines for this stage. We...
BACKGROUND: Radical resection is recommended for clinical T2N0 rectal cancer, yet some patients receive local excision or neoadjuvant therapy, practices traditionally excluded from national guidelines for this stage. We aimed to assess treatment patterns and the impact of surgical approach and neoadjuvant therapy on overall survival. METHODS: This was a retrospective cohort study utilizing the American College of Surgeons National Cancer Database. Patients diagnosed with clinical T2N0 rectal adenocarcinoma who underwent local excision or radical resection were included. The primary outcome was overall survival. RESULTS: Of 11,513 patients, 1,853 (16.1%) underwent local excision and were older, more comorbid, and more likely to be female (all p < 0.001). Five-year survival was lower for local excision (65.4%) versus radical resection (77.2%), p < 0.001). This persisted across neoadjuvant therapy subgroups. Local excision was associated with worse survival (HR = 1.15, 95% CI: 1.06-1.25, p < 0.001). Neoadjuvant chemoradiation conferred increased hazard of death compared to no neoadjuvant therapy (HR = 1.20, 95% CI: 1.11-1.30, p < 0.001). Highest risk was observed in patients receiving both local excision and neoadjuvant chemoradiation (HR = 1.36, 95% CI: 1.13-1.63, p < 0.001). CONCLUSIONS: Since 2006, local excision and neoadjuvant therapy have been used in a stable minority of patients with T2N0 disease. Recent guidelines have incorporated these treatment options. Data suggest worse overall survival associated with this minority group, highlighting the need for prospective studies to define optimal treatment strategies.
Empowering women in breast cancer surgery: A systematic review of shared decision-making between mastectomy and breast conservation.
Maes-Carballo M, Gómez-Fandiño Y, Martínez-Martínez C … +3 more , Sampol-Ramírez L, de-la-Puente-Mota N, Bueno-Cavanillas A
Surg Oncol · 2026 Jun · PMID 41980501 · Publisher ↗
BACKGROUND: As survival improves, attention in breast cancer (BC) has shifted from purely oncologic outcomes to quality of life, body image, and value-concordant decision-making. In this context, shared decision-making (...
BACKGROUND: As survival improves, attention in breast cancer (BC) has shifted from purely oncologic outcomes to quality of life, body image, and value-concordant decision-making. In this context, shared decision-making (SDM) has emerged as a cornerstone of patient-centered BC care, particularly in guiding choices between breast-conserving surgery (BCS) and mastectomy. However, its implementation and impact on patient outcomes remain inconsistently documented. METHODS: Following PRISMA guidelines, a systematic review was conducted across six databases (PubMed, Embase, Web of Science, Scopus, Cochrane Library, and Trip) up to April 2025 (OSF registration: osf. io/fr8ka). Original studies examining SDM in surgical decision-making between BCS and mastectomy were included. Data extraction and quality assessment (using the QualSyst tool) were performed independently by four reviewers. Evidence was synthesized thematically across five SDM domains: determinants of surgical choice, patient perception and outcomes, decision aids, structured SDM models, and barriers and facilitators. RESULTS: Twenty-two studies met the inclusion criteria. Most were observational (59%), with 95% of quantitative studies rated as strong (QualSyst ≥0.80). SDM consistently enhanced patient knowledge, involvement, and satisfaction, significantly reducing decisional conflict (mean reduction 6-10 points, p < 0.01) and improving congruence between treatment choice and personal values. Decision aids, particularly 3D visual and conversational tools, increased observed SDM scores by 24-32 points (OPTION-5 (Observing Patient Involvement-5), p = 0.01) and mitigated knowledge disparities among lower-socioeconomic status patients. While SDM rarely altered overall surgical distributions (BCS approximately 70%, mastectomy 30%), it refined the decision-making process and increased confidence. Implementation barriers included clinician resistance, time constraints, and systemic inequities, whereas structured frameworks and institutional support facilitated success. CONCLUSIONS: SDM in BC surgery strengthens the ethical and psychological integrity of surgical decisions by ensuring that choices between BCS and mastectomy reflect informed, deliberative, and value-concordant preferences. Though its influence on surgical distribution is limited, SDM enhances satisfaction, decisional quality, and equity. Integrating structured SDM frameworks and clinician training into standard breast surgery practice is essential to advance truly patient-centered care.
The role of MicroRNAs in modulating ZEB2-driven EMT and metastasis.
Rab SO, Midhin BK, Altalbawy FMA … +7 more , Basunduwah TS, Bishoyi AK, Walia C, Rathore G, Zwamel AH, Ravi Kumar M, El-Sehrawy AAMA
Surg Oncol · 2026 Jun · PMID 41980500 · Publisher ↗
MicroRNAs (miRNAs) are small noncoding RNAs that fine-tune gene expression by promoting mRNA degradation or translational repression. In cancer, miRNAs serve as key regulators of tumor progression, acting either as oncog...
MicroRNAs (miRNAs) are small noncoding RNAs that fine-tune gene expression by promoting mRNA degradation or translational repression. In cancer, miRNAs serve as key regulators of tumor progression, acting either as oncogenes or tumor suppressors. A central aspect of their function is the regulation of epithelial-mesenchymal transition (EMT), a process that enables epithelial cells to acquire mesenchymal features, enhancing motility, invasion, and metastatic potential. ZEB2, a transcription factor and primary EMT driver, represses epithelial markers such as E-cadherin while promoting mesenchymal traits. Its overexpression is closely associated with cancer stem cell-like properties, recurrence, and drug resistance. Multiple miRNAs directly target ZEB2 to modulate EMT and metastatic behavior. Notably, the miR-200 family (miR-200a, miR-200b, miR-200c, miR-141, and miR-429) acts as a crucial suppressor of EMT by binding ZEB2 mRNA, thereby maintaining epithelial identity. Conversely, high ZEB2 expression represses miR-200 levels, establishing a feedback loop that dictates the balance between epithelial and mesenchymal states. Other miRNAs, including miR-205, miR-206, and miR-637, also suppress ZEB2 expression, with their downregulation correlating with enhanced invasion, metastasis, and poor patient outcomes. Dysregulation of these miRNA-ZEB2 interactions shifts the cellular phenotype toward mesenchymal dominance, facilitating cancer cell migration, dissemination, and colonization at distant sites. This study aims to explore the molecular and cellular mechanisms underlying the interactions between ZEB2 and miRNAs, with a particular focus on their role in regulating EMT, migration, and metastasis in cancer. This understanding may guide the development of novel therapeutic strategies targeting the miRNA-ZEB2 axis to prevent tumor progression and improve patient outcomes.
Building and validating a machine learning-based survival prediction model for early gastric cancer: a SEER database analysis.
Zhan S, Li D, Qian X … +1 more , Feng J
Surg Oncol · 2026 Jun · PMID 41980499 · Publisher ↗
BACKGROUND: Early gastric cancer (EGC) represents a substantial disease burden. In order to manage it, this study aimed to construct a time-interval survival classification models for patients with EGC based on machine l...
BACKGROUND: Early gastric cancer (EGC) represents a substantial disease burden. In order to manage it, this study aimed to construct a time-interval survival classification models for patients with EGC based on machine learning (ML) algorithms. METHODS: This retrospective study analyzed data from the Surveillance, Epidemiology, and End Results (SEER) database covering the period from 2000 to 2021. Univariate logistic regression and least absolute shrinkage and selection operator (LASSO) were used to identify potential risk factors influencing the survival of patients with EGC. The performance of nine ML models was evaluated using receiver operating characteristic (ROC) curves, the area under the curve (AUC), and decision curve analysis (DCA). Finally, the impact of the variables on 1-3 years, 3-5 years, and 5-10 years survival outcomes was assessed by the Shapley additive explanations (SHAP). RESULTS: A total of 4088 patients with EGC were included. For 1-3 years of survival prediction, logistic regression (LR) achieved the highest AUC value of 0.8142. For 3-5 years of survival, KNN exhibited the highest AUC of 0.6362. Multilayer Perceptron (MLP) displayed the highest AUC of 0.692 in the 5-10 years survival group. The outcomes of SHAP indicated that age was the most common predictor in all groups. The primary site of the tumor, tumor size, and histologic type significantly affect the survival rates in the 1-3 years, 3-5 years, and 5-10 years groups, respectively. CONCLUSION: This study develops and validates an ML-based survival prediction model for EGC. These findings demonstrate the methodological potential of ML for understanding prognostic factors in cancer patient management.
Sarcopenia and the C-reactive protein-Albumin-Lymphocyte index as independent and complementary prognostic factors in resected non-small cell lung cancer.
Yoneyama S, Nakamura R, Nakaoka K … +9 more , Muto R, Kato T, Yamazaki K, Numata T, Ota K, Endo T, Inadome Y, Satoh H, Fukunaga K
Surg Oncol · 2026 Jun · PMID 41966786 · Publisher ↗
BACKGROUND/AIM: To investigate the relationship between sarcopenia and the C-Reactive Protein-Albumin-Lymphocyte (CALLY) index and assess their prognostic value in patients undergoing curative resection for non-small cel...
BACKGROUND/AIM: To investigate the relationship between sarcopenia and the C-Reactive Protein-Albumin-Lymphocyte (CALLY) index and assess their prognostic value in patients undergoing curative resection for non-small cell lung cancer (NSCLC). METHODS: We analysed 329 consecutive patients with NSCLC who underwent curative resection. Sarcopenia was assessed using bioelectrical impedance analysis according to international guidelines. The CALLY index was calculated from preoperative blood tests, with an optimal cutoff determined using receiver operating characteristic (ROC) analysis. We evaluated these markers' correlations and their independent prognostic significance for overall survival (OS) and recurrence-free survival (RFS). RESULTS: Sarcopenia and a low CALLY index were identified in 106 (32.2%) and 166 patients (50.5%), respectively. No significant correlation was observed between the skeletal muscle and CALLY (men: r = -0.005, p = 0.945; women: r = -0.013, p = 0.884) indices. In the multivariate analysis, both sarcopenia (OS: hazard ratio [HR] = 1.892, 95% confidence interval [CI] = 1.193-3.001, p = 0.007; RFS: HR = 2.135, 95% CI = 1.425-3.201, p < 0.001) and low CALLY index (OS: HR = 1.994, 95% CI = 1.232-3.229, p = 0.005; RFS: HR = 1.668, 95% CI = 1.108-2.525, p = 0.016) were identified as independent predictors of poor survival. Patients in the high-risk group exhibited significantly poorer OS (57.2% vs. 83.6%) and RFS (48.5% vs. 80.3%) compared to those in the low-risk group (p < 0.001). CONCLUSIONS: Sarcopenia and the CALLY index are independent and complementary prognostic factors in resectable NSCLC, aiding risk stratification and potentially guiding perioperative intervention strategies.
Development and validation of a nomogram for false-negative results in fine-needle aspiration of axillary lymph nodes in breast cancer.
Tao Y, Zheng A, Li X … +2 more , Wei J, Chen Y
Surg Oncol · 2026 Jun · PMID 41962319 · Publisher ↗
OBJECTIVE: To construct and validate a nomogram for predicting false-negative results of axillary lymph node (ALN) fine needle aspiration (FNA) in breast cancer (BC). METHODS: Using the surgical pathological results of a...
OBJECTIVE: To construct and validate a nomogram for predicting false-negative results of axillary lymph node (ALN) fine needle aspiration (FNA) in breast cancer (BC). METHODS: Using the surgical pathological results of axillary lymph nodes (ALNs) in BC patients as the gold standard, we retrospectively analyzed the clinical, pathological, and ultrasonographic characteristics of patients with false-negative lymph FNA results and identified predictive factors. Based on the independent predictors screened, a nomogram prediction model was constructed and validated using the Hosmer-Lemeshow test, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA). The calibration curve was drawn by bootstrap method for internal verification. RESULTS: Univariate analysis revealed that the following five factors were statistically significant predictors of false-negative results (P < 0.05): ultrasound features of ALN shape, corticomedullary boundary, hilum status, histological type of the primary tumor from core needle biopsy (CNB), and short-axis diameter of ALNs on ultrasound. Multivariate analysis identified three independent predictors of false-negative FNA results (P < 0.05): ultrasound features of ALN shape, corticomedullary boundary, and histological type of the primary tumor from CNB. A nomogram prediction model was successfully developed based on these independent predictors. The Hosmer-Lemeshow test yielded a P-value of 1, the area under the ROC curve (AUC) was 0.782, and the DCA threshold range for the nomogram was 0.03-0.95. The calibration curve was drawn by bootstrap method for internal verification, and the conclusion was that N = 247, Mean absolute error = 0.012, Mean squared error = 0.00035. CONCLUSION: A nomogram model was constructed to predict false-negative FNA results in ALNs of BC patients, demonstrating good predictive performance.
Elective Surgical Care Pathways Are Associated With Lower Fracture Rates at Presentation and Contribute to Superior Clinical Outcomes in Metastatic Bone Disease.
Abbott AG, Kendal JK, Wajda B … +3 more , Assadzadeh GE, Puloski SKT, Monument MJ
J Surg Oncol · 2026 Apr · PMID 41957955 · Publisher ↗
BACKGROUND AND OBJECTIVES: Metastatic bone disease (MBD) often necessitates orthopaedic surgical intervention, which occurs through either emergent or elective care pathways. This study compared post-operative outcomes b...
BACKGROUND AND OBJECTIVES: Metastatic bone disease (MBD) often necessitates orthopaedic surgical intervention, which occurs through either emergent or elective care pathways. This study compared post-operative outcomes between patients undergoing elective versus emergent surgery for MBD involving the pelvis and appendicular skeleton. METHODS: We performed a retrospective, multicenter, propensity-matched cohort study of patients who underwent surgery for MBD. Emergent surgery was defined as an unplanned admission followed by unscheduled surgery, while elective surgery referred to cases with an outpatient orthopaedic consultation and scheduled procedure. Primary outcomes were overall survival (OS) from the time of surgery, hospital length of stay (LOS), and 30-day readmission. RESULTS: Following propensity matching, 296 patients were included with 148 in each group. OS was significantly shorter in the emergent group (5.0 months 95%CI: 3.0-6.0 vs. 16.9 months 95%CI: 11.1-21.2) [p < 0.001]. LOS was significantly longer in the emergent group (13 days, 95%CI: 6-28 vs. 6 days, 95%CI: 3-10 days) [p < 0.001]. There was a significantly greater rate of readmission in the emergent group (12.2% 95%CI: 10.3-17.6 vs. 6.1% 95%CI: 3.5-10.2) [p = 0.004]. CONCLUSION: Elective surgery for MBD was associated with significantly superior clinical outcomes. Interventions that reduce the need for emergent surgery could markedly improve outcomes in this population.
Biological and comorbidity factors outweigh lymph node metrics in predicting outcomes after small-bowel neuroendocrine tumour resection.
Kotecha K, Darbhamulla S, Chan DL … +7 more , Chang KH, Bailey DL, Pavlakis N, Clarke S, Gill AJ, Mittal A, Samra JS
Surg Oncol · 2026 Jun · PMID 41955818 · Publisher ↗
BACKGROUND: Small-bowel neuroendocrine tumours (SBNETs) frequently involve mesenteric lymph nodes. While guidelines suggest minimum lymph node yields (LNY), the independent prognostic relevance of LNY and lymph node rati...
BACKGROUND: Small-bowel neuroendocrine tumours (SBNETs) frequently involve mesenteric lymph nodes. While guidelines suggest minimum lymph node yields (LNY), the independent prognostic relevance of LNY and lymph node ratio (LNR) regarding recurrence remains uncertain in contemporary cohorts. METHODS: A retrospective analysis of 102 patients undergoing R0/R1 resection for SBNETs (2005-2023) at a single tertiary institution was conducted. The primary outcome was overall survival (OS), and time to recurrence (TTR) was analyzed as a secondary endpoint, with the caveat that recurrence detection is sensitive to surveillance frequency and patient presentation. Literature-informed thresholds (LNY >8, LNR ≤0.46) were applied and validated using exploratory cut-point analysis. Predictors of outcome were assessed using Kaplan-Meier survival analysis and multivariable Cox and logistic regression models. RESULTS: At a median follow-up of 8.1 years, the 5-year overall survival (OS) for the entire cohort was 86.0%. On multivariable analysis, older age (HR 1.39; p = 0.037) and higher Charlson Comorbidity Index (HR 1.17; p = 0.093) were the primary drivers of mortality. In contrast, surgical nodal metrics (LNY and LNR) were not independent predictors of OS. Secondary analysis showed that in the localized subgroup (stage I-III), the median TTR was not reached, and the 5-year TTR rate was 73.7%. Independent predictors of recurrence/progression were higher Charlson Comorbidity Index (OR 1.90 per point; p < 0.001), younger age (OR 0.93 per year; p < 0.001), and higher Ki-67 index (OR 1.36 per %; p = 0.011). CONCLUSIONS: In this cohort, adequate lymphadenectomy (>8 nodes) assisted staging. However, nodal metrics were not statistically significant predictors of recurrence or survival after multivariable adjustment, reflecting the dominant influence of tumor biology (Ki-67) and patient comorbidity (as reflected by the CCI score) on overall survival. Prognostication and surveillance strategies should prioritize biological markers and patient factors over surgical nodal metrics alone.
Marital Status Is Associated With Treatment Attainment in Pancreatic Adenocarcinoma.
Beniwal PC, Farooq MS, Vargas GM … +4 more , Simons RA, Etherington MS, Miura JT, Karakousis GC
J Surg Oncol · 2026 Apr · PMID 41952297 · Publisher ↗
BACKGROUND: In patients with pancreatic adenocarcinoma, for whom complex pre- and postoperative therapy is necessary, the effects of social support by means of marital status have not been well studied. We therefore soug...
BACKGROUND: In patients with pancreatic adenocarcinoma, for whom complex pre- and postoperative therapy is necessary, the effects of social support by means of marital status have not been well studied. We therefore sought to assess the relationship of marital status with treatment attainment in patients with pancreatic adenocarcinoma. METHODS: This retrospective national cohort analysis used the SEER database and included adult patients with stage I-III pancreatic adenocarcinoma from 2018 to 2022 (n = 24 540). Rates of treatment (surgery, chemotherapy, radiation), time to treatment, and treatment delay (> 6 weeks from diagnosis) were compared between married, divorced, single, and widowed patients. RESULTS: Of the eligible 24 540 patients, 14 280 (58.2%) were married, 2731 (9.7%) were divorced, 3665 (14.9%) were single, and 3864 (15.7%) were widowed. Multivariable analysis demonstrated decreased likelihood of undergoing surgery for divorced (aOR: 0.61, p < 0.001), single (aOR: 0.60, p < 0.001), and widowed (aOR: 0.37, p < 0.001) patients versus married patients. Likelihood of treatment delay was higher for divorced (aOR: 1.36, p < 0.001), single (aOR: 1.43, p < 0.001), and widowed (aOR: 1.46, p < 0.001) patients versus married patients as well. CONCLUSIONS: Married patients with pancreatic adenocarcinoma had higher rates of surgery and reduced likelihood of treatment delay compared to divorced, single, and widowed patients.
A Percutaneous, High-Flow, Hyperthermic Isolated Limb Perfusion Technique for Extremity Malignancies: Point of Technique.
Selvaraju A, Krishnan CK, Muralidharan K … +4 more , Sundararajan P, Bary A, Krishnamurthy SS, Raja A
J Surg Oncol · 2026 Apr · PMID 41947637 · Publisher ↗
Isolated limb perfusion (ILP) has long been a cornerstone treatment for unresectable extremity malignancies, offering high local control while sparing the limb. Traditional hyperthermic ILP (HILP), though effective, requ...
Isolated limb perfusion (ILP) has long been a cornerstone treatment for unresectable extremity malignancies, offering high local control while sparing the limb. Traditional hyperthermic ILP (HILP), though effective, requires open vascular access and carries significant morbidity. In contrast, isolated limb infusion (ILI) employs a percutaneous approach, but it compromises perfusion quality and treatment duration. This paper describes a hybrid technique that integrates the minimally invasive percutaneous access of ILI with the high-flow, oxygenated, hyperthermic circuit characteristic of HILP. Using advanced endovascular access, extracorporeal oxygenation, and rigorous real-time leakage monitoring, this method replicates the physiological parameters of open HILP while eliminating the need for surgical incisions. The technique expands access to high-efficacy regional chemotherapy for patients previously deemed unfit for open procedures. It represents a significant advancement in limb-sparing therapy, balancing oncologic efficacy with patient safety and procedural simplicity. This paper provides a step-by-step technical guide to its implementation.
Enhanced Recovery After Surgery in Cytoreductive Surgery With HIPEC: Implementation and Outcomes From a High-Volume Tertiary Centre in a Lower-Middle Income Country.
Bansal B, Ravi V, Garg R … +5 more , Mishra A, Bhoriwal S, Mandal A, Gupta N, Ray MD
J Surg Oncol · 2026 Apr · PMID 41947623 · Publisher ↗
BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significant morbidity. Enhanced Recovery After Surgery (ERAS) protocols may improve perioperative outcomes...
BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significant morbidity. Enhanced Recovery After Surgery (ERAS) protocols may improve perioperative outcomes, but data from low- and middle-income countries (LMICs) remain limited. METHODS: We conducted an ambispective study comparing patients undergoing CRS-HIPEC before (January 2015-June 2022; n = 294) and after (July 2022-June 2024; n = 70) ERAS implementation at a high-volume tertiary cancer centre. ERAS compliance and perioperative outcomes, including length of stay (LOS), major morbidity (Clavien-Dindo III-IV), mortality, readmission, and reoperation, were analysed. RESULTS: Overall, ERAS compliance was 77.1%. Compliance was highest for preoperative and intraoperative components, while postoperative elements showed comparatively lower adherence. Median postoperative LOS decreased significantly from 8 to 5 days (p = 0.02). Major morbidity declined from 20.1% to 12.9%, although this was not statistically significant. Ninety-day mortality (4.6% vs 4.3%), readmission (15% vs 12.9%), and reoperation rates (13% vs 10%) were comparable between groups. CONCLUSION: Implementation of an ERAS pathway for CRS-HIPEC in a high-volume LMIC centre is feasible and safe, resulting in shorter hospital stay without increasing morbidity or mortality.
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