Eur J Surg Oncol [JOURNAL]
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200 papers
Effect of perioperative targeted therapy duration on prognosis in patients with gastrointestinal stromal tumors undergoing neoadjuvant imatinib therapy: A nationwide retrospective study.
Tian H, Gao X, Zhang J … +12 more , Fu Y, Gao Z, Zhou Y, Qiu H, Tao K, Zhao X, Fu Y, Zhang B, Tang J, Wang M, Zhang X, Zhang P
Eur J Surg Oncol · 2026 Jun · PMID 42401066 · Publisher ↗
BACKGROUND: Contemporary evidence highlights a paucity of systematic research addressing the prognostic implications of total targeted therapy duration in the neoadjuvant setting. Parallel to this, the optimal timeframe...
BACKGROUND: Contemporary evidence highlights a paucity of systematic research addressing the prognostic implications of total targeted therapy duration in the neoadjuvant setting. Parallel to this, the optimal timeframe for preoperative therapy remains a subject of unresolved debate in clinical practice. In this study, we estimated the impact of total targeted therapy duration on prognosis in patients with gastrointestinal stromal tumors (GIST) undergoing neoadjuvant imatinib therapy. METHODS: In this nationwide study, we retrospectively analyzed the clinical data from 186 GIST patients receiving neoadjuvant imatinib therapy from January 2010 to December 2021. Clinical data including baseline characteristics, treatment pattern, treatment outcome, adverse events and survival status were collected. The primary endpoint was progression-free survival (PFS). Secondary endpoints were overall survival (OS) and safety. Cox regression analysis was used to analyze the prognostic factors of PFS and OS. RESULTS: Among 186 patients, 149 (80.1%) were aged ≤65 years and 110 (59.1%) were male. Regarding neoadjuvant imatinib treatment duration, 59 patients (31.7%) had less than 6 months, 97 (52.2%) patients had 6 to 12 months, and 30 (16.1%) patients had more than 12 months. Multivariate Cox regression analysis indicated that residual mitotic index (>5/50 HPF: HR = 5.80, 95% CI: 2.56-13.15, P < 0.001), non-R0 resection (HR = 11.50, 95% CI: 4.71-28.08, P < 0.001), and adjuvant imatinib therapy (HR = 0.23, 95% CI: 0.07-0.74, P = 0.014) were independent prognostic factors for PFS, while residual mitotic index (>5/50 HPF: HR = 4.40, 95% CI: 1.29-15.06, P = 0.018), multivisceral resection (HR = 4.07, 95% CI: 1.09-15.19, P = 0.037), and adjuvant imatinib therapy (HR = 0.04, 95% CI: 0.01-0.17, P < 0.001) were independent prognostic factors for OS. Maximally selected log-rank analysis identified 35 months and 45 months as the optimal cut-offs for adjuvant and total targeted therapy durations, respectively. No significant difference was found in PFS and OS among patients with different neoadjuvant imatinib therapy durations (P = 0.233, P = 0.326). CONCLUSIONS: Prolonged adjuvant and total targeted therapy durations correlate with improved survival in GIST patients receiving neoadjuvant imatinib, whereas neoadjuvant imatinib duration alone does not independently affect long-term outcomes. Additionally, a low residual mitotic index remains a robust histopathological predictor of favorable prognosis.
AI-powered real-time detection and classification of peritoneal nodules in colorectal cancer using multi-center laparoscopic data: A feasibility study.
Zhong R, Yi J, Qin M … +17 more , Huang X, Liu J, Lv J, Wu Y, Huang Z, Huang Y, He F, Liu S, Zhang W, Wu P, Qin X, Qin L, Yang X, Liao C, Liu J, Tang W, Long C
Eur J Surg Oncol · 2026 Jun · PMID 42398281 · Publisher ↗
OBJECTIVE: To explore the feasibility of developing an intraoperative real-time detection model for peritoneal nodules in laparoscopic colorectal cancer surgery using computer vision and deep learning, and to provide a p...
OBJECTIVE: To explore the feasibility of developing an intraoperative real-time detection model for peritoneal nodules in laparoscopic colorectal cancer surgery using computer vision and deep learning, and to provide a preliminary assessment of its potential for assisting surgeons in nodule identification. METHODS: Laparoscopic colorectal cancer surgery videos from three regional general hospitals were collected. Systematic peritoneal exploration segments were extracted and converted into image frames to construct the dataset. Surgeons performed annotation of peritoneal nodule locations and benign/malignant classification based on pathological results. The YOLOv11l architecture was employed to train separate models for peritoneal nodule detection and benign/malignant classification. Model performance was evaluated on the test set using metrics such as mAP@50. A comparative experiment with novice surgeons was designed to assess the model's accuracy and real-time performance. RESULTS: Based on a dataset constructed from 165 multi-center surgical videos, the YOLOv11l abdominal peritoneal nodule detection model developed by us performed well on the test set, with an AP@50 of 0.846 for nodule detection and an mAP@50 of 0.835 for benign and malignant classification. The real-time inference speed reached 14 FPS, meeting the requirements for real-time laparoscopic video analysis. Compared with mainstream detection models, YOLOv11l demonstrated better performance in both nodule detection and benign and malignant classification tasks. Human-machine comparison showed that the model's recognition time was significantly shorter than that of novice surgeons, while the recognition accuracy reached 89.47%. CONCLUSION: This feasibility study demonstrates that a real-time peritoneal nodule detection and classification system based on YOLOv11l can be developed. The model shows promising accuracy and speed in identifying and classifying peritoneal nodules during laparoscopic colorectal cancer surgery. However, further validation with larger, patient-level datasets is needed before clinical application.
Advances in intraoperative margin assessment for solid tumors: Toward a new era of personalized precision surgery.
Gao Z, Zhao L, Li Z … +11 more , Wang R, Liu X, Qi X, Zhang X, Liu H, Yu Y, Yu B, Li S, Guo R, Zhu Z, Li K
Eur J Surg Oncol · 2026 Jun · PMID 42398280 · Publisher ↗
The accurate determination of surgical margin status remains a core challenge in the curative surgery of solid tumors. Conventional methods relying on intraoperative frozen sections and empirical surgeon judgment often f...
The accurate determination of surgical margin status remains a core challenge in the curative surgery of solid tumors. Conventional methods relying on intraoperative frozen sections and empirical surgeon judgment often fall short due to insufficient spatial resolution, an inability to detect molecular residues, and inherent subjectivity. These limitations fail to meet the demands of personalized precision surgery. Recent breakthroughs in multimodal intraoperative assessment technologies are driving a paradigm shift from empirical resection towards molecular navigation: advanced imaging techniques enable dynamic visualization of anatomical boundaries; fluorescence and spectral technologies provide real-time biological margin navigation by capturing tissue-specific molecular fingerprints; mass spectrometry, leveraging metabolomic signatures, can provide alerts rapidly for histologically negative yet high-risk margins; and molecular profiling methods further decode potential biological boundaries defined by spatial immune microenvironment gradients and genomic alterations. Together, these technologies are elevating the evaluation standard from "morphologically negative" to "molecularly safe" delivering unprecedented precision for surgical decision-making. However, critical bottlenecks for clinical translation persist, including high costs, a lack of cross-platform standardization, and insufficient multimodal integration. Future advancements will require leveraging complementary technological strengths, developing AI-driven automated analysis systems, and accelerating research into portable devices. An individualized margin assessment framework grounded in tumor biology and treatment response will establish a new foundation for optimizing long-term patient survival and functional preservation.
Refining oncological resectability for intrahepatic cholangiocarcinoma: Radiological assessment of mediastinal lymph node enlargement does not reflect clinical prognosis after curative resection.
Riddermann A, Delgadillo Aceves IN, Yerdelen SS … +6 more , Ringe KI, Heinrich B, Felgendreff P, Feldbrügge L, Schmelzle M, Nevermann N
Eur J Surg Oncol · 2026 Jun · PMID 42391734 · Publisher ↗
INTRODUCTION: With advances in surgical techniques, resectability of intrahepatic cholangiocarcinoma (ICCA) is now largely determined by oncological criteria. Distinguishing localized disease from early systemic spread r...
INTRODUCTION: With advances in surgical techniques, resectability of intrahepatic cholangiocarcinoma (ICCA) is now largely determined by oncological criteria. Distinguishing localized disease from early systemic spread remains a major challenge in interdisciplinary decision-making. This study aimed to evaluate the prognostic significance of radiologically enlarged mediastinal lymph nodes (emLN) in patients with resectable ICCA. MATERIALS AND METHODS: Clinical data from all consecutive patients who underwent liver resection for ICCA between 2008 and 2018 at a single high-volume center were prospectively collected, with outcome data supplemented retrospectively. RESULTS: A total of 109 patients met the inclusion criteria and comprised the study cohort. Cross-sectional imaging identified emLN in 48 patients (44 %). Overall survival (OS) and recurrence-free survival (RFS) did not differ significantly between patients with and without emLN (OS: 29 vs. 30 months, p = 0.55; RFS: 11 months in both groups, p = 0.63). Among patients with left-sided ICCA, emLN were present in 39 cases (79.6 %), compared with 33 cases (55.0 %) in patients with right-lobe tumors (p = 0.008). CONCLUSION: This is the first study to assess the potential prognostic impact of radiologically enlarged mediastinal lymph nodes in ICCA. The presence of emLN on preoperative staging was not associated with impaired survival outcomes. Therefore, patients with resectable ICCA should be considered for curative resection irrespective of this radiological finding.
Macroscopic venous tumour thrombus in paediatric adrenocortical tumours.
Redlich A, Kunstreich M, Warncke G … +5 more , Siegert S, Slavetinsky C, Vokuhl C, Fuchs J, Kuhlen M
Eur J Surg Oncol · 2026 Jun · PMID 42385411 · Publisher ↗
INTRODUCTION: Macroscopic venous tumour thrombus is recognized in adult adrenocortical tumours (ACT), but its incidence, surgical implications, and prognostic impact in children remain poorly defined. MATERIALS AND METHO...
INTRODUCTION: Macroscopic venous tumour thrombus is recognized in adult adrenocortical tumours (ACT), but its incidence, surgical implications, and prognostic impact in children remain poorly defined. MATERIALS AND METHODS: We retrospectively analysed prospectively collected registry data from 104 children and adolescents with adrenocortical carcinoma or tumours of uncertain malignant potential treated between 1997 and 2025. Patients were classified by vascular status: no invasion, microscopic invasion, macroscopic venous tumour thrombus, or unresectable disease. The study was non-randomized; treatment reflected registry recommendations and local multidisciplinary decisions. RESULTS: Vascular status was no invasion in 26 patients, microscopic invasion in 54, macroscopic venous tumour thrombus in 20, and unresectable disease in 4. Macroscopic venous tumour thrombus occurred in 19.2% and involved the adrenal vein only in 6 patients, suprarenal inferior vena cava in 4, retrohepatic inferior vena cava in 7, and intracardiac extension in 3. Right-sided tumours were numerically more frequent in the macroscopic thrombus group (14 of 20, 70.0%). This subgroup was older (median 7.3 years), had larger tumours (median 11.0 cm), and showed frequent regional lymph-node involvement (95.0%), distant metastases (30.0%), neoadjuvant treatment (55.0%), and adjuvant therapy (85.0%). Complete resection was achieved in 12 of 18 surgically treated patients. Five-year overall survival was 91.0%, 73.6%, and 56.1% for patients without vascular invasion, with microscopic invasion, and with macroscopic thrombus, respectively; corresponding event-free survival was 69.0%, 58.8%, and 42.5%. CONCLUSION: Macroscopic venous tumour thrombus identifies a high-risk subgroup, but complete resection remains achievable in selected patients and should not be equated with surgical futility.
Outcomes after pulmonary bilobectomy for NSCLC: The role of surgical type, indication, and pulmonary function.
Mangiameli G, Brascia D, Suraci A … +5 more , Re Cecconi E, Cariboni U, Testori A, Alloisio M, Marulli G
Eur J Surg Oncol · 2026 Jun · PMID 42385410 · Publisher ↗
INTRODUCTION: Bilobectomy is an uncommon but sometimes necessary procedure in selected patients with non-small cell lung cancer (NSCLC). However, whether outcomes are influenced by resection type or underlying surgical i...
INTRODUCTION: Bilobectomy is an uncommon but sometimes necessary procedure in selected patients with non-small cell lung cancer (NSCLC). However, whether outcomes are influenced by resection type or underlying surgical indication remains unclear. MATERIALS AND METHODS: This single-center study included consecutive patients undergoing bilobectomy for NSCLC between 2010 and 2024. Upper and lower bilobectomies were analyzed separately and stratified by surgical indication (trans-fissural invasion, N1 disease, or endobronchial involvement). Endpoints included major postoperative complications, overall survival (OS), and disease-free survival (DFS). Multivariable analyses identified independent predictors of outcomes. RESULTS: A total of 153 patients were included, of whom 27 (17.6%) underwent upper and 126 (82.4%) lower bilobectomy. The overall complication rate was 36.4%, higher after lower bilobectomy (p = 0.020), while no differences were observed according to surgical indication (p = 0.550). Five-year DFS and OS were 41.9% and 55.3%, with no significant differences by indication or resection type (all p > 0.05). At multivariable analysis, lower bilobectomy (OR 4.89, p = 0.011) and neoadjuvant therapy (OR 2.92, p = 0.010) were associated with postoperative complications. FEV1 independently predicted both DFS (HR 0.61, p = 0.018) and OS (HR 0.57, p = 0.015), whereas neither indication nor bilobectomy type influenced survival. CONCLUSION: Bilobectomy provides acceptable perioperative and oncologic outcomes in selected NSCLC patients. Long-term survival is primarily driven by tumor biology and functional status rather than surgical factors. While lower bilobectomy is associated with increased postoperative morbidity, resection type and indication do not independently affect survival.
Impact of 18-FDG PET-CT on the preoperative staging and management of Incidental Gall Bladder Cancer (IGBC)- A prospective study from a tertiary care centre in North India.
Kohli M, Goel S, Iqbal A … +6 more , Aggarwal A, Gupta M, Garg P, Goel V, Talwar V, Singh S
Eur J Surg Oncol · 2026 Jun · PMID 42385409 · Publisher ↗
BACKGROUND: Only few retrospective studies have investigated ability of PET-CT to diagnose distant metastases in incidental GBC with variable results. This prospective study aims to determine utility of PET-CT in potenti...
BACKGROUND: Only few retrospective studies have investigated ability of PET-CT to diagnose distant metastases in incidental GBC with variable results. This prospective study aims to determine utility of PET-CT in potentially-resectable IGBC. METHODS: All IGBC patients (stage ≥ T1b) with resectable disease on CECT chest, abdomen & pelvis were subjected to FDG-PET-CT. All additional findings and change in management plan were recorded. RESULTS: Out of 118 patients, 78 (66.10%) were females with mean age of 55.6 years. After PET scan, additional findings were seen in 46/118 patients leading to change in management plan in 32 (27.12%) patients due to presence of distant metastases, most common site being distant LN in 15 (46.8%) followed by omento-peritoneal disease in 7 (21.8%) patients. After assessment on CECT, 63 patients were planned for NACT in view of locally advanced disease but after PET-CT, management plan changed to palliative chemotherapy in 24 (38.09%) of these cases whereas it changed in only 8 of 55 (14.5%) patients initially planned for upfront surgery (p = 0.0065). Sensitivity, specificity, PPV and NPV of PET for distant metastases was found to be 84.21%, 70.83%, 69.57% and 85% respectively with diagnostic accuracy of 76.74%. The diagnostic accuracy was 86%, 97.67% and 93% for diagnosis of distant LNs, liver and peritoneal metastasis respectively. CONCLUSION: FDG PET-CT is a valuable preoperative staging adjunct for IGBC as it changed management plan in more than one-fourth of all resectable patients and in more than one-third of locally advanced cases. It must not, however, be viewed as a standalone gateway; rather, it should be followed by a mandatory staging laparoscopy to rule out occult peritoneal dissemination.
Association of clinical response and lymph node yield with prognosis after neoadjuvant therapy for esophageal squamous cell carcinoma.
Ge Q, Guo C, Ma Y … +3 more , Li J, Lian J, Lu T
Eur J Surg Oncol · 2026 Jun · PMID 42385408 · Publisher ↗
OBJECTIVES: The optimal extent of lymphadenectomy after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC) remains uncertain. We hypothesized that preoperative clinical response modifies t...
OBJECTIVES: The optimal extent of lymphadenectomy after neoadjuvant therapy for locally advanced esophageal squamous cell carcinoma (ESCC) remains uncertain. We hypothesized that preoperative clinical response modifies the prognostic value of lymph node (LN) yield. METHODS: We conducted a two-center retrospective cohort study of consecutive patients with locally advanced ESCC treated at two high-volume esophageal cancer centers in China between January 2018 and August 2023. A total of 729 patients who received neoadjuvant therapy followed by R0 McKeown esophagectomy and systematic lymphadenectomy were included. Clinical response was assessed preoperatively using Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 and patients were stratified as responders or non-responders. LN yield was modeled primarily as a continuous exposure (per 10 additional nodes) using Cox models with multivariable adjustment and stabilized inverse probability of treatment weighting (sIPTW). Nonlinearity was assessed using spline models. Secondary analyses evaluated incremental nodal yield and postoperative complications. RESULTS: Among 729 patients, 456 were responders and 273 were non-responders. Median follow-up was 41 months. The association between LN yield and survival differed significantly by clinical response. In non-responders, higher LN yield was associated with improved overall survival (OS) and recurrence-free survival (RFS) (both adjusted hazard ratio (HR) per 10 nodes, 0.66), whereas no clear survival association was observed in responders (OS: 1.07; RFS: 1.10); interaction was significant for both endpoints. Incremental nodal detection was greatest at lower LN-yield ranges and diminished thereafter. Higher LN yield was also associated with increased risks of severe postoperative complications, pleural effusion, and recurrent laryngeal nerve palsy. CONCLUSIONS: The prognostic value and clinical trade-offs of lymphadenectomy after neoadjuvant therapy may differ by preoperative clinical response. These findings support prospective validation of response-adapted surgical strategies in ESCC.
Indication-specific use of Denosumab in Giant Cell Tumour of Bone: A retrospective cohort study.
Duivenvoorden MJ, Kurisunkal V, Hannink G … +3 more , Parry M, Jeys L, Verspoor FG
Eur J Surg Oncol · 2026 Jun · PMID 42379052 · Publisher ↗
INTRODUCTION: Giant Cell Tumours of Bone (GCTB) are locally aggressive, benign bone tumours. Denosumab was initially introduced as a neoadjuvant therapy to facilitate curettage but is now also used prior to en-bloc resec...
INTRODUCTION: Giant Cell Tumours of Bone (GCTB) are locally aggressive, benign bone tumours. Denosumab was initially introduced as a neoadjuvant therapy to facilitate curettage but is now also used prior to en-bloc resection, as definitive treatment for unresectable disease, and as long-term treatment for recurrent or metastatic disease. Evidence regarding indication-specific outcomes remains limited. This study evaluated contemporary Denosumab use according to treatment intent, focusing on treatment duration, recurrence patterns, and long-term administration. MATERIALS AND METHODS: A retrospective review was conducted of all GCTB patients treated with Denosumab at the Royal Orthopaedic Hospital, Birmingham, between 2010 and 2023. Patients were categorized according to treatment intent: 1) Short-course Neoadjuvant Denosumab (SCND), 2) Long-course Neoadjuvant Denosumab (LCND), 3) Definitive Denosumab for unresectable disease, and 4) Long-term Denosumab following local or distant recurrence. RESULTS: The study included 155 patients. Twenty-eight patients (18%) received SCND for median 15 weeks (IQR 11-20), local recurrence occurring in 13 patients (46%). Fifty-two patients (34%) received LCND for median 22 weeks (IQR 13-54), local recurrence occurring in 6 patients (12%). Forty-two patients (27%) received definitive Denosumab for median 123 weeks (IQR 83-182), while 33 patients (21%) received long-term Denosumab following recurrence for median 123 weeks (IQR 29-247). Dose de-escalation was frequently feasible in patients with sustained disease control, whereas adverse events were primarily associated with prolonged treatment exposure. CONCLUSION: This study demonstrates that Denosumab is used across several distinct clinical indications in GCTB. High recurrence rates were observed following short-course neoadjuvant treatment prior to curettage, whereas prolonged disease control was frequently achieved in selected patients receiving definitive or long-term Denosumab. A preliminary clinical framework for indication-specific Denosumab use is proposed and warrants prospective validation.
Systematic total parietal peritonectomy for peritoneal mesothelioma-perioperative and oncological outcomes in an Indian cohort of 100 patients.
Kazi M, Saklani A, Kammar P … +5 more , Desouza A, Sukumar V, Lavingia V, Mehta S, Bhatt A
Eur J Surg Oncol · 2026 Jun · PMID 42379051 · Publisher ↗
BACKGROUND AND AIM: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the current standard of care for patients with peritoneal mesothelioma (PeM). In this retrospective study, we evalu...
BACKGROUND AND AIM: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) is the current standard of care for patients with peritoneal mesothelioma (PeM). In this retrospective study, we evaluate the perioperative and oncological outcomes of systematic total parietal peritonectomy (TPP) which has demonstrated a significant improvement in survival compared to selective parietal peritonectomy. METHODS: 100 patients with PeM treated by CRS-HIPEC from 1st January 2013 to 31st December 2022 at three high-volume peritoneal malignancy centers were included. All patients underwent TPP irrespective of the disease extent. A multivariable Cox-regression analysis was performed to identify prognostic factors for disease-free survival (DFS). RESULTS: Eighty-nine patients had malignant PeM (mPeM), with a median peritoneal cancer index (PCI) of 26 [IQR 20-35]. 77% had a CC0/CC1 resection. Twenty-six patients had a total small bowel mesenteric peritonectomy. 35.9% had resection of ≥1 bowel segments. The 90-day grade 3-4 morbidity was ___, and mortality 4.5%. The median overall survival (OS) and DFS were 70 months [95% confidence intervals (CI) 57- NR] and 23 months [95% CI-19-33], respectively. Ki67 > 9% (HR 9.63, p < 0.001), systemic chemotherapy use (HR 2.78, p = 0.007), and high-grade postoperative morbidity (HR 6.23, p < 0.001) were independent predictors of a poorer DFS. In 11 patients with well differentiated papillary mesothelioma, median DFS was 48 months (35-NR) and median OS 60 months (60-NR). CONCLUSION: The morbidity of TPP combined with multi-visceral resections was established. This multi-institutional study provides the first comprehensive data on PeM with oncological outcomes from India, serving as valuable baseline information from high-volume centers.
The impact of body mass index on Esophagectomy: perioperative and oncological outcomes.
Patel PH, Doyle JP, Patel NM … +7 more , Fehervari M, McGlone E, Bobotis S, Bhogal RH, Chaudry MA, Allum W, Kumar S
Eur J Surg Oncol · 2026 Jun · PMID 42379050 · Publisher ↗
BACKGROUND: The worldwide prevalence of obesity is rising; much like other cancers, it is a risk factor for esophageal cancer and influences peri-operative outcomes for major upper gastrointestinal cancer surgery. Howeve...
BACKGROUND: The worldwide prevalence of obesity is rising; much like other cancers, it is a risk factor for esophageal cancer and influences peri-operative outcomes for major upper gastrointestinal cancer surgery. However, does it remain an independent risk factor of morbidity for patients undergoing an esophagectomy? METHODS: This study includes all patients undergoing esophagectomy between January 2004 to June 2023 in a single tertiary center. The patients were divided into groups by body mass index into a normal weight (18.5-24.9 kg/m); overweight (25-29.9 kg/m); and cohort with obesity (over 30 kg/m). The primary outcome is post-operative rates of major morbidity, with secondary outcomes being high dependency unit (HDU) and hospital length of stay (LoS). Statistical analysis was conducted by survey-weighted Wilcoxon-style rank regression and COX proportional hazards models to adjust for confounding factors. Kaplan-Meier survival curves present Overall (OS) and Disease Free Survival (DFS). RESULTS: 407 patients underwent esophagectomy during the study period: 139 patients were normal weight,158 were overweight and 110 were obese. The hospital LoS and post-operative complication rates were comparable between the three groups. The 1, 3 and 5 year OS was similar across all cohorts. Sub-group analysis of open versus laparoscopic esophagectomy in people with obesity identified a significantly longer HDU stay in patients undergoing open surgery (p=0.0097) and a significantly lower OS for those undergoing open esophagectomy (HR 2.25, 95% CI:1.2-4.21, p=0.0117). CONCLUSION: This study presents the western experience from a tertiary cancer center, with comparable outcomes for patients with obesity undergoing esophagectomy. Our findings suggest patients with obesity may have better peri-operative and long-term outcomes when esophagectomy is performed laparoscopically rather than open, supporting a minimally invasive approach in this cohort.
Vessel co-option negatively affects survival in patients with advanced hepatocellular carcinoma.
Okuno M, Hori Y, Komatsu M … +11 more , Nishino H, Kawabata Y, Yoh T, Nishio T, Ogiso S, Nakamura I, Ishii T, Hirono S, Iwaisako K, Seo S, Hatano E
Eur J Surg Oncol · 2026 Jun · PMID 42379049 · Publisher ↗
AIM: Vessel co-option is a type of tumor vascularization that involves the incorporation of preexisting vessels from surrounding tissue rather than the induction of new vessel growth. This study aimed to identify the pre...
AIM: Vessel co-option is a type of tumor vascularization that involves the incorporation of preexisting vessels from surrounding tissue rather than the induction of new vessel growth. This study aimed to identify the prevalence of vessel co-option patterns in patients with hepatocellular carcinoma and to evaluate the association of vessel co-option with resistance to systemic therapy and prognosis. METHODS: Tumor vascularization patterns at the time of initial hepatectomy were pathologically evaluated in patients who underwent systemic therapy for recurrence after liver resection, and their prognosis was examined. Gene expression profiles of tumor tissue were analyzed using RNA sequencing. RESULTS: Among the 64 patients, 16 patients (25.0%) exhibited the vessel co-option pattern, and 48 patients (75.0%) had the angiogenesis pattern. No significant differences in patient background and tumor characteristics were observed between the groups. The disease control rate (53.3% vs. 56.5%, p = 1.00) and response rate (13.3% vs. 26.1%, p = 0.48) for systemic therapy were similar between the groups. While no significant difference in median PFS during systemic therapy was observed between the vessel co-option group and the angiogenesis group (4.7 vs. 4.1 months, p = 0.81), the median OS was significantly shorter in the vessel co-option group than in the angiogenesis group (12.8 months vs. 27.3 months, p = 0.018). In the vessel co-option group, RNA sequencing revealed enrichment of genes associated with cell surface interactions at the vascular wall, extracellular matrix, and neutrophil degranulation. CONCLUSIONS: Compared with the angiogenesis pattern, the vessel co-option pattern was associated with worse OS in patients with advanced HCC, suggesting that vessel co-option reflects a biologically aggressive tumor phenotype.
Surgical Quality Assessment of paravertebral catheter placement in minimally invasive esophagectomy: an exploratory post hoc analysis of the PEPMEN- trial.
van der Aa DC, Teeken MD, Kooij CD … +11 more , Hermanides J, Feenstra ML, Gisbertz SS, Ruurda JP, Hollmann MW, Cheong E, Marsman M, van Berge Henegouwen MI, van Hillegersberg R, Eshuis WJ, PEPMEN-study group
Eur J Surg Oncol · 2026 Jun · PMID 42379048 · Publisher ↗
BACKGROUND: In the recent PEPMEN trial, paravertebral analgesia (PVA) proved to be a viable alternative to thoracic epidural analgesia in transthoracic minimally invasive esophagectomy (MIE). As part of surgical quality...
BACKGROUND: In the recent PEPMEN trial, paravertebral analgesia (PVA) proved to be a viable alternative to thoracic epidural analgesia in transthoracic minimally invasive esophagectomy (MIE). As part of surgical quality assurance, video recordings of PVA catheter placement were obtained. This post-hoc analysis aimed to evaluate the feasibility and reliability of a structured video-based quality assessment tool and to explore potential associations between visually assessed catheter placement quality and clinical outcomes. METHODS: The PEPMEN trial randomized 192 patients undergoing MIE with intrathoracic anastomosis to receive either PVA or epidural analgesia. This analysis included patients in the PVA arm with complete video recordings. Two independent reviewers assessed catheter placement using a four-item tool comprising one global quality score and three technical criteria: subpleural pocket formation, pleural puncture, and catheter tip location. Associations between placement quality and recovery outcomes (Quality of Recovery scores or opioid use) were evaluated in an exploratory manner. RESULTS: Of the 98 patients randomized to PVA, 75 (76.5%) had complete video data. High-quality placement was observed in 77.3% of cases by rater one and 56.0% by rater two, with fair interrater agreement (weighted kappa = 0.24). Within the constraints of limited interrater reliability and sample size, no statistically significant associations were observed between placement quality scores and Quality of Recovery (QoR) and opioid use outcomes. CONCLUSION: Video-based assessment of paravertebral catheter placement demonstrated limited interrater reliability. No associations were observed between visually assessed placement quality and postoperative recovery outcomes. These findings highlight the importance of refinement and validation of assessment tools before their integration into surgical quality assurance strategies aimed at linking surgical quality to postoperative outcomes.
Phenotypic characterization and prevalence of preoperative respiratory sarcopenia in Chinese patients with resectable early-stage non-small cell lung cancer: A two-center cross-sectional study.
Wang ZZ, Tang RF, He JY … +5 more , Tang YL, Hong Q, Xu Q, Zhang T, Hong JF
Eur J Surg Oncol · 2026 Jun · PMID 42379047 · Publisher ↗
BACKGROUND: Respiratory sarcopenia (RS) has been associated with adverse postoperative outcomes in non-small cell lung cancer (NSCLC), but its preoperative profile in Chinese surgical patients remains unclear. METHODS: T...
BACKGROUND: Respiratory sarcopenia (RS) has been associated with adverse postoperative outcomes in non-small cell lung cancer (NSCLC), but its preoperative profile in Chinese surgical patients remains unclear. METHODS: This two-center cross-sectional study included 320 surgical patients with stage I-II resectable NSCLC. RS was operationalized using peak expiratory flow rate and pectoralis muscle index with sex-specific cutoffs reported in a Japanese surgical cohort. Systemic sarcopenia was assessed according to the 2019 Asian Working Group for Sarcopenia criteria. Logistic regression identified factors associated with RS; Venn diagrams depicted overlap with systemic sarcopenia components; postoperative recovery indicators were descriptively compared as exploratory measures. RESULTS: In this adenocarcinoma-dominant cohort (97.5%), preoperative RS was identified in 15.6% of patients. Older age (OR = 1.25 per 5-year increase, P = 0.012), higher body fat percentage (OR = 1.29 per 5% increase, P = 0.029), and higher lymphocyte count (OR = 1.92 per 1 × 10/L increase, P = 0.034) were positively associated with RS, whereas higher handgrip strength was inversely associated with RS (OR = 0.69 per 5-kg increase, P = 0.006). Isolated respiratory impairment without systemic sarcopenia components occurred in 26.0% of RS cases. RS patients had longer postoperative length of stay and chest tube duration, and higher drainage volumes than non-RS patients (all P < 0.05). CONCLUSIONS: Preoperative RS was identified in approximately one in six patients and only partially overlapped with systemic sarcopenia. Pragmatic respiratory-specific assessment may complement conventional sarcopenia screening, but standardized definitions, population-specific thresholds, and prospective validation are needed.
Prognostic impact of CT-derived sarcopenic obesity in solitary hepatocellular carcinoma after hepatectomy: Does the definition matter?
Zhang QB, Lv X, Li Y … +5 more , Qu X, Dai GX, Zhang K, Zhou Y, Chen FM
Eur J Surg Oncol · 2026 Jun · PMID 42379046 · Publisher ↗
PURPOSE: To evaluate the prognostic impact of different CT-derived definitions of sarcopenic obesity (SO) in solitary hepatocellular carcinoma (HCC) after hepatectomy. METHODS: Patients undergoing curative-intent hepatec...
PURPOSE: To evaluate the prognostic impact of different CT-derived definitions of sarcopenic obesity (SO) in solitary hepatocellular carcinoma (HCC) after hepatectomy. METHODS: Patients undergoing curative-intent hepatectomy for solitary HCC between February 2014 and December 2023 were retrospectively identified from three tertiary centers in China. Preoperative CT images at the third lumbar vertebral (L3) level were used to segment skeletal muscle and adipose tissue and derive the skeletal muscle index (SMI), visceral fat area (VFA), and visceral-to-subcutaneous fat ratio (VSR). CT-defined low muscle mass was assessed using two established SMI thresholds (Western: <52.4/<38.5 cm/m; Japanese: <42/<38 cm/m for men/women), whereas visceral obesity was assessed by VFA or sex-specific VSR cutoffs. Four conventional (SO1-SO4) and one composite (SO5) SO definitions were evaluated. Associations with overall survival were assessed using multivariable Cox models. RESULTS: Among 668 patients (median age, 58 years [interquartile range, 49-67]; 535 men), SO prevalence ranged from 3.7% to 17.4% across conventional definitions (SO1-SO4) and reached 21.6% with the composite definition (SO5). Median overall survival was consistently shorter in patients with SO than in those without SO across all definitions (25.4-42.0 vs. 74.3-80.1 months; all p < 0.001). In multivariable analyses, SO was independently associated with increased mortality risk under both conventional (SO1-SO4: hazard ratio [HR], 2.84-5.36; all p < 0.001) and composite (SO5: HR, 3.05; p < 0.001) definitions, after adjustment for cirrhosis, microvascular invasion, and tumor size. CONCLUSION: Across the evaluated definitions, CT-derived SO was independently associated with poor survival in patients with solitary HCC after hepatectomy.
Preoperative eurolung score predicts non-completion of adjuvant chemotherapy in resected stages II-III non-small cell lung cancer: Implications for perioperative systemic therapy delivery.
Park HK, Lee GD, Choi S … +5 more , Kim HR, Kim YH, Kim DK, Park SI, Yun JK
Eur J Surg Oncol · 2026 Jun · PMID 42379045 · Publisher ↗
INTRODUCTION: Although adjuvant chemotherapy (ACT) improves survival in resected stage II-III non-small cell lung cancer (NSCLC), many patients fail to complete planned treatment. We evaluated the ability of the Eurolung...
INTRODUCTION: Although adjuvant chemotherapy (ACT) improves survival in resected stage II-III non-small cell lung cancer (NSCLC), many patients fail to complete planned treatment. We evaluated the ability of the Eurolung risk score to predict ACT non-completion in real-world practice. MATERIALS AND METHODS: We retrospectively analyzed 2100 patients with pathological stage IIA-IIIA NSCLC who underwent curative-intent resection between 2013 and 2022. ACT was defined as initiation of a platinum-based doublet within 16 weeks after surgery, and completion as receipt of ≥4 cycles within 24 weeks. Eurolung morbidity and mortality scores were calculated. Binary and multinomial logistic regression assessed ACT non-completion. Discrimination was evaluated using receiver operating characteristic (ROC) analysis. A prespecified sensitivity analysis excluded patients who did not initiate ACT for non-biological reasons. RESULTS: Overall, 995 patients (47.4%) completed ACT, while 1105 (52.6%) did not initiate or discontinue treatment early. Higher Eurolung morbidity scores were independently associated with ACT non-completion (adjusted odds ratio [aOR] per point 1.73, 95% CI 1.61-1.86; p < 0.001). Using a clinically interpretable cut-off of ≥2, the morbidity score showed an aOR of 4.93 (95% CI 4.02-6.07). Discrimination was moderate in the overall cohort (area under the curve [AUC] 0.698) and improved after excluding non-biological non-initiation (AUC 0.747; DeLong p = 0.0019). Results were consistent in multinomial analyses. CONCLUSION: The Eurolung morbidity score was independently associated with ACT non-completion after resection for stage II-III NSCLC and may provide adjunctive preoperative information for counseling and multidisciplinary planning to improve systemic therapy delivery.
Association of body composition parameters with pathological response to neoadjuvant immunochemotherapy in locally advanced gastric cancer.
Lu X, Cui X, Chen H … +8 more , Zhang J, Zhang X, Yang H, Yin L, Yang B, An J, Wang G, Yu Y
Eur J Surg Oncol · 2026 Jun · PMID 42364489 · Publisher ↗
BACKGROUND: The association between body composition and pathological response to neoadjuvant immunochemotherapy (NICT) in locally advanced gastric cancer (LAGC) is unclear. This study aimed to investigate its impact. ME...
BACKGROUND: The association between body composition and pathological response to neoadjuvant immunochemotherapy (NICT) in locally advanced gastric cancer (LAGC) is unclear. This study aimed to investigate its impact. METHODS: This retrospective study included 261 LAGC patients admitted to the First Hospital of Lanzhou University between January 1, 2021 and December 31, 2024, who received NICT and subsequently underwent radical gastrectomy. Based on postoperative pathological evaluation, patients were divided into the Major Pathological Response group (MPR, n = 84) and the Incomplete Pathological Response group (IPR, n = 177). Utilizing pre- and post-NICT abdominal CT images, various body composition parameters were measured at the level of the third lumbar vertebra (L3). Various statistical methods were employed to systematically screen for factors associated with pathological response after NICT. RESULTS: Skeletal muscle density (SMD) decreased most significantly (38.9 ± 6.6 vs. 29.7 ± 3.8 HU, P < 0.001). Multivariate logistic regression analysis revealed that the absolute decrease in skeletal muscle index (SMI) during treatment was associated with lower odds of MPR (OR: 1.116, 95% CI: 1.015-1.225, P = 0.023). Exploratory analysis suggested that both pre-treatment low SMI (22.6% vs 39.0%, P = 0.009) and post-treatment low SMI (20.2% vs 44.1%, P < 0.001) were associated with poorer pathological response. Nutritional and body composition parameters decreased post-NICT. CONCLUSION: Progressive muscle loss during NICT is associated with pathological response in LAGC. Dynamic monitoring of body composition may generate hypotheses for future interventional studies. External validation is required before clinical application.
Selective axillary lymph node dissection, lymphatic microsurgical preventive healing approach, or delayed distal lymphaticovenular anastomosis: Current evidence and logical considerations.
Soran A
Eur J Surg Oncol · 2026 Jun · PMID 42349078 · Publisher ↗
Abstract loading — click title to view on PubMed.
Nodal localisation with magnetic seed in patients with stage III melanoma receiving neoadjuvant immune checkpoint inhibitors, a feasibility study.
Krabbe E, Huibers A, Ny L … +3 more , Wärnberg F, Nelson A, Olofsson Bagge R
Eur J Surg Oncol · 2026 Jun · PMID 42341443 · Publisher ↗
INTRODUCTION: Neoadjuvant immune checkpoint inhibitors (ICIs) have been established as standard care for patients with resectable macroscopic stage III melanoma. In these patients, therapeutic lymph node dissection (TLND...
INTRODUCTION: Neoadjuvant immune checkpoint inhibitors (ICIs) have been established as standard care for patients with resectable macroscopic stage III melanoma. In these patients, therapeutic lymph node dissection (TLND) has been performed. However, the PRADO trial showed that TLND and also adjuvant treatment could be omitted in patients with a major pathological response (MPR) in the index lymph node. The aim of this study was to evaluate the feasibility of using a magnetic seed (Magseed®) to localise the index node for selective removal and analysis in patients with stage III melanoma receiving neoadjuvant ICIs. METHODS: Twenty consecutive patients with resectable stage III melanoma and planned TLND after neoadjuvant ICIs were included. Magseed® was placed under ultrasound guidance at start of treatment. Index lymph node (ILN) resection was performed concurrently with TLND, 6-8 weeks after treatment initiation. A handheld magnetometer (Sentimag®) was used to localise the marked lymph node. This index lymph node was analysed separately for pathological response and seed presence. RESULTS: Transcutaneous and intraoperative localisation was successful in all 20 patients. In 19 of 20 (95%) patients, the seed was present in the surgical specimen after resection. In one patient the Magseed® dislocated during surgery. In all eleven patients with evaluable specimen in both index lymph node metastasis and additional LN metastases, the pathological response was concordant between the index and the additional lymph nodes. CONCLUSION: In this feasibility trial evaluating Magseed® as a marker for ILN resection in patients with stage III melanoma, all marked lymph nodes were successfully localised.
The impact of drains on postoperative seroma and infection after mastectomy: A retrospective study in Danish women with breast cancer.
Palshof FK, Korsholm RHR, Duriaud HM … +3 more , Grell K, Kroman N, Tvedskov TF
Eur J Surg Oncol · 2026 Jun · PMID 42341442 · Publisher ↗
INTRODUCTION: Postoperative drains are commonly used after mastectomy to reduce seroma formation, but evidence of the benefit remains unclear. We evaluated the effect of postoperative drains on seroma formation and infec...
INTRODUCTION: Postoperative drains are commonly used after mastectomy to reduce seroma formation, but evidence of the benefit remains unclear. We evaluated the effect of postoperative drains on seroma formation and infection after mastectomy in a retrospective institutional study. MATERIALS AND METHODS: We compared women with breast cancer who had mastectomy with or without suction drain in 2020. Data were retrieved from original patient files. Odds ratios (OR) and 95% confidence intervals (CI) for seroma and infection risk were calculated using logistic regression, and seroma volume was analysed with linear regression. RESULTS: We included 471 women, whereof 279 had drain and 192 had no drain. Infection rates and, among women with seroma, total seroma volume did not differ significantly by drain status. More women in the drain group did not require seroma puncture, 76 (27%), compared to the no-drain group, 29 (15%) (P < 0.001). In a multiple analysis, drains combined with local methylprednisolone injection significantly reduced the risk of seroma formation in women undergoing sentinel lymph node biopsy (OR: 0.46; 95% CI, 0.26-0.82, P = 0.008), but not in women with axillary lymph node dissection. Seroma formation risk was higher in current smokers (OR: 2.42; 95% CI, 1.12-5.20, P = 0.024) and women with BMI ≥30 (OR: 3.32; 95% CI, 1.60-6.88, P = 0.001). CONCLUSION: The use of postoperative drain in combination with methylprednisolone injection reduced the risk of seroma in women undergoing sentinel lymph node surgery. Current smokers and women with high BMI had an increased risk of seroma formation.
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