Pub Date : 2026-03-01Epub Date: 2026-03-07DOI: 10.1016/j.cson.2026.100123
Lingye Zeng , Taiguo Liu , Ping Zhou , Qinghua Zhou , Yan Zhang
Small cell lung cancer (SCLC) is an aggressive malignant tumor characterized by early dissemination and an extremely poor prognosis. The current standard-of-care treatment for limited-stage SCLC (LS-SCLC) is concurrent chemoradiotherapy followed by Durvalumab based on the phase III ADRIATIC trial. However, further research on patterns of disease progression has revealed that intrathoracic lesions were more likely to occur than extrathoracic lesions as the first site of progression, which indicates even though SCLC is considered a systemic disease, better local control measures are still needed for LS-SCLC. Neoadjuvant chemo-immunotherapy and surgery are becoming the standard treatment for resectable non-small cell lung cancer (NSCLC). It remains unclear whether the combination of immunotherapy and chemotherapy is beneficial for SCLC in the neoadjuvant setting. Here, we report a case of a patient with stage IIIB SCLC who underwent surgery and has remained disease-free for 21 months after three cycles of neoadjuvant chemo-immunotherapy, aiming to provide an illustrative basis for this treatment modality.
{"title":"Pathologic complete response and durable progression-free survival following neoadjuvant chemo-immunotherapy and surgery for stage IIIB small cell lung cancer: A case report","authors":"Lingye Zeng , Taiguo Liu , Ping Zhou , Qinghua Zhou , Yan Zhang","doi":"10.1016/j.cson.2026.100123","DOIUrl":"10.1016/j.cson.2026.100123","url":null,"abstract":"<div><div>Small cell lung cancer (SCLC) is an aggressive malignant tumor characterized by early dissemination and an extremely poor prognosis. The current standard-of-care treatment for limited-stage SCLC (LS-SCLC) is concurrent chemoradiotherapy followed by Durvalumab based on the phase III ADRIATIC trial. However, further research on patterns of disease progression has revealed that intrathoracic lesions were more likely to occur than extrathoracic lesions as the first site of progression, which indicates even though SCLC is considered a systemic disease, better local control measures are still needed for LS-SCLC. Neoadjuvant chemo-immunotherapy and surgery are becoming the standard treatment for resectable non-small cell lung cancer (NSCLC). It remains unclear whether the combination of immunotherapy and chemotherapy is beneficial for SCLC in the neoadjuvant setting. Here, we report a case of a patient with stage IIIB SCLC who underwent surgery and has remained disease-free for 21 months after three cycles of neoadjuvant chemo-immunotherapy, aiming to provide an illustrative basis for this treatment modality.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"5 1","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.cson.2025.100115
Wei Yin , Peiling Chen , Tianrui He , Weisheng Guo , Wen Zhong , Shengbao Suo , Shuben Li , Wenhua Liang , Jianxing He , Yao Guo , René Horsleben Petersen , Gaetano Rocco , Alessandro Brunelli , Calvin S.H. Ng , Thomas A. D'Amico
Locally advanced non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer-specific mortality, yet the therapeutic value of surgery remains contentious. However, driven by the success of recent neoadjuvant clinical trials, the treatment landscape for locally advanced NSCLC has evolved dramatically, significantly influencing patient-reported and oncological outcomes. Consequently, the strategic integration of surgery, particularly minimally invasive surgery (MIS) such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS), into the management of highly selected post-neoadjuvant patients is associated with improved long-term survival. Offering advantages such as reduced intraoperative blood loss, fewer perioperative complications, and faster recovery, MIS is increasingly recommended when feasible, notwithstanding the potential risk of conversion to open surgery. Furthermore, in specialized high-volume centers, MIS currently demonstrates outcomes comparable to or superior to open surgery, even in complex procedures such as post-neoadjuvant sleeve lobectomy and carinal reconstruction. In summary, this review highlights the pivotal role of MIS in managing locally advanced NSCLC and emphasizes the synergy between neoadjuvant therapy and MIS in revolutionizing lung cancer treatment and optimizing patient outcomes.
{"title":"Emerging advances in integrating minimally invasive surgery into the therapeutic landscape of locally advanced non-small cell lung cancer","authors":"Wei Yin , Peiling Chen , Tianrui He , Weisheng Guo , Wen Zhong , Shengbao Suo , Shuben Li , Wenhua Liang , Jianxing He , Yao Guo , René Horsleben Petersen , Gaetano Rocco , Alessandro Brunelli , Calvin S.H. Ng , Thomas A. D'Amico","doi":"10.1016/j.cson.2025.100115","DOIUrl":"10.1016/j.cson.2025.100115","url":null,"abstract":"<div><div>Locally advanced non-small cell lung cancer (NSCLC) accounts for the majority of lung cancer-specific mortality, yet the therapeutic value of surgery remains contentious. However, driven by the success of recent neoadjuvant clinical trials, the treatment landscape for locally advanced NSCLC has evolved dramatically, significantly influencing patient-reported and oncological outcomes. Consequently, the strategic integration of surgery, particularly minimally invasive surgery (MIS) such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracic surgery (RATS), into the management of highly selected post-neoadjuvant patients is associated with improved long-term survival. Offering advantages such as reduced intraoperative blood loss, fewer perioperative complications, and faster recovery, MIS is increasingly recommended when feasible, notwithstanding the potential risk of conversion to open surgery. Furthermore, in specialized high-volume centers, MIS currently demonstrates outcomes comparable to or superior to open surgery, even in complex procedures such as post-neoadjuvant sleeve lobectomy and carinal reconstruction. In summary, this review highlights the pivotal role of MIS in managing locally advanced NSCLC and emphasizes the synergy between neoadjuvant therapy and MIS in revolutionizing lung cancer treatment and optimizing patient outcomes.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"5 1","pages":"Article 100115"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145847704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-13DOI: 10.1016/j.cson.2026.100122
Justin James , Sumudu Welikumbura , Emily Schembri , Kirti Mehta , Michael Law , Shomik Sengupta , Christobel Saunders
Background and purpose
We externally validated the Memorial Sloan Kettering Cancer Center (MSKCC) sentinel node nomogram and compared its performance as an SLNB omission strategy with that of the SOUND and INSEMA trial strategies and the ASCO 2021 guideline.
Methods
We retrospectively analysed 1080 women with clinically and sonographically node-negative EBC treated at a tertiary Australian center between 2012 and 2020. Predicted nodal risk was generated using the MSKCC calculator. Discrimination and calibration were assessed, and clinical utility was evaluated using false-negative rate (FNR) and negative predictive value (NPV). A nomogram-guided strategy was simulated by applying an MSKCC probability cut-off to identify patients eligible for SLNB omission. Trial and guideline criteria were applied for direct comparison.
Results
Macrometastatic nodal disease was present in 187 patients (17.3%). The MSKCC nomogram showed good discrimination (AUC 0.77, 95% CI 0.73–0.80) and reasonable calibration. At a 23% risk threshold, 308 patients (29%) were eligible for SLNB omission, with an FNR of 9.6% and the highest NPV (94.2%) among all strategies evaluated. The SOUND strategy spared 493 patients (46%), with an FNR of 29.4% and an NPV of 88.8%, while the INSEMA strategy spared 723 patients (67%), with an FNR of 53.5% and an NPV of 86.2%. The ASCO 2021 guideline was the most conservative, sparing 162 patients (15%), with an FNR of 6.9% and an NPV of 92.0%.
Conclusions
A nomogram-guided approach may offer a flexible, risk-adapted alternative for SLNB omission, though prospective validation and long-term follow-up are required.
{"title":"Nomogram-guided sentinel node strategy in early breast cancer: Evaluation and comparison with current de-escalation approaches","authors":"Justin James , Sumudu Welikumbura , Emily Schembri , Kirti Mehta , Michael Law , Shomik Sengupta , Christobel Saunders","doi":"10.1016/j.cson.2026.100122","DOIUrl":"10.1016/j.cson.2026.100122","url":null,"abstract":"<div><h3>Background and purpose</h3><div>We externally validated the Memorial Sloan Kettering Cancer Center (MSKCC) sentinel node nomogram and compared its performance as an SLNB omission strategy with that of the SOUND and INSEMA trial strategies and the ASCO 2021 guideline.</div></div><div><h3>Methods</h3><div>We retrospectively analysed 1080 women with clinically and sonographically node-negative EBC treated at a tertiary Australian center between 2012 and 2020. Predicted nodal risk was generated using the MSKCC calculator. Discrimination and calibration were assessed, and clinical utility was evaluated using false-negative rate (FNR) and negative predictive value (NPV). A nomogram-guided strategy was simulated by applying an MSKCC probability cut-off to identify patients eligible for SLNB omission. Trial and guideline criteria were applied for direct comparison.</div></div><div><h3>Results</h3><div>Macrometastatic nodal disease was present in 187 patients (17.3%). The MSKCC nomogram showed good discrimination (AUC 0.77, 95% CI 0.73–0.80) and reasonable calibration. At a 23% risk threshold, 308 patients (29%) were eligible for SLNB omission, with an FNR of 9.6% and the highest NPV (94.2%) among all strategies evaluated. The SOUND strategy spared 493 patients (46%), with an FNR of 29.4% and an NPV of 88.8%, while the INSEMA strategy spared 723 patients (67%), with an FNR of 53.5% and an NPV of 86.2%. The ASCO 2021 guideline was the most conservative, sparing 162 patients (15%), with an FNR of 6.9% and an NPV of 92.0%.</div></div><div><h3>Conclusions</h3><div>A nomogram-guided approach may offer a flexible, risk-adapted alternative for SLNB omission, though prospective validation and long-term follow-up are required.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"5 1","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147448767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-03DOI: 10.1016/j.cson.2026.100119
Yi Yang , Huihua Cao , Zhengping Xu , Yanmiao Dai , Xiaolan Dai , Minke Shao , Yizhou Yao , Songbing He
Colorectal cancer (CRC) remains a leading cause of cancer incidence and mortality globally, presenting substantial clinical challenges attributable to its intricate pathogenic mechanisms and the broad spectrum of available treatment modalities. Recent breakthroughs in molecular biology have markedly advanced our understanding of the genetic and epigenetic alterations driving CRC initiation and progression. These discoveries have unraveled critical oncogenic drivers that promote tumorigenesis and precisely identified promising therapeutic targets, laying a solid foundation for the advancement of precision medicine in CRC management. This review highlights the latest progress in deciphering the molecular underpinnings of CRC, with a specific focus on the roles of gene mutations and epigenetic regulation in tumor initiation, progression, and metastasis. Additionally, it provides a comprehensive evaluation of current multidisciplinary treatment strategies, including surgical resection, chemoradiotherapy, targeted therapies, and immunotherapies, while systematically discussing their clinical efficacy, safety profiles, and inherent limitations. Notably, the review emphasizes the pivotal correlation between tumor molecular characteristics and treatment responses, underscoring the clinical imperative of personalized therapeutic approaches for CRC patients. Despite significant strides in improving patient outcomes over the past decade, considerable challenges persist, such as the development of acquired drug resistance, intratumoral and intertumoral heterogeneity, and variable treatment responsiveness across distinct molecular subtypes. By integrating cutting-edge molecular insights with clinical therapeutic strategies, this review aims to establish a robust theoretical framework for CRC management and delineate future research directions that may further enhance therapeutic efficacy and improve long-term patient prognosis.
{"title":"Precision oncology in colorectal cancer: Integrating molecular subtyping, multidisciplinary management, and emerging therapeutics","authors":"Yi Yang , Huihua Cao , Zhengping Xu , Yanmiao Dai , Xiaolan Dai , Minke Shao , Yizhou Yao , Songbing He","doi":"10.1016/j.cson.2026.100119","DOIUrl":"10.1016/j.cson.2026.100119","url":null,"abstract":"<div><div>Colorectal cancer (CRC) remains a leading cause of cancer incidence and mortality globally, presenting substantial clinical challenges attributable to its intricate pathogenic mechanisms and the broad spectrum of available treatment modalities. Recent breakthroughs in molecular biology have markedly advanced our understanding of the genetic and epigenetic alterations driving CRC initiation and progression. These discoveries have unraveled critical oncogenic drivers that promote tumorigenesis and precisely identified promising therapeutic targets, laying a solid foundation for the advancement of precision medicine in CRC management. This review highlights the latest progress in deciphering the molecular underpinnings of CRC, with a specific focus on the roles of gene mutations and epigenetic regulation in tumor initiation, progression, and metastasis. Additionally, it provides a comprehensive evaluation of current multidisciplinary treatment strategies, including surgical resection, chemoradiotherapy, targeted therapies, and immunotherapies, while systematically discussing their clinical efficacy, safety profiles, and inherent limitations. Notably, the review emphasizes the pivotal correlation between tumor molecular characteristics and treatment responses, underscoring the clinical imperative of personalized therapeutic approaches for CRC patients. Despite significant strides in improving patient outcomes over the past decade, considerable challenges persist, such as the development of acquired drug resistance, intratumoral and intertumoral heterogeneity, and variable treatment responsiveness across distinct molecular subtypes. By integrating cutting-edge molecular insights with clinical therapeutic strategies, this review aims to establish a robust theoretical framework for CRC management and delineate future research directions that may further enhance therapeutic efficacy and improve long-term patient prognosis.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"5 1","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract but remain rare overall. Locally advanced forms present therapeutic challenges, particularly in low-resource settings.
Methods
We conducted a descriptive cross-sectional study with retrospective data collection at the Hubert Koutoukou Maga National University Hospital Center (CNHU-HKM) in Benin. All patients with locally advanced GIST managed between January 2010 and January 2025 were included. Clinical features, management strategies and surgical outcomes were analyzed.
Results
Nine patients with locally advanced GIST were identified (male-to-female ratio 3.5:1). The stomach was the most frequent primary site (n = 5). Adjacent organ invasion involved the pancreas (n = 5), the spleen (n = 5), and the colon (n = 2). Seven patients received neoadjuvant imatinib. Seven patients underwent open surgical resection, which included en bloc removal of the primary tumor along with the involved adjacent organs or structures, in order to achieve complete (R0) resection whenever technically feasible. At last follow-up, five patients were alive (including one awaiting reoperation for local recurrence), three were lost to follow-up, and one had died.
Conclusion
This small series demonstrates the feasibility of integrating neoadjuvant therapy with surgery for locally advanced GIST in a low-resource African setting. The high rate of R0 resections achieved underscores the value of multimodal management, even in contexts where diagnosis is often delayed and therapeutic resources are limited.
{"title":"Locally advanced gastrointestinal stromal tumors: Surgical strategies and outcomes in a referral hospital in Sub-Saharan Africa","authors":"Freddy Houéhanou Rodrigue Gnangnon , Ismaïl Lawani , Sonia Fernande Djedeme , Adémola Lionel Destiny Padonou , Roland Goudou , Dansou Gaspard Gbessi , Aboudou Raïmi Kpossou , Jean Sehonou","doi":"10.1016/j.cson.2026.100118","DOIUrl":"10.1016/j.cson.2026.100118","url":null,"abstract":"<div><h3>Introduction</h3><div>Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract but remain rare overall. Locally advanced forms present therapeutic challenges, particularly in low-resource settings.</div></div><div><h3>Methods</h3><div>We conducted a descriptive cross-sectional study with retrospective data collection at the Hubert Koutoukou Maga National University Hospital Center (CNHU-HKM) in Benin. All patients with locally advanced GIST managed between January 2010 and January 2025 were included. Clinical features, management strategies and surgical outcomes were analyzed.</div></div><div><h3>Results</h3><div>Nine patients with locally advanced GIST were identified (male-to-female ratio 3.5:1). The stomach was the most frequent primary site (n = 5). Adjacent organ invasion involved the pancreas (n = 5), the spleen (n = 5), and the colon (n = 2). Seven patients received neoadjuvant imatinib. Seven patients underwent open surgical resection, which included en bloc removal of the primary tumor along with the involved adjacent organs or structures, in order to achieve complete (R0) resection whenever technically feasible. At last follow-up, five patients were alive (including one awaiting reoperation for local recurrence), three were lost to follow-up, and one had died.</div></div><div><h3>Conclusion</h3><div>This small series demonstrates the feasibility of integrating neoadjuvant therapy with surgery for locally advanced GIST in a low-resource African setting. The high rate of R0 resections achieved underscores the value of multimodal management, even in contexts where diagnosis is often delayed and therapeutic resources are limited.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"5 1","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-05DOI: 10.1016/j.cson.2026.100120
Grace Evelyn Steinback, Joycie Chang, Anand Rajpara, Michael Siscos
Background
Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy with poor survival outcomes, particularly among patients with barriers to timely care. Rural populations may experience delayed diagnosis and treatment due to geographic, socioeconomic, and healthcare access disparities.
Methods
A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database (2010–2021). Adults aged 25–90 years with a confirmed MCC diagnosis were included classified by Rural–Urban Continuum Codes (RUCC): metropolitan counties (RUCC 1–3) and rural counties (RUCC 4–9). MCC-specific survival was evaluated using Kaplan–Meier analysis and compared using the log-rank test. Descriptive statistics were used to compare baseline characteristics.
Results
A total of 2357 patients were identified; most were elderly, white, and male. 1965 (83.4%) resided in metropolitan counties and 392 (16.6%) in rural counties. Rural patients demonstrated lower county-level median household incomes compared with metropolitan residents. MCC-specific deaths occurred in 429 (21.8%) metropolitan residents and 102 (26.0%) rural residents. Five-year MCC-specific survival was 71.6% among metropolitan residents versus 65.6% among rural residents, (log-rank p = 0.064). Five-year cumulative survival was 51.3% among metropolitan residents compared with 46.0% among rural residents, with Kaplan-Meier curves showing a statistically significant divergence (log-rank p < 0.05).
Conclusion
Using an RUCC-based definition of rurality (RUCC 4–9), rural residence was associated with a lower 5-year MCC-specific survival and worse cumulative 5-year survival. Although the difference among MCC-specific survival did not reach conventional statistical significance, this disparity may be clinically meaningful and warrants further investigation using adjusted models.
背景：默克尔细胞癌（MCC）是一种侵袭性皮肤神经内分泌恶性肿瘤，生存预后较差，特别是在无法及时治疗的患者中。由于地理、社会经济和医疗保健机会的差异，农村人口可能会经历延迟诊断和治疗。方法采用监测、流行病学和最终结果（SEER）数据库（2010-2021）进行回顾性队列研究。25-90岁确诊MCC的成年人按城乡连续编码（RUCC）分类：大都市县（RUCC 1-3）和农村县（RUCC 4-9）。使用Kaplan-Meier分析评估mcc特异性生存，并使用log-rank检验进行比较。描述性统计用于比较基线特征。结果共检出2357例患者；大多数是老年人、白人和男性。1965人（83.4%）居住在大都市县，392人（16.6%）居住在农村县。农村患者的家庭收入中位数低于城市居民。城市居民中有429人（21.8%）死亡，农村居民中有102人（26.0%）死亡。都市居民5年mcc特异性生存率为71.6%，农村居民为65.6% （log-rank p = 0.064）。都市居民的5年累积生存率为51.3%，而农村居民为46.0%，Kaplan-Meier曲线显示有统计学意义的差异（log-rank p < 0.05）。根据基于ucc的乡村性定义（RUCC 4-9），农村居住与较低的mcc特异性5年生存率和较差的累积5年生存率相关。虽然mcc特异性生存率的差异没有达到传统的统计学意义，但这种差异可能具有临床意义，值得使用调整后的模型进行进一步研究。
{"title":"Merkel cell carcinoma: A retrospective analysis of urban vs. rural survival outcomes from the United States’ National Cancer Institute, a SEER based study","authors":"Grace Evelyn Steinback, Joycie Chang, Anand Rajpara, Michael Siscos","doi":"10.1016/j.cson.2026.100120","DOIUrl":"10.1016/j.cson.2026.100120","url":null,"abstract":"<div><h3>Background</h3><div>Merkel cell carcinoma (MCC) is an aggressive cutaneous neuroendocrine malignancy with poor survival outcomes, particularly among patients with barriers to timely care. Rural populations may experience delayed diagnosis and treatment due to geographic, socioeconomic, and healthcare access disparities.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using the Surveillance, Epidemiology, and End Results (SEER) database (2010–2021). Adults aged 25–90 years with a confirmed MCC diagnosis were included classified by Rural–Urban Continuum Codes (RUCC): metropolitan counties (RUCC 1–3) and rural counties (RUCC 4–9). MCC-specific survival was evaluated using Kaplan–Meier analysis and compared using the log-rank test. Descriptive statistics were used to compare baseline characteristics.</div></div><div><h3>Results</h3><div>A total of 2357 patients were identified; most were elderly, white, and male. 1965 (83.4%) resided in metropolitan counties and 392 (16.6%) in rural counties. Rural patients demonstrated lower county-level median household incomes compared with metropolitan residents. MCC-specific deaths occurred in 429 (21.8%) metropolitan residents and 102 (26.0%) rural residents. Five-year MCC-specific survival was 71.6% among metropolitan residents versus 65.6% among rural residents, (log-rank p = 0.064). Five-year cumulative survival was 51.3% among metropolitan residents compared with 46.0% among rural residents, with Kaplan-Meier curves showing a statistically significant divergence (log-rank p < 0.05).</div></div><div><h3>Conclusion</h3><div>Using an RUCC-based definition of rurality (RUCC 4–9), rural residence was associated with a lower 5-year MCC-specific survival and worse cumulative 5-year survival. Although the difference among MCC-specific survival did not reach conventional statistical significance, this disparity may be clinically meaningful and warrants further investigation using adjusted models.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"5 1","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397238","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-01-19DOI: 10.1016/j.cson.2026.100117
Zheng Liu , Zhexue Wang , Liu Yang , Zhiqiang Ma , Sheng Wang , Haitao Zhou , Lizhu Tang , Bo Wei , Shaojun Yu , Qiang Feng , Qingchao Tang , Ruiting Liu , Fei Wang , Guiyu Wang , Chaoxi Zhou , Wenbo Niu , Ye Wei , Xuejun Sun , Hongliang Yao , Jian Peng , Xishan Wang
Background
Gastric cancer (GC) remains a major global health burden, and minimally invasive approaches have become a primary focus in surgical oncology. Natural orifice specimen extraction surgery (NOSES) for GC integrates laparoscopic radical gastrectomy with specimen retrieval via natural orifices, aiming to minimize abdominal wall trauma while ensuring oncologic safety.
Methods
This guideline was developed through a comprehensive literature review, multidisciplinary expert panel discussions, and synthesis of accumulated clinical experience in GC-NOSES. The recommendations address operative platforms, aseptic and tumor-free techniques, digestive tract reconstruction, and procedure-specific steps. Emphasis was placed on perioperative safety, oncologic principles, and standardization of surgical procedures.
Results
Although most existing studies are small-scale, single-center, and retrospective, accumulating data suggest that GC-NOSES offers comparable oncological outcomes to conventional laparoscopic gastrectomy while reducing postoperative pain, accelerating gastrointestinal recovery, shortening hospital stay, and improving cosmetic satisfaction.
Conclusion
GC-NOSES is a promising minimally invasive option with potential benefits in postoperative recovery and quality of life. Standardized procedures, structured training, and high-quality multicenter studies are essential to further confirm its safety, refine indications, and promote global implementation.
{"title":"International guideline on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2025 version)","authors":"Zheng Liu , Zhexue Wang , Liu Yang , Zhiqiang Ma , Sheng Wang , Haitao Zhou , Lizhu Tang , Bo Wei , Shaojun Yu , Qiang Feng , Qingchao Tang , Ruiting Liu , Fei Wang , Guiyu Wang , Chaoxi Zhou , Wenbo Niu , Ye Wei , Xuejun Sun , Hongliang Yao , Jian Peng , Xishan Wang","doi":"10.1016/j.cson.2026.100117","DOIUrl":"10.1016/j.cson.2026.100117","url":null,"abstract":"<div><h3>Background</h3><div>Gastric cancer (GC) remains a major global health burden, and minimally invasive approaches have become a primary focus in surgical oncology. Natural orifice specimen extraction surgery (NOSES) for GC integrates laparoscopic radical gastrectomy with specimen retrieval via natural orifices, aiming to minimize abdominal wall trauma while ensuring oncologic safety.</div></div><div><h3>Methods</h3><div>This guideline was developed through a comprehensive literature review, multidisciplinary expert panel discussions, and synthesis of accumulated clinical experience in GC-NOSES. The recommendations address operative platforms, aseptic and tumor-free techniques, digestive tract reconstruction, and procedure-specific steps. Emphasis was placed on perioperative safety, oncologic principles, and standardization of surgical procedures.</div></div><div><h3>Results</h3><div>Although most existing studies are small-scale, single-center, and retrospective, accumulating data suggest that GC-NOSES offers comparable oncological outcomes to conventional laparoscopic gastrectomy while reducing postoperative pain, accelerating gastrointestinal recovery, shortening hospital stay, and improving cosmetic satisfaction.</div></div><div><h3>Conclusion</h3><div>GC-NOSES is a promising minimally invasive option with potential benefits in postoperative recovery and quality of life. Standardized procedures, structured training, and high-quality multicenter studies are essential to further confirm its safety, refine indications, and promote global implementation.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"5 1","pages":"Article 100117"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147397237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-11-21DOI: 10.1016/j.cson.2025.100108
Chunyan Li , Jianfu Li , Peiling Chen , Yihai Wei , Yi Zhao , Danman Zhong , Shen Lao , Ziwen Yu , Caichen Li , Bo Cheng , Hengrui Liang , Jiang Shi , Qi Cai , Shan Xiong , Feng Li , Shuting Zhan , Yang Xiang , Ran Zhong , Xin Zheng , Wenhai Fu , Wenhua Liang
Background and objective
Traditional biopsy methods often limit diagnostic accuracy and treatment options due to inadequate tissue samples. En-bloc biopsy (EB), a minimally invasive technique, offers adequate tissue for both pathological and genetic analysis while reducing tumor burden. This study evaluates the clinical applicability and survival benefits of EB in advanced lung cancer.
Methods
We retrospectively reviewed advanced lung cancer patients with pulmonary tumors and distant metastases confirmed by PET-CT, who underwent EB via video-assisted thoracoscopic surgery (VATS) at our center from 2010 to 2020. Clinical characteristics, pathological and genetic results, surgical details, and survival data were analyzed. Kaplan-Meier and Log-Rank tests were used to compare overall survival (OS) between: (1) targeted vs. non-targeted therapies within the EB group, and (2) EB vs. traditional biopsy, with further subgroup analysis focusing on targeted therapy recipients and stage IVA patients.
Results
Among 142 patients (majority male, non-smokers, under 65, ECOG 0–1), 128 (90.1 %) had adenocarcinoma. No severe perioperative complications or early postoperative deaths occurred. All 132 genetic samples were valid; 62.9 % were EGFR-positive. Median follow-up was 52.0 months; median OS, 66.0 months. In the EB group, targeted therapy was linked to longer OS than non-targeted (80.0 vs. 43.0 months, p = 0.0445). EB outperformed traditional biopsy in OS (66.0 vs. 28.0 months, p = 0.0025). Subgroups receiving targeted therapy (HR = 0.55, p = 0.0260) and with stage IVA disease (HR = 0.66, p = 0.0338) showed survival benefit.
Conclusion
VATS-based EB is safe and feasible in advanced lung cancer, improves access to precision therapy, and significantly prolongs survival.
背景和目的由于组织样本不足，传统的活检方法往往限制了诊断的准确性和治疗的选择。整体活检（EB）是一种微创技术，为病理和遗传分析提供了足够的组织，同时减少了肿瘤负担。本研究评估EB治疗晚期肺癌的临床适用性和生存获益。方法回顾性分析2010年至2020年在我中心经视频胸腔镜手术（VATS）行EB治疗的经PET-CT证实的晚期肺癌肺肿瘤及远处转移患者。分析临床特点、病理和遗传结果、手术细节和生存数据。Kaplan-Meier和Log-Rank检验用于比较EB组的总生存率（OS）：(1)靶向与非靶向治疗，(2)EB与传统活检，进一步的亚组分析侧重于靶向治疗接受者和IVA期患者。结果142例患者中（多数为男性，不吸烟，65岁以下，ECOG 0-1）， 128例（90.1%）发生腺癌。无严重围手术期并发症及术后早期死亡。所有132份基因样本均有效；62.9%为egfr阳性。中位随访时间为52.0个月；中位OS为66.0个月。在EB组中，靶向治疗比非靶向治疗的生存期更长（80.0个月对43.0个月，p = 0.0445）。在OS中，EB优于传统活检（66.0 vs 28.0个月，p = 0.0025）。接受靶向治疗（HR = 0.55, p = 0.0260）和IVA期（HR = 0.66, p = 0.0338）的亚组显示生存获益。结论基于vats的EB治疗晚期肺癌安全可行，可提高精准治疗的可及性，显著延长生存期。
{"title":"Clinical application and potential benefits of En-bloc biopsy based on minimally invasive surgery in advanced lung cancer","authors":"Chunyan Li , Jianfu Li , Peiling Chen , Yihai Wei , Yi Zhao , Danman Zhong , Shen Lao , Ziwen Yu , Caichen Li , Bo Cheng , Hengrui Liang , Jiang Shi , Qi Cai , Shan Xiong , Feng Li , Shuting Zhan , Yang Xiang , Ran Zhong , Xin Zheng , Wenhai Fu , Wenhua Liang","doi":"10.1016/j.cson.2025.100108","DOIUrl":"10.1016/j.cson.2025.100108","url":null,"abstract":"<div><h3>Background and objective</h3><div>Traditional biopsy methods often limit diagnostic accuracy and treatment options due to inadequate tissue samples. En-bloc biopsy (EB), a minimally invasive technique, offers adequate tissue for both pathological and genetic analysis while reducing tumor burden. This study evaluates the clinical applicability and survival benefits of EB in advanced lung cancer.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed advanced lung cancer patients with pulmonary tumors and distant metastases confirmed by PET-CT, who underwent EB via video-assisted thoracoscopic surgery (VATS) at our center from 2010 to 2020. Clinical characteristics, pathological and genetic results, surgical details, and survival data were analyzed. Kaplan-Meier and Log-Rank tests were used to compare overall survival (OS) between: (1) targeted vs. non-targeted therapies within the EB group, and (2) EB vs. traditional biopsy, with further subgroup analysis focusing on targeted therapy recipients and stage IVA patients.</div></div><div><h3>Results</h3><div>Among 142 patients (majority male, non-smokers, under 65, ECOG 0–1), 128 (90.1 %) had adenocarcinoma. No severe perioperative complications or early postoperative deaths occurred. All 132 genetic samples were valid; 62.9 % were EGFR-positive. Median follow-up was 52.0 months; median OS, 66.0 months. In the EB group, targeted therapy was linked to longer OS than non-targeted (80.0 vs. 43.0 months, p = 0.0445). EB outperformed traditional biopsy in OS (66.0 vs. 28.0 months, p = 0.0025). Subgroups receiving targeted therapy (HR = 0.55, p = 0.0260) and with stage IVA disease (HR = 0.66, p = 0.0338) showed survival benefit.</div></div><div><h3>Conclusion</h3><div>VATS-based EB is safe and feasible in advanced lung cancer, improves access to precision therapy, and significantly prolongs survival.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-10-23DOI: 10.1016/j.cson.2025.100100
Joseph A. Attard, Emily Siviter, Alice Millard, Eyad Issa, Giuseppe Garcea, Ashley Dennison, John Isherwood
Hepatobiliary and pancreatic (HPB) cancers present a major challenge due to their late presentation, limited treatment options, and high mortality. Artificial intelligence (AI) has emerged as a promising tool in revolutionising cancer care, offering potential advances in early detection, and treatment planning. However, real-world implementation of AI remains limited by ethical, technical, and systemic challenges. This narrative review explores the evolving landscape of AI in HPB oncology, with a focus on ethical integration, healthcare equity, and clinical applicability. Key issues discussed include algorithmic bias, informed consent, model explainability, and disparities in access to data and AI-driven tools. Promising innovations such as federated learning and large language models are explored for their potential to decentralise model training and enhance multidisciplinary workflows. The review also highlights the integration of AI into surgical navigation systems and intraoperative decision-making, as well as its application to omics data analysis for biomarker discovery. Crucially, it underscores the need for transparent and interpretable systems, the need for prospective validation in diverse populations, and the risk of clinician de-skilling. As AI technologies evolve, their safe and equitable integration into HPB oncology will require robust governance, regulatory foresight, and sustained investment in clinician education and infrastructure. This review concludes that, while AI shows potential in transforming HPB cancer care, its ethical and inclusive implementation will ultimately determine its clinical impact.
{"title":"Artificial intelligence for hepatobiliary and pancreatic cancer: Ethics, equity, and real-world integration","authors":"Joseph A. Attard, Emily Siviter, Alice Millard, Eyad Issa, Giuseppe Garcea, Ashley Dennison, John Isherwood","doi":"10.1016/j.cson.2025.100100","DOIUrl":"10.1016/j.cson.2025.100100","url":null,"abstract":"<div><div>Hepatobiliary and pancreatic (HPB) cancers present a major challenge due to their late presentation, limited treatment options, and high mortality. Artificial intelligence (AI) has emerged as a promising tool in revolutionising cancer care, offering potential advances in early detection, and treatment planning. However, real-world implementation of AI remains limited by ethical, technical, and systemic challenges. This narrative review explores the evolving landscape of AI in HPB oncology, with a focus on ethical integration, healthcare equity, and clinical applicability. Key issues discussed include algorithmic bias, informed consent, model explainability, and disparities in access to data and AI-driven tools. Promising innovations such as federated learning and large language models are explored for their potential to decentralise model training and enhance multidisciplinary workflows. The review also highlights the integration of AI into surgical navigation systems and intraoperative decision-making, as well as its application to omics data analysis for biomarker discovery. Crucially, it underscores the need for transparent and interpretable systems, the need for prospective validation in diverse populations, and the risk of clinician de-skilling. As AI technologies evolve, their safe and equitable integration into HPB oncology will require robust governance, regulatory foresight, and sustained investment in clinician education and infrastructure. This review concludes that, while AI shows potential in transforming HPB cancer care, its ethical and inclusive implementation will ultimately determine its clinical impact.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145435363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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