Pub 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":"2025-12-17","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 : 2025-12-01DOI: 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}
The global burden of colorectal cancer (CRC) continues to rise, and the role of perioperative nutrition is shifting from "passive support" to an "active therapeutic" strategy. This narrative review synthesizes recent evidence on metabolic reprogramming and prehabilitation, immunonutrition and microbiome-guided approaches, enteral nutrition and long-term prognosis, and AI-enabled precision nutrition within CRC perioperative care. Findings indicate that multimodal prehabilitation-structured exercise combined with targeted nutrition-enhances metabolic flexibility, mitigates insulin resistance and inflammation, increases preoperative functional reserve, and improves postoperative complications and recovery trajectories. Immunonutrition (e.g., omega-3 fatty acids, arginine, glutamine) and probiotic/prebiotic interventions strengthen the intestinal barrier and recalibrate the immunosuppressive tumor microenvironment, with signals for reduced infections and overall complications. Enteral nutrition correlates with improved survival, while composite nutrition-inflammation indices (PNI, CONUT, GNRI) independently refine risk stratification and optimize prognostic modeling. Microbiome- and multi-omics-informed precision nutrition, supported by AI-based dietary assessment and dynamic monitoring, offers feasible pathways for individualized interventions. However, real-world implementation is constrained by under-recognition of malnutrition, resource limitations, and variability in Enhanced Recovery After Surgery (ERAS) adherence.
Conclusions
Establishing nutrition as a strategic pillar of CRC perioperative management is evidence-based. Priorities include consensus-driven, operational evaluation and intervention workflows; clear population stratification and biomarker-guided decision criteria; and strengthened long-term follow-up and multidisciplinary collaboration to translate and amplify the metabolic and immune benefits into tangible clinical gains.
{"title":"From support to strategy: The evolving role of perioperative nutrition in regulating the prognosis of colorectal cancer surgery","authors":"Qian Wu , Chi Huang , Fengmin Zhang , Chengle Zhuang","doi":"10.1016/j.cson.2025.100110","DOIUrl":"10.1016/j.cson.2025.100110","url":null,"abstract":"<div><div>The global burden of colorectal cancer (CRC) continues to rise, and the role of perioperative nutrition is shifting from \"passive support\" to an \"active therapeutic\" strategy. This narrative review synthesizes recent evidence on metabolic reprogramming and prehabilitation, immunonutrition and microbiome-guided approaches, enteral nutrition and long-term prognosis, and AI-enabled precision nutrition within CRC perioperative care. Findings indicate that multimodal prehabilitation-structured exercise combined with targeted nutrition-enhances metabolic flexibility, mitigates insulin resistance and inflammation, increases preoperative functional reserve, and improves postoperative complications and recovery trajectories. Immunonutrition (e.g., omega-3 fatty acids, arginine, glutamine) and probiotic/prebiotic interventions strengthen the intestinal barrier and recalibrate the immunosuppressive tumor microenvironment, with signals for reduced infections and overall complications. Enteral nutrition correlates with improved survival, while composite nutrition-inflammation indices (PNI, CONUT, GNRI) independently refine risk stratification and optimize prognostic modeling. Microbiome- and multi-omics-informed precision nutrition, supported by AI-based dietary assessment and dynamic monitoring, offers feasible pathways for individualized interventions. However, real-world implementation is constrained by under-recognition of malnutrition, resource limitations, and variability in Enhanced Recovery After Surgery (ERAS) adherence.</div></div><div><h3>Conclusions</h3><div>Establishing nutrition as a strategic pillar of CRC perioperative management is evidence-based. Priorities include consensus-driven, operational evaluation and intervention workflows; clear population stratification and biomarker-guided decision criteria; and strengthened long-term follow-up and multidisciplinary collaboration to translate and amplify the metabolic and immune benefits into tangible clinical gains.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736748","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 : 2025-12-01DOI: 10.1016/j.cson.2025.100098
Liu Mei , Xu Yue , Mu Ning, Li Feng'e, Wu Shengnan, Lv Huan, Wang Xinyi, Ma Chunhua
Objective
To explore the feasibility of a new guidance method for axillary vein puncture, a totally implantable venous access port (TIVAP) was implanted via axillary vein puncture guided by a 30-degree contralateral oblique view of digital subtraction angiography (DSA).
Methods
This retrospective study reviewed clinical data of 275 patients who underwent TIVAP implantation at the Oncology Treatment Center of Tianjin Union Medical Center (February 2022–November 2024). The success rate of puncture, puncture-related complications, and short-term follow-up outcomes in patients undergoing TIVAP implantation via axillary vein puncture guided by a 30-degree contralateral oblique view of DSA were analyzed.
Results
57 patients were implanted with TIVAP via axillary vein puncture guided by a 30-degree contralateral oblique view of DSA. The right axillary vein approach was used in 53 cases (93.0 %), and the left axillary vein approach was used in 4 cases (7.0 %), among which 2 cases were switched to the left side due to venous anomalies on the right side. The puncture success rate was 100 %. Two cases (3.5 %) had accidental puncture of the subclavian artery, but no local hematoma occurred after compression. There were no puncture-related complications such as pneumothorax, air embolism, arrhythmia, or nerve damage. All patients completed a 1-month follow-up, during which no delayed hematoma, venous thrombosis, or port infection was detected.
Conclusion
TIVAP implantation via axillary vein puncture guided by a 30-degree contralateral oblique view of DSA demonstrated high technical success and acceptable short-term safety and serves as a feasible alternative in selected patients.
{"title":"The clinical application of A new DSA-Guided axillary vein puncture technique for venous infusion port","authors":"Liu Mei , Xu Yue , Mu Ning, Li Feng'e, Wu Shengnan, Lv Huan, Wang Xinyi, Ma Chunhua","doi":"10.1016/j.cson.2025.100098","DOIUrl":"10.1016/j.cson.2025.100098","url":null,"abstract":"<div><h3>Objective</h3><div>To explore the feasibility of a new guidance method for axillary vein puncture, a totally implantable venous access port (TIVAP) was implanted via axillary vein puncture guided by a 30-degree contralateral oblique view of digital subtraction angiography (DSA).</div></div><div><h3>Methods</h3><div>This retrospective study reviewed clinical data of 275 patients who underwent TIVAP implantation at the Oncology Treatment Center of Tianjin Union Medical Center (February 2022–November 2024). The success rate of puncture, puncture-related complications, and short-term follow-up outcomes in patients undergoing TIVAP implantation via axillary vein puncture guided by a 30-degree contralateral oblique view of DSA were analyzed.</div></div><div><h3>Results</h3><div>57 patients were implanted with TIVAP via axillary vein puncture guided by a 30-degree contralateral oblique view of DSA. The right axillary vein approach was used in 53 cases (93.0 %), and the left axillary vein approach was used in 4 cases (7.0 %), among which 2 cases were switched to the left side due to venous anomalies on the right side. The puncture success rate was 100 %. Two cases (3.5 %) had accidental puncture of the subclavian artery, but no local hematoma occurred after compression. There were no puncture-related complications such as pneumothorax, air embolism, arrhythmia, or nerve damage. All patients completed a 1-month follow-up, during which no delayed hematoma, venous thrombosis, or port infection was detected.</div></div><div><h3>Conclusion</h3><div>TIVAP implantation via axillary vein puncture guided by a 30-degree contralateral oblique view of DSA demonstrated high technical success and acceptable short-term safety and serves as a feasible alternative in selected patients.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684843","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 : 2025-12-01DOI: 10.1016/j.cson.2025.100107
Jinmiao Chen , Xiuqi Du , Minke Shao , Yifan Sun , Xinyu Shi , Songbing He
In recent years, the gut microbiota have identified as a modifiable key environmental factor influencing the development and progression of colorectal cancer (CRC). Molecular epidemiological studies, including cross-sectional and prospective cohort designs, have consistently identified distinct microbial dysbiosis in CRC patients, characterized by an enrichment of pro-inflammatory and genotoxin-producing bacteria, alongside a reduction in protective commensals. Mendelian randomization analyses further support a causal role for specific microbial taxa in CRC pathogenesis. Mechanistically, gut microbes contribute to tumorigenesis through direct genotoxic effects (e.g., DNA damage), activation of inflammatory pathways, and metabolite-mediated interactions—exhibiting dual roles, as seen with short-chain fatty acids versus secondary bile acids. These processes often interact with host genetic backgrounds, forming complex gene-environment interactions. These findings the potential of microbiota-derived signatures as biomarkers for early detection and prognostic prediction. Furthermore, microbiota-targeted strategies—such as dietary interventions, probiotics, pharmaceuticals, and nanotechnology-based approaches—are being actively explored for precision prevention and treatment of CRC.
{"title":"The gut microbiota and colorectal cancer: Molecular insights and translational implications","authors":"Jinmiao Chen , Xiuqi Du , Minke Shao , Yifan Sun , Xinyu Shi , Songbing He","doi":"10.1016/j.cson.2025.100107","DOIUrl":"10.1016/j.cson.2025.100107","url":null,"abstract":"<div><div>In recent years, the gut microbiota have identified as a modifiable key environmental factor influencing the development and progression of colorectal cancer (CRC). Molecular epidemiological studies, including cross-sectional and prospective cohort designs, have consistently identified distinct microbial dysbiosis in CRC patients, characterized by an enrichment of pro-inflammatory and genotoxin-producing bacteria, alongside a reduction in protective commensals. Mendelian randomization analyses further support a causal role for specific microbial taxa in CRC pathogenesis. Mechanistically, gut microbes contribute to tumorigenesis through direct genotoxic effects (e.g., DNA damage), activation of inflammatory pathways, and metabolite-mediated interactions—exhibiting dual roles, as seen with short-chain fatty acids versus secondary bile acids. These processes often interact with host genetic backgrounds, forming complex gene-environment interactions. These findings the potential of microbiota-derived signatures as biomarkers for early detection and prognostic prediction. Furthermore, microbiota-targeted strategies—such as dietary interventions, probiotics, pharmaceuticals, and nanotechnology-based approaches—are being actively explored for precision prevention and treatment of CRC.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617989","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 : 2025-12-01DOI: 10.1016/j.cson.2025.100113
Navid Mokarram Dorri , Laura Foulhioux , Christophe Zemmour , Quentin Dominique Thomas , Hélène Costaz , Fabrice Narducci , Thierry Petit , Cécile Loaec , Enora Laas , Frédéric Guyon , François Cherifi , Aude-Marie Savoye , Domenico Ferraioli , Rossi Lea , Thibault de la Motte Rouge , Frederic Marchal , Marie Gosset , Christophe Pomel , Anne-Laure Martin , Eric Lambaudie
Objectives
To evaluate the surgical management and oncologic outcomes of patients with FIGO stage IV ovarian cancer, using data from the French national ESME cohort.
Methods
This retrospective multicenter study included patients diagnosed with FIGO stage IV ovarian cancer between January 2011 and December 2016, treated in 18 French Comprehensive Cancer Centers participating in the ESME-OVR program. Clinical characteristics, treatment strategies, metastatic site patterns, and survival outcomes (overall survival [OS], progression-free survival [PFS]) were analyzed and compared between FIGO IVA and IVB stages.
Results
A total of 159 patients were identified, of whom 107 (67.3 %) had FIGO stage IVB disease. Regardless of metastatic stage, surgical strategies and were comparable. Complete debulking surgery was achieved in 75 % of cases. Most of FIGO stage IVB patients (88.8 %) presented a single metastatic site including extra-abdominal lymph nodes (50.5 %), liver (20.6 %), and lungs (10.3 %); 15.9 % of patient with distant metastases underwent local treatment and predominantly targeted nodal disease. Complete debulking surgery was significantly associated with improved OS and PFS (p = 0.002 and p < 0.001, respectively), while local treatment of metastases did not provide survival benefit. The number of metastatic sites did not significantly influence prognosis.
Conclusions
Complete debulking surgery is the critical factor from a progronostic point of view, whether in FIGO stage IVA or IVB. Feasibility of local treatment for distant metastases is observed, its impact on oncologic outcomes remains unclear and we need further prospective investigation. Surgical strategies should be integrated into a personalized approach to optimize management in advanced-stage disease.
{"title":"Metastatic sites and surgical management in stage IV ovarian cancer: Is there a place for debulking surgery in FIGO stage IVB patients? A retrospective study from the ESME national cohort","authors":"Navid Mokarram Dorri , Laura Foulhioux , Christophe Zemmour , Quentin Dominique Thomas , Hélène Costaz , Fabrice Narducci , Thierry Petit , Cécile Loaec , Enora Laas , Frédéric Guyon , François Cherifi , Aude-Marie Savoye , Domenico Ferraioli , Rossi Lea , Thibault de la Motte Rouge , Frederic Marchal , Marie Gosset , Christophe Pomel , Anne-Laure Martin , Eric Lambaudie","doi":"10.1016/j.cson.2025.100113","DOIUrl":"10.1016/j.cson.2025.100113","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the surgical management and oncologic outcomes of patients with FIGO stage IV ovarian cancer, using data from the French national ESME cohort.</div></div><div><h3>Methods</h3><div>This retrospective multicenter study included patients diagnosed with FIGO stage IV ovarian cancer between January 2011 and December 2016, treated in 18 French Comprehensive Cancer Centers participating in the ESME-OVR program. Clinical characteristics, treatment strategies, metastatic site patterns, and survival outcomes (overall survival [OS], progression-free survival [PFS]) were analyzed and compared between FIGO IVA and IVB stages.</div></div><div><h3>Results</h3><div>A total of 159 patients were identified, of whom 107 (67.3 %) had FIGO stage IVB disease. Regardless of metastatic stage, surgical strategies and were comparable. Complete debulking surgery was achieved in 75 % of cases. Most of FIGO stage IVB patients (88.8 %) presented a single metastatic site including extra-abdominal lymph nodes (50.5 %), liver (20.6 %), and lungs (10.3 %); 15.9 % of patient with distant metastases underwent local treatment and predominantly targeted nodal disease. Complete debulking surgery was significantly associated with improved OS and PFS (p = 0.002 and p < 0.001, respectively), while local treatment of metastases did not provide survival benefit. The number of metastatic sites did not significantly influence prognosis.</div></div><div><h3>Conclusions</h3><div>Complete debulking surgery is the critical factor from a progronostic point of view, whether in FIGO stage IVA or IVB. Feasibility of local treatment for distant metastases is observed, its impact on oncologic outcomes remains unclear and we need further prospective investigation. Surgical strategies should be integrated into a personalized approach to optimize management in advanced-stage disease.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145789821","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 : 2025-12-01DOI: 10.1016/j.cson.2025.100109
Stéphane Lantheaume , Sandrine Soler , Isabelle Ben Taàrit , Anne Le Hémon-Lepaul , Sophie Lantheaume , Céline Lenck , François Sensenbrenner
Introduction
The reference technique for axillary sentinel lymph node (SLN) detection in women with breast cancer uses the radioactive marker, technetium (Tc99m), which makes ambulatory surgery difficult and carries a risk of irradiation to the patient and the medical teams. The aim of this study was to investigate the feasibility of using immunofluorescence (IF), a new non-radioactive technique, for SLN detection in women with early-stage breast cancer (ESBC).
Materials and methods
Patients were included if they were suffering from ESBC (T1/T2 N0) or ductal carcinoma in situ. The SLN was first detected using IF with indocyanine green and was then confirmed using Tc99m.
Results
A total of 268 women with ESBC were included (median age: 61.4 years). Tumour location in the breast correlated with SLN location according to the anatomic classification ABCD, with >75 % of tumours located in the outer quadrants of the breast. IF was positive in 96 % of cases and allowed precise anatomic location of the SLN. The SLN was located in zone A in 87.7 % of patients and zone B in 10.1 %, which corresponds to the path of the lateral thoracic vein. Only 2.2 % of tumours were in zone C and none were in zone D. Rate of failure of detection by IF alone was 4.1 %, associated with a mean BMI of 26.8 kg/m2.
Conclusion
IF is an economic, non-invasive, non-radioactive technique for SLN detection in ESBC. Surgeons should be aware of this new, alternative procedure so that it can be used more widely in the future.
{"title":"Immunofluorescence and targeted removal of the axillary sentinel lymph node in early-stage breast cancer: a simple, safe and effective anatomical approach","authors":"Stéphane Lantheaume , Sandrine Soler , Isabelle Ben Taàrit , Anne Le Hémon-Lepaul , Sophie Lantheaume , Céline Lenck , François Sensenbrenner","doi":"10.1016/j.cson.2025.100109","DOIUrl":"10.1016/j.cson.2025.100109","url":null,"abstract":"<div><h3>Introduction</h3><div>The reference technique for axillary sentinel lymph node (SLN) detection in women with breast cancer uses the radioactive marker, technetium (Tc99m), which makes ambulatory surgery difficult and carries a risk of irradiation to the patient and the medical teams. The aim of this study was to investigate the feasibility of using immunofluorescence (IF), a new non-radioactive technique, for SLN detection in women with early-stage breast cancer (ESBC).</div></div><div><h3>Materials and methods</h3><div>Patients were included if they were suffering from ESBC (T1/T2 N0) or ductal carcinoma in situ. The SLN was first detected using IF with indocyanine green and was then confirmed using Tc99m.</div></div><div><h3>Results</h3><div>A total of 268 women with ESBC were included (median age: 61.4 years). Tumour location in the breast correlated with SLN location according to the anatomic classification ABCD, with >75 % of tumours located in the outer quadrants of the breast. IF was positive in 96 % of cases and allowed precise anatomic location of the SLN. The SLN was located in zone A in 87.7 % of patients and zone B in 10.1 %, which corresponds to the path of the lateral thoracic vein. Only 2.2 % of tumours were in zone C and none were in zone D. Rate of failure of detection by IF alone was 4.1 %, associated with a mean BMI of 26.8 kg/m<sup>2</sup>.</div></div><div><h3>Conclusion</h3><div>IF is an economic, non-invasive, non-radioactive technique for SLN detection in ESBC. Surgeons should be aware of this new, alternative procedure so that it can be used more widely in the future.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736749","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}
Giant Cell Tumor of Bone is an intermediate, locally aggressive tumor that is often diagnosed at an advanced stage due to diagnostic delays. Hypothetically, diagnostic delays may result in advanced disease, necessitating more invasive surgery and causing significant lifelong burden. This systematic review explores the available literature on diagnostic and treatment delays in Giant Cell Tumor of Bone.
Methods
A systematic review was conducted using the Medline, Embase, and Cochrane databases on February 9, 2023. A total of 15 studies representing 34 cases (32 cases analyzed) were included after thorough review and critical appraisal.
Results
Fifteen articles representing 32 cases were included. The median age of the included cases was 29 years (IQR 24–41). Tumor locations included the foot (22 %), spine (19 %), distal ulna (16 %), and other sites (43 %). Campanacci grades 2 and 3 (used to assess tumor severity) were reported in 16 % and 81 % of cases, respectively. Primary GCTB accounted for 88 % of cases, while 12 % involved local recurrence. The median diagnostic delay was 5.5 months (IQR 3.0–13.5). Patient-related delays (13 cases) had a median of 6 months (IQR 3–35), referral delays (19 cases) had a median of 4 months (IQR 3–12), and diagnostic delays (4 cases) had a median of 2.5 months (IQR 1–4).
Conclusion
Diagnostic delays in Giant Cell Tumor of Bone were identified, and were often associated with advanced disease. Further research involving a larger number of cases is essential to assess the impact of these delays on clinical outcomes and disease progression.
{"title":"Delayed diagnosis May lead to giant cell tumor of bone progression","authors":"M.J.C. Duivenvoorden , R. Hemke , G.G.J. Krebbekx , J.A.M. Bramer , N.P. Denswil , G.M.M.J. Kerkhoffs , F.G.M. Verspoor","doi":"10.1016/j.cson.2025.100106","DOIUrl":"10.1016/j.cson.2025.100106","url":null,"abstract":"<div><h3>Introduction</h3><div>Giant Cell Tumor of Bone is an intermediate, locally aggressive tumor that is often diagnosed at an advanced stage due to diagnostic delays. Hypothetically, diagnostic delays may result in advanced disease, necessitating more invasive surgery and causing significant lifelong burden. This systematic review explores the available literature on diagnostic and treatment delays in Giant Cell Tumor of Bone.</div></div><div><h3>Methods</h3><div>A systematic review was conducted using the Medline, Embase, and Cochrane databases on February 9, 2023. A total of 15 studies representing 34 cases (32 cases analyzed) were included after thorough review and critical appraisal.</div></div><div><h3>Results</h3><div>Fifteen articles representing 32 cases were included. The median age of the included cases was 29 years (IQR 24–41). Tumor locations included the foot (22 %), spine (19 %), distal ulna (16 %), and other sites (43 %). Campanacci grades 2 and 3 (used to assess tumor severity) were reported in 16 % and 81 % of cases, respectively. Primary GCTB accounted for 88 % of cases, while 12 % involved local recurrence. The median diagnostic delay was 5.5 months (IQR 3.0–13.5). Patient-related delays (13 cases) had a median of 6 months (IQR 3–35), referral delays (19 cases) had a median of 4 months (IQR 3–12), and diagnostic delays (4 cases) had a median of 2.5 months (IQR 1–4).</div></div><div><h3>Conclusion</h3><div>Diagnostic delays in Giant Cell Tumor of Bone were identified, and were often associated with advanced disease. Further research involving a larger number of cases is essential to assess the impact of these delays on clinical outcomes and disease progression.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684842","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}
The role of liver resection (LR) as extended cholecystectomy for T2 gallbladder cancer (GBC) remains controversial.
Methods
100 patients with pathological (p) T2 GBC who underwent curative surgery between 2003 and 2023 were retrospectively analyzed. Prognostic outcomes were compared between patients who underwent LR (LR+) and those who did not (LR–), with subgroup analyses by T2 substage. To assess the accuracy of preoperative T staging, 72 additional pT1/3 patients who underwent surgical resection during the same study period were evaluated.
Results
The LR+ (n = 78) and LR– (n = 22) groups showed no differences in overall survival (OS, P = 0.552) or recurrence-free survival (RFS, P = 0.538). Subgroup analyses showed no survival advantage with LR in both T2a and T2b cases. A multivariable analysis identified lymph node metastasis, elevated CA19-9, and tumor location (neck) as independent predictors of OS, but not LR (P = 0.806). Similarly, LR was not a risk factor for RFS (P = 0.677). Local recurrence occurred in one patient (LR + group). Diagnostic accuracy of T2 was 64.5 %. 2 cases of clinical T2b cases were upstaged to pT3.
Conclusions
LR did not provide clear oncological benefits in T2 GBC when adequate preoperative and intraoperative assessment was ensured. For T2a tumors, LR is likely to be omitted without compromising oncological outcomes. For even T2b cases, omission may be considered when hepatic invasion is carefully excluded.
{"title":"Reappraising the prognostic role of liver resection as part of extended cholecystectomy for T2 gallbladder cancer","authors":"Hirotoshi Noda, Yoshiyasu Kato, Ryo Ashida, Katsuhisa Ohgi, Shimpei Otsuka, Hideyuki Dei, Katsuhiko Uesaka, Teiichi Sugiura","doi":"10.1016/j.cson.2025.100112","DOIUrl":"10.1016/j.cson.2025.100112","url":null,"abstract":"<div><h3>Background</h3><div>The role of liver resection (LR) as extended cholecystectomy for T2 gallbladder cancer (GBC) remains controversial.</div></div><div><h3>Methods</h3><div>100 patients with pathological (p) T2 GBC who underwent curative surgery between 2003 and 2023 were retrospectively analyzed. Prognostic outcomes were compared between patients who underwent LR (LR+) and those who did not (LR–), with subgroup analyses by T2 substage. To assess the accuracy of preoperative T staging, 72 additional pT1/3 patients who underwent surgical resection during the same study period were evaluated.</div></div><div><h3>Results</h3><div>The LR+ (n = 78) and LR– (n = 22) groups showed no differences in overall survival (OS, <em>P</em> = 0.552) or recurrence-free survival (RFS, <em>P</em> = 0.538). Subgroup analyses showed no survival advantage with LR in both T2a and T2b cases. A multivariable analysis identified lymph node metastasis, elevated CA19-9, and tumor location (neck) as independent predictors of OS, but not LR (<em>P</em> = 0.806). Similarly, LR was not a risk factor for RFS (<em>P</em> = 0.677). Local recurrence occurred in one patient (LR + group). Diagnostic accuracy of T2 was 64.5 %. 2 cases of clinical T2b cases were upstaged to pT3.</div></div><div><h3>Conclusions</h3><div>LR did not provide clear oncological benefits in T2 GBC when adequate preoperative and intraoperative assessment was ensured. For T2a tumors, LR is likely to be omitted without compromising oncological outcomes. For even T2b cases, omission may be considered when hepatic invasion is carefully excluded.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736747","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 : 2025-12-01DOI: 10.1016/j.cson.2025.100111
Tao Jiang, Ming-yuan Chen
Recurrent nasopharyngeal carcinoma (rNPC) is insensitive to radiotherapy, and re-irradiation lead to severe adverse reactions. Studies have confirmed that endoscopic nasopharyngectomy(ENPG) combined with vascularized nasal mucosal flap repair is superior to re-irradiation with intensity-modulated radiation therapy (IMRT) in terms of survival rate, quality of life and medical costs. This surgical approach has been widely recognized and shows advantages in early-stage rNPC, marking minimally invasive surgery (MIS) for rNPC as an important treatment option. However, the efficacy of surgery for patients with de novo early-stage nasopharyngeal carcinoma(NPC) and advanced rNPC remains controversial. With the standardization and popularization of surgical procedures for NPC, the improvement of surgical staging, the perioperative management of the internal carotid artery(ICA), the advancement of skull base defect repair technology, the implementation of reasonable postoperative treatment and follow-up, as well as the innovation of lymph node dissection technology, MIS for NPC will play an increasingly important role in the treatment of NPC. Evidence-based medical evidence have confirmed that MIS offers definite survival benefits and safety advantages rNPC, serving as the core treatment option for resectable rNPC. Meanwhile, its preliminary application in de novo early-stage NPC has demonstrated potential in avoiding radiotherapy-induced injuries, opening up a new direction for disease treatment. Nevertheless, the surgical treatment of NPC still requires more multi-center and clinical studies for further validation and improvement.
{"title":"Establishment and development of minimally invasive surgery for nasopharyngeal carcinoma","authors":"Tao Jiang, Ming-yuan Chen","doi":"10.1016/j.cson.2025.100111","DOIUrl":"10.1016/j.cson.2025.100111","url":null,"abstract":"<div><div>Recurrent nasopharyngeal carcinoma (rNPC) is insensitive to radiotherapy, and re-irradiation lead to severe adverse reactions. Studies have confirmed that endoscopic nasopharyngectomy(ENPG) combined with vascularized nasal mucosal flap repair is superior to re-irradiation with intensity-modulated radiation therapy (IMRT) in terms of survival rate, quality of life and medical costs. This surgical approach has been widely recognized and shows advantages in early-stage rNPC, marking minimally invasive surgery (MIS) for rNPC as an important treatment option. However, the efficacy of surgery for patients with de novo early-stage nasopharyngeal carcinoma(NPC) and advanced rNPC remains controversial. With the standardization and popularization of surgical procedures for NPC, the improvement of surgical staging, the perioperative management of the internal carotid artery(ICA), the advancement of skull base defect repair technology, the implementation of reasonable postoperative treatment and follow-up, as well as the innovation of lymph node dissection technology, MIS for NPC will play an increasingly important role in the treatment of NPC. Evidence-based medical evidence have confirmed that MIS offers definite survival benefits and safety advantages rNPC, serving as the core treatment option for resectable rNPC. Meanwhile, its preliminary application in de novo early-stage NPC has demonstrated potential in avoiding radiotherapy-induced injuries, opening up a new direction for disease treatment. Nevertheless, the surgical treatment of NPC still requires more multi-center and clinical studies for further validation and improvement.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 4","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145736746","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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