Pub Date : 2026-01-14DOI: 10.1016/j.ejso.2026.111405
Cuma Fidan
Background
The primary objective of this study is to compare health-related quality of life (HRQoL) of cancer patients undergoing first and last follow-up after robotic surgery (RS). The secondary objective of the study is to reveal effect of moderator variables on HRQoL of cancer patients after surgery.
Methods
Random effects model was used for meta-analysis, sensitivity, publication bias, meta-anova and meta-regression analyses. Threshold values have been calculated to evaluate clinical significance.
Results
13 studies were included in the meta-analysis (total of 2.399 cancer patients). Results of meta-analysis and sensitivity analysis show that cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up. There is no publication bias. Results of meta-anova analysis show that (1) RS method has better HRQoL than other methods, (2) In gynaecologic cancers, cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up, and (3) In cases where difference between last and first follow-up after RS is above or below 43, cancer patients undergoing last follow-up have better HRQoL than first follow-up. These results are both statistically and clinically significant.
Conclusion
RS treatment is effective in terms of HRQoL in cancer patients, both statistically and clinically. Therefore, RS treatment improves HRQoL of cancer patients. The results of this study could help surgeons develop patient-centred treatment strategies.
{"title":"Comparison of health-related quality of life of cancer patients undergoing first and last follow-up after robotic surgery: A meta-analysis","authors":"Cuma Fidan","doi":"10.1016/j.ejso.2026.111405","DOIUrl":"10.1016/j.ejso.2026.111405","url":null,"abstract":"<div><h3>Background</h3><div>The primary objective of this study is to compare health-related quality of life (HRQoL) of cancer patients undergoing first and last follow-up after robotic surgery (RS). The secondary objective of the study is to reveal effect of moderator variables on HRQoL of cancer patients after surgery.</div></div><div><h3>Methods</h3><div>Random effects model was used for meta-analysis, sensitivity, publication bias, meta-anova and meta-regression analyses. Threshold values have been calculated to evaluate clinical significance.</div></div><div><h3>Results</h3><div>13 studies were included in the meta-analysis (total of 2.399 cancer patients). Results of meta-analysis and sensitivity analysis show that cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up. There is no publication bias. Results of meta-anova analysis show that (1) RS method has better HRQoL than other methods, (2) In gynaecologic cancers, cancer patients undergoing last follow-up after RS have better HRQoL than first follow-up, and (3) In cases where difference between last and first follow-up after RS is above or below 43, cancer patients undergoing last follow-up have better HRQoL than first follow-up. These results are both statistically and clinically significant.</div></div><div><h3>Conclusion</h3><div>RS treatment is effective in terms of HRQoL in cancer patients, both statistically and clinically. Therefore, RS treatment improves HRQoL of cancer patients. The results of this study could help surgeons develop patient-centred treatment strategies.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111405"},"PeriodicalIF":2.9,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Accurate identification of locally advanced rectal cancer (LARC) is crucial for treatment planning, yet conventional Magnetic resonance imaging (MRI) assessment remains subjective and experience-dependent, leading to inconsistent staging and suboptimal treatment decisions. An objective approach for preoperative risk stratification in rectal cancer patients, as an alternative to conventional MRI-based LARC identification, is therefore critically needed.
Method
We retrospectively analyzed 294 rectal adenocarcinoma patients from three cohorts who underwent preoperative MRI and surgery. Dynamic contrast-enhanced (DCE) MRI based and clinical features were analyzed for correlation with pathology and by Cox regression for feature selection, then used to build survival prediction models. Model performance was compared against MRI- and pathology-based LARC status for predicting postoperative 3-year disease-free survival (DFS). Mediation analysis assessed whether pathological characteristics mediated imaging-clinical feature effects on DFS.
Results
The kinetic DCE-MRI feature Washout inversely correlated with pathological T-stage. Preoperative carcinoembryonic antigen (CEA) (HR 1.02; 95 %CI: 1.001–1.039) and Washout (HR 0.014; 95 %CI: 0.001–0.332) were independent predictors of 3-year DFS. High-risk patients identified by the models had significantly worse survival than low-risk patients (p < 0.01). The models outperformed conventional MRI-based assessment (AUC 0.757–0.819 vs 0.600–0.672; C-index 0.755–0.774 vs 0.586–0.673). T/N stage partially mediated effects of CEA (17.7 %) and Washout (51.1 %) on DFS.
Conclusion
The developed models provide an objective, valuable tool for preoperative risk stratification as alternative to subjective LARC identification, enhancing preoperative risk stratification.
准确识别局部晚期直肠癌（LARC）对于治疗计划至关重要，然而传统的磁共振成像（MRI）评估仍然是主观的和依赖经验的，导致分期不一致和治疗决策不理想。因此，迫切需要一种客观的方法来对直肠癌患者进行术前风险分层，以替代传统的基于mri的LARC识别。方法回顾性分析3组294例直肠腺癌患者的术前MRI和手术资料。基于动态对比增强（DCE） MRI和临床特征分析与病理的相关性，并通过Cox回归进行特征选择，然后用于建立生存预测模型。将模型性能与基于MRI和病理的LARC状态进行比较，以预测术后3年无病生存（DFS）。中介分析评估病理特征是否介导影像学-临床特征对DFS的影响。结果动态DCE-MRI特征Washout与病理性t分期呈负相关。术前癌胚抗原（CEA） （HR 1.02; 95% CI: 1.001-1.039）和冲洗（HR 0.014; 95% CI: 0.001-0.332）是3年DFS的独立预测因子。模型识别出的高危患者生存率明显低于低危患者（p < 0.01）。模型优于传统的基于mri的评估（AUC 0.757-0.819 vs 0.600-0.672； c指数0.755-0.774 vs 0.586-0.673）。T/N期部分介导CEA（17.7%）和Washout（51.1%）对DFS的影响。结论所建立的模型为术前风险分层提供了一种客观、有价值的工具，可替代主观的LARC识别，加强术前风险分层。
{"title":"Clinical-radiological predictive model for preoperative risk stratification in rectal adenocarcinoma","authors":"Youfan Zhao , Zhongwei Chen , Yuguo Wei , Jiejie Zhou , Yaru Wei , Ying Zhu , Xiang Li , Yanyan Li , Ziyi Chen , Jiashan Zhan , Meihao Wang","doi":"10.1016/j.ejso.2026.111398","DOIUrl":"10.1016/j.ejso.2026.111398","url":null,"abstract":"<div><h3>Background</h3><div>Accurate identification of locally advanced rectal cancer (LARC) is crucial for treatment planning, yet conventional Magnetic resonance imaging (MRI) assessment remains subjective and experience-dependent, leading to inconsistent staging and suboptimal treatment decisions. An objective approach for preoperative risk stratification in rectal cancer patients, as an alternative to conventional MRI-based LARC identification, is therefore critically needed.</div></div><div><h3>Method</h3><div>We retrospectively analyzed 294 rectal adenocarcinoma patients from three cohorts who underwent preoperative MRI and surgery. Dynamic contrast-enhanced (DCE) MRI based and clinical features were analyzed for correlation with pathology and by Cox regression for feature selection, then used to build survival prediction models. Model performance was compared against MRI- and pathology-based LARC status for predicting postoperative 3-year disease-free survival (DFS). Mediation analysis assessed whether pathological characteristics mediated imaging-clinical feature effects on DFS.</div></div><div><h3>Results</h3><div>The kinetic DCE-MRI feature Washout inversely correlated with pathological T-stage. Preoperative carcinoembryonic antigen (CEA) (HR 1.02; 95 %CI: 1.001–1.039) and Washout (HR 0.014; 95 %CI: 0.001–0.332) were independent predictors of 3-year DFS. High-risk patients identified by the models had significantly worse survival than low-risk patients (<em>p</em> < 0.01). The models outperformed conventional MRI-based assessment (AUC 0.757–0.819 vs 0.600–0.672; C-index 0.755–0.774 vs 0.586–0.673). T/N stage partially mediated effects of CEA (17.7 %) and Washout (51.1 %) on DFS.</div></div><div><h3>Conclusion</h3><div>The developed models provide an objective, valuable tool for preoperative risk stratification as alternative to subjective LARC identification, enhancing preoperative risk stratification.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111398"},"PeriodicalIF":2.9,"publicationDate":"2026-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.ejso.2026.111399
Jacquelyn E. Fitzgerald , Avery C. Bechthold , Omari Whitlow , Olivia Monton , J. Nicholas Odom , Kimberly E. Kopecky
Background
Values elicitation, the structured process of clarifying what matters most to patients, is essential to patient-centered care in surgical oncology. This study examined how surgeons elicit, document, and incorporate patient values into surgical decision-making in clinical practice.
Methods
We conducted a 26-question international online survey (May–June 2025) assessing self-reported values elicitation practices among surgical oncologists, focusing on timing, methods, documentation, communication, and preparedness. The survey was distributed through professional networks using convenience and snowball sampling methods, wherein participants were recruited directly or referred by peers. Descriptive statistics summarized responses, and free-text answers were thematically analyzed.
Results
Ninety-one surgical oncologists responded to the survey. Most were male (n = 40, 56 %) and White (n = 52, 74 %), specializing in gastrointestinal (n = 32, 44 %), breast (n = 24, 33 %), or skin/soft tissue (n = 24, 33 %) oncology. Most reported eliciting patient values (n = 69, 87 %) and initiating values conversations (n = 52, 73 %). Surgeons reported documenting values (n = 55, 77 %) in the electronic health record and communicating them during tumor boards (n = 50, 83 %). Most surgeons (n = 48, 67 %) reported that patient values influenced recommendations in fewer than 25 % of cases. Nearly all (n = 69, 97 %) reported navigating treatment recommendations that conflicted with patients’ values. Narrative responses identified three strategies: direct questioning, goals-of-care framing, and shared decision-making dialogue. Time constraints (n = 50, 70 %) and limited training (n = 19, 27 %) were key barriers. Most (n = 66, 93 %) felt prepared, yet 78 % (n = 56) desired additional training.
Conclusions
While values elicitation was widely reported by surgical oncologists, it often did not influence surgical recommendations. Findings highlight the need to re-evaluate approaches and training for integrating patient values in surgical decision-making.
{"title":"Values elicitation among surgical oncologists: Findings from an international survey","authors":"Jacquelyn E. Fitzgerald , Avery C. Bechthold , Omari Whitlow , Olivia Monton , J. Nicholas Odom , Kimberly E. Kopecky","doi":"10.1016/j.ejso.2026.111399","DOIUrl":"10.1016/j.ejso.2026.111399","url":null,"abstract":"<div><h3>Background</h3><div>Values elicitation, the structured process of clarifying what matters most to patients, is essential to patient-centered care in surgical oncology. This study examined how surgeons elicit, document, and incorporate patient values into surgical decision-making in clinical practice.</div></div><div><h3>Methods</h3><div>We conducted a 26-question international online survey (May–June 2025) assessing self-reported values elicitation practices among surgical oncologists, focusing on timing, methods, documentation, communication, and preparedness. The survey was distributed through professional networks using convenience and snowball sampling methods, wherein participants were recruited directly or referred by peers. Descriptive statistics summarized responses, and free-text answers were thematically analyzed.</div></div><div><h3>Results</h3><div>Ninety-one surgical oncologists responded to the survey. Most were male (n = 40, 56 %) and White (n = 52, 74 %), specializing in gastrointestinal (n = 32, 44 %), breast (n = 24, 33 %), or skin/soft tissue (n = 24, 33 %) oncology. Most reported eliciting patient values (n = 69, 87 %) and initiating values conversations (n = 52, 73 %). Surgeons reported documenting values (n = 55, 77 %) in the electronic health record and communicating them during tumor boards (n = 50, 83 %). Most surgeons (n = 48, 67 %) reported that patient values influenced recommendations in fewer than 25 % of cases. Nearly all (n = 69, 97 %) reported navigating treatment recommendations that conflicted with patients’ values. Narrative responses identified three strategies: direct questioning, goals-of-care framing, and shared decision-making dialogue. Time constraints (n = 50, 70 %) and limited training (n = 19, 27 %) were key barriers. Most (n = 66, 93 %) felt prepared, yet 78 % (n = 56) desired additional training.</div></div><div><h3>Conclusions</h3><div>While values elicitation was widely reported by surgical oncologists, it often did not influence surgical recommendations. Findings highlight the need to re-evaluate approaches and training for integrating patient values in surgical decision-making.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111399"},"PeriodicalIF":2.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-09DOI: 10.1016/j.ejso.2026.111395
Jun Suh Lee , Gianluca Cassese , Yoo-Seok Yoon , Ho-Seong Han , Boram Lee , Yesong Park , Jin-Young Jang , Wooil Kwon , Chang-Sup Lim
Background
The optimal transection level (TL) during distal pancreatectomy (DP) for pancreatic tail cancer remains unclear. This study evaluated the effect of TL on survival and glucose metabolism.
Methods
We retrospectively reviewed 320 patients undergoing DP between 2000 and 2018 at three centers. Patients were grouped as proximal transection (PT, n = 264) or distal transection (DT, n = 56) relative to the aorta. Perioperative, oncologic, and metabolic outcomes were compared, including a propensity score–matched analysis.
Results
Operation time and blood loss were greater in PT, which also yielded more lymph nodes (14 vs. 10, P < 0.01), though R0 resection and nodal positivity were similar. In the matched cohort, disease-free survival (17.7 vs. 15.3 months, P = 0.76) and overall survival (27.0 vs. 30.9 months, P = 0.64) did not differ between PT and DT. Multivariable analysis confirmed no association of TL with survival. Among non-diabetic patients, PT was associated with a greater rise in HbA1c at 1 year (0.57 % vs. 0.16 %; P = 0.056), suggesting impaired glycemic control.
Conclusions
Transection level does not influence oncologic outcomes in DP for pancreatic tail cancer but may affect postoperative glucose regulation.
背景：胰腺癌远端胰腺切除术（DP）的最佳横断水平（TL）尚不清楚。本研究评估了TL对生存和葡萄糖代谢的影响。方法回顾性分析了2000年至2018年在三个中心接受DP治疗的320例患者。患者被分为相对于主动脉的近端横断（PT, n = 264）或远端横断（DT, n = 56）。围手术期、肿瘤学和代谢结果进行比较，包括倾向评分匹配分析。结果PT组手术时间更长，出血量更大，淋巴结数量也更多（14比10，P < 0.01），但R0切除和淋巴结阳性相似。在匹配的队列中，PT和DT的无病生存期（17.7个月vs 15.3个月，P = 0.76）和总生存期（27.0个月vs 30.9个月，P = 0.64）没有差异。多变量分析证实TL与生存无关联。在非糖尿病患者中，PT与1年HbA1c升高相关（0.57% vs. 0.16%; P = 0.056），提示血糖控制受损。结论胰尾癌术后胰液横切水平不影响预后，但可能影响术后血糖调节。
{"title":"Impact of pancreatic transection level on survival outcomes and glycemic control following distal pancreatectomy for pancreatic tail cancer: A multicenter cohort study","authors":"Jun Suh Lee , Gianluca Cassese , Yoo-Seok Yoon , Ho-Seong Han , Boram Lee , Yesong Park , Jin-Young Jang , Wooil Kwon , Chang-Sup Lim","doi":"10.1016/j.ejso.2026.111395","DOIUrl":"10.1016/j.ejso.2026.111395","url":null,"abstract":"<div><h3>Background</h3><div>The optimal transection level (TL) during distal pancreatectomy (DP) for pancreatic tail cancer remains unclear. This study evaluated the effect of TL on survival and glucose metabolism.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed 320 patients undergoing DP between 2000 and 2018 at three centers. Patients were grouped as proximal transection (PT, n = 264) or distal transection (DT, n = 56) relative to the aorta. Perioperative, oncologic, and metabolic outcomes were compared, including a propensity score–matched analysis.</div></div><div><h3>Results</h3><div>Operation time and blood loss were greater in PT, which also yielded more lymph nodes (14 vs. 10, P < 0.01), though R0 resection and nodal positivity were similar. In the matched cohort, disease-free survival (17.7 vs. 15.3 months, P = 0.76) and overall survival (27.0 vs. 30.9 months, P = 0.64) did not differ between PT and DT. Multivariable analysis confirmed no association of TL with survival. Among non-diabetic patients, PT was associated with a greater rise in HbA1c at 1 year (0.57 % vs. 0.16 %; P = 0.056), suggesting impaired glycemic control.</div></div><div><h3>Conclusions</h3><div>Transection level does not influence oncologic outcomes in DP for pancreatic tail cancer but may affect postoperative glucose regulation.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111395"},"PeriodicalIF":2.9,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Renal dysfunction is a known surgical risk factor, yet the influence of procedure type on this risk remains unclear. We examined whether the impact of non-dialysis and dialysis-dependent chronic kidney disease (CKD) on outcomes after liver resection for hepatocellular carcinoma (HCC) differs according to resection type.
Materials and methods
We retrospectively reviewed 877 HCC patients who underwent liver resection between 2007 and 2024 and categorized them into three groups: normal renal function, non-dialysis CKD (estimated glomerular filtration rate of <45 mL/min/1.73 m2), and dialysis-dependent CKD. Short- and long-term outcomes were analyzed using multivariable logistic and Cox regression analyses. Propensity score matching and subgroup analyses stratified by procedure type (anatomical vs. non-anatomical) were performed to validate the findings.
Results
Compared with normal renal function, non-dialysis CKD was independently associated with increased postoperative complications (overall: odds ratio [OR] 2.14; 95 % confidence interval [CI], 1.19–3.83; p = 0.011; major: OR, 2.60; 95 % CI, 1.28–5.31; p = 0.008), but not with worse survival. Dialysis-dependent CKD was not significantly linked to complications or prognosis. Propensity score matching confirmed a higher complication rate in the non-dialysis CKD group (27 % vs. 14 %, p = 0.047). In subgroup analyses, non-dialysis CKD increased postoperative complications after non-anatomical resection (OR 2.31; p = 0.022), but not after anatomical resection (OR 1.95; p = 0.233), suggesting a procedure-dependent effect.
Conclusion
Non-dialysis CKD independently increases surgical risk without affecting long-term outcomes, with a procedure-dependent risk pattern. Dialysis is not a contraindication to surgery. Tailored operative strategies are essential for HCC patients with CKD.
肾功能不全是已知的手术危险因素，但手术类型对这种危险的影响尚不清楚。我们研究了非透析和透析依赖性慢性肾脏疾病（CKD）对肝细胞癌（HCC）肝切除术后预后的影响是否因切除术类型而异。材料和方法我们回顾性分析了2007年至2024年间接受肝切除术的877例HCC患者，并将其分为三组：肾功能正常、非透析性CKD（估计肾小球滤过率为45 mL/min/1.73 m2）和透析依赖性CKD。使用多变量逻辑分析和Cox回归分析对短期和长期结果进行分析。进行倾向评分匹配和按手术类型（解剖与非解剖）分层的亚组分析来验证研究结果。结果与正常肾功能相比，非透析性CKD与术后并发症增加独立相关（总体：优势比[OR] 2.14； 95%可信区间[CI] 1.19-3.83; p = 0.011；主要：优势比[OR] 2.60; 95% CI, 1.28-5.31; p = 0.008），但与较差的生存率无关。透析依赖性CKD与并发症或预后无显著相关性。倾向评分匹配证实非透析CKD组的并发症发生率更高（27% vs. 14%, p = 0.047）。在亚组分析中，非透析性CKD增加了非解剖性切除后的术后并发症（OR 2.31; p = 0.022），但在解剖性切除后没有增加（OR 1.95; p = 0.233），提示手术依赖效应。结论非透析CKD独立增加手术风险，不影响长期预后，具有手术依赖的风险模式。透析不是手术的禁忌症。量身定制的手术策略对于HCC合并CKD患者至关重要。
{"title":"Procedure-dependent impact of non-dialysis chronic kidney disease on outcomes after liver resection for hepatocellular carcinoma","authors":"Yukihiro Watanabe, Masayasu Aikawa, Takuya Oba, Yumiko Kageyama, Yoshiki Murase, Kenichiro Takase, Yuichiro Watanabe, Hiroaki Ono, Katsuya Okada, Kojun Okamoto, Isamu Koyama","doi":"10.1016/j.ejso.2026.111387","DOIUrl":"10.1016/j.ejso.2026.111387","url":null,"abstract":"<div><h3>Introduction</h3><div>Renal dysfunction is a known surgical risk factor, yet the influence of procedure type on this risk remains unclear. We examined whether the impact of non-dialysis and dialysis-dependent chronic kidney disease (CKD) on outcomes after liver resection for hepatocellular carcinoma (HCC) differs according to resection type.</div></div><div><h3>Materials and methods</h3><div>We retrospectively reviewed 877 HCC patients who underwent liver resection between 2007 and 2024 and categorized them into three groups: normal renal function, non-dialysis CKD (estimated glomerular filtration rate of <45 mL/min/1.73 m<sup>2</sup>), and dialysis-dependent CKD. Short- and long-term outcomes were analyzed using multivariable logistic and Cox regression analyses. Propensity score matching and subgroup analyses stratified by procedure type (anatomical vs. non-anatomical) were performed to validate the findings.</div></div><div><h3>Results</h3><div>Compared with normal renal function, non-dialysis CKD was independently associated with increased postoperative complications (overall: odds ratio [OR] 2.14; 95 % confidence interval [CI], 1.19–3.83; p = 0.011; major: OR, 2.60; 95 % CI, 1.28–5.31; p = 0.008), but not with worse survival. Dialysis-dependent CKD was not significantly linked to complications or prognosis. Propensity score matching confirmed a higher complication rate in the non-dialysis CKD group (27 % vs. 14 %, p = 0.047). In subgroup analyses, non-dialysis CKD increased postoperative complications after non-anatomical resection (OR 2.31; p = 0.022), but not after anatomical resection (OR 1.95; p = 0.233), suggesting a procedure-dependent effect.</div></div><div><h3>Conclusion</h3><div>Non-dialysis CKD independently increases surgical risk without affecting long-term outcomes, with a procedure-dependent risk pattern. Dialysis is not a contraindication to surgery. Tailored operative strategies are essential for HCC patients with CKD.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111387"},"PeriodicalIF":2.9,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.ejso.2026.111382
Filippo Alberto Ferrari , Gianluca Donatiello , Matteo Pavone , Francesco Bruni , Giorgio Bogani , Marcello Ceccaroni
Minimally invasive surgery (MIS), including laparoscopy and robotic-assisted techniques, has increasingly been explored as an alternative to laparotomy for interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer (EOC). This systematic review evaluates the current evidence on the surgical feasibility, patient selection, perioperative outcomes, and oncological safety of MIS in this setting.
Following PRISMA guidelines, a systematic search of PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov was conducted for studies published between January 2015 and June 2025. Eligible studies included prospective and retrospective cohorts, randomized trials, and meta-analyses reporting outcomes of MIS for IDS in FIGO stage III–IV EOC patients after NACT. Data extraction and risk of bias assessment were independently performed by two reviewers.
Sixteen studies involving 9299 patients were included. MIS demonstrated high rates of complete cytoreduction (R0: 85–100 %) in selected patients, with significantly lower estimated blood loss, shorter hospital stays, fewer major complications, and earlier resumption of chemotherapy compared to open surgery. Operative times were generally longer, and conversion rates varied by tumor burden and selection criteria. Oncologic outcomes, including progression-free and overall survival, were comparable between MIS and laparotomy across multiple studies. Robotic-assisted IDS showed similar feasibility and outcomes, but evidence for this approach was mainly derived from small, retrospective cohorts.
In appropriately selected patients and experienced centers, MIS for IDS appears to be a feasible and oncologically safe alternative to open surgery, offering meaningful perioperative benefits. Further randomized studies are needed to confirm long-term oncological equivalence.
{"title":"Is less already enough? Minimally invasive interval debulking surgery for advanced ovarian cancer","authors":"Filippo Alberto Ferrari , Gianluca Donatiello , Matteo Pavone , Francesco Bruni , Giorgio Bogani , Marcello Ceccaroni","doi":"10.1016/j.ejso.2026.111382","DOIUrl":"10.1016/j.ejso.2026.111382","url":null,"abstract":"<div><div>Minimally invasive surgery (MIS), including laparoscopy and robotic-assisted techniques, has increasingly been explored as an alternative to laparotomy for interval debulking surgery (IDS) following neoadjuvant chemotherapy (NACT) in advanced epithelial ovarian cancer (EOC). This systematic review evaluates the current evidence on the surgical feasibility, patient selection, perioperative outcomes, and oncological safety of MIS in this setting.</div><div>Following PRISMA guidelines, a systematic search of PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov was conducted for studies published between January 2015 and June 2025. Eligible studies included prospective and retrospective cohorts, randomized trials, and meta-analyses reporting outcomes of MIS for IDS in FIGO stage III–IV EOC patients after NACT. Data extraction and risk of bias assessment were independently performed by two reviewers.</div><div>Sixteen studies involving 9299 patients were included. MIS demonstrated high rates of complete cytoreduction (R0: 85–100 %) in selected patients, with significantly lower estimated blood loss, shorter hospital stays, fewer major complications, and earlier resumption of chemotherapy compared to open surgery. Operative times were generally longer, and conversion rates varied by tumor burden and selection criteria. Oncologic outcomes, including progression-free and overall survival, were comparable between MIS and laparotomy across multiple studies. Robotic-assisted IDS showed similar feasibility and outcomes, but evidence for this approach was mainly derived from small, retrospective cohorts.</div><div>In appropriately selected patients and experienced centers, MIS for IDS appears to be a feasible and oncologically safe alternative to open surgery, offering meaningful perioperative benefits. Further randomized studies are needed to confirm long-term oncological equivalence.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111382"},"PeriodicalIF":2.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-06DOI: 10.1016/j.ejso.2026.111392
Woong Ki Park , Namkee Oh , Gyu-Seong Choi , Bogeun Kim , Ki Jo Kim , Hee Jun Choi , Jinsoo Rhu , Jai Min Ryu
Purpose
Robot-assisted nipple-sparing mastectomy (RANSM) has gained acceptance in selected patients; however, identifying the safe dissection plane remains technically challenging due to the absence of tactile feedback. Artificial intelligence (AI)–guided navigation may provide intraoperative assistance, yet no externally validated model has been reported for this procedure.
Materials and methods
This retrospective study developed and validated an AI-guided navigation system to identify the safe dissection plane during RANSM. Surgical video data from 37 procedures performed between January 2021 and December 2024 at two tertiary centers in South Korea were analyzed (internal dataset, n = 29; external dataset, n = 8). The safe dissection plane was annotated as the visual boundary between subcutaneous fat and glandular tissue. An AI segmentation model was trained using 5-fold cross-validation on the internal dataset and tested on the independent external dataset. Model performance was assessed using the Dice Similarity Coefficient (DSC), with intersection over union (IOU), sensitivity, precision, and specificity as secondary metrics.
Results
A total of 1996 internal and 293 external frames were analyzed. The model achieved a mean DSC of 74.0 % (±1.5 %), IOU: 60.0 % (±1.8 %), sensitivity: 79.7 % (±1.9 %), and precision: 71.5 % (±1.6 %) in internal validation. On external validation, the DSC was 70.8 %, IOU: 55.9 %, sensitivity: 73.1 %, precision: 72.2 %, and specificity: 96.8 %.
Conclusion
This study is the first to develop and externally validate an AI-guided navigation system for RANSM. The model demonstrated consistent performance across two institutions, suggesting potential to enhance surgical precision and safety. Larger prospective studies are warranted to confirm clinical utility.
目的：机器人辅助乳头保留乳房切除术（RANSM）在特定患者中得到认可；然而，由于缺乏触觉反馈，确定安全的解剖平面在技术上仍然具有挑战性。人工智能（AI）引导的导航可以提供术中辅助，但没有外部验证的模型用于该手术的报道。材料和方法本回顾性研究开发并验证了人工智能引导的导航系统，以确定RANSM期间的安全解剖平面。分析了2021年1月至2024年12月在韩国两家三级中心进行的37次手术的手术视频数据（内部数据集，n = 29；外部数据集，n = 8）。安全剥离平面被标注为皮下脂肪和腺组织的视觉边界。在内部数据集上使用5倍交叉验证训练AI分割模型，并在独立的外部数据集上进行测试。使用Dice Similarity Coefficient （DSC）评估模型性能，并以intersection over union （IOU）、灵敏度、精度和特异性作为次要指标。结果共分析了96例内框和293例外框。模型内部验证的平均DSC为74.0%（±1.5%），IOU为60.0%（±1.8%），灵敏度为79.7%（±1.9%），精密度为71.5%（±1.6%）。经外部验证，DSC为70.8%，IOU为55.9%，灵敏度为73.1%，精密度为72.2%，特异性为96.8%。本研究是第一个开发和外部验证人工智能导航系统的RANSM。该模型在两家机构中表现出一致的性能，表明有可能提高手术精度和安全性。有必要进行更大规模的前瞻性研究以确认临床应用。
{"title":"Development and external validation of an AI-guided navigation system for the safe dissection plane in robot-assisted nipple sparing mastectomy","authors":"Woong Ki Park , Namkee Oh , Gyu-Seong Choi , Bogeun Kim , Ki Jo Kim , Hee Jun Choi , Jinsoo Rhu , Jai Min Ryu","doi":"10.1016/j.ejso.2026.111392","DOIUrl":"10.1016/j.ejso.2026.111392","url":null,"abstract":"<div><h3>Purpose</h3><div>Robot-assisted nipple-sparing mastectomy (RANSM) has gained acceptance in selected patients; however, identifying the safe dissection plane remains technically challenging due to the absence of tactile feedback. Artificial intelligence (AI)–guided navigation may provide intraoperative assistance, yet no externally validated model has been reported for this procedure.</div></div><div><h3>Materials and methods</h3><div>This retrospective study developed and validated an AI-guided navigation system to identify the safe dissection plane during RANSM. Surgical video data from 37 procedures performed between January 2021 and December 2024 at two tertiary centers in South Korea were analyzed (internal dataset, n = 29; external dataset, n = 8). The safe dissection plane was annotated as the visual boundary between subcutaneous fat and glandular tissue. An AI segmentation model was trained using 5-fold cross-validation on the internal dataset and tested on the independent external dataset. Model performance was assessed using the Dice Similarity Coefficient (DSC), with intersection over union (IOU), sensitivity, precision, and specificity as secondary metrics.</div></div><div><h3>Results</h3><div>A total of 1996 internal and 293 external frames were analyzed. The model achieved a mean DSC of 74.0 % (±1.5 %), IOU: 60.0 % (±1.8 %), sensitivity: 79.7 % (±1.9 %), and precision: 71.5 % (±1.6 %) in internal validation. On external validation, the DSC was 70.8 %, IOU: 55.9 %, sensitivity: 73.1 %, precision: 72.2 %, and specificity: 96.8 %.</div></div><div><h3>Conclusion</h3><div>This study is the first to develop and externally validate an AI-guided navigation system for RANSM. The model demonstrated consistent performance across two institutions, suggesting potential to enhance surgical precision and safety. Larger prospective studies are warranted to confirm clinical utility.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111392"},"PeriodicalIF":2.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145975080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.ejso.2026.111388
Luigi A. De Vitis , Faye R. Harris , Leah Grcevich , Ilaria Capasso , Stephen J. Murphy , James B. Smadbeck , Alexa F. McCune , Mohamed F. Ali , Giannoula Karagouga , Sarah H. Johnson , Dorsay Sadeghian , Gabriella Schivardi , Giuseppe Cucinella , Evelyn A. Reynolds , Grace M. Choong , Lin Yang , Alyssa M. Larish , Michael T. Barrett , Angela R. Emanuel , Janet L. Schaefer-Klein , Andrea Mariani
Introduction
Although circulating tumor DNA (ctDNA) has emerged as a promising prognostic tool in various malignancies, evidence in endometrial cancer at high risk of recurrence is limited. This study evaluated the association of pre- and post-surgical ctDNA with advanced-stage disease, disease-free and overall survival in endometrial cancer with high-risk features.
Material and methods
This prospective observational study was conducted at Mayo Clinic (7/2016-6/2021). Patients with endometrial cancer at preoperative biopsy, confirmed by final pathology, were included. Blood samples were collected before and 10 weeks after surgery. Tumor-specific junctions identified in pathology specimens and blood samples were used to detect ctDNA. Associations between pre- and post-surgical ctDNA and advanced-stage disease, recurrence, and death were evaluated using logistic regression [odds ratio (OR) and 95 % confidence interval] and Cox proportional hazards [hazard ratio (HR) and 95 % confidence interval].
Results
Thirty-six patients were included: 6 (16.7 %) intermediate risk, 1 (2.8 %) high-intermediate risk, 28 (77.8 %) high risk, and 1 (2.8 %) advanced metastatic. Detection of pre- or post-surgical ctDNA was not significantly associated with advanced disease (pre-surgical OR 5.69 [0.88–66.02]; post-surgical OR 5.86 [0.83–72.68]). Pre-surgical ctDNA did not significantly predict recurrence (HR 0.99 [0.30–3.23]) or death (HR 3.23 [0.40–25.91]). In contrast, post-surgical ctDNA was associated with increased risk of recurrence (HR 3.32 [1.05–10.51]) and death (HR 5.97 [1.11–36.08]).
Conclusion
Post-surgical ctDNA detection was associated with poor outcomes in patients with endometrial cancer. These findings support the potential of ctDNA as a biomarker to personalize surveillance and guide post-surgical treatment strategies.
{"title":"Prognostic value of perioperative circulating tumor DNA (ctDNA) in endometrial cancer with high-risk features: a prospective observational study","authors":"Luigi A. De Vitis , Faye R. Harris , Leah Grcevich , Ilaria Capasso , Stephen J. Murphy , James B. Smadbeck , Alexa F. McCune , Mohamed F. Ali , Giannoula Karagouga , Sarah H. Johnson , Dorsay Sadeghian , Gabriella Schivardi , Giuseppe Cucinella , Evelyn A. Reynolds , Grace M. Choong , Lin Yang , Alyssa M. Larish , Michael T. Barrett , Angela R. Emanuel , Janet L. Schaefer-Klein , Andrea Mariani","doi":"10.1016/j.ejso.2026.111388","DOIUrl":"10.1016/j.ejso.2026.111388","url":null,"abstract":"<div><h3>Introduction</h3><div>Although circulating tumor DNA (ctDNA) has emerged as a promising prognostic tool in various malignancies, evidence in endometrial cancer at high risk of recurrence is limited. This study evaluated the association of pre- and post-surgical ctDNA with advanced-stage disease, disease-free and overall survival in endometrial cancer with high-risk features.</div></div><div><h3>Material and methods</h3><div>This prospective observational study was conducted at Mayo Clinic (7/2016-6/2021). Patients with endometrial cancer at preoperative biopsy, confirmed by final pathology, were included. Blood samples were collected before and 10 weeks after surgery. Tumor-specific junctions identified in pathology specimens and blood samples were used to detect ctDNA. Associations between pre- and post-surgical ctDNA and advanced-stage disease, recurrence, and death were evaluated using logistic regression [odds ratio (OR) and 95 % confidence interval] and Cox proportional hazards [hazard ratio (HR) and 95 % confidence interval].</div></div><div><h3>Results</h3><div>Thirty-six patients were included: 6 (16.7 %) intermediate risk, 1 (2.8 %) high-intermediate risk, 28 (77.8 %) high risk, and 1 (2.8 %) advanced metastatic. Detection of pre- or post-surgical ctDNA was not significantly associated with advanced disease (pre-surgical OR 5.69 [0.88–66.02]; post-surgical OR 5.86 [0.83–72.68]). Pre-surgical ctDNA did not significantly predict recurrence (HR 0.99 [0.30–3.23]) or death (HR 3.23 [0.40–25.91]). In contrast, post-surgical ctDNA was associated with increased risk of recurrence (HR 3.32 [1.05–10.51]) and death (HR 5.97 [1.11–36.08]).</div></div><div><h3>Conclusion</h3><div>Post-surgical ctDNA detection was associated with poor outcomes in patients with endometrial cancer. These findings support the potential of ctDNA as a biomarker to personalize surveillance and guide post-surgical treatment strategies.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111388"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145924282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.ejso.2026.111389
Ferdinando Carlo Maria Cananzi , Mattia Di Benedetto , Vittoria D'Amato , Laura Ruspi , Federico Sicoli , Salvatore Lorenzo Renne , Vittorio Lorenzo Quagliuolo , Laura Samà
{"title":"Inguinal “neoligament” reconstruction after groin soft tissue sarcoma resection: A novel surgical technique","authors":"Ferdinando Carlo Maria Cananzi , Mattia Di Benedetto , Vittoria D'Amato , Laura Ruspi , Federico Sicoli , Salvatore Lorenzo Renne , Vittorio Lorenzo Quagliuolo , Laura Samà","doi":"10.1016/j.ejso.2026.111389","DOIUrl":"10.1016/j.ejso.2026.111389","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111389"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145914927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-05DOI: 10.1016/j.ejso.2026.111390
Anna Norbeck , Mihaela Asp , Susanne Malander , Päivi Kannisto
Background
Patients with advanced ovarian cancer (AOC) who undergo primary and interval debulking surgery are often anemic at diagnosis, with iron deficiency being the most common cause. The aim was to investigate whether preoperative anemia and iron deficiency impact short-term recovery.
Methods
This retrospective cohort study included 262 patients with AOC who underwent surgery at Skane University Hospital Lund, Sweden, between January 2020 and December 2023. Patients were divided into four groups, according to preoperative anemia and iron deficiency. Iron deficiency was defined as transferrin saturation (TSAT) < 0.20. Severe complications were defined as Clavien–Dindo (CD) grade ≥3. Logistic regression analyses were used to investigate the difference between patients with and without iron deficiency.
Results
Among patients with iron deficiency anemia, 24 % of patients had more than 1 cm of residual tumor at the end of surgery, compared to 6–8 % of patients with no anemia and/or no iron deficiency, (p 0.005). The rate of severe complications (CD ≥ 3) was higher for patients with iron deficiency, odds ratio 2.47 (95 % CI 1.11–5.50), than for patients with no iron deficiency, adjusted for the Aletti score, operating time and hemoglobin (Hb) level. There was no difference between groups regarding length of hospital stay.
Conclusion
Patients with iron deficiency anemia, were less likely to undergo radical or optimal surgery. Severe postoperative complications were more common in patients with iron deficiency, with or without anemia. These analyses indicate that iron deficiency is associated with more advanced disease and complex surgical procedures.
背景：晚期卵巢癌（AOC）患者在接受原发性和间断性减癌手术时，通常在诊断时贫血，缺铁是最常见的原因。目的是研究术前贫血和缺铁是否影响短期恢复。方法本回顾性队列研究纳入了2020年1月至2023年12月在瑞典隆德斯科纳大学医院接受手术的262例AOC患者。根据术前贫血和缺铁情况将患者分为四组。缺铁定义为转铁蛋白饱和（TSAT） & 0.20。严重并发症定义为Clavien-Dindo （CD）分级≥3级。采用Logistic回归分析探讨缺铁患者与非缺铁患者之间的差异。结果在缺铁性贫血患者中，24%的患者手术结束时肿瘤残留大于1cm，而无贫血和/或无缺铁患者的这一比例为6 - 8%，（p 0.005）。经Aletti评分、手术时间和血红蛋白（Hb）水平调整后，缺铁患者的严重并发症（CD≥3）发生率高于无缺铁患者，优势比为2.47 （95% CI 1.11-5.50）。在住院时间方面，两组之间没有差异。结论缺铁性贫血患者接受根治性或最佳手术治疗的可能性较小。严重的术后并发症在缺铁、伴或不伴贫血的患者中更为常见。这些分析表明，铁缺乏与更严重的疾病和复杂的外科手术有关。
{"title":"Iron deficiency restrains short-term recovery in patients undergoing surgery for advanced ovarian cancer","authors":"Anna Norbeck , Mihaela Asp , Susanne Malander , Päivi Kannisto","doi":"10.1016/j.ejso.2026.111390","DOIUrl":"10.1016/j.ejso.2026.111390","url":null,"abstract":"<div><h3>Background</h3><div>Patients with advanced ovarian cancer (AOC) who undergo primary and interval debulking surgery are often anemic at diagnosis, with iron deficiency being the most common cause. The aim was to investigate whether preoperative anemia and iron deficiency impact short-term recovery.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included 262 patients with AOC who underwent surgery at Skane University Hospital Lund, Sweden, between January 2020 and December 2023. Patients were divided into four groups, according to preoperative anemia and iron deficiency. Iron deficiency was defined as transferrin saturation (TSAT) < 0.20. Severe complications were defined as Clavien–Dindo (CD) grade ≥3. Logistic regression analyses were used to investigate the difference between patients with and without iron deficiency.</div></div><div><h3>Results</h3><div>Among patients with iron deficiency anemia, 24 % of patients had more than 1 cm of residual tumor at the end of surgery, compared to 6–8 % of patients with no anemia and/or no iron deficiency, (<em>p 0.005</em>). The rate of severe complications (CD ≥ 3) was higher for patients with iron deficiency, odds ratio 2.47 (95 % CI 1.11–5.50), than for patients with no iron deficiency, adjusted for the Aletti score, operating time and hemoglobin (Hb) level. There was no difference between groups regarding length of hospital stay.</div></div><div><h3>Conclusion</h3><div>Patients with iron deficiency anemia, were less likely to undergo radical or optimal surgery. Severe postoperative complications were more common in patients with iron deficiency, with or without anemia. These analyses indicate that iron deficiency is associated with more advanced disease and complex surgical procedures.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111390"},"PeriodicalIF":2.9,"publicationDate":"2026-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145915100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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