Ejso最新文献

{"title":"Immunological phenotype as a predictor for response after isolated limb perfusion for patients with melanoma in-transit metastasis","authors":"Anna Constantinescu ,&nbsp;Roger Olofsson Bagge ,&nbsp;Anne Huibers","doi":"10.1016/j.ejso.2026.111424","DOIUrl":"10.1016/j.ejso.2026.111424","url":null,"abstract":"<div><h3>Background</h3><div>Isolated limb perfusion (ILP) is a regional treatment for patients with melanoma in-transit metastases (ITM) confined to extremities. Reported complete response (CR) rates for ILP varies but is approximately 50–70 %. This study aims to analyze if specific immunological phenotypes could predict CR after ILP.</div></div><div><h3>Methods</h3><div>132 patients undergoing ILP as a first treatment for melanoma ITM between January 2012 and March 2023 were included. The number and percentage of naïve and memory T and B cell subtypes, and natural killer (NK) cells, were characterized by analyzing pre-operative blood sample using fluorescence activated cell sorting (FACS). Predictive clinical and immunological factors for CR after ILP were analysed using univariable and multivariable analysis.</div></div><div><h3>Results</h3><div>Response was evaluable in 119 patients (90 %), of which 53 % achieved a CR. After adjusting for age, sex, number of metastases and size of the largest metastasis, immunological factors independently associated with a CR, were percentage of cytotoxic T cells (CD3⁺8⁺) (OR 1.07, 95 % CI 1.02–1.13, p = 0.012) and percentage of naive cytotoxic T cells (CD3⁺8⁺45RA⁺) (OR 1.11 95 % CI 1.01–1.22, p = 0.029).</div></div><div><h3>Conclusion</h3><div>Immunological phenotype described as percentage of cytotoxic T cells and naïve cytotoxic T cells are together with tumor burden important predictive factors for response after ILP for patients with melanoma ITM. This could contribute to better patient selection, individualized treatment algorithms and be a foundation for further research into systemic immunological effects of regional cancer therapies. This includes novel treatment combinations, where an ongoing trial is currently combining ILP with a PD-1 inhibitor (<span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT03685890).</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111424"},"PeriodicalIF":2.9,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074765","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}

{"title":"The clinical benefit of a near complete cytoreduction in patients with colorectal peritoneal metastases: a propensity score matched study","authors":"Peter H. Cashin ,&nbsp;David Morris ,&nbsp;Jesus Esquivel ,&nbsp;Stein Gunnar Larsen ,&nbsp;Heikki Takala ,&nbsp;Frédéric Dumont ,&nbsp;Isabelle Sourrouille ,&nbsp;Vahan Kepenekian ,&nbsp;Jean-Jacques Tuech ,&nbsp;Jean-Marc Bereder ,&nbsp;Pablo Ortega-Deballon ,&nbsp;Karine Abboud ,&nbsp;Jean-Marc Regimbeau ,&nbsp;Olivia Sgarbura ,&nbsp;Olivier Glehen","doi":"10.1016/j.ejso.2026.111437","DOIUrl":"10.1016/j.ejso.2026.111437","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer with peritoneal metastases (PM) presents a significant therapeutic challenge. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is one option to prolong survival. While completeness of cytoreduction (CC) score 0 is associated with improved outcomes, the clinical value of near-complete CC-score 1 versus open-close laparotomy (CC-3) remains unclear.</div></div><div><h3>Methods</h3><div>This retrospective study evaluates overall survival (OS) in patients with colorectal cancer PM scheduled for CRS and HIPEC from 23 global peritoneal-surface oncology centers from 2006 to 2023. A propensity score matching was performed using tumor location (colon/rectum), lymph node status, liver metastases, signet-ring histology, preoperative chemotherapy, peritoneal cancer index, and treatment year. Matching was performed using the nearest neighbor method with a caliper of 0.1, chosen after several iterations to optimize intergroup balance. Balance was assessed using standardized mean differences. Sensitivity analyses with alternative calipers and multivariable Cox regression in the unmatched cohort were considered to test the robustness of the findings. The study time-period was divided into 4 equal quartiles for analysis.</div></div><div><h3>Results</h3><div>In the unmatched cohort (n = 284), patients with CC-1 had significantly longer median OS compared to those with CC-3 (22.2 vs. 9.4 months, p &lt; 0.001). After 1:1 matching (n = 172), the OS advantage of CC-1 persisted, with a median OS of 18.9 months (95 % CI: 14.2–24.7) versus 10.5 months (95 % CI: 9.4–12.3) for CC-3, p &lt; 0.0001, HR 0.4 (95 % CI:0.27–0.56). Multivariable Cox regression confirmed CC-1 as a significant predictor of survival (HR: 0.15, 95 % CI: 0.08–0.26). The CC-1 proportion went from 55 to 65 % in time-periods 1 &amp; 2–39 % in period 3, to 11 % in period 4; leading to significantly reduced survival rates in the latter time-periods 3 &amp; 4.</div></div><div><h3>Discussion</h3><div>Near complete cytoreduction is associated with improved overall survival compared to open-close laparotomy. Prospective or standardized multicenter analyses will be required to confirm the clinical value of a near complete cytoreduction.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111437"},"PeriodicalIF":2.9,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024207","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}

{"title":"Surgery for Colorectal Peritoneal Metastases in non-expert centers is strongly associated with tumor persistence or early recurrence: a bicentric study of 106 patients","authors":"Barbara Noiret ,&nbsp;Vahan Kepenekian ,&nbsp;Maxime Leroy ,&nbsp;Marie Provost ,&nbsp;Pascal Rousset ,&nbsp;Guillaume Piessen ,&nbsp;Olivier Glehen ,&nbsp;Clarisse Eveno","doi":"10.1016/j.ejso.2026.111397","DOIUrl":"10.1016/j.ejso.2026.111397","url":null,"abstract":"<div><h3>Background</h3><div>Complete cytoreductive surgery (CRS) performed in expert centers is a key determinant of outcome in patients with colorectal peritoneal metastases (CRPM). In the contemporary context of ongoing debate regarding the role of HIPEC following the PRODIGE 7 trial, the impact of initial management outside expert centers on outcomes remains insufficiently characterized. This study evaluates the value of systematic second-look surgeries in expert centers after CRS in non-expert centers.</div></div><div><h3>Methods</h3><div>Patients with histologically confirmed CRPM who initially underwent surgery in non-expert centers followed by systematic second-look surgery in two expert centers were included between 2010 and 2022.</div></div><div><h3>Statistical analysis</h3><div>Perioperative outcomes were evaluated in both surgeries. Preoperative imaging (CT-scan/MRI) were conducted before second-look surgeries and reviewed by expert radiologists. Survival outcomes were performed by Kaplan-Meier method.</div></div><div><h3>Results</h3><div>Among 106 patients (50.9 % male, mean age 58.9 ± 10.8 years), all tumors were classified as pT3-4, with 87 % having synchronous CRPM. Initial CRS in non-expert centers was performed urgently in 35 % of cases, primarily due to occlusion or perforation (62.1 %). Complete cytoreduction (CC0) was declared in 63 % of initial CRS. Reassessment (CT/MRI) before second-look was highly predictive of intraoperative and histological presence of CRPM, but intraoperative CRPM detection occurred in 61 % (CT-negative) and 81 % (MRI-negative) with histological confirmation in 53 % and 42 %. During second-look surgery, CRPM was observed in 88 % of cases (median PCI score:6) and 11.3 % were unresectable. Median overall survival (OS) was 43 months with 1- and 5-year OS of 95 % and 34.3 %, respectively. Prognostic factors of lower OS included poorly cohesive histology, emergency surgery and incomplete cytoreduction during first surgery in non-expert centers.</div></div><div><h3>Conclusions</h3><div>In patients with CRPM initially managed in non-expert centers, expert-center reassessment, including consideration of second-look surgery, identifies persistent or recurrent peritoneal disease in a substantial proportion of patients, even in the absence of radiological evidence. These findings support the importance of early referral to expert centers for comprehensive evaluation and multidisciplinary decision-making. The impact of second-look strategies on survival outcomes warrants further prospective investigation.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111397"},"PeriodicalIF":2.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074764","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}

{"title":"Enhanced Recovery After Surgery linked to lower CRS-HIPEC costs: micro-costing analysis in a European public hospital","authors":"Carlos González de Pedro,&nbsp;Daniel Aparicio Sánchez,&nbsp;Miriam Álvarez Aguilera,&nbsp;Jaime Alonso Gómez,&nbsp;Jose Tinoco González,&nbsp;Fco Javier Padillo Ruiz,&nbsp;Daniel Díaz Gómez","doi":"10.1016/j.ejso.2026.111409","DOIUrl":"10.1016/j.ejso.2026.111409","url":null,"abstract":"<div><h3>Background</h3><div>Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS–HIPEC) is technically complex and resource-intensive. The primary objective of this study was to perform a detailed micro-costing analysis of CRS–HIPEC. As a secondary, exploratory objective, we evaluated whether adherence to an Enhanced Recovery After Surgery (ERAS) pathway was associated with differences in postoperative resource utilisation and direct hospital costs.</div></div><div><h3>Materials and methods</h3><div>A retrospective observational analysis was conducted on all consecutive CRS–HIPEC procedures performed from 2021 to 2023 in a Spanish tertiary public centre. Resource use and cost determinants were assessed using micro-costing methods. An exploratory comparison between ERAS and non-ERAS management periods was performed.</div></div><div><h3>Results</h3><div>The median cost of CRS–HIPEC was €26,386. Higher expenditure was associated with longer hospital stays, higher PCI scores, need for anastomosis and infectious complications. ERAS and non-ERAS cohorts showed similar case complexity. Despite partial implementation, ERAS adherence was associated with shorter median hospital stay (8 vs 13 days, p &lt; 0.001) and lower total median costs (€20,452.5 vs €27,346.7, p = 0.02), without an increase in severe postoperative complications (Clavien–Dindo ≥ III: 17.2 % vs 25.0 %, p = 0.454). The multivariable model (including PCI, anastomosis and severe complications) showed good discriminative performance for identifying high-cost cases (AUC = 0.923; 95 % CI 0.851–0.976).</div></div><div><h3>Conclusions</h3><div>CRS–HIPEC costs are predominantly driven by hospital stay and complication-related resource utilisation. The exploratory ERAS analysis suggests that even partial adherence may reduce postoperative stay and costs without increasing morbidity. These findings highlight the importance of perioperative optimisation to improve the clinical and economic efficiency of CRS–HIPEC programmes.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111409"},"PeriodicalIF":2.9,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024206","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}

{"title":"Evidence-based quality indicators of soft tissue sarcomas in Germany 2015–2021: An analysis of the German Cancer Registry Group","authors":"Frank Goßmann ,&nbsp;Nikola Beck ,&nbsp;Jens Jakob ,&nbsp;Bernd Kasper ,&nbsp;Franka Menge ,&nbsp;Christoph K.W. Deinzer ,&nbsp;Bianca Franke ,&nbsp;Anne Hendricks ,&nbsp;Monika Klinkhammer-Schalke ,&nbsp;Katharina Rausch ,&nbsp;Fabian Reinwald ,&nbsp;Gabriele Robers ,&nbsp;Andrea Sackmann ,&nbsp;Constanze Schneider ,&nbsp;Armin Wiegering ,&nbsp;Manije Sabet-Rashedi ,&nbsp;Peter Hohenberger ,&nbsp;Sylke Ruth Zeissig","doi":"10.1016/j.ejso.2026.111422","DOIUrl":"10.1016/j.ejso.2026.111422","url":null,"abstract":"<div><div>Empirical evidence shows that treatment of adult soft tissue sarcoma (STS) according to clinical guidelines has a survival benefit for patients. In 2021, the first evidence-based guidelines for STS were published in Germany including 14 measurable quality indicators (QIs). This paper examines the quality of care of STS in Germany across all treatment institutions prior to the publication of the clinical guideline using the QIs.</div><div>A comprehensive population-based cohort of 20,922 sarcoma patients from 11 of 16 federal states, diagnosed between 2015 and 2021 was extracted from the cancer registry data using the ICD-O-3-codes for topography and histological subtype. The QI measurements are based on the calculation rules of a group of experts. Annual percentage changes (APCs) were calculated to identify trends over time.</div><div>QI 1 (Pre-therapeutic presentation in the tumor board (initial diagnosis of STS)) increased from 9 % to 24 %. QI 7 (R0 resection for STS) showed a stable rate of over 80 %. For QI 8 (hysterectomy without morcellation for sarcoma confined to the uterus), the rate was 82 % in 2015 and rose significantly until 2017 to 94 %. QI 12 (First-line chemotherapy for STS without GIST) remained at the same level as the overall value of 79 %. For QI 14 (Postoperative mortality in retroperitoneal sarcoma), the value for the entire period was 1.4 %.</div><div>The extensive database enables QI analysis for sarcoma care. Improvements in defined QIs confirm progress, while unmet targets are identifiable. Using cancer-registry data ensures comprehensive coverage of all institutions treating sarcoma patients, extending beyond accredited sarcoma centers. Results may serve as baseline values for future evaluations of improvements in patient care following implementation of the S3 guideline.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111422"},"PeriodicalIF":2.9,"publicationDate":"2026-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024199","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}

{"title":"Factors determining the feasibility of segmentectomy for central non-small cell lung cancer and construction of a predictive model","authors":"Shusheng Zhu ,&nbsp;Zhihua Li ,&nbsp;Wenzheng Xu ,&nbsp;Weibing Wu ,&nbsp;Liang Chen","doi":"10.1016/j.ejso.2026.111418","DOIUrl":"10.1016/j.ejso.2026.111418","url":null,"abstract":"<div><h3>Objectives</h3><div>Multiple studies have demonstrated that segmentectomy is feasible and can yield long-term outcomes comparable to lobectomy for selected central non-small cell lung cancer (NSCLC). This study aimed to identify factors influencing the feasibility of segmentectomy for central NSCLC, and to develop a predictive nomogram.</div></div><div><h3>Methods</h3><div>Patients with central NSCLC ≤2 cm who underwent segmentectomy or lobectomy between 2020 and 2024 were screened. Patients were split into two groups based on their surgical date (Training set: 2020–2023 and Validation set: 2024). The least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analyses were performed to identify potential predictors. Qualified segmentectomy (surgical margin ≥ maximum tumor diameter) was classified as 0, while lobectomy or unqualified segmentectomy was classified as 1. A nomogram was developed based on these identified predictors.</div></div><div><h3>Results</h3><div>There were 303 and 105 patients in the training set and validation set, respectively. The probability of achieving sufficient margins during segmentectomy was 83.9 % in the training set and 81.3 % in the validation set. After LASSO and multivariable logistic regression analyses, four variables were retained: tumor size (OR = 3.81, <em>P</em> = 0.006), radiological type (solid vs. subsolid, OR = 5.39, <em>P</em> = 0.009), tumor-to-segmental bronchus distance (OR = 0.64, <em>P</em> = 0.036), and number of tumor-involved subsegments (OR = 1.54, <em>P</em> &lt; 0.001). The nomogram developed from these predictors exhibited good predictive ability, with an area under the curve of 0.793 in the training set and 0.777 in the validation set.</div></div><div><h3>Conclusions</h3><div>Tumor size, radiological type, tumor-to-segmental bronchus distance, and number of tumor-involved subsegments influenced the feasibility of segmentectomy for central NSCLC.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111418"},"PeriodicalIF":2.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024198","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}

{"title":"Differential prognostic impact of clinicopathologic factors for late recurrence in ER-positive breast cancer according to menopausal status","authors":"Eun-Shin Lee ,&nbsp;Mary Rose Calindas-Mendoza ,&nbsp;Seung Pil Jung ,&nbsp;Hyeong-Gon Moon ,&nbsp;Wonshik Han","doi":"10.1016/j.ejso.2026.111419","DOIUrl":"10.1016/j.ejso.2026.111419","url":null,"abstract":"<div><h3>Purpose</h3><div>Identifying high-risk patients for late recurrence is crucial for optimizing extended endocrine therapy (EET). This study investigated how clinicopathologic predictors of late recurrence diverge according to menopausal status in estrogen receptor (ER)-positive breast cancer patients who completed 5-year endocrine therapy.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 1549 patients with stage I–III ER-positive breast cancer who completed 5 years of endocrine therapy and remained recurrence-free during that period. Median follow-up was 14.7 years. Outcomes included distant metastasis-free survival (DMFS) and overall survival (OS). Analyses were stratified by menopausal status to identify status-specific risk factors.</div></div><div><h3>Results</h3><div>During the follow-up period, 208 patients (13.4 %) experienced late recurrence, with distant metastasis (6.3 %) being the most frequent event. Kaplan–Meier analyses demonstrated that tumor size &gt;2 cm and higher nodal stage were significantly associated with inferior DMFS and OS in both subgroups (all <em>P</em> &lt; .05). However, multivariable analysis revealed distinct prognostic patterns according to menopausal status. In premenopausal women, nodal involvement was the most potent driver of late recurrence; N1 stage significantly increased the risk of poor DMFS (HR 3.14, 95 % CI 1.54–6.40; <em>P</em> = .002) and OS (HR 3.39, 95 % CI 1.45–7.93; <em>P</em> = .005). Furthermore, age at diagnosis showed a significant inverse association with distant metastasis risk, with each one-year decrease in age increasing the risk by 6 % (HR 0.94; <em>P</em> = .019). In contrast, for postmenopausal patients, tumor size (&gt;2 cm) emerged as the predominant predictor for both DMFS (HR 2.70; <em>P</em> = .006) and OS (HR 2.26; <em>P</em> = .039), whereas the prognostic impact of nodal stage was notably diminished (N1: <em>P</em> = .374 for DMFS; <em>P</em> = .999 for OS). In this group, older age was independently associated with worse OS (HR 1.13; <em>P</em> &lt; .001) but did not significantly impact DMFS.</div></div><div><h3>Conclusion</h3><div>Predictors for late recurrence are different depending on menopausal status: nodal burden and young age dominate in premenopausal patients, whereas tumor size is more critical in postmenopausal patients. These findings suggest that menopausal status must be a primary consideration in risk-stratification models for EET and long-term surveillance.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111419"},"PeriodicalIF":2.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024289","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}

{"title":"Meeting expectations and its impact on the quality of life following surgery in breast cancer patients","authors":"Luis Adrian Alvarez-Lozada ,&nbsp;Ana María Salinas-Martínez ,&nbsp;Magaly Denise Peña-Arriaga ,&nbsp;Daniel Valencia-Mercado ,&nbsp;Hid Felizardo Cordero-Franco ,&nbsp;Alejandro Quiroga-Garza","doi":"10.1016/j.ejso.2026.111421","DOIUrl":"10.1016/j.ejso.2026.111421","url":null,"abstract":"<div><h3>Introduction</h3><div>Patients' and physicians' expectations may not always align, which can potentially impact postoperative quality of life. We evaluated the extent to which expectations of well-being and treatment-related information were fulfilled. We also examined its impact on the immediate and short-term quality of life following surgery in breast cancer patients<strong>.</strong></div></div><div><h3>Methods</h3><div>We prospectively followed a cohort of non-pregnant breast cancer patients who underwent surgery and had no history of breast reconstruction, prophylactic, palliative, or intensive care admission (n = 100). Expectations and the initial quality-of-life assessment were collected during the first follow-up visit, with a second measurement conducted by phone one month later. Ordinal multiple logistic regression was used, and Odds Ratios (ORs) and 95 % Confidence Intervals (CIs) were estimated.</div></div><div><h3>Results</h3><div>Physical, treatment-response, and emotional well-being expectations were largely unformed, while social well-being expectations were mostly underestimated or fulfilled as high as expected. Underestimation reduced the odds of good immediate physical well-being (OR 0.12, 95 % CI 0.02, 0.54). Also, underestimation reduced the odds of good immediate and short-term emotional well-being (OR 0.03, 95 % CI 0.01, 0.14 and OR 0.03, 95 % CI 0.01, 0.17, respectively). Meeting expectations as high as anticipated or receiving more social support than expected increased the odds of immediate and short-term social well-being.</div></div><div><h3>Conclusions</h3><div>Unformed expectations were prevalent, except in social well-being. Not meeting expectations harmed physical and emotional well-being, while meeting them benefited social well-being. Providing information about surgical treatment is crucial for setting clear and realistic expectations.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111421"},"PeriodicalIF":2.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146024205","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}

{"title":"Detailed analysis of postoperative complications and oncological outcomes in pelvic exenteration: A propensity score weighted analysis based on Japanese multicenter cohort study","authors":"Kentaro Ishida ,&nbsp;Yoshihide Inayama ,&nbsp;Koji Yamanoi ,&nbsp;Yusuke Yatabe ,&nbsp;Taito Miyamoto ,&nbsp;Rin Mizuno ,&nbsp;Masumi Sunada ,&nbsp;Mana Taki ,&nbsp;Ryusuke Murakami ,&nbsp;Kimihiko Masui ,&nbsp;Koji Kawakami ,&nbsp;Masaki Mandai ,&nbsp;Yusuke Kinugasa","doi":"10.1016/j.ejso.2026.111415","DOIUrl":"10.1016/j.ejso.2026.111415","url":null,"abstract":"<div><h3>Background</h3><div>Pelvic exenteration (PE) is a highly invasive but potentially curative surgery for advanced or recurrent pelvic malignancies. Although postoperative complications are a concern due to their invasiveness, their influence on oncological outcomes remains unclear.</div></div><div><h3>Methods</h3><div>We conducted a multi-institutional retrospective cohort study involving 261 patients who underwent PE with curative intent between 2012 and 2022. Patients were classified into exposure (Clavien-Dindo grade ≥3 complications within 30 days postoperatively) and control groups. The primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively. Propensity score weighting (standardized mortality ratio weights) was employed to adjust for 20 baseline covariates across patient, tumor, and surgical characteristics.</div></div><div><h3>Results</h3><div>After adjustment, no statistically significant difference was observed in RFS between patients with and without Clavien-Dindo grade ≥3 complications (adjusted hazard ratio [HR]: 1.34; 95 % confidence interval [CI]: 0.78–2.29; P = 0.29). Similarly, no significant association was found for OS (adjusted HR, 1.32; 95 % CI: 0.69–2.55; P = 0.29). Subgroup analyses by PE type (total PE vs. anterior PE/posterior PE) and sensitivity analyses for surgical site infections and Clavien-Dindo grade ≥2 complications showed consistent results.</div></div><div><h3>Conclusions</h3><div>In this large PE cohort with detailed clinical data and advanced statistical adjustments, major postoperative complications were not significantly associated with poor long-term oncological outcomes. Although a modest effect cannot be ruled out, and efforts must be made to avoid complications, PE remains a viable treatment option despite being highly invasive.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111415"},"PeriodicalIF":2.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017111","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}

{"title":"Colorectal cancer surgery in elderly and frail patients: Should we leave someone behind?","authors":"Ana Granados-Maturano ,&nbsp;Albert Garcia-Nalda ,&nbsp;Anna Pallisera-Lloveras ,&nbsp;Gemma Pujol-Caballe ,&nbsp;Ricard Comet-Monte ,&nbsp;Xavier Serra-Aracil","doi":"10.1016/j.ejso.2026.111406","DOIUrl":"10.1016/j.ejso.2026.111406","url":null,"abstract":"<div><h3>Background</h3><div>Frailty is a stronger determinant of surgical outcomes in colorectal cancer (CRC) than chronological age. Yet frail patients are often excluded from studies, and their long-term outcomes remain poorly defined. Most research dichotomizes patients as frail or non-frail, leaving the gradation of frailty (mild, moderate, severe) underexplored.</div></div><div><h3>Methods</h3><div>Prospective, single-center study (2017–2023) including 1028 consecutive CRC patients evaluated for curative treatment. Frailty was screened with PRISMA-7 and stratified using the IF-VIG index. Allocation to surgery or non-operative care followed multidisciplinary assessment. Primary outcomes were 30-day morbidity and mortality; secondary outcomes included length of stay, readmission, and survival.</div></div><div><h3>Results</h3><div>Frailty was identified in 115 patients (11.2 %): 38 mild, 26 moderate, and 9 severe. Forty-one frail patients (mainly mild) underwent surgery, while 74 (mostly moderate-to-severe) received non-operative care. Compared with non-frail surgical patients (n = 913), frail patients had similar surgical complication rates (22.7 % vs 21.6 %) and no 30-day mortality, but longer stays (median 9.2 vs 6.8 days; p = 0.018), more medical complications (14.6 % vs 6.6 %; p &lt; 0.001), and higher readmission (15.9 %). At 45 months, mortality was higher in frail surgical patients (69 % vs 19 %; HR 4.2, 95 % CI 2.8–6.3). Within the frail cohort, surgery improved survival over non-operative care (HR 0.62, 95 % CI 0.41–0.95).</div></div><div><h3>Conclusions</h3><div>Stratifying frailty into mild, moderate, and severe provides practical guidance for CRC management. Mildly frail patients, when optimized, can achieve outcomes comparable to non-frail individuals, while moderate-to-severe frailty often precludes surgery. Routine frailty stratification should inform individualized decisions and guide future trials in severely frail patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"52 3","pages":"Article 111406"},"PeriodicalIF":2.9,"publicationDate":"2026-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146074688","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}