IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-02 DOI: 10.1016/j.ejso.2026.111383

Thea Piso , Michael Gerken , Stefan Rolf Benz , Monika Klinkhammer-Schalke , Alois Fürst , Melanie C. Langheinrich , Saskia Thies , Stefan Loth , Constanze Schneider , Fabian Reinwald , Jacqueline Müller-Nordhorn , Andrea Sackmann , Sylke Ruth Zeissig , Bianca Franke , Vinzenz Völkel , Moritz Schmelzle , Ulf Kulik

Introduction

Resection plays a pivotal role in the treatment of rectal cancer. The aim of this study is to compare the long-term outcomes of laparoscopic, open surgical and robotic approaches.

Material and methods

The study cohort contains data of 24,725 patients with rectal cancer and curative surgery between 2010 and 2022 from a pooled database of cancer registries of ten German federal states. Primary outcome was overall survival (OS). Secondary outcomes were cumulative loco-regional recurrence (CLR) and recurrence free survival (RFS) calculated via univariable and multivariable analyses, and matched-pair analyses.

Results

Of the 24,725 patients, 12,561 (50.8 %) were treated with open, 11,248 (45.5 %) with laparoscopic and 916 patients (3.7 %) with robotic-assisted resections. In multivariable Cox regression analysis, OS was higher in the minimal invasive surgery groups compared to the open surgery group with a HR of 0.775 (p < 0.001) for the laparoscopic and HR of 0.768 (p = 0.006) for the robotic group. A comparison of robotic to open surgery regarding RFS showed a significant difference in favor of robotic surgery in multivariable Cox regression (HR 0.834, p = 0.046). The rate of CLR was lower in the robotic compared to the laparoscopic surgery group. Additionally, we found a lower conversion rate in the robotic group as compared to the laparoscopic group.

Conclusion

These findings from real-life data confirm current recommendations for minimal invasive rectal resection. There was a trend towards better outcomes after robotic compared to laparoscopic surgery. However, further studies are needed to investigate this issue and to provide definitive evidence.

切除在直肠癌的治疗中起着举足轻重的作用。本研究的目的是比较腹腔镜手术、开放手术和机器人手术的长期疗效。材料和方法研究队列包含2010年至2022年间24,725例直肠癌和治疗性手术患者的数据，这些数据来自德国10个联邦州的癌症登记汇总数据库。主要终点为总生存期（OS）。次要结果是通过单变量和多变量分析以及配对分析计算的累积局部-区域复发（CLR）和无复发生存（RFS）。结果24725例患者中，12561例（50.8%）采用开放式手术，11248例（45.5%）采用腹腔镜手术，916例（3.7%）采用机器人辅助手术。在多变量Cox回归分析中，微创手术组的OS高于开放手术组，腹腔镜组的HR为0.775 (p < 0.001)，机器人组的HR为0.768 （p = 0.006）。多变量Cox回归分析显示，机器人手术与开放手术的RFS差异有统计学意义（HR 0.834, p = 0.046）。与腹腔镜手术组相比，机器人的CLR发生率较低。此外，我们发现机器人组的转换率比腹腔镜组低。结论：这些来自实际数据的发现证实了目前对微创直肠切除术的建议。与腹腔镜手术相比，机器人手术的结果有更好的趋势。然而，需要进一步的研究来调查这个问题并提供明确的证据。

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引用次数: 0

Risk factors for contralateral inguinal lymph node metastases in unilaterally palpable groins in patients with squamous cell carcinoma of the penis 阴茎鳞状细胞癌患者对侧腹股沟淋巴结转移的危险因素。

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-28 DOI: 10.1016/j.ejso.2026.111446

Keval N. Patel , Mohit Sharma , Arunsrinivas Murlidharan , Nilkanth Suthar , Adesh Solanki , D.S. Shreyas , Luis G. Medina , Ganesh Bakshi , Shashank J. Pandya

Objective

To assess the presence of contralateral inguinal lymph node metastases (ILNM) in unilaterally palpable groins and to identify risk factors (and a risk score) for non-palpable contralateral lymph node involvement.

Materials and methods

A retrospective analysis of 148 patients with unilaterally palpable inguinal lymph nodes who underwent bilateral inguinal lymph node dissection (bILND) was conducted. Survival analysis was performed using the Kaplan-Meier analysis to compare recurrence-free survival (RFS) and overall survival (OS). Logistic regression analysis was used to identify factors that could predict bilateral ILNM. A risk score was developed based on significant factors. The accuracy of the score was evaluated using the Receiver Operating Characteristic (ROC) curve.

Result

Bilateral ILNM was found in 43.9 % of patients and unilateral ILNM in 56.1 %. There was a significant decrement in OS in bilateral ILNM but not in RFS. On multivariate analysis, the number of positive lymph nodes >2, presence of lympho-vascular invasion (LVI), and poor differentiation significantly predicted bilateral ILNM. The probability of finding bilateral ILNM increased from 8.4 % with a score of 0–59.5 %, 73.3 %, and 81.2 % with scores of 1, 2, and 3, respectively. The Area under ROC (AUROC) of the risk scoring system was 0.982.

Conclusion

There is a significant risk of contralateral ILNM in cases of unilaterally palpable lymph nodes. Bilateral ILNM has lower OS than unilateral ILNM. Risk factors predicting bilateral ILNM are identified. bILND is suggested in >/ = 2 risk factors. Proper counselling and shared decision-making should govern the management of contralateral groin in patients with a single or no risk factor.

目的：评估单侧可触及腹股沟中对侧腹股沟淋巴结转移（ILNM）的存在，并确定不可触及的对侧淋巴结累及的危险因素（和风险评分）。材料与方法：回顾性分析148例单侧可触及腹股沟淋巴结行双侧腹股沟淋巴结清扫术（bILND）的患者。采用Kaplan-Meier分析比较无复发生存期（RFS）和总生存期（OS）。采用Logistic回归分析确定可预测双侧ILNM的因素。风险评分是基于显著因素制定的。采用受试者工作特征（ROC）曲线评价评分的准确性。结果：双侧ILNM发生率为43.9%，单侧ILNM发生率为56.1%。双侧ILNM的OS有显著降低，而RFS无显著降低。在多变量分析中，阳性淋巴结bbb2.0的数量、淋巴血管浸润（LVI）的存在和分化不良显著预测双侧ILNM。发现双侧ILNM的概率分别从0- 59.5%的8.4%、1、2和3分的73.3%和81.2%增加。风险评分系统的ROC下面积（AUROC）为0.982。结论：单侧可触及淋巴结有发生对侧ILNM的危险。双侧ILNM的OS低于单侧ILNM。确定预测双侧ILNM的危险因素。>/ = 2个危险因素中建议采用bILND。适当的咨询和共同决策应支配对侧腹股沟患者的管理单一或无风险因素。

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引用次数: 0

Comparison of contrast-enhanced mammography and breast MRI in tumour extent assessment: A systematic review and meta-analysis 对比增强乳房x线摄影和乳腺MRI在肿瘤范围评估中的比较：一项系统回顾和荟萃分析

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-16 DOI: 10.1016/j.ejso.2026.111410

Sven J.E. Ermans , Romy Maas , T. Martyn Hill , Sasha I. Usiskin , Lejla Alic , Michael Douek

Introduction

Accurate estimation of tumour extent is crucial for breast cancer treatment and achieving tumour-free surgical margins. Breast MRI is a widely used imaging modality; however, the high cost and limited availability of MRI have increased interest in contrast-enhanced mammography (CEM) as a potential alternative. This meta-analysis compares the accuracy of tumour extent estimation between MRI and CEM, using histopathological size as the reference standard.

Method

Literature up to October 2024 was reviewed. Two independent reviewers extracted relevant data. For both modalities in comparison with pathology, mean differences in tumour size and pooled correlation coefficients were calculated. A direct comparison of tumour size estimates between both modalities was conducted using R² and a two-sample t-test. The I²-statistic was used to assess between-study heterogeneity.

Results

Twenty-one studies involving 1060 patients were included. Both modalities showed a mean overestimation of tumour size by ∼3 mm, with no statistical significance (P = 0.345 and P = 0.308). Correlation coefficients with pathology were 0.78 for MRI and 0.79 for CEM. Direct comparison demonstrated strong agreement (R² = 0.81) between the two modalities, and no significant difference (P = 0.65). Limited data suggested higher sensitivity but reduced specificity for MRI in the detection of multifocal/multicentric disease.

Conclusion

MRI and CEM showed comparable performance in tumour size estimation, with no significant differences compared to pathology or each other. These findings suggest CEM could potentially be an alternative for MRI, especially in resource-limited settings or for patients contraindicated for MRI. However, small study sizes and limited subgroup data highlight the need for large-scale prospective research.

准确估计肿瘤范围对乳腺癌治疗和实现无肿瘤手术切缘至关重要。乳房MRI是一种广泛使用的成像方式；然而，MRI的高成本和有限的可用性增加了对比增强乳房x光检查（CEM）作为潜在替代方案的兴趣。本荟萃分析比较了MRI和CEM之间肿瘤范围估计的准确性，使用组织病理大小作为参考标准。方法回顾截至2024年10月的文献。两名独立审稿人提取了相关数据。对于两种方式与病理比较，计算肿瘤大小和合并相关系数的平均差异。使用R2和双样本t检验对两种方式之间的肿瘤大小估计值进行直接比较。采用i2统计量评估研究间异质性。结果共纳入21项研究，1060例患者。两种方法均显示肿瘤大小平均高估约3mm，差异无统计学意义（P = 0.345和P = 0.308）。MRI与病理的相关系数为0.78，CEM为0.79。直接比较显示两种治疗方式之间具有很强的一致性（R2 = 0.81），无显著差异（P = 0.65）。有限的数据表明，MRI在检测多灶/多中心疾病时灵敏度较高，但特异性较低。结论mri和CEM对肿瘤大小的估计具有可比性，与病理或彼此之间无显著差异。这些发现表明CEM可能是MRI的替代方案，特别是在资源有限的环境中或对MRI有禁忌的患者。然而，较小的研究规模和有限的亚组数据突出了大规模前瞻性研究的必要性。

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引用次数: 0

Impact of preoperative knee extension muscle strength on prognosis in older cancer patients with resectable esophageal cancer 高龄可切除食管癌患者术前膝关节伸展肌力对预后的影响。

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2025-12-31 DOI: 10.1016/j.ejso.2025.111381

Takumi Yanagisawa , Tsuyoshi Harada , Tetsuya Tsuji , Junya Ueno , Nobuko Konishi , Nanako Hijikata , Takeo Fujita

Introduction

Older patients with esophageal cancer (EC) have a poor prognosis, and there is a global need for the development of assessment tools and appropriate supportive care during cancer treatment. Knee extension muscle strength (KEMS) is associated with physical frailty in older adults. However, the impact of KEMS on clinical outcomes is unclear in older patients with EC. This study aimed to investigate the prognostic impact of KEMS on 3-year overall survival (3-yr OS) in older patients with EC.

Materials and methods

This was a single-center retrospective cohort study of patients aged 70 years or older with EC who had undergone esophagectomy from September 2015 and January 2020. The most significant cutoffs of preoperative KEMS were defined using the log-rank test for 3-yr OS by sex. The prognostic impact of low KEMS was determined by univariate and multivariate Cox proportional hazards models adjusted for potential confounding factors.

Results

150 patients with a mean age of 74.7 years (standard deviation: 3.9) were analyzed. The cutoff of KEMS was 380 N for men and 240 N for women. Low preoperative KEMS significantly impacted 3-yr OS [adjusted hazard ratio: 3.894 (95 % confidence interval: 1.350–11.229); p = 0.009] adjusted for age, sex, skeletal muscle mass index, Charlson comorbidity index, clinical stage, pathological T stage, and surgical technique.

Conclusion

Low preoperative KEMS significantly impacted 3-yr OS in older patients with EC. Long-term postoperative care as well as perioperative rehabilitation for older EC patients with physical frailty may be particularly important for health and prognosis.

老年食管癌（EC）患者预后较差，全球需要在癌症治疗期间开发评估工具和适当的支持性护理。膝关节伸展肌力（KEMS）与老年人身体虚弱有关。然而，KEMS对老年EC患者临床结果的影响尚不清楚。本研究旨在探讨keems对老年EC患者3年总生存期（3年OS）的预后影响。材料和方法：这是一项单中心回顾性队列研究，研究对象为2015年9月至2020年1月期间接受食管切除术的70岁及以上EC患者。术前KEMS的最显著截止点是用3年OS的log-rank检验按性别定义的。低KEMS的预后影响是通过单因素和多因素Cox比例风险模型确定的，该模型对潜在的混杂因素进行了调整。结果：共分析150例患者，平均年龄74.7岁（标准差3.9）。KEMS的临界值为男性380北纬，女性240北纬。术前低KEMS显著影响3年OS[校正风险比：3.894(95%可信区间：1.350-11.229)；p = 0.009]校正了年龄、性别、骨骼肌质量指数、Charlson合并症指数、临床分期、病理T分期和手术技术等因素。结论：术前低KEMS显著影响老年EC患者3年OS。对于身体虚弱的老年EC患者，长期的术后护理和围手术期康复可能对健康和预后尤为重要。

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引用次数: 0

Immunological phenotype as a predictor for response after isolated limb perfusion for patients with melanoma in-transit metastasis 免疫表型作为黑色素瘤转移患者分离肢体灌注后反应的预测因子

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-23 DOI: 10.1016/j.ejso.2026.111424

Anna Constantinescu , Roger Olofsson Bagge , Anne Huibers

Background

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.

Methods

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.

Results

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).

Conclusion

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 (ClinicalTrials.gov NCT03685890).

游离肢体灌注（ILP）是局限于四肢的黑色素瘤转移（ITM）患者的一种局部治疗方法。据报道，ILP的完全缓解率各不相同，但大约为50 - 70%。本研究旨在分析特异性免疫表型是否可以预测ILP后的CR。方法纳入2012年1月至2023年3月期间接受ILP作为黑色素瘤ITM首次治疗的132例患者。采用荧光活化细胞分选法（FACS）分析术前血标本，观察naïve、记忆T、B细胞亚型和自然杀伤（NK）细胞的数量和百分比。采用单变量和多变量分析对ILP后发生CR的临床和免疫预测因素进行分析。结果119例（90%）患者的反应可评估，其中53%达到CR，在调整年龄、性别、转移瘤数量和最大转移瘤大小后，与CR独立相关的免疫因素是细胞毒性T细胞（CD3+8+）百分比（OR 1.07, 95% CI 1.02-1.13, p = 0.012）和初始细胞毒性T细胞（CD3+8+45RA+）百分比（OR 1.11 95% CI 1.01-1.22, p = 0.029）。结论细胞毒性T细胞百分比和naïve细胞毒性T细胞的免疫表型与肿瘤负荷一起是黑色素瘤ITM患者ILP后反应的重要预测因素。这可能有助于更好地选择患者，个性化治疗算法，并为进一步研究局部癌症治疗的系统免疫效应奠定基础。这包括新的治疗组合，目前正在进行的一项试验是将ILP与PD-1抑制剂联合使用（ClinicalTrials.gov NCT03685890）。

{"title":"Immunological phenotype as a predictor for response after isolated limb perfusion for patients with melanoma in-transit metastasis","authors":"Anna Constantinescu , Roger Olofsson Bagge , 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<sup>+</sup>8<sup>+</sup>) (OR 1.07, 95 % CI 1.02–1.13, p = 0.012) and percentage of naive cytotoxic T cells (CD3<sup>+</sup>8<sup>+</sup>45RA<sup>+</sup>) (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":"2026-03-01","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}

引用次数: 0

Interpretable machine learning model for predicting postoperative complications in esophageal squamous cell carcinoma following neoadjuvant therapy and esophagectomy 预测食管鳞状细胞癌新辅助治疗和食管切除术后并发症的可解释机器学习模型

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-16 DOI: 10.1016/j.ejso.2026.111386

Chuanquan Lin , Xian Gong , Rui Tong , Shaojia Chen , Hao Chen , Guobing Xu , Bin Zheng , Chun Chen , Wei Zheng , Zhang Yang

Objectives

Postoperative complications remain common after neoadjuvant therapy and esophagectomy for esophageal squamous cell carcinoma (ESCC), and existing risk scores have limited bedside utility. We developed and validated an interpretable machine-learning model to predict morbidity.

Methods

We retrospectively included ESCC patients who underwent neoadjuvant therapy and curative esophagectomy from 2018 to 2022. Cases from 2018 to 2021 were the training cohort; cases from 2022 were the validation cohort. The endpoint was Clavien–Dindo grade ≥ II complications within 90 days. Multimodal preoperative and intraoperative variables trained several machine-learning algorithms. Performance was evaluated by cross-validation and independent validation. Interpretability used SHapley Additive exPlanations (SHAP), and top features yielded a simplified model.

Results

In total, 239 patients were analyzed in two temporally distinct cohorts (training set, n = 174; validation set, n = 65). XGBoost achieved the best overall performance, with accuracy 0.82, AUC 0.86, and precision 0.78. SHAP analysis identified prognostic nutritional index, smoking status, carcinoembryonic antigen, age, and lymphocyte-to-monocyte ratio as the most influential predictors. A simplified five-variable model preserved predictive performance and enabled clinically actionable risk stratification: in the low-risk group, 9.1 % experienced complications, compared with 23.8 % in the medium-risk group and 68.2 % in the high-risk group. Locked cutpoints—PNI 44.07, CEA 2.98 ng/mL, age 64.00 years, and LMR 3.22—were applied without modification in the validation cohort and yielded clear stratification of incidence across threshold-defined groups.

Conclusions

An interpretable machine-learning model based on routinely available clinical variables accurately predicts postoperative complications in ESCC after neoadjuvant therapy. The simplified model enables clinically meaningful risk stratification and may support personalized perioperative management.

目的食管鳞状细胞癌（ESCC）新辅助治疗和食管切除术后的术后并发症仍然很常见，现有的风险评分在临床应用上有限。我们开发并验证了一个可解释的机器学习模型来预测发病率。方法回顾性分析2018年至2022年接受新辅助治疗和根治性食管切除术的ESCC患者。2018 - 2021年的病例为培训组；2022年的病例为验证队列。终点是90天内Clavien-Dindo级≥II级并发症。多模态术前和术中变量训练了几种机器学习算法。通过交叉验证和独立验证对性能进行评价。可解释性采用SHapley加性解释（SHAP），顶部特征产生简化模型。结果239例患者被分为两个时间上不同的队列（训练组，n = 174；验证组，n = 65）。XGBoost获得了最佳的综合性能，精度为0.82，AUC为0.86，精密度为0.78。SHAP分析确定预后营养指数、吸烟状况、癌胚抗原、年龄和淋巴细胞/单核细胞比率是最具影响力的预测因素。简化的五变量模型保留了预测性能，并实现了临床可操作的风险分层：在低风险组中，9.1%的患者出现并发症，而中风险组为23.8%，高危组为68.2%。锁定的切点（pni 44.07, CEA 2.98 ng/mL，年龄64.00岁，LMR 3.22）在验证队列中不加修改地应用，并在阈值定义的组中获得了明确的发病率分层。结论基于常规临床变量的可解释性机器学习模型可准确预测ESCC新辅助治疗后并发症。简化的模型使临床有意义的风险分层，并可能支持个性化围手术期管理。

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引用次数: 0

Development and external validation of an AI-guided navigation system for the safe dissection plane in robot-assisted nipple sparing mastectomy 机器人辅助乳头保留乳房切除术中安全解剖平面人工智能导航系统的开发与外部验证

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-06 DOI: 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。

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引用次数: 0

Comparison of health-related quality of life of cancer patients undergoing first and last follow-up after robotic surgery: A meta-analysis 机器人手术后第一次和最后一次随访癌症患者健康相关生活质量的比较：一项荟萃分析

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-14 DOI: 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.

本研究的主要目的是比较机器人手术（RS）后接受首次和最后一次随访的癌症患者的健康相关生活质量（HRQoL）。研究的次要目的是揭示调节变量对癌症患者术后HRQoL的影响。方法采用随机效应模型进行meta分析、敏感性分析、发表偏倚分析、meta方差分析和meta回归分析。计算阈值以评估临床意义。结果meta分析纳入13项研究（共计2.399例癌症患者）。meta分析和敏感性分析结果显示，RS后末次随访的癌症患者HRQoL优于第一次随访。没有发表偏倚。meta-anova分析结果显示：(1)RS法的HRQoL优于其他方法；(2)妇科肿瘤患者RS后末次随访的HRQoL优于第一次随访；(3)RS后末次随访与第一次随访的差值≥43时，末次随访的HRQoL优于第一次随访。这些结果具有统计学和临床意义。结论rs治疗对肿瘤患者的HRQoL有较好的疗效。因此，RS治疗提高了癌症患者的HRQoL。这项研究的结果可以帮助外科医生制定以患者为中心的治疗策略。

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引用次数: 0

Impact of pancreatic transection level on survival outcomes and glycemic control following distal pancreatectomy for pancreatic tail cancer: A multicenter cohort study 胰腺横断水平对胰腺癌远端胰腺切除术后生存结局和血糖控制的影响：一项多中心队列研究

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-09 DOI: 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。

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引用次数: 0

Clinical-radiological predictive model for preoperative risk stratification in rectal adenocarcinoma 直肠腺癌术前风险分层的临床-放射学预测模型

IF 2.9 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2026-03-01 Epub Date: 2026-01-10 DOI: 10.1016/j.ejso.2026.111398

Youfan Zhao , Zhongwei Chen , Yuguo Wei , Jiejie Zhou , Yaru Wei , Ying Zhu , Xiang Li , Yanyan Li , Ziyi Chen , Jiashan Zhan , Meihao Wang

Background

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。

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