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Introduction: The long term survival of patients undergoing curative resection for gastric cancer remains poor owing to high recurrence rates. The use of adjuvant chemotherapy in node positive gastric cancer to prolong survival and prevent recurrence is widely accepted. However, the role for adjuvant chemotherapy in node negative gastric cancer is less clear, particularly in the era of neoadjuvant chemotherapy.

Objective: To determine the association of adjuvant chemotherapy with survival in patients undergoing pathologically node negative gastric cancer resection, following neoadjuvant chemotherapy.

Methods: We examined a national cancer database containing patients who had undergone neoadjuvant chemotherapy and pathologically node negative curative gastrectomy. We divided these patients into those who had undergone adjuvant chemotherapy versus those who had not. Using a propensity score matched analysis, we analyzed the survival of these patients between the 2 groups.

Results: 5309 patients who had undergone curative gastrectomy were identified from the database and 806 of these patients were given adjuvant chemotherapy. Following propensity score matched analysis, patients who had been given adjuvant chemotherapy had an increased median survival of 150 vs 125 months (5-year 68 % vs 62 %, p < 0.001).

Conclusion: There is a small, but statistically significant survival benefit for adjuvant chemotherapy in patients with node negative gastric cancer who had undergone neoadjuvant chemotherapy. Further studies are required to examine the role of adjuvant chemotherapy in this subset of patients.

Background and objectives: Enhanced Recovery After Surgery (ERAS) guidelines for Radical Cystectomy (RC) were published over ten years ago. Aim of this systematic review is to update ERAS recommendations for patients undergoing RC and to give an expert opinion on the relevance of each single ERAS item.

Methods: A systematic review was performed to identify the impact of each single ERAS item on RC outcomes. Embase and Medline (through Pubmed) were searched systematically. Relevant articles were selected and graded. For each ERAS item, a level of evidence was determined. An e-Delphi consensus was then performed amongst an international panel with renowned experience in RC to provide recommendations based on expert opinion.

Key findings and limitations: Preoperative medical optimization and avoiding bowel preparation are highly recommended. Robotic-assisted RC with intracorporeal urinary diversion is moderately recommended and can help in applying other ERAS items, such as early mobilization. Medical thromboprophylaxis should be administered and nasogastric tube should be removed at the end of surgery. Perioperative fluid restriction as well as opioid-sparing anesthesia protocols should be implemented. Generally, consensus was reached on most ERAS items, with the exception of epidural anesthesia (no consensus), resection site drainage (consensus against), and type of urinary drainage. Limitations include the lack of a multidisciplinary approach to the present consensus, giving however a highly specialized surgical opinion on ERAS.

Conclusions: and clinical implications: The current study updates ERAS recommendations for patients undergoing RC and suggests application of ERAS by a panel of experts in the field.

Background: For many colorectal cancer patients, primary surgery is the standard care of treatment. Further insights in perioperative care are crucial. The aim of this study is to assess the prognostic value of body composition for postoperative complications after laparoscopic and open colorectal surgery.

Methods: From January 2013 to 2018 all consecutive patients who underwent surgery for colorectal cancer were enrolled in this study. Patients with a preoperative CT-scan <90 days before surgery were included. All CT-scans were obtained retrospectively, and body composition was analysed using a single transverse slice at the level of the third lumbar vertebra (L3) within the Slice-O-Matic-software. The studied outcome measure was the occurrence of major postoperative complications (Clavien-Dindo grade ≥3b).

Results: A total of 1213 patients were included in the final analyses. Multivariable analyses showed that patients with low-skeletal muscle mass Z-score (OR 0.67, 95 % CI 0.45-0.97, p = 0.036) or a high visceral adipose tissue Z-score (OR 1.56, 95 % CI 1.06-2.29, p = 0.023) were significantly associated with an increased risk of developing major postoperative complications after open surgery. In the laparoscopic group, all six body composition parameters were not significantly associated with an increased risk of developing a major postoperative complication.

Conclusions: In this study, open colorectal surgery in patients with either low skeletal muscle mass or high visceral adipose tissue mass was associated with increased risk of postoperative complications. Laparoscopic surgery did not show this correlation. This demonstrates the importance of using minimal invasive surgery in colorectal cancer patients and implementing this as standard care.

Purpose: To analyse the clinical and histological characteristics of breast cancers (BC) occurring after Hodgkin lymphoma (HL), as well as their outcome with particular attention to the effectiveness and safety of breast-conservative surgery with radiation therapy (RT).

Materials and methods: This is a retrospective study of 218 patients who developed stage 0 to III BC after treatment for mediastinal HL between 1951 and 2022. Comprehensive demographic, clinical, and therapeutic data were collected for HL and BC, as well as survival and locoregional control. Statistical analyses were performed using R software version 4.1.1.

Results: The median age at HL diagnosis was 24 years [7-79]. BC appeared at a median age of 47 years [22-86], with a median interval of 21 years [5-51] after HL. Locoregional treatment included mastectomy in 117 (56.0 %) and lumpectomy in 92 (44.0 %), with postoperative RT in 99 patients (47.6 %). Isocentric lateral decubitus irradiation (ILD) was performed for 48 patients treated by tumorectomy (63.2 %). With a median follow-up of 29.7 years after HL and 7.7 years after BC, the 5-year overall survival (OS) and locoregional control rates were resp. 89.2 % and 86.4 % for invasive, and 100 % for in situ cancers. The 5-year metastasis-free survival rate was 87.4 % [95 % CI: 82.7-92.4 %]. No late sequelae was reported.

Conclusion: Breast-conserving surgery, combined with appropriate RT, can be considered in the treatment of BC after HL despite prior thoracic irradiation. This approach provides comparable outcomes in terms of local control and survival while reducing the risk of long-term complications associated with mastectomy.

Introduction: The standard treatment of colorectal liver metastases (CRLM) is surgery with perioperative chemotherapy. A tumor response to systemic therapy confirmed at pathology examination is the strongest predictor of survival, but it cannot be adequately predicted in the preoperative setting. This bi-institutional retrospective study investigates whether CT-based radiomics of CRLM and peritumoral tissue provides a reliable non-invasive estimation of the pathological tumor response to chemotherapy.

Methods: All consecutive patients undergoing liver resection for CRLM at the two institutions were considered. Only patients with a radiological partial response or stable disease at chemotherapy and with a preoperative/post-chemotherapy CT performed <60 days before surgery were included. The pathological response was evaluated according to the tumor regression grade (TRG). The tumor (Tumor-VOI) was manually segmented on the portal phase of the CT and a 5-mm ring of peritumoral tissue was automatically generated (Margin-VOI). The predictive models underwent internal validation.

Results: Overall, 222 patients were included; 64 had a pathological response (29 %, TRG1-3). Two-third of patients displaying a radiological response (111/170) did not have a pathological one (TRG4-5). For TRG1-3 prediction, the clinical model performed fairly (Accuracy = 0.725, validation-AUC = 0.717 95%CI = 0.652-0.788). Radiomics improved the results: the model combining the clinical data and Tumor-VOI features had Accuracy = 0.743 and validation-AUC = 0.729 (95%CI = 0.665-0.798); the full model (clinical/Tumor-VOI/Margin-VOI) achieved Accuracy = 0.820 and validation-AUC = 0.768 (95%CI = 0.707-0.826).

Conclusion: CT-based radiomics of CRLM allows an insightful non-invasive assessment of TRG. The combined analysis of the tumor and peritumoral tissue improves the prediction. In association with clinical data, the radiomic indices outperform standard radiological and clinical evaluation.

Background: Whether inherited in the context of multiple endocrine neoplasia 2B at germline level or acquired in a lifetime, all RET p.M918T (RET c.2753T>C) mutations should activate the RET tyrosine kinase receptor alike, with similar degrees of medullary thyroid cancer (MTC) progression when disparities in disease onset and multifocal growth are accounted for.

Methods: This cross-sectional analysis of RET p.M918T-driven progression of hereditary MTC (33 patients) vs. sporadic MTC (36 patients) sought to explore this hypothesis.

Results: Patients with hereditary disease were significantly younger at thyroidectomy (medians of 10 vs. 57 yrs.) and featured significantly more often multifocal growth (69 vs. 14 %) with more thyroid tumor foci (medians of 2 foci vs. 1 focus) than patients with sporadic disease. Although the former had 3.6-fold smaller primary thyroid tumor diameters (medians of 5 vs. 18 mm) and twice as many neck nodes dissected (medians of 66.5 vs. 32 nodes) than the latter, extrathyroid tumor extension (42 vs. 36 %), node metastasis (64 vs. 77 %), distant metastasis (33 vs. 17 %), and biochemical cure rates (45 vs. 35 %) were fairly comparable, as was the number of dissected node metastases (medians of 7 vs. 8 involved nodes). Sensitivity analyses, with breakdown of patients by tumor multifocality and nodal status, corroborated these findings.

Conclusion: RET p.M918T-driven progression of MTC is similar in hereditary and sporadic disease, barring earlier development and more frequent multifocal growth of hereditary MTC. This makes a compelling case for referral of patients with RET p.M918T-driven MTCs to specialist surgical centers.

Purpose: To explore the recurrence pattern and risk factors associated with the relapse of thoracic esophageal squamous cell carcinoma (TESCC) among patients who received esophagectomy following neoadjuvant immunochemotherapy (NICT).

Methods: A total of 191 TESCC patients who received esophagectomy following NICT were retrospectively reviewed from 2019 to 2022. The first recurrence patterns were assessed. The postoperative recurrence-free survival (RFS) was determined using the Kaplan-Meier method. Multivariate recurrence risk factor analysis was performed using the logistic regression model.

Results: As of the December 31, 2023 follow-up, 66 patients experienced recurrence, with a median time to recurrence of 10.8 months (1.2-37.3 months). The recurrence pattern included locoregional recurrence (LR), distant recurrence (DR), and LR + DR, accounting for 69.7 %, 16.7 %, and 13.6 %, respectively. Locoregional lymph node (LN) predominated the pattern of postoperative recurrence (40/66), particularly in the mediastinal station 2R (17.5 %) and 4R (16.5 %). The 2-year RFS rates for groups with dissected LN stations of ≤6, 7-9, and 10-14 were 50.5 %, 72.3 %, and 63.5 %, respectively (P = 0.04). Similarly, the 2-year RFS rates for groups with dissected LNs of <15, 15-29, and ≥30 were 49.7 %, 61.6 %, and 71.6 %, respectively (P = 0.28). Furthermore, tumor length >5 cm, the T-stage evaluation as clinically stable disease, dissected LN stations ≤6, and the ypN2-3 stage were unfavorable factors for postoperative failure in patients.

Conclusions: The major pattern of LR may be LN recurrence after NICT in TESCC patients, particularly in the station 2R and 4R. In addition, less than 6 LN dissection stations or less than 15 LNs are not recommended.

Introduction: Ovarian cancer remains a leading cause of mortality among gynecological malignancies, often diagnosed at advanced stages due to nonspecific symptoms and limited screening tools. Standard treatment, including cytoreductive surgery and chemotherapy, can cause fatigue, physical dysfunction, and psychological distress, impacting quality of life. Exercise interventions have shown potential to mitigate these effects, but inconsistent methodologies in randomized controlled trials (RCTs) limit reliable conclusions and clinical integration.

Methods: A systematic review was conducted following PRISMA guidelines. RCTs assessing physical exercise effects on women with ovarian cancer were included, excluding pilot trials, reviews, and combined therapies. Data extraction and GRADE assessments were performed by two independent reviewers, and a narrative synthesis was conducted due to study heterogeneity.

Results: Eleven RCTs were analyzed, covering aerobic, resistance, and yoga interventions. Findings indicated improvements in physical function, fatigue, and psychological outcomes, such as reduced depressive symptoms and cognitive enhancements. Patients adhering to ≥150 min of moderate-intensity exercise per week experienced the most consistent benefits. Preoperative walking expedited recovery, though significant heterogeneity in study protocols precluded meta-analysis.

Discussion: Evidence supports the feasibility and benefits of exercise across ovarian cancer stages. However, inconsistency in exercise intensity, duration, and reporting hinders the development of standardized protocols. Compared to cardiological rehabilitation, ovarian cancer exercise guidelines remain underdeveloped, emphasizing the need for tailored, evidence-based interventions.

Conclusion: Exercise interventions can improve physical and mental health in ovarian cancer patients. Standardized RCTs are urgently needed to establish robust exercise protocols and enable clinical implementation, enhancing survivorship outcomes and quality of life.

Introduction: Adjuvant chemotherapy improves survival in patients with resected pancreatic ductal adenocarcinoma (PDAC). The decision to initiate chemotherapy involves both patient and physician factors, decision-specific criteria, and contextual considerations. This study aimed to assess medical oncologists' views on adjuvant chemotherapy following pancreatic resection for PDAC.

Methods: An online survey and case vignette study were distributed to medical oncologists via the Dutch Pancreatic Cancer Group (DPCG), International Hepato-Pancreato-Biliary Association (IHPBA) and related networks.

Results: A total of 91 oncologists from 14 countries participated, 46 % of whom treated more than 40 new PDAC patients annually, with a median experience of 15 years. Significant discrepancies were noted in their recommendations for adjuvant chemotherapy across case vignettes. In patients over 70, 17 % advised against chemotherapy, while 31 % said age was not a factor. Oncologists with less than 10 years of experience and those in non-academic settings were less likely to recommend adjuvant therapy. While 87 % agreed mFOLFIRINOX is the preferred adjuvant treatment, consensus on individual cases was lacking. The recommended interval between surgery and chemotherapy ranged from 3 to 26 weeks, with varying reasons for withholding treatment, primarily due to postoperative recovery and performance status.

Conclusions: Our study revealed substantial variation among oncologists in counseling on adjuvant chemotherapy after PDAC resection. This emphasizes the need for more patient involvement in decision-making and improving shared decision-making.