Pub Date : 2026-02-01Epub Date: 2025-12-27DOI: 10.1016/j.suronc.2025.102346
Ana León Bretscher , Javier Ripollés Melchor , María García Nebreda , Ane Abad Motos , Carla Iglesias Morales , José María Tena Guerrero , Cristina Gil Lapetra , Francisco José Orts Micó , Manuel Llácer Pérez , Patricia Galán Menéndez , Enrique Alday-Muñoz , Jorge Puertas Domínguez , Bakarne Ugarte Sierra , Ana Maria Pascual Bellosta , Rosalia Navarro-Perez , Raquel Risco , Virginia Moreno Blanco , Raquel García Álvarez , Irene Mojarro Zamora , Alfredo Abad Gurumeta , Gloria Paseiro Crespo
Background
Enhanced Recovery After Surgery (ERAS) pathways improve short-term outcomes in abdominal surgery, but their impact on timely initiation of adjuvant chemotherapy (Return to Intended Oncologic Therapy, RIOT) in gastric cancer remains uncertain.
Methods
This multicenter, prospective cohort study (POWER4, NCT03865810) analysed 742 patients undergoing gastrectomy across 72 Spanish hospitals (2019–2020). ERAS adherence was assessed by quartiles. Primary outcome: timely RIOT (chemotherapy initiation ≤56 days post-surgery). Secondary outcome: time to RIOT (days). Multivariable logistic and Cox regression models adjusted for clinical/tumour factors.
Results
Of 742 patients, 65 % achieved timely RIOT. Quartile-based univariable analysis revealed shorter time to RIOT with higher adherence (Q4 vs. Q1: HR 0.64, 95 % CI 0.42–0.97, *p* = 0.034), but this association disappeared in multivariable models. Advanced TNM stage (e.g., IIIC: HR 18.6, *p* < 0.001) and ASA class were stronger predictors of delayed RIOT.
Conclusions
While ERAS pathways may aid recovery, their impact on RIOT depends on high adherence and is overshadowed by tumour-related factors. Future efforts should integrate ERAS with prehabilitation for high-risk patients and target adherence thresholds ≥70 %.
手术后增强恢复（ERAS）途径改善了腹部手术的短期预后，但其对胃癌患者及时开始辅助化疗（返回预期肿瘤治疗，RIOT）的影响仍不确定。方法这项多中心前瞻性队列研究（POWER4, NCT03865810）分析了西班牙72家医院（2019-2020年）的742例胃切除术患者。ERAS依从性以四分位数评估。主要终点：及时的RIOT（化疗开始≤术后56天）。次要结果：发生暴动的时间（天）。多变量logistic和Cox回归模型调整临床/肿瘤因素。结果742例患者中，65%的患者获得了及时的RIOT。基于四分位数的单变量分析显示，依从性越高，RIOT时间越短（Q4 vs. Q1: HR 0.64, 95% CI 0.42-0.97, *p* = 0.034），但这种关联在多变量模型中消失。晚期TNM分期（如IIIC: HR 18.6, *p* < 0.001）和ASA等级是延迟性RIOT的较强预测因子。虽然ERAS途径可能有助于恢复，但其对RIOT的影响取决于高依从性，并被肿瘤相关因素所掩盖。未来的努力应将ERAS与高危患者的康复结合起来，目标依从性阈值≥70%。
{"title":"ERAS pathway adherence and its association with return to intended oncological therapy after gastrectomy","authors":"Ana León Bretscher , Javier Ripollés Melchor , María García Nebreda , Ane Abad Motos , Carla Iglesias Morales , José María Tena Guerrero , Cristina Gil Lapetra , Francisco José Orts Micó , Manuel Llácer Pérez , Patricia Galán Menéndez , Enrique Alday-Muñoz , Jorge Puertas Domínguez , Bakarne Ugarte Sierra , Ana Maria Pascual Bellosta , Rosalia Navarro-Perez , Raquel Risco , Virginia Moreno Blanco , Raquel García Álvarez , Irene Mojarro Zamora , Alfredo Abad Gurumeta , Gloria Paseiro Crespo","doi":"10.1016/j.suronc.2025.102346","DOIUrl":"10.1016/j.suronc.2025.102346","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) pathways improve short-term outcomes in abdominal surgery, but their impact on timely initiation of adjuvant chemotherapy (Return to Intended Oncologic Therapy, RIOT) in gastric cancer remains uncertain.</div></div><div><h3>Methods</h3><div>This multicenter, prospective cohort study (POWER4, NCT03865810) analysed 742 patients undergoing gastrectomy across 72 Spanish hospitals (2019–2020). ERAS adherence was assessed by quartiles. Primary outcome: timely RIOT (chemotherapy initiation ≤56 days post-surgery). Secondary outcome: time to RIOT (days). Multivariable logistic and Cox regression models adjusted for clinical/tumour factors.</div></div><div><h3>Results</h3><div>Of 742 patients, 65 % achieved timely RIOT. Quartile-based univariable analysis revealed shorter time to RIOT with higher adherence (Q4 vs. Q1: HR 0.64, 95 % CI 0.42–0.97, *p* = 0.034), but this association disappeared in multivariable models. Advanced TNM stage (e.g., IIIC: HR 18.6, *p* < 0.001) and ASA class were stronger predictors of delayed RIOT.</div></div><div><h3>Conclusions</h3><div>While ERAS pathways may aid recovery, their impact on RIOT depends on high adherence and is overshadowed by tumour-related factors. Future efforts should integrate ERAS with prehabilitation for high-risk patients and target adherence thresholds ≥70 %.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102346"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Early oral intake (EOI) is a core component of Enhanced Recovery After Surgery (ERAS) protocols. Although EOI after gastrectomy has been shown to improve recovery and reduce postoperative complications, its real-world implementation across Japan remains unclear. This study aimed to evaluate the current status and institutional factors influencing EOI after gastric cancer surgery using a nationwide database.
Methods
This retrospective observational study used Japan's nationwide Diagnosis Procedure Combination (DPC) database to analyze 26,097 patients who underwent gastric cancer surgery at 472 institutions from 2017 to 2022. Patients were divided into EOI and non-EOI groups based on oral intake initiation within two days postoperatively. Surgical methods, hospital characteristics, and length of stay were compared.
Results
Only 20.8 % of patients initiated EOI. Laparoscopic distal gastrectomy had significantly higher EOI rates compared to open procedures. However, no significant difference was observed for proximal or total gastrectomy. Larger hospitals and designated cancer centers showed higher EOI rates. The EOI group had a significantly shorter postoperative stay (median 9 vs. 12 days, p < 0.001).
Conclusions
EOI following gastrectomy is associated with shorter hospitalization, yet its adoption remains low in Japan. Institutional factors and multidisciplinary collaboration may play crucial roles in promoting EOI. Findings may inform perioperative optimization and ERAS standardization in oncologic gastric surgery.
{"title":"Nationwide field evaluation of early oral intake following gastric cancer surgery","authors":"Tsunehiko Maruyama , Kazuto Ikezawa , Hideo Suzuki , Tomohiro Kurokawa , Yoshimasa Akashi , Tatsuya Oda","doi":"10.1016/j.suronc.2026.102352","DOIUrl":"10.1016/j.suronc.2026.102352","url":null,"abstract":"<div><h3>Background</h3><div>Early oral intake (EOI) is a core component of Enhanced Recovery After Surgery (ERAS) protocols. Although EOI after gastrectomy has been shown to improve recovery and reduce postoperative complications, its real-world implementation across Japan remains unclear. This study aimed to evaluate the current status and institutional factors influencing EOI after gastric cancer surgery using a nationwide database.</div></div><div><h3>Methods</h3><div>This retrospective observational study used Japan's nationwide Diagnosis Procedure Combination (DPC) database to analyze 26,097 patients who underwent gastric cancer surgery at 472 institutions from 2017 to 2022. Patients were divided into EOI and non-EOI groups based on oral intake initiation within two days postoperatively. Surgical methods, hospital characteristics, and length of stay were compared.</div></div><div><h3>Results</h3><div>Only 20.8 % of patients initiated EOI. Laparoscopic distal gastrectomy had significantly higher EOI rates compared to open procedures. However, no significant difference was observed for proximal or total gastrectomy. Larger hospitals and designated cancer centers showed higher EOI rates. The EOI group had a significantly shorter postoperative stay (median 9 vs. 12 days, p < 0.001).</div></div><div><h3>Conclusions</h3><div>EOI following gastrectomy is associated with shorter hospitalization, yet its adoption remains low in Japan. Institutional factors and multidisciplinary collaboration may play crucial roles in promoting EOI. Findings may inform perioperative optimization and ERAS standardization in oncologic gastric surgery.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102352"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-10-28DOI: 10.1016/j.suronc.2025.102312
Giuseppe Giuliani, Francesco Guerra, Angela Tribuzi, Lorenzo De Franco, Erica Monati, Francesco Matarazzo, Michele Di Marino, Andrea Coratti
Backgraund
In recent years, robotic surgery for the treatment of esophageal cancer has expanded rapidly. In this study, we report on our standardized steps for RILE, including our perioperative outcomes.
Methods
The study includes every single step that we systematically perform during the abdominal and thoracic phases of the RILE. All consecutive patients undergoing RILE by a single surgical team were included in this analysis.
Results
A total of 68 patients were included in the analysis. There was one intraoperative complication and no conversion occurred. The rate of major postoperative complications (Clavien and Dindo > II) was 14 %: with anastomotic-related morbidity in particular, 4 (6 %) patients developed anastomotic leakage. The median number of harvested lymph nodes was 41 (range 13–113), while the rate of R0 resection was 97 %.
Conclusions
In our opinion our standardisation of RILE could help new surgical teams to start using a robotic approach for two field esophagectomy.
{"title":"Fully robotic Ivor Lewis Esophagectomy with side - to - side linear stapled anastomosis: our standardized 15 - step technique and perioperative outcomes","authors":"Giuseppe Giuliani, Francesco Guerra, Angela Tribuzi, Lorenzo De Franco, Erica Monati, Francesco Matarazzo, Michele Di Marino, Andrea Coratti","doi":"10.1016/j.suronc.2025.102312","DOIUrl":"10.1016/j.suronc.2025.102312","url":null,"abstract":"<div><h3>Backgraund</h3><div>In recent years, robotic surgery for the treatment of esophageal cancer has expanded rapidly. In this study, we report on our standardized steps for RILE, including our perioperative outcomes.</div></div><div><h3>Methods</h3><div>The study includes every single step that we systematically perform during the abdominal and thoracic phases of the RILE. All consecutive patients undergoing RILE by a single surgical team were included in this analysis.</div></div><div><h3>Results</h3><div>A total of 68 patients were included in the analysis. There was one intraoperative complication and no conversion occurred. The rate of major postoperative complications (Clavien and Dindo > II) was 14 %: with anastomotic-related morbidity in particular, 4 (6 %) patients developed anastomotic leakage. The median number of harvested lymph nodes was 41 (range 13–113), while the rate of R0 resection was 97 %.</div></div><div><h3>Conclusions</h3><div>In our opinion our standardisation of RILE could help new surgical teams to start using a robotic approach for two field esophagectomy.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102312"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Human epidermal growth factor receptor type2 (HER2)-low breast cancer has emerged as a clinically relevant subtype with novel HER2-targeted therapies. This study aimed to investigate the clinicopathological features and prognostic implications of HER2-low status in patients with early breast cancer undergoing long-term follow-up.
Methods
We retrospectively analyzed patients with HER2-negative early breast cancer who underwent surgery between 2003 and 2022. We investigated clinicopathological factors associated with HER2-low status and the clinical impacts of HER2-low/zero status on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) according to hormone receptor (HR) status using univariate and multivariate analyses.
Results
Among 3663 patients with early breast cancer, we identified 2519 HER2-negative patients (HER2-low 57%, HER2-zero 28%). HER2-low status was associated with high estrogen-receptor (ER) positivity (Allred score 8) and less mucinous histology, but there was no association with progesterone receptor (PgR) expression. HER2-low status also tended to be associated with pre/perimenopausal status and higher nuclear grade (≥2), but not with tumor size or lobular/metaplastic type. Pathological complete response rates after neoadjuvant chemotherapy were comparable between HER2-low (18.9%) and HER2-zero (21.6%), with no survival differences. HER2 status (low vs. zero) was not significantly associated with DFS, DDFS, or OS, and had no prognostic impact in patients with either HR-positive or -negative disease.
Conclusion
HER2-low breast cancer was characterized by distinct biological features, including high ER positivity (especially Allred score 8) without PgR association, but did not confer a prognostic advantage over HER2-zero disease. HER2-low status may reflect biological heterogeneity that could be relevant when interpreting treatment response rather than serving as an independent prognostic marker.
{"title":"Predictive factors and prognostic significance of HER2-low early breast cancer with long-term follow-up","authors":"Yuka Niwa , Mitsuo Terada , Yumi Wanifuchi-Endo , Takashi Fujita , Tomoko Asano , Hidetoshi Kawaguchi , Kazuki Nozawa , Nana Matsumoto , Ayaka Isogai , Hikaru Kawahara , Marie Mizumoto , Tatsuya Toyama","doi":"10.1016/j.suronc.2026.102360","DOIUrl":"10.1016/j.suronc.2026.102360","url":null,"abstract":"<div><h3>Background</h3><div>Human epidermal growth factor receptor type2 (HER2)-low breast cancer has emerged as a clinically relevant subtype with novel HER2-targeted therapies. This study aimed to investigate the clinicopathological features and prognostic implications of HER2-low status in patients with early breast cancer undergoing long-term follow-up.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with HER2-negative early breast cancer who underwent surgery between 2003 and 2022. We investigated clinicopathological factors associated with HER2-low status and the clinical impacts of HER2-low/zero status on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) according to hormone receptor (HR) status using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>Among 3663 patients with early breast cancer, we identified 2519 HER2-negative patients (HER2-low 57%, HER2-zero 28%). HER2-low status was associated with high estrogen-receptor (ER) positivity (Allred score 8) and less mucinous histology, but there was no association with progesterone receptor (PgR) expression. HER2-low status also tended to be associated with pre/perimenopausal status and higher nuclear grade (≥2), but not with tumor size or lobular/metaplastic type. Pathological complete response rates after neoadjuvant chemotherapy were comparable between HER2-low (18.9%) and HER2-zero (21.6%), with no survival differences. HER2 status (low vs. zero) was not significantly associated with DFS, DDFS, or OS, and had no prognostic impact in patients with either HR-positive or -negative disease.</div></div><div><h3>Conclusion</h3><div>HER2-low breast cancer was characterized by distinct biological features, including high ER positivity (especially Allred score 8) without PgR association, but did not confer a prognostic advantage over HER2-zero disease. HER2-low status may reflect biological heterogeneity that could be relevant when interpreting treatment response rather than serving as an independent prognostic marker.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102360"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Breast-conserving therapy requires a secure method to localize non-palpable lesions. The traditional and simple metal wire localization (WL) is challenged by more advanced and costly techniques that may have several advantages. We report the first European direct comparison between WL and SCOUT® Radar Localization (RL) comparing oncological and logistical benefits of implementing the new method in the treatment of non-palpable breast carcinomas including in situ lesions.
Methods
We retrospectively analyzed 150 breast cancer surgeries performed immediately before and after WL was replaced by RL in our unit. The last 50 wire-guided surgeries were compared to the initial 50 radar-guided surgeries (cohort I, implementation phase) and to the subsequent 50 radar-guided surgeries (cohort II, routine phase).
Results
All lesions and markers were successfully removed in all groups. No procedure-specific complications were registered. Of the 50 patients in the WL group, 8 % needed redo surgery due to positive margins, compared to 4 % in the RL groups (not statistically different). The histological margin was similar between the groups. The median time consumption during surgery was reduced by 26.5 min after establishing the radar localization method (p = 0.022). The resected tissue corresponded better with the marked area in the breast in the RL group (p = 0.026), as evaluated by a more central placement of the marker.
Conclusions
Radar localization of breast carcinomas is safe for women with non-palpable breast carcinomas including in situ lesions. The method reduces time consumption in the operating room and may give better surgical precision.
目的：保乳治疗需要一种安全的方法来定位不可触及的病变。传统和简单的金属丝定位（WL）正受到更先进和昂贵的技术的挑战，这些技术可能具有一些优势。我们报告了欧洲首次直接比较WL和SCOUT®雷达定位（RL），比较实施新方法治疗非可触及乳腺癌（包括原位病变）的肿瘤学和后勤效益。方法：我们回顾性分析了我们单位150例乳腺癌手术在WL被RL取代之前和之后立即进行的手术。将最后50例导线引导手术与最初的50例雷达引导手术（队列I，实施阶段）和随后的50例雷达引导手术（队列II，常规阶段）进行比较。结果：各组病变及标志物均成功切除。未发现手术并发症。在WL组的50例患者中，8%的患者因边缘阳性而需要重做手术，而RL组的这一比例为4%（无统计学差异）。两组间的组织学边缘相似。建立雷达定位方法后，手术中位耗时缩短26.5 min （p = 0.022）。RL组切除的组织与乳房标记区域的对应性更好（p = 0.026），通过标记更中心的位置来评估。结论：乳腺癌的雷达定位对于包括原位病变在内的非可触性乳腺癌是安全的。该方法减少了手术时间，提高了手术精度。
{"title":"SCOUT® radar localization of non-palpable breast carcinomas versus traditional wire-based localization: a single center retrospective comparison","authors":"Åse Florholmen-Kjær , Rica Mortensen , Vegard Heimly Brun","doi":"10.1016/j.suronc.2025.102324","DOIUrl":"10.1016/j.suronc.2025.102324","url":null,"abstract":"<div><h3>Purpose</h3><div>Breast-conserving therapy requires a secure method to localize non-palpable lesions. The traditional and simple metal wire localization (WL) is challenged by more advanced and costly techniques that may have several advantages. We report the first European direct comparison between WL and SCOUT® Radar Localization (RL) comparing oncological and logistical benefits of implementing the new method in the treatment of non-palpable breast carcinomas including in situ lesions.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 150 breast cancer surgeries performed immediately before and after WL was replaced by RL in our unit. The last 50 wire-guided surgeries were compared to the initial 50 radar-guided surgeries (cohort I, implementation phase) and to the subsequent 50 radar-guided surgeries (cohort II, routine phase).</div></div><div><h3>Results</h3><div>All lesions and markers were successfully removed in all groups. No procedure-specific complications were registered. Of the 50 patients in the WL group, 8 % needed redo surgery due to positive margins, compared to 4 % in the RL groups (not statistically different). The histological margin was similar between the groups. The median time consumption during surgery was reduced by 26.5 min after establishing the radar localization method (p = 0.022). The resected tissue corresponded better with the marked area in the breast in the RL group (p = 0.026), as evaluated by a more central placement of the marker.</div></div><div><h3>Conclusions</h3><div>Radar localization of breast carcinomas is safe for women with non-palpable breast carcinomas including in situ lesions. The method reduces time consumption in the operating room and may give better surgical precision.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102324"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145524296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2026-01-13DOI: 10.1016/j.suronc.2026.102351
A.M. Zaborowski , F. Wehrmann , J. McGarry , T. Harding , I. Balasubramanian , C. Spillane , L. Nolan , W. Eljack , E. Quinn , M. Corrigan , A. Lowery , M. Kerin , C. Power , M. Allen , A. Butt , A.D.K. Hill , D. Alazawi , T. Boyle , E. Connolly , A. Heeney , R.S. Prichard
Background
Axillary lymph node dissection (ALND) remains the standard of care in patients with a positive sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). The aim of this study was to determine the rate of non-sentinel lymph node metastases in patients undergoing completion ALND and to identify factors predictive of positive non-sentinel lymph nodes.
Methods
A retrospective multicentre study was performed. Patients with node-positive breast cancer who had a positive SLNB after NAC and underwent a completion ALND between 2016 and 2023 were included. Logistic regression analysis was used to identify factors predictive of positive non-sentinel lymph nodes.
Results
A total of 106 patients were included. The median age was 48 (29–74). The median number of sentinel lymph nodes (SLNs) removed was 3 (1–6) and the median number of positive SLNs was 2 (1–4). Forty-five patients (43 %) had additional positive lymph nodes at completion ALND. Additional positive nodes were identified in 53 % of patients with SLN metastases ≤2 mm and in 37 % with SLN metastases >2 mm. Final N stage was ypN1 in 81 patients (76.4 %), ypN2 in 16 (15.1 %) and ypN3 in 9 (8.5 %). ALND increased ypN stage in 20.8 % of patients (22/106). Extra-nodal extension (OR 2.34, C.I 1.06–5.20, p = 0.04) was the only factor associated with a higher likelihood of positive non-sentinel nodes.
Conclusion
In patients with a positive SLNB after NAC, 43 % had additional positive nodes. Extranodal extension was predictive of additional nodal disease. ALND increased the ypN stage in 21 %, mostly in patients with hormone-receptor positive and triple negative breast cancer which may have treatment implications.
背景：腋窝淋巴结清扫术（ALND）仍然是新辅助化疗（NAC）后前哨淋巴结活检（SLNB）阳性患者的标准护理。本研究的目的是确定完成ALND患者的非前哨淋巴结转移率，并确定预测非前哨淋巴结阳性的因素。方法：采用回顾性多中心研究。纳入了淋巴结阳性乳腺癌患者，这些患者在NAC后SLNB呈阳性，并在2016年至2023年间进行了完全性ALND。采用Logistic回归分析确定预测非前哨淋巴结阳性的因素。结果：共纳入106例患者。中位年龄为48岁（29-74岁）。切除前哨淋巴结（sln）的中位数为3(1-6)，阳性sln的中位数为2（1-4）。45例患者（43%）在完成ALND时有额外的阳性淋巴结。53%的SLN转移≤2mm的患者和37%的SLN转移≤2mm的患者发现了额外的阳性淋巴结。最终N分期为ypN1期81例（76.4%），ypN2期16例（15.1%），ypN3期9例（8.5%）。ALND增加了20.8%（22/106）患者的ypN分期。结外延伸（OR 2.34, ci 1.06-5.20, p = 0.04）是唯一与非前哨淋巴结阳性可能性较高相关的因素。结论：在NAC术后SLNB阳性的患者中，43%的患者有额外的阳性淋巴结。结外延伸可预测其他淋巴结疾病。ALND使ypN分期增加21%，主要发生在激素受体阳性和三阴性乳腺癌患者中，这可能具有治疗意义。
{"title":"The rate of non-sentinel lymph node metastases at axillary dissection in patients with a positive sentinel lymph node after neoadjuvant chemotherapy","authors":"A.M. Zaborowski , F. Wehrmann , J. McGarry , T. Harding , I. Balasubramanian , C. Spillane , L. Nolan , W. Eljack , E. Quinn , M. Corrigan , A. Lowery , M. Kerin , C. Power , M. Allen , A. Butt , A.D.K. Hill , D. Alazawi , T. Boyle , E. Connolly , A. Heeney , R.S. Prichard","doi":"10.1016/j.suronc.2026.102351","DOIUrl":"10.1016/j.suronc.2026.102351","url":null,"abstract":"<div><h3>Background</h3><div>Axillary lymph node dissection (ALND) remains the standard of care in patients with a positive sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). The aim of this study was to determine the rate of non-sentinel lymph node metastases in patients undergoing completion ALND and to identify factors predictive of positive non-sentinel lymph nodes.</div></div><div><h3>Methods</h3><div>A retrospective multicentre study was performed. Patients with node-positive breast cancer who had a positive SLNB after NAC and underwent a completion ALND between 2016 and 2023 were included. Logistic regression analysis was used to identify factors predictive of positive non-sentinel lymph nodes.</div></div><div><h3>Results</h3><div>A total of 106 patients were included. The median age was 48 (29–74). The median number of sentinel lymph nodes (SLNs) removed was 3 (1–6) and the median number of positive SLNs was 2 (1–4). Forty-five patients (43 %) had additional positive lymph nodes at completion ALND. Additional positive nodes were identified in 53 % of patients with SLN metastases ≤2 mm and in 37 % with SLN metastases >2 mm. Final N stage was ypN1 in 81 patients (76.4 %), ypN2 in 16 (15.1 %) and ypN3 in 9 (8.5 %). ALND increased ypN stage in 20.8 % of patients (22/106). Extra-nodal extension (OR 2.34, C.I 1.06–5.20, p = 0.04) was the only factor associated with a higher likelihood of positive non-sentinel nodes.</div></div><div><h3>Conclusion</h3><div>In patients with a positive SLNB after NAC, 43 % had additional positive nodes. Extranodal extension was predictive of additional nodal disease. ALND increased the ypN stage in 21 %, mostly in patients with hormone-receptor positive and triple negative breast cancer which may have treatment implications.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102351"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146031476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatoid adenocarcinoma (HAD) and adenocarcinoma with enteroblastic differentiation (ACED) are rare gastric cancer types that produce alpha-fetoprotein (AFP) that morphologically resembles the liver or fetal organ. This study investigated the molecular profiling of HAD and ACED compared with common-type gastric adenocarcinoma (CGA). This study enrolled 496 patients with gastric adenocarcinoma who underwent radical gastrectomy. Whole-exome sequencing and gene expression profiling were conducted to compare HAD/ACED and CGA. Immunohistochemistry was performed in 39 patients with HAD/ACED, including 10 who underwent genomic analysis. TP53 (100 %), CSMD3 (30 %), LRP1B, FAT3, TG, APOB, CREBBP, PASK, DROSHA, and STK40 (20 %) were mutated genes with high frequency (>20 %) in HAD/ACED. Gene expression analysis revealed 15 overexpressed genes in HAD/ACED, many of which were associated with hepatocytes and fetal organs. Furthermore, cancer stemness gene overexpression, including LIN28B, IGF2BP1, and HMGA2, which are related to TP53, was observed. Immunohistochemistry revealed positive staining for LIN28B (82 %), IGF2BP1 (94 %), and HMGA2 (72 %), as well as staining for AFP (69 %), GPC3 (75 %), and SALL4 (94 %). Additionally, positive cancer stemness gene staining was observed in CGA mucosa coexisting with HAD/ACED. HAD/ACED demonstrated higher TP53 mutation accumulation and TP53-related cancer stemness gene overexpression, including LIN28B, IGF2BP1, and HMGA2. Therefore, TP53 and these cancer stemness genes might be involved in the occurrence of HAD/ACED.
{"title":"Molecular profiling of hepatoid adenocarcinoma and adenocarcinoma with enteroblastic differentiation","authors":"Yosuke Matsumoto , Keiichi Hatakeyama , Masanori Terashima , Takeshi Nagashima , Kenichi Urakami , Tadakazu Shimoda , Takashi Sugino , Etsuro Bando , Hiroharu Yamashita , Yukiyasu Okamura , Ken Yamaguchi","doi":"10.1016/j.suronc.2025.102325","DOIUrl":"10.1016/j.suronc.2025.102325","url":null,"abstract":"<div><div>Hepatoid adenocarcinoma (HAD) and adenocarcinoma with enteroblastic differentiation (ACED) are rare gastric cancer types that produce alpha-fetoprotein (AFP) that morphologically resembles the liver or fetal organ. This study investigated the molecular profiling of HAD and ACED compared with common-type gastric adenocarcinoma (CGA). This study enrolled 496 patients with gastric adenocarcinoma who underwent radical gastrectomy. Whole-exome sequencing and gene expression profiling were conducted to compare HAD/ACED and CGA. Immunohistochemistry was performed in 39 patients with HAD/ACED, including 10 who underwent genomic analysis. <em>TP53</em> (100 %), <em>CSMD3</em> (30 %), <em>LRP1B, FAT3, TG, APOB, CREBBP, PASK, DROSHA</em>, and <em>STK40</em> (20 %) were mutated genes with high frequency (>20 %) in HAD/ACED. Gene expression analysis revealed 15 overexpressed genes in HAD/ACED, many of which were associated with hepatocytes and fetal organs. Furthermore, cancer stemness gene overexpression, including <em>LIN28B</em>, <em>IGF2BP1</em>, and <em>HMGA2</em>, which are related to <em>TP53</em>, was observed. Immunohistochemistry revealed positive staining for LIN28B (82 %), IGF2BP1 (94 %), and HMGA2 (72 %), as well as staining for AFP (69 %), GPC3 (75 %), and SALL4 (94 %). Additionally, positive cancer stemness gene staining was observed in CGA mucosa coexisting with HAD/ACED. HAD/ACED demonstrated higher <em>TP53</em> mutation accumulation and TP53-related cancer stemness gene overexpression, including <em>LIN28B</em>, <em>IGF2BP1</em>, and <em>HMGA2</em>. Therefore, <em>TP53</em> and these cancer stemness genes might be involved in the occurrence of HAD/ACED.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102325"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-01DOI: 10.1016/j.suronc.2025.102278
Hannah Götze , Stefan Niebisch , Matthias Mehdorn , Daniel Seehofer , Gertraud Stocker , Timm Denecke , Hans-Jonas Meyer
Introduction
Body composition including low skeletal muscle mass (LSMM) defined by skeletal muscle index (SMI) and subcutaneous and visceral adipose tissue (SAT and VAT) can be assessed using cross-sectional imaging techniques. Previous studies have shown promising prognostic value for several tumour entities, including esophageal cancer (EC). The aim of this study was to analyse possible associations of body composition parameters in patients with esophageal cancer undergoing curative treatment.
Methods
All patients with EC undergoing curative treatment were retrospectively evaluated between 2016 and 2023. A total of 145 patients (17 female, 11.7 %) with a mean age of 65.9 ± 10.2 years were included in the present analysis. For all patients, staging computed tomography (CT) was used to calculate LSMM, VAT, and SAT. The primary study end point was all-cause overall survival. For statistical analysis group differences were calculated using the Mann-Whitney test. Kaplan-Meier curves and multivariable Cox regression analysis was used to test the effect of body composition parameters on mortality.
Results
In total, 51 patients (35.2 %) of the patient cohort died within the observation period. According to the sarcopenia threshold of the SMI, 99 patients (68.2 %) were classified as sarcopenic and according to the VAT threshold, 102 patients (70.3 %) were classified as visceral obese. Sarcopenia and visceral obesity were associated with mortality with a hazard ratio (HR) of 2.05 (95%confidence interval (CI) 1.17, 3.57, p = 0.01) and 2.47 (95%CI 1.39, 4.37, p = 0.002) in univariable analysis, respectively. Only the combination of both, sarcopenic obesity was significantly associated in multivariable analysis (HR 2.47, 95 %CI 1.39; 4.37, p = 0.002)
Conclusions
The combination of CT-defined sarcopenia and visceral obesity showed a strong prognostic relevance in EC undergoing curative resection. The effect of sarcopenia and visceral obesity considered separately was of lesser prognostic significance. CT-defined body composition may help to better stratify patients with EC at risk of worse outcome in clinical practice.
身体组成，包括由骨骼肌指数（SMI）定义的低骨骼肌质量（LSMM）以及皮下和内脏脂肪组织（SAT和VAT），可以使用横断面成像技术进行评估。先前的研究显示了对包括食管癌（EC）在内的几种肿瘤实体的有希望的预后价值。本研究的目的是分析食管癌患者接受根治性治疗时身体成分参数的可能关联。方法回顾性分析2016年至2023年期间所有接受根治治疗的EC患者。共纳入145例患者，其中女性17例，占11.7%，平均年龄65.9±10.2岁。对于所有患者，分期计算机断层扫描（CT）用于计算LSMM， VAT和SAT。主要研究终点是全因总生存期。统计分析采用Mann-Whitney检验计算组间差异。采用Kaplan-Meier曲线和多变量Cox回归分析检验体成分参数对死亡率的影响。结果观察期内共有51例（35.2%）患者死亡。根据SMI的肌少症阈值，99例（68.2%）归为肌少症，根据VAT阈值，102例（70.3%）归为内脏型肥胖。单变量分析中，肌肉减少症和内脏肥胖与死亡率相关，风险比（HR）分别为2.05（95%可信区间（CI） 1.17, 3.57, p = 0.01）和2.47 （95%CI 1.39, 4.37, p = 0.002）。在多变量分析中，只有两者结合，肌肉减少性肥胖才有显著相关性（HR 2.47, 95% CI 1.39; 4.37, p = 0.002）。结论ct定义的肌肉减少症和内脏性肥胖的结合在行根治性切除的EC中显示出很强的预后相关性。单独考虑肌肉减少症和内脏性肥胖的影响，其预后意义较小。在临床实践中，ct定义的身体成分可能有助于更好地对预后较差的EC患者进行分层。
{"title":"Prognostic relevance of CT-defined body composition in esophageal cancer patients undergoing curative treatment","authors":"Hannah Götze , Stefan Niebisch , Matthias Mehdorn , Daniel Seehofer , Gertraud Stocker , Timm Denecke , Hans-Jonas Meyer","doi":"10.1016/j.suronc.2025.102278","DOIUrl":"10.1016/j.suronc.2025.102278","url":null,"abstract":"<div><h3>Introduction</h3><div>Body composition including low skeletal muscle mass (LSMM) defined by skeletal muscle index (SMI) and subcutaneous and visceral adipose tissue (SAT and VAT) can be assessed using cross-sectional imaging techniques. Previous studies have shown promising prognostic value for several tumour entities, including esophageal cancer (EC). The aim of this study was to analyse possible associations of body composition parameters in patients with esophageal cancer undergoing curative treatment.</div></div><div><h3>Methods</h3><div>All patients with EC undergoing curative treatment were retrospectively evaluated between 2016 and 2023. A total of 145 patients (17 female, 11.7 %) with a mean age of 65.9 ± 10.2 years were included in the present analysis. For all patients, staging computed tomography (CT) was used to calculate LSMM, VAT, and SAT. The primary study end point was all-cause overall survival. For statistical analysis group differences were calculated using the Mann-Whitney test. Kaplan-Meier curves and multivariable Cox regression analysis was used to test the effect of body composition parameters on mortality.</div></div><div><h3>Results</h3><div>In total, 51 patients (35.2 %) of the patient cohort died within the observation period. According to the sarcopenia threshold of the SMI, 99 patients (68.2 %) were classified as sarcopenic and according to the VAT threshold, 102 patients (70.3 %) were classified as visceral obese. Sarcopenia and visceral obesity were associated with mortality with a hazard ratio (HR) of 2.05 (95%confidence interval (CI) 1.17, 3.57, p = 0.01) and 2.47 (95%CI 1.39, 4.37, p = 0.002) in univariable analysis, respectively. Only the combination of both, sarcopenic obesity was significantly associated in multivariable analysis (HR 2.47, 95 %CI 1.39; 4.37, p = 0.002)</div></div><div><h3>Conclusions</h3><div>The combination of CT-defined sarcopenia and visceral obesity showed a strong prognostic relevance in EC undergoing curative resection. The effect of sarcopenia and visceral obesity considered separately was of lesser prognostic significance. CT-defined body composition may help to better stratify patients with EC at risk of worse outcome in clinical practice.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102278"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01Epub Date: 2025-09-11DOI: 10.1016/j.suronc.2025.102291
Vincent Hoffmann, Martina Dellino, Henning Bahlburg, Moritz Reike, Analena Elisa Handke, Peter Bach, Joachim Noldus, Florian Roghmann, Karl Tully
Introduction & objectives
The main obstacles to the broad application of neoadjuvant chemotherapy for locally advanced upper tract urothelial cancer(UTUC) are uncertainties regarding the accuracy of preoperative diagnostics. This study aimed to examine the predictive value of preoperative diagnostic results regarding the histopathologic findings at the time of radical nephroureterectomy (RNU).
Material & methods
An institutional dataset of patients undergoing RNU for suspected UTUC between 01/2018 and 12/2023 was analyzed. We examined the preoperative utilization of different diagnostic means and their predictive value in detecting locally advanced(i.e., ≥T2) disease. Separate uni-and multivariable logistic regression models were employed to examine the association between preoperative findings and final histology.
Results
At the time of RNU, 64.4 %(n = 74) of patients were diagnosed with ≥T2 disease. Out of 115 patients, 41.7 % underwent RNU based on cross-sectional imaging findings alone, thirty of whom had undergone a prior endourologic diagnostic workup without evidence of UTUC(62.5 %). There were no false-positive diagnoses of UTUC. On multivariable logistic regression and consecutive receiver operating characteristic(ROC) analysis, only a tumor size ≥1.9 cm during cross-sectional imaging was associated with advanced disease(OR 2.99, 95 %CI 1.65–5.43, p < 0.001).
Conclusion
In this cohort of patients undergoing RNU for suspected UTUC, only tumor size during cross-sectional imaging was associated with advanced disease. These results support the notion of tumor size as an independent risk factor, which may, in turn, guide further treatment decisions.
前言与目的：新辅助化疗广泛应用于局部晚期上尿路上皮癌（UTUC）的主要障碍是术前诊断准确性的不确定性。本研究旨在探讨术前诊断结果对根治性肾输尿管切除术（RNU）时组织病理学表现的预测价值。材料与方法：对2018年1月至2023年12月间因疑似UTUC接受RNU治疗的机构数据集进行分析。我们检查了术前不同诊断手段的使用情况，以及它们在检测局部晚期（即恶性肿瘤）中的预测价值。≥T2)疾病。采用单独的单变量和多变量logistic回归模型来检查术前发现与最终组织学之间的关系。结果：RNU时，64.4% （n = 74）的患者诊断为≥T2病变。在115例患者中，41.7%的患者仅根据横断面成像结果接受了RNU，其中30例患者在没有UTUC证据的情况下进行了先前的泌尿系统诊断检查（62.5%）。无UTUC假阳性诊断。在多变量logistic回归和连续受试者工作特征（ROC）分析中，只有在横断成像时肿瘤大小≥1.9 cm与疾病晚期相关（OR 2.99, 95% CI 1.65-5.43, p）。结论：在这组因疑似UTUC而行RNU的患者中，只有横断成像时肿瘤大小与疾病晚期相关。这些结果支持肿瘤大小作为独立危险因素的概念，这可能反过来指导进一步的治疗决策。
{"title":"The utility of preoperative diagnostics in patients undergoing radical nephroureterectomy for suspected upper tract urothelial carcinoma: Can we justify treatment without prior histologic confirmation?","authors":"Vincent Hoffmann, Martina Dellino, Henning Bahlburg, Moritz Reike, Analena Elisa Handke, Peter Bach, Joachim Noldus, Florian Roghmann, Karl Tully","doi":"10.1016/j.suronc.2025.102291","DOIUrl":"10.1016/j.suronc.2025.102291","url":null,"abstract":"<div><h3>Introduction & objectives</h3><div>The main obstacles to the broad application of neoadjuvant chemotherapy for locally advanced upper tract urothelial cancer(UTUC) are uncertainties regarding the accuracy of preoperative diagnostics. This study aimed to examine the predictive value of preoperative diagnostic results regarding the histopathologic findings at the time of radical nephroureterectomy (RNU).</div></div><div><h3>Material & methods</h3><div>An institutional dataset of patients undergoing RNU for suspected UTUC between 01/2018 and 12/2023 was analyzed. We examined the preoperative utilization of different diagnostic means and their predictive value in detecting locally advanced(i.e., ≥T2) disease. Separate uni-and multivariable logistic regression models were employed to examine the association between preoperative findings and final histology.</div></div><div><h3>Results</h3><div>At the time of RNU, 64.4 %(n = 74) of patients were diagnosed with ≥T2 disease. Out of 115 patients, 41.7 % underwent RNU based on cross-sectional imaging findings alone, thirty of whom had undergone a prior endourologic diagnostic workup without evidence of UTUC(62.5 %). There were no false-positive diagnoses of UTUC. On multivariable logistic regression and consecutive receiver operating characteristic(ROC) analysis, only a tumor size ≥1.9 cm during cross-sectional imaging was associated with advanced disease(OR 2.99, 95 %CI 1.65–5.43, p < 0.001).</div></div><div><h3>Conclusion</h3><div>In this cohort of patients undergoing RNU for suspected UTUC, only tumor size during cross-sectional imaging was associated with advanced disease. These results support the notion of tumor size as an independent risk factor, which may, in turn, guide further treatment decisions.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102291"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mesenteric caudal right approach to the superior mesenteric artery in robotic pancreaticoduodenectomy","authors":"Yutaka Nakano, Yosuke Uematsu, Minoru Kitago, Yuko Kitagawa","doi":"10.1016/j.suronc.2025.102277","DOIUrl":"10.1016/j.suronc.2025.102277","url":null,"abstract":"","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102277"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"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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