Digestive Surgery最新文献

{"title":"Are a Dilated Cecum and Small Bowel Distention on CT Imaging Associated with Worse Postoperative Outcomes in Left-Sided Obstructive Colon Cancer? A Population-Based Study.","authors":"Bas A J Kertzman, Femke J Amelung, Esther C J Consten, Pieter J Tanis, Werner A Draaisma","doi":"10.1159/dsu/acoag008","DOIUrl":"10.1159/dsu/acoag008","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate whether a dilated cecum (≥9 cm) and small-bowel distention on preoperative CT are associated with worse postoperative outcomes in patients with left-sided obstructive colon cancer (LSOCC) undergoing an emergency resection (ER) or a bridge-to-surgery (BTS).</p><p><strong>Methods: </strong>A national multicenter cohort study was conducted using data from a prospective audit performed in 75 Dutch hospitals. Patients undergoing curative resection for LSOCC (2009-2016) with available CT data on cecal diameter and small-bowel distention were included. Primary outcomes were 90-day postoperative complications and mortality, analyzed by multivariable logistic regression and stratified by treatment strategy (ER vs. BTS).</p><p><strong>Results: </strong>Of 1,282 patients, 967 underwent ER and 315 BTS. Among ER patients, concurrent cecal dilatation (≥9 cm) and small-bowel distention were independently associated with higher 90-day complications (58.8% vs. 42.7%; OR 1.91, 95% CI: 1.25-2.93; p = 0.003) and 30-day mortality (7.0% vs. 2.7%; p = 0.038). These associations were absent in BTS patients. In this high-risk CT subgroup, BTS yielded fewer complications (37.4% vs. 58.8%), lower permanent stoma rates (23.0% vs. 52.1%), and higher primary anastomosis rates (85.4% vs. 30.6%). In young (<70 years) and healthy patients (ASA I-II) without a dilated coecum or small bowel on CT, no outcome differences were found between ER and BTS.</p><p><strong>Conclusion: </strong>Concurrent cecal dilatation and small-bowel distention on CT identify high-risk patients after ER, whereas BTS mitigates these risks. Routine CT-assessment may aid individualized management.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126779","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Persistent Gender Gaps on Editorial Boards of Digestive Diseases Journals: A Cross-Sectional Study.","authors":"Amélie Christen, Elin Meyer, Emilie Liot, Guillaume Meurette, Frédéric Ris, Christian Toso, Jeremy Meyer","doi":"10.1159/dsu/acoag007","DOIUrl":"10.1159/dsu/acoag007","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the growing proportion of women in medicine, gender disparities persist in academic leadership. Editorial board membership is a key indicator of academic influence, yet data on gender representation in digestive surgery and gastroenterology journals remain limited.</p><p><strong>Methods: </strong>Journals in general surgery, digestive surgery, and gastroenterology were identified using the Clarivate database. Data collected in November 2024 included gender distribution across editorial roles, Journal Impact Factor (JIF), and the h-index of editors-in-chief. Journals with a JIF <2, non-English language, nonrelevant specialty focus, or unknown editor gender were excluded. Statistical analyses were performed using GraphPad Prism, with significance set at p < 0.05.</p><p><strong>Results: </strong>A total of 124 journals comprising 2,542 editors were analyzed. Women represented 18% of editorial board members overall and only 10% of editors-in-chief. Twenty-four journals had no female representation. Female representation was higher among deputy and associate editors but remained lower than that of men. No significant differences were observed between surgical and gastroenterology journals. A positive association was found between JIF and the proportion of women on editorial boards (p = 0.0009). Female editors-in-chief had a lower mean h-index than male editors-in-chief.</p><p><strong>Conclusion: </strong>Women remain markedly underrepresented on editorial boards of digestive surgery and gastroenterology journals, particularly in leadership roles. Although higher impact journals show modestly greater female representation, substantial gender inequities persist.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Management of Pancreatic Fistula after Pancreatic Surgery.","authors":"Theresa Angles, Guido Alsfasser","doi":"10.1159/dsu/acoag006","DOIUrl":"10.1159/dsu/acoag006","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistula is a complex and dreaded complication after pancreatic surgery. Its management is complex and dependent on clinical presentation and severity, and clear guidelines are often lacking.</p><p><strong>Summary: </strong>This review aims to present the current evidence-based strategies for mitigating the deleterious effects of POPF in the peri- and postoperative setting. Therapy of pancreatic fistula clearly means treatment of complications. Therefore, we discuss medical, interventional and surgical approaches for the management of POPF and its related complications. Furthermore, we discuss surgical as well as physical and chemical intra-operative techniques to prevent POPF.</p><p><strong>Key message: </strong>Evidence-based strategies are necessary to further reduce morbidity and mortality following pancreatic surgery and improve overall quality of care.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic Bariatric Surgery: A Critical Review of Clinical Outcomes, Learning Curves, and Economic Considerations.","authors":"Nikheel Patel, Michael A Glaysher, Nicolas Carter, Gijs van Boxel","doi":"10.1159/dsu/acoag003","DOIUrl":"10.1159/dsu/acoag003","url":null,"abstract":"<p><strong>Background: </strong>Robotic platforms have been increasingly adopted in bariatric surgery with the aim of overcoming technical limitations of conventional laparoscopy, particularly during complex reconstructive steps such as intracorporeal suturing and multi-quadrant dissection. Despite the rapid expansion of robotic bariatric surgery (RBS), uncertainty remains regarding its clinical value relative to established laparoscopic techniques.</p><p><strong>Summary: </strong>This review critically evaluates the current evidence comparing robotic Roux-en-Y gastric bypass (RRYGB) and robotic sleeve gastrectomy (RSG) with their laparoscopic counterparts. Recent meta-analyses and large registry studies demonstrate broadly comparable perioperative outcomes between RRYGB and laparoscopic RYGB (LRYGB) across major clinical endpoints. Modest advantages for RRYGB have been reported in selected intraoperative and postoperative measures, including reduced anastomotic stricture rates, reduced marginal ulceration, reduced blood loss, lower conversion rates, and improved recovery in higher-risk patient groups such as in revisional surgery and high-BMI patients. However, these findings are inconsistent and largely derived from retrospective observational studies with heterogeneous methodology and limited long-term follow-up. In contrast, current evidence does not demonstrate clear clinical advantages for RSG over laparoscopic sleeve gastrectomy (LSG), and in fact suggest inferiority in terms of short-term outcomes. Although temporal analyses suggest improvement in robotic outcomes over time, similar trends have been noted in laparoscopic cohorts, suggesting broader improvements in perioperative bariatric care. Economic analyses consistently report higher procedural costs for robotic approaches, driven primarily by operative time and consumable expenditure, although these differences may decrease with transition to totally robotic techniques, increasing institutional experience and workflow optimisation in high-volume centres.</p><p><strong>Key messages: </strong>Robotic bariatric surgery achieves outcomes comparable to laparoscopy but currently demonstrates selective advantages primarily in complex procedures such as RYGB and revisional surgery. The role of robotics in routine sleeve gastrectomy remains uncertain. Higher procedural costs and limited high-quality comparative data spanning different time periods continue to limit the ability to draw definitive conclusions. Future research should prioritise multicentre randomised trials, standardised reporting frameworks, and comprehensive economic evaluation across different emerging robotic platforms with consideration of learning curve effects.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exocrine Pancreatic Insufficiency and Nutritional Status in Patients with Resectable and Borderline Resectable Periampullary Tumors: A Prospective Longitudinal Study.","authors":"Eric Herrero Fonollosa, Laura Sobrerroca Porras, Montse Ibarra, Maria-José Barahona, Judith Camps-Lasa, Maria Galofré-Recasens, Aurora Rodríguez Campos, Salvadora Delgado Rivilla, Esteban Cugat Andorrà, Maria Isabel García Domingo","doi":"10.1159/dsu/acoag004","DOIUrl":"10.1159/dsu/acoag004","url":null,"abstract":"<p><strong>Introduction: </strong>Exocrine pancreatic insufficiency (EPI) and malnutrition are prevalent but systematically underestimated in patients with periampullary tumors.</p><p><strong>Methods: </strong>This is a prospective observational single-center study. Thirty-two patients with potentially resectable periampullary tumors underwent nutritional assessment including fecal elastase-1 (FE-1), psoas muscle index (PMI) on CT, bioelectrical impedance analysis with phase angle, and handgrip strength. Postoperative complications, Textbook Outcome (TO), and nutritional follow-up at 1, 3, and 6 months were assessed in 23 resected patients.</p><p><strong>Results: </strong>This study found EPI (FE-1 <200 μg/g) was present in 76.9% (20/26) of patients. Prealbumin was <20 mg/dL in 62.1% and vitamin D deficient in 82.8%, despite normal albumin in most patients. Sarcopenia by PMI was detected in 53.1% (17/32) of the full preoperative cohort, substantially higher than handgrip strength alone (15-17%). After resection, universal EPI (100%) was confirmed. TO was achieved in 73.9% (17/23) of patients. Median weight declined from 64.0 kg preoperatively to 61.2 kg at 6 months; cumulative weight loss from pre-illness habitual weight reached 18.5% at 6 months, of which 9.2% had already occurred before surgery. Vitamin D deficit persisted throughout follow-up; sarcopenia was numerically higher at 1 month (68.8%), with values returning toward baseline by 6 months (65.2%).</p><p><strong>Conclusion: </strong>Patients with periampullary tumors present a severe, multidimensional preoperative nutritional burden more prevalent than recognized. Systematic assessment should be incorporated into standard protocols within a structured multidisciplinary perioperative pathway.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148905309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Harmonic Scalpel Hemorrhoidectomy versus Stapled Hemorrhoidopexy in Grade III / IV Hemorrhoids: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Cayo Ferreira Arantes de Oliveira, Marcelo Albuquerque Barbosa Martins, Fatemeh Akbarpoor, Milena Dias da Silva, Fernanda Bellotti Formiga, Vincent de Parades, Ugo Grossi","doi":"10.1159/dsu/acoag005","DOIUrl":"10.1159/dsu/acoag005","url":null,"abstract":"<p><strong>Introduction: </strong>Third- and fourth-degree hemorrhoids often require surgery due to prolapse, bleeding and discomfort. Among the available procedures, there is no consensus on which surgical technique offers better results. This systematic review with meta-analysis aims to compare harmonic scalpel hemorrhoidectomy (HSH) versus stapled hemorrhoidopexy (SH).</p><p><strong>Methods: </strong>A search was conducted in the PubMed, Scopus, and Cochrane Library databases. Inclusion criteria were (a) randomized controlled trials, (b) comparing HSH and SH, (c) in patients with grade III/IV hemorrhoids, and (d) reporting at least one outcome of interest. Statistical analyses were performed in Review Manager 5.4.1 and RStudio, using a random-effects model to calculate the risk ratio and mean differences with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>We included six randomized controlled trials with a total of 375 patients. HSH was associated with a lower recurrence compared to SH. However, there were no significant differences in bleeding, fecal incontinence, operative time, hospital stay, and urinary retention. SH group was associated with less postoperative severe pain and overall pain.</p><p><strong>Conclusion: </strong>HSH and SH are comparable in the treatment of grade III/IV hemorrhoids, analyzing postoperative bleeding, fecal incontinence, operative time, hospital stay, and urinary retention. However, SH presented less severe and overall pain, showing better results in the short term and HSH presented lower recurrence, highlighting as a better outcome in the long term.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adaptive Anastomosis for Anterior Resection in Sigmoid and Proximal Rectal Cancer or Premalignant Lesions: Protocol for a Multicentre, Non-Randomised, Clinical Effectiveness Trial (ADAPT).","authors":"Lodi Grosheide, Wytze Laméris, Jurriaan Tuynman, André D'Hoore, Roel Hompes","doi":"10.1159/dsu/acoag002","DOIUrl":"10.1159/dsu/acoag002","url":null,"abstract":"<p><strong>Introduction: </strong>Anastomotic leakage (AL) after colorectal surgery is an impactful complication, associated with increased morbidity and reduced quality of life. The circular stapler commonly used for anterior resections (AR), introduces risks of cross-stapling, dog-ears, overcompression, and foreign body response, all associated with AL. An adaptive anastomosis technique eliminates these risk factors, potentially lowering the incidence of AL.</p><p><strong>Methods: </strong>The ADAPT trial is an international multicentre, non-randomised, prospective clinical effectiveness trial evaluating the clinical safety and efficacy of the C-REX adaptive anastomosis in minimally invasive AR. 165 Patients with proximal rectum or sigmoid cancer, or premalignant lesions requiring AR will be enrolled throughout multiple European colorectal centres. An adaptive colorectal anastomosis will be constructed using the C-REX RectoAid Cath. The primary endpoint is 30-day AL rate. Secondary endpoints include 90-day AL, 1-year anastomotic integrity, intraoperative performance of the C-REX device, time to evacuation of the anastomotic ring, postoperative morbidity, functional outcomes, cost-effectiveness, and surgical quality assessment.</p><p><strong>Conclusion: </strong>The ADAPT trial will evaluate whether an adaptive anastomotic technique using the C-REX RectoAid Cath, designed to eliminate key technical risk factors, reduces AL after colorectal AR in an international multicentre setting. The findings could guide strategies to improve postoperative outcomes and reduce leakage-related morbidity.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148789478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal Cancer and Advanced Neoplasia in Patients with Esophageal Squamous Cell Carcinoma: A Retrospective Cohort Study Using Fecal Occult Blood Test-Positive Controls.","authors":"Yuichi Hirano, Yasushi Yamasaki, Kenta Hamada, Yoshiyasu Kono, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Kazuhiro Noma, Motoyuki Otsuka","doi":"10.1159/dsu/acoag001","DOIUrl":"10.1159/dsu/acoag001","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with esophageal squamous cell carcinoma (SCC) may be more likely to harbor colorectal cancer (CRC) because of shared lifestyle risk factors such as smoking and alcohol. However, its prevalence and clinical significance remain unclear. We evaluated prevalence and risk factors for colorectal advanced neoplasia (CAN) and CRC in patients with esophageal SCC and compared them with fecal occult blood test (FOBT)-positive controls.</p><p><strong>Methods: </strong>We retrospectively analyzed 457 patients with esophageal SCC who underwent colonoscopy between 2017 and 2024. CRC was defined as colorectal adenocarcinoma invading the submucosal layer or beyond. CAN was defined as a ≥10-mm lesion, high-grade dysplasia, villous histology, or CRC. Risk factors were assessed using logistic regression. Propensity score matching (PSM) compared incidence of CAN and CRC with FOBT-positive controls matched for age, sex, and body mass index (caliper = 0.05).</p><p><strong>Results: </strong>Among patients with esophageal SCC, 25.4% had CAN and 10.3% had CRC. Brinkman Index (OR 1.02, 95% CI 1.00-1.04) and alcohol history (OR 2.60, 95% CI 1.13-5.97) were independently associated with CAN (p = 0.048 and 0.025), while no variable was associated with CRC in multivariate analysis. After PSM (135 matched pairs; all standardized mean difference <0.1), CRC incidence remained significantly higher in SCC than the FOBT-positive group (OR 3.79, 95% CI 1.21-11.8; p = 0.015), whereas CAN incidence did not differ.</p><p><strong>Conclusions: </strong>Patients with esophageal SCC had a higher prevalence of CRC compared with the FOBT-positive group after PSM. Lifestyle factors were linked to CAN but not CRC. Colonoscopy should be considered in patients with esophageal SCC.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1"},"PeriodicalIF":1.2,"publicationDate":"2026-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148721781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of Proctored Learning Curve in Upper Gastrointestinal Robotic Surgery.","authors":"Franco Badaloni, Mauricio G Ramirez, David Solinas, Federico Saba Zotto, Nicole Miraglia, Clara Llamosas, Adolfo E Badaloni, Richard van Hillegersberg, Jelle P Ruurda, Alejandro Nieponice","doi":"10.1159/000553630","DOIUrl":"10.1159/000553630","url":null,"abstract":"<p><strong>Introduction: </strong>Safe implementation of robotic upper gastrointestinal surgery requires an optimized learning process. We report the initial experience, outcomes and learning curve of a team introducing this technique in Argentina through the Upper GI International Robotic Association (UGIRA) structured training pathway.</p><p><strong>Methods: </strong>Consecutive patients who underwent robotic upper gastrointestinal surgery using the Da Vinci Xi® system were included from a prospective database. All procedures were performed by a single console surgeon, proctored by an experienced team from UMC Utrecht. Proctoring was performed on-site or remotely via telementoring system. The learning curve plateau was assessed using CUSUM analysis for operative time and lymph node yield.</p><p><strong>Results: </strong>Between 2022 and 2026, 66 robotic upper gastrointestinal procedures were performed by our team, including 26 esophagectomies (RAMIE), 8 total gastrectomies, and 32 benign procedures. No major complications, conversions, or mortality occurred in the benign group. In the RAMIE cohort, major complications (Clavien-Dindo ≥III) occurred in 34.6% of patients, with an anastomotic leak rate of 15.4% and a single case of 30-day mortality (3.8%). R0 resection was achieved in 96.2% of cases, with a median lymph node yield of 26 (interquartile range [IQR] 22-32). In the gastrectomy group, major complications occurred in 25.0% of patients, with no anastomotic leaks or mortality, and a median lymph node yield of 28 nodes (IQR 26-32). CUSUM analysis for RAMIE identified an operative time plateau at case 7 and a lymph node yield trough at case 18.</p><p><strong>Conclusion: </strong>This study reports the initial implementation of robotic upper gastrointestinal surgery in Argentina following the UGIRA structured training pathway enhanced by telementoring. Despite limited case volume and follow-up, the approach appears feasible and safe, with acceptable short-term perioperative and oncologic outcomes.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-11"},"PeriodicalIF":1.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Dilemma of Vanishing Lesions after Systemic Therapy in Oligometastatic Esophagogastric Cancer: A Narrative Review.","authors":"Sebastiaan F C Bronzwaer, Iris van Haarlem, Tiuri E Kroese, Hanneke W M van Laarhoven, Jelle P Ruurda, Richard van Hillegersberg, Peter S N van Rossum","doi":"10.1159/000553588","DOIUrl":"10.1159/000553588","url":null,"abstract":"<p><strong>Background: </strong>Radical local metastasis-directed treatment is increasingly considered in oligometastatic cancer. Disappearance of metastases after systemic therapy (\"vanishing lesions\") poses management dilemmas, as invisibility does not prove complete response, but local therapy carries morbidity.</p><p><strong>Summary: </strong>We searched PubMed for studies on vanishing metastases after systemic therapy in esophagogastric cancer. Complete disappearance of all metastases occurred in 1-3% of patients treated with chemotherapy alone and in 5-17% in trials using targeted or immune therapies. Series reported ≥1 vanishing lesion(s) in 8-44% of patients. Definitions relied on CT, without comparison to MRI or PET-CT. Lesion-level pathology was lacking; vanishing sites were not resected. Survival benefits were linked to radiologic complete response, but the impact of locally treating vanishing sites was not studied. Because esophagogastric data are scarce, colorectal metastases were reviewed for context: CT disappearance often overestimated cure, liver MRI frequently altered plans, 33-69% of CT/MRI-negative liver lesions still harbored viability or recurred, and survival was comparable between unresected vs. resected vanishing lesions.</p><p><strong>Key messages: </strong>Current evidence does not support routine local treatment of vanishing lesions in oligometastatic esophagogastric cancer, although this conclusion is based on a very limited and retrospective evidence base. Imaging besides CT (e.g., MRI, PET-CT) may improve staging. Individualized benefit-risk assessment and studies addressing diagnostic and therapeutic strategies are needed.</p>","PeriodicalId":11241,"journal":{"name":"Digestive Surgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.2,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148445185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}