Ejso最新文献

{"title":"T3 gallbladder cancer: surgical outcomes according to the mode of tumor spread and treatment considerations for oncological resectability","authors":"Yusuke Kawachi ,&nbsp;Jun Sakata ,&nbsp;Tatsuya Nomura ,&nbsp;Kabuto Takano ,&nbsp;Takuya Ando ,&nbsp;Koji Toge ,&nbsp;Yuki Hirose ,&nbsp;Kazuyasu Takizawa ,&nbsp;Hirosuke Ishikawa ,&nbsp;Shun Abe ,&nbsp;Hiroshi Ichikawa ,&nbsp;Yoshifumi Shimada ,&nbsp;Takashi Kobayashi ,&nbsp;Toshifumi Wakai","doi":"10.1016/j.ejso.2025.110457","DOIUrl":"10.1016/j.ejso.2025.110457","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to clarify surgical outcomes for patients with pT3 gallbladder cancer according to the mode of tumor spread.</div></div><div><h3>Methods</h3><div>A total of 85 patients with pT3 gallbladder cancer who underwent curative-intent surgery were analyzed. Each tumor was classified according to the mode of spread.</div></div><div><h3>Results</h3><div>Five-year overall survival (OS) in patients with involvement of the liver alone (n = 25), involvement of the extrahepatic bile duct alone (n = 29), involvement of one other organ/structure alone or perforation of the peritoneal side of the serosa alone (n = 9), and involvement of both the liver and one other organ/structure (n = 22) was 36.0%, 29.0%, 22.2%, and 9.1%, respectively. For patients with involvement of the liver alone, 5-year OS was &gt; 30% regardless of type of hepatectomy. Among 29 patients with involvement of the extrahepatic bile duct alone, 8 patients survived ≥ 5 years; 3 underwent extended cholecystectomy and 5 underwent more extensive resection. Despite performing extensive resection, 5-year OS was 12.5% for patients with involvement of both the liver and one other organ/structure. The mode of spread other than involvement of the liver alone or extrahepatic bile duct alone was an independent predictor of worse OS (hazard ratio 1.675; p = 0.046).</div></div><div><h3>Conclusions</h3><div>Surgery is an acceptable option for pT3 gallbladder cancer with involvement of the liver alone or extrahepatic bile duct alone regardless of the type of resection procedure. However, the survival benefit of surgery is limited for this tumor with other modes of spread.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110457"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AGO Breast Commission recommendations for the surgical therapy of breast cancer: Working Group on Gynecologic Cancers (AGO) update 2025","authors":"Toralf Reimer ,&nbsp;Thorsten Kuehn ,&nbsp;Volkmar Mueller ,&nbsp;Nina Ditsch ,&nbsp;Tanja Fehm ,&nbsp;Ute-Susann Albert ,&nbsp;Rupert Bartsch ,&nbsp;Ingo Bauerfeind ,&nbsp;Vesna Bjelic-Radisic ,&nbsp;Jens-Uwe Blohmer ,&nbsp;Wilfried Budach ,&nbsp;Peter Dall ,&nbsp;Eva Maria Fallenberg ,&nbsp;Peter A. Fasching ,&nbsp;Michael Friedrich ,&nbsp;Bernd Gerber ,&nbsp;Oleg Gluz ,&nbsp;Nadia Harbeck ,&nbsp;Andreas Hartkopf ,&nbsp;Joerg Heil ,&nbsp;Marc Thill","doi":"10.1016/j.ejso.2025.110445","DOIUrl":"10.1016/j.ejso.2025.110445","url":null,"abstract":"<div><div>The German Guideline Commission (AGO: Working Group on Gynecologic Cancers) updated its recommendations on the diagnosis and treatment of breast cancer in March 2025. Chapters on oncological and oncoplastic-reconstructive surgery are coordinated with the Working Group for Plastic, Aesthetic, and Reconstructive Surgery in Gynecology (AWOgyn). The most important changes include the incorporation of INSEMA and SOUND trial results into the guidelines. In patients with low-risk characteristics, defined as age ≥50 years, postmenopausal status, hormone receptor-positive/HER2-negative subtype, tumor grading G1-2 with a maximum preoperative size of 2 cm, and unsuspicious axillary ultrasound and clinical examination, the sentinel lymph node biopsy (SLNB) can be omitted if breast-conserving surgery and whole-breast irradiation are planned. In patients with 1–2 macrometastatic sentinel lymph nodes (SLNs) undergoing a mastectomy and postoperative irradiation, completion axillary lymph node dissection (ALND) is no longer recommended. After neoadjuvant systemic therapy (NST), ALND is recommended if the targeted axillary dissection (TAD) shows macrometastases in the sentinel and/or in the target lymph node (the node that was marked and had a macrometastasis in the biopsy before NST). Patients with isolated tumor cells in the sentinel and/or target lymph node should not receive ALND after NST. In case of ypN1mi status, the decision to perform a completion ALND should be made on a case-by-case basis. Oncoplastic surgery is safe and may replace a mastectomy in select cases.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110445"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"T3 gallbladder cancer: surgical outcomes according to the mode of tumor spread and treatment considerations for oncological resectability","authors":"Yusuke Kawachi ,&nbsp;Jun Sakata ,&nbsp;Tatsuya Nomura ,&nbsp;Kabuto Takano ,&nbsp;Takuya Ando ,&nbsp;Koji Toge ,&nbsp;Yuki Hirose ,&nbsp;Kazuyasu Takizawa ,&nbsp;Hirosuke Ishikawa ,&nbsp;Shun Abe ,&nbsp;Hiroshi Ichikawa ,&nbsp;Yoshifumi Shimada ,&nbsp;Takashi Kobayashi ,&nbsp;Toshifumi Wakai","doi":"10.1016/j.ejso.2025.110457","DOIUrl":"10.1016/j.ejso.2025.110457","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to clarify surgical outcomes for patients with pT3 gallbladder cancer according to the mode of tumor spread.</div></div><div><h3>Methods</h3><div>A total of 85 patients with pT3 gallbladder cancer who underwent curative-intent surgery were analyzed. Each tumor was classified according to the mode of spread.</div></div><div><h3>Results</h3><div>Five-year overall survival (OS) in patients with involvement of the liver alone (n = 25), involvement of the extrahepatic bile duct alone (n = 29), involvement of one other organ/structure alone or perforation of the peritoneal side of the serosa alone (n = 9), and involvement of both the liver and one other organ/structure (n = 22) was 36.0%, 29.0%, 22.2%, and 9.1%, respectively. For patients with involvement of the liver alone, 5-year OS was &gt; 30% regardless of type of hepatectomy. Among 29 patients with involvement of the extrahepatic bile duct alone, 8 patients survived ≥ 5 years; 3 underwent extended cholecystectomy and 5 underwent more extensive resection. Despite performing extensive resection, 5-year OS was 12.5% for patients with involvement of both the liver and one other organ/structure. The mode of spread other than involvement of the liver alone or extrahepatic bile duct alone was an independent predictor of worse OS (hazard ratio 1.675; p = 0.046).</div></div><div><h3>Conclusions</h3><div>Surgery is an acceptable option for pT3 gallbladder cancer with involvement of the liver alone or extrahepatic bile duct alone regardless of the type of resection procedure. However, the survival benefit of surgery is limited for this tumor with other modes of spread.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110457"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of waiting time from diagnosis to neoadjuvant chemoradiotherapy on interval distant metastases in esophageal cancer patients: A study based on the Netherlands cancer registry","authors":"Jingpu Wang ,&nbsp;Zhouqiao Wu ,&nbsp;Lucas Goense ,&nbsp;Rob H.A. Verhoeven ,&nbsp;Jelle P. Ruurda ,&nbsp;Richard van Hillegersberg","doi":"10.1016/j.ejso.2025.110456","DOIUrl":"10.1016/j.ejso.2025.110456","url":null,"abstract":"<div><h3>Introduction</h3><div>In patients with resectable esophageal cancer, interval distant metastases may be detected following neoadjuvant-intent chemoradiotherapy ((n)CRT). The specific association between the waiting time from diagnosis to the initiation of (n)CRT and interval metastases remains unclear.</div></div><div><h3>Methods</h3><div>Patients with esophageal cancer (cT1-4a N0-3 M0) received CRT with or without surgery were extracted from the Netherlands Cancer Registry. Multivariable logistic and cox regression analyses were used to compare different waiting times (≤4, 4–8 and &gt;8weeks) on the risk of interval metastases, post-(n)CRT short-term metastases (detected preoperatively, intraoperatively, or postoperatively within 120 days after CROSS regimen CRT) and overall survival (OS). Subgroup analysis based on cN stage was performed.</div></div><div><h3>Results</h3><div>Between 2015 and 2021, a total of 4394 patients were included. Compared to the waiting ≤4 weeks, the waiting &gt;8 weeks was associated with higher risk of interval metastases (p-value = 0.045),but the longer waiting times were not associated with higher risk of post-(n)CRT short-term metastases or worse OS. In the cN0 subgroup, compared to the waiting ≤4 weeks, the waiting 4–8weeks (p-value = 0.049; p-value = 0.046) and &gt;8 weeks (p-value = 0.006; p-value = 0.006) was associated with higher risk of interval metastases and post-(n)CRT short-term metastases, but was not associated with worse OS. In the cN + subgroup, the longer waiting times were not associated with interval metastases or post-(n)CRT short-term metastases or OS.</div></div><div><h3>Conclusion</h3><div>A longer waiting time from diagnosis to the initiation of (n)CRT was associated with a higher risk of interval metastases, but not with an increased risk of post-(n)CRT short-term metastases or worse OS.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110456"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of waiting time from diagnosis to neoadjuvant chemoradiotherapy on interval distant metastases in esophageal cancer patients: A study based on the Netherlands cancer registry","authors":"Jingpu Wang ,&nbsp;Zhouqiao Wu ,&nbsp;Lucas Goense ,&nbsp;Rob H.A. Verhoeven ,&nbsp;Jelle P. Ruurda ,&nbsp;Richard van Hillegersberg","doi":"10.1016/j.ejso.2025.110456","DOIUrl":"10.1016/j.ejso.2025.110456","url":null,"abstract":"<div><h3>Introduction</h3><div>In patients with resectable esophageal cancer, interval distant metastases may be detected following neoadjuvant-intent chemoradiotherapy ((n)CRT). The specific association between the waiting time from diagnosis to the initiation of (n)CRT and interval metastases remains unclear.</div></div><div><h3>Methods</h3><div>Patients with esophageal cancer (cT1-4a N0-3 M0) received CRT with or without surgery were extracted from the Netherlands Cancer Registry. Multivariable logistic and cox regression analyses were used to compare different waiting times (≤4, 4–8 and &gt;8weeks) on the risk of interval metastases, post-(n)CRT short-term metastases (detected preoperatively, intraoperatively, or postoperatively within 120 days after CROSS regimen CRT) and overall survival (OS). Subgroup analysis based on cN stage was performed.</div></div><div><h3>Results</h3><div>Between 2015 and 2021, a total of 4394 patients were included. Compared to the waiting ≤4 weeks, the waiting &gt;8 weeks was associated with higher risk of interval metastases (p-value = 0.045),but the longer waiting times were not associated with higher risk of post-(n)CRT short-term metastases or worse OS. In the cN0 subgroup, compared to the waiting ≤4 weeks, the waiting 4–8weeks (p-value = 0.049; p-value = 0.046) and &gt;8 weeks (p-value = 0.006; p-value = 0.006) was associated with higher risk of interval metastases and post-(n)CRT short-term metastases, but was not associated with worse OS. In the cN + subgroup, the longer waiting times were not associated with interval metastases or post-(n)CRT short-term metastases or OS.</div></div><div><h3>Conclusion</h3><div>A longer waiting time from diagnosis to the initiation of (n)CRT was associated with a higher risk of interval metastases, but not with an increased risk of post-(n)CRT short-term metastases or worse OS.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110456"},"PeriodicalIF":2.9,"publicationDate":"2025-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of surgery in oncological trials: the patient's perspective","authors":"J.W. Butterworth,&nbsp;P.R. Boshier,&nbsp;A. Tsai,&nbsp;S. Mavroveli,&nbsp;G.B. Hanna","doi":"10.1016/j.ejso.2025.110451","DOIUrl":"10.1016/j.ejso.2025.110451","url":null,"abstract":"<div><h3>Background</h3><div>There has recently been increased focus on patient involvement in decision making within healthcare research. Although expert opinion regarding quality of surgery in oncological trials has been reported, the patients’ perspective has not yet been explored.</div></div><div><h3>Methods</h3><div>Two in-depth focus groups were conducted with ten participants representing the oesophageal patient association (OPA). Focus group discussion explored patients’ opinion regarding quality of surgery in trials and potential mitigating strategies. Identified themes were utilised to create a semi-structured survey subsequently completed by 41 OPA members.</div></div><div><h3>Results</h3><div>Forty-five themes were identified from thematic analysis of focus group data falling within three categories: quality of surgery (n = 16); challenges to quality of surgery (n = 16) and proposed mitigating strategies (n = 13). Strategies to overcome generic challenges included: further education for non-specialists, and enhancing surgeons' training. Trial specific mitigating strategies included: utilising a structured method of assessing surgeons’ competencies, including specialist centres, and monitoring of surgery. The survey revealed key challenges to quality of surgery included insufficient beds (90 %) and a lack of funding (75 %). Key survey strategies to overcome challenges to quality of surgery included: Monitoring to check operative standards are being met within trials (94 %), and; raising awareness/training regarding postoperative complications amongst non-specialist healthcare providers (94 %).</div></div><div><h3>Conclusion</h3><div>This is the first study to explore patient perspective on quality of surgery. Public healthcare planners and members of the surgical oncology community should recognise the importance of patient perceived challenges and consider incorporation of their proposed mitigation strategies to improve the quality of surgery in clinical trials.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110451"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145156752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postoperative physiotherapy in enhanced recovery pathways: A general surgery evidence update, dominated by colorectal studies","authors":"Louise C. Burgess ,&nbsp;Chloe Bascombe ,&nbsp;Thomas W. Wainwright","doi":"10.1016/j.ejso.2025.110447","DOIUrl":"10.1016/j.ejso.2025.110447","url":null,"abstract":"<div><h3>Introduction</h3><div>Physiotherapy is a pivotal component of enhanced recovery protocols, particularly in initiating early mobilisation and supporting the return to functional independence. Despite this, there is a lack of guidance on optimal post-mobilisation physiotherapy strategies. This systematic review aims to synthesise and critically appraise the most recent evidence on postoperative physiotherapy interventions within enhanced recovery pathways for general surgical patients. This review seeks to advance scientific understanding and provide guidance for the optimisation of physiotherapy practice within enhanced recovery pathways.</div></div><div><h3>Materials and methods</h3><div>A systematic review of the literature between 2000 and 2024 was conducted to identify studies of physiotherapy interventions in general surgical populations following an enhanced recovery protocol.</div></div><div><h3>Results</h3><div>Ten studies met the inclusion criteria. Six studies were conducted in colorectal patients, one study (plus a secondary analysis) was conducted in radical cystectomy patients, one in head and neck patients undergoing oncologic resection, and one included a mixed patient sample (colon, rectum, stomach, pancreas and liver surgery). Interventions involving early physiotherapy were found to benefit postoperative walking distance, achievement of activities of daily living and length of stay in hospital. There was mixed evidence for influence on readiness for discharge, quality of recovery measures and health-related quality of life. No consistent effects were observed for inpatient satisfaction or functional outcome.</div></div><div><h3>Conclusion</h3><div>This review supports the feasibility and potential benefits of a structured physiotherapy interventions within enhanced recovery protocols. These results highlight the potential for structured mobilisation interventions to enhance recovery, particularly when supported by education and technology-based strategies.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110447"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145091360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to treatment initiation in primary extremity sarcomas: Determinants and oncological outcomes in a tertiary LMIC cancer center","authors":"Anand Murali ,&nbsp;Chandra Kumar Krishnan ,&nbsp;Vivek Patel ,&nbsp;Shrinivas Venkatesh ,&nbsp;Gaurav Ravi Kumar ,&nbsp;Shalini Shree ,&nbsp;Ashik Bary ,&nbsp;Ayloor Seshadri Ramakrishnan ,&nbsp;Anand Raja","doi":"10.1016/j.ejso.2025.110449","DOIUrl":"10.1016/j.ejso.2025.110449","url":null,"abstract":"<div><h3>Background</h3><div>or purpose: Time to treatment initiation (TTI) has emerged as a key quality control metric in oncology, with early treatment initiation translating to improved survival in certain malignancies. However, data is lacking for primary extremity sarcomas (PES). Hence, this study aimed to quantify TTI, identify factors influencing TTI, and evaluate its effect on oncological outcomes in PES.</div></div><div><h3>Methods</h3><div>This study was a retrospective analysis of patients with PES who received curative-intent treatment between 2011 and 2020. Various demographic details, tumor characteristics, treatment, healthcare variables, and oncological outcomes were analysed.</div></div><div><h3>Results</h3><div>Median TTI for primary bone sarcoma (PBS) was 24 days, and for primary soft tissue sarcoma (PSTS) was 35 days. Univariate analysis of PBS, age &gt;20 years (p &lt; 0.001), low-grade tumors (p = 0.011), chondrosarcoma as histology (p &lt; 0.001), and surgery as the first treatment (p &lt; 0.001) modality were associated with a delayed TTI. On multivariate analysis, only age (p &lt; 0.001) and histology (p = 0.002) retained significance. In PSTS, age &gt;20 years (p = 0.018) and non-affordability (p = 0.019) were significant in both univariate and multivariate analyses. Differences in TTI (early vs late) did not translate to changes in oncological outcomes, with similar overall survival rates at both 3-year and 5-year follow-up, for both PBS (p = 0.719) and PSTS (p = 0.786).</div></div><div><h3>Conclusion</h3><div>TTI is multifactorial. Though early treatment initiation did not impact survival rates, this study introduces a structured framework for auditing institutional workflows to identify bottlenecks and facilitate system-level improvements in the delivery of multidisciplinary sarcoma care.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110449"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145095507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic impact of myopenia and establishment of a nomogram for predicting survival following radical gastrectomy in patients with gastric cancer: A multicenter study","authors":"Chang-Yue Zheng ,&nbsp;Xiao-liang Huang ,&nbsp;Ju Wu ,&nbsp;Xian-tu Qiu ,&nbsp;Bin Zu ,&nbsp;Hui-bin Liu ,&nbsp;Rui Xu ,&nbsp;Han-he Chen ,&nbsp;Wei Lin","doi":"10.1016/j.ejso.2025.110450","DOIUrl":"10.1016/j.ejso.2025.110450","url":null,"abstract":"<div><h3>Introduction</h3><div>The prognostic value of myopenia following radical gastrectomy (RG) remains controversial.</div></div><div><h3>Materials and methods</h3><div>Patients who underwent RG between January 2015 and December 2018 at two East Asian centers were retrospectively included. Myopenia was defined using sex-specific computed tomography-derived L3 skeletal muscle index, with cut-off values determined by X-tile software based on overall survival (OS). Cox regression models identified independent prognostic factors for OS and disease-free survival (DFS), whereas logistic regression identified risk factors for textbook outcomes (TO). A LASSO-based prognostic nomogram was developed, and its performance was evaluated using calibration curves, concordance index, time-dependent receiver operating characteristic, and decision curve analysis.</div></div><div><h3>Results</h3><div>Overall, 943 patients were included (211 and 732 with and without myopenia, respectively). The myopenia group had a significantly lower TO rate (P = 0.003), and myopenia was confirmed as an independent risk factor for TO failure (P &lt; 0.05). Moreover, the myopenia group had significantly lower 5-year OS (45.5 % vs. 69.3 %, P &lt; 0.001) and DFS (45.0 % vs. 66.8 %, P &lt; 0.001), with myopenia independently associated with poor prognosis. The nomogram developed in this study outperformed the tumor-node-metastasis staging system in predicting 3- and 5-year OS (both P &lt; 0.05), demonstrating superior net clinical benefits across a threshold range of 10 %–80 %. Risk stratification effectively discriminated 5-year OS (94.3 % vs. 61.2 % vs. 24.2 %, P &lt; 0.001). These results were reproduced in the validation cohort.</div></div><div><h3>Conclusions</h3><div>Myopenia independently predicts both short-term outcomes and long-term prognosis after RG. The myopenia-integrated nomogram showed strong predictive accuracy and clinical utility for individualized prognostic assessment of patients with gastric cancer.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110450"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145079927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of surgery in oncological trials: the patient's perspective","authors":"J.W. Butterworth,&nbsp;P.R. Boshier,&nbsp;A. Tsai,&nbsp;S. Mavroveli,&nbsp;G.B. Hanna","doi":"10.1016/j.ejso.2025.110451","DOIUrl":"10.1016/j.ejso.2025.110451","url":null,"abstract":"<div><h3>Background</h3><div>There has recently been increased focus on patient involvement in decision making within healthcare research. Although expert opinion regarding quality of surgery in oncological trials has been reported, the patients’ perspective has not yet been explored.</div></div><div><h3>Methods</h3><div>Two in-depth focus groups were conducted with ten participants representing the oesophageal patient association (OPA). Focus group discussion explored patients’ opinion regarding quality of surgery in trials and potential mitigating strategies. Identified themes were utilised to create a semi-structured survey subsequently completed by 41 OPA members.</div></div><div><h3>Results</h3><div>Forty-five themes were identified from thematic analysis of focus group data falling within three categories: quality of surgery (n = 16); challenges to quality of surgery (n = 16) and proposed mitigating strategies (n = 13). Strategies to overcome generic challenges included: further education for non-specialists, and enhancing surgeons' training. Trial specific mitigating strategies included: utilising a structured method of assessing surgeons’ competencies, including specialist centres, and monitoring of surgery. The survey revealed key challenges to quality of surgery included insufficient beds (90 %) and a lack of funding (75 %). Key survey strategies to overcome challenges to quality of surgery included: Monitoring to check operative standards are being met within trials (94 %), and; raising awareness/training regarding postoperative complications amongst non-specialist healthcare providers (94 %).</div></div><div><h3>Conclusion</h3><div>This is the first study to explore patient perspective on quality of surgery. Public healthcare planners and members of the surgical oncology community should recognise the importance of patient perceived challenges and consider incorporation of their proposed mitigation strategies to improve the quality of surgery in clinical trials.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 12","pages":"Article 110451"},"PeriodicalIF":2.9,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157126","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}