Ejso最新文献

{"title":"Pheochromocytoma manifested as a surgical emergency","authors":"Eugenia Yiannakopoulou","doi":"10.1016/j.ejso.2025.110439","DOIUrl":"10.1016/j.ejso.2025.110439","url":null,"abstract":"<div><div>Pheochromocytoma is a rare tumour derived from chromaffin cells of the adrenal medulla, derived from embryonic neural crest cells. Pheochromocytoma affects approximately 0.3 %–0.6 % of the hypertensive population. Most cases of pheochromocytomas are sporadic, but they may also be associated with multiple endocrine neoplasia Type II, von Hippel Lindau Syndrome, and less commonly with Neurofibromatosis Type 1. If symptomatic, the clinical presentation of pheochromocytoma is highly variable. The classic presentation of pheochromocytoma involves the triad of paroxysmal headaches, palpitations, and diaphoresis accompanied by marked hypertension. However, pheochromocytoma may rupture either spontaneously or following trauma and mimic surgical emergencies, including acute abdomen and haemorrhagic shock, that may be lethal if not diagnosed promptly. The proper treatment of ruptured pheochromocytoma is elective adrenalectomy after medical or interventional patient stabilization. Emergency adrenalectomy for pheochromocytoma and is associated with significant morbidity and mortality. Emergency adrenalectomy can be complicated by circulatory shock due to excess catecholamine release, cardiomyopathy and adult respiratory distress syndrome.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110439"},"PeriodicalIF":2.9,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043987","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":"Peritoneal Surface Oncology surgery: Reflections on key determinants of success for female surgeons in this challenging discipline.","authors":"Beate Rau, Aditi Bhatt, Lana Bijelic, Olivia Sgarbura, Diane Goere, Naoual Bakrin, Clarisse Eveno, Delia Cortes-Guiral, Claramae Chia-Shulyn, Kjersti Flatmark","doi":"10.1016/j.ejso.2025.110434","DOIUrl":"https://doi.org/10.1016/j.ejso.2025.110434","url":null,"abstract":"<p><p>This article explores the career pathways of women in the field of surgical oncology, specifically their growth and development as surgical oncologists. Nine global female surgical oncologists and experts in Peritoneal Surface Oncology (PSO) share personal reflections of the challenges and facilitators of career success in this challenging and highly specialized field of surgery.</p><p><strong>Methods: </strong>Nine high profile female surgeons with expertise in PSO were recruited by direct contact with the lead author and asked to provide a detailed reflection of their career pathways, with a focus on barriers and facilitators to success.</p><p><strong>Results: </strong>Most participants were highly driven, motivated by the poor prognosis of the disease early in their careers and the new opportunities PSO offered. Many moved between units or countries in search of training, often sacrificing work-life balance. Strong role models-usually male-were cited as mentors, and many participants now lead the units they helped establish. None expressed regrets, and all took pride in the advances achieved during their careers. While some women mentioned gender bias, most felt that within PSO, surgical skills and commitment outweighed such barriers.</p><p><strong>Conclusions: </strong>These reflections should provide encouragement to the next generation of aspiring surgical oncologists to pursue their desire to enter this challenging area of surgery in the future.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"110434"},"PeriodicalIF":2.9,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145102712","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":"Ideal outcomes in pancreatic neuroendocrine tumor vs. adenocarcinoma following resection: A nationwide study using ACS-NSQIP","authors":"Jiage Qian ,&nbsp;Sebastiaan Ceuppens ,&nbsp;Nikhil V. Tirukkovalur ,&nbsp;Kenneth K. Lee ,&nbsp;Amer H. Zureikat ,&nbsp;Alessandro Paniccia","doi":"10.1016/j.ejso.2025.110438","DOIUrl":"10.1016/j.ejso.2025.110438","url":null,"abstract":"<div><h3>Background</h3><div>Prior evidence suggests higher postoperative complications in pancreatic neuroendocrine tumors (pNET) compared to ductal adenocarcinoma (PDAC). This study refines the comparison using the Ideal Outcome (IO) metric and identifies predictors of IO.</div></div><div><h3>Methods</h3><div>A retrospective cohort study was performed using the 2014–2023 standard and pancreas-targeted ACS-NSQIP database to identify patients with PDAC or pNET who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP). IO was defined as absence of clinically relevant postoperative pancreatic fistula (CR-POPF), prolonged length of stay (LOS), severe complications, reoperation, readmission, and mortality.</div></div><div><h3>Results</h3><div>A total of 25,290 PDAC and 4914 pNET patients were included. In PD, IO was lower in pNET (44.2 %) compared to PDAC (56.9 %, p &lt; 0.001), with pNET having higher rates of severe complications (31.2 % vs. 19.0 %, p &lt; 0.001), prolonged LOS (28.9 % vs. 25.8 %; p = 0.004), CR-POPF (26.7 % vs. 10.9 %; p &lt; 0.001), and readmission (23.6 % vs. 15.3 %; p &lt; 0.001). In contrast, pNET had higher IO after DP (60.1 % vs. 57.1 %; p = 0.008), with higher CR-POPF (19.2 % vs. 13.4 %; p &lt; 0.001) but lower prolonged LOS (18.5 % vs. 26.4 %; p &lt; 0.001). In PD, predictors of lower IO for both histologies included male sex (PDAC aOR 0.83; pNET 0.60), obesity (0.77; 0.63), hypertension (0.89; 0.79), small duct (0.81; 0.75), and soft gland (0.62; 0.57). In DP, minimally invasive surgery was associated with higher IO in both cancer types (PDAC aOR 1.71; pNET 1.52; all p &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>Compared to PDAC, IO rate for pNET was lower after PD but higher after DP. CR-POPF was consistently higher in pNET, while other components of IO varied by procedure.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110438"},"PeriodicalIF":2.9,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043986","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":"Women as surgical leaders: from fixing women to fixing systems.","authors":"I T Rubio, L Pitoni","doi":"10.1016/j.ejso.2025.110433","DOIUrl":"https://doi.org/10.1016/j.ejso.2025.110433","url":null,"abstract":"<p><p>Advancing women in surgical leadership has traditionally focused on individual adaptation, mentorship, resilience, and personal skills rather than addressing systemic barriers. Despite improvements in awareness, representation, and support networks, meaningful change remains limited due to persistent institutional biases, structural constraints, and cultural norms. Female surgeons face additional challenges related to recruitment, mentorship, research access, and work-life integration, particularly around motherhood, which can penalize career progression even in supportive systems. Leadership programs and sponsorship opportunities remain unevenly available, and formal recognition of mentorship and informal leadership roles is often lacking. True transformation requires shifting from \"fixing women\" to \"fixing systems\" through formal leadership curricula, institutional accountability, and measurable outcomes. By empowering women to actively shape culture rather than merely navigate it, surgery can achieve female leadership that is inclusive, effective, and equitable. Addressing these challenges demands a collective responsibility of surgical societies, academic centers, and hospital leadership to foster structural reform, recognize diverse career trajectories, and cultivate visible female role models.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"110433"},"PeriodicalIF":2.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039371","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":"Discrepancy between mammographic and pathological sizing of screen-detected DCIS: Risk factors and impact on ipsilateral recurrence rates","authors":"C.C. Kirwan ,&nbsp;B. Hilton ,&nbsp;K. Clements ,&nbsp;D. Dodwell ,&nbsp;S.E. Pinder ,&nbsp;A. Shaaban ,&nbsp;H. Stobart ,&nbsp;M. Wallis ,&nbsp;E. Provenzano ,&nbsp;A.J. Maxwell ,&nbsp;N. Sharma ,&nbsp;E. Sawyer ,&nbsp;S. Lowes ,&nbsp;O. Kearins ,&nbsp;R.I. Cutress ,&nbsp;S. Mylvaganam ,&nbsp;A. Thompson ,&nbsp;the Sloane Project Steering Group (NHS Prospective Study of Screen-Detected Non-invasive Neoplasias)","doi":"10.1016/j.ejso.2025.110431","DOIUrl":"10.1016/j.ejso.2025.110431","url":null,"abstract":"<div><h3>Background</h3><div>Discrepancy between mammographic and pathological sizing of DCIS can lead to surgical overtreatment, with poorer cosmesis or unnecessary mastectomy, or undertreatment and recurrence.</div></div><div><h3>Methods</h3><div>Within the UK Sloane Project prospective cohort study of screen-detected DCIS (2003–2012), we investigated factors associated with 'pathology larger (PL)’ (pathological larger than mammographic size) or ‘mammogram larger (ML)’ (mammographic larger than pathologic size), size discrepancy and the impact on ipsilateral recurrence.</div></div><div><h3>Results</h3><div>Among 9937 patients (mean age 60; range 46–87), mammographic size remained constant at median 19 mm (IQR 10–35)mm whilst pathological size increased from 16(10–28)mm to 20(10–33)mm (p = 0.001)over the study. The mammographic and pathological size discrepancy decreased from 3.4 mm to 0.2 mm (p &lt; 0.05).</div><div>In patients undergoing BCS, size discrepancy of ≥5 mm was associated with increased 5-year ipsilateral recurrence if lesions were PL (odds ratio(OR) 1.37 (C.I. 1.03–1.82, p = 0.03) and if lesions were ML (OR 1.4 (C.I. 1.10–1.86, p = 0.008), compared to &lt;5 mm discrepancy.</div><div>Factors associated with PL by ≥ 5 mm were high grade (OR 1.9 [95 % CI 1.5–2.4, p &lt; 0.001]) and mastectomy (OR 4.4 [C.I. 3.8–5.1, p &lt; 0.001]) and for ML ≥ 5 mm was larger mammographic tumour size (&gt;40 mm; OR 115.7 [C.I. 82.3–162.6], p &lt; 0.001]).</div></div><div><h3>Conclusion</h3><div>Mammographic-pathological size discrepancy is associated with higher recurrence following BCS for DCIS.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110431"},"PeriodicalIF":2.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043989","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":"From conventional minimally invasive to robotic-assisted Ivor Lewis esophagectomy – A Nordic single-center retrospective study","authors":"Tobias Hauge ,&nbsp;Egil Johnson ,&nbsp;Magnus Fasting ,&nbsp;Dag Førland ,&nbsp;Caroline Skagemo ,&nbsp;Tom Mala","doi":"10.1016/j.ejso.2025.110417","DOIUrl":"10.1016/j.ejso.2025.110417","url":null,"abstract":"<div><h3>Background</h3><div>High-quality studies from Asia have demonstrated that robotic assisted minimally invasive esophagectomy (RAMIE) is a feasible and comparable alternative to conventional minimally invasive esophagectomy (MIE), evidence regarding its application to Western patients remains limited. This study evaluates the short-term outcomes during the initial phase of RAMIE implementation in comparison to the previous standard MIE technique in a Nordic center.</div></div><div><h3>Methods</h3><div>A retrospective single center study of prospectively registered data, comparing short-term outcomes between the final 100 patients operated with MIE and the first 100 patients operated with RAMIE. The primary outcome was the total number of lymph nodes harvested. Secondary outcomes included postoperative pneumonia, anastomotic leakage, serious complications (Clavien Dindo <span><math><mrow><mo>≥</mo></mrow></math></span> 3), length of operation, length of hospital stay and resection margin status. An inverse probability weighting model and regression analysis was conducted.</div></div><div><h3>Results</h3><div>200 patients were included (RAMIE n = 100, MIE n = 100). Matched groups (RAMIE n = 96, MIE n = 97) showed no difference in total number of lymph nodes harvested (RAMIE 22.1 vs. MIE 23.7, p = 0.50). RAMIE had higher postoperative pneumonia risk (OR = 2.3, p &lt; 0.01), longer length of operation (+33.9 min, p &lt; 0.01) and marginally increased risk of anastomotic leakage (OR = 2.4, p = 0.05). Comparing the last 50 patients operated with RAMIE to the MIE group, there was no difference in length of operation (OR = 10.3, p = 0.43).</div></div><div><h3>Conclusion</h3><div>The short-term oncological outcomes and safety remain secure even during the initial phases of RAMIE implementation in a Nordic cohort. The perioperative outcome for some measures after RAMIE were inferior to MIE, potentially related to learning curve aspects.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110417"},"PeriodicalIF":2.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145060391","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":"Revisiting the paradigm: Asymptomatic high-grade endometrial cancer diagnosis is not associated with improved outcomes","authors":"Ahmet Namazov ,&nbsp;Limor Helpman ,&nbsp;Ram Eitan ,&nbsp;Zvi Vaknin ,&nbsp;Ofer Lavie ,&nbsp;Amnon Amit ,&nbsp;Tally Levy ,&nbsp;Inbar Ben Shachar ,&nbsp;Ilan Atlas ,&nbsp;Ilan Bruchim ,&nbsp;Alon Ben Arie ,&nbsp;Ofer Gemer","doi":"10.1016/j.ejso.2025.110427","DOIUrl":"10.1016/j.ejso.2025.110427","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the survival of women with high grade endometrial cancer between asymptomatic and women presenting bleeding symptoms.</div></div><div><h3>Design</h3><div>An Israel Gynecologic Oncology Group multi-center retrospective cohort study.</div></div><div><h3>Methods</h3><div>The study included women who underwent surgery for high-grade endometrial cancer. We compared outcomes between women presenting with postmenopausal bleeding and asymptomatic women diagnosed with high-grade endometrial cancer. Recurrence-free, disease-specific and overall survival were assessed using the Kaplan Meier method and compared using the log-rank test. Risk factors for recurrence and death were evaluated using Cox regression analysis; the primary exposure variable assessed was the presence of postmenopausal bleeding.</div></div><div><h3>Results</h3><div>Of the 584 women with high-grade histology, 498 (85.3 %) presented with postmenopausal bleeding and 86 (14.7 %) were asymptomatic. The median follow-up was 52 months (12–120 months). There was no difference in recurrence-free survival between women diagnosed with postmenopausal bleeding and asymptomatic women (70.1 % vs.64.6 % at 5 years, p = 0.35, respectively). There were no significant differences in disease-specific survival (66.3 % vs. 64.2 % at 5 years, p = 0.83) or in overall survival (56.4 % vs. 58 % at five years, p = 0.55) between study groups. The multivariate Cox regression analysis did not reveal any significant association between postmenopausal bleeding and survival.</div></div><div><h3>Conclusion</h3><div>In this study, the diagnosis of high-grade endometrial cancer in asymptomatic women was not associated with earlier disease stage at diagnosis. In women with incidental ultrasonographic findings of a thickened endometrium or polyp, routine invasive evaluation may be unnecessary.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110427"},"PeriodicalIF":2.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004667","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":"Comparison of efficacy between the da Vinci surgical system and Toumai® robotic surgical systems for robot-assisted radical prostatectomy and robot-assisted partial nephrectomy","authors":"Yiyang Chen ,&nbsp;Zhenghong Liu ,&nbsp;Bin Zheng ,&nbsp;Xiaolong Qi,&nbsp;Qi Zhang,&nbsp;Feng Liu,&nbsp;Zujie Mao,&nbsp;Pu Zhang,&nbsp;Heng Wang,&nbsp;Haichang Li,&nbsp;Yixuan Mou,&nbsp;Xiaowen Qin,&nbsp;Dahong Zhang,&nbsp;Shuai Wang","doi":"10.1016/j.ejso.2025.110426","DOIUrl":"10.1016/j.ejso.2025.110426","url":null,"abstract":"<div><h3>Background</h3><div>The Toumai® surgical robot, a cutting-edge medical assistance robot, was developed and launched in China.</div></div><div><h3>Objective</h3><div>Compare the effectiveness and safety of the da Vinci robotic surgical system and the Toumai® surgical robot in RARP and RAPN surgeries(the Toumai® -RARP versus the DV-RARP, the Toumai®-RAPN versus the DV-RAPN).</div></div><div><h3>Design, setting, and participants</h3><div>One randomized controlled trials were conducted among patients aged 18–77 years suspected of having T1a N0M0 renal cancer, and another randomized controlled trial was conducted among patients aged 55–79 years suspected of having T2 N0M0 prostate cancer.</div></div><div><h3>Reasults</h3><div>The clinical characteristics of the two groups of patients undergoing the same surgical procedure showed no significant differences. All surgeries were successfully completed without the need for conversion from laparoscopic to open surgery. The operative time in the Toumai® group was significantly longer. Additionally, there were no significant differences between the two groups in key indicators such as blood loss, length of hospital stay, complication rates, and functional outcomes.</div></div><div><h3>Conclusions</h3><div>This comparative study on the efficacy and safety between the Toumai® system and the da Vinci system demonstrates that the Toumai® surgical robot and the da Vinci robotic system achieve comparable safety profiles, surgical outcomes, and postoperative expectations when performing RAPN and RARP procedures, with no statistically significant differences observed.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110426"},"PeriodicalIF":2.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085360","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":"Hyperthermic intraperitoneal chemotherapy (HIPEC) for primary advanced-stage or recurrent ovarian cancer: A systematic review and meta-analysis of randomized control trials","authors":"Gabriela Branquinho Guerra ,&nbsp;Camila Mariana de Paiva Reis ,&nbsp;Júnior Samuel Alonso de Menezes ,&nbsp;Ana Paula Valério-Alves ,&nbsp;Rafaela de Melo Sprogis ,&nbsp;Raphaela Anderson Colares ,&nbsp;Rafael Morriello","doi":"10.1016/j.ejso.2025.110424","DOIUrl":"10.1016/j.ejso.2025.110424","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian cancer has the highest mortality among gynecologic malignancies. Despite cytoreductive surgery (CRS) and systemic therapy, peritoneal recurrence remains common. Hyperthermic intraperitoneal chemotherapy (HIPEC) delivers heated chemotherapy directly to the peritoneal cavity, enhancing local cytotoxicity and offering a potential therapeutic strategy.</div></div><div><h3>Methods</h3><div>We searched PubMed, Embase, and Cochrane for randomized controlled trials (RCTs) comparing CRS plus HIPEC versus CRS alone. Hazard ratios (HR), odds ratios (OR), and mean differences (MD) were pooled using Review Manager 5.4. Heterogeneity was assessed using I² statistics. Primary outcomes were overall survival (OS) and progression-free survival (PFS); secondary outcomes included operative time, Grade 3–5 adverse events, time to adjuvant chemotherapy, and hospital length of stay (LOS). Subgroup analyses were performed for primary vs. recurrent cancer, neoadjuvant chemotherapy (NACT) vs. no NACT, HIPEC duration (60 vs. 90 min), and high-grade serous vs. other histologies.</div></div><div><h3>Results</h3><div>Eight RCTs (1259 patients) were included; 636 (50.52%) received CRS with HIPEC. HIPEC significantly improved OS (HR 0.79; 95% CI 0.67–0.94; p = 0.006; I² = 9%), especially in primary ovarian cancer (HR 0.75; 95% CI 0.60–0.94; p = 0.01; I² = 0%). No OS benefit was observed in recurrent disease (HR 0.87; 95% CI 0.63–1.19; p = 0.38; I² = 39%). PFS showed no overall difference (HR 0.86; p = 0.30). HIPEC increased operative time (MD 127.75 min; p &lt; 0.00001), LOS (MD 1.49 days; p = 0.03), and Grade 3–5 adverse events (OR 1.50; p = 0.03).</div></div><div><h3>Conclusions</h3><div>In ovarian cancer, HIPEC significantly improved OS, especially in primary disease and following NACT. However, increased morbidity was observed. Further studies should refine patient selection and optimize protocols.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110424"},"PeriodicalIF":2.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145004666","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":"Prognosis and clinical characteristics of signet ring cell colorectal peritoneal metastases – a Swedish population-based study","authors":"Malin Enblad ,&nbsp;Lana Ghanipour ,&nbsp;Gabriella Palmer ,&nbsp;Valentinus Valdimarsson ,&nbsp;Elinor Bexe Lindskog ,&nbsp;Peter Cashin","doi":"10.1016/j.ejso.2025.110429","DOIUrl":"10.1016/j.ejso.2025.110429","url":null,"abstract":"<div><h3>Background</h3><div>Signet ring cell (SRC) colorectal cancer is strongly associated with peritoneal metastases (PM), but the role of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) remains uncertain due to poor prognosis. This study aimed to analyse the prognostic impact of SRCs, assess clinical characteristics, and evaluate the risk of open-close laparotomy.</div></div><div><h3>Methods</h3><div>This Swedish population-based study included patients with colorectal PM accepted for initial CRS and HIPEC at four national centres between 2010 and 2023. Data were retrieved from the Swedish HIPEC registry. Tumours with ≥50% and &lt;50% SRCs were included.</div></div><div><h3>Results</h3><div>Among 810 patients, 97 (12%) had SRC tumours. SRC patients had a higher risk of open-close laparotomy (22% vs. 13%, p=0.04) and worse 5-year overall survival (OS) compared to non-SRC patients (18% vs. 32%, p=0.004). SRC patients were younger, more often had synchronous PM, regional lymph node metastases, higher peritoneal cancer index, and were less likely to receive neoadjuvant treatment or have synchronous liver metastases. At diagnosis, PM were more often an unexpected intraoperative finding, and SRC patients exhibited a stronger preoperative systemic inflammatory response, with a higher CRP/albumin ratio. Among those undergoing CRS and HIPEC, the 5-year OS was 24% (95% CI: 14–40) in SRC patients and 36% (95% CI: 32–42, p=0.056) in non-SRC patients.</div></div><div><h3>Conclusion</h3><div>SRC colorectal PM is associated with a high risk of open-close laparotomy, poor prognosis, and distinct clinical features. These findings highlight the aggressive nature of SRCs but suggest that CRS and HIPEC should not be excluded for these patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 11","pages":"Article 110429"},"PeriodicalIF":2.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144996951","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}