Journal of Surgical Oncology最新文献

{"title":"Gallbladder Cancer: A NCDB Analysis of Outcomes Predictors.","authors":"Rayner P Cardoso, Eman Zineldin, Yara Sakr, Ali Abdelhady, Joshua J Horns, Courtney L Scaife, Marshall S Baker, Erin P Ward, T Clark Gamblin","doi":"10.1002/jso.70373","DOIUrl":"https://doi.org/10.1002/jso.70373","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder cancer (GBC) is a rare but aggressive malignancy with poor long-term survival after resection. National data describing temporal changes in adjuvant therapy, surgical quality metrics, and facility-level outcomes remain limited.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the National Cancer Database from 2004 to 2022. Patients with primary GBC who underwent surgical resection and had no documented metastatic disease, T1a disease, or R2 resection were included. Adjuvant therapy was defined as chemotherapy and/or radiotherapy initiated within 90 days after surgery. Survival was estimated using Kaplan-Meier methods, and predictors of overall survival (OS) were evaluated using multivariable Cox proportional hazards regression.</p><p><strong>Results: </strong>A total of 31 812 patients were included. Median age was 65 years; 64.4% were older than 70 years, and 69.2% were female. Adenocarcinoma was the most common histology (74.2%). Median OS was 23.3 months, with 1-, 3-, and 5-year survival rates of 65.4%, 38.1%, and 26.4% respectively. R0 resection was associated with longer median OS than R1 resection (39.8 vs. 9.9 months; p < 0.001). Adjuvant chemotherapy increased from 24.8% before BILCAP to 32.7% after BILCAP, whereas radiotherapy decreased from 9.1% to 3.1% (both p < 0.001). Older patients were less likely to receive adjuvant therapy than younger patients (23.8% vs. 36.6%; p < 0.001). Academic centers had higher rates of R0 resection (69.4% vs. 64.3%), lymph node evaluation (59.9% vs. 42.9%), and ≥ 6-node examination (16.9% vs. 7.7%) compared with community facilities (all p < 0.001). In complete-case Cox regression, age > 65 years, lymph node positivity, larger tumor size, R1 margin, and treatment at non-academic facilities were associated with worse survival, whereas adjuvant therapy was associated with improved survival (HR: 0.82; 95% CI: 0.78-0.87).</p><p><strong>Conclusions: </strong>Survival after resection of GBC remains poor. Margin-negative resection, nodal evaluation, adjuvant therapy, and treatment facility type were associated with outcomes. Chemotherapy use increased after BILCAP, but older patients remained less likely to receive postoperative therapy. These findings support improved surgical staging, greater adherence to adjuvant therapy guidelines, and multidisciplinary care for resected GBC.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069031","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":"Walking to the Operating Room: A Qualitative Study of Colorectal Cancer Patient Experiences in a Dutch Academic Hospital.","authors":"Ise S M van Gool, Jip van der Klugt, Christel Gielen, Ghislaine A P G van Mastrigt, Francine Schneider, Merel L Kimman, Arnoud G Peppelenbosch, Tim Lubbers","doi":"10.1002/jso.70381","DOIUrl":"https://doi.org/10.1002/jso.70381","url":null,"abstract":"<p><strong>Background and objectives: </strong>This study explores experiences of colorectal cancer (CRC) patients with the Surgery on Foot (SOF) protocol. In contrast to patients being admitted to the hospital the night before surgery, these patients arrive at the hospital on the day of surgery, walk to the operating room, and lie down on the operating table for the first time. SOF aims to enhance autonomy and reduce preoperative anxiety.</p><p><strong>Methods: </strong>CRC patients who underwent the SOF protocol were recruited with purposive sampling and interviewed using a semi-structured interview guide. Interviews were conducted, transcribed verbatim, and analyzed using reflective thematic analysis by two independent researchers.</p><p><strong>Results: </strong>This study included 14 patients. The overall experiences were positive and SOF was highly recommended. Preoperative factors that contributed to feelings of control and reassurance were a personal approach, involved medical staff and care partner presence. Some patients reported anxiety and discomfort related to the hospital environment and personal preferences.</p><p><strong>Conclusions: </strong>The SOF protocol was well-received and positively influenced aspects of patient-centered care, including communication, emotional support, and involvement of care partners. The findings support wider use of SOF to improve patients' preoperative experiences. More research is recommended for evaluation on (cost) effectiveness.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039466","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":"Palliative Transverse Blowhole Colostomy to Address Distal Colonic Obstruction in Advanced Peritoneal Malignancies: A Case Series.","authors":"Lauren Marek, Nina DiMauro, Bridget Fahy, Alissa Greenbaum","doi":"10.1002/jso.70403","DOIUrl":"https://doi.org/10.1002/jso.70403","url":null,"abstract":"<p><strong>Background: </strong>Distal colonic obstruction in patients with peritoneal carcinomatosis due to advanced peritoneal surface malignancy (PSM) can present significant challenges. Unfavorable anatomic factors, colonic distention, and poor nutritional status may preclude conventional resection or loop colostomy. Transverse blowhole colostomy (TBC) may provide a safe and less invasive option for rapid decompression and symptom palliation.</p><p><strong>Methods: </strong>We performed a retrospective review of adult patients with unresectable PSM and symptomatic distal colonic obstruction who underwent TBC by a single surgeon at an NCI-designated Comprehensive Cancer Center between September 2022 and October 2024. Demographic, clinical, operative, and postoperative outcomes were evaluated.</p><p><strong>Results: </strong>Six patients underwent TBC for distal colonic obstruction secondary to advanced PSM, including colorectal and appendiceal adenocarcinoma, retroperitoneal sarcoma, and primary peritoneal carcinoma. Mean operative time was 64 minutes. TBC was successfully created in all patients, including one in whom laparoscopic loop colostomy was not possible because of extensive peritoneal disease. All patients experienced immediate relief of obstructive symptoms and tolerated a regular diet by postoperative day 1 or 2. No complications directly attributable to TBC occurred. Postoperative survival varied substantially, ranging from 2 days to 20 months, with two patients alive at the time of publication.</p><p><strong>Conclusion: </strong>TBC is a technically feasible, low-morbidity option for rapid decompression and palliation of distal colonic obstruction in carefully selected patients with advanced, unresectable PSM. Limited requirement for colonic mobilization or intra-abdominal exploration may make it particularly useful when extensive carcinomatosis or a fixed, distended colon makes conventional diversion difficult.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061946","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":"Breast-Conserving Therapy Versus Mastectomy in Estrogen Receptor-Positive Breast Cancer: A PAM50-Adjusted Survival Analysis.","authors":"Hasan Roumani, Osman Aydas","doi":"10.1002/jso.70404","DOIUrl":"https://doi.org/10.1002/jso.70404","url":null,"abstract":"<p><strong>Background and objectives: </strong>Breast-conserving therapy (BCT), defined as breast-conserving surgery followed by radiotherapy, and mastectomy without radiotherapy, are widely used local treatment strategies for breast cancer; however, survival comparisons between these approaches may be confounded by intrinsic tumor biology. The PAM50 gene expression classifier defines biologically distinct molecular subtypes with established prognostic relevance. We evaluated survival outcomes between these surgical approaches in estrogen receptor-positive breast cancer while accounting for intrinsic molecular subtype.</p><p><strong>Methods: </strong>Using data from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC), we conducted a retrospective cohort study of estrogen receptor-positive patients treated with either BCT or mastectomy without radiotherapy. Inverse probability of treatment weighting balanced clinicopathologic and treatment-related variables. PAM50 subtype was excluded from the propensity-score model but retained in the weighted survival models because of its prognostic relevance. Weighted Cox proportional hazards models evaluated breast cancer-specific survival (BCSS) and overall survival (OS).</p><p><strong>Results: </strong>Mastectomy without radiotherapy was associated with worse BCSS (HR 1.59, 95% CI 1.19-2.12, p = 0.002) and worse OS (HR 1.55, 95% CI 1.26-1.91, p < 0.001) compared with BCT.</p><p><strong>Conclusions: </strong>BCT was associated with improved breast cancer-specific and overall survival after adjustment for clinicopathologic and molecular factors.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149061938","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":"Impact of Body Mass Index on Surgical Outcomes After Delayed Breast Reconstruction.","authors":"Anaïs Benziane, Violette Mesdag, Emilie Bogart, Clothilde Petitnicolas, Camille Defoort, Loïc Boulanger, Marie-Pierre Chauvet, Marie-Cécile Le Deley, C Régis, K Hannebicque","doi":"10.1002/jso.70397","DOIUrl":"https://doi.org/10.1002/jso.70397","url":null,"abstract":"<p><strong>Background and objectives: </strong>Obesity is associated with increased postoperative morbidity in surgery. However, its specific impact on complications following delayed breast reconstruction (DBR) remains insufficiently documented.</p><p><strong>Methods: </strong>We conducted a retrospective single-center study including patients who underwent first-time delayed breast reconstruction between 2018 and 2023. The primary objective was to evaluate the association between Body Mass Index (BMI) and the occurrence of postoperative complications.</p><p><strong>Results: </strong>A total of 310 patients were included and categorized into three BMI groups (<25, N = 143; [25-30 [N = 97; ≥30 kg/m², N = 70). The proportion of complications increased significantly with BMI: 29% in patients with BMI < 25, 39% in overweight patients, and 59% in obese patients. Surgical site infections, antibiotic use, and wound-healing disorders were significantly more frequent in obese patients. In multivariable analysis, higher BMI and autologous reconstruction were significantly associated with postoperative complications. A higher BMI was not significantly associated with an increased risk of reconstructive failure or hospital readmission.</p><p><strong>Conclusion: </strong>Higher BMI is associated with increased postoperative complications after DBR without a significantly higher rate of reconstructive failure, supporting the feasibility of delayed breast reconstruction in obese patients.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149039442","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 Epitrochlear and Humeral Lymphatic Pathway: Deep Lymphatic System Compensation After Axillary Lymph Node Dissection.","authors":"Madeleine Givant, James E Fanning, Angela Chen, Sarah Thomson, Kathleen Shillue, Aaron Fleishman, Caitlin M Connolly, Kevin Donohoe, Dhruv Singhal","doi":"10.1002/jso.70407","DOIUrl":"https://doi.org/10.1002/jso.70407","url":null,"abstract":"<p><strong>Background and objectives: </strong>Superficial-to-deep lymphatic drainage has been proposed as a mechanism to reduce an individual's risk of developing breast cancer-related lymphedema (BCRL). The epitrochlear-humeral pathway provides superficial-to-deep lymphatic drainage and may be preferentially recruited when the superficial lymphatic system becomes inadequate. We evaluated the presence or absence of epitrochlear-humeral lymph node drainage in breast cancer survivors post-axillary lymph node dissection (ALND) who did not develop BCRL.</p><p><strong>Methods: </strong>Female breast cancer survivors without BCRL after ALND underwent lymphatic mapping with ICG lymphography and SPECT/CT lymphoscintigraphy. The presence of epitrochlear and/or humeral drainage was recorded and compared between volunteers based on linear versus nonlinear patterns on ICG lymphography.</p><p><strong>Results: </strong>Twenty-five volunteers, a median of 13.0 years after ALND, met the inclusion criteria. Drainage to both the epitrochlear and humeral nodes was observed in 56% (14/25). Linear ICG patterns were present in 32% (8/25), while 68% (17/25) demonstrated nonlinear patterns. Epitrochlear and humeral drainage was observed in 38% (3/8) of volunteers with linear patterns compared with 65% (11/17) of those with nonlinear patterns.</p><p><strong>Conclusions: </strong>Superficial-to-deep lymphatic drainage is common in breast cancer survivors without BCRL after ALND and may represent an important compensatory mechanism of the deep lymphatic system.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011962","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":"Dynamic ctDNA Monitoring Predicts Recurrence and Guides Therapy in Postoperative Hepatocellular Carcinoma.","authors":"Jianliang Xu, Hui Wang, Mingxing Xu, Yanjie Li, Yi Zhang, Jiehui Tan, Nan Lin","doi":"10.1002/jso.70405","DOIUrl":"https://doi.org/10.1002/jso.70405","url":null,"abstract":"<p><strong>Background: </strong>Hepatocellular carcinoma (HCC) remains a global health challenge with high recurrence rates despite surgical resection. Current biomarkers lack sensitivity for early relapse detection, underscoring the need for novel strategies. Circulating tumor DNA (ctDNA) has emerged as a promising tool for minimal residual disease (MRD) monitoring, yet its prognostic and therapeutic implications in HCC remain underexplored.</p><p><strong>Methods: </strong>This retrospective study enrolled 23 HCC patients undergoing R0 resection. Preoperative and serial postoperative plasma samples were analyzed using a 425-gene next-generation sequencing panel to detect MRD. Tissue-plasma mutation concordance, recurrence risk stratification, and therapeutic applications were evaluated.</p><p><strong>Results: </strong>MRD positivity at postoperative Day 7 predicted significantly shorter disease-free survival (DFS: 3.06 vs. not reached; p = 0.0027). Dynamic monitoring revealed three recurrence risk groups: persistently MRD-positive (highest risk, HR 4.12; p < 0.001), MRD-negative-to-positive (intermediate), and continuously negative (lowest). ctDNA detected recurrence 16 weeks earlier than imaging (81.8% sensitivity, 100% specificity). High tissue-plasma mutation concordance (84.6%) confirmed ctDNA's biological relevance, with TP53 (60.9% tissue/70% plasma) and CTNNB1 (17.4%/25%) as predominant drivers. ASXL1 mutations (p = 0.025) and microvascular invasion (p < 0.05) independently predicted poor DFS.</p><p><strong>Conclusions: </strong>Dynamic ctDNA analysis improves postoperative HCC management through early recurrence prediction and precision therapy guidance. High mutation concordance validates its role in reflecting tumor heterogeneity, while MRD trajectory stratification enables personalized surveillance.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012038","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":"Intraoperative Evaluation of Sarcoma Surgical Margins With Indocyanine Green Fluorescence Imaging: Results From an Observational Study.","authors":"Sumail Bhogal, Matthew Gong, William Li, Brenda Diergaarde, Alma Heyl, Clark Roth, Lawrence Garvin, Alexander Hoffman, Amanda Locker, Ines Lohse, Maria Silvaggio, Stella Lee, Richard McGough, Kurt Weiss","doi":"10.1002/jso.70383","DOIUrl":"https://doi.org/10.1002/jso.70383","url":null,"abstract":"<p><strong>Introduction: </strong>Sarcomas are rare malignancies that affect both adults and children. Surgical removal with negative histopathological margins is the foundation of sarcoma treatment. Failure to achieve negative margins puts patients at risk of local recurrence (LR). LR rates range between 10% and 30%. Intraoperative margin assessment is largely subjective and based on surgeon experience. Indocyanine green (ICG) dye has been used for decades for many medical and surgical applications. We previously demonstrated its capacity to guide intraoperative margin assessment in a mouse sarcoma model and described its use in human patients. Here we describe our experience in a larger cohort of 51 patients that enabled us to develop sarcoma-specific ICG parameters.</p><p><strong>Methods: </strong>After IRB approval, we performed an observational study on sarcoma patients at our institution. Intraoperative ICG measurements were compared with surgeons' impressions of margin adequacy and final histopathological margin evaluations. The incidence of LR was compared with these three data points (ICG, surgeon impression, final pathology). Statistical modeling was applied to develop sarcoma-specific ICG parameters.</p><p><strong>Results: </strong>67 patients were recruited and 16 were excluded, leaving 51 patients. Pathology identified 15 (29.4%) positive margins while surgeons predicted 8 (15.7%) positive margins. Compared with pathology, surgeons correctly identified only 4 out of 15 positive margins (sensitivity: 26.7%) and 32 out of 36 negative margins (specificity: 88.9%). To determine sarcoma-specific ICG parameters, we inspected an ROC curve. ROC curve analysis with signal-to-background ratio (SBR) as predictor showed AUC of 0.6704. Youden index was 0.35 and the corresponding optimal ICG-SBR cut point was 1.67. With margins classified as positive if SBR ≥ 1.67, the corresponding sensitivity was 93.3%, specificity 41.7%, PPV 40.0%, NPV 93.8% and accuracy 56.9%. Sensitivity was higher with the SBR method with greater identification of positive margins intraoperatively. NPV was also higher with this method.</p><p><strong>Conclusions: </strong>Here we describe sarcoma-specific parameters for intraoperative ICG. While ICG is extremely sensitive for detecting positive sarcoma margins, it cannot replace surgeons' clinical expertise. This study suggests that a prospective randomized clinical trial might discern how the sensitivity of ICG and the specificity of surgeon experience could be combined to decrease the incidence of LR.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148990532","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":"Evaluating the Accuracy of ChatGPT-4o in Addressing Complex Clinical Questions Based on NCCN Guidelines for Rectal Adenocarcinoma","authors":"Ryan Meyer,&nbsp;Tamir E. Bresler,&nbsp;Kevin M. Palmer,&nbsp;Tyler Wilson,&nbsp;Shivam Pandya,&nbsp;Manabu Fujita","doi":"10.1002/jso.70314","DOIUrl":"10.1002/jso.70314","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The management of rectal adenocarcinoma requires navigation of complex, branching guideline pathways encompassing neoadjuvant sequencing, surgical approach, organ preservation, and surveillance, yet real-world guideline adherence remains as low as 60–70%. The ability of current-generation large language models (LLMs) to accurately navigate these decision points has not been fully characterized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this cross-sectional, vignette-based study, 135 clinical questions were constructed from 45 pages of NCCN Rectal Cancer Guidelines (Version 4.2024). ChatGPT-4o was queried using standardized prompts with up to 3 clarifying questions permitted per query. Responses were independently evaluated by two physician raters on a 5-point Likert scale, with potential discrepancies adjudicated by a board-certified surgical oncologist. Primary outcomes were the proportion of responses rated Correct (score ≥ 3) and Accurate (score ≥ 4). Inter-rater reliability was assessed using Cohen's kappa, and subgroup analysis was performed across clinical domains using the Kruskal-Wallis test.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 135 questions, 127 (94.1%; 95% CI, 88.7–97.0%) were Correct and 121 (89.6%; 95% CI, 83.3–93.7%) were Accurate. One hundred two responses (75.6%) were completely correct without additional prompting. Performance was consistent across clinical domains (Kruskal-Wallis H = 0.530, <i>p</i> = 0.767). Inter-rater agreement was perfect (κ = 1.0). Eight responses (5.9%) contained partially or wholly incorrect information, with errors concentrated in multi-step conditional treatment decision points.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>ChatGPT-4o demonstrates high concordance with NCCN rectal cancer guidelines across all evaluated clinical domains with notable improvement over prior ChatGPT iterations evaluated by our group. The concentration of errors in complex conditional treatment algorithms suggests that LLMs excel at discrete factual recall but may struggle with multi-step reasoning under clinical uncertainty. Prospective validation using real-world clinical data and comparison with multidisciplinary tumor board recommendations remain necessary prior to clinical integration.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"525-530"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391364","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":"Outcomes of Talimogene Laherparepvec in Soft Tissue Sarcoma","authors":"Taylor P. Williams,&nbsp;Sabrina Catalano,&nbsp;David A. Liebner,&nbsp;Valerie P. Grignol","doi":"10.1002/jso.70330","DOIUrl":"10.1002/jso.70330","url":null,"abstract":"<div>\u0000 \u0000 <p>Talimogene laherparepvec (T-VEC), an intralesional therapy designed to elicit an immunogenic anti-tumor response, has a favorable safety profile in phase II trial and may be an effective second-line therapeutic in sarcoma; however, there is a paucity of data on its therapeutic efficacy. We present a case series of patients who received T-VEC for sarcoma at a high-volume sarcoma center. A total of four patients who had prior progression of disease on immune checkpoint inhibitors (ICI) received a median of 9.5 (range, 4–15) doses of T-VEC over 26.5 (range, 10–49) weeks with a median progression free-survival of 9 weeks (range, 9–10). Only one patient experienced toxicity, which presented as mild flu-like symptoms. This case series of patients receiving T-VEC for sarcoma adds to the literature of intralesional therapies for this rare disease. Our experience suggests that T-VEC may be administered safely and may provide local tumor control in select patients with sarcoma who have failed prior therapy with ICI.</p>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"505-507"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430765","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}