Indian Journal of Surgical Oncology最新文献

{"title":"Revisiting Rotter's Lymph Nodes: Insights from Axillary Clearance Surgery at a Tertiary Care Hospital from India.","authors":"Geeta Kadayaprath, Gautam Anand, Preeti Grewal","doi":"10.1007/s13193-025-02528-w","DOIUrl":"10.1007/s13193-025-02528-w","url":null,"abstract":"<p><p>Interpectoral lymph nodes (IPNs), or Rotter's lymph nodes, are a critical yet understudied component of breast cancer lymphatic drainage, with potential implications for staging and therapeutic outcomes. Despite their role in \"skip metastases,\" clinical guidelines remain ambiguous regarding IPN dissection due to conflicting evidence on their metastatic rates and associated surgical risks. This study aims to address gaps in population-specific data, particularly in India, where breast cancer burden is high, and modified radical mastectomy (MRM) is prevalent. This study sought to quantify IPN metastasis rates in Indian breast cancer patients, identify clinicopathological predictors of IPN involvement, and propose evidence-based criteria for selective IPN dissection to balance oncologic efficacy and surgical morbidity. A retrospective analysis of 472 breast cancer patients (2017-2024) undergoing axillary lymph node dissection (ALND) with mastectomy/lumpectomy was conducted. IPNs were dissected separately and examined pathologically. Clinicopathological variables, including tumor size, nodal status, extranodal extension (ENE), and molecular subtypes, were analyzed. Univariate and multivariate logistic regression identified predictors of IPN occurrence and metastasis. IPNs were detected in 9.1% (43/472) of patients, with metastasis in 3.47% (16/460) of the total node positive cases. No isolated IPN metastases (without axillary involvement) were observed. Advanced nodal disease (pN3: OR = 3.78, *p* < 0.001), ENE (OR = 2.15, *p* = 0.012), and pathological Stage III (OR = 2.95, *p* < 0.001) independently predicted IPN occurrence. IPN metastasis correlated strongly with ENE (OR = 3.4, *p* = 0.005), pN2/N3 stage (OR = 4.8, *p* < 0.001), and larger metastatic nodal size (*p* = 0.002). No associations were found with molecular subtypes or tumor location. IPN metastasis is rare in early-stage (pN0/pN1) disease but increases significantly with advanced nodal burden. Selective IPN dissection in high-risk patients (pN2/pN3, ENE) may optimize staging accuracy while minimizing unnecessary morbidity. These findings support a risk-stratified approach to IPN evaluation in resource-variable settings. Further prospective studies are needed to validate long-term oncologic outcomes.</p><p><strong>Graphical abstract: </strong></p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1978-1984"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sebaceous Gland Carcinoma of the Head and Neck: a Retrospective Case Series Highlighting Clinicopathologic characteristics, Pattern of Nodal Metastasis & its Management Implications.","authors":"Aswin Mullath, Anoop Attakkil, Sandeep Vijay, Raveena R Nair, Hridya Hareendran","doi":"10.1007/s13193-025-02486-3","DOIUrl":"10.1007/s13193-025-02486-3","url":null,"abstract":"<p><p>Sebaceous gland carcinoma (SGC) is a rare but highly aggressive adnexal tumor, most frequently arising in the eyelid, while extraocular head-and-neck presentations are uncommon and often misdiagnosed; reported 5-year survival rates range from 50 to 80% in the literature.The potential for regional lymphatic spread, particularly to the intraparotid nodes, has been documented in 10-21% of periocular cases and up to one quarter of extraocular cases, making nodal evaluation a critical component of management. We reviewed patients with histologically proven head and neck SGC treated with curative intent at a tertiary oncology center in Southern India between 2014 and 2022. Eight patients were identified, with a median age of 61 years. The eyelid was the predominant site (<i>n</i>=6), followed by the scalp and preauricular region (<i>n</i>=2). All patients underwent wide local excision with intraoperative frozen section margin assessment. Five patients underwent elective superficial parotidectomy, and metastasis was confirmed in two cases representing 25% of the total cohort and 40% among those who had parotidectomy with one case arising from an eyelid primary and the other from a scalp primary. Adjuvant radiotherapy was delivered to five patients with adverse histopathologic features. After a median follow-up of 24 months, all patients were alive without evidence of recurrence. These findings particularly the observed nodal metastasis underscore the aggressive nature of SGC, the real risk of parotid nodal involvement, and the need for complete surgical excision. Current literature supports considering elective parotidectomy in high-risk, node-negative patients because parotid metastasis is well-documented in case series, though larger studies are still needed to define optimal nodal management.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1817-1819"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of C-Reactive Protein, Serum Albumin, and the CRP-Albumin Ratio in Predicting Outcomes Following Pancreaticoduodenectomy.","authors":"Archit Gupta, Azhar Perwaiz, Amanjeet Singh, Adarsh Chaudhary","doi":"10.1007/s13193-025-02490-7","DOIUrl":"10.1007/s13193-025-02490-7","url":null,"abstract":"<p><p>Pancreaticoduodenectomy (PD) remains the only curative option for pancreatic ductal adenocarcinoma (PDAC) and other periampullary malignancies. Despite improvements in surgical techniques, morbidity rates remain high. Early identification of patients at risk for complications can improve outcomes. C-reactive protein (CRP) and the CRP-albumin ratio (CAR) are emerging inflammatory markers with potential prognostic value in predicting postoperative complications. This prospective, tertiary hospital-based study included patients undergoing PD between August 2022 and October 2023. Preoperative and postoperative CRP, albumin, and CAR levels were measured on postoperative days (POD) 1, 3, and 5. The association between these markers and postoperative complications was analyzed using univariate and multivariate logistic regression. A total of 160 patients were included. Elevated CRP on POD 3 and increased CAR on POD 3 and 5 were significantly associated with postoperative complications. ROC curve analysis demonstrated that CAR had superior predictive ability compared to CRP alone. CRP and CAR serve as useful adjuncts for early postoperative risk assessment following PD. CAR, particularly on POD 5, demonstrated moderate but clinically relevant discriminatory ability in identifying patients at risk of complications. Integrating these markers into postoperative management protocols could enable timely interventions and improved patient outcomes. Further multicenter studies are warranted to validate these findings.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1831-1837"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841622","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative Outcomes in Locally Advanced Head and Neck Cancers Reconstructed using Free Flap : Early Experience at Tertiary Health Care Centre.","authors":"Ankita Jain, Anuj Singh, Jaiveer Singh Shekhawat, Umesh Jethwani, Sandip Patel, Naveen Sharma, Anushree Chaturvedi","doi":"10.1007/s13193-025-02493-4","DOIUrl":"10.1007/s13193-025-02493-4","url":null,"abstract":"<p><p>Head and neck squamous cell cancers (HNSCC) are one of the most common cancers in India. According to GLOBOCAN 2020, there will be 2.1 million new cancer cases in India by 2040, Head and neck cancer (HNC), in particular, accounts for 30% of the all-cancer cases. Treating HNSCC is a difficult task for surgeons since most of the cases in our country present at advanced stages. One of the biggest hurdles in reconstruction of the defects of these complex cases is the ability to perform microvascular flaps. Many advanced HNSCC which were previously considered inoperable, are now operable with the use of microvascular surgery reconstruction. All patients of HNSCC who underwent resection and free flap reconstruction in the Department of Surgical Oncology at a tertiary health care centre from February 2023 to October 2024 were included in the study. It is a retrospective analysis of the data collected from the treated patients. A total of 60 patients were included, comprising 48 males and 12 females, with the majority presenting in Stage III or IV disease. Three types of free flaps were used: anterolateral thigh (ALT) (n = 38), radial artery forearm (RAFF) (n = 18), and free fibula (n = 4). The facial artery was the most common recipient vessel (44 cases), followed by the superior thyroid artery (16 cases). Fourteen patients (23.3%) required early re-exploration for flap perfusion issues (n = 12) or bleeding (n = 4). The overall flap success rate was 83.3%, with a salvage rate of 16.7% (2/12). The mean operative duration was 4.2 h for ALT, 4.0 h for RAFF, and 6.0 h for fibula flaps, showing progressive reduction with experience. Postoperative oral competence and swallowing outcomes were satisfactory, with 70% achieving intelligible speech and 75% reporting good aesthetic and social acceptance at 6 months. Microvascular surgical reconstruction has changed the landscape of management of locally advanced head and neck squamous cell cancers (LAHNSCC). Because the donor site is morbidity is less free flap reconstruction offers surgeons the opportunity to improve the healing process and leads to better functional and aesthetic outcomes.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1956-1961"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Pitfall of Synovial Sarcoma.","authors":"Jiro Ichikawa, Tomonori Kawasaki, Masanori Wako","doi":"10.1007/s13193-025-02523-1","DOIUrl":"10.1007/s13193-025-02523-1","url":null,"abstract":"","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"2004-2005"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current Practices in Axillary Management for Clinically Node-Negative Breast Cancer among Breast Surgeons in India: a Cross-Sectional Survey Study.","authors":"Akhila Bommareddy, Giridhar Chidananda Murthy","doi":"10.1007/s13193-025-02509-z","DOIUrl":"10.1007/s13193-025-02509-z","url":null,"abstract":"<p><p>The management of the axilla in early breast cancer has evolved considerably, with sentinel lymph node biopsy (SLNB) now preferred for clinically node-negative (cN0) patients. Landmark trials such as ACOSOG Z0011 have advocated for the selective omission of axillary lymph node dissection (ALND) in certain cases, but real-world practice patterns, especially in India, remain under-reported. An online cross-sectional survey was conducted among breast surgeons in India to evaluate their practices in axillary management, familiarity with key clinical trials, and factors influencing clinical decisions. A total of 121 breast surgeons participated. While 97.5% were familiar with the ACOSOG Z0011 trial, only 52.9% had altered their practice based on its recommendations. Methylene blue dye alone was the most common SLNB technique (40.5%). Selective Level III dissection was performed by 91.7% of respondents. However, 71.9% still performed completion ALND for patients with 1-2 macrometastatic sentinel nodes. Despite high awareness of international evidence, significant variation persists in axillary management practices among Indian breast surgeons. There is a need for improved guideline dissemination, multidisciplinary decision-making, and resource optimization to achieve uniform, evidence-based care.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13193-025-02509-z.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1771-1776"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518703/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-World Outcomes of Chemoradiotherapy for Anal Squamous Cell Carcinoma: Insights from Northeast India.","authors":"Abhinandan Das, Jyotiman Nath, Tapashi Das, Saswati Datta, Partha Sarathi Roy, Yanpothung Yanthan, Jahnabi Das, Rudrasankar Chakraborty","doi":"10.1007/s13193-025-02505-3","DOIUrl":"10.1007/s13193-025-02505-3","url":null,"abstract":"<p><p>Anal squamous cell carcinoma (SCC) is a rare malignancy with rising incidence rates. While chemoradiotherapy (CCRT) has become the standard of care for nonmetastatic anal SCC, there is limited data on treatment outcomes from India, particularly the Northeastern region. This study aims to evaluate the clinical characteristics, treatment outcomes, and toxicity profiles of definitive CCRT for anal SCC at a tertiary cancer center in Northeast India. A retrospective, single-center study was conducted on 22 patients diagnosed with nonmetastatic anal SCC who received definitive CCRT between 2017 and 2021. Radiotherapy was delivered using 3D-CRT, IMRT, or VMAT, with concurrent chemotherapy comprising Mitomycin C (MMC) and 5-fluorouracil (5-FU). Acute and late toxicities were assessed, and survival outcomes were analyzed using the Kaplan-Meier method. The median age of the cohort was 54 years, with a male predominance (64%). The majority of patients had Stage III disease, and the most common symptoms were perianal pain and rectal bleeding. The median overall survival (OS) was 46 months, with 1-year, 2-year, and 3-year OS rates of 95.7%, 78.3%, and 63.6%, respectively. The 3-year locoregional control (LRC) and colostomy-free survival (CFS) rates were 57% and 60%, respectively. Patients receiving ≥ 54 Gy had significantly better survival outcomes. Common acute toxicities experienced included dermatitis, anemia, and neutropenia. Late toxicities were mild, with no grade 3 or 4 late effects observed. CCRT with 5-FU and MMC remains the gold standard for nonmetastatic anal SCC, offering favorable survival outcomes and preserving sphincter function. Advanced radiation techniques like IMRT and VMAT help minimize toxicity. These findings align with both regional and international studies, though further studies are essential to optimize radiation dose regimens and explore novel therapies to further improve patient outcomes.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1892-1898"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine Green Fluorescence-Guided Lymphadenectomy in Laparoscopic Radical Gastrectomy for Gastric Cancer: A Pilot Randomized Pilot Study.","authors":"Rajkumar Pareshbhai Patel, T Subramanyeshwar Rao, Sujit Chyau Patnaik, Pratap Reddy Ramalingam, Syed Nusrath","doi":"10.1007/s13193-025-02494-3","DOIUrl":"10.1007/s13193-025-02494-3","url":null,"abstract":"<p><p>Adequate lymphadenectomy is crucial for optimal oncological outcomes in gastric cancer. Indocyanine green (ICG) fluorescence imaging may enhance lymph node retrieval during laparoscopic D2 lymphadenectomy. This study evaluates efficacy of ICG-guided lymphadenectomy in improving nodal yield and perioperative safety in gastric carcinoma. In this prospective randomized pilot study at a tertiary cancer care, 30 patients with gastric adenocarcinoma were randomized 1:1 to ICG-guided or standard laparoscopic D2 lymphadenectomy. ICG (0.5 mL, 2.5 mg/mL) was injected subserosally in the ICG group. The primary endpoint was total nodal yield; secondary endpoints included metastatic node ratio, morbidity, mortality, and operative outcomes. The ICG group had a significantly higher mean nodal yield (55.5 ± 14.3 vs. 41.2 ± 16.0 nodes, <i>P</i> = 0.0057). Metastatic node ratio (0.19 vs. 0.20) and positive nodes (10.7 vs. 8.3, <i>P</i> = 0.49) were similar. ICG group had increased D1 nodal yield (41.0 ± 14.5 vs. 25.3 ± 12.5, <i>P</i> = 0.006) but not D2 nodes (14.5 ± 5.3 vs. 15.9 ± 8.7, <i>P</i> = 0.51). Postoperative complications were similar, with Clavien-Dindo grade ≥ 2 occurring in 26.7% of patients in the ICG group versus 33.3% in the non-ICG group (<i>P</i> = 1), and no mortality was observed. Operative time, blood loss, and length of hospital stay were comparable between the groups. In this single-center pilot randomized study, ICG-guided lymphadenectomy during laparoscopic gastrectomy for gastric cancer resulted in a higher overall lymph node yield without affecting the metastatic nodal ratio. Larger trials are warranted to confirm these findings and evaluate long-term oncological benefits.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13193-025-02494-3.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1807-1816"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Level V Lymph Node Involvement in Oral Cavity Squamous Cell Carcinoma: Incidence and Implications for Surgical Management.","authors":"M K Mukarram Hussain, Sudam Sadangi, Snehasis Pradhan, Shyam Kumar Hariharan, Amit Kumar Samal, Sujan Kumar Voni, Twinkle Rout, Sunil Kumar Agrawala","doi":"10.1007/s13193-025-02492-5","DOIUrl":"10.1007/s13193-025-02492-5","url":null,"abstract":"<p><p>In India, oral cavity squamous cell carcinoma (OCSCC) is the most common cancer in men and the third most common in women, largely due to prevalent habits such as betel nut and tobacco chewing. Regional lymph node metastasis is the most significant prognostic factor in OCSCC, influencing both survival and recurrence. Among the cervical nodal levels, involvement of posterior-triangle (Level V) nodes is considered exceedingly rare in oral cavity cancers, raising concerns about the necessity of routine Level V dissection. Avoiding unnecessary dissection of this nodal level may help reduce postoperative morbidity, especially shoulder dysfunction, without compromising oncologic control. A prospective study was conducted on 128 patients with histologically confirmed OCSCC to evaluate the incidence of Level V lymph node metastasis and its correlation with adverse pathological features, including perineural invasion (PNI), extranodal extension (ENE), and depth of invasion (DOI). Statistical analyses were used to assess associations between these factors. Level V nodal metastasis was observed in only 1 of 128 cases (0.8%). Significant correlations were found between Level V involvement and both PNI and ENE, with a trend towards significance for DOI. These findings suggest that Level V metastasis is rare and typically associated with high-risk pathological features. Therefore, routine Level V dissection may not be warranted for all patients with OCSCC. A selective approach-reserving Level V clearance for patients with multilevel nodal involvement or high-risk features-may minimize surgical morbidity while maintaining oncologic safety.</p><p><strong>Supplementary information: </strong>The online version contains supplementary material available at 10.1007/s13193-025-02492-5.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1917-1921"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Microscopically Incomplete Resection (R1) of Intrahepatic Cholangiocarcinoma: What's the Next Step?","authors":"Michael Osseis, Christian Mouawad","doi":"10.1007/s13193-025-02496-1","DOIUrl":"10.1007/s13193-025-02496-1","url":null,"abstract":"<p><p>Intrahepatic cholangiocarcinoma (ICC) carries a poor prognosis, with microscopically positive margins (R1) significantly worsening survival. Despite this, current guidelines provide ambiguous recommendations for adjuvant therapy (AT) in R1 cases, partly due to extrapolation from heterogeneous biliary tract cancers. To critically appraise the scarce evidence on AT following R1 resection for ICC, highlight existing knowledge gaps, and outline priorities for future research. We conducted a focused review of studies evaluating survival benefit of AT after R1 resection in ICC, using PRISMA guidelines. Only two retrospective studies specifically addressed this question. Neither study demonstrated a clear survival benefit for adjuvant chemotherapy in R1 resections. Broader data on biliary tract cancers remain heterogeneous and inconclusive. Recent retrospective studies suggest possible benefit from chemoradiation in select subgroups, but robust, prospective trials are lacking. There is insufficient high-quality evidence to guide AT decisions in R1 ICC. Multi-institutional registries and randomized trials focused specifically on ICC are urgently needed. Until then, individualized, multidisciplinary decision-making remains critical.</p>","PeriodicalId":46707,"journal":{"name":"Indian Journal of Surgical Oncology","volume":"17 8","pages":"1739-1746"},"PeriodicalIF":0.7,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13518702/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148841614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}