Annals of Surgical Oncology最新文献

{"title":"Locally Recurrent Rectal Cancer in the Molecular Era: A Scoping Review of Biomarkers of Oncologic Outcome following Salvage Surgery.","authors":"Jennifer K Vu, Evonne Younan, Sascha Karunaratne, Sarah Sutherland, Paul A Sutton, Y Nancy You, Oliver Peacock, Daniel Steffens, Michael J Solomon, Kilian G M Brown","doi":"10.1245/s10434-026-20116-2","DOIUrl":"10.1245/s10434-026-20116-2","url":null,"abstract":"<p><strong>Background: </strong>Radical salvage surgery offers the only chance of cure for patients with locally recurrent rectal cancer (LRRC), yet up to 50% develop disease recurrence after surgery. Identification of those at highest risk of disease recurrence may improve selection for surgery and intensification of neoadjuvant treatment. This scoping review aimed to identify molecular determinants of oncologic outcomes following surgery for LRRC.</p><p><strong>Materials and methods: </strong>This study was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. MEDLINE, Embase, CENTRAL, and Scopus databases were searched for articles published between 2005 and 2025 that reported associations between blood, tissue, or other molecular factors and postoperative oncologic outcomes (recurrence and survival) in patients undergoing treatment for LRRC.</p><p><strong>Results: </strong>The search identified 2799 articles, of which 17 were included. Sample size varied from 21 to 213 patients. Locoregional recurrence rates after surgery ranged from 15% to 52% (various timepoints between 3 and 5 years), while 5-year overall survival ranged from 22% to 53%. Elevated carcinoembryonic antigen (CEA) was associated with shorter overall survival in 11 studies, and poorer relapse-free survival in 1 study. Elevated serum carbohydrate antigen 19-9 (CA19-9) was associated with shorter overall survival and disease-specific survival in two studies. No studies evaluating contemporary biomarkers (mutational profile, microsatellite instability, or circulating-tumour DNA) were identified.</p><p><strong>Conclusions: </strong>Evidence evaluating molecular biomarkers in LRRC is limited and has focused on traditional serum biomarkers such as CEA and CA19-9. Contemporary colorectal cancer biomarkers including mutational profile and ctDNA are yet to be studied in this population.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10629-10640"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675342/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148598139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phase II Multicenter Clinical Trial of Intraoperative Molecular Imaging with Abenacianine During Lung Cancer Surgery.","authors":"Luis J Herrera, Gavin M Wright, Jae Y Kim, Janani S Reisenauer, David C Rice, Sunil Singhal","doi":"10.1245/s10434-026-19951-0","DOIUrl":"10.1245/s10434-026-19951-0","url":null,"abstract":"<p><strong>Background: </strong>Surgery is the cornerstone for locally contained lung cancer; however, intraoperative challenges include accurate lesion localization and assessment of surgical margins. Intraoperative molecular imaging (IMI) using near-infrared fluorescence-guided surgery is a real-time tumor-targeted optical imaging technique. A multicenter phase II clinical trial evaluated abenacianine (VGT-309), a cathepsin-targeted near-infrared (NIR) IMI agent for visualization of pulmonary nodules and margins during surgery. The primary objective was to assess the efficacy of abenacianine.</p><p><strong>Methods: </strong>At six sites, patients scheduled to undergo surgery for known or suspected cancer in the lung received intravenous abenacianine 0.32 mg/kg 12-36 h before surgery. Efficacy was measured by the proportion of clinically significant events, defined as localization of lesions not found by standard surgical techniques, identification of additional cancers, identification of inadequate surgical margins confirmed by histology, and detection of cancerous lymph nodes.</p><p><strong>Results: </strong>Of 89 patients who received abenacianine and surgical resection, 40 (45%) had at least one clinically significant event. Abenacianine with NIR imaging identified lesions not found by standard methods in 33 (37%) patients, synchronous and occult cancers not found by preoperative imaging in three (3%) patients, margins within 10 mm of the closest staple line in eight (9%) patients, and cancerous lymph nodes in one (1%) patient. Abenacianine was safe and well-tolerated in this study; there were no drug-related serious adverse events.</p><p><strong>Conclusions: </strong>IMI with abenacianine during standard-of-care lung cancer surgery improved intraoperative localization, identification of occult lesions, margin assessment, and lymph node detection, enabling a more complete oncologic resection.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10283-10291"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13470622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global Disparities in Insurance Coverage of Post-Mastectomy Breast Reconstruction.","authors":"Aiman Perween Afsar, Barbara Mullen, Andrea A Moreira, Bill V Tran, Aparna Vijayasekaran","doi":"10.1245/s10434-026-20075-8","DOIUrl":"10.1245/s10434-026-20075-8","url":null,"abstract":"<p><p>Post-mastectomy breast reconstruction (PMBR) plays a critical role in restoring physical appearance and psychosocial well-being. However, pronounced geographic and socioeconomic disparities in PMBR access persist worldwide, largely driven by insurance coverage variations. We reviewed English-language literature examining regional insurance disparities in PMBR access through PubMed searches and reference screening. Access to PMBR varies dramatically across regions. Africa demonstrates the lowest utilization; fewer than 10% of eligible women undergo reconstruction, primarily through out-of-pocket payments. In Asia, South Korea's national insurance coverage achieves 77% PMBR rates, whereas limited coverage in China and India restricts access to affluent urban populations. Europe, Australia, New Zealand, and Brazil provide universal coverage with variable utilization. North America demonstrates legislative mandates in the United States, yet socioeconomic disparities persist, while Canada offers universal coverage with underutilization. Policy interventions requiring legislative mandates, guideline-based surgical counseling, and rural outreach are essential to address these equity gaps.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10760-10766"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337684","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":"A Neuron Projection Guidance Signature Associates with Immune-Cold Tumor Microenvironment and Poor Outcomes in Breast Cancer.","authors":"Kei Kawashima, Kohei Chida, Masanori Oshi, Akimitsu Yamada, Kazutaka Narui, Shipra Gandhi, John M L Ebos, Scott I Abrams, Arin Bhattacharjee, Itaru Endo, Kazuaki Takabe","doi":"10.1245/s10434-026-19932-3","DOIUrl":"10.1245/s10434-026-19932-3","url":null,"abstract":"<p><strong>Background: </strong>Neural involvement in the tumor microenvironment (TME) has increasingly been recognized as a regulator of cancer aggressiveness. However, its characterization in breast cancer remains a challenge due to very low nerve density in this cancer type. This study investigates the clinical relevance of cancer-medicated nerve recruitment activity in the TME of breast cancer patients.</p><p><strong>Methods: </strong>Transcriptomic and clinical data from 9017 breast cancer patients across multiple cohorts were analyzed. A Neuron Projection Guidance (NPG) score generated by GSVA of a MSigDB gene set was used to quantify nerve recruitment activity. Patients were dichotomized by cohort-specific medians.</p><p><strong>Results: </strong>The NPG score was associated with axonogenesis-related gene expressions. NPG-high tumors exhibited lower cell proliferation, indicated by less Ki67 gene expression, and less enrichment of proliferation-related Hallmark gene sets. NPG-high tumors revealed significantly lower mutational burdens and neoantigen loads, which were consistent with an immune-cold TME, characterized by lower infiltration of immune effector cells, decreased cytolytic activity, and suppressed immune-related pathways. NPG scores were higher in patients who did not achieve pathological complete response after neoadjuvant chemotherapy. Moreover, high NPG scores were associated with poorer survival. These associations were observed in triple-negative breast cancer (TNBC), but not consistently in ER+/HER2- nor HER2+ subtypes.</p><p><strong>Conclusions: </strong>These findings reveal a previously unrecognized tumor-neuronal cross-talk in TNBC biology, which associates with an immune-cold TME, reduced chemotherapeutic efficacy, and unfavorable clinical outcomes. Such a network has potential implications for risk stratification and therapeutic decision-making in TNBC.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10425-10435"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148590230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing the Workflow of Full Robotic Pancreatoduodenectomy: A Counterclockwise Step-by-Step Approach to Resection and Reconstruction.","authors":"Luca Morelli, Annalisa Comandatore, Gregorio Di Franco, Simone Guadagni, Giovanni Caprili, Niccolò Ramacciotti, Bianca Bechini, Raffaele Gaeta, Luca Pollina, Claudia Cariello, Elisa Giovannetti, Niccolò Furbetta","doi":"10.1245/s10434-026-20364-2","DOIUrl":"10.1245/s10434-026-20364-2","url":null,"abstract":"<p><strong>Background: </strong>Robotic technology has enabled the execution of complex surgical procedures through a fully minimally invasive approach. Among these procedures, robotic pancreatoduodenectomy (R-PD) remains particularly challenging due to its duration and the numerous steps involved. The authors present a standardized approach designed as a reproducible framework potentially applicable to the majority of standard R-PD techniques aimed at enhancing operative workflow.</p><p><strong>Methods: </strong>The technique is based on a stepwise model for the resection phase, performed in a counterclockwise sequence that provides a logical and reproducible pathway through the complex anatomy of the pancreatic head. The reconstruction phase follows a second counterclockwise-inspired sequence, relying on standardized anastomotic techniques designed to improve reproducibility and operative flow.</p><p><strong>Results: </strong>Between May 2018 and November 2025, 150 consecutive R-PDs were performed in our General Surgery Unit. The mean console time was 279.44 ± 55.85 min. All the procedures were completed using a fully robotic approach, without conversion to open surgery. The median hospital stay was 12 days (range, 9-23 days). Major complications (Clavien-Dindo ≥3) occurred for 20 patients (13.3 %). Clinically relevant postoperative pancreatic fistula developed in 10 patients (6.7 %), whereas clinically relevant delayed gastric emptying was reported in 35 patients (23.3 %). The 30- and 90-day mortality rates were 1.3 % (2/150 patients) and 3.3 % (5/150 patients), respectively.</p><p><strong>Conclusions: </strong>The structured, counterclockwise-inspired surgical sequence described combined with standardized reconstruction techniques may represent an effective strategy for performing most standard R-PDs. This approach has the potential to streamline workflow and enhance surgical outcomes.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10715-10724"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787554","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":"ASO Author Reflections: Can Graded Histologic Regression Guide Postoperative Chemotherapy Regimen Switching for Locally Advanced Gastric Cancer?","authors":"Dongfeng Song, Xiang Wang, Lin Zhao","doi":"10.1245/s10434-026-20477-8","DOIUrl":"10.1245/s10434-026-20477-8","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10740-10741"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966417","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":"Preoperative Nutritional Risk Defines Treatment Tolerance and Guides Adjuvant Immunotherapy in Resectable Esophageal Squamous Cell Carcinoma.","authors":"Yizhou Huang, Maohui Chen, Zhenyuan Yang, Bingqiang Cai, Yongcong Zhang, Jiarui Wu, Wei Li, Chun Chen, Bin Zheng","doi":"10.1245/s10434-026-20172-8","DOIUrl":"10.1245/s10434-026-20172-8","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition is a critical determinant of treatment tolerance in esophageal squamous cell carcinoma (ESCC). However, its utility in guiding dynamic perioperative decision-making and adjuvant immunotherapy selection remains undefined.</p><p><strong>Methods: </strong>This study evaluated 498 locally advanced ESCC patients receiving neoadjuvant chemoimmunotherapy and planned esophagectomy. A classification and regression tree (CART) model stratified patients by baseline PG-SGA score. The primary endpoint was treatment tolerance as defined by a composite Neoadjuvant Therapy Tolerance Grade (NAT-TG) that integrated therapy completion and surgical feasibility. The secondary endpoints included postoperative morbidity and survival outcomes. Additionally, dynamic preoperative nutritional trajectories were longitudinally tracked.</p><p><strong>Results: </strong>The CART model identified three distinct nutritional risk strata. Increasing nutritional risk was strongly associated with impaired treatment tolerance, reflected by reduced surgical completion (97.1% vs 93.3% vs 76.7%; P < 0.001) and higher-grade (≥3) toxicities. High-risk patients experienced significantly more severe postoperative complications (38.2% vs 18.0%; P < 0.001). Longitudinal monitoring showed that a persistent-severe dynamic nutritional trajectory independently predicted major postoperative complications (odds ratio, 3.21; P < 0.001). At a median follow-up period of 41 months, baseline high nutritional risk independently predicted inferior overall survival (hazard ratio, 2.03; P < 0.001). Notably, within the cohort that underwent resection, adjuvant immunotherapy significantly improved 3-year overall survival for high-risk patients, from 41.7% to 65.8% (P = 0.043), whereas no such benefit was observed in lower-risk groups.</p><p><strong>Conclusions: </strong>Integrating baseline nutritional triage with dynamic longitudinal monitoring effectively predicts treatment tolerance and prognosis in ESCC. This framework identifies a high-risk subset that derives substantial survival benefit from adjuvant immunotherapy consolidation.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10247-10258"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148403425","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":"Chest Wall Perforator Flaps in Oncoplastic Breast Surgery: A Series of 157 Consecutive Cases at the Paris Breast Center.","authors":"Ljuba Morando, Jenny-Claude Millochau, Claude Nos, Benoit Couturaud, Alejandro Martin Sanchez, Isabelle Sarfati, Krishna B Clough","doi":"10.1245/s10434-026-19930-5","DOIUrl":"10.1245/s10434-026-19930-5","url":null,"abstract":"<p><strong>Background: </strong>Chest wall perforator flaps (CWPF) are emerging as a versatile and safe oncoplastic technique for breast-conserving surgery, particularly in small to medium breasts and challenging tumor locations. Despite proven benefits, their adoption remains limited by the lack of long-term real-world data.</p><p><strong>Methods: </strong>A single-institution retrospective analysis was conducted to assess CWPF outcomes in 157 patients with early-stage breast cancer treated at the Paris Breast Center between 2005 and 2024. Primary outcomes were complication rates, re-excision, and conversion to mastectomy rates. Secondary outcomes included local and distant recurrence, and overall survival with median follow-up exceeding 4 years.</p><p><strong>Results: </strong>The median age was 60 years; most tumors were cT1-T2 with median size 14.4 mm. CWPF types were anterior intercostal artery perforator (AICAP; 70.7%), lateral intercostal artery perforator (LICAP; 18.5%), LICAP + lateral thoracic artery perforator (LTAP; 6.4%), and LTAP (4.5%). Early complications (grade ≥II) occurred in 5.1% with no partial or total flap loss. The rate of re-excision was 5.7% and of completion mastectomy was 0.6%. The median follow-up was 48 months; local recurrence occurred in 2.5% and distant recurrence in 6.4%, with no deaths.</p><p><strong>Conclusions: </strong>CWPF reinforces the evolving role of oncoplastic surgery in safely extending breast-conserving opportunities, including neoadjuvant systemic therapy and re-operative settings. Prospective, multicentric studies including patient-reported outcomes are warranted to further validate these findings.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10805-10815"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148293239","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":"ASO Author Reflections: Risk-Adapted Use of Adjuvant Systemic Therapy in Real-World Kidney Cancer Care.","authors":"Maximilian Filzmayer, Michele Petix, Leonardo Quarta, Filippo Orlandi, Jordan A Goyal, Luca Carmignani, Alberto Briganti, Salvatore Micali, Shahrokh F Shariat, Mike Wenzel, Yasmine Heß-Busch, Clara Humke, Fred Saad, Felix K-H Chun, Pierre I Karakiewicz","doi":"10.1245/s10434-026-20472-z","DOIUrl":"10.1245/s10434-026-20472-z","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10496-10497"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13675272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148849680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to \"Structure, not Discretion: What the Retreat from Metrics in Breast Surgical Oncology Fellowship Selection Overlooks\" by Wang.","authors":"Joyce L Eum, Carinne W Anderson","doi":"10.1245/s10434-026-20564-w","DOIUrl":"10.1245/s10434-026-20564-w","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10599-10600"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148954631","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}