Surgical Oncology

Laparoscopic interval debulking offers better PFS and less morbidity than laparotomy in advanced ovarian cancer

This systematic review and meta-analysis pooled 14 studies including 16,578 FIGO III–IV patients undergoing interval debulking after neoadjuvant chemotherapy. Minimally invasive surgery achieved complete macroscopic cytoreduction more often than laparotomy (RR 1.12; 95% CI 1.01–1.23). Progression-free survival favored laparoscopy (HR 0.67; 95% CI 0.48–0.94), while overall survival was similar (HR 0.81; 95% CI 0.64–1.04). Laparoscopy halved postoperative complications (RR 0.50; 95% CI 0.33–0.76), reduced blood loss and hospital stay, and enabled earlier adjuvant chemotherapy. Authors consider laparoscopic interval debulking an oncologically safe alternative in selected patients, although overall certainty of evidence is low. 1

Laparoscopic hepatectomy outperforms RFA for small HCC despite higher morbidity

This retrospective study compared laparoscopic hepatectomy (n=109) with radiofrequency ablation (n=145) in 254 patients with small hepatocellular carcinoma. At 36 months, overall survival was higher with laparoscopic surgery than RFA (85.32% vs 66.21%; P<0.001). Disease-free survival also favored surgery (64.22% vs 44.83%; P=0.002); laparoscopic hepatectomy independently improved OS (HR 0.55; 95% CI 0.38–0.79). Laparoscopic hepatectomy required longer operations, more blood loss, longer recovery, higher costs, and far higher complication rates than RFA (62.39% vs 15.87%). For fit patients with resectable small HCC, laparoscopic hepatectomy offers superior long-term outcomes and should be strongly considered over RFA. 2

Tumor-informed WGS ctDNA tumor fraction may support organ preservation in rectal cancer

This prospective study used a primary-tumor-informed whole-genome sequencing assay to track circulating tumor DNA in locally advanced rectal cancer. Baseline ctDNA was detectable in 95% of patients, and higher baseline tumor fraction predicted lower likelihood of sustained clinical complete response. High tumor fraction during or after neoadjuvant therapy correlated with reduced sustained clinical complete response and higher relapse risk. During surveillance, very low tumor fraction was frequently seen in patients without recurrence, suggesting persistent low-level ctDNA without clinical failure. The assay’s high sensitivity supports potential use in treatment de-escalation and watch-and-wait selection, but specificity requires further validation. 3

GA-CARES finds no benefit and possible harm from propofol versus volatile anesthesia in cancer resection

The GA-CARES multicenter randomized trial assigned 1,766 adults undergoing high-risk cancer resections to propofol-only or volatile-only anesthesia maintenance. With minimum 2-year follow-up, intent-to-treat analysis showed no survival benefit for propofol (HR 1.16; 95% CI 0.96–1.41; P=0.115). Per-protocol analysis demonstrated higher mortality with propofol (25.5% vs 20%; HR 1.31; 95% CI 1.05–1.64; P=0.017). Disease-free survival was similar between groups (HR 1.10; 95% CI 0.9–1.36), and subgroup analyses were consistent. These data do not support choosing propofol over volatile agents to improve oncologic outcomes in major cancer surgeries. 4