30-Second Takeaway
- Transitional CTCs in resectable PDAC stratify systemic recurrence risk and highlight patients deriving substantial benefit from adjuvant chemotherapy.
- Preoperative biopsy reliably identifies retroperitoneal sarcoma histology, but frequently underestimates grade, especially in dedifferentiated liposarcoma.
- Robotic gastrectomy provides long-term recurrence outcomes equivalent to laparoscopy, so platform choice can prioritize expertise and perioperative goals.
- Multimodal perioperative rehabilitation in frail older GI cancer patients shifts many from frail to pre-frail by discharge and early follow-up.
- Enhanced MRI modeling with the dark-light-dark sign improves rectal nodal staging, particularly for sub-5-mm nodes relevant to organ preservation.
Week ending December 27, 2025
Targeted perioperative strategies and imaging tools to refine risk, treatment intensity, and function in GI and urologic oncology
Transitional CTCs refine recurrence risk and adjuvant benefit after PDAC resection
In the prospective CLUSTER trial of 123 resectable PDAC patients, transitional CTCs were detected preoperatively in 67%. Higher preoperative trCTC counts showed a linear association with systemic recurrence, whereas CA19-9 showed no meaningful correlation. Postoperative trCTC positivity indicated minimal residual disease and higher recurrence risk. Among trCTC-positive patients, adjuvant chemotherapy was associated with substantially improved overall survival (adjusted HR 0.21, 95% CI 0.09–0.49). These findings support adding pre- and postoperative trCTC assessment to risk stratification and adjuvant decision-making after PDAC resection.
Preoperative biopsy in retroperitoneal sarcoma: histology robust, grade often underestimated
This prospective Resar registry analysis included 894 adults with primary localized retroperitoneal sarcoma undergoing biopsy then curative-intent surgery. Histologic subtype concordance between biopsy and resection was high at 87.7% (κ=0.814), supporting histology-based planning. Grade concordance was 76.1% (weighted κ=0.652) and was particularly poor for grade 3 tumors and dedifferentiated liposarcomas. A quarter of tumors labeled well-differentiated liposarcoma on biopsy were reclassified as dedifferentiated at resection. High-volume centers showed better histologic and grade concordance, supporting referral to specialized sarcoma units for preoperative decisions.
Robotic and laparoscopic gastrectomy show equivalent 3-year recurrence outcomes
This multicenter retrospective study compared 941 robotic and 941 laparoscopic gastrectomies for gastric cancer using propensity score matching. Three-year recurrence rates were nearly identical between robotic and laparoscopic groups (15.1% vs 15.0%; p=0.949). Three-year recurrence-free survival and time to recurrence were also similar, with no signal of oncologic inferiority for robotic surgery. Subgroup analyses by age, extent of resection, and pathological stage consistently demonstrated comparable recurrence outcomes. These data support choosing robotic versus laparoscopic gastrectomy based on expertise, resources, and perioperative priorities rather than oncologic concerns.
Perioperative multimodal rehabilitation reduces frailty in older GI cancer patients
This single-blind randomized trial enrolled 96 frail older patients undergoing colorectal or gastric cancer surgery. The intervention group received perioperative multimodal rehabilitation combining nutritional support, exercise, and psychological care; controls received routine care. Frailty status by Fried Frailty Phenotype did not differ at admission or postoperative day one between groups. By discharge, the intervention group had significantly more pre-frail and fewer frail patients than controls (P<0.001). One week post-discharge, most intervention patients were pre-frail with markedly fewer remaining frail compared with controls (P<0.001).
References
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Additional Reads
Optional additional studies from this edition.