Surgical Oncology

Prospective CLAEG registry supports abdominal-focused lymphadenectomy and total gastrectomy for AEG

In 2044 radical resections for AEG across 44 centers, nodal metastases were predominantly abdominal rather than mediastinal. Category-1 abdominal nodes included stations 1, 2, 3, 4, 7, 8a, 9, and 11p, supporting prioritization of abdominal lymphadenectomy. Neoadjuvant therapy was associated with lower nodal metastasis rates, suggesting meaningful nodal downstaging. Among gastrectomies, total gastrectomy had fewer postoperative complications than proximal gastrectomy and enabled more extensive lymphadenectomy. Laparoscopic resection offered faster postoperative recovery than open surgery, without higher complication rates or perioperative mortality. 1

Multimodal prehabilitation reduces complications in frail older gastric cancer patients

This multicenter RCT randomized 368 frail patients aged 65–85 years undergoing radical gastrectomy to ERAS alone or ERAS plus supervised multimodal prehabilitation. Among 347 analyzable patients, prehabilitation reduced 30-day postoperative complications versus ERAS alone (17.2% vs 28.7%; P = .01). Benefits were driven by fewer minor and medical complications, while serious surgical morbidity was not clearly different. Prehabilitation improved preoperative 6-minute walk distance and preserved functional capacity above baseline four weeks postoperatively. ICU stay, ventilation time, hospital stay, and inflammatory markers generally favored prehabilitation, with high protocol adherence. 2

Mature minimally invasive PD achieves PDAC outcomes comparable to open surgery, with advantages in selected type 0 cases

This cohort compared 112 minimally invasive and 245 open pancreatoduodenectomies for resectable or borderline resectable PDAC after the MIPD learning curve. Operation time was longer with MIPD, but blood loss, transfusion needs, pancreatic fistula, and delayed gastric emptying were similar. Overall and disease-free survival did not differ between MIPD and open groups after propensity score matching. In type 0 resections without vascular involvement, overall survival was equivalent, but disease-free survival favored MIPD. These data support MIPD as an oncologically sound option for PDAC, particularly for tumors not requiring vascular resection. 3

PCI and primary site refine peritoneal recurrence risk after CRS/HIPEC for colorectal metastases

Among 133 patients with colorectal peritoneal metastases achieving CC-0 CRS/HIPEC, 48.1% developed peritoneal surface recurrence. Higher PCI was associated with recurrence, and each PCI point corresponded to a 2.43-week earlier relapse among those who recurred. Right- and sigmoid-colon primaries independently predicted peritoneal recurrence compared with other locations, even after adjusting for PCI. Tumor stage, histology, intraperitoneal agent, and common molecular alterations were not associated with recurrence risk. Modeling PCI continuously, rather than using early/late categories, allows more nuanced risk stratification for surveillance and adjuvant strategies. 4