Surgical Oncology

Post-neoadjuvant staging laparoscopy reduces futile laparotomy in resectable/borderline PDAC

In PREOPANC-2, 240 of 322 explored patients underwent staging laparoscopy immediately before planned pancreatic resection after neoadjuvant therapy. Occult metastases were identified in 12.1% overall and were the main reason for aborting resection without pancreatectomy. Non-therapeutic laparotomy was significantly lower with staging laparoscopy versus direct laparotomy (4.5% vs 17.1%; number needed to treat 8). Tumor size ≥3 cm and baseline CA19-9 >500 U/ml independently predicted occult metastatic disease, with stepwise increases in metastatic risk. 1

Salvage focal therapy offers lower-morbidity alternative to salvage prostatectomy after radiorecurrent disease

This international matched cohort compared salvage focal therapy using HIFU or cryotherapy with salvage radical prostatectomy for localized radiorecurrent prostate cancer. Among 923 eligible patients, 419 underwent salvage focal therapy and 504 underwent salvage prostatectomy across multiple centers and eras. Ten-year cancer-specific survival exceeded 90% in both groups, with no statistically significant difference despite numerically higher survival after prostatectomy. Perioperative complications, especially major Clavien-Dindo events, were less frequent after focal therapy than after prostatectomy. 2

Response-guided omission of second TURBT appears safe in selected T1 NMIBC

The prospective HuNIRe trial tested selective second TURBT in T1 non-muscle-invasive bladder cancer after complete initial resection. Patients had urine cytology at 3–4 weeks and cystoscopy at 4–6 weeks; only abnormal findings triggered reTUR, otherwise BCG started directly. This strategy avoided reTUR in 71% of 90 patients, and no patient was upstaged to muscle-invasive disease at repeat resection. At 26-month median follow-up, 2-year recurrence-free and progression-free survival were similar between patients with and without reTUR. 3

Very early recurrence after retroperitoneal sarcoma resection mirrors unresected prognosis

This international cohort included 651 patients with primary, non-metastatic retroperitoneal sarcoma treated at two high-volume centers. Of 566 resected patients, 46% recurred, and 19% of these recurrences occurred within six months of surgery. Patients with a 0–6 month disease-free interval had overall survival similar to unresected patients, while later relapse was associated with better survival. On multivariable analysis, disease-free interval independently correlated with overall survival, but early recurrence carried a death hazard comparable to non-resection. 4