Surgical Oncology

Staging laparoscopy with cytology upstages nearly one-quarter of high-risk gastric cancers

In 113 high-risk gastric cancer patients with negative imaging, staging laparoscopy with peritoneal washing revealed peritoneal metastasis or positive cytology in 23%. Most occult disease was cytology-only, underscoring limited sensitivity of CT, MRI, PET/CT, and EUS for early peritoneal spread. All positive cases had treatment modified, sending low-PCI patients to induction chemotherapy followed by CRS + HIPEC. Higher-PCI patients were spared non-therapeutic laparotomy and received systemic chemotherapy plus PIPAC instead. No perioperative complications or treatment delays occurred, supporting routine staging laparoscopy with washing in high-risk gastric cancer pathways. 1

Chemoimmunotherapy improves 3-year outcomes despite lower pCR than chemoradiation in resectable ESCC

This multicenter study compared neoadjuvant chemoradiotherapy versus chemoimmunotherapy followed by surgery in 225 locally advanced esophageal squamous cell carcinoma patients. After propensity matching, chemoradiotherapy achieved higher radiologic response, T/N downstaging, and pathologic complete response than chemoimmunotherapy. Despite this, chemoimmunotherapy produced better 3-year overall survival (75.9% vs 55.6%) and disease-free survival (66.4% vs 47.3%). Subgroup analyses suggested chemoradiotherapy may be preferable in clinically node-positive or non-cT4 disease, while clinical N stage independently predicted survival. These findings favor chemoimmunotherapy as a survival-oriented strategy but call for randomized trials to refine regimen selection by stage. 2

Umbrella analysis reinforces liver transplantation as survival-superior to resection for HCC

This umbrella review synthesized four quantitative meta-analyses comparing liver transplantation and resection for hepatocellular carcinoma between 2000 and 2025. Pooled hazard ratios favored transplantation for overall survival (HR 1.35; 95% CI 1.17-1.55) and disease-free survival (HR 2.58; 95% CI 2.25-2.96). The benefit persisted across Milan and extended criteria and was consistent by viral etiology, era, and geographic region. Methodological safeguards addressed overlapping primary studies, and intention-to-treat analyses supported robustness. Transplantation should be prioritized for eligible HCC patients when organs are available, with resection reserved mainly for graft-limited settings. 3

Surgery for selected PDAC recurrences, especially lung and remnant pancreas, confers marked survival benefit

In a multicenter cohort of 1,527 resectable or borderline-resectable PDAC patients, 96 underwent surgery for postoperative recurrence or metastasis. Overall survival from initial surgery was longer with resection of recurrence than without (75.0 vs 25.8 months). Time-dependent Cox modeling showed large survival gains with pneumonectomy for lung metastases (HR 0.12) and remnant pancreatectomy (HR 0.20). Hepatectomy for liver metastasis was not associated with significant survival benefit (HR 0.46). These results support aggressive resection of isolated lung or remnant pancreatic recurrences in selected fit patients, but question routine liver metastasectomy. 4