30-Second Takeaway
- AEG and pancreatic head data refine lymphadenectomy targets without clear perioperative penalty.
- Minimally invasive approaches in PDAC and AEG appear oncologically sound in selected patients after learning curves.
- Simple, bedside risk tools now better stratify CRLM and colorectal peritoneal metastasis after aggressive surgery.
- Frailty and cachexia are powerful, modifiable predictors of gastric surgery morbidity.
- Structured, including technology-enabled, prehabilitation meaningfully improves short-term outcomes and symptoms.
Week ending January 31, 2026
Optimizing surgical strategy, risk stratification, and prehabilitation across upper GI, pancreatic, and colorectal metastasis surgery
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.
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.
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.
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.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.