Surgical Oncology

RNI after NAC and BCS does not improve survival in ypN0 cN+ breast cancer

This NCDB analysis included 7137 cN+ stage II–III breast cancer patients treated with neoadjuvant chemotherapy and breast-conserving surgery. Regional nodal irradiation was used in 57.7% of patients yet was associated with worse overall survival versus no RNI (79.9% vs 84.4%). Among ypN0 patients, there was no overall survival difference between RNI and no-RNI groups, despite frequent use of RNI. In ypN+ patients, those receiving RNI had worse overall survival, although recurrence patterns could not be evaluated. These data support individualized consideration of RNI omission in ypN0 patients after NAC and BCS while questioning benefit in ypN+ disease. 1

Single-dye SLNB after NAT in initially cN1 breast cancer shows acceptable FNR

This multicenter diagnostic trial assessed single-blue-dye sentinel lymph node biopsy after neoadjuvant therapy in women initially presenting with cN1 breast cancer. SLNB succeeded in 90.97% of 432 patients, with an overall false-negative rate of 8.96% among 201 node-positive cases. False-negative rates were lower in women ≤60 years, BMI <25 kg/m2, ER-negative tumors, and when ≥4 sentinel nodes were retrieved. Higher BMI and ER-positive tumors independently increased false-negative risk, whereas retrieving more nodes reduced it. These findings support single-dye SLNB as a pragmatic option where dual tracers are unavailable, particularly when four or more SLNs are harvested. 2

Preoperative ctDNA strongly predicts occult nodal disease and recurrence in early ESCC

This two-center Korean cohort included 74 patients with clinical T1b or T2N0 esophageal squamous cell carcinoma undergoing radical esophagectomy without neoadjuvant therapy. Preoperative tumor-informed ctDNA was detected in 48.6% of patients and was more frequent in T2N0 than T1b disease. ctDNA positivity was associated with markedly worse recurrence-free and overall survival over a median 37.7-month follow-up. In T2N0 patients, ctDNA positivity predicted occult nodal metastasis with very high positive predictive values in both cohorts. ctDNA remained independently associated with nodal metastasis and outperformed guideline high-risk features, supporting its use in neoadjuvant decision-making. 3

Prehabilitation reduces severe complications and improves function after colorectal cancer surgery

This meta-analysis pooled 11 randomized trials including 976 adults undergoing elective colorectal cancer resection. Prehabilitation significantly improved postoperative 6-minute walk distance by about 33 meters, exceeding the minimal clinically important difference. Programs also reduced severe postoperative complications without changing overall complication rates or hospital length of stay. Benefits were greatest with multimodal, longer-duration interventions and when function was assessed more than four weeks postoperatively. These results support embedding structured prehabilitation within colorectal cancer ERAS pathways to enhance recovery and reduce serious morbidity. 4