Surgical Oncology

Preventive IPMN resections deliver excellent survival but reveal substantial low-grade overtreatment

Among 2275 IPMN patients, 1728 (77%) underwent preventive pancreatic resection without preoperative signs of cancer. Final pathology showed low-grade dysplasia in 63%, high-grade dysplasia in 27%, and T1 invasive carcinoma in 10%. One-year overall survival was 97%, and 5-year survival exceeded 90% across low-grade, high-grade, and T1 subgroups. Age ≥75 years and T1c versus low-grade dysplasia independently predicted worse long-term mortality. The high frequency of low-grade dysplasia with excellent survival underscores significant overtreatment and supports more conservative surveillance-based strategies. 1

Multimodal intraprocedural assessment enables corrective reablation for colorectal liver metastases

This single-center prospective trial treated 77 patients with 104 colorectal liver metastases using PET/CT-guided microwave ablation. Minimal ablation margin, PET avidity, and rapid viability assessment from center and margin biopsies guided immediate reablation decisions. Fourteen percent of lesions required immediate reablation for viable tumor, margins under 5 mm, or residual PET uptake. Ablation margins over 5 mm markedly reduced local tumor progression; no progression occurred when margins exceeded 10 mm. Biopsy-proven complete ablation with margins greater than 5 mm yielded a 12% three-year cumulative local progression rate. 2

Histologic subtype informs extent of resection for 2–3 cm pN0M0 NSCLC

This SEER study analyzed 1458 patients with 2–3 cm pN0M0 acinar, papillary, micropapillary, or solid non-small cell lung cancers. Age, sex, surgical procedure, and pleural invasion were independent prognostic factors for overall survival. Sublobar resection was associated with worse survival than lobectomy for solid and acinar histologies. Pleural invasion adversely affected survival only in acinar carcinoma, indicating histology-specific pleural risk. These data support favoring lobectomy over sublobar resection for 2–3 cm solid and acinar tumors, especially when pleural invasion is present. 3

Comprehensive review of thermal and nonthermal liver ablation and their immunologic potential

This review details mechanisms and clinical applications of thermal liver ablation techniques and nonthermal methods like irreversible electroporation and histotripsy. It summarizes effectiveness for primary and secondary liver tumors and contrasts advantages with surgical resection. The authors emphasize ablation-induced bioeffects, including immune modulation, as a rationale for combining with chemotherapy or immunotherapy. Guidance is provided for designing ablation–immunotherapy trials to exploit potential systemic and vaccine-like effects. Future directions include artificial intelligence for intraprocedural feedback, partial automation, and optimization of ablation strategies. 4