30-Second Takeaway
- Adding intraoperative RFA to chemotherapy in unresectable LAPC increases toxicity without survival or quality-of-life benefit.
- Thermal ablation for 3–5 cm colorectal liver metastases trades higher local retreatment for fewer complications and shorter stays.
- Parenchyma-sparing lung metastasectomy provides survival comparable to anatomical resection with lower short-term morbidity.
Week ending April 4, 2026
Concise surgical oncology updates across pancreas, liver, lung, hereditary breast, and bladder cancer
Intraoperative RFA fails to improve survival and worsens QoL in unresectable LAPC
In PELICAN, 188 patients with unresectable, nonprogressive LAPC after induction chemotherapy were randomized to intraoperative RFA plus chemotherapy or chemotherapy alone. Median overall survival was similar: 12.1 months with RFA versus 11.6 months with chemotherapy alone (HR 1.07; 95% CI 0.80–1.45; P = .64). Progression-free survival did not improve with RFA and numerically favored chemotherapy alone (5.8 vs 6.9 months; P = .47). Grade 3 or higher serious adverse events were more frequent with RFA (27% vs 11%; P = .004).
Thermal ablation versus resection for 3–5 cm CRLM: trade-offs in local control and morbidity
The AmCORE registry compared outcomes after thermal ablation, resection, or combined treatment for 448 colorectal liver metastases sized 3–5 cm in 320 patients. Local tumor progression-free survival per tumor favored resection over ablation (HR 1.86; 95% CI 1.24–2.81; P = .0025). Overall local control per tumor did not significantly differ between ablation and resection (HR 1.48; 95% CI 0.70–3.11; P = .307). Complication rates were significantly higher after resection, whereas hospital stay was shortest after ablation (median 3 vs 5 days).
Non-anatomical pulmonary metastasectomy preserves lung with similar survival
This European multicenter study analyzed 1,647 adults undergoing curative-intent pulmonary metastasectomy, comparing anatomical versus non-anatomical resections in a matched cohort. Among 324 anatomical and 830 non-anatomical resections, overall long-term survival was similar (HR 1.122; 95% CI 0.909–1.385; P = .283), with 5-year survival 62%. Early after surgery, anatomical resections had worse overall survival (HR 1.549; 95% CI 1.135–2.114; P = .006). Any-site recurrence-free survival did not significantly differ, but locoregional recurrence-free survival favored anatomical resection (HR 0.651; 95% CI 0.520–0.817; P < .001).
Risk-reducing mastectomy in BRCA1/2 carriers offers profound risk reduction with low major morbidity
This nationwide Swedish cohort included 1,208 BRCA1/2 carriers without prior breast cancer to assess cancer risk and complications after risk-reducing mastectomy (RRM). Among 507 women undergoing RRM (median age 39.7 years), one developed breast cancer, corresponding to 2 cases per 10,000 person-years. Among 701 women without RRM (median age 50.6 years), 112 developed breast cancer, corresponding to 162 cases per 10,000 person-years. Occult breast cancer was discovered in 3.4% at RRM, indicating a nontrivial rate of subclinical disease at prophylactic surgery.
References
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Additional Reads
Optional additional studies from this edition.