30-Second Takeaway
- Risk models before and after pancreatectomy now better flag patients unlikely to benefit or prone to very early recurrence.
- For suspected early right colon cancer after endoscopic resection, central vascular ligation rarely adds nodal yield or oncologic value.
- Preoperative radiotherapy for primary retroperitoneal sarcoma does not materially increase major postoperative complications in randomized data.
- Robotic gastrectomy improves several perioperative endpoints but does not enhance adjuvant systemic therapy delivery or survival.
- CT–pathology size discordance near 20 mm in stage I NSCLC suggests current CT-based lobectomy thresholds may overtreat many patients.
Week ending April 18, 2026
Sharpening surgical selection and extent across GI, thoracic, and sarcoma oncology
Model predicts futile pancreatectomy after neoadjuvant therapy for PDAC
Among 529 patients undergoing NAT then pancreatectomy for borderline or locally advanced PDAC, 24.4% had futile resection, defined as death or recurrence within six months. A multivariable model using post-NAT direct bilirubin, tumor size, ASA III status, lower WBC, albumin, and CA19-9 change independently predicted futile surgery. Discrimination was good in both derivation (AUC 0.815) and external validation (AUC 0.763) cohorts, with appropriate calibration. An online calculator was created to facilitate individualized risk estimation before committing to high-risk pancreatic resection.
Neoadjuvant strategies plus resection improve outcomes in BRPC and LAPC
This systematic review and meta-analysis included 88 studies with 8585 patients with BRPC or LAPC treated with neoadjuvant approaches aiming for secondary resection. Regimens incorporating chemotherapy and radiotherapy, sequentially or concurrently, achieved the highest R0 resection and N0 rates in resected patients. Compared with non-operative management, chemotherapy alone (HR 0.33) and sequential chemotherapy then radiotherapy (HR 0.49) improved survival after resection. No neoadjuvant regimen showed clear superiority over others, and heterogeneity plus predominantly retrospective data limit regimen-specific recommendations.
Preoperative RT does not raise major complication risk in primary retroperitoneal sarcoma
This post hoc STRASS analysis evaluated 242 patients with primary retroperitoneal sarcoma randomized to surgery alone or preoperative radiotherapy plus surgery. Major postoperative complications (Clavien-Dindo ≥3 within 60 days) occurred in 19.5% with surgery alone versus 20.2% with preoperative RT (P = 0.90). On multivariable analysis, preoperative RT was not independently associated with major complications (OR 0.95; 95% CI 0.48-1.87). In the WDLPS/G1–G2 DDLPS subgroup, results were similar, indicating no clinically meaningful increase in major morbidity with preoperative RT.
Central superior mesenteric nodal disease is absent in this early right colon cancer series
This single-center study included 119 patients undergoing additional right colectomy after endoscopic resection for clinically suspected early-stage right-sided colon cancer. Most patients had T1 tumors (89.1%), with nodal metastases present in 10.1% overall. Despite a mean harvest of 39.7 nodes, all metastatic nodes were peritumoral or pericolic; none involved superior mesenteric stations. Only one patient (0.8%) developed recurrence at 48.2 months’ mean follow-up, as liver metastases. These data suggest D2 dissection may be adequate, and routine complete mesocolic excision with central vascular ligation might be unnecessary in such cases.
References
Numbered in order of appearance. Click any reference to view details.
Additional Reads
Optional additional studies from this edition.