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Introduction Synovial sarcoma is one of the most common soft tissue sarcomas in children. Guidelines regarding the adequate extent of resection margins and the role of re‐resection are lacking. We sought to evaluate the adequate resection margin and the role of re‐resection in predicting outcomes in children with synovial sarcomas. Methods A cohort of 36 patients less than 18 years of age at diagnosis who were treated for localized synovial sarcoma at three tertiary pediatric hospitals between January 2004 and December 2020 were included in this study. Patient and tumor demographics, treatment information, and margin status after surgical resection were collected from the medical record. Clinical, treatment, and surgical characteristics, as well as outcomes including hazard ratios (HRs), event‐free survival (EFS), and overall survival (OS) were compared by resection margins group and re‐resection status. Results Patients in the R1 resection group were significantly more likely to relapse or die compared to patients in the R0 resection group. However, there was no significant difference in EFS (HR 0.52, p = 0.54) or OS (HR 1.56, p = 0.719) in R0 patients with less than 5 mm margins compared to R0 patients with more than 5 mm margins. Patients with R1 on initial or re‐resection had significantly worse OS than patients who had R0 resection on initial or re‐resection (HR = 10.12, p = 0.005). Conclusion This study re‐affirms that R0 resection is an independent prognostic predictor of better OS/EFS in pediatric synovial sarcoma. Second, our study extends this finding to report negative margins on initial resection or re‐resection is associated with better OS/EFS than positive margins on initial resection or re‐resection. Lastly, we found that there is no difference in outcomes associated with re‐resection or <5 mm margins for R0 patients, indicating that re‐resection and <5 mm margins are acceptable if microscopic disease is removed. R0 resection is an independent prognostic predictor of better OS/EFS in pediatric synovial sarcoma. Negative margins on initial resection or re‐resection are associated with better OS/EFS than positive margins on initial resection or re‐resection. There is no difference in outcomes associated with re‐resection or  <5 mm margins for R0 patients.

Purpose Previous evidence suggests that glioma re-resection can be effective in improving clinical outcomes. Furthermore, the use of mapping techniques during surgery has proven beneficial for newly diagnosed glioma patients. However, the effects of these mapping techniques during re-resection are not clear. This systematic review aimed to assess the evidence of using these techniques for recurrent glioma patients. Methods A systematic search was performed to identify relevant studies. Articles were eligible if they included adult patients with recurrent gliomas (WHO grade 2–4) who underwent re-resection. Study characteristics, application of mapping, and surgical outcome data on survival, patient functioning, and complications were extracted. Results The literature strategy identified 6372 articles, of which 125 were screened for eligibility. After full-text evaluation, 58 articles were included in this review, comprising 5311 patients with re-resection for glioma. Of these articles, 17% (10/58) reported the use of awake or asleep intraoperative mapping techniques during re-resection. Mapping was applied in 5% (280/5311) of all patients, and awake craniotomy was used in 3% (142/5311) of the patients. Conclusion Mapping techniques can be used during re-resection, with some evidence that it is useful to improve clinical outcomes. However, there is a lack of high-quality support in the literature for using these techniques. The low number of studies reporting mapping techniques may, next to publication bias, reflect limited application in the recurrent setting. We advocate for future studies to determine their utility in reducing morbidity and increasing extent of resection, similar to their benefits in the primary setting.

Background For patients with hepatocellular carcinoma (HCC) with microvascular invasion (MVI) after curative resection, the effects of various postoperative adjuvant therapies are not summarized in detail, and the comparison between the effects of various adjuvant therapies is still unclear. Thus, we collected existing studies on postoperative adjuvant therapies for patients with HCC with MVI after curative resection and analyzed the effects of various adjuvant therapies. Method We collected all studies on postoperative adjuvant therapy for patients with HCC with MVI after curative resection from PubMed, EMBASE, Cochrane Library and SinoMed ending on May 1, 2019. Overall survival (OS) and disease-free/recurrence-free survival (RFS) between each group were compared in these studies by calculating the pooled hazard ratio (HR) and 95% confidence interval (CI). All statistical analyses were assessed by two authors independently. Result A total of 13 studies were included in this study, including 824 postoperative adjuvant transarterial chemoembolization (pa-TACE) patients, 90 postoperative radiotherapy patients, 57 radiofrequency ablation (RFA)/re-resection patients, 16 sorafenib patients and 886 postoperative conservative treatment patients. The results showed that pa-TACE significantly improved OS and RFS compared with postoperative conservative treatment in patients with HCC with MVI after curative resection (HR: 0.64, 95% CI: 0.55–0.74, p < 0.001; HR: 0.70, 95% CI: 0.62–0.78, p < 0.001, respectively). There was no significant difference in OS between pa-TACE and radiotherapy in patients with HCC with MVI (HR: 1.75, 95% CI: 0.92–3.32, p = 0.087). RFS in patients with HCC with MVI after pa-TACE was worse than that after postoperative adjuvant radiotherapy (HR: 2.29, 95% CI: 1.43–3.65, p < 0.001). The prognosis of pa-TACE and RFA/re-resection in patients with MVI with recurrent HCC had no significant differences (HR: 0.65, 95% CI: 0.09–4.89, p = 0.671). Adjuvant treatments significantly improved the OS and RFS of patients compared with the postoperative conservative group (HR: 0.580, 95% CI: 0.480–0.710, p < 0.001; HR: 0.630, 95% CI: 0.540–0.740, p < 0.001, respectively). Conclusion Compared with postoperative conservative treatment, pa-TACE, postoperative radiotherapy and sorafenib can improve the prognosis of patients with hepatocellular carcinoma with microvascular invasion after curative resection. Postoperative radiotherapy can reduce the recurrence of patients with HCC with MVI after curative resection compared with pa-TACE.

‌To identify factors influencing margins, re-excision rates, and prognosis in breast-conserving surgery (BCS) patients, and compare the accuracy of ultrasonography (US), mammography (MG), and magnetic resonance imaging (MRI) in assessing tumor size, axillary lymph node status and margins using pathology as the gold standard.‌ A retrospective analysis was conducted on 2775 consecutive invasive breast cancer patients who receive BCS between June 2014 and June 2024. All patients underwent preoperative US, MG, and MRI. The positive margin rate was 18.2% (506/2775).‌ Independent predictors of margin status included pT, lymphovascular invasion (LVI), extensive intraductal component (EIC), US-measured tumor size, MRI-based abnormal enhancement extent, fibroglandular tissue (FGT), background parenchymal enhancement (BPE), non-mass-like enhancement (NME), and axillary lymph node metastasis (ALNM). Factors influencing margin status varied significantly across MRI tumor size subgroups and molecular subtypes. US demonstrated the highest accuracy for preoperative tumor size assessment, while MRI outperformed other modalities in evaluating resection margin status and ALNM. Among 2,450 patients who successfully underwent BCS, the reoperation rate was independently associated with HER2, EIC, MRI abnormal enhancement extent, FGT, BPE, and ALNM. The local-regional recurrence (LRR) rate was 2.5%, with independent predictors including age, molecular subtype, LVI, EIC, MRI abnormal enhancement extent, BPE, ductal pattern orientation, and radiotherapy status.‌ Preoperative imaging and molecular subtyping provide critical insights into margin status and recurrence risk in BCS patients. Tailored surgical planning and adjuvant therapy based on these factors may optimize clinical outcomes and reduce recurrence rates.

Purpose Glioblastoma (GBM) inevitably recurs despite maximal safe resection and standard chemoradiotherapy. The factors influencing survival after first recurrence and re-resection remain controversial. Research question What are the prognostic factors influencing survival following re-resection of glioblastoma? Methods A systematic search of major databases was conducted for original studies reporting on survival outcomes. Data on hazard ratios (HR) for overall survival and key prognostic factors were extracted, followed by meta-analyses of univariate and multivariate Cox models. Study quality and risk of bias were assessed. Results A total of 30 studies were included. Gross total resection and methylated MGMT promoter status were significantly associated with improved survival, with pooled HRs of 0.52 (95% CI: 0.36–0.76, p  < 0.001) and 0.58 (95% CI: 0.45–0.75, p  < 0.001), respectively. In contrast, age was modestly associated with worse survival (HR: 1.02, 95% CI: 1.01–1.03, p  < 0.001). Preoperative Karnofsky Performance Status (KPS) < 70 was associated with worse survival (HR: 2.25, 95% CI: 1.59–3.19, p  < 0.001). Adjuvant chemotherapy (HR: 0.69, 95% CI: 0.33–1.45, p  = 0.33) and time to re-resection (HR: 0.69, 95% CI: 0.41–1.16, p  = 0.16) failed to show consistent survival benefits. Conclusion Our findings suggest gross total resection of contrast-enhancing tumour and MGMT promoter methylation are strongly associated with improved survival following first recurrence of glioblastoma. Conversely, age, preoperative KPS, adjuvant chemotherapy, and timing of re-resection showed inconsistent or non-significant associations, emphasizing the need for prospective studies to refine prognostic assessments and guide individualized treatment strategies in recurrent glioblastoma. Highlights Re-resection should be considered where gross total re-resection is feasible. Methylated MGMT promoter status indicates effectiveness of alkylating agents in recurrent glioblastoma. More congruence in study design and outcome reporting on KPS and time to re-resection is required to conclude on their prognostic influence.

Background Surgically accessible brain metastases are treated through microsurgical removal followed by radiation therapy, resulting in improved progression-free and overall survival. Some patients experience recurrence, prompting the need for effective management strategies. Despite the prevalence of recurrence, there remains a gap in the literature regarding the outcomes of patients undergoing re-resection of brain metastases. Objectives This study aims to comprehensively characterize clinical, radiological, histopathological, and treatment-related aspects, along with outcomes, for patients undergoing re-resection of locally and distantly recurrent brain metastases. Methods We conducted a single-center retrospective cohort study, including patients who underwent secondary brain metastasis resection following prior primary brain metastasis resection and irradiation. Results Among 60 patients, 41 (68.3%) had local recurrences, and 19 (31.7%) had distant recurrences. Median intracranial progression-free survival was 7.7 months [95% CI: 6.5–11.2], time to re-resection was 11.6 months [95% CI: 9.1–15.3], and overall survival was 30.8 months [95% CI: 20.4–49.5]. Non-small cell lung cancer (NSCLC) was the most common primary tumor. Post-initial resection treatments included radiation alone (31.7%), radiation plus chemotherapy (25.0%), radiation plus targeted therapy (15.0%), and radiation plus immunotherapy (28.3%). Cavity irradiation was performed in 46 patients (76.7%) and whole brain radiation in 14 (23.3%). Post-re-resection treatments varied: 21 patients (35.0%) received best supportive care, 15 (25.0%) radiation only, 12 (20.0%) systemic therapy only, and 12 (20.0%) both radiation and systemic therapy. Independent risk factors for shorter overall survival included non-breast cancer histology, pre-re-resection tumor volume > 9 mL, pre-re-resection Karnofsky Performance Status ≤ 60%, and presence of vital tumor cells at re-resection. Conclusion Brain metastasis resection of local and distant recurrences is feasible and a treatment option for selected patients with good clinical performance status. This study underscores the potential role of re-resection in brain metastasis. Further research to improve patient selection and treatment algorithms is warranted.

Background Liver re-resection plays a paramount role in treatment of patients with posthepatectomy hepatocellular carcinoma (HCC) recurrence. Laparoscopic liver resection has been a feasible alternative to open surgery. However, whether laparoscopic liver re-resection for posthepatectomy HCC recurrence is better than open liver re-resection remains unknown. Method From January 2008 to December 2015, 30 patients with recurrent HCC after prior liver resection underwent laparoscopic liver re-resection in our center. To minimize any confounding factors, a propensity score matching study using a patient ratio of 1:1 was conducted to compare the short- and long-term outcomes of patients who underwent laparoscopic or open liver re-resection. Result With the open surgery group compared laparoscopic group, operative time was 207.50 versus 200.5 min ( p  = 0.903), blood loss was 400 versus 100 ml ( p  = 0.000196), blood transfusion rate was 43.3 versus 0.0% ( p  = 0.000046), complication rates were 30.0 versus 6.7% ( p  = 0.01), and hospital stay was 13.5 versus 9.5 days ( p  = 0.000008). The median follow-up was 35 months. The 1-year, 3-year, 5-year disease-free survival rates were 79.0, 51.0, and 31.9%, versus 78.3, 57.4, and 43.0%, respectively ( p  = 0.474). The 1-year, 3-year, and 5-year overall survival rates were 89.4, 75, and 67.5%, versus 96.7, 85.0, and 74.4%, respectively ( p  = 0.413). Conclusion Laparoscopic liver re-resection for patients with posthepatectomy HCC recurrence provided comparable perioperative and oncological outcomes as open liver re-resection and can be a safe alternative to open procedure.

PurposeWhile liver resection is a well-established treatment for primary HCC, surgical treatment for recurrent HCC (rHCC) remains the topic of an ongoing debate. Thus, we investigated perioperative and long-term outcome in patients undergoing re-resection for rHCC in comparative analysis to patients with primary HCC treated by resection.MethodsA monocentric cohort of 212 patients undergoing curative-intent liver resection for HCC between 2010 and 2020 in a large German hepatobiliary center were eligible for analysis. Patients with primary HCC (n = 189) were compared to individuals with rHCC (n = 23) regarding perioperative results by statistical group comparisons and oncological outcome using Kaplan–Meier analysis.ResultsComparative analysis showed no statistical difference between the resection and re-resection group in terms of age (p = 0.204), gender (p = 0.180), ASA category (p = 0.346) as well as main preoperative tumor characteristics, liver function parameters, operative variables, and postoperative complications (p = 0.851). The perioperative morbidity (Clavien-Dindo ≥ 3a) and mortality were 21.7% (5/23) and 8.7% (2/23) in rHCC, while 25.4% (48/189) and 5.8% (11/189) in primary HCC, respectively (p = 0.851). The median overall survival (OS) and recurrence-free survival (RFS) in the resection group were 40 months and 26 months, while median OS and RFS were 41 months and 29 months in the re-resection group, respectively (p = 0.933; p = 0.607; log rank).ConclusionRe-resection is technically feasible and safe in patients with rHCC. Further, comparative analysis displayed similar oncological outcome in patients with primary and rHCC treated by liver resection. Re-resection should therefore be considered in European patients diagnosed with rHCC.

PurposeTo investigate the role of en bloc re-resection (EBRS) in patients who had undergone previous en bloc resection for high-risk non-muscle-invasive bladder cancer (NMIBC).MethodsAn international, multicenter, observational retrospective analysis of prospectively collected data. Patients with a high-risk NMIBC who had previously undergone en bloc resection were scheduled for EBRS of the resected area after 40 days. The primary outcome was the presence of residual tumor or recurrence-free survival.ResultsOverall, 78 patients underwent EBRS. Only five (6.41%) residual cancers were found: one patient had a pTa G3 (1.28%) cancer and four (5.13%) had a pTis. The detrusor muscle was preserved in all samples. Only one patient had a positive margin on EBRS. No procedure called for a conversion to traditional re-TURBT. No patient experienced bladder perforation or other intra-operative complications. The recurrence rate at the first follow-up cystoscopy (RRFF-C at 3 months) was 3.85% (three patients). The median follow-up period was 30.8 months (range 6.9–76.0 months). In univariate analysis, the only predictor of recurrence was grade. Overall we observed 11 recurrences. Only one tumor progressed to T2 MIBC.ConclusionsThe low rates of residual tumor, recurrence, and progression seem to raise doubts about the efficacy of EBRS in patients who have previously undergone en bloc resection. EBRS appears to be a feasible and safe procedure with a low rate of complications. However, further data will be needed before EBRS can be used in clinical trials or recommended as a treatment modality.

Purpose Recently, recommendations on perioperative care have been published to optimize postoperative outcomes in preoperative patients with inflammatory bowel disease. This study evaluated the current use of preoperative screening and prehabilitation strategies (PS) prior to elective ileocolic resection (ICR) in patients with Crohn’s disease (CD). Methods Patients with CD who underwent an elective ICR were identified from a Dutch prospective cohort study. Primary endpoint was to evaluate to what extent IBD-relevant PS were applied in patients with CD prior to ICR according to the current recommendations. Results In total, 109 CD patients were included. Screening of nutritional status was performed in 56% of the patients and revealed malnutrition in 46% of these patients. Of the malnourished patients, 46% was referred to a dietitian. Active smoking and alcohol consumption were reported in 20% and 28%; none of these patients were referred for a cessation program. A preoperative anemia was diagnosed in 61%, and ferritin levels were assessed in 26% of these patients. Iron therapy was started in 25% of the patients with an iron deficiency anemia. Exposure to corticosteroids at time of ICR was reported in 29% and weaned off in 3%. Consultation of a dietitian, psychologist, and physiotherapist was reported in 36%, 7%, and 3%. Physical fitness was assessed in none of the patients. Conclusion PS are not routinely applied and not individually tailored in the preoperative setting prior to elective ICR in patients with CD. Prior to implementation, future research on the costs and effectiveness of PS on postoperative outcomes and quality of life is necessary.