Novel Surgical Treatment Approaches in Advanced Gastrointestinal Neoplasms

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 30 December 2025 | Viewed by 1842

Special Issue Editors


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Guest Editor
Surgical Unit of Peritoneum and Retroperitoneum, Fondazione Policlinico Universitario A. Gemelli IRCCS, L.go A. Ge-melli, Rome, Italy
Interests: surgical oncology; cytoreductive surgery; hipec; laparoscopic surgery; colorectal cancer; gastric cancer; peritoneal me-tastases
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Guest Editor
Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
Interests: liver metastases; hepatobiliary surgery; laparoscopic surgery

Special Issue Information

Dear Colleagues,

We are delighted to announce a Special Issue dedicated to "Novel Surgical Treatment Approaches in Advanced Gastrointestinal Neoplasms", focusing on innovative surgical techniques. This Special Issue aims to showcase pioneering advancements in surgical oncology for the management of complex gastrointestinal neoplasms.

Gastrointestinal malignancies present intricate challenges that often necessitate surgical intervention as a cornerstone of treatment. Recent years have witnessed significant advancements in surgical approaches, encompassing minimally invasive techniques, organ-preserving surgeries, and enhanced perioperative care protocols. Additionally, modalities such as Hyperthermic Intraperitoneal Chemotherapy (HIPEC) and Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) have shown promise as adjuncts to surgery, facilitating targeted chemotherapy delivery.

This Special Issue seeks to highlight groundbreaking research and clinical experiences that push the boundaries of surgical oncology in the realm of advanced gastrointestinal neoplasms. We invite submissions of original research articles, comprehensive reviews, and insightful perspectives that explore novel surgical interventions, perioperative management strategies, outcomes assessment, and the integration of surgical techniques with systemic therapies.

By fostering collaboration among surgical oncologists, researchers, and allied healthcare professionals, this Special Issue aims to advance the field's understanding and implementation of innovative surgical solutions for gastrointestinal malignancies. We encourage authors to contribute their pioneering work to this Special Issue, thereby shaping the future of surgical oncology and improving outcomes for patients facing advanced gastrointestinal neoplasms.

Dr. Francesco Santullo
Dr. Agostino Maria De Rose
Guest Editors

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Keywords

  • advanced gastrointestinal neoplasms
  • colon cancer
  • cytoreductive surgery
  • gastric cancer
  • liver metastases
  • peritoneal metastases
  • HIPEC (hyperthermic intraperitoneal chemotherapy)
  • PIPAC (pressurized intraperitoneal aerosol chemotherapy)
  • pancreatic cancer

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Published Papers (2 papers)

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Research

14 pages, 1112 KiB  
Article
Neo-Adjuvant Chemotherapy in Gastric Adenocarcinoma: Impact on Surgical and Oncological Outcomes in a Western Referral Center
by Claudio Fiorillo, Beatrice Biffoni, Ludovica Di Cesare, Fausto Rosa, Sergio Alfieri, Lodovica Langellotti, Roberta Menghi, Vincenzo Tondolo and Giuseppe Quero
Cancers 2025, 17(15), 2465; https://doi.org/10.3390/cancers17152465 - 25 Jul 2025
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Abstract
Background/Objectives: Neo-adjuvant chemotherapy (NACT) is increasingly utilized in Western countries for the treatment of gastric cancer (GC). While its oncologic benefits are well established, its impact on surgical safety and long-term outcomes remain a matter of debate. This study evaluates the real-world [...] Read more.
Background/Objectives: Neo-adjuvant chemotherapy (NACT) is increasingly utilized in Western countries for the treatment of gastric cancer (GC). While its oncologic benefits are well established, its impact on surgical safety and long-term outcomes remain a matter of debate. This study evaluates the real-world effect of NACT on perioperative and oncologic outcomes in a high-volume Western center. Methods: Data from 254 patients who underwent gastrectomy with D2 lymphadenectomy for GC between March 2016 and January 2024 were prospectively collected and retrospectively analyzed. Patients were categorized into an upfront surgery group (n = 144, 56.7%) and a NACT group (n = 110, 43.3%). The primary outcome was to compare the two study groups in terms of perioperative outcomes, as well as overall (OS) and disease-free survival (DFS). Multivariate analyses were conducted to identify factors associated with perioperative complications and long-term survival. Results: Patients in the NACT group were younger (median age 65 vs. 72 years; p = 0.001) and had fewer comorbidities. NACT was associated with a higher incidence of proximal tumors (54–49.1% vs. 37–25.7%; p = 0.001), diffuse-type tumors (27–45.8% vs. 39–31.7%; p = 0.03), and lymph-node metastases (82–74.1% vs. 84–58%; p = 0.007). No significant differences were observed in median hospital stay (9 (7–16) and 10 (8–22) days for the upfront and NACT groups, respectively; p = 0.26), post-operative mortality (11–7.6% and 5–4.5% for the upfront and NACT groups, respectively; p = 0.32), and major complications (30–20.8% and 23–20.9% for the upfront and NACT groups, respectively; p = 0.99). Among patients receiving NACT, the FLOT regimen was associated with a lower rate of complications (12–16.2% vs. 11–30.5% in the non-FLOT cohort; p = 0.05) and reoperations (4–5.4% vs. 8–22.2% in the non-FLOT group; p = 0.008). Tumor location was identified as an independent predictor of perioperative complications (OR 4.7, 95% C.I.: 1.56–14.18; p = 0.006), while non-FLOT regimens were independently associated with higher reoperation rates (OR 0.22, 95% C.I.: 0.06–0.86; p = 0.003). Five-year OS was comparable between the two groups (44.6% in the NACT group vs. 47.7% in the upfront surgery group; p = 0.96). N+ status (OR 2.5, 95% C.I. 1.42–4.40; p = 0.001) and R+ margins (OR 1.89, 95% C.I. 0.98–3.65; p = 0.006) were negative independent prognostic factors for DFS. Conclusions: Although several selection biases limit the generalizability of our findings, our results suggest that NACT prior to gastrectomy for GC does not increase postoperative morbidity and mortality in appropriately selected patients. However, its use in elderly and polymorbid patients should be carefully considered to determine the safest and most effective therapeutic approach, particularly in selecting the appropriate chemotherapy regimen, to minimize the risk of postoperative complications requiring surgical reintervention. Full article
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17 pages, 1843 KiB  
Article
Efficacy and Insights from an Extensive Series of Cytoreductive Surgery for Peritoneal Neoplasms: A High-Volume Single-Center Experience
by Matteo Aulicino, Francesco Santullo, Giorgio D’Annibale, Carlo Abatini, Miriam Attalla El Halabieh, Cecilia Orsini, Lorenzo Barberis, Luca D’Agostino, Ilaria Tersigni, Fiammetta Pacelli, Claudio Lodoli, Andrea Di Giorgio, Federica Ferracci and Fabio Pacelli
Cancers 2024, 16(24), 4229; https://doi.org/10.3390/cancers16244229 - 19 Dec 2024
Cited by 1 | Viewed by 1322
Abstract
Background: Advances in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have improved outcomes for selected patients with peritoneal surface malignancies (PSMs). Methods: This retrospective study analyzed 743 PSM patients treated at Fondazione Policlinico Universitario Agostino [...] Read more.
Background: Advances in cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) and pressurized intraperitoneal aerosol chemotherapy (PIPAC) have improved outcomes for selected patients with peritoneal surface malignancies (PSMs). Methods: This retrospective study analyzed 743 PSM patients treated at Fondazione Policlinico Universitario Agostino Gemelli from January 2016 to February 2024. The primary aim was to assess median overall survival (mOS), median disease-free survival (mDFS), and median progression-free survival (mPFS) stratified by tumor origin. Secondary outcomes examined the role of diagnostic laparoscopy in the management of PSMs and intra- and postoperative complications’ rates. Results: A total of 1113 procedures were performed: 389 CRS, 370 PIPAC, and 354 diagnostic laparoscopies. Colorectal cancer was the predominant indication for CRS (52.4%), with a mOS of 52 months and mDFS of 22 months. Patients affected by gastric cancer undergoing CRS had a mOS of 18 months and a mDFS of 13 months, while PIPAC yielded a mOS of 9 months and a mPFS of 4 months. Among patients with pseudomyxoma peritonei undergoing CRS, the 5-year DFS rate was 64.1%, and OS rate was 89%. Patients affected by mesothelioma and treated with CRS exhibited a median OS of 43 months and a DFS of 26 months. Pancreatic and hepatobiliary cancers were treated with PIPAC, with a respective mOS of 12 and 8 months. Postoperative complications occurred in 12.6% of CRS, 3.2% of PIPAC, and 1.7% of diagnostic laparoscopies. High peritoneal cancer index (PCI), gastric resection, and blood loss over 500 mL were identified as risk factors for major complications in a multivariate analysis. Conclusions: Developing a highly experienced multidisciplinary team is crucial for delivering tailored treatment strategies which aim to achieve optimal oncological outcomes while preserving patients’ quality of life. Full article
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