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Optimizing Surgical Procedures and Enhancing Outcomes in the Management of Gastrointestinal Cancer

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

Deadline for manuscript submissions: 30 June 2026 | Viewed by 1544

Special Issue Editors

Prof. Dr. Tim Strate

E-Mail Website
Guest Editor
Krankenhaus Reinbek St. Adolf-Stift, Reinbek, Germany
Interests: minimally invasive surgery; tumor operations
Dr. Jonas Herzberg

E-Mail Website
Guest Editor
Department of Surgery, Krankenhaus Reinbek St. Adolf-Stift, 21465 Reinbek, Germany
Interests: oncologic surgery; prevention of postoperative complications
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The global burden of gastrointestinal cancer continues to rise; therefore, optimizing surgical procedures is critical to improve patient short- and long-term outcomes and quality of life.

Advanced surgical techniques, such as minimally invasive and robotic-assisted surgeries, have improved the field by reducing recovery times, minimizing complications, and improving surgical outcome. Additionally, integrating multidisciplinary approaches, including preoperative imaging, intraoperative chemotherapy like HIPEC and PIPAC, and recovery protocols, ensures tailored interventions that maximize therapeutic benefits.

In this Special Issue entitled “Optimizing Surgical Procedures and Enhancing Outcomes in the Management of Gastrointestinal Cancer”, we aim to report novel surgical approaches and strategies reducing postoperative complications such as anastomotic leakage and improving the short- and long-term outcomes in gastrointestinal cancer patients.

Prof. Dr. Tim Strate
Dr. Jonas Herzberg
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • gastrointestinal malignancies
  • surgical oncology
  • postoperative outcome
  • quality of life
  • anastomotic leakage
  • anastomotic technique
  • HIPEC
  • PIPAC

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Published Papers (2 papers)

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Research

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16 pages, 2343 KB  
Article
Surgical Outcomes of Hybrid-Robotic Compared with Non-Robotic Oncological Esophagectomy for Adenocarcinoma Using a Fail-Safe Protocol—A Cohort Study
by Jonas Herzberg, Matilda Bariani, Tim Strate, Salman Yousuf Guraya and Human Honarpisheh
Cancers 2026, 18(11), 1820; https://doi.org/10.3390/cancers18111820 - 1 Jun 2026
Viewed by 345
Abstract
Background: Ivor Lewis esophagectomy for esophageal malignancies is a core element of the treatment but still comes with substantial postoperative complications. Especially within the learning curve of robotic esophagectomy, an optimal treatment pathway is crucial to minimize the clinical impact of this [...] Read more.
Background: Ivor Lewis esophagectomy for esophageal malignancies is a core element of the treatment but still comes with substantial postoperative complications. Especially within the learning curve of robotic esophagectomy, an optimal treatment pathway is crucial to minimize the clinical impact of this phase. This study aimed to compare the surgical outcomes of hybrid-robotic esophagectomy for adenocarcinoma of the esophagus with non-robotic procedures using a fail-safe protocol. Methods: This retrospective single-center study evaluated the outcome of hybrid-robotic procedures within the early robotic learning curve in comparison to a historical control group of laparoscopic and open non-robotic procedures using uni- and multivariable regression analysis. CUSUM analysis was applied for learning curve outcomes. All procedures were performed between January 2016 and December 2025 within a standardized fail-safe approach. The primary end point was the occurrence of anastomotic leakage (AL), whereas the overall complications as well as the number of harvested lymph nodes were secondary end points. Results: A total of 156 patients were analyzed, including 50 hybrid-robotic and 106 non-robotic resections. Robotic surgery was associated with a higher lymph node yield (40.9 ± 11.0 vs. 35.7 ± 13.1; p = 0.011) and a lower lymph node ratio (0.085 vs. 0.125; p = 0.046). The AL rate was 4.0% in the robotic group and 5.7% in the non-robotic group. Length of stay was significantly shorter after robotic procedures (13.1 ± 5.5 vs. 18.6 ± 11.3 days; p < 0.001). Conclusions: Establishing a robotic esophagectomy program within an established structured fail-safe protocol was not associated with an increased risk of anastomotic leakage or major complications. Within this standardized setting, an increased lymph node yield, potentially optimizing oncological quality was observed. These findings indicate that acceptable preoperative safety and oncological outcomes can be achieved even during the learning curve of hybrid-robotic esophagectomy embedded in a structured fail-safe protocol. Full article
(This article belongs to the Special Issue Optimizing Surgical Procedures and Enhancing Outcomes in the Management of Gastrointestinal Cancer)
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Review

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16 pages, 1224 KB  
Review
Securing the Achilles’ Heel of Esophagectomy: An Updated Evidence-Based Roadmap for Anastomotic Leak Prevention
by Lorenzo Viggiani d’Avalos, Marcel A. Schneider, Diana Vetter, Pascal Burri, Daniel Gerö and Christian A. Gutschow
Cancers 2026, 18(8), 1294; https://doi.org/10.3390/cancers18081294 - 19 Apr 2026
Viewed by 670
Abstract
Background: Esophagectomy remains the definitive curative treatment for esophageal cancer but is historically burdened by significant procedure-related morbidity. Anastomotic leakage (AL) is still the “Achilles’ heel” of esophageal surgery, serving as a primary benchmark for surgical quality due to its profound impact [...] Read more.
Background: Esophagectomy remains the definitive curative treatment for esophageal cancer but is historically burdened by significant procedure-related morbidity. Anastomotic leakage (AL) is still the “Achilles’ heel” of esophageal surgery, serving as a primary benchmark for surgical quality due to its profound impact on patient recovery, healthcare costs, and long-term oncological outcomes. While surgical expertise and perioperative care have matured, reported AL rates remain persistently high. This necessitates a shift in focus from purely technical modifications toward integrated, data-driven preventive strategies. Purpose: Five years after our initial review, this update synthesizes the rapid evolution in AL prevention. We evaluate the transition from empirical surgical pragmatism to evidence-based protocols, integrating recent breakthroughs in real-time perfusion monitoring, prophylactic endoluminal technologies, and multidisciplinary patient optimization. This work provides a contemporary “roadmap” for navigating the complexities of esophageal reconstruction. Conclusions: The prevention of AL has evolved into a multimodal “bundle” that begins well before the index operation. This review highlights the critical shift toward quantitative perfusion assessment via indocyanine green fluorescence angiography, which is increasingly replacing subjective visual inspection as the standard for anastomotic site selection. We discuss the emerging role of gastric ischemic preconditioning as a biological strategy to enhance conduit vascularity, alongside the paradigm of proactive management using preemptive endoluminal vacuum therapy to mitigate septic sequelae in high-risk cases. Furthermore, we examine technical refinements in conduit construction and conditioning—focusing on the ‘tension-perfusion’ relationship—and the essential role of structured prehabilitation within enhanced recovery after surgery frameworks. While the quality of evidence remains heterogeneous, the move toward standardized reporting and objective monitoring marks a new era of precision in esophageal surgery. Full article
(This article belongs to the Special Issue Optimizing Surgical Procedures and Enhancing Outcomes in the Management of Gastrointestinal Cancer)
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