Monthly general surgery bulletin — October 1, 2026

Period covered: September 1 to October 1, 2026. Note for the month: this issue overlaps almost entirely with the September 28 edition, so it concentrates on what that edition did not include (the items already published, including prophylactic mesh in subcostal laparotomy and EAGLE-2, remain at https://boletinesmedicos.com/en/cirugia-general/2026-09-28.html). The heaviest items: final overall survival from MATTERHORN in resectable gastric cancer and organ preservation in STAR-TREC for rectal cancer. Four items come from outside North America and Western Europe (one from Japan, three from Russia). Nothing from the period could be verified in bariatric surgery or in general surgical oncology (breast, thyroid, melanoma, sarcoma); for China, Korea, the Middle East, India and Latin America, local-language searches returned only material predating the period or without a confirmable publication date. Fifteen items.

Abdominal wall and hernia

1. Cyanoacrylate versus sutures or tacks for mesh fixation in ventral hernia repair: same chronic pain

[Clinical trial] [Italy]
Pragmatic randomized trial at seven accredited Italian centers (Updates in Surgery, September 7, 2026): 214 patients with primary or incisional ventral hernia (109 laparoscopic, 105 open), allocated 1:1 to cyanoacrylate glue fixation (Glubran 2) or to monofilament sutures or absorbable tacks. The primary outcome, chronic pain at 3 and 6 months, occurred only in the open cohort (12 of 105, 11.4%) with no difference between arms. Glue was an independent factor for fewer perioperative complications (OR 0.457; 95% CI 0.244–0.855), shorter operating time (−7.2 min) and less pain at discharge (−0.36 VAS points).
Why it matters: the trial is negative on its primary outcome and the benefit appears only in secondary outcomes; we found no trial registration number or conflict-of-interest statement. It fits a meta-analysis of 16 trials (1,608 patients) in totally extraperitoneal repair published in Hernia on August 25: fixing the mesh increases chronic inguinal pain (RR 1.68; 95% CI 1.29–2.19) without a demonstrated reduction in recurrence (RR 0.53; 95% CI 0.22–1.23).
https://link.springer.com/article/10.1007/s13304-026-02817-1
https://link.springer.com/article/10.1007/s10029-026-03818-0

Hepatobiliary and pancreas

2. SOFT Preop: short-course radiotherapy before pancreatic cancer surgery, better tolerated but with an adverse survival signal

[Meeting] [USA]
Single-institution randomized phase II trial (Medical College of Wisconsin), presented as a late-breaking abstract at the ASTRO Annual Meeting in Boston on September 28, 2026: 102 patients with resectable, borderline resectable or selected locally advanced pancreatic adenocarcinoma, after at least one month of chemotherapy, assigned to 5-fraction stereotactic body radiotherapy or to conventional 28-fraction chemoradiotherapy; 83 underwent surgery. Primary endpoint (positive nodes in the specimen): 41% versus 38%, no difference. Preoperative physical function and fatigue were better with the short course, but there were 6 versus 2 locoregional recurrences, median progression-free survival of about 14 versus 22 months, median overall survival of 26 versus 43 months, and 43% versus 58% of patients alive at 3 years.
Why it matters: none of the survival differences was significant and the trial was not powered to detect them, but they all point the same way; this is a single-center meeting abstract without peer review and does not justify switching to short regimens for convenience.
https://ascopost.com/news/september-2026/short-course-sbrt-better-preserves-physical-function-before-pancreatic-cancer-surgery

3. Grade C pancreatic fistula after pancreatoduodenectomy: 100% mortality without relaparotomy

[Publication] [Russia]
Retrospective cohort of 1,083 pancreatoduodenectomies (2011–2024) published in Khirurgiya. Zhurnal im. N.I. Pirogova on September 11, 2026. Clinically relevant fistula in 273 (25.2%), grade C in 52. In grade C, 26 of 41 reoperated patients died (63.4%) and 11 of 11 non-reoperated patients died (p = 0.022). Independent factors for progression from grade B to C: leak of the pancreatodigestive anastomosis, preoperative biliary stenting, ischemic heart disease and high body mass index.
Why it matters: a large but retrospective thirteen-year series, with no centers, funding or conflicts visible in the abstract (full text is paywalled); the comparison between reoperated and non-reoperated patients is biased by who made it to the operating room. It supports restricting preoperative biliary drainage to clear indications. (source in Russian)
https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2026/9/1002312072026091061

4. Extracorporeal detoxification in acute pancreatitis without a renal indication: no benefit

[Publication] [Russia]
Retrospective study (2020–2024) in the same issue of the Pirogov journal, September 11, 2026: 128 patients with moderately severe and severe acute pancreatitis, 53 of them treated with extracorporeal detoxification. SOFA on days 5–6 was 1.67 versus 0.70 points (p < 0.001), with a short-lived effect on laboratory parameters and adverse effects on hemostasis, albumin and hemoglobin. The authors conclude that it is not advisable for non-renal indications.
Why it matters: not randomized, and the technique was very likely given to the sickest patients (confounding by indication), but the conclusion matches the international evidence and argues against a practice still widespread in the region. (source in Russian)
https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2026/9/1002312072026091047

5. Artificial intelligence model estimating pancreatic cancer risk three years before diagnosis

[Meeting] [USA]
Scientific Forum abstract from the American College of Surgeons Clinical Congress 2026 (Washington, September 26–29; press release September 24), from Mayo Clinic: machine-learning model on longitudinal electronic health records and routine laboratory tests, with 6,066 pancreatic cancer cases and 33,396 controls. Three years before diagnosis, area under the ROC curve 0.853 and under the precision-recall curve 0.712; a predicted risk above 50% corresponded to an 88% likelihood of diagnosis within one year.
Why it matters: retrospective, from a single health system, without external validation or peer review; until prospective validation exists it cannot be used to decide whom to screen.
https://www.facs.org/media-center/press-releases/2026/artificial-intelligence-model-predicts-pancreatic-cancer-risk-3-years-before-diagnosis/

Colorectal and digestive oncology

6. MATTERHORN, final overall survival: perioperative durvalumab plus FLOT in resectable gastric cancer

[Clinical trial] [International, 20 countries]
Double-blind phase 3 trial published in The Lancet on September 9, 2026: 948 patients with resectable gastric or gastroesophageal junction adenocarcinoma (stage II–IVa) at 147 centers, assigned to durvalumab or placebo with perioperative FLOT followed by maintenance. At a median follow-up of about 43 months, overall survival HR 0.78 (95% CI 0.63–0.96; p = 0.021); at 36 months, 69% versus 62%. Pathological complete response 24% versus 9%. Immune-mediated adverse events 23% versus 7%; possibly treatment-related deaths, 6 versus 2.
Why it matters: it consolidates perioperative immunotherapy as a standard, and surgeons will increasingly operate after this regimen; the trial is sponsored by the manufacturer, node-negative patients showed no benefit (HR 1.01) and survival data are only 37% mature. Figures come from a summary of the article (the journal page was not accessible).
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)01254-7/fulltext
https://www.cancernetwork.com/view/perioperative-durvalumab-combo-boosts-survival-in-resectable-gastric-cancer

7. STAR-TREC: organ preservation in early-stage and intermediate-stage rectal cancer

[Clinical trial] [United Kingdom, Netherlands, Denmark, Belgium and Sweden]
Randomized phase 2/3 trial published in The Lancet Oncology (University of Birmingham release, August 24, 2026): more than 500 patients assigned to standard radical surgery, five weeks of chemoradiotherapy or five days of short-course radiotherapy, with radical surgery only if response was insufficient and local excision of small residual disease. At 12 months, chemoradiotherapy allowed four in five patients to keep their rectum and was more effective than short-course radiotherapy at avoiding radical surgery.
Why it matters: it is the largest randomized organ-preservation trial in non-advanced rectal cancer, but only one-year results are available and three more years of recurrence and survival follow-up are pending; we could not access the article to extract exact per-arm figures. It falls three days outside the 35-day window; it is included for its weight and because it was not in the previous edition.
https://doi.org/10.1016/S1470-2045(26)00228-7
https://www.birmingham.ac.uk/news/2026/clinical-trial-finds-new-rectal-cancer-treatment-spares-major-surgery-and-side-effects

8. Abdominal wall blocks after minimally invasive colorectal surgery: bilateral dual TAP block improves 24-hour recovery

[Clinical trial] [Japan]
Single-center, three-arm randomized trial (National Cancer Center Hospital, Tokyo) with blinded patients and assessors (British Journal of Surgery, September 2, 2026): 320 patients assigned to intravenous patient-controlled analgesia alone, or combined with a surgical rectus sheath block or a laparoscopic bilateral dual TAP block; 309 analyzed. QoR-15 at 24 hours: dual TAP versus control, adjusted difference 10.44 points (95% CI 3.06–17.83; p = 0.003); rectus sheath block, 5.50 points (95% CI −1.88 to 12.89), superiority not shown. Median time to first rescue analgesia 25.3 and 27.8 hours versus 3.3 hours. No differences in 48-hour fentanyl consumption or length of stay. Registration jRCT1031240153.
Why it matters: a well-designed, registered trial supporting a block the surgeon performs under laparoscopic vision at no meaningful added cost; it is single-center and the benefit is limited to early quality of recovery.
https://academic.oup.com/bjs/article/113/9/znag109/8780327

9. STARDUST: duodenal stump leakage after gastrectomy for cancer

[Publication] [Europe]
Retrospective cohort from the GASTRODATA group at 24 high-volume European centers (British Journal of Surgery, September 1, 2026): 2,422 patients operated between 2019 and 2022. Duodenal stump leakage in 64 (2.6%), with 90-day mortality of 17.2% (11 of 64). Independent factors: preoperative weight loss, unreinforced stump, Billroth II reconstruction and postoperative transfusion.
Why it matters: retrospective and without intervals in the abstract, but it proposes standardized reporting of an uncommon, lethal complication and points to a cheap, modifiable factor: reinforcing the stump.
https://academic.oup.com/bjs/article/113/9/znag105/8778471

10. Robotic versus laparoscopic rectal resection: better functional outcomes in a small series

[Publication] [Russia]
Two-center retrospective study (Pirogov journal, September 11, 2026): 87 patients after sphincter-preserving rectal resection (48 laparoscopic, 39 robot-assisted), with LARS, IPSS, FACT-C and SF-36 questionnaires and MRI pelvimetry. The robotic group had better scores on all questionnaires (p < 0.001); a narrow pelvis correlated with worse function only in the laparoscopic group. The abstract gives no numeric scale values.
Why it matters: hypothesis-generating and no more; small, retrospective, without randomization or visible adjustment and with no conflict statement in the abstract; available randomized trials have not shown a functional advantage of this size. (source in Russian)
https://www.mediasphera.ru/issues/khirurgiya-zhurnal-im-n-i-pirogova/2026/9/1002312072026091019

Trauma, emergency and bariatric surgery

11. Underweight status and frailty in emergency general surgery: the malnourished patient carries the highest risk

[Meeting] [USA]
Scientific Forum abstract, ACS Clinical Congress 2026 (release September 25), from the University of Chicago, using ACS NSQIP 2019–2024: 334,278 adults undergoing emergency general surgery, 37.6% frail. Compared with normal-weight, non-frail patients, underweight status increased the odds of death by 92% and frailty alone by 59%; with a body mass index of 30 to 34.9 the odds were 43% lower. Underweight, frail patients had 9.8% mortality and 15.8% readmissions.
Why it matters: retrospective, not peer reviewed and unable to establish causality (underweight is a marker of advanced disease), but useful for risk stratification and for the conversation with the family before an emergency laparotomy.
https://www.facs.org/media-center/press-releases/2026/underweight-patients-face-92-increased-odds-of-death-after-emergency-general-surgery/

12. Deaths linked to treatable emergency surgical conditions are rising in the United States

[Meeting] [USA]
Scientific Forum abstract, ACS 2026 (release September 25), from OSF HealthCare (Peoria), using CDC WONDER death certificates in adults aged 18 to 64: 19,601 deaths associated with appendicitis, acute cholecystitis and abdominal wall hernia with obstruction or gangrene. The rate rose from 0.4 to 0.6 per 100,000 between 1999 and 2020 (about 50%); in rural areas it rose 86% versus 49% in urban areas.
Why it matters: unadjusted rates and diagnoses that may be listed only as contributing causes; it does not prove causation, but it is consistent with the closure of rural surgical services and with the surgeon atlas in item 15.
https://www.facs.org/media-center/press-releases/2026/deaths-linked-to-treatable-emergency-surgical-conditions-are-rising-in-the-us/

Bariatric surgery and trauma: no new verifiable trial or guideline was identified within the period. The IFSO World Congress was held in Toronto on September 1–4, but we could not confirm results presented there. The Revista do Colégio Brasileiro de Cirurgiões (volume 53, 2026) carries an SBAIT consensus on splenic trauma and a meta-analysis on nonoperative management of penetrating liver trauma, both without a confirmable publication date, so they are not included as items.

General surgical oncology

No verifiable items this month. The SENOMAC overall survival data (omission of axillary dissection with sentinel node macrometastases) circulated again, but they date from ASCO in June 2026 and fall outside the period.

Cross-cutting

13. Manufacturer meta-analysis: robotic surgery in benign disease versus laparoscopy and open surgery

[Industry] [USA; also covered in Korea]
On September 8, 2026, Intuitive announced the publication in Annals of Surgery Open of a meta-analysis of 366 studies (13 randomized trials, 21 prospective cohorts, 101 database studies and 231 retrospective cohorts), with more than 14 million procedures across 13 benign indications and 32 countries. Versus laparoscopy: 54% lower odds of conversion, 13% lower odds of transfusion, about 4 hours shorter stay and 24 minutes longer operating time, with no difference in 30-day complications, surgical site infection, readmission or mortality. Versus open surgery: 46% lower odds of complications and 60% lower odds of surgical site infection.
Why it matters: the authors include Intuitive employees and only 3.6% of the studies are randomized; versus laparoscopy the advantage comes down to conversion and a few hours of stay, with no difference in hard outcomes and longer operating time. The release gives no confidence intervals or article citation. (additional coverage in Korean)
https://investor.intuitivesurgical.com/news-releases/news-release-details/new-meta-analysis-shows-statistically-significant-improvements
https://www.asiae.co.kr/article/2026091709285077129

14. Perioperative care for anxiety and depression in older adults

[Clinical trial] [USA]
Randomized trial published in JAMA Network Open on September 9, 2026 (Washington University in St. Louis): 306 adults aged 60 or older with mild to moderate symptoms of depression or anxiety, scheduled for cardiac, oncologic or orthopedic surgery, assigned to a bundle of educational materials, 8 to 12 phone sessions with a wellness coach and review of high-risk medications, or to educational materials alone. At 3 months, symptom reduction was 2.2 to 2.5 points greater on a 48-point scale; in the cancer surgery subgroup, nearly 5 points.
Why it matters: a modest effect, no intervals in the release and a population only partly from general surgery, but the intervention is low risk and fits well into a prehabilitation program. Funded by the NIH.
https://doi.org/10.1001/jamanetworkopen.2026.32619
https://www.eurekalert.org/news-releases/1142806

15. US surgeon atlas: 38% of counties have no general surgeon

[Publication] [USA]
Cross-sectional study by the American College of Surgeons and the University of North Carolina, published in the Journal of the American College of Surgeons and presented on September 28, 2026: 201,394 surgeons in 12 specialties across all 3,144 counties (59.2 per 100,000 people). 1,180 counties (38%), home to 15.1 million people, have no general surgeon; 951 have no surgeon in any of the 12 specialties.
Why it matters: this is planning data, not clinical data, and it does not measure travel times or volume; it is of interest as a reproducible method (provider registry crossed with census data) for mapping surgical shortfalls in other countries.
https://www.facs.org/media-center/press-releases/2026/15-million-americans-live-in-a-county-with-no-general-surgeon/

Upcoming meetings and dates

36th National Congress of Surgery (Spanish Association of Surgeons): Madrid, November 2–5, 2026. 96th Argentine Congress of Surgery: Buenos Aires, November 2–4, 2026. 45th Congress of the European Society of Surgical Oncology: Madrid, November 4–6, 2026 (per the congress website; worth confirming on the society's site). The ESMO Congress 2026 takes place in Madrid this fall; we could not verify the exact dates for this edition.

Monthly general surgery bulletin — October 1, 2026
Fifteen verified items from September: The Lancet, Lancet Oncology, British Journal of Surgery, Updates in Surgery, JAMA Network Open, Russia's Pirogov journal, and the ASTRO and ACS meetings.
Three worth your time:
• MATTERHORN (Lancet, n = 948): perioperative durvalumab plus FLOT in resectable gastric cancer, overall survival HR 0.78; 69% vs 62% at 3 years. Manufacturer-sponsored, and no benefit in node-negative patients.
• STAR-TREC (Lancet Oncology, more than 500 patients): chemoradiotherapy let 4 in 5 patients keep their rectum at 12 months. Only one year of follow-up so far.
• SOFT Preop (ASTRO, n = 102): 5-fraction radiotherapy before pancreatic cancer surgery preserved physical function, but median survival was 26 vs 43 months. Not significant, single center.
Full bulletin, with a critical reading of each study and links to the primary sources:
https://boletinesmedicos.com/en/cirugia-general/2026-10-01.html
#GeneralSurgery #Surgery #SurgicalOncology #GastricCancer #RectalCancer

General surgery, Sept 2026: MATTERHORN final OS, perioperative durvalumab + FLOT in resectable gastric cancer: HR 0.78 (69% vs 62% at 3 y). STAR-TREC: 4 in 5 keep their rectum at 12 months with chemoradiotherapy. https://boletinesmedicos.com/en/cirugia-general/2026-10-01.html