MedBulletinsAura Celeste
Español
General surgery

Monthly general surgery bulletin — November 1, 2026

🎧 Listen to this issueAudio newscast · 6:40 min
Download MP3Send audio via WhatsApp

This issue covers October 2 through November 1, 2026. It was a month with few new randomized trials in general surgery and plenty of registry and congress data: the most relevant material came from JAMA Surgery (the STOPS trial and cohorts on ventral hernia, gastric cancer, and bariatric surgery), Annals of Surgical Oncology (breast lesion localization), and the ESMO Congress in Madrid, where the AZUR-1 trial put organ preservation in mismatch repair–deficient rectal cancer back at the center of the debate. Nine verified items, each with a link to its primary source.

Abdominal wall and hernia

1. Ventral hernia: women present with more complex hernias and recur more at 2 and 3 years

[Publication] [United States]
Cohort from the Abdominal Core Health Quality Collaborative registry of 31,358 adults undergoing elective primary or incisional ventral hernia repair from 2012 to 2023 (14,303 women and 17,055 men), published in JAMA Surgery on October 28. Women had more incisional (72.0% vs 49.4%) and recurrent (28.0% vs 20.3%) hernias, more 30-day surgical site infection (2.6% vs 1.7%; in incisional hernia repair, adjusted OR 1.40; 95% CI 1.17-1.67), more readmissions (3.4% vs 2.5%), and longer mean stay (2.05 vs 1.41 days). Recurrence was similar at 1 year (12.6% vs 11.7%; adjusted OR 0.89; 95% CI 0.75-1.07) but higher at 2 (19.3% vs 15.7%) and 3 years (20.9% vs 17.6%) in unadjusted comparisons; women started with worse quality of life and more pain and improved more by 1 year.
Why it matters: this is a voluntary registry with complete-case analysis and enormous loss to follow-up (6,463 patients with 1-year recurrence data), and the 2- and 3-year recurrence differences are unadjusted; the useful message is not that sex is a cause, but that baseline complexity differs and belongs in preoperative counseling and risk stratification.

Sources

2. How fragile is the randomized evidence in inguinal hernia: fragility index of 42 trials

[Publication] [International]
Systematic review published in Hernia on October 9 that recalculated the fragility index of 42 randomized trials (14,505 patients, 44 primary comparisons, all laparoscopic vs open) in inguinal hernia repair. In the 12 comparisons with a significant result the median fragility index was 4 (IQR 3-5.25) and one third (4 of 12) had an index of 3 or less; for individual complications all four significant results had an index of 3 or less (median 1). In 4 of 78 extracted comparisons the significance classification changed when the P value was recalculated.
Why it matters: many of the "findings" we cite to choose a technique rest on three or four patients having a different outcome; this does not invalidate the trials, but it forces us to read effect size, confidence interval, and losses, not just the P value.

Sources

  • [Article] Maria Clara Morais, Denise Padilha Abs de Almeida, Beatriz Laus Pereira Lima, et al. "Fragility of randomized clinical trials comparing surgical approaches for inguinal hernia repair: a systematic review". Hernia. 2026;30:369. DOI: 10.1007/s10029-026-03869-3. Subscription. https://link.springer.com/article/10.1007/s10029-026-03869-3

Hepatobiliary

3. Quality benchmarks for elective cholecystectomy: 48,564 patients from the Swedish GallRiks registry

[Publication] [Sweden]
Nationwide registry study published in BJS Open on October 13 that applied the achievable benchmark of care method to 48,564 elective laparoscopic cholecystectomies for benign indications at 81 facilities (2015-2023). The benchmark for severe complications (Clavien-Dindo III or higher) was 1.0% vs 1.7% overall; conversion 0.1% vs 1.3%; bile leakage 0.1% vs 0.6%; reoperation 0.1% vs 0.7%; readmission 1.4% vs 3.2%; intraoperative drain 0.6% vs 3.2%; length of stay 0 days. Independent risk factors for severe complications: ASA III or higher (OR 1.35), previous abdominal surgery (OR 2.15), and altered gallbladder morphology on intraoperative assessment (OR 1.24). There were 7 deaths (<0.1%).
Why it matters: this is a single country with a selected population (prior major upper abdominal surgery and abnormal or unperformed intraoperative cholangiograms were excluded) and complication grades were partly assigned retrospectively; even so, it provides concrete reference figures for auditing a service, and the authors themselves note that a benchmark is not a prescriptive target.

Sources

Colorectal and digestive oncology

4. AZUR-1: 47% sustained clinical complete response at 12 months by central review with dostarlimab monotherapy in mismatch repair–deficient rectal cancer

[Congress] [International]
Global, open-label, single-arm registrational phase 2 trial (NCT05723562) presented at the ESMO Congress in Madrid on October 25 (abstract LBA87, A. Cercek) and published online the same day in Annals of Oncology. 154 patients with dMMR/MSI-H locally advanced (stage II-III) rectal cancer received dostarlimab 500 mg every 3 weeks for 9 cycles. The primary endpoint, sustained clinical complete response at 12 months (cCR12) by independent central review, was 47% (54 of 116 evaluable); by investigator it was 68% (98 of 144 evaluable). According to the FDA, 110 of 154 patients (71%) received dostarlimab alone, without additional treatment or disease progression. In the FDA regulatory report, 26 of 154 patients underwent surgery, with or without other treatments; separately, of the 15 patients operated on after dostarlimab alone, 12 had a pathologic complete response. Immune-mediated grade 3 or higher adverse events in 3%; according to CancerNetwork coverage, treatment-related grade 3 or higher adverse events occurred in 10% and there were no related deaths. The FDA granted accelerated approval to dostarlimab for this indication on October 19, based on AZUR-1.
Why it matters: this GSK-sponsored single-arm study has different maturity in central and investigator assessments: central complete responses were identified later and, according to the FDA, at data cutoff 38 patients with complete response by central review had not yet completed 12 months of follow-up. The 47% and 68% rates require that context and do not by themselves demonstrate that one assessor downgrades the effect; these are interim data that call for caution before promising "no surgery". Even so, in dMMR locally advanced rectal cancer, checking mismatch repair status before planning total mesorectal excision is no longer optional.

Sources

5. STOPS: subtotal colectomy with cecorectal anastomosis is noninferior to total colectomy in slow-transit constipation

[Clinical trial] [China]
Multicenter, open-label (with blinded outcome assessors and statisticians), randomized noninferiority trial at 12 tertiary hospitals in 8 Chinese provinces, published in JAMA Surgery on October 21 (NCT05352074). 252 adults with refractory slow-transit constipation (88% women, mean age 49.5 years) were randomized (126 per arm) to subtotal colectomy with cecorectal anastomosis or total colectomy with ileorectal anastomosis. At 12 months the Wexner constipation score was 7.01 vs 6.84 (adjusted difference 0.17; 95% CI −0.93 to 1.27; margin 1.32; noninferiority P = .02). Fecal incontinence at 3 months was lower with subtotal colectomy (8.7% vs 21.4%), but the 3-month Wexner score favored total colectomy (7.31 vs 5.45), as did 1-year satisfaction (95.8% vs 97.5%); perioperative morbidity 10.3% vs 12.7% (P = .41).
Why it matters: the upper confidence limit (1.27) sits right at the margin (1.32), the trial is open-label, single-country, and run by surgeons with more than 50 colectomies for this indication; with 24- and 36-month follow-up pending, the practical reading is that subtotal colectomy is a reasonable option for patients who prioritize early continence, not a new standard.

Sources

6. Gastric cancer with positive peritoneal cytology or localized peritoneal metastasis: 1,181 patients from the JCOG group

[Publication] [Japan]
Retrospective cohort from 48 institutions of the Stomach Cancer Study Group of the Japan Clinical Oncology Group, published in JAMA Surgery on October 7, with 1,181 patients treated from 2016 to 2022 for CY1 or P1a gastric cancer without other metastases. Overall 5-year survival was 25.0% (median 24.3 months). Upfront gastrectomy outperformed upfront chemotherapy (27.6% vs 19.0% at 5 years; HR 0.80; 95% CI 0.69-0.93), but chemotherapy followed by gastrectomy outperformed gastrectomy followed by chemotherapy (39.9% vs 31.4%; P = .01). Patients who converted to P0CY0 before surgery (92 patients) reached 50.5% at 5 years; gastrectomy without conversion 17.2%; chemotherapy alone 3.2%.
Why it matters: this is retrospective, with obvious selection bias (those who respond to chemotherapy are the ones who reach surgery) and small subgroups (46 patients in nonconversion gastrectomy), but it reinforces that in CY1 or P1a disease surgery makes sense mainly as conversion after effective chemotherapy.

Sources

  • [Article] Keiichi Fujiya, Masanori Tokunaga, Kazuyoshi Yamamoto, et al. "Treatment Outcomes for Gastric Cancer With Positive Peritoneal Lavage Cytology or Localized Peritoneal Metastasis". JAMA Surg. 2026. DOI: 10.1001/jamasurg.2026.4647. Subscription (free abstract). https://jamanetwork.com/journals/jamasurgery/fullarticle/2854884

Bariatric surgery

7. Bariatric surgery and obesity-related cancer: 784,105 Nordic adults, less cancer overall and a signal of more pancreatic cancer

[Publication] [Denmark, Finland, and Sweden]
Population-based NordOSCo cohort built from national registries from 1992 to 2023, published in JAMA Surgery on October 14, with 784,105 adults aged 18 to 59 with an obesity record, of whom 99,614 underwent bariatric surgery. Surgery was associated with lower incidence of obesity-related cancer (adjusted incidence rate ratio 0.81; 95% CI 0.77-0.85), with no difference between ages 18-39 and 40-59 (0.80 vs 0.81; interaction P = .88) or by sex for non-sex-specific cancers (interaction P = .50). By site: liver 0.49, endometrium 0.51, ovary 0.73; in contrast, pancreatic cancer 2.21 (95% CI 1.44-3.39), particularly in younger adults.
Why it matters: this is observational, without individual weight or smoking data, so the pancreatic association may reflect surveillance, residual confounding, or a real effect; it deserves specific follow-up and is worth mentioning when consenting younger patients, without negating the overall benefit.

Sources

Surgical oncology

8. Supine MRI–guided breast cancer locator vs wire localization: 14.4% vs 21.1% positive margins

[Clinical trial] [United States, Canada, United Kingdom, and Austria]
Randomized 1:1 trial at 23 sites (NCT04397185) published in Annals of Surgical Oncology on October 22. 457 patients with nonpalpable breast cancer undergoing breast-conserving surgery were assigned to the Breast Cancer Locator (supine MRI-based guidance) or wire localization; the main analysis included 418 who underwent surgery (209 per arm). Positive margins 14.4% (30/209) vs 21.1% (44/209); difference stratified by tumor type on core biopsy −7.1 percentage points (95.4% CI −14.3 to 0.1); noninferiority was met (P = .011) and superiority was not met in the primary analysis (P = .025 vs a .023 threshold), although it was met in the sensitivity analysis stratified by final histology (difference −7.5 percentage points; P = .019). Operative time was longer with the locator (98.5 vs 83.5 minutes; difference reported by the study, 13 minutes).
Why it matters: this is the manufacturer's (Cairn Surgical) pivotal trial and, according to its release, the device remains investigational in the US; it requires supine MRI, the formal result is noninferiority, and in many centers today the real comparator is no longer the wire but magnetic or radioactive seeds, which were not evaluated.

Sources

Cross-cutting

9. Days at home at 90 days as a patient-centered outcome after gastrointestinal cancer surgery: 91,270 operations in Ontario

[Publication] [Canada]
Population-based Ontario cohort (2003-2021) published in JAMA Surgery on October 21 with 91,270 elective gastrointestinal cancer operations in 89,378 adults (mean age 67.3 years). Median days at home at 90 days was 82 (IQR 77-85): lowest in esophageal cancer (76) and highest in small-bowel cancer (84). Preoperative frailty subtracted 2.6 days (95% CI 2.3-2.9), a laparoscopic approach added 3.0 days (95% CI 2.9-3.1), major morbidity reduced the median to 70 days, and death within the first year to 62.
Why it matters: this is administrative and retrospective data, but it proposes a simple metric that patients understand, which could serve to compare enhanced recovery programs and minimally invasive approaches without relying only on mortality or Clavien-Dindo.

Sources

Upcoming meetings and dates

  • ESSO 45, Congress of the European Society of Surgical Oncology: November 4-6, 2026, Madrid.

Sources

  • [Meeting] ESSO 45, 45th Congress of the European Society of Surgical Oncology, official congress website, November 4-6, 2026. https://esso45.essoweb.org/

Get every issue by email

Free. One email with each new issue, with a short summary and links to the page and the audio. No ads inside the content: any sponsor is identified and has no say in the selection. We do not share your data; unsubscribe with a single message.

← October 11, 2026