This Week in Surgery — Jun 5, 2026

Welcome to This Week in Surgery. This week we're covering 8 notable papers spanning advances in surgical oncology, the impact of new drugs on surgical practice, and cutting-edge innovations in xenotransplantation and neurostimulation. Let's dive in.

We begin this week in surgical oncology, with two papers on rectal cancer that address management at opposite ends of the disease spectrum. For early-stage disease, a study in *Surgical Endoscopy* challenges the role of minimally invasive local excision. Using the Swedish Colorectal Cancer Registry, investigators compared outcomes for pT1 rectal cancer treated with either transanal endoscopic microsurgery, or TEM, versus standard surgical resection [1]. In a cohort of over 850 patients with a median follow-up of nearly five years, TEM was associated with a significantly higher rate of recurrence. The overall recurrence rate was 11% after TEM compared to just 5% after resection. This translated to a five-year disease-free interval of 88% for TEM versus 95% for surgery. After adjusting for multiple factors, the risk of recurrence was nearly three times higher with TEM. Critically, this held true for both low-risk and high-risk tumors. For low-risk tumors, the local recurrence rate was 8% with TEM versus zero percent with resection. These nationwide data suggest that even for favorable early-stage tumors, the organ-sparing approach comes at a significant cost in terms of local control, a finding that should be central to patient counseling.

At the other end of the spectrum, for locally advanced rectal cancer, a major goal is to identify patients who can safely undergo a 'watch-and-wait' approach after neoadjuvant therapy. A paper in the *Annals of Surgery* presents a new tool to aid in this selection [8]. Researchers developed a machine learning model using data from over 300 patients who received total neoadjuvant therapy, or TNT, followed by surgical resection. The model, which incorporates variables from before and after treatment, was designed to predict which patients would have a pathological complete response, or pCR. It achieved good discrimination, with an area under the curve of 0.71. More importantly, when the model was tested on a separate group of 83 patients managed with a watch-and-wait strategy, it also performed well in predicting who would have a persistent clinical complete response, with an area under the curve of 0.69. This suggests that such a model could be a valuable, objective tool to help clinicians select appropriate candidates for non-operative management, moving the field toward more data-driven decision making for organ preservation.

Staying within oncology, we have two papers on lung cancer, one focused on preoperative optimization and the other on long-term prevention. From *The Journal of Surgical Research*, a prospective cohort study provides a clear, actionable answer to a common clinical question: how long should patients stop smoking before lung cancer surgery? [7]. The study followed 156 patients and found that quitting smoking for more than 8 weeks preoperatively was independently associated with a lower risk of postoperative pulmonary complications compared to quitting for less than 4 weeks. This duration cut the risk by more than half. The authors identified 8 weeks as a critical inflection point. Interestingly, the duration of smoking cessation did not impact non-respiratory complications. This provides surgeons with a specific, evidence-based timeframe to give patients to optimize their pulmonary outcomes. Meanwhile, a paper in *Cell* looks much further upstream, toward molecular cancer prevention [6]. Researchers used machine learning to identify a 14-protein signature in the plasma that can predict the risk of developing lung cancer more than five years before a diagnosis. This signature was elevated in smokers and people exposed to air pollution. The most compelling finding came from a re-analysis of the CANTOS trial, which had shown that the anti-inflammatory drug canakinumab could reduce lung cancer incidence. The number needed to treat in the original trial was too high for broad use. However, this new protein signature successfully identified a subgroup of individuals who benefited much more from the therapy, effectively lowering the number needed to treat. This work provides a potential roadmap for using circulating biomarkers to target preventative therapies to high-risk individuals.

Rounding out our oncology section is a report from the *Annals of Surgical Oncology* on the management of bilateral Wilms tumor [5]. This retrospective review of 96 pediatric patients from a French cohort highlights the ongoing challenge of achieving complete tumor removal while preserving as much kidney function as possible. The single most important factor associated with needing a total nephrectomy, rather than nephron-sparing surgery, was tumor contact with major vascular structures. The study also found that giving additional chemotherapy for tumors with non-sensitive histology or extensive vascular contact did little to change the ultimate surgical strategy. From a technical standpoint, the analysis suggested that performing the surgeries in a staged fashion, addressing one kidney at a time, resulted in less morbidity compared to operating on both kidneys in a single setting, although this trend did not reach statistical significance.

Now for a look at the future of surgery, starting with a major step forward in xenotransplantation. Published in the *Annals of Surgery*, a study details the creation and preclinical testing of genetically modified pigs for kidney donation [3]. To overcome rejection, researchers used CRISPR/Cas9 to knock out the Swine Leukocyte Antigen-DR, or SLA-DR, which is the dominant class II MHC antigen in pigs. These pigs were found to be healthy and free of potential zoonotic pathogens. Four kidneys from these donor pigs were then transplanted into immunosuppressed rhesus monkeys. Two of the four recipients achieved long-term, life-supporting graft function, surviving over a year with normal creatinine levels. The two early graft losses were due to pre-existing donor-specific antibodies against other pig antigens, highlighting the importance of crossmatching. The success in this preclinical model suggests that this SLA-DR knockout pig is a promising and safe prototype for evaluation in human clinical trials.

In another area of surgical innovation, a feasibility trial in *Nature Medicine* explores the use of spinal cord stimulation to restore function after stroke [4]. Researchers implanted seven participants with chronic, profound arm and hand weakness with epidural leads over the cervical spinal cord. During the four-week study, there were no serious adverse events. With the stimulation turned on, participants experienced immediate functional benefits, including an average 32% increase in strength. Notably, even with a very low dose of motor activity—just over 8 hours in total—participants showed sustained improvement. By the end of the study, their motor scores had improved by an average of 6.6 points from baseline, and spasticity was reduced in all participants. These findings provide preliminary evidence for the safety and efficacy of cervical spinal cord stimulation as a potential neuroprosthetic solution to assist upper limb function for people living with the long-term effects of stroke.

Finally, a report from *JAMA* points to a major shift in the landscape of metabolic surgery [2]. While the article does not contain a formal abstract, its title and content highlight a significant trend: as the use of GLP-1 agonists for weight loss has surged, the volume of metabolic and bariatric surgery procedures has begun to decline. This observation raises critical questions for the surgical community about the future role of surgery in the treatment of obesity and its related comorbidities, and how surgical and medical therapies will coexist and compete in the coming years.

If you only have time for one paper this week, make it the study in *Surgical Endoscopy* on transanal endoscopic microsurgery versus resection for T1 rectal cancer [1]. It provides compelling nationwide data suggesting that even for low-risk tumors, the minimally invasive approach carries a significantly higher risk of local recurrence, a crucial piece of information for patient counseling.

Here are the key takeaways from this week in Surgery. First, for early, low-risk T1 rectal cancer, formal resection offers better local control than transanal endoscopic microsurgery, which had an 8% local recurrence rate in this group compared to zero for resection. Second, before lung cancer resection, counsel patients that quitting smoking for at least 8 weeks significantly reduces their risk of postoperative pulmonary complications. Third, for bilateral Wilms tumor, a staged surgical approach may be safer than a single-stage operation, and vascular involvement is the key factor limiting nephron-sparing surgery. Fourth, in locally advanced rectal cancer, new machine learning models show promise in identifying patients who achieve a complete response to neoadjuvant therapy and may be candidates for a watch-and-wait strategy. And finally, the rise of effective medical therapies for obesity, like GLP-1 agonists, appears to be correlated with a decline in bariatric surgery volumes, a trend surgeons need to monitor.

That's your roundup for This Week in Surgery. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.