Cutting edge blog

To mark Oesophageal Cancer Awareness Month 2026, we have brought together a selection of recent high-impact papers from BJS and BJS Open that showcase advances in oesophageal and oesophagogastric junction cancer research. These studies span surgical innovation, trial methodology, international outcomes benchmarking, treatment strategy, and intraoperative decision-making. Together, they highlight both progress and ongoing challenges — from evaluating robot-assisted oesophagectomy and questioning surrogate trial endpoints, to improving conduit perfusion assessment and refining margin control. This curated set of highlights reflects the breadth of current evidence shaping modern oesophageal cancer care.

______

______

Born in the Waxhaw District of South Carolina in 1767 to a Scottish-Irish family, Jackson grew up “a tall, lean, remarkably agile, freckle-faced boy with bright blue eyes, a shock of tousled hair that was almost red and a temper in keeping.”1 Already as young he was known to have a character that “spelled combat, whatever the odds.” Jackson’s temper ended him up in multiple duels and other fights throughout his life.

Major digestive surgery not only carries clinical risks but also imposes a significant functional and emotional burden. In this context, prehabilitation emerges as a key strategy to optimize patient readiness before entering the operating room.

This analysis is based on a prospective cohort study conducted at a tertiary hospital, including 188 patients undergoing major elective gastrointestinal surgery. Of these, 94 completed a multimodal prehabilitation program, while 94 received standard preoperative care (Table 1). Outcomes were assessed using the validated QoR-15 questionnaire at baseline, discharge, and 30 days post-discharge, alongside clinical and functional recovery indicators (Figure 1).

Preoperative clinic data and type of surgery by group

Correspondence to: Martin Storr (email: m.storr@internistenzentrum.de)

Center for Endoscopy

Starnberg

Correspondence to: Daniel Eckhardt (email: daniel.eckhardt@klinikum-nuernberg.de)

Department of General, Visceral, and Thoracic Surgery

Klinikum Nürnberg

Correspondence to: Janhavi Venkataraman (email: Janhavi.Venkataraman@hcahealthcare.co.uk; janhavivraman@gmail.com)

The London Breast Institute

Princess Grace Hospital

Correspondence to: Rebecka Hultgren (email: rebecka.hultgren@ki.se)

Department of Vascular Surgery

Karolinska Institutet

Correspondence to: Antonio Manenti (e-mail: antonio.manenti_2024@libero.it)

Department of Surgery

Polyclinic Hospital

When George Washington was sworn in as the first president of the United States, New York City was the capital. The new president was inaugurated on the balcony of Federal Hall on April 30, 1789. Less than two months later, Washington was ill with a condition that could have killed him. He had developed a tender and extremely painful swelling on his left thigh, accompanied by chills and high fever. Although most historical accounts indicate that the president’s ailment was a huge abscess on his left thigh, the exact nature, and even its location, have remained somewhat of a controversy among biographers. Some have called it “a large and painful tumor on his left thigh,” others “a fast-growing tumor,” a “carbuncle” or “malignant carbuncle.” In a book, published about seventy years after the event, the lesion was described as a “painful tumor … upon his thigh,” and a reason was proposed why the illness had developed, explaining that, “it was brought on by the excitements and labors which he had undergone since his inauguration.”1

Whereas most writings suggest that the abscess was on Washington’s left thigh, recently some historians have suggested that it was “an irritation on his left buttock that began as a minor saddle-sore (Washington was an avid horseback rider) and became a painful infected boil,” which ultimately developed into a “very large tumor.”2 The same authors suggested that most previous accounts, placing the abscess on the president’s leg rather than on the buttock, did so to spare Washington from the embarrassment of being reported to have a medical problem close to his private parts.

To honour Pancreatic Cancer Awareness Month, we are highlighting some of the most important research published this year in BJS Journals, BJS and BJS Open, on pancreatic cancer. Advancing research in this field is essential to improving patient outcomes and offering hope. Together, we can make a difference.

Surgeons come from different cultures, have different religious beliefs, work in varying health systems and resources and are ultimately guided by legal requirements of the country they work in. We link all of these factors by describing the science behind decisions, heuristics, cognitive processing and human factors. We discuss how surgeons interpret the risk of surgery to the patient but have to be conscious that they are also balancing the risk to themselves. The latter being an increasing consideration as surgical outcomes are reported according to key quality performance indices, such as anastomotic leak. The personality of the surgeon is explored finding not a ‘bad’ trait but traits that may respond suboptimally in certain circumstances. To overcome this, achieving ‘personality awareness’ is proposed.

Most surgeons would say that they learnt decision-making through experience in their day-to-day job, with few having had formal training within their surgical training programmes. Residents also describe indirect training and alongside a medical student, give us insights into the progression of decision-making from student to independent surgeon.

When things do not go as planned, we question our decisions and although often not wrong, we can have a strong and negative emotional response. We describe the difference between adverse events and errors and how both can lead to burnout. Human factors can cause both as a result of a longer term stress with the delicate interplay of the surgeon, hospital and job discussed. Mentoring or support programmes could play an important role.

The health of political leaders has always been of public interest. In the US, in particular, health issues surrounding the president continue to create headlines, and although it may be debated whether private information about diseases and their treatments should be made public, nowadays everyone, including the presidents, agree that information about the health of officials could and should be open to the public eye. After all, conditions that may affect the wellbeing of the president, especially when surgery is involved, could have huge implications from both a political and economic standpoint.

My book, Presidents Under the Knife. Surgical Successes, Failures, and Deceptions, narrates surgeries performed on presidents while they were in office. The surgical procedures are described from a surgeon’s perspective, but importantly, the book also recounts many of the political fallouts and implications of the procedures. As implied in the subtitle of the book, we find successes, failures, and deceptions when learning about the surgeries on American presidents.

Even the country’s first president had surgery. In June of 1789, only a couple of months into his presidency, Washington had surgery for a “tumor” on his left leg. It turned out to be a large abscess giving rise to immense pain and “threatening” fevers. The cutting open of the abscess and drainage of its content may have saved the president from dying of sepsis.

Correspondence to: Wenjiang Wu (email: 1053660645@qq.com)

Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine

Shenzhen

Correspondence to: Matilda Annebäck (email: matilda.anneback@uu.se)

Department of Surgical Sciences

Uppsala University

Correspondence to: Ming Wang (email: wm8383204@163.com; wangming2010@alumni.sjtu.edu.cn.)

Department of Gastrointestinal Surgery

Heze Municipal Hospital

Correspondence to: Mikael Lindmark (e-mail: mikael.e.lindmark@umu.se)

Norrlands Universitetssjukhus

1A, 9 tr, Kirurgcentrum Umeå 901 85

Correspondence to: Anshika Upasani (email: anshikaupasani11@gmail.com)

Department of General Surgery

All India Institute of Medical Sciences

Correspondence to: Christian Sturesson (email: christian.sturesson@ki.se)

Department of Clinical Science

Intervention and Technology

Breast cancer is the most common cancer affecting women worldwide. It is likely that many people reading this know someone who has been affected by this condition. For many, surgery remains the cornerstone of curative treatment. Breast cancer surgery has advanced significantly since the first radical mastectomies of the late 19th century to today’s refined breast-conserving and reconstructive techniques.

Surgery remains a key component of treatment of breast cancer. For early-stage disease, removing the tumour can be enough to eradicate cancer completely. In more advanced cases, surgery is complemented by chemotherapy, radiotherapy, and hormone therapy.

The success of breast cancer surgery has not happened by chance. It reflects decades of rigorous research, often led by surgeons. Trials that once compared radical mastectomy with breast-conserving surgery laid the foundations for a global shift in practice. Randomised studies in axillary surgery demonstrated that less can be more, avoiding major complications such as lymphoedema without compromising oncological standards. The surgical research forces driving this rapid development have changed lives. They also act as an exemplar for other specialties.

Change takes time – in all fields, including surgery. Yet, innovation is highly prized. The latest tools and technologies are celebrated and heavily invested in. But not all improvements require new technology.

For example, robotic pancreatic surgery is being adopted worldwide at a cost of millions in capital investment and ongoing expenses. Evidence shows it is mostly non-inferior to the standard of care.1–4 Another example is histotripsy for liver tumors, which has been rapidly purchased across multiple centers since FDA approval in 2023, spreading like mushrooms after the rain. Evidence is limited to technical feasibility, with no proof of superiority over standard care.5 Both technologies are used only in selected patients. By contrast, high-volume anesthesiology care for hepato-pancreato-biliary (HPB) surgery is associated with15% lower odds of 90-day major morbidity (OR 0.85, 95% CI 0.76–0.94), requires no capital investment, no recurring costs, and applies to all patients.

We are not debating or questioning the benefits of these technologies or the need to invest in new treatments. Rather, we would like to ask: if we are so willing to spend vast sums on new technology, why are we far less inclined to redesign how operative teams are organized?

Correspondence to: Stefan Schneeberger (e-mail: stefan.schneeberger@i-med.ac.at)

Department of Visceral

Transplant and Thoracic Surgery

Correspondence to: Yuzhou Zhu (e-mail: Zhuyuzhou@scu.edu.cn)

Colorectal Cancer Center

Department of General Surgery

Correspondence to: Fredrik Wärnberg (e-mail: fredrik.warnberg@vgregion.se)

Department of Surgery

Sahlgrenska University Hospital

Correspondence to: Anders Mark-Christensen (e-mail: andersmark@dadlnet.dk)

Department of Surgery

Odense University Hospital