Hirono S, Kitahata Y, Motobayashi H, Satoi S, Sho M, Takami H et al.
Ann Surg 2026; 283: 581-592.
Some 360 patients were followed for median of 39.3 months, and the two groups had similar median overall survival (hazard ratio 1.02, 95 per cent confidence interval 0.76 to 1.37, P=0.897). The mean change in circulating tumour DNA copy number from immediately after laparotomy to just before removal of specimen was significantly different, with a drop in levels observed in the mesenteric group (10.2 ±2.6 versus -7.3 ±2.6 copies, P<0.0001).
Comment: No survival advantage found with the SMA-first approach, despite more favorable intraoperative ctDNA dynamics.
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