European Journal of Surgical Oncology

Background COST Action CA24158 DISSECT (Disparities in Surgical Specialization and Education in Cancer Training) is a European multidisciplinary research network focused on identifying and reducing disparities in cancer surgery training across Europe and beyond. Working Group 4 (WG4, Surgical Mentorship) focuses on mentorship as a practical mechanism to support equitable professional development, technical progression, research capacity, leadership and wellbeing across diverse training settings. Yet mentorship remains inconsistently defined, delivered and evaluated. Methods WG4 conducted a scoping review with narrative synthesis. Predefined questions addressed definitions, relationship components, mentoring models, measurable outcomes, implementation barriers, evaluation tools and non-technical skills. Candidate papers were centralised in Rayyan and screened against PICO(TT)-based eligibility criteria, with reference-list searches supplementing targeted database searches. Key characteristics and findings were extracted into a shared evidence table for narrative synthesis. Results Of 136 records identified, 47 studies were included. Mentorship was characterised as a purposeful, sustained developmental relationship supporting clinical judgement, technical development, professional identity, career planning, wellbeing and academic growth. Effective programmes require purposeful matching, role clarity, mentor and mentee preparation, psychological safety, continuity, bidirectional feedback and rematching routes. The included evidence suggested potential benefits for technical skills, safety indicators, academic productivity, career progression and professional identity, although outcome measurement remained heterogeneous. Conclusions Surgical mentorship should move from informal chance encounters to structured, inclusive and measurable infrastructure for cancer surgery training. This review provides an evidence-informed basis for a DISSECT WG4 mentorship framework adaptable across institutions, countries and resource settings.

BACKGROUND: Endoscopic resection is the standard treatment for early-stage oesophageal carcinoma, but oesophagectomy is recommended when margins are involved or histopathological features suggest a high risk of lymph node metastasis. This study evaluated residual malignancy after endoscopic resection and the accuracy of postoperative risk stratification. METHODS: Data were extracted from the Dutch Upper Gastrointestinal Cancer Audit (DUCA) for patients who underwent oesophagectomy after endoscopic resection between 2011 and 2019. Surgical decisions were guided by multidisciplinary team discussion based on endoscopic, radiological and histological risk factors. Outcomes included the presence of residual tumour, discrepancies between clinical and pathological staging, and surgical morbidity and mortality. Secondary outcomes were compared with those of patients undergoing oesophagectomy for locally advanced disease. RESULTS: A total of 146 patients were included, with a median age of 67 years. Residual tumour was identified in 67%, with 63% having intramural tumour and 18.5% lymph node metastases. Clinical-pathological stage discordance occurred in 63% of patients, comprising 24% upstaging and 39% downstaging. Postoperative complications occurred in 61% of patients, with 21.2% experiencing severe complications. The 30-day or in-hospital mortality rate was 1.4%, comparable to outcomes for patients with locally advanced disease. CONCLUSION: Residual tumour was identified in two-thirds of patients undergoing oesophagectomy after endoscopic resection, with nearly one fifth demonstrating lymph node involvement. Clinical-pathological staging discrepancies were frequent, highlighting limitations in current post-endoscopic risk assessment. These findings apply to a selected subgroup of patients who proceeded to oesophagectomy after endoscopic resection and should not be interpreted as evidence that R0 endoscopic resection is generally non-curative for most early oesophageal cancers. Postoperative outcomes mirrored those of patients undergoing surgery for advanced disease, underscoring the importance of improved risk stratification to reduce overtreatment.