Clinical Surgical Oncology最新文献

Perihilar cholangiocarcinoma, a formidable adversary in the field of hepatobiliary surgery, presents multifaceted challenges. This paper reviews its historical context, classification criteria, and regional variations in definition. It emphasizes the critical role of preoperative assessment, including hepatic hilum anatomy, biliary infiltration characteristics, and residual liver volume evaluation. The impact of the Bismuth-Corlette classification on surgical approach selection is elucidated, providing insights into tailored surgical options for each subtype based on the authors’ center experience in the last ten years. The article also touches upon laparoscopic and robotic surgery potential, underscoring the need for further research in this domain. Finally, it explores the potential role of liver transplantation as a treatment option for select patients ineligible for conventional surgery.

Colorectal cancer (CRC) is a global health concern, ranking among the leading causes of cancer-related mortality. This review critically evaluates the role of liquid biopsy in detecting minimal residual disease (MRD) in CRC. The increasing incidence, particularly in China, highlights the urgency of innovative approaches for early prediction of recurrence and metastasis. The importance of MRD should be underscored as residual tumor cells post-treatment significantly impact patient prognosis. Liquid biopsy methods, including circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), exosomes, and circulating tumor RNA, are dissected for their potential in identifying molecular markers associated with CRC. The focus on ctDNA highlights its non-invasive nature, real-time monitoring capabilities, and superiority over traditional detection methods in terms of sensitivity and timeliness. The review also delves into the limitations, such as clonal hematopoiesis and the critical consideration of optimal timing for postoperative ctDNA detection. In conclusion, the review highlights the significant potential of liquid biopsy, particularly ctDNA, as a dynamic and non-invasive tool for MRD detection in CRC. By complementing traditional methods, liquid biopsy contributes to precision in tumor research and personalized treatment. These advancements offer promising avenues for improving CRC patient prognosis and tailoring individualized treatment strategies.

Background

Previous studies have shown that inflammation is closely linked to the occurrence and progression of cancer. While the role of immune-inflammatory cell proportions in cancer prognosis has been demonstrated, further research is required to fully understand their predictive value. This study aims to investigate the potential of immune-inflammatory cell proportions, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width-to-platelet ratio (RPR), and monocyte-to-lymphocyte ratio (MLR), in predicting endometrial cancer (EC).

Methods

In this study, 18 patients with EC were included to create receiver operating characteristic (ROC) curves for NLR, MLR, PLR, and RPR, and the area under the curve (AUC) was calculated. Binary LOGISTIC regression analysis was then used to develop composite indicators. Subsequently, ROC curves were generated for the combined indicators, and the corresponding AUCs were calculated to evaluate the diagnostic efficacy of NLR, MLR, PLR, and RPR individually and in combination. The model was validated in an additional cohort.

Result

In the single-indicator ROC analysis, the baseline AUC for NLR was 0.724, with a significance level of p ​< ​0.05, indicating good predictive power. For the two-indicator combined ROC analysis, the combined AUC of NLR with each of the three other indicators was greater than 0.724 with a significance level of p ​< ​0.05. In the three-indicator combined ROC analysis, the baseline AUC of the combined indicators (including NLR) was greater than 0.766, and a p value of 0.001. Moreover, the baseline AUC of the validation set was 0.726.

Conclusion

Our findings suggest that the immune-inflammatory cell ratios, especially NLR, have a good predictive value for EC. Furthermore, the combined predictive value of the immune-inflammatory cell ratio is more effective than using individual applications.

Pelvic exenteration is often required for primary rectal cancer beyond total mesorectal excision (PRC-bTME) and locally recurrent rectal cancer (LRRC). Some patients with radical resection can achieve long-term survival, but they need to face risks, such as huge surgical trauma, serious perioperative complications, permanent loss of organ function and decline in quality of life. Preoperative evaluation of PRC-bTME and LRRC should emphasize multidisciplinary collaboration and develop individualized diagnosis and treatment strategies. The principles of function preservation and risk-benefit balance in surgery oncology should be followed, and R₀ resection should be emphasized. Perioperative complications, surgical trauma and organ function loss should be minimized to achieve the best quality control and balance point. This consensus was formulated by the Colorectal Cancer Committee of the Chinese Medical Doctor Association and the Gastrointestinal Surgery Committee of China International Exchange and Promotive Association for Medical and Health Care. The draft was formed based on the summary of domestic and foreign research progress and expert experience. After discussion, review and modification by experts, an anonymous voting was conducted for each major opinion, and in-depth verification was carried out according to the principles of evidence-based medicine. Finally, the Chinese expert consensus on the pelvic exenteration with primary rectal cancer beyond total mesorectal excision planes and locally recurrent rectal cancer (2023 edition) was formed. This consensus mainly summarizes the indications and contraindications of pelvic exenteration (PE) for PRC-bTME and LRRC, preoperative diagnosis and evaluation, perioperative treatment, as well as the resection scope, surgical methods, reconstruction of related organs, safety and complications of PE, postoperative follow-up and other issues, in order to provide guidance for PE in patients with PRC-bTME and LRRC.

Background

Since the early 2000s, robotic-assisted surgery has evolved in the field of thoracic surgery, and robotic-assisted pulmonary lobectomy (RAPL) has become a popular and safe treatment method for patients seeking removal of lung cancer. The purpose of the current study was to identify and examine the top-50 most influential articles in RAPL from 2003 to 2021 using bibliometric analysis.

Hypothesis, materials, and methods

The Clarivate Web of Science Core Collection was systematically searched to gather data on RAPL. Descriptive information for each article was collected and reported using descriptive statistics. The terms “robotic” AND “pulmonary” AND “lobectomy” were used to search this database and returned 468 articles published since 2003.

Results

Bibliometric analysis of the top-50 most influential manuscripts concluded that these articles were published between the years 2003 and 2021 and were collectively cited 2476 times. Mean number of total citations per article was 49.5 (95% confidence interval [37.8, 61.2]). The most influential articles experienced greatest increase in citations in 2020 with 450 total citations and an average of 9.0 citations per article. Our analysis demonstrated an increase in total number of citations for RAPL from 2003 to 2021, and 68% of the most cited articles were published after 2016. All 50 articles were published in English, and the United States (32) and the People's Republic of China (6) had the top number of publications. The top affiliation was the University of Michigan with 6 publications. The most popular journals were Annals of Thoracic Surgery and the Journal of Thoracic and Cardiovascular Surgery, with 7 and 6, respectively, of the top 50 manuscripts.

Conclusion

Given the rising popularity of RAPL since 2003, a current list of the most influential articles in RAPL can provide a reference point to guide better practice and address future areas of thoracic research.

With a logistical advantage, new wire-free procedures have simplified implantation and retrieval of non-palpable breast cancers with enhanced clinical outcomes. The objective of current systematic review and meta-analysis is to assess the clinical effectiveness between three new wireless non-radiation localisation techniques, such as Magseed, Radiofrequency identification TAG and Savi-scout reflector from published literature over a 3 year period. The study, following PRISMA guidelines, identified 26 studies from 2020 to 2022 involving 6275 innovative agents, analyzing three groups. Statistical analysis using Medcalc software showed a pooled positive margin rate of 12.28% (95% CI, 10–15%) and a re-excision rate of 11.29% (95%CI, 9–14%) for all three wireless group combined whereas studies that compare them with wire showed higher positive margin rate of 14.87% (95% CI, 12–18%) and re-excision rate of 16.23% (95% CI, 14–18%) for wire-guided localisation. Compared with odd's ratio, there was no statistical significance for margin involvement between WGL and novel agents OR 0.870 95% CI (0.707–1.071); z=-1.310 p=0.190; however, there was a statistical significance with fewer re-excision for wireless group OR 0.791; 95% CI (0.648–0.965); z=-2.309 p=0.021. In sub group analysis with kruskal-wallis test, there was no statistical significance between each group for both margin-positivity (p=0.797; Chi² 0.605) and re-excision rates (p=0.464; chi²1.535). Consolidated insertion and retrieval success for wireless group were 98.13% and 99.13% respectively whereas WGL had a similar retrieval success rate of 99.63%. To establish the best localisation approach, future prospective randomised trials will be required to assess quantitative cost-effective analyses.

Purpose

Methods

Results

Conclusions

Purpose

Management of obstructive colorectal cancer (OCRC) can be achieved through either emergent resection of the primary tumor (single operation), or the creation of temporary decompression stoma or self-expandable metallic stents (SEMS) insertion followed by tumor resection (staged procedure). The aim of the study was to compare the short-term outcomes of single and staged surgery in acute non-metastatic elderly OCRC patients.

Methods

Twenty-two elderly patients (aged over 75) scheduled to receive either single surgery (n ​= ​14) or staged surgery (n ​= ​8) for the management of acute OCRC were enrolled from 2012 to 2017. The stoma rate, postoperative complications were compared.

Results

The stoma rate was 42.9% in single surgery group and 25% in SEMS group. No difference was found in the rate of total complications (50% vs 25%, P ​= ​0.25). In the single surgery group, four patients (28.6%) experienced SSIs, and pneumonia occurred in three patients (21.4%), whereas none of the patient in staged surgery had infection related complication. Overall, the rate of infection related complication in single surgery group (50%) was significantly higher than that in staged surgery group (P ​= ​0.015).

Conclusions

Either single or stage surgery is feasible for acute elderly OCRC patients. However, single surgery is associated with significant increase in infection related complication.