Pub Date : 2025-03-25DOI: 10.1016/j.cson.2025.100080
Alex Boddy
Informed consent is a cornerstone of ethical medical practice, particularly in high-stakes oncological surgery where treatment options are complex and risks are significant. This paper explores the potential of digital platforms and artificial intelligence (AI) to enhance the informed consent process. The traditional consent process, reliant on face-to-face interactions and paper-based documentation, is increasingly being supplemented by digital solutions that offer remote consultations, personalized patient information, and electronic consent forms. These digital pathways not only improve accessibility and patient comprehension but also streamline documentation, reducing errors and administrative burdens. AI technologies, including ambient digital scribes and large language models (LLMs), could further augment this process by generating personalized risk assessments, simplifying complex medical information, and facilitating multilingual communication. However, success will also depend on addressing ethical concerns, ensuring equitable access, and preserving the irreplaceable human connection between patients and clinicians. By augmenting rather than replacing clinician expertise, digital platforms and AI can empower patients to make truly informed decisions in oncological care.
{"title":"Enhancing informed consent in oncological surgery through digital platforms and artificial intelligence","authors":"Alex Boddy","doi":"10.1016/j.cson.2025.100080","DOIUrl":"10.1016/j.cson.2025.100080","url":null,"abstract":"<div><div>Informed consent is a cornerstone of ethical medical practice, particularly in high-stakes oncological surgery where treatment options are complex and risks are significant. This paper explores the potential of digital platforms and artificial intelligence (AI) to enhance the informed consent process. The traditional consent process, reliant on face-to-face interactions and paper-based documentation, is increasingly being supplemented by digital solutions that offer remote consultations, personalized patient information, and electronic consent forms. These digital pathways not only improve accessibility and patient comprehension but also streamline documentation, reducing errors and administrative burdens. AI technologies, including ambient digital scribes and large language models (LLMs), could further augment this process by generating personalized risk assessments, simplifying complex medical information, and facilitating multilingual communication. However, success will also depend on addressing ethical concerns, ensuring equitable access, and preserving the irreplaceable human connection between patients and clinicians. By augmenting rather than replacing clinician expertise, digital platforms and AI can empower patients to make truly informed decisions in oncological care.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100080"},"PeriodicalIF":0.0,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cson.2025.100078
Judit Erdos, Louise Schmidt
Purpose
This systematic review evaluates the effectiveness and safety of three innovative treatments – stereotactic body radiotherapy (SBRT), proton therapy (PT), and irreversible electroporation (IRE) – against existing treatments for localized prostate cancer.
Methods and materials
We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, considering articles on patient-relevant outcomes (quality of life, survival and safety) published between February 2018 and February 2024 in English or German.
Results
Randomized controlled trials (RCTs) could not be identified for IRE and PT, preventing definitive effectiveness assessments. The evidence on IRE from five observational studies (n = 846) is insufficient for conclusive toxicity evaluations. For PT, eight observational studies (n = 5514) show inconsistent gastrointestinal (GI) and genitourinary (GU) toxicity trends, with long-term data indicating persistent GI symptoms and a significant increase in severe GU toxicities. For SBRT, three RCTs (n = 2138) and two observational studies (n = 460) could be found. The results show minor, non-significant differences in survival rates compared to conventional fractionation, a type of external radiation, after two and five years. Cumulative grade ≥1 GI toxicity with SBRT was significantly lower than with conventional fractionation at treatment end and at one year. Initial GU acute toxicities were lower in the SBRT group but not significantly different after one year. Observational data confirms low initial GU acute toxicities, aligning with RCT trends by three months.
Conclusions
The evidence for SBRT, PT, and IRE in treating localized prostate cancer is inconclusive. While it is unclear whether these therapies can replace more invasive procedures like prostatectomy or significantly improve quality of life or survival, SBRT appears as effective as conventional fractionation for survival outcomes in low-to intermediate-risk patients. Further RCTs are needed to evaluate the long-term effectiveness and safety of these treatments compared to standard methods.
{"title":"The effectiveness and safety of stereotactic body radiotherapy (SBRT), proton therapy (PT), and irreversible electroporation (IRE) for localized prostate cancer","authors":"Judit Erdos, Louise Schmidt","doi":"10.1016/j.cson.2025.100078","DOIUrl":"10.1016/j.cson.2025.100078","url":null,"abstract":"<div><h3>Purpose</h3><div>This systematic review evaluates the effectiveness and safety of three innovative treatments – stereotactic body radiotherapy (SBRT), proton therapy (PT), and irreversible electroporation (IRE) – against existing treatments for localized prostate cancer.</div></div><div><h3>Methods and materials</h3><div>We performed a systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, considering articles on patient-relevant outcomes (quality of life, survival and safety) published between February 2018 and February 2024 in English or German.</div></div><div><h3>Results</h3><div>Randomized controlled trials (RCTs) could not be identified for IRE and PT, preventing definitive effectiveness assessments. The evidence on IRE from five observational studies (n = 846) is insufficient for conclusive toxicity evaluations. For PT, eight observational studies (n = 5514) show inconsistent gastrointestinal (GI) and genitourinary (GU) toxicity trends, with long-term data indicating persistent GI symptoms and a significant increase in severe GU toxicities. For SBRT, three RCTs (n = 2138) and two observational studies (n = 460) could be found. The results show minor, non-significant differences in survival rates compared to conventional fractionation, a type of external radiation, after two and five years. Cumulative grade ≥1 GI toxicity with SBRT was significantly lower than with conventional fractionation at treatment end and at one year. Initial GU acute toxicities were lower in the SBRT group but not significantly different after one year. Observational data confirms low initial GU acute toxicities, aligning with RCT trends by three months.</div></div><div><h3>Conclusions</h3><div>The evidence for SBRT, PT, and IRE in treating localized prostate cancer is inconclusive. While it is unclear whether these therapies can replace more invasive procedures like prostatectomy or significantly improve quality of life or survival, SBRT appears as effective as conventional fractionation for survival outcomes in low-to intermediate-risk patients. Further RCTs are needed to evaluate the long-term effectiveness and safety of these treatments compared to standard methods.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100078"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143593224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Retroperitoneal liposarcomas (RPLS) is the most prevalent soft tissue sarcomas in this location; dedifferentiated liposarcoma (DDLS) poses significant challenges for treatment due to its aggressive nature and poor prognosis. Myogenic dedifferentiation within DDLS may influence surgical outcomes and patient survival. This study investigates the impact of myogenic dedifferentiation and neutrophil-lymphocyte ratio (NLR) as an inflammatory marker on surgical complications and treatment outcomes in RPLS.
Methods
We retrospectively analyzed the medical records of 176 patients diagnosed with retroperitoneal sarcoma from January 1, 2005, to December 31, 2018. Fifty patients with DDLPS met the inclusion criteria. Immunohistochemical analyses for muscle-specific markers identified myogenic dedifferentiation. Patients were grouped based on the presence of myogenic dedifferentiation. Preoperative NLR was calculated, and a receiver operating characteristic (ROC) curve determined the optimal NLR cut-off for stratifying inflammatory profiles. Associations between myogenic dedifferentiation, NLR, surgical complications, and treatment outcomes were analyzed.
Results
Patients with myogenic dedifferentiation had significantly higher surgical complication rates and lower overall survival (median OS: 26.6 vs. 40.8 months, p < 0.001). An NLR cut-off of 2.6 (AUC = 0.775, 95% CI: 0.63–0.91) predicted myogenic dedifferentiation with 86.7% sensitivity and 54.6% specificity. Elevated NLR was strongly associated with myogenic dedifferentiation (odds ratio = 7.71, 95% CI: 1.51–39.41, p = 0.014), suggesting a heightened inflammatory response influencing tumor aggressiveness.
Conclusion
Myogenic dedifferentiation and elevated NLR are associated with increased surgical complications and poorer prognosis in patients with DDLPS. The strong correlation between high NLR and myogenic dedifferentiation underscores the potential role of inflammation in tumor progression. These findings highlight the need for further research into immunotherapy as a possible treatment option for this patient subset to improve management and outcomes.
{"title":"The role of inflammation and muscle dedifferentiation in the prognosis of retroperitoneal dedifferentiated liposarcoma","authors":"Dorian Yarih Garcia-Ortega , Gabriela Concepción Alamilla-García , Ana Paulina Melendez-Fernandez , Sylvia Veronica Villavicencio-Valencia , Claudia Haydee Sarai Caro-Sanchez , Kuauhyama Luna-Ortiz","doi":"10.1016/j.cson.2025.100072","DOIUrl":"10.1016/j.cson.2025.100072","url":null,"abstract":"<div><h3>Introduction</h3><div>Retroperitoneal liposarcomas (RPLS) is the most prevalent soft tissue sarcomas in this location; dedifferentiated liposarcoma (DDLS) poses significant challenges for treatment due to its aggressive nature and poor prognosis. Myogenic dedifferentiation within DDLS may influence surgical outcomes and patient survival. This study investigates the impact of myogenic dedifferentiation and neutrophil-lymphocyte ratio (NLR) as an inflammatory marker on surgical complications and treatment outcomes in RPLS.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed the medical records of 176 patients diagnosed with retroperitoneal sarcoma from January 1, 2005, to December 31, 2018. Fifty patients with DDLPS met the inclusion criteria. Immunohistochemical analyses for muscle-specific markers identified myogenic dedifferentiation. Patients were grouped based on the presence of myogenic dedifferentiation. Preoperative NLR was calculated, and a receiver operating characteristic (ROC) curve determined the optimal NLR cut-off for stratifying inflammatory profiles. Associations between myogenic dedifferentiation, NLR, surgical complications, and treatment outcomes were analyzed.</div></div><div><h3>Results</h3><div>Patients with myogenic dedifferentiation had significantly higher surgical complication rates and lower overall survival (median OS: 26.6 vs. 40.8 months, p < 0.001). An NLR cut-off of 2.6 (AUC = 0.775, 95% CI: 0.63–0.91) predicted myogenic dedifferentiation with 86.7% sensitivity and 54.6% specificity. Elevated NLR was strongly associated with myogenic dedifferentiation (odds ratio = 7.71, 95% CI: 1.51–39.41, p = 0.014), suggesting a heightened inflammatory response influencing tumor aggressiveness.</div></div><div><h3>Conclusion</h3><div>Myogenic dedifferentiation and elevated NLR are associated with increased surgical complications and poorer prognosis in patients with DDLPS. The strong correlation between high NLR and myogenic dedifferentiation underscores the potential role of inflammation in tumor progression. These findings highlight the need for further research into immunotherapy as a possible treatment option for this patient subset to improve management and outcomes.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100072"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143534906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cson.2024.100070
Jiang Liu , Jie Hua , Rong Tang , Wei Wang
Introduction
To evaluate the efficacy and safety of the Double U-Stitch technique in open, laparoscopic and robotic pancreaticoduodenectomy.
Materials and methods
A retrospective study was conducted involving 180 patients who underwent pancreaticoduodenectomy (PD) at the Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, between November 2021 to December 2023. Patients were categorized into three groups: open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD), and robotic pancreaticoduodenectomy (RPD). The Double U-Stitch technique was applied in all cases and perioperative data were collected.
Results
All Double U-Stitch techniques were completed according to the standard, whether in the OPD group, LPD group, or RPD group. The average pancreaticojejunal anastomosis time was less than 25min (14.5min in the OPD group, 24.2min in the LPD group and 24.4min in the RPD group, P < 0.0001). The incidence of clinically relevant pancreatic fistula was 11.6% in OPD group and 9.5% in minimally invasive group (LPD + RPD) (P > 0.05). There was a low incidence rate of postoperative complications which consisted of bile leak, intra-abdominal infection, hemorrhage, and delayed gastric emptying. There was no 90-day mortality observed.
Conclusion
The Double U-Stitch technique demonstrated comparable safety and efficacy across different surgical approaches for PD.
{"title":"Standardized pancreaticojejunostomy by double U-stitch technique in open, laparoscopic, and robotic pancreatoduodenectomies","authors":"Jiang Liu , Jie Hua , Rong Tang , Wei Wang","doi":"10.1016/j.cson.2024.100070","DOIUrl":"10.1016/j.cson.2024.100070","url":null,"abstract":"<div><h3>Introduction</h3><div>To evaluate the efficacy and safety of the Double U-Stitch technique in open, laparoscopic and robotic pancreaticoduodenectomy.</div></div><div><h3>Materials and methods</h3><div>A retrospective study was conducted involving 180 patients who underwent pancreaticoduodenectomy (PD) at the Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, between November 2021 to December 2023. Patients were categorized into three groups: open pancreaticoduodenectomy (OPD), laparoscopic pancreaticoduodenectomy (LPD), and robotic pancreaticoduodenectomy (RPD). The Double U-Stitch technique was applied in all cases and perioperative data were collected.</div></div><div><h3>Results</h3><div>All Double U-Stitch techniques were completed according to the standard, whether in the OPD group, LPD group, or RPD group. The average pancreaticojejunal anastomosis time was less than 25min (14.5min in the OPD group, 24.2min in the LPD group and 24.4min in the RPD group, P < 0.0001). The incidence of clinically relevant pancreatic fistula was 11.6% in OPD group and 9.5% in minimally invasive group (LPD + RPD) (P > 0.05). There was a low incidence rate of postoperative complications which consisted of bile leak, intra-abdominal infection, hemorrhage, and delayed gastric emptying. There was no 90-day mortality observed.</div></div><div><h3>Conclusion</h3><div>The Double U-Stitch technique demonstrated comparable safety and efficacy across different surgical approaches for PD.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100070"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143510358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cson.2025.100076
Japneet Kaur , Elizabeth Mathew Iype , Shaji Thomas , Bipin Varghese , Nebu Abraham George , Ankit Vishwani , Jagathnath Krishna
In Head and neck squamous cell carcinoma (HNSCC), the clinical assessment of mandibular involvement is often inaccurate and unreliable. Involvement of mandible, upstages the disease to stage IV. An important role of imaging in evaluating patients with SCC of the oral cavity is to evaluate the presence and extent of mandibular bone invasion. AIM-To determine the correlation between clinical, radiological and pathological findings in detecting mandibular invasion by squamous cell carcinoma in oral cavity. METHODOLOGY - Prospective study including patients who presented to Head and Neck oncology clinic, RCC TRIVANDRUM, with squamous cell carcinoma of the oral cavity with tumour clinically fixed to or near to mandible in biopsy proven SCC planned for treatment as per department protocol. RESULTS- 131 patients were studied in 1 year, out of which 79 percent were males, 40 percent had clinical bone erosion, and 34 percent had radiological bone erosion. SENSITIVITY of CT - 88%, SPECIFICITY-77.4%, PPV-47.8%, NPV-96.5%, ACCURACY - 79.4%. CONCLUSION-Precise assessment of the extent of mandibular invasion is therefore important for treatment planning to obtain both tumour resection and good functional results of jaw. CT scan is a sensitive tool for predicting bone erosion and should be routinely used in all cases of oral cavity malignancy and combined with thorough clinical examination.
{"title":"Understanding the impact of mandibular invasion on oral squamous cell carcinoma: A clinicoradiopathological perspective","authors":"Japneet Kaur , Elizabeth Mathew Iype , Shaji Thomas , Bipin Varghese , Nebu Abraham George , Ankit Vishwani , Jagathnath Krishna","doi":"10.1016/j.cson.2025.100076","DOIUrl":"10.1016/j.cson.2025.100076","url":null,"abstract":"<div><div>In Head and neck squamous cell carcinoma (HNSCC), the clinical assessment of mandibular involvement is often inaccurate and unreliable. Involvement of mandible, upstages the disease to stage IV. An important role of imaging in evaluating patients with SCC of the oral cavity is to evaluate the presence and extent of mandibular bone invasion. AIM-To determine the correlation between clinical, radiological and pathological findings in detecting mandibular invasion by squamous cell carcinoma in oral cavity. METHODOLOGY - Prospective study including patients who presented to Head and Neck oncology clinic, RCC TRIVANDRUM, with squamous cell carcinoma of the oral cavity with tumour clinically fixed to or near to mandible in biopsy proven SCC planned for treatment as per department protocol. RESULTS- 131 patients were studied in 1 year, out of which 79 percent were males, 40 percent had clinical bone erosion, and 34 percent had radiological bone erosion. SENSITIVITY of CT - 88%, SPECIFICITY-77.4%, PPV-47.8%, NPV-96.5%, ACCURACY - 79.4%. CONCLUSION-Precise assessment of the extent of mandibular invasion is therefore important for treatment planning to obtain both tumour resection and good functional results of jaw. CT scan is a sensitive tool for predicting bone erosion and should be routinely used in all cases of oral cavity malignancy and combined with thorough clinical examination.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100076"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143563106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In recent years the incidence of early-onset colorectal cancer (EOCRC) has increased. This disease entity presents with a different clinical and pathological pattern, unlike late-onset colorectal cancer (LOCRC).
Materials and methods
117 patients with colorectal cancer were included and divided into EOCRC (≤45 years) and LOCRC (>45 years) from July 2022 to Dec 2023. Descriptive statistics were used for data presentation. Mann-Whitney test was used for skewed data. Frequencies and proportions were used to characterize categorical variables. Fisher's Exact Test or Chi-square was used to compare the proportions.
Results
37(31.6%) were EOCRC, and 80(68.4%) were LOCRC. EOCRC patients presented more frequently with stage III disease 15(48.4%) vs LOCRC 29(42%) (p = 0.288). Majority were left-sided tumors 26(70.2%) in EOCRC vs 55(68.8%) in LOCRC, and rectum was involved in 18(48.6%) vs 39(48.8%) respectively. Poorly differentiated cancer was more common in five (19.2%) vs five (10.4%) in both groups (p = 0.538). Signet ring cell morphology and mucin positivity respectively were significantly higher in the EOCRC group nine (32.1%) vs three (5.6%) in the LOCRC (p = 0.0023), EOCRC group 18(66.7%) vs LOCRC 18(33.3%) (p = 0.0042). Overall, there were seven (6.3%) 30-day perioperative mortalities three (8.3%) in EOCRC, and four (5.3%) in the LOCRC group (p = 0.68). 30-day perioperative complications are more common in the LOCRC group (p = 0.0192).
Conclusion
Clinical outcomes, in the form of post-operative morbidity and length of stay, were significantly lower among the younger group of patients. However, high rates of advanced-stage, poorly differentiated, and mucin-secreting tumor patients were seen in the younger age group.
{"title":"Post-operative and short-term oncological outcomes in patients with early-onset colorectal cancer: A prospective observational study","authors":"Kanai Debnath , Yashwant Sakaray , Santosh Irrinki , Satish Subbiah Nagaraj , Cherring Tandup , Siddhant Khare , Ajay Savlania , Divya Dahiya , Periasamy Kannan , Arvind Sekar , Anupam Kumar Singh , Lileswar Kaman","doi":"10.1016/j.cson.2025.100077","DOIUrl":"10.1016/j.cson.2025.100077","url":null,"abstract":"<div><h3>Background</h3><div>In recent years the incidence of early-onset colorectal cancer (EOCRC) has increased. This disease entity presents with a different clinical and pathological pattern, unlike late-onset colorectal cancer (LOCRC).</div></div><div><h3>Materials and methods</h3><div>117 patients with colorectal cancer were included and divided into EOCRC (≤45 years) and LOCRC (>45 years) from July 2022 to Dec 2023. Descriptive statistics were used for data presentation. Mann-Whitney test was used for skewed data. Frequencies and proportions were used to characterize categorical variables. Fisher's Exact Test or Chi-square was used to compare the proportions.</div></div><div><h3>Results</h3><div>37(31.6%) were EOCRC, and 80(68.4%) were LOCRC. EOCRC patients presented more frequently with stage III disease 15(48.4%) vs LOCRC 29(42%) <strong>(p = 0.288)</strong>. Majority were left-sided tumors 26(70.2%) in EOCRC vs 55(68.8%) in LOCRC, and rectum was involved in 18(48.6%) vs 39(48.8%) respectively. Poorly differentiated cancer was more common in five (19.2%) vs five (10.4%) in both groups <strong>(p = 0.538)</strong>. Signet ring cell morphology and mucin positivity respectively were significantly higher in the EOCRC group nine (32.1%) vs three (5.6%) in the LOCRC <strong>(p = 0.0023),</strong> EOCRC group 18(66.7%) vs LOCRC 18(33.3%) <strong>(p = 0.0042)</strong>. Overall, there were seven (6.3%) 30-day perioperative mortalities three (8.3%) in EOCRC, and four (5.3%) in the LOCRC group <strong>(p = 0.68)</strong>. 30-day perioperative complications are more common in the LOCRC group <strong>(p = 0.0192)</strong>.</div></div><div><h3>Conclusion</h3><div>Clinical outcomes, in the form of post-operative morbidity and length of stay, were significantly lower among the younger group of patients. However, high rates of advanced-stage, poorly differentiated, and mucin-secreting tumor patients were seen in the younger age group.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100077"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143551636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-03-01DOI: 10.1016/j.cson.2024.100071
Roman Mirela Mariana , Karler Clarence , Del Marmol Véronique , Bourgeois Pierre
Background
In patients undergoing complete axillary lymph node dissection (CALND) for breast cancer, axillary lymphatic leakages can be detected using near-infrared fluorescence imaging after subcutaneous injection of indocyanine green (ICG) into the ipsilateral hand. This study investigates the impact of these leaks on postoperative fluid volumes collected in drains (Vd) and through punctures (Vp).
Methods
A total of 55 patients received a single subcutaneous ICG injection in the ipsilateral hand either the day before or on the day of surgery. Postoperative fluid volumes, including drain output (Vd) and puncture collections (Vp), were analyzed and compared in relation to the presence or absence of fluorescence detected perioperatively in axillary lymph nodes (AxLNs) and drains.
Results
Fluorescence in AxLN: The absence of fluorescence in the AxLN was associated with a tendency for lower Vd but showed no significant effect on Vp or the total volume of fluid collected (Vt = Vd + Vp). Fluorescent Axillary Leak: Similar trends were observed for the intraoperative detection of a fluorescent axillary leak, although the statistical significance was less pronounced. Fluorescence in Drains: The absence of fluorescence in postoperative drains was significantly correlated with lower values for all analyzed parameters, including Vd, Vp, Vt, the proportion of patients requiring punctures, and the number of punctures.
Conclusion
The findings support the hypothesis that postoperative fluid collections in the axilla after CALND are due primarily to lymphatic leakage from the arm rather than to the removal of axillary lymph nodes. The detection of fluorescence during surgery offers a foundation for targeted strategies to mitigate lymphatic leakages and associated complications. The efficacy of such approaches should be validated through a prospective, multicenter, randomized trial.
{"title":"Confirmation of the importance of lymphatic leakage in the formation of axillary fluid collections after lymph node dissection for breast cancer","authors":"Roman Mirela Mariana , Karler Clarence , Del Marmol Véronique , Bourgeois Pierre","doi":"10.1016/j.cson.2024.100071","DOIUrl":"10.1016/j.cson.2024.100071","url":null,"abstract":"<div><h3>Background</h3><div>In patients undergoing complete axillary lymph node dissection (CALND) for breast cancer, axillary lymphatic leakages can be detected using near-infrared fluorescence imaging after subcutaneous injection of indocyanine green (ICG) into the ipsilateral hand. This study investigates the impact of these leaks on postoperative fluid volumes collected in drains (Vd) and through punctures (Vp).</div></div><div><h3>Methods</h3><div>A total of 55 patients received a single subcutaneous ICG injection in the ipsilateral hand either the day before or on the day of surgery. Postoperative fluid volumes, including drain output (Vd) and puncture collections (Vp), were analyzed and compared in relation to the presence or absence of fluorescence detected perioperatively in axillary lymph nodes (AxLNs) and drains.</div></div><div><h3>Results</h3><div>Fluorescen<strong>ce in AxLN</strong>: The absence of fluorescence in the AxLN was associated with a tendency for lower Vd but showed no significant effect on Vp or the total volume of fluid collected (Vt = Vd + Vp). <strong>Fluorescent Axillary Leak</strong>: Similar trends were observed for the intraoperative detection of a fluorescent axillary leak, although the statistical significance was less pronounced. <strong>Fluorescence in Drains</strong>: The absence of fluorescence in postoperative drains was significantly correlated with lower values for all analyzed parameters, including Vd, Vp, Vt, the proportion of patients requiring punctures, and the number of punctures.</div></div><div><h3>Conclusion</h3><div>The findings support the hypothesis that postoperative fluid collections in the axilla after CALND are due primarily to lymphatic leakage from the arm rather than to the removal of axillary lymph nodes. The detection of fluorescence during surgery offers a foundation for targeted strategies to mitigate lymphatic leakages and associated complications. The efficacy of such approaches should be validated through a prospective, multicenter, randomized trial.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100071"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143679054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-10DOI: 10.1016/j.cson.2025.100075
Cunlong Lu , Zhenlong Han , Hui Gao , Yongke Liu , Long Li , Tuo Shi , Houxin Zhu , Zhaoli Liu , Liangdong Cheng , Yanbing Zhou
Background
To explore the effects of different surgical strategies on clinical outcome and survival for the low-grade appendiceal mucinous neoplasm (LAMN), providing evidence support for the best treatment strategy.
Materials and methods
This study retrospectively analyzed the clinicopathological and survival outcome of LAMN data between 2013 and 2023 from multicenter, including preoperative, intraoperative, and postoperative data. Kaplan-Meier method and Cox regression analysis model were used for survival analysis.
Results
184 patients pathologically diagnosed with LAMN were included. The median age was 59 (50,69) years. All the patients were performed surgery, including simple appendectomy, appendectomy with caecal resection, ileocecectomy and right hemicolectomy (RHC). Compared with extended resection, local resection achieved better short-term outcome. Appendectomy has higher OS rate compared to the RHC with pairwise comparison (97% vs. 79.2%, χ = 11.14, P < 0.001). Multivariate Cox regression analysis showed that age>60 years (hazard radio (HR) = 1.125, 95%CI: 1.051–1.205, P < 0.01), tumor recurrence (HR = 7.019, 95%CI 2.226–22.135, P < 0.001), adjuvant chemotherapy (HR = 6.486, 95%CI 1.897–22.178, P = 0.003) and recurrence risk (HR = 13.303, 95%CI 4.165–42.493, P = 0.002) were independent risk factors for survival of LAMN.
Conclusion
Appendectomy showed favorable short-term outcome and OS rate compared with right hemicolectomy when the tumor is not ruptured and surgical margin is negative. Tumor recurrence, age>60 years, adjuvant chemotherapy and high recurrence risk indicates poor prognosis. Large clinical trials of surgical therapy for LAMN are urgently needed.
{"title":"Clinical outcome and survival of low-grade appendiceal mucinous neoplasm with different surgical treatment: A multicenter clinical retrospective study","authors":"Cunlong Lu , Zhenlong Han , Hui Gao , Yongke Liu , Long Li , Tuo Shi , Houxin Zhu , Zhaoli Liu , Liangdong Cheng , Yanbing Zhou","doi":"10.1016/j.cson.2025.100075","DOIUrl":"10.1016/j.cson.2025.100075","url":null,"abstract":"<div><h3>Background</h3><div>To explore the effects of different surgical strategies on clinical outcome and survival for the low-grade appendiceal mucinous neoplasm (LAMN), providing evidence support for the best treatment strategy.</div></div><div><h3>Materials and methods</h3><div>This study retrospectively analyzed the clinicopathological and survival outcome of LAMN data between 2013 and 2023 from multicenter, including preoperative, intraoperative, and postoperative data. Kaplan-Meier method and Cox regression analysis model were used for survival analysis.</div></div><div><h3>Results</h3><div>184 patients pathologically diagnosed with LAMN were included. The median age was 59 (50,69) years. All the patients were performed surgery, including simple appendectomy, appendectomy with caecal resection, ileocecectomy and right hemicolectomy (RHC). Compared with extended resection, local resection achieved better short-term outcome. Appendectomy has higher OS rate compared to the RHC with pairwise comparison (97% vs. 79.2%, χ = 11.14, <em>P</em> < 0.001). Multivariate Cox regression analysis showed that age>60 years (hazard radio (HR) = 1.125, 95%CI: 1.051–1.205, <em>P</em> < 0.01), tumor recurrence (HR = 7.019, 95%CI 2.226–22.135, <em>P</em> < 0.001), adjuvant chemotherapy (HR = 6.486, 95%CI 1.897–22.178, <em>P</em> = 0.003) and recurrence risk (HR = 13.303, 95%CI 4.165–42.493, <em>P</em> = 0.002) were independent risk factors for survival of LAMN.</div></div><div><h3>Conclusion</h3><div>Appendectomy showed favorable short-term outcome and OS rate compared with right hemicolectomy when the tumor is not ruptured and surgical margin is negative. Tumor recurrence, age>60 years, adjuvant chemotherapy and high recurrence risk indicates poor prognosis. Large clinical trials of surgical therapy for LAMN are urgently needed.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100075"},"PeriodicalIF":0.0,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143474712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-09DOI: 10.1016/j.cson.2025.100074
Dimitrios Chatziisaak , Pascal Burri , Thomas Steffen , Stephan Bischofberger
The incidence of esophageal and rectal cancer is rising globally. The combination of neoadjuvant chemoradiotherapy (nCRT) with watchful waiting (W&W) strategies has been shown to be an effective approach for maintaining a high quality of life (QoL), particularly in the treatment of rectal cancer. This approach has recently been experimentally extended to the treatment of esophageal cancer. This narrative review provides an overview of the current status of nCRT and watchful waiting (W&W) strategies in both cancer types.
The findings of the review indicate that nCRT significantly improves survival and response rates in both cancers. In patients with esophageal cancer, neoadjuvant therapy followed by surgery resulted in a median overall survival that was nearly double the expected survival time and demonstrated high rates of complete pathological response. In the case of rectal cancer, nCRT has been shown to result in high rates of complete response, which in turn has the effect of organ preserving and improving overall oncological outcomes and QoL.
The review concludes that the W&W strategies, initially developed for rectal cancer, can be safely extended to selected cases of esophageal cancer, making organ preservation a feasible option that improves patients' quality of life. It is imperative that internationally accepted guidelines and precise patient selection criteria are established to ensure consistent outcomes and enhance long-term monitoring.
{"title":"A comprehensive narrative review on paradigm shift in the treatment of esophageal and rectal cancer","authors":"Dimitrios Chatziisaak , Pascal Burri , Thomas Steffen , Stephan Bischofberger","doi":"10.1016/j.cson.2025.100074","DOIUrl":"10.1016/j.cson.2025.100074","url":null,"abstract":"<div><div>The incidence of esophageal and rectal cancer is rising globally. The combination of neoadjuvant chemoradiotherapy (nCRT) with watchful waiting (W&W) strategies has been shown to be an effective approach for maintaining a high quality of life (QoL), particularly in the treatment of rectal cancer. This approach has recently been experimentally extended to the treatment of esophageal cancer. This narrative review provides an overview of the current status of nCRT and watchful waiting (W&W) strategies in both cancer types.</div><div>The findings of the review indicate that nCRT significantly improves survival and response rates in both cancers. In patients with esophageal cancer, neoadjuvant therapy followed by surgery resulted in a median overall survival that was nearly double the expected survival time and demonstrated high rates of complete pathological response. In the case of rectal cancer, nCRT has been shown to result in high rates of complete response, which in turn has the effect of organ preserving and improving overall oncological outcomes and QoL.</div><div>The review concludes that the W&W strategies, initially developed for rectal cancer, can be safely extended to selected cases of esophageal cancer, making organ preservation a feasible option that improves patients' quality of life. It is imperative that internationally accepted guidelines and precise patient selection criteria are established to ensure consistent outcomes and enhance long-term monitoring.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100074"},"PeriodicalIF":0.0,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-03DOI: 10.1016/j.cson.2025.100073
Adil Aziz Khan, Sana Ahuja, Sristi Barman, Sufian Zaheer
Background
Optimal management of stage II colorectal cancer (CRC) patients is complex due to variability in oncologic outcomes. Tumor budding (TB) and poorly differentiated clusters (PDCs) have emerged as significant prognostic factors. This study evaluates the prognostic significance of a combined scoring system of TB and PDCs in CRC patients.
Materials and methods
A retrospective study included 68 patients who underwent curative surgery. H&E-stained sections were assessed for TB and PDCs. TB was graded according to ITBCC recommendations: Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (≥10 buds). PDCs were counted as clusters of ≥5 cells without gland formation: PDC1 (0–4 clusters), PDC2 (5–9 clusters), and PDC3 (≥10 clusters). TB and PDC scores were combined, resulting in a score range of 2–4. Histological sections were also evaluated for lymphovascular invasion (LVI), perineural invasion (PNI), and other pathological parameters. Statistical analyses were performed using Chi-Square and Fisher's exact tests.
Results
TB was high in 32.35% of cases and low in 47.06%. High PDCs were present in 47.06% of cases. The combined scoring system showed 55.88% of cases with a score of 3, indicating intermediate risk. Statistical significance was observed between combined scores and T stage, LVI, PNI, histological grade, extranodal extension, and tumor size (p < 0.05).
Conclusion
The combined scoring system for TB and PDCs demonstrated superior prognostic performance compared to individual assessments. This system provides a more comprehensive risk stratification, which may guide more tailored treatment decisions in CRC management.
{"title":"A combined scoring system for tumor budding and poorly differentiated clusters in colorectal cancer: A retrospective study","authors":"Adil Aziz Khan, Sana Ahuja, Sristi Barman, Sufian Zaheer","doi":"10.1016/j.cson.2025.100073","DOIUrl":"10.1016/j.cson.2025.100073","url":null,"abstract":"<div><h3>Background</h3><div>Optimal management of stage II colorectal cancer (CRC) patients is complex due to variability in oncologic outcomes. Tumor budding (TB) and poorly differentiated clusters (PDCs) have emerged as significant prognostic factors. This study evaluates the prognostic significance of a combined scoring system of TB and PDCs in CRC patients.</div></div><div><h3>Materials and methods</h3><div>A retrospective study included 68 patients who underwent curative surgery. H&E-stained sections were assessed for TB and PDCs. TB was graded according to ITBCC recommendations: Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (≥10 buds). PDCs were counted as clusters of ≥5 cells without gland formation: PDC1 (0–4 clusters), PDC2 (5–9 clusters), and PDC3 (≥10 clusters). TB and PDC scores were combined, resulting in a score range of 2–4. Histological sections were also evaluated for lymphovascular invasion (LVI), perineural invasion (PNI), and other pathological parameters. Statistical analyses were performed using Chi-Square and Fisher's exact tests.</div></div><div><h3>Results</h3><div>TB was high in 32.35% of cases and low in 47.06%. High PDCs were present in 47.06% of cases. The combined scoring system showed 55.88% of cases with a score of 3, indicating intermediate risk. Statistical significance was observed between combined scores and T stage, LVI, PNI, histological grade, extranodal extension, and tumor size (p < 0.05).</div></div><div><h3>Conclusion</h3><div>The combined scoring system for TB and PDCs demonstrated superior prognostic performance compared to individual assessments. This system provides a more comprehensive risk stratification, which may guide more tailored treatment decisions in CRC management.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 1","pages":"Article 100073"},"PeriodicalIF":0.0,"publicationDate":"2025-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143394998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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