Clinical Surgical Oncology最新文献_第2页

Establishment and development of minimally invasive surgery for nasopharyngeal carcinoma 鼻咽癌微创手术的建立与发展

Clinical Surgical Oncology

Pub Date : 2025-12-01 DOI: 10.1016/j.cson.2025.100111

Tao Jiang, Ming-yuan Chen

Recurrent nasopharyngeal carcinoma (rNPC) is insensitive to radiotherapy, and re-irradiation lead to severe adverse reactions. Studies have confirmed that endoscopic nasopharyngectomy(ENPG) combined with vascularized nasal mucosal flap repair is superior to re-irradiation with intensity-modulated radiation therapy (IMRT) in terms of survival rate, quality of life and medical costs. This surgical approach has been widely recognized and shows advantages in early-stage rNPC, marking minimally invasive surgery (MIS) for rNPC as an important treatment option. However, the efficacy of surgery for patients with de novo early-stage nasopharyngeal carcinoma(NPC) and advanced rNPC remains controversial. With the standardization and popularization of surgical procedures for NPC, the improvement of surgical staging, the perioperative management of the internal carotid artery(ICA), the advancement of skull base defect repair technology, the implementation of reasonable postoperative treatment and follow-up, as well as the innovation of lymph node dissection technology, MIS for NPC will play an increasingly important role in the treatment of NPC. Evidence-based medical evidence have confirmed that MIS offers definite survival benefits and safety advantages rNPC, serving as the core treatment option for resectable rNPC. Meanwhile, its preliminary application in de novo early-stage NPC has demonstrated potential in avoiding radiotherapy-induced injuries, opening up a new direction for disease treatment. Nevertheless, the surgical treatment of NPC still requires more multi-center and clinical studies for further validation and improvement.

复发性鼻咽癌（rNPC）对放疗不敏感，再照射会导致严重的不良反应。研究证实，内镜下鼻咽切除术（ENPG）联合带血管的鼻黏膜瓣修复术在生存率、生活质量和医疗费用方面都优于调强放疗（IMRT）再照射。这种手术方式在早期rNPC中得到广泛认可并显示出优势，标志着微创手术（MIS）作为rNPC的重要治疗选择。然而，手术治疗新发早期鼻咽癌（NPC）和晚期鼻咽癌（rNPC）的疗效仍存在争议。随着鼻咽癌手术程序的规范化和普及，手术分期的完善，颈内动脉围手术期管理的完善，颅底缺损修复技术的进步，术后合理治疗和随访的实施，以及淋巴结清扫技术的创新，鼻咽癌MIS将在鼻咽癌治疗中发挥越来越重要的作用。循证医学证据证实，MIS具有明确的生存效益和安全性优势，可作为可切除的rNPC的核心治疗方案。同时，其在新生早期鼻咽癌中的初步应用显示出避免放疗性损伤的潜力，为疾病治疗开辟了新的方向。然而，鼻咽癌的手术治疗仍需要更多的多中心和临床研究来进一步验证和改进。

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引用次数: 0

Corrigendum to “Outpatient revisits associated with three sentinel lymph node detection techniques for breast cancer: A propensity score weighted analysis” [Clin. Surg. Oncol. 4 (2025)100087] “与乳腺癌三种前哨淋巴结检测技术相关的门诊复诊：倾向评分加权分析”的勘误表[临床。中华外科杂志4 (2025)100087 [j]

Clinical Surgical Oncology

Pub Date : 2025-12-01 DOI: 10.1016/j.cson.2025.100114

Michelle P. Sosa , Deirdre G. McNicholas , Arbelina B. Bebla , Seth Emont , Zhun Cao , Manu Tyagi , Craig Lipkin , Sommer Gunia

引用次数: 0

Automated CT-based sarcopenia assessment for risk stratification of patients undergoing colorectal cancer resection 基于ct的肌肉减少症自动评估结直肠癌切除术患者的风险分层

Clinical Surgical Oncology

Pub Date : 2025-12-01 DOI: 10.1016/j.cson.2025.100105

Johannes Vogelsang , Gernot Pucher , Fabian Hörst , René Hosch , Johannes Haubold , Philipp Keyl , Christopher M. Sauer , David Albers , Peter Markus , Jan P. Neuhaus , Andreas D. Rink , Jürgen Treckmann , Ulf P. Neumann , Kai Nassenstein , Michael Forsting , Hideo A. Baba , Jan Egger , Stefan Kasper , Martin Schuler , Felix Nensa , Julius Keyl

Despite the prognostic relevance of sarcopenia in colorectal cancer, it has not yet been incorporated into routine clinical patient assessment. This study investigates the potential of automatically CT-derived muscle-to-bone ratio (MBR) for preoperative stratification of colorectal cancer patients.

We retrospectively analyzed CT images of 117 colorectal cancer patients undergoing surgical resection. A deep learning model was used to assess the abdominal MBR as a measure of sarcopenia. Univariable and multivariable analyses were performed to analyze the association between MBR and overall survival (OS), in-hospital mortality, length of stay (LOS), and postoperative C-reactive protein (CRP) levels.

In univariable analysis, preoperative MBR was significantly associated with OS (hazard ratio (HR) 0.29, 95 % CI: 0.13–0.64, p < 0.005). In multivariable analysis adjusted for age, sex, and UICC stage, higher MBR remained independently associated with improved OS (HR 0.28, 95 % CI: 0.10–0.79, p = 0.017) and reduced in-hospital mortality (coefficient (β) = -2.58, p = 0.031). Subgroups based on MBR showed significantly different OS in Kaplan-Meier analysis (p < 0.005). Furthermore, patients with low preoperative MBR exhibited significantly higher postoperative CRP values (p = 0.039). No significant association was observed between MBR and LOS.

Our study demonstrates the potential of deep learning-derived MBR for automated sarcopenia assessment and patient stratification in colorectal cancer surgery.

尽管结直肠癌中肌肉减少症与预后相关，但尚未纳入常规临床患者评估。本研究探讨了自动ct衍生的肌骨比（MBR）在结直肠癌患者术前分层中的潜力。我们回顾性分析117例结直肠癌手术切除患者的CT图像。使用深度学习模型评估腹部MBR作为肌肉减少症的测量。进行单变量和多变量分析，分析MBR与总生存期（OS）、住院死亡率、住院时间（LOS）和术后c反应蛋白（CRP）水平之间的关系。单变量分析中，术前MBR与OS显著相关（风险比0.29,95% CI: 0.13-0.64, p < 0.005）。在调整了年龄、性别和UICC分期的多变量分析中，较高的MBR仍然与改善的OS （HR 0.28, 95% CI: 0.10-0.79, p = 0.017）和降低的住院死亡率（系数(β) = -2.58, p = 0.031）独立相关。Kaplan-Meier分析显示，基于MBR的亚组OS差异显著（p < 0.005）。此外，术前MBR较低的患者术后CRP值明显较高（p = 0.039）。MBR和LOS之间没有明显的关联。我们的研究证明了基于深度学习的MBR在结肠直肠癌手术中用于自动肌肉减少症评估和患者分层的潜力。

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引用次数: 0

The role of artificial intelligence in emergency general surgery: Trends, advances, and future directions 人工智能在急诊普外科中的作用：趋势、进展和未来方向

Clinical Surgical Oncology

Pub Date : 2025-11-02 DOI: 10.1016/j.cson.2025.100103

Lasitha B. Samarakoon , Elon Correa , Wen Y. Chung

Artificial intelligence (AI) is increasingly integrated into emergency general surgery (EGS), offering advances in diagnosis, decision support, operative planning, intraoperative guidance, and postoperative management. This review synthesises current evidence on AI applications in EGS, drawing on meta-analyses, large-scale datasets, and landmark studies. Key domains include risk prediction, intraoperative assistance, surgical video analysis, training, prehabilitation, and operational coordination. Evidence shows AI can improve diagnostic accuracy, streamline workflows, and enhance patient outcomes, though benefits vary by setting, resource availability, and clinical domain. Adoption is accelerating, supported by rising global funding, yet constrained by regulatory, ethical, and implementation challenges. Addressing these barriers, standardising evaluation metrics, and expanding high-quality, multicentre trials will be essential to realise AI's full potential in EGS.

人工智能（AI）越来越多地融入急诊普通外科（EGS），在诊断、决策支持、手术计划、术中指导和术后管理方面提供了进步。本文综合了人工智能在EGS中应用的现有证据，利用了荟萃分析、大规模数据集和里程碑式的研究。关键领域包括风险预测、术中辅助、手术视频分析、培训、康复和操作协调。有证据表明，人工智能可以提高诊断准确性，简化工作流程，并改善患者的治疗效果，尽管益处因环境、资源可用性和临床领域而异。在全球资金不断增加的支持下，采用正在加速，但仍受到监管、道德和实施方面挑战的制约。解决这些障碍，标准化评估指标，扩大高质量的多中心试验，对于实现人工智能在EGS中的全部潜力至关重要。

引用次数: 0

Artificial intelligence for hepatobiliary and pancreatic cancer: Ethics, equity, and real-world integration 人工智能治疗肝胆癌和胰腺癌：伦理、公平和现实世界的整合

Clinical Surgical Oncology

Pub Date : 2025-10-23 DOI: 10.1016/j.cson.2025.100100

Joseph A. Attard, Emily Siviter, Alice Millard, Eyad Issa, Giuseppe Garcea, Ashley Dennison, John Isherwood

Hepatobiliary and pancreatic (HPB) cancers present a major challenge due to their late presentation, limited treatment options, and high mortality. Artificial intelligence (AI) has emerged as a promising tool in revolutionising cancer care, offering potential advances in early detection, and treatment planning. However, real-world implementation of AI remains limited by ethical, technical, and systemic challenges. This narrative review explores the evolving landscape of AI in HPB oncology, with a focus on ethical integration, healthcare equity, and clinical applicability. Key issues discussed include algorithmic bias, informed consent, model explainability, and disparities in access to data and AI-driven tools. Promising innovations such as federated learning and large language models are explored for their potential to decentralise model training and enhance multidisciplinary workflows. The review also highlights the integration of AI into surgical navigation systems and intraoperative decision-making, as well as its application to omics data analysis for biomarker discovery. Crucially, it underscores the need for transparent and interpretable systems, the need for prospective validation in diverse populations, and the risk of clinician de-skilling. As AI technologies evolve, their safe and equitable integration into HPB oncology will require robust governance, regulatory foresight, and sustained investment in clinician education and infrastructure. This review concludes that, while AI shows potential in transforming HPB cancer care, its ethical and inclusive implementation will ultimately determine its clinical impact.

肝胆和胰腺（HPB）癌由于其出现较晚、治疗选择有限和高死亡率而面临重大挑战。人工智能（AI）已经成为一种有前途的工具，可以彻底改变癌症治疗，在早期发现和治疗计划方面提供潜在的进步。然而，人工智能在现实世界的实施仍然受到伦理、技术和系统挑战的限制。这篇叙述性综述探讨了HPB肿瘤学中人工智能的发展前景，重点是伦理整合、医疗公平和临床适用性。讨论的关键问题包括算法偏差、知情同意、模型可解释性以及获取数据和人工智能驱动工具方面的差异。有前途的创新，如联邦学习和大型语言模型，探索其分散模型训练和增强多学科工作流程的潜力。该综述还强调了人工智能与外科导航系统和术中决策的整合，以及它在生物标志物发现的组学数据分析中的应用。至关重要的是，它强调需要透明和可解释的系统，需要在不同人群中进行前瞻性验证，以及临床医生技能下降的风险。随着人工智能技术的发展，将其安全、公平地融入HPB肿瘤学将需要强有力的治理、监管远见以及对临床医生教育和基础设施的持续投资。本综述的结论是，尽管人工智能显示出改变HPB癌症治疗的潜力，但其伦理和包容性的实施将最终决定其临床影响。

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引用次数: 0

The management of Juvenile Tumour Systems implants following limb salvage surgery for bone sarcoma: A British consensus informing best practice and consistent care 骨肉瘤残肢手术后少年肿瘤系统植入物的管理：英国共识告知最佳实践和一致护理

Clinical Surgical Oncology

Pub Date : 2025-10-22 DOI: 10.1016/j.cson.2025.100099

Rebecca O'Keeffe , Sarah Massey

Aims

The aim of this study was to gain a consensus for best practice of follow up of patients following limb salvage surgery with a Juvenile tumour Systems (JTS) extendible implant to benchmark and guide consistent care.

Methods

A two-round modified Delphi study was conducted by paediatric sarcoma specialists. They identified 8 areas of follow up care that required consensus agreement. Statements were based around leg length measurement, long-leg X-Rays, joint range of movement, procedure within the lengthening appointment, physiotherapy, shoe raises, training, frequency of appointments. A pre-determined threshold of >70 % for consensus, with a threshold of >60 % being considered as ‘points to consider’.

Results

Sixteen professionals and manufacturers consented to be part of the consensus. A total of 63 statements were generated for the initial questionnaire, at the end of which 9 statements reached consensus. The remaining 54 statements were discussed and refined to 31 for the second questionnaire. Following two rounds of questionnaires and web conferences a total of 29 statements reached consensus.

Conclusion

Paediatric sarcoma specialists have reached expert consensus to provide a framework for consistent follow up management of JTS implants, many of which could be generalised to other non-invasive growing implants. We would recommend that clinicians use these statements to ensure follow-up care is consistent.

目的本研究的目的是为残肢保留手术后使用少年肿瘤系统（JTS）可扩展植入物的患者随访的最佳实践达成共识，以基准和指导一致的护理。方法采用两轮改良德尔菲法，由小儿肉瘤专家进行。他们确定了需要达成共识的8个后续护理领域。这些陈述是基于腿长测量、长腿x光片、关节活动范围、延长预约的程序、物理治疗、提鞋、训练、预约频率。预先确定的70%的共识阈值，60%的阈值被认为是“考虑点”。结果16名专业人员和生产厂家同意参与共识。最初的调查表共有63项陈述，最后有9项陈述达成协商一致意见。对剩下的54项陈述进行了讨论，并将其提炼为31项，用于第二份调查表。经过两轮问卷调查和网络会议，共有29项声明达成共识。结论小儿肉瘤专家已经达成专家共识，为JTS种植体的随访管理提供了一个框架，其中许多可以推广到其他非侵入性生长种植体。我们建议临床医生使用这些陈述来确保后续护理的一致性。

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引用次数: 0

Role of primary tumour surgery in the management of oligometastatic breast cancer 原发性肿瘤手术在低转移性乳腺癌治疗中的作用

Clinical Surgical Oncology

Pub Date : 2025-10-22 DOI: 10.1016/j.cson.2025.100101

Byung Choi, Amr Mousa, Tyler Longbone, Lavandan Jegatheeswaran, Mohammed Elsiddig, Vishal Patel, Ekambaram Babu, Arunmoy Chakravorty

Metastatic breast cancer has long considered an incurable disease, however a subset coined oligometastatic breast cancer (OMBC) has challenged this assumption. OMBC represents a stable entity that presents as an intermediary state between locoregional and widespread disease where metastasised cells are limited to suitable sites potentially amenable to treatment. However, the treatment for OMBC is not standardised and a major limitation is diagnostic difficulty as it relies only on imaging findings. In the United Kingdom, a case by case discussion of treatment is made due to lack of guidance or framework. The role of primary surgical excision of the breast tumour in OMBC has been scrutinised with varying outcomes to date. This review evaluates the role of primary surgical excision and future directions in the field of OMBC management. Most studies to date have been retrospective in nature, given the diagnostic challenges of OMBC and studies to date have failed to show conclusive evidence regarding surgery to the primary tumour. Some favourable factors seem to be hormone receptor positivity and bone pre-dominant metastasis, however there is a need for better understanding in the distinct biology of OMBC to characterise and determine the value of surgery to the primary tumour as well as adjuvant oncological treatments.

转移性乳腺癌长期以来被认为是一种无法治愈的疾病，然而，一种被称为寡转移性乳腺癌（OMBC）的亚型挑战了这一假设。OMBC是一种稳定的实体，表现为局部和广泛疾病之间的中间状态，其中转移细胞局限于可能适合治疗的合适部位。然而，OMBC的治疗尚未标准化，主要的限制是诊断困难，因为它仅依赖于影像学表现。在英国，由于缺乏指导或框架，对治疗进行个案讨论。原发性手术切除乳腺肿瘤在OMBC中的作用已被仔细审查，迄今为止有不同的结果。本文综述了原发性手术切除在OMBC治疗领域的作用和未来发展方向。鉴于OMBC的诊断挑战，迄今为止的大多数研究本质上都是回顾性的，而且迄今为止的研究未能提供有关原发肿瘤手术的确凿证据。一些有利因素似乎是激素受体阳性和骨前显性转移，然而，需要更好地了解OMBC的独特生物学特征，以确定手术对原发肿瘤以及辅助肿瘤治疗的价值。

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引用次数: 0

Breaking barriers: Pembrolizumab's role in overcoming targeted therapy resistance in BRAF-mutant melanoma 突破障碍：Pembrolizumab在克服braf突变黑色素瘤靶向治疗耐药中的作用

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100095

Omer A. Idris , Abdulaziz Shebrain , Ali Jawad , Sabrina C. Pacione , Delour Haj , Hanin Bzizi , Yaqub O. Ahmedfiqi , Bahar Saadaie Jahromi , Nicholas Deleon , Tiantian Zhang , Amanda Hunt , Ramona Meraz Lewis , Diana Westgate

Melanoma, a malignancy of melanocytes, has increased globally, posing significant treatment challenges. BRAF mutations, particularly V600E and V600K variants, occur in approximately 40–60 % of cutaneous melanomas and activate the MAPK/ERK signaling pathway. Although BRAF and MEK inhibitors have improved response rates and survival, acquired resistance—due to genetic alterations, activation of alternative pathways, and phenotypic changes—remains a major hurdle.

Pembrolizumab, an anti-PD-1 immune checkpoint inhibitor, has emerged as a promising option to overcome resistance to targeted therapies. This review explores the rationale for using pembrolizumab post-resistance, emphasizing its ability to enhance immune recognition through the immunogenic effects of prior targeted therapies and its synergistic potential when combined with BRAF and MEK inhibitors. Clinical evidence from KEYNOTE trials and real-world studies demonstrates pembrolizumab's efficacy as monotherapy and in combination regimens, leading to improved progression-free and overall survival in patients with advanced melanoma. Mechanistic insights from preclinical studies suggest that targeted therapies modulate the tumor microenvironment and enhance antigen presentation, augmenting the effectiveness of pembrolizumab. Novel biomarkers such as tumor mutational burden (TMB), PD-L1 expression, and circulating tumor DNA (ctDNA) are examined for their potential to predict treatment response and guide personalized therapy. Challenges related to increased toxicity in combination therapies, economic impact, and patient heterogeneity are discussed, highlighting the need for careful patient selection and management strategies. Future directions include optimizing treatment sequencing, exploring novel therapeutic combinations, and advancing personalized medicine through integrative genomic and immunologic data. This review underscores the pivotal role of pembrolizumab in managing BRAF-mutant melanoma and emphasizes the importance of integrated therapeutic strategies to improve patient outcomes.

黑色素瘤是一种黑色素细胞的恶性肿瘤，在全球范围内呈上升趋势，带来了重大的治疗挑战。BRAF突变，特别是V600E和V600K突变，发生在大约40 - 60%的皮肤黑色素瘤中，并激活MAPK/ERK信号通路。尽管BRAF和MEK抑制剂提高了反应率和生存率，但由于遗传改变、替代途径的激活和表型改变，获得性耐药仍然是一个主要障碍。Pembrolizumab是一种抗pd -1免疫检查点抑制剂，已成为克服靶向治疗耐药的有希望的选择。本综述探讨了耐药后使用派姆单抗的基本原理，强调其通过先前靶向治疗的免疫原性效应增强免疫识别的能力，以及与BRAF和MEK抑制剂联合使用时的协同潜力。KEYNOTE试验和现实世界研究的临床证据表明，pembrolizumab作为单药治疗和联合治疗方案的疗效，可改善晚期黑色素瘤患者的无进展和总生存期。临床前研究的机制见解表明，靶向治疗调节肿瘤微环境并增强抗原呈递，从而增强派姆单抗的有效性。新的生物标志物，如肿瘤突变负荷（TMB）， PD-L1表达和循环肿瘤DNA （ctDNA）被检查其预测治疗反应和指导个性化治疗的潜力。讨论了与联合治疗毒性增加、经济影响和患者异质性相关的挑战，强调了谨慎选择患者和管理策略的必要性。未来的发展方向包括优化治疗序列，探索新的治疗组合，以及通过整合基因组和免疫数据推进个性化医疗。本综述强调了派姆单抗在治疗braf突变黑色素瘤中的关键作用，并强调了综合治疗策略对改善患者预后的重要性。

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引用次数: 0

Outcome of patients scheduled for CRS and HIPEC yet only undergoing explorative laparotomy 计划进行CRS和HIPEC但仅进行探查性剖腹手术的患者的结果

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100093

Valentinus Valdimarsson, Ingvar Syk, Victor Verwaal

Background

Some patients scheduled for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) only undergo explorative laparotomy (open/close procedure) due to extensive tumor spread or challenges in achieving complete cytoreduction (CC0). This study aimed to evaluate the surgical outcomes and overall survival in patients with peritoneal surface malignancy (PSM) who only undergo open/closed laparotomy.

Methods

All patients scheduled for CRS and HIPEC in Malmö, Sweden, between 2015 and 2023, who only underwent open/close laparotomy were included. Patients without malignant diagnoses were excluded. Clinical, survival, and complication data were analyzed.

Results

A total of 28 patients underwent open/closed laparotomy only. Before the laparotomy, 15 (54 %) patients had undergone diagnostic laparoscopy with a median PCI score of 13.0 (IQR 10.0–19.0). During the laparotomy, the median PCI score was found to be 29.0 (IQR 25.5–33.0). The most common reason for not proceeding with CRS and HIPEC surgery was a high PCI score (61 %). Three patients (11 %) experienced serious postoperative complications (Clavien-Dindo ≥3b), and one patient died during the first postoperative day. After the explorative laparotomy, twenty-one (78 %) patients received palliative chemotherapy (median survival of 13.4 months), whereas six received none (median survival of 3.5 months), with missing data from one patient.

Conclusion

Patients diagnosed with PSM who undergo only exploratory laparotomy (open/close) have a very poor prognosis. Exploratory laparotomy poses a significant risk of serious postoperative complications, as well as a lengthy hospital stay. Improved diagnostic tools are urgently needed to help identify the right patients for CRS and HIPEC treatment.

一些计划进行细胞减少手术（CRS）和腹腔内高温化疗（HIPEC）的患者由于肿瘤广泛扩散或难以实现完全细胞减少（CC0），只能进行探查性剖腹手术（开/闭手术）。本研究旨在评估腹膜表面恶性肿瘤（PSM）患者仅行开腹/闭腹手术的手术效果和总生存率。方法纳入2015年至2023年期间在瑞典Malmö进行CRS和HIPEC手术的所有仅行开腹/闭腹手术的患者。排除无恶性诊断的患者。分析临床、生存和并发症数据。结果28例患者仅行开腹/闭腹手术。开腹前，15例（54%）患者接受了诊断性腹腔镜检查，PCI评分中位数为13.0 （IQR 10.0-19.0）。剖腹手术时，PCI评分中位数为29.0 （IQR 25.5-33.0）。不进行CRS和HIPEC手术的最常见原因是PCI评分高（61%）。3例患者（11%）出现严重的术后并发症（Clavien-Dindo≥3b）， 1例患者在术后第一天死亡。探查性剖腹手术后，21例（78%）患者接受了姑息性化疗（中位生存期为13.4个月），而6例患者未接受姑息性化疗（中位生存期为3.5个月），其中1例患者数据缺失。结论单纯剖腹探查（开腹/闭腹）诊断为PSM的患者预后极差。剖腹探查术存在严重的术后并发症风险，并且住院时间较长。迫切需要改进的诊断工具来帮助确定适合CRS和HIPEC治疗的患者。

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引用次数: 0

Evaluating the quality and readability of AI-generated ophthalmic surgery education: A four model comparison 评价人工智能眼科外科教育的质量和可读性：四种模式的比较

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100092

Rickvir S. Sidhu , Arrane Selvamogan

引用次数: 0