Clinical Surgical Oncology最新文献_第2页

Surgical management of non-colorectal non-neuroendocrine liver oligometastases: Sarcoma, breast, gastric, and pancreatic cancers 非结直肠非神经内分泌肝脏寡转移瘤的外科治疗：肉瘤、乳腺癌、胃癌和胰腺癌

Clinical Surgical Oncology

Pub Date : 2024-06-01 DOI: 10.1016/j.cson.2024.100047

Huda Muhammad, Brendan Visser

引用次数: 0

Effects of preoperative biliary drainage on the outcomes of surgical treatment in cholangiocarcinoma: A propensity score matching analysis 术前胆道引流对胆管癌手术治疗效果的影响：倾向评分匹配分析。

Clinical Surgical Oncology

Pub Date : 2024-04-24 DOI: 10.1016/j.cson.2024.100046

Poowanai Sarkhampee , Sunhawit Junrungsee , Apichat Tantraworasin , Pongserath Sirichindakul , Weeris Ouransatien , Satsawat Chansitthichok , Nithi Lertsawatvicha , Paiwan Wattanarath

Background

Hyperbilirubinemia is known to increase morbidity and mortality in patients undergoing liver resection for cholangiocarcinoma (CCA). Preoperative biliary drainage (PBD) in patients who have no acute cholangitis or require portal vein embolization is still debatable. The goal of this study is to investigate how PBD affects the surgical results after liver resection.

Methods

Between October 2013 and December 2020, CCA patients presenting with obstructive jaundice who underwent liver resection were retrospectively reviewed. The pre-operative, peri-operative and post-operative characteristics were extracted. To compare the outcomes of the PBD and direct surgery groups, propensity score matching analysis (PSM) and multivariable risk regression analysis were used to analyze.

Results

A total of 355 patients were enrolled, with 99 of them undergoing PBD. At diagnosis, those with PBD showed significantly greater bilirubin levels than those without (20.7 vs 9.6 mg/dL, p < 0.001). However, after drainage, the bilirubin level in the PBD group was lower than the direct surgery group (5.5 vs 9.6 mg/dL, p < 0.001). Overall postoperative morbidity and mortality were unaffected by PBD in full patient cohort. However, after PSM, PBD was associated with decreased major post-hepatectomy liver failure (PHLF) and 90-day mortality rate, (20.3% vs 39.24%, p = 0.014 and 3.8% vs 22.8%, p = 0.001, respectively). At multivariable analysis of PSM patient cohort, PBD was associated with decreased major post-operative complication (RR 0.64, 95%CI 0.419–0.986), PHLF (RR 0.40, 95%CI 0.227–0.705) and 90-day mortality (RR 0.21, 95%CI 0.086–0.629).

Conclusion

PBD was associated with decreased post-hepatectomy liver failure and postoperative mortality after liver resection in jaundiced CCA patients.

背景众所周知，高胆红素血症会增加因胆管癌（CCA）而接受肝切除术的患者的发病率和死亡率。对于没有急性胆管炎或需要门静脉栓塞的患者，术前胆道引流（PBD）仍存在争议。本研究旨在探讨 PBD 如何影响肝脏切除术后的手术效果。方法回顾性研究了 2013 年 10 月至 2020 年 12 月间，接受肝脏切除术的梗阻性黄疸 CCA 患者。方法对 2013 年 10 月至 2020 年 12 月期间接受肝脏切除术的梗阻性黄疸 CCA 患者进行回顾性研究，提取其术前、围手术期和术后特征。为了比较PBD组和直接手术组的结果，采用了倾向得分匹配分析（PSM）和多变量风险回归分析进行分析。诊断时，PBD 患者的胆红素水平明显高于非 PBD 患者（20.7 vs 9.6 mg/dL，p < 0.001）。然而，引流后，PBD 组的胆红素水平低于直接手术组（5.5 vs 9.6 mg/dL，p < 0.001）。在所有患者中，PBD 对术后总体发病率和死亡率没有影响。但在 PSM 术后，PBD 与肝切除术后主要肝功能衰竭（PHLF）和 90 天死亡率的降低有关（分别为 20.3% vs 39.24%，p = 0.014 和 3.8% vs 22.8%，p = 0.001）。在对 PSM 患者群进行多变量分析时，PBD 与术后主要并发症（RR 0.64，95%CI 0.419-0.986）、PHLF（RR 0.40，95%CI 0.227-0.705）和 90 天死亡率（RR 0.21，95%CI 0.086-0.629）的降低有关。

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引用次数: 0

The role of free flap reconstruction after resection of extremity and trunk soft tissue sarcomas. Results of two referral centers in Argentina 四肢和躯干软组织肉瘤切除术后游离皮瓣重建的作用。阿根廷两家转诊中心的研究结果

Clinical Surgical Oncology

Pub Date : 2024-04-17 DOI: 10.1016/j.cson.2024.100042

Sergio D. Quildrian , Walter S. Nardi , María G. Vega , Jorge A. Chapela

Introduction

For patients affected by extremity or trunk soft-tissue sarcomas (STS) large resections might be needed to achieve negative margins. This is a common scenario especially in locally advanced or recurrent tumors often within a pre-irradiated field. The objective of this study was to evaluate the results of free-flap reconstructions (FFR) after sarcoma surgery.

Objective

The endpoints were surgical results, quality of surgical margins and oncological outcome.

Methods

Retrospective analysis of patients with extremity and trunk STS with free-flap reconstruction between 2008 and 2022. Demographic and tumor data, perioperative treatment, margin status, morbidity and evolution were evaluated.

Results

Of 467 patients, 25 (5.35%) required 26 free-flap reconstructions. Surgery was performed on an irradiated field in 8 (32%) patients. Reconstructions were mostly needed for distal lower extremity resections and the most common type of flap used was antero-lateral tight (ALT) flap. No R2 resections were performed. R0 and R1 resections were achieved in 22 (84.6%) and 4 (15.4%), respectively. All R1 resections were preplanned positive along a preserved critical structure. Surgical morbidity rate was 26% (7/26) and the re-operation rate was 15% (4/26) with 7.7% flap losses (2/26). At a median follow-up of 38 months, 7 (28%) patients presented local recurrences.

Conclusion

In a referral sarcoma center, having a multidisciplinary surgical team capable of complex resections and reconstructions is of utmost importance for a correct and integral surgical planning. This allows optimal oncologic resections with acceptable morbidity.

导言：对于四肢或躯干软组织肉瘤（STS）患者，可能需要进行大面积切除才能达到阴性边缘。这种情况很常见，尤其是局部晚期或复发性肿瘤，通常是在放射治疗前的区域内。本研究旨在评估肉瘤术后游离瓣重建（FFR）的效果。方法回顾性分析2008年至2022年期间接受游离瓣重建的四肢和躯干STS患者。结果在467例患者中，有25例（5.35%）需要进行26次游离瓣重建手术。8例（32%）患者的手术是在照射野进行的。大部分下肢远端切除术需要进行重建，最常用的皮瓣类型是前外侧紧皮瓣（ALT）。没有进行R2切除术。分别有22例（84.6%）和4例（15.4%）实现了R0和R1切除。所有R1切除术都是沿保留的关键结构进行的预规划阳性切除术。手术发病率为26%（7/26），再次手术率为15%（4/26），皮瓣脱落率为7.7%（2/26）。在中位 38 个月的随访中，有 7 例（28%）患者出现局部复发。这样才能在可接受的发病率下进行最佳的肿瘤切除手术。

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引用次数: 0

Outcome of patients with liposarcoma: A retrospective review over 12 Years in a single center 脂肪肉瘤患者的预后：单一中心 12 年来的回顾性研究

Clinical Surgical Oncology

Pub Date : 2024-04-17 DOI: 10.1016/j.cson.2024.100043

Teck Liang Tie, Suryasmi Duski

Background

Liposarcoma is the most common soft tissue sarcoma, which comprises around 20% of soft tissue sarcoma. While diverse therapeutic approaches exist for liposarcoma, the primary goal remains the achievement of effective local disease control. Wide resection of liposarcoma is the cornerstone of treatment. Radiotherapy is often employed as an adjuvant measure to enhance the local disease control. At Hospital Kuala Lumpur, the treatment protocol includes R0 resection and followed by adjuvant radiotherapy. This study aims to review the demographic characteristic of liposarcoma patients and evaluate the efficacy of their treatment based on the treatment protocol.

Method and material

This is a retrospective cohort study. A total of 72 patients (male/female = 43/29) were included in this study. Recorded parameters included the histologic subtype, tumor location, treatment modality, resection margin, radiotherapy status, and occurrences of local recurrence and metastasis.

Result

Histopathological examination revealed a varied spectrum of liposarcoma subtypes, with the predominant subtype being atypical lipomatous tumor (n = 35), followed by myxoid liposarcoma (n = 32), two cases of dedifferentiated liposarcoma, and three cases of pleomorphic liposarcoma. Of these patients, 69 underwent resection, while three necessitated amputations. Total 62 achieving negative and 10 cases had R1 margins. Adjuvant radiotherapy was administered in 58 cases. Overall, the local recurrence was observed in only six cases.

Conclusion

This study emphasizes that achieving R0 resection is the fundamental approach in the treatment of liposarcoma and is able to minimize the risk of local recurrence.

背景脂肪肉瘤是最常见的软组织肉瘤，约占软组织肉瘤的 20%。虽然脂肪肉瘤的治疗方法多种多样，但首要目标仍然是实现有效的局部疾病控制。广泛切除脂肪肉瘤是治疗的基础。放疗通常被用作辅助措施，以加强对局部疾病的控制。吉隆坡医院的治疗方案包括 R0 切除术和辅助放疗。本研究旨在回顾脂肪肉瘤患者的人口统计学特征，并根据治疗方案评估其疗效。本研究共纳入 72 例患者（男/女=43/29）。结果组织病理学检查显示脂肪肉瘤亚型多样，主要亚型为非典型脂肪瘤（35 例），其次为肌样脂肪肉瘤（32 例），2 例为去分化脂肪肉瘤，3 例为多形性脂肪肉瘤。在这些患者中，69 例接受了切除手术，3 例需要截肢。共有 62 例达到阴性，10 例边缘为 R1。58例患者接受了辅助放疗。总的来说，只有6例患者出现了局部复发。结论这项研究强调，实现R0切除是治疗脂肪肉瘤的基本方法，能够将局部复发的风险降至最低。

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引用次数: 0

Nationwide analysis of the breast cancer guidelines adherence in Bulgaria 对保加利亚乳腺癌指南遵守情况的全国性分析

Clinical Surgical Oncology

Pub Date : 2024-04-16 DOI: 10.1016/j.cson.2024.100044

Dobromir Dimitrov , Iskra Daskalova , Ivelina Petrova , Meri Shoshkova , Tsanko Yotsov , Damyan Boychev , Tihomir Andreev , Nikolai Ramadanov , Martin Karamanliev

Introduction

The diagnosis and treatment of breast cancer have tremendously changed in the last decades improving the survival and quality of life of the patients. Adherence to clinical practice guidelines in oncology significantly improves patients’ recurrence-free and overall survival. Nowadays, no national registry/database for breast cancer patients is available. This study aims to perform a nationwide analysis of the breast cancer guidelines adherence in Bulgaria, in particular regarding the diagnostic methods for histological confirmation and the types of radical surgery performed using an artificial intelligence (AI) powered software.

Materials and methods

We analyzed data from January 2019 to August 2023 nationwide using the platform with access to anonymized medical information from Bulgaria's leading territorial oncology hospitals. A total of 13,790 patients met the inclusion criteria.

Results

The gold standard diagnostic tool, CNB, was done in 5427 patients (39.35%), an intraoperative frozen section was performed as a method for confirmation of breast cancer in 6257 patients (45.37%) and the standard technique for lymph node evaluation, sentinel lymph node biopsy, was done in 357 patients (2.99%).

Conclusion

In Bulgaria, there are still difficulties in achieving comparable rates of core-needle biopsy for the diagnosis of breast cancer and we have demonstrated unacceptably high rates of frozen section use for intraoperative diagnosis of breast cancer. Breast-conserving surgery is widely accepted and available, but still, the rates are lower than usual for developed countries. The rates of sentinel lymph node biopsy, however, are unreasonably low.

导言在过去的几十年中，乳腺癌的诊断和治疗发生了巨大的变化，提高了患者的生存率和生活质量。遵守肿瘤学临床实践指南可显著提高患者的无复发率和总生存率。目前，还没有针对乳腺癌患者的全国性登记/数据库。本研究旨在对保加利亚乳腺癌指南的遵守情况进行全国范围的分析，特别是使用人工智能（AI）驱动的软件进行组织学确认的诊断方法和根治手术的类型。材料和方法我们使用保加利亚主要地区肿瘤医院的匿名医疗信息访问平台，分析了2019年1月至2023年8月的全国数据。共有 13790 名患者符合纳入标准。结果5427 名患者（39.35%）采用了金标准诊断工具 CNB，6257 名患者（45.37%）采用了术中冷冻切片作为乳腺癌的确认方法，357 名患者（2.99%）采用了淋巴结评估的标准技术--前哨淋巴结活检。结论在保加利亚，核心针活检用于乳腺癌诊断的比例仍难以达到可比水平，而且我们已经证明冷冻切片用于乳腺癌术中诊断的比例高得令人无法接受。保乳手术已被广泛接受和使用，但其比例仍低于发达国家的一般水平。然而，前哨淋巴结活检率低得不合理。

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引用次数: 0

Corrigendum to “Chinese guidelines for the diagnosis and comprehensive treatment of colorectal liver metastases (V. 2023)” [Clin. Surg. Oncol. 2 (2023) 100013] "中国结直肠肝转移瘤诊断和综合治疗指南（V. 2023）"勘误表[Clin. Surg. Oncol.

Clinical Surgical Oncology

Pub Date : 2024-03-01 DOI: 10.1016/j.cson.2024.100039

Li Ren , Dexiang Zhu , Jin Gu , Baoqing Jia , Jin Li , Xinyu Qin , Xishan Wang , Ruihua Xu , Yingjiang Ye , Suzhan Zhang , Zhongtao Zhang , Jianmin Xu , Jia Fan , China CRLM Guideline Group, Chinese College of Surgeons, Chinese Medical Doctor Association, Section of Gastrointestinal Surgery, Branch of Surgery, Chinese Medical Association, Section of Colorectal & Anal Surgery, Branch of Surgery, Chinese Medical Association, Colorectal Cancer Professional Committee, Chinese Anti-Cancer Association, Colorectal Cancer Professional Committee, Chinese Medical Doctor Association, Colorectal Cancer Expert Committee, Chinese Society of Clinical Oncology, Chinese Society of Colon & Rectal Surgeons, Chinese College of Surgeons, Chinese Medical Doctor Association, Metastasis Research Committee, Anorectal Branch of Chinese Medical Doctor Association, Colorectal Oncology Group, Branch of Oncology, Chinese Medical Association, Metastatic Tumor Therapy Branch of China International Exchange and Promotive Association for Medical and Health Care, Colorectal Disease Branch of China International Exchange and Promotive Association for Medical and Health Care

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引用次数: 0

Radiation therapy of renal cell carcinoma skeletal metastases – Does histologic subtype predict progression? 肾细胞癌骨骼转移的放射治疗--组织学亚型能否预测病情发展？

Clinical Surgical Oncology

Pub Date : 2024-03-01 DOI: 10.1016/j.cson.2024.100040

Kavin Sundaram , Joshua M. Lawrenz , Precious C. Oyem , Aditya Banerjee , Shannon Wu , Paras Shah , Shireen Parsai , Chirag Shah , Nathan W. Mesko , John Reith , Lukas M. Nystrom

Introduction

This investigation assessed whether the following factors were associated with radiographic local progression in bone metastases from renal cell carcinoma (RCC): (1) high-risk histologic features (2) lesional surgery (3) biologically effective dose (BED) of radiation therapy.

Methods and materials

A single-institution database identified all patients who underwent surgery and radiation therapy for bone metastases from RCC to the appendicular skeleton and pelvis from 2006 to 2016. Thirty-six patients underwent radiotherapy for 80 metastases. While all patients had surgical stabilization, 17/36 also had lesional surgery to address the metastatic lesion. Progression of each individual lesion was determined using the application of RECIST criteria to imaging at last follow-up.

Results

The rate of progressive disease was 8/25 (32%) in the high-risk group versus 5/55 (9%) in the standard-risk group (p = 0.019). The rate of progression among high-risk metastases undergoing lesional surgery was 0/9 versus 8/16 (50%) having non-lesional surgery (p = 0.0218). The rate of progression among standard-risk metastases undergoing lesional surgery was 1/16 (6%) versus 4/39 (10%) with non-lesional surgery (p = 1.00). High-risk histologic features (OR: 10.592, 95% confidence interval: 1.347–83.271, p = 0.025) and as well as a reduction in risk with every additional Gray of BED (OR: 0.902, 95% confidence interval: 0.827–0.984, p = 0.021) were found to predict progressive disease.

Conclusions

Bone metastases from renal cell carcinoma with high-risk histologic features are associated with less favorable response to radiotherapy than those with standard-risk histology. Delivery of a higher BED was associated with lower odds of progression.

导读：这项研究评估了以下因素是否与肾细胞癌（RCC）骨转移的放射学局部进展有关：（1）高危组织学特征（2）病变手术（3）放疗的生物有效剂量（BED）。方法和材料一个单一机构的数据库确定了2006年至2016年期间所有因RCC骨转移至阑尾骨骼和骨盆而接受手术和放疗的患者。36名患者因80处转移灶接受了放疗。虽然所有患者都接受了手术稳定治疗，但其中17/36的患者还接受了病灶手术来治疗转移病灶。结果高危组中疾病进展率为8/25（32%），而标准风险组为5/55（9%）（P = 0.019）。接受病变手术的高危转移灶中，疾病进展率为0/9，而接受非病变手术的为8/16（50%）（P = 0.0218）。接受病变手术的标准风险转移灶的进展率为1/16（6%），而接受非病变手术的标准风险转移灶的进展率为4/39（10%）（p = 1.00）。高风险组织学特征（OR：10.592，95% 置信区间：1.347-83.271，p = 0.025）和每增加一个 BED 格雷风险降低（OR：0.902，95% 置信区间：0.827-0.984，p = 0.结论与标准风险组织学相比，具有高风险组织学特征的肾细胞癌骨转移与放疗反应较差有关。较高的BED与较低的进展几率相关。

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引用次数: 0

Erratum regarding missing statements in previously published articles 关于以前发表的文章中缺失声明的更正

Clinical Surgical Oncology

Pub Date : 2024-03-01 DOI: 10.1016/j.cson.2024.100041

引用次数: 0

The long-term outcomes of metachronous tumors for non-small cell lung cancer 非小细胞肺癌并发肿瘤的长期预后

Clinical Surgical Oncology

Pub Date : 2024-03-01 DOI: 10.1016/j.cson.2024.100035

Celalettin Kocaturk , Cem Emrah Kalafat , Celal Bugra Sezen , Mustafa Vedat Dogru , Levent Cansever , Muzaffer Metin , Mehmet Ali Bedirhan

Background

We aimed to identify prognostic factors for mortality and survival in patients operated on for metachronous primary lung cancer (MPLC).

Materials and methods

The data of 67 non-small cell lung cancer patients with MPLC, diagnosed and operated upon between January 2000 and December 2015, were retrospectively analyzed.

Results

Of the 67 included patients, 63 (94%) were male and 4 (6%) were female. The overall survival rate after second surgery was 53.6% at 5 years and 34.1% at 10 years. The mean survival time was 64 months (95% confidence interval: 35–92 months). Adjuvant treatment improved survival (p = 0.039). Although the survival of grade N0 and N1 patients did not differ, four grade N2 patients exhibited poor survival (p = 0.02). Cox's regression analysis revealed that grade N2 disease decreased survival 5.3- fold, the absence of adjuvant treatment decreased survival 2 fold and pT4 grade decreased survival 3.4 fold.

Conclusions

New lung tumors may be detected during follow-up of lung cancer patients who have been definitively treated. In such cases, if extrapulmonary metastases and N2 lymphatic involvement are absent, there is no recurrence in the surgical margins of the first operation, and there is only one new tumor, we suggest that surgical treatment should be initially chosen for patients with adequate cardiopulmonary reserves regardless of the time of appearance of the second tumor, whether or not the histopathological type is the same as that of the first tumor.

背景我们的目的是确定因并发原发性肺癌（MPLC）而接受手术的患者的死亡率和生存率的预后因素。材料和方法我们对2000年1月至2015年12月期间确诊并接受手术的67例MPLC非小细胞肺癌患者的数据进行了回顾性分析。结果在纳入的67例患者中，63例（94%）为男性，4例（6%）为女性。第二次手术后，5年总生存率为53.6%，10年总生存率为34.1%。平均存活时间为64个月（95%置信区间：35-92个月）。辅助治疗提高了生存率（P = 0.039）。虽然N0级和N1级患者的生存率没有差异，但4名N2级患者的生存率较低（P = 0.02）。Cox回归分析显示，N2级患者的生存率降低了5.3倍，未接受辅助治疗的患者生存率降低了2倍，pT4级患者的生存率降低了3.4倍。在这种情况下，如果没有肺外转移和 N2 淋巴受累，第一次手术的手术边缘没有复发，并且只有一个新的肿瘤，我们建议无论第二个肿瘤出现的时间长短，组织病理学类型是否与第一个肿瘤相同，心肺储备充足的患者都应首先选择手术治疗。

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引用次数: 0

Feeding Jejunostomy in Pancreatico-Duodenectomy patients: Is it important 胰腺十二指肠切除术患者的进食空肠造口术：是否重要

Clinical Surgical Oncology

Pub Date : 2024-03-01 DOI: 10.1016/j.cson.2024.100038

Ahmed Mohamed Abdelaziz Hassan , Hesham A. Elmeligy , Magdy Elsebae , Mohamed Abdo , Ahmed M. Azzam , Mahmoud Rady

Background

During a pancreaticoduodenectomy, Feeding Jejunostomy (FJ) is frequently placed to improve postoperative nutrition. Our aim is to ascertain the effects of the FJ tube after pancreaticoduodenectomy.

Methods

Prospective analysis was performed on all patients who underwent concurrent FJ after pancreaticoduodenectomy (Whipples surgery) between 2022 and 2023. On POD 1, FJ feeds were frequently initiated. After the patient had taken enough oral feeds, the jejunostomy feeds were stopped. Frequency and mean were used to represent the data.

Results

A total of 48 patients underwent pancreaticoduodenectomy with concomitant FJ. A total of 35 (72.9%) were men and the mean age was 49.2 years. The majority (28, 58.3 %) of these patients had cancer head of the pancreas as an indication for surgery. Only 13 out of 48 (27%) patients required nutrition supplementation through FJ on POD 10. Only 1 out of 48 (2%) patients required FJ feeds on POD 30. None of these patients had tube-related complications in the 30-day postoperative period. There was a single FJ-related mortality in the 30-day postoperative period due to pulmonary embolism. The patients, who required prolonged FJ feeds had grade C pancreatic leaks, delayed gastric emptying, and surgical site infection.

Conclusion

The routine use of concurrent FJ in patients undergoing pancreaticoduodenectomy has a good outcome, especially for those who require prolonged postoperative nutritional supplementation because of grade c pancreatic leak and delayed gastric emptying.

背景在胰十二指肠切除术中，为了改善术后营养状况，通常会放置进食空肠造口（FJ）。我们的目的是确定胰十二指肠切除术后 FJ 管的效果。方法我们对 2022 年至 2023 年期间胰十二指肠切除术（Whipples 手术）后同时接受 FJ 的所有患者进行了前瞻性分析。在 POD 1，FJ 喂养经常被启动。在患者口服足够的饲料后，停止空肠造口喂养。结果共有 48 名患者接受了胰十二指肠切除术，并同时进行了 FJ。其中 35 例（72.9%）为男性，平均年龄为 49.2 岁。其中大部分患者（28 人，占 58.3%）的手术指征是胰头癌。48 名患者中只有 13 名（27%）需要在 POD 10 通过 FJ 补充营养。48 名患者中只有 1 名（2%）需要在 POD 30 日进行 FJ 喂食。这些患者在术后 30 天内均未出现与管道相关的并发症。术后 30 天内，有一名患者因肺栓塞而死亡。结论对接受胰十二指肠切除术的患者常规使用同期 FJ 有良好的效果，尤其是对那些因 C 级胰漏和胃排空延迟而需要术后长期营养补充的患者。

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引用次数: 0