Pub Date : 2025-09-01Epub Date: 2025-08-11DOI: 10.1016/j.cson.2025.100089
Maria Angela D. Magpantay , Corine Astroth , Alfred Garcia , Dong Ren , Oliver Eng , Michael P. O'Leary
Introduction
Lymphangioleiomyomatosis (LAM) is a rare disease mainly affecting women of child-bearing age that primarily involves lung parenchyma smooth muscles with resulting cystic changes. This disease can present symptomatically as shortness of breath or as a recurrent pneumothorax. Rare instances of extrapulmonary manifestations involving the kidneys and other visceral organs have been reported. Herein, we describe an unusual case of LAM in a patient with a retroperitoneal mass showing pure perivascular growth pattern.
Case presentation
We report a case of a 41-year-old female who presented with abdominal pain and was found to have a left para-aortic mass. This was at the aortic bifurcation and concerning for a paraganglioma; however, laboratory analysis excluded a functional mass. The patient was lost to follow-up due to complications from the COVID-19 pandemic and established care 4 years later, at which time biopsy revealed the diagnosis of LAM. She ultimately underwent surgical resection.
Conclusion
This is a unique presentation of non-pulmonary, para-aortic LAM. This case reviews the relevant literature and presents a methodical histologic work up of this unusual mass.
{"title":"Unusual lymphangioleiomyomatosis presenting as a pure perivascular growth pattern","authors":"Maria Angela D. Magpantay , Corine Astroth , Alfred Garcia , Dong Ren , Oliver Eng , Michael P. O'Leary","doi":"10.1016/j.cson.2025.100089","DOIUrl":"10.1016/j.cson.2025.100089","url":null,"abstract":"<div><h3>Introduction</h3><div>Lymphangioleiomyomatosis (LAM) is a rare disease mainly affecting women of child-bearing age that primarily involves lung parenchyma smooth muscles with resulting cystic changes. This disease can present symptomatically as shortness of breath or as a recurrent pneumothorax. Rare instances of extrapulmonary manifestations involving the kidneys and other visceral organs have been reported. Herein, we describe an unusual case of LAM in a patient with a retroperitoneal mass showing pure perivascular growth pattern.</div></div><div><h3>Case presentation</h3><div>We report a case of a 41-year-old female who presented with abdominal pain and was found to have a left para-aortic mass. This was at the aortic bifurcation and concerning for a paraganglioma; however, laboratory analysis excluded a functional mass. The patient was lost to follow-up due to complications from the COVID-19 pandemic and established care 4 years later, at which time biopsy revealed the diagnosis of LAM. She ultimately underwent surgical resection.</div></div><div><h3>Conclusion</h3><div>This is a unique presentation of non-pulmonary, para-aortic LAM. This case reviews the relevant literature and presents a methodical histologic work up of this unusual mass.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-09-02DOI: 10.1016/j.cson.2025.100097
Guanming Chen , Jesus C. Fabregas , Zhigang Xie , Ilyas Sahin , Girish Mishra , Jiamin Hu , Rachel E. Liu-Galvin , Young-Rock Hong
Background
Few real-world studies have characterized the utilization pattern and overall survival (OS) benefits associated with neoadjuvant therapy (NAT) among patients diagnosed with colon cancer.
Patients and methods
In this retrospective cohort study, we identified adult patients diagnosed with stages II-IV colon cancer from 2015 to 2020 using the US National Cancer Database. Patients were grouped based on treatment modality and sequence: NAT and those treated by upfront surgery followed by adjuvant therapy (ADT). We examined utilization pattern of NAT by patients’ sociodemographic, medical, and facility characteristics. We then used Kaplan Meier method and Cox proportional hazards models to compare OS across cancer stages between two groups.
Results
Of the 116,905 patients who met inclusion criteria, 8110 (6.9 %) received NAT. Overall, patients underwent NAT were generally younger (age ≤64 years), privately insured, diagnosed with stage IV colon cancer, and with liver metastasis. Receipt of NAT was associated with significantly improved OS among patients with stage IV colon cancer after adjusting for covariates (hazard ratio, 0.79; 95 % CI: 0.76–0.83, p < 0.001). Subgroup analysis results showed that NAT was associated with better OS compared to those received ADT regardless of age, liver metastasis status, comorbidity score, and KRAS mutation status. For patients with stages II or III colon cancer, NAT was not associated with improved OS.
Conclusion
Neoadjuvant therapy was significantly associated with improved OS among patients with stage IV colon cancer. Future investigations are needed to understand the role of NAT in locally advanced colon cancer.
背景：很少有现实世界的研究描述了结肠癌患者新辅助治疗（NAT）的使用模式和总生存期（OS）获益。患者和方法在这项回顾性队列研究中，我们使用美国国家癌症数据库，确定了2015年至2020年诊断为II-IV期结肠癌的成年患者。患者根据治疗方式和顺序进行分组：NAT和术前手术后辅助治疗（ADT）。我们根据患者的社会人口学、医学和设施特征检查了NAT的使用模式。然后，我们使用Kaplan Meier方法和Cox比例风险模型来比较两组癌症分期的OS。结果在符合纳入标准的116,905例患者中，8110例（6.9%）接受了NAT治疗。总体而言，接受NAT治疗的患者通常较年轻（年龄≤64岁），有私人保险，诊断为IV期结肠癌，并有肝转移。调整协变量后，接受NAT治疗与IV期结肠癌患者的OS显著改善相关（风险比0.79;95% CI: 0.76-0.83, p < 0.001）。亚组分析结果显示，无论年龄、肝转移情况、合并症评分和KRAS突变状态如何，与接受ADT的患者相比，NAT与更好的OS相关。对于II期或III期结肠癌患者，NAT与改善OS无关。结论新辅助治疗可显著改善IV期结肠癌患者的OS。需要进一步的研究来了解NAT在局部晚期结肠癌中的作用。
{"title":"Neoadjuvant therapy for patients with advanced colon cancer: Analysis of the National Cancer Database (NCDB)","authors":"Guanming Chen , Jesus C. Fabregas , Zhigang Xie , Ilyas Sahin , Girish Mishra , Jiamin Hu , Rachel E. Liu-Galvin , Young-Rock Hong","doi":"10.1016/j.cson.2025.100097","DOIUrl":"10.1016/j.cson.2025.100097","url":null,"abstract":"<div><h3>Background</h3><div>Few real-world studies have characterized the utilization pattern and overall survival (OS) benefits associated with neoadjuvant therapy (NAT) among patients diagnosed with colon cancer.</div></div><div><h3>Patients and methods</h3><div>In this retrospective cohort study, we identified adult patients diagnosed with stages II-IV colon cancer from 2015 to 2020 using the US National Cancer Database. Patients were grouped based on treatment modality and sequence: NAT and those treated by upfront surgery followed by adjuvant therapy (ADT). We examined utilization pattern of NAT by patients’ sociodemographic, medical, and facility characteristics. We then used Kaplan Meier method and Cox proportional hazards models to compare OS across cancer stages between two groups.</div></div><div><h3>Results</h3><div>Of the 116,905 patients who met inclusion criteria, 8110 (6.9 %) received NAT. Overall, patients underwent NAT were generally younger (age ≤64 years), privately insured, diagnosed with stage IV colon cancer, and with liver metastasis. Receipt of NAT was associated with significantly improved OS among patients with stage IV colon cancer after adjusting for covariates (hazard ratio, 0.79; 95 % CI: 0.76–0.83, <em>p</em> < 0.001). Subgroup analysis results showed that NAT was associated with better OS compared to those received ADT regardless of age, liver metastasis status, comorbidity score, and KRAS mutation status. For patients with stages II or III colon cancer, NAT was not associated with improved OS.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant therapy was significantly associated with improved OS among patients with stage IV colon cancer. Future investigations are needed to understand the role of NAT in locally advanced colon cancer.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-28DOI: 10.1016/j.cson.2025.100094
Rickvir S. Sidhu , Arrane Selvamogan
{"title":"Assessing the quality and readability of AI chatbot responses to frequently asked questions about basal cell carcinoma","authors":"Rickvir S. Sidhu , Arrane Selvamogan","doi":"10.1016/j.cson.2025.100094","DOIUrl":"10.1016/j.cson.2025.100094","url":null,"abstract":"","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-13DOI: 10.1016/j.cson.2025.100091
Zhekun Huang , Songbin Lin , Peiwen Zhou , Yang Lv , Guodong He , Ye Wei , Jianmin Xu , Wentao Tang
Background
Anastomotic leakage are common and serious complications after surgery for low and intermediate rectal cancers; a prophylactic stoma is thought to reduce the incidence of anastomotic leakage and alleviate its serious complications. However, it also comes with numerous risks. This study will investigate the value of prophylactic stomas in robot-assisted radical surgery for low and intermediate rectal cancers.
Methods
We included 670 patients with low-to-intermediate rectal cancer who underwent robot-assisted radical resection at two hospitals within Fudan University from June 2016 to October 2022 (77 underwent prophylactic stoma and 593 did not have prophylactic stoma). The clinical data of the patients were collected and analyzed using a propensity score matching method that matched the groups at a 1:1 ratio based on sex, diabetes mellitus, body mass index, neoadjuvant chemoradiotherapy, distance of the lower edge of the tumor from the anal verge, maximum diameter of the tumor, and preoperative incomplete obstruction.
Results
Patients in the prophylactic stoma group had a significantly lower incidence of symptomatic anastomotic leakage than the non-stoma group. There were no significant differences in the overall postoperative complication, unplanned readmission, or 30-day postoperative reoperation rates between the groups; however, the prophylactic stoma group had a lower number of postoperative hospital days and lower average hospital costs. Preoperative bowel obstruction was an independent risk factor for postoperative anastomotic leakage in the prophylactic stoma group.
Conclusions
Prophylactic stomas based on a robotic platform are beneficial for some high-risk patients with low-to-intermediate rectal cancer.
{"title":"Prophylactic stoma in robotic radical surgery for low-to-intermediate rectal cancer","authors":"Zhekun Huang , Songbin Lin , Peiwen Zhou , Yang Lv , Guodong He , Ye Wei , Jianmin Xu , Wentao Tang","doi":"10.1016/j.cson.2025.100091","DOIUrl":"10.1016/j.cson.2025.100091","url":null,"abstract":"<div><h3>Background</h3><div>Anastomotic leakage are common and serious complications after surgery for low and intermediate rectal cancers; a prophylactic stoma is thought to reduce the incidence of anastomotic leakage and alleviate its serious complications. However, it also comes with numerous risks. This study will investigate the value of prophylactic stomas in robot-assisted radical surgery for low and intermediate rectal cancers.</div></div><div><h3>Methods</h3><div>We included 670 patients with low-to-intermediate rectal cancer who underwent robot-assisted radical resection at two hospitals within Fudan University from June 2016 to October 2022 (77 underwent prophylactic stoma and 593 did not have prophylactic stoma). The clinical data of the patients were collected and analyzed using a propensity score matching method that matched the groups at a 1:1 ratio based on sex, diabetes mellitus, body mass index, neoadjuvant chemoradiotherapy, distance of the lower edge of the tumor from the anal verge, maximum diameter of the tumor, and preoperative incomplete obstruction.</div></div><div><h3>Results</h3><div>Patients in the prophylactic stoma group had a significantly lower incidence of symptomatic anastomotic leakage than the non-stoma group. There were no significant differences in the overall postoperative complication, unplanned readmission, or 30-day postoperative reoperation rates between the groups; however, the prophylactic stoma group had a lower number of postoperative hospital days and lower average hospital costs. Preoperative bowel obstruction was an independent risk factor for postoperative anastomotic leakage in the prophylactic stoma group.</div></div><div><h3>Conclusions</h3><div>Prophylactic stomas based on a robotic platform are beneficial for some high-risk patients with low-to-intermediate rectal cancer.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-01Epub Date: 2025-08-29DOI: 10.1016/j.cson.2025.100096
Amine Majdoubi , Anass El Aachi , Mohammed El Hammouti , Haïtam Aabalou , Ayoub Kharkhach , Tariq Bouhout , Badr Serji
Introduction
Anastomotic fistulas remain one of the most feared complications following rectal surgery, particularly after Total Mesorectal Excision (TME). They compromise prognosis, prolong hospitalization, and increase costs due to the additional interventions they necessitate.
Aims
To identify predictive factors for the occurrence of anastomotic fistulas, with the goal of personalizing and optimizing surgical management—particularly to guide decisions regarding the use of defunctioning stomas.
Materials and methods
We conducted a retrospective observational study on 78 patients who underwent TME with low rectal anastomosis for rectal adenocarcinoma at Hassan II University Hospital in Oujda, between December 2017 and May 2024.
Results
Of the 78 patients, 21 developed anastomotic fistulas, yielding an incidence rate of 26.9 %. Late-onset cases were predominant (16 cases, 76.19 %) compared to early-onset cases (five cases, 23.81 %). In univariate analysis, diabetes (p = 0.002), intraoperative incidents (p = 0.014) - particularly blood loss exceeding 150 cc (p = 0.001) - and smoking (p = 0.005) were significant risk factors for fistula development. In multivariate analysis, diabetes (OR = 10.87; p = 0.003) and intraoperative blood loss >150 ml (OR = 7.38; p = 0.030) emerged as independent predictors of fistula development. Active smoking showed a borderline association (OR = 6.46; p = 0.056), suggesting a potential but not statistically confirmed impact on anastomotic fistula. These findings are consistent with the existing literature. In contrast, other factors commonly reported in the literature, such as male sex (p = 0.530), ASA score (p = 0.612), anemia (p = 0.324), and preoperative (p = 0.781) and postoperative albumin levels (p = 0.119), did not show a significant association in our study.
Discussion and conclusion
While the identified risk factors are relevant, they alone are insufficient to warrant major modifications in our surgical strategy, particularly regarding the decision to perform a defunctioning stoma. Further studies are necessary to validate these findings.
吻合口瘘是直肠手术后最可怕的并发症之一，特别是在全肠系膜切除术（TME）后。它们损害预后，延长住院时间，并由于需要额外干预而增加费用。目的确定吻合口瘘发生的预测因素，以实现个性化和优化手术治疗的目标，特别是指导关于使用功能障碍造口的决定。材料与方法我们对2017年12月至2024年5月在Oujda Hassan II大学医院行TME低位直肠吻合治疗直肠腺癌的78例患者进行了回顾性观察研究。结果78例患者中发生吻合口瘘21例，发生率26.9%。晚发病例16例（76.19%），早发病例5例（23.81%）。在单因素分析中，糖尿病（p = 0.002）、术中事件（p = 0.014）——特别是失血量超过150cc （p = 0.001）——和吸烟（p = 0.005）是瘘管发生的重要危险因素。在多因素分析中，糖尿病（OR = 10.87; p = 0.003）和术中出血量>；150 ml （OR = 7.38; p = 0.030）成为瘘发生的独立预测因素。积极吸烟呈边缘相关性（OR = 6.46; p = 0.056），提示对吻合口瘘有潜在的影响，但未得到统计学证实。这些发现与现有文献一致。相比之下，文献中常见的其他因素，如男性（p = 0.530）、ASA评分（p = 0.612）、贫血（p = 0.324）、术前（p = 0.781）和术后白蛋白水平（p = 0.119）等，在我们的研究中并没有显示出显著的相关性。讨论和结论虽然确定的危险因素是相关的，但它们本身不足以保证我们对手术策略进行重大修改，特别是在决定进行功能缺损时。需要进一步的研究来验证这些发现。
{"title":"Risk factors for anastomotic fistula after total mesorectal excision: A monocentric retrospective study of 78 patients","authors":"Amine Majdoubi , Anass El Aachi , Mohammed El Hammouti , Haïtam Aabalou , Ayoub Kharkhach , Tariq Bouhout , Badr Serji","doi":"10.1016/j.cson.2025.100096","DOIUrl":"10.1016/j.cson.2025.100096","url":null,"abstract":"<div><h3>Introduction</h3><div>Anastomotic fistulas remain one of the most feared complications following rectal surgery, particularly after Total Mesorectal Excision (TME). They compromise prognosis, prolong hospitalization, and increase costs due to the additional interventions they necessitate.</div></div><div><h3>Aims</h3><div>To identify predictive factors for the occurrence of anastomotic fistulas, with the goal of personalizing and optimizing surgical management—particularly to guide decisions regarding the use of defunctioning stomas.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective observational study on 78 patients who underwent TME with low rectal anastomosis for rectal adenocarcinoma at Hassan II University Hospital in Oujda, between December 2017 and May 2024.</div></div><div><h3>Results</h3><div>Of the 78 patients, 21 developed anastomotic fistulas, yielding an incidence rate of 26.9 %. Late-onset cases were predominant (16 cases, 76.19 %) compared to early-onset cases (five cases, 23.81 %). In univariate analysis, diabetes (p = 0.002), intraoperative incidents (p = 0.014) - particularly blood loss exceeding 150 cc (p = 0.001) - and smoking (p = 0.005) were significant risk factors for fistula development. In multivariate analysis, diabetes (OR = 10.87; p = 0.003) and intraoperative blood loss >150 ml (OR = 7.38; p = 0.030) emerged as independent predictors of fistula development. Active smoking showed a borderline association (OR = 6.46; p = 0.056), suggesting a potential but not statistically confirmed impact on anastomotic fistula. These findings are consistent with the existing literature. In contrast, other factors commonly reported in the literature, such as male sex (p = 0.530), ASA score (p = 0.612), anemia (p = 0.324), and preoperative (p = 0.781) and postoperative albumin levels (p = 0.119), did not show a significant association in our study.</div></div><div><h3>Discussion and conclusion</h3><div>While the identified risk factors are relevant, they alone are insufficient to warrant major modifications in our surgical strategy, particularly regarding the decision to perform a defunctioning stoma. Further studies are necessary to validate these findings.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-03-25DOI: 10.1016/j.cson.2025.100079
Wenlong Qiu , Yu Liu , Wei Zhao , Shiwen Mei , Yuegang Li , Qian Liu
Objective
This study aims to assess the necessity and outcomes of bilateral lateral lymph node dissection (LLND) in rectal cancer, while exploring the role of Indocyanine Green (ICG) in enhancing surgical precision.
Methods
A retrospective analysis was conducted on 157 patients who underwent LLND between January 1, 2010, and December 31, 2022. The study focused on the incidence of bilateral lymph node metastasis, the predictors of metastasis, and the role of ICG-guided dissection in improving surgical outcomes. Propensity score matching (PSM) was used to compare the outcomes between the control and fluorescence-guided lymph node dissection (FLND) groups.
Results
Bilateral lateral lymph node metastasis was found in 6.4 % of patients. Positive D2 lymph nodes were the only significant predictor of bilateral metastasis. ICG, used via submucosal injection, significantly improved lymph node identification and dissection accuracy. Patients in the FLND group had a higher median number of harvested lymph nodes (32 vs. 19, P = 0.042) and better postoperative outcomes, including shorter hospital stay (6 vs. 9 days, P = 0.038) and less blood loss (30 ml vs. 180 ml, P < 0.001). Kaplan-Meier analysis showed no significant differences in disease-free survival (P = 0.658) or overall survival (P = 0.331) between groups.
Conclusion
While ICG-enhanced bilateral LLND improves short-term surgical outcomes, its impact on long-term survival remains unclear. The findings suggest selective use of bilateral LLND based on specific risk factors, particularly in patients with positive D2 lymph nodes. Further studies are required to refine guidelines and establish the procedure's long-term benefits.
目的探讨直肠癌行双侧淋巴结清扫术（LLND）的必要性及预后，同时探讨吲哚菁绿（ICG）在提高手术精度中的作用。方法回顾性分析2010年1月1日至2022年12月31日期间接受LLND治疗的157例患者。本研究的重点是双侧淋巴结转移的发生率，转移的预测因素，以及icg引导下的清扫在改善手术效果中的作用。倾向评分匹配（PSM）用于比较对照组和荧光引导淋巴结清扫（FLND）组之间的结果。结果6.4%的患者出现双侧淋巴结转移。D2阳性淋巴结是双侧转移的唯一显著预测因子。ICG通过粘膜下注射使用，显著提高了淋巴结识别和清扫的准确性。FLND组患者淋巴结清扫中位数较高（32 vs 19, P = 0.042），术后预后较好，包括住院时间较短（6 vs 9天，P = 0.038），出血量较少(30 ml vs 180 ml, P <；0.001)。Kaplan-Meier分析显示，两组无病生存期（P = 0.658）和总生存期（P = 0.331）无显著差异。结论：虽然icg增强的双侧LLND改善了短期手术结果，但其对长期生存的影响尚不清楚。研究结果建议根据特定的危险因素选择性地使用双侧LLND，特别是在D2淋巴结阳性的患者中。需要进一步的研究来完善指导方针，并确定该手术的长期效益。
{"title":"Efficacy of ICG-guided bilateral lateral lymph node dissection in rectal cancer","authors":"Wenlong Qiu , Yu Liu , Wei Zhao , Shiwen Mei , Yuegang Li , Qian Liu","doi":"10.1016/j.cson.2025.100079","DOIUrl":"10.1016/j.cson.2025.100079","url":null,"abstract":"<div><h3>Objective</h3><div>This study aims to assess the necessity and outcomes of bilateral lateral lymph node dissection (LLND) in rectal cancer, while exploring the role of Indocyanine Green (ICG) in enhancing surgical precision.</div></div><div><h3>Methods</h3><div>A retrospective analysis was conducted on 157 patients who underwent LLND between January 1, 2010, and December 31, 2022. The study focused on the incidence of bilateral lymph node metastasis, the predictors of metastasis, and the role of ICG-guided dissection in improving surgical outcomes. Propensity score matching (PSM) was used to compare the outcomes between the control and fluorescence-guided lymph node dissection (FLND) groups.</div></div><div><h3>Results</h3><div>Bilateral lateral lymph node metastasis was found in 6.4 % of patients. Positive D2 lymph nodes were the only significant predictor of bilateral metastasis. ICG, used via submucosal injection, significantly improved lymph node identification and dissection accuracy. Patients in the FLND group had a higher median number of harvested lymph nodes (32 vs. 19, P = 0.042) and better postoperative outcomes, including shorter hospital stay (6 vs. 9 days, P = 0.038) and less blood loss (30 ml vs. 180 ml, P < 0.001). Kaplan-Meier analysis showed no significant differences in disease-free survival (P = 0.658) or overall survival (P = 0.331) between groups.</div></div><div><h3>Conclusion</h3><div>While ICG-enhanced bilateral LLND improves short-term surgical outcomes, its impact on long-term survival remains unclear. The findings suggest selective use of bilateral LLND based on specific risk factors, particularly in patients with positive D2 lymph nodes. Further studies are required to refine guidelines and establish the procedure's long-term benefits.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100079"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143759224","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 : 2025-06-01Epub Date: 2025-06-10DOI: 10.1016/j.cson.2025.100083
Jiapei Lin , Yilin Li , Dongrui Li , Liyong Zhuo , Jian Wei , Jingwei Wei
Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, with high incidence and death rates. Despite significant progress in conventional diagnostic methods such as imaging studies and biomarkers, inherent limitations hinder their effectiveness. The rapid development of large model techniques has unveiled considerable potential for improving imaging-based diagnosis and prognostic evaluation of HCC. This review highlights recent advances in applying large models to HCC, emphasizing developments in deep neural network architecture and multimodal data integration. It examines how these models enhance early diagnosis accuracy through automated feature extraction and explores their role in integrating clinical variables, radiomics, genomics, and pathology data, offering novel perspectives for prognosis assessment. Despite their promise, challenges such as data quality, model interpretability, and generalization capacity remain. The review concludes by discussing the future potential of large models in HCC diagnosis and prognosis, addressing key challenges and ethical considerations for clinical adoption.
{"title":"Application of large models in imaging diagnosis and prognostic analysis in hepatocellular carcinoma","authors":"Jiapei Lin , Yilin Li , Dongrui Li , Liyong Zhuo , Jian Wei , Jingwei Wei","doi":"10.1016/j.cson.2025.100083","DOIUrl":"10.1016/j.cson.2025.100083","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) remains a leading cause of cancer-related mortality worldwide, with high incidence and death rates. Despite significant progress in conventional diagnostic methods such as imaging studies and biomarkers, inherent limitations hinder their effectiveness. The rapid development of large model techniques has unveiled considerable potential for improving imaging-based diagnosis and prognostic evaluation of HCC. This review highlights recent advances in applying large models to HCC, emphasizing developments in deep neural network architecture and multimodal data integration. It examines how these models enhance early diagnosis accuracy through automated feature extraction and explores their role in integrating clinical variables, radiomics, genomics, and pathology data, offering novel perspectives for prognosis assessment. Despite their promise, challenges such as data quality, model interpretability, and generalization capacity remain. The review concludes by discussing the future potential of large models in HCC diagnosis and prognosis, addressing key challenges and ethical considerations for clinical adoption.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100083"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144313363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-05-24DOI: 10.1016/j.cson.2025.100081
Anas A. Preukschas , Amila Cizmic , Philip C. Müller , Christoph Kümmerli , Faik Güntac Uzunoglu , Thilo Hackert , Felix Nickel
Robotic pancreatic surgery is complex, and its establishment in an institution require a structured approach to secure optimal short- and long-term outcomes. This article provides a structured training proposition for robotic pancreatic surgery and gives an overview of the learning curves and examines the key takeaways.
The preclinical training in robotic pancreatic surgery can be divided into a basic and advanced phase. The basic phase includes virtual reality training, biotissue drills, and specialized training courses. The advanced phase consists of reaching benchmarks for the biotissue drills and completing video-based training. After establishing a dedicated interprofessional surgical team index procedures and first robotic pancreatic cases can be performed under the supervision of a proctor.
Three phases of clinical training are proposed: competency, proficiency, and mastery. Competency referring to be able to perform the procedure without supervision in patients without risk factors and with average technical difficulty. Proficiency signifying consistently reaching benchmark- and textbook outcome in patients with risk factors and extended indications. Mastery is achieving benchmark values for morbidity rates even in complex cases requiring vessel or multi-visceral resections and with patients having multiple risk factors.
The number of cases to overcome the initial phase of the learning curve vary between 7 and 46 for robotic distal pancreatectomy and 8–100 for robotic partial pancreaticoduodenectomy. Significantly longer learning phases of 60–200 cases are reported to complete all three learning phases.
In conclusion the hallmarks for safe and efficient implementation of robotic pancreatic surgery are a dedicated team, structured training program and stepwise patient selection.
{"title":"Training and learning curves in robotic pancreatic surgery","authors":"Anas A. Preukschas , Amila Cizmic , Philip C. Müller , Christoph Kümmerli , Faik Güntac Uzunoglu , Thilo Hackert , Felix Nickel","doi":"10.1016/j.cson.2025.100081","DOIUrl":"10.1016/j.cson.2025.100081","url":null,"abstract":"<div><div>Robotic pancreatic surgery is complex, and its establishment in an institution require a structured approach to secure optimal short- and long-term outcomes. This article provides a structured training proposition for robotic pancreatic surgery and gives an overview of the learning curves and examines the key takeaways.</div><div>The preclinical training in robotic pancreatic surgery can be divided into a basic and advanced phase. The basic phase includes virtual reality training, biotissue drills, and specialized training courses. The advanced phase consists of reaching benchmarks for the biotissue drills and completing video-based training. After establishing a dedicated interprofessional surgical team index procedures and first robotic pancreatic cases can be performed under the supervision of a proctor.</div><div>Three phases of clinical training are proposed: competency, proficiency, and mastery. Competency referring to be able to perform the procedure without supervision in patients without risk factors and with average technical difficulty. Proficiency signifying consistently reaching benchmark- and textbook outcome in patients with risk factors and extended indications. Mastery is achieving benchmark values for morbidity rates even in complex cases requiring vessel or multi-visceral resections and with patients having multiple risk factors.</div><div>The number of cases to overcome the initial phase of the learning curve vary between 7 and 46 for robotic distal pancreatectomy and 8–100 for robotic partial pancreaticoduodenectomy. Significantly longer learning phases of 60–200 cases are reported to complete all three learning phases.</div><div>In conclusion the hallmarks for safe and efficient implementation of robotic pancreatic surgery are a dedicated team, structured training program and stepwise patient selection.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-06-11DOI: 10.1016/j.cson.2025.100084
Laura Aguilera Saiz , Harald C. Groen , Wouter J. Heerink , Theo J.M. Ruers
The lower abdominopelvic region is characterized by complex anatomy harbouring many vital structures in a constrained area. Advanced guidance can enhance the precision and efficiency of lower abdominopelvic surgical procedures. This can be achieved with image-guided surgical navigation systems, which use preoperative data to display real-time updates of intraoperative data. The current literature review explores the current state and prospective approaches for developing clinical navigation systems tailored for the lower abdominopelvic region. We aim to identify current knowledge gaps and technological challenges in navigation and explore potential solutions proposed in the literature. A comprehensive literature review of the current state of the art of navigation systems was performed. Relevant clinical and technical information from the publications was extracted and added value of navigation systems was analysed. According to the reviewed literature, existing commercial navigation systems focus mainly on rigid structure navigation. Despite being certified for spine, hip, knee and neurosurgery, commercial systems were used in 16 out of 29 studies for non-rigid pelvic surgery, which was outside their intended use. Comparative studies showed that navigation was of added value for surgical efficiency and clinical outcomes. Navigation in lower abdominopelvic surgeries contributed to more precise resection margins and reduction of local recurrences, resulting in more precise and safe surgeries. Various promising navigation systems show high performance in lower abdominopelvic surgery. However, their implementation is mainly examined in feasibility studies. Consequently, the use of navigation systems in clinical standard routine still remains limited.
{"title":"Tracking systems in navigated lower abdominopelvic surgery, a review","authors":"Laura Aguilera Saiz , Harald C. Groen , Wouter J. Heerink , Theo J.M. Ruers","doi":"10.1016/j.cson.2025.100084","DOIUrl":"10.1016/j.cson.2025.100084","url":null,"abstract":"<div><div>The lower abdominopelvic region is characterized by complex anatomy harbouring many vital structures in a constrained area. Advanced guidance can enhance the precision and efficiency of lower abdominopelvic surgical procedures. This can be achieved with image-guided surgical navigation systems, which use preoperative data to display real-time updates of intraoperative data. The current literature review explores the current state and prospective approaches for developing clinical navigation systems tailored for the lower abdominopelvic region. We aim to identify current knowledge gaps and technological challenges in navigation and explore potential solutions proposed in the literature. A comprehensive literature review of the current state of the art of navigation systems was performed. Relevant clinical and technical information from the publications was extracted and added value of navigation systems was analysed. According to the reviewed literature, existing commercial navigation systems focus mainly on rigid structure navigation. Despite being certified for spine, hip, knee and neurosurgery, commercial systems were used in 16 out of 29 studies for non-rigid pelvic surgery, which was outside their intended use. Comparative studies showed that navigation was of added value for surgical efficiency and clinical outcomes. Navigation in lower abdominopelvic surgeries contributed to more precise resection margins and reduction of local recurrences, resulting in more precise and safe surgeries. Various promising navigation systems show high performance in lower abdominopelvic surgery. However, their implementation is mainly examined in feasibility studies. Consequently, the use of navigation systems in clinical standard routine still remains limited.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-01Epub Date: 2025-06-06DOI: 10.1016/j.cson.2025.100082
Rhea M Iyer
<div><h3>Objectives</h3><div>The purpose of this research is to demonstrate the benefit of SIEV inclusion and to identify the factors that deem a patient a suitable for SIEV grafting in a large patient cohort. By doing so we aim to facilitate more efficient preoperative planning and decrease the return to theatre (RTT) rates resulting from venous congestion or inappropriate SIEV use.</div></div><div><h3>Methods</h3><div>This was a retrospective study conducted at the St. Andrew's Centre for Burns and Plastic Surgery in Broomfield Hospital, United Kingdom. 60 patients who underwent a DIEP flap reconstruction between January 1st, 2020, and December 31, 2021, were selected based on having undergone a unilateral DIEP reconstruction either with or without additional SIEV use with no other adjunct flap technique used. The patients were stratified into two cohort groups: DIEP + SIEV use patient group (<em>n</em> = 30) and DIEP only patients (<em>n</em> = 30). For these patients a range of biographical data was obtained including: the presence of co – morbidities (BMI, BP, co – existing conditions such as diabetes mellitus) as well as flap characteristics (flap weight, time taken to raise the flap and the ischaemia time) from the free – flap audit forms and this was compared to anatomical data that was obtained from the pre – operative CT angiography reports detailing vascular characteristics: the Size/calibre of the SIEV (large = >3.0 mm, medium = 2.0–3.0 mm and small = <2.0mm), the presence of venous anastomosis and midline crossover. The data was recorded on a spreadsheet and compared with the DIEP only group to ascertain, p – values using Chi<sup>2</sup>/Fisher's Exact Test (for non – parametric/binary data) and the Two – Tailed P – values (parametric data) where appropriate, Microsoft Excel's correlation toolkit was also used to determine the extent of correlation between the cohort groups.</div></div><div><h3>Results</h3><div>For non-parametric values (binary) statistical significance was present for: High BMI defined as BMI >26 kg/m2 (p = 0.01), High BP-defined as BP > 140/90 mmHg (P < 0.01), Vein 2-IMVP (anastomosis between the second vein used whether this be a SIEV or not and the IMVP within the chest wall (p < 0.00001), Large SIEV calibre – defined as >3 mm (p = 0.015) and small SIEV calibre – defined as <2.00 mm (p = 0.0251). The average flap weight in the DIEP + SIEV cohort was 857.80g and in the DIEP only cohort was 641.92g (p = 0.024) therefore a larger flap weight was associated with SIEV usage in our cohort. Patients presenting with these characteristics conferred a superficial venous drainage system dominance and were therefore more numerous in the DIEP + SIEV cohort group compared to the DIEP only group. The RTT was defined to be 3-times higher in the DIEP only group and the overall cost benefit of primary SIEV use, extrapolated for the defined year period was determined to be £26
{"title":"Assessing the prophylactic use of superficial inferior epigastric vessels (SIEV) for the super-drainage of deep inferior epigastric perforator flaps (DIEPs), correlated to patient demographic, anatomical and operative risk factors","authors":"Rhea M Iyer","doi":"10.1016/j.cson.2025.100082","DOIUrl":"10.1016/j.cson.2025.100082","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this research is to demonstrate the benefit of SIEV inclusion and to identify the factors that deem a patient a suitable for SIEV grafting in a large patient cohort. By doing so we aim to facilitate more efficient preoperative planning and decrease the return to theatre (RTT) rates resulting from venous congestion or inappropriate SIEV use.</div></div><div><h3>Methods</h3><div>This was a retrospective study conducted at the St. Andrew's Centre for Burns and Plastic Surgery in Broomfield Hospital, United Kingdom. 60 patients who underwent a DIEP flap reconstruction between January 1st, 2020, and December 31, 2021, were selected based on having undergone a unilateral DIEP reconstruction either with or without additional SIEV use with no other adjunct flap technique used. The patients were stratified into two cohort groups: DIEP + SIEV use patient group (<em>n</em> = 30) and DIEP only patients (<em>n</em> = 30). For these patients a range of biographical data was obtained including: the presence of co – morbidities (BMI, BP, co – existing conditions such as diabetes mellitus) as well as flap characteristics (flap weight, time taken to raise the flap and the ischaemia time) from the free – flap audit forms and this was compared to anatomical data that was obtained from the pre – operative CT angiography reports detailing vascular characteristics: the Size/calibre of the SIEV (large = >3.0 mm, medium = 2.0–3.0 mm and small = <2.0mm), the presence of venous anastomosis and midline crossover. The data was recorded on a spreadsheet and compared with the DIEP only group to ascertain, p – values using Chi<sup>2</sup>/Fisher's Exact Test (for non – parametric/binary data) and the Two – Tailed P – values (parametric data) where appropriate, Microsoft Excel's correlation toolkit was also used to determine the extent of correlation between the cohort groups.</div></div><div><h3>Results</h3><div>For non-parametric values (binary) statistical significance was present for: High BMI defined as BMI >26 kg/m2 (p = 0.01), High BP-defined as BP > 140/90 mmHg (P < 0.01), Vein 2-IMVP (anastomosis between the second vein used whether this be a SIEV or not and the IMVP within the chest wall (p < 0.00001), Large SIEV calibre – defined as >3 mm (p = 0.015) and small SIEV calibre – defined as <2.00 mm (p = 0.0251). The average flap weight in the DIEP + SIEV cohort was 857.80g and in the DIEP only cohort was 641.92g (p = 0.024) therefore a larger flap weight was associated with SIEV usage in our cohort. Patients presenting with these characteristics conferred a superficial venous drainage system dominance and were therefore more numerous in the DIEP + SIEV cohort group compared to the DIEP only group. The RTT was defined to be 3-times higher in the DIEP only group and the overall cost benefit of primary SIEV use, extrapolated for the defined year period was determined to be £26","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 2","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144470007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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