Clinical Surgical Oncology最新文献_第4页

Tracking systems in navigated lower abdominopelvic surgery, a review 导航下腹部骨盆手术的跟踪系统综述

Clinical Surgical Oncology

Pub Date : 2025-06-01 DOI: 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.

下腹部骨盆区域的特点是复杂的解剖窝藏许多重要的结构在一个有限的区域。先进的引导技术可以提高下腹部骨盆手术的精度和效率。这可以通过图像引导的手术导航系统来实现，该系统使用术前数据来显示术中数据的实时更新。目前的文献综述探讨了目前的状态和未来的方法，发展临床导航系统量身定制的下腹部骨盆区域。我们的目标是确定当前导航方面的知识差距和技术挑战，并探索文献中提出的潜在解决方案。对导航系统的现状进行了全面的文献综述。从出版物中提取相关临床和技术信息，并分析导航系统的附加价值。根据文献综述，现有的商业导航系统主要集中在刚性结构导航上。尽管已获得脊柱、髋关节、膝关节和神经外科的认证，但在29项非刚性骨盆手术研究中，有16项使用了商业系统，这超出了它们的预期用途。比较研究表明，导航对手术效率和临床结果具有附加价值。下盆腔手术导航，切除边缘更精确，局部复发减少，手术更精确、更安全。各种有前途的导航系统在下腹部骨盆手术中表现出很高的性能。但是，它们的执行情况主要在可行性研究中加以审查。因此，导航系统在临床标准常规中的应用仍然有限。

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引用次数: 0

Training and learning curves in robotic pancreatic surgery 机器人胰腺手术的训练和学习曲线

Clinical Surgical Oncology

Pub Date : 2025-06-01 DOI: 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.

机器人胰腺手术是复杂的，它在一个机构的建立需要一个结构化的方法来确保最佳的短期和长期的结果。本文提供了一个结构化的胰腺机器人手术训练命题，并给出了学习曲线的概述，并检查了关键要点。胰腺机器人手术的临床前训练可分为基础阶段和高级阶段。基本阶段包括虚拟现实训练、生物组织训练和专业培训课程。高级阶段包括达到生物组织训练的基准和完成基于视频的训练。在建立了专门的跨专业外科团队后，索引程序和第一个胰腺机器人病例可以在监控员的监督下进行。临床训练分为三个阶段：胜任、熟练和精通。胜任能力是指能够在没有危险因素和一般技术难度的患者中在没有监督的情况下进行手术。熟练程度表明在患者的危险因素和扩展适应症中始终达到基准和教科书结果。即使在需要血管或多脏器切除的复杂病例和患者有多种危险因素的情况下，Mastery也达到了发病率的基准值。克服学习曲线初始阶段的病例数在机器人远端胰腺切除术的7 - 46例和机器人部分胰十二指肠切除术的8-100例之间变化。据报道，60-200个案例的学习阶段明显更长，以完成所有三个学习阶段。总之，安全有效地实施机器人胰腺手术的特点是一个专门的团队，结构化的培训计划和逐步选择患者。

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引用次数: 0

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 评估预防使用腹壁下浅血管（SIEV）进行腹壁下深穿支皮瓣（DIEPs）超引流，与患者人口统计学、解剖学和手术危险因素相关

Clinical Surgical Oncology

Pub Date : 2025-06-01 DOI: 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

目的本研究的目的是证明SIEV纳入的益处，并确定在大型患者队列中认为患者适合SIEV移植的因素。通过这样做，我们的目标是促进更有效的术前计划，并减少因静脉充血或不适当的SIEV使用而导致的重返手术室（RTT）率。方法：这是一项在英国布鲁姆菲尔德医院圣安德鲁烧伤和整形外科中心进行的回顾性研究，在2020年1月1日至2021年12月31日期间，选择了60例接受了DIEP皮瓣重建的患者，这些患者是基于接受了单侧DIEP重建，有或没有使用额外的SIEV，没有使用其他辅助皮瓣技术。患者被分为两个队列组：DIEP + SIEV使用患者组（n = 30）和仅DIEP患者（n = 30）。对于这些患者，我们获得了一系列的传记数据，包括：从游离皮瓣审计表中获得的合并症（BMI， BP，共存的疾病，如糖尿病）以及皮瓣特征（皮瓣重量，皮瓣提升时间和缺血时间）的存在，并将其与术前CT血管造影报告中获得的详细血管特征的解剖数据进行比较。SIEV的尺寸/口径（大= >3.0 mm，中= 2.0-3.0 mm，小= <2.0mm），是否存在静脉吻合和中线交叉。将数据记录在电子表格上，并与仅DIEP组进行比较，以确定p值，使用Chi2/Fisher精确检验（非参数/二进制数据）和双尾p值（参数数据），在适当的情况下，还使用Microsoft Excel的相关工具包来确定队列组之间的相关程度。结果对于非参数值（二元），高BMI定义为BMI >；26 kg/m2 (p = 0.01)，高BP定义为BP >；140/90 mmHg (P <；静脉2-IMVP（不论是否SIEV）与胸壁内IMVP吻合(p <；0.00001)，大SIEV口径-定义为>；3毫米（p = 0.015）和小SIEV口径-定义为<；2.00毫米（p = 0.0251）。DIEP + SIEV队列的平均皮瓣重量为857.80g，仅DIEP队列的平均皮瓣重量为641.92g (p = 0.024)，因此在我们的队列中，较大的皮瓣重量与SIEV的使用有关。呈现这些特征的患者赋予了浅静脉引流系统优势，因此与仅DIEP组相比，DIEP + SIEV队列组的患者数量更多。RTT被定义为仅DIEP组的3倍，而主要SIEV使用的总体成本效益，根据所定义的年份推断，被确定为26,796英镑。结论我们的有限队列研究证明了在DIEP患者中使用SIEV的成本和临床效益，并支持在具有上述特征的患者中预防性使用SIEV，以更有证据的方式推荐SIEV的使用，将我们的分析扩展到更广泛的患者范围将是有益的。

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引用次数: 0

Efficacy of ICG-guided bilateral lateral lymph node dissection in rectal cancer ICG 引导下直肠癌双侧淋巴结清扫术的疗效

Clinical Surgical Oncology

Pub Date : 2025-03-25 DOI: 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。

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引用次数: 0

Enhancing informed consent in oncological surgery through digital platforms and artificial intelligence 通过数字平台和人工智能加强肿瘤手术的知情同意

Clinical Surgical Oncology

Pub Date : 2025-03-25 DOI: 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.

知情同意是合乎道德的医疗实践的基石，特别是在高风险的肿瘤手术中，治疗方案复杂，风险很大。本文探讨了数字平台和人工智能（AI）在加强知情同意过程方面的潜力。传统的同意流程依赖于面对面的互动和基于纸张的文件，越来越多地被提供远程咨询、个性化患者信息和电子同意书的数字解决方案所补充。这些数字途径不仅提高了可访问性和患者理解能力，而且简化了文件，减少了错误和管理负担。人工智能技术，包括环境数字抄写器和大型语言模型（llm），可以通过生成个性化风险评估、简化复杂的医疗信息和促进多语言交流，进一步增强这一过程。然而，成功还将取决于解决伦理问题，确保公平获取，以及保持患者和临床医生之间不可替代的人际关系。通过增强而不是取代临床医生的专业知识，数字平台和人工智能可以使患者在肿瘤治疗中做出真正明智的决定。

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引用次数: 0

The effectiveness and safety of stereotactic body radiotherapy (SBRT), proton therapy (PT), and irreversible electroporation (IRE) for localized prostate cancer 立体定向放射治疗（SBRT）、质子治疗（PT）和不可逆电穿孔（IRE）治疗局限性前列腺癌的有效性和安全性

Clinical Surgical Oncology

Pub Date : 2025-03-01 DOI: 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.

目的：本系统评价了立体定向放射治疗（SBRT）、质子治疗（PT）和不可逆电穿孔（IRE）三种创新治疗方法对局限性前列腺癌的有效性和安全性。方法和材料我们根据系统评价和荟萃分析指南的首选报告项目进行了系统评价，考虑了2018年2月至2024年2月期间以英语或德语发表的有关患者相关结局（生活质量、生存和安全性）的文章。结果IRE和PT的随机对照试验（rct）无法确定，因此无法确定有效性评估。来自5项观察性研究（n = 846）的IRE证据不足以进行结论性毒性评价。对于PT， 8项观察性研究（n = 5514）显示不一致的胃肠道（GI）和泌尿生殖系统（GU）毒性趋势，长期数据表明持续的胃肠道症状和严重的GU毒性显著增加。对于SBRT，可以找到3个rct （n = 2138）和2个观察性研究（n = 460）。结果显示，在2年和5年后，与常规分割术（一种外部辐射）相比，这种方法的存活率存在微小的、不显著的差异。在治疗结束和治疗一年时，SBRT的累积≥1级胃肠道毒性显著低于常规分馏法。SBRT组的初始GU急性毒性较低，但一年后无显著差异。观察数据证实初始GU急性毒性较低，与三个月后的RCT趋势一致。结论SBRT、PT和IRE治疗局限性前列腺癌的证据尚无定论。虽然目前尚不清楚这些疗法是否可以取代更具侵入性的手术，如前列腺切除术或显着提高生活质量或生存率，但在中低风险患者的生存结果中，SBRT似乎与传统的分步手术一样有效。与标准方法相比，需要进一步的随机对照试验来评估这些治疗的长期有效性和安全性。

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引用次数: 0

The role of inflammation and muscle dedifferentiation in the prognosis of retroperitoneal dedifferentiated liposarcoma 炎症和肌肉去分化在腹膜后去分化脂肪肉瘤预后中的作用

Clinical Surgical Oncology

Pub Date : 2025-03-01 DOI: 10.1016/j.cson.2025.100072

Dorian Yarih Garcia-Ortega , Gabriela Concepción Alamilla-García , Ana Paulina Melendez-Fernandez , Sylvia Veronica Villavicencio-Valencia , Claudia Haydee Sarai Caro-Sanchez , Kuauhyama Luna-Ortiz

Introduction

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.

腹膜后脂肪肉瘤（RPLS）是该部位最常见的软组织肉瘤；去分化脂肪肉瘤（DDLS）由于其侵袭性和预后差，给治疗带来了重大挑战。DDLS的肌原性去分化可能影响手术结果和患者生存。本研究探讨了肌原性去分化和中性粒细胞淋巴细胞比率（NLR）作为炎症标志物对RPLS手术并发症和治疗结果的影响。方法回顾性分析2005年1月1日至2018年12月31日诊断为腹膜后肉瘤的176例患者的病历。50例DDLPS患者符合纳入标准。肌肉特异性标记物的免疫组织化学分析确定了肌原性去分化。患者根据是否存在肌原性去分化进行分组。计算术前NLR，并通过受试者工作特征（ROC）曲线确定炎症谱分层的最佳NLR截止值。分析了肌原性去分化、NLR、手术并发症和治疗结果之间的关系。结果肌原性去分化患者的手术并发症发生率明显较高，总生存期较低(中位OS: 26.6 vs 40.8个月，p <；0.001)。NLR截止值为2.6 (AUC = 0.775, 95% CI: 0.63-0.91)，预测肌原性去分化的敏感性为86.7%，特异性为54.6%。NLR升高与肌原性去分化密切相关（优势比= 7.71,95% CI: 1.51-39.41, p = 0.014），提示炎症反应增强影响肿瘤侵袭性。结论肌原性去分化和NLR升高与DDLPS患者手术并发症增加和预后不良有关。高NLR和肌原性去分化之间的强相关性强调了炎症在肿瘤进展中的潜在作用。这些发现强调需要进一步研究免疫疗法作为该患者亚群的可能治疗选择，以改善管理和结果。

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引用次数: 0

Standardized pancreaticojejunostomy by double U-stitch technique in open, laparoscopic, and robotic pancreatoduodenectomies 在开放、腹腔镜和机器人胰十二指肠切除术中应用双u针技术的标准化胰空肠吻合术

Clinical Surgical Oncology

Pub Date : 2025-03-01 DOI: 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.

前言：评价双u针技术在开放、腹腔镜和机器人胰十二指肠切除术中的疗效和安全性。材料与方法回顾性研究于2021年11月至2023年12月在复旦大学上海肿瘤中心胰腺外科行胰十二指肠切除术（PD）的180例患者。患者分为三组：开放胰十二指肠切除术（OPD）、腹腔镜胰十二指肠切除术（LPD）和机器人胰十二指肠切除术（RPD）。所有病例均采用双u针技术，并收集围手术期资料。结果OPD组、LPD组、RPD组均按标准完成双u针穿刺。胰空肠吻合时间平均小于25min (OPD组14.5min， LPD组24.2min， RPD组24.4min), P <；0.0001)。临床相关胰瘘发生率在OPD组为11.6%，在微创组（LPD + RPD）为9.5% (P >；0.05)。术后并发症发生率低，包括胆漏、腹腔感染、出血和胃排空延迟。未观察到90天死亡率。结论双u针技术在不同手术入路治疗PD的安全性和有效性相当。

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引用次数: 0

Understanding the impact of mandibular invasion on oral squamous cell carcinoma: A clinicoradiopathological perspective 了解下颌浸润对口腔鳞状细胞癌的影响：临床放射病理学观点

Clinical Surgical Oncology

Pub Date : 2025-03-01 DOI: 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.

在头颈部鳞状细胞癌（HNSCC），临床评估下颌累及往往是不准确和不可靠的。累及下颌骨，将疾病提前至IV期。在评估口腔鳞状细胞癌患者时，影像学的一个重要作用是评估下颌骨侵犯的存在和程度。目的：探讨口腔鳞状细胞癌侵袭下颌骨的临床、影像学和病理表现的相关性。方法：前瞻性研究包括在TRIVANDRUM头颈肿瘤诊所就诊的口腔鳞状细胞癌患者，该患者的肿瘤临床固定在下颌骨或靠近下颌骨，活检证实SCC计划按照部门方案进行治疗。结果：131例患者在1年内被研究，其中79%为男性，40%有临床骨侵蚀，34%有放射性骨侵蚀。CT敏感性- 88%，特异性-77.4%,PPV-47.8%, NPV-96.5%，准确率- 79.4%。结论：准确评估下颌骨的侵犯程度对于制定治疗计划以获得肿瘤切除和良好的颌骨功能效果至关重要。CT扫描是预测骨侵蚀的敏感工具，应在所有口腔恶性肿瘤病例中常规使用，并结合彻底的临床检查。

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引用次数: 0

Post-operative and short-term oncological outcomes in patients with early-onset colorectal cancer: A prospective observational study 早发性结直肠癌患者的术后和短期肿瘤预后：一项前瞻性观察研究

Clinical Surgical Oncology

Pub Date : 2025-03-01 DOI: 10.1016/j.cson.2025.100077

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

Background

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.

近年来，早发性结直肠癌（EOCRC）的发病率有所上升。这种疾病实体呈现不同的临床和病理模式，不像晚发性结直肠癌（LOCRC）。材料与方法纳入2022年7月至2023年12月117例结直肠癌患者，分为EOCRC（≤45岁）和LOCRC（≤45岁）两组。数据采用描述性统计。偏斜数据采用Mann-Whitney检验。频率和比例被用来描述分类变量。采用Fisher精确检验（Fisher’s Exact Test）或卡方检验（Chi-square Test）进行比例比较，结果EOCRC 37例（31.6%），LOCRC 80例（68.4%）。EOCRC患者更频繁出现III期疾病15例（48.4%），而LOCRC患者29例（42%）（p = 0.288）。多数为左侧肿瘤，EOCRC 26例（70.2%），LOCRC 55例（68.8%），直肠18例（48.6%），LOCRC 39例（48.8%）。低分化癌在两组中5例（19.2%）比5例（10.4%）更常见（p = 0.538）。EOCRC组9（32.1%）比LOCRC组3 (5.6%)，EOCRC组18（66.7%）比LOCRC 18(33.3%) （p = 0.0042）的印戒细胞形态和粘蛋白阳性分别显著高于LOCRC组9（32.1%）和LOCRC组3（5.6%）。总体而言，EOCRC组有7例（6.3%）围手术期30天死亡率，3例（8.3%），LOCRC组有4例（5.3%）（p = 0.68）。LOCRC组30天围手术期并发症更为常见（p = 0.0192）。结论年轻组患者的术后发病率和住院时间明显较低。然而，晚期、低分化和粘液分泌肿瘤患者的比例在年轻年龄组中较高。

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引用次数: 0