Clinical Surgical Oncology最新文献

英文中文

Confirmation of the importance of lymphatic leakage in the formation of axillary fluid collections after lymph node dissection for breast cancer 确认淋巴渗漏在乳腺癌淋巴结清扫后腋窝积液形成中的重要性

Clinical Surgical Oncology

Pub Date : 2025-03-01 DOI: 10.1016/j.cson.2024.100071

Roman Mirela Mariana , Karler Clarence , Del Marmol Véronique , Bourgeois Pierre

Background

In patients undergoing complete axillary lymph node dissection (CALND) for breast cancer, axillary lymphatic leakages can be detected using near-infrared fluorescence imaging after subcutaneous injection of indocyanine green (ICG) into the ipsilateral hand. This study investigates the impact of these leaks on postoperative fluid volumes collected in drains (Vd) and through punctures (Vp).

Methods

A total of 55 patients received a single subcutaneous ICG injection in the ipsilateral hand either the day before or on the day of surgery. Postoperative fluid volumes, including drain output (Vd) and puncture collections (Vp), were analyzed and compared in relation to the presence or absence of fluorescence detected perioperatively in axillary lymph nodes (AxLNs) and drains.

Results

Fluorescence in AxLN: The absence of fluorescence in the AxLN was associated with a tendency for lower Vd but showed no significant effect on Vp or the total volume of fluid collected (Vt = Vd + Vp). Fluorescent Axillary Leak: Similar trends were observed for the intraoperative detection of a fluorescent axillary leak, although the statistical significance was less pronounced. Fluorescence in Drains: The absence of fluorescence in postoperative drains was significantly correlated with lower values for all analyzed parameters, including Vd, Vp, Vt, the proportion of patients requiring punctures, and the number of punctures.

Conclusion

The findings support the hypothesis that postoperative fluid collections in the axilla after CALND are due primarily to lymphatic leakage from the arm rather than to the removal of axillary lymph nodes. The detection of fluorescence during surgery offers a foundation for targeted strategies to mitigate lymphatic leakages and associated complications. The efficacy of such approaches should be validated through a prospective, multicenter, randomized trial.

背景：在接受乳腺癌完全性腋窝淋巴结清扫术（CALND）的患者中，在同侧手部皮下注射吲哚菁绿（ICG）后，使用近红外荧光成像可以检测腋窝淋巴渗漏。本研究探讨了这些泄漏对术后引流管（Vd）和穿刺（Vp）收集的液体量的影响。方法55例患者在手术前或手术当日接受同侧手部单次皮下注射ICG。分析和比较术后液体量，包括排液量（Vd）和穿刺收集量（Vp）与围手术期腋窝淋巴结（AxLNs）和排液中荧光检测的存在或不存在的关系。结果AxLN中的荧光：AxLN中荧光的缺失与Vd降低的趋势有关，但对Vp或收集的液体总量（Vt = Vd + Vp）无显著影响。荧光腋窝漏：术中检测到的荧光腋窝漏也有类似的趋势，尽管统计学意义不太明显。引流管中的荧光：术后引流管中没有荧光与所有分析参数（Vd、Vp、Vt、需要穿刺的患者比例、穿刺次数）的较低值显著相关。结论本研究结果支持了CALND术后腋窝积液主要是由于上臂淋巴渗漏而非腋窝淋巴结切除的假设。手术期间荧光检测为有针对性的策略提供了基础，以减轻淋巴泄漏和相关并发症。这些方法的有效性应该通过前瞻性、多中心、随机试验来验证。

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引用次数: 0

Clinical outcome and survival of low-grade appendiceal mucinous neoplasm with different surgical treatment: A multicenter clinical retrospective study 不同手术治疗的低级别阑尾黏液性肿瘤的临床结局和生存：一项多中心临床回顾性研究

Clinical Surgical Oncology

Pub Date : 2025-02-10 DOI: 10.1016/j.cson.2025.100075

Cunlong Lu , Zhenlong Han , Hui Gao , Yongke Liu , Long Li , Tuo Shi , Houxin Zhu , Zhaoli Liu , Liangdong Cheng , Yanbing Zhou

Background

To explore the effects of different surgical strategies on clinical outcome and survival for the low-grade appendiceal mucinous neoplasm (LAMN), providing evidence support for the best treatment strategy.

Materials and methods

This study retrospectively analyzed the clinicopathological and survival outcome of LAMN data between 2013 and 2023 from multicenter, including preoperative, intraoperative, and postoperative data. Kaplan-Meier method and Cox regression analysis model were used for survival analysis.

Results

184 patients pathologically diagnosed with LAMN were included. The median age was 59 (50,69) years. All the patients were performed surgery, including simple appendectomy, appendectomy with caecal resection, ileocecectomy and right hemicolectomy (RHC). Compared with extended resection, local resection achieved better short-term outcome. Appendectomy has higher OS rate compared to the RHC with pairwise comparison (97% vs. 79.2%, χ = 11.14, P < 0.001). Multivariate Cox regression analysis showed that age>60 years (hazard radio (HR) = 1.125, 95%CI: 1.051–1.205, P < 0.01), tumor recurrence (HR = 7.019, 95%CI 2.226–22.135, P < 0.001), adjuvant chemotherapy (HR = 6.486, 95%CI 1.897–22.178, P = 0.003) and recurrence risk (HR = 13.303, 95%CI 4.165–42.493, P = 0.002) were independent risk factors for survival of LAMN.

Conclusion

Appendectomy showed favorable short-term outcome and OS rate compared with right hemicolectomy when the tumor is not ruptured and surgical margin is negative. Tumor recurrence, age>60 years, adjuvant chemotherapy and high recurrence risk indicates poor prognosis. Large clinical trials of surgical therapy for LAMN are urgently needed.

背景探讨不同手术策略对低级别阑尾黏液性肿瘤（LAMN）临床预后和生存的影响，为最佳治疗策略提供证据支持。材料与方法本研究回顾性分析了2013 - 2023年多中心LAMN的临床病理和生存结局，包括术前、术中和术后数据。生存率分析采用Kaplan-Meier法和Cox回归分析模型。结果184例经病理诊断为LAMN的患者入组。中位年龄59岁（50岁，69岁）。所有患者均行手术治疗，包括单纯阑尾切除术、阑尾切除术合并盲肠切除术、回肠切除术和右半结肠切除术（RHC）。与扩大切除相比，局部切除短期疗效更好。两两比较，阑尾切除术的OS率高于RHC (97% vs. 79.2%, χ = 11.14, P <；0.001)。多因素Cox回归分析显示，年龄60岁(HR) = 1.125, 95%CI: 1.051 ~ 1.205, P <；0.01),肿瘤复发(HR = 7.019, 95% ci 2.226 - -22.135, P & lt;0.001)、辅助化疗（HR = 6.486, 95%CI 1.897 ~ 22.178, P = 0.003）和复发风险（HR = 13.303, 95%CI 4.165 ~ 42.493, P = 0.002）是影响LAMN生存的独立危险因素。结论在肿瘤未破裂、切缘阴性的情况下，阑尾切除术较右半结肠切除术具有较好的短期疗效和总生存率。肿瘤复发、年龄60岁、辅助化疗、复发率高提示预后较差。迫切需要对LAMN进行外科治疗的大规模临床试验。

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引用次数: 0

A comprehensive narrative review on paradigm shift in the treatment of esophageal and rectal cancer 食管癌和直肠癌治疗模式转变的综合叙述综述

Clinical Surgical Oncology

Pub Date : 2025-02-09 DOI: 10.1016/j.cson.2025.100074

Dimitrios Chatziisaak , Pascal Burri , Thomas Steffen , Stephan Bischofberger

The incidence of esophageal and rectal cancer is rising globally. The combination of neoadjuvant chemoradiotherapy (nCRT) with watchful waiting (W&W) strategies has been shown to be an effective approach for maintaining a high quality of life (QoL), particularly in the treatment of rectal cancer. This approach has recently been experimentally extended to the treatment of esophageal cancer. This narrative review provides an overview of the current status of nCRT and watchful waiting (W&W) strategies in both cancer types.

The findings of the review indicate that nCRT significantly improves survival and response rates in both cancers. In patients with esophageal cancer, neoadjuvant therapy followed by surgery resulted in a median overall survival that was nearly double the expected survival time and demonstrated high rates of complete pathological response. In the case of rectal cancer, nCRT has been shown to result in high rates of complete response, which in turn has the effect of organ preserving and improving overall oncological outcomes and QoL.

The review concludes that the W&W strategies, initially developed for rectal cancer, can be safely extended to selected cases of esophageal cancer, making organ preservation a feasible option that improves patients' quality of life. It is imperative that internationally accepted guidelines and precise patient selection criteria are established to ensure consistent outcomes and enhance long-term monitoring.

食管癌和直肠癌的发病率在全球范围内呈上升趋势。新辅助放化疗（nCRT）与观察等待（W&；W）策略的结合已被证明是维持高生活质量（QoL）的有效方法，特别是在直肠癌的治疗中。这种方法最近被实验性地扩展到食管癌的治疗中。本文综述了两种癌症类型的nCRT和观察等待（W&；W）策略的现状。回顾的结果表明，nCRT显著提高了两种癌症的生存率和应答率。在食管癌患者中，手术后的新辅助治疗导致中位总生存期几乎是预期生存期的两倍，并显示出高的完全病理反应率。在直肠癌的病例中，nCRT已被证明具有高完全缓解率，这反过来又具有器官保存和改善总体肿瘤预后和生活质量的作用。该综述的结论是，最初为直肠癌开发的W&；W策略可以安全地扩展到选定的食管癌病例，使器官保存成为一种可行的选择，可以提高患者的生活质量。必须制定国际公认的指导方针和精确的患者选择标准，以确保一致的结果并加强长期监测。

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引用次数: 0

A combined scoring system for tumor budding and poorly differentiated clusters in colorectal cancer: A retrospective study 结直肠癌肿瘤出芽和低分化簇的联合评分系统：一项回顾性研究

Clinical Surgical Oncology

Pub Date : 2025-02-03 DOI: 10.1016/j.cson.2025.100073

Adil Aziz Khan, Sana Ahuja, Sristi Barman, Sufian Zaheer

Background

Optimal management of stage II colorectal cancer (CRC) patients is complex due to variability in oncologic outcomes. Tumor budding (TB) and poorly differentiated clusters (PDCs) have emerged as significant prognostic factors. This study evaluates the prognostic significance of a combined scoring system of TB and PDCs in CRC patients.

Materials and methods

A retrospective study included 68 patients who underwent curative surgery. H&E-stained sections were assessed for TB and PDCs. TB was graded according to ITBCC recommendations: Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (≥10 buds). PDCs were counted as clusters of ≥5 cells without gland formation: PDC1 (0–4 clusters), PDC2 (5–9 clusters), and PDC3 (≥10 clusters). TB and PDC scores were combined, resulting in a score range of 2–4. Histological sections were also evaluated for lymphovascular invasion (LVI), perineural invasion (PNI), and other pathological parameters. Statistical analyses were performed using Chi-Square and Fisher's exact tests.

Results

TB was high in 32.35% of cases and low in 47.06%. High PDCs were present in 47.06% of cases. The combined scoring system showed 55.88% of cases with a score of 3, indicating intermediate risk. Statistical significance was observed between combined scores and T stage, LVI, PNI, histological grade, extranodal extension, and tumor size (p < 0.05).

Conclusion

The combined scoring system for TB and PDCs demonstrated superior prognostic performance compared to individual assessments. This system provides a more comprehensive risk stratification, which may guide more tailored treatment decisions in CRC management.

背景：由于肿瘤预后的可变性，II期结直肠癌（CRC）患者的最佳管理是复杂的。肿瘤萌芽（TB）和低分化簇（PDCs）已成为重要的预后因素。本研究评估了结核和前列腺癌联合评分系统在结直肠癌患者中的预后意义。材料与方法回顾性研究68例手术治疗患者。H&； e染色切片检测TB和PDCs。根据ITBCC推荐的结核病分级：Bd1（0-4个芽），Bd2（5-9个芽）和Bd3（≥10个芽）。不形成腺体的PDCs以≥5个细胞为簇计数：PDC1（0-4个簇）、PDC2（5 - 9个簇）和PDC3（≥10个簇）。结合TB和PDC评分，得到2-4分的评分范围。组织切片也评估淋巴血管侵犯（LVI），神经周围侵犯（PNI）和其他病理参数。采用卡方检验和Fisher精确检验进行统计分析。结果stb高发病例占32.35%，低发病例占47.06%。47.06%的病例存在高PDCs。综合评分系统中，55.88%的病例得分为3分，为中等风险。综合评分与T分期、LVI、PNI、组织学分级、结外扩展、肿瘤大小之间的差异均有统计学意义(p <；0.05)。结论与单独评估相比，TB和PDCs联合评分系统具有更好的预后效果。该系统提供了更全面的风险分层，可以指导CRC管理中更有针对性的治疗决策。

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Clinical Surgical Oncology

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Clinical Surgical Oncology

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Clinical Surgical Oncology

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Clinical Surgical Oncology

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Clinical Surgical Oncology

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Clinical Surgical Oncology

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Clinical Surgical Oncology

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