Surgical Oncology Insight最新文献

{"title":"Superparamagnetic tracer and paramagnetic seed for marking of sentinel lymph nodes and index metastatic nodes before neoadjuvant chemotherapy to facilitate subsequent sentinel lymph node biopsy and targeted axillary dissection in breast cancer patients: A feasibility study","authors":"Kian Chin ,&nbsp;Roger Olofsson Bagge ,&nbsp;Nushin Mirzaei ,&nbsp;Anikó Kovács ,&nbsp;Henrik Leonhardt ,&nbsp;Pontus Zaar ,&nbsp;Andreas Karakatsanis ,&nbsp;Eirini Pantiora ,&nbsp;Staffan Eriksson ,&nbsp;Maria Ekholm ,&nbsp;Alastair Thompson ,&nbsp;Peter Barry ,&nbsp;Michael Boland ,&nbsp;Vivian Man ,&nbsp;Ava Kwong ,&nbsp;Fredrik Wärnberg","doi":"10.1016/j.soi.2024.100114","DOIUrl":"10.1016/j.soi.2024.100114","url":null,"abstract":"<div><h3>Background/objective</h3><div>Axillary staging after neoadjuvant chemotherapy (NACT) is associated with low detection and high false negative rates for sentinel lymph node biopsies (SLNB). The optimal method for lymphatic mapping is not determined. The aim was to study the feasibility of pre-marking axillary lymph nodes before NACT with a paramagnetic approach, utilizing superparamagnetic iron oxide nanoparticles (SPIO) and paramagnetic seeds (Magseed®).</div></div><div><h3>Methods</h3><div>Eighty patients with clinically node negative (cN0) and node positive (cN+) breast cancers were included. All had SPIO injected before and technetium-99m (Tc⁹⁹^m) after NACT. The index metastatic nodes (Index-met) were pre-marked with Magseed®⁾. Primary endpoint was SLN and Index-met detection per patient. Secondary endpoints were concordance and reversed concordance of tracers.</div></div><div><h3>Results</h3><div>Thirty-nine cN0 and 37 cN+ patients who underwent SLNB and targeted axillary dissections (TAD) were eligible for analyses. The overall SLN detection with SPIO and Tc⁹⁹^m were: 65/76 (86 %) vs. 60/76 (79 %), (95 % CI for difference between tracers 1 %-12 %, p = 0.01) respectively. The overall concordance and reversed concordance were 84/106 (79 %) vs. 84/193 (49 %), (95 % CI 21 %-39 %, p &lt; 0.001) respectively. Detection of Index-met with Magseed® and Tc⁹⁹^m were 36/37 (97 %) vs. 20/36 (56 %), (95 % CI 27 %-59 %, p &lt; 0.001) respectively. The median number of nodes retrieved with SPIO and Tc⁹⁹^m were 2 (IQR 1–3) and 1 (IQR 1–2) (p &lt; 0.001), respectively.</div></div><div><h3>Conclusions</h3><div>It was feasible to perform axillary staging by pre-marking the relevant lymph nodes using a paramagnetic approach before NACT. Notably, a large proportion of SPIO marked lymph nodes were different from those marked by Tc⁹⁹^m.</div></div><div><h3>Synopsis</h3><div>This study investigated using a paramagnetic approach for axillary nodal mapping <em>before</em> neoadjuvant chemotherapy comparing to a conventional mapping performed after chemotherapy. The results indicated feasibility of the paramagnetic method which also identified a different group of lymph nodes. However, these results require a further validation with a larger study.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100114"},"PeriodicalIF":0.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143182391","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}

{"title":"Outcomes of minimally invasive and open prophylactic gastrectomy for hereditary diffuse gastric cancer","authors":"Sara K. Daniel,&nbsp;Deshka S. Foster,&nbsp;M. Usman Ahmad,&nbsp;Joseph D. Forrester,&nbsp;Byrne Lee,&nbsp;Daniel Delitto,&nbsp;Amanda R. Kirane,&nbsp;Brendan C. Visser,&nbsp;Monica M. Dua,&nbsp;Jeffrey A. Norton,&nbsp;George A. Poultsides","doi":"10.1016/j.soi.2024.100112","DOIUrl":"10.1016/j.soi.2024.100112","url":null,"abstract":"<div><h3>Background</h3><div>Mutations in the <em>CDH1</em> gene predispose individuals to hereditary diffuse gastric cancer. As these tumors can evade endoscopic screening, prophylactic total gastrectomy is often recommended. Since skill with minimally invasive surgery (MIS) has progressed, we compared <em>CDH1</em> mutation carriers who underwent open vs MIS total gastrectomy.</div></div><div><h3>Methods</h3><div>A retrospective review of 48 <em>CDH1</em> carriers who underwent total gastrectomy from May 2004 to April 2023 was performed. Eight patients were excluded because they were symptomatic prior to surgery and had advanced signet ring cell adenocarcinoma.</div></div><div><h3>Results</h3><div>Twenty-eight open and 12 MIS total gastrectomy patients were included; one MIS case was converted to open. The groups were comparable regarding age, comorbidities, and pre-operative carcinoma identified (42 % vs 36 %). Blood loss was lower with MIS gastrectomy (200 vs 23 mL) while operative time was longer (163 vs 286 minutes). The number of lymph nodes harvested (18 vs 23) and the percentage with carcinoma (86 % vs 92 %) were not different between open and MIS approaches. Length of stay was shorter after MIS gastrectomy (7 vs 5 days). In the MIS group, there were no major post-operative complications (2.5 % open) or readmissions within 90 days (11 % open). Subsequent surgery or dilation was infrequent (18 % vs 8 %). Less weight loss was seen after MIS gastrectomy, reaching significance at 9 months post-operatively (-25 % vs −13 %).</div></div><div><h3>Conclusions</h3><div>MIS total gastrectomy is the preferred operation for <em>CDH1</em> carriers, resulting in shorter hospitalization without compromising pathology or safety.</div></div><div><h3>Synopsis</h3><div>Minimally invasive total gastrectomy performed for patients with CDH1 mutations has minimal short- or long-term complications and was associated with shorter length of stay and less weight loss than open total gastrectomy, without compromising lymph node yield or margin status.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100112"},"PeriodicalIF":0.0,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142745868","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}

{"title":"Impact of an online risk prediction tool for sentinel node metastasis on clinical decision-making in melanoma care: A mixed methods study","authors":"Rehana A. Salam ,&nbsp;Serigne N. Lo ,&nbsp;Alexander H.R. Varey ,&nbsp;Andrew J. Spillane ,&nbsp;Michael A. Henderson ,&nbsp;Richard A. Scolyer ,&nbsp;Victoria J. Mar ,&nbsp;John F. Thompson ,&nbsp;Robyn P.M. Saw ,&nbsp;Alexander C.J. van Akkooi ,&nbsp;Jonathan R. Stretch ,&nbsp;Alison Button-Sloan ,&nbsp;Angela Hong ,&nbsp;Rachael L. Morton ,&nbsp;Caroline G. Watts ,&nbsp;Andrea L. Smith ,&nbsp;Anne E. Cust","doi":"10.1016/j.soi.2024.100111","DOIUrl":"10.1016/j.soi.2024.100111","url":null,"abstract":"<div><h3>Background</h3><div>The decision to perform a sentinel lymph node biopsy (SLNB) procedure can be guided by risk prediction tools. We aimed to investigate the impact of an online risk prediction tool for sentinel node metastasis on clinical decision-making.</div></div><div><h3>Methods</h3><div>We conducted a mixed methods study using an online questionnaire and semi-structured interviews between April 2022 and March 2023. Australian clinicians and patients/carers who were using the Melanoma Institute Australia risk prediction tool were invited to participate.</div></div><div><h3>Results</h3><div>Sixty-one participants completed the questionnaire (52 clinicians including 36 general practitioners of whom 32 worked at skin cancer clinics; 14 surgeons; and 9 patients/carers). More than half of the clinicians reported that the tool had influenced the number of patients they were referring for SLNB procedures: 40 % reported increased referrals, 9 % reported fewer referrals, and 33 % reported no change. Over half (57 %) of the patient/carer participants reported using the risk tool alongside a clinician for shared decision-making. Interview findings suggested that the tool made clinicians feel more confident in their clinical decision to perform or refer patients for consideration of SLNB. Clinicians found the tool useful in guiding discussions about SLNB. However, there was uncertainty in interpreting risk scores if they had wide confidence intervals and some ambiguity in clinical decision-making if the risk score did not align with the clinician’s expectations.</div></div><div><h3>Conclusion</h3><div>This online risk prediction tool was acceptable to clinicians and patients/carers, useful for clinical decision-making and led to increased discussion between clinicians and patients regarding the SLNB procedure.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 4","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703376","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}

{"title":"Erratum [Surg Oncol Insight 1 (2024)] – Part 2","authors":"","doi":"10.1016/j.soi.2024.100108","DOIUrl":"10.1016/j.soi.2024.100108","url":null,"abstract":"","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 4","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592971","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}

{"title":"Effect of travel distance on outcomes of patients with malignant peritoneal mesothelioma treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy","authors":"Javid Sadjadi,&nbsp;Li Luo,&nbsp;Bridget Fahy,&nbsp;Alissa Greenbaum","doi":"10.1016/j.soi.2024.100110","DOIUrl":"10.1016/j.soi.2024.100110","url":null,"abstract":"<div><h3>Background</h3><div>Malignant peritoneal mesothelioma (MPM) is a rare disease with a generally poor prognosis treated with systemic chemotherapy alone. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can offer improved overall survival in select patients. This study examined the effect of travel distance on oncologic outcomes in patients with MPM undergoing CRS-HIPEC.</div></div><div><h3>Methods</h3><div>The National Cancer Database (NCDB) was reviewed from 2006 to 2020. The primary variable was distance traveled to CRS-HIPEC facility (&lt;50 miles versus ≥50 miles). Primary outcome was overall survival. Secondary outcomes examined 30- and 90-day post-surgical outcomes.</div></div><div><h3>Results</h3><div>Overall, 650 patients met inclusion criteria; 345 patients traveled &lt; 50 miles and 305 patients traveled ≥ 50 miles. Rates of MPM were highest in the Northeast, Middle and South Atlantic regions. Patients traveling ≥50 miles were younger, had a lower median income, and were more likely to be privately insured and treated at an academic center. There was no difference in overall survival between groups (p=0.87). Secondary outcomes were comparable: 30-day survival was 98 % in both groups (p=0.9), 90-day survival was 93 % in both groups (p=0.9), 30-day readmission rate was 11 % in the shorter travel distance group versus 7 % (p=0.2). Hospital length of stay (LOS) was longer in the ≥50 miles group (9 vs 8 days; p=0.02).</div></div><div><h3>Conclusions</h3><div>Outcomes following CRS-HIPEC for MPM did not differ based upon distance traveled for treatment, though patients who travel ≥ 50 miles have an increased LOS. Regionalization of CRS-HIPEC for MPM does not result in worse oncologic or surgical outcomes.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142722786","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}

{"title":"Surviving to thriving: Virtual nutrition education in patients with breast cancer","authors":"Trevor F. Roush ,&nbsp;Anna S. Sarkisova ,&nbsp;Jeanette M. Lamb ,&nbsp;Susan K. Boolbol ,&nbsp;Carinne W. Anderson","doi":"10.1016/j.soi.2024.100109","DOIUrl":"10.1016/j.soi.2024.100109","url":null,"abstract":"<div><h3>Introduction</h3><div>Improved outcomes in the treatment of breast cancer has increased the importance of formal survivorship. National guidelines and accreditation standards require institutional survivorship programs; however, implementation presents operational challenges. While existing literature affirms the need for clinician involvement in survivorship, applicability to virtual formats is unknown. Here we report our 3-year experience with design and implementation of virtual nutrition workshops in breast cancer survivorship.</div></div><div><h3>Materials and methods</h3><div>Free virtual workshops were developed by an interdisciplinary team and offered to eligible participants on a quarterly basis. Workshop content focused on diet, nutrition, and exercise in cancer prevention, development, and recurrence. A question-and-answer session addressed misconceptions about nutrition and cancer. Participants were invited to participate in an evaluation survey after each workshop. Post-workshop assessment of course effectiveness was performed with a four-point Likert scale and qualitative comments.</div></div><div><h3>Results</h3><div>116 women participated in the workshops. Quarterly attendance consistently grew and averaged sixteen participants per session. Post workshop surveys demonstrated significant improvements in participants’ knowledge, and likelihood of behavioral modification. 93 % of participants had the highest rating for likelihood of making a change to their diet, and 83 % for likelihood of making changes to physical activity. Qualitative feedback supported both the effectiveness of the education as well as the virtual group setting.</div></div><div><h3>Conclusions</h3><div>Virtual group workshops are effective for survivorship education. They present a feasible way to improve access to oncologic-trained dieticians for low-acuity concerns. The realistic design affords itself to easy reproducibility in other institutions seeking to implement disease-specific survivorship programs.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 4","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573303","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}

{"title":"Implant outcomes following breast conservation therapy in patients with history of augmentation mammoplasty","authors":"Abigail Krull ,&nbsp;Sarah Mclaughlin ,&nbsp;Santo Maimone ,&nbsp;James Jakub ,&nbsp;Brian Rinker ,&nbsp;Laura Vallow ,&nbsp;Lauren Cornell","doi":"10.1016/j.soi.2024.100107","DOIUrl":"10.1016/j.soi.2024.100107","url":null,"abstract":"<div><h3>Background</h3><div>In women who are eligible, breast conservation therapy (BCT) is often the preferred local treatment for early-stage BC. Concern for implant contracture in patients undergoing BCT including radiation therapy (RT) with prior augmentation mammoplasty has been expressed in several prior studies. The exact incidence of patient dissatisfaction remains unknown.</div></div><div><h3>Methods</h3><div>A single institution retrospective review was performed for patients with prior augmentation mammoplasty who received BCT for BC between 2010 and 2020. 77 patients met inclusion criteria. Of these, 34 were consented and completed study survey which included validated BREAST-Q modules. Data was reviewed with primarily descriptive analyses. P-values were calculated from Fisher’s exact test and Kruskal-Wallis rank sum test.</div></div><div><h3>Results</h3><div>34 patients completed study survey, with 55.9 % of patients (n=19) having silicone implants and 44.1 % (n=15) having saline. Most implants (91.1 %, n=31) were retropectoral. Median total dose of RT was 4005 cGy and median age of implants at BC diagnosis was 16 years (range 2, 40). 41 % (n=14) of patients reported dissatisfaction with breast appearance, with median BREAST-Q RASCH score for satisfaction with breasts 48 (range 20–82). No differences in breast satisfaction were seen in patients with silicone implants compared to saline (p= 0.171) although there were improved reported physical well-being chest scores in patients with saline implants (median 100 vs 89; p = 0.039).</div></div><div><h3>Conclusions</h3><div>A large proportion of women are dissatisfied with implant appearance following BCT with RT. Future larger studies are needed to explore contributing factors for dissatisfaction including implant type, location, RT dosing and fractionation.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 4","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142573302","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}

{"title":"Outcomes of mediastinal envelope closure during minimally invasive esophagectomy","authors":"Cynthia J. Susai ,&nbsp;Katemanee Burapachaisri ,&nbsp;Yun-Yi Hung ,&nbsp;Kian C. Banks ,&nbsp;Nathan J. Alcasid ,&nbsp;Rachel E. Wile ,&nbsp;Katherine E. Barnes ,&nbsp;Jeffrey B. Velotta","doi":"10.1016/j.soi.2024.100104","DOIUrl":"10.1016/j.soi.2024.100104","url":null,"abstract":"<div><h3>Background</h3><div>Limited outcomes data exists regarding whether mediastinal envelope closure during minimally invasive esophagectomy (MIE) is related to outcomes including anastomotic leak and postoperative pyloric dilation. We hypothesized that mediastinal envelope closure would be associated with fewer adverse outcomes.</div></div><div><h3>Methods</h3><div>Patients undergoing MIE between 9/1/2017 and 11/15/2021 were studied. Patients were divided into two groups, complete envelope closure (CC) or partially closed/ not closed (NC), and baseline characteristics and outcomes were compared. Multivariable logistic regression analysis was performed to evaluate variables associated with a composite outcome of anastomotic leak and/or pyloric dilation.</div></div><div><h3>Results</h3><div>We identified 181 patients. Age, sex, race/ethnicity, BMI, smoking history, CCI, ECOG status, operative duration, cancer stage/histology, intraoperative fluids, EBL, and EEA size were not statistically different between the CC and NC groups, though use of indocyanine green-enhanced fluorescence evaluation (ICG) was significantly different (24.5 % versus 67.6 %, p &lt;0.001). The CC group experienced lower rates of anastomotic leak (2 % vs 14.7 %, p = 0.007), postoperative pyloric dilation (15.6 % vs 32.4 %, p = 0.025), and delayed gastric emptying (6.1 % vs 20.6 %, p = 0.015). Risk factors for a composite outcome defined as anastomotic leak and/or pyloric dilation were evaluated using a multivariable logistic regression, and NC was an independent predictor of this composite outcome (aOR 3.74, p = 0.007).</div></div><div><h3>Conclusions</h3><div>Complete mediastinal envelope closure is associated with decreased rates of anastomotic leak, postoperative pyloric dilation, and delayed gastric emptying. Further prospective trials involving mediastinal envelope closure are warranted to elucidate its positive effect on postoperative outcomes.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 4","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2024-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142554646","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}

{"title":"Real-world analysis of neuroendocrine tumor misdiagnosis and associated costs","authors":"Callisia N. Clarke ,&nbsp;David Ray ,&nbsp;Nicole Princic ,&nbsp;Meghan Moynihan ,&nbsp;Alexandria Phan","doi":"10.1016/j.soi.2024.100105","DOIUrl":"10.1016/j.soi.2024.100105","url":null,"abstract":"<div><h3>Purpose</h3><div>Conditions for which neuroendocrine tumor (NET) is commonly misdiagnosed were compared among patients with and without NET, and the associated healthcare costs were described.</div></div><div><h3>Methods</h3><div>Adults with a NET diagnosis were selected retrospectively from the IBM MarketScan claims databases during 1/1/2015–12/31/2018 (earliest = index), comprising the NET cases. Non-NET controls included age/gender matched patients without any cancer diagnoses. Patients were followed for a five year look back period when conditions for which NET is commonly misdiagnosed (gastrointestinal, respiratory, metabolic [i.e. liver disease], dermatologic) were measured and compared between cases and matched controls using odds ratios. Misdiagnosis-related costs were reported per patient per month (PPPM) from the earliest misdiagnosis to NET diagnosis. Patients with pancreatic adenocarcinoma misdiagnoses and related costs were reported separately.</div></div><div><h3>Results</h3><div>This analysis included 3460 NET cases and 10,370 non-NET controls (mean age 61 years). Compared to non-NET controls, 70 % of NET cases had a diagnosis of a gastrointestinal, respiratory, metabolic, or dermatologic condition, with 2.07 higher odds (95 % CI 1.91–2.25). Median time from earliest potential misdiagnosis to NET was 3.4 years. Overall mean (standard deviation) healthcare costs related to misdiagnoses were $2858 ($6495) PPPM. Costs were highest for gastrointestinal misdiagnoses ($3350 [$7108]). Among NET cases, 69 (2 %) patients had a pancreatic adenocarcinoma misdiagnosis; related PPPM costs were substantial ($29,321 [$62,385]) and driven by outpatient services including treatment administration.</div></div><div><h3>Conclusion</h3><div>The increased odds of common misdiagnosis conditions among NET cases compared with non-NET controls, contributing to unnecessary healthcare costs, supports the need for accurate identification of NET.</div></div><div><h3>Synopsis</h3><div>The majority of patients with NET (70 %) were previously misdiagnosed, occurring a median of 3.4 years before correct diagnosis. Total mean healthcare costs related to misdiagnoses were $2858 PPPM and costs related to pancreatic adenocarcinoma misdiagnoses were substantial ($29,321 PPPM).</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 4","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531314","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}

{"title":"Definition of early recurrence of hepatocellular carcinoma based on the concordance index and optimal treatment strategy","authors":"Kei Kitamura,&nbsp;Toshiro Ogura,&nbsp;Ibuki Fujinuma,&nbsp;Satoshi Nomura,&nbsp;Takashi Fukuda,&nbsp;Amane Takahashi","doi":"10.1016/j.soi.2024.100106","DOIUrl":"10.1016/j.soi.2024.100106","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) has a high rate of recurrence and requires multiple treatment options. Early recurrence has been associated with poor prognosis; however, the timing of early recurrence varies in the literature. Therefore, in this study, we aimed to determine the timing of early recurrence with the best prognostic value and clarify the appropriate treatment strategy.</div></div><div><h3>Methods</h3><div>This retrospective study conducted to determine prognosis and treatments included 274 patients with HCC who underwent liver resection at the Saitama Cancer Center. The prognostic value of early recurrence at each surveillance period was calculated using Harrell's concordance index (C-index).</div></div><div><h3>Results</h3><div>The C-index at 9 months postoperatively was 0.656, which was the highest cut-off value for early recurrence. Notably, 122 patients had no recurrence, 58 had early recurrence (&lt;9 months), and 94 had late recurrence (≥9 months). The 5-year overall survival (OS) of patients with early recurrence was worse (16.5 %, p&lt;0.001), whereas that of those with late and no recurrences were similar (79.2 % vs. 70.9 %, p=0.86). The 5-year OS rate of patients with late intrahepatic recurrence in the surgery group was 100 %.</div></div><div><h3>Conclusion</h3><div>The optimal cutoff value for the timing of early recurrence was 9 months postoperatively. The early recurrence group had a high rate of extrahepatic recurrence and poor OS, whereas late recurrences were mostly intrahepatic, with no difference in prognosis between the late and no recurrence groups. Patients with intrahepatic recurrence after &gt;9 months are considered for rehepatectomy because of its good outcomes.</div></div><div><h3>Synopsis</h3><div>The C-index-based optimal cutoff for the timing of early HCC recurrence was 9 months postoperatively. The early recurrence group had a high rate of extrahepatic recurrence and poor OS, whereas late recurrences were mostly intrahepatic with a good prognosis.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 4","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142531313","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}