Pub Date : 2024-03-01DOI: 10.1016/j.soi.2023.100003
Julie Hallet , Sean Bennett , Calvin Law
Background
Due to unique indolent biology, neuroendocrine tumors (NETs) can be managed for many years with prolonged survival. Goals of NETs therapy differ from other more common solid malignancies. Cytoreductive surgery plays an important role in the multidisciplinary management of NETs. It offers an opportunity to reduce both tumor burden and hormonal load to improve symptom-free survival and quality of life, and spare systemic therapy options. Parenchyma-sparing liver cytoreduction is recommended technique to preserve liver parenchyma for future treatments upon progression or recurrence.
Methods
This video reviews parenchyma-sparing cytoreductive surgery for NETs liver metastases. Approaches and techniques, and their rationale are reviewed.
Results
We focus on the management of hepatic metastases in well differentiated low grade intestinal neuroendocrine neoplasm (or NET). The video reviews the steps of parenchyma-sparing liver metastases with enucleation for NETs. Considering the goal for cytoreduction for an indolent disease, wide margins are not aimed for. We highlight the technical aspects of enucleations to avoid anatomical resection and preserve parenchyma, which is critical in minimizing morbidity and optimizing long-term sequencing of therapies for a chronic malignancy.
Conclusion
We herein illustrate the steps and rationale for hepatic parenchyma-sparing cytoreduction for metastatic NETs. This approach can lead to significant tumoral and hormonal control, with favorable long-term outcomes. Parenchyma-sparing resection should be used over anatomical resection.
{"title":"Parenchymal sparing liver resection for cytoreduction of neuroendocrine tumors metastases","authors":"Julie Hallet , Sean Bennett , Calvin Law","doi":"10.1016/j.soi.2023.100003","DOIUrl":"10.1016/j.soi.2023.100003","url":null,"abstract":"<div><h3>Background</h3><p>Due to unique indolent biology, neuroendocrine tumors (NETs) can be managed for many years with prolonged survival. Goals of NETs therapy differ from other more common solid malignancies. Cytoreductive surgery plays an important role in the multidisciplinary management of NETs. It offers an opportunity to reduce both tumor burden and hormonal load to improve symptom-free survival and quality of life, and spare systemic therapy options. Parenchyma-sparing liver cytoreduction is recommended technique to preserve liver parenchyma for future treatments upon progression or recurrence.</p></div><div><h3>Methods</h3><p>This video reviews parenchyma-sparing cytoreductive surgery for NETs liver metastases. Approaches and techniques, and their rationale are reviewed.</p></div><div><h3>Results</h3><p>We focus on the management of hepatic metastases in well differentiated low grade intestinal neuroendocrine neoplasm (or NET). The video reviews the steps of parenchyma-sparing liver metastases with enucleation for NETs. Considering the goal for cytoreduction for an indolent disease, wide margins are not aimed for. We highlight the technical aspects of enucleations to avoid anatomical resection and preserve parenchyma, which is critical in minimizing morbidity and optimizing long-term sequencing of therapies for a chronic malignancy.</p></div><div><h3>Conclusion</h3><p>We herein illustrate the steps and rationale for hepatic parenchyma-sparing cytoreduction for metastatic NETs. This approach can lead to significant tumoral and hormonal control, with favorable long-term outcomes. Parenchyma-sparing resection should be used over anatomical resection.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 1","pages":"Article 100003"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247023000038/pdfft?md5=54480d7ef4c5ffcd845c91efad1a99df&pid=1-s2.0-S2950247023000038-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139019441","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 : 2024-03-01DOI: 10.1016/j.soi.2023.100001
Benjamin N. Schmeusser , Edouard H. Nicaise , Arnold R. Palacios , Eric Midenberg , Mohammed Said , Jeffrey Pearl , Kenneth Ogan , Viraj A. Master
Purpose
Drain evaluation and management is an essential skill for practicing surgeons. There are a multitude of laboratory analyses that may assist in the elucidation of a drain fluid source. Our goal is to review the current biochemical analyses of drain fluid available in an effort to guide perioperative management.
Materials and methods
A PubMed search of all available English language literature for drain fluid analysis following urologic and general surgeries was conducted. Further sources were identified in the reference lists of identified articles. All relevant articles published were reviewed and used to delineate the appropriate drain fluid tests that could be ordered. The interpretation of these test results was also discussed. The data was then presented in a series of patient scenarios that exemplify postoperative complications seen.
Results
Biochemical analysis of drain fluid can be used to assist in the diagnosis of the postoperative urologic tract, intestinal, hepatopancreaticobiliary, and infectious complications. Drain fluid studies including creatinine, urea, triglyceride, cell count, protein, pH, specific gravity, gram stain, culture, lactate dehydrogenase, amylase, lipase, albumin, bilirubin, and alkaline phosphatase have been reviewed accordingly.
Conclusions
Commonly available laboratory analyses may assist the surgeon in perioperative drain management. Our review summarizes these studies through case examples. Understanding the applicability of these studies is essential to improve surgical practice.
Synopsis
A review of drain fluid evaluation and management in genitourinary procedures as depicted in a case-by-case fashion. This article demonstrates the indications and utilities of drain fluid studies in postoperative patients to best assist and inform surgical practice.
{"title":"A Practical Approach for Drain Fluid Analysis Following Genitourinary Surgery","authors":"Benjamin N. Schmeusser , Edouard H. Nicaise , Arnold R. Palacios , Eric Midenberg , Mohammed Said , Jeffrey Pearl , Kenneth Ogan , Viraj A. Master","doi":"10.1016/j.soi.2023.100001","DOIUrl":"10.1016/j.soi.2023.100001","url":null,"abstract":"<div><h3>Purpose</h3><p>Drain evaluation and management is an essential skill for practicing surgeons. There are a multitude of laboratory analyses that may assist in the elucidation of a drain fluid source. Our goal is to review the current biochemical analyses of drain fluid available in an effort to guide perioperative management.</p></div><div><h3>Materials and methods</h3><p>A PubMed search of all available English language literature for drain fluid analysis following urologic and general surgeries was conducted. Further sources were identified in the reference lists of identified articles. All relevant articles published were reviewed and used to delineate the appropriate drain fluid tests that could be ordered. The interpretation of these test results was also discussed. The data was then presented in a series of patient scenarios that exemplify postoperative complications seen.</p></div><div><h3>Results</h3><p>Biochemical analysis of drain fluid can be used to assist in the diagnosis of the postoperative urologic tract, intestinal, hepatopancreaticobiliary, and infectious complications. Drain fluid studies including creatinine, urea, triglyceride, cell count, protein, pH, specific gravity, gram stain, culture, lactate dehydrogenase, amylase, lipase, albumin, bilirubin, and alkaline phosphatase have been reviewed accordingly.</p></div><div><h3>Conclusions</h3><p>Commonly available laboratory analyses may assist the surgeon in perioperative drain management. Our review summarizes these studies through case examples. Understanding the applicability of these studies is essential to improve surgical practice.</p></div><div><h3>Synopsis</h3><p>A review of drain fluid evaluation and management in genitourinary procedures as depicted in a case-by-case fashion. This article demonstrates the indications and utilities of drain fluid studies in postoperative patients to best assist and inform surgical practice.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 1","pages":"Article 100001"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247023000014/pdfft?md5=8a5e9878494da764bb613544b348c3f7&pid=1-s2.0-S2950247023000014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139304393","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 : 2024-03-01DOI: 10.1016/j.soi.2023.100002
Naveena AN Kumar , Akhil Palod, Nawaz Usman, Nithesh JB
{"title":"Laparoscopic radical antegrade modular pancreatosplenectomy (RAMPS) for a large SPEN of distal pancreas","authors":"Naveena AN Kumar , Akhil Palod, Nawaz Usman, Nithesh JB","doi":"10.1016/j.soi.2023.100002","DOIUrl":"10.1016/j.soi.2023.100002","url":null,"abstract":"","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 1","pages":"Article 100002"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247023000026/pdfft?md5=2a1d40d8b252376c01607ef9bbabc3de&pid=1-s2.0-S2950247023000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014852","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 : 2024-03-01DOI: 10.1016/j.soi.2024.100036
Megan L. Sulciner , Jiping Wang , Miranda B. Lam , Jason L. Hornick , Dennis P. Orgill , Elizabeth H. Baldini , Chandrajit P. Raut , Mark Fairweather
Background
Pleomorphic dermal sarcoma (PDS) of the scalp is a rare cutaneous malignancy, the location of which creates unique technical and cosmetic obstacles. Optimal management is not defined. We reviewed our institution’s approach and outcomes for this entity.
Materials & methods
Between 2000–2020, 15 patients with scalp PDS were evaluated and treated at our multidisciplinary sarcoma center. Patient characteristics, treatment approach, and outcomes were analyzed.
Results
Thirteen patients (87%) presented with primary disease alone, one (7%) presented with recurrent disease after initial resection, and one (7%) presented with synchronous primary and metastatic disease. Radiation therapy (RT) was recommended in 10 patients (67%) and completed in 8 (53%) (3 preoperative, 5 postoperative). Eight patients (53%) underwent staged plastic surgery complex wound closure. Thirteen patients were alive without disease, one was alive with disease, and one was deceased with known recurrent disease at time of last follow-up.
Conclusion
Limited data are available to guide management of scalp PDS. Due to possible need for staged plastic surgery closure to ensure negative margins and optimize wound healing, initiation of postoperative RT may be delayed. Future multi-institutional study is required to further define the extent of surgery and role and timing of RT.
{"title":"Multidisciplinary management of pleomorphic dermal sarcoma of the scalp: A single institution study","authors":"Megan L. Sulciner , Jiping Wang , Miranda B. Lam , Jason L. Hornick , Dennis P. Orgill , Elizabeth H. Baldini , Chandrajit P. Raut , Mark Fairweather","doi":"10.1016/j.soi.2024.100036","DOIUrl":"10.1016/j.soi.2024.100036","url":null,"abstract":"<div><h3>Background</h3><p>Pleomorphic dermal sarcoma (PDS) of the scalp is a rare cutaneous malignancy, the location of which creates unique technical and cosmetic obstacles. Optimal management is not defined. We reviewed our institution’s approach and outcomes for this entity.</p></div><div><h3>Materials & methods</h3><p>Between 2000–2020, 15 patients with scalp PDS were evaluated and treated at our multidisciplinary sarcoma center. Patient characteristics, treatment approach, and outcomes were analyzed.</p></div><div><h3>Results</h3><p>Thirteen patients (87%) presented with primary disease alone, one (7%) presented with recurrent disease after initial resection, and one (7%) presented with synchronous primary and metastatic disease. Radiation therapy (RT) was recommended in 10 patients (67%) and completed in 8 (53%) (3 preoperative, 5 postoperative). Eight patients (53%) underwent staged plastic surgery complex wound closure. Thirteen patients were alive without disease, one was alive with disease, and one was deceased with known recurrent disease at time of last follow-up.</p></div><div><h3>Conclusion</h3><p>Limited data are available to guide management of scalp PDS. Due to possible need for staged plastic surgery closure to ensure negative margins and optimize wound healing, initiation of postoperative RT may be delayed. Future multi-institutional study is required to further define the extent of surgery and role and timing of RT.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 2","pages":"Article 100036"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000458/pdfft?md5=80850a8c77b4e340559fe09d4e8f878f&pid=1-s2.0-S2950247024000458-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140088232","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 : 2024-02-28DOI: 10.1016/j.soi.2024.100016
Austin D. Williams , Jennifer LaRoy , Tiana Le , Debra A. Mangino , Mark E. Robson , Alexandra S. Heerdt , Tracy-Ann Moo
{"title":"Clinical challenges in breast care for patients with PTEN pathogenic variants: A case series and literature review","authors":"Austin D. Williams , Jennifer LaRoy , Tiana Le , Debra A. Mangino , Mark E. Robson , Alexandra S. Heerdt , Tracy-Ann Moo","doi":"10.1016/j.soi.2024.100016","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100016","url":null,"abstract":"","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 2","pages":"Article 100016"},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000124/pdfft?md5=80c8a074c5de1c73e2949041bd091efb&pid=1-s2.0-S2950247024000124-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140069152","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 : 2024-02-15DOI: 10.1016/j.soi.2024.100015
Shishir K. Maithel
{"title":"Message from the Editor-in-Chief","authors":"Shishir K. Maithel","doi":"10.1016/j.soi.2024.100015","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100015","url":null,"abstract":"","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 1","pages":"Article 100015"},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000112/pdfft?md5=ac0c001d704895209619ea9a986e2eab&pid=1-s2.0-S2950247024000112-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941812","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 : 2024-02-09DOI: 10.1016/j.soi.2024.100014
Tommaso Violante , Davide Ferrari , Courtney N. Day , Kellie L. Mathis , Eric J. Dozois , David W. Larson
Background
The COVID-19 pandemic posed an unprecedented global threat to healthcare systems, causing delays in colorectal cancer (CRC) diagnoses. This study aims to assess the impact of COVID-19 on the presentation of cancer stages in the U.S.
Methods
Data from the national cancer database (2015–2020) were analyzed, categorizing patients into pre-COVID (2015–2019) and COVID (2020) groups for evaluation.
Results
In the COVID group, patients with colon cancer had a notably higher prevalence of Clinical stage IV disease at diagnosis, accompanied by an increased incidence of metastatic disease (Clinical stage IV C, 12.9% vs. 4.5%, p < 0.001). Similar trends were observed for rectal cancer (Clinical stage IV C, 2.2% vs. 0.8%, p < 0.001). Black patients, those with specific insurance status (Medicaid or not insured vs. private insurance), and patients in the COVID cohort were significantly associated with worse clinical stages in both colon and rectal cancer on multivariable analysis.
Conclusion
The impact of COVID-19 has led to a notable surge in advanced-stage colorectal cancer diagnoses, with ongoing repercussions anticipated. Colorectal surgeons should devise strategies to address this issue and establish pandemic preparedness measures for future healthcare crises.
背景COVID-19大流行对医疗保健系统构成了前所未有的全球性威胁，导致结直肠癌（CRC）诊断延误。本研究旨在评估 COVID-19 对美国癌症分期的影响。结果在 COVID 组中，结肠癌患者在诊断时临床 IV 期疾病的患病率明显较高，同时转移性疾病的发生率也有所增加（临床 IV 期 C，12.9% 对 4.5%，p < 0.001）。直肠癌也出现了类似的趋势（临床 IV 期 C，2.2% 对 0.8%，p <0.001）。在多变量分析中，黑人患者、特定保险状况（医疗补助或无保险与私人保险）患者以及 COVID 队列中的患者与结肠癌和直肠癌较差的临床分期显著相关。结直肠外科医生应制定策略解决这一问题，并为未来的医疗危机制定流行病防备措施。
{"title":"The effect of the pandemic on colorectal cancer in the United States: An increased disease burden","authors":"Tommaso Violante , Davide Ferrari , Courtney N. Day , Kellie L. Mathis , Eric J. Dozois , David W. Larson","doi":"10.1016/j.soi.2024.100014","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100014","url":null,"abstract":"<div><h3>Background</h3><p>The COVID-19 pandemic posed an unprecedented global threat to healthcare systems, causing delays in colorectal cancer (CRC) diagnoses. This study aims to assess the impact of COVID-19 on the presentation of cancer stages in the U.S.</p></div><div><h3>Methods</h3><p>Data from the national cancer database (2015–2020) were analyzed, categorizing patients into pre-COVID (2015–2019) and COVID (2020) groups for evaluation.</p></div><div><h3>Results</h3><p>In the COVID group, patients with colon cancer had a notably higher prevalence of Clinical stage IV disease at diagnosis, accompanied by an increased incidence of metastatic disease (Clinical stage IV C, 12.9% vs. 4.5%, p < 0.001). Similar trends were observed for rectal cancer (Clinical stage IV C, 2.2% vs. 0.8%, p < 0.001). Black patients, those with specific insurance status (Medicaid or not insured vs. private insurance), and patients in the COVID cohort were significantly associated with worse clinical stages in both colon and rectal cancer on multivariable analysis.</p></div><div><h3>Conclusion</h3><p>The impact of COVID-19 has led to a notable surge in advanced-stage colorectal cancer diagnoses, with ongoing repercussions anticipated. Colorectal surgeons should devise strategies to address this issue and establish pandemic preparedness measures for future healthcare crises.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 1","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000100/pdfft?md5=a064e4bcd84766e58462a083d4d6890a&pid=1-s2.0-S2950247024000100-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139749208","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 : 2024-02-09DOI: 10.1016/j.soi.2024.100012
Mohamedraed Elshami, John B. Ammori, Jeffrey M. Hardacre, Jordan M. Winter, Lee M. Ocuin
Background
Prior studies have shown that achievement of textbook oncologic outcomes (TOO) after pancreatectomy for pancreatic adenocarcinoma (PDAC) is associated with better survival outcomes. However, the associations between TOO, procedure type, and treatment sequence has not been examined.
Methods
Patients with resected PDAC were identified within the National Cancer Database (2010–2018). We analyzed rates of TOO (defined as no 30-day readmission, no 90-day mortality, no prolonged length of stay, negative surgical margins, receipt of multi-agent chemotherapy, and nodal yield ≥12) stratified by procedure (pancreatoduodenectomy vs. distal pancreatectomy vs. total pancreatectomy) and treatment sequence (up-front surgery vs. neoadjuvant therapy).
Results
A total of 20,155 patients were identified. Patients who underwent distal pancreatectomy were less likely to have TOO compared to pancreatoduodenectomy (12.6% vs. 17.5%; OR=0.77, 95% CI: 0.68–0.88). There was no difference in TOO between patients who underwent total pancreatectomy compared to pancreatoduodenectomy (16.4% vs. 17.5%; OR=0.96, 95% CI: 0.84–1.11). Neoadjuvant chemotherapy was associated with a 5-fold increase in the odds of TOO (OR=5.07, 95% CI: 4.35–5.91). TOO was associated with improved OS regardless of surgical procedure (pancreatoduodenectomy: median OS: 33.7 vs. 20.5mo; HR=0.69, 95% CI: 0.65–0.73; distal pancreatectomy: median OS: 35.8 vs. 23.9mo; HR=0.73, 95% CI: 0.64–0.84; total pancreatectomy: median OS: 30.1 vs. 19.9mo; HR=0.69, 95% CI: 0.61–0.79).
Conclusions
The rate of TOO was lower for distal pancreatectomy as compared to pancreatoduodenectomy or total pancreatectomy. Neoadjuvant therapy was associated with higher likelihood of TOO. Regardless of pancreatectomy type, TOO was associated with improved OS.
背景先前的研究表明，胰腺腺癌（PDAC）胰腺切除术后达到教科书中的肿瘤治疗效果（TOO）与更好的生存结果相关。然而，TOO、手术类型和治疗顺序之间的关系尚未得到研究。方法在国家癌症数据库（2010-2018 年）中确定了切除 PDAC 的患者。我们分析了按手术方式（胰十二指肠切除术 vs. 远端胰腺切除术 vs. 全胰腺切除术）和治疗顺序（前期手术 vs. 新辅助治疗）分层的TOO率（定义为无30天再入院、无90天死亡率、无住院时间延长、手术切缘阴性、接受多药化疗和结节率≥12）。与胰十二指肠切除术相比，接受远端胰腺切除术的患者发生TOO的几率较低（12.6% vs. 17.5%；OR=0.77，95% CI：0.68-0.88）。与胰十二指肠切除术相比，全胰腺切除术患者的TOO没有差异（16.4% vs. 17.5%；OR=0.96，95% CI：0.84-1.11）。新辅助化疗与TOO几率增加5倍相关（OR=5.07，95% CI：4.35-5.91）。无论采用哪种手术方式，TOO都与OS的改善有关（胰十二指肠切除术：中位OS：33.7 vs. 20.5）：33.7个月 vs. 20.5个月；HR=0.69，95% CI：0.65-0.73；胰腺远端切除术：中位OS：35.8个月 vs. 23.9个月：35.8个月 vs. 23.9个月；HR=0.73，95% CI：0.64-0.84；全胰切除术：中位OS：结论与胰十二指肠切除术或全胰切除术相比，远端胰腺切除术的TOO率较低。新辅助治疗与更高的TOO可能性相关。无论采用哪种胰腺切除术，TOO都与OS的改善有关。
{"title":"Associations between pancreatectomy type, treatment sequence and textbook oncologic outcomes in patients with localized pancreatic adenocarcinoma","authors":"Mohamedraed Elshami, John B. Ammori, Jeffrey M. Hardacre, Jordan M. Winter, Lee M. Ocuin","doi":"10.1016/j.soi.2024.100012","DOIUrl":"https://doi.org/10.1016/j.soi.2024.100012","url":null,"abstract":"<div><h3>Background</h3><p>Prior studies have shown that achievement of textbook oncologic outcomes (TOO) after pancreatectomy for pancreatic adenocarcinoma (PDAC) is associated with better survival outcomes. However, the associations between TOO, procedure type, and treatment sequence has not been examined.</p></div><div><h3>Methods</h3><p>Patients with resected PDAC were identified within the National Cancer Database (2010–2018). We analyzed rates of TOO (defined as no 30-day readmission, no 90-day mortality, no prolonged length of stay, negative surgical margins, receipt of multi-agent chemotherapy, and nodal yield ≥12) stratified by procedure (pancreatoduodenectomy vs. distal pancreatectomy vs. total pancreatectomy) and treatment sequence (up-front surgery vs. neoadjuvant therapy).</p></div><div><h3>Results</h3><p>A total of 20,155 patients were identified. Patients who underwent distal pancreatectomy were less likely to have TOO compared to pancreatoduodenectomy (12.6% vs. 17.5%; OR=0.77, 95% CI: 0.68–0.88). There was no difference in TOO between patients who underwent total pancreatectomy compared to pancreatoduodenectomy (16.4% vs. 17.5%; OR=0.96, 95% CI: 0.84–1.11). Neoadjuvant chemotherapy was associated with a 5-fold increase in the odds of TOO (OR=5.07, 95% CI: 4.35–5.91). TOO was associated with improved OS regardless of surgical procedure (pancreatoduodenectomy: median OS: 33.7 vs. 20.5mo; HR=0.69, 95% CI: 0.65–0.73; distal pancreatectomy: median OS: 35.8 vs. 23.9mo; HR=0.73, 95% CI: 0.64–0.84; total pancreatectomy: median OS: 30.1 vs. 19.9mo; HR=0.69, 95% CI: 0.61–0.79).</p></div><div><h3>Conclusions</h3><p>The rate of TOO was lower for distal pancreatectomy as compared to pancreatoduodenectomy or total pancreatectomy. Neoadjuvant therapy was associated with higher likelihood of TOO. Regardless of pancreatectomy type, TOO was associated with improved OS.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 1","pages":"Article 100012"},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000082/pdfft?md5=3c795ca7a99d59e29d8373401f1711e7&pid=1-s2.0-S2950247024000082-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139744110","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 : 2024-02-09DOI: 10.1016/j.soi.2024.100011
Muhammad O. Awiwi , Neal Bhutani , Brian K. Bednarski , Tyuyoshi Konishi , Ajaykumar C. Morani , George J. Chang , Harmeet Kaur
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Pub Date : 2024-02-09DOI: 10.1016/j.soi.2024.100013
Emma Vail , Patrick M. Boland , Toni Beninato , Mariam F. Eskander , Miral S. Grandhi , Haejin In , Timothy J. Kennedy , Russell C. Langan , Jason C. Maggi , Dirk F. Moore , Henry A. Pitt , Shishir K. Maithel , Brett L. Ecker
Background
Post-resection detection of cell-free DNA (cfDNA) is strongly prognostic of recurrence for patients with localized colorectal cancer (CRC). The sensitivity and specificity of this biomarker in the setting of CRC liver metastases (CRCLM) have not yet been systematically quantified.
Methods
PubMed was queried from database inception to June 2, 2023 for English-language publications reporting post-operative cfDNA status and recurrence-free survival (RFS) in patients with resected CRCLM. Weighted mean cfDNA positivity rates and RFS probabilities were utilized to estimate the sensitivity and specificity for recurrence at 1, 3 and 5 years after surgery. Recurrence risk using hazard ratios (HRs) and 95% CIs were calculated using a random-effects model and the DerSimonian-Laird method.
Results
Of 98 records, 10 studies (all non-randomized) were eligible, inclusive of 669 patients. The median weighted follow-up from surgical resection was 30.6 months (range 9.7–77.0 months). The mean postoperative cfDNA positivity rate was 38.5%, and cfDNA status was prognostic of RFS in 10 of 10 (100%) studies with a pooled HR of 3.11 (95% CI 2.29–4.22). Among cfDNA-positive patients, the weighted rate of recurrence was 75.0%, 92.5%, and 96.8% at 1, 3 and 5 years, respectively. Among cfDNA-negative patients, the weighted rate of recurrence was 35.7%, 59.7% and 60.7% at 1, 3 and 5 years, respectively. Sensitivity and specificity of cfDNA positivity was 67.8% and 30.0% for recurrence within 1 year, 60.9% and 15.7% for recurrence within 3 years, and 61.5% and 7.6% for recurrence within 5 years, respectively.
Conclusions
cfDNA-positivity following resection of CRCLM is highly prognostic of recurrence, which may have implications for treatment escalation strategies for this molecularly selected cohort. In contrast, recurrence was common in the cfDNA-negative cohort, cautioning against de-escalation strategies for these patients.
{"title":"The prognostic role of post-operative cfDNA after resection of Colorectal Liver Metastases: A Systematic Review and Meta-Analysis","authors":"Emma Vail , Patrick M. Boland , Toni Beninato , Mariam F. Eskander , Miral S. Grandhi , Haejin In , Timothy J. Kennedy , Russell C. Langan , Jason C. Maggi , Dirk F. Moore , Henry A. Pitt , Shishir K. Maithel , Brett L. Ecker","doi":"10.1016/j.soi.2024.100013","DOIUrl":"10.1016/j.soi.2024.100013","url":null,"abstract":"<div><h3>Background</h3><p>Post-resection detection of cell-free DNA (cfDNA) is strongly prognostic of recurrence for patients with localized colorectal cancer (CRC). The sensitivity and specificity of this biomarker in the setting of CRC liver metastases (CRCLM) have not yet been systematically quantified.</p></div><div><h3>Methods</h3><p>PubMed was queried from database inception to June 2, 2023 for English-language publications reporting post-operative cfDNA status and recurrence-free survival (RFS) in patients with resected CRCLM. Weighted mean cfDNA positivity rates and RFS probabilities were utilized to estimate the sensitivity and specificity for recurrence at 1, 3 and 5 years after surgery. Recurrence risk using hazard ratios (HRs) and 95% CIs were calculated using a random-effects model and the DerSimonian-Laird method.</p></div><div><h3>Results</h3><p>Of 98 records, 10 studies (all non-randomized) were eligible, inclusive of 669 patients. The median weighted follow-up from surgical resection was 30.6 months (range 9.7–77.0 months). The mean postoperative cfDNA positivity rate was 38.5%, and cfDNA status was prognostic of RFS in 10 of 10 (100%) studies with a pooled HR of 3.11 (95% CI 2.29–4.22). Among cfDNA-positive patients, the weighted rate of recurrence was 75.0%, 92.5%, and 96.8% at 1, 3 and 5 years, respectively. Among cfDNA-negative patients, the weighted rate of recurrence was 35.7%, 59.7% and 60.7% at 1, 3 and 5 years, respectively. Sensitivity and specificity of cfDNA positivity was 67.8% and 30.0% for recurrence within 1 year, 60.9% and 15.7% for recurrence within 3 years, and 61.5% and 7.6% for recurrence within 5 years, respectively.</p></div><div><h3>Conclusions</h3><p>cfDNA-positivity following resection of CRCLM is highly prognostic of recurrence, which may have implications for treatment escalation strategies for this molecularly selected cohort. In contrast, recurrence was common in the cfDNA-negative cohort, cautioning against de-escalation strategies for these patients.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"1 1","pages":"Article 100013"},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000094/pdfft?md5=2eceae0a79a2fb6d5baec1009788de2e&pid=1-s2.0-S2950247024000094-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139875599","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}
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