Pub Date : 2025-08-05DOI: 10.1016/j.soi.2025.100171
Shou-Tung Chen , Chi-Cheng Huang , Ta-Chung Chao , Wei-Pang Chung , Chih-Yi Hsu , Cheng-Ping Yu , Wen-Ling Kuo , Po-Hsiang Huang , Dwan-Ying Chang , Yi-Fang Tsai , Hsu-Huan Chou , Jun-Ping Shiau , Kuo-Ting Lee , CHIN-YAO LIN , Ming-Yang Wang , An-Chieh Feng , Liang-Chih Liu , Jiun-I. Lai , Yuan-Ching Chang , Guo-Shiou Liao
Background
Breast cancer (BC) is one of the most common cancers among women in Taiwan, with an increasing incidence rate. Advancements in treatment, particularly new-generation antibody-drug conjugates (ADCs), have shown promise for HER2-low BC. This consensus aims to help clinicians formulate treatment guidelines for HER2-low patients.
Methods
The Taiwan Breast Cancer Society convened a multidisciplinary panel to conduct a systematic literature review and discuss nine key topics. The panel utilized the US Preventive Services Task Force and GRADE approach for evidence grading and employed the modified Delphi technique to achieve expert consensus.
Results
The panel developed 25 consensus statements regarding ADCs and HER2 status. Key findings include that HER2 expression is necessary for trastuzumab-DM1 (T-DM1) and trastuzumab deruxtecan (T-DXd), while TROP2 testing is not required for sacituzumab govitecan (SG). T-DXd is the preferred second-line treatment for HER2-positive metastatic breast cancer and is effective in HER2-low disease and brain metastases. For HR-positive/HER2-negative metastatic breast cancer, both T-DXd and SG improve outcomes after endocrine therapy and CDK4/6 inhibitors. In triple-negative breast cancer, SG offers significant benefits in refractory cases. For HER2-low breast cancer, T-DXd is considered first in HR-positive cases, and SG in HR-negative cases. The routine sequential use of multiple ADCs is not currently supported by evidence
Conclusion
This consensus provides essential insights into HER2-low BC, highlighting its characteristics and evolving treatment options, serving as a practical reference for clinicians.
{"title":"Taiwan Expert Consensus on the appropriate treatment strategies for HER2-low breast cancer","authors":"Shou-Tung Chen , Chi-Cheng Huang , Ta-Chung Chao , Wei-Pang Chung , Chih-Yi Hsu , Cheng-Ping Yu , Wen-Ling Kuo , Po-Hsiang Huang , Dwan-Ying Chang , Yi-Fang Tsai , Hsu-Huan Chou , Jun-Ping Shiau , Kuo-Ting Lee , CHIN-YAO LIN , Ming-Yang Wang , An-Chieh Feng , Liang-Chih Liu , Jiun-I. Lai , Yuan-Ching Chang , Guo-Shiou Liao","doi":"10.1016/j.soi.2025.100171","DOIUrl":"10.1016/j.soi.2025.100171","url":null,"abstract":"<div><h3>Background</h3><div>Breast cancer (BC) is one of the most common cancers among women in Taiwan, with an increasing incidence rate. Advancements in treatment, particularly new-generation antibody-drug conjugates (ADCs), have shown promise for HER2-low BC. This consensus aims to help clinicians formulate treatment guidelines for HER2-low patients.</div></div><div><h3>Methods</h3><div>The Taiwan Breast Cancer Society convened a multidisciplinary panel to conduct a systematic literature review and discuss nine key topics. The panel utilized the US Preventive Services Task Force and GRADE approach for evidence grading and employed the modified Delphi technique to achieve expert consensus.</div></div><div><h3>Results</h3><div>The panel developed 25 consensus statements regarding ADCs and HER2 status. Key findings include that HER2 expression is necessary for trastuzumab-DM1 (T-DM1) and trastuzumab deruxtecan (T-DXd), while TROP2 testing is not required for sacituzumab govitecan (SG). T-DXd is the preferred second-line treatment for HER2-positive metastatic breast cancer and is effective in HER2-low disease and brain metastases. For HR-positive/HER2-negative metastatic breast cancer, both T-DXd and SG improve outcomes after endocrine therapy and CDK4/6 inhibitors. In triple-negative breast cancer, SG offers significant benefits in refractory cases. For HER2-low breast cancer, T-DXd is considered first in HR-positive cases, and SG in HR-negative cases. The routine sequential use of multiple ADCs is not currently supported by evidence</div></div><div><h3>Conclusion</h3><div>This consensus provides essential insights into HER2-low BC, highlighting its characteristics and evolving treatment options, serving as a practical reference for clinicians.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100171"},"PeriodicalIF":0.0,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144830321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-31DOI: 10.1016/j.soi.2025.100170
Karolina A. Plonowska-Hirschfeld, Patrik Pipkorn
Background
Facial contour defects after parotidectomy are an important aesthetic consideration. While free fat grafts are frequently utilized to restore facial volume, their long-term durability can be variable and volume under-correction due to fat necrosis is a recognized disadvantage, particularly in patients requiring adjuvant radiation.1 Parascapular vascularized free fat flaps offer an attractive alternative reconstructive approach; in our institutional experience, they can confer more predictable and stable volume of fat transferred with minimal donor site morbidity.2 Herein, we present our approach to adipofascial parascapular free flap harvest for post-parotidectomy facial defects.
Methods
This video demonstrates vascularized free parascapular fat flap harvest for reconstruction of a parotidectomy defect. Approaches and techniques are reviewed.
Results
We highlight the technical aspects of parascapular free flap reconstruction after resection of a 3.5 cm pleomorphic adenoma in a 32-year-old male. Total parotidectomy with preservation of facial nerve was performed. The cumulative cut-to-close time for ablation and microvascular reconstruction was 210 min.
Conclusion
Adipofascial parascapular free flap is an attractive reconstructive option for parotidectomy defects with facial contour distortion.
{"title":"Parascapular adipofascial free flap for post-parotidectomy reconstruction","authors":"Karolina A. Plonowska-Hirschfeld, Patrik Pipkorn","doi":"10.1016/j.soi.2025.100170","DOIUrl":"10.1016/j.soi.2025.100170","url":null,"abstract":"<div><h3>Background</h3><div>Facial contour defects after parotidectomy are an important aesthetic consideration. While free fat grafts are frequently utilized to restore facial volume, their long-term durability can be variable and volume under-correction due to fat necrosis is a recognized disadvantage, particularly in patients requiring adjuvant radiation.<span><span><sup>1</sup></span></span> Parascapular vascularized free fat flaps offer an attractive alternative reconstructive approach; in our institutional experience, they can confer more predictable and stable volume of fat transferred with minimal donor site morbidity.<span><span><sup>2</sup></span></span> Herein, we present our approach to adipofascial parascapular free flap harvest for post-parotidectomy facial defects.</div></div><div><h3>Methods</h3><div>This video demonstrates vascularized free parascapular fat flap harvest for reconstruction of a parotidectomy defect. Approaches and techniques are reviewed.</div></div><div><h3>Results</h3><div>We highlight the technical aspects of parascapular free flap reconstruction after resection of a 3.5 cm pleomorphic adenoma in a 32-year-old male. Total parotidectomy with preservation of facial nerve was performed. The cumulative cut-to-close time for ablation and microvascular reconstruction was 210 min.</div></div><div><h3>Conclusion</h3><div>Adipofascial parascapular free flap is an attractive reconstructive option for parotidectomy defects with facial contour distortion.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100170"},"PeriodicalIF":0.0,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144770762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-15DOI: 10.1016/j.soi.2025.100169
V.Christian Sanderfer , Ansley B. Ricker , Alexis M. Holland , Erin Donahue , Reilly Shea , Matigan Simpson , Katelyn Cockerham , Nicholas Mullis , Sophia Bellavia , Ella Schwarzen , M.Hart Squires , Kunal C. Kadakia , Jonathan C. Salo
Objective
Esophagectomy is a complex operation associated with significant morbidity for fit patients. Risk calculation is essential to guide pre-operative patient selection. This study used CT-derived body composition measures and age to develop a model for the prediction of postoperative mortality after minimally-invasive esophagectomy.
Methods
Patients who underwent minimally-invasive esophagectomy from 2010 to 2022 were identified. Preoperative CT scans at the L3-vertebral level were analyzed to calculate skeletal muscle gauge (SMG) as the product of skeletal muscle index and density. Patient demographics, clinical characteristics, and outcomes were collected. Patients were grouped based on SMG (low muscle = bottom quartile vs normal muscle = top 3 quartiles) and age (≥75 vs <75 years). Ninety-day postoperative mortality was compared between risk groups.
Results
Of 399 patients, mean age was 62.8 years. Anastomotic leak occurred in 8.3 %, pneumonia in 17.0 %, discharge to home in 81.5 % and 90-day mortality in 5.5 %. Ninety-day mortality by risk group showed 1.8 % mortality for patients < 75 years with normal muscle (n = 281), 10 % mortality for patients < 75 years with low muscle (n = 72), 5.6 % mortality for patients ≥ 75 years with normal muscle (n = 18), and 32 % mortality among patients ≥ 75 years with low muscle (n = 28).
Conclusions
Low-risk patients (<75 years with normal muscle), which comprised 70 % of our study cohort, had favorable outcomes with 1.8 % 90-day postoperative mortality. Contrastingly, patients ≥ 75 years with low muscle measures were at high risk with 32 % mortality. Predictive models including SMG and age can identify high-risk groups and predict postoperative mortality after minimally-invasive esophagectomy.
{"title":"Body composition and post-operative outcomes after minimally-invasive esophagectomy","authors":"V.Christian Sanderfer , Ansley B. Ricker , Alexis M. Holland , Erin Donahue , Reilly Shea , Matigan Simpson , Katelyn Cockerham , Nicholas Mullis , Sophia Bellavia , Ella Schwarzen , M.Hart Squires , Kunal C. Kadakia , Jonathan C. Salo","doi":"10.1016/j.soi.2025.100169","DOIUrl":"10.1016/j.soi.2025.100169","url":null,"abstract":"<div><h3>Objective</h3><div>Esophagectomy is a complex operation associated with significant morbidity for fit patients. Risk calculation is essential to guide pre-operative patient selection. This study used CT-derived body composition measures and age to develop a model for the prediction of postoperative mortality after minimally-invasive esophagectomy.</div></div><div><h3>Methods</h3><div>Patients who underwent minimally-invasive esophagectomy from 2010 to 2022 were identified. Preoperative CT scans at the L3-vertebral level were analyzed to calculate skeletal muscle gauge (SMG) as the product of skeletal muscle index and density. Patient demographics, clinical characteristics, and outcomes were collected. Patients were grouped based on SMG (low muscle = bottom quartile vs normal muscle = top 3 quartiles) and age (≥75 vs <75 years). Ninety-day postoperative mortality was compared between risk groups.</div></div><div><h3>Results</h3><div>Of 399 patients<strong>,</strong> mean age was 62.8 years. Anastomotic leak occurred in 8.3 %, pneumonia in 17.0 %, discharge to home in 81.5 % and 90-day mortality in 5.5 %. Ninety-day mortality by risk group showed 1.8 % mortality for patients < 75 years with normal muscle (n = 281), 10 % mortality for patients < 75 years with low muscle (n = 72), 5.6 % mortality for patients ≥ 75 years with normal muscle (n = 18), and 32 % mortality among patients ≥ 75 years with low muscle (n = 28).</div></div><div><h3>Conclusions</h3><div>Low-risk patients (<75 years with normal muscle), which comprised 70 % of our study cohort, had favorable outcomes with 1.8 % 90-day postoperative mortality. Contrastingly, patients ≥ 75 years with low muscle measures were at high risk with 32 % mortality. Predictive models including SMG and age can identify high-risk groups and predict postoperative mortality after minimally-invasive esophagectomy.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-11DOI: 10.1016/j.soi.2025.100167
Laura Benuzzi , Alessandra Borghi , Marco Baia , Melissa Lillian Wood , Elena Di Blasi , Marco Fiore , Chiara Colombo , Stefano Radaelli , Alessandro Gronchi , Dario Callegaro
Introduction
Retroperitoneal sarcomas (RPS) are rare tumors, comprising 15 % of all soft tissue sarcomas (STS). Surgery remains the cornerstone of treatment for localized RPS and is tailored to histologic type.1 In liposarcoma, the most common RPS, en-bloc resection of the tumor with adjacent organs (such as the colon, kidney, and psoas muscle) is performed to ensure complete clearance of ipsilateral retroperitoneal fat and minimize the risk of local recurrence. Conversely, solitary fibrous tumors (SFT) have a lower risk of local recurrence, and adjacent organs are resected only if invaded.2, 3 Minimally invasive surgery (MIS) may be considered for select patients with SFT at specialized sarcoma centers.4
Video
This video presents a 67-year-old man with a 9 cm left retroperitoneal SFT treated with preoperative radiotherapy. The patient underwent laparoscopic en-bloc resection, including a marginal portion of the ipsilateral psoas and quadratus lumborum muscles, perirenal fat, and gonadal vessels, while the ipsilateral kidney, ureter, and femoral nerve were preserved.
Results
Following multidisciplinary discussion, and considering histologic type, preoperative radiotherapy, and initial imaging, complete en-bloc resection was achieved with a kidney-sparing procedure, resulting in negative microscopic margins. Oncological surgical principles for STS were upheld, with dissection performed outside anatomical planes to ensure clear margins. Postoperative recovery was uneventful, and the patient was discharged home on postoperative day 4. The patient is alive and disease-free one year after surgery.
Conclusions
This video demonstrates the feasibility and safety of MIS for select patients with retroperitoneal SFT treated at sarcoma referral centers, emphasizing adherence to oncological surgical principles.
{"title":"Laparoscopic resection of a left retroperitoneal solitary fibrous tumor","authors":"Laura Benuzzi , Alessandra Borghi , Marco Baia , Melissa Lillian Wood , Elena Di Blasi , Marco Fiore , Chiara Colombo , Stefano Radaelli , Alessandro Gronchi , Dario Callegaro","doi":"10.1016/j.soi.2025.100167","DOIUrl":"10.1016/j.soi.2025.100167","url":null,"abstract":"<div><h3>Introduction</h3><div>Retroperitoneal sarcomas (RPS) are rare tumors, comprising 15 % of all soft tissue sarcomas (STS). Surgery remains the cornerstone of treatment for localized RPS and is tailored to histologic type.<span><span><sup>1</sup></span></span> In liposarcoma, the most common RPS, en-bloc resection of the tumor with adjacent organs (such as the colon, kidney, and psoas muscle) is performed to ensure complete clearance of ipsilateral retroperitoneal fat and minimize the risk of local recurrence. Conversely, solitary fibrous tumors (SFT) have a lower risk of local recurrence, and adjacent organs are resected only if invaded.<span><span>2</span></span>, <span><span>3</span></span> Minimally invasive surgery (MIS) may be considered for select patients with SFT at specialized sarcoma centers.<span><span><sup>4</sup></span></span></div></div><div><h3>Video</h3><div>This video presents a 67-year-old man with a 9 cm left retroperitoneal SFT treated with preoperative radiotherapy. The patient underwent laparoscopic en-bloc resection, including a marginal portion of the ipsilateral psoas and quadratus lumborum muscles, perirenal fat, and gonadal vessels, while the ipsilateral kidney, ureter, and femoral nerve were preserved.</div></div><div><h3>Results</h3><div>Following multidisciplinary discussion, and considering histologic type, preoperative radiotherapy, and initial imaging, complete en-bloc resection was achieved with a kidney-sparing procedure, resulting in negative microscopic margins. Oncological surgical principles for STS were upheld, with dissection performed outside anatomical planes to ensure clear margins. Postoperative recovery was uneventful, and the patient was discharged home on postoperative day 4. The patient is alive and disease-free one year after surgery.</div></div><div><h3>Conclusions</h3><div>This video demonstrates the feasibility and safety of MIS for select patients with retroperitoneal SFT treated at sarcoma referral centers, emphasizing adherence to oncological surgical principles.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-07-09DOI: 10.1016/j.soi.2025.100168
Benedetta Alberghetti , Riccardo Oliva , Elena Casetta , Filippo Maria Capomacchia , Antonella Biscione , Stefano Cosma , Giovanni Scambia , Francesco Fanfani , Luigi Carlo Turco
Purpose
Endometrial cancer (EC) ranks as the second most prevalent gynecologic cancer worldwide. In presumed early-stage conditions, minimally invasive surgery (MIS) plays a pivotal role in this scenario, and robot-assisted surgery (RAS) shows benefits in learning curves, ergonomics, and precision, with equivalent oncologic outcomes compared to laparoscopy.
This study describes the first European experience using the da Vinci SP™ system (Intuitive Surgical, Sunnyvale, CA, United States) for the robotic surgical staging of EC, evaluating its feasibility, safety, and perioperative outcomes.
Methods
Ten consecutive patients were selected to undergo RAS surgical staging with the da Vinci SP™ system for presumed early-stage EC based on preoperative imaging. All patients were preoperatively evaluated with diagnostic hysteroscopy, CT-scan, and MRI. The surgical procedure included type A radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral sentinel lymph node (SLN) dissection.
Perioperative outcomes and complications were prospectively recorded.
Results
All procedures were successfully completed using a full RAS approach, with one conversion to open surgery for specimen integrity and retrieval. Median estimated blood loss was 50 mL (range: 50–250 mL), and median operative time was 127 min (range: 116–172 min). No major intraoperative complications were reported, and postoperative recovery was uneventful.
In 4 cases, unilateral pelvic lymphadenectomy was required due to failed SNL detection.
Conclusion
This study demonstrated that the da Vinci SP™ system was a feasible and safe alternative for the management of presumed early-stage EC. The single-port approach showed high reliability and potential benefits in terms of invasiveness, cosmesis, and postoperative recovery. Larger studies are necessary to further evaluate its role compared to conventional multiport robotic systems.
{"title":"Europe’s First da Vinci SP™ robotic experience in endometrial cancer: A pilot study on feasibility, safety, and perioperative outcomes with practical tips & tricks","authors":"Benedetta Alberghetti , Riccardo Oliva , Elena Casetta , Filippo Maria Capomacchia , Antonella Biscione , Stefano Cosma , Giovanni Scambia , Francesco Fanfani , Luigi Carlo Turco","doi":"10.1016/j.soi.2025.100168","DOIUrl":"10.1016/j.soi.2025.100168","url":null,"abstract":"<div><h3>Purpose</h3><div>Endometrial cancer (EC) ranks as the second most prevalent gynecologic cancer worldwide. In presumed early-stage conditions, minimally invasive surgery (MIS) plays a pivotal role in this scenario, and robot-assisted surgery (RAS) shows benefits in learning curves, ergonomics, and precision, with equivalent oncologic outcomes compared to laparoscopy.</div><div>This study describes the first European experience using the da Vinci SP™ system (Intuitive Surgical, Sunnyvale, CA, United States) for the robotic surgical staging of EC, evaluating its feasibility, safety, and perioperative outcomes.</div></div><div><h3>Methods</h3><div>Ten consecutive patients were selected to undergo RAS surgical staging with the da Vinci SP™ system for presumed early-stage EC based on preoperative imaging. All patients were preoperatively evaluated with diagnostic hysteroscopy, CT-scan, and MRI. The surgical procedure included type A radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral sentinel lymph node (SLN) dissection.</div><div>Perioperative outcomes and complications were prospectively recorded.</div></div><div><h3>Results</h3><div>All procedures were successfully completed using a full RAS approach, with one conversion to open surgery for specimen integrity and retrieval. Median estimated blood loss was 50 mL (range: 50–250 mL), and median operative time was 127 min (range: 116–172 min). No major intraoperative complications were reported, and postoperative recovery was uneventful.</div><div>In 4 cases, unilateral pelvic lymphadenectomy was required due to failed SNL detection.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the da Vinci SP™ system was a feasible and safe alternative for the management of presumed early-stage EC. The single-port approach showed high reliability and potential benefits in terms of invasiveness, cosmesis, and postoperative recovery. Larger studies are necessary to further evaluate its role compared to conventional multiport robotic systems.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cancer care presents a huge financial burden to patients globally. This burden is particularly significant in low- and middle-income countries (LMICs) with high poverty rates and minimal sustainable funding models. In Nigeria, the most populous country in Africa with over 100,000 new cancer cases yearly, out-of-pocket costs for cancer care exceed the GDP per capita. The objective of this scoping review is to describe the available options for cancer financing for patients in Nigeria and to make recommendations for researchers and policy makers based on a review of the literature.
Methods
We conducted a comprehensive search of PUBMED, Economic Literature and African Medicus Index databases using a search strategy based on the core concepts of “healthcare financing”, “cancer patients” and “Nigeria”. There were no restrictions by publication timing or study design. However gray literature was excluded. Two independent reviewers conducted abstract screening and full-text review. Conflicts were reconciled by a third reviewer or by consensus where necessary. Data abstraction, synthesis, and analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.
Results
From 408 screened articles, 19 studies met the eligibility criteria, covering a time frame from 2008 to 2024. Most of the studies (14/19) were original research and based in urban (14/19) settings. The majority covered financing options for cancer treatment (16/19), while others covered screening and diagnosis. The available sources of cancer financing can be classified into out-of-pocket (OOP) insurance (public and private), family/relative support, loans, and non-governmental funding. Importantly, OOP was the predominant source of health care financing. Studies reported on the adverse impact of high OOP costs on catastrophic healthcare spending, delays in diagnosis as well as adherence to treatment. Studies unanimously recommended expanding private and public insurance coverage for improving financial risk protection against catastrophic health payments.
Conclusion
Evidence suggests that healthcare financing options are grossly limited for cancer patients in Nigeria with most patients paying OOP. We recommend the implementation of mandatory health insurance and expanded coverage for cancer care services. There is also a need for research into financing options available to patients across different settings, especially in rural and underserved regions. Furthermore, more rigorous study designs to capture financing options for both direct and indirect costs of cancer care are necessary.
癌症治疗给全球患者带来了巨大的经济负担。这一负担在贫困率高、可持续融资模式极少的低收入和中等收入国家尤为严重。尼日利亚是非洲人口最多的国家，每年新发癌症病例超过10万例，其癌症治疗的自付费用超过了人均国内生产总值。本次范围审查的目的是描述尼日利亚患者癌症融资的可用选择，并在文献审查的基础上为研究人员和决策者提出建议。方法采用以“医疗融资”、“癌症患者”和“尼日利亚”为核心概念的检索策略，对PUBMED、Economic Literature和African Medicus Index数据库进行综合检索。没有出版时间或研究设计的限制。但是灰色文献被排除在外。两名独立审稿人进行摘要筛选和全文审查。冲突由第三方审稿人或在必要时通过一致意见进行调解。数据抽象、综合和分析按照系统评价的首选报告项目和范围评价的元分析扩展（PRISMA-ScR）指南进行。结果在408篇筛选文章中，有19项研究符合入选标准，时间跨度为2008年至2024年。大多数研究（14/19）是基于城市环境的原创研究（14/19）。大多数涉及癌症治疗的融资选择（16/19），而其他涉及筛查和诊断。现有的癌症资金来源可分为自费（OOP）保险（公共和私人）、家庭/亲属支持、贷款和非政府资金。重要的是，面向对象方案是保健筹资的主要来源。研究报告了高OOP成本对灾难性医疗保健支出、诊断延误以及坚持治疗的不利影响。研究一致建议扩大私人和公共保险的覆盖范围，以改善针对灾难性健康支付的财务风险保护。结论有证据表明，尼日利亚癌症患者的医疗融资选择严重有限，大多数患者支付OOP。我们建议实施强制性医疗保险，扩大癌症护理服务的覆盖范围。还需要研究不同情况下，特别是在农村和服务不足地区，患者可获得的融资选择。此外，更严格的研究设计是必要的，以捕获癌症治疗的直接和间接成本的融资选择。
{"title":"Cancer care financing in Nigeria: A scoping review of the literature","authors":"Sophia Okeke , Oluwasegun Afolaranmi , Toluwanimi S. Aduloju , Moyinoluwa Akinwumi , Emmanuel Uduigwome , Egide Abahuje , Elieen Wafford , Oluwafemi Akin-Adigun , Kristina Diaz , Funmilola Wuraola , Chinenye Iwuji , Gregory Knapp , Shilpa Murthy , Anna Dare , Olusegun Isaac Alatise , Peter Kingham , Juliet S. Lumati","doi":"10.1016/j.soi.2025.100166","DOIUrl":"10.1016/j.soi.2025.100166","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer care presents a huge financial burden to patients globally. This burden is particularly significant in low- and middle-income countries (LMICs) with high poverty rates and minimal sustainable funding models. In Nigeria, the most populous country in Africa with over 100,000 new cancer cases yearly, out-of-pocket costs for cancer care exceed the GDP per capita. The objective of this scoping review is to describe the available options for cancer financing for patients in Nigeria and to make recommendations for researchers and policy makers based on a review of the literature.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of PUBMED, Economic Literature and African Medicus Index databases using a search strategy based on the core concepts of “healthcare financing”, “cancer patients” and “Nigeria”. There were no restrictions by publication timing or study design. However gray literature was excluded. Two independent reviewers conducted abstract screening and full-text review. Conflicts were reconciled by a third reviewer or by consensus where necessary. Data abstraction, synthesis, and analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.</div></div><div><h3>Results</h3><div>From 408 screened articles, 19 studies met the eligibility criteria, covering a time frame from 2008 to 2024. Most of the studies (14/19) were original research and based in urban (14/19) settings. The majority covered financing options for cancer treatment (16/19), while others covered screening and diagnosis. The available sources of cancer financing can be classified into out-of-pocket (OOP) insurance (public and private), family/relative support, loans, and non-governmental funding. Importantly, OOP was the predominant source of health care financing. Studies reported on the adverse impact of high OOP costs on catastrophic healthcare spending, delays in diagnosis as well as adherence to treatment. Studies unanimously recommended expanding private and public insurance coverage for improving financial risk protection against catastrophic health payments.</div></div><div><h3>Conclusion</h3><div>Evidence suggests that healthcare financing options are grossly limited for cancer patients in Nigeria with most patients paying OOP. We recommend the implementation of mandatory health insurance and expanded coverage for cancer care services. There is also a need for research into financing options available to patients across different settings, especially in rural and underserved regions. Furthermore, more rigorous study designs to capture financing options for both direct and indirect costs of cancer care are necessary.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-26DOI: 10.1016/j.soi.2025.100161
Hameeda Arif Arain, Azeem Izhar, Herbert Chen, C. Corbin Frye
Lymph node metastases in thyroid cancer significantly influence staging, prognosis, and surgical management. The decision to perform a neck dissection primarily depends on the type of thyroid cancer. In differentiated thyroid cancer (papillary and follicular), neck dissections are typically only performed when lymph node metastases are present. In undifferentiated thyroid cancer (medullary and anaplastic), there is a role for prophylactic neck dissection in certain scenarios. One principle shared by all types of thyroid cancer is that neck dissections should be compartment-oriented and are guided by the location and extent of disease. This review outlines the cervical lymph node anatomy, indication for neck dissection, and surgical techniques.
{"title":"Neck dissection in the management of thyroid cancer: An overview","authors":"Hameeda Arif Arain, Azeem Izhar, Herbert Chen, C. Corbin Frye","doi":"10.1016/j.soi.2025.100161","DOIUrl":"10.1016/j.soi.2025.100161","url":null,"abstract":"<div><div>Lymph node metastases in thyroid cancer significantly influence staging, prognosis, and surgical management. The decision to perform a neck dissection primarily depends on the type of thyroid cancer. In differentiated thyroid cancer (papillary and follicular), neck dissections are typically only performed when lymph node metastases are present. In undifferentiated thyroid cancer (medullary and anaplastic), there is a role for prophylactic neck dissection in certain scenarios. One principle shared by all types of thyroid cancer is that neck dissections should be compartment-oriented and are guided by the location and extent of disease. This review outlines the cervical lymph node anatomy, indication for neck dissection, and surgical techniques.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-20DOI: 10.1016/j.soi.2025.100159
LaDonna E. Kearse , Courtney Day , Andrea Zironda , Jessica Mitchell , Zhaohui Jin , Susanne G. Warner , Cornelius A. Thiels
Background and objectives
Hepatic Artery Infusion (HAI) Pump placement and subsequent 6 + months of HAI chemotherapy is an intensive treatment regimen available to select patients with colorectal liver metastasis. The effects on quality of life (QOL) from HAI placement and chemotherapy are largely unknown. We aimed to evaluate the use of patient-reported outcome (PRO) surveys to measure the QOL in these patients.
Methods
Patients scheduled for HAI pump placement between 2022 and 2023 were prospectively enrolled. PROs were collected using PROMIS and LASA scales preoperatively, postoperative (POD) days 2, 7, 14, and monthly until 6 months. Complications were recorded using Clavien-Dindo score.
Results
Twelve patients were included. Median [IQR] age at surgery was 55.0 (43.8–62.5) years. All patients successfully initiated HAI and systemic therapy. Mean (± SD) LASA QOL was 8.0 ± 1.9 preoperatively, 6.4 ± 1.8 on POD 2, 7.2 ± 1.3 at 1 month, 8.2 ± 1.3 at 3 months, and 7.5 ± 1.7 at 6 months. LASA QOL, pain severity, and fatigue scores returned to baseline in 8/11, 10/11, and 8/11 patients at 3 months, respectively. At 6 months, 3/11, 9/11, and 7/11 patients reported return to baseline social, pain, and fatigue scores.
Conclusions
PROMIS and LASA measures are potential tools for evaluating PROs in patient undergoing HAI therapy. Preliminary data suggests baseline QOL mostly returns within 3 months of HAI placement, and initiation of HAI treatment does not appear to significantly impact QOL. These results support the inclusion of such PROs in future randomized trials to assess effects of HAI chemotherapy on QOL.
{"title":"Prospective evaluation of the quality of life and safety in patients receiving hepatic artery infusion pump chemotherapy","authors":"LaDonna E. Kearse , Courtney Day , Andrea Zironda , Jessica Mitchell , Zhaohui Jin , Susanne G. Warner , Cornelius A. Thiels","doi":"10.1016/j.soi.2025.100159","DOIUrl":"10.1016/j.soi.2025.100159","url":null,"abstract":"<div><h3>Background and objectives</h3><div>Hepatic Artery Infusion (HAI) Pump placement and subsequent 6 + months of HAI chemotherapy is an intensive treatment regimen available to select patients with colorectal liver metastasis. The effects on quality of life (QOL) from HAI placement and chemotherapy are largely unknown. We aimed to evaluate the use of patient-reported outcome (PRO) surveys to measure the QOL in these patients.</div></div><div><h3>Methods</h3><div>Patients scheduled for HAI pump placement between 2022 and 2023 were prospectively enrolled. PROs were collected using PROMIS and LASA scales preoperatively, postoperative (POD) days 2, 7, 14, and monthly until 6 months. Complications were recorded using Clavien-Dindo score.</div></div><div><h3>Results</h3><div>Twelve patients were included. Median [IQR] age at surgery was 55.0 (43.8–62.5) years. All patients successfully initiated HAI and systemic therapy. Mean (± SD) LASA QOL was 8.0 ± 1.9 preoperatively, 6.4 ± 1.8 on POD 2, 7.2 ± 1.3 at 1 month, 8.2 ± 1.3 at 3 months, and 7.5 ± 1.7 at 6 months. LASA QOL, pain severity, and fatigue scores returned to baseline in 8/11, 10/11, and 8/11 patients at 3 months, respectively. At 6 months, 3/11, 9/11, and 7/11 patients reported return to baseline social, pain, and fatigue scores.</div></div><div><h3>Conclusions</h3><div>PROMIS and LASA measures are potential tools for evaluating PROs in patient undergoing HAI therapy. Preliminary data suggests baseline QOL mostly returns within 3 months of HAI placement, and initiation of HAI treatment does not appear to significantly impact QOL. These results support the inclusion of such PROs in future randomized trials to assess effects of HAI chemotherapy on QOL.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100159"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144365875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-18DOI: 10.1016/j.soi.2025.100158
Autumn Beavers , Juliet S. Lumati , Erika Clarke , Yilin Yang , Jin He
Introduction
Post-operative portal vein thrombosis (PPVT) is a potentially fatal complication following pancreatectomy and can occur in 1.2–5 %1 of patients after resection. Treatment strategies include therapeutic anticoagulation (TAC), portal vein stent (PVS), or thrombectomy. To date, there has been no consensus on the optimal treatment strategy. The objective of this study is to systematically review the incidence and management of PPVT following pancreatectomy and to compare the clinical outcomes of treatment.
Methods
We conducted a systematic review and searched Embase, PubMed, Cochrane, Web of Science, and Scopus databases for studies published between December 1990 and July 2022. MeSH terms were used to identify quantitative studies involving pancreatectomies and PPVT. We extracted data on the PPVT incidence, management, and clinical outcomes, which included thrombus resolution rate and 90-day mortality. Two reviewers [YY, AB] independently performed study selection, data abstraction, and quality assessment.
Results
Of the 1028 studies initially identified, 12 were eligible for inclusion. Pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were the most common surgeries performed. The incidence of PPVT ranged from 1.5 % to 26 %. Five studies reported outcomes of TAC, three reported outcomes of PVS, and five reported outcomes for patients treated with multiple strategies. Of the TAC-only studies, 1 study reported 100 % thrombus resolution (n = 2). 3 studies found no difference in thrombus resolution rate or mortality. In the 3 studies that reported PVS-only, initial technical success rates were 66.7 % (n = 3), 100 % (n = 3), and 100 % (n = 9), respectively. Long-term patency rates were not uniformly reported. Most deaths were reported in studies that performed surgical thrombectomy (4 studies, mortality rate of 40–100 %) compared to TAC-only (1 study, mortality rate of 33 %), and PVS-only (1 study, mortality rate of 66 %).
Conclusion
PPVT is often managed with combined strategies and, less commonly with thrombectomy or PVS alone. PVS has high initial technical success rates, though the long-term patency rate is limited to small case series. Mortality was most frequently reported in patients treated with surgical thrombectomy; this might be because of selection bias for high-risk patients. Thrombus resolution after treatment was not consistently reported in the literature. Given the significant heterogeneity between studies, there is no consensus on the optimal strategy. Larger quantitative studies that routinely assess treatment response and report long-term outcomes are needed.
{"title":"Management of post-operative portal vein thrombosis after pancreatectomy: A systematic review","authors":"Autumn Beavers , Juliet S. Lumati , Erika Clarke , Yilin Yang , Jin He","doi":"10.1016/j.soi.2025.100158","DOIUrl":"10.1016/j.soi.2025.100158","url":null,"abstract":"<div><h3>Introduction</h3><div>Post-operative portal vein thrombosis (PPVT) is a potentially fatal complication following pancreatectomy and can occur in 1.2–5 %<sup>1</sup> of patients after resection. Treatment strategies include therapeutic anticoagulation (TAC), portal vein stent (PVS), or thrombectomy. To date, there has been no consensus on the optimal treatment strategy. The objective of this study is to systematically review the incidence and management of PPVT following pancreatectomy and to compare the clinical outcomes of treatment.</div></div><div><h3>Methods</h3><div>We conducted a systematic review and searched Embase, PubMed, Cochrane, Web of Science, and Scopus databases for studies published between December 1990 and July 2022. MeSH terms were used to identify quantitative studies involving pancreatectomies and PPVT. We extracted data on the PPVT incidence, management, and clinical outcomes, which included thrombus resolution rate and 90-day mortality. Two reviewers [YY, AB] independently performed study selection, data abstraction, and quality assessment.</div></div><div><h3>Results</h3><div>Of the 1028 studies initially identified, 12 were eligible for inclusion. Pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy were the most common surgeries performed. The incidence of PPVT ranged from 1.5 % to 26 %. Five studies reported outcomes of TAC, three reported outcomes of PVS, and five reported outcomes for patients treated with multiple strategies. Of the TAC-only studies, 1 study reported 100 % thrombus resolution (n = 2). 3 studies found no difference in thrombus resolution rate or mortality. In the 3 studies that reported PVS-only, initial technical success rates were 66.7 % (n = 3), 100 % (n = 3), and 100 % (n = 9), respectively. Long-term patency rates were not uniformly reported. Most deaths were reported in studies that performed surgical thrombectomy (4 studies, mortality rate of 40–100 %) compared to TAC-only (1 study, mortality rate of 33 %), and PVS-only (1 study, mortality rate of 66 %).</div></div><div><h3>Conclusion</h3><div>PPVT is often managed with combined strategies and, less commonly with thrombectomy or PVS alone. PVS has high initial technical success rates, though the long-term patency rate is limited to small case series. Mortality was most frequently reported in patients treated with surgical thrombectomy; this might be because of selection bias for high-risk patients. Thrombus resolution after treatment was not consistently reported in the literature. Given the significant heterogeneity between studies, there is no consensus on the optimal strategy. Larger quantitative studies that routinely assess treatment response and report long-term outcomes are needed.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100158"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144724765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-06-16DOI: 10.1016/j.soi.2025.100157
Noah S. Brown , Matthew A. Firpo , Courtney L. Scaife
Introduction
The current standard for preoperative nodal staging for pancreatic adenocarcinoma, endoscopic ultrasound, varies widely in its accuracy, with pathologic concurrence as low as 41 %. Patients who are found to have 4 or more pathologically positive lymph nodes are defined as N2 nodal status. These patients experience extremely poor overall survival.
Objective
We sought to identify any biomarkers specific to this patient population to better stratify these patients pre-operatively.
Methods
We began with an existing database of patients with histologically confirmed pancreatic adenocarcinoma treated at the University of Utah between January 2004 and October 2019. These patients and their biological samples have already been screened using a 31 analyte panel to detect early stage disease. We recategorized these patients using the updated AJCC 8th edition introducing N2 disease. The individual analytes were then screened for their ability to distinguish N2 disease.
Results
Basigin (BSG) was significantly elevated in N2 disease (mean 17.45, SD 13.53) compared to N0 disease (mean 12.09, SD 11.47), p = 0.014 by Dunn's test) while Leucine-rich alpha-2-glycoprotein 1 (LRG1) was significantly decreased in N2 disease (mean 3446.21, SD 2719.12) compared to N0 disease (mean 5727.25, SD 3236.40, p = 0.025).
Conclusion
BSG and LRG1 could be useful in preoperatively identifying candidates that would benefit most from resection. This offers a foundation for future studies to combine biomarkers and clinical factors into a machine learning algorithm to reliably distinguish N2 disease in the preoperative setting. This may affect the pre-surgical discussion and provide vital prognostic information to patients.
{"title":"Pre-operative biomarkers may predict nodal status in pancreatic ductal adenocarcinoma","authors":"Noah S. Brown , Matthew A. Firpo , Courtney L. Scaife","doi":"10.1016/j.soi.2025.100157","DOIUrl":"10.1016/j.soi.2025.100157","url":null,"abstract":"<div><h3>Introduction</h3><div>The current standard for preoperative nodal staging for pancreatic adenocarcinoma, endoscopic ultrasound, varies widely in its accuracy, with pathologic concurrence as low as 41 %. Patients who are found to have 4 or more pathologically positive lymph nodes are defined as N2 nodal status. These patients experience extremely poor overall survival.</div></div><div><h3>Objective</h3><div>We sought to identify any biomarkers specific to this patient population to better stratify these patients pre-operatively.</div></div><div><h3>Methods</h3><div>We began with an existing database of patients with histologically confirmed pancreatic adenocarcinoma treated at the University of Utah between January 2004 and October 2019. These patients and their biological samples have already been screened using a 31 analyte panel to detect early stage disease. We recategorized these patients using the updated AJCC 8th edition introducing N2 disease. The individual analytes were then screened for their ability to distinguish N2 disease.</div></div><div><h3>Results</h3><div>Basigin (BSG) was significantly elevated in N2 disease (mean 17.45, SD 13.53) compared to N0 disease (mean 12.09, SD 11.47), p = 0.014 by Dunn's test) while Leucine-rich alpha-2-glycoprotein 1 (LRG1) was significantly decreased in N2 disease (mean 3446.21, SD 2719.12) compared to N0 disease (mean 5727.25, SD 3236.40, p = 0.025).</div></div><div><h3>Conclusion</h3><div>BSG and LRG1 could be useful in preoperatively identifying candidates that would benefit most from resection. This offers a foundation for future studies to combine biomarkers and clinical factors into a machine learning algorithm to reliably distinguish N2 disease in the preoperative setting. This may affect the pre-surgical discussion and provide vital prognostic information to patients.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100157"},"PeriodicalIF":0.0,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144330592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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