Surgical Oncology Insight最新文献_第8页

Intraoperative fluid management in patients undergoing CRS-HIPEC, a retrospective study CRS-HIPEC患者术中液体处理的回顾性研究

Surgical Oncology Insight

Pub Date : 2025-03-08 DOI: 10.1016/j.soi.2025.100133

Mark Antkowiak , Megan Meyer , Gerard Manecke , Harpreet Gill , Andrew Lowy , Jula Veerapong , Joel Baumgartner

Introduction

CRS-HIPEC requires complex perioperative fluid management due to the associated physiologic disturbances. Several studies have postulated that restrictive intraoperative fluid management is associated with decreased postoperative morbidity. Evidence-based guidelines for fluid management in CRS-HIPEC have not yet been established and proper management of intraoperative fluid therapy remains controversial.

Methods

We performed a retrospective cohort study on patients undergoing CRS-HIPEC at a high-volume center with a total of 620 procedures performed from March 2011 to December 2020. Patients were split into restrictive and liberal fluid administration groups by intraoperative fluid administration rate and the primary outcome of comprehensive complication index (CCI) was compared between groups. Univariable and multivariable regression analyses were performed to evaluate the association of perioperative factors on outcomes and to control for confounding factors.

Results

Of 620 total procedures performed, 58 were excluded due to missing data. In the remaining procedures, patients had a mean age of 55 years (range 20, 86), mean peritoneal carcinomatosis index of 13.8 (CI 13.1, 14.5), and mean intraoperative fluid administration rate of 12.1 mL/kg/hr (CI 11.7, 12.5). The mean CCI for the restrictive fluid management group was 12.5 (CI 10.8, 14.3) and for the liberal group was 14.2 (CI 12.5, 16.1) [p = 0.18]. Univariable and multivariable regression analyses showed no association between intraoperative fluid rate and CCI (univariable coefficient = 0.17, p = 0.19; multivariable coefficient = 0.14, p = 0.52).

Conclusions

Restrictive intraoperative fluid management during CRS-HIPEC is not associated with decreased postoperative morbidity as measured by CCI.

Synopsis

This is the largest study to date evaluating the association of intraoperative fluid administration with postoperative complications in patients undergoing CRS-HIPEC. We find that fluid administration strategy is not associated with postoperative complications. Rather than restrictive management, our study suggests that fluid administration should be tailored to individual patient needs.

导言由于相关的生理紊乱，CRS-HIPEC 需要复杂的围手术期液体管理。多项研究推测，限制性术中液体管理与降低术后发病率有关。CRS-HIPEC 术中液体管理的循证指南尚未确立，术中液体治疗的正确管理仍存在争议。方法我们对一家高流量中心的 CRS-HIPEC 患者进行了一项回顾性队列研究，研究对象是 2011 年 3 月至 2020 年 12 月期间接受 CRS-HIPEC 的 620 例患者。根据术中输液率将患者分为限制性输液组和自由输液组，并比较两组间的主要结果--综合并发症指数（CCI）。进行单变量和多变量回归分析，以评估围手术期因素与预后的关系，并控制混杂因素。在剩余的手术中，患者的平均年龄为 55 岁（20-86 岁不等），平均腹膜癌变指数为 13.8（CI 13.1-14.5），平均术中输液量为 12.1 mL/kg/hr（CI 11.7-12.5）。限制性液体管理组的平均 CCI 为 12.5（CI 10.8，14.3），自由组为 14.2（CI 12.5，16.1）[p = 0.18]。单变量和多变量回归分析表明，术中输液率与 CCI 之间没有关联（单变量系数 = 0.17，P = 0.19；多变量系数 = 0.14，P = 0.52）。摘要这是迄今为止评估术中输液与接受 CRS-HIPEC 患者术后并发症关系的最大规模研究。我们发现输液策略与术后并发症无关。我们的研究表明，输液管理应根据患者的个体需求量身定制，而不是限制性管理。

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引用次数: 0

The evolving treatment for early-stage lung cancer: Immunotherapy 早期肺癌的新疗法：免疫疗法

Surgical Oncology Insight

Pub Date : 2025-03-04 DOI: 10.1016/j.soi.2025.100128

Erin A. Gillaspie

This review article is about the development and use of immunotherapy in the evolving treatment for early-stage lung cancer, which has profoundly altered the treatment landscape. As described in this article, early trial efforts and approvals concentrated on agents for use in the adjuvant phase of treatment and then moved to the neoadjuvant setting. Seminal trials and results are described.

这篇综述文章是关于免疫疗法在早期肺癌治疗中的发展和应用，它已经深刻地改变了治疗前景。如本文所述，早期的试验和批准主要集中在辅助治疗阶段，然后转移到新辅助治疗阶段。描述了开创性的试验和结果。

引用次数: 0

A single institution experience using ultrasound-guided intralesional immunotherapy in recurrent melanoma 超声引导下病灶内免疫治疗复发性黑色素瘤的单一机构经验

Surgical Oncology Insight

Pub Date : 2025-03-01 DOI: 10.1016/j.soi.2025.100130

Olivia P. Waldron , Joanna T. Buchheit , Colette R. Pameijer

Background and objectives

Intralesional therapy for recurrent melanoma is well-established for palpable lesions, however the benefit of ultrasound-guided (US) injections for non-palpable melanoma has not been well-established. This study evaluates the safety and efficacy of US-guided injection of talimogene laherparepvec (T-VEC) in the treatment of recurrent melanoma.

Methods

A single-institution retrospective chart review was conducted of patients who received T-VEC between 2018 and 2023. T-tests, Fisher’s exact tests and Chi-squared tests compared patient and treatment characteristics, side effects and outcomes between US-guided and non-US guided injections.

Results

Of 36 patients, 11 (31 %) underwent US-guided and 25 (69 %) underwent non-US-guided T-VEC injections. The most common side effects in both groups were fever and chills. The US-guided cohort had no local or systemic complications while the non-US guided group had three patients with complications. Similar response (complete or partial) rates (63.6 % US guided vs 60 % non-US guided) and progression (36.4 % US-guided vs 36 % non-US guided) occurred among the cohorts (p = 0.8). Six-month survival after starting T-VEC treatment was 72.7 % in US-guided and 76 % in non-US guided (p = 0.84).

Conclusions

US-guided injections for non-palpable recurrent melanoma are safe and demonstrate similar efficacy to non-US-guided injections, which increases treatment options for some patients.

背景和目的病灶内治疗复发性黑色素瘤对于可触及的病变是公认的，然而超声引导（US）注射对于不可触及的黑色素瘤的益处尚未确定。本研究评估了美国引导注射利莫gene laherparepvec （T-VEC）治疗复发性黑色素瘤的安全性和有效性。方法对2018 - 2023年接受T-VEC治疗的患者进行单机构回顾性图表分析。t检验、Fisher精确检验和卡方检验比较了美国引导和非美国引导注射之间的患者和治疗特征、副作用和结果。结果36例患者中，11例（31 %）接受了us引导，25例（69 %）接受了非us引导的T-VEC注射。两组中最常见的副作用都是发烧和发冷。美国引导组没有出现局部或全身并发症，而非美国引导组有3例患者出现并发症。相似的缓解（完全或部分）率（63.6% %美国指导vs 60% %非美国指导）和进展（36.4% %美国指导vs 36% %非美国指导）在队列中发生（p = 0.8）。开始T-VEC治疗后的6个月生存率，us引导组为72.7 %，非us引导组为76 % （p = 0.84）。结论超声引导下注射治疗复发性不可触及黑色素瘤是安全的，其疗效与非超声引导下注射相似，增加了部分患者的治疗选择。

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引用次数: 0

Starting a Hepato-Pancreato-Biliary surgery program from scratch: Closing the gap in West Africa 从零开始肝胆胰手术项目：缩小西非的差距

Surgical Oncology Insight

Pub Date : 2025-02-21 DOI: 10.1016/j.soi.2025.100132

Olusegun I. Alatise , Erica Mann , Catherine N. Zivanov , Titilayo A. Ojumu , Adewale A. Aderounmu , Adewale O. Adisa

The burden of hepato-pancreato-biliary (HPB) disease in West Africa ranks among the highest incidence rates and poorest survival outcomes globally. In this paper, we discuss the landscape of HPB disease in West Africa and the available infrastructure to mitigate it. We describe the development of the HPB surgery program at Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), a tertiary referral and teaching hospital in Ile-Ife, Osun State, Nigeria. We detail our case volume and describe our progressive development towards becoming the singular dedicated HPB surgery and only endoscopic retrograde cholangiopancreatography (ERCP) program in Nigeria. Our hospital’s capacity to be a leader in this way can partly be attributed to our successful partnerships with international collaborators.

西非的肝-胰-胆（HPB）疾病负担是全球发病率最高和生存结果最差的国家之一。在本文中，我们讨论了西非HPB疾病的景观和现有的基础设施，以减轻它。我们描述了在Obafemi Awolowo大学教学医院综合体（OAUTHC）的HPB手术项目的发展，这是一家位于尼日利亚奥孙州Ile-Ife的三级转诊和教学医院。我们详细介绍了我们的病例数量，并描述了我们逐步发展成为尼日利亚唯一的专门的HPB手术和内窥镜逆行胆管胰胆管造影（ERCP）项目。我们医院在这方面处于领先地位的能力部分归功于我们与国际合作者的成功伙伴关系。

引用次数: 0

Society of surgical oncology medical student & trainee primer for breast surgical oncology 肿瘤外科学会乳腺肿瘤外科医学生和实习生入门指南

Surgical Oncology Insight

Pub Date : 2025-02-13 DOI: 10.1016/j.soi.2025.100129

Marissa K. Boyle , Julia M. Selfridge , Rachel E. Sargent , Y. Everett Warren Jr , Julia M. Chandler , Christopher P. Childers , Breast Specialty Members, 2024-2025 SSO Fellows and Young Attendings Committee

The goal of this primer is to educate the future generation of surgeons and prepare trainees for their clinical rotations in the operating room and with patient care. This primer will introduce medical students and trainees to the management of benign breast disease and breast cancer for their clinical breast surgical oncology rotation. More comprehensive management of patients and the knowledge required to do so will stem from the most recent clinical trials and advances in the field, which is ever evolving.

本入门的目标是教育下一代外科医生，并为他们在手术室和病人护理的临床轮转做好准备。本读本将向医学生和实习生介绍乳腺良性疾病和乳腺癌的管理，以供临床乳腺外科肿瘤轮转。更全面的患者管理和这样做所需的知识将源于最新的临床试验和该领域的进展，这是不断发展的。

引用次数: 0

Real world experience with omission of therapeutic lymph node dissection in clinical stage III malignant melanoma treated with checkpoint or kinase inhibition systemic therapy 临床III期恶性黑色素瘤采用检查点或激酶抑制全身性治疗时遗漏治疗性淋巴结清扫的真实世界经验

Surgical Oncology Insight

Pub Date : 2025-02-13 DOI: 10.1016/j.soi.2025.100131

Michael J. Kirsch , Elliott J. Yee , Patrick Hosokawa , William Robinson , Theresa Medina , Luke Mantle , John Blair Hamner , Martin D. McCarter , Camille L. Stewart

Background

Management of clinical stage III melanoma, which historically was treated with surgical therapeutic lymph node dissection (TLND), has changed significantly due to the introduction of effective systemic therapies including immune checkpoint and BRAF/MEK inhibitors. We asked how surgical interventions changed progression free survival and overall survival in this population.

Methods

The Flatiron Health electronic health records database for Advanced Melanoma was queried for patients with clinical stage III melanoma treated between 2018 and 2022 with systemic therapy. Patients were stratified by receipt of TLND.

Results

There were 533 patients with clinical stage III melanoma treated with systemic therapy identified; 235 (44.1 %) underwent TLND prior to systemic therapy, 17 (3.2 %) underwent TLND after receipt of systemic therapy, and 281 (52.7 %) received systemic therapy alone and did not have surgery. There were 38.1 % (n = 203) who experienced disease progression at 2 years. Patients in the no surgery group had the best 2-year progression free survival (67.3 %) compared to the upfront surgery (58.3 %) and surgery after systemic therapy groups (23.5 %, p = 0.001), and there was no difference in 2-year overall survival (82.2 % vs 80.0 % vs 82.3 %, p = 0.81). These findings persisted on multivariable analysis.

Conclusions

In this modern era dataset, more than half of patients with clinical stage III melanoma were treated with systemic therapy alone, despite guideline recommendations for TLND. They had superior progression free survival and similar overall survival compared to those also treated with potentially morbid surgery. Randomized data are needed to evaluate appropriate omission of surgery in this patient population.

临床III期黑色素瘤的治疗，历来通过手术治疗性淋巴结清扫（TLND）治疗，由于引入了有效的全身疗法，包括免疫检查点和BRAF/MEK抑制剂，已经发生了重大变化。我们询问手术干预如何改变该人群的无进展生存期和总生存期。方法查询Flatiron Health晚期黑色素瘤电子健康记录数据库，查询2018年至2022年接受全身治疗的临床III期黑色素瘤患者。患者通过接受TLND进行分层。结果533例临床III期黑色素瘤患者接受了全身治疗；235例（44.1% %）患者在接受全身治疗前接受了TLND， 17例（3.2 %）患者在接受全身治疗后接受了TLND， 281例（52.7% %）患者单独接受了全身治疗，未进行手术。38.1 % （n = 203）的患者在2年内出现疾病进展。患者无手术组有最好的2年无进展生存(67.3 %)相比前期手术(58.3 %),手术后全身疗法组(23.5 % p = 0.001),和没有区别2年总生存期(82.2 vs 80.0  % % 82.3 vs %,p = 0.81)。这些发现在多变量分析中仍然存在。结论：在这个现代数据集中，超过一半的临床III期黑色素瘤患者单独接受了全身治疗，尽管指南推荐TLND。与那些接受潜在病态手术治疗的患者相比，他们有更好的无进展生存和相似的总生存。需要随机数据来评估在该患者群体中是否适当省略手术。

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引用次数: 0

Robotic right posterior sectionectomy for biliary cystadenoma. Description of standardized approach in anatomical liver resection 机器人右侧胆囊囊腺瘤后切开术。解剖性肝切除术的标准化入路描述

Surgical Oncology Insight

Pub Date : 2025-01-27 DOI: 10.1016/j.soi.2025.100127

Parisa Y. Kenary, Sharona Ross, Iswanto Sucandy

Objective

With recent advances in surgical technology, minimally invasive liver resection is gradually becoming the gold-standard practice 1, 2, 4. Biliary cystadenoma is a rare tumor with malignant potential, therefore parenchymal-sparing liver resection is the preferred approach 3, 4. Due to its technical challenge, laparoscopic or robotic anatomical right posterior sectionectomy are infrequently performed in daily practice and rarely described in multimedia literatures. Herein, we describe our standardized technique for robotic right posterior sectionectomy.

Methods

A 65-year-old woman presented with a complex 5.3 cm multiloculated liver cyst involving segment 6/7. CT scan and MRI revealed multiple enhancing solid mural nodules and thickened septum concerning for neoplasm. Right posterior sectoral portal vein and hepatic artery were ligated to establish inflow control. After an adequate liver mobilization and dissection of hepatocaval confluence, the line of the parenchymal transection was drawn toward the root of the right hepatic vein following a demarcation line. Mapping of the middle and right hepatic veins was undertaken using ultrasonic guidance. Parenchymal division was undertaken under intermittent Pringle maneuver as necessary. The operation was completed with transection of the right hepatic vein using a robotic stapler.

Results

The operative time of 5 hours with minimal blood loss. The postoperative course was uneventful. A final pathology report confirmed a 6 cm multiloculated biliary cystadenoma without evidence of invasive carcinoma.

Conclusion

Robotic right posterior sectionectomy is technically demanding, however feasible, safe, and reproducible. We believe this technique can provide an alternative method to the conventional open operation for segment 6/7 liver tumor resection.

目的随着外科技术的进步，微创肝切除术正逐渐成为金标准。胆道囊腺瘤是一种罕见的有恶性潜能的肿瘤，因此保留肝实质切除是首选的方法3,4。由于其技术上的挑战，腹腔镜或机器人解剖右后段切除术在日常实践中很少进行，也很少在多媒体文献中进行描述。在此，我们描述了我们的标准化技术的机器人右后路切除术。方法一名65岁女性患者为复杂的5.3 cm多房性肝囊肿，累及6/7节段。CT及MRI显示多发强化实性壁结节及中隔增厚，可能为肿瘤。结扎右后门静脉及肝动脉以控制血流。在充分的肝脏动员和肝腔汇合处剥离后，肝实质横断线沿着分界线向右肝静脉根方向绘制。超声引导下绘制肝中、右静脉。必要时以间歇性普林格尔手法进行实质分割。手术通过机器人吻合器切断右肝静脉完成。结果手术时间5 h，出血量最小。术后过程平淡无奇。最后的病理报告证实了一个6 厘米的多室胆道囊腺瘤，没有浸润性癌的证据。结论机器人右后路切除术技术要求高，但可行、安全、可重复性好。我们相信该技术可以为6/7节段肝肿瘤切除术提供一种传统开放手术的替代方法。

{"title":"Robotic right posterior sectionectomy for biliary cystadenoma. Description of standardized approach in anatomical liver resection","authors":"Parisa Y. Kenary, Sharona Ross, Iswanto Sucandy","doi":"10.1016/j.soi.2025.100127","DOIUrl":"10.1016/j.soi.2025.100127","url":null,"abstract":"<div><h3>Objective</h3><div>With recent advances in surgical technology, minimally invasive liver resection is gradually becoming the gold-standard practice <span><span>1</span></span>, <span><span>2</span></span>, <span><span>4</span></span>. Biliary cystadenoma is a rare tumor with malignant potential, therefore parenchymal-sparing liver resection is the preferred approach <span><span>3</span></span>, <span><span>4</span></span>. Due to its technical challenge, laparoscopic or robotic anatomical right posterior sectionectomy are infrequently performed in daily practice and rarely described in multimedia literatures. Herein, we describe our standardized technique for robotic right posterior sectionectomy.</div></div><div><h3>Methods</h3><div>A 65-year-old woman presented with a complex 5.3 cm multiloculated liver cyst involving segment 6/7. CT scan and MRI revealed multiple enhancing solid mural nodules and thickened septum concerning for neoplasm. Right posterior sectoral portal vein and hepatic artery were ligated to establish inflow control. After an adequate liver mobilization and dissection of hepatocaval confluence, the line of the parenchymal transection was drawn toward the root of the right hepatic vein following a demarcation line. Mapping of the middle and right hepatic veins was undertaken using ultrasonic guidance. Parenchymal division was undertaken under intermittent Pringle maneuver as necessary. The operation was completed with transection of the right hepatic vein using a robotic stapler.</div></div><div><h3>Results</h3><div>The operative time of 5 hours with minimal blood loss. The postoperative course was uneventful. A final pathology report confirmed a 6 cm multiloculated biliary cystadenoma without evidence of invasive carcinoma.</div></div><div><h3>Conclusion</h3><div>Robotic right posterior sectionectomy is technically demanding, however feasible, safe, and reproducible. We believe this technique can provide an alternative method to the conventional open operation for segment 6/7 liver tumor resection.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143183218","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}

引用次数: 0

Prognostic factors for patients with T2/T3 gallbladder cancer: Does extent of resection matter? T2/T3胆囊癌患者的预后因素：切除程度重要吗？

Surgical Oncology Insight

Pub Date : 2025-01-27 DOI: 10.1016/j.soi.2025.100126

Stacy Goins , Kristen E. Rhodin , Austin M. Eckhoff , Michela Fabricius , Allison N. Martin , Daniel P. Nussbaum , Garth Herbert , Kevin N. Shah , Sabino Zani , Dan G. Blazer , Peter J. Allen , Michael E. Lidsky

Background

Gallbladder cancer (GBC) portends a poor prognosis, and guidelines recommend radical cholecystectomy for patients with T1b and greater disease. We evaluated prognostic factors for T2 and T3 GBC among a contemporary cohort.

Methods

The National Cancer Database (NCDB) was queried for patients with resected pathologic T2 and T3 GBC from 2004 to 2018. Patients were stratified by extent of resection: simple (SC) vs radical cholecystectomy (RC). Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods.

Results

Altogether, 10,107 patients (6426 [63.6 %] T2; 3681 [36.4 %] T3) were identified: 2203 (21.8 %) underwent SC and 7904 (78.2 %) RC. Patients with SC were more likely to have T2 disease, negative nodes, and positive margins. Tumor grade, node positivity, margin positivity, and T3 stage were associated with greater mortality. Treatment at an academic center and receipt of adjuvant chemotherapy were associated with improved survival. Extent of surgical resection was not associated with OS in unadjusted and adjusted analyses (adjusted HR 0.98, 95 % CI 0.92–1.05, p = 0.62).

Discussion

Outcomes for patients with resected T2 and T3 GBC remain poor, though these retrospective data suggest RC is not associated with better OS. Multidisciplinary management and prospective investigation are needed to advance outcomes and facilitate selection of patients who may benefit from radical resection.

胆囊癌（GBC）预示着预后不良，指南建议对T1b及更严重疾病的患者进行根治性胆囊切除术。我们在一个当代队列中评估了T2和T3 GBC的预后因素。方法查询2004 - 2018年病理切除的T2和T3 GBC患者的国家癌症数据库（NCDB）。根据切除程度对患者进行分层：单纯（SC）和根治性胆囊切除术（RC）。采用Kaplan-Meier法和多变量Cox比例风险法比较总生存期（OS）。结果共10107例(6426例[63.6 %]T2；其中，2203例（21.8% %）行SC， 7904例（78.2% %）行RC。SC患者更容易出现T2病变、阴性淋巴结和阳性边缘。肿瘤分级、淋巴结阳性、边缘阳性和T3分期与较高的死亡率相关。在学术中心接受治疗和接受辅助化疗与生存率的提高有关。在未调整和调整分析中，手术切除程度与OS无关（调整后危险度0.98,95 % CI 0.92-1.05, p = 0.62）。切除T2和T3 GBC患者的预后仍然很差，尽管这些回顾性数据表明RC与更好的OS无关。需要多学科管理和前瞻性调查来提高预后，并方便选择可能从根治性切除术中受益的患者。

{"title":"Prognostic factors for patients with T2/T3 gallbladder cancer: Does extent of resection matter?","authors":"Stacy Goins , Kristen E. Rhodin , Austin M. Eckhoff , Michela Fabricius , Allison N. Martin , Daniel P. Nussbaum , Garth Herbert , Kevin N. Shah , Sabino Zani , Dan G. Blazer , Peter J. Allen , Michael E. Lidsky","doi":"10.1016/j.soi.2025.100126","DOIUrl":"10.1016/j.soi.2025.100126","url":null,"abstract":"<div><h3>Background</h3><div>Gallbladder cancer (GBC) portends a poor prognosis, and guidelines recommend radical cholecystectomy for patients with T1b and greater disease. We evaluated prognostic factors for T2 and T3 GBC among a contemporary cohort.</div></div><div><h3>Methods</h3><div>The National Cancer Database (NCDB) was queried for patients with resected pathologic T2 and T3 GBC from 2004 to 2018. Patients were stratified by extent of resection: simple (SC) vs radical cholecystectomy (RC). Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods.</div></div><div><h3>Results</h3><div>Altogether, 10,107 patients (6426 [63.6 %] T2; 3681 [36.4 %] T3) were identified: 2203 (21.8 %) underwent SC and 7904 (78.2 %) RC. Patients with SC were more likely to have T2 disease, negative nodes, and positive margins. Tumor grade, node positivity, margin positivity, and T3 stage were associated with greater mortality. Treatment at an academic center and receipt of adjuvant chemotherapy were associated with improved survival. Extent of surgical resection was not associated with OS in unadjusted and adjusted analyses (adjusted HR 0.98, 95 % CI 0.92–1.05, p = 0.62).</div></div><div><h3>Discussion</h3><div>Outcomes for patients with resected T2 and T3 GBC remain poor, though these retrospective data suggest RC is not associated with better OS. Multidisciplinary management and prospective investigation are needed to advance outcomes and facilitate selection of patients who may benefit from radical resection.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 1","pages":"Article 100126"},"PeriodicalIF":0.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143298665","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}

引用次数: 0

Hepatic and peri-hepatic cytoreductive surgery in low-grade appendiceal mucinous neoplasms 低级别阑尾黏液性肿瘤的肝脏及肝周细胞减少术

Surgical Oncology Insight

Pub Date : 2025-01-22 DOI: 10.1016/j.soi.2025.100125

Catherine R. Lewis, Tamara L. Floyd, Casey J. Allen, David L. Bartlett, Patrick L. Wagner

Background

Low-grade appendiceal mucinous neoplasm (LAMN) is a rare tumor that carries a risk of rupture causing pseudomyxoma peritonei (PMP). With PMP, intraperitoneal surfaces and organs become involved, including the liver capsule, porta hepatis, and peri-hepatic regions. Extensive porta hepatis and peri-hepatic involvement in PMP is often cited as a contraindication for cytoreduction. We present a retrospective review of successful cytoreductive surgery (CRS) in patients with LAMN involvement of the porta hepatis and peri-hepatic tissues.

Methods

A retrospective review identified patients over a 3-year period with a diagnosis of LAMN with porta hepatis and peri-hepatic involvement. Peri-operative records were reviewed for all patients who met study criteria.

Results

We identified 41 patients with LAMN and porta hepatis and/or peri-hepatic involvement who underwent CRS with successful debulking of these regions. Non-anatomic hepatic parenchymal resection was required in 19 patients. Median peritoneal carcinoma index was 28, and median length of stay was 13.5 days. Clavien-Dindo Grade ≥ 3 complications were seen following 36 % of cases, with no liver-specific morbidity and no peri-operative mortalities.

Discussion

Peri-hepatic or portal involvement by PMP can be safely addressed during CRS and should not preclude attempts at complete cytoreduction in appropriate patients who may achieve long-term disease control.

背景：低级别阑尾黏液瘤（LAMN）是一种罕见的肿瘤，具有破裂风险，可导致腹膜假性黏液瘤（PMP）。PMP累及腹腔内表面和器官，包括肝包膜、肝门和肝周区域。广泛的肝门和肝周累及PMP常被认为是细胞减少的禁忌症。我们提出了一个回顾性的回顾成功的细胞减少手术（CRS）患者的LAMN累及肝门和肝周组织。方法回顾性分析诊断为肝门及肝周累及LAMN的3年以上患者。回顾了所有符合研究标准的患者的围手术期记录。结果我们确定了41例LAMN和肝门及/或肝周受累的患者，他们接受了CRS手术，并成功切除了这些区域。19例患者行非解剖性肝实质切除术。腹膜癌中位指数为28，中位住院时间为13.5天。36% %的病例出现≥3级的Clavien-Dindo并发症，无肝脏特异性发病率和围手术期死亡率。在CRS期间，PMP累及肝周或门静脉是可以安全处理的，不应排除对可能实现长期疾病控制的适当患者进行完全细胞减少的尝试。

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引用次数: 0

Optimal surveillance for detecting sarcoma lung metastasis – A systematic review 检测肉瘤肺转移的最佳监控方法 - 系统综述

Surgical Oncology Insight

Pub Date : 2025-01-15 DOI: 10.1016/j.soi.2025.100124

Neha Malik, Kate Krause, Emily Z. Keung, Heather G. Lyu, Heather Lillemoe, Christopher Scally, Keila Torres, Kelly Hunt, Mary Austin, Christina L. Roland

Introduction

Accurate diagnosis of lung metastasis for patients with soft tissue sarcoma (STS) can impact overall survival, but there is considerable variability in imaging utilized to detect metastasis. Chest x-ray (CXR) or computer tomography (CT) scan of the chest are the most common studies in current practice.

Methods

A systematic literature search was performed. Databases were searched from inception to January 3, 2024. Articles were reviewed to determine if CXR or CT chest was associated with improved overall or recurrence-free survival in patients with STS. Articles were also reviewed for data on cost-effectiveness of CXR versus CT chest. The quality of evidence was assessed by the Critical Appraisal Skills Programme.

Results

259 abstracts were screened, and twenty-seven studies were selected for full-text review. Nine studies met all inclusion criteria. Seven studies included data on survival or recurrence rates and four included data on the cost of imaging modality. The seven studies all had conflicting results on the impact of CXR versus chest CT on survival and recurrence. The four studies that looked at cost found that CXR was more cost-effective, but in certain patients, screening with chest CT could be cost-effective.

Conclusion

The literature defining the optimal surveillance method for lung metastases for patients with STS is limited. Most of the studies had a low quality of evidence due to study design and significant risk of bias. Randomized controlled trials are needed to further understand the best imaging modality for lung metastasis surveillance in this patient population.

导言软组织肉瘤（STS）患者肺转移的准确诊断会影响患者的总生存率，但用于检测转移的成像技术存在很大差异。胸部 X 光（CXR）或胸部计算机断层扫描（CT）是目前最常用的检查方法。检索了从开始到 2024 年 1 月 3 日的数据库。对文章进行了审查，以确定 CXR 或胸部 CT 是否与 STS 患者总生存率或无复发生存率的提高有关。还对文章进行了审查，以了解 CXR 与胸部 CT 的成本效益数据。结果筛选出 259 篇摘要，并选择了 27 项研究进行全文综述。九项研究符合所有纳入标准。其中七项研究包含存活率或复发率数据，四项研究包含成像方式成本数据。在 CXR 与胸部 CT 对生存率和复发率的影响方面，这七项研究的结果相互矛盾。对成本进行调查的四项研究发现，CXR 更具成本效益，但在某些患者中，使用胸部 CT 进行筛查可能更具成本效益。由于研究设计和严重的偏倚风险，大多数研究的证据质量较低。需要进行随机对照试验，以进一步了解该患者群体肺转移监测的最佳成像模式。

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引用次数: 0