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Background: The efficacy of local control for pancreatic cancer liver metastases (PCLM), including surgical treatment, remains controversial, with no consensus on the management and clinical significance of disappearing liver metastases (DLMs). This study aimed to evaluate the clinical implications of DLMs in treating PCLM after multi-agent chemotherapy, utilizing contrast-enhanced imaging modalities.

Methods: A retrospective analysis was conducted on patients who underwent curative resection for pancreatic cancer with synchronous or metachronous liver metastases between 2014 and 2023. Surgical indications were based on our recently reported ABCD criteria (Anatomical/Biological/Conditional/Duration). Both contrast-enhanced computed tomography (CE-CT) and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI) were used to monitor metastatic lesions in the liver. DLMs were defined as tumors undetected on CE-CT post-chemotherapy.

Results: A total of 58 lesions in 29 patients with PCLM who underwent surgical resection were evaluated. Of the 13 lesions evident on CE-CT, 76.9 % (10/13) contained clinically/pathologically residual tumors. Of the 45 DLMs, 16 (35.6 %) had residual tumors. Twenty-six DLMs (57.8 %) were detected on EOB-MRI or intraoperative screening (contrast-enhanced ultrasonography and palpation), with 42.3 % (11/26) being residual tumors. Nineteen DLMs were undetectable by any modality, of which 26.3 % (5/19) were confirmed to be residual tumors with a median follow-up of 32 months. The median overall survival from initiating treatment for PCLM was 48.5 months.

Conclusion: Integrating EOB-MRI into preoperative evaluations for PCLM enhances the detection of clinically relevant DLMs. Our findings highlight the potential benefits of considering an image-guided surgical approach in selected patients.

Postoperative pancreatitis is an unusual complication of upper abdominal surgery that can result in severe morbidity and has been associated with postoperative death. It can be caused by trauma to the surface of the gland, injury to pancreatic ducts, vascular compromise, ductal obstruction within the pancreas parenchyma or because of duodenal stagnation. Our database of peritoneal surface malignancy patients was surveyed in a search for patients who manifested signs and symptoms of severe postoperative pancreatitis. Patients who were confirmed by a chart review to have postoperative pancreatitis are included in this study. The clinical and histologic features of these patients and the effects of pancreatitis on outcome were itemized. From a database of 1200 patients who were treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) and/or early postoperative intraperitoneal chemotherapy (EPIC), 12 patients (1.0 %) were confirmed to have severe postoperative pancreatitis. A lesser sac peritonectomy procedure was performed in 10 of the 12 patients (83.3 %). Eight of the 12 patients (66.6 %) required a return to the operating room. Seven of the 12 patients (58.3 %) manifested anastomotic leakage. A total gastrectomy was required in 58 patients with 6 patients (10.3 %) developing pancreatitis. The median length of hospital stay was 62 days. Two patients (16.6 %) died postoperatively. The clinical features and outcome of 12 patients who developed severe postoperative pancreatitis after CRS and HIPEC are presented. These data may assist in the postoperative management of patients having a major CRS. An early diagnosis requires a high index of suspicion.

Introduction: Hepatopancreatoduodenectomy (HPD) is necessary to achieve a reliable margin-negative resection for widespread perihilar cholangiocarcinoma (PhCC), yet data on long-term outcomes following HPD for PhCC remain limited.

Materials and methods: A retrospective cohort study was conducted on 167 patients with PhCC who underwent surgery with curative-intent between 2000 and 2023. Hepatic resection and extrahepatic bile duct resection (Hr-BDR) were performed for cases presumed to have localized tumors, while HPD was conducted for cases with presumed extensive tumor spread. Short- and long-term outcomes, including surgery details, pathological findings, postoperative complications, survival rates, and recurrence patterns, were compared.

Results: Forty-five patients underwent HPD and 122 underwent Hr-BDR. No differences were observed in the T or N factors of the TNM staging between both groups (P = 0.09 and 0.09). Overall postoperative significant complications (38 % vs. 34 %, P = 0.62), 90-day mortality rates (2 % vs. 2 %, P = 0.80), and 5-year cancer-specific survival (45 % vs. 40 %, P = 0.81) were comparable between both groups. However, the 5-year survival rate of the HPD group was significantly higher than that of the Hr-BDR group with positive invasive duodenal-side ductal margins (45 % vs. 0 %, P = 0.03). Local and remnant bile duct recurrence were significantly less frequent in the HPD than in the Hr-BDR group (20 % vs. 37 %, P = 0.04; 11 % vs. 0 %, P = 0.02, respectively).

Conclusion: Although HPD for widespread PhCC requires careful postoperative management, it has the potential to provide excellent long-term outcomes, and it should be considered proactively.

Background: Pancreatectomy with venous resection (PVR) is nowadays considered standard. However, there is still concern about increased postoperative morbidity and impaired long-term outcome depending on the type of venous resection and reconstruction. The aim was to investigate the predictors of morbidity and long-term survival in patients undergoing PVR in a high-volume center.

Methods: All consecutive patients undergoing PVR at a single center between January 2008 and January 2019 were retrieved from a prospectively maintained database. Factors associated with postoperative complications and long-term survival were analyzed.

Results: Of 290 patients with isolated PVRs, 188 (65 %) were performed for pancreatic ductal adenocarcinoma (PDAC). Surgical complications developed in 56 % of patients (n = 163), and 11 % (n = 36) had severe complications (Clavien-Dindo>3a). The 90-day mortality was 4.1 %. Venous thrombosis occurred in 4.8 % (n = 14), resulting in one mortality (0.3 %). No technical factors were predictive for the development of severe complications. Longer vein segments >3 cm could be resected with similar short- and long-term outcome as shorter segments. The survival of patients undergoing PVR for resectable, borderline and locally advanced PDAC was similar (median of 18, 14, and 23 months, p = 0.7). On multivariate analysis, elevated CA19-9>200 U/mL and ASA score≥3 were independent predictors of survival (p = 0.02), but not resectability at diagnosis nor type of venous reconstruction.

Conclusion: The type of venous resection/reconstruction does not influence outcome and should be tailored according to patients' and tumors' characteristics during PVR. The long-term survival after PVR for PDAC is influenced by tumor-and patient-related characteristics, and not technical vascular-resection associated factors.

The increasing detection of submucosal tumors (SMTs) in the upper gastrointestinal tract (UGI) is due to the increased clinical use of endoscopy and imaging technology. Some of these SMTs have malignant potential and may cause clinical symptoms. Thus, it is recommended in clinical guidelines to consider resection of these SMTs. Endoscopic techniques have become widely used in the diagnosis and treatment of SMT in the UGI as compared with traditional surgery due to their advantages of minimally invasive, quick recovery, and economical cost. Recently, new endoscopic techniques and instruments have been continuously implemented, leading to revolutionary innovation in endoscopic treatments. However, the safety and efficacy of these innovative techniques remain unclear. Therefore, we have comprehensively summarized the various techniques used in the treatment of UGI tumors in recent years, evaluated the indications and effects of each technique, and compared their benefits and disadvantages. We hope that this review will provide a more comprehensive reference for clinical and endoscopic practitioners, and help them develop more individualized treatment plans for different patients. This will ultimately expand the patient population that can benefit from these innovative technologies.

Background: Breast cancer is a major health issue for women in Africa. This study aims to assess the burden of the disease using the latest estimates from Global Cancer Observatory 2022.

Methods: Data were sourced from the Global Cancer Observatory 2022. Age-standardized incidence rates (ASIR) and mortality rates (ASMR) per 100,000 person-years were calculated using direct age standardization based on the Segi-Doll World standard population. Pearson's correlation coefficient was employed to assess the relationship between the Human Development Index (HDI) and both incidence and mortality rates. Projections for breast cancer cases and deaths by 2050 were estimated based on global demographic forecasts.

Results: In 2022, Africa reported an estimated 198.3 thousand new breast cancer cases and 91.3 thousand deaths. Nigeria reported the highest incidence (32,278) and deaths (16,332). Algeria had the highest ASIR (61.9/100,000) while Cameroon had the highest ASMR (27.4/100,000). ASMR increased with age, surged in individuals over 70 in Africa. Chad had the earliest ASIR peak age at 40-49 years (40.3/100,000) and earliest ASMR peak age at 50-59 years (24.1/100,000). A positive correlation was observed between HDI and incidence rates. Projections suggest that by 2050, Nigeria and Egypt will bear the highest disease burden, with Tanzania and Zambia experiencing nearly 200 % rise in incidence, while Guinea and Niger will see mortality rates surge by over 200 %.

Conclusions: Breast cancer mortality is higher in low socio-economic countries. Efforts should focus on low socio-economic countries, implementing rapid intervention measures to mitigate the growing cancer crisis.

Cytoreductive surgery remains controversial in pleural mesothelioma. The MARS2 trial suggested that extended pleurectomy decortication following neoadjuvant chemotherapy was associated with no survival benefit, more serious adverse events and poorer quality of life than systemic chemotherapy alone in patients with resectable pleural mesothelioma. However, patient selection, chemotherapy scheme, high surgical mortality (9 %) and poor outcomes in the surgical cohort have been raised by mesothelioma experts as potential issues in MARS2. The EORTC-L1205trial reported high morbidity, but low surgical mortality (1.7 %) and more favourable outcomes, suggesting that well-selected patients could benefit from extended pleurectomy decortication and systemic chemotherapy. Other recently-published studies show that cytoreductive surgery remains a valuable option in well-selected patients offering median survivals of 34-38 months, when the best systemic options combining chemotherapy agents, anti-angiogenics or immune checkpoint inhibitors offer median survivals of 18-24 months. Careful patient selection is essential to avoid futile or detrimental surgery and there is evidence that preservation of the diaphragm is associated with lower morbidity and mortality, better long-term outcomes.

Introduction: A precise preoperative tumor monitoring method that reflects tumor burden during neoadjuvant treatment is required to guide individualized perioperative treatment strategies for esophageal squamous cell carcinoma (ESCC). This study examined the clinical significance of preoperative circulating tumor DNA (ctDNA) in the plasma of patients undergoing neoadjuvant chemotherapy (NAC) followed by esophagectomy.

Materials and methods: Plasma samples were collected longitudinally for ctDNA analysis as well as genomic DNA from primary lesions from patients with histologically confirmed ESCC who received neoadjuvant chemotherapy (NAC) followed by subtotal esophagectomy. Next-generation sequencing was used to identify mutations in both the plasma and primary tumors. We evaluated the relationship between ctDNA alterations and recurrence in patients with locally advanced ESCC.

Results: Pretreatment samples from 25 patients (100 %) showed the same mutations in both ctDNA and primary tumors; therefore, they were classified as ctDNA-positive before treatment. In the cohort of 25 patients analyzed, those who tested positive for ctDNA after NAC had a significantly higher risk of recurrence; the 36-month recurrence-free survival rates were 92 % for ctDNA-negative patients and 8 % for ctDNA-positive patients (p < 0.001).

Conclusions: Preoperative ctDNA status may be a promising prognostic biomarker that can be assessed before surgery in patients with ESCC who received NAC. Expanded cohort validation will allow for more personalized multidisciplinary treatment approaches for ESCC tailored to ctDNA analysis.

Objective: This study aimed to compare the surgical and oncological outcomes of robotic mastectomy (RM) and conventional mastectomy (CM) for breast cancer.

Methods: Our institutional registry of women with breast cancer who received RM between 2018 and 2023 and CM between 2016 and 2023 were reviewed. Propensity score matching of clinicopathological variables was used to match 123 RM patients with 123 CM patients. Surgical outcomes, reconstruction type, margin status, complications, recurrence-free survival (RFS), and overall survival (OS) were compared between the 2 groups. Complications with increasing RM experience were also examined.

Results: More autologous flap reconstructions were used in RM (67 % vs. 39 %, p < 0.001), but more implant reconstructions were used in CM (61 % vs. 33 %, p < 0.001). The complication rate, especially breast skin necrosis, was lower in the RM group (10 % vs. 26 %, p = 0.002). Nipple-areolar complex necrosis in nipple-sparing mastectomy was similar between the groups (33 % vs. 27 %, p = 0.45). At a median follow-up of 30 months, RFS was comparable between the 2 groups, as was OS (median follow-up 36 months). More RM experience was associated with shorter operation time and lower surgical complication and margin positive rates.

Conclusion: The oncological outcomes of RM and CM are similar at a follow-up of about 3 years. RM is associated with a significantly lower rate of breast skin necrosis, and the advantage of RM exists with different types of breast reconstruction. Increasing RM experience leads to improved overall results.