Ejso最新文献

Objective: The present systematic review and meta-analysis aims to assess the proportion of patients with radiological findings of residual disease following debulking surgery and determine its impact on survival outcomes.

Methods: We systematically searched the international literature using the Medline, Scopus, Clinicaltrials.gov, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar until July 2025 for studies that evaluated the proportion of patients with radiological evidence of residual disease following debulking surgery. The review was registered in PROSPERO prior to its conduct (CRD420251065596).

Results: Eleven studies were found eligible for inclusion in the present systematic review. Proportion meta-analysis indicated that 40% of patients had radiologic evidence of residual disease postoperatively (Generalized Mixed Linear Model 40%, 95% CI 33%, 48%). Differences in progression free survival were significantly worse among patients with residual disease (HR 2.08, 95% CI 1.42, 3.05). Similar findings were observed in the overall survival of patients (HR 1.93, 95% CI 1.49, 2.52).

Conclusion: The proportion of patients with radiological criteria of residual disease following debulking surgery appears to be significant. There seem to be evidence that indicate a negative impact on survival outcomes of patients with epithelial ovarian cancer, although these should be interpreted cautiously given the heterogeneity and limitations of the available evidence, but may be relevant during preoperative patient counseling to help establish realistic expectations.

Background: Patent Blue V (PBV) is widely used for sentinel lymph node biopsy (SLNB) in breast cancer and melanoma, but can rarely cause life-threatening perioperative hypersensitivity reactions (POH).

Methods: We conducted a retrospective analysis of POH to PBV in SLNBs for breast cancer and melanoma between February 2016 and May 2024, alongside a prospective survey of PBV administration techniques in 60 SLNB procedures for breast cancer and melanoma. The clinical characteristics of five patients with confirmed POH to PBV are also described.

Results: Eight of 2515 breast cancer patients and six of 1621 melanoma patients were referred to the Danish Anaesthesia Allergy Center (DAAC) for suspected POH. POH to PBV was confirmed in five patients with breast cancer (0.2%) and none in patients with melanoma (p = 0.16). Breast surgeons used deeper, higher-volume injections, while plastic surgeons favoured lower-volume intradermal techniques. All confirmed reactions occurred in otherwise healthy women, with onset of symptoms 20-70 min post-injection, predominantly as cutaneous signs and hypotension. Two patients required postoperative transfer to the Intensive Care Unit (ICU).

Discussion: POH to PBV is rare but clinically significant, with a rate of 0.2% in breast cancer SLNBs and 0% in melanoma SLNBs, though this difference was not statistically significant in our study. Variations in PBV administration techniques between breast and plastic surgeons may contribute to the different rates. In five patients with confirmed POH to PBV symptoms consisted mainly of mucocutaneous signs and hypotension. Awareness of these rare but potentially life-threatening reactions, along with prompt management, is essential for both surgeons and anaesthesiologists. This study further underscores the importance of vigilant perioperative monitoring and formal allergy evaluation to guide future care.

Advancing women in surgical leadership has traditionally focused on individual adaptation, mentorship, resilience, and personal skills rather than addressing systemic barriers. Despite improvements in awareness, representation, and support networks, meaningful change remains limited due to persistent institutional biases, structural constraints, and cultural norms. Female surgeons face additional challenges related to recruitment, mentorship, research access, and work-life integration, particularly around motherhood, which can penalize career progression even in supportive systems. Leadership programs and sponsorship opportunities remain unevenly available, and formal recognition of mentorship and informal leadership roles is often lacking. True transformation requires shifting from "fixing women" to "fixing systems" through formal leadership curricula, institutional accountability, and measurable outcomes. By empowering women to actively shape culture rather than merely navigate it, surgery can achieve female leadership that is inclusive, effective, and equitable. Addressing these challenges demands a collective responsibility of surgical societies, academic centers, and hospital leadership to foster structural reform, recognize diverse career trajectories, and cultivate visible female role models.

Despite female medical students and newly qualifying doctors now outnumbering males, surgery remains a male-dominated specialty. Whilst numbers of female within surgical specialties continue to rise, they still lag behind other specialties, even though women have equivalent or better surgical outcomes than their male counterparts. Reasons for this under representation are multifactorial, but include historic cultural issues, lack of representation, sexism, misogyny, sexual misconduct and challenges with pregnancy and childcare, that disproportionally affect female surgeons. Cancer surgery has traditionally been male dominated, often involving complex, lengthy surgery and is often a very competitive career. However, the data suggests that female surgeons have greater empathy, sensitivity and communication skills, which are assets in this often emotionally charged area of practice. This article presents an overview of these issues and calls for systemic reform and a cultural shift in surgical specialties to address these barriers.

Despite comprising the majority of medical students, women remain significantly underrepresented in senior academic surgical positions. In the Netherlands, only 15.6 % of surgical professors are female. This article examines cultural and structural barriers, including unequal access to networks, underrepresentation on editorial boards, academic "housework," implicit bias, and unequal caregiving responsibilities, that hinder women's advancement in academic surgery. Targeted interventions such as mentorships, flexible work policies, salary transparency, and gender-conscious recruitment (e.g., Eindhoven University of Technology's preferential hiring strategy) have shown promise in promoting equity without compromising academic output. The "critical mass" threshold of 28 % female representation emerges as a tipping point for cultural change. Achieving gender equity in academic surgery requires both systemic reform and cultural transformation to ensure equal opportunity, career sustainability, and inclusive institutional environments.

Introduction: Previous studies have reported an overall lower breast cancer incidence in women from Asian and Black backgrounds compared with white women. Age standardised and age specific incidence rates in the largest specific ethnicities within Asian and Black groups are not reported.

Materials and methods: Data on population size and the age distribution of women in five ethnic groups of interest (white British, Black African, Black Caribbean, Indian and Pakistani) were extracted from the Office for National Statistics 2001, 2011 and 2021 census data for England.Cancer registrations for invasive breast cancer (ICD-10 C50) in women in England aged ≥25 years during 2011-2019 with a recorded ethnicity were extracted from the National Cancer Registration and Analysis Service.Age standardised (ASIRs) and age specific (ASRs) incidence rates in five ethnic groups of interest were calculated.

Results: 329,655 women who were aged ≥25 years and in one of the five ethnic groups of interest had a record of an incident C50 cancer registration during 2011-2019. The ASIR was highest for white women (199.6 (95% CI 198.9-200.3)), and lowest for Black African women (118.2 (95% CI 111.6-125.1)). The ASRs for invasive breast cancer were generally lower in women from minority ethnic groups compared to white women in all age groups examined except for younger Black Caribbean women.

Conclusions: There are significant differences in breast cancer incidence rates between women from specific ethnicities. This requires further investigation in large scale prospective studies considering potential differences by ethnicity in known risk factors for breast cancer.

Surgery has historically been a male-dominated field; however, the representation of female surgeons has steadily increased, necessitating a comprehensive review of comparative performance. This narrative review synthesises recent literature to evaluate male and female surgeons across several key domains: technical skills, non-technical abilities, patient outcomes, and academic contributions. In terms of technical skills, research presents nuanced findings. While some studies suggest a potential male advantage in visuospatial skills, other evidence indicates that these initial differences can be mitigated or eliminated through dedicated training and prior experience with activities such as video games. Conversely, female surgeons consistently demonstrate superior manual dexterity. In non-technical areas, female surgeons consistently receive higher patient scores for communication, including providing clear explanations, listening attentively, and dedicating sufficient time during consultations. The literature on patient outcomes is complex and sometimes contradictory. Several large-scale observational studies and meta-analyses have reported a small but statistically significant reduction in mortality for patients treated by female surgeons, whereas other research has found no such association. Despite these findings, female surgeons remain underrepresented in senior academic and organisational leadership roles, with persistent disparities in departmental chair positions and grant funding. This gap is not necessarily attributable to a lack of productivity but rather to insufficient mentorship and institutional support. The evidence highlights that individual qualities and training are more significant than gender, although persistent systemic biases continue to pose challenges to female surgeons' career advancement and patient trust. Addressing these prejudices is essential to fostering a safe and equitable environment for all.

This article explores the career pathways of women in the field of surgical oncology, specifically their growth and development as surgical oncologists. Nine global female surgical oncologists and experts in Peritoneal Surface Oncology (PSO) share personal reflections of the challenges and facilitators of career success in this challenging and highly specialized field of surgery.

Methods: Nine high profile female surgeons with expertise in PSO were recruited by direct contact with the lead author and asked to provide a detailed reflection of their career pathways, with a focus on barriers and facilitators to success.

Results: Most participants were highly driven, motivated by the poor prognosis of the disease early in their careers and the new opportunities PSO offered. Many moved between units or countries in search of training, often sacrificing work-life balance. Strong role models-usually male-were cited as mentors, and many participants now lead the units they helped establish. None expressed regrets, and all took pride in the advances achieved during their careers. While some women mentioned gender bias, most felt that within PSO, surgical skills and commitment outweighed such barriers.

Conclusions: These reflections should provide encouragement to the next generation of aspiring surgical oncologists to pursue their desire to enter this challenging area of surgery in the future.

Although there has been substantial progress in the inclusion of women in the oncology workforce, we are far from realising our full potential. This commentary discusses progress from the perspective of radiation oncology, asking what the remaining barriers are, whether these are common to all oncological disciplines, and highlighting the need to address common underlying systemic barriers to equity in the workplace in order to realise the potential of our whole workforce for the benefit of our patients.

Background: Sarcomas are a heterogeneous group of cancers requiring cautious monitoring and expert management. The emerging role of Artificial Intelligence (AI) and Mixed Reality (MR) may represent a turning point in sarcoma care. This systematic review evaluates their application in sarcoma management.

Methods: A comprehensive search of PubMed/MEDLINE, Embase, Scopus, and Web of Science up to June 2025 was conducted following PRISMA guidelines. Eligible studies included case series, cohort studies, multicenter studies, diagnostic accuracy studies and prediction model studies reporting on AI or MR use in sarcoma. Review articles and non-English studies were excluded. Data extracted included design, population, modality, sarcoma subtype, and reported outcomes.

Results: Twenty-three studies met inclusion criteria: 1 case series, 1 case report, 2 cohort studies, 8 diagnostic accuracy studies and 11 prediction model studies with a cumulative sample size of 8478 patients. The most frequently investigated tumors were osteosarcoma (n = 6), soft tissue sarcoma (STS) (n = 5), and chondrosarcoma (n = 4). AI was primarily applied in imaging-based diagnosis (n = 12, reported accuracy 78-95 %), histopathological grading (n = 5), and radiogenomic models (n = 4). MR was used in preoperative planning (n = 3), intraoperative navigation (n = 2), and surgical training (n = 2). No integrated AI/MR platforms were reported.

Conclusion: AI and MR show strong potential in improving sarcoma management, particularly for diagnostic accuracy and surgical planning. However, the literature remains heterogeneous, consisting mostly of preliminary studies with limited statistical power. Large-scale multicenter studies are required to validate the impact of AI and MR on outcomes and safely integrate these technologies into routine care.