Ejso最新文献

英文中文

Revisiting colonic obstruction criteria and optimal timing for SEMS placement in colon cancer

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-02 DOI: 10.1016/j.ejso.2025.109631

Xiaojie Wang

引用次数: 0

Surgical management, including the role of transplantation, for intrahepatic and peri-hilar cholangiocarcinoma 肝内和肝周胆管癌的手术治疗，包括移植的作用。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.108248

Abdullah K. Malik , Brian R. Davidson , Derek M. Manas

Intrahepatic and peri-hilar cholangiocarcinoma are life threatening disease with poor outcomes despite optimal treatment currently available (5-year overall survival following resection 20-35%, and <10% cured at 10-years post resection). The insidious onset makes diagnosis difficult, the majority do not have a resection option and the high recurrence rate post-resection suggests that occult metastatic disease is frequently present. Advances in perioperative management, such as ipsilateral portal vein (and hepatic vein) embolisation methods to increase the future liver remnant volume, genomic profiling, and (neo)adjuvant therapies demonstrate great potential in improving outcomes. However multiple areas of controversy exist. Surgical resection rate and outcomes vary between centres with no global consensus on how ‘resectable’ disease is defined – molecular profiling and genomic analysis could potentially identify patients unlikely to benefit from resection or likely to benefit from targeted therapies. FDG-PET scanning has also improved the ability to detect metastatic disease preoperatively and avoid futile resection. However tumours frequently invade major vasculo-biliary structures, with resection and reconstruction associated with significant morbidity and mortality even in specialist centres. Liver transplantation has been investigated for very selected patients for the last decade and yet the selection algorithm, surgical approach and both value of both neoadjuvant and adjuvant therapies remain to be clarified. In this review, we discuss the contemporary management of intrahepatic and peri-hilar cholangiocarcinoma.

肝内胆管癌和肝周胆管癌是威胁生命的疾病，尽管目前有最佳治疗方法，但疗效不佳（切除术后 5 年总生存率为 20%-35%，而肝内胆管癌为 20%-30%）。

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引用次数: 0

Reply to the Editor: Reassessing margin standards in breast-conserving therapy 回复编辑：重新评估保乳治疗的切缘标准。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109504

Emad A. Rakha , Cecily Quinn , Stephen Fox , Yazan A. Masannat , Andreas Karakatsanis , J. Michael Dixon

引用次数: 0

Long-term outcomes after postponing surgery to optimise patients with acute right-sided obstructing colon cancer 优化急性右侧梗阻性结肠癌患者延迟手术后的长期预后。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109521

Elize W. Lockhorst , Jeske R.E. Boeding , Lissa Wullaert , Robert R.J. Coebergh van den Braak , Arjen M. Rijken , Cornelis Verhoef , Paul D. Gobardhan , Jennifer M.J. Schreinemakers

Aim

To retrospectively analyse the short- and long-term oncological, morbidity and mortality outcomes in patients diagnosed with acute right-sided obstructing colon cancer. Patients who underwent pre-optimisation prior to the oncological resection were compared to patients who did not undergo pre-optimisation.

Methods

All consecutive patients with right-sided obstructing colon cancer, either with a high clinical suspicion or confirmed diagnosis by histological analysis, who underwent curative-intent treatment between March 2013 and December 2020 were included. Patients were divided into two groups: an optimised group and a non-optimised group. Preoperative optimisation included additional nutrition, physiotherapy, and, if needed, bowel decompression. Data about disease-free survival and mortality were collected up to three years after surgery.

Results

Sixty-two patients were included. Thirty patients underwent the optimisation protocol before postponed surgery, and 32 patients received emergency surgery, without optimisation (surgery performed with a median of 9.6 days versus 22 h after admission). The postoperative complication rate was significantly lower in the optimisation group (50 % vs 78 %, p = 0.033). No significant differences were found in the 90-day mortality rate (7 % vs 13 %, p = 0.672) and three-year overall survival rate (43 % vs 56 %, p = 0.49). After three years, sixteen (53 %) patients in the optimised group and twenty (63 %) in the non-optimised were deceased (p = 0.672).

Conclusion

Postponing the surgery with preoperative optimisation in patients with obstructing right-sided colon cancer results in a significantly lower 90-day complication rate and suggests no negative effect on survival rates compared to an acute resection. Although, further research with a larger sample size is needed.

目的：回顾性分析急性右侧梗阻性结肠癌患者的短期和长期肿瘤学、发病率和死亡率。在肿瘤切除前进行预优化的患者与未进行预优化的患者进行比较。方法：纳入2013年3月至2020年12月期间所有连续接受治疗的右侧梗阻性结肠癌患者，无论是临床高度怀疑还是经组织学分析确诊。患者分为两组：优化组和非优化组。术前优化包括额外的营养，物理治疗，如果需要，肠减压。手术后3年的无病生存率和死亡率数据被收集。结果：纳入62例患者。30例患者在推迟手术前接受了优化方案，32例患者接受了紧急手术，未进行优化（手术时间中位数为9.6天，入院后22小时）。优化组术后并发症发生率明显降低（50% vs 78%, p = 0.033）。90天死亡率（7%对13%，p = 0.672）和3年总生存率（43%对56%，p = 0.49）无显著差异。三年后，优化组16例（53%）患者死亡，非优化组20例（63%）患者死亡（p = 0.672）。结论：对梗阻性右侧结肠癌患者进行术前优化后推迟手术可显著降低90天并发症发生率，且与急性切除相比，对生存率无负面影响。不过，还需要更大样本量的进一步研究。

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引用次数: 0

Are 1 mm margins necessary after breast-conserving surgery for invasive cancer? A critical look at the proposed change 浸润性癌保乳手术后是否需要1mm切缘？以批判的眼光看待提议的改变。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109505

Gianluca Franceschini, Riccardo Masetti

引用次数: 0

Advert 2025 BASO Annual Conference

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2025.109647

引用次数: 0

Ablative techniques in colorectal liver metastases: A systematic review, descriptive summary of practice, and recommendations for optimal data reporting 结直肠肝转移的消融技术：系统回顾，实践的描述性总结，以及对最佳数据报告的建议。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109487

Wee Han Ng , Catarina Machado , Alice Rooney , Robert Jones , Jonathan Rees , Samir Pathak

Background

Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) are alternative treatments for colorectal liver metastasis (CRLM) patients that are unsuitable for resection. However, consensus is lacking regarding selection criteria, tumour characteristics, ablation technique delivery, and device settings. This study aims to summarise current evidence to inform future prospective studies.

Methods

A systematic review was conducted following PRISMA guidelines. Studies assessing RFA and MWA treatment of CRLM were identified in Medline, Embase, Web of Science and the Cochrane database of systematic reviews, from inception until 31^st August 2024.

Results

Fifty-two studies were included (retrospective cohort n = 45, prospective cohort n = 5, non-randomized comparative studies n = 2). Fifty-four inclusion criteria were used across 45 studies and were not stated in 7 studies. Tumours varied in mean number [1-8] and diameter (1.54–4.35 cm). Neoadjuvant chemotherapy use (10–100 % of patients), ablation delivery approach (open n = 4, laparoscopic n = 11, percutaneous n = 26, mixed n = 5), anaesthetic mode (GA n = 18, LA n = 11, mixed n = 2) and delivering clinician (radiologist n = 11, surgeon n = 16, both n = 1) all varied. Thirty-two studies lacked complete ablation device settings. Six studies followed a standardized ablation algorithm and 14 studies had specific settings. Five-year survival ranged from 0 to 69.7 % for ablation.

Conclusions

There is significant heterogeneity in the reporting of study design, patient selection, and ablation techniques for CRLM. The lack of standardized approaches and inconsistent reporting of methodology and outcomes make it challenging to determine the optimal ablative treatment for CRLM. We recommend that future research should focus on clearly defining selection and treatment criteria, as well as treatment delivery.

背景：射频消融（RFA）和微波消融（MWA）是不适合切除的结直肠癌肝转移（CRLM）患者的替代治疗方法。然而，在选择标准、肿瘤特征、消融技术输送和设备设置方面缺乏共识。本研究旨在总结现有证据，为未来的前瞻性研究提供信息。方法：按照PRISMA指南进行系统评价。评估RFA和MWA治疗CRLM的研究在Medline， Embase， Web of Science和Cochrane系统评价数据库中进行了鉴定，从开始到2024年8月31日。结果：纳入了52项研究（回顾性队列n = 45，前瞻性队列n = 5，非随机比较研究n = 2）。45项研究使用了54项纳入标准，7项研究未说明。肿瘤的平均数目[1-8]和直径（1.54-4.35 cm）不同。新辅助化疗使用（10- 100%）、消融给药方式（开放4例、腹腔镜11例、经皮26例、混合5例）、麻醉方式（GA 18例、LA 11例、混合2例）和给药临床医生（放射科医生11例、外科医生16例，均为1例）各不相同。32项研究缺乏完整的消融装置设置。6项研究遵循标准化消融算法，14项研究具有特定设置。消融术的5年生存率为0 ~ 69.7%。结论：CRLM的研究设计、患者选择和消融技术报道存在显著的异质性。缺乏标准化的方法和不一致的方法和结果报告使得确定CRLM的最佳消融治疗具有挑战性。我们建议未来的研究应侧重于明确界定选择和治疗标准，以及治疗方法。

{"title":"Ablative techniques in colorectal liver metastases: A systematic review, descriptive summary of practice, and recommendations for optimal data reporting","authors":"Wee Han Ng , Catarina Machado , Alice Rooney , Robert Jones , Jonathan Rees , Samir Pathak","doi":"10.1016/j.ejso.2024.109487","DOIUrl":"10.1016/j.ejso.2024.109487","url":null,"abstract":"<div><h3>Background</h3><div>Radiofrequency Ablation (RFA) and Microwave Ablation (MWA) are alternative treatments for colorectal liver metastasis (CRLM) patients that are unsuitable for resection. However, consensus is lacking regarding selection criteria, tumour characteristics, ablation technique delivery, and device settings. This study aims to summarise current evidence to inform future prospective studies.</div></div><div><h3>Methods</h3><div>A systematic review was conducted following PRISMA guidelines. Studies assessing RFA and MWA treatment of CRLM were identified in Medline, Embase, Web of Science and the Cochrane database of systematic reviews, from inception until 31<sup>st</sup> August 2024.</div></div><div><h3>Results</h3><div>Fifty-two studies were included (retrospective cohort n = 45, prospective cohort n = 5, non-randomized comparative studies n = 2). Fifty-four inclusion criteria were used across 45 studies and were not stated in 7 studies. Tumours varied in mean number [1-8] and diameter (1.54–4.35 cm). Neoadjuvant chemotherapy use (10–100 % of patients), ablation delivery approach (open n = 4, laparoscopic n = 11, percutaneous n = 26, mixed n = 5), anaesthetic mode (GA n = 18, LA n = 11, mixed n = 2) and delivering clinician (radiologist n = 11, surgeon n = 16, both n = 1) all varied. Thirty-two studies lacked complete ablation device settings. Six studies followed a standardized ablation algorithm and 14 studies had specific settings. Five-year survival ranged from 0 to 69.7 % for ablation.</div></div><div><h3>Conclusions</h3><div>There is significant heterogeneity in the reporting of study design, patient selection, and ablation techniques for CRLM. The lack of standardized approaches and inconsistent reporting of methodology and outcomes make it challenging to determine the optimal ablative treatment for CRLM. We recommend that future research should focus on clearly defining selection and treatment criteria, as well as treatment delivery.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109487"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk factors for postoperative liver dysfunction in robot-assisted gastrectomy for gastric cancer

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2025.109668

Rei Ogawa, Takaki Yoshikawa, Yurina Fujisaki, Masashi Nishino, Ryota Sakon, Takeyuki Wada, Tsutomu Hayashi, Yukinori Yamagata, Yasuyuki Seto

Background

Liver dysfunction after robotic gastrectomy for gastric cancer is common. Liver elevation or cutting of the accessory left hepatic artery (ALHA) can cause liver dysfunction, which may be emphasized by the prolonged operation time in robotic gastrectomy.

Methods

To identify the risk factors for liver dysfunction, we examined 160 patients who underwent robot-assisted gastrectomy between August 2019 and April 2024. Liver dysfunction was defined as an elevated AST level (≥100 IU/L) on postoperative day 1. The risk factors were explored using univariate and multivariate logistic regression analyses.

Results

Liver dysfunction was observed in 25.6 % (41/160). Significant independent risk factors were cutting of ALHA, liver elevation by Nathanson retractor, body mass index (BMI) ≥23.65, and blood loss ≥179.5 ml. Among them, cutting of the ALHA had the highest odds ratio (19.5), followed by the liver elevation method (10.07), blood loss (7.06), and BMI (3.99). Notably, the anatomical type of ALHA was significantly associated with liver dysfunction: Type C, no branches from the proper hepatic artery, had the highest incidence of liver dysfunction (4/4, 100 %); followed by Type B, only medial artery branches from the proper hepatic artery (4/5, 80 %); and Type A, medial and lateral arteries diverged from the proper hepatic artery (2/9, 22.2 %). Although no patient with liver dysfunction required special medication, all patients with Type C showed liver atrophy on follow-up computed tomography one year after surgery.

Conclusions

Surgeons must pay attention to the type of ALHA and gentle elevation of the liver in robot-assisted gastrectomy, especially when the BMI is high or blood loss is predicted.

{"title":"Risk factors for postoperative liver dysfunction in robot-assisted gastrectomy for gastric cancer","authors":"Rei Ogawa, Takaki Yoshikawa, Yurina Fujisaki, Masashi Nishino, Ryota Sakon, Takeyuki Wada, Tsutomu Hayashi, Yukinori Yamagata, Yasuyuki Seto","doi":"10.1016/j.ejso.2025.109668","DOIUrl":"10.1016/j.ejso.2025.109668","url":null,"abstract":"<div><h3>Background</h3><div>Liver dysfunction after robotic gastrectomy for gastric cancer is common. Liver elevation or cutting of the accessory left hepatic artery (ALHA) can cause liver dysfunction, which may be emphasized by the prolonged operation time in robotic gastrectomy.</div></div><div><h3>Methods</h3><div>To identify the risk factors for liver dysfunction, we examined 160 patients who underwent robot-assisted gastrectomy between August 2019 and April 2024. Liver dysfunction was defined as an elevated AST level (≥100 IU/L) on postoperative day 1. The risk factors were explored using univariate and multivariate logistic regression analyses.</div></div><div><h3>Results</h3><div>Liver dysfunction was observed in 25.6 % (41/160). Significant independent risk factors were cutting of ALHA, liver elevation by Nathanson retractor, body mass index (BMI) ≥23.65, and blood loss ≥179.5 ml. Among them, cutting of the ALHA had the highest odds ratio (19.5), followed by the liver elevation method (10.07), blood loss (7.06), and BMI (3.99). Notably, the anatomical type of ALHA was significantly associated with liver dysfunction: Type C, no branches from the proper hepatic artery, had the highest incidence of liver dysfunction (4/4, 100 %); followed by Type B, only medial artery branches from the proper hepatic artery (4/5, 80 %); and Type A, medial and lateral arteries diverged from the proper hepatic artery (2/9, 22.2 %). Although no patient with liver dysfunction required special medication, all patients with Type C showed liver atrophy on follow-up computed tomography one year after surgery.</div></div><div><h3>Conclusions</h3><div>Surgeons must pay attention to the type of ALHA and gentle elevation of the liver in robot-assisted gastrectomy, especially when the BMI is high or blood loss is predicted.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109668"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Intraoperative surgical navigation improves margin status in advanced malignancies of the anterior craniofacial area: A prospective observational study with systematic review of the literature and meta-analysis 术中手术导航改善颅面前部晚期恶性肿瘤的切缘状态：一项前瞻性观察性研究，系统回顾文献和荟萃分析。

IF 3.5 2区医学 Q2 ONCOLOGY

Ejso

Pub Date : 2025-02-01 DOI: 10.1016/j.ejso.2024.109514

Marco Ferrari , Piergiorgio Gaudioso , Stefano Taboni , Giacomo Contro , Giuseppe Roccuzzo , Paola Costantino , Michael J. Daly , Harley H.L. Chan , Maxime Fieux , Alessandra Ruaro , Roberto Maroldi , Alberto Signoroni , Alberto Deganello , Jonathan C. Irish , Florent Carsuzaa , Piero Nicolai

The current scientific evidence suggests that surgical navigation (SN) can contribute to improve oncologic outcomes in sinonasal and craniofacial surgery. The present study investigated the feasibility of intraoperative SN and its role in improving the outcomes of surgically treated sinonasal and craniofacial tumors.

This prospective study compared navigation-guided surgery for sinonasal or craniofacial malignancies with a pair-matched cohort (1:2 matching) of patients operated without SN. A systematic review of the literature was performed.

Thirty-five patients who underwent navigation-guided surgery were included. The pair-matched control cohort included 70 patients operated without SN. The margin status analysis demonstrated a lower rate of positive margins (p = 0.013) in the SN group, especially in pT4 (p = 0.034), recurrent (p = 0.024), high-grade tumors (p = 0.043), and endoscopic-assisted open surgery (p = 0.035). The mean preoperative time did not show a significant difference between surgeries performed with or without SN (1.26 vs. 1.23 h, p = 0.445). However, surgeries utilizing SN had a significantly longer median duration compared to those without (8.10 vs. 6.00 h, p = 0.029). A total of 209 patients were included in the meta-analysis; 91 patients (43.5 %) underwent surgery with SN. The results of the meta-analysis showed an improvement in terms of negative margins rate with the use of SN (OR = 2.62; 95%-confidence interval: 1.33–5.17).

In conclusion, intraoperative SN can contribute to achieve a clear margin resection, especially in locally advanced tumors, recurrences, highly aggressive histologies, and when endoscopic-assisted open surgery is employed.

目前的科学证据表明，手术导航（SN）有助于改善鼻鼻部和颅面外科手术的肿瘤预后。本研究探讨术中SN的可行性及其在改善鼻窦和颅面肿瘤手术治疗效果中的作用。这项前瞻性研究比较了导航引导下鼻窦或颅面恶性肿瘤的手术与一对配对队列（1:2配对）的无SN手术患者。对文献进行了系统的回顾。35例接受导航手术的患者被纳入研究。配对对照组包括70例未行SN手术的患者。切缘状态分析显示，SN组切缘阳性率较低（p = 0.013），特别是pT4 （p = 0.034）、复发（p = 0.024）、高级别肿瘤（p = 0.043）和内镜辅助开放手术（p = 0.035）。术前平均时间在有无SN的情况下无显著差异（1.26 h vs 1.23 h, p = 0.445）。然而，与未使用SN的手术相比，使用SN的手术中位持续时间明显更长（8.10 h对6.00 h, p = 0.029）。meta分析共纳入209例患者；91例（43.5%）患者接受手术治疗。meta分析结果显示，使用SN后，负边际率有所改善(OR = 2.62；95%置信区间：1.33-5.17)。综上所述，术中SN有助于实现清晰的切缘切除，特别是在局部晚期肿瘤、复发、高度侵袭性组织学以及采用内镜辅助开放手术时。

{"title":"Intraoperative surgical navigation improves margin status in advanced malignancies of the anterior craniofacial area: A prospective observational study with systematic review of the literature and meta-analysis","authors":"Marco Ferrari , Piergiorgio Gaudioso , Stefano Taboni , Giacomo Contro , Giuseppe Roccuzzo , Paola Costantino , Michael J. Daly , Harley H.L. Chan , Maxime Fieux , Alessandra Ruaro , Roberto Maroldi , Alberto Signoroni , Alberto Deganello , Jonathan C. Irish , Florent Carsuzaa , Piero Nicolai","doi":"10.1016/j.ejso.2024.109514","DOIUrl":"10.1016/j.ejso.2024.109514","url":null,"abstract":"<div><div>The current scientific evidence suggests that surgical navigation (SN) can contribute to improve oncologic outcomes in sinonasal and craniofacial surgery. The present study investigated the feasibility of intraoperative SN and its role in improving the outcomes of surgically treated sinonasal and craniofacial tumors.</div><div>This prospective study compared navigation-guided surgery for sinonasal or craniofacial malignancies with a pair-matched cohort (1:2 matching) of patients operated without SN. A systematic review of the literature was performed.</div><div>Thirty-five patients who underwent navigation-guided surgery were included. The pair-matched control cohort included 70 patients operated without SN. The margin status analysis demonstrated a lower rate of positive margins (p = 0.013) in the SN group, especially in pT4 (p = 0.034), recurrent (p = 0.024), high-grade tumors (p = 0.043), and endoscopic-assisted open surgery (p = 0.035). The mean preoperative time did not show a significant difference between surgeries performed with or without SN (1.26 <em>vs.</em> 1.23 h, p = 0.445). However, surgeries utilizing SN had a significantly longer median duration compared to those without (8.10 <em>vs.</em> 6.00 h, p = 0.029). A total of 209 patients were included in the meta-analysis; 91 patients (43.5 %) underwent surgery with SN. The results of the meta-analysis showed an improvement in terms of negative margins rate with the use of SN (OR = 2.62; 95%-confidence interval: 1.33–5.17).</div><div>In conclusion, intraoperative SN can contribute to achieve a clear margin resection, especially in locally advanced tumors, recurrences, highly aggressive histologies, and when endoscopic-assisted open surgery is employed.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109514"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Ejso

Pub Date : 2025-02-01 DOI: 10.1016/S0748-7983(25)00041-1

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