Pub Date : 2025-02-01DOI: 10.1016/j.ejso.2024.109508
Youchang Sun, Sheng Li
{"title":"Comment on “Factors associated with leakage after reversal of protective stoma in patients with locally advanced rectal cancer following curative resection and anastomosis”","authors":"Youchang Sun, Sheng Li","doi":"10.1016/j.ejso.2024.109508","DOIUrl":"10.1016/j.ejso.2024.109508","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109508"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863801","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}
While liver resection remains the best curative option for hepatocellular carcinoma (HCC), it is unclear whether the consistent progress of multidisciplinary approaches in managing HCC over several decades has influenced the outcomes of liver resection.
Methods
Patients undergoing liver resection for HCC from 1993 to 2022 in our institution were retrospectively assessed and stratified into three periods according to the year of liver resection, P1 (1993–2000), P2 (2001–2009), and P3 (2010–2022), and tumor status using the Barcelona Clinic Liver Cancer (BCLC) staging system.
Results
A total of 1257 patients were included (P1:P2:P3 = 385:490:382, BCLC stage 0/A:B:C = 908:214:135). In the entire cohort, long-term surgical outcomes significantly improved across the three periods. In BCLC stage 0/A HCC, the 5-year overall survival (OS) rate improved from P1 to P3 (P1: 65.5 %, P2: 71.3 %, P3: 80.4 %), with HRs of 0.655 (95 % CI: 0.536 to 0.800) and 0.595 (95 % CI: 0.455 to 0.778) for P2 vs. P1 and P3 vs. P1, respectively. Conversely, limited advancements were observed in patients with BCLC stage B or C HCC. Multivariate analysis in BCLC stage 0/A patients demonstrated that ICGR15 > 15 %, ALBI grade 2 or 3 (vs. 1), multiple tumors, microvascular invasion, and surgical period (P2 vs.P1) remained independent poor prognostic factors for OS.
Conclusions
Substantial advancements in the long-term outcomes for HCC patients undergoing liver resection, particularly in BCLC stage 0/A, were observed, while minimal improvement was noted for BCLC stage B and C.
{"title":"Chronological evolution in liver resection for hepatocellular carcinoma: Prognostic trends across three decades in early to advanced stages","authors":"Takeshi Takamoto , Satoshi Nara , Daisuke Ban , Takahiro Mizui , Masami Mukai , Minoru Esaki , Kazuaki Shimada","doi":"10.1016/j.ejso.2024.109461","DOIUrl":"10.1016/j.ejso.2024.109461","url":null,"abstract":"<div><h3>Background</h3><div>While liver resection remains the best curative option for hepatocellular carcinoma (HCC), it is unclear whether the consistent progress of multidisciplinary approaches in managing HCC over several decades has influenced the outcomes of liver resection.</div></div><div><h3>Methods</h3><div>Patients undergoing liver resection for HCC from 1993 to 2022 in our institution were retrospectively assessed and stratified into three periods according to the year of liver resection, P1 (1993–2000), P2 (2001–2009), and P3 (2010–2022), and tumor status using the Barcelona Clinic Liver Cancer (BCLC) staging system.</div></div><div><h3>Results</h3><div>A total of 1257 patients were included (P1:P2:P3 = 385:490:382, BCLC stage 0/A:B:C = 908:214:135). In the entire cohort, long-term surgical outcomes significantly improved across the three periods. In BCLC stage 0/A HCC, the 5-year overall survival (OS) rate improved from P1 to P3 (P1: 65.5 %, P2: 71.3 %, P3: 80.4 %), with HRs of 0.655 (95 % CI: 0.536 to 0.800) and 0.595 (95 % CI: 0.455 to 0.778) for P2 vs. P1 and P3 vs. P1, respectively. Conversely, limited advancements were observed in patients with BCLC stage B or C HCC. Multivariate analysis in BCLC stage 0/A patients demonstrated that ICGR15 > 15 %, ALBI grade 2 or 3 (vs. 1), multiple tumors, microvascular invasion, and surgical period (P2 vs.P1) remained independent poor prognostic factors for OS.</div></div><div><h3>Conclusions</h3><div>Substantial advancements in the long-term outcomes for HCC patients undergoing liver resection, particularly in BCLC stage 0/A, were observed, while minimal improvement was noted for BCLC stage B and C.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109461"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142779675","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}
Pub Date : 2025-02-01DOI: 10.1016/S0748-7983(25)00038-1
{"title":"Rosetrees research grants in cancer surgery","authors":"","doi":"10.1016/S0748-7983(25)00038-1","DOIUrl":"10.1016/S0748-7983(25)00038-1","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109610"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143198541","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ejso.2025.109632
Hiba Kamran, Hasnain Wajeeh Saqib, Reem Muhammad
Soft tissue sarcomas (STS) are rare and aggressive tumors with limited treatment options. A recent study by Burkhard-Meier et al. highlights Local Ablative Therapy (LAT) as a promising approach for metastatic STS, particularly pulmonary metastasectomy, which showed the best survival outcomes. Smaller tumors and longer treatment-free intervals were key predictors of success. Combining LAT with systemic therapy further improved progression-free survival. Advancements in stereotactic body radiation therapy (SBRT) offer potential benefits for STS, though data remains limited. While SBRT has shown success in breast and lung cancers, its role in STS requires further research. Until more trials confirm its efficacy, traditional LAT remains the preferred approach for carefully selected patients.
{"title":"From traditional LAT to stereotactic radiotherapy: Evolving options for metastatic soft tissue sarcoma","authors":"Hiba Kamran, Hasnain Wajeeh Saqib, Reem Muhammad","doi":"10.1016/j.ejso.2025.109632","DOIUrl":"10.1016/j.ejso.2025.109632","url":null,"abstract":"<div><div>Soft tissue sarcomas (STS) are rare and aggressive tumors with limited treatment options. A recent study by Burkhard-Meier et al. highlights Local Ablative Therapy (LAT) as a promising approach for metastatic STS, particularly pulmonary metastasectomy, which showed the best survival outcomes. Smaller tumors and longer treatment-free intervals were key predictors of success. Combining LAT with systemic therapy further improved progression-free survival. Advancements in stereotactic body radiation therapy (SBRT) offer potential benefits for STS, though data remains limited. While SBRT has shown success in breast and lung cancers, its role in STS requires further research. Until more trials confirm its efficacy, traditional LAT remains the preferred approach for carefully selected patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 6","pages":"Article 109632"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488152","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ejso.2024.108304
Owen McGreevy , Mohammed Bosakhar , Timothy Gilbert , Marc Quinn , Stephen Fenwick , Hassan Malik , Christopher Goldring , Laura Randle
Cholangiocarcinoma (CCA) is an adenocarcinoma of the hepatobiliary system with a grim prognosis. Incidence is rising globally and surgery is currently the only curative treatment, but is only available for patients who are fit and diagnosed in an early-stage of disease progression. Great importance has been placed on developing preclinical models to help further our understanding of CCA and potential treatments to improve therapeutic outcomes. Preclinical models of varying complexity and cost have been established, ranging from more simplistic in vitro 2D CCA cell lines in culture, to more complex in vivo genetically engineered mouse models. Currently there is no single model that faithfully recaptures the complexities of human CCA and the in vivo tumour microenvironment. Instead a multi-model approach should be used when designing preclinical trials to study CCA and potential therapies.
{"title":"The importance of preclinical models in cholangiocarcinoma","authors":"Owen McGreevy , Mohammed Bosakhar , Timothy Gilbert , Marc Quinn , Stephen Fenwick , Hassan Malik , Christopher Goldring , Laura Randle","doi":"10.1016/j.ejso.2024.108304","DOIUrl":"10.1016/j.ejso.2024.108304","url":null,"abstract":"<div><div>Cholangiocarcinoma (CCA) is an adenocarcinoma of the hepatobiliary system with a grim prognosis. Incidence is rising globally and surgery is currently the only curative treatment, but is only available for patients who are fit and diagnosed in an early-stage of disease progression. Great importance has been placed on developing preclinical models to help further our understanding of CCA and potential treatments to improve therapeutic outcomes. Preclinical models of varying complexity and cost have been established, ranging from more simplistic <em>in vitro</em> 2D CCA cell lines in culture, to more complex <em>in vivo</em> genetically engineered mouse models. Currently there is no single model that faithfully recaptures the complexities of human CCA and the <em>in vivo</em> tumour microenvironment. Instead a multi-model approach should be used when designing preclinical trials to study CCA and potential therapies.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 108304"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400784","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}
Immunonutrition (IMN) modulates the activity of the immune system. However, the effects of IMN on cancer patients following colorectal surgery is still lacking. We performed a systematic review and meta-analysis to evaluate the outcomes of IMN in patients undergoing laparoscopic versus open colorectal surgery.
Methods
A systematic search of multiple electronic data sources was conducted in accordance with PRISMA guidelines and included MEDLINE via PubMed, EMBASE, Scopus, and Web of Science. All eligible studies reporting comparative outcomes of immunonutrition in colorectal surgery were included. Subgroup analysis of outcomes of interest was performed and data were analysed using Review Manager (RevMan) Version 5.4.1.
Results
Nine randomised controlled trials (RCTs) were identified. The final pooled analysis included 1199 patients (592 IMN group and 592 control group). Of these, 55.3 % (655/1184) had open colorectal surgery (OG) and 44.7 % (529/1184) underwent laparoscopic colorectal surgery (LG). IMN reduced the risk of wound infection significantly in the OG [risk ratio (RR) 0.48, 95 % confidence interval (CI) 0.32 to 0.72; p = 0.0005)] and the open and laparoscopic group (OLG) [RR 0.33, 95 % CI 0.15 to 0.76; p = 0.008]. Moreover, IMN was also associated with a significantly shorter length of hospital stay (MD – 2.37 days, 95 % CI - 3.39 to −1.36; p < 0.0001) in the OG. Other post-operative morbidities (anastomotic leak and ileus) and mortality outcomes in the OG, LG, and OLG were comparable.
Conclusions
Pre-operative IMN could reduce the wound infection rate and shorten length of hospital stay in patients following elective colorectal surgery. The benefit of these improved clinical outcomes could be further evaluated with a cost-benefit analysis. IMN should be recommended as nutritional adjunct in the Enhanced Recovery after Surgery (ERAS) pathway following colorectal surgery.
免疫营养（IMN）调节免疫系统的活性。然而，IMN对结直肠癌术后癌症患者的影响仍缺乏研究。我们进行了一项系统回顾和荟萃分析，以评估腹腔镜与开放式结直肠手术患者IMN的结果。方法：根据PRISMA指南系统检索多个电子数据源，包括PubMed、EMBASE、Scopus和Web of Science的MEDLINE。所有报告结肠直肠手术免疫营养比较结果的符合条件的研究被纳入。使用Review Manager (RevMan) Version 5.4.1对感兴趣的结果进行亚组分析和数据分析。结果：纳入9项随机对照试验（RCTs）。最终汇总分析纳入1199例患者（IMN组592例，对照组592例）。其中55.3%（655/1184）行开腹结直肠手术（OG）， 44.7%（529/1184）行腹腔镜结直肠手术（LG）。IMN显著降低了OG组的伤口感染风险[风险比（RR） 0.48, 95%可信区间（CI） 0.32 ~ 0.72；p = 0.0005)]和开放和腹腔镜组（OLG） [RR 0.33, 95% CI 0.15 ~ 0.76；p = 0.008]。此外，IMN还与住院时间显著缩短相关(MD - 2.37天，95% CI - 3.39至-1.36；结论：择期结直肠手术患者术前IMN可降低伤口感染率，缩短住院时间。这些改善的临床结果的益处可以通过成本效益分析进一步评估。应推荐IMN作为结直肠手术后增强术后恢复（ERAS）途径的营养辅助。
{"title":"Effects of enteral immunonutrition in laparoscopic versus open resections in colorectal cancer surgery: A meta-analysis of randomised controlled trials","authors":"Chee Siong Wong (Specialist Registrar) , Shafquat Zaman (Specialist Registrar) , Koushik Siddiraju (Clinical Health Researcher) , Archana Sellvaraj (Junior Specialty doctor) , Tariq Ghattas (Junior Specialty doctor) , Yegor Tryliskyy (Specialist Registrar)","doi":"10.1016/j.ejso.2024.109488","DOIUrl":"10.1016/j.ejso.2024.109488","url":null,"abstract":"<div><h3>Introduction</h3><div>Immunonutrition (IMN) modulates the activity of the immune system. However, the effects of IMN on cancer patients following colorectal surgery is still lacking. We performed a systematic review and meta-analysis to evaluate the outcomes of IMN in patients undergoing laparoscopic versus open colorectal surgery.</div></div><div><h3>Methods</h3><div>A systematic search of multiple electronic data sources was conducted in accordance with PRISMA guidelines and included MEDLINE via PubMed, EMBASE, Scopus, and Web of Science. All eligible studies reporting comparative outcomes of immunonutrition in colorectal surgery were included. Subgroup analysis of outcomes of interest was performed and data were analysed using Review Manager (RevMan) Version 5.4.1.</div></div><div><h3>Results</h3><div>Nine randomised controlled trials (RCTs) were identified. The final pooled analysis included 1199 patients (592 IMN group and 592 control group). Of these, 55.3 % (655/1184) had open colorectal surgery (OG) and 44.7 % (529/1184) underwent laparoscopic colorectal surgery (LG). IMN reduced the risk of wound infection significantly in the OG [risk ratio (RR) 0.48, 95 % confidence interval (CI) 0.32 to 0.72; p = 0.0005)] and the open and laparoscopic group (OLG) [RR 0.33, 95 % CI 0.15 to 0.76; <em>p</em> = 0.008]. Moreover, IMN was also associated with a significantly shorter length of hospital stay (MD – 2.37 days, 95 % CI - 3.39 to −1.36; <em>p</em> < 0.0001) in the OG. Other post-operative morbidities (anastomotic leak and ileus) and mortality outcomes in the OG, LG, and OLG were comparable.</div></div><div><h3>Conclusions</h3><div>Pre-operative IMN could reduce the wound infection rate and shorten length of hospital stay in patients following elective colorectal surgery. The benefit of these improved clinical outcomes could be further evaluated with a cost-benefit analysis. IMN should be recommended as nutritional adjunct in the Enhanced Recovery after Surgery (ERAS) pathway following colorectal surgery.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109488"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142871728","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ejso.2024.109538
Elan Novis , Ahmad Sulaiman , Jonathan Stretch , David Chung , Kevin London , Terence Wong , Serigne N. Lo , Thomas E. Pennington , Robyn P.M. Saw , Sydney Ch'ng , Kerwin F. Shannon , Andrew J. Spillane , Omgo E. Nieweg , John F. Thompson , Alexander C.J. van Akkooi , Michael Rtshiladze
Background
Although most melanomas drain to the more common major lymph node basins (axilla, groin, neck), rarely they drain to deep SLN locations such as intra-abdominal and intra-thoracic (including intercostal and internal mammary) sites, which pose a higher surgical risk and complexity for procurement. Our study is aimed at determining the rate of positivity and likelihood of recurrence in these nodal sites to guide management decisions for patients with truncal melanomas which drain to these ‘deep’ SLN locations.
Methods
Retrospective data collected between May 2008 and May 2022 including all patients with truncal melanomas who underwent lymphoscintigraphy resulting in the identification of deep SLNs in intra-abdominal and intra-thoracic sites were included. The associations between retrieval of SLNs and recurrence-free survival (RFS) and overall survival (OS) were investigated.
Results
74 patients with a total of 91 SLNs located at deep sites were included. 11 (15 %) patients with a total of 12 lymph nodes had SLNB of these deep nodes, all of which were intercostal nodes. Only 1 patient had a positive SLNB. In total, 24 (32 %) patients developed recurrence. However, the remaining patients did not recur at the deep SLN sites. There were no statistically significant associations between retrieval of deep SLNs and RFS or OS. 3-year RFS in the patients who had deep SLNB performed was 62 % compared to 54 % and 50 % in those who had no SLNB or incomplete SLNB, respectively (p = 0.63).
Conclusion
In this study omitting procurement of these deep SLNs did not result in reduced RFS or OS.
{"title":"Clinical significance of intra-thoracic and intra-abdominal sentinel lymph nodes detected on lymphoscintigraphy in truncal melanoma patients","authors":"Elan Novis , Ahmad Sulaiman , Jonathan Stretch , David Chung , Kevin London , Terence Wong , Serigne N. Lo , Thomas E. Pennington , Robyn P.M. Saw , Sydney Ch'ng , Kerwin F. Shannon , Andrew J. Spillane , Omgo E. Nieweg , John F. Thompson , Alexander C.J. van Akkooi , Michael Rtshiladze","doi":"10.1016/j.ejso.2024.109538","DOIUrl":"10.1016/j.ejso.2024.109538","url":null,"abstract":"<div><h3>Background</h3><div>Although most melanomas drain to the more common major lymph node basins (axilla, groin, neck), rarely they drain to deep SLN locations such as intra-abdominal and intra-thoracic (including intercostal and internal mammary) sites, which pose a higher surgical risk and complexity for procurement. Our study is aimed at determining the rate of positivity and likelihood of recurrence in these nodal sites to guide management decisions for patients with truncal melanomas which drain to these ‘deep’ SLN locations.</div></div><div><h3>Methods</h3><div>Retrospective data collected between May 2008 and May 2022 including all patients with truncal melanomas who underwent lymphoscintigraphy resulting in the identification of deep SLNs in intra-abdominal and intra-thoracic sites were included. The associations between retrieval of SLNs and recurrence-free survival (RFS) and overall survival (OS) were investigated.</div></div><div><h3>Results</h3><div>74 patients with a total of 91 SLNs located at deep sites were included. 11 (15 %) patients with a total of 12 lymph nodes had SLNB of these deep nodes, all of which were intercostal nodes. Only 1 patient had a positive SLNB. In total, 24 (32 %) patients developed recurrence. However, the remaining patients did not recur at the deep SLN sites. There were no statistically significant associations between retrieval of deep SLNs and RFS or OS. 3-year RFS in the patients who had deep SLNB performed was 62 % compared to 54 % and 50 % in those who had no SLNB or incomplete SLNB, respectively (p = 0.63).</div></div><div><h3>Conclusion</h3><div>In this study omitting procurement of these deep SLNs did not result in reduced RFS or OS.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109538"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812634","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ejso.2025.109584
Sebastián Jerí-McFarlane , Álvaro García-Granero , Marco Antonio Martínez-Ortega , Isabel Amengual-Antich , Ángela Rodríguez Robayo , Margarita Gamundí-Cuesta , Francisco Xavier González-Argenté
Background
This study investigates the effectiveness of a three-dimensional reconstruction mathematical model (3D-IPR) for preoperative planning in locally advanced colon cancer (LACC) with threatened surgical margins. The objective was to evaluate the utility of a 3D-IPR surgical planner tool in cases of LACC with threatened surgical margins. Additionally, the study aims to compare the diagnostic accuracy of the 3D-IPR model against conventional CT scans in determining the infiltration of neighboring structures.
Methods
This Single-center, prospective, observational, comparative, non-randomized study.
Inclusión criteria
Patients over 18 years old undergoing surgery for LACC as indicated by a radiologist's analysis of CT scans. Preoperative confirmation of neoplasm by colonoscopy. Exclusion criteria: patients who had received neoadjuvant chemotherapy, suspected carcinomatosis on preoperative CT and patients with unresectable tumors. All patients were selected consecutively.
Procedures
Intervention involved using a 3D-IPR model as a surgical planning tool for patients with LACC. The 3D-IPR provided detailed metrics about the tumor and surrounding structures to assist in surgical planning. Surgical procedures were guided by the radiological assessments from CT scans and intraoperative findings, with surgeries categorized based on surgical margins as R0, R1, or R2.
The primary endpoint was the diagnostic accuracy of the 3D-IPR model in determining tumor infiltration of neighboring structures compared to conventional CT scans. The measure used to assess this outcome was the definitive pathological report of tumor infiltration, which served as the gold standard for comparison. Demographic, intraoperative, morbidity, mortality, and pathological data were analyzed.
Results
21 patients were assessed, 1 excluded with a final sample of 20 patients. 3D-IPR model demonstrated higher diagnostic accuracy for tumor infiltration of neighboring structures compared to conventional CT scans, with sensitivity, specificity, Positive Predictive Value, and Negative Predictive Value of 70 %, 90 %, 87.5 %, and 75 %, respectively. Surgeries were predominantly minimally invasive (70 %), with no major complications or mortality within 30 days, and a 0 % conversion rate to open surgery.
Conclusions
The 3D-IPR model significantly enhances preoperative planning accuracy, reducing the risk of incomplete resections and improving surgical outcomes. This technology offers a reliable basis for surgical decisions, potentially improving patient prognosis and survival rates.
{"title":"Tailored-surgery for locally advanced colon cancer based on 3D mathematical reconstruction surgical planner: Observational comparative non-randomized study","authors":"Sebastián Jerí-McFarlane , Álvaro García-Granero , Marco Antonio Martínez-Ortega , Isabel Amengual-Antich , Ángela Rodríguez Robayo , Margarita Gamundí-Cuesta , Francisco Xavier González-Argenté","doi":"10.1016/j.ejso.2025.109584","DOIUrl":"10.1016/j.ejso.2025.109584","url":null,"abstract":"<div><h3>Background</h3><div>This study investigates the effectiveness of a three-dimensional reconstruction mathematical model (3D-IPR) for preoperative planning in locally advanced colon cancer (LACC) with threatened surgical margins. The objective was to evaluate the utility of a 3D-IPR surgical planner tool in cases of LACC with threatened surgical margins. Additionally, the study aims to compare the diagnostic accuracy of the 3D-IPR model against conventional CT scans in determining the infiltration of neighboring structures.</div></div><div><h3>Methods</h3><div>This Single-center, prospective, observational, comparative, non-randomized study.</div></div><div><h3>Inclusión criteria</h3><div>Patients over 18 years old undergoing surgery for LACC as indicated by a radiologist's analysis of CT scans. Preoperative confirmation of neoplasm by colonoscopy. Exclusion criteria: patients who had received neoadjuvant chemotherapy, suspected carcinomatosis on preoperative CT and patients with unresectable tumors. All patients were selected consecutively.</div></div><div><h3>Procedures</h3><div>Intervention involved using a 3D-IPR model as a surgical planning tool for patients with LACC. The 3D-IPR provided detailed metrics about the tumor and surrounding structures to assist in surgical planning. Surgical procedures were guided by the radiological assessments from CT scans and intraoperative findings, with surgeries categorized based on surgical margins as R0, R1, or R2.</div><div>The primary endpoint was the diagnostic accuracy of the 3D-IPR model in determining tumor infiltration of neighboring structures compared to conventional CT scans. The measure used to assess this outcome was the definitive pathological report of tumor infiltration, which served as the gold standard for comparison. Demographic, intraoperative, morbidity, mortality, and pathological data were analyzed.</div></div><div><h3>Results</h3><div>21 patients were assessed, 1 excluded with a final sample of 20 patients. 3D-IPR model demonstrated higher diagnostic accuracy for tumor infiltration of neighboring structures compared to conventional CT scans, with sensitivity, specificity, Positive Predictive Value, and Negative Predictive Value of 70 %, 90 %, 87.5 %, and 75 %, respectively. Surgeries were predominantly minimally invasive (70 %), with no major complications or mortality within 30 days, and a 0 % conversion rate to open surgery.</div></div><div><h3>Conclusions</h3><div>The 3D-IPR model significantly enhances preoperative planning accuracy, reducing the risk of incomplete resections and improving surgical outcomes. This technology offers a reliable basis for surgical decisions, potentially improving patient prognosis and survival rates.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 109584"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982959","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ejso.2023.107117
Lynn E. Nooijen , Marieke T. de Boer , Andries E. Braat , Maxime Dewulf , Marcel den Dulk , Jeroen Hagendoorn , Frederik J.H. Hoogwater , Hwai-Ding Lam , Quintus Molenaar , Ulf Neumann , Robert J. Porte , Rutger-Jan Swijnenburg , Babs Zonderhuis , Geert Kazemier , Heinz-josef Klümpen , Thomas van Gulik , Bas Groot Koerkamp , Joris I. Erdmann
Background
Currently, no practical definition of potentially resectable, borderline or unresectable perihilar cholangiocarcinoma (pCCA) is available. Aim of this study was to define criteria to categorize patients for use in a future neoadjuvant or induction therapy study.
Method
Using the modified DELPHI method, hepatobiliary surgeons from all tertiary referral centers in the Netherlands were invited to participate in this study. During five online meetings, predefined factors determining resectability and additional factors regarding surgical resectability and operability were discussed.
Results
The five online meetings resulted in 52 statements. After two surveys, consensus was reached in 63% of the questions. The main consensus included a definition regarding potential resectability. 1) Clearly resectable: no vascular involvement (≤90°) of the future liver remnant (FLR) and expected feasibility of radical biliary resection. 2) Clearly unresectable: non-reconstructable venous and/or arterial involvement of the FLR or no feasible radical biliary resection. 3) Borderline resectable: all patients between clearly resectable and clearly unresectable disease.
Conclusion
This DELPHI study resulted in a practical and applicable resectability, or more accurate, an explorability classification, which can be used to categorize patients for use in future neoadjuvant therapy studies.
{"title":"National consensus on a new resectability classification for perihilar cholangiocarcinoma - A modified Delphi method","authors":"Lynn E. Nooijen , Marieke T. de Boer , Andries E. Braat , Maxime Dewulf , Marcel den Dulk , Jeroen Hagendoorn , Frederik J.H. Hoogwater , Hwai-Ding Lam , Quintus Molenaar , Ulf Neumann , Robert J. Porte , Rutger-Jan Swijnenburg , Babs Zonderhuis , Geert Kazemier , Heinz-josef Klümpen , Thomas van Gulik , Bas Groot Koerkamp , Joris I. Erdmann","doi":"10.1016/j.ejso.2023.107117","DOIUrl":"10.1016/j.ejso.2023.107117","url":null,"abstract":"<div><h3>Background</h3><div>Currently, no practical definition of potentially resectable, borderline or unresectable perihilar cholangiocarcinoma (pCCA) is available. Aim of this study was to define criteria to categorize patients for use in a future neoadjuvant or induction therapy study.</div></div><div><h3>Method</h3><div>Using the modified DELPHI method, hepatobiliary surgeons from all tertiary referral centers in the Netherlands were invited to participate in this study. During five online meetings, predefined factors determining resectability and additional factors regarding surgical resectability and operability were discussed.</div></div><div><h3>Results</h3><div>The five online meetings resulted in 52 statements. After two surveys, consensus was reached in 63% of the questions. The main consensus included a definition regarding potential resectability. 1) Clearly resectable: no vascular involvement (≤90°) of the future liver remnant (FLR) and expected feasibility of radical biliary resection. 2) Clearly unresectable: non-reconstructable venous and/or arterial involvement of the FLR or no feasible radical biliary resection. 3) Borderline resectable: all patients between clearly resectable and clearly unresectable disease.</div></div><div><h3>Conclusion</h3><div>This DELPHI study resulted in a practical and applicable resectability, or more accurate, an explorability classification, which can be used to categorize patients for use in future neoadjuvant therapy studies.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 107117"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50161154","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}
Pub Date : 2025-02-01DOI: 10.1016/j.ejso.2024.108352
T.M. Gilbert , L. Randle , M. Quinn , O. McGreevy , L. O’leary , R. Young , R. Diaz-Neito , R.P. Jones , B. Greenhalf , C. Goldring , S. Fenwick , H. Malik , D.H. Palmer
Cholangiocarcinoma (CCA) remains a devastating malignancy and a significant challenge to treat. The majority of CCA patients are diagnosed at an advanced stage, making the disease incurable in most cases. The advent of high-throughput genetic sequencing has significantly improved our understanding of the molecular biology underpinning cancer. The identification of ‘druggable’ genetic aberrations and the development of novel targeted therapies against them is opening up new treatment strategies. Currently, 3 targeted therapies are approved for use in CCA; Ivosidenib in patients with IDH1 mutations and Infigratinib/Pemigatinib in those with FGFR2 fusions. As our understanding of the biology underpinning CCA continues to improve it is highly likely that additional targeted therapies will become available in the near future. This is important, as it is thought up to 40 % of CCA patients harbour a potentially actionable mutation. In this review we provide an overview of the molecular pathogenesis of CCA and highlight currently available and potential future targeted treatments.
胆管癌（CCA）仍然是一种破坏性极大的恶性肿瘤，也是治疗上的一大挑战。大多数 CCA 患者在确诊时已是晚期，因此在大多数情况下无法治愈。高通量基因测序技术的出现大大提高了我们对癌症分子生物学基础的认识。发现 "可药物治疗 "的基因畸变并开发针对这些畸变的新型靶向疗法，为我们开辟了新的治疗策略。目前，有 3 种靶向疗法获准用于 CCA：Ivosidenib 用于 IDH1 基因突变的患者，Infigratinib/Pemigatinib 用于 FGFR2 基因融合的患者。随着我们对 CCA 生物学基础的了解不断加深，很有可能在不久的将来会有更多的靶向疗法问世。这一点非常重要，因为据认为多达 40% 的 CCA 患者存在潜在的可采取行动的突变。在这篇综述中，我们概述了 CCA 的分子发病机制，并重点介绍了目前可用的和未来潜在的靶向治疗方法。
{"title":"Molecular biology of cholangiocarcinoma and its implications for targeted therapy in patient management","authors":"T.M. Gilbert , L. Randle , M. Quinn , O. McGreevy , L. O’leary , R. Young , R. Diaz-Neito , R.P. Jones , B. Greenhalf , C. Goldring , S. Fenwick , H. Malik , D.H. Palmer","doi":"10.1016/j.ejso.2024.108352","DOIUrl":"10.1016/j.ejso.2024.108352","url":null,"abstract":"<div><div><span>Cholangiocarcinoma<span><span> (CCA) remains a devastating malignancy and a significant challenge to treat. The majority of CCA patients are diagnosed at an advanced stage, making the disease incurable in most cases. The advent of high-throughput genetic sequencing has significantly improved our understanding of the molecular biology underpinning cancer. The identification of ‘druggable’ genetic aberrations and the development of novel </span>targeted therapies against them is opening up new treatment strategies. Currently, 3 targeted therapies are approved for use in CCA; </span></span>Ivosidenib<span><span> in patients with IDH1 mutations and Infigratinib/Pemigatinib in those with FGFR2 fusions. As our understanding of the biology underpinning CCA continues to improve it is highly likely that additional targeted therapies will become available in the near future. This is important, as it is thought up to 40 % of CCA patients harbour a potentially actionable mutation. In this review we provide an overview of the </span>molecular pathogenesis of CCA and highlight currently available and potential future targeted treatments.</span></div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 2","pages":"Article 108352"},"PeriodicalIF":3.5,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140803494","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}
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