Journal of Surgical Oncology最新文献

Background and objectives: Radical local therapy is effective for oligo-recurrence of non-small cell lung cancer (NSCLC). We retrospectively assessed patients with oligo-recurrent NSCLC and detailed the clinical course after radical local therapy.

Methods: We analyzed 1028 patients who underwent complete resection for NSCLC. We defined oligo-recurrence as up to two metachronous recurrences, radical local therapy as local therapy performed with curative intent, and progressive disease as the appearance of new lesions/re-enlargement of the initial recurrence sites.

Results: Of the 132 patients who developed oligo-recurrence, 88 received radical local therapy. Fifty-eight patients had progressive disease. Fifteen patients remained cancer free for > 5 years. Epidermal growth factor receptor (EGFR) positivity was associated with disease progression (odds ratio, 3.90; p = 0.025). Active treatment for disease progression (hazard ratio, 2.54; p = 0.012) and the absence of re-enlarged lesions at sites of radical local therapy for recurrence (hazard ratio, 2.32; p = 0.031) were associated with prolonged post-recurrence overall survival.

Conclusions: Patients with EGFR mutations who develop oligo-recurrence should be monitored for disease progression. Re-enlargement of lesions after radical local therapy was associated with a poor prognosis. A good prognosis can be expected with active treatment, even in the event of disease progression.

Introduction: Complete surgical resection is the mainstay of treatment for retroperitoneal sarcomas (RPS). For primary well-differentiated liposarcomas and dedifferentiated liposarcomas, aggressive en-bloc resection of adjacent organs is crucial for local control. Diaphragmatic resection may be necessary in left-sided RPS cases. While primary closure of defects is usually possible, large defects may require alternative methods such as prosthetic reconstruction.

Methods: We developed an innovative technique for reconstructing diaphragmatic defects after RPS resection using a rectangular polytetrafluoroethylene band called ROCK band (robust organic composite for kinetic restoration of the diaphragm). This technique involves fixing the folded band to the prevertebral fascia and diaphragm to ensure tension-free closure while preserving diaphragm function. The study analyzed patients treated with this technique at IRCCS-Humanitas Research Hospital from January to December 2023.

Results: Four patients underwent left RPS resection with ROCK band reconstruction. The median age was 56.5 years, with a male/female ratio of 1/3. Median tumor size was 24.5 cm, and median operative time was 409.5 min. There were no ROCK band-related complications, diaphragmatic hernias, or respiratory failures.

Conclusions: This technique provides a safe, effective, and adaptable method for diaphragmatic reconstruction after RPS resection, improving anatomical and functional outcomes. Larger studies are needed for validation.

Background and objectives: The presence of lymph node metastases in patients with gastric and gastroesophageal junction (GEJ) adenocarcinoma provides prognostic information and guides treatment decisions. We sought to determine the sensitivity of computed tomography (CT) imaging for clinical nodal staging in patients with resectable gastric and GEJ adenocarcinoma and determine a lymph node size cut-off to optimize diagnostic accuracy.

Methods: We performed a retrospective review of patients who underwent curative-intent resection for gastric or GEJ adenocarcinoma at our institution between 2010 and 2023. We reviewed CT scan images performed immediately before resection and measured lymph nodes in the short axis to identify patients with lymph nodes larger than the radiologic upper limit of normal. We compared histopathologic data from resection specimens to CT scans to determine pathologic concordance for metastatic involvement of lymph nodes and calculated the sensitivity and specificity of CT scans to identify nodal metastases. We used the largest lymph node measurement from each scan to construct a receiver operating characteristic (ROC) curve and calculated Youden's J Index to determine the optimal lymph node size cut-off.

Results: We identified 192 consecutive patients who underwent resection during the study period and had preoperative CT scans available for review. 72 patients (38%) had diffuse or mixed type tumors, and 85 patients (44%) had intestinal-type tumors. 157 patients (82%) underwent neoadjuvant chemotherapy or chemoradiation. 110 patients (57%) had pathologic node-positive disease and in this cohort, 27 patients (25%) had lymph nodes deemed radiographically enlarged. The sensitivity of preoperative CT scans for nodal metastases was 25%, and specificity was 83%. Based on the ROC curve, an optimal lymph node size cutoff of 6.5 mm was identified. At this cutoff, the estimated sensitivity was 47%, and the estimated specificity was 72%. When patients were stratified by Lauren histology, the AUC for intestinal-type tumors was significantly better than for diffuse or mixed-type tumors (p = 0.02). The area under the ROC curve for patients with diffuse or mixed type tumors was 0.51 indicating lymph node size on CT scan was no better than random chance for diagnosis of lymph node metastases.

Conclusions: CT scans are not sensitive to identify nodal metastases in gastric and GEJ adenocarcinoma using current radiologic guidelines. While a lower lymph node size cutoff may improve sensitivity, this does not benefit patients with diffuse or mixed-type tumors. Since CT scans understage a large proportion of patients with gastric and GEJ cancers, techniques to improve clinical nodal staging in this population are needed.

Background and methods: Surgery remains the standard of care for non-small cell lung cancer (NSCLC) but is applicable to ≤ 30% of patients. Pulsed Electric Fields (PEF) ablation uses short-duration, high-voltage electrical pulses to induce cell death without relying on thermal mechanisms. Safety findings are reported from a two-arm, non-randomized, study evaluating the use of PEF in patients with early-stage NSCLC.

Methods: PEF energy was delivered bronchoscopically or percutaneously to 36 patients with suspected or confirmed early-stage NSCLC approximately 20 days before resection; 8 control patients had biopsy only. The primary safety analysis was the device and/or procedure related serious adverse events (AEs) rate from PEF procedure through resection. Immunohistochemical evaluation of resected tissue was also assessed.

Results: PEF was delivered to all patients in the treatment group after biopsy of targeted tumor. No device or procedure-related AE were observed. Histopathological assessment of resected tumors demonstrated a cellular depletion zone characterized by decrease or absence of tumor cellularity and a variable degree of inflammation. Tertiary lymphoid structures were observed within PEF-treated tumors.

Conclusions: These clinical observations and histopathologic tissue alterations, indicate that PEF energy delivery is feasible and safe in NSCLC, with potential signals of immune system activation.

This "How I Do It" study provides an in-depth exploration of techniques for pancreatic reconstruction following pancreaticoduodenectomy. The study includes a video demonstration highlighting the step-by-step strategies and appropriate indications for each reconstruction method using the robotic system.

Purpose: To quantify improvements in adverse in-hospital outcomes between historical and contemporary robot-assisted radical cystectomy (RARC) versus historical and contemporary open RC (ORC).

Material and methods: Within the National Inpatient Sample (2010-2019), RARC and ORC ileal conduit diversion patients were identified. Multivariable logistic and Poisson regression models were fitted.

Results: Of RARC patients, 1343 (39%) were historical (2010-2014) and 2087 (61%) were contemporary (2015-2019). Of ORC patients, 5812 (54%) were historical and 5019 (46%) were contemporary. Versus historical counterparts, contemporary RARC patients exhibited significantly better adverse in-hospital outcomes in 9 of 13 categories, with improvements ranging from -82% for intraoperative complications to -22% for cumulative postoperative complications. Similarly, versus historical, contemporary ORC patients also exhibited significantly better adverse in-hospital outcomes in 9 of 13 categories, with improvements ranging from -72% for intraoperative complications to -12% for median length of stay (LOS). When contemporary RARC was compared to contemporary ORC, RARC adverse in-hospital outcomes were better in 7 of 13 comparisons, with improvements ranging from -55% for blood transfusions to -18% for median LOS. Similarly, when historical RARC was compared to historical ORC, RARC adverse in-hospital outcomes were better in 6 of 13 comparisons, with improvements ranging from -55% for blood transfusions to -15% for median LOS.

Conclusion: The magnitude of the improvement in adverse in-hospital outcomes was comparable between contemporary versus historical RARC (nine improved categories) and contemporary versus historical ORC (nine improved categories). However, contemporary RARC outperformed contemporary ORC in 7 of 13 categories of adverse in-hospital outcomes.

Background and objectives: Despite advancements in rectal cancer treatment, therapy of local recurrence remains a significant challenge as it has to be individualized to the extent of recurrence and prior treatment. This study aims to analyze outcomes of patients with local recurrence after resection for rectal cancer, focusing on R0-resection rates and overall survival (OS).

Methods: A retrospective cohort study included 31 patients with local recurrence after initial curative resection for rectal cancer between 2003 and 2021.

Results: Recurrence was diagnosed in 77.4% of cases during scheduled routine follow-up and 58,1% of patients reported of symptoms at the time of diagnosis. Symptomatic patients tended to be treated palliatively (66.7%, 12/18, p = 0.073). A curative treatment approach was intended in 48.4% of all patients, with 80% achieving R0-resection by surgery. The 5-year OS was significantly longer in patients achieving R0-resection (58.3% vs. 5.3%, p = 0.0) and decreased in symptomatic patients (11.1% vs. 46.2%, p = 0.025).

Conclusions: These findings emphasize the importance of early recurrence detection, optimally in a scheduled cancer follow-up.

Background and methods: Minimally invasive large thymoma resection remains controversial given the paucity of long-term oncological outcomes. We described the recurrence and survival of patients with thymomas ≥ 5 cm resected robotically.

Methods: Consecutive thymoma resections between January 2006 and December 2022 were reviewed. Thymic carcinoma/neuroendocrine tumors, induction therapy treatment, and Stage IV disease were excluded. For thymomas ≥ 5 cm, open versus robotic resections were compared. With robotic resections, thymomas ≥/< 5 cm were compared. The outcomes were freedom from recurrence (FFR) and overall survival (OS).

Results: There were 40 thymomas ≥ 5 cm (15 open and 25 robotic) and 52 robotic thymoma < 5 cm resections. Median follow-up was 5 years with 4 (4%) patients having recurrences and 5 (5%) demised. In thymomas ≥ 5 cm, patients were similar, except for higher comorbidities in the open cohort. Five-year FFR (p = 0.42) and OS (p = 0.34) were comparable. Patients with robotic resection of thymomas ≥/< 5 cm were similar, except those < 5 cm were more frequently Masaoka-Koga Stage II. Five-year FFR (p = 0.62) and OS (p = 0.62) were similar.

Conclusions: Resectable large thymomas, ≥ 5 cm, can be approached robotically with similar recurrence and survival when compared to open or smaller robotic resections. In otherwise appropriate thymomas, considerations such as location and proximity to surrounding structures, over size alone, should guide the approach.