Journal of Surgical Oncology最新文献

Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative blood loss, yet its specific role in hepatic resection remains unclear. This meta-analysis, performed according to PRISMA guidelines, evaluated the efficacy and safety of TXA in liver surgery. Outcomes of interest included mean intraoperative blood loss, the proportion of patients receiving transfusion, and mean units of red blood cells transfused intraoperatively and postoperatively. Secondary endpoints included postoperative mortality, thromboembolic events, and hospital length of stay. Of 36 articles assessed, nine studies met eligibility criteria for inclusion. TXA use was associated with a statistically significant reduction in intraoperative blood loss (SMD - 0.18; 95% CI, - 0.28 to - 0.09; p < 0.01), although transfusion requirements did not differ significantly between groups (RR 0.81; 95% CI, 0.47-1.38; p = 0.44). Interpretation of these findings is limited by substantial heterogeneity among included studies (I² = 82%). While TXA appears effective in reducing intraoperative bleeding, its use may confer a higher risk of postoperative thromboembolic complications, suggesting that TXA administration during hepatic resection should be selective and individualized rather than routine.

Background and objectives: The proportion of free-standing hospitals is rapidly declining in favor of healthcare systems. We aim to compare outcomes after pancreatoduodenectomy (PD) between hospital volume and surgeon volume within consolidated healthcare systems.

Methods: Utilizing New York State's SPARCS database, we identified adults undergoing PD (2016-2019) at flagship (highest volume within a system) or non-flagship hospitals. Analysis compared 30- and 90-day outcomes by hospital and surgeon annual volume (hospital volume ≥ 20 vs < 20PD/yr and surgical volume ≥ 10 vs < 10PD/yr). We controlled for patient self-selection across surgeons and facilities using propensity-score matching.

Results: Among 1633 patients, 68.8% were treated at flagship hospitals. Compared to patients treated at non-flagship hospitals, those at flagship hospitals had lower median postoperative length of stay (8-days vs. 10-days, p < 0.01), fewer transfusions (17% vs 29%, p < 0.01), other post-procedural (8.1% vs 12.6%, p = 0.02), and overall complications (53% vs 59%, p = 0.07). The lowest overall complications and length of stay (p < 0.05) were observed at high-volume hospitals regardless of surgeon volume.

Conclusions: More favorable outcomes among pancreatoduodenectomy patient were observed at high-volume flagship hospitals. When planning a complex surgery, patients should be referred to the highest volume hospital within their healthcare system to optimize post-operative outcomes.

Background and objectives: Simultaneous rectal and hepatic resection for metastatic rectal cancer is less commonly performed due to concerns about safety, and the oncological outcomes are less well described. The objective of this study is to examine peri-operative and oncological outcomes for patients with rectal cancer liver metastases (RCLM) after simultaneous resection.

Methods: A single-center, retrospective analysis of patients who underwent curative-intent, simultaneous total mesorectal excision (TME) and hepatectomy for RCLM (January 2011 to May 2024). Post-operative safety and oncological outcomes were examined.

Results: 92 patients were analyzed, with the majority having high burden of hepatic metastases. No deaths occurred. 14 patients (15%) had > Clavien-Dindo Grade 3 complication, drainage of perihepatic fluid in eight patients (9%), and an anastomotic dehiscence in three patients (3%). Median follow up was 51 mo, and median OS was 70 mo, RFS was 10 mo, and H-RFS was 17 mo. Positive hepatic margin was associated with decreased OS, while a high Clinical Risk Score, a high Tumor Burden Score, and > 6 cycles of neoadjuvant chemotherapy were associated with decreased RFS and H-RFS.

Conclusion: Simultaneous resection of RCLM was associated with peri-operative safety and long term survival in patients with high-risk disease, and can be reasonably offered in appropriate setting.

Background and objectives: Postoperative early recurrence (ER) of biliary tract cancers (BTCs) leads to significant medical, psychological, social, and economic disadvantages for patients. Approximately 30% of patients with curatively resected BTCs experience recurrence within the first 12 months after the surgery. JCOG1202 randomized phase III trial demonstrated the survival benefit of adjuvant S-1 in patients with resected BTCs. The objective of this exploratory study was to investigate the risk factors for ER in patients with resected BTCs in the JCOG1202 cohort.

Methods: Of the 440 patients enrolled in JCOG1202, 217 who underwent observation and 207 who received adjuvant S-1 were eligible in this analysis. ER was defined as recurrence or death within 12 months after enrollment.

Results: ER was observed in 59 and 38 patients in observation and adjuvant S-1, respectively. Multivariable logistic regression analysis identified CA19-9 levels > 37 U/ml (odds ratio (OR): 2.79, 95% confidence interval (CI): 1.26-6.17), poorly differentiation (vs. well-differentiated/papillary) (OR: 4.75, 95% CI: 1.93-11.69), moderate differentiation (vs. well-differentiated/papillary) (OR: 1.96, 95% CI: 1.07-3.57), lymph node metastases ≥ 4 (vs. 0) (OR: 3.99, 95% CI: 1.67-9.51), lymph node metastases 1-3 (vs. 0) (OR: 2.66, 95% CI: 1.47-4.81), and R1 resection (OR: 2.17, 95% CI: 1.07-4.41) as independent risk factors for ER. Adjuvant S-1 chemotherapy significantly reduced ER (OR: 0.49, 95% CI: 0.29-0.83).

Conclusions: Postoperative CA19-9 levels, tumor differentiation, lymph node metastases, residual tumors, and adjuvant S-1 significantly affected ER in patients with curatively resected BTCs. Patients at high ER risk may require more intensive adjuvant therapy.

Trial registration: UMIN000011688.

This systematic review and meta-analysis evaluated the diagnostic performance of artificial intelligence (AI) models that analyze preoperative prostate MRI images in conjunction with clinical parameters for predicting extraprostatic extension (EPE) in prostate cancer. A comprehensive search of PubMed, Embase, and Web of Science up to July 2025 identified 14 eligible studies involving 2,131 patients. The pooled analysis demonstrated that integrated radiomics-clinical models achieved high diagnostic performance, with a sensitivity of 0.83 (95% CI: 0.78-0.87), specificity of 0.82 (95% CI: 0.77-0.86), and an area under the curve (AUC) of 0.89 (95% CI: 0.86-0.92). The diagnostic odds ratio (DOR) was 19.82 (95% CI: 12.33-31.86), indicating robust discrimination between EPE-positive and EPE-negative cases. Subgroup analysis suggested models using deep learning algorithms had marginally higher accuracy (DOR: 24.6) than those using traditional machine learning (DOR: 17.3), though the difference was not statistically significant. Heterogeneity among studies stemmed from variations in MRI protocols, segmentation methods, and modeling approaches. No significant publication bias was detected. The results affirm that integrating radiomic features from multiparametric MRI (e.g., T2-weighted, diffusion-weighted imaging) with clinical variables (e.g., PSA, Gleason score) significantly outperforms conventional assessments for preoperative EPE prediction, demonstrating excellent diagnostic accuracy and supporting its potential clinical application in risk stratification. This supports the potential of combined models to enhance risk stratification and guide personalized surgical planning. Future research should prioritize standardized radiomics workflows, external validation, and multi-center collaborations to facilitate clinical adoption.

Introduction: Hepatic artery infusion chemotherapy (HAIC) has been used in efforts to improve outcomes in patients with locally advanced cholangiocarcinoma. Reported experiences are generally small institutional series. The efficacy of HAIC in locally advanced cholangiocarcinoma is not well defined.

Methods: We performed a comprehensive search using the electronic databases PubMed, Embase, Cochrane, ClinicalTrials. Gov, and WHO Clinical Trials from inception to August 2024.

Results: A total of 202 publications were screened, with 15 studies representing 588 patients meeting the inclusion criteria. Most patients demonstrated either a partial response or stable disease after therapy (CR: 2.5%, PR: 38.1%, SD: 43.4%, PD: 12.7%, NA: 3.3%). Meta-analysis found a pooled median overall survival of 18.3 months (95% CI: 14.1-22.4 months) and progression-free survival of 10.0 months (95% CI: 7.7-12.3 months).

Conclusion: HAIC demonstrates an improvement over reported survival for systemic chemotherapy alone when used as either an adjunct or in place of systemic therapy for first-line treatment in patients with cholangiocarcinoma.

Background and objectives: Osteoid Osteoma (OO) is a painful, benign bone tumor that can be treated surgically with en bloc resection, curettage, and radiofrequency ablation (RFA). This study aims to measure recurrence rates after initial treatment by treatment type and to examine clinical factors associated with recurrence.

Methods: A retrospective review of patients with an OO diagnosis was performed using a pathology database from a tertiary pediatric hospital between November 1, 2004 and July 1, 2024. Statistical analysis examined the relationships among surgical technique, recurrence, and clinical variables.

Results: 24 patients met inclusion criteria with a median follow-up of 1.41 years (interquartile range, IQR 2.0) and a median age at treatment of 9.92 years (IQR 5.8-13.5). Twelve patients (50.0%) experienced symptomatic tumor recurrence, with a median time to recurrence of 0.92 years (IQR 0.1-3.0). Of those with tumor recurrence, five patients were initially treated with excision and curettage, while the remaining nine underwent RFA. There was no significant correlation between recurrence and surgical intervention (p = 0.667), age at initial surgery (p = 0.468), or patient sex (p = 0.667).

Conclusions: Surgical management of pediatric OO is linked to high recurrence rates, and recurrence is not related to surgical intervention, age, or patient sex.