Journal of Surgical Oncology最新文献

Background

Total mesorectal excision (TME) is the standard surgical treatment for rectal cancer. Transanal local excision (TLE) after neoadjuvant chemoradiotherapy (nCRT) is an organ-preserving option, avoiding morbidity of TME. This study compared TLE versus TME following nCRT.

Methods

We searched Medline, PubMed, Embase, Web of Science, Scopus, Cochrane databases, Google Scholar, and CINHAL to 30 April 2025. Eligible studies were adults with nonmetastatic mid or low rectal cancer treated with nCRT followed by TLE or TME. Outcomes included local recurrence, disease free survival (DFS), overall survival (OS), and postoperative complications. Risk of bias was assessed using Cochrane RoB 2 for randomized trials and Newcastle-Ottawa Scale (NOS) for cohorts.

Results

Nineteen studies were included. TLE was associated with higher local recurrence in cohorts (RR = 1.823; 95% CI = 1.222–2.720; p = 0.003), but no difference in RCTs (RR = 1.248; 95% CI = 0.618–2.518; p = 0.537). DFS (HR = 1.121; p = 0.174) and OS (HR = 1.032; p = 0.830) did not differ. Postoperative morbidity was lower after TLE (RR = 0.429; p = 0.005).

Conclusion

Strengths include robust search, study quality and number of patients, while heterogeneity in nCRT protocol, follow up, and complication reporting are limitations. Higher recurrence in TLE in cohorts but not in RCTs suggests safety of TLE when strict selection criteria are applied.

Registration: PROSPERO CRD420251076513.

Objective

Endoscopic submucosal dissection (ESD) is increasingly preferred as an alternative to surgery and as an organ-preserving method for the treatment of rectal lesions. However, its impact on bowel function—particularly the development of low anterior resection syndrome (LARS)—remains poorly understood. This study aimed to evaluate the incidence of LARS following rectal ESD and to identify associated clinical and pathological factors.

Methods

Data from 118 patients who underwent rectal ESD between January 2018 and December 2024 were retrospectively analyzed. Demographic characteristics, lesion location and size, histopathological findings, and LARS scores were recorded. All procedures were performed by the same experienced colorectal surgeon. For functional assessment, patients were contacted by telephone, and the LARS score was administered.

Results

Of the patients included in the study, 60.9% were male, with a mean age of 68.2 ± 11.0 years. In total, 93.2% of lesions were located in the rectum, while 6.8% were located in the anal canal or anorectal junction. The mean lesion size was 5.04 ± 3.19 cm. Lymphovascular invasion was detected in four patients. Minor LARS was observed in 3.4% (n = 4) of cases, and no cases of major LARS were identified. All patients with LARS had adenomas located in the lower rectum containing high-grade dysplasia.

Conclusion

The incidence of LARS after rectal ESD is low and limited to minor symptoms. Lesion location, size, and dysplasia grade may influence LARS development. These findings support ESD as a functionally safe treatment approach. Further validation in larger, prospective studies is warranted.

Trial Registration

This study was a retrospective observational analysis.

Background and Objectives

The indication for sublobar resection is determined based on radiologic findings, but some cases exhibit radiology-pathology discordance. This study aimed to examine the impact of histologic subtypes on radiology-pathology discordance and their preoperative predictability.

Methods

We reviewed 585 patients with clinical stage IA adenocarcinoma and examined the relationship between radiology-pathology discordance and histologic characteristics, focusing on high-grade components: solid (SOL) or micropapillary (MIP). The predictive ability of radiologic or cytopathologic examinations for those subtypes was evaluated.

Results

Radiology-pathology discordance was found in 148 (25.2%) patients and was significantly associated with the presence of histologic high-grade components, with 71.9% and 70.4% of patients with upstaged lymph node and pleural invasion statuses having high-grade components. The preoperative prediction of high-grade components varied between subtypes, and radiographically pure-solid appearance and high maximum standardized uptake value were independent predictors of the SOL subtype, but not MIP. Among pre- or intraoperative cytopathologic examinations, intraoperative touch imprint cytology exhibited superior detection ability for MIP component.

Conclusions

Histologic high-grade components are highly associated with radiology-pathology discordance in early-stage lung adenocarcinoma. Radiologic assessment would be beneficial for predicting the SOL subtype, but not MIP. Alternatively, intraoperative cytologic assessment would complement the detection of MIP subtype.

Background

We assessed predictors of overall (OS) and cancer-specific survival (CSS) in stage I colorectal cancer (CRC).

Methods

Retrospective analysis of patients with stage I colon or rectal adenocarcinomas from the SEER database (2010–2020) Survival was assessed using Kaplan-Meier statistics and multivariable Cox regression analyses. The primary outcomes were 5-year OS and CSS.

Results

40,001 patients (51.3% male; mean age: 65.1 ± 12.6 years) were included. Colon and rectal cancers accounted for 75.8% and 24.2%, respectively. Five-year OS and CSS were 83.1% (95% CI: 82.6–83.5%) and 93.2% (95% CI: 92.9–93.5%), respectively. Factors independently associated with worse OS were age (HR: 1.07; p < 0.001), male sex (HR:1.48; p < 0.001), Black race (HR: 1.25; p < 0.001), single, divorced, or widowed status (HR: 1.49, 1.46, and 1.43; p < 0.001), tumor size (HR: 1.001; p = 0.008), poorly differentiated carcinomas (HR: 1.32; p < 0.001), undifferentiated carcinomas (HR:1.44; p = 0.026), perineural invasion (HR: 1.84; p < 0.001), elevated CEA levels (HR: 1.68; p < 0.001), and systemic therapy (neoadjuvant: HR: 1.3; p = 0.032, adjuvant: HR: 2.2; p < 0.001, both: HR: 1.97; p < 0.001). Factors independently associated with worse CSS were age (HR: 1.05; p < 0.001), male sex (HR: 1.32; p < 0.001), Black race (HR: 1.43; p < 0.001), marital status (HR: 1.44, 1.28, and 1.68; p < 0.001), tumor size (HR: 1.003; p < 0.001), poorly differentiated carcinomas (HR: 1.77; p < 0.001), perineural invasion (HR: 2.29; p < 0.001), elevated CEA levels (HR: 2.24; p < 0.001), and systemic therapy (neoadjuvant: HR: 2.53; p = 0.032, adjuvant: HR: 4.22; p < 0.001, both: HR: 3.83; p < 0.001).

Conclusions

Although patients with stage I CRC had excellent survival, single, older, Black, male patients with large, high-grade tumors associated with perineural invasion and elevated CEA levels had a higher mortality risk.

Introduction

Melanoma is a heterogeneous malignancy, the incidence of which has increased by 20% in the Hispanic population over the past two decades. We aimed to compare the clinical, pathological, and outcome-related characteristics of Hispanic patients with melanoma in Peru (HPP) versus the United States (HPUS).

Methods

Two retrospective cohorts were evaluated: HPP diagnosed with melanoma at a tertiary institution in Lima-Peru and HPUS with melanoma registered in the Surveillance, Epidemiology, and End Results Program during the period 2010–2019.

Results

A total of 1136 HPP and 5302 HPUS were included. HPP patients were older (61.17 vs. 56.63 years, p < 0.001), more likely to be male (51.5% vs. 39.6%, p < 0.001), and resided in nonmetropolitan areas (49.6% vs. 3.5%, p < 0.001). HPP had a higher prevalence of primary lesions in the lower extremities (75.5% vs. 36.9%, p < 0.001) and ulceration (65.3% vs. 21.3%, p < 0.001). Histologically, HPP most commonly presented with acral lentiginous melanoma (38.1%), while HPUS had a more superficial spreading type (30.8%, p < 0.001). HPP showed greater Breslow depth (mean: 7.66 vs. 1.51 mm, p < 0.001) and mitotic activity and were diagnosed at more advanced stages: stage III (36.5% vs. 15.0%, p < 0.001). With a median follow-up of 74 months, HPP exhibited worse 5-year overall survival (OS) rates across all stages versus HPUS.

Conclusions

HPP with melanoma exhibit more aggressive pathological features than their HPUS counterparts and are diagnosed at more advanced stages, resulting in poorer OS rates across all stages, and being HPP is a prognostic factor of a worse OS. These findings emphasize the need for further research to deepen our understanding of the molecular factors influencing this diverse biological presentation in Hispanic populations.

Background

While peripheral excision margins in cutaneous melanoma are well established, the optimal excision depth remains unclear. In plantar melanoma, the fat pad plays a key functional role, raising concerns about whether full excision is necessary for thin and intermediate-thickness lesions. This study evaluated the association between excision depth and oncologic outcomes in T1–T3 plantar melanoma.

Methods

Patients with primary T1–T3 plantar melanoma who underwent wide excision between 2008 and 2022 were reviewed. They were grouped by excision depth: intra-adiposal (partial fat pad preservation) and suprafascial (complete removal). Oncologic and functional outcomes, assessed via the Foot Function Index (FFI), were compared.

Results

Ninety-four patients (40 intra-adiposal, 54 suprafascial) were analyzed (median follow-up, 43 months). Tumor-free margins were achieved in all cases. Baseline characteristics were similar, except for lesion location. Recurrence rates were comparable, and excision depth was not significantly associated with recurrence-free survival. FFI scores from 26 patients (13 per group) tended to be better in the intra-adiposal group, though not statistically significant.

Conclusions

In thin to intermediate-thickness plantar melanoma, intra-adiposal excision may be oncologically safe if tumor-free margins are achieved, potentially offering functional benefits without compromising oncologic outcomes.

Background and Objectives

This study aims to evaluate the predictive factors associated with failed sentinel lymph node (SLN) mapping in a large, retrospective cohort of patients with early-stage endometrial cancer (EC).

Methods

We retrospectively evaluated a series of EC patients who underwent laparoscopic SLN mapping with intracervical indocyanine green (ICG) injection in five referred oncological centers from January 2019 to March 2024. We compared the clinical and pathological features of bilateral and failed SLN mapping, which was defined as either unilateral mapping or no SLN mapping. Logistic regression was used to identify predictors of failure.

Results

Among 623 analyzed patients, 437 (70.14%) had a successful bilateral procedure. On univariate analysis, age (p = 0.03), non-endometrioid histology (p = 0.02) and previous vaginal delivery (p = 0.015) were significant associated with failed SLN mapping. On multivariable analysis, only increasing age (OR 1.03; 95% CI, 1.01–1.04, p = 0.03) and non-endometrioid histology (OR 1.81; 95% CI, 1.01–3.19) were independently associated with unsuccessful procedure. No significant differences were observed for BMI, enlarged lymph nodes, intraoperative lysis of adhesion, LVSI, grade 3, and FIGO stage.

Conclusions

Increasing age and non-endometrioid histology are independent predictors of bilateral SLN mapping failure in EC patients undergoing SLN mapping with cervical ICG injection.