Journal of Surgical Oncology最新文献

Background and objectives: Pancreatoduodenectomy (PD) has been associated with significant morbidity and mortality. To reduce morbidity, minimally invasive pancreatoduodenectomies (MIPD) have become more prevalent. We aimed to compare short-term survival and complications for open (OPD) versus MIPD and to assess the relationship between operative approach and operative time on outcomes.

Methods: Patients undergoing PD between 2017 and 2020 were identified within the National Surgical Quality Improvement Program (NSQIP). The primary outcome was operative time, and the secondary outcomes were death at 30 days, reoperation, readmission, and NSQIP-identified 30-day postoperative complications. A multivariable logistic regression was performed.

Results: A total of 14 977 PDs were performed from 2017 to 2020. MIPD increased from less than 8% of pancreatoduodenectomies performed in 2017 to over 10% of PD by 2020. Of the MIPD cohort, 62% were robotic, and 38% were laparoscopic, with robotic surgery becoming most prevalent by the end of the study period. MIPD was associated with significantly longer operative times than OPD (p < 0.01). MIPD was associated with decreased odds of postoperative bleeding and surgical site infection (p < 0.01), but higher odds of death at 30 days.

Conclusions: MIPD has been shown to have improved postoperative outcomes compared to OPD but is associated with longer operative times, which can be associated with increased complications.

Palliative surgery is commonly performed in cancer centers worldwide. Yet, there is little agreement on the definition of palliative surgery or its relevant outcomes. This systematic review sought to characterize the definitions of palliative surgery and outcomes for patients with cancer undergoing thoraco-abdominal procedures. Following PRISMA guidelines, we conducted a search using PubMed, EMBASE and CINAHL databases to identify English-language publications between August 1, 2005, and December 31, 2023 reporting palliative thoraco-abdominal procedures for patients with cancer. Definitions of palliative surgery were coded and analyzed using an inductive approach. Outcomes were classified according to an outcome measures hierarchy. Among 92 articles met inclusion criteria and four themes emerged in how palliative surgery was defined throughout the literature: prognosis (incurable cancer diagnosis), purpose (intent to treat symptoms or improve quality of life), procedure type (specific operative interventions), or persistent disease following surgery (incomplete cytoreduction). Survival (90%) and perioperative complications/morbidity (72%) were the most commonly reported outcomes, whereas symptom relief, quality of life, and sustainability of success were infrequently reported. Definitions of palliative surgery vary across studies of patients with cancer undergoing thoracic or abdominal procedures and measured outcomes often do not align with the intent of surgery.

The Peritoneal Surface Oncology Group International (PSOGI) previously issued a recommendation endorsing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for treating diffuse malignant peritoneal mesothelioma (DMPM). However, broader acceptance of this approach, particularly within some segments of medical oncology, remains limited. To address this, PSOGI initiated a multisociety consensus effort, involving multidisciplinary International Societies, to strengthen and expand the endorsement of CRS-HIPEC for DMPM. Using the GRADE ADOLOPMENT approach, the expert panel systematically reviewed existing guidelines and evaluated the available evidence to reinforce the recommendation. The panel unanimously recommended CRS-HIPEC for a carefully selected subset of DMPM patients, emphasizing that this approach offers the best potential for improved survival compared to systemic chemotherapy alone. Despite the very low certainty of evidence, a strong recommendation was issued, reflecting the panel's recognition of the life-threatening feature of DMPM and the limited efficacy of systemic chemotherapy. This consensus also highlights the importance of centralized and expert-driven care. The recommendation aligns with previous guidelines and underscores the critical need for broader acceptance of this treatment strategy in managing this rare and aggressive malignancy.

Background: Flat bone chondrosarcomas have worse outcomes than extremity tumors, but there is no data directly comparing the different flat bones. The aim of this study was to examine differences in recurrence and survival between pelvic and scapular chondrosarcoma.

Methods: One hundred and sixty-nine (42 scapula, 127 pelvic) patients with chondrosarcoma who underwent surgical resection were reviewed. High-grade tumors were defined as lesions that were Grade 3 or dedifferentiated on surgical pathology.

Results: Patients with low-intermediate grade lesions of the scapula were more likely to have positive margins during definitive surgical management (14% vs. 3%, OR 5, 95% CI [1.15, 22.6], p = 0.02), however, this did not translate to differences in recurrence or survival (p > 0.05). The presence of an associated soft tissue mass in low-intermediate grade lesions was not associated with increased recurrence. Among high-grade tumors, patients with scapular lesions had worse DSS (HR 2.99, 95% CI [1.05, 8.51], p = 0.04). One- and 2-year DSS for high-grade pelvic tumors was 75% and 57%, respectively, and 50% and 33% for scapular tumors.

Conclusion: Survival for high-grade chondrosarcoma of the flat bones is poor, particularly for those of the scapula. Despite a higher rate of positive margins for low-intermediate grade lesions of the scapula, there was no significant difference in survival compared to low-intermediate grade lesions of the pelvis. Additional studies with larger sample sizes are needed to further elucidate differences between these locations.

Background: Currently, there is a paucity of data that describes the length of time required to realize improvement in pain and function following surgery for patients with metastatic cancer to bone.

Methods: One hundred patients with impending or completed pathologic fractures due to metastatic cancer to bone were enrolled in this prospective cohort study. Outcomes were measured with a Computer Adaptive Test of Patient Reported Outcomes for Pain Interference and Physical Function domains, to determine the time required to achieve a Minimal Clinically Important Difference (MCID) in the tested domains.

Results: Eighty-one patients were included in the analysis. Thirty-two patients (39.5%) survived and completed the follow-up to 1 year, while 23 (28.4%) died before the end of the data collection. Fifty-one patients (63.0%) achieved at least a 5-point improvement in Physical Function and 59 (72.8%) achieved at least a 5-point improvement in Pain Interference. The time to achieve the MCID was 6 weeks for the Physical Function and 4 weeks for the Pain Interference domain.

Conclusion: The majority of patients with impending or completed pathologic fractures due to metastatic cancer see clinically important improvements in pain and function after surgery in an average of 4 and 6 weeks, respectively.

Background: Hospitals are rapidly consolidating to create large healthcare systems. Whether outcomes following colorectal cancer resection at flagship hospitals differ from those at non-flagship hospitals is unknown.

Methods: A 6-year retrospective analysis of an all-payor New York State (NYS) hospital database was conducted. All adult patients with a colorectal resection for primary resectable colorectal cancer were included. Within each system, the hospital with the most colorectal resections was designated the "flagship" hospital. Thirty-day outcomes at flagship facilities were compared to affiliated, non-flagship hospitals following colorectal resection while matching for patient-level differences.

Results: In total, 28 400 patients were included across 31 healthcare systems in NYS. There were no differences in mortality (0.9% vs. 1.1%), 30-day readmissions (10.5% vs. 11.9%), or postoperative outcomes between matched patients treated at flagship versus non-flagship facilities (p > 0.05).

Conclusions: There are no differences in perioperative outcomes between flagship and non-flagship hospitals in a given system in NYS. Patients with resectable non-metastatic colorectal cancer may not need to undergo oncologic resection at flagship hospitals to receive high-quality perioperative care.

Background and objectives: Both malignancy and orthopedic surgery are known risk factors for developing venous thromboembolism (VTE). Therefore, this study aimed to compare VTE rates among patients receiving enoxaparin, apixaban, rivaroxaban, or aspirin (ASA).

Methods: The Premier Healthcare Database was utilized to identify all patients who underwent surgery for neoplastic pathologic fractures of the lower extremities from 2015 to 2021. Four cohorts based on receipt of ASA, apixaban, enoxaparin, or rivaroxaban were identified. Propensity matching with the enoxaparin cohort as the comparator was performed. Patient demographics, hospital factors, comorbidities, and 90-day complications were compared.

Results: From 2015 to 2021, 3762 patients underwent surgical intervention for neoplastic pathologic fracture of the lower extremities. Enoxaparin recipients showed significantly lower aggregate VTE rates than those on apixaban (p = 0.008) while exhibiting higher VTE occurrence than ASA-treated patients (p = 0.050).

Conclusion: Our study demonstrates that the administration of enoxaparin in patients undergoing surgical intervention for neoplastic pathologic fractures of the lower extremities may lead to significantly higher rates of aggregate VTE postoperatively compared to ASA. This data suggests that further research is warranted to determine if surgeons may safely consider using ASA in patients with no other reported risk factors or need for anticoagulation postoperatively, even in active malignancy.