Journal of Surgical Oncology最新文献

To provide evidence-based guidelines about Peritoneal Surface Malignancy (PSM) treatment for the Peritoneal Surfaces Oncology Group International. The GRADE ADOLOPMENT method was used to adapt recommendations from the Italian Medical Oncology Association Guideline on PSM. Seven scientific society were involved to form five guideline panels composed of 28 medical professionals from 14 countries. Panelists prioritized 7 relevant questions. A knowledge synthesis team updated evidence and summarized information. The panel agreed on seven recommendations.

Background: Merkel cell carcinoma (MCC) is a radiosensitive aggressive skin cancer that spreads via the lymphatics. There is uncertainty regarding the optimal management of the nodal basin for patients with MCC with clinically positive nodes. We study the efficacy of single node excision (SNE) as an alternative to a therapeutic lymph node dissection (TLND) in patients with limited nodal disease.

Methods: We performed a retrospective cohort study of patients with MCC with clinical nodal disease who underwent resection in the form of either SNE or TLND using the National Cancer Database. The association between type of surgery and overall survival (OS) was estimated using the Kaplan-Meier method and Cox proportional hazards modeling.

Results: 1835 patients met all inclusion criteria with 281 patients undergoing SNE and the remainder undergoing TLND. Patients receiving SNE and TLND were equally likely to receive radiation to the nodal basin (SNE 44.5% vs. TLND 48.5%, p = 0.22). There was no difference in 5-year OS between patients who received SNE versus TLND (SNE 43.9% vs. TLND 44.7%, p = 0.36). This persisted in a multivariable Cox proportional hazards model in which receipt of SNE remained not significantly associated with survival after adjusting for clinical and treatment factors including receipt of radiation (Hazard Ratio [HR] 1.17, 95% CI 0.96-1.42, p = 0.11). In patients undergoing SNE with radiation, 5-year OS was 54.4% (95% CI 44.1-63.6).

Conclusions: TLND is not associated with a survival advantage over SNE. Further prospective study into patterns of recurrence and safety of SNE is needed.

Background and objectives: Due to heterogeneous characteristics of primary cancers, the efficacy of pulmonary metastasectomy (PM) in nonprimary lung cancers has not been investigated. This study aims to investigate the clinical outcomes of PM for non-primary lung cancer.

Methods: A systematic search for meta-analyses on PM for nonprimary lung cancers was conducted, encompassing publications up to January 3, 2024. This included seven primary cancers: renal cell, breast, adrenocortical, head and neck cancers, melanoma, germ cell tumors, and sarcoma. Overall survival and recurrence rates post-PM were assessed using random-effect models.

Results: This study included 16 systematic-review articles and 101 individual studies, involving 10 277 patients who underwent PM for nonprimary lung cancer. About half of the patients (47.1%) presented with multiple metastasis, and complete resection achieved in 87.2% [95% CI: 83.0-90.8]. The pooled 5-year overall survival rate post-PM was 41.2% [95%CI: 37.1%-45.4%]. Patients with germ cell tumors demonstrated higher survival rate (p < 0.05), while melanoma exhibited the worst outcome (p < 0.05). During follow-up, 57.6% [95% CI: 46.4-68.1] had recurrence; 48% of them had intrathoracic-only recurrence.

Conclusion: This study underscores the survival benefits associated with PM. Overall survival rates following PM did not differ based on primary cancer types. These findings highlight the importance of recognizing and incorporating PM into clinical practice when appropriate.

Background: Lymphovascular invasion (LVI) is an important prognosticator in rectal cancer (RC). We aimed to determine predictors for LVI in RC and incorporate them into a predictive risk score (PRS).

Methods: Case-control analysis of predictors of LVI in RC using data from a national database (2010-2019). Main outcome was LVI in RC and its predictors. Odds ratios of significant independent predictors of LVI were incorporated into a PRS.

Results: 55,178 patients were included (60.9% male; mean age: 61.3 years). LVI was detected in 10,446 (18.9%). Independent predictors were carcinomas that were signet-ring cell (OR: 1.98, p < 0.001), moderately differentiated (OR: 1.58, p < 0.001), poorly differentiated (OR: 3.9, p < 0.001), or undifferentiated carcinomas (OR: 4.1, p < 0.001), cN1 (OR: 1.21, p < 0.001), and cN2 (OR: 1.49, p < 0.001), stage and incorporated into a PRS (0-8). Incidence of LVI was 16.3% in the low-risk group, 27.8% in the intermediate-risk group, and 40.5% in the high-risk group (p < 0.001). The PPV of the score was 40.5%, NPV was 83.7%, accuracy was 82.4%, and specificity was 97.9%.

Conclusions: High-grade adenocarcinomas, signet-ring cell carcinomas, and lymph node involvement in clinical assessment were independently associated with LVI in RC. Incorporation of these predictors into a PRS conferred high specificity and good accuracy.

Background: The aim of this study was to examine cases of malpractice litigation in primary sarcoma and metastatic bone disease in orthopedic oncology, to identify the areas in which orthopedic surgeons may be guilty of negligence, and to make them aware of this.

Methods: A comprehensive examination was conducted on all closed medical malpractice cases involving bone and soft tissue malignant tumors from 2014 to 2024. Patient demographics, histopathological diagnosis, and malpractice claims made in a variety of specialties were recorded. The inclusion and exclusion criteria of the study resulted in the inclusion of 70 cases of primary bone and soft tissue sarcoma and 36 cases of metastatic bone disease.

Results: A total of 47 primary tumors were bone sarcoma and 23 were soft tissue sarcoma. A total of 11 patients with primary sarcoma were accepted for malpractice claims, representing 16% of all cases within this category. Nevertheless, no evidence of malpractice was identified among the patients with metastatic bone disease (p = 0.012). Orthopedists (44 of 85 defendants), pathologists (14 of 85 defendants), and radiologists (7 of 85 defendants) were the most common defendants in primary sarcoma malpractice cases. Surgeons other than orthopedists (21 of 49 defendants), medical oncologists (4 of 49 defendants), and radiation oncologists (4 of 49 defendants) were the most common defendants in metastatic bone disease malpractice cases.

Conclusion: Analysis of our cases suggests that malpractice claims are more likely filed against orthopedic surgeons for the treatment of primary malignant bone and soft tissue tumors than for metastatic bone disease.

Introduction: Breast sarcomas are rare, heterogeneous malignancies often associated with prior radiation and require a multidisciplinary approach, including a comprehensive reconstruction plan. We analyzed reconstructive outcomes in a large cohort of patients with breast sarcomas and provide a contemporary treatment algorithm.

Methods: We retrospectively reviewed patients who underwent breast reconstruction after surgical treatment for breast sarcoma at our institution between January 2010 and December 2023. We analyzed patient and tumor characteristics, oncologic treatments, reconstructive approaches, and outcomes.

Results: Eighty patients underwent 81 reconstructions. The median age at diagnosis was 53 years. The most common subtypes were primary angiosarcoma (35.8%) and radiation-associated angiosarcoma (33.3%). The median follow-up was 23 months. Oncologic management was multimodal: 63.0% received preoperative chemotherapy, 59.3% received post-operative chemotherapy, 35.8% received both pre- and post-operative chemotherapy, and 34.6% received pre- or post-operative radiation therapy. Forty-three (53.1%) patients underwent total mastectomy with or without chest wall resection requiring soft-tissue reconstruction. Thirty-eight (46.9%) patients underwent formal breast reconstruction. Autologous reconstructions included local tissue rearrangement (39.5%), pedicled flaps (18.5%), regional flaps (16.0%), and free flaps (13.6%). Most patients (82.7%) underwent immediate reconstruction.

Conclusion: Breast sarcomas are managed with multimodal therapy, and most patients undergo immediate reconstruction. Autologous reconstruction remains the first choice in radiated patients, however implant-based reconstruction has increased with modern approaches. Complication rates are acceptable and similar across sarcoma subtypes. Breast reconstruction is an essential component of care for these patients and can be performed safely and with good results.

Background and objectives: Infectious complications after pancreatic resections are common, but perioperative factors linked to postoperative bacterial growth are not well-studied.

Methods: This retrospective study analyzed bacterial cultures from patients undergoing pancreatic resection (November 2008 to October 2022), assessing predictors for positive cultures and characterizing bacteria. Complications and outcomes of patients with positive cultures were also examined.

Results: Among 620 patients, bile samples were collected in 95 (95/620; 15.3%), with 60 (60/95; 63.1%) testing positive, 58 of them underwent pancreaticoduodenectomy. Of these, in 50 (50/58; 86.2%) the culture yielded polymicrobial growth but specific types of bacteria were not identified. Multivariate analysis identified preoperative bile duct stenting as a significant predictor of positive bile cultures (OR: 3.54; 95% CI: 1.95-6.42; p < 0.001), and positive cultures were linked to higher reoperation rates (OR: 2.40; 95% CI:1.18-4.90; p < 0.001. Positive drain cultures within 30 days from surgery were associated with higher rates of clinically significant pancreatic fistula (OR: 2.24; 95% CI: 1.00-5.11; p = 0.05), and reoperations) OR: 4.37; 95% CI: 1.62-11.79; p = 0.03). Patients with pancreatic adenocarcinoma and positive bile cultures had shorter disease-free survival with a median of 13 months (95% CI: 8-17) versus 18 months (95% CI: 8-29; p = 0.04).

Conclusions: Bile sampling is recommended in all pancreaticoduodenectomies. Managing polymicrobial growth with broad and prolonged antibiotics may reduce postoperative infections.

Background and objectives: Rectal mucinous adenocarcinoma (MA) has poor response to neoadjuvant chemoradiation (NCR) and higher involved radial surgical margin rates than nonmucinous rectal adenocarcinoma (NMA).

Methods: The National Cancer Database (2010-2018) was queried for adult patients with clinical stage II and III rectal cancer. Patients with MA and NMA treated with NCR and total mesorectal excision (TME) were identified. We sought to evaluate differences in pathologic downstaging and completeness of resection between MA and NMA rectal adenocarcinoma.

Results: We identified 13 294 patients, 12 655 (95.2%) NMA and 639 (4.8%) MA. After 3:1 propensity score matching for pathologic outcomes, 1707 NMA and 569 MA patients were included. MA patients had more involved distal (2.1% vs. 1.1%, p = 0.047) and radial (29% vs. 15%, p < 0.001) margins, and less pathologic downstaging (49% vs. 55%, p = 0.015). Among MA patients, minimally invasive resection had higher distal (2.1% vs. 1.4%, p = 0.65) and radial margin involvement (35% vs. 26%, p = 0.09) compared to open resection. Incomplete resection rates were similar between low anterior and abdominoperineal resection.

Conclusions: TME of locally advanced rectal MA treated with NCR resulted in nearly double the involved radial surgical margins compared to NMA. Operative approach should be carefully considered. Extended or extra-mesorectal resection may reduce the risk of incomplete resection.