Journal of Surgical Oncology最新文献

This systematic review and meta-analysis assessed long-term outcomes following total pancreatectomy with islet autotransplantation (TPIAT). Seventeen studies including 1332 patients were analyzed. The pooled insulin independence rate was 34%, with higher rates for non-chronic pancreatitis indications (68%) versus chronic pancreatitis (33%). TPIAT is effective in preserving endocrine function. Further studies are needed to validate outcomes across extended indications and to standardize reporting, incorporating metabolic markers and patient-reported quality-of-life endpoints over long-term follow-up.

Oesophageal carcinoma is a rising global health burden, with surgical resection and perioperative chemotherapy forming the cornerstone of curative treatment. However, uncertainty persists regarding the optimal surgical approach, partly due to heterogeneity in outcome reporting, which hinders data synthesis and evidence-based decision-making. To address this, a core outcome set (COS) for oesophageal cancer surgery was developed through international consensus among clinicians and patients. This study systematically evaluates the uptake of these core outcomes in contemporary surgical research. A systematic review was conducted of randomised controlled trials and prospective cohort studies investigating oesophagectomy for oesophageal cancer, published between 2010 and 2024. The reporting of ten COS-recommended outcomes was assessed across eligible studies. Fifty-eight studies involving 22 260 patients were included (39 cohort studies; 19 RCTs). No study reported all 10 core outcomes. The median number of core outcomes reported was 4 (interquartile range 3-5). The frequency of individual core outcome reporting was as follows: in-hospital mortality (86%), conduit necrosis/leak (81%), respiratory complications (79%), overall survival (30%), ability to eat and drink (44%), quality of life (26%), inoperability (23%), reflux symptoms (21%), severe nutritional effects (19%), and need for reintervention (16%). No improvement in core outcome reporting was observed over the study period. Promoting COS implementation and improving methodological rigour is essential to ensure that future research reflects the priorities of both clinicians and patients, and facilitates meaningful evidence synthesis.

Background and objective: Palliative surgery in oncology aims to relieve symptoms, improve quality of life, and respect patient autonomy in advanced cancer. This study aimed to develop evidence-based recommendations for safely indicating and performing palliative surgeries in Brazil, considering clinical, ethical, and multidisciplinary aspects.

Methods: A modified Delphi consensus was conducted with nine experts from the Brazilian Society of Surgical Oncology, including surgical and clinical oncologists, palliative care specialists, and a psychologist. Sixteen key recommendations were formulated based on literature review and a national survey identifying gaps in training, communication, and technical safety. Consensus was defined as ≥ 80% agreement, achieved in a single round.

Results: Recommendations emphasize individualized patient selection based on functional status, frailty, prognosis, and symptom severity. Multidisciplinary evaluation, shared decision-making, clear communication, and consideration of minimally invasive techniques were prioritized. Palliative procedures focus on symptom control rather than survival extension, with evidence supporting improved quality of life, reduced hospital admissions, and enhanced oral intake.

Conclusions: Palliative surgery should be guided by strict clinical criteria, multidisciplinary planning, and patient-centered communication. Active patient participation, ethical deliberation, and evidence-based practices ensure safe, effective, and humanized care, avoiding futile or disproportionate interventions.

Core needle biopsy (CNB) is the preferred diagnostic method for suspected soft tissue and bone sarcoma, but nondiagnostic results remain common. To clarify the role of repeat biopsy, we conducted a systematic review of studies reporting repeat CNB after an initial nondiagnostic CNB, searching MEDLINE, EMBASE and PubMed. Nine studies involving nearly 9757 initial CNBs were included. Meta-analysis showed a pooled diagnostic yield of 69% (95% CI: 0.564-0.819) for repeat CNB. Subgroup analyses demonstrated a significantly higher diagnostic yield in bone sarcoma (83.1%) compared with soft tissue sarcoma (48.5%). The repeat CNB rate following a nondiagnostic initial biopsy was 5.48%. This study represents the first systematic review and meta-analysis evaluating repeat CNB in this setting, and it highlights substantial variability in diagnostic yield between sarcoma subtypes. Further research focusing on repeat biopsy across specific sarcoma subgroups is warranted to guide clinical decision-making.

Background and objectives: Pancreatic ductal adenocarcinoma (PDAC) is characterized by limited survival rates, yet patients who achieve optimal CA19-9 response to neoadjuvant therapy (NAT) exhibit improved survival. This study examines the association between initial CA19-9 levels and survival in PDAC patients who achieved CA19-9 normalization with systemic chemotherapy.

Methods: A retrospective, multi-institutional analysis of patients with resectable/borderline-resectable PDAC, who underwent NAT and curative-intent pancreatectomy at the University of Pittsburgh Medical Center, University of Texas Southwestern Medical Center, NorthShore University, and West Virginia University To contexualize thi between 2010 and 2022, was performed. CA19-9 secretors (> 37 U/mL, with total bilirubin < 2) at diagnosis, with optimal response to NAT (normalization and > 50% drop in CA19-9) were included. A cutoff for pre-NAT CA19-9 of 400 U/mL was determined to maximize sensitivity and specificity for survival benefit, and the cohort was accordingly divided into two groups. Kaplan-Meier and Cox proportional-hazards models were used for univariate and multivariable analyses.

Results: A total of 134 patients were included, 32 (23.9%) had a pre-NAT CA19-9 ≥ 400U/mL. DFS and OS were considerably higher among patients with pre-NAT CA19-9 < 400U/mL (median(95%CI) in months, DFS:19.8(16.0,33.4) versus 7.8(5.0,13.0); OS:49.0(34.5,70.7) versus 23.1(13.8,50.9)). On multivariable analysis, pre-NAT CA19-9 ≥ 400 U/mL was significantly associated with reduced DFS and OS (DFS:HR = 2.4, p = 0.001; OS:HR = 1.9, p = 0.028).

Conclusion: In this select cohort of PDAC patients with optimal NAT response, pre-NAT CA19-9 ≥ 400U/mL is strongly associated with decreased DFS and OS.

Background and objectives: The aim of this study is to compare the efficacy of the laparoscopic pylorus-preserving gastrectomy (LPPG) and laparoscopic distal gastrectomy (LDG) for gastric cancer (GC) on postoperative complications and nutritional status.

Methods: We conducted a literature search of PubMed, EMBASE, Scopus, and Cochrane Library databases before April 20th, 2025.

Results: We found that the rate of delayed gastric emptying and gastric stasis after LPPG was higher than that after LDG, while there was no significant difference in the incidence of pulmonary diseases, anastomotic leakage, pulmonary fistula, or other complications. The prevention of dumping syndrome and the improvement in nutritional status seemed to be better in LPPG.

Conclusions: No more valuable benefits of LDG in reducing complications was found.

Objectives: Our study aims to retrospectively analyze the combined effects of closed continuous irrigation drainage technique (CCIDT) and narrative nursing on recovery, anxiety, and quality of life in ultra-low rectal cancer (ULRC) patients undergoing anus-preserving operation.

Methods: A total of 224 ULRC patients were analyzed with four groups: conventional drainage with routine care (Group A), conventional drainage with narrative nursing (Group B), irrigated drainage with routine care (Group C), and irrigated drainage with narrative nursing (Group D). The outcome assessment included the first postoperative exhaust time, drainage tube placement time, and length of stay. Anxiety levels were measured using the Generalized Anxiety Disorder-7 scale, and quality of life was assessed using the EORTC QLQ-C30 questionnaire.

Results: The CCIDT significantly shortened the first postoperative exhaust time, drainage tube placement time, and length of stay compared to conventional drainage techniques (p < 0.001 for all comparisons). However, CCIDT did not significantly affect the occurrence of anastomotic fistulas or abdominal infections. Narrative nursing significantly reduced anxiety levels (p < 0.001) and improved quality of life (p < 0.001). However, narrative nursing did not influence the incidence of anastomotic fistulas or abdominal infections. The combination of CCIDT and narrative nursing effectively enhances postoperative recovery, reduces anxiety, and improves quality of life in ULRC patients.

Background: Metastatic disease in the humerus presents with severe pain, compromised upper extremity function, and impending or completed pathologic fractures. Prophylactic fixation can improve quality of life, yet little is known about the variability in negotiated payor rates for this procedure, which may influence surgical decision making. The objective of this study was to examine factors associated with variations in negotiated payor rates for prophylactic fixation of the proximal humerus.

Methods: A cross-sectional analysis of negotiated payor rates for current procedural terminology (CPT) code 23491 (prophylactic fixation of the proximal humerus) was conducted using data from the Turquoise Health database. Hospital size was categorized by total bed capacity; payor classes included commercial, Medicare Advantage, managed Medicaid, veterans' affairs, workers' compensation, dual Medicare-Medicaid, exchange plans, and self-pay. Rural-Urban Commuting Area (RUCA) codes, Area Deprivation Index (ADI), and median household income were used to characterize regional factors. Statistical analyses were conducted in R version 4.2.3.

Results: A total of 88,858 negotiated payor rates were evaluated. The average negotiated payor rate in the sample was $11,088. Hospitals with a bed capacity of 1,000-1,500 had the highest mean rates (a +$577 difference from the 0-100 bed reference group, p < 0.0001), whereas mid-sized hospitals (300-500 beds) had significantly lower rates (-$220 difference, p < 0.0001). Workers' compensation yielded the highest rates, exceeding self-pay by $11,620 (p < 0.0001). Metropolitan hospitals, on average, had lower rates than non-metropolitan hospitals ($575 difference, p < 0.0001). Median household income was associated with a clinically insignificant increase in rates ($0.005 per dollar, p < 0.0001), while ADI showed no significant effect.

Conclusions: Substantial variability in negotiated payor rates for prophylactic fixation of the humerus was evident across hospital sizes, payor types, and geographic contexts. These findings underscore the importance of transparent negotiations and value-based reimbursement frameworks to ensure equitable, cost-effective access to orthopaedic oncology care.

Background and objectives: Primary tumor size is a key prognostic factor in osteosarcoma, but quantitative risk estimates and optimal thresholds remain undefined. We quantified the size-survival relationship in high-grade osteosarcoma.

Methods: We analyzed 1,807 high-grade osteosarcoma patients from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021) using Cox regression, systematic threshold testing (40-150 mm with multiple testing corrections), and propensity score matching at the AJCC 80 mm threshold.

Results: Each 10 mm increase in tumor size was associated with a 6.6% increased hazard of death after adjusting for age, sex, tumor site, surgery, radiation, and chemotherapy (Hazard ratio [HR] = 1.066, p < 0.001; adjusted C-index = 0.694). Binary AJCC staging demonstrated limited mortality discrimination (34.4% vs 44.4%, 10-percentage-point spread), while three-tier soft tissue sarcoma (STS)-adapted staging revealed a 21-percentage-point mortality gradient (26.6% to 47.7%) with superior adjusted discrimination (C-index = 0.695 vs 0.680, p < 0.001). All tested thresholds demonstrated significant associations, with no single optimal cutpoint identified. Polynomial testing indicated a linear relationship (p = 0.334). Propensity score matching at the AJCC 8 cm threshold of 666 patient pairs confirmed the effect (HR = 1.443, 95%-confidence interval: 1.214-1.715, p < 0.001). Polynomial testing indicated a linear relationship (p = 0.253).

Conclusion: Tumor size demonstrates a continuous dose-response relationship with survival. Three-tier STS staging outperforms binary AJCC classification for risk stratification.