Journal of Surgical Oncology最新文献

Introduction: Pancreaticoduodenectomy (PD) carries substantial risks in elderly patients, emphasizing the need for optimized perioperative care. Comprehensive geriatric assessments (CGAs) - evaluating medical, functional, and psychosocial domains - may mitigate these risks. This study investigates the impact of a preoperative evaluation by a dedicated geriatric surgery service on outcomes in elderly patients undergoing PD.

Methods and materials: This was a retrospective cohort study of elderly (age over 75 years) patients that underwent PD (GA + 75, n = 23) following preoperative workup by a specialized geriatric surgery service (GSS). Control groups included elderly patients without geriatric assessment (non-GA + 75, n = 73) and non-elderly patients ( < 75 years, n = 275). Short- and long-term outcomes were compared across the groups.

Results: While baseline demographics were similar between GA + 75 and non-GA + 75 groups, comorbidity profiles differed. Higher rates of chronic obstructive pulmonary disease (21.7% vs. 2.7%, p = 0.002) and asthma (26% vs. 1.4%, p < 0.001) were observed in the GA + 75 group. Despite this, GA + 75 patients had significantly lower rates of postoperative pneumonia (4.3% vs. 18.1%, p < 0.001), readmission (26.1% vs. 41.6%, p < 0.001; also lower than the non-elderly cohort), and delirium (4.3% vs. 36.1%, p < 0.001). There were no significant differences in overall major complications or 30-/90-day survival rates as well as long-term outcomes between the groups.

Conclusions: Preoperative evaluation by a dedicated GSS was associated with improved postoperative outcomes in elderly patients undergoing PD. These findings support the integration of CGAs into perioperative planning to enhance recovery and reduce complications in older adults.

Retraction: D.L. Vitello, C.D. Logan, N.N. Zaza, K.R. Bates, R. Jacobs, J. Feinglass, R.P. Merkow, and D.J. Bentrem, "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection," Journal of Surgical Oncology 130, no. 8 (2024): 1532-1538. The above article, published online on 10 October 2024 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors; the journal Editor-in-Chief, Laleh Melstrom; and Wiley Periodicals LLC. The retraction has been agreed after identifying this article as a duplicate of a previously published version[1]. The authors unintentionally resubmitted the manuscript, and this duplication was not detected prior to publication. In accordance with COPE and Wiley policies, duplicate publication is prohibited; therefore, the redundant article is being retracted. [1] D.L. Vitello, C.D. Logan, N.N. Zaza, K.R. Bates, R. Jacobs, J. Feinglass, R.P. Merkow, and D.J. Bentrem, "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection," Journal of Surgical Oncology 130, no. 5 (2024): 1111-1118, https://doi.org/10.1002/jso.27815.

The use of breast conservation surgery for early-stage breast cancer is common, and adjuvant radiotherapy is often recommended to reduce the risk of ipsilateral breast tumor recurrence. Historical trials have used sequential boost techniques with favorable outcomes with reduction in local recurrence and acceptable cosmetic outcomes. In recent years, there has been renewed interest in incorporating a concurrent tumor bed boost to reduce the number of radiation treatments delivered. This focused review summarizes the literature surrounding the indications, outcomes, and treatment planning considerations for radiation tumor bed boost for early-stage breast cancer patients.

Background: Malignant ovarian germ cell tumours (MOGCT) are rare tumours that disproportionally affect younger women. The Arbeitsgemeinschaft fuer Gynaekologische Onkologie (AGO) study group has established a clinico-pathological database (Current Ovarian geRm cell and SEx cord stromal Tumour Treatment strategies, CORSETT) to provide an overview of the current treatment strategies and survival of MOGCT patients.

Methods: Twenty German centres provided mixed retro- and prospective data of patients with tumour specimens treated between 2001 and 2014. A second opinion pathology board reviewed the tumour specimens. Descriptive analyses of the treatment strategies and fertility outcomes were conducted. Kaplan-Meier curves were plotted for disease-free and overall survival data.

Results: Seventy-seven MOGCT patients were included, 36 malignant dysgerminoma (MD), 21 malignant teratoma (MT) and 20 mixed MOGCT (MM) patients. Patients had a median age of 28 (MD), 38 (MT) and 33 (MM) years and fertility-sparing surgery (FSS) was offered in most (83% MD, 81% MT and 75% MM) patients. Final FIGO stage I disease was diagnosed in 78% (MD), 81% (MT) and 60% (MM) and adjuvant systemic treatment was given to 56% (MD), 53% (MT) and 70% (MM) patients. After a median observation time of 78.2 months, 5% (MD), 14% (MT) and 45% (MM) experienced disease recurrence. Overall survival was excellent in all groups (100% MD, 100% MT and 95% MM).

Discussion: In this descriptive analysis, FSS was the surgical method of choice for patients with MOGCT in AGO centres without negative impact on OS. MOGCTs appeared however as a heterogeneous group of tumours with particularly high recurrence rates for patients with MM.

Bladder cancer, the most prevalent urinary system malignancy, is characterized by high recurrence rates and prolonged treatment. While therapeutic advances have substantially improved survival, they have also heightened the prominence of financial toxicity (FT)-a treatment-related economic burden that severely impairs the quality of life of patients and their families. This review synthesizes evidence on the prevalence, influencing factors, impact on health outcomes, and management strategies of FT in bladder cancer, offering insights for individualized clinical support and health policy refinement. Future research should broaden study populations, employ diverse methodologies, and develop healthcare system-specific interventions to establish a comprehensive FT management framework.

Surgery remains curative for esophageal gastrointestinal stromal tumors (GISTs), while debates persist between minimally invasive enucleation and radical esophagectomy. Limited evidence from case reports and small cohorts necessitates a systematic evaluation to guide clinical decisions. This review showed that enucleation may be considered for small and low-mitotic-index esophageal GISTs with benign tendency. Despite higher R1 and tumor rupture rates, survival outcomes were comparable to esophagectomy. Enucleation, including endoscopic enucleation, was safe and effective in selected cases.

Background and objectives: This study investigates the clinical characteristics, pathological features, immunohistochemical profiles, and prognostic factors of solitary fibrous tumors (SFTs) to provide insights into their management and prognosis.

Methods: A retrospective analysis was conducted on 43 cases of SFTs diagnosed at a single center. Patient demographics, tumor characteristics, immunohistochemical (IHC) markers, and outcomes were collected.

Results: Among the 43 cases, the majority of tumors were infratentorial (81%), and 60% were classified as WHO Grade 1. IHC analyses revealed high expression rates of STAT6 (62.5%), CD34 (82.5%), and Ki-67 (100%). Ki-67 demonstrated the strongest correlation with tumor grade and risk scores (r = 0.62, p < 0.001; r = 0.68, p < 0.001), indicating its role as a significant prognostic marker. CD34 and STAT6 also showed moderate correlations with tumor aggressiveness. Metastatic presentations were noted in 57.5% of cases. The study highlights the heterogeneity of SFTs and the importance of IHC markers in risk stratification.

Conclusion: The findings underscore the utility of IHC markers, particularly Ki-67, STAT6, and CD34, in assessing the aggressiveness and prognosis of SFTs. Future studies should focus on multicenter validations, integration of advanced molecular diagnostics, and long-term follow-up to refine risk models and therapeutic strategies.

Background: Patients with early-stage cutaneous melanoma (CM) have low individual risk but account for most distant recurrences. The utility of gene expression profiling (GEP) in CM risk stratification and clinical management remains unclear.

Methods: From 2015 to 2022, CM patients at a single center were universally referred for DecisionDx 31-GEP. Patients with prior recurrence or not undergoing excision were excluded. The Kaplan-Meier method and Cox proportional hazards models were used to evaluate primary outcomes of recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and melanoma-specific survival (MSS). Secondary outcomes were sentinel lymph node biopsy (SLNB) positivity and recurrence subtype events.

Results: 689 patients were analyzed: 63% GEP Class 1A, 16.1% Class 1B/2A, 16.1% Class 2B, and 4.8% unclassified. After staging, 86.6% were stage I/II and 13.4% stage III. Median follow-up was 4.85 years. On multivariable analysis, GEP remained significantly predictive of RFS (Class 1B/2A HR = 4.022; Class 2B HR = 3.052), DMFS (Class 1B/2A HR = 4.403; Class 2B HR = 3.729), and MSS (Class 1B/2A HR = 6.656; Class 2B HR = 11.583) (p < 0.05 for all). Older Class 1A patients with indication for SLNB had lower SLNB positivity (2.8% ≥ 65 years, 0% ≥ 75 years).

Conclusions: Our data show GEP remains a robust predictor of recurrence and MSS after adjusting for clinicopathologic factors overall but is not predictive for all outcomes in stage-stratified analyses, particularly Stage II disease. Stage IA patients should forgo GEP altogether testing due to its futility in this population. Older patients with low-risk GEP may be candidates for avoidance of SLNB given lower positivity rates. GEP Class 2B patients represent a relatively high-risk population regardless of SLNB status.

Background: Endoscopic resection (ER) is increasingly utilized for early gastric cancer (EGC) due to its minimally invasive profile and comparable survival to gastrectomy (GR). However, concerns regarding oncologic efficacy and institutional volume impact persist. This study evaluates how ER volume quartiles impact outcomes and guideline adherence in EGC management.

Methods: A retrospective analysis of the NCDB from 2010 to 2021 for patients with cT1aN0M0 gastric adenocarcinoma was performed comparing ER and GR. Primary outcomes were oncologic outcomes, rates of guideline adherence, and survival stratified by institutional ER volume tertiles (high, mid, low). Multivariable logistic, linear regression, and Cox proportional hazards models were used.

Results: A total of 1461 patients were analyzed; 937 (61.4%) undergoing ER and 524 (35.7%) GR. 57.5% of ER occurred in the latter half of the study time period, and increasing proportional ER utilization in EGC was observed over time. When stratified by ER volume tertiles, margin positivity (14.6% high volume vs. 13.7% mid vs. 15.5% low, p = 0.85), LVI rates (6.3% high vs. 9.5% mid vs. 9.7% low, p = 0.32), guideline discordant care (22.6% high vs. 22.3% mid vs. 24.3% low, p = 0.82), and survival (vs. low volume: high HR 1.04, p = 0.87; mid HR 1.27, p = 0.39) did not differ by institutional ER volume. High-volume centers preferentially used ER (OR 1.76, p < 0.01) compared to low and mid-volume centers. Guideline-discordant ER correlated with earlier years (OR 0.69, p = 0.03) but not institutional volume (vs. low volume: high OR 0.94, p = 0.76; mid OR 0.90, p = 0.61).

Conclusion: ER for EGC is rapidly expanding across US institutions at all volume levels. ER achieves comparable oncological outcomes and survival independent of ER volume when guideline-concordant criteria are met, suggesting centralization may be unnecessary for EGC. The guideline discordant care rate of ~24% across all institutions highlights the need for adherence to ER criteria for EGC.

Background and objectives: We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients.

Methods: This single-center retrospective cohort study included patients aged ≥ 75 years with pathological stage I-III disease after R0 resection who underwent surgery within September 2012-2022, stratified by CFS score. Univariate and multivariate analyses assessed risk factors for postoperative complications. Cox proportional hazards models identified prognostic factors for overall survival (OS) and disease-specific survival (DSS).

Results: Among 109 patients (median age: 78 [interquartile range, 76-82]; 65.1% male), the CFS 5-7 group (n = 17) had a higher stoma creation rate (70.6% vs. 43.5%; p = 0.063) than the CFS 1-4 group (n = 92), and none in this group underwent lateral pelvic lymph node dissection. No independent risk factors were identified for postoperative complications with Clavien-Dindo grade ≥ II. CFS 5-7 was independently associated with worse OS (hazard ratio [HR] = 10.073; p < 0.001) and DSS (HR = 9.135; p = 0.003), and 3-year OS (63.6% vs. 85.6%, p < 0.001) and DSS (74.3% vs. 90.7%, p = 0.035) were significantly poorer.

Conclusions: CFS provides a simple and effective preoperative assessment tool for evaluating patient frailty that significantly influences long-term outcomes in patients undergoing minimally invasive rectal cancer surgery.