Journal of Surgical Oncology最新文献

Background: Liver cancer incidence and mortality have been shown to differ by race, ethnicity, and geography. This study aims to analyze disparities in the multimodal treatment of liver cancers in Louisiana.

Methods: Cases of nonmetastatic liver cancer in Louisiana from 2010 to 2020 were obtained from the Louisiana Tumor Registry. Generalized linear mixed models were used to model the receipt of therapy.

Results: A total of 2948 patients met inclusion criteria where 30.5% received no therapy. Multivariable models identified patients with increased odds of pursuing no treatment which include those 70 and older, no domestic partner, uninsured, high poverty, and rural residence (p < 0.05).

Conclusions: Available therapeutic modalities are underutilized in Louisiana with a considerable number of patients receiving no treatment for liver cancer. Older age, no domestic partner, uninsured, rural residence, and high poverty are risk factors for not receiving treatment. Allocating resources to these patients is an important step in reversing inequities.

Introduction: Stockholm, Sweden had among the highest excess mortality rates during the first wave of the SARS-CoV-2 pandemic. In March 2020, an entire hospital implemented an infection-free cold site infrastructure and scaled up imperative mainly colorectal cancer surgery, for the Stockholm health care region. The study evaluated the efficacy of the concept.

Methods: Strict preadmission screening and prophylactic interventions were implemented. The outcomes of the cold site cohort (30th March-21st June 2020) were compared to a prepandemic control. Population-based data on colorectal cancer patients were collected from the Swedish Colorectal Cancer Registry.

Results: There were 107 patients in the cold site cohort and 109 in the control cohort. None developed COVID-19 within 30 days postoperatively. The proportions of pelvic and laparoscopic surgery were similar. The cold site cohort had more potentially avoidable stomas (32/94 (34%) vs 19/91 (21%), p = 0.0442). In the region, the proportion of colorectal cancer resections at the cold site increased from prepandemic 12.9% (58 of 448) to 43.3% (94 of 217) (p < 0.001).

Conclusion: A SARS-CoV-2-cold site can be kept infection-free by screening, allowing increased volumes of colorectal cancer surgery with outcomes comparable to prepandemic practice. The cold site model should be more widely adopted in future similar scenarios.

Summary: This study reports on the implementation of an entire cold site hospital for imperative colorectal surgery, in particular colorectal cancer, during the SARS-CoV-2 pandemic. By comparing outcomes to prepandemic practices, we demonstrated that the cold site hospital was effective in preventing infection and safely increasing surgical volume many-fold.

Background and objectives: There is emerging evidence that host related variables predict outcomes in various cancers. The Host index (H-index) incorporates various host-related, blood-derived biomarkers (immunological and nutritional parameters) as a single mathematical formula. The aim of this study was to evaluate outcomes using the H-index as a prognostic marker in gallbladder cancer (GBC) patients undergoing curative resection.

Methods: Retrospective cohort study of surgically treated GBCs at a tertiary cancer centre from January 2010 to May 2023 was performed. Patients who had received neoadjuvant therapy, metastatic (M1) disease at time of surgical exploration and incidental GBCs were excluded. Baseline neutrophil, lymphocyte, monocyte and platelet counts, hemoglobin and albumin levels were recorded. H-index was computed and analysed.

Results: 241 curatively resected GBC patients were included. The H-index was inversely associated with disease free survival (DFS), both on univariate (79.7 vs. 61.4% for H-index  3.4 respectively; p = 0.046) and multivariate analysis (Hazard ratio [HR] for recurrence: 1.954 [95% C.I.: 1.366-2.796]; p = < 0.001). Using the maximally distributed rank statistics, a cut-off of 1.31 showed a significant difference in 3-year DFS (86.2 vs. 68.4% for H-index  1.31 respectively; HR: 2.21 [95% CI: 1.16-4.21]; p = 0.013) but not overall survival (OS) (p = 0.269).

Conclusion: A higher H-index predicted for worse DFS in curatively resected GBC patients. This shows host related variables do play a role in influencing outcomes in GBC. However, larger prospective studies are required to further strengthen this finding.

Summary: Host-related, blood derived biomarkers can influence outcomes in various solid tumours. A higher baseline Host index (H-index) value which incorporates various blood-derived biomarkers, predicted for worse disease-free survival in curatively resected gallbladder cancers.

Background: The use of advanced diagnostic methods, such as high-resolution CT or PET-CT scans, are limited in low and middle-income countries (LMICs). In gastric cancer, occult peritoneal disease may be present in up to 20% of cases, limiting the benefits of surgical resection. Accurate staging of gastric cancer is essential to ensure optimal patient management and prevent undue morbidity from unnecessary surgery. Our study evaluated the diagnostic accuracy and safety of staging laparoscopy (SL) versus computed tomography (CT) in detecting peritoneal metastases for gastric cancer in Ukraine.

Methods: Patients who underwent SL between October 2017 and October 2022 were retrospectively reviewed. SL was performed for each newly diagnosed patient with gastric cancer without evidence of distant metastases, except when peritoneal carcinomatosis was in question. Pathological findings at SL were compared with initial CT reports, and analysis of the sensitivity and specificity for SL was performed.

Results: Of 516 patients undergoing SL, 410 had no radiological considerations for distant metastases. Among them, radiographically occult peritoneal metastatic disease was found in 134 (32.7%). Overall SL sensitivity for peritoneal metastases was 90.6% (95% confidence interval [CI]: 85.8%-94.1%) and specificity 100.0% (95% CI: 98.8%-100.0%). Complications after SL occurred in 5 (1%) of patients. No mortality was associated with SL.

Conclusion: SL is a safe and effective method to evaluate the presence of peritoneal disease in patients with gastric cancer. This method may be appropriate for LMICs, where availability of advanced imaging technologies is limited.

Advancements in cancer care have significantly extended the life expectancy of rectal cancer patients and the impact of treatment-related toxicity on long-term quality of life has become a crucial factor in determining the most suitable type of neoadjuvant therapy, particularly for patients who are likely to undergo surgery. While radiotherapy has traditionally been regarded as the cornerstone for achieving improved local control in rectal cancer, it is accompanied by a range of associated complications, including bowel and bladder dysfunction, gonadal ablation, and Low Anterior Resection Syndrome. De-escalation of treatment is undoubtedly beneficial for many patients, and this approach should be tailored to consider their expectations while prioritizing patient care in decision-making. Although there is inadequate data to support the oncologic safety of a watch-and-wait approach without radiation or to omit radiation in patients with suspicious lateral pelvic lymph nodes, sufficient evidence exists to justify de-escalation by avoiding radiation before surgery in many other patients who respond well to chemotherapy.