Journal of Surgical Oncology最新文献

Background and objectives: Simultaneous rectal and hepatic resection for metastatic rectal cancer is less commonly performed due to concerns about safety, and the oncological outcomes are less well described. The objective of this study is to examine peri-operative and oncological outcomes for patients with rectal cancer liver metastases (RCLM) after simultaneous resection.

Methods: A single-center, retrospective analysis of patients who underwent curative-intent, simultaneous total mesorectal excision (TME) and hepatectomy for RCLM (January 2011 to May 2024). Post-operative safety and oncological outcomes were examined.

Results: 92 patients were analyzed, with the majority having high burden of hepatic metastases. No deaths occurred. 14 patients (15%) had > Clavien-Dindo Grade 3 complication, drainage of perihepatic fluid in eight patients (9%), and an anastomotic dehiscence in three patients (3%). Median follow up was 51 mo, and median OS was 70 mo, RFS was 10 mo, and H-RFS was 17 mo. Positive hepatic margin was associated with decreased OS, while a high Clinical Risk Score, a high Tumor Burden Score, and > 6 cycles of neoadjuvant chemotherapy were associated with decreased RFS and H-RFS.

Conclusion: Simultaneous resection of RCLM was associated with peri-operative safety and long term survival in patients with high-risk disease, and can be reasonably offered in appropriate setting.

Background and objectives: Postoperative early recurrence (ER) of biliary tract cancers (BTCs) leads to significant medical, psychological, social, and economic disadvantages for patients. Approximately 30% of patients with curatively resected BTCs experience recurrence within the first 12 months after the surgery. JCOG1202 randomized phase III trial demonstrated the survival benefit of adjuvant S-1 in patients with resected BTCs. The objective of this exploratory study was to investigate the risk factors for ER in patients with resected BTCs in the JCOG1202 cohort.

Methods: Of the 440 patients enrolled in JCOG1202, 217 who underwent observation and 207 who received adjuvant S-1 were eligible in this analysis. ER was defined as recurrence or death within 12 months after enrollment.

Results: ER was observed in 59 and 38 patients in observation and adjuvant S-1, respectively. Multivariable logistic regression analysis identified CA19-9 levels > 37 U/ml (odds ratio (OR): 2.79, 95% confidence interval (CI): 1.26-6.17), poorly differentiation (vs. well-differentiated/papillary) (OR: 4.75, 95% CI: 1.93-11.69), moderate differentiation (vs. well-differentiated/papillary) (OR: 1.96, 95% CI: 1.07-3.57), lymph node metastases ≥ 4 (vs. 0) (OR: 3.99, 95% CI: 1.67-9.51), lymph node metastases 1-3 (vs. 0) (OR: 2.66, 95% CI: 1.47-4.81), and R1 resection (OR: 2.17, 95% CI: 1.07-4.41) as independent risk factors for ER. Adjuvant S-1 chemotherapy significantly reduced ER (OR: 0.49, 95% CI: 0.29-0.83).

Conclusions: Postoperative CA19-9 levels, tumor differentiation, lymph node metastases, residual tumors, and adjuvant S-1 significantly affected ER in patients with curatively resected BTCs. Patients at high ER risk may require more intensive adjuvant therapy.

Trial registration: UMIN000011688.

This systematic review and meta-analysis evaluated the diagnostic performance of artificial intelligence (AI) models that analyze preoperative prostate MRI images in conjunction with clinical parameters for predicting extraprostatic extension (EPE) in prostate cancer. A comprehensive search of PubMed, Embase, and Web of Science up to July 2025 identified 14 eligible studies involving 2,131 patients. The pooled analysis demonstrated that integrated radiomics-clinical models achieved high diagnostic performance, with a sensitivity of 0.83 (95% CI: 0.78-0.87), specificity of 0.82 (95% CI: 0.77-0.86), and an area under the curve (AUC) of 0.89 (95% CI: 0.86-0.92). The diagnostic odds ratio (DOR) was 19.82 (95% CI: 12.33-31.86), indicating robust discrimination between EPE-positive and EPE-negative cases. Subgroup analysis suggested models using deep learning algorithms had marginally higher accuracy (DOR: 24.6) than those using traditional machine learning (DOR: 17.3), though the difference was not statistically significant. Heterogeneity among studies stemmed from variations in MRI protocols, segmentation methods, and modeling approaches. No significant publication bias was detected. The results affirm that integrating radiomic features from multiparametric MRI (e.g., T2-weighted, diffusion-weighted imaging) with clinical variables (e.g., PSA, Gleason score) significantly outperforms conventional assessments for preoperative EPE prediction, demonstrating excellent diagnostic accuracy and supporting its potential clinical application in risk stratification. This supports the potential of combined models to enhance risk stratification and guide personalized surgical planning. Future research should prioritize standardized radiomics workflows, external validation, and multi-center collaborations to facilitate clinical adoption.

Introduction: Hepatic artery infusion chemotherapy (HAIC) has been used in efforts to improve outcomes in patients with locally advanced cholangiocarcinoma. Reported experiences are generally small institutional series. The efficacy of HAIC in locally advanced cholangiocarcinoma is not well defined.

Methods: We performed a comprehensive search using the electronic databases PubMed, Embase, Cochrane, ClinicalTrials. Gov, and WHO Clinical Trials from inception to August 2024.

Results: A total of 202 publications were screened, with 15 studies representing 588 patients meeting the inclusion criteria. Most patients demonstrated either a partial response or stable disease after therapy (CR: 2.5%, PR: 38.1%, SD: 43.4%, PD: 12.7%, NA: 3.3%). Meta-analysis found a pooled median overall survival of 18.3 months (95% CI: 14.1-22.4 months) and progression-free survival of 10.0 months (95% CI: 7.7-12.3 months).

Conclusion: HAIC demonstrates an improvement over reported survival for systemic chemotherapy alone when used as either an adjunct or in place of systemic therapy for first-line treatment in patients with cholangiocarcinoma.

Background and objectives: Osteoid Osteoma (OO) is a painful, benign bone tumor that can be treated surgically with en bloc resection, curettage, and radiofrequency ablation (RFA). This study aims to measure recurrence rates after initial treatment by treatment type and to examine clinical factors associated with recurrence.

Methods: A retrospective review of patients with an OO diagnosis was performed using a pathology database from a tertiary pediatric hospital between November 1, 2004 and July 1, 2024. Statistical analysis examined the relationships among surgical technique, recurrence, and clinical variables.

Results: 24 patients met inclusion criteria with a median follow-up of 1.41 years (interquartile range, IQR 2.0) and a median age at treatment of 9.92 years (IQR 5.8-13.5). Twelve patients (50.0%) experienced symptomatic tumor recurrence, with a median time to recurrence of 0.92 years (IQR 0.1-3.0). Of those with tumor recurrence, five patients were initially treated with excision and curettage, while the remaining nine underwent RFA. There was no significant correlation between recurrence and surgical intervention (p = 0.667), age at initial surgery (p = 0.468), or patient sex (p = 0.667).

Conclusions: Surgical management of pediatric OO is linked to high recurrence rates, and recurrence is not related to surgical intervention, age, or patient sex.

Background: We assessed overall survival (OS) and cancer-specific-survival (CSS) of radical resection compared to local excision for stage 1 rectal cancer in very old patients (≥ 80 years).

Methods: This retrospective cohort study included patients aged ≥ 80 years who underwent surgery for stage 1 rectal cancer from the SEER database from 2000-2020. Patients were divided into radical resection and local excision groups, and were exact matched for T stage, tumor grade, and tumor size. The main outcome measures were OS and CSS.

Results: 6379 patients ≥ 80 years underwent local or radical resection of stage 1 rectal cancer; 51.9% were female and 47% had T1 tumors. After matching, 1125 patients were included in each group. The median OS was longer in patients who underwent radical resection (60 months vs. 51 months, p = 0.009), yet there were no significant differences in CSS between the two groups. When stratified by the T stage, there was no benefit for radical resection in T1 tumors (p = 0.33). In multivariate analysis, radical resection and local excision had similar hazard of mortality (HR 1.03, 95%CI 0.76-1.38).

Conclusion: Radical resection and local excision had similar CSS in very old patients with stage 1 rectal cancer. A personalized approach considering patient status and treatment goals should be used for each patient.

Background and objectives: Tumor involvement of the posterior mandible often requires resection of the mandibular condyle and associated soft tissue. This study explores clinical and patient-reported outcomes (PROs) associated with condyle preservation versus resection during reconstruction.

Methods: This retrospective cohort study examined patients who underwent bony free flap reconstruction of posterolateral mandible defects from 2017 to 2021. Major clinical outcomes included length of stay (LOS), duration of follow-up, cancer recurrence, and all-cause mortality. PROs were assessed using the validated FACE-Q Head and Neck Cancer module survey for overall, short-term (0-1 year postoperatively), and long-term (> 1 year postoperatively) outcomes. The cohorts included (1) condyle preservation, (2) condyle resection with condyle autotransplantation, and (3) condyle resection without autotransplantation.

Results: 94 patients were included in the study. Major clinical outcomes did not significantly differ between cohorts (all p > 0.439). Compared to the condyle-resected cohort, condyle-preserved patients overall reported superior Overall Facial Appearance (p = 0.035), Eating Function (p = 0.034), Appearance/Face Distress (p = 0.020), Eating Distress (p = 0.017), and Cancer Worry (p = 0.002). Long-term assessments revealed more marked advantages for in-situ condyle preservation compared to condyle resection in Overall Facial Appearance (p = 0.022), Eating Function (p = 0.004), Smiling Function (p = 0.035), Swallowing Function (p = 0.003), Eating Distress (p = 0.006), and Cancer Worry (p = 0.011). Among condyle-resected patients, condyle autograft did not significantly improve FACE-Q scores (all p > 0.177).

Conclusions: In-situ condyle preservation yielded superior PROs compared to condyle resection ± condyle autograft, particularly over 1 year postoperatively. Major clinical outcomes did not significantly differ.

Locally advanced breast carcinoma (LABC) is a frequent condition in Brazil and in developing countries. Neoadjuvant systemic therapy (NST) has allowed for surgical de-escalation of the breast and/or axilla, leading to increasing the rates of breast-conserving-surgery, skin/nipple preservative mastectomies and axillary preservation. There are no established quality indicators for LABC or NST. This article aimed to review the topic, highlighting Brazilian studies, identifying thirty potential quality indicators for surgical treatment.

Breast cancer remains a leading cause of cancer-related mortality among women globally. Vietnamese women experience unique challenges, including sociocultural, linguistic, and systemic barriers, contributing to disparities in screening utilization, late-stage diagnoses, and treatment outcomes. Despite advances in early detection and care, inequities persist. A systematic review was conducted following PRISMA guidelines, with the protocol registered on PROSPERO. PubMed, Embase, and Scopus were searched for original studies published from 2000 to 2024 examining breast cancer screening, outcomes, molecular/genetic features, and disparities in Vietnamese populations. Narrative synthesis was employed due to heterogeneity in study metrics and methodologies. Forty-one studies encompassing 39,324 Vietnamese participants (mean age 48.15 ± 7.48 years) were included. Social networks and acculturation positively influenced screening uptake, while systemic barriers such as language, cultural stigma, and lack of insurance deterred participation. Across included studies, mammography screening rates among Vietnamese women ranged widely from 26% to 83%, consistently lower than the U.S. national average of 81%, and lower than rates reported in many Asian American subgroups. Late-stage diagnoses were prevalent, occurring in 32.9% of Vietnamese women, with foreign-born Vietnamese women exhibiting higher mortality than U.S.-born counterparts. Molecular studies revealed distinct tumor subtypes, including higher HER2-positive and triple-negative breast cancer rates. Interventions, including culturally tailored education and patient navigator programs, demonstrated success in addressing screening and care disparities. Vietnamese women face significant breast cancer disparities driven by sociocultural, systemic, and biological factors. Effective solutions require integrating culturally tailored solutions to promote equitable outcomes and reduce disparities in breast cancer care.