Journal of Surgical Oncology最新文献

Introduction: The management of extremity soft tissue sarcomas (STS) involving major vessels presents unique challenges, historically leading to amputation. Advances in vascular reconstruction have enabled limb-sparing surgery (LSS), but outcomes and perioperative risks remain uncertain. This systematic review and meta-analysis aimed to evaluate oncologic results following LSS with vascular reconstruction in extremity STS.

Methods: A systematic review and single-arm meta-analysis were performed according to PRISMA guidelines, with registration in PROSPERO. PubMed, Embase, and Cochrane Library were searched from inception to June 2025 for studies reporting outcomes in patients with extremity STS undergoing LSS with vascular reconstruction. Pooled analyses estimated limb salvage, survival, and complication rates using random-effects models.

Results: Thirty-one studies comprising 520 patients were included. Approximately 58% were male, with a mean age ranging from 29.3 to 59 years. The most common tumor localizations were the thigh (59.5%), inguinal region (15.9%), and popliteal fossa (8.6%). Liposarcoma (24.0%), synovial sarcoma (19.6%), and osteosarcoma (14.8%) were the most frequent histological subtypes. The pooled limb salvage rate was 89% (95% CI, 86%-92%), while amputation occurred in 10% (95% CI, 8%-14%). One- and 5-year overall survival rates were 89% and 62%, respectively, with disease-free survival rates of 74% and 55%. Major complications included graft thrombosis (19%), wound complications (29%), and wound infection (22%).

Conclusions: Limb-sparing surgery with vascular reconstruction is effective for extremity STS involving major vessels, enabling high limb salvage and favorable long-term survival without compromising oncologic outcomes. However, substantial perioperative morbidity persists, underscoring the need for multidisciplinary care, careful patient selection, and prospective studies to refine indications and enhance quality of life.

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.