BACKGROUND AND AIMThis is a report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, in which we studied the incidence of disease at pathological evaluation in different morphological appearances of peritoneal malignancies (PM) on imaging.METHODSRadiological findings were captured in a specific format that included a description of the morphological appearance of PM and a correlation performed with pathological findings.RESULTSIn 630 patients enroled at seven centres (September 2022-December 2023), 24 morphological terms were used. Among prespecified terms (N = 8 used in 6350 [92.2%] regions), scalloping was pathologically positive in 93.5%, confluent disease in 78.8%, tumour nodules in 69.6%, thickening in 66.1%, infiltration in 56.3%. Among unspecified appearances (N = 16) for 540 (7.8%) regions, 'enhancement' was positive in 41.5%, micronodules in 65.3% and nodularity in 60.2%. Hierarchal clustering placed gastric cancer and rare tumours together and colorectal cancer, ovarian cancer and peritoneal mesothelioma in one cluster.CONCLUSIONSThe incidence of disease at pathological evaluation for most morphological appearances was high (> 50%). Morphological description should be provided in routine radiology reports. A set of standardized terms with their description should be developed by a consensus among experienced radiologists.
{"title":"The Significance of the Morphological Appearance of Peritoneal Lesions on Imaging in Patients With Peritoneal Malignancies-A Report From Phase 1 of the PRECINCT Study.","authors":"Aditi Bhatt,Pascal Rousset,Brendan J Moran,Mudaddal Kazi,Dario Baratti,Amine Souadka,Marcello Deraco,Paolo Sammartino,Armando Sardi,Olivier Glehen,","doi":"10.1002/jso.27869","DOIUrl":"https://doi.org/10.1002/jso.27869","url":null,"abstract":"BACKGROUND AND AIMThis is a report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, in which we studied the incidence of disease at pathological evaluation in different morphological appearances of peritoneal malignancies (PM) on imaging.METHODSRadiological findings were captured in a specific format that included a description of the morphological appearance of PM and a correlation performed with pathological findings.RESULTSIn 630 patients enroled at seven centres (September 2022-December 2023), 24 morphological terms were used. Among prespecified terms (N = 8 used in 6350 [92.2%] regions), scalloping was pathologically positive in 93.5%, confluent disease in 78.8%, tumour nodules in 69.6%, thickening in 66.1%, infiltration in 56.3%. Among unspecified appearances (N = 16) for 540 (7.8%) regions, 'enhancement' was positive in 41.5%, micronodules in 65.3% and nodularity in 60.2%. Hierarchal clustering placed gastric cancer and rare tumours together and colorectal cancer, ovarian cancer and peritoneal mesothelioma in one cluster.CONCLUSIONSThe incidence of disease at pathological evaluation for most morphological appearances was high (> 50%). Morphological description should be provided in routine radiology reports. A set of standardized terms with their description should be developed by a consensus among experienced radiologists.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marij Hartog, Sara J. E. Beishuizen, Reon Togo, Rozemarijn L. van Bruchem‐Visser, Casper H. J. van Eijck, Francesco U. S. Mattace‐Raso, Chulja J. Pek, Roeland F. de Wilde, Bas Groot Koerkamp, Harmke A. Polinder‐Bos
IntroductionPeriampullary cancer has a poor prognosis. Surgical resection is a potentially curative but high‐risk treatment. Comprehensive geriatric assessment (CGA) can inform treatment decisions, but has not yet been evaluated in older patients eligible for pancreatic surgery.MethodsThis prospective observational study included patients ≥ 70 years of age eligible for pancreatic surgery. Frailty was defined as impairment in at least two of five domains: somatic, psychological, functional, nutritional, and social. Outcomes included postoperative complications, functional decline, and mortality.ResultsOf the 88 patients included, 87 had a complete CGA. Sixty‐five patients (75%) were frail and 22 (25%) were non‐frail. Frail patients were more likely to receive nonsurgical treatment (43.1% vs. 9.1% p = 0.004). Fifty‐seven patients underwent surgery, of which 52 (59%) underwent pancreaticoduodenectomy. The incidence of postoperative delirium was three times higher in frail patients (29.7% vs. 0%, p = 0.005). The risk of mortality was three times higher in frail patients (HR: 3.36, 95% CI: 1.43–7.89, p = 0.006).ConclusionFrailty is common in older patients eligible for pancreatic surgery and is associated with treatment decision, a higher incidence of delirium and a three times higher risk of all‐cause mortality. CGA can contribute to shared decision‐making and optimize perioperative care in older patients.
{"title":"Comprehensive Geriatric Assessment, Treatment Decisions, and Outcomes in Older Patients Eligible for Pancreatic Surgery","authors":"Marij Hartog, Sara J. E. Beishuizen, Reon Togo, Rozemarijn L. van Bruchem‐Visser, Casper H. J. van Eijck, Francesco U. S. Mattace‐Raso, Chulja J. Pek, Roeland F. de Wilde, Bas Groot Koerkamp, Harmke A. Polinder‐Bos","doi":"10.1002/jso.27862","DOIUrl":"https://doi.org/10.1002/jso.27862","url":null,"abstract":"IntroductionPeriampullary cancer has a poor prognosis. Surgical resection is a potentially curative but high‐risk treatment. Comprehensive geriatric assessment (CGA) can inform treatment decisions, but has not yet been evaluated in older patients eligible for pancreatic surgery.MethodsThis prospective observational study included patients ≥ 70 years of age eligible for pancreatic surgery. Frailty was defined as impairment in at least two of five domains: somatic, psychological, functional, nutritional, and social. Outcomes included postoperative complications, functional decline, and mortality.ResultsOf the 88 patients included, 87 had a complete CGA. Sixty‐five patients (75%) were frail and 22 (25%) were non‐frail. Frail patients were more likely to receive nonsurgical treatment (43.1% vs. 9.1% <jats:italic>p</jats:italic> = 0.004). Fifty‐seven patients underwent surgery, of which 52 (59%) underwent pancreaticoduodenectomy. The incidence of postoperative delirium was three times higher in frail patients (29.7% vs. 0%, <jats:italic>p</jats:italic> = 0.005). The risk of mortality was three times higher in frail patients (HR: 3.36, 95% CI: 1.43–7.89, <jats:italic>p</jats:italic> = 0.006).ConclusionFrailty is common in older patients eligible for pancreatic surgery and is associated with treatment decision, a higher incidence of delirium and a three times higher risk of all‐cause mortality. CGA can contribute to shared decision‐making and optimize perioperative care in older patients.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gabriel De La Cruz Ku, Carly Wareham, Caroline King, Akash Koul, Anshumi Desai, Sarah M. Persing, Salvatore Nardello, Abhishek Chatterjee
BackgroundOncoplastic surgery (OPS) has increased in popularity over the recent years. It is a form of breast conservation surgery allowing for larger partial mastectomy (PM) resections followed by either volume displacement or volume replacement reconstruction techniques. However, there is a lack of evidence on the effectiveness and safety of OPS with radiotherapy (OPS + RT) in high‐risk breast cancer phenotypes, such as triple negative breast cancer (TNBC) and HER2 positive (HER2+) patients. Our aim was to compare the breast cancer‐specific survival (BCSS) and postoperative surgical complications in OPS + RT compared to PM alone with radiation (PM + RT) and total mastectomy (MTX) without radiotherapy (MTX‐RT).MethodsPatient data were analyzed from the Surveillance, Epidemiology, and End Results (SEER) cancer registries from January 1, 2012 to December 31, 2020. Patients were stratified according to the type of surgery. Cox regression analysis was performed to assess prognostic factors of BCSS.ResultsA total of 24 621 patients with high‐risk breast cancer phenotypes were identified, 180 underwent OPS + RT; 13 402, PM + RT; and 11 039 MTX‐RT. OPS + RT was more frequently performed in younger (mean age of 65.53 years, SD: 9.29, p < 0.001), non‐Hispanic White (90.5% vs. 77.7% vs. 76.3%) and single women (17.9% vs. 12.1% vs. 13.3%). MTX‐RT was usually performed in patients with high histological grade, TNBC, and higher stages. Overall complication rates were higher in the MTX‐RT, compared to OPS + RT and PM + RT, 2%, 1.1%, and 0.7%, respectively, p < 0.001. Rates of hematoma and surgical site infections were higher in the MTX‐RT group. With a median follow‐up of 46 months, OPS + RT had better BCSS rates at 5 years compared to PM + RT and MTX‐RT (97.1% vs. 94.7% vs. 89.8%, p < 0.001). MTX‐RT was found to be an independent prognostic factor of worse BCSS compared to OPS + RT (hazard ratio [HR] = 2.584; 95% confidence interval [CI]: 1.005–7.171), while PM + RT had no difference compared to OPS + RT (HR = 1.670, 95% CI: 0.624–4.469).ConclusionsOPS is a safe breast surgical option in patients with HER2+ and TNBC. Patients with high‐risk phenotypes who underwent OPS + RT and have similar BCSS and complication rates compared to standard breast surgical options. As such, OPS should be considered as an option whenever breast conservation surgery is being discussed.
背景近年来，乳房整形手术（Oncoplastic surgery，OPS）越来越受欢迎。它是一种乳房保护手术，可进行较大的乳房部分切除术（PM），然后采用体积置换或体积替代重建技术。然而，对于三阴性乳腺癌（TNBC）和HER2阳性（HER2+）患者等高危乳腺癌表型，OPS+放疗（OPS+RT）的有效性和安全性还缺乏证据。我们的目的是比较OPS+RT与单纯PM+放疗（PM+RT）和全乳房切除术（MTX）+放疗（MTX-RT）相比的乳腺癌特异性生存率（BCSS）和术后手术并发症。方法对2012年1月1日至2020年12月31日期间来自监测、流行病学和最终结果（SEER）癌症登记处的患者数据进行分析。根据手术类型对患者进行了分层。结果共发现24 621例高风险乳腺癌患者，其中180例接受了OPS+RT；13 402例接受了PM+RT；11 039例接受了MTX-RT。更多年轻（平均年龄 65.53 岁，SD：9.29，p < 0.001）、非西班牙裔白人（90.5% vs. 77.7% vs. 76.3%）和单身女性（17.9% vs. 12.1% vs. 13.3%）接受了 OPS + RT。MTX-RT通常用于组织学分级高、TNBC和分期较高的患者。与OPS + RT和PM + RT相比，MTX-RT的总体并发症发生率更高，分别为2%、1.1%和0.7%，P< 0.001。MTX-RT组的血肿和手术部位感染率更高。中位随访时间为46个月，与PM + RT和MTX-RT相比，OPS + RT在5年内的BCSS率更高（97.1% vs. 94.7% vs. 89.8%，p <0.001）。与OPS + RT相比，MTX-RT是BCSS恶化的独立预后因素（危险比[HR] = 2.584；95%置信区间[CI]：1.005-7.171），而PM + RT与OPS + RT相比没有差异（HR = 1.670，95% CI：0.624-4.469）。与标准乳腺手术方案相比，接受OPS+RT的高风险表型患者的BCSS和并发症发生率相似。因此，无论何时讨论保乳手术，都应将 OPS 作为一种选择。
{"title":"Is Oncoplastic Surgery Safe in High‐Risk Breast Cancer Phenotypes?","authors":"Gabriel De La Cruz Ku, Carly Wareham, Caroline King, Akash Koul, Anshumi Desai, Sarah M. Persing, Salvatore Nardello, Abhishek Chatterjee","doi":"10.1002/jso.27899","DOIUrl":"https://doi.org/10.1002/jso.27899","url":null,"abstract":"BackgroundOncoplastic surgery (OPS) has increased in popularity over the recent years. It is a form of breast conservation surgery allowing for larger partial mastectomy (PM) resections followed by either volume displacement or volume replacement reconstruction techniques. However, there is a lack of evidence on the effectiveness and safety of OPS with radiotherapy (OPS + RT) in high‐risk breast cancer phenotypes, such as triple negative breast cancer (TNBC) and HER2 positive (HER2+) patients. Our aim was to compare the breast cancer‐specific survival (BCSS) and postoperative surgical complications in OPS + RT compared to PM alone with radiation (PM + RT) and total mastectomy (MTX) without radiotherapy (MTX‐RT).MethodsPatient data were analyzed from the Surveillance, Epidemiology, and End Results (SEER) cancer registries from January 1, 2012 to December 31, 2020. Patients were stratified according to the type of surgery. Cox regression analysis was performed to assess prognostic factors of BCSS.ResultsA total of 24 621 patients with high‐risk breast cancer phenotypes were identified, 180 underwent OPS + RT; 13 402, PM + RT; and 11 039 MTX‐RT. OPS + RT was more frequently performed in younger (mean age of 65.53 years, SD: 9.29, <jats:italic>p</jats:italic> < 0.001), non‐Hispanic White (90.5% vs. 77.7% vs. 76.3%) and single women (17.9% vs. 12.1% vs. 13.3%). MTX‐RT was usually performed in patients with high histological grade, TNBC, and higher stages. Overall complication rates were higher in the MTX‐RT, compared to OPS + RT and PM + RT, 2%, 1.1%, and 0.7%, respectively, <jats:italic>p</jats:italic> < 0.001. Rates of hematoma and surgical site infections were higher in the MTX‐RT group. With a median follow‐up of 46 months, OPS + RT had better BCSS rates at 5 years compared to PM + RT and MTX‐RT (97.1% vs. 94.7% vs. 89.8%, <jats:italic>p</jats:italic> < 0.001). MTX‐RT was found to be an independent prognostic factor of worse BCSS compared to OPS + RT (hazard ratio [HR] = 2.584; 95% confidence interval [CI]: 1.005–7.171), while PM + RT had no difference compared to OPS + RT (HR = 1.670, 95% CI: 0.624–4.469).ConclusionsOPS is a safe breast surgical option in patients with HER2+ and TNBC. Patients with high‐risk phenotypes who underwent OPS + RT and have similar BCSS and complication rates compared to standard breast surgical options. As such, OPS should be considered as an option whenever breast conservation surgery is being discussed.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Justin Dourado, Giovanna Dasilva, Steven D. Wexner
BackgroundThis study aimed to investigate factors associated with prolonged operative time in laparoscopic right hemicolectomy for colon cancer.MethodsThis was a retrospective review of patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Linear and binary logistic regression analyses were performed to determine factors associated with prolonged operative time. The association between longer operative times and complications and hospital stay was assessed.ResultsOne hundred and ninety‐seven patients (52.3% female; mean age: 68.8 ± 14.1 years) were included. Factors independently associated with operative time were male sex (β = 17.3, 95% CI: 2, 32.5; p = 0.026) and extended hemicolectomy (β = 67.7, 95% CI: 27.6, 107.9; p = 0.001). American Society of Anesthesiologists (ASA) IV classification had a borderline significant association with operative time (β = 100.4, 95% CI: −2.05, 202.9; p = 0.055). Male sex (r = 0.158; p = 0.026), body mass index (r = 0.205; p = 0.004), ASA classification (r = 0.232; p = 0.001), extended hemicolectomy (r = 0.256; p < 0.001), and intracorporeal vessel control (r = 0.161; p = 0.025) had significant positive correlation with operative times. Patients with operative times ≥ 160 min had significantly longer hospital stays (5 vs. 4 days; p = 0.043) and similar complication rates to patients with shorter operative times.ConclusionsMale sex, advanced ASA classification, and extended hemicolectomy were independently and significantly associated with longer operative times in laparoscopic right hemicolectomy. Longer operative times were associated with longer hospital stays and similar complication rates.
背景本研究旨在调查腹腔镜结肠癌右半结肠切除术手术时间延长的相关因素。方法这是一项回顾性研究，研究对象为2011年至2021年间接受腹腔镜右半结肠切除术的结肠癌患者。进行了线性和二元逻辑回归分析，以确定与手术时间延长相关的因素。结果 共纳入197名患者（52.3%为女性；平均年龄：68.8 ± 14.1岁）。与手术时间独立相关的因素是男性（β = 17.3，95% CI：2，32.5；p = 0.026）和扩大半结肠切除术（β = 67.7，95% CI：27.6，107.9；p = 0.001）。美国麻醉医师协会（ASA）IV 级分类与手术时间（β = 100.4，95% CI：-2.05，202.9；p = 0.055）有边缘显著性关联。男性性别（r = 0.158; p = 0.026）、体重指数（r = 0.205; p = 0.004）、ASA 分级（r = 0.232; p = 0.001）、扩大半结肠切除术（r = 0.256; p < 0.001）和体外血管控制（r = 0.161; p = 0.025）与手术时间呈显著正相关。结论在腹腔镜右半结肠切除术中，男性性别、ASA 分级晚期和扩大半结肠切除术与较长的手术时间显著相关。较长的手术时间与较长的住院时间和相似的并发症发生率有关。
{"title":"Factors Associated With Prolonged Operative Times in Laparoscopic Right Hemicolectomy and Its Association With Short‐Term Outcomes","authors":"Sameh Hany Emile, Nir Horesh, Zoe Garoufalia, Rachel Gefen, Justin Dourado, Giovanna Dasilva, Steven D. Wexner","doi":"10.1002/jso.27872","DOIUrl":"https://doi.org/10.1002/jso.27872","url":null,"abstract":"BackgroundThis study aimed to investigate factors associated with prolonged operative time in laparoscopic right hemicolectomy for colon cancer.MethodsThis was a retrospective review of patients with colon cancer who underwent laparoscopic right hemicolectomy between 2011 and 2021. Linear and binary logistic regression analyses were performed to determine factors associated with prolonged operative time. The association between longer operative times and complications and hospital stay was assessed.ResultsOne hundred and ninety‐seven patients (52.3% female; mean age: 68.8 ± 14.1 years) were included. Factors independently associated with operative time were male sex (<jats:italic>β</jats:italic> = 17.3, 95% CI: 2, 32.5; <jats:italic>p</jats:italic> = 0.026) and extended hemicolectomy (<jats:italic>β </jats:italic>= 67.7, 95% CI: 27.6, 107.9; <jats:italic>p</jats:italic> = 0.001). American Society of Anesthesiologists (ASA) IV classification had a borderline significant association with operative time (<jats:italic>β </jats:italic>= 100.4, 95% CI: −2.05, 202.9; <jats:italic>p</jats:italic> = 0.055). Male sex (<jats:italic>r</jats:italic> = 0.158; <jats:italic>p</jats:italic> = 0.026), body mass index (<jats:italic>r</jats:italic> = 0.205; <jats:italic>p</jats:italic> = 0.004), ASA classification (<jats:italic>r</jats:italic> = 0.232; <jats:italic>p</jats:italic> = 0.001), extended hemicolectomy (<jats:italic>r</jats:italic> = 0.256; <jats:italic>p</jats:italic> < 0.001), and intracorporeal vessel control (<jats:italic>r</jats:italic> = 0.161; <jats:italic>p</jats:italic> = 0.025) had significant positive correlation with operative times. Patients with operative times ≥ 160 min had significantly longer hospital stays (5 vs. 4 days; <jats:italic>p</jats:italic> = 0.043) and similar complication rates to patients with shorter operative times.ConclusionsMale sex, advanced ASA classification, and extended hemicolectomy were independently and significantly associated with longer operative times in laparoscopic right hemicolectomy. Longer operative times were associated with longer hospital stays and similar complication rates.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanni Catalano, Laura Alaimo, Yutaka Endo, Odysseas P. Chatzipanagiotou, Andrea Ruzzenente, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas G. Koerkamp, Itaru Endo, Minoru Kitago, Timothy M. Pawlik
Background and ObjectivesAmong patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC.MethodsPatients undergoing curative‐intent liver surgery for ICC (1990–2020) were identified from a multi‐institutional database. A predictive model was developed and validated. An easy‐to‐use risk calculator was made available online.ResultsAmong 1420 patients, 300 (21.1%) received an intraoperative transfusion. Independent predictors of transfusion included severe preoperative anemia (OR = 1.65, 95% CI 1.10–2.47), T2 category or higher (OR = 2.00, 95% CI 1.36–3.02), positive lymph nodes (OR = 1.75, 95% CI 1.32–2.32) and major resection (OR = 2.56, 95%CI 1.85–3.58). Receipt of blood transfusion significantly correlated with worse outcomes. The model showed good discriminative ability in both training (AUC = 0.68, 95% CI 0.66–0.72) and bootstrapping validation (C‐index = 0.67, 95% CI 0.65–0.70) cohorts. An online risk calculator of blood transfusion requirement was developed (https://catalano-giovanni.shinyapps.io/TransfusionRisk).ConclusionsIntraoperative blood transfusion was significantly associated with poor postoperative outcomes among patients undergoing surgery for ICC. The identification of patients at high risk of transfusion could improve perioperative patient care and blood resources allocation.
背景和目的在接受肝内胆管癌（ICC）肝切除术的患者中，需要输血的围手术期出血是一种常见的并发症，但术前识别有输血风险的患者仍具有挑战性。本研究的目的是为 ICC 手术中需要输血的患者制定术前风险评分。方法从一个多机构数据库中确定了因 ICC 而接受治愈性肝脏手术的患者（1990-2020 年）。开发并验证了一个预测模型。结果在1420名患者中，有300人（21.1%）接受了术中输血。输血的独立预测因素包括术前严重贫血（OR = 1.65，95% CI 1.10-2.47）、T2 类或以上（OR = 2.00，95% CI 1.36-3.02）、淋巴结阳性（OR = 1.75，95% CI 1.32-2.32）和大部切除（OR = 2.56，95% CI 1.85-3.58）。接受输血与较差的预后明显相关。该模型在训练（AUC = 0.68，95% CI 0.66-0.72）和引导验证（C-指数 = 0.67，95% CI 0.65-0.70）队列中均显示出良好的判别能力。结论在接受 ICC 手术的患者中，术中输血与术后不良预后显著相关。识别输血高风险患者可改善围术期患者护理和血液资源分配。
{"title":"Development and Validation of a Predictive Risk Score for Blood Transfusion in Patients Undergoing Curative‐Intent Surgery for Intrahepatic Cholangiocarcinoma","authors":"Giovanni Catalano, Laura Alaimo, Yutaka Endo, Odysseas P. Chatzipanagiotou, Andrea Ruzzenente, Luca Aldrighetti, Matthew Weiss, Todd W. Bauer, Sorin Alexandrescu, George A. Poultsides, Shishir K. Maithel, Hugo P. Marques, Guillaume Martel, Carlo Pulitano, Feng Shen, François Cauchy, Bas G. Koerkamp, Itaru Endo, Minoru Kitago, Timothy M. Pawlik","doi":"10.1002/jso.27903","DOIUrl":"https://doi.org/10.1002/jso.27903","url":null,"abstract":"Background and ObjectivesAmong patients undergoing liver resection for intrahepatic cholangiocarcinoma (ICC), perioperative bleeding requiring blood transfusion is a common complication, yet preoperative identification of patients at risk for transfusion remains challenging. The objective of this study was to develop a preoperative risk score for blood transfusion requirement during surgery for ICC.MethodsPatients undergoing curative‐intent liver surgery for ICC (1990–2020) were identified from a multi‐institutional database. A predictive model was developed and validated. An easy‐to‐use risk calculator was made available online.ResultsAmong 1420 patients, 300 (21.1%) received an intraoperative transfusion. Independent predictors of transfusion included severe preoperative anemia (OR = 1.65, 95% CI 1.10–2.47), T2 category or higher (OR = 2.00, 95% CI 1.36–3.02), positive lymph nodes (OR = 1.75, 95% CI 1.32–2.32) and major resection (OR = 2.56, 95%CI 1.85–3.58). Receipt of blood transfusion significantly correlated with worse outcomes. The model showed good discriminative ability in both training (AUC = 0.68, 95% CI 0.66–0.72) and bootstrapping validation (C‐index = 0.67, 95% CI 0.65–0.70) cohorts. An online risk calculator of blood transfusion requirement was developed (<jats:ext-link xmlns:xlink=\"http://www.w3.org/1999/xlink\" xlink:href=\"https://catalano-giovanni.shinyapps.io/TransfusionRisk\">https://catalano-giovanni.shinyapps.io/TransfusionRisk</jats:ext-link>).ConclusionsIntraoperative blood transfusion was significantly associated with poor postoperative outcomes among patients undergoing surgery for ICC. The identification of patients at high risk of transfusion could improve perioperative patient care and blood resources allocation.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shigeki Kusamura, Aditi Bhatt, Kurt van Der Speeten, Vahan Kepenekian, Martin Hübner, Clarisse Eveno, Ignace de Hingh, Jean‐Baptiste Delhorme, Abdelkader Taibi, Laurent Villeneuve, Rea Lo Dico, Brendan Moran, Kim Govaerts, Oliver Zivanovic, Donal Brennan, Cedric Nadeau, Willemien Van Driel, Naoual Bakrin, Pompiliu Piso, Victor J. Verwaal, Santiago González‐Moreno, Mohammad Alyami, Olivia Sgarbura, Beate Rau, Marcello Deraco, Olivier Glehen
The 2022 PSOGI (Peritoneal Surface Oncology Group International) and RENAPE (French Network for Rare Peritoneal Malignancies) consensus on hyperthermic intraperitoneal chemotherapy (HIPEC) was a comprehensive effort aimed at standardizing treatment protocols for various peritoneal malignancies. This initiative is critical due to the wide range of technical variations in HIPEC procedures and the resulting need for standardization to ensure consistent and effective patient care and meaningful audit of multicenter data.
{"title":"Review of 2022 PSOGI/RENAPE Consensus on HIPEC","authors":"Shigeki Kusamura, Aditi Bhatt, Kurt van Der Speeten, Vahan Kepenekian, Martin Hübner, Clarisse Eveno, Ignace de Hingh, Jean‐Baptiste Delhorme, Abdelkader Taibi, Laurent Villeneuve, Rea Lo Dico, Brendan Moran, Kim Govaerts, Oliver Zivanovic, Donal Brennan, Cedric Nadeau, Willemien Van Driel, Naoual Bakrin, Pompiliu Piso, Victor J. Verwaal, Santiago González‐Moreno, Mohammad Alyami, Olivia Sgarbura, Beate Rau, Marcello Deraco, Olivier Glehen","doi":"10.1002/jso.27885","DOIUrl":"https://doi.org/10.1002/jso.27885","url":null,"abstract":"The 2022 PSOGI (Peritoneal Surface Oncology Group International) and RENAPE (French Network for Rare Peritoneal Malignancies) consensus on hyperthermic intraperitoneal chemotherapy (HIPEC) was a comprehensive effort aimed at standardizing treatment protocols for various peritoneal malignancies. This initiative is critical due to the wide range of technical variations in HIPEC procedures and the resulting need for standardization to ensure consistent and effective patient care and meaningful audit of multicenter data.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142258268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and objectives: Lymphaticovenular anastomosis (LVA) is a surgical technique used to alleviate lymphedema by bypassing the lymphatic and venous vessels and facilitating lymphatic fluid drainage. Accurate evaluation of anastomotic patency is crucial for assessing LVA outcomes. Traditional near-infrared fluorescence lymphography has limitations, including fluorescence diffusion in subcutaneous fat and difficulty evaluating areas beneath the dermal backflow. Photoacoustic imaging (PAI) is a potential alternative for high-resolution visualization of lymphatic and blood vessels. We aimed to evaluate the utility of PAI for assessing LVA patency.
Methods: Using the LUB0 PAI system, we examined patients who underwent LVA. Imaging was conducted using subcutaneously injected indocyanine green (ICG) to visualize lymphatic vessels.
Results: Results showed clear patency in some cases, inability to evaluate it in others, and confirmed occlusion in certain instances.
Conclusions: While PAI provides valuable insights, challenges remain, including the potential for ambiguous results from the intermittent nature of lymphatic flow and difficulty visualizing low-ICG-concentration lymphatic vessels. Nonetheless, PAI offers a promising method for detailed 3D evaluation of anastomoses. It may improve surgical outcomes and contribute to future evidence in the field. Further advancements, including real-time video assessment, may enhance the accuracy and reliability of LVA patency evaluation.
背景和目的：淋巴管-静脉吻合术（LVA）是一种通过绕过淋巴管和静脉血管并促进淋巴液引流来缓解淋巴水肿的外科技术。准确评估吻合口的通畅性对于评估 LVA 的效果至关重要。传统的近红外荧光淋巴造影术存在局限性，包括荧光在皮下脂肪中的扩散以及难以评估真皮回流下方的区域。光声成像（PAI）是淋巴和血管高分辨率可视化的潜在替代方法。我们的目的是评估 PAI 在评估 LVA 通畅性方面的实用性：我们使用 LUB0 PAI 系统对接受 LVA 的患者进行了检查。使用皮下注射的吲哚菁绿（ICG）进行成像，以观察淋巴管：结果显示，一些病例的淋巴管通畅，而另一些病例则无法评估通畅情况，某些病例的淋巴管还被证实闭塞：结论：虽然 PAI 提供了有价值的见解，但仍存在挑战，包括淋巴流动的间歇性可能导致结果不明确，以及难以观察低 ICG 浓度的淋巴管。尽管如此，PAI 还是为吻合口的详细三维评估提供了一种很有前景的方法。它可以改善手术效果，并为该领域的未来证据做出贡献。包括实时视频评估在内的进一步发展可能会提高 LVA 通畅性评估的准确性和可靠性。
{"title":"Evaluation of Postoperative Anastomotic Patency in Lymphaticovenular Anastomosis Using Photoacoustic Imaging.","authors":"Yushi Suzuki, Hiroki Kajita, Marika Otaki, Shiho Watanabe, Hayato Nagashima, Keisuke Okabe, Nobuaki Imanishi, Hisashi Sakuma, Kazuo Kishi","doi":"10.1002/jso.27898","DOIUrl":"https://doi.org/10.1002/jso.27898","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lymphaticovenular anastomosis (LVA) is a surgical technique used to alleviate lymphedema by bypassing the lymphatic and venous vessels and facilitating lymphatic fluid drainage. Accurate evaluation of anastomotic patency is crucial for assessing LVA outcomes. Traditional near-infrared fluorescence lymphography has limitations, including fluorescence diffusion in subcutaneous fat and difficulty evaluating areas beneath the dermal backflow. Photoacoustic imaging (PAI) is a potential alternative for high-resolution visualization of lymphatic and blood vessels. We aimed to evaluate the utility of PAI for assessing LVA patency.</p><p><strong>Methods: </strong>Using the LUB0 PAI system, we examined patients who underwent LVA. Imaging was conducted using subcutaneously injected indocyanine green (ICG) to visualize lymphatic vessels.</p><p><strong>Results: </strong>Results showed clear patency in some cases, inability to evaluate it in others, and confirmed occlusion in certain instances.</p><p><strong>Conclusions: </strong>While PAI provides valuable insights, challenges remain, including the potential for ambiguous results from the intermittent nature of lymphatic flow and difficulty visualizing low-ICG-concentration lymphatic vessels. Nonetheless, PAI offers a promising method for detailed 3D evaluation of anastomoses. It may improve surgical outcomes and contribute to future evidence in the field. Further advancements, including real-time video assessment, may enhance the accuracy and reliability of LVA patency evaluation.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on: Analysis of Clinical and Pathological Characteristics of Retroperitoneal Paraganglioma and Associated Prognostic Factors.","authors":"Hua Zhao, Jiayue Xu, Yuejun Zhou","doi":"10.1002/jso.27905","DOIUrl":"https://doi.org/10.1002/jso.27905","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142289843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Comment on: “Liver Resection Is Superior to Tumor Ablation in Patients With Multifocal Hepatocellular Carcinoma”","authors":"You‐Fei Wei, Yin‐Feng Xu","doi":"10.1002/jso.27887","DOIUrl":"https://doi.org/10.1002/jso.27887","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUND AND AIMIn this report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, a correlation was performed between the radiological PCI (peritoneal cancer index; rPCI) and surgical PCI (sPCI). The impact of timing of peritoneal malignancy (PM) and previous abdominal surgery was also studied.METHODSThe rPCI and sPCI were considered the 'same' if they differed by ≤ 3 points. The agreement was assessed using Bland-Altman analysis and the strength of the agreement was assessed using the concordance correlation coefficient (CCC). The extent of prior surgery was classified according to prior surgical score (PSS).RESULTSIn 707 (79.4%) patients, rPCI and sPCI concurred in 280 (39.6%). In the Bland-Altman analysis, < 40% patients were in the ±3 PCI points limit of acceptable difference. The average difference between the two scores was 4.5 points (95% CI- -5.16 to -3.92). The CCC- was 0.59 for the whole cohort ('moderate' concordance) and was not influenced by imaging modality, timing of PM or PSS.CONCLUSIONSThe rPCI underestimated sPCI by an average of 4.5 points. The role of peritoneal MRI in patients undergoing iterative procedures and the performance of imaging according to sites of recurrence need further evaluation.
{"title":"Impact of Previous Abdominal Surgery and Timing of Peritoneal Metastases on Accuracy of Imaging in Predicting the Surgical PCI: A Report From the PRECINCT Study.","authors":"Aditi Bhatt,Pascal Rousset,Brendan J Moran,Mudaddal Kazi,Dario Baratti,David Morris,Daniel Labow,Armando Sardi,Paolo Sammartino,Olivier Glehen,","doi":"10.1002/jso.27868","DOIUrl":"https://doi.org/10.1002/jso.27868","url":null,"abstract":"BACKGROUND AND AIMIn this report from Phase 1 of the prospective, observational, PRECINCT (Pattern of peritoneal dissemination and REsponse to systemic Chemotherapy IN Common and uncommon peritoneal Tumours) study, a correlation was performed between the radiological PCI (peritoneal cancer index; rPCI) and surgical PCI (sPCI). The impact of timing of peritoneal malignancy (PM) and previous abdominal surgery was also studied.METHODSThe rPCI and sPCI were considered the 'same' if they differed by ≤ 3 points. The agreement was assessed using Bland-Altman analysis and the strength of the agreement was assessed using the concordance correlation coefficient (CCC). The extent of prior surgery was classified according to prior surgical score (PSS).RESULTSIn 707 (79.4%) patients, rPCI and sPCI concurred in 280 (39.6%). In the Bland-Altman analysis, < 40% patients were in the ±3 PCI points limit of acceptable difference. The average difference between the two scores was 4.5 points (95% CI- -5.16 to -3.92). The CCC- was 0.59 for the whole cohort ('moderate' concordance) and was not influenced by imaging modality, timing of PM or PSS.CONCLUSIONSThe rPCI underestimated sPCI by an average of 4.5 points. The role of peritoneal MRI in patients undergoing iterative procedures and the performance of imaging according to sites of recurrence need further evaluation.","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142184603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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