Journal of Surgical Oncology最新文献

Background: Advances in orthopedic oncology have significantly improved outcomes following extremity tumor resections; however, complications like nonunion, hardware failure, and radiation-induced fractures can occur after orthopedic fixation. While the vascularized fibula-free flap (FFF) is well-established in primary reconstructions, its effectiveness as a salvage option is not well described. We report our 25-year experience with the use of FFF in salvage extremity reconstruction.

Methods: This retrospective case series included patients undergoing extremity salvage with FFF after failure of primary oncologic reconstructions from 1995 to 2021. Demographics, surgical indications, reconstructive details, functional outcomes, complications, and Musculoskeletal Tumor Society (MSTS) scores were analyzed.

Results: Fifteen patients (ages 6-71 years) met inclusion criteria, which included nine humeral and six femoral reconstructions, with an average follow-up of 6.7 years. Indications for salvage were radiation-induced fracture (n = 6), nonunion (n = 3), allograft fracture (n = 3), and hardware failure (n = 3). The median interval between the initial surgery for tumor resection and FFF for limb salvage was 4 years 3 months (mean: 9 years, range: 10 months to 29.3 years). All lower-extremity reconstructions achieved full weight-bearing without pain. Upper-extremity reconstructions resulted in full functional restoration in six patients and minor functional deficits in three. Bony union of fibula flap was achieved in 78.5% patients. Reoperation were performed in 4 patients for wound issues (n = 2) and hardware removal (n = 2).

Conclusion: FFF is a reliable and effective option for management of oncologic-related complications of the extremities. It can avoid amputations and improve limb function.

Background: Colorectal cancer (CRC) remains one of the leading causes of cancer-related mortality worldwide. Despite advances in surgery and adjuvant therapy, recurrence after curative resection remains a major challenge, and current surveillance tools such as carcinoembryonic antigen (CEA) and imaging lack sensitivity for detecting minimal residual disease (MRD). Circulating microRNAs (miRNAs) have emerged as promising biomarkers due to their stability in plasma and disease-specific expression profiles.

Objective: This study aimed to evaluate the clinical relevance of four circulating cell-free miRNAs-miR-155, miR-221, miR-34a, and miR-143-for monitoring tumor clearance following surgery in CRC patients.

Methods: Plasma samples were obtained from CRC patients at multiple perioperative time points and compared with samples from healthy controls. Expression levels of the selected miRNAs were quantified using real-time PCR, normalized to cel-miR-39, and analyzed in relation to clinicopathological features. Dynamic postoperative changes and diagnostic performance were assessed, including ROC curve analysis.

Results: Circulating miR-155 and miR-221 were significantly upregulated in CRC patients compared with controls, whereas the tumor suppressor miRNAs miR-34a and miR-143 were markedly downregulated. Postoperative samples showed progressive normalization of these markers, though variability persisted in a subset of patients. The combined four-miRNA panel achieved excellent diagnostic accuracy (AUC = 0.999), outperforming CEA in distinguishing CRC from controls. No independent predictive effect of individual miRNAs was demonstrated in multivariate models, but biologically consistent trends were observed.

Conclusion: Circulating miR-155, miR-221, miR-34a, and miR-143 demonstrate dynamic early postoperative changes and hold promise as minimally invasive biomarkers of short-term tumor clearance after colorectal cancer surgery. While the combined panel shows strong diagnostic performance at baseline, longer-term prospective studies with multi-year follow-up are required to establish their role in recurrence surveillance alongside established markers such as CEA and ctDNA.

Background and objectives: The benefit of neoadjuvant chemotherapy in resectable biliary tract cancer remains unclear.

Methods: A systematic review and meta-analysis of 23 studies (n = 11,344) compared neoadjuvant chemotherapy with upfront surgery.

Results: Neoadjuvant therapy improved overall survival (HR = 0.69) and R0 resection rates (OR = 1.30) without increasing postoperative morbidity or mortality.

Conclusions: Neoadjuvant chemotherapy may improve survival and surgical outcomes in resectable biliary tract cancer.

Background and objectives: Robot-assisted thoracoscopy (RATS) is rapidly emerging as the preferred approach for the resection of thymic epithelial tumors (TET). Current challenges include the role of RATS in locally advanced disease and combined additional resections.

Methods: This single-center study included all consecutive robot-assisted surgeries for TET performed between 2018 and 2024. We report perioperative outcomes and findings from a large center for robotic surgery center.

Results: One hundred and forty-three patients underwent RATS for the resection of histologically confirmed TET, including 130 (91%) patients with thymoma and 13 (9%) patients with thymic carcinoma. The median tumor size was 54 mm (35.5-75) and most patients presented in a localized stage of disease, with 120 patients (83.9%) in TNM stage I (TNM 8th edition). The conversion rate to open surgery was 4.2% and R0 resection was achieved in 134 (93.7%) patients. Combined extended resections that included lung, pericardium or great vessels were performed in 44 (30.8%) patients and were the only independent predictor of postoperative complications in a multivariable logistic regression model (OR 2.87; p = 0.03).

Conclusions: Robot-assisted surgery is feasible and without unexpected safety concerns for TET. Combined extended resections, often necessary for locally advanced disease, are a significant predictor of postoperative complications.

Introduction: There remains uncertainty regarding whether the determination of a safe margin is the responsibility of the surgeon or the pathologist during the pathological analysis of tissue from various procedures. This study aims to assess the alterations in surgical margin dimensions of tissue 1 h post-excision, following 24 h of formalin fixation, and pathological in comparison to the margin determined prior to excision.

Patients and methods: Measurements and mean values were taken for each specimen at four stages: before excision, 1 h post-excision, after 24 h of 10% formalin fixation, and following pathologic examination. BCCs and SCCs were evaluated independently, and statistical analyses were performed to assess changes in the measurements of the specimens.

Results: Table 1 illustrates highly significant reductions of the order of 70%-80% overall in the measured specimen margin widths over time for all of the categories measured.

Conclusion: Excised skin cancers were found to undergo significant shrinkage at every stage of pathological evaluation, resulting in a surgical margin significantly narrower than the safety margin initially determined. We have clarified what the surgical margin reported by the dermatopathologist actually means. In this way, it was aimed to eliminate the disagreement between the surgeon and the pathologist and to prevent the need for additional surgery and morbidities.

Background: This study aims to evaluate potential disparities in multimodal treatment and its impact on outcomes among pancreatic cancer patients in Louisiana.

Methods: Data on pancreatic cancer cases diagnosed between 2000 and 2020 were obtained from the Louisiana Tumor Registry. Bivariate relationships were assessed via Chi-square tests. Treatment was modeled with logistic regression models. Time-to-treatment was modeled with negative binomial regression models. Overall survival was analyzed with Cox proportional hazards models. Results are reported as odds ratio (OR), rate ratios (RR), hazards ratio (HR), and 95% Wald confidence intervals.

Results: A total of 8,466 patients with pancreatic cancer were included. A significantly higher proportion of nonmetastatic cases received therapy compared to metastatic cases. Non-Hispanic Black patients with nonmetastatic disease experienced a significantly longer time to treatment compared to Non-Hispanic White patients. In the metastatic model, uninsured patients and those with Medicaid had the highest odds of not receiving therapy. Primary resection was a strong predictor of improved survival. Nonsurgical therapy also contributed to better outcomes.

Conclusion: The findings of this study are instrumental in designing a more granular investigation of multi-level determinants to identify the actionable items driving the observed disparities associated with worse outcomes.

This retrospective study evaluated predictors of early versus late recurrence in 277 patients with oral squamous cell carcinoma (OSCC) who underwent surgical treatment between 2017 and 2020. Using receiver operating characteristic analysis, an 8-month disease-free survival cutoff effectively stratified patients into early (DFS < 8 months) and late (DFS ≥ 8 months) recurrence groups. Early recurrence was associated with significantly poorer overall survival (mean OS 24.03 months) compared to late recurrence (mean OS 35.26 months). Multivariate logistic regression identified adjuvant therapy status and type, bone involvement, positive pathological nodal stage, and perineural invasion as independent predictors of early recurrence. Local recurrences demonstrated better survival outcomes than regional or distant failures. The findings underscore the prognostic significance of recurrence timing and highlight the need for risk-adapted surveillance and tailored adjuvant strategies in high-risk OSCC patients.

Introduction: Sentinel lymph node biopsy (SLNB) after neoadjuvant treatment (NAT) is an increasing option for axillary surgery in patients responding to treatment, whether diagnosed as clinically node-negative (cN0) or node-positive (cN + ). This study evaluates SLNB trends in patients with NAT in a large European population.

Materials and methods: Data sourced from EUSOMADB, collating prospectively collected data from certified European Breast Units, included 17,321 patients who have undergone NAT between 2010 and 2021. Of those, 9,226 and 8.095 are clinically N0 and cN1, respectively.

Results: During the study period, for cN0 patients, there has been a significant increase in the proportion of cases with SLNB, rising from 86% in the 2010-2015 period to 94% in the 2016-2021 period. Consequently, a decline in direct axillary dissection (AD) has been shown in both periods, dropping from 14% to 6% (p < 0.001). Similarly, in cN+ patients, SLNB increased from 25% to 40%, while direct AD decreased from 75% to 60% (p < 0.001). Regarding immunohistochemistry subtypes, higher SLNB rates were reported in triple-negative and HER2-enriched tumors. Nevertheless, SLNB rates rose significantly across all immunohistochemical subtypes (p < 0.001) between both periods. Multivariate analysis identified as statistically significant predictors of SLNB: surgery period (second period), molecular subtype (HER2-positive, triple-negative), breast-conserving surgery and type of NAT.

Conclusion: This study evidences a substantial shift towards SLNB as the primary axillary surgery following NAT during the study period. This trend emphasizes a preference for less invasive procedures, likely due to the efficacy of neoadjuvant therapy in reducing axillary lymph node involvement.

Objective: Extraskeletal Ewing sarcoma (EES) is a variant of Ewing sarcoma that originates from soft tissues rather than bones. Our study aims to characterize the differences between EES and skeletal ES (SES) in the pediatric population.

Methods: We conducted a retrospective review of children ≤ 18 years with ES recorded in the National Cancer Data Base (NCDB) from 2004 to 2022. Kaplan-Meier curves and Cox proportional hazards regression analysis were used to identify risk factors associated with survival.

Results: Among 7446 identified patients, 1016 (20.9%) had EES and 6430 (79.1%) had SES. EES patients were older (median 14 vs. 13 years, p = 0.007), more often female (46.9% vs. 41.2%, p = 0.0009), and had smaller tumors (7.5 vs. 8.0 cm, p = 0.003). Tumor distribution differed significantly, with EES was most frequent in the thorax (49.8%) and head and neck (11.8%), while SES more common in the lower limbs (30.2%) and pelvis (25.3%) (p < 0.0001). EES patients were more likely to receive surgery alone (4.2% vs. 1.8%) or a combination of surgery, chemotherapy, and radiation (25.9% vs. 20.7%) but less likely to receive chemotherapy and radiation without surgery (19.4% vs. 29.3%, p < 0.05). Five-year overall survival was similar between SES (72.2%) and EES (73.7%) (p = 0.70). Multivariable analysis confirmed EES was not an independent predictor of survival (aHR 0.94; 95% CI 0.81-1.10). Factors independently associated with mortality were older age, metastasis at diagnosis, and positive surgical margins.

Conclusions: Demographic, treatment characteristics, and prognostic factors differ between pediatric patients with SES and EES. However, survival is similar between the two groups.