Journal of Surgical Oncology最新文献

Introduction: Elective neck dissection (END) for oral tongue squamous cell carcinoma (OTSCC) typically involves level 4 due to potential metastases that may bypass levels 1-2. Our study challenges this notion and investigates the necessity of level 4 inclusion in END for OTSCC.

Methods: A retrospective cohort study performed in a tertiary-care university affiliated medical center and included all OTSCC patients treated with END from 2000 to 2020, with a minimum 2-year follow-up. The study compared patients with END levels 1-3 to those with levels 1-4 regarding regional recurrence, disease-specific and disease-free survival rates.

Results: 120 patients with OTSCC and clinically negative neck were included. END included levels 1-4 in 33 patients (27.5%) and levels 1-3 in the remaining 87 patients (72.5%). Out of all 33 patients who underwent END of levels 1-4, only 1 patient had level 4 metastasis (3%). There was no significant difference in the regional recurrence rate (21.8% vs. 18.2%, p = 0.66) and level 4 recurrence rate (3.5% vs. 3%, p = 0.91) between the groups. No difference regarding 5-years overall, disease-specific, and disease-free survival was demonstrated between the 1-3 END and 1-4 END groups (69.3% vs. 61.1%, Log-rank p = 0.7, 82% vs. 66.2%, Log-rank p = 0.15% and 66.4% vs. 60.7%, Log-rank p = 0.54, respectively).

Conclusion: Inclusion of level 4 in the elective neck dissection for OTSCC does not seem to improve regional control, disease-free and overall survival. Hence, elective neck dissection of levels 1-3 seems appropriate for most cases of OTSCC, as for other oral cavity subsites.

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.

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.

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.

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.

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: 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.

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.

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.

Effective communication is crucial in surgical oncology. This scoping review synthesizes literature on patient perspectives of communication in surgical oncology, reporting findings from 15 primary sources across six domains: (1) emotional support, optimism, and surgeon demeanor, (2) patient expectations and expectation setting, (3) communication aids or tools, (4) shared decision-making, (5) prognosis and oncologic outcomes, and (6) appearances and office setting.