Jiawen Deng, Myron Moskalyk, Matthew Shammas‐Toma, Ahmed Aoude, Michelle Ghert, Sahir Bhatnagar, Anthony Bozzo
BackgroundOncological resection and reconstruction involving the lower extremities commonly lead to reoperations that impact patient outcomes and healthcare resources. This study aimed to develop a machine learning (ML) model to predict this reoperation risk.MethodsThis study was conducted according to TRIPOD + AI. Data from the PARITY trial was used to develop ML models to predict the 1‐year reoperation risk following lower extremity oncological resection and reconstruction. Six ML algorithms were tuned and calibrated based on fivefold cross‐validation. The best‐performing model was identified using classification and calibration metrics.ResultsThe polynomial support vector machine (SVM) model was chosen as the best‐performing model. During internal validation, the SVM exhibited an AUC‐ROC of 0.73 and a Brier score of 0.17. Using an optimal threshold that balances all quadrants of the confusion matrix, the SVM exhibited a sensitivity of 0.45 and a specificity of 0.81. Using a high‐sensitivity threshold, the SVM exhibited a sensitivity of 0.68 and a specificity of 0.68. Total operative time was the most important feature for reoperation risk prediction.ConclusionThe models may facilitate reoperation risk stratification, allowing for better patient counseling and for physicians to implement measures that reduce surgical risks.
背景涉及下肢的肿瘤切除和重建通常会导致再次手术，从而影响患者的预后和医疗资源。本研究旨在开发一种机器学习（ML）模型来预测这种再手术风险。本研究按照 TRIPOD + AI 的方法进行，利用 PARITY 试验的数据开发 ML 模型，预测下肢肿瘤切除和重建术后 1 年的再手术风险。在五倍交叉验证的基础上，对六种 ML 算法进行了调整和校准。结果多项式支持向量机（SVM）模型被选为表现最佳的模型。在内部验证过程中，SVM 的 AUC-ROC 为 0.73，Brier 得分为 0.17。使用平衡混淆矩阵所有象限的最佳阈值，SVM 的灵敏度为 0.45，特异度为 0.81。使用高灵敏度阈值时，SVM 的灵敏度为 0.68，特异度为 0.68。总手术时间是预测再次手术风险的最重要特征。
{"title":"Development of Machine Learning Models for Predicting the 1‐Year Risk of Reoperation After Lower Limb Oncological Resection and Endoprosthetic Reconstruction Based on Data From the PARITY Trial","authors":"Jiawen Deng, Myron Moskalyk, Matthew Shammas‐Toma, Ahmed Aoude, Michelle Ghert, Sahir Bhatnagar, Anthony Bozzo","doi":"10.1002/jso.27854","DOIUrl":"https://doi.org/10.1002/jso.27854","url":null,"abstract":"BackgroundOncological resection and reconstruction involving the lower extremities commonly lead to reoperations that impact patient outcomes and healthcare resources. This study aimed to develop a machine learning (ML) model to predict this reoperation risk.MethodsThis study was conducted according to TRIPOD + AI. Data from the PARITY trial was used to develop ML models to predict the 1‐year reoperation risk following lower extremity oncological resection and reconstruction. Six ML algorithms were tuned and calibrated based on fivefold cross‐validation. The best‐performing model was identified using classification and calibration metrics.ResultsThe polynomial support vector machine (SVM) model was chosen as the best‐performing model. During internal validation, the SVM exhibited an AUC‐ROC of 0.73 and a Brier score of 0.17. Using an optimal threshold that balances all quadrants of the confusion matrix, the SVM exhibited a sensitivity of 0.45 and a specificity of 0.81. Using a high‐sensitivity threshold, the SVM exhibited a sensitivity of 0.68 and a specificity of 0.68. Total operative time was the most important feature for reoperation risk prediction.ConclusionThe models may facilitate reoperation risk stratification, allowing for better patient counseling and for physicians to implement measures that reduce surgical risks.","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":"142184601","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}
Kimberly J. Song, Isaac Faith, Stephanie Tuminello, Emanuela Taioli, Kenneth Rosenzweig, Raja M. Flores
BackgroundSurgery has been the standard procedure for resectable primary LC. Survival after stereotactic body radiation therapy, another treatment, is significantly biased due to preponderance of data from patients deemed unsuitable for surgery. We examined survival of patients refusing surgery in favor of radiation therapy.MethodsWe used the Surveillance, Epidemiology, and End Results database to identify patients with primary Stage I NSCLC diagnosed between 2007 and 2016. Patients were excluded if it was unknown if they were recommended for surgery or if surgery was contraindicated. Multiple predictors were assessed: radiation versus surgery, age at diagnosis, sex, race/ethnicity, health insurance status, marital status, tumor size, and histology. A multivariate analysis was performed to estimate hazard ratios and generate Kaplan−Meier survival curves.ResultsWhen adjusted for confounding variables, survival was greater for patients undergoing surgical resection than those refusing surgery in favor of radiation (HRadj 2.66; 95% CI: 2.27−3.11, p < 0.001) or for those receiving no standardized treatment (HRadj 4.43; 95% CI: 3.57−5.50, p < 0.001).ConclusionsSBRT is an effective treatment for inoperable early LC but there is limited data comparing outcomes against surgical resection. When eligible for both, patients refusing surgery and choosing radiation had worse survival when adjusting for variables including age, tumor size, and histology, and suggests that surgical resection is a superior treatment modality.
背景手术一直是可切除原发性肺癌的标准治疗方法。立体定向体放射治疗是另一种治疗方法，但由于被认为不适合手术的患者数据居多，因此该疗法的生存率存在明显偏差。我们研究了拒绝手术而选择放疗的患者的生存情况。方法我们使用监测、流行病学和最终结果数据库来识别2007年至2016年间确诊的原发性I期NSCLC患者。如果不知道患者是否被推荐接受手术或手术有禁忌症，则将其排除在外。对多种预测因素进行了评估：放疗与手术、诊断时的年龄、性别、种族/民族、医疗保险状况、婚姻状况、肿瘤大小和组织学。结果在对混杂变量进行调整后，接受手术切除的患者的生存率高于拒绝手术而选择放射治疗的患者（HRadj 2.66; 95% CI: 2.27-3.11, p < 0.001）或未接受标准化治疗的患者（HRadj 4.43; 95% CI: 3.57-5.50, p < 0.001）。当两者都符合条件时，在对年龄、肿瘤大小和组织学等变量进行调整后，拒绝手术而选择放射治疗的患者生存率更低，这表明手术切除是一种更优越的治疗方式。
{"title":"Patients With Surgically Resectable Lung Cancer Who Opt for Radiation Have Worse Outcomes","authors":"Kimberly J. Song, Isaac Faith, Stephanie Tuminello, Emanuela Taioli, Kenneth Rosenzweig, Raja M. Flores","doi":"10.1002/jso.27873","DOIUrl":"https://doi.org/10.1002/jso.27873","url":null,"abstract":"BackgroundSurgery has been the standard procedure for resectable primary LC. Survival after stereotactic body radiation therapy, another treatment, is significantly biased due to preponderance of data from patients deemed unsuitable for surgery. We examined survival of patients <jats:italic>refusing</jats:italic> surgery in favor of radiation therapy.MethodsWe used the Surveillance, Epidemiology, and End Results database to identify patients with primary Stage I NSCLC diagnosed between 2007 and 2016. Patients were excluded if it was unknown if they were recommended for surgery or if surgery was contraindicated. Multiple predictors were assessed: radiation versus surgery, age at diagnosis, sex, race/ethnicity, health insurance status, marital status, tumor size, and histology. A multivariate analysis was performed to estimate hazard ratios and generate Kaplan−Meier survival curves.ResultsWhen adjusted for confounding variables, survival was greater for patients undergoing surgical resection than those refusing surgery in favor of radiation (HR<jats:sub>adj</jats:sub> 2.66; 95% CI: 2.27−3.11, <jats:italic>p</jats:italic> < 0.001) or for those receiving no standardized treatment (HR<jats:sub>adj</jats:sub> 4.43; 95% CI: 3.57−5.50, <jats:italic>p</jats:italic> < 0.001).ConclusionsSBRT is an effective treatment for inoperable early LC but there is limited data comparing outcomes against surgical resection. When eligible for both, patients refusing surgery and choosing radiation had worse survival when adjusting for variables including age, tumor size, and histology, and suggests that surgical resection is a superior treatment modality.","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":"142184609","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":"Impact of Comprehensive Geriatric Assessment on Treatment Strategies and Complications in Older Adults With Colorectal Cancer Considering Surgery","authors":"Qiang Hu, Xiyin Yang","doi":"10.1002/jso.27892","DOIUrl":"https://doi.org/10.1002/jso.27892","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":"142184594","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}
Yun Song, Eunise Chen, Yi‐Ju Chiang, James C. Yao, Daniel M. Halperin, Deyali Chatterjee, Brian D. Badgwell
Background and ObjectivesNot all gastric neuroendocrine tumors (GNETs) may be classified into one of the three described clinicopathologic subtypes. The purpose of this study was to better characterize GNET subtypes and associated outcomes.MethodsPatients treated for GNET at our institution (1995−2021) were identified. Pathologic specimens of tumors that could not be classified as type 1, 2, or 3 were further reviewed. GNETs were categorized as proton pump inhibitor (PPI)‐associated based on changes in the background gastric mucosa consistent with PPI use. Distant metastasis at presentation (DM) and disease‐specific survival (DSS) were evaluated.ResultsAmong 246 patients, there were 164 (67%) type 1, 5 (2%) type 2, 52 (21%) type 3, and 18 (7%) PPI‐associated GNETs. Seven (3%) tumors remained unclassified. DM was more frequent with type 3 GNETs (38%) than type 1 (1%), type 2 (20%), or PPI‐associated tumors (11%, p < 0.001). Ten‐year DSS rates were 100% for type 1, 53% (95% confidence interval [CI], 38%−75%) for type 3, and 80% (95% CI, 58%−100%) for PPI‐associated tumors (p < 0.001). GNET subtype, race, and DM were independently associated with DSS.ConclusionsPPI‐associated tumors may represent a distinct GNET subtype with intermediate outcomes. Other factors should also be considered in overall prognosis.
{"title":"Classification of Gastric Neuroendocrine Tumors and Associations With Survival","authors":"Yun Song, Eunise Chen, Yi‐Ju Chiang, James C. Yao, Daniel M. Halperin, Deyali Chatterjee, Brian D. Badgwell","doi":"10.1002/jso.27876","DOIUrl":"https://doi.org/10.1002/jso.27876","url":null,"abstract":"Background and ObjectivesNot all gastric neuroendocrine tumors (GNETs) may be classified into one of the three described clinicopathologic subtypes. The purpose of this study was to better characterize GNET subtypes and associated outcomes.MethodsPatients treated for GNET at our institution (1995−2021) were identified. Pathologic specimens of tumors that could not be classified as type 1, 2, or 3 were further reviewed. GNETs were categorized as proton pump inhibitor (PPI)‐associated based on changes in the background gastric mucosa consistent with PPI use. Distant metastasis at presentation (DM) and disease‐specific survival (DSS) were evaluated.ResultsAmong 246 patients, there were 164 (67%) type 1, 5 (2%) type 2, 52 (21%) type 3, and 18 (7%) PPI‐associated GNETs. Seven (3%) tumors remained unclassified. DM was more frequent with type 3 GNETs (38%) than type 1 (1%), type 2 (20%), or PPI‐associated tumors (11%, <jats:italic>p</jats:italic> < 0.001). Ten‐year DSS rates were 100% for type 1, 53% (95% confidence interval [CI], 38%−75%) for type 3, and 80% (95% CI, 58%−100%) for PPI‐associated tumors (<jats:italic>p</jats:italic> < 0.001). GNET subtype, race, and DM were independently associated with DSS.ConclusionsPPI‐associated tumors may represent a distinct GNET subtype with intermediate outcomes. Other factors should also be considered in overall prognosis.","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":"142224108","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}
BackgroundWe compared the predictive performance of the 7th and 8th editions of the AJCC staging systems in stratifying disease‐related survival outcomes in patients with GBC undergoing curative intent surgery.MethodsPatients that underwent curative intent surgery for GBC at our institution (2014 and 2021) were included in the study. Various clinico‐pathological data were extracted to perform Kaplan–Meier survival analysis.ResultsA total of 240 patients were included in the study. Both, TNM‐7, and TNM‐8 staging systems can stratify patients into stages with statistically significant differences in disease‐free and overall survival. Survival rates drop with stage progression. Using TNM‐8, 8/240 (3.33%) patients were upstaged from Stage IIIB (TNM‐7) to IVB (TNM‐8) and 12/240 (5%) were down‐staged from Stage IVB(TNM‐7) to IIIB(TNM‐8). Survival curves of the re‐classified patients matched those of the corresponding TNM‐8 stage. Additionally, there was statistically significant difference in their survival (p < 0.001) compared to their corresponding TNM‐7 stage. There was no statistically significant difference in survival rates between stages IIA, IIB (TNM‐8), and stage II (TNM‐7). However, stage IIA had a slightly better survival than stage IIB.ConclusionThough both TNM‐7 and TNM‐8 are useful for stratifying patients with GBC, TNM‐8 has a better prognostic performance than TNM‐7.
{"title":"Comparison of Prognostic Performance of 8th and 7th Edition of AJCC Staging System for Patients With Gallbladder Cancer Undergoing Curative Intent Surgery","authors":"Sameer Gupta, Abhishek Verma, Arun Chaturvedi, Puneet Prakash, Vijay Kumar, Sanjeev Misra, Naseem Akhtar, Shiv Rajan, Preeti Agarwal, Lynette Smith, Makayla Schissel, Chandrakanth Are","doi":"10.1002/jso.27875","DOIUrl":"https://doi.org/10.1002/jso.27875","url":null,"abstract":"BackgroundWe compared the predictive performance of the 7th and 8th editions of the AJCC staging systems in stratifying disease‐related survival outcomes in patients with GBC undergoing curative intent surgery.MethodsPatients that underwent curative intent surgery for GBC at our institution (2014 and 2021) were included in the study. Various clinico‐pathological data were extracted to perform Kaplan–Meier survival analysis.ResultsA total of 240 patients were included in the study. Both, TNM‐7, and TNM‐8 staging systems can stratify patients into stages with statistically significant differences in disease‐free and overall survival. Survival rates drop with stage progression. Using TNM‐8, 8/240 (3.33%) patients were upstaged from Stage IIIB (TNM‐7) to IVB (TNM‐8) and 12/240 (5%) were down‐staged from Stage IVB(TNM‐7) to IIIB(TNM‐8). Survival curves of the re‐classified patients matched those of the corresponding TNM‐8 stage. Additionally, there was statistically significant difference in their survival (<jats:italic>p</jats:italic> < 0.001) compared to their corresponding TNM‐7 stage. There was no statistically significant difference in survival rates between stages IIA, IIB (TNM‐8), and stage II (TNM‐7). However, stage IIA had a slightly better survival than stage IIB.ConclusionThough both TNM‐7 and TNM‐8 are useful for stratifying patients with GBC, TNM‐8 has a better prognostic performance than TNM‐7.","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":"142184455","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}
Hanna Kakish, Claire Drigotas, Alexander W. Loftus, Christina S. Boutros, Susan J. Doh, John B. Ammori, Luke D. Rothermel, Richard S. Hoehn
IntroductionUpper gastrointestinal (UGI) cancers require multidisciplinary treatment, but surgery provides the only potentially curative option. We sought to understand reasons for attrition before surgery within our regional hospital network.MethodsWe performed chart reviews of patients (age 18–80) with stage I–III UGI cancers (gastroesophageal junction, gastric, and hepatopancreatobiliary adenocarcinomas) in our multihospital cancer registry from 2015 to 2021. Our primary outcome was reasons for surgical attrition. Univariable analysis identified factors related to surgical attrition and the Kaplan–Meier method estimated overall survival based on surgery receipt.ResultsSeven hundred and ninety‐two patients were included in our analysis, of whom 107 (13.5%) did not undergo curative surgery. Reasons for not undergoing surgery included medical comorbidities (30.8%), patient preference/nonmedical barriers (24.3%, which included: not interested without further explanation, worried about complications, nonadherence to appointments, insurance issues, did not wish for blood transfusion, lack of social support, preferring home care, and worried about recurrence), psychosocial (5.6%), progression while on neoadjuvant therapy or waiting for transplant (15.0% and 7.5%), poor performance status (3.7%), side effects of neoadjuvant therapy (3.7%), and death unrelated to treatment or unknown cause (9.4%). Nonsurgical management was not associated with race, socioeconomic status, or distance traveled for care. Survival was greatly improved for patients who underwent surgery (158 vs. 63 weeks, p < 0.05).ConclusionNearly one in seven patients (18–80 years old) with UGI cancers evaluated at our academic cancer center did not undergo surgical resection. Reasons for surgical attrition included potentially modifiable issues, and addressing these barriers could help overcome inequities in cancer treatment and survival.
{"title":"Reasons for Surgical Attrition Among Nonmetastatic Upper Gastrointestinal Cancer Patients: A Single Institutional Experience","authors":"Hanna Kakish, Claire Drigotas, Alexander W. Loftus, Christina S. Boutros, Susan J. Doh, John B. Ammori, Luke D. Rothermel, Richard S. Hoehn","doi":"10.1002/jso.27865","DOIUrl":"https://doi.org/10.1002/jso.27865","url":null,"abstract":"IntroductionUpper gastrointestinal (UGI) cancers require multidisciplinary treatment, but surgery provides the only potentially curative option. We sought to understand reasons for attrition before surgery within our regional hospital network.MethodsWe performed chart reviews of patients (age 18–80) with stage I–III UGI cancers (gastroesophageal junction, gastric, and hepatopancreatobiliary adenocarcinomas) in our multihospital cancer registry from 2015 to 2021. Our primary outcome was reasons for surgical attrition. Univariable analysis identified factors related to surgical attrition and the Kaplan–Meier method estimated overall survival based on surgery receipt.ResultsSeven hundred and ninety‐two patients were included in our analysis, of whom 107 (13.5%) did not undergo curative surgery. Reasons for not undergoing surgery included medical comorbidities (30.8%), patient preference/nonmedical barriers (24.3%, which included: not interested without further explanation, worried about complications, nonadherence to appointments, insurance issues, did not wish for blood transfusion, lack of social support, preferring home care, and worried about recurrence), psychosocial (5.6%), progression while on neoadjuvant therapy or waiting for transplant (15.0% and 7.5%), poor performance status (3.7%), side effects of neoadjuvant therapy (3.7%), and death unrelated to treatment or unknown cause (9.4%). Nonsurgical management was not associated with race, socioeconomic status, or distance traveled for care. Survival was greatly improved for patients who underwent surgery (158 vs. 63 weeks, <jats:italic>p</jats:italic> < 0.05).ConclusionNearly one in seven patients (18–80 years old) with UGI cancers evaluated at our academic cancer center did not undergo surgical resection. Reasons for surgical attrition included potentially modifiable issues, and addressing these barriers could help overcome inequities in cancer treatment and survival.","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":"142184602","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}
BackgroundRobotic‐assisted lymphatic reconstruction has gained increasing interest over the past few years.ObjectivesThe aim of this study was to systematically investigate the benefits of robotic‐assisted lymphatic surgery based on currently published literature.MethodsA systematic review evaluating the feasibility, surgical aspects, and both objective and subjective improvements in patients with impairment of the peripheral or central lymphatic system was performed according to the PRISMA guidelines. The review was registered on PROSPERO.ResultsThe literature search yielded 328 articles after the removal of duplicates, followed by a full‐text review of the 29 articles, out of which a total of 11 relevant articles were deemed eligible. Among these, seven used a retrospective design and four a prospective design. All studies included confirmed the feasibility of robotic‐assisted lymphatic surgery and reported promising results concerning both technical aspects and patient‐related outcomes. However, currently, only a limited number of studies directly compare the robotic‐assisted approach to the manual approach, and these studies have limited statistical analyses.ConclusionDespite the heterogeneous measurands, all studies showed the feasibility of robotic‐assisted lymphatic surgery, and seven provided promising data on patient‐related outcomes. Additional studies are needed to further identify future directions in robotic‐assisted lymphatic surgery.
{"title":"Systematic Review of Robotic‐Assisted Peripheral and Central Lymphatic Surgery","authors":"Imholz Carlotta, Grünherz Lisanne, Lindenblatt Nicole","doi":"10.1002/jso.27866","DOIUrl":"https://doi.org/10.1002/jso.27866","url":null,"abstract":"BackgroundRobotic‐assisted lymphatic reconstruction has gained increasing interest over the past few years.ObjectivesThe aim of this study was to systematically investigate the benefits of robotic‐assisted lymphatic surgery based on currently published literature.MethodsA systematic review evaluating the feasibility, surgical aspects, and both objective and subjective improvements in patients with impairment of the peripheral or central lymphatic system was performed according to the PRISMA guidelines. The review was registered on PROSPERO.ResultsThe literature search yielded 328 articles after the removal of duplicates, followed by a full‐text review of the 29 articles, out of which a total of 11 relevant articles were deemed eligible. Among these, seven used a retrospective design and four a prospective design. All studies included confirmed the feasibility of robotic‐assisted lymphatic surgery and reported promising results concerning both technical aspects and patient‐related outcomes. However, currently, only a limited number of studies directly compare the robotic‐assisted approach to the manual approach, and these studies have limited statistical analyses.ConclusionDespite the heterogeneous measurands, all studies showed the feasibility of robotic‐assisted lymphatic surgery, and seven provided promising data on patient‐related outcomes. Additional studies are needed to further identify future directions in robotic‐assisted lymphatic surgery.","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":"142184604","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}
Atousa Khiabany, Alexander A. Dermanis, Mei Sien Liew, Kai Ren Ong, Sivesh K. Kamarajah, Ewen A. Griffiths
BackgroundCDH1 (E‐cadherin) genetic mutations are associated with a 30%−70% increased lifetime risk of hereditary diffuse gastric cancer (HDGC). Although prophylactic total gastrectomy (PTG) reduces long‐term risk of gastric cancer, the associated morbidity and mortality remain unclear. This systematic review aims to characterise postoperative surgical outcomes in patients undergoing total gastrectomy.MethodsA systematic literature search was performed for studies reporting endoscopic surveillance, surgical and pathological outcomes for patients with CDH1 mutation undergoing a total gastrectomy.ResultsThirty‐nine studies included 1849 patients, of which 96% had a CDH1 (n = 1777) or CTNNA1 (n = 3) mutation. Endoscopy outcomes were reported for 1640 patients. Cancer foci were identified in 32% (n = 523/1640) and 71% of these patients went on to have a total gastrectomy (n = 369/523). The remaining 78% of patients did not have cancer foci detected on endoscopy (n = 1117/1640). Of these patients, 62% underwent a total gastrectomy (n = 688/1117) and 81% were found to have cancer on surgical histology (n = 556/688). Pathological staging was reported for 790 patients undergoing surgery, of which 68% had pT1 disease (n = 537). Postoperative complications were reported for 430 patients across 23 studies, with the most common complications being anastomotic strictures (25%), anastomotic leaks (13%), wound infections (12%) and pulmonary complications (11%). Only one postoperative death was reported within 30 days.ConclusionRates of early cancers are high in CDH1 patients undergoing PTG, highlighting the need for improvement in reliable endoscopic surveillance. Although postoperative mortality in this surgical cohort remains low, high rates of postoperative complications warrant careful patient counselling.
{"title":"A Systematic Review of Surgical and Pathological Outcomes in Patients With a CDH1 Mutation Undergoing Total Gastrectomy","authors":"Atousa Khiabany, Alexander A. Dermanis, Mei Sien Liew, Kai Ren Ong, Sivesh K. Kamarajah, Ewen A. Griffiths","doi":"10.1002/jso.27855","DOIUrl":"https://doi.org/10.1002/jso.27855","url":null,"abstract":"Background<jats:italic>CDH1</jats:italic> (E‐cadherin) genetic mutations are associated with a 30%−70% increased lifetime risk of hereditary diffuse gastric cancer (HDGC). Although prophylactic total gastrectomy (PTG) reduces long‐term risk of gastric cancer, the associated morbidity and mortality remain unclear. This systematic review aims to characterise postoperative surgical outcomes in patients undergoing total gastrectomy.MethodsA systematic literature search was performed for studies reporting endoscopic surveillance, surgical and pathological outcomes for patients with <jats:italic>CDH1</jats:italic> mutation undergoing a total gastrectomy.ResultsThirty‐nine studies included 1849 patients, of which 96% had a <jats:italic>CDH1</jats:italic> (<jats:italic>n</jats:italic> = 1777) or CTNNA1 (<jats:italic>n</jats:italic> = 3) mutation. Endoscopy outcomes were reported for 1640 patients. Cancer foci were identified in 32% (<jats:italic>n</jats:italic> = 523/1640) and 71% of these patients went on to have a total gastrectomy (<jats:italic>n</jats:italic> = 369/523). The remaining 78% of patients did not have cancer foci detected on endoscopy (<jats:italic>n</jats:italic> = 1117/1640). Of these patients, 62% underwent a total gastrectomy (<jats:italic>n</jats:italic> = 688/1117) and 81% were found to have cancer on surgical histology (<jats:italic>n</jats:italic> = 556/688). Pathological staging was reported for 790 patients undergoing surgery, of which 68% had pT1 disease (<jats:italic>n</jats:italic> = 537). Postoperative complications were reported for 430 patients across 23 studies, with the most common complications being anastomotic strictures (25%), anastomotic leaks (13%), wound infections (12%) and pulmonary complications (11%). Only one postoperative death was reported within 30 days.ConclusionRates of early cancers are high in <jats:italic>CDH1</jats:italic> patients undergoing PTG, highlighting the need for improvement in reliable endoscopic surveillance. Although postoperative mortality in this surgical cohort remains low, high rates of postoperative complications warrant careful patient counselling.","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":"142224090","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}
Teun B. M. van den Heuvel, Robin J. Lurvink, Koen P. B. Rovers, Irene E. G. van Hellemond, Ignace H. J. T. de Hingh
In patients with resectable colorectal peritoneal metastases, it is unclear whether systemic chemotherapy, in addition to cytoreductive surgery‐hyperthermic intraperitoneal chemotherapy (CRS‐HIPEC), improves overall survival (OS). This systematic review of 12 retrospective studies involving 3721 patients aimed to summarize the available evidence. Contradictory results were found regarding the effectiveness of neoadjuvant, adjuvant, and perioperative systemic therapies on OS, with a high risk of bias. Available evidence remains inconclusive, stressing the need for prospective, randomized trials, like the ongoing Dutch CAIRO6‐trial.
对于可切除的结直肠腹膜转移瘤患者，目前尚不清楚在进行囊肿切除手术-腹腔内热化疗（CRS-HIPEC）的同时进行全身化疗是否能提高总生存率（OS）。本系统性综述对涉及3721名患者的12项回顾性研究进行了分析，旨在总结现有证据。在新辅助治疗、辅助治疗和围手术期系统治疗对 OS 的有效性方面发现了相互矛盾的结果，偏倚风险较高。现有证据仍无定论，强调需要进行前瞻性随机试验，如正在进行的荷兰 CAIRO6 试验。
{"title":"Systemic chemotherapy in addition to CRS‐HIPEC for colorectal peritoneal metastases: A critical systematic review on the impact on overall survival","authors":"Teun B. M. van den Heuvel, Robin J. Lurvink, Koen P. B. Rovers, Irene E. G. van Hellemond, Ignace H. J. T. de Hingh","doi":"10.1002/jso.27849","DOIUrl":"https://doi.org/10.1002/jso.27849","url":null,"abstract":"In patients with resectable colorectal peritoneal metastases, it is unclear whether systemic chemotherapy, in addition to cytoreductive surgery‐hyperthermic intraperitoneal chemotherapy (CRS‐HIPEC), improves overall survival (OS). This systematic review of 12 retrospective studies involving 3721 patients aimed to summarize the available evidence. Contradictory results were found regarding the effectiveness of neoadjuvant, adjuvant, and perioperative systemic therapies on OS, with a high risk of bias. Available evidence remains inconclusive, stressing the need for prospective, randomized trials, like the ongoing Dutch CAIRO6‐trial.","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":"142184611","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}
Claire Drigotas, Alexander W. Loftus, John B. Ammori, Luke D. Rothermel, Richard S. Hoehn
Cytoreductive surgery (CRS) with heated intraoperative intraperitoneal chemotherapy (HIPEC) has been shown to improve survival for patients with malignant peritoneal mesothelioma (MPM). Presently, there is no standardized HIPEC protocol with respect to chemotherapeutic agent, dose, administration temperature, or duration and limited literature comparing outcomes in different regimens. In this study, we analyze common practices and outcomes of published HIPEC regimens to gain insight into current practice to inform future directions of study. We conducted a literature search for investigational studies of CRS and HIPEC for MPM treatment in adults and identified 35 such articles. These studies were analyzed for institution type and location, drug regimens, perfusion temperatures and time, and study outcomes including median survival, complication rates, and perioperative mortality rates. On review, there is significant heterogeneity in HIPEC regimens and outcome reporting metrics, suggesting a need for multi‐institutional standardized study protocols to better determine the safest and most efficacious treatment regimen.
{"title":"Perfusion Strategies for Cytoreductive Surgery With Heated Intraperitoneal Chemotherapy for Malignant Peritoneal Mesothelioma","authors":"Claire Drigotas, Alexander W. Loftus, John B. Ammori, Luke D. Rothermel, Richard S. Hoehn","doi":"10.1002/jso.27882","DOIUrl":"https://doi.org/10.1002/jso.27882","url":null,"abstract":"Cytoreductive surgery (CRS) with heated intraoperative intraperitoneal chemotherapy (HIPEC) has been shown to improve survival for patients with malignant peritoneal mesothelioma (MPM). Presently, there is no standardized HIPEC protocol with respect to chemotherapeutic agent, dose, administration temperature, or duration and limited literature comparing outcomes in different regimens. In this study, we analyze common practices and outcomes of published HIPEC regimens to gain insight into current practice to inform future directions of study. We conducted a literature search for investigational studies of CRS and HIPEC for MPM treatment in adults and identified 35 such articles. These studies were analyzed for institution type and location, drug regimens, perfusion temperatures and time, and study outcomes including median survival, complication rates, and perioperative mortality rates. On review, there is significant heterogeneity in HIPEC regimens and outcome reporting metrics, suggesting a need for multi‐institutional standardized study protocols to better determine the safest and most efficacious treatment regimen.","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":"142184458","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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