Journal of Surgical Oncology最新文献

Background and objectives: This study evaluates the prognostic value of venous tumor thrombus (VTT) in patients with advanced renal cell carcinoma (RCC) undergoing radical resection and inferior vena cava (IVC) thrombectomy.

Methods: Retrospective review of patients with radical nephrectomy for RCC and associated VTT (2000-2024). Patients were dichotomized into Neves 0-II (infrahepatic) and Neves III-IV groups (suprahepatic) IVC involvement for univariate analysis.

Results: A total of 64 patients (34 Neves 0-II and 30 Neves III-IV) were analyzed. No significant differences in patient or cancer characteristics. Neves III-IV was associated with greater blood loss (> 2 L) (62.1% vs. 37.9%, p = 0.02), greater intensive care unit length of stay (LOS) (4.4 vs. 1.4 days, p = 0.02), and postoperative LOS (11.0 vs. 6.5 days, p = 0.005). Overall, 30-day mortality was only 1.6% with a mean follow-up of 56.1 months. Local recurrence was 7.8% and IVC patency 96.9%. One-year survival was 82.0%, 5-year survival was 58.4%, and 15-year survival was 42.5% without significant difference between Neves levels.

Conclusions: Radical nephrectomy with VTT thrombectomy and primary IVC repair is safe with high early survival and low local recurrence. Extent of IVC tumor thrombus extension is not a poor prognostic factor for early or late survival.

Background: Native Hawaiian and Pacific Islander (NHPI) women experience significant disparities in breast cancer treatment and outcomes, including lower rates of postmastectomy reconstruction, higher refusal rates of radiation therapy, and delays in surgical care. These disparities contribute to poorer survival and increased complications compared to other racial/ethnic groups. This systematic review and meta-analysis aim to quantify these disparities and assess their impact on breast cancer outcomes in NHPI women.

Methods: A comprehensive search of PubMed, Scopus, and Embase databases was conducted to identify studies reporting on breast cancer surgery, reconstruction, radiation therapy refusal, and surgical delays for NHPI women. Thirteen studies, encompassing a total of 5 546 918 patients, were included, and meta-analyses were performed to pool odds ratios (OR) and hazard ratios (HR) for key outcomes using random-effects models. Heterogeneity was assessed using I² statistics. Thematic analysis was also conducted to explore cultural and structural factors influencing treatment disparities.

Results: NHPI women had significantly lower odds of receiving postmastectomy reconstruction compared to non-Hispanic White women (pooled OR = 2.02, 95% confidence interval [CI]: 1.96-2.08, I² = 99%). Delays in surgical care were more frequent, with NHPI women being 4.51 times more likely to experience delays (OR = 4.51, 95% CI: 3.82-5.32, I² = 99%). Radiation therapy refusal was notably higher, with a pooled hazard ratio of 3.28 (95% CI: 2.99-3.58, I² = 77%) indicating that NHPI women who refused radiation therapy had more than three times the risk of mortality compared to those who accepted it. Thematic analysis revealed that geographic isolation, limited access to specialized care, and cultural perceptions surrounding cancer treatments, including fear of radiation due to historical trauma, contributed significantly to treatment disparities.

Conclusions: Native Hawaiian and Pacific Islander women face considerable barriers to receiving equitable breast cancer treatment and reconstruction, resulting in worse outcomes compared to other racial/ethnic groups. Efforts to address these disparities must focus on improving access to care, reducing treatment delays, and implementing culturally sensitive interventions. Targeted policies and healthcare system improvements, especially in geographically isolated areas, are critical to improving survival and treatment outcomes for NHPI women.

Background: Patients in low- and middle-income countries (LMICs) are disproportionately affected by liver cancers but there is a lack of understanding of their postoperative outcomes. This study aimed to review the current status of research in LMICs regarding outcomes after oncologic hepatectomy and synthesize the data reported in the literature.

Methods: The PubMed, Scopus, Embase, Web of Science, and World Health Organization (WHO) Global Index Medicus databases were searched from database inception to May 26th, 2022. Studies that reported outcomes after oncologic hepatectomy in LMIC settings were eligible for inclusion. Two independent reviewers performed record screening and data extraction. Risk of bias assessment was performed using the National Institutes of Health Study Quality Assessment tools. Pooled results with 95% confidence intervals (95% CIs) were calculated using a random effects model.

Results: One hundred and thirty-five studies and 16 985 patients were included. Most studies were of a "fair" quality. Two studies described pediatric patients. Only one study was from a low-income country and most African regions were not represented. The rates of major and minor complications were 11% and 27%, respectively, while 30- and 90-day mortality rates were 2% and 3% each. Postoperative liver failure (8%), surgical site infections (6%), and bile leaks (6%) were common complications.

Conclusions: This review indicates a dearth of data from LMICs on outcomes after hepatectomy, particularly from African regions and low-income countries.

In the 1970s, we learned breast conservation therapy (BCT) was not inferior to mastectomy. Early BCT methods could result in deformities that were unacceptable to patients and to their surgeons. By the 1990s, surgeons began to apply the principles of plastic surgery to improve outcomes. The term oncoplastic surgery was first described in the 1990s by Werner Audretsch. We offer a review of principles, techniques, current controversies, and challenges in broadening the utilization of OPS.

Introduction: There is no consensus on the optimal surveillance interval for patients undergoing resection of colorectal liver metastases (CRLM). We sought to assess the timing and intensity of recurrence following curative-intent resection of CRLM utilizing a recurrence-free survival (RFS) hazard function analysis.

Methods: Patients with CRLM who underwent curative-intent resection were identified from a multi-institutional database. The RFS hazard function was used to plot hazard rates and identify the peak of recurrence over time.

Results: Among 1804 patients, the median RFS was 19.9 months. In the analytic cohort, the RFS hazard curve peaked at 5.9 months (peak hazard rate: 0.054) and gradually declined, indicative of early recurrence. In subgroup analyses, patients with high and medium tumor burden scores (TBS) had RFS hazard peaks at 4.9 months (peak hazard rate: 0.060) and 5.8 months (peak hazard rate: 0.054), respectively. In contrast, patients with low TBS had a later peak at 7.5 months, with the lowest peak hazard rate of 0.047.

Conclusions: The recurrence peak for CRLM patients occurred approximately 6 months postsurgery, highlighting the need for intensified early postoperative surveillance. Patients with high TBS experienced earlier recurrence, underscoring the importance of close monitoring, particularly during the first 6 months after surgery.

Background and objectives: Prospective data on presentation and outcomes of colorectal cancer (CRC) in Nigeria are limited; however, emergency presentation with advanced disease is thought common.

Methods: Consecutive CRC patients presenting at six sites over 6 years were included. Risk factors for emergency presentation were evaluated using logistic regression methods. Overall survival (OS) was compared between emergent and elective patients using Kaplan-Meier methods and the log-rank test.

Results: Of 535 patients, 30.7% presented emergently. Median age was 56 years, 55% were men, and 5.0% reported a cancer family history. Emergency patients had more proximal cancers (42.1% vs. 24.0%), Stage IV disease (61.6% vs. 40.2%; p < 0.001), lower household income (₦35 000/month vs. ₦50 000/month), lower education levels (p = 0.008) and accessed care with nonmotorized transport (50.6% vs. 37.2%; p = 0.005). Median OS was shorter in the emergency group (6.4 vs. 17.4 months; p < 0.001). Across clinical stages, emergency presentation was associated with worse OS (Stage IV median OS 4.8 vs. 9.4 months; p = 0.002). Surgery improved survival in both groups, although emergency patients had higher 30-day postoperative mortality (23.2% vs. 9.1%; p < 0.001).

Conclusions: Emergent Nigerian CRC patients have worse OS than elective patients. Cancer control efforts should focus on faster cancer detection, early presentation, diagnosis, and treatment.

Introduction: Despite advances in imaging modalities, a significant number of adrenal tumors are considered indeterminate and removed surgically. Currently, there is no intraoperative tool available to provide further information about the nature of indeterminate adrenal tumors. The aim of this study was to investigate whether near-infrared indocyanine green (ICG) imaging can be used in this regard.

Methods: This was an institutional review board-approved study. Within 9 years, 197 patients underwent robotic adrenalectomy with ICG imaging. Adrenal tumors were characterized prospectively as fluorescent or nonfluorescent intraoperatively. ICG was administered as a 2.5 mg dose, one to three times a procedure. No patient developed an allergic reaction. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.

Results: Robotic transabdominal lateral adrenalectomy was performed in 155 patients and posterior retroperitoneal adrenalectomy in 42 patients. One hundred and eighty-four patients had benign adrenal tumors, 10 patients had malignant tumors, and three patients had tumors of uncertain malignant potential. Sensitivity, specificity, PPV, and NPV to predict a benign tumor were 87%, 38.5%, 95.2%, and 17.2%.

Conclusions: To our knowledge, this is the largest study on ICG imaging of adrenal tumors. High PPV to detect benign tumors suggests a utility of ICG to provide the surgeon with further information about the benign vs malignant nature of indeterminate adrenal tumors taken to surgery.

Background: This study aims to assess the clinical and oncologic outcomes of high-dose brachytherapy (BRT) versus both preoperative and postoperative external beam radiation therapy (EBRT) in the setting of high-grade soft tissue sarcoma.

Methods: This is a retrospective cohort study of 144 patients treated surgically for soft tissue sarcoma at the same institution from 2010 to 2021. Patients treated for a soft tissue sarcoma with surgery and radiation therapy in the form of BRT, Neoadjuvant EBRT (Neo-EBRT) or adjuvant EBRT (AD-EBRT) were included.

Results: 56 patients were treated with BRT, 42 with Neo-EBRT, and 46 with AD-EBRT. There was a greater incidence of grouped wound complications in Neo-EBRT with 50% compared to both BRT with 25% and AD-EBRT with 28.3% (p = 0.02). Univariate and multivariate analysis showed that there was an increased risk of wound complications with Neo-EBRT when compared to brachytherapy (p = 0.03 and p = 0.007, respectively). Univariate and multivariate analysis showed that there was no difference in risk of LR between treatment groups (p = 0.28).

Conclusion: Brachytherapy is a valuable treatment modality that offers clinical and logistical advantages when compared to the conventional Neo-EBRT in soft tissue sarcomas. Brachytherapy offers a lower risk of wound complications and a comparable local control. This manuscript presents decision-making strategies for determining the appropriate radiation modality for specific circumstances.

Background: In Nigeria, gastric cancer is the 10th most common and 9th most deadly malignancy. The limited availability of robust data makes further characterizing it challenging. The objective of this study was to assess the presentation, and management of gastric cancer in Nigeria using an institutional cancer registry.

Methods: We reviewed a prospective database of patients diagnosed with any gastric cancer at a single tertiary referral center over 15 years (2007-2022). Patients with suspected gastric cancer were surveyed for sociodemographics and then added to the institutional gastric cancer registry. Thereafter, periodic chart review and phone call was used to obtain investigation results, and survival data, respectively. Only patients with complete histopathology were included in analysis.

Results: 138 patients met inclusion criteria (mean age 55.3 years, 68.8% male). Patients typically presented with weight loss (119, 86.2%) and anorexia (92, 66.7%). Blood work (132, 95.7%) and ultrasound (80, 57.9%) were the most common investigations. Most fully staged patients presented with metastatic disease (39, 90.2%). Patients underwent at least one treatment modality (109, 79.0%), and most 54 (49.5%) underwent both chemotherapy and surgery. Patients undergoing surgery usually had resection of their tumor (58, 67.4%). The median time of follow-up was 45.6 months, and 51.4% (71) of patients were dead at that time point.

Conclusion: Our gastric cancer database identified that most patients present with advanced disease and are undergoing at least one treatment modality. The next steps include initiatives to strengthen the quality of registry data, identify high-risk patients, and provide timely treatment.

Lymphatic surgery has demonstrated promising outcomes for the treatment of lymphedema alongside nonsurgical techniques. Physiologic lymphatic surgeries including lymphovenous bypass and vascularized lymph node transplants address the fluid burden in lymphedema whereas reductive surgeries including suction lipectomy and excisional techniques address the fibroadipose component of the disease. Lymphedema patients often present with both fluid and fat components that may require different procedures for optimal results. In addition, the chronic, progressive nature of lymphedema can warrant the need for multiple procedures to address different anatomic areas as well as further improve outcomes. This paper reviews the current literature on staging different or repeated lymphatic procedures and proposes an algorithm to navigate physiologic and reductive lymphatic surgery when multiple procedures are needed to optimize surgical outcomes.