Journal of Surgical Oncology最新文献

Introduction: Soft tissue sarcoma (STS) resections of the thigh have high rates of wound complications, but the effect of tumor depth and surrounding tissue composition on wound risk is not fully understood. We aimed to determine whether skin-to-tumor distance and regional thigh adiposity independently predict postoperative wound complications.

Methods: We retrospectively reviewed 125 patients who underwent thigh STS resection from 2013 to 2025. Preoperative MRI or CT was used to measure (1) the shortest skin-to-tumor distance in the quadrant with the greatest tumor burden and (2) average thigh adiposity across the remaining quadrants. The primary endpoint was a composite of wound dehiscence, infection, or return to the operating room within 90 days. Multivariable logistic regression was used, adjusting for demographic, treatment, and tumor variables.

Results: Composite wound complications occurred in 34 patients (27%). Each 1-cm increase in skin-to-tumor distance reduced the odds of complication by approximately 80% (OR = 0.21, 95%-CI: 0.07-0.61, p = 0.004), while each 1-cm increase in average thigh adiposity nearly doubled the risk (OR = 1.92, 95%-CI: 1.08-3.41, p = 0.025). Findings were consistent for wound dehiscence, with similar trends observed for infection.

Conclusion: Both superficial tumor location and increased thigh adiposity independently predict postoperative wound complications. Incorporating radiographic measures of local coverage and regional tissue quality may enhance preoperative risk assessment and assist in reconstructive planning for extremity soft tissue sarcoma surgery.

Background: Colorectal cancer screening mainly targets a population between 50 and 70 years of age; however, it is inconsistently implemented in people over 70. The aim of this study was to analyze the association between colorectal cancer (CRC) screening, postoperative mortality, and perioperative and oncologic outcomes in a large population of patients over 70 years of age who underwent surgery for CRC.

Methods: Data regarding people over 70 who underwent CRC surgery were retrieved from a nationally validated retrospective database, including four consecutive years (2018-2021) and 81 centers. The patients were divided into two groups according to their participation in the CRC screening program: Screening versus No Screening. The outcomes of the study were 30-day mortality; urgent, palliative and minimally invasive surgery rates; Clavien-Dindo ≥ III; advanced oncologic stage; R0 resection and length of hospital stay (LOS). Logistic regression analysis was carried out and adjusted for multiple confounders.

Results: Of the 10,346 patients over 70,676 were in the screening group, and 9670 were in the no screening group. At logistic regression, CRC screening was significantly associated with a reduction in 30-day mortality (OR 0.41, 95% CI 0.18-0.92, p = 0.032), urgent surgery (OR 0.06, 95% CI 0.02-0.14, p < 0.001), palliative surgery (OR 0.32, 95% CI 0.19-0.54, p < 0.001), Clavien-Dindo ≥ III complications (OR 0.69, 95% CI 0.51-0.93, p = 0.016) and advanced oncologic stage (OR 0.53, 95% CI 0.45-0.62, p < 0.001), and a significant increase in R0 resections (OR 3.15, 95% CI 1.67-5.94, p < 0.001) and laparoscopic surgery (OR 1.93, 95% CI 1.57-2.38, p < 0.001). The crude and adjusted Odds Ratio similarity confirmed this correlation, regardless of the comorbidities and confounders.

Conclusions: Adherence to CRC screening should be further encouraged and standardized for people over 70.

Introduction: Alveolar rhabdomyosarcoma (ARMS) is a rare, aggressive soft-tissue malignancy occurring mostly in children. Pelvic presentation poses diagnostic and therapeutic challenges due to proximity to critical structures. This study aims to assess the prognostic treatment factors associated with pelvic ARMS.

Methods: We conducted a retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) database (2000-2021) that included patients with ARMS. Variables included demographics, socioeconomic factors, and treatment modalities. Logistic regression evaluated associations between tumor location and treatment receipt. Cancer-specific mortality was analyzed using Cox proportional hazards regression, with Weibull parametric survival analysis performed to quantify survival time benefits.

Results: The study included 678 ARMS patients (585 non-pelvic vs. 93 pelvic). Patients with pelvic tumors had significantly higher mortality risk (hazard ratio [HR] = 1.44, 95%-confidence interval [95% CI]: 1.08-1.94, p = 0.014) and were less likely to undergo resection (45.1% vs. 30.1%, p = 0.007). Weibull parametric analysis demonstrated radiation therapy was associated with improved survival in pelvic tumors, with patients receiving radiation having a predicted median survival of 34.7 months compared to 17.0 months for those not receiving radiation (17.7 month difference, p = 0.039). Both radiation therapy (HR = 0.56, 95% CI: 0.43-0.71, p < 0.001) and surgery (HR = 0.61, 95% CI: 0.48-0.78, p < 0.001) were independently associated with decreased cancer-specific mortality.

Conclusions: Radiation therapy demonstrated a significant survival benefit in pelvic ARMS, emphasizing the need for standardized treatment strategies in high-risk sites.

Background and objective: Endoscopic resection (ER) is increasingly used for early-stage duodenal adenocarcinoma (DA). This study aimed to identify factors guiding ER selection for clinical T1/T2N0 DA.

Methods: A retrospective National Cancer Database analysis (2010-2021) included patients with clinical T1/T2N0M0 DA with available pathological staging among those who underwent surgical resection. Outcomes were overall survival and lymph node upstaging (LNU). Survival was evaluated using Cox proportional hazard models, and predictors of LNU were assessed using logistic regression.

Results: Among 527 patients, 68 underwent ER and 459 underwent a major resection. Overall survival did not differ between the two groups (HR: 0.96, 95% CI: 0.65-1.40). Among major resections, nodal upstaging occurred in about 40% of patients and was associated with worse survival (T1 HR: 1.72, 95% CI: 1.18-2.50) and (T2 HR: 2.06, 95% CI: 1.28-3.33). Poor differentiation (OR: 2.83, 95% CI: 1.08-7.45), lymphovascular invasion (OR 7.19, 95% CI: 4.48-11.53), and age (≥ 80 compared to < 65-OR: 0.40, 95% CI: 0.20-0.82) were significant predictors of LNU.

Conclusion: Nearly 40% of clinically node-negative T1/T2 DA patients who underwent a major resection had LNU, which was associated with worse overall survival. Pathologic features should guide ER selection.

Synopsis: Among clinically node-negative T1/T2 duodenal adenocarcinomas, 40% of patients who underwent major resections had lymph node upstaging, which was associated with worse survival; lymphovascular invasion, poor differentiation, and older age were significant predictors of nodal upstaging. The importance of these findings underscores the need for duodenal adenocarcinoma-specific guidelines to guide endoscopic resection in early T-stage disease.

Introduction: Pathological complete response (pCR) after neoadjuvant chemotherapy is associated with improved prognosis in patients with triple-negative breast cancer (TNBC). Differences in pathological response rates between the breast and axillary lymph nodes have prompted interest in understanding response patterns that may, in the future, inform strategies aimed at omitting axillary surgical evaluation. This systematic review aimed to describe and compare the prevalence of breast and axillary pathological responses in TNBC patients treated with neoadjuvant chemotherapy.

Methods: This systematic review was conducted following the PRISMA statement and registered in PROSPERO (ID: CRD498121). Searches were performed in the PubMed, Embase, and Web of Science databases. Studies that described node pathological response (NpCR) and breast pathological response (BpCR) in TNBC patients undergoing neoadjuvant chemotherapy were included. Article selection was independently performed by two reviewers using the Rayyan platform. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale.

Results: Across the included studies, NpCR rates were consistently higher than BpCR rates in TNBC patients. No study reported higher BpCR compared with NpCR. The mean prevalence of BpCR was 32% (SD 0.6), NpCR was 38.3% (SD 0.9).

Conclusion: Among TNBC patients treated with neoadjuvant chemotherapy, NpCR occurs more frequently than BpCR. These findings provide a descriptive overview of current response patterns and may inform future research exploring the safety of omitting axillary surgical evaluation. Factors beyond tumor subtype likely influence response patterns, indicating the need for further research to identify predictive biomarkers and optimize treatment strategies.

Background: While the incidence of periprosthetic joint infection (PJI) after oncologic proximal tibia reconstruction (PTR) is well documented, limited data exists on the clinical course and infection eradication rates after PJI onset. Our study evaluated treatment success and functional outcomes associated with different surgical strategies for PJI after oncologic PTR.

Methods: We retrospectively identified patients treated for PJI after oncologic PTR with a megaprosthesis or allograft-prosthetic composite between 1995 and 2023 at two tertiary care institutions. Surgical strategies included debridement, antibiotics, and implant retention (DAIR), DAIR with modular component exchange and stem retention (DAIR plus), and two-stage revision. Reinfection-free survival (RFS) and amputation-free survival were evaluated using Kaplan-Meier analysis. Functional outcomes and quality of life were assessed at last follow-up using the Musculoskeletal Tumor Society (MSTS) and EuroQol (EQ-index) questionnaires.

Results: Six-month RFS was 22% for DAIR, 66.7% for DAIR plus, and 83.3% for two-stage revision (p = 0.002). At 2 years, DAIR plus and two-stage showed higher RFS compared to DAIR (p < 0.001). Median MSTS was 63.4%, and EQ index 68.4, with no differences between groups.

Conclusions: DAIR plus showed non-inferior outcomes compared to two-stage revision and may be a feasible alternative in cases with well-fixed stems. Functional outcomes remain poor.

Level of evidence: Level III.

People experiencing homelessness (PEH) face significant barriers to surgical care. This scoping review identified 26 studies describing cancer surgery in PEH. Major themes that emerged for PEH were poor access to surgical specialists, advanced stage at cancer presentation, worse surgical outcomes compared to housed cancer patients, and loss to follow-up care. Although some studies proposed strategies like housing support and improved care coordination, few evaluated targeted interventions. These findings highlight a critical gap in oncologic surgical care for PEH and emphasize the need for targeted research and policy initiatives.

Objective: To explore the current status of patient involvement in neoadjuvant treatment decision-making among individuals with locally advanced gastric cancer, and to further identify the factors influencing their level of participation.

Methods: This cross-sectional study included patients with locally advanced gastric cancer and was conducted between July 2023 and April 2024 at two hospitals in Guangzhou, China. Data were collected using the Questionnaire of Cancer Patients' Decision-Making Regarding Treatment, the Decisional Conflict Scale, the Health Literacy Management Scale, the Fear of Progression Questionnaire-Short Form, and the Perceived Social Support Scale. Univariate analyzes and multivariable logistic regression were performed to identify factors associated with patient participation in neoadjuvant treatment decision-making.

Results: Patients with a positive attitude toward participating in neoadjuvant therapy decision-making also demonstrated higher actual participation levels (χ² = 47.05, p < 0.001). Binary logistic regression analysis identified several factors influencing decision-making attitudes in patients with locally advanced gastric cancer, including being a worker or self-employed, decisional conflict, health literacy (willingness to improve health), and fear of disease progression. Additionally, factors influencing the actual level of participation in decision-making included having a college education, being employed in government or public institutions, a per capita monthly household income of 5,001-10,000 CNY (≈700-1,400 USD), decisional conflict, health literacy (willingness to improve health), and social support (family support).

Conclusions: The decision-making participation of patients with locally advanced gastric cancer is influenced by multiple factors, highlighting the need for comprehensive interventions tailored to these influences.

Tranexamic acid (TXA) is widely used across surgical specialties to reduce perioperative blood loss, yet its specific role in hepatic resection remains unclear. This meta-analysis, performed according to PRISMA guidelines, evaluated the efficacy and safety of TXA in liver surgery. Outcomes of interest included mean intraoperative blood loss, the proportion of patients receiving transfusion, and mean units of red blood cells transfused intraoperatively and postoperatively. Secondary endpoints included postoperative mortality, thromboembolic events, and hospital length of stay. Of 36 articles assessed, nine studies met eligibility criteria for inclusion. TXA use was associated with a statistically significant reduction in intraoperative blood loss (SMD - 0.18; 95% CI, - 0.28 to - 0.09; p < 0.01), although transfusion requirements did not differ significantly between groups (RR 0.81; 95% CI, 0.47-1.38; p = 0.44). Interpretation of these findings is limited by substantial heterogeneity among included studies (I² = 82%). While TXA appears effective in reducing intraoperative bleeding, its use may confer a higher risk of postoperative thromboembolic complications, suggesting that TXA administration during hepatic resection should be selective and individualized rather than routine.