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Complications After Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy - Can We Do Better? 细胞修复手术和腹腔内热化疗后的并发症--我们能做得更好吗?
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-18 DOI: 10.1002/jso.27988
Miguel E Alberto V, Daniela Zuluaga, Axel Winter, Johann Pratschke, Beate Rau, Safak Gül

The main aim of this review is to analyze postoperative complications after cytoreductive surgery and intraperitoneal chemotherapy. Although the literature in this field is ever growing, reporting on complication is not a given. Nevertheless, some main risk factors such as prior surgery, high tumor burden and the center's expertize have an impact on patient outcomes. Transparency is key, if we want to continue to improve.

本综述的主要目的是分析细胞减灭术和腹腔内化疗后的术后并发症。尽管该领域的文献不断增加,但并发症的报告并不是必然的。然而,一些主要的风险因素,如之前的手术、高肿瘤负荷和中心的专业水平,都会对患者的预后产生影响。如果我们想继续改进,透明度是关键。
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引用次数: 0
Role of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (CRS/HIPEC) in the Treatment of Peritoneal Carcinomatosis From Small Bowel Adenocarcinoma-A Systematic Review and Meta-Analysis. 细胞减灭术和腹腔内热化疗(CRS/HIPEC)在治疗小肠腺癌腹膜癌肿中的作用--系统回顾和荟萃分析。
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-17 DOI: 10.1002/jso.27956
Deemantha G Fernando, Rodney Sparapani, Harveshp Mogal

Introduction: While systemic chemotherapy (SC) is the mainstay of treatment of peritoneal carcinomatosis from small bowel adenocarcinomas (SBA-PC), its efficacy and outcomes remain poor. Therefore, the role of curative-intent surgery needs to be better defined. Using a systematic review and meta-analysis, this study aims to define the role of CRS/HIPEC in patients with SBA-PC.

Methods: A systematic literature search was performed using PubMed and MEDLINE following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies published between 1990 and 2023. Articles were scored and incorporated within approximate normality of means/proportions formulae to compare outcomes of CRS/HIPEC and SC alone.

Results: Ten studies with 461 patients undergoing CRS/HIPEC and seven studies with 285 patients undergoing SC alone were identified. In the CRS/HIPEC group, 215 (46.6%) were male and the median age was 46.5-66 years. The primary tumor was located mostly in the duodenum (n = 169, 36.7%) and ileum (n = 108, 23.4%). Grade was unspecified in most patients (n = 232, 50.3%). Median Peritoneal Cancer Index (PCI) ranged between 10 and 12, and 93.1% underwent complete cytoreduction (CC 0/1). CRS/HIPEC-related major morbidity and mortality was 20.7% (SD = 2.5, 95% CI 15.6-25.6) and 1.7% (SD = 0.8, 95% CI 0.1-3.3), respectively. With a median follow-up of 21.1 (SD = 1.1, 95% CI 18.9-23.3) months, CRS/HIPEC demonstrated median overall survival of 32.3 (SD = 1.19, 95% CI 30-34.6) versus 14.5 (SD = 0.19, 95% CI 14.1-14.9) months for SC alone (p < 0.0003).

Conclusion: In comparison to SC alone, CRS/HIPEC may result in long-term survival with acceptable perioperative morbidity, in select SBA-PC patients with low-volume disease undergoing complete cytoreduction.

简介:虽然全身化疗(SC)是治疗小肠腺癌腹膜癌肿(SBA-PC)的主要方法,但其疗效和预后仍然不佳。因此,需要更好地界定治愈性手术的作用。本研究采用系统综述和荟萃分析法,旨在明确 CRS/HIPEC 在 SBA-PC 患者中的作用:方法:按照系统综述和荟萃分析首选报告项目(PRISMA)指南,使用 PubMed 和 MEDLINE 对 1990 年至 2023 年间发表的研究进行了系统文献检索。对文章进行评分,并纳入近似正态均值/比例公式,以比较 CRS/HIPEC 和单纯 SC 的结果:结果:共发现10项研究,461名患者接受了CRS/HIPEC治疗;7项研究,285名患者仅接受了SC治疗。在 CRS/HIPEC 组中,215 名(46.6%)患者为男性,中位年龄为 46.5-66 岁。原发肿瘤主要位于十二指肠(169 例,36.7%)和回肠(108 例,23.4%)。大多数患者的肿瘤分级不明(232例,50.3%)。腹膜癌指数(PCI)中位数介于 10 和 12 之间,93.1% 的患者接受了完全细胞减灭术(CC 0/1)。与 CRS/HIPEC 相关的主要发病率和死亡率分别为 20.7% (SD = 2.5, 95% CI 15.6-25.6) 和 1.7% (SD = 0.8, 95% CI 0.1-3.3)。中位随访时间为 21.1 个月(SD = 1.1,95% CI 18.9-23.3),CRS/HIPEC 的中位总生存期为 32.3 个月(SD = 1.19,95% CI 30-34.6),而单用 SC 的中位总生存期为 14.5 个月(SD = 0.19,95% CI 14.1-14.9)(P 结论:CRS/HIPEC 与单用 SC 相比,CRS/HIPEC 的中位总生存期更长:与单纯 SC 相比,CRS/HIPEC 可使部分接受完全细胞减灭术的低容量 SBA-PC 患者获得长期生存,且围术期发病率可接受。
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引用次数: 0
Are Nomograms Useful for Predicting Sentinel Lymph Node Status in Melanoma Patients? 预测黑色素瘤患者前哨淋巴结状态的提名图有用吗?
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-17 DOI: 10.1002/jso.27976
Kristel Lourdault, Arthur W Cowman, Douglas Hanes, Anthony J Scholer, Tyler Aguilar, Richard Essner

Background and objectives: Clinical nomograms have been developed to predict sentinel lymph node (SLN) status in early-stage melanoma patients, but the clinical utility of these tools remains debatable. We created and validated a nomogram using data from a randomized clinical trial and assessed its accuracy against the well-validated Melanoma Institute Australia (MIA) nomogram.

Methods: We developed our model to predict SLN status using logistic regression on clinicopathological patient data from the Multicenter Selective Lymphadenectomy Trial-I. The model was externally validated using the National Cancer Database (NCDB) data set, and its performance was compared to that of the MIA nomogram.

Results: Our model had good discrimination between positive and negative SLNs, with a training set area under the curve (AUC) of 0.706 (0.661-0.751). Our model achieved an AUC of 0.715 (0.706-0.724) compared to 0.723 (0.715-0.731) with the MIA model, using the NCDB set.

Conclusion: Our model performed similarly to the MIA model, confirming that despite using different clinical features and data sets, no clinical nomogram is currently accurate enough for clinical use.

背景和目的:已有临床提名图用于预测早期黑色素瘤患者的前哨淋巴结(SLN)状态,但这些工具的临床实用性仍有待商榷。我们利用一项随机临床试验的数据创建并验证了一个提名图,并对照经过充分验证的澳大利亚黑色素瘤研究所(MIA)提名图评估了其准确性:我们根据多中心选择性淋巴腺切除术试验 I 的临床病理患者数据,利用逻辑回归建立了预测 SLN 状态的模型。我们使用国家癌症数据库(NCDB)数据集对该模型进行了外部验证,并将其性能与 MIA 提名图进行了比较:结果:我们的模型对阳性和阴性 SLN 有很好的区分度,训练集的曲线下面积 (AUC) 为 0.706(0.661-0.751)。我们的模型的AUC为0.715(0.706-0.724),而使用NCDB集的MIA模型的AUC为0.723(0.715-0.731):我们的模型与 MIA 模型表现相似,这证实了尽管使用了不同的临床特征和数据集,但目前还没有一种临床提名图足够准确,可用于临床。
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引用次数: 0
The Emerging Role of Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Pancreatic Cancer. 细胞减灭术和腹腔内热化疗 (HIPEC) 在胰腺癌中的新作用。
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-17 DOI: 10.1002/jso.27880
Cornelius Thiels, Travis E Grotz

Peritoneal spread is a frequent cause of metastasis in both the synchronous and metachronous settings for patients with pancreatic cancer. Recent improvements in systemic chemotherapy for pancreatic cancer may now allow for the careful selection of patients with oligometastatic disease isolated to the peritoneum who may benefit from consolidative cytoreduction and HIPEC.

腹膜扩散是胰腺癌患者在同步和非同步情况下发生转移的常见原因。近年来,胰腺癌全身化疗技术不断改进,现在可以谨慎选择腹膜少转移的患者,这些患者可能会从巩固性细胞减灭术和腹膜切除术中获益。
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引用次数: 0
The Effects of HIPEC on Survival of Gastric Cancer Patients With Peritoneal Metastasis. HIPEC对腹膜转移的胃癌患者生存期的影响
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-17 DOI: 10.1002/jso.27877
Zhong-He Ji, Qi-Di Zhao, Yan Li

Cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) has been recommended by Peritoneal Surface Oncology Group International (PSOGI) and several other academic organizations as the treatment of choice for selected patients with gastric cancer peritoneal metastasis (GCPM). This review updates the recent progress in CRS+HIPEC for GCPM, with particular focus on the potential curing effects of this approach for subclinical GCPM patients.

国际腹膜表面肿瘤学组织(PSOGI)和其他一些学术组织已推荐将细胞减灭术(CRS)+腹腔热化疗(HIPEC)作为选定的胃癌腹膜转移(GCPM)患者的首选治疗方法。本综述更新了 CRS+HIPEC 治疗 GCPM 的最新进展,尤其关注这种方法对亚临床 GCPM 患者的潜在治疗效果。
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引用次数: 0
Challenges in feeding jejunostomy management: A call for better patient support 喂养空肠造口术管理的挑战:呼吁为患者提供更好的支持。
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-17 DOI: 10.1002/jso.27801
Ibrahim Zouhri, Nizar Ghanou, Laila Amrani, Oumayma Lahnaoui, Amine Benkabbou, Ayman  El Fassi, Oussama Souni, Brahim El Ahmadi, Zakaria Houssain Belkhadir, Amine Souadka
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引用次数: 0
Trends and Outcomes of Neoadjuvant Chemotherapy for Clinical Stage T1 Pancreatic Cancer. 临床 T1 期胰腺癌新辅助化疗的趋势和疗效。
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-14 DOI: 10.1002/jso.28003
Shruti Koti, Oliver Standring, Nandan Vithlani, Neda Amini, Danielle Deperalta, Gary Deutsch, Martin Karpeh, Matthew Weiss, Neha Lad

Background: Neoadjuvant chemotherapy (NC) for early pancreatic ductal adenocarcinoma (PDAC) remains controversial. We investigate the adoption of NC and its impact on survival in clinical T1 (cT1) PDAC.

Methods: National Cancer Database (2006-2017) was reviewed for cT1 PDAC. Patients receiving NC and surgery were compared with patients undergoing upfront surgery (US).

Results: A total of 5886 patients were included. NC use increased from 4.8% in 2006 to 18.8% in 2017. The NC group (n = 618) versus the US group (n = 5268) had: younger age (66 years vs. 68 years), smaller tumor size (2 cm vs. 2.2 cm), more pancreas head tumors (77% vs. 70.6%), lower lymph-vascular invasion (25.9% vs. 40.6%), and less lymph node positivity (43.6% vs. 54.5%), p < 0.001. Factors associated with receipt of NC were: younger age, recent year of diagnosis, and treatment at an academic program. In the NC group versus the US group, median OS was 35.2 months versus 28.3 months, p < 0.001. Factors associated with improved survival included: well differentiated pathology, R0 surgical margins, and receipt of chemotherapy.

Conclusion: In cT1 PDAC, chemotherapy is associated with improved survival. In a surgery-first approach, only 59% of patients receive adjuvant chemotherapy. These data suggest consideration of neoadjuvant therapy for early pancreatic cancer.

背景:早期胰腺导管腺癌(PDAC)的新辅助化疗(NC)仍存在争议。我们调查了临床T1(cT1)PDAC采用NC的情况及其对生存率的影响:对全国癌症数据库(2006-2017 年)中 cT1 PDAC 的数据进行了回顾。方法:对全国癌症数据库(2006-2017年)中的cT1 PDAC患者进行回顾性研究,将接受NC和手术的患者与接受前期手术(US)的患者进行比较:结果:共纳入 5886 例患者。NC使用率从2006年的4.8%增至2017年的18.8%。NC组(n = 618)与US组(n = 5268)相比:年龄更小(66岁 vs. 68岁)、肿瘤尺寸更小(2厘米 vs. 2.2厘米)、胰头肿瘤更多(77% vs. 70.6%)、淋巴管侵犯更少(25.9% vs. 40.6%)、淋巴结阳性率更低(43.6% vs. 54.5%),P 结论:对于 cT1 PDAC,化疗可提高生存率。在以手术为先的方法中,只有 59% 的患者接受了辅助化疗。这些数据建议考虑对早期胰腺癌进行新辅助治疗。
{"title":"Trends and Outcomes of Neoadjuvant Chemotherapy for Clinical Stage T1 Pancreatic Cancer.","authors":"Shruti Koti, Oliver Standring, Nandan Vithlani, Neda Amini, Danielle Deperalta, Gary Deutsch, Martin Karpeh, Matthew Weiss, Neha Lad","doi":"10.1002/jso.28003","DOIUrl":"10.1002/jso.28003","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant chemotherapy (NC) for early pancreatic ductal adenocarcinoma (PDAC) remains controversial. We investigate the adoption of NC and its impact on survival in clinical T1 (cT1) PDAC.</p><p><strong>Methods: </strong>National Cancer Database (2006-2017) was reviewed for cT1 PDAC. Patients receiving NC and surgery were compared with patients undergoing upfront surgery (US).</p><p><strong>Results: </strong>A total of 5886 patients were included. NC use increased from 4.8% in 2006 to 18.8% in 2017. The NC group (n = 618) versus the US group (n = 5268) had: younger age (66 years vs. 68 years), smaller tumor size (2 cm vs. 2.2 cm), more pancreas head tumors (77% vs. 70.6%), lower lymph-vascular invasion (25.9% vs. 40.6%), and less lymph node positivity (43.6% vs. 54.5%), p < 0.001. Factors associated with receipt of NC were: younger age, recent year of diagnosis, and treatment at an academic program. In the NC group versus the US group, median OS was 35.2 months versus 28.3 months, p < 0.001. Factors associated with improved survival included: well differentiated pathology, R0 surgical margins, and receipt of chemotherapy.</p><p><strong>Conclusion: </strong>In cT1 PDAC, chemotherapy is associated with improved survival. In a surgery-first approach, only 59% of patients receive adjuvant chemotherapy. These data suggest consideration of neoadjuvant therapy for early pancreatic cancer.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622933","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}
引用次数: 0
Watch-and-Wait Approach Following Neoadjuvant Chemo-Radiotherapy for Locally Advanced Rectal Cancer: A Retrospective Single-Center Cohort Study. 局部晚期直肠癌新辅助化疗放疗后的观察和等待方法:一项回顾性单中心队列研究。
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-14 DOI: 10.1002/jso.28001
Georgi Kalev, Sylvia Buettner, Tianzuo Zhan, Ralf-Dieter Hofheinz, Judit Boda-Heggemann, Christoph Reissfelder, Steffen Seyfried, Georgi Vassilev, Julia Hardt

Background and objectives: The watch-and-wait (WW) strategy in patients after complete clinical response (cCR) following chemoradiotherapy for locally advanced rectal cancer (LARC) offers the option of organ preservation. The aim of this study was to assess the oncological outcomes of WW patients treated and followed up in a German referral cancer center.

Methods: In this retrospective study, we analyzed the clinical records of consecutive patients with LARC who underwent neoadjuvant radiotherapy/chemoradiotherapy at our institution between January 2020 and December 2023 and received non-operative management after cCR.

Results: A total of 30 patients undergoing WW for LARC were included. After a median follow-up of 17 months (SD = 10 months), local regrowth occurred in four patients (4/30, 13.3%), and one patient (1/30, 3.3%) developed distant metastasis. No predictor for tumor regrowth could be identified based on radiological findings at diagnosis, including cT4 and/or cN2, involvement of the mesorectal fascia, extramural vascular invasion or infiltration of the anal sphincter/levator. All patients with local regrowth were successfully surgically treated (R0 resection).

Conclusion: Nonoperative management for patients with cCR after neoadjuvant therapy for LARC proved to be safe. R0 resection was successfully achieved in all patients who underwent salvage surgery.

背景和目的:对局部晚期直肠癌(LARC)化疗后完全临床反应(cCR)的患者采取观察和等待(WW)策略,可选择保留器官。本研究旨在评估在德国一家癌症转诊中心接受治疗和随访的观察等待策略患者的肿瘤治疗效果:在这项回顾性研究中,我们分析了 2020 年 1 月至 2023 年 12 月期间在我院接受新辅助放疗/化疗的连续 LARC 患者的临床记录,这些患者在接受 cCR 后接受了非手术治疗:结果:共纳入30例接受WW治疗的LARC患者。中位随访 17 个月(SD = 10 个月)后,4 例患者(4/30,13.3%)出现局部生长,1 例患者(1/30,3.3%)出现远处转移。根据诊断时的放射学结果,包括cT4和/或cN2、直肠系膜筋膜受累、壁外血管侵犯或肛门括约肌/提肛肌浸润等,无法确定肿瘤再生的预测因素。所有局部再生的患者都成功接受了手术治疗(R0切除):结论:事实证明,对LARC新辅助治疗后出现cCR的患者进行非手术治疗是安全的。所有接受挽救手术的患者都成功实现了R0切除。
{"title":"Watch-and-Wait Approach Following Neoadjuvant Chemo-Radiotherapy for Locally Advanced Rectal Cancer: A Retrospective Single-Center Cohort Study.","authors":"Georgi Kalev, Sylvia Buettner, Tianzuo Zhan, Ralf-Dieter Hofheinz, Judit Boda-Heggemann, Christoph Reissfelder, Steffen Seyfried, Georgi Vassilev, Julia Hardt","doi":"10.1002/jso.28001","DOIUrl":"https://doi.org/10.1002/jso.28001","url":null,"abstract":"<p><strong>Background and objectives: </strong>The watch-and-wait (WW) strategy in patients after complete clinical response (cCR) following chemoradiotherapy for locally advanced rectal cancer (LARC) offers the option of organ preservation. The aim of this study was to assess the oncological outcomes of WW patients treated and followed up in a German referral cancer center.</p><p><strong>Methods: </strong>In this retrospective study, we analyzed the clinical records of consecutive patients with LARC who underwent neoadjuvant radiotherapy/chemoradiotherapy at our institution between January 2020 and December 2023 and received non-operative management after cCR.</p><p><strong>Results: </strong>A total of 30 patients undergoing WW for LARC were included. After a median follow-up of 17 months (SD = 10 months), local regrowth occurred in four patients (4/30, 13.3%), and one patient (1/30, 3.3%) developed distant metastasis. No predictor for tumor regrowth could be identified based on radiological findings at diagnosis, including cT4 and/or cN2, involvement of the mesorectal fascia, extramural vascular invasion or infiltration of the anal sphincter/levator. All patients with local regrowth were successfully surgically treated (R0 resection).</p><p><strong>Conclusion: </strong>Nonoperative management for patients with cCR after neoadjuvant therapy for LARC proved to be safe. R0 resection was successfully achieved in all patients who underwent salvage surgery.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622947","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}
引用次数: 0
Implementation of a Screening Program for High-Grade Anal Dysplasia in High-Risk Patients in a Tertiary Cancer Center. 在一家三级癌症中心对高危患者实施高级别肛门发育不良筛查计划。
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-13 DOI: 10.1002/jso.27719
Rodrigo Otavio de Castro Araujo, Marcus Valadão, Jose Antonio Dias da Cunha E Silva, Leticia Lintomen, Marianne Monteiro Garrido, Pedro Lucas de Mendonça Barbosa, Maria Midori Miura Piragibe, Keyla Maciel Carvalho, Naomi Jay, Fabio Eudes Leal

Introduction: The incidence of anal squamous cell carcinoma (SCC) has been increasing over the last decades. Human papillomavirus (HPV) infection accounts for more than 90% of anal cancers, and HIV co-infection increases the risk of invasive cancer. Men who have sex with men (MSM) with HIV are the highest risk group for developing anal high-grade squamous intraepithelial lesions (aHSILs), which can be found in 45%-50% of these patients and are precursor lesions for invasive cancer. Anal cytology is an effective screening tool, but it lacks sensitivity. High-resolution anoscopy (HRA) is the gold standard procedure for diagnosis and treatment of aHSILs. Recent data suggest that early detection and treatment of aHSILs could prevent the development of invasive cancer in this population.

Objective: The objective of the study was to describe the implementation of an office-based screening program for anal cancer prevention in a Comprehensive Cancer Center in Brazil.

Methods: Training included participation in the International Anal Neoplasia Society (IANS) HRA course at UCSF Medical Center Mount Zion in San Francisco, CA, USA, by three colorectal cancer surgeons. In-person and hands-on training was provided by a specialist through the AIDS Malignancy Consortium (AMC) of the US NIH. Equipment purchased and provided by the AMC included a colposcope with a digital camera, a hands-free mouse pedal, and a photo documentation imaging software program that allows images to be recorded for documentation and training purposes.

Results: The program was implemented in 2022 after a delay of more than two years due to the COVID-19 pandemic. An average of 24 exams are performed monthly. Patients with HIV aged 35 years or older who are undergoing antiretroviral therapy were recruited from the metropolitan area of Rio de Janeiro and referred by primary care providers for screening. Patients diagnosed with aHSILs are scheduled for in-office ablative treatment in the clinic. From March 2022 to June 2024, 324 exams were performed, and aHSIL was found in 38.2% of 220 high-risk patients, including 45 of 129 MSMs (34.9%), 6 of 19 transgender women (31.6%), and 33 of 72 women living with HIV (45.8%). A total of 69 treatments for aHSIL were performed in 62 patients. Patients are followed on a regular basis and long-term results are awaited, including the effectiveness of local therapy for aHSIL.

Conclusions: The screening and treatment program was successfully implemented in a tertiary comprehensive Cancer Center. Team training and external proctorship were decisive for the achievement of benchmark standards. The program aims to permanently provide screening for the prevention of anal cancer through the detection and treatment of aHSIL within the National Cancer Institute of Brazil for populations considered at-risk for anal cancer.

简介过去几十年来,肛门鳞状细胞癌(SCC)的发病率一直在上升。人类乳头瘤病毒(HPV)感染占肛门癌的 90% 以上,而艾滋病病毒(HIV)合并感染会增加罹患浸润性癌症的风险。感染艾滋病毒的男男性行为者(MSM)是罹患肛门高级别鳞状上皮内病变(aHSILs)的高危人群,45%-50%的患者可发现这种病变,而且这种病变是浸润性癌症的前驱病变。肛门细胞学检查是一种有效的筛查工具,但缺乏敏感性。高分辨率肛门镜检查(HRA)是诊断和治疗 aHSIL 的金标准程序。最近的数据表明,早期发现和治疗 aHSIL 可预防该人群中浸润性癌症的发生:本研究旨在描述巴西一家综合癌症中心实施的基于诊室的肛门癌预防筛查计划:培训包括由三名结直肠癌外科医生参加在美国加利福尼亚州旧金山加州大学旧金山医学中心锡安山举办的国际肛门肿瘤学会(IANS)HRA课程。一名专家通过美国国立卫生研究院艾滋病恶性肿瘤联盟 (AMC) 提供了现场和实践培训。AMC购买并提供的设备包括一个带数码相机的阴道镜、一个免提鼠标踏板和一个照片记录成像软件程序,该软件可记录图像,用于记录和培训:由于 COVID-19 大流行,该计划推迟了两年多,于 2022 年开始实施。平均每月进行 24 次检查。从里约热内卢大都会地区招募正在接受抗逆转录病毒治疗的 35 岁或以上艾滋病毒感染者,由初级保健提供者转介进行筛查。确诊为 aHSIL 的患者将在诊所接受诊室内消融治疗。从 2022 年 3 月到 2024 年 6 月,共进行了 324 次检查,220 名高危患者中有 38.2% 发现了 aHSIL,其中包括 129 名 MSM 中的 45 名(34.9%)、19 名变性女性中的 6 名(31.6%)以及 72 名感染 HIV 的女性中的 33 名(45.8%)。62 名患者共接受了 69 次 aHSIL 治疗。对患者进行定期随访,并等待长期结果,包括对 aHSIL 进行局部治疗的效果:结论:筛查和治疗计划在一家三级综合癌症中心成功实施。团队培训和外部监查是达到基准标准的决定性因素。该计划旨在通过在巴西国家癌症研究所内检测和治疗aHSIL,为被认为有肛门癌风险的人群长期提供筛查,以预防肛门癌。
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引用次数: 0
Total Gastrectomy for Gastric Malignancy: Trends Over 15 Years in Major Morbidity, Mortality, and Patient Selection From The National Surgical Quality Improvement Program. 胃恶性肿瘤全胃切除术:国家外科质量改进计划》15 年来的主要发病率、死亡率和患者选择趋势。
IF 2 3区 医学 Q3 ONCOLOGY Pub Date : 2024-11-13 DOI: 10.1002/jso.27990
Nicholas J Kelly, Neha Shafique, Gabriella N Tortorello, Gracia Vargas, John T Miura, Giorgos C Karakousis

Introduction: We examined trends in major morbidity and mortality following total gastrectomy for malignancy in a national cohort.

Methods: The National Surgical Quality Improvement Program was used to identify patients who underwent total gastrectomy for malignancy from 2007 to 2021. Joinpoint regression was used to determine annual percent changes (APCs) in thirty-day postoperative major morbidity, mortality, and length of stay (LOS). Major morbidity included deep and organ space surgical site infection, venous thromboembolism, cardiac event, pneumonia, acute renal failure, sepsis, and respiratory failure.

Results: Of 3515 patients, the median age was 65 years (IQR = 55-73), 59% were male, and 57.9% were White. Major morbidity was 23%, which did not change over time (APC = -1.4, 95% CI = -3.4 to 0.58), nor were there changes in individual morbidities with time. The most common morbidities were organ space surgical site infection (9.2%) and pneumonia (8.5%). Mortality rate in the study cohort was 2.7% and did not change (APC = -6.2, 95% CI = -13.0 to 1.1). LOS (median 9 days) also did not vary with time (APC = -2.3, 95% CI = -7.8 to 3.9). There was an increase in patients with diabetes (21.6% vs. 11.2%, p < 0.05), BMI ≥ 30 (31.1% vs. 18.2%, p < 0.05), and ASA IV-V status (11.6% vs. 3.5%, p < 0.05).

Conclusion: Morbidity and mortality following total gastrectomy for malignancy have not significantly changed over the last fifteen years. While this may in part be explained by increased patient comorbidity, efforts should be made to improve patient selection and mitigate postoperative complications to allow for timely adjuvant therapies.

简介:我们研究了全国队列中恶性肿瘤全胃切除术后主要发病率和死亡率的趋势:我们研究了全国队列中恶性肿瘤全胃切除术后主要发病率和死亡率的趋势:方法:利用国家外科质量改进计划(National Surgical Quality Improvement Program)来识别 2007 年至 2021 年期间因恶性肿瘤接受全胃切除术的患者。采用连接点回归法确定术后三十天主要发病率、死亡率和住院时间(LOS)的年度百分比变化(APCs)。主要发病率包括深部和器官间隙手术部位感染、静脉血栓栓塞、心脏事件、肺炎、急性肾功能衰竭、败血症和呼吸衰竭:在3515名患者中,中位年龄为65岁(IQR=55-73),59%为男性,57.9%为白人。主要发病率为 23%,随着时间的推移没有变化(APC = -1.4, 95% CI = -3.4-0.58),单个发病率也没有变化。最常见的疾病是器官间隙手术部位感染(9.2%)和肺炎(8.5%)。研究队列中的死亡率为2.7%,没有变化(APC = -6.2,95% CI = -13.0至1.1)。住院时间(中位 9 天)也未随时间变化(APC = -2.3,95% CI = -7.8-3.9)。糖尿病患者有所增加(21.6% 对 11.2%,P 结论:全胃切除术后的发病率和死亡率并没有随着时间的推移而变化:过去十五年中,恶性肿瘤全胃切除术后的发病率和死亡率没有明显变化。虽然部分原因可能是患者合并症增加,但应努力改进患者选择,减少术后并发症,以便及时进行辅助治疗。
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引用次数: 0
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Journal of Surgical Oncology
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