Vitello, D. J., N. N. Zaza, K. R. Bates, L. M. Janczewski, G. Rodriguez, and D. J. Bentrem (2024), Current National Treatment Trends for Gastric Adenocarcinoma in the United States. Journal of Surgical Oncology 130 (10): 1563–1572. https://doi.org/10.1002/jso.27863.
D. Bentrem was the Editor-in-Chief of the Journal of Surgical Oncology and simultaneously a coauthor of this article. Measures to manage this potential conflict of interest during the peer review process were not taken. Subsequently, both the peer review process and the content of the article were independently re-evaluated by the publisher's research integrity team. Despite any perceived conflict of interest, the publisher considers the results presented in this article to be reliable.
Vitello， D. J， N. N. Zaza， K. R. Bates， L. M. Janczewski， G. Rodriguez和D. J. Bentrem(2024)，美国胃腺癌的治疗趋势。肿瘤外科杂志，130(10):1563-1572。https://doi.org/10.1002/jso.27863.D。Bentrem是《外科肿瘤学杂志》的主编，同时也是这篇文章的合著者。在同行评审过程中没有采取措施来管理这种潜在的利益冲突。随后，同行评议过程和文章内容都由出版商的研究诚信团队独立重新评估。尽管存在明显的利益冲突，但出版商认为本文提供的结果是可靠的。
{"title":"Correction to “Current National Treatment Trends for Gastric Adenocarcinoma in the United States”","authors":"","doi":"10.1002/jso.70139","DOIUrl":"10.1002/jso.70139","url":null,"abstract":"<p>Vitello, D. J., N. N. Zaza, K. R. Bates, L. M. Janczewski, G. Rodriguez, and D. J. Bentrem (2024), Current National Treatment Trends for Gastric Adenocarcinoma in the United States. <i>Journal of Surgical Oncology</i> 130 (10): 1563–1572. https://doi.org/10.1002/jso.27863.</p><p>D. Bentrem was the Editor-in-Chief of the <i>Journal of Surgical Oncology</i> and simultaneously a coauthor of this article. Measures to manage this potential conflict of interest during the peer review process were not taken. Subsequently, both the peer review process and the content of the article were independently re-evaluated by the publisher's research integrity team. Despite any perceived conflict of interest, the publisher considers the results presented in this article to be reliable.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70139","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph M. Escandón, Lucas Kreutz-Rodrigues, Anthony E. Fadel, Jayson P. Kemble, James T. Paget, Matthew T. Houdek, Boyd Viers, Karim Bakri
Purpose
There is limited evidence regarding the optimal timing of urosymphyseal fistula (USF) repair. Our aim was to conduct a comparative analysis evaluating the postoperative complications and surgical outcomes among patients undergoing surgery for USF, comparing those treated in an early versus delayed fashion.
Methods
Fifty-eight patients with diagnosis of USF and who underwent fistula decompression, pubic bone resection, and urinary tract reconstruction were included. Patients who underwent USF repair within 100 days of diagnosis were classified as having early repair, while those treated after 100 days were considered to have delayed repair.
Results
Thirty-one underwent delayed USF repair (53.4%), while 27 underwent early repair (46.6%). Most patients were male (96.8%). The median age (72 years vs. 69 years, p = 0.13) and mean BMI (28.7 vs. 28.6, p = 0.97) were comparable between groups. The rate of overall 90-day complications following USF repair was comparable between groups (77.4% vs. 63%, p = 0.228). We did not find a difference between the rates early complications among groups. The rates of long-term recurrent pain (46.7% vs. 11.1%, p = 0.004), recurrent osteomyelitis (20% vs. 0%, p = 0.014), and fistula (23.3% vs. 3.7%, p = 0.033) were higher in the delayed USF repair group compared to the early USF repair group. The follow up time was similar between groups too (25.43-months vs. 32.8-months, p = 0.257).
Conclusion
While early USF repair might not affect the incidence of early complications within 90 days post-surgery, it is associated with reduced rates of long-term recurrent pain, recurrent osteomyelitis, and fistula recurrence compared to delayed USF repair.
目的：关于尿联合瘘（USF）修复的最佳时机的证据有限。我们的目的是进行一项比较分析，评估USF手术患者的术后并发症和手术结果，比较早期和延迟治疗的患者。方法：58例确诊为USF并行瘘管减压、耻骨切除、尿路重建的患者。诊断100天内接受USF修复的患者被归类为早期修复，而100天后接受治疗的患者被认为是延迟修复。结果：延迟修复31例（53.4%），早期修复27例（46.6%）。患者以男性居多（96.8%）。中位年龄（72岁对69岁，p = 0.13）和平均BMI（28.7对28.6,p = 0.97）组间具有可比性。两组间USF修复后90天总并发症发生率相当（77.4% vs. 63%, p = 0.228）。我们没有发现组间早期并发症发生率的差异。与早期USF修复组相比，延迟USF修复组的长期复发性疼痛（46.7%对11.1%,p = 0.004）、复发性骨髓炎（20%对0%，p = 0.014）和瘘管（23.3%对3.7%,p = 0.033）发生率更高。两组间随访时间相似（25.43个月vs 32.8个月，p = 0.257）。结论：虽然早期USF修复可能不会影响术后90天内早期并发症的发生率，但与延迟USF修复相比，它可以降低长期复发性疼痛、复发性骨髓炎和瘘复发率。
{"title":"Timing for Repair of Urosymphyseal Fistula After Diagnosis Determines the Incidence Postoperative Outcomes","authors":"Joseph M. Escandón, Lucas Kreutz-Rodrigues, Anthony E. Fadel, Jayson P. Kemble, James T. Paget, Matthew T. Houdek, Boyd Viers, Karim Bakri","doi":"10.1002/jso.70133","DOIUrl":"10.1002/jso.70133","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>There is limited evidence regarding the optimal timing of urosymphyseal fistula (USF) repair. Our aim was to conduct a comparative analysis evaluating the postoperative complications and surgical outcomes among patients undergoing surgery for USF, comparing those treated in an early versus delayed fashion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Fifty-eight patients with diagnosis of USF and who underwent fistula decompression, pubic bone resection, and urinary tract reconstruction were included. Patients who underwent USF repair within 100 days of diagnosis were classified as having early repair, while those treated after 100 days were considered to have delayed repair.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-one underwent delayed USF repair (53.4%), while 27 underwent early repair (46.6%). Most patients were male (96.8%). The median age (72 years vs<i>.</i> 69 years, <i>p</i> = 0.13) and mean BMI (28.7 vs<i>.</i> 28.6, <i>p</i> = 0.97) were comparable between groups. The rate of overall 90-day complications following USF repair was comparable between groups (77.4% vs<i>.</i> 63%, <i>p</i> = 0.228). We did not find a difference between the rates early complications among groups. The rates of long-term recurrent pain (46.7% vs<i>.</i> 11.1%, <i>p</i> = 0.004), recurrent osteomyelitis (20% vs<i>.</i> 0%, <i>p</i> = 0.014), and fistula (23.3% vs<i>.</i> 3.7%, <i>p</i> = 0.033) were higher in the delayed USF repair group compared to the early USF repair group. The follow up time was similar between groups too (25.43-months vs<i>.</i> 32.8-months, <i>p</i> = 0.257).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>While early USF repair might not affect the incidence of early complications within 90 days post-surgery, it is associated with reduced rates of long-term recurrent pain, recurrent osteomyelitis, and fistula recurrence compared to delayed USF repair.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 2","pages":"217-225"},"PeriodicalIF":1.9,"publicationDate":"2025-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145701272","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}
Jon-Luc Poirier, Spencer M. Richardson, Adam M. Knox, L. Daniel Wurtz, Christopher D. Collier
Background
Resection of extremity soft tissue tumors is common and frequently performed by orthopedic, plastic, and general surgeons. It is unknown if tumor location, Preoperative workup, and Postoperative care varies by specialty, which is the aim of this study.
Methods
A retrospective review was performed of 4,223 soft tissue tumors resected from the extremities and pelvis within a large single-state health system between 2009 and 2019. A more detailed cross-sectional review was performed on 450 tumors resected in 2016. Demographic and tumor characteristics, surgeon specialty (orthopedic, plastic, general), Preoperative workup (imaging, biopsy), and Postoperative management were collected and analyzed.
Results
General surgeons were more likely to resect tumors superficial to fascia (82.1%), compared to plastic and orthopedic surgeons (53.7% and 27.9%). Orthopedic surgeons were more likely to resect malignant tumors (28.2%) than plastic and general surgeons (14.0% and 4.5%). 16.3% of tumors resected by general surgeons had either Preoperative MRI or tissue diagnosis, compared to 42.6% for plastic surgeons and 90.5% for orthopedic surgeons (p < 0.001). Of the tumors resected by general surgeons without Preoperative MRI or tissue diagnosis, 2.6% were malignant. Finally, Postoperative documentation of neurovascular status, range of motion, and referral to physical therapy were more likely performed by orthopedic surgeons (all p < 0.001).
Conclusion
Practice patterns vary significantly among orthopedic, plastic, and general surgeons treating soft tissue tumors of the extremities and pelvis. These findings highlight the need for multidisciplinary engagement and standardization of treatment algorithms and training practices across the various surgical specialties.
{"title":"Practice Patterns Vary Among Orthopedic, Plastic, and General Surgeons Resecting Soft Tissue Tumors of the Extremities and Pelvis","authors":"Jon-Luc Poirier, Spencer M. Richardson, Adam M. Knox, L. Daniel Wurtz, Christopher D. Collier","doi":"10.1002/jso.70147","DOIUrl":"10.1002/jso.70147","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Resection of extremity soft tissue tumors is common and frequently performed by orthopedic, plastic, and general surgeons. It is unknown if tumor location, Preoperative workup, and Postoperative care varies by specialty, which is the aim of this study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective review was performed of 4,223 soft tissue tumors resected from the extremities and pelvis within a large single-state health system between 2009 and 2019. A more detailed cross-sectional review was performed on 450 tumors resected in 2016. Demographic and tumor characteristics, surgeon specialty (orthopedic, plastic, general), Preoperative workup (imaging, biopsy), and Postoperative management were collected and analyzed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>General surgeons were more likely to resect tumors superficial to fascia (82.1%), compared to plastic and orthopedic surgeons (53.7% and 27.9%). Orthopedic surgeons were more likely to resect malignant tumors (28.2%) than plastic and general surgeons (14.0% and 4.5%). 16.3% of tumors resected by general surgeons had either Preoperative MRI or tissue diagnosis, compared to 42.6% for plastic surgeons and 90.5% for orthopedic surgeons (<i>p</i> < 0.001). Of the tumors resected by general surgeons without Preoperative MRI or tissue diagnosis, 2.6% were malignant. Finally, Postoperative documentation of neurovascular status, range of motion, and referral to physical therapy were more likely performed by orthopedic surgeons (all <i>p</i> < 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Practice patterns vary significantly among orthopedic, plastic, and general surgeons treating soft tissue tumors of the extremities and pelvis. These findings highlight the need for multidisciplinary engagement and standardization of treatment algorithms and training practices across the various surgical specialties.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"101-107"},"PeriodicalIF":1.9,"publicationDate":"2025-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747694/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Effective communication in oncological reconstructive surgery is fundamental to ensuring patient comprehension, trust, and informed consent. Yet, the use of deviant terminology—language that is misleading, euphemistic, or excessively technical—can obstruct doctor-patient understanding. This article examines how such terminology, common across both clinical and promotional settings, affects patients’ interpretation of reconstructive and restorative procedures following cancer treatment. Expressions such as “minimally invasive” or cosmetic marketing terms like “mommy makeover” may obscure the complexity and risk of interventions, while excessive jargon can alienate patients. These linguistic distortions risk undermining informed consent and shared decision-making. To address this, surgeons working within oncological contexts should prioritise plain language, apply the teach-back method, and adopt standardised terminology supported by professional associations. Furthermore, cultural competence and visual decision aids can enhance comprehension, particularly among diverse patient populations. By aligning terminology with medical accuracy and patient needs, reconstructive surgeons can promote transparency, safety, and patient-centred care throughout the oncological journey.
{"title":"Deviant Terminology in Oncological Reconstructive Surgery: Implications for Communication and Ethical Practice","authors":"Bruno Di Pace, Roxanne H. Padley","doi":"10.1002/jso.70146","DOIUrl":"10.1002/jso.70146","url":null,"abstract":"<div>\u0000 \u0000 <p>Effective communication in oncological reconstructive surgery is fundamental to ensuring patient comprehension, trust, and informed consent. Yet, the use of <i>deviant terminology</i>—language that is misleading, euphemistic, or excessively technical—can obstruct doctor-patient understanding. This article examines how such terminology, common across both clinical and promotional settings, affects patients’ interpretation of reconstructive and restorative procedures following cancer treatment. Expressions such as “minimally invasive” or cosmetic marketing terms like “mommy makeover” may obscure the complexity and risk of interventions, while excessive jargon can alienate patients. These linguistic distortions risk undermining informed consent and shared decision-making. To address this, surgeons working within oncological contexts should prioritise plain language, apply the teach-back method, and adopt standardised terminology supported by professional associations. Furthermore, cultural competence and visual decision aids can enhance comprehension, particularly among diverse patient populations. By aligning terminology with medical accuracy and patient needs, reconstructive surgeons can promote transparency, safety, and patient-centred care throughout the oncological journey.</p>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"8-10"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635041","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}
Kole Joachim, Amanda Perrotta, Adrian Lin, Sumin Jeong, Brandon Gettleman, Christopher Hamad, Michael Fice, Lauren E. Wessel, Nicholas M. Bernthal, Alexander B. Christ
Introduction
External hemipelvectomy and hip disarticulation represent some of the most complex oncologic procedures; however, the actual excess morbidity compared to matched controls remains poorly quantified. We aimed to quantify the excess risk and resource utilization associated with major amputations using a distance-weighted methodology.
Methods
We conducted a retrospective cohort study using National Surgical Quality Improvement Program (NSQIP) data (2019–2023). Patients undergoing external hemipelvectomy or hip disarticulation (major amputation cohort) (n = 52) were compared to composite controls created from patients undergoing other pelvic oncologic procedures (n = 152). Composite controls were generated using distance-weighted matching based on 16 variables, including demographics, comorbidities, laboratory values, and procedural complexity. Primary outcomes included length of stay, uncomplicated outcome (defined as the absence of major complications, readmissions, reoperations, mortality, and length of stay ≤75th percentile), and massive transfusion.
Results
The major amputation cohort demonstrated significant excess morbidity with 5.0 days longer length of stay (9.0 vs 4.0 days, p < 0.001), 40.3% lower uncomplicated outcome rate (34.6% vs 74.9%, p < 0.001), and a trend towards excess massive transfusion risk (5.8% vs 0.0%, p = 0.083).
Conclusion
Distance-weighted matching demonstrated that major amputations carry excess morbidity and resource utilization with prolonged hospitalization and reduced uncomplicated outcome probability.
{"title":"Distance Weighted Matching in the Quantification of Excess Morbidity in External Hemipelvectomy and Hip Disarticulation","authors":"Kole Joachim, Amanda Perrotta, Adrian Lin, Sumin Jeong, Brandon Gettleman, Christopher Hamad, Michael Fice, Lauren E. Wessel, Nicholas M. Bernthal, Alexander B. Christ","doi":"10.1002/jso.70144","DOIUrl":"10.1002/jso.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>External hemipelvectomy and hip disarticulation represent some of the most complex oncologic procedures; however, the actual excess morbidity compared to matched controls remains poorly quantified. We aimed to quantify the excess risk and resource utilization associated with major amputations using a distance-weighted methodology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a retrospective cohort study using National Surgical Quality Improvement Program (NSQIP) data (2019–2023). Patients undergoing external hemipelvectomy or hip disarticulation (major amputation cohort) (<i>n</i> = 52) were compared to composite controls created from patients undergoing other pelvic oncologic procedures (<i>n</i> = 152). Composite controls were generated using distance-weighted matching based on 16 variables, including demographics, comorbidities, laboratory values, and procedural complexity. Primary outcomes included length of stay, uncomplicated outcome (defined as the absence of major complications, readmissions, reoperations, mortality, and length of stay ≤75th percentile), and massive transfusion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The major amputation cohort demonstrated significant excess morbidity with 5.0 days longer length of stay (9.0 vs 4.0 days, <i>p</i> < 0.001), 40.3% lower uncomplicated outcome rate (34.6% vs 74.9%, <i>p</i> < 0.001), and a trend towards excess massive transfusion risk (5.8% vs 0.0%, <i>p</i> = 0.083).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Distance-weighted matching demonstrated that major amputations carry excess morbidity and resource utilization with prolonged hospitalization and reduced uncomplicated outcome probability.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"108-116"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145635015","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}
Reem Y. Albuainain, Reem Althawadi, Raja Eid, Hussain A. Abdulla
Background and Objectives
Increasing evidence supports the oncologic safety of omitting axillary surgery for patients with early breast cancer undergoing breast conserving surgery (BCS). However, there is concern that sentinel lymph node biopsy (SLNB) is necessary to inform adjuvant radiotherapy and systemic therapy decisions. The aim was to assess the oncological and survival outcomes of omitting surgical axillary staging in early breast cancer.
Methods
A systematic literature search of relevant databases was performed. Eligible studies compared omission of axillary surgery with conventional axillary staging. A meta-analysis using the Mantel-Haenszel method was performed to calculate pooled risk ratios (RR) for axillary recurrence (AR), disease-free survival (DFS) and overall survival (OS) for omission of axillary surgery compared with conventional axillary surgery.
Results
Five studies involving 8108 patients were included. Omission of axillary surgery was associated with a higher risk of AR (RR 3.82 95% CI 1.48–9.82, p < 0.005). No significant differences were observed in in DFS (RR 1.09 95% CI 0.91–1.30, p = 0.33) or OS (RR 1.06 95% CI 0.72–1.55; p = 0.78).
Conclusions
Axillary surgery may be safely omitted in a highly select group of older patients with favourable tumour biology undergoing BCS. Multidisciplinary team input remains essential to appropriately select adjuvant treatments when nodal staging is omitted.
背景和目的：越来越多的证据支持早期乳腺癌患者行保乳手术（BCS）时省略腋窝手术的肿瘤学安全性。然而，有人担心前哨淋巴结活检（SLNB）对于辅助放疗和全身治疗决策是必要的。目的是评估早期乳腺癌省略手术腋窝分期的肿瘤学和生存结果。方法：对相关数据库进行系统的文献检索。符合条件的研究比较了遗漏腋窝手术与常规腋窝分期。采用Mantel-Haenszel方法进行荟萃分析，计算与常规腋窝手术相比，遗漏腋窝手术的腋窝复发（AR）、无病生存（DFS）和总生存（OS）的合并风险比（RR）。结果：纳入5项研究，共8108例患者。省略腋窝手术与AR的高风险相关（RR 3.82 95% CI 1.48-9.82, p）。结论：在高度选择性的肿瘤生物学良好的老年患者行BCS时，可以安全省略腋窝手术。当忽略淋巴结分期时，多学科团队的投入对于适当选择辅助治疗仍然至关重要。
{"title":"Oncological Outcomes of Omitting Axillary Surgery in Early Breast Cancer: A Systematic Review and Meta-Analysis","authors":"Reem Y. Albuainain, Reem Althawadi, Raja Eid, Hussain A. Abdulla","doi":"10.1002/jso.70145","DOIUrl":"10.1002/jso.70145","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Increasing evidence supports the oncologic safety of omitting axillary surgery for patients with early breast cancer undergoing breast conserving surgery (BCS). However, there is concern that sentinel lymph node biopsy (SLNB) is necessary to inform adjuvant radiotherapy and systemic therapy decisions. The aim was to assess the oncological and survival outcomes of omitting surgical axillary staging in early breast cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic literature search of relevant databases was performed. Eligible studies compared omission of axillary surgery with conventional axillary staging. A meta-analysis using the Mantel-Haenszel method was performed to calculate pooled risk ratios (RR) for axillary recurrence (AR), disease-free survival (DFS) and overall survival (OS) for omission of axillary surgery compared with conventional axillary surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five studies involving 8108 patients were included. Omission of axillary surgery was associated with a higher risk of AR (RR 3.82 95% CI 1.48–9.82, <i>p</i> < 0.005). No significant differences were observed in in DFS (RR 1.09 95% CI 0.91–1.30, <i>p</i> = 0.33) or OS (RR 1.06 95% CI 0.72–1.55; <i>p</i> = 0.78).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Axillary surgery may be safely omitted in a highly select group of older patients with favourable tumour biology undergoing BCS. Multidisciplinary team input remains essential to appropriately select adjuvant treatments when nodal staging is omitted.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 2","pages":"133-140"},"PeriodicalIF":1.9,"publicationDate":"2025-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145634989","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}
Ahmed Alnajar, Mehmet Akcin, John I. Lew, Tanaz M. Vaghaiwalla
Background
Patients with early-stage well-differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of health (SDH) and care at Minority-Serving Hospitals (MSHs) on outcomes remains understudied. This study evaluates the combined influence of SDH and hospital type on long-term survival in sbNETs.
Methods
The 2010–2020 National Cancer Database was queried for adults with G1/G2 sbNETs, Stage I/II disease, who underwent surgical resection. Patients with G3 NETs, Stage III/IV disease, neuroendocrine carcinoma, duodenal primary tumors, or incomplete follow-up were excluded. A composite SDH score was developed using four sociogeographic factors: (1) low income, (2) low education, (3) rurality, (4) travel distance > 250 miles. Patients were categorized as SDH+ (score 0–1) or SDH– burden (score 2–4). Hospitals in the top decile for Black and Hispanic representation were classified as MSHs. Kaplan-Meier and Cox regression analyses were performed.
Results
Among 2688 patients (median age 64; 48% female), 57% were SDH–. Five-, 10-, and 15-year survival rates were 79%, 62%, and 49%, respectively. At MSHs, 5-year survival was 82% for SDH+ versus 63% for SDH–. At non-MSHs, survival was 82% for SDH+ versus 77% for SDH–. Median survival for SDH– patients was 11 years at MSHs versus 12 at non-MSHs. In regression analysis, SDH– status was linked to worse survival (HR 1.24, p < 0.001); treatment at non-MSHs predicted better survival (HR 0.41, p < 0.001). Black patients had higher mortality risk (HR 1.20, p = 0.002); no difference was observed for Hispanic patients.
Conclusion
Higher SDH burden and treatment at MSHs were associated with decreased survival in early-stage sbNETs. Implementing a composite SDH score in clinical practice may provide a practical tool for risk stratification and guide equity-focused interventions for patients with sbNETs.
{"title":"Higher Composite Social Determinants of Health Scores Are Associated With Worse Survival in Patients With Small Bowel Neuroendocrine Tumors","authors":"Ahmed Alnajar, Mehmet Akcin, John I. Lew, Tanaz M. Vaghaiwalla","doi":"10.1002/jso.70143","DOIUrl":"10.1002/jso.70143","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Patients with early-stage well-differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of health (SDH) and care at Minority-Serving Hospitals (MSHs) on outcomes remains understudied. This study evaluates the combined influence of SDH and hospital type on long-term survival in sbNETs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The 2010–2020 National Cancer Database was queried for adults with G1/G2 sbNETs, Stage I/II disease, who underwent surgical resection. Patients with G3 NETs, Stage III/IV disease, neuroendocrine carcinoma, duodenal primary tumors, or incomplete follow-up were excluded. A composite SDH score was developed using four sociogeographic factors: (1) low income, (2) low education, (3) rurality, (4) travel distance > 250 miles. Patients were categorized as SDH+ (score 0–1) or SDH– burden (score 2–4). Hospitals in the top decile for Black and Hispanic representation were classified as MSHs. Kaplan-Meier and Cox regression analyses were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 2688 patients (median age 64; 48% female), 57% were SDH–. Five-, 10-, and 15-year survival rates were 79%, 62%, and 49%, respectively. At MSHs, 5-year survival was 82% for SDH+ versus 63% for SDH–. At non-MSHs, survival was 82% for SDH+ versus 77% for SDH–. Median survival for SDH– patients was 11 years at MSHs versus 12 at non-MSHs. In regression analysis, SDH– status was linked to worse survival (HR 1.24, <i>p</i> < 0.001); treatment at non-MSHs predicted better survival (HR 0.41, <i>p</i> < 0.001). Black patients had higher mortality risk (HR 1.20, <i>p</i> = 0.002); no difference was observed for Hispanic patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher SDH burden and treatment at MSHs were associated with decreased survival in early-stage sbNETs. Implementing a composite SDH score in clinical practice may provide a practical tool for risk stratification and guide equity-focused interventions for patients with sbNETs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"117-125"},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747697/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rena A. Li, Antoinette T. Nguyen, Kethan Bajaj, Brigid M. Coles, Robert D. Galiano
Backgrounds and Methods
American Indian and Alaska Native (AI/AN) populations face significant health disparities across multiple cancer types, yet melanoma-specific outcomes remain under-investigated. A comprehensive search of Embase, Scopus, and PubMed identified 20 studies meeting inclusion criteria. Three meta-analyses were conducted using random effects models to assess: (1) adjusted hazard ratios for mortality risk, (2) adjusted odds ratios for late-stage diagnosis, and (3) age-adjusted incidence rates.
Results
The meta-analysis revealed significant disparities in melanoma outcomes for AI/AN patients. AI/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR = 1.43, 95% CI: 1.12–1.82, p = 0.0041) and a 75% higher likelihood of late-stage diagnosis (pooled adjusted OR = 1.75, 95% CI: 1.16–2.65, p = 0.0080). AI/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages.
Conclusion
This study provides the first meta-analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care.
Discussion
These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI/AN communities.
背景和方法：美国印第安人和阿拉斯加原住民（AI/AN）人群在多种癌症类型中面临显著的健康差异，但黑色素瘤特异性结局仍未得到充分研究。Embase、Scopus和PubMed的综合检索确定了20项符合纳入标准的研究。使用随机效应模型进行了三项荟萃分析，以评估：(1)死亡率风险的校正风险比，(2)晚期诊断的校正优势比，(3)年龄校正发病率。结果：荟萃分析显示AI/AN患者的黑色素瘤结局存在显著差异。与白人患者相比，AI/AN患者的死亡风险高43%（合并aHR = 1.43, 95% CI: 1.12-1.82, p = 0.0041），晚期诊断的可能性高75%（合并调整OR = 1.75, 95% CI: 1.16-2.65, p = 0.0080）。AI/AN患者始终表现出较差的预后因素，包括更高的Breslow厚度、溃疡率增加和更晚期的疾病阶段。结论：本研究提供了第一个荟萃分析证据，证明AI/AN人群中黑色素瘤结局的统计学显著差异。系统性障碍包括保险差异、地理隔离、治疗延误和获得专业皮肤科护理的机会有限。讨论：这些发现证明有针对性的干预措施是合理的，包括加强筛查计划、改善医疗基础设施和政策改革，以解决影响人工智能/人工智能社区的保险和获取障碍。
{"title":"Disparities in Cutaneous Melanoma Diagnosis and Survival Among American Indian and Alaskan Native Patients: A Systematic Review and Meta-Analysis","authors":"Rena A. Li, Antoinette T. Nguyen, Kethan Bajaj, Brigid M. Coles, Robert D. Galiano","doi":"10.1002/jso.70136","DOIUrl":"10.1002/jso.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Backgrounds and Methods</h3>\u0000 \u0000 <p>American Indian and Alaska Native (AI/AN) populations face significant health disparities across multiple cancer types, yet melanoma-specific outcomes remain under-investigated. A comprehensive search of Embase, Scopus, and PubMed identified 20 studies meeting inclusion criteria. Three meta-analyses were conducted using random effects models to assess: (1) adjusted hazard ratios for mortality risk, (2) adjusted odds ratios for late-stage diagnosis, and (3) age-adjusted incidence rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The meta-analysis revealed significant disparities in melanoma outcomes for AI/AN patients. AI/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR = 1.43, 95% CI: 1.12–1.82, <i>p</i> = 0.0041) and a 75% higher likelihood of late-stage diagnosis (pooled adjusted OR = 1.75, 95% CI: 1.16–2.65, <i>p</i> = 0.0080). AI/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides the first meta-analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI/AN communities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"54-72"},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145588023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anouk Benseler, Adina Tanen, Taymaa May, Lisa Avery, Genevieve Bouchard-Fortier, Marcus Q. Bernardini, Liat Hogen
Background and Objective
Stage IVB high-grade serous ovarian cancer (HGSOC) carries a poor prognosis. We aimed to: (1) describe the characteristics and survival of patients treated with primary cytoreductive surgery (PCS), interval cytoreductive surgery (ICS) or chemotherapy alone, (2) investigate the correlation between disease distribution and treatment type, and (3) evaluate the impact of cytoreductive surgery (CS) “aggressiveness” and outcome on survival.
Methods
A single-center retrospective cohort study of Stage IVB HGSOC patients. Demographics, tumor characteristics, treatment including “aggressive” CS (upper abdominal and extraperitoneal procedures), and outcomes were analyzed using descriptive statistics and survival analysis, with nonparametric tests and Cox-proportional hazard models.
Results
Of 110 patients, 24 (22%) underwent PCS, 73 (66%) ICS, and 13 (12%) chemotherapy alone. Median overall survival (OS) was 76.2 (PCS), 36.9 (ICS), and 20.1 months (chemotherapy alone) (p = 0.014). Supradiaphragmatic lymph-node metastasis differed across groups (p = 0.042). “Aggressive” CS was performed in 53.6% of the surgical cohort, with 54.86% no-gross-residual (NGR), 34% optimal ≤ 1 cm ≤ and 11.3% suboptimal/aborted surgical outcome. Median OS post CS for NGR, optimal ≤ 1 cm, and suboptimal was 67.55, 35.26, and 20.97 months, respectively (p = 0.006).
Conclusions
OS for Stage IVB HGSOC follows a hierarchical pattern: PCS, ICS, and chemotherapy. Disease distribution guides treatment and residual tumor after CS correlates with survival.
{"title":"Treatment Strategy and Residual Disease as Determinants of Survival in Stage IVB High-Grade Serous Ovarian Cancer: A Retrospective Cohort Study","authors":"Anouk Benseler, Adina Tanen, Taymaa May, Lisa Avery, Genevieve Bouchard-Fortier, Marcus Q. Bernardini, Liat Hogen","doi":"10.1002/jso.70142","DOIUrl":"10.1002/jso.70142","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>Stage IVB high-grade serous ovarian cancer (HGSOC) carries a poor prognosis. We aimed to: (1) describe the characteristics and survival of patients treated with primary cytoreductive surgery (PCS), interval cytoreductive surgery (ICS) or chemotherapy alone, (2) investigate the correlation between disease distribution and treatment type, and (3) evaluate the impact of cytoreductive surgery (CS) “aggressiveness” and outcome on survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-center retrospective cohort study of Stage IVB HGSOC patients. Demographics, tumor characteristics, treatment including “aggressive” CS (upper abdominal and extraperitoneal procedures), and outcomes were analyzed using descriptive statistics and survival analysis, with nonparametric tests and Cox-proportional hazard models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 110 patients, 24 (22%) underwent PCS, 73 (66%) ICS, and 13 (12%) chemotherapy alone. Median overall survival (OS) was 76.2 (PCS), 36.9 (ICS), and 20.1 months (chemotherapy alone) (<i>p</i> = 0.014). Supradiaphragmatic lymph-node metastasis differed across groups (<i>p</i> = 0.042). “Aggressive” CS was performed in 53.6% of the surgical cohort, with 54.86% no-gross-residual (NGR), 34% optimal ≤ 1 cm ≤ and 11.3% suboptimal/aborted surgical outcome. Median OS post CS for NGR, optimal ≤ 1 cm, and suboptimal was 67.55, 35.26, and 20.97 months, respectively (<i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>OS for Stage IVB HGSOC follows a hierarchical pattern: PCS, ICS, and chemotherapy. Disease distribution guides treatment and residual tumor after CS correlates with survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"73-80"},"PeriodicalIF":1.9,"publicationDate":"2025-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号