Journal of Surgical Oncology最新文献

Malignant proliferating trichilemmal tumors (MPTT) are rare skin lesions arising from the outer sheath of the hair follicle root. Because of their rarity and difficulty in pathologic identification, these skin lesions are often initially misdiagnosed. After a literature review, we found initial clinical or histopathological misdiagnosis has an associated 10.4-fold increase in recurrence and 2.18-fold increase in deaths.

Introduction: Pancreatic acinar cell carcinoma (pACC) is a rare malignancy with unique clinical and molecular features. The role of chemotherapy in pACC management is not well established.

Methods: The National Cancer Database (NCDB) for pACC was used. Cox regression was used in resected pACC patients to identify significant overall survival (OS) predictors. Patients were then divided based on these risk factors into propensity-matched group of surgery versus surgery + chemotherapy and Kaplan-Meier analysis was performed with log-rank tests to compare OS.

Results: The NCDB 2004-2020 included 1592 pACC patients, 1553 were selected. Median age was 66 and 1090 (70.2%) were males. 622 (40.1%) received chemotherapy only, 257 (16.5%) had surgery only, and 365 (23.5%) had both. 189 Patients who received surgery were only matched to peers who had surgery + chemotherapy. The median OS for surgery only was 57.8 ± 6.0 versus 54.2 ± 9.9 months for surgery + chemotherapy (p = 0.836). Cox regression identified nodal and margin status as independent predictors of OS. Therefore, subgroups of patients with node-negative, node-positive, margin-negative, and margin-positive resections were similarly matched 1:1 for the receipt of surgery only versus surgery + chemotherapy. Only patients with node-positive disease had a significant OS benefit with the addition of chemotherapy (44.2 ± 7.3 vs. 27.5 ± 10.5 months; p = 0.036).

Conclusion: Our analysis suggests that surgical resection remains the cornerstone of therapy for pACC. Node status and margin status are the primary prognosticators. The addition of chemotherapy provides an OS benefit only in node-positive disease.

Background and objectives: Preoperative anemia can impact postoperative outcomes, but its importance in gastrointestinal cancer patients, and significance of anemia etiology remains unclear. We aimed to characterize the frequency and impact of preoperative anemia, and iron-deficiency anemia (IDA), on perioperative outcomes.

Methods: We performed a retrospective cohort study of adult patients undergoing elective gastrointestinal cancer surgery. The primary outcome was the incidence of perioperative RBC transfusion. Secondary outcomes included 90-day postoperative major morbidity, ICU admission, and 90-day hospital readmission. Multivariable analyses were performed to assess the association between preoperative anemia and IDA and outcomes.

Results: Preoperative anemia was present in 55.5% of patients (n = 15 414), and 58.3% of anemic patients were iron deficient. Preoperative anemia was independently associated with increased risk of RBC transfusion (RR 2.88, 95% CI 2.60-3.20), and secondary outcomes. For every preoperative hemoglobin decrease of 1 g/dL, the adjusted risk of perioperative RBC transfusion increased by 40% (RR 1.39, 95% CI 1.37-1.42).

Conclusion: Preoperative anemia is prevalent, and an independent risk factor for adverse postoperative outcomes. Decreases in preoperative hemoglobin levels elevate the risk of transfusion and adverse outcomes, supporting further study to optimize management of treatable causes of preoperative anemia including IDA.

Background and objectives: Neurogenic bladder (NB), a complication of gynecological cancer treatment, entails significant symptoms such as loss of urinary urgency, incontinence, and renal dysfunction. To investigate whether lymphatic fluid stagnation at the pelvis causes NB, we investigated the effectiveness of lymphaticovenular anastomosis (LVA) for NB.

Methods: In this retrospective study between 2014 and April 2024, LVA was performed on 52 patients complaining of preoperative urinary dysfunction with lower extremity lymphedema following pelvic lymphadenectomy in gynecologic cancer treatment. Pre- and postoperative assessments evaluated NB symptoms and volume reduction of lower extremities.

Results: With an average follow-up period of 35.0 months, the volume of the affected limbs was reduced in all patients. Symptoms of urinary function were improved in 44 out of 52 patients, as improved urinary urgency, disappearance of incontinence, and independence from self-catheterization. Among 15 patients who underwent pre- and postoperative questionnaire assessment of NB, the mean score of NB severity decreased significantly from 16.9 ± 7.1 points preoperatively to 4.3 ± 3.6 points postoperatively (p < 0.01).

Conclusions: The specific reason for NB following gynecologic cancer treatment remains unclear. Our study results suggest that lymphatic fluid stagnation itself might be a reason for NB and LVA could reduce these symptoms.

Individuals that identify as lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) make up a medically underserved population, that experience disparities in cancer care. Specific cancer incidence and mortality in this population is understudied, as national cancer registries and cancer surveys have limited data about sexual orientation or gender identity. The LGBTQIA community face disparate cancer outcomes in prevention, screening, diagnosis, and treatment due to barriers that limit access to cancer care. To better understand these concerns, we will take a deep dive into the three primary barriers that prevent access to cancer care: personal, provider and systems barriers.

Background and objectives: Infrequent preoperative goals of care (GOC) documentation leads to challenges in medical decision-making when patients experience postoperative complications. We evaluated the feasibility of enhancing GOC documentation through a patient portal-based values questionnaire.

Methods: A patient values questionnaire (PVQ) was distributed to patients before their Gynecologic Surgical Oncology clinic appointments via an electronic health record (EHR)-based portal from June to October 2023. Surgeons and advanced practice providers were encouraged to address PVQ responses during clinic appointments. Patient acceptability surveys were sent to PVQ respondents and clinicians were interviewed to assess feasibility and acceptability.

Results: PVQ response rate was 225/383 (59%); 29% of all patients had an established cancer diagnosis. Clinicians deemed preoperative GOC documentation important and the PVQ valuable to prepare for unexpected postoperative complications. Accessing questionnaire responses through the EHR was a technical barrier. Clinicians agreed that GOC should be addressed after diagnosis and treatment discussions, but before surgery. Ninety percent of patients felt comfortable discussing GOC at their first clinic appointment.

Conclusion: Patient portals facilitate preoperative GOC documentation, however, clarifying and integrating values into care require ongoing discussions between clinicians and patients. Optimal timing of GOC elicitation is posttreatment planning and before surgery when the patient is most informed.

Background and objectives: Lymphedema treatment has traditionally focused on region-specific interventions. However, recent evidence suggests otherwise. This study aims to evaluate whether the benefits of liposuction for lymphedema are confined to the treated limb or extend to other areas of the body.

Methods: Patients who underwent liposuction for extremity lymphedema between January and June 2023 at Cleveland Clinic were included in the study. Patients with less than 1-year follow-up or incomplete post-operative tracking studies were excluded. Pre- and post-operative evaluations included patient report, 3D volumetric measurements, and indocyanine green lymphography (ICGL). Liposuction was performed under general anesthesia with circumferential removal of pathological bulk.

Results: Thirty-eight limbs in 36 patients (33 females, 3 males, mean age 58 years) underwent surgery. All reported marked improvements, with some noting the improvements as "life-changing." Improvements in lymphatic functions were observed in all operative limbs (38) and non-operative contralateral limbs (38), with an average volume reduction of 30.0% and 19.5%, respectively. ICGL further confirmed improved lymphatic drainage in all limbs (76).

Conclusions: Liposuction, traditionally considered a region-specific treatment for lymphedema, exerts therapeutic effects beyond the surgical site, suggesting broader systemic benefits.

Objective: The outcomes of active surveillance (AS) for pleomorphic adenomas (PA) as an alternative to upfront parotidectomy have not been previously documented in the literature. This cohort study aims to assess the safety and feasibility of AS for parotid gland PA.

Methods: All patients with of previously untreated PA managed between 1990 and 2015 were reviewed. Patients who underwent AS for a minimum of 1 year from the initial consultation were identified. Patient demographics, the reason for AS, tumor growth rate, indication for surgery in those patients eventually operated, final pathology, and surgical sequelae were analyzed.

Results: During the study period, 610 patients with primary PA were treated in our institution. Of whom, 14 (2.3%) underwent AS for a period between 1 and 10 years with a median of 3.73 years (interquartile range [IQR] 1.3-4.9). Patient comorbidities were the most common reason for opting for AS (n = 6, 43%), followed by patients' preference to delay surgery (n = 4, 29%) and older age (n = 2, 14%). The median growth rate was 0.58 mm/year (IQR 0.04, 3.8, range -5.01 to 4.98 mm/year). In patients who eventually underwent parotidectomy (n = 10, 71.4%), the most common reason for intervention was tumor growth (8/10, 80%). Two patients had postsurgical mild transient facial nerve paresis with full recovery, and no carcinomas were discovered on final pathology.

Conclusion: In this selected cohort of patients with PA, the tumor growth rate was lower than traditionally believed. Patients who eventually underwent surgery did not suffer from serious complications and there was no evidence of clinical or pathological malignancy.