Kristen N. Kaiser, Alexa J. Hughes, Jeannette W. Chung, Adam S. Wilk, Katie Ross-Driscoll, Rachel E. Patzer, Karl Y. Bilimoria, Ryan J. Ellis
Introduction
Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, classification and regression trees (CART), stratum specific likelihood ratios (SSLR)). The objective of this study was to compare variation in hospital-level VTs for pancreatectomy across multiple methodologies.
Methods
Patients undergoing pancreatectomy from 2004 to 2021 were identified using the National Cancer Database. RCS, optimal cutpoints, CART, and SSLR were used to compute VTs based on 90-day mortality. From a single clinical data set, VTs were derived multiple times for each method by varying statistical parameters within each model.
Results
Overall, 61,920 patients underwent pancreatectomy at 982 hospitals. VTs associated with reductions in 90-day mortality ranged from 9.2 to 26.1 cases/year (RCS), 15.7–33.8 cases/year (optimal cutpoints), and 11–18 cases/year (CART), all based on modifiable statistical parameters. SSLR analysis yielded a singular VT of 21 cases/year without variability due to lack of statistical input.
Conclusion
Among 4 common strategies for identifying VT that we studied, SSLR required the fewest assumptions. This may make it ideal for enhancing transparency and standardization in outcomes reporting.
{"title":"Reproducibility and Consistency of Methods to Define Hospital-Level Procedural Volume Thresholds for Pancreatectomy","authors":"Kristen N. Kaiser, Alexa J. Hughes, Jeannette W. Chung, Adam S. Wilk, Katie Ross-Driscoll, Rachel E. Patzer, Karl Y. Bilimoria, Ryan J. Ellis","doi":"10.1002/jso.70134","DOIUrl":"10.1002/jso.70134","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, classification and regression trees (CART), stratum specific likelihood ratios (SSLR)). The objective of this study was to compare variation in hospital-level VTs for pancreatectomy across multiple methodologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing pancreatectomy from 2004 to 2021 were identified using the National Cancer Database. RCS, optimal cutpoints, CART, and SSLR were used to compute VTs based on 90-day mortality. From a single clinical data set, VTs were derived multiple times for each method by varying statistical parameters within each model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 61,920 patients underwent pancreatectomy at 982 hospitals. VTs associated with reductions in 90-day mortality ranged from 9.2 to 26.1 cases/year (RCS), 15.7–33.8 cases/year (optimal cutpoints), and 11–18 cases/year (CART), all based on modifiable statistical parameters. SSLR analysis yielded a singular VT of 21 cases/year without variability due to lack of statistical input.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among 4 common strategies for identifying VT that we studied, SSLR required the fewest assumptions. This may make it ideal for enhancing transparency and standardization in outcomes reporting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"92-100"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530728","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}
Jason M. Aubrey, Hannah R Liefeld, Colleen Armstrong, Anna Levine, Jessica Thompson, Amie Hop, G. Paul Wright
Background
Breast cancer management requires complex decision-making and varies widely at international, national, and institutional levels. Our study evaluates the impact of nonpunitive, real-time reviews of individual surgeons' practice patterns within a single institution.
Methods
Data from a prospective breast cancer database from the prior 12-month period were reviewed every 6 months in unblinded sessions. Surgeons compared their practices with those of their colleagues during three review sessions, without any benchmarks or punitive measures.
Results
A mean of 663 cases were reviewed for each 12-month period. Significant changes in practice patterns were observed, including notable reductions in re-excision rates (20.1% vs. 11.2%, p < 0.001), sentinel lymph node (SLN) biopsy utilization in patients over 70 with favorable biology (24.2% vs. 12.2%, p = 0.037), intraoperative SLN analysis in surgery-first patients (28.7% vs. 2.7%, p < 0.001), and immediate breast reconstruction (46.2% vs. 34.7%, p = 0.027). Additionally, there were significant increases in the use of breast conserving therapy (75.3% vs. 83.1%, p = 0.006) and outpatient mastectomy (58.4% vs. 79.9%, p < 0.001). Clinical variation in intraoperative SLN analysis and prophylactic measures was notably reduced. These adjustments resulted in an estimated annual cost saving of $467 619.
Conclusions
Practice pattern reviews significantly altered surgical practices, reducing clinical variation and demonstrating that strategic investments in quality initiatives can greatly enhance resource utilization and generate substantial cost savings.
背景：乳腺癌管理需要复杂的决策，在国际、国家和机构层面差异很大。我们的研究评估了对单个机构内单个外科医生的实践模式进行非惩罚性、实时评估的影响。方法：每6个月回顾一次前瞻性乳腺癌数据库中过去12个月的数据。在没有任何基准或惩罚措施的情况下，外科医生将他们的做法与同事进行了三次评估。结果：平均每12个月复查663例。我们观察到实践模式的显著变化，包括再切除率的显著降低（20.1% vs. 11.2%）。结论：实践模式回顾显著改变了手术实践，减少了临床差异，并证明对质量倡议的战略投资可以极大地提高资源利用率，并产生大量的成本节约。
{"title":"Prospective Review of Practice Patterns in Breast Cancer Surgery Facilitates Rapid Practice Change, Reduced Clinical Variation, and Cost Savings","authors":"Jason M. Aubrey, Hannah R Liefeld, Colleen Armstrong, Anna Levine, Jessica Thompson, Amie Hop, G. Paul Wright","doi":"10.1002/jso.70130","DOIUrl":"10.1002/jso.70130","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Breast cancer management requires complex decision-making and varies widely at international, national, and institutional levels. Our study evaluates the impact of nonpunitive, real-time reviews of individual surgeons' practice patterns within a single institution.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from a prospective breast cancer database from the prior 12-month period were reviewed every 6 months in unblinded sessions. Surgeons compared their practices with those of their colleagues during three review sessions, without any benchmarks or punitive measures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A mean of 663 cases were reviewed for each 12-month period. Significant changes in practice patterns were observed, including notable reductions in re-excision rates (20.1% vs. 11.2%, <i>p</i> < 0.001), sentinel lymph node (SLN) biopsy utilization in patients over 70 with favorable biology (24.2% vs. 12.2%, <i>p</i> = 0.037), intraoperative SLN analysis in surgery-first patients (28.7% vs. 2.7%, <i>p</i> < 0.001), and immediate breast reconstruction (46.2% vs. 34.7%, <i>p</i> = 0.027). Additionally, there were significant increases in the use of breast conserving therapy (75.3% vs. 83.1%, <i>p</i> = 0.006) and outpatient mastectomy (58.4% vs. 79.9%, <i>p</i> < 0.001). Clinical variation in intraoperative SLN analysis and prophylactic measures was notably reduced. These adjustments resulted in an estimated annual cost saving of $467 619.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Practice pattern reviews significantly altered surgical practices, reducing clinical variation and demonstrating that strategic investments in quality initiatives can greatly enhance resource utilization and generate substantial cost savings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"39-45"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530755","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}
Alanna Hickey, Gabriel De la Cruz Ku, Caroline King, Camila Franco, Saman Namazian, Sarah Roberts, Kabir A. Torres, Sarah Persing, Salvatore Nardello, Abhishek Chatterjee
Background
The 21-gene recurrence score is a useful tool to predict the recurrence risk in patients with early hormone receptor positive (HR + ) and human epidermal receptor-2 negative (HER2-) breast cancer, which helps to determine those patients who may benefit from chemotherapy. Our goal was to assess whether there was a disparity in the use of the 21-gene recurrence score, especially between races and income levels.
Methods
Using the SEER Medicare database, we analyzed breast cancer patients diagnosed from 2012 to 2017. Inclusion criteria were HR + /HER2- phenotype, clinical stages I and II in post-menopausal women, and Stage 1 cancers in premenopausal women. Differences in the application of the 21-gene recurrence score with regard to race and income level were studied using chi-square analysis.
Results
Overall, 124 761 patients were included. Of these, 99.1% were females, and 32.9% had 21-gene recurrence score testing. The median age was 70 years (range 27–100). Most patients had invasive ductal carcinoma (86.6%) followed by invasive lobular carcinoma (13.4%), of which 66.0% were stage I and 34.0% as stage II. When comparing subgroups based on testing, White race had a lower application rate (83.8% vs. 84.3%, p = 0.031), compared to African-Americans (8.7% vs. 8.3%, p = 0.031). Similarly, patients with ≥ 10% poverty index showed a lower frequency of testing (46.0% vs. 47.3%, p < 0.001). However, clinically meaningful disparities by race or income were not observed. Underuse of 21-gene recurrence score was more evident among older patients ( ≥ 65, 76.9% vs. 61%, p < 0.001), separated/divorced/widowed individuals (38.7% vs. 28.4%, p < 0.001), and those undergoing mastectomy (39% vs. 29.5%, p < 0.001) compared to breast-conserving surgery.
Conclusions
No clinically significant disparities were observed in race or income level in the application of the 21-gene recurrence score, which is reassuring, particularly as chemotherapy treatment regimens continue to trend appropriately trend toward de-escalation. However, underuse was more evident among older patients, separated/divorced/widowed individuals, and those undergoing mastectomy, highlighting opportunities to improve equity and adherence to guideline-based testing.
{"title":"Do Racial and Income Disparities Exist in the Application of 21-Gene Recurrence Score?","authors":"Alanna Hickey, Gabriel De la Cruz Ku, Caroline King, Camila Franco, Saman Namazian, Sarah Roberts, Kabir A. Torres, Sarah Persing, Salvatore Nardello, Abhishek Chatterjee","doi":"10.1002/jso.70128","DOIUrl":"10.1002/jso.70128","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The 21-gene recurrence score is a useful tool to predict the recurrence risk in patients with early hormone receptor positive (HR + ) and human epidermal receptor-2 negative (HER2-) breast cancer, which helps to determine those patients who may benefit from chemotherapy. Our goal was to assess whether there was a disparity in the use of the 21-gene recurrence score, especially between races and income levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the SEER Medicare database, we analyzed breast cancer patients diagnosed from 2012 to 2017. Inclusion criteria were HR + /HER2- phenotype, clinical stages I and II in post-menopausal women, and Stage 1 cancers in premenopausal women. Differences in the application of the 21-gene recurrence score with regard to race and income level were studied using chi-square analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 124 761 patients were included. Of these, 99.1% were females, and 32.9% had 21-gene recurrence score testing. The median age was 70 years (range 27–100). Most patients had invasive ductal carcinoma (86.6%) followed by invasive lobular carcinoma (13.4%), of which 66.0% were stage I and 34.0% as stage II. When comparing subgroups based on testing, White race had a lower application rate (83.8% vs. 84.3%, <i>p</i> = 0.031), compared to African-Americans (8.7% vs. 8.3%, <i>p</i> = 0.031). Similarly, patients with ≥ 10% poverty index showed a lower frequency of testing (46.0% vs. 47.3%, <i>p</i> < 0.001). However, clinically meaningful disparities by race or income were not observed. Underuse of 21-gene recurrence score was more evident among older patients ( ≥ 65, 76.9% vs. 61%, <i>p</i> < 0.001), separated/divorced/widowed individuals (38.7% vs. 28.4%, <i>p</i> < 0.001), and those undergoing mastectomy (39% vs. 29.5%, <i>p</i> < 0.001) compared to breast-conserving surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>No clinically significant disparities were observed in race or income level in the application of the 21-gene recurrence score, which is reassuring, particularly as chemotherapy treatment regimens continue to trend appropriately trend toward de-escalation. However, underuse was more evident among older patients, separated/divorced/widowed individuals, and those undergoing mastectomy, highlighting opportunities to improve equity and adherence to guideline-based testing.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"16-30"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530773","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}
Asad Gul Rao, Muhammad Ahmad Nadeem, Abdul Rafeh Awan, Chase J. Wehrle, Abby Gross, Antonio Giuseppucci, Beren Berber, Syed Mohiuddin, Tyler Stevens, Hassan Siddiki, Kathryn A. Stackhouse, Samer Naffouje, Daniel Joyce, Toms Augustin, Robert Simon, R. Matthew Walsh, Rob Naples
Gastric outlet obstruction (GOO) in locally advanced pancreatic cancer (LAPC) can be managed with endoscopic duodenal stenting (EDS), gastrojejunostomy (GJ), or EUS-guided gastroenterostomy (EUS-GE). In our meta-analysis of LAPC patients, EDS enabled quicker recovery and chemotherapy but had higher re-intervention rates, while GJ offered greater durability. Our systematic review showed EUS-GE had high success and low re-intervention in malignant GOO, though LAPC-specific data were lacking. Further comparative studies are needed to guide individualized treatment.
{"title":"Comparing Palliative Approaches for GOO in Locally Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis","authors":"Asad Gul Rao, Muhammad Ahmad Nadeem, Abdul Rafeh Awan, Chase J. Wehrle, Abby Gross, Antonio Giuseppucci, Beren Berber, Syed Mohiuddin, Tyler Stevens, Hassan Siddiki, Kathryn A. Stackhouse, Samer Naffouje, Daniel Joyce, Toms Augustin, Robert Simon, R. Matthew Walsh, Rob Naples","doi":"10.1002/jso.70131","DOIUrl":"10.1002/jso.70131","url":null,"abstract":"<div>\u0000 \u0000 <p>Gastric outlet obstruction (GOO) in locally advanced pancreatic cancer (LAPC) can be managed with endoscopic duodenal stenting (EDS), gastrojejunostomy (GJ), or EUS-guided gastroenterostomy (EUS-GE). In our meta-analysis of LAPC patients, EDS enabled quicker recovery and chemotherapy but had higher re-intervention rates, while GJ offered greater durability. Our systematic review showed EUS-GE had high success and low re-intervention in malignant GOO, though LAPC-specific data were lacking. Further comparative studies are needed to guide individualized treatment.</p>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"81-91"},"PeriodicalIF":1.9,"publicationDate":"2025-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145530679","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}
{"title":"Letter to the Editor: Comment on: “Factors Associated With Residual Positive Lymph Nodes With Targeted Axillary Lymph Node Dissection for Breast Cancer and Accuracy of Clipped Node Retrieval in Non-Mapping Patients”","authors":"Liyan Wang, Jing Zhou, Hong Zhao","doi":"10.1002/jso.70126","DOIUrl":"10.1002/jso.70126","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 8","pages":"1305-1306"},"PeriodicalIF":1.9,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145452349","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}
Laura E. Gould, Edward. T. Pring, Ioanna Drami, Joannis Constantinides, Nicola Hodges, Colin W. Steele, Campbell S.D. Roxburgh, Elaine M. Burns, John T. Jenkins
Aim
To determine whether high complexity pelvic exenterations alter perineal wound morbidity and to assess risk factors for perineal flap complications following complex rectal cancer surgery.
Methods
A retrospective analysis of consecutive adults undergoing complex rectal cancer resections with immediate gluteal flap perineal reconstruction between January 2013-July 2021 at a tertiary referral centre. Conventional complex cancer resections were compared with “high complexity” exenterations, including en bloc sacrectomy and extended lateral pelvic side wall excision. Primary outcomes were short-term (wound infection, necrosis, dehiscence) and long-term (sinus, fistula, hernia) perineal flap complications.
Results
We identified 194 patients (median 56 years, 60% male) with gluteal flap reconstructions; 163 (84%) for advanced or recurrent rectal cancer. Gluteal artery perforator flaps were predominantly used (176, 92%). Wound infections were more common in the conventional group (23.2% vs. 6.3%, p = 0.001), but no other differences in complications were observed between groups. Obesity (HR 2.70, 95% CI 1.22–5.97, p = 0.014) and total pelvic exenteration (HR 2.13, 95% CI 1.07–4.23, p = 0.031) were associated with short-term complications. Age over 65 years predicted readmission/reoperation (HR 2.66, 95%CI 1.07–6.6, p = 0.040). Ureteric/ileal conduit leaks were associated with long-term complications (HR 3.37, 95% CI 1.21–9.34, p = 0.024). No flap losses occurred.
Conclusion
Gluteal fasciocutaneous perforator flaps provide reliable perineal reconstruction after complex rectal cancer surgery. The extent of surgery and resulting defect size did not significantly influence perineal wound complication rates.
目的：探讨高复杂性盆腔切除是否会改变会阴伤口的发病率，并评估复杂直肠癌手术后会阴皮瓣并发症的危险因素。方法：回顾性分析2013年1月至2021年7月在三级转诊中心连续接受复杂直肠癌切除术并立即臀皮瓣会阴重建的成年人。将传统的复杂肿瘤切除与“高复杂性”切除进行比较，包括整体骶骨切除术和扩大盆腔侧壁外侧切除术。主要结局为短期（伤口感染、坏死、裂开）和长期（窦、瘘、疝）会阴皮瓣并发症。结果：我们确定了194例（中位56岁，60%男性）臀皮瓣重建；163例（84%）为晚期或复发性直肠癌。臀动脉穿支皮瓣应用较多（176,92%）。伤口感染在常规组更为常见（23.2% vs. 6.3%, p = 0.001），但两组间并发症发生率无差异。肥胖（HR 2.70, 95% CI 1.22-5.97, p = 0.014）和盆腔全切术（HR 2.13, 95% CI 1.07-4.23, p = 0.031）与短期并发症相关。年龄大于65岁预测再入院/再手术（HR 2.66, 95%CI 1.07-6.6, p = 0.040）。输尿管/回肠导管泄漏与长期并发症相关（HR 3.37, 95% CI 1.21-9.34, p = 0.024）。无皮瓣损失。结论：臀筋膜皮肤穿支皮瓣可提供复杂直肠癌术后可靠的会阴重建。手术范围及缺损大小对会阴伤口并发症发生率无显著影响。
{"title":"Gluteal Flap Reconstruction Following Complex Rectal Cancer Surgery: A Large Consecutive Series of Perineal Wounds Exploring Risk Factors for Complications","authors":"Laura E. Gould, Edward. T. Pring, Ioanna Drami, Joannis Constantinides, Nicola Hodges, Colin W. Steele, Campbell S.D. Roxburgh, Elaine M. Burns, John T. Jenkins","doi":"10.1002/jso.70113","DOIUrl":"10.1002/jso.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To determine whether high complexity pelvic exenterations alter perineal wound morbidity and to assess risk factors for perineal flap complications following complex rectal cancer surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of consecutive adults undergoing complex rectal cancer resections with immediate gluteal flap perineal reconstruction between January 2013-July 2021 at a tertiary referral centre. Conventional complex cancer resections were compared with “high complexity” exenterations, including en bloc sacrectomy and extended lateral pelvic side wall excision. Primary outcomes were short-term (wound infection, necrosis, dehiscence) and long-term (sinus, fistula, hernia) perineal flap complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 194 patients (median 56 years, 60% male) with gluteal flap reconstructions; 163 (84%) for advanced or recurrent rectal cancer. Gluteal artery perforator flaps were predominantly used (176, 92%). Wound infections were more common in the conventional group (23.2% vs. 6.3%, <i>p</i> = 0.001), but no other differences in complications were observed between groups. Obesity (HR 2.70, 95% CI 1.22–5.97, <i>p</i> = 0.014) and total pelvic exenteration (HR 2.13, 95% CI 1.07–4.23, <i>p</i> = 0.031) were associated with short-term complications. Age over 65 years predicted readmission/reoperation (HR 2.66, 95%CI 1.07–6.6, <i>p</i> = 0.040). Ureteric/ileal conduit leaks were associated with long-term complications (HR 3.37, 95% CI 1.21–9.34, <i>p</i> = 0.024). No flap losses occurred.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Gluteal fasciocutaneous perforator flaps provide reliable perineal reconstruction after complex rectal cancer surgery. The extent of surgery and resulting defect size did not significantly influence perineal wound complication rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 8","pages":"1399-1406"},"PeriodicalIF":1.9,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445010","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}
Eva Lindell Jonsson, W. K. Fraser Hill, Marielle Saayman, Spencer Yakaback, Golpira Elmi Assadzadeh, E. J. Gregory McKinnon, Claire Temple-Oberle
<div> <section> <h3> Introduction</h3> <p>Lymphedema (LE) is chronic swelling due to inadequate lymphatic function, which can occur after therapeutic lymph node dissection (TLND) for melanoma. At our institution, the risk of LE is 12% for axillary and 38% for ilioinguinal lymph node dissection. This study investigated LE rates in patients undergoing TLND with immediate lymphatic reconstruction (ILR) using lymphaticovenous anastomosis (LVA), a microsurgical technique aimed at preventing LE.</p> </section> <section> <h3> Methods</h3> <p>Patients with melanoma requiring TLND were recruited prospectively from the Tom Baker Cancer Center and were consented to undergo ILR at the time of their node dissection. Institutional ethics board approval was obtained (Ethics ID HREBA. cc-20-9426). This study was not a registered clinical trial; the ongoing randomized LYMbR trial (NCT05136079) is registered but does not include this cohort. The main objective was to assess the development of LE, which was defined as a 10% increase in postsurgical limb volume compared with the contralateral limb. In addition, participants completed the Lymphoedema Quality of Life Questionnaire (LYMQoL), a validated LE-specific quality of life patient-reported outcome measure (PROM) before surgery and at each 6-month assessment, to assess for any changes in quality of life related to LE. A direct comparison was made to historical institutional rates of LE after TLND without ILR. Kaplan-Meier analysis assessed overall survival and lymphedema-free survival, while Mann-Whitney U test compared quality of life between patients with and without lymphedema.</p> </section> <section> <h3> Results</h3> <p>Between August 2020 and October 2022, 22 patients (14 men and 8 women) with a median age of 68 (range 43–80) were included in the study and underwent TLND for melanoma with ILR. 16 patients underwent ALND, and 6 patients underwent ILND with ILR. There were no complications directly related to the ILR part of the procedure. All disease was at least stage III. At a median follow-up of 34 months (range: 0−51 months), three patients met the criteria for LE, one who underwent ALND and two ILND. Of these three patients, two had regional recurrence and one suffered from a DVT and a postoperative wound infection in the affected limb. LYMQoL scores were equal or better (p = NS) in patients without LE than those with LE across all domains except for mood: function (median IQR 1.0 vs 1.0, <i>p</i> = 0.78), appearance (1.0 vs 1.6, <i>p</i> = 0.19), symptom burden (1.1 vs 1.6, <i>p</i> = 0.52), and mood (1.1 vs 1.0, <i>p</i> = 0.87).</p> </section> <section>
简介：淋巴水肿（LE）是由于淋巴功能不足引起的慢性肿胀，可在黑色素瘤治疗性淋巴结清扫（TLND）后发生。在我们的机构，腋窝淋巴结清扫的LE风险为12%，髂腹股沟淋巴结清扫的LE风险为38%。本研究调查了TLND患者使用淋巴-静脉吻合术（LVA）进行即时淋巴重建（ILR）的LE发生率，这是一种旨在预防LE的显微外科技术。方法：从Tom Baker癌症中心前瞻性招募需要TLND的黑色素瘤患者，并同意在淋巴结清扫时接受ILR。已获得机构伦理委员会批准（伦理ID: HREBA）。cc - 20 - 9426)。这项研究不是一项注册的临床试验；正在进行的随机淋巴瘤试验（NCT05136079）已注册，但不包括该队列。主要目的是评估LE的发展，其定义为与对侧肢体相比，术后肢体体积增加10%。此外，参与者还完成了淋巴水肿生活质量问卷（lyqol），这是一种经过验证的LE特异性生活质量患者报告的结果测量（PROM），用于在手术前和每6个月评估时评估与LE相关的生活质量的任何变化。与TLND后无ILR的历史机构发生率进行了直接比较。Kaplan-Meier分析评估了总生存期和无淋巴水肿生存期，Mann-Whitney U检验比较了有无淋巴水肿患者的生活质量。结果：在2020年8月至2022年10月期间，22名患者（14名男性和8名女性）被纳入研究，中位年龄为68岁（范围43-80），并接受了黑色素瘤伴ILR的TLND。ALND 16例，ILR伴ILND 6例。没有与手术中ILR部分直接相关的并发症。所有疾病至少为III期。在中位随访34个月（范围：0-51个月）时，3例患者符合LE标准，1例患者行ALND， 2例患者行ILND。在这3例患者中，2例发生局部复发，1例发生深静脉血栓形成和术后患肢伤口感染。除情绪外，无LE患者的lyqol评分与LE患者相同或更好（p = NS）：功能（IQR中位数1.0 vs 1.0, p = 0.78），外观（1.0 vs 1.6, p = 0.19），症状负担（1.1 vs 1.6, p = 0.52）和情绪（1.1 vs 1.0, p = 0.87）。结论：该研究与其他队列研究一致，证明了ILR在TLND黑色素瘤患者中的有效性，这将在一项正在进行的随机试验（LYMbR - NCT05136079）中得到进一步检验。
{"title":"Pilot Study of Immediate Lymphatic Reconstruction (ILR) During Lymph Node Dissection for Node-Positive Melanoma: Feasibility, Safety, and Early Outcomes","authors":"Eva Lindell Jonsson, W. K. Fraser Hill, Marielle Saayman, Spencer Yakaback, Golpira Elmi Assadzadeh, E. J. Gregory McKinnon, Claire Temple-Oberle","doi":"10.1002/jso.70127","DOIUrl":"10.1002/jso.70127","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Lymphedema (LE) is chronic swelling due to inadequate lymphatic function, which can occur after therapeutic lymph node dissection (TLND) for melanoma. At our institution, the risk of LE is 12% for axillary and 38% for ilioinguinal lymph node dissection. This study investigated LE rates in patients undergoing TLND with immediate lymphatic reconstruction (ILR) using lymphaticovenous anastomosis (LVA), a microsurgical technique aimed at preventing LE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with melanoma requiring TLND were recruited prospectively from the Tom Baker Cancer Center and were consented to undergo ILR at the time of their node dissection. Institutional ethics board approval was obtained (Ethics ID HREBA. cc-20-9426). This study was not a registered clinical trial; the ongoing randomized LYMbR trial (NCT05136079) is registered but does not include this cohort. The main objective was to assess the development of LE, which was defined as a 10% increase in postsurgical limb volume compared with the contralateral limb. In addition, participants completed the Lymphoedema Quality of Life Questionnaire (LYMQoL), a validated LE-specific quality of life patient-reported outcome measure (PROM) before surgery and at each 6-month assessment, to assess for any changes in quality of life related to LE. A direct comparison was made to historical institutional rates of LE after TLND without ILR. Kaplan-Meier analysis assessed overall survival and lymphedema-free survival, while Mann-Whitney U test compared quality of life between patients with and without lymphedema.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between August 2020 and October 2022, 22 patients (14 men and 8 women) with a median age of 68 (range 43–80) were included in the study and underwent TLND for melanoma with ILR. 16 patients underwent ALND, and 6 patients underwent ILND with ILR. There were no complications directly related to the ILR part of the procedure. All disease was at least stage III. At a median follow-up of 34 months (range: 0−51 months), three patients met the criteria for LE, one who underwent ALND and two ILND. Of these three patients, two had regional recurrence and one suffered from a DVT and a postoperative wound infection in the affected limb. LYMQoL scores were equal or better (p = NS) in patients without LE than those with LE across all domains except for mood: function (median IQR 1.0 vs 1.0, <i>p</i> = 0.78), appearance (1.0 vs 1.6, <i>p</i> = 0.19), symptom burden (1.1 vs 1.6, <i>p</i> = 0.52), and mood (1.1 vs 1.0, <i>p</i> = 0.87).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 ","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"133 1","pages":"46-53"},"PeriodicalIF":1.9,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12747685/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145445045","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}
Bates, K. R., W. Jones, M. R. Liggett, N. N. Zaza, D. J. Vitello, and D. J. Bentrem. 2025. “Complications Following Open Versus Minimally Invasive Resection of Gastric Adenocarcinoma.” Journal of Surgical Oncology 131: 1302–1312. https://doi.org/10.1002/jso.28073.
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.
贝茨，K. R.， W. Jones， M. R. Liggett， N. N. Zaza， D. J. Vitello和D. J. Bentrem. 2025。开放性与微创胃腺癌切除术后的并发症。肿瘤外科杂志31:1302-1312。https://doi.org/10.1002/jso.28073.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 “Complications Following Open Versus Minimally Invasive Resection of Gastric Adenocarcinoma”","authors":"","doi":"10.1002/jso.70124","DOIUrl":"10.1002/jso.70124","url":null,"abstract":"<p>Bates, K. R., W. Jones, M. R. Liggett, N. N. Zaza, D. J. Vitello, and D. J. Bentrem. 2025. “Complications Following Open Versus Minimally Invasive Resection of Gastric Adenocarcinoma.” <i>Journal of Surgical Oncology</i> 131: 1302–1312. https://doi.org/10.1002/jso.28073.</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":"132 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70124","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145438346","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}
Vitello, D. J., D. Shah, B. Ko, et al. 2024. “Establishing the Clinical Relevance of Grade A Post-Hepatectomy Liver Failure.” Journal of Surgical Oncology 129: 745–753. https://doi.org/10.1002/jso.27570.
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.
{"title":"Correction to “Establishing the Clinical Relevance of Grade A Post-Hepatectomy Liver Failure”","authors":"","doi":"10.1002/jso.70121","DOIUrl":"10.1002/jso.70121","url":null,"abstract":"<p>Vitello, D. J., D. Shah, B. Ko, et al. 2024. “Establishing the Clinical Relevance of Grade A Post-Hepatectomy Liver Failure.” <i>Journal of Surgical Oncology</i> 129: 745–753. https://doi.org/10.1002/jso.27570.</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":"132 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145438317","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}
Janczewski, L. M., D. J. Vitello, X. Peters, C. Valukas, R. P. Merkow, and D. J. Bentrem. 2024. “Association of Hospital Volume With Quality Care Outcomes Following Minor and Major Hepatectomy for Primary Liver Cancer.” Journal of Surgical Oncology 130: 1033–1041. https://doi.org/10.1002/jso.27819.
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.
{"title":"Correction to “Association of Hospital Volume With Quality Care Outcomes Following Minor and Major Hepatectomy for Primary Liver Cancer”","authors":"","doi":"10.1002/jso.70122","DOIUrl":"10.1002/jso.70122","url":null,"abstract":"<p>Janczewski, L. M., D. J. Vitello, X. Peters, C. Valukas, R. P. Merkow, and D. J. Bentrem. 2024. “Association of Hospital Volume With Quality Care Outcomes Following Minor and Major Hepatectomy for Primary Liver Cancer.” <i>Journal of Surgical Oncology</i> 130: 1033–1041. https://doi.org/10.1002/jso.27819.</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":"132 8","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145438301","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}
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