Journal of Surgical Oncology最新文献

Background and objectives: Infectious complications after pancreatic resections are common, but perioperative factors linked to postoperative bacterial growth are not well-studied.

Methods: This retrospective study analyzed bacterial cultures from patients undergoing pancreatic resection (November 2008 to October 2022), assessing predictors for positive cultures and characterizing bacteria. Complications and outcomes of patients with positive cultures were also examined.

Results: Among 620 patients, bile samples were collected in 95 (95/620; 15.3%), with 60 (60/95; 63.1%) testing positive, 58 of them underwent pancreaticoduodenectomy. Of these, in 50 (50/58; 86.2%) the culture yielded polymicrobial growth but specific types of bacteria were not identified. Multivariate analysis identified preoperative bile duct stenting as a significant predictor of positive bile cultures (OR: 3.54; 95% CI: 1.95-6.42; p < 0.001), and positive cultures were linked to higher reoperation rates (OR: 2.40; 95% CI:1.18-4.90; p < 0.001. Positive drain cultures within 30 days from surgery were associated with higher rates of clinically significant pancreatic fistula (OR: 2.24; 95% CI: 1.00-5.11; p = 0.05), and reoperations) OR: 4.37; 95% CI: 1.62-11.79; p = 0.03). Patients with pancreatic adenocarcinoma and positive bile cultures had shorter disease-free survival with a median of 13 months (95% CI: 8-17) versus 18 months (95% CI: 8-29; p = 0.04).

Conclusions: Bile sampling is recommended in all pancreaticoduodenectomies. Managing polymicrobial growth with broad and prolonged antibiotics may reduce postoperative infections.

Background and objectives: Rectal mucinous adenocarcinoma (MA) has poor response to neoadjuvant chemoradiation (NCR) and higher involved radial surgical margin rates than nonmucinous rectal adenocarcinoma (NMA).

Methods: The National Cancer Database (2010-2018) was queried for adult patients with clinical stage II and III rectal cancer. Patients with MA and NMA treated with NCR and total mesorectal excision (TME) were identified. We sought to evaluate differences in pathologic downstaging and completeness of resection between MA and NMA rectal adenocarcinoma.

Results: We identified 13 294 patients, 12 655 (95.2%) NMA and 639 (4.8%) MA. After 3:1 propensity score matching for pathologic outcomes, 1707 NMA and 569 MA patients were included. MA patients had more involved distal (2.1% vs. 1.1%, p = 0.047) and radial (29% vs. 15%, p < 0.001) margins, and less pathologic downstaging (49% vs. 55%, p = 0.015). Among MA patients, minimally invasive resection had higher distal (2.1% vs. 1.4%, p = 0.65) and radial margin involvement (35% vs. 26%, p = 0.09) compared to open resection. Incomplete resection rates were similar between low anterior and abdominoperineal resection.

Conclusions: TME of locally advanced rectal MA treated with NCR resulted in nearly double the involved radial surgical margins compared to NMA. Operative approach should be carefully considered. Extended or extra-mesorectal resection may reduce the risk of incomplete resection.

Background: Pancreatic adenocarcinoma has a predisposition to invade the neural tissue surrounding the superior mesenteric artery (SMA). Before the advent of neoadjuvant chemotherapy (NAC), any invasion of this tissue was often considered as unresectable disease. Currently, patients who respond favourably to NAC have potentially resectable disease. There is debate over the exact technique of removing this shell of tumour tissue surrounding the SMA, and whether it is comparable to arterial resection and reconstruction.

Methods: We describe a technique of en bloc arterial divestment in which an endovascular stapler combined with sharp dissection is used to divide the shell of periadventitial SMA tissue.

Conclusions: In patients with locally advanced disease, the technique of arterial divestment can be safely performed where the tumour is not invading below the external elastic lamina. This allows complete tumour resection without incurring the higher morbidity and mortality associated with SMA resection.

Breast cancer is the most commonly diagnosed cancer among women in Southeast Asia. However, significant disparities in access to postmastectomy breast reconstruction persist due to cultural, economic, and healthcare-related factors. These disparities result in unequal access to care, impacting patient outcomes, and overall quality of life. A systematic review was conducted following PRISMA guidelines to assess trends, disparities, and outcomes in breast reconstruction across Southeast Asia. The review included 15 studies published between 2000 and 2023 from countries including Singapore, Malaysia, Vietnam, Thailand, and Brunei. Data extracted focused on disparities related to ethnicity, socioeconomic status, geographic location, and surgical outcomes. Statistical analysis included summarizing key variables across studies. Significant cultural and economic barriers to breast reconstruction were identified. Cultural beliefs influenced uptake, with Malay women preferring autologous tissue reconstruction (92.3%), while Chinese women had lower reconstruction rates due to traditional beliefs. Economic constraints limited access to advanced techniques like the DIEP flap, which had a median cost of SGD 11 009.38, significantly higher than the TRAM flap (SGD, 300.51, p < 0.001). Geographic disparities further restricted access, especially in rural areas. Complication rates were higher in obese patients, with total flap loss at 6% and fat necrosis at 10%. Studies from Vietnam and Thailand reported 5-year overall survival rates of 95% and disease-free survival rates of 80.7% for early-stage breast cancer patients undergoing reconstruction. Breast reconstruction disparities in Southeast Asia are driven by complex interactions between cultural, economic, and healthcare-related factors. Efforts to reduce these disparities must focus on increasing patient education, expanding reconstructive options, and addressing systemic healthcare inequalities. Targeted interventions, including policy changes to subsidize reconstruction and improve surgeon training in rural areas, are critical to ensuring equitable access and improving patient outcomes across the region.

Malignant cutaneous adnexal tumors (MCATs) are rare. Previous population-based studies to determine the clinical features and prognosis of MCATs mainly included Caucasian patients, and the characteristics of Asian patients with MCATs have not yet been investigated. We aimed to investigate the characteristics of Asian patients with MCAT using a Japanese database. This retrospective study of patients with MCATs from 2012 to 2015 was conducted using a database linked to the Hospital-Based Cancer Registry and Diagnosis Procedure Combination data. Patient characteristics and survival data were analyzed using the Kaplan-Meier method and Cox regression analysis. A total of 1930 patients were included. The median age at diagnosis was 76 years (range, 14-107 years), and 46.3% of the patients were male. The most common histological finding was sebaceous adenocarcinoma (41.6%), followed by porocarcinoma (21.7%). The 5-year overall survival rate was 72.3% (95% confidence interval [CI]: 70.2%-74.3%). A favorable factor for overall survival was female sex (hazard ratio [HR]: 0.78, 95% CI: 0.64-0.96), while unfavorable factors were age > 80 years (HR: 4.40, 95% CI: 3.56-5.46), Stage ≥II (Stage II, HR: 1.34, 95% CI: 1.05-1.71; Stage III, HR: 3.12, 95% CI: 2.16-4.50; Stage IV, HR: 7.31, 95% CI: 4.92-10.87), and histologic findings of spiradenocarcinoma (HR: 4.66, 95% CI: 1.64-13.24). Tumor characteristics and prognosis of MCATs differed among subtypes. Moreover, we found differences between our data and those from other databases. Further investigations are warranted to explore these differences.

A considerable amount of recent research has focused on the role of artificial intelligence (AI) in colorectal cancer (CRC), aiming to improve outcomes in CRC. However, AI for young onset colorectal cancer (yoCRC)-defined as colorectal cancer in patients less than 50 years old-is not nearly as explored, and its role in the prevention, detection, and management of yoCRC remains largely unknown. To address this gap, we performed an integrative review on AI in yoCRC. We conducted a comprehensive literature search of PubMed, Medline (Ovid), and Embase for articles published from 2020 to 2024, adhering to specific inclusion and exclusion criteria. This integrative review involved gathering information from diverse research designs and literature sources. After removing duplicates and applying inclusion criteria, a total of 11 articles were included in the review. Our analysis identified one review discussing the importance of AI in yoCRC, three articles presenting research studies mentioning applications for yoCRC, and seven comprehensive investigations utilizing AI with a specific focus on yoCRC. The findings indicate that while AI in CRC is an evolving research field, there are few plans or implementations reported on how to incorporate AI specifically in yoCRC. Potential limitations of this review include the limited number of databases searched and the scope of search queries used. Nonetheless, this review highlights the need for more targeted research on AI applications in yoCRC. Future research can build upon the foundation of AI in CRC with adjustments to account for the increasing incidence of yoCRC.

Oral cancer commonly affects various parts of the oral cavity, including the lips, tongue, gums, palate, and inner cheeks. Oral rehabilitation involves multiple approaches aimed at restoring and improving oral function, esthetics, and overall well-being. This study assessed the functional outcomes and quality of life in patients who underwent rehabilitation following an oral cancer diagnosis. A comprehensive literature search was performed across PubMed, Cochrane Library, Dimensions, ScienceDirect, CINAHL, and Google Scholar databases. The study included patients diagnosed with oral cancer who had undergone oral rehabilitation. Functional outcomes and quality of life were key selection criteria. The methodological quality of the included studies was assessed, and data were systematically extracted and analyzed. A significant relationship was observed between the type of maxillectomy and quality of life, with obturator retention and stability being critical factors. Radiotherapy was found to adversely impact oral function and implant survival rates, with a strong correlation between radiation treatment and reduced implant survival (p < 0.00001). Additionally, dentition and the timing of implant placement were associated with recurrence rates and adverse effects. The findings highlight the crucial role of oral rehabilitation in improving both functional outcomes and quality of life in oral cancer patients. This study underscores the importance of incorporating oral rehabilitation into oral cancer treatment to enhance patient recovery and overall health.

Background and objectives: Randomized clinical trials have shown that sub-lobar resection for clinical stage (cStage) IA non-small cell lung cancer (NSCLC) is non-inferior to lobar resection. We evaluated traditional and conditional survival differences between lobectomy, wedge resection, and segmentectomy in patients with cStage IA NSCLC.

Methods: The National Cancer Database (2004-2019) was queried for patients with cStage IA (≤ 2 cm) NSCLC who underwent upfront lobectomy, segmentectomy, or wedge resection. Patients were stratified by extent of resection. Propensity-matched traditional (TSA) and conditional (CSA) survival analyses were performed. Propensity score included age, gender, histology, tumor grade, and Charlson-Deyo score. Number of lymph nodes (LN) harvested was also compared between groups.

Results: There were 46 395 patients who met the inclusion criteria, of whom 32 599 (70.3%) received lobectomy, 11 181 (24.1%) wedge resection, and 2615 (5.6%) segmentectomy. Following propensity matching, all groups contained 2615 patients. In the TSA, segmentectomy (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.08-1.32) and wedge resection (HR: 1.41, CI: 1.28-1.56) were associated with worse 5-year survival. This remained significant in CSA at 3- and 5-years post-resection in patients who underwent segmentectomy (HR: 1.24, CI: 1.08-1.43 and HR: 1.23, CI: 1.02-1.49, respectively) and wedge resection (HR: 1.42, CI: 1.24-1.63 and HR: 1.33, CI: 1.11-1.59, respectively). Wedge resection and segmentectomy were associated with a lower number of harvested LN (median = 4 and 6, respectively) compared to lobectomy (8, p < 0.001).

Conclusion: Analysis of real-world data suggests that lobectomy is associated with improved traditional and conditional 5-year survival as well as LN harvest.

Background: Patients undergoing abdominal-based free flap breast reconstruction are at risk for perioperative venous thromboembolism (VTE), but the optimal anticoagulation protocol remains unknown. We hypothesized that a standardized chemoprophylaxis protocol would minimize VTE events without increasing hematoma, flap loss, or reoperation.

Methods: A retrospective review was conducted on patients who underwent abdominal-based free flap breast reconstruction from 2010 to 2023. In 2015, we implemented an enhanced recovery after surgery (ERAS) protocol including preoperative enoxaparin. Patients with a BMI < 30 and > 30 received enoxaparin for 7 and 30 days postoperatively, respectively. 2010-2015 patients were pre-ERAS and 2015-2023 patients were the ERAS cohort. Patient demographics, comorbidities, and outcomes were analyzed. The primary outcomes were VTE, hematoma, flap loss, and reoperation.

Results: 2317 patients were included: 679 were pre-ERAS and 1638 were in the ERAS cohort. The incidence of deep vein thrombosis (0.7%) and pulmonary embolism (pre-ERAS 0.6% vs. ERAS 0.5%) was low in both cohorts with no significant differences. Hematoma (pre-ERAS 7.2% vs. ERAS 5.5%) and reoperation (pre-ERAS 7.8% vs. ERAS 9.7%) were similar, but the ERAS cohort had significantly lower flap failure (0.7% vs. 2.1%, p < 0.05).

Conclusions: A standardized perioperative anticoagulation protocol for abdominal-based breast reconstruction maintained low VTE rates without increasing hematoma, flap failure, or reoperation.