World Journal of Surgical Oncology最新文献

Lung adenocarcinoma is the most prevalent type of lung cancer, with invasive lung adenocarcinoma being the most common subtype. Screening and early treatment of high-risk individuals have improved survival; however, significant differences in prognosis still exist among patients at the same stage, especially in the early stages. Invasive lung adenocarcinoma has different histological morphologies and biological characteristics that can distinguish its prognosis. Notably, several studies have found that the pathological subtypes of invasive lung adenocarcinoma are closely associated with clinical treatment. This review summarised the distribution of various pathological subtypes of invasive lung adenocarcinoma in the population and their relationship with sex, smoking, imaging features, and other histological characteristics. We comprehensively analysed the genetic characteristics and biomarkers of the different pathological subtypes of invasive lung adenocarcinoma. Understanding the interaction between the pathological subtypes of invasive lung adenocarcinoma and the tumour microenvironment helps to reveal new therapeutic targets for lung adenocarcinoma. We also extensively reviewed the prognosis of various pathological subtypes and their effects on selecting surgical methods and adjuvant therapy and explored future treatment strategies.

Background: To explore the safety and feasibility of the modified approach for accessing the superior mesenteric artery (SMA) in total laparoscopic radical resection for right colon cancer.

Methods: This single-center retrospective study included 107 patients who underwent total laparoscopic radical resection of right colon cancer at The First Affiliated Hospital of Wannan Medical College between August 2022 and December 2023. 53 patients were in the modified SMA approach (modified group) and 54 patients were in the traditional SMA approach (control group). The control group and modified group underwent total laparoscopic radical resection of right colon cancer, and the following baseline and pathological characteristics of the two groups were compared: intraoperative condition, postoperative recovery, and postoperative complications. Our modified surgical method was to isolate the mesocolon using a cranial(the ligament of Treitz) -to- caudal(the pedicle of ileocolic) pathway and the orderly ligation of blood vessels in the SMA.

Results: There was no statistically significant difference in the baseline characteristics or pathological data between the two groups. Compared with the traditional SMA approach, the modified SMA approach had a shorter surgical time(P < 0.001) and vascular dissection time (P < 0.001) and less intraoperative blood loss (P = 0.000). There was no statistically significant difference in the number of total harvested lymph nodes or positive harvested lymph nodes between the two groups of patients (P > 0.05); There was no statistically significant difference in postoperative hospital stay, time to first flatus, time to pull out drainage tube and drainage between the two groups of patients (P > 0.05), and there was no statistically significant difference in the incidence of complications between the two groups of patients (P > 0.05).

Conclusion: The modified SMA approach in totally laparoscopic radical resection for right colon cancer can shorten the surgical and vascular dissection time, reduce intraoperative bleeding and reduce the surgical difficulty and intraoperative risk of the SMA approach for right colon cancer. In clinical practice, its safety and feasibility are relatively high, and it is worth promoting.

Trial registration: The study was approved by the Ethics Committee of The First Affiliated Hospital of Wannan Medical College and registered with the China Clinical Trials Registry (ChiCTR2300075919, Date of Registration:2023-09-19- retrospective registration) http://www.chictr.org.cn/index.aspx .

Purpose: The European Working Group on Sarcopenia in Older People (EWGSOP) revised the consensus in 2018, including that using computed tomography (CT) imaging of the lumbar third vertebra (L3) for the evaluation of muscle mass. However, there is currently discrepancy and confusion in the application of specific cross-sectional and cutoff values for L3. This study aimed to standardize the diagnosis of low muscle mass using L3-CT.

Materials and methods: This study included patients who underwent radical gastrectomy for gastric cancer between July 2014 and February 2019. Sarcopenia factors were measured preoperatively. Patients were followed up to obtain actual clinical outcomes. We used the cutoff values obtained based on the inferior aspect of L3-CT images to diagnose sarcopenia in three aspects, respectively. Univariate and multivariate analyses were used to compare long-term and short-term postoperative prognostic differences.

Results: Sarcopenia was found to be an independent risk factor for postoperative complications and overall survival in patients with all three diagnoses of sarcopenia. According to the multivariate model for predicting postoperative complications, patients with inferior-L3 sarcopenia (n = 154,13.8%) had a greater odds ratio (OR) than patients with superior-L3 sarcopenia (n = 220,19.7%) or transverse-L3 sarcopenia (n = 194,17.4%) did (OR, inferior sarcopenia vs. superior sarcopenia, transverse sarcopenia, 2.030 vs. 1.608, 1.679). Furthermore, patients with inferior-L3 sarcopenia had the highest hazard ratio (HR) (HR, inferior sarcopenia vs. superior sarcopenia, transverse sarcopenia, 1.491 vs. 1.408, 1.376) in the multivariate model for predicting overall survival.

Conclusion: We recommend that when diagnosing low muscle mass using L3-CT, the intercepted cross section should be uniform and consistent with the aspect on which the cutoff value is based.

Objective: Salvage resection for residual lung cancer harboring epidermal growth factor receptor (EGFR) mutations following EGFR-tyrosine kinase inhibitor (TKI) treatment is gaining traction for its survival benefits. However, the impact of pathological factors on survival remains unclear.

Methods: Between 2013 and 2023, we retrospectively reviewed 34 patients with advanced lung adenocarcinoma who received EGFR-TKI therapy. After a median TKI treatment duration of 9.1 months, all patients demonstrated either partial response (n = 27) or stable disease (n = 7) before salvage surgery. Demographic, pathological outcomes, progression-free survival (PFS), and overall survival (OS) were analyzed.

Results: Among the 34 patients, six (17.6%) achieved a pathological complete response (pCR) and nine (26.5%) had a major pathological response (MPR). Additionally, 11 patients (32.4%) exhibited spread through air spaces (STAS), and lymphovascular invasion (LVI) was observed in nine patients (26.5%). The 3-year PFS and OS rates were 55.8% and 60.5%, respectively. No significant differences in PFS or OS were observed regarding mutation type, TKI generation, pCR, MPR, or LVI. However, Kaplan-Meier analysis revealed that STAS was associated with shorter PFS compared to non-STAS cases (p = 0.01). In multivariate analysis, STAS was identified as an independent prognostic factor for PFS (hazard ratio: 2.83, 95% CI: 1.35-28.54, p = 0.02). No significant prognosticators were found for OS in univariate or multivariate analyses.

Conclusion: While salvage surgery following TKI treatment is feasible and prolongs survival by removing residual primary tumor with potential TKI resistance, STAS may contribute to a higher risk of early progression. This finding warrants further investigation and tailored treatment strategies.

Background: In previous studies, elevated expression of UBE2L3 has been observed in osteosarcoma cells, and silencing UBE2L3 has been shown to promote oxidative stress and induce necroptosis. However, the exact molecular mechanisms underlying these findings remain unclear.

Objective: The purpose of this study is to investigate the molecular mechanisms by which interfering with UBE2L3 expression promotes necroptosis and impacts the progression of osteosarcoma, building upon previous in vitro cell experiments.

Methods: Osteosarcoma cells were transfected with shNC and shUBE2L3 plasmids, and the cells were injected into the right tibia of nude mice to establish a tumor xenograft model. The growth rate, changes in body weight, and tumor volume of the mice in each group were observed. After 15 days, the mice were sacrificed, and the tumors were dissected and analyzed for tumor volume. Immunohistochemical staining was performed to detect changes in the expression of necroptosis-related proteins, such as PCNA, p-MLKL, and p-RIP1. Additionally, U2OS and HOS cells were transfected with UBE2L3-silencing plasmids, and immunoprecipitation was performed to investigate the interaction between UBE2L3 and the necroptosis protein MLKL. By combining these experiments, we aim to evaluate the impact of UBE2L3 on necroptosis both in vitro and in vivo and elucidate its specific role in targeting MLKL to regulate necroptosis as a therapeutic approach for osteosarcoma.

Results: After interfering with UBE2L3, the growth rate of tumors in nude mice significantly slowed down, accompanied by a notable reduction in tumor volume and weight. These findings suggest that inhibiting the expression of UBE2L3 can suppress the growth of osteosarcoma. Furthermore, immunohistochemical analysis revealed that following UBE2L3 interference, the intensity of staining for the necrotic proteins p-MLKL and p-RIP1 was increased and PCNA staining was decreased, indicating that interfering with UBE2L3 expression can promote necroptosis. Moreover, through transfection of UBE2L3 silencing plasmids into osteosarcoma cells in vitro, immunoprecipitation and ubiquitination results demonstrated that UBE2L3 can specifically bind to MLKL. Overexpression of UBE2L3 promoted the ubiquitination of MLKL and reduced its expression. Thus, down-regulation of UBE2L3 could modulate downstream MLKL expression and promote necrosis of osteosarcoma cells.

Conclusion: UBE2L3 selectively binds to MLKL, exerting ubiquitination-mediated regulation on downstream MLKL. Decreased expression of UBE2L3 modulates MLKL expression and promotes necrosis, thereby inhibiting osteosarcoma growth.

Background: The rationale behind the use of HIPEC involves targeted elimination of microscopic peritoneal metastasis, a common route for GCa dissemination, thereby improving the overall survival and reducing recurrences. Moreover, the reasoning behind the use of IORT is enhanced loco-regional control and, therefore, reducing recurrence rates.

Methods: From February 2013 to June 2023, all GCa patients who underwent HIPEC plus IORT during surgery were included in this study. Median overall survival (OS) and disease-free (DFS) survival were used to evaluate the efficacy of this treatment strategy amongst GCa patients, along with the rate of occurrence and severity of post-operative complications associated with this treatment strategy.

Results: The median OS and DFS were 63 and 87 months, respectively. More than one-third of the patients in our cohort did not develop any post-operative complications. In patients who developed post-operative complications, the median number of post-operative complications was 1 (IQR 1-2). Most encountered complications were Clavien-Dindo (CD) grade II complications (33.33%) and no in-hospital mortality was observed.

Conclusions: This complex, multimodal treatment strategy results in a significantly prolonged OS and DFS when compared to other treatment strategies for gastric cancer patients, with no added morbidity or mortality.

Background: Liposarcoma of the gallbladder is an exceptionally rare malignancy originating from adipose tissue. Its rarity and diagnostic challenges make this case noteworthy. Liposa rcomas exhibit diverse histological subtypes, each with distinct biological behaviors, and there is limited consensus on optimal treatment approaches. This report emphasizes the importance of accurate diagnosis, effective therapeutic strategies, and detailed analysis of clinical outcomes in managing such rare cases.

Case presentation: A 35-year-old woman presented with a two-month history of a palpable abdominal mass accompanied by mild bloating. She reported no significant discomfort, systemic symptoms, or changes in bowel habits. Imaging revealed a large abdominal mass displacing adjacent organs. Magnetic resonance imaging suggested a mixed-signal lesion originating from the gallbladder, and laboratory tests showed elevated inflammatory markers. The patient underwent successful surgical excision of the mass and cholecystectomy. Pathological examination confirmed a well-differentiated liposarcoma closely associated with the gallbladder. Immunohistochemistry indicated positivity for CDK4, MDM2, P16, S-100, and CD34, with a low proliferation index (Ki-67 ~ 10%). Postoperative recovery was uneventful, and the patient showed significant improvement. Long-term management, including genetic testing and follow-up, was planned to monitor recurrence risk and explore potential targeted therapies.

Conclusions: This case underscores the importance of considering rare malignancies like liposarcoma of the gallbladder in the differential diagnosis of abdominal masses. Early diagnosis through imaging and histopathological confirmation is crucial for optimal management. Complete surgical excision remains the cornerstone of treatment, particularly for well-differentiated subtypes, which generally have favorable prognoses. The findings highlight the need for multidisciplinary care and further research into genetic and molecular mechanisms to guide future targeted treatments.

Breast cancer is a prevalent malignancy worldwide, and its treatment has increasingly shifted towards precision medicine, with immunotherapy emerging as a key therapeutic strategy. Deubiquitination, an essential epigenetic modification, is regulated by deubiquitinating enzymes (DUBs) and plays a critical role in immune function and tumor progression. Ubiquitin-specific proteases (USPs), a prominent subgroup of DUBs, are involved in regulating immune cell functions, antigen processing, and T cell development in the context of breast cancer. Certain USPs also modulate the differentiation of immune cells, such as myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs), within the breast cancer immune microenvironment. Furthermore, several USPs influence the expression of PD-L1, thus affecting the efficacy of immune checkpoint inhibitors. The overexpression of USPs may promote immune evasion, contributing to the development of treatment resistance. This review elucidates the role of USPs in modulating the immune microenvironment and immune responses in breast cancer. Additionally, it discusses effective strategies for combining USP inhibitors with other therapeutic agents to enhance treatment outcomes. Therefore, targeting USPs presents the potential to enhance the efficacy of immunotherapy and overcome drug resistance, offering a more effective treatment strategy for breast cancer patients.

Background: Colorectal cancer (CRC) frequently metastasizes to the liver and lungs, leading to poor prognosis. Advances in chemotherapy, minimally invasive surgery, and perioperative care have expanded adjuvant chemotherapy (AC) regimens and eligibility for AC. However, the impact of AC after curative resection of distant metastases on recurrence and prognosis remains uncertain. This study evaluated the role of AC in CRC liver and lung metastases, focusing on cases with curative resection based on the latest studies published in the past five years.

Methods: This systematic review followed PRISMA guidelines. Literature searches of Medline and Cochrane Library (2019-2023) identified studies on AC or observation after curative resection of CRC metastases, reporting outcomes such as overall survival (OS) and disease-free survival (DFS). Data analysis was performed using Review Manager and R software, with results expressed as hazard ratios (HR) and 95% confidence intervals (CI).

Results: Seven studies met the eligibility criteria, including one randomized controlled trial and six retrospective studies, encompassing 1580 patients who underwent curative resection (R0) for CRC metastases. This meta-analysis showed a positive trend in OS for the AC group compared to that for the surgery-alone group (HR 0.86, 95% CI: 0.73-1.01; p = 0.06), but the difference was insignificant. AC significantly improved DFS (HR 0.81, 95% CI: 0.66-0.99; p = 0.04). Subgroup analysis indicated that AC significantly improved DFS and tended to improve OS for liver metastasis. In contrast, AC did not improve OS in cases of lung metastasis.

Conclusions: This meta-analysis suggests that AC demonstrated significant positive effects on DFS. Moreover, AC could contribute to improvements in OS. These findings, supported by the latest research, reinforce the recommendation of AC as a valuable strategy for improving both recurrence and survival outcomes in patients with curatively resected distant CRC metastases.

Objective: This study aimed to summarize and explore how to establish a good surgical space via a gasless transoral endoscopic thyroidectomy vestibular approach (TOETVA) to facilitate smooth surgical progress.

Methods: This study was conducted between January 2022 and December 2023. The study involved 281 patients with papillary thyroid carcinoma who underwent gasless TOETVA at The First Affiliated Hospital of the University of Science and Technology of China. The suspension method was used to establish the surgical space during the operation. The key steps and difficulties of surgical space construction were summarized, and the clinicopathological characteristics and surgical complications of the patients were analyzed.

Results: The mean surgical duration was 167.86 ± 25.38 min, and the time needed to create the surgical space (from incision of the lip mucosa to incision of the anterior border of the neck) was 17.82 ± 9.44 min. During the construction of the surgical space, there was 1 case of thermal skin burn and 2 cases of bleeding from the anterior jugular vein, with no permanent injury to the mental nerve.

Conclusion: In the gasless TOETVA, the suspension method of surgical space construction was employed to rapidly establish a stable three-dimensional operating space that was less prone to collapse, thus facilitating the smooth implementation of subsequent surgical procedures.