World Journal of Surgical Oncology最新文献

Background: With recent advances in genetics research, genetic analysis is increasingly being used in clinical practice. We report a case in which genetic analysis aided in diagnosing a local recurrence of sigmoid colon cancer, initially suspected to be a primary neoplasm of the small intestine.

Case presentation: A 61-year-old male underwent laparoscopic sigmoidectomy for stage IIIB sigmoid colon cancer, followed by 8 cycles of CAPOX adjuvant chemotherapy, one and a half years prior. A follow-up CT scan performed one and a half years postoperatively revealed a mass in the small intestine near the ileal end, adjacent to the staple line of the previous colonic anastomosis. PET imaging showed high uptake in the small intestine but no significant uptake at the site of the prior anastomotic ring. Based on these findings, a primary small intestine neoplasm was suspected, rather than a local recurrence of the sigmoid cancer, prompting laparoscopic surgery. Intraoperative findings revealed an inflamed mass in the ileum, approximately 30 cm proximal to the cecum, involving staples from the previous anastomotic site. Consequently, an ileocecal resection combined with resection of the prior colonic anastomosis was performed. Macroscopically, the resected specimen revealed a 25-mm Type 2 tumor in the ileum extending into the previous anastomotic site of the large intestine, while the colonic mucosa remained intact. Histopathological examination identified a moderately differentiated tubular adenocarcinoma, consistent with the histology of the primary sigmoid cancer, raising the possibility of local recurrence. To analyze the origin of the ileal tumor, we performed whole-genome sequencing and subsequent PCR direct sequencing. As a result, identical mutations in two key driver genes (KRAS c.35G > A and PIK3CA c.1624G > A), as well as a mutation in a passenger gene (BBS9 c.2218_2222del), were identified in the primary and ileal tumors. These findings confirmed that the ileal tumor was a local recurrence rather than a new primary malignancy.

Conclusions: The present case highlights the practical application of genetic analysis in clinical practice, particularly when clinical diagnosis and histopathological findings are inconclusive or conflicting.

Background: Knowledge on the incidence of surgical complications after oesophagectomy for oesophageal cancer in nationwide practice is scarce. The aim of this study was to assess complication trends after oesophagectomy in a nationwide, population-based, unselected cohort.

Methods: All patients undergoing oesophagectomy for oesophageal cancer in Finland in 1987-2016 were included. All complications defined by the Esophagectomy Complications Consensus Group (ECCG) were reported in three 10-year periods. Chi-square test and Kruskal-Wallis test were used to compare outcomes in these periods.

Results: A total of 1493 patients were included. From 1987 to 1996 to 2007-2016, improvements were seen in the rate of major complications (49% vs. 43%, p = 0.039), length of hospital stay (19 vs. 14 days, median, p < 0.001), length of ICU-stay (3 vs. 2 days, median, p < 0.001) and 90-day mortality (17.9% vs. 5.4%, p < 0.001), while pneumonia (16% vs. 23%, p = 0.029) and anastomotic leak (8% vs. 12% in total leaks, p = 0.006 for type II leak) increased. The most common complications were pneumonia, pleural effusion requiring drainage (16% vs. 23%, p = 0.080), atrial dysrhythmia (16% vs. 15%, p = 0.464) and anastomotic leak. The most common complication categories defined by ECCG were pulmonary (36% vs. 42%, p = 0.151) and gastrointestinal (21% vs. 23%, p = 0.398) complications.

Conclusions: This study reports high postoperative morbidity after oesophagectomy in nationwide practice. Mortality has significantly improved during the years, and it appears that patients who would have died earlier, can now be rescued. While the relative occurrence of complications has remained constant, overall morbidity has decreased as the more severe outcomes have decreased.

Background: The surgery of adenocarcinoma of the esophagogastric junction (AEG) is a complex procedure that increases postoperative morbidity compared to distal gastric cancer. In this study, we included thoracic anatomical parameters of patients for the first time to investigate their impact on the postoperative outcomes of transabdominal gastrectomy for Siewert type II/III AEG.

Methods: All patients with Siewert type II or III AEG of our institution who underwent transabdominal proximal or total gastrectomy from January 2015 to December 2022 were included in this study. We measured thoracic anatomical parameters on the level of the lower edge of the sternum using preoperative computer tomography. The anteroposterior diameter of the thorax was measured as the distance from the posterior edge of the sternum to the anterior edge of the spine, while the transverse diameter was the maximum distance between the ribs on both sides. Patients' data and postoperative details were retrospectively collected. Correlation between thoracic anatomical parameters with postoperative complications were analyzed.

Results: Overall, 647 patients were eligible for this study. The incidence of postoperative complications was 28.1%, with postoperative pulmonary complications occurring in 24.7%. In multivariate analysis, anteroposterior thoracic diameter > 10.2 cm was an independent risk factor for postoperative complications (OR = 1.891, 95% CI: 1.137-3.146, p = 0.014), transverse thoracic diameter > 23.3 cm was an independent risk factor for postoperative pulmonary complications (OR = 2.243, 95% CI: 1.234-4.079, p = 0.004). In open group, transverse thoracic diameter over 23.3 cm correlated independently with postoperative complications (OR = 2.451, 95% CI: 1.219-4.927, p = 0.012) and postoperative pulmonary complications (OR = 2.988, 95% CI: 1.407-6.347, p = 0.004). However, this correction was not significant in laparoscopy-assisted group.

Conclusions: Thoracic size is an independent risk factor affecting the postoperative outcomes of transabdominal gastrectomy for Siewert type II and III AEG. Patients with larger thoracic cage are at a higher risk of postoperative complications, particularly pulmonary complications. For those patients, laparoscopic surgery may be a viable option.

Background: Acute compartment syndrome (ACS) is characterized by increased pressure within the fascial network of any muscle, leading to impaired circulation and potential myonecrosis. Very rarely, soft tissue infiltration by metastatic disease can cause localized swelling that increases intercompartmental pressures. We report an unusual case of invasive, poorly differentiated upper gastrointestinal adenocarcinoma presented by acute compartment syndrome of the lower extremity and subsequent acute kidney injury (AKI) caused by myonecrosis-induced cast nephropathy.

Case presentation: A 52-year-old male presented to the hospital with rapid onset unilateral right leg pain and tense edema accompanied by myonecrosis with no explicable etiology complicated by AKI. Surgical fasciotomy and subsequent muscle biopsy yielded poorly differentiated non-small cell adenocarcinoma. CT imaging identified diffuse adenopathy along with abnormal thickening of the distal esophagus, gastroesophageal (GE) junction, and gastric cardia. Further investigation via upper esophagogastroduodenoscopy (EGD) revealed an exophytic mass in the distal esophagus extending into the stomach. This lesion was confirmed via biopsy as primary invasive poorly differentiated upper gastrointestinal (UGI) adenocarcinoma.

Conclusion: This case highlights the need for clinicians to implement high-risk screening for UGI cancers and consider skeletal muscle metastasis as a cause of nontraumatic ACS. It emphasizes the importance of interdisciplinary collaboration in managing such complex cases and the role of timely surgical and oncological intervention in preventing long-term complications of ACS. Furthermore, it highlights the potential use of more efficient and specific MR imaging techniques to diagnose ambiguous cases of ACS.

Background and objective: Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are recognized for their aesthetic benefits in breast cancer patients. However, detailed evaluations with large samples of their long-term oncological effectiveness are limited. This study aims to compare the long-term oncologic outcomes of NSM/SSM and traditional mastectomy (TM) in patients with stage I-III breast cancer and to identify influential preoperative factors.

Methods: Among the 12,802 breast cancer patients who underwent surgery from 2009 to 2022 in West China Hospital of Sichuan University, 295 NSM/SSM patients and 584 TM patients were selected after propensity score matching adjusted for variables. Survival outcomes were analyzed using Kaplan-Meier estimates, Fisher's exact test, and log-rank tests, with Cox regression identifying survival predictors.

Results: The median follow-up period was 97.93 months. Local recurrence (LR) was 5.76 ± 1.36% for NSM/SSM compared to 3.25 ± 0.73% for TM (p = 0.076). Overall survival (OS) was comparable (p = 0.601), while disease-free survival (DFS) showed a trend toward significance (p = 0.066). However, there was a significant difference in distant metastasis-free survival (DMFS) (p = 0.029). The 5-year OS rates between the matched groups were similar (98.11% vs. 98.09%, p = 1.000), while the TM group exhibited higher 5-year DFS(95.14% vs. 92.03%, p = 0.335). Following the univariate analysis, multivariate analysis identified significant DFS predictors: stage (HR = 2.701, p = 0.031), radiotherapy (HR = 1.928, p = 0.018), and targeted therapy (HR = 5.584, p < 0.001). For OS, significant predictors included stage (HR = 8.309, p = 0.021) and PR status (HR = 0.35, p = 0.010).

Conclusions: NSM/SSM demonstrated comparable OS and DFS to TM, though with lower DMFS. Preoperative ultrasound parameters showed no significant impact on long-term outcomes, confirming the oncologic safety of NSM/SSM. Tailored adjuvant therapies and appropriate follow-up may further optimize patient prognoses.

Purpose: The efficacy of postoperative adjuvant chemotherapy in patients with stage II colorectal cancer has been a subject of debate. This study aimed to evaluate the prognostic and predictive significance of DNA ploidy and stroma ratio in patients diagnosed with stage II colorectal cancer (CRC).

Methods: Clinical data and tumor tissues from 179 patients with stage II CRC were collected retrospectively. DNA ploidy (P) and stroma (S) were assessed using automatic image analysis tools powered by machine learning.

Results: Patients were categorized into three risk groups: PS-low (diploid and low stroma, PS-L), PS-intermediate (non-diploid or high stroma, PS-M), and PS-high (non-diploid and high-stroma, PS-H). According to the univariable model, the PS-H group exhibited significantly poorer 5-year overall survival rates at 73.0% compared to 87.8%, with a hazard ratio (HR) of 2.281 (95% CI: 0.946-5.502, P = 0.066), as well as lower 5-year disease-free survival rates at 69.4% versus 86.6%, HR = 2.323 (95% CI: 1.016-5.308, P = 0.046) among stage II colorectal cancer patients. Notably, chemotherapy was associated with improved overall survival [HR = 83.460 (95% CI: 0.179-38925.833), P = 0.003] and disease-free survival [HR = 8.628 (95% CI: 1.059-70.265), P = 0 .044] in individuals within the PS-high group.

Conclusion: While ploidy and stroma alone do not possess predictive power regarding survival outcomes for stage II colorectal cancer patients, those receiving chemotherapy within the PS-H group demonstrated enhanced survival rates. Therefore, combining assessments of ploidy and stroma may serve as an adjunctive tool in clinical decision-making processes to guide chemotherapy treatment strategies for patients diagnosed with stage II colorectal cancer.

Purpose: This study aimed to investigate the expression and clinical relevance of the androgen receptor (AR) in breast cancer.

Methods: This retrospective study examined the expression of AR in breast cancer and its correlation with patients' clinicopathological and immunohistochemical characteristics. A total of 521 patient records were gathered and assessed. Patients were categorized as either positive or negative for AR expression, and statistical analyses were conducted using the chi-square test, logistic regression in SPSS 26.0, and Kaplan-Meier analysis.

Results: AR was detected in 83.7% of the 521 patients studied. There was a statistically significant difference in the prevalence of AR positivity among different molecular subtypes, estrogen receptor (ER) status, progesterone receptor (PR) status, human epidermal growth factor receptor 2 (HER2) status, and epidermal growth factor receptor (EGFR) (P < 0.05). Logistic regression analysis further revealed that ER and PR positivity were identified as risk factors for AR expression, and Kaplan-Meier curve analysis demonstrated the potential of AR as a prognostic indicator for breast cancer outcomes. Additionally, AR positivity was associated with a favorable prognosis.

Conclusions: The results suggest a strong correlation between AR expression and ER and PR co-expression in breast cancer. Additionally, AR positivity in the absence of ER and PR expression is associated with a favorable prognosis, indicating potential therapeutic value as a novel target in breast cancer treatment. Particularly in endocrine resistance or triple-negative breast cancer (TNBC), AR may serve as a significant prognostic indicator, warranting further investigation.