World Journal of Surgical Oncology最新文献

A 34-year-old male patient with recently diagnosed with medullary thyroid carcinoma underwent total thyroidectomy and radical neck dissection, requiring sharp dissection to separate the tumour from the trachea. He required post operative intubation due to bilateral vocal cord paralysis. He developed ischaemic necrosis of the upper two thirds of the trachea presenting with marked surgical emphysema and an infective wound. The wound was opened, drained and an endotracheal tube was negotiated through the sloughed trachea into the distal intrathoracic trachea with the cuff inflated just above the carina. This complication was managed with total pharyngo-laryngectomy, anterior deep mediastinal tracheostomy and construction of a neo-cervical oesophagus with a free lateral thigh fascio-cutaneous flap. This case highlights the potential complications of a procedure, perseverance, collaboration amongst various disciplines and teamwork for treating a rare and complex condition. The patient was discharged and has had an excellent recovery with good quality of life over two years of follow up.

Background: Gastric cancer remains a major global health challenge, ranking fourth in cancer-related deaths. Total gastrectomy with lymphadenectomy is the standard treatment, with advancements in surgery shifting towards minimally invasive techniques to reduce surgical trauma and metabolic response. Esophagojejunal anastomotic leak is a frequent complication of gastrectomy, significantly increasing morbidity and mortality rates by up to 64%.

Materials and methods: A retrospective cohort study reviewed adults undergoing total gastrectomy for gastric cancer who developed esophagojejunal anastomotic leaks. The study described patient characteristics, diagnostic methods, and management at Clinica Universitaria Colombia from 2013 to 2023.

Results: Among 500 patients who had total gastrectomy, 54 developed esophagojejunal leaks. The cohort was 64.8% male, average age 55.2 years (± 14.87), and average BMI 24.5 kg/m². Notably, 18.5% smoked, 11.1% had lung disease, and 9.3% had heart disease or diabetes. Chest tomography was used in 60% of cases, followed by endoscopy in 35.2%. Endoscopic management with fully covered stents was the main strategy, used in 84% of cases. Average hospitalization was 18 days, with 33% needing intensive care, and overall hospital stay was 23.31 ± 16.33 days. Patients undergoing neoadjuvant and elective laparoscopic surgeries had a significant 30-day mortality risk.

Conclusions: Despite advances in surgical techniques and perioperative management, esophagojejunal anastomotic leaks continue to represent a serious complication, increasing morbidity and mortality. Therefore, early postoperative detection, based on the patient's clinical signs that allow confirmatory studies to be performed, is crucial. This facilitates the implementation of timely treatments, whether conservative, through the use of endoscopic or percutaneous strategies, or surgical procedures. The next step for the scientific community will be to conduct studies with long-term follow-ups to ensure consistency of the high-quality results reported so far.

Objective: To observe the clinical efficacy of TPO receptor agonists and platelet transfusion in chemotherapy-induced thrombocytopenia in malignant tumors.

Methods: Clinical data from 120 patients with malignant tumors who developed thrombocytopenia following chemotherapy at our hospital were retrospectively collected and randomly divided into three groups: A, B, and C, with 40 patients in each group. Group A was treated with a TPO receptor agonist (avatrombopag), group B received autologous platelet transfusion, and group C received a combination of both treatments. The clinical efficacy of the three groups was compared, including platelet levels at different time points during treatment, platelet recovery time (time to reach < 50 × 10⁹/L, ≥ 75-100 × 10⁹/L, and ≥ 100 × 10⁹/L), changes in serum cytokine levels (PF4, TPO, vWF) before and after treatment, and fluctuations in coagulation function indicators (APTT, PT, FIB) before and after treatment to analyze the effectiveness of each treatment regimen.

Results: About clinical efficacy, the effectiveness in group A was comparable to that in group B (P > 0.05), while the effective rate in group C was significantly higher than that in groups A and B (P < 0.05). Regarding platelet counts, repeated measures analysis of variance showed significant differences in the time effect, group effect, and interaction effect for platelet counts (PLT) among the three groups (P < 0.05). Concerning platelet recovery time, the time to reach PLT < 50 × 10⁹/L, the time to recover to 75-100 × 10⁹/L, and the time to recover to ≥ 100 × 10⁹/L were similar in groups A and B (P > 0.05). However, the time for these parameters in group C was significantly shorter than in groups A and B (P < 0.05). In terms of changes in platelet parameters, post-treatment levels of PF4, TPO, and vWF in all three groups were significantly higher than pre-treatment levels. The PF4, TPO, and vWF levels in groups A and B were similar (P > 0.05), whereas group C had significantly higher levels compared to groups A and B (P < 0.05). Regarding coagulation indices, post-treatment levels of APTT and PT decreased, while FIB levels increased in all three groups (P < 0.05). There were no significant differences in APTT and FIB levels between groups A and B (P > 0.05). However, group C had significantly lower APTT and higher FIB levels compared to groups A and B (P < 0.05). There were no significant differences in PT levels among the three groups post-treatment (P > 0.05).

Conclusion: Autologous platelet transfusion and TPO receptor agonists are effective clinical methods for treating chemotherapy-induced thrombocytopenia. The combined use of both treatments yields better therapeutic results.

Early-onset (EOCC) and late-onset cervical cancers (LOCC) represent two clinically distinct subtypes, each defined by unique clinical manifestations and therapeutic responses. However, their immunological profiles remain poorly explored. Herein, we analyzed single-cell transcriptomic data from 4 EOCC and 4 LOCC samples to compare their immune architectures. Epithelial cells in EOCC exhibited a notable dual immunological phenotype, characterized by immune-suppressive properties driven by elevated CXCL production, alongside immune-stimulatory features linked to heightened HLA molecule expression. CD4 + and CD8 + T cells in LOCC demonstrated a heightened activation state, while NK cells exhibited diminished cytotoxicity. Macrophages in LOCC displayed enhanced polarization towards both M1 and M2 phenotypes, along with dendritic cells showing augmented antigen-presenting capacity. Regarding cancer-associated fibroblasts (CAFs), EOCC was enriched with inflammatory CAFs, whereas LOCC harbored a higher proportion of antigen-presenting CAFs. These findings reveal the multifaceted immune heterogeneity between EOCC and LOCC, underscoring the imperative for age-tailored immunotherapeutic strategies.

Background: The delivery of cancer services changed significantly during the COVID-19 pandemic. This study aimed to describe changes in presentations, assess the change in recommendations by the MDT during the pandemic, and describe the subsequent long-term impact of these changes on survival rates in patients with EG cancer.

Methods: A retrospective cohort study was designed comparing three patient groups of those referred to EG MDT in the same 6-month period pre-pandemic (PP;2019) during the initial phase of the pandemic (P1;2020) and the year after the initial phase (P2;2021). The primary aim of this study was to describe and compare deviations from the standard of care across these three timeframes. Secondary outcomes included differences in the number of new cases with early and advanced oesophageal and gastric lesions, a comparison of survival rates among the groups, and an analysis of postoperative histopathology to identify any shifts in the tumour stage across the studied periods.

Results: A consistent demographic profile across these periods was maintained, but with a significant decrease in patient referrals during P1 (35.25% reduction from PP to P1 and 9.5% reduction from PP to P2), quicker 'time to treatment' during P1 (130.8 days in P1 vs 162 in PP and 178.9 in P2), and notable changes in treatment modalities. Additionally, we found an increased deviation from initial curative to palliative intent in the P2 group (6.4% changed in P2 vs 2.2% in PP and 3.5% in P2) primarily driven by disease progression. A further significant observation was the emergence of more aggressive tumour characteristics, particularly in the P2 group, albeit without a statistically significant difference in two-year overall survival rates among the groups (p-value 0.31).

Conclusion: The COVID-19 pandemic significantly impacted oesophagogastric cancer care, with a reduction in patient referral rates during the initial pandemic phase and a subsequent increase in more advanced stage disease. Our findings from a major UK EG centre highlight accelerated treatment decision-making during the initial pandemic phase was possible and that standard of care was maintained. These insights provide valuable lessons for healthcare systems in managing cancer care during global health emergencies.

Background: In recent years, the association between systemic immune-inflammation index (SII) and the prognosis of patients with colorectal cancer (CRC) has remained a topic of considerable debate. To address this, the present study was carried out to investigate the prognostic significance of SII in CRC.

Methods: Databases including PubMed, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were scrutinized up to March 27, 2024. The relationship between pre- and post-treatment SII levels and the prognosis of CRC was evaluated. Following literature screening, quality assessment, and extraction of outcome measures, a meta-analysis was conducted using Stata. Publication bias was assessed by funnel plots and Egger's test.

Results: A total of 27 studies were included in the analysis. Pooled results demonstrated that a high SII level was associated with poor overall survival (OS, HR = 1.78, 95% CI = 1.40-2.26), progression-free survival (PFS, HR = 1.80, 95% CI = 1.26-2.56), disease-free survival (DFS, HR = 1.91, 95% CI = 1.43-2.56), and recurrence-free survival (RFS, HR = 3.29, 95% CI = 1.58-6.88). Notably, the association between pre-treatment SII and OS, PFS, and DFS was stronger than that observed for post-treatment SII, indicating that treatment may attenuate the predictive valueof SII for survival outcomes. Additionally, elevated SII was correlated with poor tumor differentiation, tumor location in the rectum, and larger tumor size ≥ 5 cm.

Conclusion: Our meta-analysis suggested that a high SII is a predictor of poor prognosis in CRC patients. High SII levels were strongly correlated with inferior OS, PFS, DFS, and RFS. The relationship between SII and survival outcomes was attenuated post-treatment compared to pre-treatment. Additionally, elevated SII was correlated with clinicopathological factors in CRC patients. These findings suggest that SII can serve as an independent prognostic indicator for CRC.

Objective: To assess the tolerability of multimodal therapy in soft tissue sarcoma patients, particularly with regard to their quality of life and level of distress.

Materials and methods: A retrospective cohort study enrolled individuals receiving sarcoma therapy at the sarcoma center of the University of Tuebingen between 2017 and 2022. Participants completed an online survey that included the EORTC's questionnaire (QLQ-C30), coupled with the distress thermometer and demographic inquiries. The primary emphasis was on comparing three distinct modalities: Radiation, Chemotherapy and Surgery. The data were analysed performing one-way ANOVA.

Results: A total of 237 patients were included in the study. There was a significant difference (p < 0.001) in quality of life according to the EORTC scores (high score = high quality of life) between the different treatments: chemotherapy (mean: 26.8 [standard deviation: 19.5]), radiotherapy (51.0 [21.5]), and surgery (46.9 [28.3]). Similarly, a statistically significant discrepancy (p < 0.001) was found in average distress levels (high score = high level of distress) corresponding to each treatment type: radiation (5.0 [2.7]), surgery (6.0 [2.9]), and chemotherapy (7.4 [2.4]). The rates of patients willing to undergo the same treatment varied across groups, with the highest percentage observed in the surgery group (94.2%), followed by radiation (87.4%), and chemotherapy (73.5%).

Conclusion: Patients receiving multimodal therapy for soft tissue often find chemotherapy particularly demanding. Impairment of both quality of life and physical well-being is more likely and tends to be more severe compared with radiation or surgery. These observations should be taken into consideration when consenting patients and offering treatment plans.

Background: Hepatocellular Carcinoma (HCC) and cholangiocellular adenocarcinoma (CCA) are the most common primary liver tumors representing a major global health burden. In early disease stages, tumor resection may provide long-term survival in selected patients. However, morbidity and mortality rates are still relatively high after extended liver surgery with perioperative bacterial infections representing major complications. In this study, we evaluate the impact of perioperative infection on the postoperative overall survival (OS) of patients undergoing resection of HCC or CCA.

Material and methods: Two hundred two patients that received liver surgery for HCC (139) or CCA (63) at our tertiary referral center were included between 2008 and 2020. Infection prior or after surgery was assessed using patient documentation and correlated to patients´ survival rates and other clinical characteristics.

Results: Patients with perioperative infection displayed a significantly impaired OS compared to patients without a documented infection (419 (95% CI: 262-576) days vs. 959 (95% CI: 637-1281) days; log rank X²(1) = 10.28; p < 0.001). Subgroup analysis revealed that this effect was only observed among HCC patients, while the outcome of CCA patients was independent of pre- or postoperative infections. Moreover, non-anatomical resection of liver tumors was beneficial in patients with HCC (1541 (95%CI: 1110-1972) vs. 749 (95%CI: 0-1528) days; log rank X²(1) = 5.387; p = 0.02) but not CCA.

Conclusion: Perioperative infection is an important prognostic factor after surgery for HCC but not CCA.

Background: To assess the effectiveness of tumor biomarkers in distinguishing epithelial ovarian tumors (EOTs) and guiding clinical decisions across each Ovarian-Adnexal Reporting and Data System (O-RADS) MRI risk category, the aim is to prevent unnecessary surgeries for benign lesions, avoid delays in treating malignancies, and benefit individuals requiring fertility preservation or those intolerant to over-extensive surgery.

Methods: A total of 54 benign, 104 borderline, and 203 malignant EOTs (BeEOTs, BEOTs and MEOTs) were enrolled and retrospectively assigned risk scores. The role of tumor biomarkers in diagnosing and managing EOTs within each risk category was evaluated by combining receiver operating characteristic (ROC) curves with clinicopathological characteristics.

Results: A score of 3 was assigned to 66.67% of BeEOTs, 50.96% of BEOTs, and 13.80% of MEOTs, whereas cancer antigen 125 (CA125) ≥ 60.39 U/ml helped identify MEOTs with a low-risk time-intensity curve (TIC) for prompt surgical assessment. Only 3.7% of the BeEOTs were classified as O-RADS MRI 4/5, whereas 48.08% and 86.2% of the BEOTs and MEOTs were classified, respectively. Overall, EOTs with a score of 4/5 are candidates for semi-elective surgery owing to the low probability of benign lesions. For EOTs with a ROMA index less than 20.14% (premenopausal) or 29.9% (postmenopausal), minimally invasive surgery is recommended for diagnostic and therapeutic purposes. Comprehensive staging or cytoreductive surgery is recommended for the remaining patients, especially when fertility preservation is not a priority.

Conclusions: The O-RADS MRI primarily differentiates BeEOTs with risk scores of 2/4/5 from BEOTs/MEOTs, while tumor biomarkers further enhance the diagnosis and clinical management of EOTs with scores of 3/4/5. Future studies should focus on multi-center, prospective studies with larger sample sizes to validate and refine the integration of O-RADS MRI with tumor biomarkers.

Objective: This study aimed to evaluate and compare the clinicopathologic features of primary fallopian tubal carcinoma (PFTC) and high-grade serous ovarian cancer (HGSOC) and explore the prognostic factors of these two malignant tumors.

Methods: Fifty-seven patients diagnosed with PFTC from 2006 to 2015 and 60 patients diagnosed with HGSOC from 2014 to 2015 with complete prognostic information were identified at Women's Hospital of Zhejiang University. The clinicopathological and surgical data were collected, and the survival of the patients was followed for 5 years after surgery. The Cox proportional risk model was used to analyze the impact on survival.

Results: For PFTC patients, the mean age was 57 years (range, 35-77 years). The most common clinical manifestations were abnormal vaginal bleeding and/or discharge (61%). A total of 72% of the cases were found at the early stage, and 90% of the tumors were high grade (51 cases). 51% of patients were diagnosed with PFTC before surgery, while the rest were misdiagnosed. Twenty-one patients relapsed. The overall survival (OS) rate was 82%. OS was significantly related to FIGO stage, the preoperative serum CA 125 level, lymphadenectomy, residual tumor size, appendectomy, and the number of cycles of chemotherapy. However, only FIGO stage was an independent prognostic variable for OS. For patients with HGSOC, the OS rate was 67%. OS was significantly related to FIGO stage, residual tumor size, and laterality. However, only residual tumor size was an independent prognostic variable for OS.

Conclusions: Our study provides important clinicopathologic insights into PFTC and HGSOC. We identified FIGO stage as an independent prognostic factor for PFTC patients and residual tumor size as an independent prognostic factor for HGSOC patients. These findings emphasize the critical role of accurate staging and achieving a residual tumor size of less than 1 cm during surgery. Our research contributes to refining clinical decision-making, supporting the importance of optimal surgical outcomes, and guiding personalized treatment strategies to improve patient prognosis in both PFTC and HGSOC patients.