World Journal of Surgical Oncology最新文献

Objective: Unifocal papillary thyroid carcinoma (PTC) refers to thyroid cancer that has only one isolated lesion, it has also the possibility of lymph node metastasis (LNM). Circulating tumor cell (CTC) has been used to assist in the assessment of tumor progression, but the relationship between CTCs levels and LNM in unifocal PTC patients is unclear.

Methods: The clinical records (age, gender, Hashimoto's thyroiditis, thyroid function, tumor size, invaded capsule (thyroid cancer penetrating the capsule), clinical stage, and LNM) of unifocal PTC patients in Meizhou People's Hospital were analyzed retrospectively. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff value of CTCs levels to distinguish LNM. The relationship between CTCs level and clinical features was analyzed. Logistic regression analysis was used to evaluate the relationship between CTCs and LNM.

Results: A total of 507 unifocal PTC patients were included, and 198(39.1%) patients with LNM. The critical value of CTCs was 9.25 FU/3mL by ROC analysis, and 288(56.8%) unifocal PTC patients with preoperative CTC-positive(≥ 9.25 FU/3mL). The patients with positive CTCs had higher proportions of normal thyroid function (91.3% vs. 84.5%, p = 0.018), and LNM (44.1% vs. 32.4%, p = 0.008) than patients with negative. High preoperative CTCs level (≥ 9.25/<9.25 FU/3mL, odds ratio(OR): 1.653, 95% confidence interval(CI): 1.115-2.451, p = 0.012), tumor size > 1 cm (OR: 3.189, 95% CI: 2.069-4.913, p < 0.001), and invaded capsule (OR: 1.521, 95% CI: 1.005-2.302, p = 0.047) were associated with LNM among unifocal PTC in multivariate logistic regression analysis.

Conclusions: High preoperative CTCs level (≥ 9.25 FU/3mL), tumor size > 1 cm, and invaded capsule were associated with LNM among unifocal PTC.

Purpose: To explore the application effect of the technique of "priority dissecting of the inferior mesenteric artery combined with complete medial approach (IMA-CMA)" in laparoscopic left-sided colon cancer radical resection.

Methods: A total of 99 patients who underwent laparoscopic left-sided colon cancer radical resection with splenic flexure mobilization between September 2021 to May 2023 were included. Sixty-eight of these patients were analyzed after propensity score matching (PSM). The perioperative characteristics were compared.

Results: Among these enrolled patients, 45 underwent the traditional approach, and 54 underwent IMA-CMA approach. After PSM, the patients were matched to include 34 patients in each group, with no significant differences in the sex (p = 0.618) or location of tumor (p = 0.798) between the two groups. The patients in IMA-CMA group had shorter operating time (p = 0.032), less intraoperative blood loss (p = 0.003), a higher number of harvested lymph nodes (p = 0.044) and center group lymph nodes(p = 0.037), and a shorter postoperative hospital stay (p = 0.011). Number of positive lymph nodes and postoperative complications were not significantly different between the two groups.

Conclusions: The technique of IMA-CMA for splenic flexure mobilization is safe and feasible. It can reduce operating time, intraoperative blood loss and postoperative hospital stay, which is conducive to achieving a thorough D3 lymphadenectomy without increasing the incidence of perioperative complications.

Background: This study aimed to investigate the knowledge, attitudes, and practices (KAP) regarding whole-course management among patients with gastrointestinal (GI) cancers.

Methods: This cross-sectional study enrolled patients with GI cancers at the Inner Mongolia Hospital of Peking University Cancer Hospital between November 2023 and April 2024. Data were collected through a self-administered questionnaire, which captured demographic information and scores on KAP.

Results: A total of 408 participants were included in this study. The mean KAP scores were 10.62 ± 3.14 (out of a maximum of 15), 39.11 ± 4.94 (out of a maximum of 50), and 31.35 ± 5.60 (out of a maximum of 40), respectively. Knowledge was positively correlated with attitudes (r = 0.307, P < 0.001) and practices (r = 0.417, P < 0.001), while attitudes were positively correlated with practices (r = 0.383, P < 0.001). The structural equation model indicated that knowledge influenced attitudes (β = 0.573, P < 0.001) and practices (β = 0.466, P < 0.001), while attitudes influenced practices (β = 0.525, P < 0.001).

Conclusions: Patients with GI cancers demonstrated insufficient knowledge, moderate attitudes, and suboptimal practices regarding whole-course management. Improvements in practice could be achieved by enhancing knowledge and attitudes through specialized health education.

Background: Minimally invasive pancreaticoduodenectomy (MIPD) has seen increased adoption due to advancements in surgical techniques and technology. However, the impact of hepatic artery variations (HAV) and clinically relevant HAV (CR-HAV) on MIPD outcomes remains under-investigated. This study aims to explore the differences in surgical and oncological outcomes of MIPD with or without HAV and CR-HAV.

Methods: We enrolled 267 consecutive patients who underwent MIPD at Peking Union Medical College Hospital between January and December 2023. HAV was identified preoperatively through enhanced abdominal CT and three-dimensional reconstruction, and classified according to the Michels and Hiatt systems. Clinically relevant hepatic artery variations (CR-HAV) were defined based on their potential impact on the surgical approach. We collected and analyzed perioperative data and oncological outcomes between patients with and without HAV and CR-HAV. Propensity score matching (PSM) was used to minimize baseline confounding. Survival analysis was performed using the Kaplan-Meier method with log-rank tests.

Results: HAV was identified in 26.1% of patients, and CR-HAV in 18.9%. The median operation time was significantly longer in HAV (+) group compared to HAV (-) group (6.72 vs. 5.80 h, p = 0.013). No significant differences were found between HAV/CR-HAV (+) and (-) groups regarding intraoperative blood loss, conversion to laparotomy, postoperative complications, surgical mortality, length of stay, re-operation, and re-admission. Kaplan-Meier survival analysis showed no significant differences in overall survival or progression-free survival between HAV/CR-HAV (+) and (-) groups in the malignant cohort.

Conclusion: HAV and CR-HAV do not significantly impact overall or progression-free survival in patients undergoing MIPD. While HAV is associated with longer operation times, other perioperative and oncological outcomes remain comparable between HAV/CR-HAV (+) and (-) groups.

Background: Renal cell carcinoma (RCC) is a frequent and aggressive type of kidney cancer with limited therapeutic options. Although phosphatase and tensin homolog (PTEN) have been recognized as a potential tumor suppressor in all kinds of cancers, its function in RCC remains to be thoroughly elucidated.

Objective: This article was recruited to examine the PTEN's role in managing the PI3K/AKT pathway and its impact on the RCC cell proliferation and migration.

Methods: This study collected renal cancer and adjacent non-cancerous tissue samples from our hospital. HK-2 and 786-O cells were used, with 786-O cells divided into control, vector, and oe-PTEN groups. PTEN and related protein levels were detected using RT-qPCR and Western blot. Statistical analyses were performed using the Mann-Whitney U test and Kruskal-Wallis H test. Cell viability and migration were assessed using the CCK-8 assay and wound healing assay. All analyses were conducted with SPSS 22.0 software, with statistical significance defined as p < 0.05.

Results: RT-qPCR results showed that PTEN expression was significantly increased in RCC tumor tissues compared to normal tissues (p < 0.01). However, PTEN mRNA levels were significantly reduced in 786-O cells compared to HK-2 cells (p < 0.01). In 786-O cells with low PTEN expression, further induction of PTEN overexpression significantly inhibited PI3K/AKT signaling activity (p < 0.01), accompanied by decreased cell viability and migration ability. These results indicate that the expression pattern of PTEN in RCC is complex, but its overexpression can exert tumor-suppressive effects by inhibiting the PI3K/AKT signaling pathway.

Conclusion: Our findings demonstrate that PTEN overexpression in RCC cells leads to decreased PI3K/AKT signaling, decreasing cell viability and migration. This study highlights the critical role of PTEN in RCC progression and suggests potential therapeutic targets for intervention.

Background: Radiofrequency ablation (RFA) is considered a promising alternative to surgical excision for patients with small, unifocal early-stage breast cancer. A significant concern with the application of RFA in patients diagnosed with ductal carcinoma in situ (DCIS) via needle biopsy is the underdiagnosis of invasive cancer. The extent of this underdiagnosis in DCIS patients eligible for RFA has not been clearly defined.

Methods: This retrospective study assessed lesions diagnosed as DCIS via needle biopsy and eligible for RFA at our institution from April 2009 to March 2024. The eligibility criteria for RFA included a lesion size of ≤ 1.5 cm, unifocality, and clinical node negativity. Underdiagnosis was defined as the presence of invasive cancer in surgical specimens. We evaluated the frequency and risk factors associated with underdiagnosis.

Results: During the study period, 606 lesions were diagnosed as DCIS via needle biopsy. Of these, 209 lesions met the criteria for RFA, with underdiagnosis determined in 40 lesions (19.1%). The distribution of pathological T (pT) stages among these lesions was as follows: DCIS in 169 lesions (80.9%), pT1mi in 20 lesions (9.6%), pT1a in 5 lesions (2.4%), pT1b in 9 lesions (4.3%), pT1c in 5 lesions (2.4%), and pT2 in 1 lesion (0.5%). Multivariate logistic regression analysis identified lesion size ≥ 10 mm as a significant risk factor for underdiagnosis (p = 0.016). Adjuvant endocrine therapy and chemotherapy were administered to 26 (65.0%) and 6 (15.0%) of the underdiagnosed lesions, respectively.

Conclusions: Our findings highlight the risk of underdiagnosing invasive breast cancer in patients undergoing RFA for needle biopsy-diagnosed DCIS. It is crucial to acknowledge the potential for undertreatment when considering RFA as a treatment option.

Background: Minimally invasive left pancreatectomy (MILP) is increasingly performed worldwide, necessitating the need for improved understanding of vascular anatomy during surgery. However, the effect of differences in vascular anatomy on surgical outcomes remains unclear. In this study, we aimed to evaluate the effect of vascular anatomical variations on surgical outcomes and identify factors that influence open and minimally invasive surgery (MIS) outcomes.

Methods: This was a single-center retrospective study involving 123 patients who underwent left pancreatectomy (LP). We analyzed the correlation between vascular anatomical variations, namely, (i) the root of the splenic artery (SpA; types 1 and 2), (ii) the parent artery of the dorsal pancreatic artery, (iii) confluence patterns of the left gastric vein, and (iv) the inferior mesenteric vein, and surgical outcomes. We also performed a risk analysis of prolonged operation time, considering surgery-related factors.

Results: SpA type 2 was only significantly associated with longer operation time (p < 0.01) in LP procedures. In all LP cases, the pancreatic resection line (above the portal vein: odds ratio [OR] 3.47; 95% confidence interval [CI] 1.69-11.18; p < 0.01), the SpA type (type 2; OR 2.77; 95% CI 1.16-6.94; p = 0.02), and surgery type (MIS; OR 5.24; 95% CI 2.17-14.00; p < 0.001) were independently associated with prolonged operation times. In open-LP cases, high body mass index (> 24 kg/m²; OR 7.24; 95% CI 1.89-36.34; p < 0.01), tumor location (pancreatic body; OR 6.89; 95% CI 1.79-33.79; p < 0.01), and the SpA type (type 2; OR 5.86; 95% CI 1.72-24.65; p < 0.01) showed significant association with prolonged operations. In MILP cases, sex (male; OR 9.07; 95% CI 2.61-38.65; p < 0.001) and the pancreatic resection line (above the portal vein; OR 4.12; 95% CI 1.18-17.08; p = 0.03) showed significant associations.

Conclusions: SpA type 2 may negatively affect surgical outcomes. Therefore, it is important to recognize and approach vascular anatomy appropriately. MIS, especially robotic surgery, may be effective in mitigating the negative effects of variations in vascular anatomy.

Background: Acute kidney injury after CRS + HIPEC is a serious postoperative complication, but only a few studies have reported its postoperative risk factors. In addition, there are large discrepancies in the results of available observational studies.

Methods: We searched The Cochrane Library, Embase, Web of Science,and PubMed to identify observational studies reporting risk factors for AKI after CRS + HIPEC. A meta-analysis was performed to investigate the effect of various preoperative and intraoperative risk factors on AKI after CRS + HIPEC.

Results: A total of 7 studies were included in this study, comprising 1550 patients who developed AKI after CRS + HIPEC. The results of meta-analysis showed that the significant preoperative risk factors were age, sex, BMI, eGFR, Hb, PCI, diabetes mellitus, and hypertension. IO cisplatin, IO SBP < 100 was identified as an intraoperative risk factor, whereas IO mitomycin emerged as a protective factor for postoperative AKI. In addition, the risk of postoperative AKI varied by primary tumor site, with Appendix being less prone to AKI, while mesothelioma and ovarian, two sites with a greatly elevated risk of postoperative AKI.

Conclusions: This meta-analysis identified a number of risk factors for postoperative AKI after CRS + HIPEC. By identifying these risk factors, it is more beneficial for clinicians to perform early preoperative interventions and select the most appropriate treatment strategy for their patients, thus minimizing the risk of postoperative AKI.

Trial registration: PROSPERO CRD42024585269.

Background: Gastric cancer (GC) poses significant challenges globally, ranking fifth in incidence and fourth in cancer-related mortality. SALL4, a stem cell transcription factor with multiple isoforms, includes SALL4-A as its full-length form. This study aims to evaluate the diagnostic potential of SALL4-A isoform expression in GC and its clinical significance.

Method: Immunohistochemical (IHC) analysis was conducted on Tissue Micro Array (TMA) slides from 167 GC patients. Clinicopathological parameters were correlated with SALL4-A expression, and survival analysis was performed. Diagnostic performance was assessed using metrics such as sensitivity, specificity, and area under the curve (AUC).

Results: SALL4-A exhibited distinct cytoplasmic expression in GC, correlating with lower histological grade (p = 0.003) and TNM stage (p = 0.003), particularly in the intestinal subtype. Diagnostic evaluation showed an AUC of 0.803 for cytoplasmic expression, demonstrating high diagnostic potential. However, SALL4-A expression did not show significant prognostic value.

Conclusion: Cytoplasmic SALL4-A expression in GC is associated with less aggressive tumor phenotypes and shows promise as a diagnostic marker. Further research is warranted to elucidate its mechanistic role and potential integration into clinical practice.