World Journal of Surgical Oncology最新文献

Background: The objective of this study was to evaluate the clinicopathological characteristics and patterns of care among women diagnosed with vulvar malignancy at a tertiary care teaching institute. Additionally, the study aimed to analyse the implications of revised FIGO staging system on stage shift and patient outcomes.

Methods: A retrospective observational study was conducted, wherein hospital records of biopsy-proven cases of vulvar cancers managed over a period of 10 years were comprehensively reviewed. The assignment of FIGO staging was performed utilizing both 2009 and 2021 FIGO staging systems for comparative analysis. Statistical analysis was performed using STATA version 17. Survival curves were constructed using the Kaplan-Meier method, with differences assessed using the log-rank test. Additionally, multivariable analysis was conducted using the Cox proportional hazard model.

Results: A total of 82 cases meeting the inclusion criteria were enrolled in the study. Management patterns varied widely, with the majority undergoing surgery (73.2%), followed by definitive radiotherapy with or without chemotherapy (10.9%), neoadjuvant radiotherapy and subsequent surgery (4.9%), and palliative care (10.9%). Post-operative radiotherapy was administered in 31.7% of cases. The disease-specific recurrence rate was found to be 32.9%, and the mortality rate was 30.5%. The median Disease-Free Survival (DFS) was 17 months (interquartile range [IQR]: 1-36 months), while the Overall Survival (OS) was 27 months (IQR: 9-52 months). Upon application of the 2021 staging system, a stage shift was observed in 18% of cases of advanced vulvar cancer. The 3-year DFS and OS were reduced for stage IIIA and stage IVA, while showing improvement for stage IIIB.

Conclusions: The revised FIGO 2021 staging system offers enhanced simplicity in its application within clinical practice and demonstrates improved correlation with prognosis. Approximately 18% cases experienced restaging under the updated system.

Trial registration number: Not applicable.

Background/aim: This research study was conducted to examine the clinical characteristics and post-splenectomy survival outcomes of patients diagnosed with hepatosplenic T-cell lymphoma (HSTCL).

Materials and methods: A total of 10 cases of HSTCL patients admitted to the Hematology Department of Fudan University Affiliated Huadong Hospital between January 2012 and December 2021 were included. In addition, we also included 30 other cases reported from domestic and international sources. All pathological specimens were stained with hematoxylin and eosin (H&E) and immunohistochemistry, with color development using DAB staining. Survival analysis was conducted using Kaplan-Meier curves and log-rank tests.

Results: In the 10 HSTCL patients, Epstein-Barr virus (EBV) infection was confirmed. Six patients had died, with 5 of them within 1 year of disease onset. Survival analysis showed poorer prognosis in patients with hemophagocytic syndrome and thrombocytopenia. Patients who underwent splenectomy followed by chemotherapy had a higher median and average survival time compared to those who only received chemotherapy. The study included a total of 40 HSTCL patients, with 29 males and 11 females, and an average age of onset at 42.3 years. All patients presented with fever, with some exhibiting emaciation and/or hemophagocytic syndrome. Splenomegaly, hepatomegaly, lymphadenopathy, and bone marrow involvement were found in the patients. Common laboratory findings included leukopenia, anemia, and thrombocytopenia. All patients exhibited elevated ferritin levels and decreased blood calcium levels.

Conclusion: Those patients suffering from hemophagocytic syndrome at the onset of this disease face greater treatment-related difficulties and a higher risk of mortality. Combined chemotherapy after splenectomy may improve HSTCL patient survival.

Purpose: To develop and validate a nomogram for predicting the overall survival (OS) of ovarian cancer patients with liver metastases (OCLM).

Methods: This study identified 821 patients in the Surveillance, Epidemiology, and End Results (SEER) database. All patients were randomly divided in a ratio of 7:3 into a training cohort (n = 574) and a validation cohort (n = 247). Clinical factors associated with OS were assessed using univariate and multivariate Cox regression analyses, and backward stepwise regression was applied using the Akaike information criterion (AIC) to select the optimal predictor variables. The nomogram for predicting the OS of the OCLM patients was constructed based on the identified prognostic factors. Their prediction ability was evaluated using the concordance index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curves analysis (DCA) in both the training and validation cohorts.

Results: We identified factors that predict OS for OCLM patients and constructed a nomogram based on the data. The ROC, C-index, and calibration analyses indicated that the nomogram performed well over the 1, 2, and 3-year OS in both the training and validation cohorts. Additionally, in contrast to the External model from multiple perspectives, our model shows higher stability and accuracy in predictive power. DCA curves, NRI, and IDI index demonstrated that the nomogram was clinically valuable and superior to the External model.

Conclusion: We established and validated a nomogram to predict 1,2- and 3-year OS of OCLM patients, and our results may also be helpful in clinical decision-making.

Objectives: To investigate the clinicopathological characteristics and prognosis of patients with undifferentiated uterine sarcomas (UUS).

Methods: 29 patients with UUS who were treated at our institution between 2001 and 2020 were analyzed.

Results: The median age at diagnosis was 52 years (range: 26-70 years). The FIGO 2009 distribution by stage was as follows: stage I, 17 patients (58.6%); stage II, 5 patients (17.2%); stage III, 4 patients (13.8%); and stage IV, 3 patients (10.3%). For 28 patients who underwent surgical treatment, 27 patients (96.4%) underwent total/sub-radical/radical hysterectomy combined bilateral salpingo-oophorectomy, 17 (58.6%) pelvic lymphadenectomy, 7 (24.1%) para-aortic lymphadenectomy and 8 (28.6%) patients underwent omentectomy, as part of the initial surgical treatment. The median follow-up was 23.4 months (range: 4.5-200.2 months). 18 patients (62.1%) died during follow up, and 13 patients (72.2%, 13/18) died within 2 years after diagnosis. Median progression-free survival (mPFS) and overall survival (mOS) for the entire cohort were 15.5 and 27.4 months, respectively. 2-year and 5-year PFS were 40.3% and 26.9%. 2-year and 5-year OS were 54.0% and 36.5%. Stage-specific median PFS and OS were as follows: stage I-II-17.7 and 35.5 months, stage III-IV-6.0 and 6.7 months. Patients with recurrent UUS who underwent cytoreduction surgery associated with an improved overall survival (mOS: 52.9 vs. 17.9 months), but the difference was not statistically significant (P = 0.081).

Conclusions: UUS are a rare group of tumors with an aggressive behavior and poor outcomes. A majority rapidly develops distant metastases despite surgical resection.

Background: Oral leiomyomatous hamartoma (OLH) corresponds to an abnormal, benign and disorganized overgrowth of mature smooth muscle tissue, which can develop in any site where this tissue is found in healthy conditions. The present systematic review aimed to analyze the clinicopathological characteristics of OLH.

Materials and methods: The protocol of this study was constructed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and was registered in the Open Science Framework (OSF): OSF.IO/BMPUX. Five electronic databases were used to identify studies for this systematic review: PubMed, Web of Science, Dentistry & Oral Science Source, Scopus and ScienceDirect, from January 15th, 1945 to January 10th, 2024. The Joanna Briggs Institute (JBI) tool was used to assess the risk of bias and the quality of the included reports and case series.

Results: A comprehensive search yielded 5,562 articles, of which 55 met the inclusion criteria. The total number of subjects studied in the included investigations was sixty-six. The subjects' ages varied from newborns to 61 years, with a mean age ± standard deviation of 71.23 ± 123.01 months. 50.7% were males and 49.3% were females. Most lesions presented normochromic color (24.24%), pedunculated base (31.81%), firm consistency (22.72%), with an average size of 1.20 cm, present on the dorsum of the tongue (31.81%) or anterior part of the alveolar border of the maxilla (30.30%). Treatment was carried out by surgical excision (78.46%) and half of the studies report that there were no recurrences.

Conclusions: The cases described in the medical-dental literature provide valuable information to date on the clinicopathologic and immunohistochemical profile of OLH. Although it is a rare lesion, it should be considered as part of the differential diagnosis in newborns, infants, children and young adults with lingual and/or maxillary masses present in the midline.

Background: Testicular yolk sac tumor (YST) is a rare neoplasm with limited practical guidance for preoperative diagnostic assessment. This study aims to conduct a retrospective analysis of the value of clinical profiles and MRI parameters in accurately diagnosing pediatric testicular YST while exploring characteristic indicators for these patients.

Methods: This retrospective study analyzed eighty patients with a testicular mass who underwent surgical treatment and preoperative MRI. Clinical characters (age, preoperative serum alpha-fetoprotein (AFP) levels), and radiology features were recorded and compared. Subsequently, patients were categorized into YST and non-YST groups based on histology. Comparative statistical analyses were then used to compare factors between the two groups. The receiver operating characteristic curve (ROC) analysis was conducted to evaluate the diagnostic performance of the indicators for pediatric testicular YST.

Results: Forty patients (50%) were diagnosed with YST. In comparison to the non-YST group, patients with testicular YST were younger and had larger tumor sizes, accompanied by significantly elevated AFP levels. On MRI, most YST cases (n = 38) exhibited predominantly solid lesions, whereas non-YST tumors were more likely to contain cystic components. The bright dot sign and thickened spermatic cord might also be helpful in differentiating YST (p < 0.05). The optimal factor for diagnosing testicular YST was signal intensity, with an AUC value of 0.936 (95%CI: 0.877 ~ 0.995).

Conclusions: A predominantly solid testicular mass with a bright dot sign, thickened spermatic cord ipsilaterally, and elevated AFP levels should raise suspicion for YST.

Gastric cancer (GC) treatment is increasingly undergoing laparoscopic total gastrectomy (LTG) procedures. However, we conducted this research to evaluate postoperative outcomes, particularly surgical complications associated with intracorporeal and extracorporeal esophagojejunostomies using linear or circular stapling techniques following LTG for GC treatment. We aimed to compare short-term postoperative outcomes, such as surgical complications and anastomotic outcomes, between the two groups. Method From January 2020 to August 2022, we conducted a retrospective analysis of data from 160 consecutive patients diagnosed with GC who received either IEJ (n = 35) or EEJ (n = 125) during LTG. We utilized the Mann-Whitney U test to ascertain the statistical significance between the two groups. For comparing categorical variables, including numbers and percentages, we employed either the Pearson chi-square test, continuity correction, or Fisher's exact test as appropriate.ResultsThe operative time was similar (IEJ: 184.57 ± 36.489 vs. EEJ: 189.22 ± 43.584; P = 0.565), however, the number of positive lymph nodes was performed more in the IEJ group (IEJ: 4.71 ± 6.114 vs. EEJ: 6.39 ± 9.067 (P = 0.305). The blood loss in the IEJ group was lower than that of the EEJ (IEJ: 73.1429.182 vs. EEJ: 100.6461.693 mL, P = 0.012). There were three anastomosis leakages in the EEJ and one in the IEJ group (EEJ, 3.2% vs. IEJ, 2.8%; P > 0.999). Anastomosis bleeding only occurred in the EEJ (EEJ 1%; P = 0.003). Although the EEJ linear stapling technique had two deaths (EEJ, 1.6%).ConclusionAlthough EEJ is frequently utilized in the linear stapling technique, research indicates that the use of IEJ minimizes the incidence of complications in LTG.

Background: The IBS^® Tissue Removal Device, as a new technology, currently lacks a systematic evaluation of its effectiveness in treating endometrial polyps. Furthermore, the exact cause of polyps recurrence is not yet clear. The purpose of this article is to compare the efficacy of the IBS^® Tissue Removal Device with hysteroscopic cold knife resection for the treatment of endometrial polyps and analyze the recurrence factors of endometrial polyps.

Methods: 202 patients with endometrial polyps who were admitted to Changzhou Maternal and Child Health Care Hospital from January 2019 to December 2022 were included in the retrospective studies. Based on the surgical technique, these patients were categorized into two groups: the IBS group (n = 100) and the cold knife group (n = 102). Following surgery, both groups underwent a year of follow-up. Data from the perioperative period (operation time, intraoperative blood loss, intraoperative rehydration, intraoperative complications, length of hospital stay), follow-up data (postoperative endometrial thickness, postoperative vaginal bleeding time, complication rate, menstrual recovery time, pregnancy rate, and recurrence rate) and general clinical data (age, BMI(Body mass index, BMI), number of pregnancies or miscarriages, number of hysteroscopic operations, preoperative white blood cells, fasting blood glucose, polyp diameter) were compared between the two groups.

Results: The recurrence rate of the IBS group was 6% (6/100), which was lower than that of the cold knife group (14.7% (15/102), and the difference was statistically significant (P < 0.05). The operation time, intraoperative blood loss, and postoperative vaginal bleeding time in the IBS group were significantly lower than those in the cold knife group (P < 0.05), and the multivariate analysis of polyp recurrence showed that polyp diameter was closely related to postoperative recurrence (P < 0.05). The preoperative white blood cells and blood sugar levels have no association with the diameter of polyps. (P > 0.05). There was also no significant difference between IBS group and cold knife group in intraoperative rehydration, intraoperative complications and postoperative hospital stay, intermenstrual bleeding, recovery of menstruation and endometrial thickness and postoperative pregnancy between the IBS group and the cold knife group (P > 0.05).

Conclusion: The IBS^® Tissue Removal Device can reduce the recurrence rate of endometrial polyps after surgery, improve the perioperative indexes, and reduce the postoperative vaginal bleeding time, which is better than that of hysteroscopic cold knife resection.

Background: Precise preoperative localization is crucial for improving the success rate and reducing the duration of thoracoscopic surgeries. This study aimed to evaluate the efficacy, safety, and patient perception of the four-hook localization needle compared to the traditional double-hook localization needle in the localization of pulmonary nodules.

Methods: We conducted a retrospective analysis of 207 patients who underwent video-assisted thoracoscopic surgery (VATS). Seventy-six patients used a four-hook localization needle preoperatively, while 121 patients used the traditional double-hook needle. Propensity score matching was employed to balance the baseline characteristics of the two groups and minimize confounding bias. We compared the surgery success rate, surgical field success rate, complication rate, and post-localization respiratory pain score between the two groups.

Results: Both localization methods achieved a 100% success rate. The four-hook needle had a statistically significant shorter localization time (20.00 min vs. 21.00 min, P = 0.046) and a lower preoperative displacement rate (5.81% vs. 17.36%, P = 0.014) compared to the double-hook needle. Both before and after propensity score matching, the postoperative respiratory pain score was significantly lower in the four-hook group compared to the double-hook group (P < 0.001). After balancing baseline characteristics, univariate (P = 0.036) and multivariate (P = 0.039) logistic regression analyses indicated that the four-hook group had a significantly lower risk of localization complications compared to the double-hook group.

Conclusions: The four-hook localization needle outperforms the traditional double-hook needle due to its shorter localization time, lower post-localization respiratory pain score, and reduced displacement rate, making it a simpler and safer option. Furthermore, the four-hook needle effectively reduces the risk of complications, presenting a promising method for preoperative localization of pulmonary nodules.

Background: Accurate preoperative localization is a challenge in thoracoscopic surgery for multiple pulmonary nodules. In this study, we aimed to assess the accuracy and feasibility of electromagnetic navigation (EN)-guided percutaneous localization.

Methods: We enrolled 50 patients with multiple pulmonary nodules for EN-guided (EN group) or CT-guided (CT group) localization. The primary outcome was the localization accuracy, and the primary analysis was to assess the noninferiority (noninferiority margin of 5 mm) of EN-induced localization deviation compared with that of CT-induced deviation. The secondary outcomes included the procedural duration, anxiety score, and incidence of complications.

Results: Among the 50 patients randomized to the EN- and CT-guided groups, 24 patients (53 nodules) underwent EN-guided preoperative marking, and 25 patients (54 nodules) underwent CT-guided preoperative marking. The demographic, clinical, and radiological characteristics did not differ significantly between the groups (P > 0.05). Among these patients, the EN group was noninferior in terms of localization deviation compared with the CT group (9.0 [6.5] vs. 7.5 [6.0] mm; P = 0.33; absolute difference 0.9 [95% CI] 0.03-1.77]). Furthermore, the procedural duration was 16.3 (4.2) minutes for the EN group and 22.3 (8.2) minutes for the CT group (P = 0.002). Additionally, the EN group exhibited significant improvements compared with the CT group on the basis of the Amsterdam Preoperative Anxiety and Information Scale, particularly in relation to the S and C subscales' cumulative scores.

Conclusions: EN was found to be noninferior to CT in terms of localization accuracy, as it significantly decreased the procedural duration and relieved psychological stress for patients who underwent simultaneous surgery for multiple pulmonary nodules.

Clinical trial registration: Chinese Clinical Trial Registry Identifier: ChiCTR2200056734.