World Journal of Surgical Oncology最新文献

Objectives: The aim of this study was to investigate the impact of interleukin-27 (IL- 27) gene polymorphism and additional interactions with environmental factors on non-small cell lung cancer (NSCLC) risk based on a Chinese population.

Methods: SNPStats online software (http://bioinfo.iconcologia.net/SNPstats) was used for Hardy-Weinberg equilibrium (HWE) testing. Stratified analysis was performed by logistic regression model to examine the impact of IL- 27 gene SNPs and environmental factors, and additional gene-environment interaction on NSCLC risk.

Results: Logistic regression analysis showed a significant association between rs153109, rs181206 and increased NSCLC risk. However, no significant relationship was found between NSCLC risk and rs17855750 or rs40837 genotype with minor allele. Logistic regression also indicated a significant association between smoking status or alcohol consumption and NSCLC risk in this study. We performed crossover analysis to investigate the interaction between two SNPs (rs153109 and rs181206) and two environmental factors (smoking status and alcohol consumption) using logistic regression. We found that ever or current smokers with rs153109- AG or GG genotype have the highest NSCLC risk, compared with never smokers with the AA genotype after covariate adjustment, OR (95%CI) = 3.02 (1.97-5.12), p = 0.012. However, no significant interaction effect was found between rs153109 and alcohol consumption, rs181206 and smoking, rs181206 and alcohol consumption.

Conclusion: Our results support an important association of the IL- 27 gene rs153109, rs181206, smoking and alcohol consumption with increased NSCLC risk. We also found a significant impact of an interaction between rs153109 minor allele and ever or current smoking on NSCLC risk.

Background: Gastric cancer remains a significant global health challenge. Surgical resection continues to be the cornerstone of treatment, but traditional gastrectomy is often associated with negative impacts on nutritional status and quality of life. Function-preserving surgical techniques, widely adopted in East Asian countries due to early cancer detection, have shown promise in improving postoperative outcomes. In contrast, Western guidelines have yet to integrate these procedures into routine practice.

Main body: Function-preserving surgeries, including pylorus-preserving gastrectomy and proximal gastrectomy, aim to maintain gastric function while ensuring oncological safety. These procedures are primarily indicated for early gastric cancers and have demonstrated comparable survival outcomes to standard resections in well-selected patients. Endoscopic resections and segmental gastrectomy represent additional function-sparing options under investigation. The main functional complications, such as gastric stasis or reflux esophagitis, have prompted the development of various reconstructive techniques, including double-tract methods, jejunal interposition, and pouch reconstructions. Despite their proven benefits in Eastern countries, the implementation of these surgeries in Western settings is limited. Challenges include the lower incidence of early gastric cancer, lack of surgeon experience, and absence of guideline endorsement. However, increased centralization of care, enhanced diagnostic accuracy, and growing emphasis on patient-reported outcomes have reignited interest in adapting these strategies for Western populations. Additionally, emerging evidence suggests that even patients with more advanced disease may benefit from improved short-term functional outcomes, potentially aiding in faster recovery and return to adjuvant therapies.

Conclusion: Function-preserving surgery in gastric cancer offers oncologically safe alternatives that may significantly improve postoperative quality of life and nutritional outcomes. As global treatment paradigms evolve, adapting these techniques in the West, particularly within high-volume centers, could represent a significant step forward. Further randomized trials and Western-centric data are essential to validate the broader applicability of these procedures and refine patient selection criteria.

The infrapyloric lymph nodes (LNs) are defined as No. 6 LNs and as one of the regional gastric LNs in the Japanese classification of gastric carcinoma. No. 6 LNs are recommended to be dissected completely even in D1 lymphadenectomy for distal and total gastrectomy in the Japanese Gastric Cancer Treatment Guideline. Omento-bursectomy, whose survival advantage for advanced gastric cancer patients was not shown by the Japanese Clinical Oncology Group 1001 trial, has been proposed to be a useful technique for safe and secure dissection of No. 6 LNs in gastric cancer surgery. In the present review, we first discuss the reason why omento-bursectomy is considered to be a useful technique for dissection of No. 6 LNs, reframing the gastric LNs as a parapancreatic lymph chain based on the dorsal pancreas, mesogastrium, and mesoduodenum embryology. Second, we introduce the outermost layer-oriented dissection (OLD) of No. 6 LNs in performing an omentum-preserving gastrectomy (OPG) devised at Fujita Health University and their favorable outcomes. Last, we discuss the reason why the incidence of postoperative pancreatic fistula in laparoscopic distal gastrectomy is significantly higher than open gastrectomy for stage Ⅰ gastric cancer patients, for whom the OPG is likely performed, in a retrospective cohort study based on the Japanese National Clinical Database. Although single-institution retrospective clinical studies are referenced in this review, it is considered that reframing the gastric LNs as a parapancreatic lymph chain based on the embryology can enhance safe No.6 LNs dissection in the various types of gastric cancer surgery.

Background: Emotional distress (ED), characterized by symptoms of depression and anxiety, is highly prevalent in patients with breast cancer. Although retrospective studies suggest an association between ED and adverse cancer outcomes, findings from prospective studies remain inconsistent.

Objective: This prospective observational study aimed to investigate the association between emotional distress and long-term survival outcomes in patients with breast cancer following curative surgery.

Methods: A total of 159 patients with breast cancer were enrolled. Baseline levels of emotional distress were assessed using standardized scales. Patients were prospectively followed for up to 7 years to monitor overall survival (OS) and progression-free survival (PFS). Inverse probability of treatment weighting (IPTW) was employed to adjust the baseline confounders.

Results: The unadjusted 7-year OS and PFS rates in patients with ED were numerically lower than those without ED (OS: 78.5% vs. 93.7%; PFS: 76.9% vs. 89.3%). After adjustment using IPTW, emotional distress was independently associated with lower OS (adjusted HR = 6.52, 95% CI: 1.78-23.89, P = 0.005) and PFS (adjusted HR = 3.73, 95% CI: 1.19-11.71, P = 0.024).

Conclusion: This study provides prospective evidence that emotional distress is associated with reduced survival and an increased risk of disease progression in breast cancer patients following curative surgery. These findings highlight the importance of integrating psychological assessment and supportive care into routine oncologic management.

Background: Distant metastases are the leading cause of death for patients with differentiated thyroid cancer (DTC), and surgery and radioactive iodine (RAI) therapy are effective treatments for them. However, there remains a large proportion of patients with poor prognoses, and there exists no consensus on whether systemic chemotherapy or beam radiation should be administrated to improve their prognoses.

Method: The clinicopathology information of patients with metastatic DTC (mDTC) was retrospectively collected and analyzed. A nomogram was created to predict their prognosis and divided patients into high- and low-risk groups, and the external validation was performed.

Results: The Cox regression showed that sex, age, metastatic sites, surgery, and radiotherapy were independent influencing factors affecting OS. Fine-gray competing risk analysis showed that age, T-stage, N-stage, metastatic sites, and radiotherapy were independent risk factors for TCSD. The nomogram we constructed proved to be effective and robust with high efficiency, with C-indexes of 0.785 (95% CI = 0.752-0.813) and 0.794 (95%CI = 0.766-0.831) on the train and test sets, respectively. mDTC patients were further classified into high- and low-risk groups based on the prediction of nomogram, those in the high-risk group had significantly worse OS and higher TCSD than those in the low-risk group (P < 0.001), and chemotherapy significantly improved OS and reduced TCSD for patients in the high-risk group, whereas local beam radiation did not provide any survival benefit. In the external validation dataset, the 1-, 3-, and 5-year AUC values of the model ranged from 0.833 to 0.873, which further proved the efficiency of our model.

Conclusion: This study developed an accurate prognostic model for patients with mDTC, which may be applicable in future clinical practice for prognosis and death prediction. For high-risk patients, as predicted by nomogram, systemic chemotherapy was the recommended therapy option for them.

Background: Primary leiomyosarcoma (LMS) of the colon is an exceptionally rare malignancy, accounting for less than 0.1% of colorectal cancers. Because of its rarity and nonspecific presentation, preoperative diagnosis is challenging, and optimal management strategies remain undefined.

Case presentation: A 47-year-old woman with no prior medical history underwent screening colonoscopy, which revealed a 2.5-cm ulcerative mass in the proximal descending colon. Biopsies performed twice, including a follow-up examination one month later, showed only chronic inflammation. Computed tomography demonstrated eccentric wall thickening with minimal pericolic infiltration, raising suspicion for malignancy. The patient underwent laparoscopic radical en bloc resection of the splenic flexure and descending colon with D2 lymphadenectomy, followed by stapled colo-colic anastomosis. Histopathology revealed a 4.2 × 3.5 cm spindle-cell tumor with high cellularity, moderate pleomorphism, > 100 mitoses/50 HPF, and invasion extending to the subserosal layer. Immunohistochemistry showed positivity for smooth muscle actin and desmin, and negativity for CD34, CD117, DOG-1, and S-100. The Ki-67 index was 70-80%. Resection margins and all 13 lymph nodes were negative. The postoperative course was uneventful, and the patient remains disease-free at 11 months.

Conclusion: Colonic LMS is a rare and aggressive tumor that often evades preoperative diagnosis, especially when biopsies are inconclusive. Surgical resection with negative margins is the mainstay of treatment, and close surveillance is essential due to the high risk of recurrence.

Background: Conventional open surgery (OP) is effective and simple for treating papillary thyroid cancer (PTC), but the excessive separation of band strap muscles causes discomfort in the anterior cervical region and a long scar, which may impair the patient's life quality and beauty. Gasless endoscopic surgery via subclavicular approach (ESSA) may provide a better alternative.

Methods: The prospective data of 90 PTC patients who underwent ESSA or OP (45:45) in hemithyroidectomy and central neck dissection (CND) in our center from March 2022 to August 2023 were analyzed. Safety indicator incidence of complications, efficiency indicator No. lymph nodes (LNs) of CND, postoperative recurrence of central neck LNs indicated by Ultrasound (US) at 6 months, postoperative functions of the anterior cervical region and cosmetic satisfaction were recorded as the primary endpoints.

Results: The ESSA group had no significant differences with the OP group in baseline data, complications, No. LNs (9.04 ± 4.58 vs. 9.87 ± 4.89, p = 0.413) and metastatic LNs (1.60 ± 2.79 vs.1.69 ± 2.50, p = 0.874) of CND. The two groups had no postoperative recurrence of central neck LNs indicated by ultrasound (US) at 6 months. The ESSA group exhibited better functionally sensitive and motional outcomes in the anterior cervical region compared to the OP group (P = 0.0217 and P = 0.008), and had higher cosmetic satisfaction than the OP group (P < 0.001).

Conclusion: Compared with OP, ESSA is equally safe and effective, but more cosmetic and conducive to preserving functions of the anterior cervical region. ESSA can be considered an alternative approach to OP in hemithyroidectomy and CND.