Surgical Oncology-Oxford最新文献

Background: disease burden (PCI), completeness of cytoreduction or histological features, are known to influence survival after CRS-HIPEC for colorectal peritoneal metastases (CPM). However, there is still debate about influence of CPM onset. The aim of this study is to determine the impact of CPM onset on oncological outcomes after CRS-HIPEC.

Methods: all patients with CPM scheduled for CRS-HIPEC at one reference center between December 2007 and September 2022 were included. s-PM were defined as those diagnosed at primary disease treatment; m-PM were considered those diagnosed during follow-up. Survival outcomes and recurrence rates were compared using a pragmatic analysis.

Results: 125 patients with s-CPM and 170 patients with m-CPM were analyzed. Median follow-up was 58.6 and 50.6 months in s-CPM and m-CPM groups(p = 0.11). Complete cytoreduction (CCS-0/-1) rates were comparable: 84 % s-CPM vs. 88.2 % m-CPM(p = 0.190). Overall survival (OS) was significantly shorter in s-CPM: 24.7 vs. 46.6 months (p = 0.024). Conversely, median disease-free survival was similar in both groups, 10 months vs. 11 months(p = 0.155). Patients in the s-CPM group presented more pN+(p = 0.001), higher histologic grade(p = 0.007) and PCI(p = 0.04), and higher rate of concurrent liver metastases(p = 0.004). RAS/BRAF gene mutations and microsatellite instability did not differ significantly. Perioperative chemotherapy regimens and tolerance were also similar.

Conclusions: despite s-CPM being associated with impaired OS after CRS-HIPEC, the onset of PM was not found to be an independent determinant for survival. High-risk molecular and histological features strongly influence oncological outcomes after CRS-HIPEC. This is valuable data that could aid in preoperative patient selection process for CRS-HIPEC.

Background: Esophageal cancer (EC) is a disease with a poor prognosis. While treatment options have been improved, there is no consensus for surveillance strategies following therapy with curative intent. As the incidence of EC is rising and a large fraction of patients will experience disease recurrence, the need for evidence-based treatment and optimal surveillance is evident.

Study design: Included were 1128 patients with esophageal and gastroesophageal junction cancer (squamous cell/adenocarcinoma) that underwent surgical resection at the University Hospital Cologne (UHC) between 2012 and 2021. Patients were retrospectively split into two groups: monitored structured surveillance at the center (n = 635) (MSS) and not monitored surveillance (n = 493) (NMS).

Results: In the MSS group, we identified 292 (45.98 %) cases of recurrence while 66 (13.39 %) cases of recurrence were identified in the NMS group. Overall survival (OS) was not significantly longer in MSS than in NMS, yet a positive trend can be seen (p = 0.108). Progression free survival (PFS) was significantly different between groups (p ≤ 0.05). Almost a third of recurrences diagnosed in MSS were limited to a singular location. About 35 % of recurrences in MSS were treated or were intended to be treated with local treatment options like surgery or curative intended radiotherapy, by times in combination with sensitizing chemotherapy. The correlation of time of recurrence and time of death was stronger within NMS than in MSS.

Conclusions: Structured surveillance leads to detection of more patients with singular recurrence but no clear sign of prolonged survival. Further prospective trials are warranted to define the clinical benefit of structured surveillance.

Background: The common techniques used in nipple-sparing mastectomy (NSM) are hydrodissection (tumescent dissection) and electrocautery. We hypothesized that bipolar scissors (diathermy scissors) would improve surgical outcomes in mastectomy.

Methods: We prospectively compared 50 patients undergoing NSM using the bipolar scissor technique to retrospective data from patients who had previously undergone NSM with hydrodissection (n = 50) or electrocautery (n = 50). Operation time, intraoperative bleeding, drainage per day, duration till drain removal, and serious complications were compared.

Results: Operation time was significantly better with the bipolar scissors (34.1 ± 4.9 min) and hydrodissection (36.2 ± 6.6 min) compared to monopolar electrocautery (53.7 ± 4.8 min) (p < 0.001). Intraoperative bleeding was significantly less with the bipolar scissors (123.4 ± 27.7 ml) and hydrodissection (126.6 ± 25.1 ml) compared to electrocautery (161.8 ± 25.0 ml) (p < 0.001). Additionally, the drainage per day and the duration till drain removal was 79.7 ± 18.3 ml for 3.22 ± 0.79 days and 92.4 ± 41.3 ml for 3.58 ± 1.23 days for the bipolar scissors and hydrodissection techniques respectively were significantly better compared to 124.8 ± 40.3 ml for 4.58 ± 1.23 days (p < 0.001) for the electrocautery method. Finally, the bipolar scissor technique had the least complications (2 %) compared to hydrodissection (20 %) (p < 0.004).

Conclusion: Although hydrodissection was as effective as bipolar scissors in reducing operation time, intraoperative bleeding, postoperative drainage, and the duration of drainage compared with electrocautery, hydrodissection was associated with more serious complications than the bipolar scissors technique.

Background: Soft-tissue sarcomas (STSs) are a diverse group of malignancies challenging to treat when surgery is not an option. The aim of this study was to investigate the survival of non-surgical cases in STSs, and to examine the impact of radiation therapy (RT) on survival within this group of cases.

Methods: Utilizing the SEER database, we conducted a retrospective cohort study of localized extremity non-small round cell sarcoma diagnosed between 2000 and 2019. A total of 444 non-operative cases were identified and analyzed for cancer-specific survival (CSS) and overall survival (OS) using Kaplan-Meier and Cox proportional hazards models.

Results: Among the non-operative cohort, the median age at diagnosis was 72 years. The median survival was 10 months, with AJCC 8th edition clinical stage-specific 5-year CSS rates of 80 % for Stage 1B, 53 % for Stage 2, 47 % for Stage 3A, and 22 % for Stage 3B. The 5-year OS rates were 56 % for Stage 1B, 31 % for Stage 2, 26 % for Stage 3A, and 14 % for Stage 3B. Nearly half of the patients received RT, which was more prevalent in higher clinical stages. RT was associated with improved survival rates for both CSS and OS in patients who are unable to undergo surgical intervention.

Conclusions: RT is associated with improved survival in non-operative localized extremity non-small round cell sarcoma patients. These insights are vital for clinical decision-making, emphasizing the need for personalized, non-surgical interventions to improve outcomes for patients where surgery is not feasible.

Background: Thermal and chemical ablation techniques may consolidate recurrent metastatic cervical lymph nodes as alternatives to repeat neck dissection in thyroid cancer patients. This meta-analysis aims to compare the efficacy and safety across modalities.

Methods: Four databases were searched for studies on radiofrequency (RFA), microwave (MWA), laser (LA), and ethanol ablation (EA) treating metastatic cervical nodes from thyroid cancer. The outcomes analyzed included treatment response, oncologic control, and complications. Random effects meta-analytical pooling was conducted.

Results: There were 25 studies (n = 1061 nodes) examining the four ablation methods. Patients showed comparable baseline characteristics and initial lymph node sizes ranging from 0.96 to 1.28 cm. All modalities achieved substantial node volume reduction (88.4 %) and disappearance (62.8 %), with significant biochemical decline (from 6.01 to 1.13 ng/ml, p = 0.18 between groups). MWA showed the highest volume reduction (99.4 %) and disappearance rate (87.6 %) versus slower efficacy of RFA (93.0 %, 72.1 %), LA (77.9 %, 62.5 %), and EA (81.8 %, 58.4 %). New malignancy/metastases risks ranged from 0.03 % to 1.3 % without between-group differences (p = 0.52). Major complications were absent; transient voice changes (0.05%-10.6 %) and neck pain (0.0%-5.9 %) were the main overall complaints. However, overall complication rates significantly varied by modality (1.1%-10.6 %; p = 0.003).

Conclusions: Thermal and chemical ablation is effective in controlling the metastatic disease burden in patients with thyroid cancer, offering a potentially less morbid and non-surgical alternative to re-operation. Additional prospective data could confirm the long-term equivalent of revision neck dissection and stratify patients based on concomitant Hashimoto's and genomic mutations. Clarifying optimal patient selection and standardizing prognostic indexing could further enhance utilization.

Aim: Prognosis of pancreatic cancer is improved by combining postoperative adjuvant chemotherapy and preoperative adjuvant chemotherapy with surgery, while the importance of extended dissection surgery has decreased. To better understand prognostic factors of recurrence, we focused on the timing of postoperative adjuvant chemotherapy in patients with pancreatic cancer.

Methods: One hundred patients who underwent pancreatectomy or pancreaticoduodenectomy and chemotherapy for pancreatic cancer were classified into early and late postoperative adjuvant therapy initiation groups. Prognosis was evaluated retrospectively using known prognostic factors.

Results: On receiver operating characteristic analysis, optimum cut-off between the early (<52 days; n = 60) and late adjuvant initiation groups (≥52 days; n = 40) was 52 days. The two groups were well-matched, except the early initiation group had more surgeries with D2 lymph node dissection (75 % vs 48 %; p = 0.01); fewer postoperative complications (17 % vs 59 %; p = 0.04), including less postoperative pancreatic fistula (13 % vs 35 %; p = 0.03); and longer disease-free survival (0.7 years v 0.5 years; p = 0.02). On multivariate evaluation, early initiation and completion of adjuvant therapy were associated with increased overall survival, while early initiation was associated with prolonged disease-free survival.

Conclusions: Prognosis of patients with pancreatic cancer is improved by earlier rather than later initiation of postoperative adjuvant therapy.