Surgical Oncology-Oxford最新文献_第2页

Additional colectomy after endoscopic excision of malignant polyps: is it always necessary? 内镜下恶性息肉切除术后附加结肠切除术是否总是必要的？

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-04 DOI: 10.1016/j.suronc.2026.102361

Mariana Marques, Mariana Peyroteo, Luís Lencastre, André Vale Guimarães, Maria João Madeira-Cardoso, Paula Ferreira Pinto, José Carlos Pereira, Flávio Videira, Joaquim Abreu de Sousa

Background

Management of malignant colonic polyps following endoscopic excision remains controversial. Surgery is recommended after incomplete excision and/or in the presence of recognized risk factors. The objective of this study was to evaluate the short and long-term results of surgery following endoscopic excision of malignant colon polyps.

Materials and methods

We present a 6-year retrospective observational study, in a tertiary oncology center, analyzing all patients diagnosed with malignant colonic polyps after endoscopic excision, submitted to surgery between January 2015 and December 2020.

Results

124 patients were included. Four underwent polypectomy of 2 malignant polyps at the same time. Of the 128 endoscopic excision specimens, 75% (n = 96) were located at the sigmoid colon and 80.5% (n = 103) demonstrated more than one histological risk factor, namely, deep submucosal invasion (DSI) - >1000 μm, tumor budding, histological grade 2 or 3, lymphatic, venous or perineural invasion. An R0 resection was achieved in 77 (60.16%) endoscopic specimens. Of these, 25 had a single histological risk factor, the majority of which (n = 19; 76%) presenting with DSI. Of these 25 patients (R0 with only one risk factor), none had residual disease in the surgical specimen (local or nodal), and none had recurrence of the disease.

Conclusion

The absence of disease in the surgical specimen after endoscopic excision in patients with an R0 endoscopic resection with a single risk factor, namely DSI, suggests that surgery can be spared in this subset of patients.

背景：内镜下恶性结肠息肉切除术后的处理仍然存在争议。在不完全切除和/或存在公认的危险因素时，建议进行手术。本研究的目的是评估内镜下恶性结肠息肉切除术后的短期和长期结果。材料和方法：我们在一家三级肿瘤中心进行了一项为期6年的回顾性观察研究，分析了2015年1月至2020年12月期间所有经内镜切除诊断为恶性结肠息肉的患者。结果：纳入124例患者。4例同时行2个恶性息肉切除术。在128例内镜切除标本中，75% （n = 96）位于乙状结肠，80.5% （n = 103）表现出不止一种组织学危险因素，即粘膜下深部浸润(DSI) - >1000 μm，肿瘤出芽，组织学2级或3级，淋巴，静脉或神经周围浸润。77例（60.16%）内镜标本实现R0切除。其中，25例有单一组织学危险因素，其中大多数（n = 19; 76%）表现为DSI。在这25例患者中（R0只有一个危险因素），手术标本中没有残留疾病（局部或淋巴结），也没有疾病复发。结论：对于R0内镜切除且危险因素单一（DSI）的患者，内镜切除后手术标本无病变，提示该亚群患者可以省去手术。

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引用次数: 0

Surgical management of primary hepatic neuroendocrine tumors: A 20-year population-based analysis 原发性肝脏神经内分泌肿瘤的外科治疗：一项基于20年人群的分析。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 DOI: 10.1016/j.suronc.2026.102358

Alexandra H. Helbing , Tony Boualoy , Ambria S. Moten

Background

Primary hepatic neuroendocrine tumors (PHNETs) are rare neoplasms with limited population-level data to guide treatment. We evaluated clinical, pathologic, and treatment factors associated with surgical intervention and survival using a contemporary national cohort.

Methods

Patients diagnosed with PHNETs from 2000 to 2021 were identified within the Surveillance, Epidemiology, and End Results (SEER) database. Demographic, tumor, and treatment characteristics were analyzed. Multivariable logistic regression identified predictors of surgical resection. Kaplan-Meier and Cox models evaluated overall survival (OS) and cause-specific survival (CSS).

Results

A total of 669 patients met inclusion criteria. Surgical resection was performed in 16.4 % of cases. Compared with localized disease, regional disease was associated with significantly lower odds of surgery (OR 0.25, 95 % CI: 0.14–0.45). Ten-year OS was 21.8 % for localized, 12.5 % for regional, and 4.8 % for distant disease (p < 0.001). Well differentiated tumors were associated with superior 5- and 10-year OS and CSS compared to poorly differentiated tumors (p < 0.001). Among patients with localized or regional disease, surgical resection was associated with a 10-year OS of 44.9 % versus 9.2 % without surgery (p < 0.001). On multivariable analysis, poorly differentiated histology (HR 2.69, 95 % CI: 1.93–3.77) and larger tumor size (HR 1.01, 95 % CI: 1.00–1.01) were associated with increased mortality, while surgical resection remained protective (HR 0.23, 95 % CI: 0.15–0.37).

Conclusions

Surgical resection is associated with significantly improved survival in patients with localized or regional PHNETs. Tumor grade, stage, and size remain key prognostic factors in this rare malignancy.

背景：原发性肝神经内分泌肿瘤（PHNETs）是一种罕见的肿瘤，在人群水平上的数据有限，无法指导治疗。我们使用当代国家队列评估了与手术干预和生存率相关的临床、病理和治疗因素。方法：在监测、流行病学和最终结果（SEER）数据库中确定2000年至2021年诊断为PHNETs的患者。分析人口统计学、肿瘤和治疗特点。多变量logistic回归确定了手术切除的预测因素。Kaplan-Meier和Cox模型评估总生存期（OS）和病因特异性生存期（CSS）。结果：669例患者符合纳入标准。16.4%的病例行手术切除。与局部疾病相比，局部疾病与手术的几率显著降低相关（OR: 0.25, 95% CI: 0.14-0.45）。局限性PHNETs的10年总生存率为21.8%，局部疾病为12.5%，远处疾病为4.8%(结论：手术切除与局限性或区域性PHNETs患者的生存率显著提高相关。肿瘤分级、分期和大小仍然是这种罕见恶性肿瘤的关键预后因素。

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引用次数: 0

Cranial-to-caudal approach in laparoscopic surgery for left-sided colon cancer: Longer specimens and higher lymph node yield 左侧结肠癌腹腔镜手术颅尾入路：更长的标本和更高的淋巴结率。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 DOI: 10.1016/j.suronc.2026.102354

Beslen Goksoy , Cem B. Ofluoglu , Ibrahim F. Azamat , Gorkem Uzunyolcu , Serra Z. Akkoyunlu , Ilker Ozgur , Feza Ekiz

Background

Medial-to-lateral (ML) approach is the standard technique in laparoscopic surgery for left-sided colon cancer. However, it can be technically challenging; such as in patients with intra-abdominal adhesions or during splenic flexure mobilization. To overcome these difficulties, we adopted a cranial-to-caudal (CC) approach as an alternative technique. This study aimed to compare the CC and ML approaches in terms of short-term clinical and mid-term oncological outcomes.

Methods

Patients performed laparoscopic surgery for left-sided colon cancer between October 2018 and November 2022 were retrospectively analyzed. Patients were classified into two groups. The primary outcome was the length of the resected specimen. Secondary outcomes were pathological parameters, perioperative outcomes, recurrence-free survival (RFS) and overall survival (OS).

Results

Seventy-four patients were included (ML, n = 39; CC, n = 35). The CC group had longer specimen lengths compared with the ML group (32.9 ± 6.8 cm vs 28.9 ± 6.4 cm; p = 0.022), and longer proximal margin (11.8 ± 3.3 cm vs 9.9 ± 2.3 cm; p = 0.004). Lymph node yield was also higher in the CC group (26.4 ± 8.7 vs 22.3 ± 6.5; p = 0.033). On multivariable analysis, specimen length was independently associated with lymph node yield (β = 0.73; 95% CI, 0.47–1.20; p < 0.001). During a mean follow-up of 44 months, RFS (88.6% vs 89.7%; p = 0.84) and OS (88.6% vs 87.2%; p = 0.67) were similar between the groups.

Conclusions

In laparoscopic surgery for left-sided colon cancer, the CC approach yielded longer resected specimens and more lymph node counts compared with the ML approach, but did not improve oncologic outcomes.

背景：中外侧入路是左侧结肠癌腹腔镜手术的标准技术。然而，这在技术上可能具有挑战性；如腹腔粘连或脾屈曲活动时。为了克服这些困难，我们采用颅尾（CC）入路作为替代技术。本研究旨在比较CC和ML方法在短期临床和中期肿瘤预后方面的差异。方法：回顾性分析2018年10月至2022年11月行左侧结肠癌腹腔镜手术的患者。患者分为两组。主要结果是切除标本的长度。次要结局包括病理参数、围手术期结局、无复发生存期（RFS）和总生存期（OS）。结果：纳入74例患者（ML, n = 39； CC, n = 35）。与ML组相比，CC组的标本长度更长（32.9±6.8 cm比28.9±6.4 cm, p = 0.022），近端缘更长（11.8±3.3 cm比9.9±2.3 cm, p = 0.004）。CC组淋巴结率也较高（26.4±8.7 vs 22.3±6.5;p = 0.033）。在多变量分析中，标本长度与淋巴结产率独立相关（β = 0.73; 95% CI, 0.47-1.20; p）。结论：在腹腔镜下左侧结肠癌手术中，与ML入路相比，CC入路切除的标本更长，淋巴结计数更多，但并没有改善肿瘤预后。

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引用次数: 0

Systemic inflammatory and thyroid markers for predicting malignancy in indeterminate (Bethesda III–IV) thyroid nodules; could thyroglobulin be a clue? 预测不确定（Bethesda III-IV）甲状腺结节恶性的全身炎症和甲状腺标志物甲状腺球蛋白会是线索吗？

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 DOI: 10.1016/j.suronc.2026.102355

Aykut Çelik , Tuğba Matlım Özel , Sezer Akbulut , Görkem Yıldız , Hüseyin Karatay , Serkan Sarı

Background

Numerous blood-based markers have been proposed as potential predictors of malignancy, not only in thyroid but also in various cancer types. This study aimed to evaluate the diagnostic utility of these markers for predicting malignancy in indeterminate thyroid nodules.

Method

After literature review, we identified a set of markers potentially useful for predicting malignancy. Age, gender, nodule size, platelet count, mean platelet volume, platelet distribution width, lymphocyte/monocyte ratio, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, platelet large cell ratio, immature granulocyte, thyroid-stimulating hormone, thyroglobulin, thyroglobulin-antibody and thyroid peroxidase-antibody levels were prospectively collected from patients who underwent thyroidectomy at our institution. The relationship between these markers and malignancy in indeterminate nodules was evaluated.

Results

Among 1392 patients who underwent thyroidectomy between March-2021 and June-2024, 225 were operated for indeterminate thyroid nodules. In these patients, both nodule size ≥4 cm and serum thyroglobulin levels were found to be significantly associated with malignancy in univariate analysis (p < 0.05). ROC curve analysis identified a Tg cut-off value of 299 ng/mL. In multivariate analysis, when a nodule size threshold of 4 cm and a Tg cut-off of 299 ng/mL were applied, the significance of Tg as an independent predictor of malignancy became more pronounced.

Conclusion

The relationship between nodule size and malignancy is known, but elevated thyroglobulin levels have been found to be an independent risk factor for malignancy in indeterminate nodules. Although it needs to be generalized with more data, it is an inexpensive and simple diagnostic test that could guide us in patients with indeterminate cytologic findings.

背景：许多基于血液的标志物已被提出作为恶性肿瘤的潜在预测因子，不仅在甲状腺，而且在各种类型的癌症。本研究旨在评估这些标志物在不确定甲状腺结节中预测恶性肿瘤的诊断效用。方法：经过文献回顾，我们确定了一组可能用于预测恶性肿瘤的标志物。前瞻性收集我院行甲状腺切除术患者的年龄、性别、结节大小、血小板计数、平均血小板体积、血小板分布宽度、淋巴细胞/单核细胞比、中性粒细胞/淋巴细胞比、血小板/淋巴细胞比、血小板大细胞比、未成熟粒细胞、促甲状腺激素、甲状腺球蛋白、甲状腺球蛋白抗体和甲状腺过氧化物酶抗体水平。评估这些标记物与不确定结节恶性程度的关系。结果：在2021年3月至2024年6月期间接受甲状腺切除术的1392例患者中，225例因甲状腺结节不确定而手术。在这些患者中，单因素分析发现结节大小≥4 cm和血清甲状腺球蛋白水平与恶性肿瘤显著相关(p)结论：结节大小与恶性肿瘤之间的关系是已知的，但甲状腺球蛋白水平升高已被发现是不确定结节恶性肿瘤的独立危险因素。虽然它需要更多的数据来推广，但它是一种廉价和简单的诊断测试，可以指导我们对有不确定细胞学发现的患者。

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引用次数: 0

Predictive factors and prognostic significance of HER2-low early breast cancer with long-term follow-up 低her2早期乳腺癌长期随访预测因素及预后意义

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 DOI: 10.1016/j.suronc.2026.102360

Yuka Niwa , Mitsuo Terada , Yumi Wanifuchi-Endo , Takashi Fujita , Tomoko Asano , Hidetoshi Kawaguchi , Kazuki Nozawa , Nana Matsumoto , Ayaka Isogai , Hikaru Kawahara , Marie Mizumoto , Tatsuya Toyama

Background

Human epidermal growth factor receptor type2 (HER2)-low breast cancer has emerged as a clinically relevant subtype with novel HER2-targeted therapies. This study aimed to investigate the clinicopathological features and prognostic implications of HER2-low status in patients with early breast cancer undergoing long-term follow-up.

Methods

We retrospectively analyzed patients with HER2-negative early breast cancer who underwent surgery between 2003 and 2022. We investigated clinicopathological factors associated with HER2-low status and the clinical impacts of HER2-low/zero status on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) according to hormone receptor (HR) status using univariate and multivariate analyses.

Results

Among 3663 patients with early breast cancer, we identified 2519 HER2-negative patients (HER2-low 57%, HER2-zero 28%). HER2-low status was associated with high estrogen-receptor (ER) positivity (Allred score 8) and less mucinous histology, but there was no association with progesterone receptor (PgR) expression. HER2-low status also tended to be associated with pre/perimenopausal status and higher nuclear grade (≥2), but not with tumor size or lobular/metaplastic type. Pathological complete response rates after neoadjuvant chemotherapy were comparable between HER2-low (18.9%) and HER2-zero (21.6%), with no survival differences. HER2 status (low vs. zero) was not significantly associated with DFS, DDFS, or OS, and had no prognostic impact in patients with either HR-positive or -negative disease.

Conclusion

HER2-low breast cancer was characterized by distinct biological features, including high ER positivity (especially Allred score 8) without PgR association, but did not confer a prognostic advantage over HER2-zero disease. HER2-low status may reflect biological heterogeneity that could be relevant when interpreting treatment response rather than serving as an independent prognostic marker.

背景：人表皮生长因子受体2型(HER2)-低乳腺癌已成为一种临床相关的亚型，并有新的HER2靶向治疗。本研究旨在探讨长期随访的早期乳腺癌患者her2低状态的临床病理特征及预后意义。方法：我们回顾性分析2003年至2022年间接受手术的her2阴性早期乳腺癌患者。根据激素受体（HR）状态，研究了与her2低状态相关的临床病理因素，以及her2低/零状态对无病生存（DFS）、远端生存（DDFS）和总生存（OS）的临床影响。结果：在3663例早期乳腺癌患者中，我们确定了2519例her2阴性患者（her2低57%，her2零28%）。her2低与高雌激素受体（ER）阳性（Allred评分8分）和较少粘液组织学相关，但与孕激素受体（PgR）表达无关。her2低状态也倾向于与绝经前/围绝经期状态和较高的核分级（≥2）相关，但与肿瘤大小或小叶/化生类型无关。新辅助化疗后的病理完全缓解率在her2低（18.9%）和her2零（21.6%）之间相当，没有生存差异。HER2状态（低vs零）与DFS、DDFS或OS无显著相关性，并且对hr阳性或阴性疾病患者的预后没有影响。结论：低her2乳腺癌具有明显的生物学特征，包括无PgR关联的高ER阳性（特别是Allred评分为8），但与无her2的疾病相比并没有预后优势。her2低状态可能反映了生物学异质性，在解释治疗反应时可能相关，而不是作为独立的预后标志物。

{"title":"Predictive factors and prognostic significance of HER2-low early breast cancer with long-term follow-up","authors":"Yuka Niwa , Mitsuo Terada , Yumi Wanifuchi-Endo , Takashi Fujita , Tomoko Asano , Hidetoshi Kawaguchi , Kazuki Nozawa , Nana Matsumoto , Ayaka Isogai , Hikaru Kawahara , Marie Mizumoto , Tatsuya Toyama","doi":"10.1016/j.suronc.2026.102360","DOIUrl":"10.1016/j.suronc.2026.102360","url":null,"abstract":"<div><h3>Background</h3><div>Human epidermal growth factor receptor type2 (HER2)-low breast cancer has emerged as a clinically relevant subtype with novel HER2-targeted therapies. This study aimed to investigate the clinicopathological features and prognostic implications of HER2-low status in patients with early breast cancer undergoing long-term follow-up.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed patients with HER2-negative early breast cancer who underwent surgery between 2003 and 2022. We investigated clinicopathological factors associated with HER2-low status and the clinical impacts of HER2-low/zero status on disease-free survival (DFS), distant DFS (DDFS), and overall survival (OS) according to hormone receptor (HR) status using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>Among 3663 patients with early breast cancer, we identified 2519 HER2-negative patients (HER2-low 57%, HER2-zero 28%). HER2-low status was associated with high estrogen-receptor (ER) positivity (Allred score 8) and less mucinous histology, but there was no association with progesterone receptor (PgR) expression. HER2-low status also tended to be associated with pre/perimenopausal status and higher nuclear grade (≥2), but not with tumor size or lobular/metaplastic type. Pathological complete response rates after neoadjuvant chemotherapy were comparable between HER2-low (18.9%) and HER2-zero (21.6%), with no survival differences. HER2 status (low vs. zero) was not significantly associated with DFS, DDFS, or OS, and had no prognostic impact in patients with either HR-positive or -negative disease.</div></div><div><h3>Conclusion</h3><div>HER2-low breast cancer was characterized by distinct biological features, including high ER positivity (especially Allred score 8) without PgR association, but did not confer a prognostic advantage over HER2-zero disease. HER2-low status may reflect biological heterogeneity that could be relevant when interpreting treatment response rather than serving as an independent prognostic marker.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102360"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146138105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nationwide field evaluation of early oral intake following gastric cancer surgery 胃癌手术后早期口服摄取量的全国实地评估

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 DOI: 10.1016/j.suronc.2026.102352

Tsunehiko Maruyama , Kazuto Ikezawa , Hideo Suzuki , Tomohiro Kurokawa , Yoshimasa Akashi , Tatsuya Oda

Background

Early oral intake (EOI) is a core component of Enhanced Recovery After Surgery (ERAS) protocols. Although EOI after gastrectomy has been shown to improve recovery and reduce postoperative complications, its real-world implementation across Japan remains unclear. This study aimed to evaluate the current status and institutional factors influencing EOI after gastric cancer surgery using a nationwide database.

Methods

This retrospective observational study used Japan's nationwide Diagnosis Procedure Combination (DPC) database to analyze 26,097 patients who underwent gastric cancer surgery at 472 institutions from 2017 to 2022. Patients were divided into EOI and non-EOI groups based on oral intake initiation within two days postoperatively. Surgical methods, hospital characteristics, and length of stay were compared.

Results

Only 20.8 % of patients initiated EOI. Laparoscopic distal gastrectomy had significantly higher EOI rates compared to open procedures. However, no significant difference was observed for proximal or total gastrectomy. Larger hospitals and designated cancer centers showed higher EOI rates. The EOI group had a significantly shorter postoperative stay (median 9 vs. 12 days, p < 0.001).

Conclusions

EOI following gastrectomy is associated with shorter hospitalization, yet its adoption remains low in Japan. Institutional factors and multidisciplinary collaboration may play crucial roles in promoting EOI. Findings may inform perioperative optimization and ERAS standardization in oncologic gastric surgery.

背景：高剂量口服摄入（EOI）是增强术后恢复（ERAS）方案的核心组成部分。虽然胃切除术后EOI已被证明可以改善恢复并减少术后并发症，但其在日本的实际实施情况仍不清楚。本研究旨在通过全国数据库评估胃癌术后情绪激动的现状及影响因素。方法本回顾性观察研究使用日本全国诊断程序组合（DPC）数据库，分析2017年至2022年472家机构接受胃癌手术的26,097例患者。根据术后2天内开始口服的情况将患者分为情绪激动组和非情绪激动组。比较手术方法、医院特点和住院时间。结果仅20.8%的患者启动了EOI。与开放式手术相比，腹腔镜胃远端切除术的EOI发生率明显更高。然而，近端胃切除术和全端胃切除术无显著差异。较大的医院和指定的癌症中心显示出更高的情绪激动率。EOI组术后住院时间明显缩短（中位9天vs. 12天，p < 0.001）。结论胃切除术后seoi与较短住院时间相关，但在日本其采用率仍然较低。制度因素和多学科合作可能在促进EOI中发挥关键作用。研究结果可为肿瘤胃外科围手术期优化和ERAS标准化提供参考。

{"title":"Nationwide field evaluation of early oral intake following gastric cancer surgery","authors":"Tsunehiko Maruyama , Kazuto Ikezawa , Hideo Suzuki , Tomohiro Kurokawa , Yoshimasa Akashi , Tatsuya Oda","doi":"10.1016/j.suronc.2026.102352","DOIUrl":"10.1016/j.suronc.2026.102352","url":null,"abstract":"<div><h3>Background</h3><div>Early oral intake (EOI) is a core component of Enhanced Recovery After Surgery (ERAS) protocols. Although EOI after gastrectomy has been shown to improve recovery and reduce postoperative complications, its real-world implementation across Japan remains unclear. This study aimed to evaluate the current status and institutional factors influencing EOI after gastric cancer surgery using a nationwide database.</div></div><div><h3>Methods</h3><div>This retrospective observational study used Japan's nationwide Diagnosis Procedure Combination (DPC) database to analyze 26,097 patients who underwent gastric cancer surgery at 472 institutions from 2017 to 2022. Patients were divided into EOI and non-EOI groups based on oral intake initiation within two days postoperatively. Surgical methods, hospital characteristics, and length of stay were compared.</div></div><div><h3>Results</h3><div>Only 20.8 % of patients initiated EOI. Laparoscopic distal gastrectomy had significantly higher EOI rates compared to open procedures. However, no significant difference was observed for proximal or total gastrectomy. Larger hospitals and designated cancer centers showed higher EOI rates. The EOI group had a significantly shorter postoperative stay (median 9 vs. 12 days, p < 0.001).</div></div><div><h3>Conclusions</h3><div>EOI following gastrectomy is associated with shorter hospitalization, yet its adoption remains low in Japan. Institutional factors and multidisciplinary collaboration may play crucial roles in promoting EOI. Findings may inform perioperative optimization and ERAS standardization in oncologic gastric surgery.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102352"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146076764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Endoscopic management of upper GI anastomotic leaks after oesophagectomy or gastrectomy: Experience from a high-volume centre 食管切除术或胃切除术后上消化道吻合口瘘的内镜治疗：来自高容量中心的经验

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-01-20 DOI: 10.1016/j.suronc.2026.102353

Claudia Sanchez-Gonzalez , Jose Luis Fernandez Aguilar , Javier Moreno Ruiz , Custodia Montiel Casado , Luis Antonio Vazquez Pedreño , Ines Cañas Garcia , Julio Santoyo Santoyo

Anastomotic leaks after oesophagectomy or gastrectomy represent a major complication in upper gastrointestinal cancer surgery. This study evaluated outcomes of endoscopic management in a high-volume tertiary centre. We retrospectively analysed 29 patients treated between 2016 and 2025. Most leaks (82.8 %) were initially managed with self-expandable metal stents (SEMS), while 17.2 % received a sequential approach with endoscopic vacuum therapy (EVT) followed by SEMS. Clinical success was achieved in 89.7 % of cases, with only two requiring surgical reintervention. One death was attributed to endoscopic treatment. Median time to discharge was 21 days for SEMS and 32 days for EVT-SEMS. These findings support endoscopic therapy as a safe, effective, and organ-preserving first-line option for anastomotic leaks. The sequential use of EVT followed by SEMS is a newly described approach that may offer added benefits in selected patients and warrants further evaluation in specialised centres.

食管切除术或胃切除术后吻合口漏是上消化道肿瘤手术的主要并发症。本研究评估了高容量三级中心的内镜治疗结果。我们回顾性分析了2016年至2025年间接受治疗的29例患者。大多数渗漏（82.8%）最初采用自膨胀金属支架（SEMS）治疗，而17.2%的患者采用内窥镜真空治疗（EVT）的顺序方法，然后再进行SEMS。89.7%的病例取得临床成功，只有2例需要手术再干预。1例死亡归因于内窥镜治疗。SEMS的平均出院时间为21天，EVT-SEMS的平均出院时间为32天。这些发现支持内镜治疗作为一种安全、有效、保存器官的一线治疗吻合口瘘的选择。连续使用EVT之后的SEMS是一种新描述的方法，可以为选定的患者提供额外的好处，值得在专业中心进一步评估。

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引用次数: 0

Robotic extended left hepatectomy and Roux-en-Y hepaticojejunostomy for hilar cholangiocarcinoma after neoadjuvant treatment 机器人扩展左肝切除术和Roux-en-Y肝空肠吻合术治疗肝门部胆管癌新辅助治疗

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-01-13 DOI: 10.1016/j.suronc.2026.102350

Marcel Autran Machado, Bruno H. Mattos, Murillo M. Lobo Filho, Fábio F. Makdissi

引用次数: 0

The rate of non-sentinel lymph node metastases at axillary dissection in patients with a positive sentinel lymph node after neoadjuvant chemotherapy 新辅助化疗后前哨淋巴结阳性患者腋窝清扫时的非前哨淋巴结转移率。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-01-13 DOI: 10.1016/j.suronc.2026.102351

A.M. Zaborowski , F. Wehrmann , J. McGarry , T. Harding , I. Balasubramanian , C. Spillane , L. Nolan , W. Eljack , E. Quinn , M. Corrigan , A. Lowery , M. Kerin , C. Power , M. Allen , A. Butt , A.D.K. Hill , D. Alazawi , T. Boyle , E. Connolly , A. Heeney , R.S. Prichard

Background

Axillary lymph node dissection (ALND) remains the standard of care in patients with a positive sentinel lymph node biopsy (SLNB) following neoadjuvant chemotherapy (NAC). The aim of this study was to determine the rate of non-sentinel lymph node metastases in patients undergoing completion ALND and to identify factors predictive of positive non-sentinel lymph nodes.

Methods

A retrospective multicentre study was performed. Patients with node-positive breast cancer who had a positive SLNB after NAC and underwent a completion ALND between 2016 and 2023 were included. Logistic regression analysis was used to identify factors predictive of positive non-sentinel lymph nodes.

Results

A total of 106 patients were included. The median age was 48 (29–74). The median number of sentinel lymph nodes (SLNs) removed was 3 (1–6) and the median number of positive SLNs was 2 (1–4). Forty-five patients (43 %) had additional positive lymph nodes at completion ALND. Additional positive nodes were identified in 53 % of patients with SLN metastases ≤2 mm and in 37 % with SLN metastases >2 mm. Final N stage was ypN1 in 81 patients (76.4 %), ypN2 in 16 (15.1 %) and ypN3 in 9 (8.5 %). ALND increased ypN stage in 20.8 % of patients (22/106). Extra-nodal extension (OR 2.34, C.I 1.06–5.20, p = 0.04) was the only factor associated with a higher likelihood of positive non-sentinel nodes.

Conclusion

In patients with a positive SLNB after NAC, 43 % had additional positive nodes. Extranodal extension was predictive of additional nodal disease. ALND increased the ypN stage in 21 %, mostly in patients with hormone-receptor positive and triple negative breast cancer which may have treatment implications.

背景：腋窝淋巴结清扫术（ALND）仍然是新辅助化疗（NAC）后前哨淋巴结活检（SLNB）阳性患者的标准护理。本研究的目的是确定完成ALND患者的非前哨淋巴结转移率，并确定预测非前哨淋巴结阳性的因素。方法：采用回顾性多中心研究。纳入了淋巴结阳性乳腺癌患者，这些患者在NAC后SLNB呈阳性，并在2016年至2023年间进行了完全性ALND。采用Logistic回归分析确定预测非前哨淋巴结阳性的因素。结果：共纳入106例患者。中位年龄为48岁（29-74岁）。切除前哨淋巴结（sln）的中位数为3(1-6)，阳性sln的中位数为2（1-4）。45例患者（43%）在完成ALND时有额外的阳性淋巴结。53%的SLN转移≤2mm的患者和37%的SLN转移≤2mm的患者发现了额外的阳性淋巴结。最终N分期为ypN1期81例（76.4%），ypN2期16例（15.1%），ypN3期9例（8.5%）。ALND增加了20.8%（22/106）患者的ypN分期。结外延伸（OR 2.34, ci 1.06-5.20, p = 0.04）是唯一与非前哨淋巴结阳性可能性较高相关的因素。结论：在NAC术后SLNB阳性的患者中，43%的患者有额外的阳性淋巴结。结外延伸可预测其他淋巴结疾病。ALND使ypN分期增加21%，主要发生在激素受体阳性和三阴性乳腺癌患者中，这可能具有治疗意义。

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引用次数: 0

Risk reduction bilateral salpingo-oophorectomy with vNOTES: A new era in cancer prevention strategies 风险降低双侧输卵管卵巢切除术与vNOTES：癌症预防策略的新时代。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-01-02 DOI: 10.1016/j.suronc.2025.102349

Maria Pellisé-Tintoré , Thomas Gaillard , Enora Laas , Virginie Fourchotte , Hélène Didelot , Lea Pauly , Jean Guillaume Feron , Fabien Reyal , Fabrice Lecuru

Introduction

Women with BRCA1 and BRCA2 mutations face a significantly increased lifetime risk of developing ovarian and fallopian tube cancer. Minimally invasive techniques are the gold standard access to perform risk-reduction operations. This study aims to evaluate the feasibility and safety of prophylactic bilateral salpingo-oophorectomy using the vaginal natural orifice transluminal endoscopic surgery (vNOTES) technique as a risk-reduction strategy.

Material and methods

A prospective study was conducted between October 2023 and December 2024, involving 25 high-risk women at an international, university-affiliated cancer center. All patients underwent prophylactic bilateral salpingo-oophorectomy via transvaginal access using vNOTES. Key data collected included age, BMI, operative time, and blood loss, with primary outcomes focusing on feasibility, complications, and recovery.

Results

Twenty-five BRCA-mutated patients underwent prophylactic bilateral adnexectomy via vNOTES. Median age was 48 years (range 41–59) and median BMI 24.1 kg/m² (range 19.1–30.4). All procedures were completed without conversion to laparoscopy or laparotomy, and vNOTES enabled full abdominal exploration. Median operative time was 40 min (IQR 32–44), with minimal blood loss (<100 mL in 96 %) and no intraoperative complications. Postoperative recovery was uneventful, with no pain reported and 96 % of patients discharged the same day. No late complications related to the surgical technique were observed.

Conclusion

Prophylactic bilateral salpingo-oophorectomy using the vNOTES technique appears to be a feasible and safe option for reducing the risk of ovarian and fallopian tube cancers in high-risk women. Further studies with larger cohorts are needed to validate these findings.

简介：携带BRCA1和BRCA2突变的女性患卵巢癌和输卵管癌的风险显著增加。微创技术是进行降低风险手术的黄金标准。本研究旨在评估使用阴道自然口腔内内镜手术（vNOTES）技术作为降低风险策略的预防性双侧输卵管卵巢切除术的可行性和安全性。材料和方法：一项前瞻性研究于2023年10月至2024年12月进行，涉及一家国际大学附属癌症中心的25名高风险女性。所有患者均采用vNOTES经阴道预防性双侧输卵管卵巢切除术。收集的关键数据包括年龄、BMI、手术时间和出血量，主要结局关注可行性、并发症和恢复情况。结果：25例brca突变患者通过vNOTES行预防性双侧附件切除术。中位年龄为48岁（范围41-59），中位BMI为24.1 kg/m2（范围19.1-30.4）。所有手术均在未转为腹腔镜或开腹手术的情况下完成，vNOTES实现了全腹探查。中位手术时间为40分钟（IQR 32-44），出血量最小(结论：使用vNOTES技术预防性双侧输卵管-卵巢切除术似乎是降低高危妇女卵巢癌和输卵管癌风险的可行和安全的选择。需要更大规模的进一步研究来验证这些发现。

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