Laparoscopic surgery with three-dimensional (3D) vision has recently been introduced, allowing enhanced visualization and improved suturing capabilities. However, its clinical impact has not been widely studied, particularly in laparoscopic pancreatoduodenectomy (LPD), where visualization and suturing are critical. In this study, we compared outcomes between 2D and 3D LPD.
Methods
In our center, the first 2D-LPD was performed in 2011, and 3D-LPD was introduced in 2019. To assess the impact of 3D vision while minimizing bias related to the learning curve, we compared two consecutive four-year periods before and after the implementation of 3D vision: a first period with 2D-LPD (2015–2018) and a second period with 3D-LPD (2019–2022). There were no major modifications in surgical technique between the two periods. Operative and postoperative outcomes were compared between 2D and 3D LPD, both before and after propensity score matching. A generalized linear mixed model (GLMM) was associated to account for the time-effect.
Results
During the study period, 162 LPDs were performed, including 79 with 2D-LPD and 83 with 3D-LPD. There was no significant difference in baseline clinical characteristics, except for ampullary tumors, which were more frequently operated on in the 2D-LPD group (16 % vs. 4.8 %; p = 0.016). Operative data and pancreatic characteristics were similar between groups. However, 3D-LPD was associated with a lower conversion rate (0 % vs. 6 %; p = 0.026) and a lower transfusion rate (0 % vs. 6 %; p = 0.027). After propensity score matching (2D-LPD: n = 39; 3D-LPD: n = 83), outcomes remained significantly better with 3D-LPD, with fewer grade C postoperative pancreatic fistulas (10 % vs. 2 %; p = 0.038) and lower readmission rates (10 % vs. 0 %; p = 0.009), while median hospital stay was similar between groups (14 vs. 15 days; p = 0.699).
Conclusion
This study shows that 3D-LPD, compared to 2D-LPD, is associated with a lower incidence of grade C postoperative pancreatic fistula and readmission. Given its availability and cost-effectiveness compared to robotic surgery, 3D-LPD should be promoted.
{"title":"Laparoscopic pancreatoduodenectomy with 3D vision compared to 2D vision is associated with less severe morbidity and improved results","authors":"Safi Dokmak , Charles de Ponthaud , Chihebeddine Romdhani , Béatrice Aussilhou , Thibaud Bertrand , Mickael Lesurtel , Alain Sauvanet , Fadhel Samir Ftériche","doi":"10.1016/j.suronc.2025.102297","DOIUrl":"10.1016/j.suronc.2025.102297","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic surgery with three-dimensional (3D) vision has recently been introduced, allowing enhanced visualization and improved suturing capabilities. However, its clinical impact has not been widely studied, particularly in laparoscopic pancreatoduodenectomy (LPD), where visualization and suturing are critical. In this study, we compared outcomes between 2D and 3D LPD.</div></div><div><h3>Methods</h3><div>In our center, the first 2D-LPD was performed in 2011, and 3D-LPD was introduced in 2019. To assess the impact of 3D vision while minimizing bias related to the learning curve, we compared two consecutive four-year periods before and after the implementation of 3D vision: a first period with 2D-LPD (2015–2018) and a second period with 3D-LPD (2019–2022). There were no major modifications in surgical technique between the two periods. Operative and postoperative outcomes were compared between 2D and 3D LPD, both before and after propensity score matching. A generalized linear mixed model (GLMM) was associated to account for the time-effect.</div></div><div><h3>Results</h3><div>During the study period, 162 LPDs were performed, including 79 with 2D-LPD and 83 with 3D-LPD. There was no significant difference in baseline clinical characteristics, except for ampullary tumors, which were more frequently operated on in the 2D-LPD group (16 % vs. 4.8 %; p = 0.016). Operative data and pancreatic characteristics were similar between groups. However, 3D-LPD was associated with a lower conversion rate (0 % vs. 6 %; p = 0.026) and a lower transfusion rate (0 % vs. 6 %; p = 0.027). After propensity score matching (2D-LPD: n = 39; 3D-LPD: n = 83), outcomes remained significantly better with 3D-LPD, with fewer grade C postoperative pancreatic fistulas (10 % vs. 2 %; p = 0.038) and lower readmission rates (10 % vs. 0 %; p = 0.009), while median hospital stay was similar between groups (14 vs. 15 days; p = 0.699).</div></div><div><h3>Conclusion</h3><div>This study shows that 3D-LPD, compared to 2D-LPD, is associated with a lower incidence of grade C postoperative pancreatic fistula and readmission. Given its availability and cost-effectiveness compared to robotic surgery, 3D-LPD should be promoted.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102297"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304400","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}
Pub Date : 2025-10-01Epub Date: 2025-08-06DOI: 10.1016/j.suronc.2025.102275
Katarzyna Chawrylak, Wojciech Górski, Katarzyna Sędłak, Radoslaw Mlak, Marta Kaus, Agnieszka Hotloś, Zuzanna Chilimoniuk, Konrad Gładysz, Katarzyna Mielniczek, Magdalena Leśniewska, Zuzanna Pelc, Michał Bednarz, Wiktor Grela, Natalia Gniaź, Aleksandra Górska, Karolina Kasprzak, Damian Wach, Albert Chomątowski, Jakub Stawikowski, S Vincent Grasso, Marcin Kubiak, Andrew Gumbs, Timothy M Pawlik, Wojciech P Polkowski, Karol Rawicz- Pruszyński
Background: Cachexia is a multifactorial syndrome characterized by weight and muscle loss, often linked to malnutrition and inflammation. Malnutrition affects almost 40 % of colorectal cancer (CRC) patients, contributing to worse surgical outcomes, higher morbidity, and increased mortality. This study evaluates the Cachexia Index (CXI) for malnutrition detection in CRC patients.
Patients and methods: Seventy patients (54.3 % men; median age 65) underwent bioelectrical impedance analysis, blood tests, and nutritional assessments before surgery. Patients were recruited between November 1, 2023, and October 30, 2024. CXI, calculated as [Skeletal Mass Index × Serum Albumin]/Neutrophil-to-Lymphocyte-Ratio, was compared with the Subjective Global Assessment.
Results: The median CXI was 13.7 (range: 1.9-53.8), with malnourished or at-risk patients exhibiting significantly lower median CXI values (9.5 vs. 14.9; p = 0.0262) than well-nourished individuals. Tumor location also influenced CXI; patients with sigmoid colon tumors had the highest median CXI, while those with caecum tumors had the lowest (22.2 vs. 8.2; p = 0.0202). CXI demonstrated 100 % sensitivity and 60 % specificity for malnutrition detection, with a cutoff of ≤12.09 (AUC = 0.80; 95 % CI: 0.69-0.89; p < 0.0001). Malnourished patients had a significantly lower median CXI (9.5 vs. 14.9; p = 0.0262).
Conclusions: These findings support CXI as a reliable, non-invasive biomarker for malnutrition in CRC patients, with potential applications in personalized nutritional and therapeutic care.
背景：恶病质是一种以体重和肌肉减少为特征的多因素综合征，通常与营养不良和炎症有关。几乎40%的结直肠癌（CRC）患者营养不良，导致手术结果更差、发病率更高和死亡率增加。本研究评价恶病质指数（Cachexia Index， CXI）在CRC患者营养不良检测中的应用价值。患者和方法：70例(男性54.3%；中位年龄65岁)在手术前进行了生物电阻抗分析、血液检查和营养评估。患者于2023年11月1日至2024年10月30日期间招募。CXI计算方法为[骨量指数×血清白蛋白]/中性粒细胞与淋巴细胞比值，与主观总体评价进行比较。结果：中位CXI为13.7（范围：1.9-53.8），营养不良或高危患者的中位CXI值明显较低(9.5 vs. 14.9；P = 0.0262)。肿瘤位置也影响CXI；乙状结肠肿瘤患者的中位CXI最高，盲肠肿瘤患者的中位CXI最低(22.2 vs 8.2；p = 0.0202)。CXI检测营养不良的灵敏度为100%，特异性为60%，截止值≤12.09 (AUC = 0.80；95% ci: 0.69-0.89；结论：这些发现支持CXI作为CRC患者营养不良的可靠、无创生物标志物，在个性化营养和治疗护理中具有潜在的应用前景。
{"title":"Diagnostic utility of the preoperative cachexia index for malnutrition in colorectal cancer: A prospective cohort study.","authors":"Katarzyna Chawrylak, Wojciech Górski, Katarzyna Sędłak, Radoslaw Mlak, Marta Kaus, Agnieszka Hotloś, Zuzanna Chilimoniuk, Konrad Gładysz, Katarzyna Mielniczek, Magdalena Leśniewska, Zuzanna Pelc, Michał Bednarz, Wiktor Grela, Natalia Gniaź, Aleksandra Górska, Karolina Kasprzak, Damian Wach, Albert Chomątowski, Jakub Stawikowski, S Vincent Grasso, Marcin Kubiak, Andrew Gumbs, Timothy M Pawlik, Wojciech P Polkowski, Karol Rawicz- Pruszyński","doi":"10.1016/j.suronc.2025.102275","DOIUrl":"10.1016/j.suronc.2025.102275","url":null,"abstract":"<p><strong>Background: </strong>Cachexia is a multifactorial syndrome characterized by weight and muscle loss, often linked to malnutrition and inflammation. Malnutrition affects almost 40 % of colorectal cancer (CRC) patients, contributing to worse surgical outcomes, higher morbidity, and increased mortality. This study evaluates the Cachexia Index (CXI) for malnutrition detection in CRC patients.</p><p><strong>Patients and methods: </strong>Seventy patients (54.3 % men; median age 65) underwent bioelectrical impedance analysis, blood tests, and nutritional assessments before surgery. Patients were recruited between November 1, 2023, and October 30, 2024. CXI, calculated as [Skeletal Mass Index × Serum Albumin]/Neutrophil-to-Lymphocyte-Ratio, was compared with the Subjective Global Assessment.</p><p><strong>Results: </strong>The median CXI was 13.7 (range: 1.9-53.8), with malnourished or at-risk patients exhibiting significantly lower median CXI values (9.5 vs. 14.9; p = 0.0262) than well-nourished individuals. Tumor location also influenced CXI; patients with sigmoid colon tumors had the highest median CXI, while those with caecum tumors had the lowest (22.2 vs. 8.2; p = 0.0202). CXI demonstrated 100 % sensitivity and 60 % specificity for malnutrition detection, with a cutoff of ≤12.09 (AUC = 0.80; 95 % CI: 0.69-0.89; p < 0.0001). Malnourished patients had a significantly lower median CXI (9.5 vs. 14.9; p = 0.0262).</p><p><strong>Conclusions: </strong>These findings support CXI as a reliable, non-invasive biomarker for malnutrition in CRC patients, with potential applications in personalized nutritional and therapeutic care.</p>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"62 ","pages":"102275"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823129","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}
Pub Date : 2025-10-01Epub Date: 2025-08-05DOI: 10.1016/j.suronc.2025.102274
E L Meier, H J P Tielemans, R F Pronk, D J O Ulrich, S Hummelink
Background: Preoperative perforator mapping of the Profunda Artery Perforator (PAP) flap is hindered by challenges in aligning preoperative images with the intraoperative lithotomy position of the leg. Dynamic Infrared Thermography (DIRT) is a real-time, quick, and non-invasive imaging modality that is increasingly explored for preoperative perforator mapping. This feasibility study demonstrates the application of Projected Augmented Reality to project thermal images of DIRT directly on the skin for the identification of perforators before PAP flap breast reconstructions.
Methods: A portable self-aligning projection device (Anatomy Projector) was integrated with a thermal sensor to obtain thermal information and automatically project thermal images onto the patient's medial thigh before PAP flap dissection. Projected DIRT hotspots were evaluated with hand-held Doppler (HHD) and compared to locations of intraoperative perforators following a Cartesian coordinate system.
Results: Preoperative DIRT examination yielded a projection of 127 DIRT hotspots in 20 PAP flaps. All projected hotspots could be verified with Doppler (100 %) and 82.1 % of intraoperative perforators correlated with a projected DIRT hotspot within a 3 cm radius. Notably, 30.4 % of these matches involved the first appearing DIRT hotspot, and 82.6 % of these matches involved a DIRT hotspot within the first 5 appearing hotspots.
Conclusion: This feasibility study pioneers the use of Projected Augmented Reality for the display of thermal images of DIRT directly on the skin for the preoperative perforator identification before PAP flap harvest. High resemblance with HHD and intraoperative perforators was found. Future research should examine the further applications in the intraoperative and postoperative setting.
{"title":"Projected augmented reality and dynamic infrared thermography enhances profunda artery perforator flap perforator mapping.","authors":"E L Meier, H J P Tielemans, R F Pronk, D J O Ulrich, S Hummelink","doi":"10.1016/j.suronc.2025.102274","DOIUrl":"10.1016/j.suronc.2025.102274","url":null,"abstract":"<p><strong>Background: </strong>Preoperative perforator mapping of the Profunda Artery Perforator (PAP) flap is hindered by challenges in aligning preoperative images with the intraoperative lithotomy position of the leg. Dynamic Infrared Thermography (DIRT) is a real-time, quick, and non-invasive imaging modality that is increasingly explored for preoperative perforator mapping. This feasibility study demonstrates the application of Projected Augmented Reality to project thermal images of DIRT directly on the skin for the identification of perforators before PAP flap breast reconstructions.</p><p><strong>Methods: </strong>A portable self-aligning projection device (Anatomy Projector) was integrated with a thermal sensor to obtain thermal information and automatically project thermal images onto the patient's medial thigh before PAP flap dissection. Projected DIRT hotspots were evaluated with hand-held Doppler (HHD) and compared to locations of intraoperative perforators following a Cartesian coordinate system.</p><p><strong>Results: </strong>Preoperative DIRT examination yielded a projection of 127 DIRT hotspots in 20 PAP flaps. All projected hotspots could be verified with Doppler (100 %) and 82.1 % of intraoperative perforators correlated with a projected DIRT hotspot within a 3 cm radius. Notably, 30.4 % of these matches involved the first appearing DIRT hotspot, and 82.6 % of these matches involved a DIRT hotspot within the first 5 appearing hotspots.</p><p><strong>Conclusion: </strong>This feasibility study pioneers the use of Projected Augmented Reality for the display of thermal images of DIRT directly on the skin for the preoperative perforator identification before PAP flap harvest. High resemblance with HHD and intraoperative perforators was found. Future research should examine the further applications in the intraoperative and postoperative setting.</p>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"62 ","pages":"102274"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805191","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}
Pub Date : 2025-09-27DOI: 10.1016/j.suronc.2025.102298
Simona O. Dima , Andrei Sorop , Shuji Kitahara , Namrata Setia , Mihaela Chivu-Economescu , Lilia Matei , Vlad Herlea , Nicolae C. Pechianu , Takenori Inomata , Aya Matsui , Anna Khachatryan , Shuichi Aoki , Gregory Y. Lauwers , Irinel Popescu , Dan G. Duda
With approximately one million diagnosed cases and over 700,000 deaths recorded annually, gastric cancer (GC) is the third most common cause of cancer-related deaths worldwide. GC is a heterogeneous tumor. Thus, optimal management requires biomarkers of prognosis, treatment selection, and treatment response. The Cancer Genome Atlas program sub-classified GC into molecular subtypes, providing a framework for treatment personalization using traditional chemotherapies or biologics. We hypothesized that integrating immunohistochemistry markers, tumor gene expression profiles, and serum cytokines would define biologically distinct subtypes of gastric cancer and associate with overall survival independently of clinicopathologic factors and provide incremental prognostic value beyond existing classifications. Here, we report a comprehensive study of GC vascular and immune markers associated with tumor microenvironment (TME) based on stage and molecular subtypes, and their correlation with outcomes. Using tissues and blood circulating biomarkers and a molecular classification, we identified tumor archetypes, which show that the TME evolves with the disease stage and is a determinant of prognosis. Moreover, our TME-based subtyping strategy allowed the identification of archetype-specific prognostic biomarkers such as CDH1-mutant GC and circulating IL-6 that provided information beyond and independent of TMN staging, MSI status, and consensus molecular subtyping. The results show that integrating molecular subtyping with TME-specific biomarkers could contribute to improved patient prognostication and may provide a basis for treatment stratification, including for contemporary anti-angiogenesis and immunotherapy approaches.
{"title":"A tumor microenvironment-based classification of gastric cancer for more effective diagnosis and treatment","authors":"Simona O. Dima , Andrei Sorop , Shuji Kitahara , Namrata Setia , Mihaela Chivu-Economescu , Lilia Matei , Vlad Herlea , Nicolae C. Pechianu , Takenori Inomata , Aya Matsui , Anna Khachatryan , Shuichi Aoki , Gregory Y. Lauwers , Irinel Popescu , Dan G. Duda","doi":"10.1016/j.suronc.2025.102298","DOIUrl":"10.1016/j.suronc.2025.102298","url":null,"abstract":"<div><div>With approximately one million diagnosed cases and over 700,000 deaths recorded annually, gastric cancer (GC) is the third most common cause of cancer-related deaths worldwide. GC is a heterogeneous tumor. Thus, optimal management requires biomarkers of prognosis, treatment selection, and treatment response. The Cancer Genome Atlas program sub-classified GC into molecular subtypes, providing a framework for treatment personalization using traditional chemotherapies or biologics. We hypothesized that integrating immunohistochemistry markers, tumor gene expression profiles, and serum cytokines would define biologically distinct subtypes of gastric cancer and associate with overall survival independently of clinicopathologic factors and provide incremental prognostic value beyond existing classifications. Here, we report a comprehensive study of GC vascular and immune markers associated with tumor microenvironment (TME) based on stage and molecular subtypes, and their correlation with outcomes. Using tissues and blood circulating biomarkers and a molecular classification, we identified tumor archetypes, which show that the TME evolves with the disease stage and is a determinant of prognosis. Moreover, our TME-based subtyping strategy allowed the identification of archetype-specific prognostic biomarkers such as <em>CDH1</em>-mutant GC and circulating IL-6 that provided information beyond and independent of TMN staging, MSI status, and consensus molecular subtyping. The results show that integrating molecular subtyping with TME-specific biomarkers could contribute to improved patient prognostication and may provide a basis for treatment stratification, including for contemporary anti-angiogenesis and immunotherapy approaches.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102298"},"PeriodicalIF":2.4,"publicationDate":"2025-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145208276","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}
Pub Date : 2025-09-24DOI: 10.1016/j.suronc.2025.102296
Vijay P. Khatri MBChB, MBA, FACS, FSSO, FASGO, FICS
{"title":"A platform for sharing current research and advancing patient care","authors":"Vijay P. Khatri MBChB, MBA, FACS, FSSO, FASGO, FICS","doi":"10.1016/j.suronc.2025.102296","DOIUrl":"10.1016/j.suronc.2025.102296","url":null,"abstract":"","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102296"},"PeriodicalIF":2.4,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145202089","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}
Pub Date : 2025-09-15DOI: 10.1016/j.suronc.2025.102294
Dan G. Duda , Mohamed Abdel Wahab , Kyoichi Takaori
{"title":"Thirty-Five years of globalizing surgical oncology knowledge: A look into the future – IASGO Cairo 2024","authors":"Dan G. Duda , Mohamed Abdel Wahab , Kyoichi Takaori","doi":"10.1016/j.suronc.2025.102294","DOIUrl":"10.1016/j.suronc.2025.102294","url":null,"abstract":"","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102294"},"PeriodicalIF":2.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088137","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}
Pub Date : 2025-09-15DOI: 10.1016/j.suronc.2025.102295
Yvonne L. Eaglehouse , Sarah Darmon , Michele M. Gage , Craig D. Shriver , Kangmin Zhu
Background
Access to care has been identified as a contributor to racial-ethnic differences in treatment receipt and survival of colon cancer in the U.S. Less is known about racial-ethnic differences in aspects and outcomes of colon cancer surgery and whether access to care plays a role. We aimed to study colon cancer surgery and short-term postoperative outcomes in the Military Health System (MHS), which provides access to care regardless of patient characteristics.
Methods
We used the MilCanEpi database to identify patients aged 18 or older who were diagnosed with stage I-III colon adenocarcinoma between 2001 and 2014 and received colectomy as treatment. Outcomes included positive surgical margins, inadequate lymphadenectomy (<12 nodes examined), 30-day complications (any; general or gastrointestinal), and 30-day hospital readmissions. Multivariable Poisson regression models estimated the adjusted risk ratios (ARRs) and 95 % confidence intervals (CIs) in association with race-ethnicity for each outcome.
Results
The study included 157 Asian or Pacific Islander, 258 non-Hispanic Black, 111 Hispanic, and 1131 non-Hispanic White patients. Overall, the risk of measured outcomes did not differ significantly for racial-ethnic minority groups compared to non-Hispanic White (ARRs and their 95 % CIs included 1.00). By complication type, Hispanic patients had significantly lower risk of bowel obstruction (ARR = 0.55, 95 % CI = 0.32, 0.96) compared to non-Hispanic White patients, with no other statistically significant racial-ethnic differences.
Conclusions
In the universal access MHS, there were no overall significant racial-ethnic differences in surgical aspects or experience of 30-day outcomes of colectomy for non-metastatic colon cancer.
背景：在美国，获得治疗的机会被认为是导致结肠癌治疗接受和生存的种族差异的一个因素。对于结肠癌手术的各个方面和结果的种族差异以及是否获得治疗的机会起作用，我们知之甚少。我们旨在研究军事卫生系统（MHS）中的结肠癌手术和短期术后结果，该系统提供不考虑患者特征的护理。方法：我们使用MilCanEpi数据库识别2001年至2014年间诊断为I-III期结肠腺癌并接受结肠切除术治疗的18岁及以上患者。结果包括手术切缘阳性，淋巴结切除术不充分(结果：该研究包括157名亚洲或太平洋岛民，258名非西班牙裔黑人，111名西班牙裔和1131名非西班牙裔白人患者。总体而言，与非西班牙裔白人相比，少数族裔群体测量结果的风险没有显著差异（arr及其95% ci包括1.00）。从并发症类型来看，西班牙裔患者发生肠梗阻的风险明显低于非西班牙裔白人患者（ARR = 0.55, 95% CI = 0.32, 0.96），其他种族间差异无统计学意义。结论：在普遍可及的MHS中，在非转移性结肠癌结肠切除术30天结局的手术方面或经验方面，总体上没有显著的种族差异。
{"title":"Short-term surgical outcomes for colon adenocarcinoma: Racial-Ethnic comparisons in a universal access health system","authors":"Yvonne L. Eaglehouse , Sarah Darmon , Michele M. Gage , Craig D. Shriver , Kangmin Zhu","doi":"10.1016/j.suronc.2025.102295","DOIUrl":"10.1016/j.suronc.2025.102295","url":null,"abstract":"<div><h3>Background</h3><div>Access to care has been identified as a contributor to racial-ethnic differences in treatment receipt and survival of colon cancer in the U.S. Less is known about racial-ethnic differences in aspects and outcomes of colon cancer surgery and whether access to care plays a role. We aimed to study colon cancer surgery and short-term postoperative outcomes in the Military Health System (MHS), which provides access to care regardless of patient characteristics.</div></div><div><h3>Methods</h3><div>We used the MilCanEpi database to identify patients aged 18 or older who were diagnosed with stage I-III colon adenocarcinoma between 2001 and 2014 and received colectomy as treatment. Outcomes included positive surgical margins, inadequate lymphadenectomy (<12 nodes examined), 30-day complications (any; general or gastrointestinal), and 30-day hospital readmissions. Multivariable Poisson regression models estimated the adjusted risk ratios (ARRs) and 95 % confidence intervals (CIs) in association with race-ethnicity for each outcome.</div></div><div><h3>Results</h3><div>The study included 157 Asian or Pacific Islander, 258 non-Hispanic Black, 111 Hispanic, and 1131 non-Hispanic White patients. Overall, the risk of measured outcomes did not differ significantly for racial-ethnic minority groups compared to non-Hispanic White (ARRs and their 95 % CIs included 1.00). By complication type, Hispanic patients had significantly lower risk of bowel obstruction (ARR = 0.55, 95 % CI = 0.32, 0.96) compared to non-Hispanic White patients, with no other statistically significant racial-ethnic differences.</div></div><div><h3>Conclusions</h3><div>In the universal access MHS, there were no overall significant racial-ethnic differences in surgical aspects or experience of 30-day outcomes of colectomy for non-metastatic colon cancer.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102295"},"PeriodicalIF":2.4,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088157","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}
Pub Date : 2025-09-12DOI: 10.1016/j.suronc.2025.102293
Marco Tonello , Carola Cenzi , Paola Del Bianco , Elisa Pizzolato , Chiara Maria Biatta , Francesca Bergamo , Giulia Tasca , Anna Roma , Selma Ahcene Djaballah , Beatrice Bordignon , Giovanna Magni , Giacomo Moratello , Gaetano Ramondo , Sara Lonardi , Pierluigi Pilati , Antonio Sommariva , Gian Luca De Salvo
Introduction
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising palliative treatment for patients with peritoneal malignancies who are not candidates for curative surgery. This study aimed to assess the efficacy and feasibility of implementing a PIPAC program at a single cancer center.
Methods
An open-label, single-arm, phase II study was conducted, enrolling patients with peritoneal tumors of various origins. Participants received bidirectional chemotherapy (intravenous and PIPAC). The primary endpoint was PIPAC efficacy measured as pathological response, while secondary endpoints included safety and feasibility of the technique, quality of life, and clinical outcomes.
Results
From March 2021 to March 2024, 32 patients were screened, and 25 were enrolled, resulting in 58 PIPAC procedures. The complication rate was low, with severe surgical complications occurring in 1.7 % of procedures and CTCAE grade 3 complications in 3.4 %. A major pathological response was observed in 56 % of cases, and seven patients (28.0 %) underwent curative-intent cytoreductive surgery after at least two PIPAC treatments. Both the Peritoneal Cancer Index (PCI) and the Peritoneal Regression Score (PRGS) decreased after repeated PIPAC (p = 0.016 and p = 0.047, respectively). Ascites volume also decreased significantly after the first PIPAC (p = 0.001). The median overall survival (OS) was 9.6 months, with responding patients (PRGS 1–2) showing better clinical outcomes (OS: 21.0 vs. 5.5 months,p < 0.001; PFS: 8.2 vs. 2.4 months,p < 0.001) and quality of life (p = 0.003).
Conclusion
PIPAC can be safely combined with systemic chemotherapy in patients with peritoneal malignancies, demonstrating efficacy in controlling ascites and achieving major pathological response. Further studies are necessary to determine its potential survival benefits.
{"title":"Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal malignancies: a monocentric, single-arm open-label phase II clinical trial","authors":"Marco Tonello , Carola Cenzi , Paola Del Bianco , Elisa Pizzolato , Chiara Maria Biatta , Francesca Bergamo , Giulia Tasca , Anna Roma , Selma Ahcene Djaballah , Beatrice Bordignon , Giovanna Magni , Giacomo Moratello , Gaetano Ramondo , Sara Lonardi , Pierluigi Pilati , Antonio Sommariva , Gian Luca De Salvo","doi":"10.1016/j.suronc.2025.102293","DOIUrl":"10.1016/j.suronc.2025.102293","url":null,"abstract":"<div><h3>Introduction</h3><div>Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising palliative treatment for patients with peritoneal malignancies who are not candidates for curative surgery. This study aimed to assess the efficacy and feasibility of implementing a PIPAC program at a single cancer center.</div></div><div><h3>Methods</h3><div>An open-label, single-arm, phase II study was conducted, enrolling patients with peritoneal tumors of various origins. Participants received bidirectional chemotherapy (intravenous and PIPAC). The primary endpoint was PIPAC efficacy measured as pathological response, while secondary endpoints included safety and feasibility of the technique, quality of life, and clinical outcomes.</div></div><div><h3>Results</h3><div>From March 2021 to March 2024, 32 patients were screened, and 25 were enrolled, resulting in 58 PIPAC procedures. The complication rate was low, with severe surgical complications occurring in 1.7 % of procedures and CTCAE grade 3 complications in 3.4 %. A major pathological response was observed in 56 % of cases, and seven patients (28.0 %) underwent curative-intent cytoreductive surgery after at least two PIPAC treatments. Both the Peritoneal Cancer Index (PCI) and the Peritoneal Regression Score (PRGS) decreased after repeated PIPAC (p = 0.016 and p = 0.047, respectively). Ascites volume also decreased significantly after the first PIPAC (p = 0.001). The median overall survival (OS) was 9.6 months, with responding patients (PRGS 1–2) showing better clinical outcomes (OS: 21.0 vs. 5.5 months,p < 0.001; PFS: 8.2 vs. 2.4 months,p < 0.001) and quality of life (p = 0.003).</div></div><div><h3>Conclusion</h3><div>PIPAC can be safely combined with systemic chemotherapy in patients with peritoneal malignancies, demonstrating efficacy in controlling ascites and achieving major pathological response. Further studies are necessary to determine its potential survival benefits.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102293"},"PeriodicalIF":2.4,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082172","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}
Pub Date : 2025-09-11DOI: 10.1016/j.suronc.2025.102291
Vincent Hoffmann, Martina Dellino, Henning Bahlburg, Moritz Reike, Analena Elisa Handke, Peter Bach, Joachim Noldus, Florian Roghmann, Karl Tully
Introduction & objectives
The main obstacles to the broad application of neoadjuvant chemotherapy for locally advanced upper tract urothelial cancer(UTUC) are uncertainties regarding the accuracy of preoperative diagnostics. This study aimed to examine the predictive value of preoperative diagnostic results regarding the histopathologic findings at the time of radical nephroureterectomy (RNU).
Material & methods
An institutional dataset of patients undergoing RNU for suspected UTUC between 01/2018 and 12/2023 was analyzed. We examined the preoperative utilization of different diagnostic means and their predictive value in detecting locally advanced(i.e., ≥T2) disease. Separate uni-and multivariable logistic regression models were employed to examine the association between preoperative findings and final histology.
Results
At the time of RNU, 64.4 %(n = 74) of patients were diagnosed with ≥T2 disease. Out of 115 patients, 41.7 % underwent RNU based on cross-sectional imaging findings alone, thirty of whom had undergone a prior endourologic diagnostic workup without evidence of UTUC(62.5 %). There were no false-positive diagnoses of UTUC. On multivariable logistic regression and consecutive receiver operating characteristic(ROC) analysis, only a tumor size ≥1.9 cm during cross-sectional imaging was associated with advanced disease(OR 2.99, 95 %CI 1.65–5.43, p < 0.001).
Conclusion
In this cohort of patients undergoing RNU for suspected UTUC, only tumor size during cross-sectional imaging was associated with advanced disease. These results support the notion of tumor size as an independent risk factor, which may, in turn, guide further treatment decisions.
前言与目的：新辅助化疗广泛应用于局部晚期上尿路上皮癌（UTUC）的主要障碍是术前诊断准确性的不确定性。本研究旨在探讨术前诊断结果对根治性肾输尿管切除术（RNU）时组织病理学表现的预测价值。材料与方法：对2018年1月至2023年12月间因疑似UTUC接受RNU治疗的机构数据集进行分析。我们检查了术前不同诊断手段的使用情况，以及它们在检测局部晚期（即恶性肿瘤）中的预测价值。≥T2)疾病。采用单独的单变量和多变量logistic回归模型来检查术前发现与最终组织学之间的关系。结果：RNU时，64.4% （n = 74）的患者诊断为≥T2病变。在115例患者中，41.7%的患者仅根据横断面成像结果接受了RNU，其中30例患者在没有UTUC证据的情况下进行了先前的泌尿系统诊断检查（62.5%）。无UTUC假阳性诊断。在多变量logistic回归和连续受试者工作特征（ROC）分析中，只有在横断成像时肿瘤大小≥1.9 cm与疾病晚期相关（OR 2.99, 95% CI 1.65-5.43, p）。结论：在这组因疑似UTUC而行RNU的患者中，只有横断成像时肿瘤大小与疾病晚期相关。这些结果支持肿瘤大小作为独立危险因素的概念，这可能反过来指导进一步的治疗决策。
{"title":"The utility of preoperative diagnostics in patients undergoing radical nephroureterectomy for suspected upper tract urothelial carcinoma: Can we justify treatment without prior histologic confirmation?","authors":"Vincent Hoffmann, Martina Dellino, Henning Bahlburg, Moritz Reike, Analena Elisa Handke, Peter Bach, Joachim Noldus, Florian Roghmann, Karl Tully","doi":"10.1016/j.suronc.2025.102291","DOIUrl":"10.1016/j.suronc.2025.102291","url":null,"abstract":"<div><h3>Introduction & objectives</h3><div>The main obstacles to the broad application of neoadjuvant chemotherapy for locally advanced upper tract urothelial cancer(UTUC) are uncertainties regarding the accuracy of preoperative diagnostics. This study aimed to examine the predictive value of preoperative diagnostic results regarding the histopathologic findings at the time of radical nephroureterectomy (RNU).</div></div><div><h3>Material & methods</h3><div>An institutional dataset of patients undergoing RNU for suspected UTUC between 01/2018 and 12/2023 was analyzed. We examined the preoperative utilization of different diagnostic means and their predictive value in detecting locally advanced(i.e., ≥T2) disease. Separate uni-and multivariable logistic regression models were employed to examine the association between preoperative findings and final histology.</div></div><div><h3>Results</h3><div>At the time of RNU, 64.4 %(n = 74) of patients were diagnosed with ≥T2 disease. Out of 115 patients, 41.7 % underwent RNU based on cross-sectional imaging findings alone, thirty of whom had undergone a prior endourologic diagnostic workup without evidence of UTUC(62.5 %). There were no false-positive diagnoses of UTUC. On multivariable logistic regression and consecutive receiver operating characteristic(ROC) analysis, only a tumor size ≥1.9 cm during cross-sectional imaging was associated with advanced disease(OR 2.99, 95 %CI 1.65–5.43, p < 0.001).</div></div><div><h3>Conclusion</h3><div>In this cohort of patients undergoing RNU for suspected UTUC, only tumor size during cross-sectional imaging was associated with advanced disease. These results support the notion of tumor size as an independent risk factor, which may, in turn, guide further treatment decisions.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102291"},"PeriodicalIF":2.4,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082185","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}
This study aimed to compare perioperative outcomes and complications between the transperitoneal approach (Tp) and extraperitoneal approach (Ep) in robot-assisted radical prostatectomy (RARP) at our institution.
Methods
We retrospectively reviewed data from 894 patients who underwent RARP between 2014 and 2023, including 539 with Ep and 355 with Tp. Ep was selected for patients who did not require extended lymph node dissection (ELND), whereas Tp was selected for patients who required ELND. Propensity score matching (PSM) was performed, resulting in 326 matched pairs. Primary outcomes included severe complications (Clavien–Dindo grade III or higher). Secondary outcomes included transfusion rates, console time without ELND and postoperative length of stay.
Results
Following PSM, severe complications occurred in 0 patients (0 %) in the Ep group and in 14 patients (4.3 %) in the Tp group, with bowel-related complications more frequent in the latter. The transfusion rate was low in both groups (0.6 % [Ep] vs. 0 % [Tp], p = 0.43). Operative parameters showed comparable console time without ELND (185 min [Ep] vs. 179 min [Tp], p = 0.30). Postoperative length of stay was comparable between groups (median, 6 days for both; p = 0.05). Peritoneal injuries occurred in 19 % of patients in the Ep group but did not lead to major complications or conversion to Tp in most cases.
Conclusions
This study suggests that both Tp and Ep are feasible approaches for RARP, with Ep potentially associated with fewer bowel complications.
目的比较我院机器人辅助根治性前列腺切除术（RARP）中经腹腔入路（Tp）和腹腔外入路（Ep）的围手术期预后和并发症。方法回顾性分析2014年至2023年间894例RARP患者的数据，其中539例Ep患者和355例Tp患者。不需要扩展淋巴结清扫（ELND）的患者选择Ep，而需要ELND的患者选择Tp。进行倾向得分匹配（PSM），得到326对匹配。主要结局包括严重并发症（Clavien-Dindo III级或更高）。次要结果包括输血率、无ELND的安慰时间和术后住院时间。结果经PSM治疗后，Ep组出现严重并发症0例（0%），Tp组出现严重并发症14例（4.3%），Tp组出现肠道相关并发症较多。两组输血率均较低（0.6% [Ep] vs. 0% [Tp], p = 0.43）。手术参数显示无ELND的控制台时间（185 min [Ep] vs. 179 min [Tp], p = 0.30）。术后住院时间组间比较（中位数均为6天，p = 0.05）。Ep组19%的患者出现腹膜损伤，但大多数病例未导致严重并发症或转化为Tp。结论本研究提示Tp和Ep都是RARP的可行方法，Ep可能与较少的肠道并发症相关。
{"title":"Safety and perioperative outcomes in extraperitoneal versus transperitoneal robot-assisted radical prostatectomy: A propensity score matching study from a single regional center","authors":"Atsushi Igarashi, Riki Obayashi, Akihiro Yamamoto, Akihiko Nagoshi, Tasuku Fujiwara, Naoki Akagi, Yuto Hattori, Noboru Shibasaki, Mutsushi Kawakita, Toshinari Yamasaki","doi":"10.1016/j.suronc.2025.102292","DOIUrl":"10.1016/j.suronc.2025.102292","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare perioperative outcomes and complications between the transperitoneal approach (Tp) and extraperitoneal approach (Ep) in robot-assisted radical prostatectomy (RARP) at our institution.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed data from 894 patients who underwent RARP between 2014 and 2023, including 539 with Ep and 355 with Tp. Ep was selected for patients who did not require extended lymph node dissection (ELND), whereas Tp was selected for patients who required ELND. Propensity score matching (PSM) was performed, resulting in 326 matched pairs. Primary outcomes included severe complications (Clavien–Dindo grade III or higher). Secondary outcomes included transfusion rates, console time without ELND and postoperative length of stay.</div></div><div><h3>Results</h3><div>Following PSM, severe complications occurred in 0 patients (0 %) in the Ep group and in 14 patients (4.3 %) in the Tp group, with bowel-related complications more frequent in the latter. The transfusion rate was low in both groups (0.6 % [Ep] vs. 0 % [Tp], p = 0.43). Operative parameters showed comparable console time without ELND (185 min [Ep] vs. 179 min [Tp], p = 0.30). Postoperative length of stay was comparable between groups (median, 6 days for both; p = 0.05). Peritoneal injuries occurred in 19 % of patients in the Ep group but did not lead to major complications or conversion to Tp in most cases.</div></div><div><h3>Conclusions</h3><div>This study suggests that both Tp and Ep are feasible approaches for RARP, with Ep potentially associated with fewer bowel complications.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102292"},"PeriodicalIF":2.4,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145050166","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}
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