Surgical Oncology-Oxford最新文献_第9页

Preoperative prediction of severe short-term complications in patients with bladder cancer undergoing radical cystectomy 膀胱癌根治性膀胱切除术患者严重短期并发症的术前预测

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-19 DOI: 10.1016/j.suronc.2025.102253

Thomas Vetsch , Markus Huber , Patrick Y. Wuethrich , Marc A. Furrer

Background and objective

Radical cystectomy (RC) is associated with a high risk of postoperative complications. The prediction of individual patient risk for severe complications can facilitate preoperative shared decision-making. Patients with elevated risk may be referred to prehabilitation with the aim to mitigate the risk to improve perioperative outcomes. We developed models to predict severe short-term postoperative complications using preoperatively available clinical variables.

Methods

Data from a prospective cohort of 1313 RC patients treated between 1999 and 2021 was used. Preoperative demographic, laboratory, and cancer-related variables were defined as domains to predict severe complications measured by the Comprehensive Complication Index (CCI). Machine-learning models were trained for each postoperative day and predictor domain. The area under the receiver operating characteristic curve (AUROC) was reported as the primary outcome. Clinical utility was examined using Decision Curve Analysis (DCA).

Results

The best performing model had an AUROC of 0.69 (95 % CI 0.63–0.75) for severe complications on postoperative day (POD) 14. Mean AUROCs across POD 1–30 were 0.64 for all variables combined, 0.58 for demographics, 0.56 for laboratory values, and 0.53 for cancer-related factors. Model calibration and stability improved from POD 10 onwards. Decision curve analysis indicated the highest net benefit from models incorporating all predictors, with demographic variables contributing most among individual domains.

Conclusions and clinical implications

Limited clinical utility of the trained models was observed. The benefit for preoperative clinical decision-making is unclear. Clinical utility may improve by the inclusion of variables related to function in future models (e.g., frailty).

背景和目的根治性膀胱切除术（RC）与术后并发症的高风险相关。个体患者严重并发症风险的预测可以促进术前共同决策。高危患者可进行康复治疗，以降低风险，改善围手术期预后。我们利用术前可用的临床变量建立了预测严重短期术后并发症的模型。方法数据来自1999年至2021年期间接受治疗的1313例RC患者的前瞻性队列。术前人口统计学、实验室和癌症相关变量被定义为通过综合并发症指数（CCI）预测严重并发症的域。机器学习模型在术后每一天和预测域进行训练。受试者工作特征曲线下面积（AUROC）作为主要终点。采用决策曲线分析（DCA）检验临床效用。结果最佳模型术后14天严重并发症AUROC为0.69 （95% CI 0.63-0.75）。POD 1-30的平均auroc为所有变量组合的0.64，人口统计学为0.58，实验室值为0.56，癌症相关因素为0.53。从POD 10开始，模型校准和稳定性得到改善。决策曲线分析表明，结合所有预测因子的模型净效益最高，人口变量在个别领域的贡献最大。结论和临床意义观察到训练模型的临床应用有限。术前临床决策的益处尚不清楚。通过在未来的模型中纳入与功能相关的变量（例如，虚弱），临床效用可能会得到改善。

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引用次数: 0

Survival outcomes and pathologic complete response following neoadjuvant chemoradiotherapy versus chemotherapy alone in locally advanced rectal cancer 局部晚期直肠癌新辅助放化疗与单独化疗后的生存结果和病理完全缓解

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-19 DOI: 10.1016/j.suronc.2025.102252

Metincan Erkaya , Cigdem Benlice , Bilgi Baca , Emre Gorgun

Background

The management of locally advanced rectal cancer (LARC) continues to evolve, marked by significant advancements in treatment paradigms. Total neoadjuvant therapy (TNT) has emerged as a promising strategy, while de-escalation approaches, such as neoadjuvant chemotherapy (nCT) alone, are gaining traction to mitigate radiation-related toxicities without compromising oncologic efficacy. This study aimed to compare survival outcomes and pathologic complete response (pCR) rates between patients with LARC treated with neoadjuvant chemoradiotherapy (nCRT) and those treated with nCT alone.

Methods

This retrospective cohort study analyzed data from the National Cancer Database (NCDB) between 2015 and 2019. The inclusion criteria were non-metastatic clinical T2 node-positive, T3 node-negative, and T3 node-positive rectal adenocarcinoma patients undergoing partial proctectomy with neoadjuvant therapy. The stabilized inverse probability of treatment weighting (IPTW) was applied to balance the baseline characteristics. Overall survival was assessed using Kaplan-Meier curves and multivariable Cox proportional hazards models, while pCR rates were analyzed using logistic regression.

Results

Of 6886 patients included, 386 (5.6 %) received nCT alone, and 6500 (94.4 %) received nCRT. After IPTW adjustment, no significant difference in overall survival was observed between nCRT and nCT alone groups (HR: 0.99, 95 % CI: 0.69–1.41, p = 0.936). pCR rates were similar (OR: 1.20, 95 % CI: 0.77–1.98, p = 0.438). Subgroup analysis revealed non-significant trends toward higher pCR rates with nCRT in T3 node-positive patients (OR: 1.44, 95 % CI: 0.77–3.05, p = 0.297). Residual tumor margins (HR: 3.04, 95 % CI: 2.34–3.94, p < 0.001) and incomplete pathological response (HR: 1.68, 95 % CI: 1.22–2.31, p = 0.002) were significant predictors of worse survival outcomes regardless of treatment modality.

Conclusion

This large-scale analysis demonstrates comparable overall survival and pCR rates between nCRT and nCT alone in carefully selected with LARC patients, supporting the growing evidence for selective radiation omission strategies. These findings align with those of contemporary de-escalation trials and suggest that nCT alone may be a viable treatment option for specific patient subgroups. Future prospective studies incorporating quality of life assessments and long-term functional outcomes are essential to optimize personalized treatment strategies and refine patient selection criteria for radiation de-escalation in LARC management.

背景局部晚期直肠癌（LARC）的治疗不断发展，治疗模式显著进步。总的新辅助治疗（TNT）已成为一种有前景的策略，而降级方法，如单独的新辅助化疗（nCT），正在获得吸引力，以减轻辐射相关的毒性，而不影响肿瘤疗效。本研究旨在比较LARC患者接受新辅助放化疗（nCRT）和单独接受nCT治疗的患者的生存结局和病理完全缓解（pCR）率。方法本回顾性队列研究分析了2015年至2019年美国国家癌症数据库（NCDB）的数据。纳入标准是非转移性临床T2淋巴结阳性、T3淋巴结阴性和T3淋巴结阳性的直肠腺癌患者，他们接受了部分直肠切除术并进行了新辅助治疗。采用稳定的治疗加权逆概率（IPTW）来平衡基线特征。采用Kaplan-Meier曲线和多变量Cox比例风险模型评估总生存率，采用logistic回归分析pCR率。结果6886例患者中，单独接受nCT治疗的386例（5.6%），接受nCRT治疗的6500例（94.4%）。调整IPTW后，nCRT组与单独nCT组的总生存率无显著差异（HR: 0.99, 95% CI: 0.69-1.41, p = 0.936）。pCR率相似（OR: 1.20, 95% CI: 0.77 ~ 1.98, p = 0.438）。亚组分析显示，在T3淋巴结阳性患者中，nCRT的pCR率升高趋势不显著（OR: 1.44, 95% CI: 0.77-3.05, p = 0.297）。残余肿瘤边缘(HR: 3.04, 95% CI: 2.34-3.94, p <；0.001)和不完全病理反应（HR: 1.68, 95% CI: 1.22-2.31, p = 0.002）是预后较差的显著预测因子，与治疗方式无关。结论：这项大规模分析表明，在精心挑选的LARC患者中，nCRT和单独nCT的总生存率和pCR率相当，支持选择性放射遗漏策略的证据越来越多。这些发现与当代降压试验的结果一致，表明单独的nCT可能是特定患者亚组的可行治疗选择。纳入生活质量评估和长期功能结果的未来前瞻性研究对于优化个性化治疗策略和完善LARC管理中辐射降级的患者选择标准至关重要。

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引用次数: 0

Octogenarians with lower BMI have comparatively poor survival in potentially resectable pancreatic cancer: outcomes over 5-year follow-up BMI较低的八旬老人在潜在可切除的胰腺癌中生存率相对较低：5年随访结果

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-07 DOI: 10.1016/j.suronc.2025.102248

Hideki Motobayashi, Atsushi Shimizu, Yuji Kitahata, Akihiro Takeuchi, Tomohiro Yoshimura, Masatoshi Sato, Kyohei Matsumoto, Shinya Hayami, Atsushi Miyamoto, Kensuke Nakamura, Manabu Kawai

Background

The indication and benefit of pancreatectomy for octogenarians with pancreatic cancer remains controversial. This study aims to evaluate prognostic factors in patients with pancreatic cancer after 5-year follow-up.

Methods

We retrospectively reviewed the 229 patients who underwent pancreatectomy at our hospital between 2005 and 2018 for potentially resectable pancreatic cancer. Of these, 216 patients were divided into three groups based on age: <70 years old (n = 97), 70–79 years old (n = 81), and ≥80 years old (n = 38).

Results

Seventy patients (32.4 %) achieved 5-year survival. Median survival time and five-year overall survival in each group were: 37.3 months and 37.1 % for patients <70 years old, 26.0 months and 30.9 % for those 70–79 years old, and 20.2 months and 23.7 % for those ≥80 years old. The patients who were ≥80 years old and had BMI <20 kg/m² had a significantly poorer prognosis than those <80 years old and who had BMI ≥20 kg/m² (P = 0.006). Independent prognostic factors were age ≥80 years and BMI <20 kg/m², preoperative CA19-9 ≥ 500 IU/L, transfusion, tumor size ≥20 mm, positive lymph node, and non-completion of adjuvant therapy. Moreover, age ≥80 years, BMI <20 kg/m², preoperative CA19-9, and severe complications were each associated with non-completion of adjuvant therapy.

Conclusions

Octogenarians with lower BMI, which might be attributed to lower completion rate of adjuvant therapy, had especially poorer prognosis.

背景八十多岁胰腺癌患者行胰腺切除术的适应症和益处仍有争议。本研究旨在评估胰腺癌患者5年随访后的预后因素。方法回顾性分析2005年至2018年在我院行胰腺切除术的229例潜在可切除胰腺癌患者。其中，216例患者根据年龄分为三组：70岁（n = 97）、70 - 79岁（n = 81）和≥80岁（n = 38）。结果70例（32.4%）患者达到5年生存率。两组患者的中位生存期和5年总生存期分别为：70岁患者37.3个月和37.1%，70 - 79岁患者26.0个月和30.9%，≥80岁患者20.2个月和23.7%。年龄≥80岁且BMI≥20 kg/m2的患者预后明显差于年龄≥80岁且BMI≥20 kg/m2的患者（P = 0.006）。独立预后因素为：年龄≥80岁，BMI≥20 kg/m2，术前CA19-9≥500 IU/L，输血，肿瘤大小≥20 mm，淋巴结阳性，辅助治疗未完成。年龄≥80岁、BMI≥20 kg/m2、术前CA19-9、严重并发症均与未完成辅助治疗相关。结论老年患者BMI越低，其预后越差，可能与辅助治疗完成率越低有关。

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引用次数: 0

A phase 1 study of intra-arterial CBL0137 in extremity melanomas and sarcomas 动脉内CBL0137治疗四肢黑色素瘤和肉瘤的一期研究

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-07 DOI: 10.1016/j.suronc.2025.102243

Joseph J. Skitzki , Minhyung Kim , Daniel T. Fisher , John M. Kane III , Han Yu , Kayla Catalfamo , Garin Tomaszewski , Michael Petroziello , Andrei Purmal , Katerina V. Gurova , Andrei V. Gudkov

Introduction

Regional therapies for cancer leverage the ability to isolate the circulation to a diseased extremity or organ and deliver high doses of chemotherapy that would be systemically prohibitive due to toxicity. Virtually all regional therapies utilize the original chemotherapy agent, melphalan, which requires circulatory isolation. CBL0137 is a small molecule with multiple anti-tumor effects when given intra-arterially (IA) that shows similar efficacy to melphalan in preclinical models, but without the need for circulatory isolation.

Materials and methods

Patients with advanced, unresectable melanoma or sarcoma (n = 5, sarcoma 60 %, melanoma 40 %) of the extremity entered a rapid dose-escalation phase of a clinical trial of IA CBL0137. CBL0137 was administered via a single IA catheter placed proximal to the site of tumor(s) in the affected extremity and delivered over 15 min. Primary objective was to define dose-limiting toxicities with secondary objectives of assessing response and pharmacokinetics (PK).

Results

The treatments were well tolerated with minimal to no toxicity for all patients. PK data showed predictable, dose-dependent drug exposures with rapid tissue uptake and markedly decreased systemic concentrations as compared to matched intravenous dosing data. CBL0137 preferentially accumulated within tumor tissue as compared to surrounding normal tissue in the infused limb without the need for tourniquet. Sixty percent of patients treated in this protocol would not have been eligible for standard regional therapies with one patient demonstrating prolonged disease stability while avoiding major amputation.

Conclusions

The historic restrictions of standard regional therapies may be overcome with IA CBL0137, and this treatment is potentially applicable to a wide range of cancers beyond the extremities.

局部癌症治疗利用将血液循环隔离到患病肢体或器官的能力，并提供高剂量的化疗，这将是由于毒性而全身禁止的。几乎所有的局部治疗都使用最初的化疗药物美法兰，这需要循环隔离。CBL0137是一种具有多种抗肿瘤作用的小分子，当动脉内给药（IA）时，在临床前模型中显示出与美法兰相似的疗效，但不需要循环分离。材料和方法患有晚期，不可切除的黑色素瘤或肉瘤（n = 5，肉瘤60%，黑色素瘤40%）的患者进入IA CBL0137临床试验的快速剂量递增阶段。CBL0137通过放置在受影响肢体肿瘤近端处的单根IA导管给药，给药时间超过15分钟。主要目的是确定剂量限制性毒性，次要目的是评估反应和药代动力学（PK）。结果所有患者均具有良好的耐受性，毒性最小至无毒性。PK数据显示，与匹配的静脉给药数据相比，可预测的剂量依赖性药物暴露具有快速的组织摄取和显着降低的全身浓度。在不需要止血带的情况下，与周围正常组织相比，CBL0137在输注肢体的肿瘤组织中优先积累。该方案治疗的60%的患者不符合标准的局部治疗条件，其中一名患者表现出长期的疾病稳定性，同时避免了大面积截肢。结论IA CBL0137可以克服标准局部治疗的局限性，这种治疗方法可能适用于四肢以外的广泛癌症。

{"title":"A phase 1 study of intra-arterial CBL0137 in extremity melanomas and sarcomas","authors":"Joseph J. Skitzki , Minhyung Kim , Daniel T. Fisher , John M. Kane III , Han Yu , Kayla Catalfamo , Garin Tomaszewski , Michael Petroziello , Andrei Purmal , Katerina V. Gurova , Andrei V. Gudkov","doi":"10.1016/j.suronc.2025.102243","DOIUrl":"10.1016/j.suronc.2025.102243","url":null,"abstract":"<div><h3>Introduction</h3><div>Regional therapies for cancer leverage the ability to isolate the circulation to a diseased extremity or organ and deliver high doses of chemotherapy that would be systemically prohibitive due to toxicity. Virtually all regional therapies utilize the original chemotherapy agent, melphalan, which requires circulatory isolation. CBL0137 is a small molecule with multiple anti-tumor effects when given intra-arterially (IA) that shows similar efficacy to melphalan in preclinical models, but without the need for circulatory isolation.</div></div><div><h3>Materials and methods</h3><div>Patients with advanced, unresectable melanoma or sarcoma (n = 5, sarcoma 60 %, melanoma 40 %) of the extremity entered a rapid dose-escalation phase of a clinical trial of IA CBL0137. CBL0137 was administered via a single IA catheter placed proximal to the site of tumor(s) in the affected extremity and delivered over 15 min. Primary objective was to define dose-limiting toxicities with secondary objectives of assessing response and pharmacokinetics (PK).</div></div><div><h3>Results</h3><div>The treatments were well tolerated with minimal to no toxicity for all patients. PK data showed predictable, dose-dependent drug exposures with rapid tissue uptake and markedly decreased systemic concentrations as compared to matched intravenous dosing data. CBL0137 preferentially accumulated within tumor tissue as compared to surrounding normal tissue in the infused limb without the need for tourniquet. Sixty percent of patients treated in this protocol would not have been eligible for standard regional therapies with one patient demonstrating prolonged disease stability while avoiding major amputation.</div></div><div><h3>Conclusions</h3><div>The historic restrictions of standard regional therapies may be overcome with IA CBL0137, and this treatment is potentially applicable to a wide range of cancers beyond the extremities.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"61 ","pages":"Article 102243"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144322073","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

Abdominal aortic calcification predicts poor prognosis for patients with gastric cancer who underwent curative gastrectomy 腹主动脉钙化预示胃癌行根治性胃切除术患者预后不良

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-07 DOI: 10.1016/j.suronc.2025.102247

Naoko Fukushima , Takahiro Masuda , Kenei Furukawa , Kazuto Tsuboi , Masami Yuda , Keita Takahashi , Masaichi Ogawa , Toru Ikegami , Fumiaki Yano , Ken Eto

Background

Abdominal aortic calcification is a pathological vascular disorder associated with various diseases and has recently been associated with the prognosis of various cancers. This study aimed to investigate the association between abdominal aortic calcification and prognosis in patients who underwent curative gastrectomy for gastric cancer.

Methods

We analyzed 251 patients who underwent curative gastrectomy for gastric cancer between January 2014 and February 2020. The volume of abdominal aortic calcification was assessed using routine preoperative computed tomography. The cutoff values were assessed using receiver operating characteristic curve analysis of the survival status at the 3-year follow-up, and set to 585.

Results

Higher abdominal aortic calcification volume was identified in 151 patients (60 %). Multivariate analysis showed that abdominal aortic calcification (P = 0.0120, P = 0.0430, respectively), and stage II or III disease (P = 0.0000, P=0.0000, respectively) were independent and significant predictors of the disease-free and cancer-specific survival. Additionally, patients with higher abdominal aortic calcification volume were significantly older and had a higher prevalence of hypertension, diabetes, chronic renal failure, and cardiovascular diseases.

Conclusions

Abdominal aortic calcification showed a strong preoperative prognostic indicator in patients undergoing curative gastrectomy for gastric cancer.

腹主动脉钙化是一种与多种疾病相关的病理性血管疾病，近年来已被发现与多种癌症的预后有关。本研究旨在探讨胃癌根治性胃切除术患者腹主动脉钙化与预后的关系。方法分析2014年1月至2020年2月251例胃癌根治性胃切除术患者。术前常规计算机断层扫描评估腹主动脉钙化的体积。采用3年随访时生存状态的受试者工作特征曲线分析评估截止值，设为585。结果151例（60%）腹主动脉钙化体积增高。多因素分析显示，腹主动脉钙化（P = 0.0120， P= 0.0430）和II期或III期疾病（P =0.0000， P=0.0000）是无病生存和癌症特异性生存的独立且显著的预测因素。此外，腹主动脉钙化体积较高的患者明显年龄较大，高血压、糖尿病、慢性肾衰竭和心血管疾病的患病率较高。结论腹主动脉钙化是预测胃癌根治性胃切除术患者术前预后的重要指标。

{"title":"Abdominal aortic calcification predicts poor prognosis for patients with gastric cancer who underwent curative gastrectomy","authors":"Naoko Fukushima , Takahiro Masuda , Kenei Furukawa , Kazuto Tsuboi , Masami Yuda , Keita Takahashi , Masaichi Ogawa , Toru Ikegami , Fumiaki Yano , Ken Eto","doi":"10.1016/j.suronc.2025.102247","DOIUrl":"10.1016/j.suronc.2025.102247","url":null,"abstract":"<div><h3>Background</h3><div>Abdominal aortic calcification is a pathological vascular disorder associated with various diseases and has recently been associated with the prognosis of various cancers. This study aimed to investigate the association between abdominal aortic calcification and prognosis in patients who underwent curative gastrectomy for gastric cancer.</div></div><div><h3>Methods</h3><div>We analyzed 251 patients who underwent curative gastrectomy for gastric cancer between January 2014 and February 2020. The volume of abdominal aortic calcification was assessed using routine preoperative computed tomography. The cutoff values were assessed using receiver operating characteristic curve analysis of the survival status at the 3-year follow-up, and set to 585.</div></div><div><h3>Results</h3><div>Higher abdominal aortic calcification volume was identified in 151 patients (60 %). Multivariate analysis showed that abdominal aortic calcification (<em>P</em> = 0.0120, <em>P</em> = 0.0430, respectively), and stage II or III disease (<em>P</em> = 0.0000, <em>P=</em>0.0000, respectively) were independent and significant predictors of the disease-free and cancer-specific survival. Additionally, patients with higher abdominal aortic calcification volume were significantly older and had a higher prevalence of hypertension, diabetes, chronic renal failure, and cardiovascular diseases.</div></div><div><h3>Conclusions</h3><div>Abdominal aortic calcification showed a strong preoperative prognostic indicator in patients undergoing curative gastrectomy for gastric cancer.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"61 ","pages":"Article 102247"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144255392","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

Prophylactic drain placement versus non-drainage following gastric cancer surgery: A systematic review and meta-analysis of randomized controlled trials 胃癌手术后预防性引流与非引流：随机对照试验的系统回顾和荟萃分析

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-07 DOI: 10.1016/j.suronc.2025.102246

Ahmed Maher Khalil , Emtenan Arishi , Ayman Megahed , Nouran H. Kamel , Ahmed W. Hageen , Najla K. Alzahrani , Deema Alanzi , Abdulmalik A. Aiban , Marwan Farea , Abdullah Albukhari , Salem M. Abokhanjar , Majd Elmahi

Gastric cancer remains a significant global health burden and a leading cause of cancer-related deaths. Surgical resection is the primary curative treatment, but postoperative complications can negatively impact outcomes. Prophylactic drainage (PD) has been widely used to reduce these complications by facilitating early detection and management of fluid collections. This study evaluates the role of PD following gastric cancer surgery through a systematic review and meta-analysis of randomized controlled trials (RCTs). We searched PubMed, Web of Science, Scopus, and Cochrane databases up to January 15, 2025, and analyzed dichotomous data using risk ratio (RR) and continuous data using mean difference (MD), both with 95 % confidence intervals (CI), using R version 4.3 (PROSPERO ID: CRD42025650045). Four RCTs involving 728 patients were included. The analysis revealed that PD was associated with a significantly lower risk of mortality compared to no drainage (RR: 0.45 [95 % CI: 0.21–0.94]; P = 0.03). However, there were no significant differences between the drainage and non-drainage groups in the incidence of intra-abdominal abscess (RR: 1.23 [95 % CI: 0.49–3.06]; P = 0.66), surgical-site infection (RR: 0.93 [95 % CI: 0.56–1.52]; P = 0.76), pulmonary infection (RR: 0.66 [95 % CI: 0.37–1.18]; P = 0.16), duodenal stump leakage (RR: 1.54 [95 % CI: 0.51–4.71]; P = 0.45), anastomotic leakage (RR: 1.47 [95 % CI: 0.64–3.39]; P = 0.37), or reoperation rates (RR: 0.95 [95 % CI: 0.40–2.27]; P = 0.90). Additionally, no significant differences were observed in the length of hospital stay (MD: 0.10 [95 % CI: −0.39 to 0.58]; P = 0.70) or time to the first soft diet (MD: 0.21 [95 % CI: −0.09 to 0.50]; P = 0.17). In conclusion, PD following gastric cancer surgery is associated with a reduced risk of mortality but does not significantly impact the incidence of perioperative complications or recovery metrics. These findings suggest that while PD may offer a survival benefit, it does not appear to reduce common postoperative complications or accelerate recovery.

胃癌仍然是一个重大的全球健康负担，也是癌症相关死亡的主要原因。手术切除是主要的治疗方法，但术后并发症会对预后产生负面影响。预防性引流（PD）已被广泛用于通过促进早期发现和管理液体收集来减少这些并发症。本研究通过随机对照试验（rct）的系统评价和荟萃分析来评估PD在胃癌手术后的作用。我们检索了PubMed、Web of Science、Scopus和Cochrane数据库，截止到2025年1月15日，使用R版本4.3 (PROSPERO ID: CRD42025650045)，使用风险比（RR）分析二分数据，使用均值差（MD）分析连续数据，两者的置信区间（CI）均为95%。纳入4项随机对照试验，共728例患者。分析显示，与不引流相比，PD与死亡风险显著降低(RR: 0.45 [95% CI: 0.21-0.94]；p = 0.03)。然而，引流组与非引流组腹内脓肿发生率无显著差异(RR: 1.23 [95% CI: 0.49-3.06]；P = 0.66)、手术部位感染(RR: 0.93 [95% CI: 0.56-1.52]；P = 0.76)、肺部感染(RR: 0.66 [95% CI: 0.37 ~ 1.18]；P = 0.16)，十二指肠残端渗漏(RR: 1.54 [95% CI: 0.51-4.71]；P = 0.45)，吻合口漏(RR: 1.47 [95% CI: 0.64-3.39]；P = 0.37)或再手术率(RR: 0.95 [95% CI: 0.40 ~ 2.27]；p = 0.90)。此外，住院时间没有显著差异(MD: 0.10 [95% CI: - 0.39至0.58]；P = 0.70)或第一次软性饮食的时间(MD: 0.21 [95% CI:−0.09 ~ 0.50]；p = 0.17)。总之，胃癌手术后PD与死亡率降低相关，但对围手术期并发症的发生率或恢复指标没有显著影响。这些发现表明，虽然PD可能提供生存的好处，但它似乎并没有减少常见的术后并发症或加速恢复。

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引用次数: 0

Is lateral pelvic lymph node dissection necessary for good responder to neoadjuvant chemoradiation in locally advanced rectal cancer? 局部晚期直肠癌新辅助放化疗是否需要骨盆外侧淋巴结清扫？

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-07 DOI: 10.1016/j.suronc.2025.102249

Jung Hoon Bae , Jumyung Song , Ji Hoon Kim , Bong-Hyeon Kye , In Kyu Lee , Hyeon-Min Cho , Yoon Suk Lee

Background

Response to preoperative chemoradiation (CRT) is an important indicator of the possibility of lateral pelvic lymph node (LPN) metastasis. However, the effect of LPN dissection (LPND) in good responders to CRT remains unclear. This study aimed to identify the optimal treatment strategy for patients with rectal cancer who respond well to preoperative CRT.

Methods

This multi-institutional retrospective study evaluated patients with locally advanced rectal cancer and clinically suspected LPN metastases who underwent total mesorectal excision with LPND after CRT. The patients were divided into two groups based on the largest lymph node diameter post-CRT (cutoff: 5 mm): good (n = 38) and poor responders (n = 53).

Results

LPN metastasis was significantly higher in poor responders (18 patients, 34.0 %) than in good responders (5 patients, 13.2 %) (p = 0.024). All 5 patients in the good responder group had low rectal cancer (i.e., tumors located within 5 cm from the anal verge (AV)). Low rectal cancer was the only significant predictor for LPN metastasis in good responders (p = 0.004). However, LPN size before and after CRT did not predict LPN metastasis in this group (p = 0.947 and 0.910, respectively). When LPND was indicated for all poor responders and for good responders with tumors located ≤5 cm from the AV, the sensitivity for LPN metastasis diagnosis was 100 %.

Conclusion

Among rectal cancer patients with good response to preoperative CRT, pathological LPN metastasis occurs in 13.2 %, and tumor height is a significant risk factor for LPN metastasis. LPND might be considered for low rectal tumors, regardless of preoperative CRT response.

术前放化疗（CRT）反应是判断盆腔外侧淋巴结（LPN）转移可能性的重要指标。然而，LPN解剖（LPN dissection, lnd）在CRT应答良好患者中的作用尚不清楚。本研究旨在确定对术前CRT反应良好的直肠癌患者的最佳治疗策略。方法本研究是一项多机构回顾性研究，评估局部晚期直肠癌和临床怀疑LPN转移的患者在CRT后行全肠系膜切除术并LPN。根据crt后最大淋巴结直径（截止时间：5 mm）将患者分为两组：良好（n = 38）和不良反应（n = 53）。结果不良反应组（18例，34.0%）slpn转移率显著高于良好反应组（5例，13.2%）（p = 0.024）。反应良好组的5例患者均为低位直肠癌（即肿瘤位于距肛门边缘（AV） 5cm以内）。低位直肠癌是良好应答者LPN转移的唯一显著预测因子（p = 0.004）。然而，CRT前后LPN大小并不能预测本组LPN转移（p分别= 0.947和0.910）。当所有不良反应者和良好反应者，肿瘤位于距AV≤5cm处时，LPN转移诊断的敏感性为100%。结论术前CRT反应良好的直肠癌患者中，病理性LPN转移发生率为13.2%，肿瘤高度是发生LPN转移的重要危险因素。无论术前CRT反应如何，低位直肠肿瘤均可考虑lpd。

{"title":"Is lateral pelvic lymph node dissection necessary for good responder to neoadjuvant chemoradiation in locally advanced rectal cancer?","authors":"Jung Hoon Bae , Jumyung Song , Ji Hoon Kim , Bong-Hyeon Kye , In Kyu Lee , Hyeon-Min Cho , Yoon Suk Lee","doi":"10.1016/j.suronc.2025.102249","DOIUrl":"10.1016/j.suronc.2025.102249","url":null,"abstract":"<div><h3>Background</h3><div>Response to preoperative chemoradiation (CRT) is an important indicator of the possibility of lateral pelvic lymph node (LPN) metastasis. However, the effect of LPN dissection (LPND) in good responders to CRT remains unclear. This study aimed to identify the optimal treatment strategy for patients with rectal cancer who respond well to preoperative CRT.</div></div><div><h3>Methods</h3><div>This multi-institutional retrospective study evaluated patients with locally advanced rectal cancer and clinically suspected LPN metastases who underwent total mesorectal excision with LPND after CRT. The patients were divided into two groups based on the largest lymph node diameter post-CRT (cutoff: 5 mm): good (n = 38) and poor responders (n = 53).</div></div><div><h3>Results</h3><div>LPN metastasis was significantly higher in poor responders (18 patients, 34.0 %) than in good responders (5 patients, 13.2 %) (p = 0.024). All 5 patients in the good responder group had low rectal cancer (i.e., tumors located within 5 cm from the anal verge (AV)). Low rectal cancer was the only significant predictor for LPN metastasis in good responders (p = 0.004). However, LPN size before and after CRT did not predict LPN metastasis in this group (p = 0.947 and 0.910, respectively). When LPND was indicated for all poor responders and for good responders with tumors located ≤5 cm from the AV, the sensitivity for LPN metastasis diagnosis was 100 %.</div></div><div><h3>Conclusion</h3><div>Among rectal cancer patients with good response to preoperative CRT, pathological LPN metastasis occurs in 13.2 %, and tumor height is a significant risk factor for LPN metastasis. LPND might be considered for low rectal tumors, regardless of preoperative CRT response.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"61 ","pages":"Article 102249"},"PeriodicalIF":2.3,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144261525","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

Implementation of enhanced recovery after surgery in breast reconstruction: Lessons from a French tertiary center 提高乳房重建术后恢复的实施：来自法国三级中心的经验教训

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-07 DOI: 10.1016/j.suronc.2025.102250

Alexandre Vinel , Florence Babre , Antoine Dannepond , Julie Commeny , Diane Adam , Anaïs Delgove , Audrey Michot

Introduction

Enhanced Recovery After Surgery (ERAS) programs have significantly improved postoperative outcomes across various surgical disciplines. In April 2022, an ERAS protocol tailored for patients undergoing DIEP free flap breast reconstruction was implemented at the Bordeaux Cancer Center, France. This study aimed to assess the impact of this protocol on length of stay (LOS), complication rates, and compliance with protocol items.

Material and methods

A retrospective pre-post observational study was conducted, including 56 consecutive patients who underwent DIEP flap reconstruction at the Bergonié Institute between September 2020 and April 2023. Twenty-eight patients received conventional perioperative care, while 28 patients were managed under the ERAS protocol. Outcomes assessed included LOS, early and 90-day postoperative complications, and adherence to the protocol's 20 key items.

Results

Median LOS was comparable between groups, at 4.5 days pre-ERAS and 5 days post-ERAS (p = 0.52). Early and 90-day complication rates showed no significant differences. The average compliance with protocol items was 14.2 out of 20 per patient, with 35 % of recommendations followed in less than 66 % of cases.

Conclusion

The initial evaluation of the ERAS program showed no significant reduction in LOS or morbidity, primarily due to suboptimal adherence. These findings highlight the importance of optimizing compliance with protocol recommendations to further improve recovery outcomes, reduce LOS and potentially lower overall healthcare costs.

手术后增强恢复（ERAS）项目显著改善了各种外科学科的术后结果。2022年4月，法国波尔多癌症中心实施了为接受DIEP无瓣乳房重建的患者量身定制的ERAS方案。本研究旨在评估该方案对住院时间（LOS）、并发症发生率和方案项目依从性的影响。材料和方法对2020年9月至2023年4月在bergoni研究所连续接受DIEP皮瓣重建的56例患者进行了回顾性前后观察性研究。28例患者接受常规围手术期护理，28例患者接受ERAS方案。评估的结果包括LOS，早期和90天的术后并发症，以及对方案20个关键项目的依从性。结果eras前4.5天和eras后5天，两组间的中位LOS具有可比性（p = 0.52）。早期和90天并发症发生率无显著差异。每20名患者中平均有14.2名患者遵守了协议项目，在不到66%的病例中，有35%的建议被遵循。ERAS计划的初步评估显示，主要由于依从性不佳，LOS或发病率没有显著降低。这些研究结果强调了优化遵守方案建议的重要性，以进一步改善恢复结果，减少LOS，并可能降低总体医疗保健成本。

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引用次数: 0

Relationship between the distance from the tumor to major blood vessels and prognosis of deep soft tissue sarcomas 肿瘤离大血管的距离与深部软组织肉瘤预后的关系

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-05 DOI: 10.1016/j.suronc.2025.102244

Tadashi Iwai , Maria Anna Smolle , Dominik Kaiser , Lukas Jud , Sandro F. Fucentese , Daniel Andreas Müller

Introduction

Recent reports show that vascular proximity on magnetic resonance imaging (MRI) increases the risk of local recurrence of thigh soft tissue sarcomas (STS). However, it remains unclear whether the defined radiological distance between the tumor and major blood vessels influences local recurrence-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS). We aimed to verify this association among patients with deep STS.

Methods

Clinical-pathological data of 149 patient's deep STS treated between 2014 and 2023 at a single institution were retrospectively analyzed. Based on MRI findings, the distance between the tumor and major blood vessels was investigated using two groups (“In contact” and “Not in contact”). Sex, age, tumor size, location, grade, AJCC staging, and distance to major blood vessels were evaluated using Cox proportional hazards regression models. Five-year survival rates were assessed using the Kaplan–Meier method.

Results

Median follow-up duration was 40 (interquartile range [IQR]: 19–75) months. The five-year OS, LRFS, and MFS rates were 72.5 %, 95.5 %, and 85.2 %, respectively. Multivariate analysis revealed significant associations between poor OS and tumor stage IV as well as “In contact” with major blood vessels. Additionally, the statistical significance between distant metastasis and “In contact” with major blood vessels was clarified.

Conclusions

A radiological “In contact” between the tumor and major blood vessels was a significant factor associated with poor prognosis and distant metastasis. Orthopedic oncologists should consider a treatment strategy based on the relationship between the distance from the tumor to major blood vessels on MRI preoperatively.

最近的报道显示，磁共振成像（MRI）血管邻近增加了大腿软组织肉瘤（STS）局部复发的风险。然而，目前尚不清楚肿瘤与主要血管之间的放射学距离是否会影响局部无复发生存期（LRFS）、无转移生存期（MFS）和总生存期（OS）。我们的目的是在深部STS患者中验证这种关联。方法回顾性分析我院2014 ~ 2023年收治的149例深部STS患者的临床病理资料。根据MRI结果，采用两组（接触组和非接触组）研究肿瘤与大血管之间的距离。使用Cox比例风险回归模型评估性别、年龄、肿瘤大小、位置、分级、AJCC分期和到大血管的距离。采用Kaplan-Meier法评估5年生存率。结果中位随访时间为40个月（四分位数间距[IQR]: 19-75）。5年OS、LRFS和MFS分别为72.5%、95.5%和85.2%。多因素分析显示，不良OS与肿瘤IV期以及与大血管“接触”之间存在显著关联。此外，还明确了远处转移与大血管“接触”之间的统计学意义。结论肿瘤与大血管的放射学“接触”是导致预后不良和远处转移的重要因素。骨科肿瘤学家应根据术前MRI显示的肿瘤与大血管之间的距离关系来考虑治疗策略。

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引用次数: 0

Delphi for management of N2 non-small cell lung cancer 德尔福治疗N2型非小细胞肺癌

IF 2.3 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2025-06-03 DOI: 10.1016/j.suronc.2025.102245

Hind Eid , Elias Karam , Antoine EL. Kik , Fadi El Karak , Ammar Chamaa , Bassem Habr , Hampig Raphael Kourie , Fares Azouri , Viviane Smayra , Noel Aoun , Joseph Kattan , Georges Chahine , Marwan Ghosn , Jad Wakim , Hussein Nasserddine , Fadi Nasr , Georges Khayat , Joseph Nakad , Carine Harmouche , Georges Dabar , Moussa Riachy

Mediastinal lymph node involvement is a prognostic factor in patients with localized NSCLC. Both ipsilateral and subcarinal nodal involvement are classified as N2 disease. However, there is no universally agreed-upon approach for diagnosing and treating this condition. The aim of this study is to elaborate an institutional N2 consensus. A multidisciplinary expert panel at Hotel Dieu de France provided informed consent to participate in the modified Delphi process. Twelve basic statements were started by a steering committee of three independent reviewers on the basis of international consensus, medical literature and personal experience. In the first round, physicians answered an open-ended questionnaire that was analyzed thematically. In the second round, the participants rated the generated statements and added their comments. In the third round, the participants rated their agreement via a 6-point Likert scale. Consensus was defined as ≥80 % agreement (A+ or A) with a statement. Nineteen physicians completed the three rounds. A full consensus was reached in eleven statements. Preoperative mediastinal staging is mandatory in patients with resectable N2 disease. It should be considered in patients with a high SUVmax (maximum standardized uptake value) (≥3), proximal or apical tumors and high carcinoembryonic antigen levels. Surgery is performed in the absence of neoadjuvant treatment depending on a single station with nonbulky disease and stage T3 invasive/T4 disease. In patients with N2 disease at several stations, radio chemotherapy is the main treatment, followed by durvalumab in patients with good general status. In pN2 patients, postsurgical treatment is based on the condition of the surgical resection margin. These findings will help physicians in multidisciplinary discussions agree on clinical decisions.

纵隔淋巴结受累是局部非小细胞肺癌患者的预后因素。同侧和隆突下淋巴结受累均归为N2型疾病。然而，目前还没有普遍认可的诊断和治疗方法。本研究的目的是阐述一个机构N2共识。法国上帝酒店的一个多学科专家小组提供了参与修改后的德尔菲程序的知情同意。由三名独立审稿人组成的指导委员会在国际共识、医学文献和个人经验的基础上提出了12项基本声明。在第一轮中，医生们回答了一份开放式问卷，并对问卷进行了主题分析。在第二轮中，参与者对生成的语句进行评分并添加评论。在第三轮中，参与者通过6分李克特量表对他们的同意程度进行评分。一致性定义为≥80%的一致性（A+或A）。19名医生完成了三轮检查。11项声明达成了完全的一致意见。对于可切除的N2疾病患者，术前纵隔分期是强制性的。对于SUVmax（最大标准化摄取值）高（≥3）、近端或根尖肿瘤和高癌胚抗原水平的患者应考虑。手术是在没有新辅助治疗的情况下进行的，这取决于单个站点的非大块性疾病和T3期侵袭性/T4期疾病。在几个站点的N2疾病患者中，放化疗是主要治疗方法，其次是一般状况良好的患者杜伐单抗。在pN2患者中，术后治疗是基于手术切除边缘的情况。这些发现将有助于医生在多学科讨论中就临床决策达成一致。

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引用次数: 0