Annals of Surgical Oncology最新文献

Background: Colorectal liver metastasis (CLM) is classified into technical and oncologic categories, with recommended treatments for each resectability category. However, the classification of recurrent CLM has not been established to date.

Methods: This study evaluated patients with CLM who underwent initial liver resection between 2006 and 2020 and subsequently experienced liver recurrence. Long-term outcomes and prognostic factors associated with recurrent CLM were investigated.

Results: From 949 patients who underwent an initial liver resection, the analysis included 392 patients with liver recurrence. Repeat liver resection was associated with a significantly longer prognosis than non-resection (5-year overall survival [OS] from initial liver resection: 66.3 % vs 27.2 %, p < 0.0001). Multivariable analysis indicated the following independent prognostic factors: four or more recurrent tumors (p = 0.015), tumor 5 cm or larger in size (p = 0.004), and presence of extrahepatic diseases (p = 0.003). The patients were stratified into resectable, borderline resectable, and unresectable recurrent CLM groups based on these criteria. The prognosis varied significantly across the groups, with 5-year OS rates of 67.3 % for resectable recurrent CLM, 30.8 % for borderline resectable recurrent CLM, and 2.6 % for unresectable recurrent CLM (p < 0.0001). Patients with borderline resectable recurrent CLM who did not receive adjuvant chemotherapy after initial liver resection had a positive prognostic impact of preoperative chemotherapy (p = 0.049).

Conclusion: The significant independent predictors of recurrent CLM prognosis were four or more tumors, tumor size of 5 cm or larger, and the presence of extrahepatic diseases at recurrence. It is critical to onsider the current condition and tumor resectability at the time of recurrence, and tailored treatments could further improve recurrent CLM outcomes.

Background: Pancreaticoduodenectomy (PD) is a complex procedure involving the dissection of the superior mesenteric artery and vein. However, a safe and standardized technique for dissecting the jejunal veins (JVs) in the mesojejunum during PD remains elusive.

Methods: We retrospectively analyzed 198 patients who underwent open PD with mesojejunum dissection using an anterior artery-first approach and evaluated anatomical variations in the first JV trunk (FJVT) and its tributaries. This study introduces the concept of a "dangerous crossover vein" (DCV) to describe tributaries that cross the transection line of the mesojejunum. Surgical techniques and perioperative outcomes were assessed.

Results: The FJVT drained the territory supplied by the first to second jejunal arteries in 144 patients (75%) and the first to third or more in 50 patients (25%). The FJVT was preserved in 100 patients (50.5%) and sacrificed in 98 (49.5%). Dangerous crossover veins were encountered in 117 patients (59%) and safely managed with standardized mesojejunal dissection. There were no significant differences in blood loss or operative time between patients with or without DCVs.

Conclusions: Understanding the anatomy of JVs and the concept of DCVs is critical for safe mesojejunal dissection during PD. Our approach facilitates secure dissection of JVs regardless of their anatomical variations.

Background: Two surgical approaches have emerged for axillary staging in cN1 breast cancer patients after neoadjuvant chemotherapy (NAC): sentinel lymph node biopsy (SLNB) and targeted axillary dissection (TAD). Direct comparisons of technical and oncological outcomes with SLNB versus TAD are lacking.

Methods: We routinely performed SLNB from 2017 to 2018 for cN1 breast cancer patients who converted to cN0 after NAC, then adopted TAD from 2019 to 2022. To minimize the false-negative rate (FNR), we required retrieval of ≥3 sentinel lymph nodes (SLN) (2017-2018) or retrieval of the clipped node (CN) and ≥2 SLN (2019-2022). In ypN0 cases meeting these criteria, axillary lymph node dissection (ALND) was omitted. We compared the rate of per-protocol required ALND due to technical failure of SLNB versus TAD and reported axillary recurrence rates.

Results: Among 191 cN1 ypN0 patients, 77 underwent SLNB and 114 underwent TAD. The overall rate of required ALND due to technical failure was 14.7% and did not differ between SLNB versus TAD (16.9% vs. 13.2%, p = 0.38). The most common technical failure with SLNB was retrieving <3 SLN (10.4%); for TAD, it was not retrieving the CN (7.1%). Median follow-up was 3.9 years for SLNB patients and 1.7 years for TAD patients; there were 1 (1.3%) and 0 (0.0%) axillary recurrences, respectively.

Conclusions: Sentinel lymph node biopsy and TAD for cN1 patients after NAC showed equivalent technical failure rates and low axillary recurrence rates. When applying strict criteria to minimize FNR of axillary staging surgery, approximately 15% of ypN0 patients may be overtreated with ALND.

Objective: This study aimed to compare adverse in-hospital outcomes in ileal conduit versus neobladder urinary diversion type after radical cystectomy (RC) in contemporary versus historical patients.

Methods: Patients were identified within the National Inpatient Sample (NIS 2000-2019). Propensity score matching (PSM; 1:2 ratio) and multivariable logistic regression models (LRMs) were used.

Results: Of 10,533 contemporary (2011-2019) patients, 943 (9.0%) underwent neobladder urinary diversion, while 9590 (91.0%) underwent ileal conduit urinary diversion. Furthermore, of 9742 historical (2010-2019) patients, 932 (9.6%) underwent neobladder urinary diversion and 8810 (90.4%) underwent ileal conduit urinary diversion. After 1:2 PSM, within the contemporary cohort, 943/943 (100%) neobladder versus 1886/9590 (19.6%) ileal conduit patients were included. Similarly, within the historical cohort, 932/932 (100%) neobladder versus 1864/8810 (21.1%) ileal conduit patients were included after PSM. In multivariable LRMs, relative to contemporary neobladder patients, contemporary ileal conduit patients exhibited higher rates of overall postoperative (49.0 vs. 43.6%; multivariable odds ratio [MOR] 1.2), wound (4.2 vs. 2.7%; MOR 1.6), and genitourinary (13.1% vs. 10.0%; MOR 1.3) complications as well as blood transfusions (19.0 vs. 15.6%; MOR 1.3). Conversely, in multivariable LRMs within the historical cohort, no differences were recorded between ileal conduit and neobladder patients.

Conclusions: Unlike historical comparisons between ileal conduit and neobladder patients, where no differences in adverse in-hospital outcomes were recorded, analyses relying on a contemporary patient cohort subject to PSM and multivariable adjustment revealed higher rates of adverse in-hospital outcomes in 4/13 examined categories. This observation should be considered at informed consent.