Annals of Surgical Oncology最新文献

Background: Breast cancer patients treated with axillary lymph node dissection (ALND) have an approximate 20-30% lifetime risk of developing lymphedema, with multiple factors implicated in the pathogenesis. In patients undergoing mastectomy, ALND can be performed through the mastectomy incision or through a separate axillary incision. It is unknown whether the latter causes more lymphatic disruption resulting in higher lymphedema rates. We aimed to assess whether ALND through the mastectomy incision versus a separate incision impacts rates of breast cancer-related lymphedema (BCRL).

Methods: A retrospective chart review was performed of patients who underwent mastectomy and ALND from 2017 to 2020. Patients were grouped by ALND via mastectomy or a separate incision. The primary outcome of interest was development of BCRL as defined by ICD-10 codes.

Results: A total of 1,036 patients were included; 483 via a separate axillary incision and 553 underwent ALND via the mastectomy incision. Median time to lymphedema development was 15 months. The BCRL rates between patients who had ALND via a separate incision were not significantly different from those who had ALND via the mastectomy incision (29 vs. 30%, p = 0.77). Multivariable logistical regression showed patients with ALND performed through a separate incision did not have significantly greater odds of developing lymphedema compared with those with ALND performed through the mastectomy incision (odds ratio 0.89; 95% confidence interval 0.65-1.21; p = 0.45).

Conclusions: Patients who received ALND via a separate axillary incision as compared to the mastectomy incision do not have significantly greater rates of BCRL. Oncologic safety should be prioritized when considering lymph node retrieval technique.

Background: When bladder cancer recurs after bacillus Calmette-Guérin (BCG) for high-risk non-muscle-invasive disease, after trimodal therapy (TMT), or after other bladder-preserving therapy for muscle-invasive disease, patients face time-sensitive decisions that determine whether cure remains achievable. Treating physicians must guide these choices by balancing oncologic safety with quality of life, comorbidities, and patient preferences.

Methods: We reviewed 2024-2025 guidelines from the American Urological Association/Society of Urologic Oncology (AUA/SUO), National Comprehensive Cancer Network (NCCN), and European Association of Urology (EAU), while incorporating pivotal trials and recent drug approvals. Emphasis was placed on translating recommendations into practical decision-making for clinicians and patients.

Results: For post-BCG recurrence, early radical cystectomy (RC) offers the highest chance of cure for medically fit patients and is recommended throughout all three guidelines. When surgery is not possible or declined, bladder-sparing therapies, including four recently US Food and Drug Administration (FDA)-approved drugs, can be considered with strict surveillance. In post-TMT recurrence, RC is standard for invasive relapse, with bladder preservation reserved for select noninvasive cases. In both settings, optimal outcomes require timely workup, presentation of all viable options, and coordination of multidisciplinary input with a strong emphasis on close surveillance and follow-up.

Conclusions: Management of bladder cancer recurrence is optimized when therapy aligns with patient goals while safeguarding oncologic outcomes. Regardless of the path chosen, early engagement of a multidisciplinary team and shared decision-making are essential to delivering the best possible care.

Background: The purpose of this study was to compare patient-reported outcomes (PROs) and perioperative clinical outcomes during 1 year post surgery between robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS), including multiportal (M-VATS) and uniportal (U-VATS) approaches, in patients with lung cancer.

Methods: Data from a prospective cohort study (CN-PRO-Lung3) were analyzed, and patients with primary lung cancer who underwent RATS or VATS were included. Primary outcomes were postoperative symptoms and daily functioning assessed using the Perioperative Symptom Assessment (PSA)-Lung, and exploratory outcomes included health-related quality of life (HRQoL) based on the Five-Level EuroQol Five-Dimensional Questionnaire and other clinical outcomes. Propensity score matching (PSM) was adjusted for baseline differences.

Results: After the PSM of 687 patients, 91 patients were matched between RATS and M-VATS and 119 between RATS and U-VATS. Compared with those undergoing M-VATS, patients undergoing RATS reported lower rates of moderate-to-severe fatigue (P = 0.017) and disturbed sleep (P = 0.049) in the hospital. Additionally, RATS demonstrated better clinical outcomes, including more lymph-node dissections (P < 0.001), less blood loss (P < 0.001), shorter operative time (P < 0.001), and reduced hospital stays (P < 0.001) than M-VATS but incurred higher costs (P < 0.001). Compared with those undergoing U-VATS, patients undergoing RATS reported higher rates of moderate-to-severe cough (P = 0.007) and slower initial HRQoL recovery after discharge.

Conclusions: Compared with M-VATS, RATS offers perioperative advantages, including reduced symptoms and better clinical outcomes, but at higher costs. Compared with U-VATS, RATS enhanced lymph-node dissection rates but increased postoperative cough and slowed HRQoL recovery. This study highlights the importance of incorporating PROs into surgical decision-making. Clinical registration ChiCTR2000033016 ( https://www.chictr.org.cn/searchprojEN.html ).

Background: The benefit of neoadjuvant radiation for esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC) remains controversial. This study comprised a histology-stratified pooled analysis of randomized controlled trials (RCTs) comparing neoadjuvant chemoradiation (nCRT) to neoadjuvant chemotherapy alone (nCT) for esophageal cancer.

Methods: A PRISMA 2020-compliant systematic review for RCTs comparing nCRT to nCT for esophageal cancer and a histology-stratified pooled random-effects meta-analyses were performed.

Results: Nine RCTs published from 2009 to 2024 were included, comprising 2174 patients (1083 nCRT, 1091 nCT). Of these, 1125 patients had AC (51.7%) and 1049 had SCC (48.3%). Most patients received cisplatin with 5-fluorouracil. Patients with SCC undergoing nCRT were more often resected (odds ratio [OR] 1.94; 95% confidence interval [CI] 1.05-3.60; P=0.03) and more often had a pathologic complete response (OR 8.78; 95% CI 3.27-23.57; P<0.0001) than those undergoing nCT; R0 resection rates (OR 2.18; 95% CI 0.81-5.9; P=0.12) and anastomotic leaks (OR 0.91; 95% CI 0.55-1.49; P=0.70) were similar. For AC, nCRT was associated with similar resection rates (OR 0.90; 95% CI 0.49-1.64; P=0.72), similar pathologic complete response (OR 2.77; 95% CI 0.84-9.21; P=0.10), more R0 resections (OR 2.94; 95% CI 1.51-5.74; P=0.002), and similar leak rates (OR 1.10; 95% CI 0.71-1.70; P=0.67). nCRT was associated with fewer local recurrences for SCC (OR 0.58; 95% CI 0.40-0.86; P=0.006) but not AC (OR 1.04; 95% CI 0.70-1.53; P=0.86) (subgroup test P=0.04) and improved 3-year overall survival for SCC (OR 1.51; 95% CI 1.16-1.96; P=0.002) but not AC (OR 0.81; 95% CI 0.60-1.10; P=0.18) (subgroup test P=0.002).

Conclusions: Neoadjuvant radiation appears to confer meaningful improvement in long-term outcomes for SCC but not AC.

Background: The role of secondary cytoreductive surgery (SCS) in recurrent ovarian cancer has increased in recent years. Randomized prospective trials have shown a survival advantage in cases of complete gross resection.^1,2 In this context, minimally invasive surgery has taken on a significant role, especially in cases of single and oligometastatic recurrence.^3-6 The aim of this video is to describe the feasibility of a robotic triple-site approach for SCS in recurrent ovarian cancer.

Methods: A case of oligometastatic platinum-sensitive ovarian cancer recurrence in a woman in her 40s is presented. Preoperative computed and emission tomography scans detected three sites of recurrence: a right cardiophrenic lymph node, a nodule at the hepatic hilum between the head of the pancreas and the hepatic artery, and interaortocaval lymphadenopathy below the left renal vein. After a preoperative 3D reconstruction, a robotic SCS was performed in three anatomical regions.

Results: Complete cytoreduction was achieved. The operation time was 200 min, and the estimated blood loss was 100 mL. The patient underwent extensive adhesiolysis because of previous surgery. No intraoperative complications occurred. The histological examination confirmed the metastatic involvement of the three lesions.

Conclusions: A robotic approach can be considered in selected patients with extrapelvic ovarian cancer recurrence, even in different anatomical sites, in oncological centers with a multidisciplinary team of expert surgeons. Patient selection and preoperative 3D reconstruction are very important elements in the surgical planning.