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Predicting Late Tumor Recurrence in Surgical Hepatocellular Carcinoma: What Have We Missed? 预测外科肝细胞癌晚期肿瘤复发:我们错过了什么?
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-27 DOI: 10.1245/s10434-025-18980-5
Teh-Ia Huo, Shu-Yein Ho
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引用次数: 0
Refining Oncologic Surgical Emergencies: A Framework for Precision Management. 精细化肿瘤外科急诊:精确管理的框架。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-29 DOI: 10.1245/s10434-025-18118-7
Ling Chen, Dansong Wang
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引用次数: 0
ASO Author Reflections: Bridging the Gut-Immune Axis and Histology: A Novel Computational Approach to Colorectal Cancer. ASO作者反思:连接肠道免疫轴和组织学:一种新的结肠直肠癌计算方法。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-26 DOI: 10.1245/s10434-025-18972-5
Wenhao Bao
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引用次数: 0
Surgical Oncologists for Sustainability: A Statement from the SSO Surgical Oncologists for Sustainability Committee. 外科肿瘤学家可持续发展:SSO外科肿瘤学家可持续发展委员会的声明。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-11-11 DOI: 10.1245/s10434-025-18711-w
Emmanuel M Gabriel, Kathryn T Chen, Miral Amin, Rebecca Ann Craufurd Auer, Ricardo Julio Bello, Russell S Berman, Pam Hayden, Kayleigh Herrick-Reynolds, Tari A King, Ioannis T Konstantinidis, Kayla Laraia, Gary N Mann, Corbin Morris, Colette Pameijer, Ranjna Sharma, Georgios Tsoulfas, Jaeyun Jane Wang, E Shelley Hwang

Global climate change has been shown to have significant health impacts, which has been the subject of several scoping reviews. As surgical oncologists, we see both (1) the negative effects of climate change that increase the risk for cancer in the general population and (2) the contributions of our multidisciplinary cancer management on fueling climate change. As such, there is a perpetuating feedback loop where climate change has been shown to increase cancer incidence, but cancer treatment in turn contributes to climate change. In recognizing climate change as a significant issue, many organizations have raised awareness of sustainable health care and promoted sustainable practices to reduce waste and help mitigate the impact of health care on the environment. To this end, the Society of Surgical Oncology (SSO) established the Surgical Oncologists for Sustainability Committee. Our objectives in this paper are to (1) increase awareness among our surgical oncology community about the issues regarding sustainable cancer surgery, (2) outline the unique problems related to cancer care caused by climate change, and (3) broadly review high-yield changes that can be made to promote sustainability in surgical oncology. We aim to inspire and begin to equip surgical oncologists to lead environmental sustainability in their practices and their communities.

全球气候变化已被证明对健康有重大影响,这已成为几次范围审查的主题。作为外科肿瘤学家,我们看到(1)气候变化的负面影响增加了普通人群患癌症的风险,(2)我们的多学科癌症管理对加剧气候变化的贡献。因此,存在一个持续的反馈循环,即气候变化已被证明会增加癌症发病率,但癌症治疗反过来又会导致气候变化。由于认识到气候变化是一个重大问题,许多组织提高了对可持续医疗保健的认识,并推广可持续做法,以减少浪费,帮助减轻医疗保健对环境的影响。为此,外科肿瘤学会(SSO)成立了外科肿瘤学家可持续发展委员会。我们在本文中的目标是:(1)提高我们的外科肿瘤学社区对可持续癌症手术问题的认识,(2)概述气候变化引起的癌症护理相关的独特问题,(3)广泛回顾可以促进外科肿瘤学可持续发展的高产变化。我们的目标是激励并开始装备外科肿瘤学家在他们的实践和社区中领导环境可持续性。
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引用次数: 0
Postoperative Impact of Closed Incision Negative Pressure Therapy Following Oncoplastic Breast Surgery. 乳腺肿瘤整形术后闭合切口负压治疗的影响。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-11-15 DOI: 10.1245/s10434-025-18738-z
N Harris, P Aiello, D Detz, D Hanssen, C Farrell, C Balsay-Patel, J Whiting, S Hoover, N Khakpour, J Kiluk, L Kruper, C Laronga, M Mallory, M C Lee, B Czerniecki

Introduction: The application of closed incision negative pressure therapy (ciNPT) systems over closed surgical incisions purportedly lowers postoperative complications; however, there is little evidence to support its use in oncoplastic breast surgery. The primary objective of this study was to compare major and minor wound complication rates in patients with breast cancer undergoing oncoplastic procedures, with and without the use of the ciNPT.

Patients and methods: A prospectively maintained database of patients undergoing breast conserving oncoplastic procedures with placement of ciNPT system at a single institution was queried. This cohort was compared with a retrospective contemporaneous control group receiving primary two-layered suture and skin adhesive closure only. Major complications included abscess/hematoma/seroma needing drainage, and wound breakdown or asymmetry requiring return to the OR. Minor complications included breast lymphedema/erythema, minor nipple necrosis, and wound breakdown or mild asymmetry not requiring return to OR. Analyses were performed using Chi-square test or Fisher's exact test, where applicable, and univariate logistic regression models, with statistical significance set at p < 0.05.

Results: Of 186 patients, there were 93 in the ciNPT and 93 in the control group. There were significantly fewer major complications in the ciNPT group (1.1% ciNPT versus 10.8% control, p = 0.010). There was no significant difference in the rates of minor complications, and no difference in complication rates based on comorbidities or tumor characteristics.

Conclusions: ciNPT decreases major postoperative wound complications in patients with breast cancer undergoing oncoplastic procedures. Minimization of major postoperative complications can help ensure the timely initiation of adjuvant therapy following breast conserving oncoplastic procedures.

简介:闭合切口负压治疗(ciNPT)系统在闭合手术切口上的应用据称降低了术后并发症;然而,几乎没有证据支持它在乳房肿瘤整形手术中的应用。本研究的主要目的是比较接受肿瘤成形术的乳腺癌患者在使用和不使用ciNPT时的主要和次要伤口并发症发生率。患者和方法:查询了在单一机构放置ciNPT系统进行保乳肿瘤整形手术的患者的前瞻性数据库。该队列与同期回顾性对照组进行比较,对照组只接受初级两层缝合和皮肤胶粘剂闭合。主要并发症包括脓肿/血肿/血肿需要引流,伤口破裂或不对称需要返回手术室。轻微并发症包括乳房淋巴水肿/红斑,轻微乳头坏死,伤口破裂或轻度不对称,不需要返回手术室。采用卡方检验或Fisher精确检验(如适用)和单变量logistic回归模型进行分析,p < 0.05为统计学显著性。结果:186例患者中,ciNPT组93例,对照组93例。ciNPT组的主要并发症显著减少(1.1% ciNPT vs 10.8%对照组,p = 0.010)。轻微并发症发生率无显著差异,基于合并症或肿瘤特征的并发症发生率无显著差异。结论:ciNPT减少了乳腺癌患者接受肿瘤整形手术后的主要伤口并发症。最大限度地减少术后主要并发症可以帮助确保在保乳肿瘤整形手术后及时开始辅助治疗。
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引用次数: 0
Sentinel Node Biopsy Alone Versus Sentinel Node Biopsy Plus Axillary Dissection in cT2 cN0/1 Breast Cancer After Neoadjuvant Chemotherapy: 15-Year Results of a Prospective Interventional Study. 单纯前哨淋巴结活检与新辅助化疗后cT2 cN0/1乳腺癌前哨淋巴结活检加腋窝清扫:一项前瞻性介入研究的15年结果
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-11-18 DOI: 10.1245/s10434-025-18673-z
Gabriele Martelli, Francesco Barretta, Carlo Muzi, Chiara Listorti, Federica Pilotta, Ilaria Maugeri, Chiara Osio, Deborah Bonfili, Claudio Vernieri, Giulia Bianchi, Giancarlo Pruneri, Secondo Folli, Gianfranco Scaperrotta, Paolo Baili, Rosalba Miceli, Cristina Ferraris

Background: Recent guidelines recommend sentinel lymph node biopsy (SNB) of cN1 breast cancer when the axilla is clinically clear after neoadjuvant chemotherapy (NAC). It remains controversial whether further axillary treatment is required if the axillary sentinel nodes (SNs) are pN0.

Methods: This prospective non-randomized study analyzed 486 consecutive patients with cT2 cN0/1 breast cancer recruited from 2007 through 2021. Axillary status was assessed by palpation and ultrasound only. After NAC, patients who were cN0 underwent SNB. Those with negative SNs usually received no further axillary treatment, and those with involved SNs usually received AD. The primary end points were overall and disease-free survival for the SNB-only versus the SNB+AD patients, as estimated by the Kaplan-Meier method and log-rank test, with application of a propensity score because treatment assignment was not randomized.

Results: After a median follow-up of 102 months (interquartile range [IQR], 59-162 months) for the SNB-only patients and 200 months (IQR, 168-213 months) for the SNB+AD patients, overall and disease-free survival did not differ between the pN0 SNB-only and the pN0 SNB+AD patients. Furthermore, no SNB-only patient experienced axillary recurrence.

Conclusions: For cT2 CN0/1 breast cancer patients who are cN0 after NAC, SNB can be offered, with no further axillary treatment if the SNs are negative, irrespective of axillary status beforehand, with no adverse effect on long-term outcomes.

背景:最近的指南推荐在新辅助化疗(NAC)后腋窝临床清晰时对cN1乳腺癌进行前哨淋巴结活检(SNB)。如果腋窝前哨淋巴结(SNs)为pN0,是否需要进一步的腋窝治疗仍然存在争议。方法:这项前瞻性非随机研究分析了2007年至2021年招募的486例连续的cT2 cN0/1乳腺癌患者。腋窝状态仅通过触诊和超声评估。NAC后,cN0患者行SNB。SNs阴性的患者通常不接受进一步的腋窝治疗,而SNs受累者通常接受AD治疗。主要终点是仅SNB与SNB+AD患者的总生存率和无病生存率,通过Kaplan-Meier方法和log-rank检验估计,由于治疗分配不是随机的,应用了倾向评分。结果:经过102个月的中位随访(四分位数范围[IQR], 59-162个月),SNB+AD患者200个月(IQR, 168-213个月),pN0 SNB-only和pN0 SNB+AD患者的总生存率和无病生存率无差异。此外,没有snb患者出现腋窝复发。结论:对于NAC后为cN0的cT2 cN0 /1乳腺癌患者,可以给予SNB,如果SNs为阴性,则无需进一步腋窝治疗,无论之前腋窝状态如何,对长期预后无不良影响。
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引用次数: 0
Tumor-Intrinsic Microbiome-Based Subtyping of Esophageal Cancer as Predictive Biomarkers for Postoperative Survival. 基于肿瘤内在微生物组的食管癌亚型作为术后生存的预测性生物标志物。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-11-20 DOI: 10.1245/s10434-025-18760-1
Jiang-Shan Huang, Zhen-Yang Zhang, Qi-Hong Zhong, Fei-Long Guo, Jing-Yu Wu, Sui Chen, Wen-Wei Lin, Jiang-Bo Lin

Objective: This study aims to investigate the impact of different treatment regimens on the intratumoral microbiota (ITM) composition in esophageal cancer patients and its association with prognosis.

Methods: Tumor tissue samples from 107 esophagectomy patients were analyzed by using 5R 16S rRNA sequencing. Patients were classified into esophagotype A and B via hierarchical clustering, and the relationship between microbiota and prognosis was assessed through Kaplan-Meier survival analysis and Cox regression.

Results: Significant differences in ITM diversity and composition were observed between the neoadjuvant chemoimmunotherapy (nCIT) and surgery alone groups. Esophagotype A was enriched with Firmicutes and Lactobacillus, while esophagotype B with Proteobacteria and Fusobacterium. Survival analysis revealed that patients with esophagotype B had significantly worse outcomes compared with esophagotype A. The 3- and 5-year overall survival rates for esophagotype A were 73 and 69.2%, respectively, significantly higher than those for esophagotype B (57 and 37.5%; p < 0.05 and p < 0.01, respectively). Similarly, the 3- and 5-year recurrence-free survival rates for esophagotype A were both 80.7% compared with 64 and 50.1% for esophagotype B. Multivariable Cox regression confirmed microbial clustering within esophageal cancer subtypes as an independent prognostic factor.

Conclusions: This study classifies esophageal cancer based on ITM signatures, highlighting the microbiota's prognostic significance and supporting the potential of microbiome-based strategies for personalized treatment.

目的:探讨不同治疗方案对食管癌患者瘤内微生物群(ITM)组成的影响及其与预后的关系。方法:采用5r16s rRNA测序对107例食管切除术患者的肿瘤组织样本进行分析。通过分层聚类将患者分为A型和B型,并通过Kaplan-Meier生存分析和Cox回归评估微生物群与预后的关系。结果:新辅助化疗免疫治疗组(nCIT)与单纯手术组ITM的多样性和组成有显著差异。食管A型富含厚壁菌门和乳杆菌,食管B型富含变形菌门和梭杆菌。生存分析显示,B型食管患者预后明显差于A型食管患者。A型食管患者3年和5年总生存率分别为73%和69.2%,显著高于B型食管患者(分别为57%和37.5%,p < 0.05和p < 0.01)。同样,A型食管3年和5年无复发生存率均为80.7%,而b型食管3年和5年无复发生存率分别为64%和50.1%。多变量Cox回归证实,食管癌亚型内的微生物聚类是一个独立的预后因素。结论:本研究基于ITM特征对食管癌进行分类,突出了微生物群的预后意义,并支持基于微生物群的个性化治疗策略的潜力。
{"title":"Tumor-Intrinsic Microbiome-Based Subtyping of Esophageal Cancer as Predictive Biomarkers for Postoperative Survival.","authors":"Jiang-Shan Huang, Zhen-Yang Zhang, Qi-Hong Zhong, Fei-Long Guo, Jing-Yu Wu, Sui Chen, Wen-Wei Lin, Jiang-Bo Lin","doi":"10.1245/s10434-025-18760-1","DOIUrl":"10.1245/s10434-025-18760-1","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to investigate the impact of different treatment regimens on the intratumoral microbiota (ITM) composition in esophageal cancer patients and its association with prognosis.</p><p><strong>Methods: </strong>Tumor tissue samples from 107 esophagectomy patients were analyzed by using 5R 16S rRNA sequencing. Patients were classified into esophagotype A and B via hierarchical clustering, and the relationship between microbiota and prognosis was assessed through Kaplan-Meier survival analysis and Cox regression.</p><p><strong>Results: </strong>Significant differences in ITM diversity and composition were observed between the neoadjuvant chemoimmunotherapy (nCIT) and surgery alone groups. Esophagotype A was enriched with Firmicutes and Lactobacillus, while esophagotype B with Proteobacteria and Fusobacterium. Survival analysis revealed that patients with esophagotype B had significantly worse outcomes compared with esophagotype A. The 3- and 5-year overall survival rates for esophagotype A were 73 and 69.2%, respectively, significantly higher than those for esophagotype B (57 and 37.5%; p < 0.05 and p < 0.01, respectively). Similarly, the 3- and 5-year recurrence-free survival rates for esophagotype A were both 80.7% compared with 64 and 50.1% for esophagotype B. Multivariable Cox regression confirmed microbial clustering within esophageal cancer subtypes as an independent prognostic factor.</p><p><strong>Conclusions: </strong>This study classifies esophageal cancer based on ITM signatures, highlighting the microbiota's prognostic significance and supporting the potential of microbiome-based strategies for personalized treatment.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"2189-2201"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145562503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Lymph Node Invasion Prediction in Prostate Cancer: A Comparative Machine-Learning Study. 前列腺癌淋巴结侵袭预测:比较机器学习研究。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-11-24 DOI: 10.1245/s10434-025-18761-0
Osman Can, Özgün Yücel, Yiğit Can Filtekin, Ahmet Eren Sağır, Çağrı Şevik, Kahraman Aksoy, Alper Ötünçtemur, Halil Lutfi Canat

Background: Accurate preoperative prediction of lymph node invasion (LNI) in prostate cancer is critical for guiding lymph node dissection. Current nomograms often fail to optimall balance the risks of missing metastatic cases and unnecessary dissections. Machine-learning models can provide improved predictive performance through more flexible modeling of complex clinical data.

Methods: The authors developed machine-learning models using clinicopathologic features to predict LNI. Due to a significant class imbalance between LNI-positive and LNI-negative cases, a synthetic minority oversampling technique (SMOTE) was applied to balance the dataset. Four machine-learning algorithms (k-Nearest Neighbors, Random Forest, Support Vector Machine, and Extreme Gradient Boosting [XGBoost]) were trained using 10-fold cross-validation. Model performance was evaluated using accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. SHapley Additive exPlanations (SHAP) analysis was performed for interpretability.

Results: The Random Forest model demonstrated the highest predictive performance. Key predictive features included prostate-specific antigen (PSA) density, clinical stage, and presence of the cribriform pattern. Use of SHAP analysis enabled visualization of individual feature contributions. Compared with existing nomograms, Random Forest and XGBoost achieved superior discrimination performance.

Conclusion: Machine-learning models may outperform traditional nomograms in predicting LNI in prostate cancer, especially when trained on balanced datasets and combined with explainability tools such as SHAP. Further external validation and inclusion of additional features can improve model generalizability.

背景:前列腺癌术前准确预测淋巴结浸润(LNI)对指导淋巴结清扫至关重要。目前的x线图常常不能最佳地平衡转移性病例缺失和不必要的切片的风险。机器学习模型可以通过对复杂临床数据更灵活的建模来提供更好的预测性能。方法:作者利用临床病理特征开发了机器学习模型来预测LNI。由于lni阳性和lni阴性病例之间存在明显的类别不平衡,因此采用合成少数过采样技术(SMOTE)来平衡数据集。四种机器学习算法(k-Nearest Neighbors, Random Forest, Support Vector Machine, and Extreme Gradient Boosting [XGBoost])使用10倍交叉验证进行训练。使用准确性、灵敏度、特异性和受试者工作特征曲线下的面积来评估模型的性能。SHapley加性解释(SHAP)分析可解释性。结果:随机森林模型表现出最高的预测性能。关键的预测特征包括前列腺特异性抗原(PSA)密度、临床分期和筛状模式的存在。使用SHAP分析可以可视化各个特性的贡献。与现有的态图相比,随机森林和XGBoost具有更好的识别性能。结论:机器学习模型在预测前列腺癌LNI方面可能优于传统的正态图,特别是在平衡数据集上训练并结合SHAP等可解释性工具时。进一步的外部验证和附加特征的包含可以提高模型的泛化性。
{"title":"Lymph Node Invasion Prediction in Prostate Cancer: A Comparative Machine-Learning Study.","authors":"Osman Can, Özgün Yücel, Yiğit Can Filtekin, Ahmet Eren Sağır, Çağrı Şevik, Kahraman Aksoy, Alper Ötünçtemur, Halil Lutfi Canat","doi":"10.1245/s10434-025-18761-0","DOIUrl":"10.1245/s10434-025-18761-0","url":null,"abstract":"<p><strong>Background: </strong>Accurate preoperative prediction of lymph node invasion (LNI) in prostate cancer is critical for guiding lymph node dissection. Current nomograms often fail to optimall balance the risks of missing metastatic cases and unnecessary dissections. Machine-learning models can provide improved predictive performance through more flexible modeling of complex clinical data.</p><p><strong>Methods: </strong>The authors developed machine-learning models using clinicopathologic features to predict LNI. Due to a significant class imbalance between LNI-positive and LNI-negative cases, a synthetic minority oversampling technique (SMOTE) was applied to balance the dataset. Four machine-learning algorithms (k-Nearest Neighbors, Random Forest, Support Vector Machine, and Extreme Gradient Boosting [XGBoost]) were trained using 10-fold cross-validation. Model performance was evaluated using accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve. SHapley Additive exPlanations (SHAP) analysis was performed for interpretability.</p><p><strong>Results: </strong>The Random Forest model demonstrated the highest predictive performance. Key predictive features included prostate-specific antigen (PSA) density, clinical stage, and presence of the cribriform pattern. Use of SHAP analysis enabled visualization of individual feature contributions. Compared with existing nomograms, Random Forest and XGBoost achieved superior discrimination performance.</p><p><strong>Conclusion: </strong>Machine-learning models may outperform traditional nomograms in predicting LNI in prostate cancer, especially when trained on balanced datasets and combined with explainability tools such as SHAP. Further external validation and inclusion of additional features can improve model generalizability.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"2802-2808"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145585933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
ASO Author Reflections: Neoadjuvant Chemotherapy and Prediction of Residual Axillary Disease in Breast Cancer Patients. ASO作者反思:乳腺癌患者新辅助化疗与腋窝残留病变的预测。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-16 DOI: 10.1245/s10434-025-18905-2
Vanessa M S Ross, Miranda Addie, Megan Roy Pickard, Vanessa Josey, Tarek Benzouak, Victor Villareal-Corpuz, Ipshita Prakash, Stephanie M Wong, Sarkis Meterissian
{"title":"ASO Author Reflections: Neoadjuvant Chemotherapy and Prediction of Residual Axillary Disease in Breast Cancer Patients.","authors":"Vanessa M S Ross, Miranda Addie, Megan Roy Pickard, Vanessa Josey, Tarek Benzouak, Victor Villareal-Corpuz, Ipshita Prakash, Stephanie M Wong, Sarkis Meterissian","doi":"10.1245/s10434-025-18905-2","DOIUrl":"10.1245/s10434-025-18905-2","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"2332-2333"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145767149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
Surgical Outcomes of Robotic, Minimally Invasive, and Open Esophagectomy After Neoadjuvant Therapy: a Propensity Score-Matching Study. 新辅助治疗后机器人、微创和开放式食管切除术的手术效果:一项倾向评分匹配研究。
IF 3.5 2区 医学 Q2 ONCOLOGY Pub Date : 2026-03-01 Epub Date: 2025-12-04 DOI: 10.1245/s10434-025-18809-1
Jiahuang Hong, Peiyuan Wang, Junpeng Lin, Hao He, Huaiyuan Zhang, Youqiang Qiu, Xiaoyong Liu, Shuoyan Liu, Feng Wang

Background: This study compared surgical outcomes among robot-assisted minimally invasive esophagectomy (RAMIE), minimally invasive esophagectomy (MIE), and open esophagectomy (OE) in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant therapy (NAT).

Patients and methods: After 1:1:1 propensity score matching (PSM) of 667 eligible patients (n = 56 per group), we compared lymph node (LN) yield, postoperative outcomes, survival, and subgroup analysis by tumor location.

Results: After PSM, RAMIE achieved higher total LN yield than MIE (45.4 versus 36.3, P = 0.003) and OE (30.1, P < 0.001), particularly in the upper mediastinum (2R/2L/4L and 8U), subcarinal (7), cervical (1R), and perigastric stations (all P < 0.05). Recurrent laryngeal nerve (RLN) palsy was lower with RAMIE versus MIE (8.9% versus 26.8%, P = 0.041) and OE (28.6%, P = 0.023). Hospital stay was shorter for RAMIE versus MIE (9 versus 12 days, P = 0.001) and OE (15 days, P < 0.001). Most postoperative outcomes showed no intergroup differences. Both RAMIE and MIE were associated with better overall survival (OS) and disease-free survival (DFS) versus OE (hazard ratio [HR] 0.39-0.46; P < 0.05), with no significant difference between them. Exploratory analyses suggested that this association was more apparent for upper/middle tumors.

Conclusions: For NAT-treated resectable ESCC, RAMIE offers more extensive lymphadenectomy extent (higher LN yield) and safety (lower RLN palsy, shorter hospitalization) over MIE/OE. Both minimally invasive techniques showed better survival than OE and support their use after NAT, with a relatively stronger signal for upper/middle tumors.

背景:本研究比较了机器人辅助微创食管切除术(RAMIE)、微创食管切除术(MIE)和开放式食管切除术(OE)对食管鳞状细胞癌(ESCC)患者新辅助治疗(NAT)后的手术效果。患者和方法:对667例符合条件的患者(每组56例)进行1:1:1倾向评分匹配(PSM)后,我们比较了淋巴结(LN)的产出率、术后结局、生存率和肿瘤位置的亚组分析。结果:经PSM后,RAMIE的总LN产量高于MIE(45.4比36.3,P = 0.003)和OE (30.1, P < 0.001),特别是在上纵隔(2R/2L/4L和8U)、隆突下(7)、宫颈(1R)和胃周(均P < 0.05)。RAMIE组喉返神经(RLN)麻痹率低于MIE组(8.9%比26.8%,P = 0.041)和OE组(28.6%,P = 0.023)。RAMIE的住院时间比MIE短(9天比12天,P = 0.001), OE的住院时间短(15天,P < 0.001)。大多数术后结果无组间差异。与OE相比,RAMIE和MIE均具有更好的总生存期(OS)和无病生存期(DFS)(风险比[HR] 0.39-0.46; P < 0.05),两者之间无显著差异。探索性分析表明,这种关联在上/中端肿瘤中更为明显。结论:对于nat治疗的可切除ESCC, RAMIE比MIE/OE提供更广泛的淋巴结切除范围(更高的LN产量)和安全性(更低的RLN瘫痪,更短的住院时间)。两种微创技术的生存率均高于OE,支持其在NAT后的应用,且对上/中端肿瘤的信号相对较强。
{"title":"Surgical Outcomes of Robotic, Minimally Invasive, and Open Esophagectomy After Neoadjuvant Therapy: a Propensity Score-Matching Study.","authors":"Jiahuang Hong, Peiyuan Wang, Junpeng Lin, Hao He, Huaiyuan Zhang, Youqiang Qiu, Xiaoyong Liu, Shuoyan Liu, Feng Wang","doi":"10.1245/s10434-025-18809-1","DOIUrl":"10.1245/s10434-025-18809-1","url":null,"abstract":"<p><strong>Background: </strong>This study compared surgical outcomes among robot-assisted minimally invasive esophagectomy (RAMIE), minimally invasive esophagectomy (MIE), and open esophagectomy (OE) in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant therapy (NAT).</p><p><strong>Patients and methods: </strong>After 1:1:1 propensity score matching (PSM) of 667 eligible patients (n = 56 per group), we compared lymph node (LN) yield, postoperative outcomes, survival, and subgroup analysis by tumor location.</p><p><strong>Results: </strong>After PSM, RAMIE achieved higher total LN yield than MIE (45.4 versus 36.3, P = 0.003) and OE (30.1, P < 0.001), particularly in the upper mediastinum (2R/2L/4L and 8U), subcarinal (7), cervical (1R), and perigastric stations (all P < 0.05). Recurrent laryngeal nerve (RLN) palsy was lower with RAMIE versus MIE (8.9% versus 26.8%, P = 0.041) and OE (28.6%, P = 0.023). Hospital stay was shorter for RAMIE versus MIE (9 versus 12 days, P = 0.001) and OE (15 days, P < 0.001). Most postoperative outcomes showed no intergroup differences. Both RAMIE and MIE were associated with better overall survival (OS) and disease-free survival (DFS) versus OE (hazard ratio [HR] 0.39-0.46; P < 0.05), with no significant difference between them. Exploratory analyses suggested that this association was more apparent for upper/middle tumors.</p><p><strong>Conclusions: </strong>For NAT-treated resectable ESCC, RAMIE offers more extensive lymphadenectomy extent (higher LN yield) and safety (lower RLN palsy, shorter hospitalization) over MIE/OE. Both minimally invasive techniques showed better survival than OE and support their use after NAT, with a relatively stronger signal for upper/middle tumors.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"2103-2113"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145676268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
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Annals of Surgical Oncology
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