Annals of Surgical Oncology最新文献

Background: The prognostic role of lymphadenectomy during esophagectomy for esophageal cancer in complete responders to neoadjuvant therapy is uncertain. This study aimed to help clarify this question.

Patients and methods: This was a bi-national population-based cohort study in Sweden (2006-2024) and Finland (2006-2019). The main cohort included 515 patients with esophageal cancer who underwent esophagectomy after complete or near-complete tumor response without lymph node metastasis following neoadjuvant therapy. A secondary cohort included 669 patients with similar tumor response, regardless of nodal status. Data came from medical records and national health data registers. Associations between lymphadenectomy (categorized in quartiles) and 5-year mortality were assessed using multivariable Cox regression, yielding hazard ratios (HR) with 95% confidence intervals (CI), adjusted for age, sex, country, comorbidity, type of neoadjuvant therapy, calendar year, tumor histology, hospital volume, tumor location, tumor response, and T stage.

Results: In the main cohort, comparing the highest quartile of lymphadenectomy (≥ 27 nodes) with the lowest (0-11 nodes) indicated decreased 5-year all-cause mortality (HR 0.54, 95% CI 0.34-0.88). Stratified analyses suggested no significant association for complete responders (HR 0.68, 95% CI 0.39-1.16), but for near-complete responders (HR 0.32, 95% CI 0.14-0.72). The associations disappeared when assessing stage purification bias in the secondary cohort (n = 669), with the corresponding HRs of 0.91 (95% CI 0.63-1.32) for all responders, 1.01 (95% CI 0.61-1.66) for complete responders, and 0.79 (95% CI 0.47-1.33) for near-complete responders. Results were similar for 5-year disease-specific mortality.

Conclusions: After considering stage purification bias, more extensive lymphadenectomy did not improve the long-term survival among patients with complete or near-complete tumor response after neoadjuvant therapy.

Background: Accurate characterization of the breast cancer-related lymphedema (BCLR) population is essential to understand its pathophysiology and develop predictive models for identifying at-risk patients and implementing tailored preventive microsurgical strategies. Key factors influencing BCRL severity and progression remain unclear. This study characterizes patients with BCRL seeking microsurgical treatment and evaluates the impact of oncological treatment intensity on lymphedema severity and progression.

Methods: This cohort study was conducted at an outpatient tertiary lymphedema clinic between 2017 and 2023. BCRL severity was assessed at intake by a lymphedema-specialized plastic surgeon using International Society of Lymphology staging and indocyanine green lymphography with near-infrared fluorescence imaging (ICG-NIFI). Data were collected during scheduled medical evaluations and analyzed retrospectively. Exploratory analysis investigated associations between oncological treatment intensity and BCRL severity and progression.

Results: A total of 163 consecutive female patients with BCRL were included. Lymphedema severity varied significantly, with no consistent link between severity and time since onset. A significant association was found between axillary lymph node dissection (ALND) and ICG-NIFI stages (p<0.001). However, no significant associations were found between oncological treatment intensity-surgery, radiotherapy, systemic treatment-and BCRL severity and progression. Analyses further revealed associations between lymphedema severity, body mass index, postmenopausal status, and clinical course.

Conclusion: This study provides a comprehensive profile of patients with BCRL seeking microsurgical treatment, revealing variable lymphedema progression patterns. Oncological treatment intensity did not appear to influence BCRL severity or progression, suggesting that these may depend more on biological predisposition. These findings enhance BCRL understanding and highlight the importance of precise patient characterization, laying the foundation for targeted, individually tailored preventive microsurgical interventions.

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.

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.

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.

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.

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.

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.