Annals of Surgical Oncology最新文献

Purpose: Our objective was to assess the perioperative quality of life (QoL) of patients with pancreatic cancer (PC) and accurately capture the complex interactions and causal pointers that contribute to fluctuations.

Methods: This longitudinal study (October 2024 to March 2025) assessed QoL in patients with PC undergoing potentially curative surgery at four stages: the day of admission (T1), 3-5 days postoperatively (T2), the day of discharge (T3), and 1 month postoperatively (T4). Analysis of variance and cross-lagged panel network (CLPN) analyzed stage differences and dynamic interactions, and centrality calculations mapped important intervention targets between stages.

Results: Among 277 analyzed patients (89.64% response rate from 309 approached), 66.79% had ductal adenocarcinoma; the remaining cases comprised pancreatic neuroendocrine tumors (11.91%), invasive intraductal papillary mucinous neoplasms (7.58%), solid pseudopapillary tumors (5.42%), and other types (8.3%). QoL differed significantly between stages (P < 0.001). Dimension scores for functioning and global health status declined before gradually improving, whereas symptoms followed an inverse pattern. Nodes with higher bridge-expected influence, out-expected influence, or in-expected influence in each CLPN were targets for clinical care (mainly pain and nausea and vomiting in T1→T2, pain and social functioning in T2→T3, and fatigue and financial difficulties in T3→T4). The accuracy and stability of the CLPN were verified as acceptable.

Conclusions: The CLPN could precisely identify the interactions and causal connections among QoL dimensions across different stages. It provides anticipatory and prospective guidance for clinical healthcare professionals to enhance holistic care outcomes through early intervention on vital targets that impede dysfunction and symptom exacerbation.

Background: Abdominal malignant tumors sometimes involve the inferior vena cava (IVC).^1-4 In such cases, radical resection, including IVC resection and reconstruction, is a critical component of curative treatment.^3,4 Although patch repair or synthetic tube grafts are used for IVC reconstruction, synthetic grafts may carry risks of infection and thrombosis.^5-7 Although tubularized bovine pericardium grafts have shown favorable outcomes, the technical details are not well documented.^1,8-11 CASE PRESENTATION: IVC patch reconstruction using bovine pericardial grafts was performed in three cases. In one, the patch extended over more than two-thirds of the circumference, and the reconstruction was carried out in an irregular shape to preserve the branch of the left renal vein. By using a tubularized bovine pericardium graft, a smooth shape enabled easier reconstruction of the branches. A 33-year-old woman presented with an initially unresectable large leiomyosarcoma invading the IVC and hepatic veins. After chemotherapy shrank the tumor, surgical resection, including right nephrectomy, partial hepatectomy, and IVC resection, was performed. A 14 cm tube graft was created in the operating room using bovine pericardium, and this was anastomosed to the IVC. Elevated left renal vein pressure indicated side-to-end anastomosis. Postoperative computed tomography confirmed graft patency, and the patient was discharged uneventfully on postoperative day 10.

Conclusions: We present the technical details of IVC resection and reconstruction using a tubularized bovine pericardium graft, along with left renal vein reconstruction.

Background: Men are often diagnosed with node-positive breast cancer and treated with mastectomy because of a lack of screening and an unfavorable tumor-to-breast ratio. The AMAROS trial showed no difference in outcomes between axillary lymph node dissection (ALND) and axillary radiation in women with cT1-2N0 breast cancer with positive sentinel lymph nodes (+SLNs). Axillary management in men remains unstandardized, so we assessed current trends and outcomes.

Methods: Males with cT1-2N0M0 breast cancer undergoing mastectomy with one to two +SLNs were identified from the National Cancer Database (2018-2021). Patients were stratified by axillary management. Postmastectomy radiotherapy (PMRT) included chest wall and axillary fields. Management strategies and overall survival were analyzed.

Results: Among 445 patients, 25% had no further axillary treatment, 22% underwent ALND, 29% PMRT, and 24% ALND+PMRT. Patients with two +SLNs more often underwent ALND+PMRT (43% vs. 19%, p < 0.001). The use of PMRT rose over time (23-36%), whereas ALND alone declined (27-12%). Additional positive nodes were found in 31% of ALND cases, with no difference between ALND and ALND+PMRT. Performance of ALND delayed PMRT (194 vs. 133 days from diagnosis, p < 0.001). On multivariable analysis, two +SLNs predicted ALND+PMRT (odds ratio 2.5, p = 0.006). Older age (p < 0.001) and two +SLNs (p = 0.03) were linked to worse overall survival, whereas axillary management was not (p = 0.23).

Conclusion: Although axillary strategies are proven safe and effective in women, their extrapolation to men is inconsistent. Half of men undergoing mastectomy are undertreated or overtreated, underscoring the need for multidisciplinary consensus and prospective male-specific data to guide care and reduce morbidity.

Background: To define the impact of perineural invasion (PNI) on long-term survival of patients following curative-intent resection of pancreatic neuroendocrine tumors (pNETs).

Patients and methods: Patients with pNETs who underwent curative-intent resection (R0/R1) between 2000 and 2020 were identified from a multi-institutional database. The impacts of PNI on overall survival (OS) and disease-free survival (DFS) were analyzed.

Results: Among 700 patients, 171 (n = 24.4%) had a pNET with PNI. The presence of PNI was associated with higher tumor grade (G3, 8.2% vs. 2.5%, p < 0.001), more advanced AJCC T disease (T3-T4, 58.5% vs. 15.9%, p < 0.001), and a higher incidence of nodal metastasis (52.6% vs. 21.2%, p < 0.001) versus patients with no PNI. Patients with PNI had a worse OS (median, with PNI 115.9 months vs. no PNI not reached, p < 0.001) and DFS (median, with PNI 51.9 vs. no PNI 115.4 months, p < 0.001) versus patients with no PNI. On multivariable analysis PNI was an independent risk factor associated with worse OS (HR = 2.624, 95%CI 1.475-4.668, p = 0.001), as well as DFS (HR = 1.972, 95%CI 1.396-2.786, p < 0.001). Among 256 patients with very early staged tumors (G1N0) who underwent an R0 resection, PNI remained a strong independent factor associated with worse long-term survivals (OS, HR = 3.892, 95%CI 1.196-12.662, p = 0.024; DFS, HR = 2.530, 95%CI 1.010-6.339, p = 0.048).

Conclusions: PNI was an independent adverse prognostic factor among patients undergoing curative-intent resection of pNETs, even among individuals with early-stage disease. The presence of PNI should be routinely assessed and considered in the prognostic stratification of patients following resection of pNETs.

Background: Surgical care for pancreatic ductal adenocarcinoma (PDAC) is increasingly centralized to high-volume hospitals (HVHs), prompting many patients to travel farther for resection. While surgery is centralized, adjuvant chemotherapy is often delivered locally, resulting in care fragmentation. The implications of this separation on chemotherapy receipt and survival are unclear. This study evaluated associations between travel distance, care fragmentation, and receipt of adjuvant chemotherapy in patients undergoing upfront PDAC resection at HVHs and assessed how these factors influenced overall survival.

Methods: Patients with non-metastatic PDAC who underwent upfront resection at HVHs (≥20 pancreatectomies/year) were identified from the National Cancer Database (2007-2021). The cohort was stratified by adjuvant chemotherapy receipt, travel distance (deciles D1-D10), and care fragmentation. Multivariable logistic regression assessed factors associated with chemotherapy receipt; Cox proportional hazards models evaluated survival.

Results: Among 17,807 patients treated at 97 HVHs, 10,200 (57%) received adjuvant chemotherapy. Patients traveling ≥14 miles (≥D4) were less likely to receive adjuvant chemotherapy (D4 odds ratio [OR] 0.85; 95% confidence interval [CI] 0.73-0.99; P=0.04). Patients experiencing care fragmentation were more likely to receive adjuvant therapy (64.3% vs. 54.4%, OR 1.51; 95% CI 1.35-1.69; P<0.001). Travel ≥20 miles (≥D5) was associated with higher mortality (hazards ratio [HR] 1.12; 95% CI 1.02-1.23; P=0.01). Conversely, receipt of adjuvant chemotherapy (HR 0.77; 95% CI 0.73-0.81; P<0.001) and fragmented care (HR 0.89; 95% CI 0.84-0.93; P<0.001) were associated with improved survival.

Conclusions: Longer travel distance was associated with lower chemotherapy receipt and worse survival. Care fragmentation was linked to improved treatment access and survival, underscoring the need for coordinated cross-institutional care.

Background: Familial pancreatic cancer (FPC) will be enriched for germline mutations (GLMs), particularly in homologous recombination repair (HRR) genes, but its distinction from sporadic pancreatic cancer (PC) remains unclear.

Methods: We retrospectively analyzed 111 resected PCs, including 13 patients with FPC (11.8%) and 98 with non-FPC (88.2%). Whole-exome sequencing targeted 151 cancer-related genes, with parallel gene expression profiling. GLMs were assessed by ClinVar and in silico tools. Homologous recombination deficiency (HRD) scores, COSMIC signatures, immune deconvolution, and survival were compared.

Results: Patients with FPC and non-FPC were comparable in age, sex, tumor stage, and receipt of adjuvant chemotherapy. ClinVar-annotated GLMs were found in 2/13 patients with FPC (15.4%) and 4/98 patients with non-FPC (4.1%). FPC cases more often carried pancreatitis-associated variants (SPINK1, CFTR), whereas non-FPC included HRR-related variants (PALB2, FANCG). When potentially pathogenic HRR-related variants were considered together, prevalence was similar (23.1% vs. 12.2%, p = 0.380). HRD scores did not differ (median 22 vs. 19, p = 0.591), and high HRD scores (≥ 42) were observed only in two non-FPC cases, including one with PALB2. Differential expression analysis revealed no significant differences after false discovery rate correction. Multivariate analysis indicated that FPC status was not an independent prognostic factor (hazard ratio 1.73, p = 0.084).

Conclusions: Transcriptomic profiles and HRD status were similar between patients with FPC and patients with non-FPC. A spectrum of GLMs was observed in both groups, suggesting that hereditary risk variants are not exclusive to FPC and underscoring the importance of germline testing in all patients with PC.