Annals of Surgical Oncology最新文献

Background: Nearly 25% of opioid-related deaths are from prescribed opioids, and the exacerbation of the opioid epidemic by the coronavirus disease 2019 (COVID-19) pandemic underscores the urgent need to address superfluous prescribing. Therefore, we sought to align local opioid prescribing practices with national guidelines in postoperative non-metastatic breast cancer patients.

Methods: A single-institution analysis included non-metastatic breast surgery patients treated between April 2020 and July 2021. 'Overprescription' was defined as a discharge prescription quantity of oral morphine equivalents (OMEs) greater than the upper limit of the procedure-specific Michigan Opioid Prescribing Engagement Network (OPEN) recommendations. Univariable and multivariate analyses identified risk factors associated with opioid prescribing.

Results: Overall, 464 patients met the inclusion criteria: 280 patients underwent lumpectomy, and 184 patients underwent mastectomy. 52% of patients were overprescribed opioids, including 74% of lumpectomy patients (p < 0.001) and 90% of patients undergoing lumpectomy with axillary surgery (p < 0.001). Mastectomy patients were overprescribed less frequently (< 25%). The quantity of opioids prescribed at discharge did not correlate to inpatient opioid requirements (r = 0.024, p = 0.604). Increased age, tobacco use, and long surgery duration were associated with higher quantities of opioids prescribed at discharge.

Conclusion: Patients undergoing less aggressive breast surgery are at very high risk of overprescription, and real-life prescribing patterns do not correlate to national guidelines or inpatient need. Future work will optimize adherence to procedure-specific guidelines and implement tailored discharge protocols.

Background: The incidence of rectal cancer has decreased overall, but the incidence of early-onset rectal cancer (eoRC) has increased. Early-onset rectal cancer and late-onset rectal cancer (loRC) differ due to phenotypical, genetic characteristics, and higher stage presentations in eoRC. Thus, eoRC patients undergo more aggressive neoadjuvant treatments. This paper was designed to evaluate the impact of age on the pathological complete response rates in sporadic locally advanced rectal cancer.

Methods: All patients with stage II-III rectal cancer who underwent neoadjuvant therapy and curative rectal resection between January 2018 and December 2023 were included and allocated to eoRC (<50 years) and loRC (≥50 years) groups based on their age at diagnosis.

Results: A total of 381 patients were included (93 eoRC and 288 loRC). Preoperative radiological imaging revealed higher clinical nodal staging in the eoRC group (p = 0.002). A higher proportion of eoRC resulted in a pathological complete response compared with loRC (29% vs. 18.8%, p = 0.035). The rate of pathological complete response in eoRC and loRC did not differ between patients treated by total neoadjuvant therapy (TNT) and those treated by standard chemoradiotherapy (29.2% vs. 28.6%, p = 0.95 in eoRC and 21.7% vs. 25.9%, p = 0.097 in loRC). Multivariable analysis resulted in young age of onset (odds ratio 2.68; 95% confidence interval 1.11-6.51; p = 0.029) and KRAS wildtype (odds ratio 3.37; 95% confidence interval 1.25-9.07; p = 0.016) as being independent predictors of pathological complete response.

Conclusions: Sporadic eoRC and KRAS wildtype tumors are predictive factors for pathological complete response in stage II-III rectal cancer.

Background: Local relapse has not been eradicated even in the era of total mesorectum excision.^1,2 Although various approaches have been attempted, R0 resection remains the only potentially curative treatment.^3,4 PATIENT AND METHODS: A 45-year-old woman with a history of laparoscopic abdominoperineal resection was diagnosed with pelvic recurrence 7 months ago. Then, she received chemoradiotherapy. Magnetic resonance imaging (MRI) and positron emission tomography-computed tomography (PET-CT) showed pelvic recurrences at the surface of the right piriformis and obturator internus, posterior vaginal wall, and presacral fascia. The patient also had bilateral hydronephrosis. No distant metastasis was found. First, the lateral pelvic lymph nodes were removed. Then, the internal iliac arteries and veins were transected. Next, the fibrotic ureters were isolated and cut. Then, presacral fascia at the S4 and S5 levels was excised. Anteriorly, the urethra and vagina were transected. Lastly, the suspected pelvic recurrent lesions were resected en bloc with partial right piriformis, obturator internus, and gluteus maximus through a combined abdominal and perineal approach. Greater omental pedicle flap was transplanted into the pelvic cavity and pelvic floor was reconstructed.

Results: The operative time was 600 min, and blood loss was 400 ml. Postoperative course was uneventful, and the patient was discharged 14 days after surgery. Pathology report showed a moderately differentiated rectal adenocarcinoma invading the vagina, presacral fascia, and pelvic musculature. All margins were negative.

Conclusions: As demonstrated by this case, image-guided total pelvic exenteration with presacral fascia and sidewall musculature excision provides an opportunity to cure pelvic recurrence of rectal cancer.⁵.