Annals of Surgical Oncology最新文献

Background: Cellulitis, resulting from impaired lymphatic function, is a debilitating complication of breast cancer-related lymphedema (BCRL) that contributes to lymphedema progression. However, the clinical presentation and microbiologic profile of BCRL-associated cellulitis remain poorly defined. This study investigated the prevalence, clinical features, and treatment outcomes of cellulitis in BCRL, aiming to identify risk factors for recurrence and inform evidence-based treatment strategies.

Methods: A retrospective review was conducted of cellulitis episodes among 2920 patients with BCRL treated at a single institution between 2000 and 2024. Demographic, clinical, microbiologic, and treatment data were analyzed. Univariate and multivariable Cox proportional hazards models were used to evaluate risk factors associated with recurrent cellulitis.

Results: A total of 418 cellulitis episodes were documented among 231 patients with BCRL, indicating a prevalence of 7.9% (231/2920) and a recurrence rate of 39.0% (90/231). Blood cultures were obtained in 255 (61.7%) episodes, of which 33 (12.9%) were positive. Streptococcus agalactiae was the most frequently isolated pathogen (8/33; 24.2%). Risk factors independently associated with recurrence included any radiotherapy (hazard ratio [HR] 2.15; 95% confidence interval [CI] 1.24-3.72; P < 0.01), axillary lymph node dissection (HR 1.96; 95% CI 1.05-3.68; P < 0.05), and shorter time from BCRL diagnosis to the initial cellulitis episode (HR 0.99; 95% CI 0.99-0.99; P < 0.01).

Conclusions: Cellulitis is a significant complication of BCRL with a high recurrence rate. Radiotherapy, axillary lymph node dissection, and early cellulitis onset are associated with recurrence. These findings support proactive surveillance and risk-stratified prevention strategies to reduce infection burden and improve outcomes in this high-risk population.

Background: De novo metastatic breast cancer-defined by distant metastases at diagnosis-poses treatment challenges. While systemic therapy is standard, the benefit of primary tumor surgery remains debated. This study compared surgical patterns and survival in China versus the USA to provide evidence for personalized strategies.

Patients and methods: In this multicenter retrospective cohort study, patients with surgically treated de novo metastatic breast cancer were identified from the National Cancer Center Oncology Information Database (NCCOID; n = 2037, 2013-2020) and Surveillance, Epidemiology, and End Results (SEER) (n = 3175, 2013-2020). Clinical features, treatments, and overall survival (OS) were contrasted. Kaplan-Meier curves and multivariable Cox models identified OS predictors.

Results: Compared with SEER, NCCOID patients were younger and had more T2 tumors; mastectomy predominated in both, though breast-conserving surgery was more frequent in SEER, and preoperative systemic therapy was more common in NCCOID. NCCOID achieved superior OS (1 year, 3 year, 5 year: 91.5%, 77.4%, 67.9%, respectively) versus SEER (87.7%, 62.8%, 46.4%). Improved survival was seen in hormone-receptor-positive tumors, smaller primary lesions (lower T category), and bone-only metastases. Multivariate analysis confirmed age 35-54 years, HR+ and HER2+ status, and limited (especially bone-only) metastases as independent favorable factors.

Conclusions: Surgical management of de novo metastatic breast cancer differs between China and the USA. Select patients-particularly those with HR+ or HER2+ tumors, small primaries, and limited metastases-may benefit from resection, underscoring the need for multidisciplinary, personalized decision-making and prospective validation of optimal surgical timing.

Background: Informal caregivers of patients with appendiceal cancer (AC) undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) may experience physical and psychological distress. The aim of this study was to determine the incidence of burden and decision regret among caregivers of patients with AC who underwent CRS-HIPEC.

Patients and methods: An anonymous, IRB-exempt survey was administered to caregivers of patients with AC who underwent CRS-HIPEC. The primary outcome was caregiver burden (ZBI-12 survey). Secondary outcomes were assessed with the Decision Regret Scale (DRS), PROMIS-29 v 2.0 for quality of life (QOL), and the FACIT-COST for financial toxicity (FT).

Results: A total of 34 caregivers were included. The mean ZBI-12 score was 16 (IQR 9.5-22.5), which has been described as a meaningful cutoff for high burden. There were no major demographics or tumor characteristic differences between high and low burden groups. The most common burdens were feeling stressed caring for their family member (58.8%) and feeling they had lost control of their life since their relative's illness (26.5%). Caregiver burden was significantly related to increased decision regret (R = 0.399, p = 0.019). Higher FT was seen in incomplete surgical debulking (58.3% in the high FT group versus 0%; p = 0.005) and patients and caregivers who traveled ≥ 50 miles to the CRS-HIPEC center.

Conclusions: Half of caregivers reported high burden, which was associated with worse QOL and regret. Future studies will explore opportunities to improve support and resources for caregivers of patients undergoing CRS-HIPEC, both perioperatively and in the long-term.

Background: This study was designed to evaluate the prognostic impact of laparoscopic gastrectomy combined with postoperative hyperthermic intraperitoneal chemotherapy (HIPEC) in gastric cancer patients exhibiting positive peritoneal lavage cytology (CY1) without visible metastases.

Methods: Data from 263 patients undergoing peritoneal lavage cytology and laparoscopic gastrectomy between December 2017 and December 2022 were retrospectively analyzed. Patients were stratified into CY1 (positive cytology) or CY0 (negative cytology) groups, with CY1 cases further subdivided into HIPEC and non-HIPEC cohorts based on postoperative HIPEC administration. Postoperative recurrence and survival outcomes were compared across cohorts.

Results: Among 263 patients, 214 were CY0 and 49 CY1 with 27 CY1 patients receiving HIPEC and 22 non-HIPEC. HIPEC-treated CY1 patients demonstrated lower postoperative recurrence (66.7% vs. 90.9%) and visible peritoneal metastasis rates (29.6% vs. 59.1%) than non-HIPEC counterparts (P < 0.05). CY0 patients exhibited higher 3-year overall survival (OS) and progression-free survival (PFS) rates compared with both non-HIPEC CY1 and HIPEC-treated CY1 subgroups. HIPEC-treated CY1 patients showed superior 3-year OS (51.8% vs. 18.2%, P = 0.005) and PFS (35% vs. 13.6%, P = 0.037) than non-HIPEC CY1. Notably, stage III CY0 cohort demonstrated comparable survival outcomes to HIPEC-treated CY1 cohort (overall survival 56.4% vs. 51.8%, P = 0.39; progression-free survival 51% vs. 35%, P = 0.14). Cox analysis identified non-HIPEC and pN2-3 stage as independent risk factors for OS, while non-HIPEC, pT4, and pN2-3 stages predicted poorer PFS in CY1 patients.

Conclusions: Hyperthermic intraperitoneal chemotherapy following laparoscopic gastrectomy demonstrated efficacy in reducing postoperative peritoneal metastasis rates while enhancing prognosis of CY1 patients, achieving oncologic outcomes comparable to stage III CY0 counterparts, although additional investigation remains imperative.

Background: Artificial intelligence (AI) has shown potential in various fields; however, its practical application in surgery remains limited. We developed an AI system capable of automatically recognizing surgical phases in robot-assisted radical prostatectomy (RARP) and confirmed its accuracy through cross-surgeon validation.

Materials and methods: We analyzed clinical data from 102 patients who underwent RARP, including 81 consecutive patients operated on by one surgeon (surgeon A) and 21 operated on by five other surgeons (surgeons B-F). In total, 65 of the 81 patients were used for AI development, while the remaining 16, in addition to the 21 patients operated on by surgeons B-F, were used for AI validation. We classified surgical operations into nine phases. Well-trained surgeons annotated the time corresponding to each surgical phase for each video. We used Temporal Convolutional Networks for the Operating Room (TeCNO) to develop the AI model and evaluated its precision.

Results: In AI development, 919,231 frames were utilized. Testing involved 216,357 frames from surgeon A and 249,553 frames from surgeons B-F. When the developed AI was used to analyze surgical videos from surgeon A, precision reached 0.94. In contrast, when the AI was applied to videos from surgeons B-F, precision was 0.83.

Conclusions: The AI we developed not only showed high accuracy, but also demonstrated generalizability across different surgeons. By comprehensively evaluating surgical videos, our AI may be used to assess the quality of surgeries, thereby providing valuable feedback to surgeons and enhancing the effectiveness of surgical education.

Background: Robotic pancreaticoduodenectomy (RPD) has been increasingly used in the management of pancreatic ductal adenocarcinoma (PDAC).^1,2 However, portal vein (PV) or superior mesenteric vein (SMV) involvement remains a technical challenge.^3-6 In particular, stapled wedge vein resection during RPD has not been well described.

Patient and methods: We present the case of a 65-year-old male with PDAC initially suspected to have liver metastasis. He underwent 11 cycles of gemcitabine and nab-paclitaxel, followed by diagnostic laparoscopy with liver biopsy, which revealed no malignancy. Then, surgical resection was recommended. Intraoperatively, after careful dissection of the SMV, a 5-mm segment of tumor adherence was identified on the right wall of the SMV. A stapled wedge resection was then performed. The SMV lumen appeared mildly narrowed after stapling, but no stenosis was evident and venous flow was satisfactory by inspection. This maneuver allowed medial retraction of the PV-SMV, facilitating exposure of the superior mesenteric artery and completion of resection-without vascular clamping.

Results: The operation time was 6 h, with minimal blood loss. The patient was discharged on postoperative day 5 without complications, including venous-related events. Final pathology confirmed portal vein invasion, but an R0 resection was achieved. Among five patients who underwent PV/SMV wedge resection at our institution, no postoperative venous thrombosis or stenosis occurred.

Conclusions: Stapled wedge resection of the PV/SMV is feasible and safe during RPD for selected patients with minimal venous adherence. Further case accumulation and long-term evaluation are required to determine the appropriate indications, particularly with respect to safety and oncologic outcomes.