Annals of Surgical Oncology最新文献

Background: Research investigating the potential impact of postoperative adjuvant chemotherapy cycles on patients with lymph node-negative gastric cancer following neoadjuvant chemotherapy is currently sparse. This study aims to explore the effect of adjuvant chemotherapy cycles on the prognosis of this specific patient group.

Patients and methods: We analyzed clinicopathological data from patients at four institutions between 2010 and 2020. Independent risk factors associated with 3-year overall survival (OS) were identified using a Cox proportional hazards regression model.

Results: We enrolled a total of 219 patients in this study. Patients with lymph node-negative gastric cancer who received neoadjuvant chemotherapy and underwent at least five cycles of adjuvant chemotherapy (AC ≥ 5) after surgery had a significantly higher 3-year overall survival rate of 86.8% compared with those who received fewer than five cycles (AC < 5) with a survival rate of 68.1% (P = 0.016). Multivariate analysis identified several factors, including AC ≥ 5 (HR 0.367, 95% CI 0.166-0.815, P = 0.014), ypT stage ≥ 2 (HR 2.779, 95% CI 1.199-6.438, P = 0.017), and poorly differentiated tumors (HR 2.501, 95% CI 1.385-4.517, P = 0.002), as independently associated with 3-year OS in this patient group. Stratified analysis further revealed that AC ≥ 5 significantly enhanced long-term outcomes in patients with ypT stage ≥2 (3-year OS, 82.5% vs. 62.6%, P = 0.025) and in those with poorly differentiated tumors (3-year OS, 82.6% vs. 53.3%, P = 0.021).

Conclusion: Patients who have lymph node-negative gastric cancer following neoadjuvant chemotherapy, with either ypT stage ≥ 2 or poorly differentiated gastric cancers, may experience benefits from undergoing at least five cycles of adjuvant chemotherapy.

Background: Minimally invasive technique for surgical management of colorectal metastasis is becoming the standard practice in the United States. Paracaval colorectal metastasis is a technically challenging tumor to resect due to its location.^1-4 Abutment of the inferior vena cava (IVC) often requires advanced technique for vascular dissection and potential need for partial venous resection. The authors describe their technique of robotic subtotal caudate lobe resection for paracaval tumor requiring tangential IVC resection.

Methods: A 76-year-old man after partial nonanatomic liver resection of colorectal metastases in segments 2, 4, and 8 presented with a new paracaval caudate tumor. A positron emission tomography (PET) scan showed a 3-cm FDG avid tumor with a standard uptake value (SUV) of 8.3 without extrahepatic metastasis. After a diagnostic laparoscopy, subtotal caudate lobe resection was undertaken. Short hepatic veins were divided to fully mobilize the Spiegel and paracaval portion. Liver transection was performed along the right side of the IVC. Upon the final IVC dissection, vascular abutment by the dorsal aspect of the tumor was encountered. Meticulous vascular dissection, performed with partial tangential IVC resection, was completed to gain complete tumor resection.

Results: The operation time was 3.5 h, with 100 ml of blood loss. The postoperative course was uneventful, and the patient was discharged home on postoperative day 2. The pathology results showed a moderately differentiated metastatic adenocarcinoma (3.8 × 3 × 1.8 cm) with a histologically negative vascular margin. The patient currently is 2 years from the operation without recurrence of disease.

Conclusion: The authors describe a safe and feasible technique of robotic subtotal caudate lobe hepatic resection with partial IVC resection, which can be useful to practicing hepatobiliary surgeons.

Introduction: Preserving the breast contour after mastectomy is proven to be beneficial for the quality of life of a large group of patients with breast cancer (BC). The aim of the present study is to provide an up-to-date overview of immediate breast reconstruction (IBR) in hospitals in the Netherlands over the past 10 years.

Patients and methods: Nationwide data of patients with BC who underwent a mastectomy for ductal carcinoma in situ (DCIS) or invasive BC between January 2012 and September 2022 were requested from the Dutch Breast Cancer Audit (NBCA). Primary outcome was the incidence and trend in application of IBR. Secondary outcomes were factors associated with the use of IBR and the variation among Dutch hospitals.

Results: In total, 56,164 patients underwent a mastectomy for DCIS (n = 8334) or invasive BC (n = 47,830) (2012-2022). The use of IBR for DCIS increased from 39 in 2012 to 48% in 2022 (2012-2017; range 0-85% and 2018-2021; range 0-83%). For DCIS, age < 50 years and lower DCIS grade were positively associated with IBR. The use of IBR for invasive BC increased from 16 in 2012 to 29% in 2022 (2012-2017; range 0-74%, 2018-2022; range 0-77%). For invasive BC, age < 40 years, neoadjuvant chemotherapy, and no adjuvant radiotherapy were positively associated with IBR.

Conclusion: Despite an overall increase of IBR, national variations remain. Further prospective research is initiated ( www.decidestudie.com ) to investigate this variation, which may lead to a more even distribution of IBR use among hospitals in the Netherlands.

Lymphadenectomy (LND) is a crucial component of the curative surgical treatment of gastric cancer (GC). The LND serves to both accurately stage the disease and offer therapeutic benefits. At the time of "curative-intent" gastrectomy, D2 LND is the optimal treatment for patients with locally advanced GC due to its survival benefits and acceptable morbidity. Mastery of the technical aspects of LND, especially D2, requires significant training, adequate case volume, and expertise. This review discusses key aspects of D2 LND, including its status as the standard treatment for locally advanced GC, definition and anatomic borders, technical details, and controversial topics such as splenic hilar dissection and omentectomy. The application of indocyanine green (ICG) fluorescence imaging to elucidate the drainage patterns of GC and to facilitate lymph node (LN) identification is briefly reviewed. Finally, GC standardization and centralization, including surgical treatment, are discussed.

Background: The role of prophylactic primary tumor resection (PTR) in patients with small intestinal neuroendocrine tumors (SI-NETs) and unresectable liver metastases is a matter of debate.

Objective: We aimed to evaluate outcomes in patients with SI-NETs who underwent PTR, according to the presence of metastasis and symptoms from primary.

Material and methods: Data from patients who underwent PTR for SI-NETs from a single referral center (2007-2023) were prospectively collected. Patients were divided into three groups: non-metastatic (M0) and metastatic with primary tumor-related symptoms (MS) or metastatic asymptomatic (MA). Kaplan-Meier curves for overall survival (OS) and event-free survival (EFS) were generated and compared by group. Univariate and multivariable Cox regression analyses were performed to assess the significance of risk factors.

Results: Of 147 patients, 53 were M0, 23 were MS, and 71 were MA. Median follow-up was 26 months. The 5- and 10-year OS estimates were 100% and 100% in M0 patients, 82 and 21% in MS patients, and 89 and 80% in MA patients, respectively (p < 0.001). Median EFS was 91 months overall and 43,126 months and not reached for the MS, MA, and M0 groups, respectively (p < 0.001). In multivariable analysis, MS (hazard ratio [HR] 3.92, 95% confidence interval [CI] 1.71-9.52), functioning tumors (HR 1.98, 95% CI 1.03-3.81), and G2 grade (HR 3.20, 95% CI 1.64-6.85) were associated with a shorter EFS.

Conclusions: In this large retrospective series, the MS group had a significantly worse OS and EFS compared with M0 and MA. This finding suggests that prophylactic PTR might benefit SI-NET patients with unresectable liver metastases, as symptom development could impair long-term prognosis after surgery.

Background: The prognosis of perihilar cholangiocarcinoma (PHC) is poor even after curative resection, highlighting the need for effective adjuvant chemotherapy. The efficacy of adjuvant S-1 chemotherapy following major hepatectomy for PHC is unclear, and thus the aim of this study was to elucidate this.

Methods: Consecutive patients with PHC who underwent major hepatectomy (hemihepatectomy or trisectionectomy extending to segment 1 with extrahepatic bile duct resection) at three high-volume centers in Japan from 2007 to 2020 were retrospectively evaluated. Patients with Clavien-Dindo grade V complications, pStage 0, I, or IVB disease, and those who underwent adjuvant radiation therapy were excluded from analysis. Propensity score matching analysis was performed to compare the disease-specific survival (DSS) of patients who underwent adjuvant S-1 chemotherapy with those who underwent observation.

Results: Overall, 373/480 patients were eligible, of whom 81 underwent adjuvant S-1 chemotherapy and 146 underwent observation. In the global cohort, DSS was similar in the S-1 and observation groups (p = 0.18), while in the matched cohort (S-1, n = 44; observation, n = 44), DSS was similar between the S-1 and observation groups (p = 0.09). On multivariate analysis, percutaneous biliary drainage (PTBD), CA19-9 levels of ≥ 300 U/mL at operation, and lymph node (LN) metastasis were independent predictors of poor survival following major hepatectomy for PHC. In subgroup analysis of patients with LN metastasis, DSS was better in the S-1 group than in the observation group (p = 0.001).

Conclusions: Adjuvant S-1 chemotherapy following major hepatectomy might be effective in PHC patients with LN metastasis.