Annals of Surgical Oncology最新文献

Background: Since 2022, the Commission on Cancer (CoC) has developed three new breast cancer quality measures (QMs): time to surgery (BCSdx) and radiation (BCSRT) and the use of neoadjuvant therapy for triple negative and HER2/neu positive breast cancer (BneoCT). This study assesses CoC center historical performance for these measures and facility factors associated with low performance.

Methods: We examined the median number of days for time to surgery and radiation, and the proportion of facilities that achieved an estimated performance rate (EPR) of 70%, 80%, and 90% from 2004 to 2020 for all three measures. Multivariable logistic regression analysis was used to determine the association between facility factors and not achieving 80% EPR for all three measures.

Results: The median number of days to surgery and radiation in 2004 were 16 and 43, respectively, compared with 34 and 48 in 2020 (p < 0.01). For BneoCT, BCSdx, and BCSRT measures, the proportion of facilities that attained ≥ 80% EPR was 68.5%, 72.2%, and 35.2%, respectively. The proportion of facilities that attained ≥ 80% EPR in 2004 was 92.3% for BCSdx and 49.8% for BCSRT compared with 69.6% and 39.4%, respectively, in 2020. BneoCT performance improved over time. Academic facilities and facilities serving a larger proportion of socioeconomically disadvantaged patients were approximately twice as likely to be unable to achieve compliance with all three QMs.

Conclusions: Performance levels for BCSRT are the lowest of all three measures. Academic centers and centers with a higher proportion of Medicaid patients are more likely to have lower adherence with all three QMs.

Background: Laparoscopic radical antegrade modular pancreatosplenectomy combined with celiac axis resection and portal vein reconstruction is a new procedure for the treatment of pancreatic cancer. This surgical technique may offer patients with pancreatic cancer involving the portal vein and celiac axis an opportunity for radical surgical resection. We aim to evaluate the short- and long-term efficacy and describe the surgical details of this technique.

Patients and methods: A 74-year-old man was diagnosed with pancreatic neck-body cancer, with a tumor size of 2.5 × 2.0 × 1.5 cm and local vascular invasion of the celiac axis, common hepatic artery, and portal vein. After four cycles of modified neoadjuvant folinic acid, fluorouracil, oxaliplatin, and irinotecan (FOLFIRINOX) therapy, reevaluation showed that the tumor size had considerably reduced, and the surrounding enlarged lymph nodes disappeared. Laparoscopic radical antegrade modular pancreatosplenectomy, combined with celiac axis resection and portal vein reconstruction, was performed.

Results: The operative time was 300 min, with blood loss of 200 mL. The drainage tube was removed 5 days postoperatively, and the patient was discharged 9 days later. The patient received eight cycles of modified FOLFIRINOX chemotherapy over the following month. After 15 months of follow-up, no tumor recurrence or metastasis was observed.

Conclusions: Laparoscopic radical antegrade modular pancreatosplenectomy, combined with celiac axis resection and portal vein reconstruction, is a safe and effective treatment option for patients with pancreatic neck-body cancer involving the celiac axis and portal vein.

Background: The impact of time to surgery (TTS) on survival in patients with perihilar cholangiocarcinoma (PHC) is uncertain.

Methods: Data from PHC patients scheduled for surgery between 2011 and 2020 were reviewed. Patients were grouped based on the median TTS, defined as the time from diagnosis to surgery. Survival outcomes were analyzed for all patients and those undergoing potentially curative resection (resection without distant metastasis).

Results: Of 224 patients, the median TTS was 64 days (range 19-212), with the patients being divided into two groups: long-TTS group (TTS ≥64 days, n = 116) and short-TTS group (TTS <64 days, n = 108). The long-TTS group showed higher rates of preoperative biliary infection (52% vs. 33%; p = 0.004) and portal vein embolization (84% vs. 49%; p < 0.001) compared with the short-TTS group. Forty-seven patients (18%) had unresectable tumors or distant metastasis, with a median overall survival (OS) of 18 months. The rate of potentially curative resection tended to be lower in the long-TTS group (74%) compared with the short-TTS group (84%), although it was not statistically significant (p = 0.063). However, OS for the entire cohort was comparable between the long-TTS and short-TTS groups (median OS 40 vs. 36 months; p = 0.986). Multivariable analysis revealed that TTS was not associated with survival in patients who underwent potentially curative resection.

Conclusions: Although the potentially curative resection rate tended to be lower in the long-TTS group, TTS did not impact survival in patients undergoing potentially curative resection for PHC.

Background: Prophylactic lymphovenous bypass (pLVB) is a microsurgical technique aimed to prevent breast cancer-related lymphedema (BCRL) after axillary lymph node dissection (ALND) by redirecting lymphatic flow from the ligated lymphatics into neighboring veins. This report describes the authors' 9-year institutional experience of pLVB in patients undergoing ALND to prevent BCRL.

Methods: Patients who underwent ALND were reviewed. Demographic and oncologic data were analyzed. The primary outcomes included limb circumference and perometry. The secondary outcomes included patient-reported outcomes, incidence of cellulitis, and need for therapeutic lymphovenous bypass (LVB). Furthermore, the study identified risk factors for the development of BCRL within the ALND plus pLVB population.

Results: Of the 370 patients, 25% underwent ALND plus pLVB. Demographic and oncologic features were similar between the two cohorts, and the average follow-up time was 23 months. The rate of BCRL was 8.7% in the ALND plus pLVB group and 20.1% in the no-pLVB group (p < 0.05), whereas the postoperative circumferential measurements were significantly improved among the ALND plus pLVB patients. In addition, the patients treated with ALND plus pLVB had a lower incidence of positive symptoms of lymphedema (pain, tightness, heaviness) and were less likely to require therapeutic LVB. The medical history of cardiac arrythmia was identified as a risk factor for the development of lymphedema in the ALND plus pLVB cohort.

Conclusions: Prophylactic lymphovenous bypass contributes to a decreased incidence of lymphedema as well as improved patient symptoms and limb functionality. Furthermore, pLVB modulates disease severity for patients who experience BCRL. The authors advocate that pLVBs should be routinely offered to breast cancer patients undergoing ALND.