Annals of Surgical Oncology最新文献

Background: This study aimed to evaluate the necessity of lymph node sampling for specific non-small cell lung cancer (NSCLC).

Methods: Patients with small-size (≤2 cm) NSCLC who underwent surgical resection between 2009 and 2022 were retrospectively screened. The characteristics of patients with nodal metastasis were demonstrated. For selected patients, the perioperative and long-term outcomes with and without lymphadenectomy were compared.

Results: Of the 2713 patients enrolled in this study, 75 (2.76 %) had involvement of nodules with a minimum solid size of 6 mm. No patient with pure ground glass opacity (0/945) had nodal metastasis, whereas 14 patients with part-solid nodules (14/1260, 1.11 %) and 61 patients with solid nodules (61/508, 12.01 %) had nodal involvement. Patients who had NSCLC with solid components smaller than 6 mm (n=1588) had no nodal metastasis. Of these patients, 339 underwent sublobar resection without lymphadenectomy (SRN0), 1056 received sublobar resection with lymphadenectomy (SRN1), and 190 received lobectomy with lymphadenectomy (LRN1). The patients with SRN0 had a shorter operating time, less volume of drainage, a lower incidence of chylothorax (0 % vs 0.6 % vs. 2.1 %; P = 0.012) and air leakage, as well as a shorter postoperative hospital stay (3 vs. 4 vs. 4 days; P < 0.001) than those with SRN1 or LRN1. The 5-year recurrence-free survival was 100 % for the patients with SRN0, 99.2 % for those with SRN1, and 98.5 % for those with LRN1 (P = 0.370).

Conclusion: Lymphadenectomy may be unnecessary for NSCLC smaller than 6 mm in solid size. Sublobar resection without lymphadenectomy had favorable effects on postoperative complications and fast recovery with no compromise of long-term outcomes.

Introduction: Children and young adults diagnosed with sarcoma often present with pulmonary metastases requiring wedge resection. It is important to balance the risk of pulmonary recurrence against the desire to limit resection of benign parenchyma. This study aims to determine the impact of resection margins on survival and recurrence among pediatric and young adult sarcoma patients.

Patients and methods: We conducted a retrospective cohort study of patients ages 25 years and younger with primary or recurrent osteogenic, Ewing's, or soft tissue sarcoma who underwent pulmonary metastasectomy (2006-2022). Margins were categorized as > 1 mm, ≥ 5 mm, or ≥ 10 mm length. Two-year overall survival (OS), disease-free survival (DFS), and regional disease-free survival, consisting of pulmonary recurrence following metastasectomy, were analyzed using the Kaplan-Meier method. Cox analysis utilized patient, tumor, and treatment factors to predict risk of death and/or recurrence.

Results: In total, 122 patients were identified for analysis. The median number of wedge resections was 3.5, median nodule size was 12.5 mm, and median margin length was 3 mm. A 5-mm margin was associated with improvements in DFS and regional-DFS (10.6% vs. 29.7%, p = 0.01 and 10.7% versus 31.1%, p = 0.005, respectively). On Cox analysis, margin length was not associated with OS (p > 0.05); however, 5 mm (HR 0.46, p = 0.005) and 10-mm margins (HR 0.39, p = 0.04) were associated with improvements in regional DFS. Margin length was not associated with development of postoperative complications (p = 0.20).

Conclusions: Among pediatric and young adult sarcoma patients with pulmonary metastases, increased margin length was associated with decreasing risk of local recurrence but not the development of postoperative complications.

Background: The use of multiagent FOLFIRINOX chemotherapy for pancreatic adenocarcinoma in a neoadjuvant setting has been associated with an increased rate of complete pathological response (CPR) after surgery. This study investigated the long-term outcomes of patients with CPR in a multicenter setting to identify prognostic factors for overall survival (OS) and recurrence-free survival (RFS).

Methods: This retrospective cohort study examined biopsy-proven pancreatic adenocarcinomas with CPR after neoadjuvant chemotherapy or chemoradiotherapy and surgery, between January 2006 and December 2023 across 22 French and  2 Belgian centers. Cox analyses were used to identify prognostic factors of OS and RFS.

Results: There were 101 patients with CPR after chemotherapy (n = 58, 57.4%) and chemoradiotherapy (n = 43, 42.6%) followed by surgery. Neoadjuvant FOLFIRINOX was used in 90% of patients. The median OS after surgery was 177 months (95% confidence interval (CI) 58.9-177 months) with 1-, 3-, 5-, and 10-year OS rates of 93%, 75%, 63%, and 51%, respectively. The median RFS was 67.8 months (95% CI:34.4-NR) with 1-, 3-, 5-, and 10-year RFS rates of 83%, 58%, 54%, and 49%, respectively. The multivariate Cox analysis of OS and RFS showed that preoperative radiotherapy was an independent negative prognostic factor for OS (hazard ratio (HR) 2.51; 95% CI 1.00-6.30; p = 0.03) and RFS (HR 2.62; 95% CI 1.27-5.41; p = 0.009).

Conclusions: Complete pathologic response after neoadjuvant treatment is associated with remarkable long-term survival that is usually not seen after the resection of pancreatic adenocarcinomas. One-third of the patients still experienced disease recurrence, which was more common in those receiving preoperative chemoradiotherapy.