Annals of Surgical Oncology最新文献

Background: Cannabis use is increasing and is of particular interest to patients with cancer. There is no prospective data regarding its impact on perioperative outcomes. We asked how chronic usage of cannabis compounds (cannabinoids) impacted postoperative pain, opiate use, and complications after abdominal surgery for the treatment of cancer.

Patients and methods: This was a single center prospective observational cohort study conducted from 9/2021-3/2024 of patients 21+ years old, undergoing abdominal surgery for the treatment of cancer, and either chronic cannabinoid users (≥1x/week for last 3 months) or non-users (for the last year). Plasma cannabinoids were measured preoperatively on the day of surgery.

Results: Of 223 patients screened, 64 subjects completed enrollment (24 chronic cannabinoid users, 40 non-users). Most were male (67%) and underwent an open abdominal surgery (75%). 41% developed complications, 23% of which were severe (grade 3+) complications. Chronic users with detectable cannabinoid levels had significantly higher pain scores, which persisted in multivariable analysis. Chronic users also received significantly more morphine milligram equivalents (MME) (8-hours postoperatively: 28.8 vs 9.8, p=0.036, during the total hospitalization: 273 vs 202.1, p=0.046, prescribed: 150 vs 100, p=0.047, taken through POD30: 67.5 vs 5, p=0.03). Differences in MME prescribed and taken postoperatively persisted in multivariable analysis. Chronic users had fewer overall complications (5/23 (22%) vs 21/41 (51%), p=0.025), but similar frequency to non-users for severe complications (2/23 (8.7%) vs 4/41 (9.8%), p=0.33).

Conclusions: Chronic cannabinoid use increased postoperative pain and MME use for patients undergoing abdominal surgery for the treatment of cancer, but did not increase complications. Further study regarding preoperative cannabinoid cessation and use of cannabinoids for postoperative pain is warranted.

Background: This study aimed to compare perioperative outcomes between laparoscopic and robotic transabdominal lateral adrenalectomies.

Background: Despite growing interest in robotic adrenalectomy (RA), its benefits compared with those for laparoscopic adrenalectomy (LA) need to be identified. Two previously published randomized studies used out-of-date technologies and included only pheochromocytoma patients, respectively.

Methods: A prospective randomized clinical trial was conducted by a single surgeon between May 2024 and February 2025. Patients with adrenal tumors eligible for minimally invasive lateral transabdominal adrenalectomy were randomized to LA or RA. The trial was powered to detect a 30-min difference in operative time. The secondary outcomes were perioperative outcomes, cost, and ergonomics, measured by the NASA Task Load Index (NASA-TLX) and the Rapid Upper Limb Assessment (RULA).

Results: In the study, 27 patients were randomized to each group. The groups were similar in demographics, clinical characteristics, and operative indications. The operative times and secondary outcomes were similar between the groups except that the RA group had a lower median operating surgeon NASA-TLX score (16 vs 48; P ≤ 0.001) and a lower overall RULA score (14 vs 17; P = 0.001) than the LA group. Operation room, hospital, and total costs were similar between the groups. Although all the procedures were completed as planned in the RA group, the LA group had four conversions from the original minimally invasive plan (conversion to open, hand-assisted procedure, and partial adrenalectomy and abortion of the procedure in one patient each).

Conclusions: Perioperative outcomes, including cost, were similar between LA and RA, with better ergonomics and fewer conversions from the original minimally invasive surgical plan in the RA group.

Background: Compliance with training protocol is essential to achieve physiologic improvements associated with exercise. This study aimed to assess the compliance and response to a 4-week high-intensity interval training (HIIT)-based protocol as part of a multimodal prehabilitation program for patients with colorectal cancer awaiting surgery and to explore potential associated factors.

Methods: The study analyzed 136 patients allocated to a prehabilitation exercise training program in a multicenter prehabilitation program. Compliance with training was defined based on intensity and time in HIIT during each session. Response to training was considered if patients increased peak oxygen uptake (VO_2peak) ≥10 % or >2.5 ml/kg/min after training.

Results: Data compliance was available for 104 patients. Non-compliant participants (n = 37, 35.6 %) had lower cardiorespiratory fitness (CRF) at baseline (mean difference, -2.74 ml/kg/min; p < 0.01) and tended to be older (p = 0.053). Approximately one of four patients exhibited a clinically meaningful response to exercise. Younger patients and those with lower CRF at baseline had greater odds of responding to training (Epx[B], 0.739; 95 % confidence interval {CI}, 0.58-0.93]) and Exp(B), 476 [95 % CI, 0.266-0.85 respectively). Furthermore, patients who increased VO_2peak at least 2.5 Mml/kg/min had no severe complications (Comprehensive Complication Index [CCI], ≤20) and experienced better postoperative recovery than the non-responding patients (p = 0.043 and p < 0.001 respectively).

Conclusions: Compliance with a HIIT protocol among colorectal cancer patients was found to be affected by baseline CRF and age. Only one of four patients showed a clinically significant improvement in VO_2peak after training, which was associated with less severe postoperative complications.

Background: Accurate preoperative identification of high-volume central lymph node metastasis (hv-CLNM; defined as more than 5 central lymph node metastases) is critical for guiding surgical decisions-lobectomy or total thyroidectomy-in patients with papillary thyroid carcinoma (PTC) clinically diagnosed with central neck lymph node metastasis (cN1a). Total thyroidectomy is generally preferred for patients with hv-CLNM. In contrast, lobectomy may be sufficient for patients with low-volume metastasis (5 or fewer lymph node metastases). This study aimed to identify predictors of hv-CLNM in preoperatively low-risk cN1a and to develop a predictive model to estimate the risk of hv-CLNM, thereby optimizing surgical decision-making.

Methods: A total of 707 patients with pathologically confirmed PTC and classified as preoperatively low-risk cN1a were retrospectively enrolled. Clinical and ultrasound features were collected. Variables were selected using least absolute shrinkage and selection operator regression, followed by multivariate logistic regression to construct a predictive model. Internal validation was performed. Recurrence-free survival was compared between lobectomy and total thyroidectomy groups using propensity score matching.

Results: Hv-CLNM occurred in 13.4% (96/707) of patients. Independent predictors of hv-CLNM included age, sex, tumor size, tumor location, and lymph node calcification. The nomogram demonstrated good discrimination (area under the plasma concentration-time curve = 0.75) and calibration. After adjustment, recurrence-free survival did not significantly differ between surgical groups.

Conclusions: This nomogram, based on readily available clinical and ultrasound features, effectively predicts the risk of hv-CLNM in preoperatively low-risk cN1a PTC. This tool may facilitate individualized surgical planning. Lobectomy appears to be a safe and appropriate option for most patients in this subgroup.

Background: Total vascular exclusion (TVE) enables the resection of centrally located liver tumors but remains associated with considerable intra- and perioperative morbidity. We present the Hannover Modification of TVE, which combines veno-venous extracorporeal membrane oxygenation (vvECMO) and a closed-loop in situ hypothermic oxygenated perfusion (CLIP) of the liver using the Bridge-to-Life^® VitaSmart system for targeted parenchymal protection.

Methods: A 62-year-old woman with FGFR2-fused intrahepatic cholangiocarcinoma (iCCA) involving the hepatocaval confluence and all three hepatic veins, previously deemed unresectable, underwent partial ALPPS-preserving segment IVb. One week later, extended right trisectionectomy with reconstruction of the left hepatic vein was performed under TVE. Dual perfusion circuits were established: (1) a portocaval anastomosis was established and systemic and portal venous return was maintained via vvECMO; (2) cold (4 °C), oxygenated HTK solution was infused via a left portal vein catheter, drained through the hepatic veins into the IVC, and recirculated through a caval outflow cannula.

Results: The CLIP approach ensured continuous oxygenation and hypothermia of the liver during resection and venous reconstruction without systemic cooling. Operative time was 4 hours and 3 minutes, with 72 minutes of CLIP and 130 minutes of vvECMO. Histopathology revealed a 6.5-cm iCCA (ypT1a, G2) with negative margins (R0). The postoperative course was uneventful, and the patient was discharged on postoperative day 7 with excellent liver function.

Conclusions: The Hannover CLIP technique effectively combines controlled, recirculated HOPE with vvECMO. This approach minimizes ischemic injury to the liver, kidneys, and intestines and facilitates safe resection of highly complex central liver tumors under TVE.

Background: Recent trials established safety of axillary lymph node dissection (ALND) omission in patients with 1-2 positive lymph nodes (LN) on sentinel LN biopsy (SLNB). However, the benefit of ALND in patients with 3-5 positive LNs remains debated. We examined national trends of ALND versus SLNB in this subgroup and evaluated survival outcomes.

Patients and methods: Using the National Cancer Database, we identified patients with pT0-2 ER+/HER2- breast cancer with 3-5 positive LNs who underwent adjuvant chemotherapy, endocrine therapy, and radiation therapy from January 2012 to December 2020. We compared patients who had SLNB alone versus ALND ± SLNB RESULTS: Among 13,270 patients, 1712 (12.9%) had SLNB and 11,558 (87.1%) had ALND. ALND rates decreased by 18.3% during the study period (93.4% to 75.1%). Compared with ALND, SLNB group had higher proportion of three positive LNs (63.1% versus 43.1%, p < 0.001), Charlson Comorbidity Index 0 (87.4% versus 84.4%, p = 0.001), pT1 tumor (42.8% versus 35.4%, p < 0.001), well-to-moderately differentiated tumor (72% versus 66.9%, p < 0.001), absence of lymphovascular invasion (42.7% versus 36.3%, p < 0.001), and lobular histology (16.5% versus 12.7%, p < 0.001). There was no difference in overall survival (OS) between SLNB and ALND in univariate or multivariable models (adjusted HR 1.0, p = 0.77).

Conclusions: National rates for ALND decreased in patients with 3-5 positive LNs over the last decade. There was no difference in OS with omission of ALND in patients with ER+/HER2- breast cancer with 3-5 positive LNs, supporting further studies to evaluate deescalation of axillary surgery in this population.

Background: This study aimed to compare perioperative outcomes between da Vinci XI and da Vinci SI or SP robotic radical prostatectomies.

Methods: The study systematically searched four databases: Embase, PubMed, Cochrane Library, and Web of Science. The search time ranged from database creation to July 2025. Statistical analysis was performed using Stata17. Effect denoted a continuous variable, whereas OR/RR denoted a binary variable, and the 95 % confidence interval (CI) was calculated.

Results: The seven included studies involved 2297 patients undergoing robotic radical prostatectomy. Compared with SP, XI had a longer hospital stay (effect, 0.91; 95 % CI 0.04-1.77; P < 0.05). Compared with SI, XI had a lower positive margin rate (odds ratio, 0.74; 95 % CI 0.57-0.97; P < 0.05). Operation time, estimated blood loss, overall complications, and major complications did not differ among XI, SI, and SP.

Conclusion: Compared with SP, XI's hospital stay appeared to be longer. Compared with SI, XI seemed to have a lower positive surgical margin. However, more research is needed to determine differences in oncology outcomes and cost-effectiveness among several robotic surgical platforms.