Annals of Surgical Oncology最新文献

Background: Anastomotic leakage (AL) is a major complication in colorectal surgery, particularly following rectal cancer surgery, necessitating effective prevention strategies. The increasing frequency of colorectal resections and anastomoses during cytoreductive surgery (CRS) for peritoneal carcinomatosis further complicates this issue owing to the diverse patient populations with varied tumor distributions and surgical complexities. This study aims to assess and compare AL incidence and associated risk factors across conventional colorectal cancer surgery (CRC), gastrointestinal CRS (GI-CRS), and ovarian CRS (OC-CRS), with a secondary focus on evaluating the role of protective ostomies.

Patients and methods: A retrospective analysis was performed on 1324 patients undergoing CRC, GI-CRS, and OC-CRS between January 2015 and December 2022. Multivariate analysis was utilized to identify preoperative, intraoperative, and postoperative variables as potential AL risk factors.

Results: The overall AL rate was 3.0% (40/1324), with no significant differences among the three groups. Distinct risk factors were identified for each group: CRC (preoperative chemoradiotherapy), GI-CRS (ECOG score ≥ 2, preoperative albumin < 30 mg/dL), and OC-CRS (BMI < 18 kg/m², pelvic lymphadenectomy, preoperative albumin < 30 mg/dL, anastomosis distance < 10 cm, postoperative anemia). Protective ostomies did not reduce AL incidence, and a notable discrepancy exists between AL risk factors and those influencing protective ostomy decisions.

Conclusions: AL, while rare, remains a serious postoperative complication in CRC and CRS. Key risk factors include preoperative nutritional status and surgical details such as blood supply and anastomosis level. Each patient group presents unique risks, which must be carefully weighed when considering protective ileostomy.

Background: AT-rich interaction domain 4B (ARID4B) is a transcriptional activator that regulates the phosphatidylinositol 3-kinase (PI3K)/AKT pathway in prostate cancer. However, the role of ARID4B in hepatocellular carcinoma (HCC) has remained unclear.

Methods: This study included 162 patients who had undergone primary hepatic resection for HCC between 2008 and 2019. Their HCC samples were immunohistochemically stained for ARID4B, and ARID4B score was calculated from the intensity and percentage of staining. We retrospectively investigated the association of ARID4B score with disease-free and overall survival, and primary recurrence patterns of HCC. Furthermore, human HCC cell lines (HuH-1 and HuH-7) were knocked down for ARID4B using small-interfering RNA (siRNA), and the expression of PI3K/AKT proteins, cell proliferation, migration, and invasion ability were assessed.

Results: In multivariate analyses, negative HBs-antigen (p = 0.02), multiple tumors (p < 0.01), microvascular invasion (p = 0.03), and high ARID4B score (p = 0.01) were independent predictors of disease-free survival, while tumor size >5 cm (p = 0.03), microvascular invasion (p < 0.01), and high ARID4B score (p = 0.04) were independent predictors of overall survival. A high ARID4B score was associated with high serum α-fetoprotein (AFP) level (p = 0.04), poor tumor differentiation (p < 0.01), and microvascular invasion (p < 0.01). ARID4B scores were significantly lower in the no recurrence, intrahepatic recurrence, and extrahepatic recurrence groups, in that order. Knockdown of ARID4B using siRNA in human HCC cell lines significantly suppressed the PI3K/AKT pathway, cell proliferation, migration, and invasion.

Conclusions: ARID4B may activate the PI3K/AKT signaling pathway in HCC and may be a prognostic factor after hepatic resection for HCC.

For patients with nonmetastatic soft tissue sarcoma (STS) who are at high risk of local recurrence, the standard of care for limb-conserving local management is combined radiotherapy and surgery. Radiotherapy for STS entails 5 weeks of conventionally fractionated radiotherapy (25 × 2 Gy) preoperatively or 6 or more weeks postoperatively. There is growing interest in the use of preoperative hypofractionated regimes, viz. shorter courses with higher daily doses, for STS. Recent studies have investigated ultrahypofractionation (UHF, ≥ 5 Gy per fraction) and moderate hypofractionation (MHF, > 2 Gy but < 5 Gy per fraction) for STS. Regimens that are designed to be isoeffective for tumor control indeed result in equivalent local relapse-free survival. However, as the daily dose increases, the impacts to normal tissues and potential for toxicities increase owing to differences in fraction-size sensitivity between STS and normal tissues (e.g., skin, subcutaneous tissue, vascular structures, and bone). This article reviews the key studies informing the debate about hypofractionation for STS. We evaluate the current data that reveal relatively small patient cohorts, short follow-up time, and inconsistent toxicity reporting. A randomized, controlled investigation of conventional fractionation, MHF, and UHF is needed. The current phase 2 data confirm that any such study should have co-primary endpoints of both local relapse-free survival as well as immediate- and long-term toxicities because the fundamental question being investigated with significant increase in daily fraction size while maintaining isoeffective total dose (~ 50 Gy equivalent) is: what are the dose impacts to late-responding normal tissues that may result in decrements to physical functioning for patients?

Background: Nipple-sparing mastectomy (NSM) is infrequently performed in older women, at least in part owing to concerns regarding age-related complications. We describe postoperative outcomes of NSM in older women and risk factors for complications, with the goal of informing patient selection and decision-making.

Patients and methods: Cases of NSM with immediate implant-based reconstruction were identified from an institutional database (2009-2019). Patient characteristics and postoperative complications were compared between women 45-54 years, 55-64 years, and  ≥ 65 years. Regression models were used to identify risk factors for serious complications and reconstruction failure.

Results: Of 1998 NSMs in 1197 women, 1296 were in women 45-54 years, 521 in women 55-64 years, and 181 in women ≥ 65 years. Women ≥ 65 years had higher rates of comorbidities and more frequently incurred early postoperative complications (11% versus 7.3% in 55-64 years and 5.2% in 45-54 years, p = 0.005), particularly hematoma (5.0% versus 1.5% in 55-64 years and 1.2% in 45-54 years, p < 0.001). On univariate analysis, unadjusted rates of infection, necrosis, serious complications, and reconstruction failure did not differ significantly by age. Permanent reconstruction failure occurred in eight (4.4%) women ≥ 65 years. On multivariable analysis, age was not an independent predictor of serious complications or reconstruction failure, though current smoking, in addition to factors more common in older women (diabetes, hypertension, anticoagulation, prior radiotherapy), emerged as independent risk factors.

Conclusions: After adjusting for patient factors, older age did not increase risk of complications after NSM. Studies on functional and quality-of-life outcomes may help further refine patient selection and facilitate decision-making.