Annals of Surgical Oncology最新文献

Background: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is an extensive operation that can lead to substantial postoperative pain. A continuous wound irrigation system (CWIS) plus intraoperative methadone has been shown to be superior to neuraxial analgesia with an epidural for postoperative pain management. This study investigates the cost of CWIS + methadone compared with epidural analgesia after CRS/HIPEC.

Methods: Patient data were extracted from hospital admission data from all patients undergoing open CRS/HIPEC at our institution from 2018 to 2021. Cost data evaluated as hospital charges to the patient were obtained from publicly available hospital charge data. A Markov decision analytic model was developed to compare charge data between two pain management strategies, and a probabilistic sensitivity analysis was conducted using a Monte Carlo simulation.

Results: In our base-case analysis, we found savings of $USD7466 per patient for CWIS + methadone compared with epidural analgesia. In our sensitivity analysis, CWIS + methadone incurred fewer total charges in 93.3% of simulations for an average savings of $USD7844 per patient. The provider charges were lower in 90.4% of simulations, for an average savings of $USD691 per patient. The resource charges were lower in 91.4% of simulations for an average savings of $USD7154 per patient.

Conclusion: This study demonstrates that CWIS + methadone is a more cost-effective strategy in most cases, exhibiting dominance over epidural analgesia in 91.4% of simulations.

Background: The oncological safety of bladder preservation therapy (BPT) versus standard radical cystectomy (RC) in elderly patients with muscle-invasive bladder cancer (MIBC) remains controversial.

Materials and methods: Adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 statement and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) guidelines, we conducted a systematic literature review of publications indexed in the PubMed, Embase, Web of Science, and China National Knowledge Infrastructure (CNKI) databases through July 2025. This meta-analysis evaluated the oncological safety of BPT compared with that of RC for the treatment of elderly patients with MIBC. The outcomes were overall survival (OS) rates at 1, 5, and 10 years; cancer-specific survival (CSS) rates at 1 and 5 years; and mortality rates.

Results: Our analysis included 8 studies with a total of 4888 patients, comprising 2534 patients undergoing BPT and 2354 undergoing RC. BPT and RC did not differ significantly in 1-year OS (odds ratio [OR]) 0.81; 95% confidence interval [CI] 0.46, 1.41; p = 0.45), 5-year OS (OR 0.83; 95% CI 0.51, 1.36; p = 0.46), 10-year OS (OR 1.09; 95% CI 0.24, 4.89; p = 0.91), and 1-year CSS (OR 0.80; 95% CI 0.61, 1.04; p = 0.10). However, BPT was inferior in terms of 5-year CSS (OR 0.51; 95% CI 0.42, 0.63; p < 0.00001) and exhibited a higher mortality rate (OR 2.06; 95% CI 1.24, 3.42; p = 0.005).

Conclusions: BPT was proven more favorable for elderly patients when contrasted with those of unstratified age groups. Indirect comparisons within BPT sub-analyses suggest that combining transurethral resection of bladder tumors (TURBT) with chemoradiotherapy (CRT) might yield greater benefits than either treatment alone or in dual combination. Due to high heterogeneity and the retrospective design of included studies, the results should be interpreted with caution.

Background: Risk calculators (RCs) support clinicians estimating the likelihood that a pancreatic intraductal papillary mucinous neoplasm (IPMN) would progress so that surveillance might be discontinued for low-risk lesions. We tested the effect of an RC on clinicians' judgment and decision-making and identified their cancer risk threshold for changing their decision.

Patients and methods: We presented clinicians with three vignettes (V1, V2, and V3) of patients with low-risk IPMNs and asked them to assess the likelihood that the IPMN would progress to develop high-risk features and whether they would recommend continuing surveillance imaging. Clinicians were randomly assigned to the clinical vignettes alone (n = 35) or supplemented by data from the Dutch-American Risk Stratification Tool (DART-1 RC: n = 37). We compared clinicians' judgments and decisions between groups and assessed their cancer risk threshold (level of risk at which recommendation would change).

Results: Across all vignettes, the RC resulted in no change in clinicians' judged likelihood of IPMN progression (V1 8.49 vs. 8.41%, p = 0.09; V2 4.39 vs. 6.75%, p = 0.99; V3 13.61 vs. 13.29%, p = 0.27) or recommendation to continue surveillance (V1 57 vs. 41%, p = 0.78; V2 41 vs. 59%, p = 0.55; V3 66 vs. 34%, p = 0.31). Clinicians varied in their reported risk threshold (V1 9%, interquartile range [IQR] 2, 13%; V2 9% [IQR 1, 15%], V3 8% [IQR 3, 20%]).

Conclusions: An RC did not significantly influence clinicians' risk perception or decision to continue surveillance, although the study was limited by low sample size. The cancer risk threshold at which clinicians would change their recommendation varies widely. Future work is needed to understand why RCs do not appear to alter decision-making.

Background: Pembrolizumab monotherapy is the standard first-line treatment for advanced non-small-cell lung cancer (NSCLC) with programmed cell death ligand-1 (PD-L1) expression ≥ 50%. However, long-term effectiveness and safety in real-world populations remain underexplored.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library through February 2025 for real-world studies reporting outcomes of first-line pembrolizumab monotherapy in patients with advanced NSCLC and PD-L1 ≥ 50%, excluding those with EGFR/ALK alterations. Primary outcomes were pooled mean overall survival (OS), timepoint-specific OS rates, and progression-free survival. Secondary outcomes included adverse event rates and hazard ratios (HRs) for OS based on age, Eastern Cooperative Oncology Group performance status, PD-L1 intensity, and brain metastases. Kaplan-Meier curves were digitally reconstructed using R.

Results: In total, 12 studies encompassing 17,506 patients were included. The pooled mean OS was 21.0 months (95% confidence interval [CI] 16.9-25.1), and the 60-month OS rate was 29.0%. Mean progression-free survival was 8.7 months (95% CI 6.3-11.0). Any-grade and grade ≥3 adverse events occurred in 52% and 12% of patients, respectively. Age ≥70 years was associated with worse OS (HR 1.26; 95% CI 1.23-1.29). Eastern Cooperative Oncology Group status ≥2 was also linked to poorer outcomes (HR 2.05; 95% CI 1.04-4.05). No significant OS difference was observed for PD-L1 or brain metastases.

Conclusions: Real-world evidence confirms the long-term effectiveness and safety of pembrolizumab monotherapy for advanced NSCLC with PD-L1 ≥50%. Survival outcomes closely mirrored those from previous trials, supporting the generalizability of pembrolizumab's benefit across routine practice.

Background: Celiac axis stenosis (CAS) is a significant vascular condition in patients undergoing pancreatoduodenectomy due to division of the celiac circulation during the procedure. However, the reliable conditions for when to intervene remain undefined.

Methods: We retrospectively analyzed 1,042 consecutive patients who underwent pancreatoduodenectomy. The stenosis diameter and maximum diameter of the celiac axis were measured on preoperative multidetector CT to calculate the stenosis rate (SR). In the patients with CAS (SR ≥ 50%), two additional CT-based markers of arcade development were quantified: 1) the gastroduodenal-to-common hepatic artery diameter (GDA/CHA) ratio and 2) the diameter of the collateral artery connecting the GDA and inferior pancreatoduodenal artery. Four factors (stenosis diameter ≤2 mm, SR ≥70%, GDA/CHA ratio ≥1.0, collateral artery diameter ≥3 mm) were assessed as predictors of intraoperative intervention.

Results: Eighty-five patients (8.2%) had CAS (SR ≥50%), of which only 11 (1.1% of the entire cohort) required intervention: median arcuate ligament division (n = 4), arterial reconstruction (n = 5), or collateral preservation (n = 2). Each of the four factors (stenosis diameter ≤2 mm, SR ≥70%, GDA/CHA ratio ≥1.0, collateral artery diameter ≥3 mm) was associated with the need for intervention. Intervention for CAS was not required in any case in which none of the four factors were present. In contrast, all patients with three or more positive factors required intervention.

Conclusions: The four factors (stenosis diameter, SR, GDA/CHA ratio, and collateral artery diameter) may serve as important predictors of CAS intervention. Incorporating these factors into preoperative planning enables surgeons to prepare necessary resources.