Annals of Surgical Oncology最新文献

Background: Preventative medication (PM) uptake is low among patients at an elevated risk of breast cancer, largely due to fears of intolerance. This study aimed to investigate whether a new, surgical advanced practice provider (APP)-run clinic was effectively prescribing PM. We hypothesized equivalent rates of PM uptake compared to consultation with medical oncologists (MD).

Patients and methods: The APP-run clinic and accompanying database were initiated 01/2023, including patients with benign breast complaints and/or an elevated risk of invasive breast cancer. A historic single-institution surgical database and this prospective database were queried for patients with ductal carcinoma in situ between 04/2007-05/2023 and 01/2023-01/2024, respectively. Patients with invasive breast cancer within the prior 5 years were excluded. Chart review abstracted PM type/dose. Chi square analysis compared PM uptake rates and dose.

Results: A total of 523 patients met study criteria; the MD sample and APP sample were relatively well balanced except fewer hormone receptor positive patients in the MD sample (266/309 [86.1%] versus 202/214 [94.4%] APP, p < 0.01). PM uptake was lower in the MD sample (96/309 [31.1%] compared to the APP sample (86/214 [40.2%], p = 0.03). There was significantly more tamoxifen prescribed among the APP sample (58.2% vs. 35.6% among MD, p = 0.02), and low-dose tamoxifen prescribing increased significantly (47.3% vs. 9.8% MD, p < 0.01).

Conclusions: Our surgical APP-run breast health clinic has demonstrated equivalent PM uptake as compared to patients seen previously by medical oncologists. This model should be considered broadly. Additionally, low-dose tamoxifen has become the prescription of choice; thus, long-term studies of tamoxifen 5 mg are warranted.

Introduction: Pancreatoduodenectomy (PD) is a complex surgery with high morbidity and mortality, often associated with complications like post-pancreatectomy hemorrhage (PPH) and postoperative pancreatic fistulas (POPF). The corticosteroids administered intraoperatively has been shown to improve postoperative outcomes in patients undergoing surgery. However, their impact on complications following PD remains controversial.

Results: A comprehensive review of literature found no significant impact of perioperative corticosteroids on postoperative complications in PD, including postoperative major complications (PMCs), POPF, infectious complications, delayed gastric emptying (DGE), post-pancreatectomy hemorrhage (PPH), bile leakage, reoperation, or 30-days mortality.

Conclusion: Other medications, such as octreotide, antibiotics, and probiotics, have shown potential in reducing complications, but further research is needed, especially for corticosteroids in PD. In the near future, more randomized controlled trials should be conducted, along with well-designed clinical studies, to provide high-level evidence for the potential benefits of corticosteroids in PD for targeted populations.

Background: The current study aimed to examine second breast cancer (SBC) risks associated with breast-conserving surgery (BCS) and unilateral mastectomy among breast cancer (BC) survivors.

Methods: The study enrolled patients with diagnoses of stages I to III BC who underwent surgery between 2000 and 2019. Fine-Gray competing risk regression models were used to estimate the cumulative incidence of SBC and to evaluate the associations between clinical factors and SBC development. Poisson regression analysis was performed to assess the risk for SBC after BCS compared with mastectomy by age and latency period. The Kaplan-Meier method was applied to examine survival between patients undergoing breast-conserving therapy (BCT) and those undergoing mastectomy for SBC.

Results: Among 740,349 patients, 467,480 underwent BCS, and 272,869 underwent mastectomy. The 10-year cumulative incidence of mastectomy was 3.77% for SBC and 2.11% for BCS. Compared with mastectomy, BCS was associated with a significantly higher risk of LR and a modestly elevated risk of contralateral breast cancer (CBC). The significant risk factors for SBC were age at initial BC diagnosis, race, marital status, year of diagnosis, tumor size, histology, molecular subtype, cancer stage, metropolitan status, type of surgery, and radiotherapy. Dynamic risk assessments showed that the relative risk of SBC after BCS versus mastectomy decreased with advancing age, but increased with longer follow-up periods.

Conclusions: This cohort study showed that BC survivors undergoing BCS have a higher risk of SBC than those undergoing mastectomy. With the ongoing evolution of surgical options, achieving optimal long-term outcomes necessitates a more comprehensive assessment that balances oncologic efficacy with patient-centered outcomes.

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: Previous results from the KEYNOTE-716 trial demonstrated significantly improved recurrence-free survival (RFS) and distant metastasis-free survival (DMFS) with adjuvant pembrolizumab versus placebo in patients with resected stage IIB or IIC melanoma. We present a post hoc analysis of efficacy according to primary tumor location.

Methods: KEYNOTE-716 (NCT03553836) is a randomized, multicenter, double-blind, phase III study. Patients aged ≥ 12 years with newly diagnosed, resected stage IIB or IIC melanoma (sentinel node-negative) were randomly assigned (1:1) to pembrolizumab 200 mg every 3 weeks (2 mg/kg up to 200 mg for pediatric patients) or placebo. This post hoc analysis evaluated RFS and DMFS by primary tumor location of the head/neck, trunk, or extremities.

Results: Overall, 976 patients were assigned to pembrolizumab (n = 487) or placebo (n = 489). Median follow-up was 39.4 months (range 26.0-51.4). The hazard ratios {HRs (95% confidence interval [CI])} for RFS were 0.60 (0.38-0.93) for the head/neck subgroup, 0.57 (0.38-0.84) for the trunk subgroup, and 0.69 (0.47-1.02) for the extremities subgroup. The HRs (95% CI) for DMFS were 0.65 (0.37-1.14) for the head/neck subgroup, 0.59 (0.38-0.92) for the trunk subgroup, and 0.53 (0.31-0.90) for the extremities subgroup.

Conclusion: RFS and DMFS consistently favored adjuvant pembrolizumab over placebo in most subgroups analyzed in this post hoc analysis from the KEYNOTE-716 trial. These results support the benefit of adjuvant pembrolizumab on RFS and DMFS in patients with resected high-risk stage II melanoma, irrespective of primary tumor location.