Annals of Surgical Oncology最新文献

Background: Hepatic artery infusion (HAI) chemotherapy improves hepatic recurrence rates and survival for patients with colorectal liver metastases (CRLM) in the adjuvant setting. Dose reductions of HAI floxuridine (FUDR) are common due to hepatotoxicity. The impact of these dose adjustments on patient outcomes is unclear.

Methods: This study retrospectively analyzed patients who underwent adjuvant HAI pump placement for CRLM between January 2000 and October 2017. The study enrolled only patients intended to receive six cycles of FUDR. Hepatic recurrence and overall survival (OS) were correlated with the number of FUDR cycles and dose density, defined as the actual FUDR dose received divided by the expected total during six cycles.

Results: The study identified 344 patients who met the inclusion criteria. Of these 344 patients, 173 received up to four cycles of FUDR and 171 received > 4 cycles. The median dose density was 0.42 (range, 0.17-1.13). Competing risk analysis of the two groups showed no difference in risk for liver recurrence (p = 0.357). Neither the cycles of FUDR received (hazard ratio [HR], 0.93; p = 0.237) nor the FUDR dose density (HR, 1.26; p = 0.631) was associated with hepatic recurrence in the univariable analysis. Dose density was not associated with improved OS (HR, 1.35; p = 0.486), although in the multivariable analysis, increased FUDR cycles were associated with improved OS (HR, 0.86; p = 0.005).

Conclusions: In adjuvant HAI therapy for CRLM, neither the number of FUDR cycles nor the dose density of FUDR is associated with hepatic recurrence.

Background: Standard treatment for perihilar cholangiocarcinoma (PHCC) involves major hepatectomy with caudate lobectomy and biliary-enteric reconstruction (Ann Surg. 258:129-140; Ann Surg Oncol. 29:6759-6771). Some patients may develop recurrence or second primary malignancies involving the intrapancreatic bile duct (J Am Coll Surg. 221:1041-1049; Surgery. 163:732-738). In selected cases, re-resection including pancreaticoduodenectomy (PD) may offer a valuable treatment option (Ann Surg. 262:121-129). However, reports of PD following prior PHCC surgery are extremely limited, and the technical aspects have not been systematically described (J Gastrointest Surg. 2015:19(12):2138-2145; J Med Case Rep. 2016:10(1):299).

Methods: Between January 2012 and May 2025, five patients underwent PD after previous PHCC surgery. Operative videos and records were reviewed to assess characteristic technical elements, including adhesiolysis around the hepaticojejunostomy, mesenteric dissection with preservation of the jejunal limb blood supply, and complex reconstruction strategies. Postoperative outcomes were collected from medical records. Based on these data, we evaluated the technical feasibility of PD in this setting and proposed a classification of reconstruction patterns.

Results: PD was successfully completed in all five cases. The median operative time was 463 minutes, and the median blood loss was 1155 mL. No complications of Clavien-Dindo grade III or higher occurred. The original hepaticojejunostomy was preserved in all cases. In four cases, the existing afferent limb was used for pancreaticojejunostomy (Child or Whipple type). In the remaining case, a new elevated jejunal limb was created for double-tract reconstruction.

Conclusion: PD after prior PHCC surgery is technically feasible and can be safely performed. The proposed classification, along with the surgical video, may provide practical guidance for preoperative planning and intraoperative decision-making (see supplementary Figure 1).

Background: Previous studies have validated the oncologic safety of minimally invasive surgery (MIS) for advanced gastric cancer, but the feasibility of applying MIS to treat Borrmann type IV gastric cancer remains unclear. Given its distinct clinicopathological features, poor prognosis, and technical complexities in surgery, further investigation is needed. This study aimed to compare the surgical and oncological outcomes between open surgery and MIS in patients with Borrmann type IV gastric cancer.

Methods: We retrospectively analyzed data from 1025 patients who underwent open (n = 888) or minimally invasive (n = 137) gastrectomy for Borrmann type IV gastric cancer between 2003 and 2021. Propensity score matching was performed to balance baseline characteristics, and short- and long-term outcomes were compared between the matched groups.

Results: After propensity score matching, each group included 112 matched patients. The MIS group had longer operative times (p < 0.001) but shorter hospital stays (p < 0.001) than the open surgery group. Other perioperative outcomes showed no significant differences. Overall and recurrence-free survival were comparable between the two groups (p = 0.741 and p = 0.707, respectively). Adjusted hazard ratios for death and recurrence following MIS compared with open surgery were 1.20 (95% confidence interval 0.78-1.85, p = 0.396) and 1.22 (95% confidence interval 0.83-1.79, p = 0.308), respectively.

Conclusion: Our findings suggest that MIS for Borrmann type IV gastric cancer may offer long-term oncologic outcomes comparable to those with open surgery while preserving the inherent benefits of MIS.