Annals of Surgical Oncology最新文献

Background: Data to inform surgical management of the axilla after neoadjuvant endocrine therapy (NET) are limited. Here we report nodal status, surgical procedure, and outcomes among patients enrolled between 2016 and 2020 in the Palbociclib and Endocrine therapy for LObular breast cancer Preoperative Study (NCT02764541).

Methods: Women with hormone receptor-positive, HER2-negative tumors > 1.5 cm, any cN, were randomized 2:1 to NET ± palbociclib for 24 weeks. Axillary surgery (sentinel lymph node biopsy [SLNB] ± axillary dissection [ALND]) and nodal evaluation (H&E ± IHC) were not specified in the protocol. Pathologic node-positive (ypN+) rates, local-regional recurrence-free interval (LRRFI), and breast cancer-specific survival (BCSS), compared by univariate Cox proportional hazards, were prespecified exploratory endpoints.

Results: A total of 188 patients were analyzed (128 treated with NET + palbociclib, 60 NET), median age 56.5 years (interquartile range [IQR] 50-66). 82 (43.6%) had lobular histology, 99 (52.7%) were cN0, 84 (44.7%) cN+, and 5 (2.6%) cN unknown. Of cN+ patients with known ypN, nodal pathologic complete response rates were 10.9% (6/55) after NET + palbociclib and 13.6% (3/22) after NET. Among 108 ypN+ patients, 26 (24.1%) underwent SLNB, 82 (75.9%) ALND, and 99 (91.7%) radiation. At 4.65 years (IQR 3.66-5.56) median follow-up, 3-year LRRFI for ypN+ patients treated with SLNB only was 96% (88.6%, 100%) and ALND was 97.4% (93.9%, 100.0%), p = 0.6; 3-year BCSS for SLNB was 96.0% (88.6%, 100.0%) and ALND was 100.0% (100%, 100%), p = 0.9.

Conclusions: The addition of palbociclib to NET did not impact pathologic nodal outcomes. Among those with ypN+ disease, neither LRRFI nor BCSS appears to be impacted by performance of ALND.

Trial registration: clinicaltrials.gov, NCT02764541.

Background: Currently, patients with biopsy-proven axillary disease undergoing neoadjuvant chemotherapy (NAC) must undergo completion axillary lymph node dissection (cALND) if there is residual disease in the sentinel lymph nodes (SLN). In the era of axillary de-escalation, our objectives were to evaluate the frequency of involved non-SLN during cALND and whether clinical, radiologic, and pathologic characteristics can predict non-SLN involvement.

Methods: This was a multicenter, retrospective cohort study of patients with biopsy proven node-positive breast cancer between 2012 and 2024, who had residual nodal metastases (ypN+) post NAC and underwent cALND following SLN biopsy (SLNB) or targeted axillary lymph node dissection (TAD). Patients were grouped by the presence or absence of positive non-SLN at cALND (cALND+ vs. cALND-). Descriptive statistics were used to compare demographic, radiologic and pathologic data between groups. Univariate and multivariate analyses were used to identify predictors of cALND+.

Results: Overall, 122 ypN+ patients were included in the study; 57 (46.7%) had cALND+. Predictors of cALND+ on multivariate analysis included the number of abnormal lymph nodes on pretreatment axillary ultrasound (odds ratio [OR] 3.74, 95% confidence interval [CI] 1.5-10, p = 0.006), SLN extracapsular extension on final pathology (OR 2.6, 95% CI 1.08-6.5, p = 0.036), lymphovascular invasion (OR 2.47, 95% CI 1.05-6.02, p = 0.041) and SLN ratio (positive SLNs/total SLNs excised) > 0.5 (OR 4.33, 95% CI 1.88-10.4, p < 0.001).

Conclusions: This study proposes factors that predict cALND+ in initially node-positive patients who undergo NAC and have ypN+ disease on SLNB/TAD and identifies patients who should potentially be selected for cALND versus those who maybe be spared.

Background: The efficacy of Hi-cut pancreaticoduodenectomy (PD) for widespread distal cholangiocarcinoma (DCC) remains unclear. This study re-evaluated the impact of Hi-cut PD on survival, recurrence, and short-term complications.

Methods: The study retrospectively enrolled patients who underwent curative-intent PD for DCC between 2005 and 2021. Hi-cut PD was defined as bile duct resection beyond the midpoint between the superior border of the pancreas and the hepatic duct confluence. Bile duct margin status was classified as group A (negative or carcinoma in situ by PD), group B (negative or carcinoma in situ by Hi-cut PD), or group C (residual invasive cancer by Hi-cut PD).

Results: The study enrolled 104 patients: 52 (50.0%) in group A, 46 (44.2%) in group B, and 6 (5.8%) in group C. The 5-year overall survival rates in groups A and B were comparable (52.3% vs 52.5%; p = 0.793). The patients without lymph node metastasis had a significantly better 5-year overall survival in group B than in group C (70% vs 25%; p = 0.027). Local recurrence rates were similar between the groups, and major surgical complications (Clavien-Dindo ≥IIIa) were comparable between groups A and B (15.4% vs 21.7%; p = 0.418). Although multiple bile duct orifices were most frequent in group B, the incidence of biliary fistula increased significantly only when five or more orifices were reconstructed (40% vs 4% with one orifice; p = 0.003).

Conclusions: Hi-cut PD for widespread DCC yielded survival outcomes comparable with PD without increasing local recurrence or major short-term complication rates, supporting its feasibility and oncologic validity as a less invasive alternative to hepatopancreatoduodenectomy for select patients.

Background: Completely endophytic renal tumors (CERTs) pose significant challenges in surgical decision-making owing to their intricate anatomical locations and structures. Currently, clinical practice lacks a standardized classification system to guide surgical approaches for CERTs situated in diverse anatomical regions. This study proposes an innovative imaging-guided classification system designed to facilitate personalized surgical guidance. In addition, we evaluated the system's effectiveness in improving surgical precision and clinical outcomes.

Patients and methods: A retrospective analysis was conducted on 190 patients with CERT who underwent partial nephrectomy (PN) at the Second Hospital of Tianjin Medical University from 2018 to 2024. Utilizing the novel imaging-based CERT classification, optimal surgical strategies were identified for each subtype. The clinicopathologic characteristics, postoperative renal function recovery, and prognostic outcomes among patient subgroups were systematically assessed. Furthermore, independent predictors of Trifecta achievement in patients with CERT following PN were identified.

Results: The 190 CERT cases were classified into three categories on the basis of imaging criteria: Type I (N = 57), Type II (N = 107; subdivided into IIa: 70, and IIb: 37), and Type III (N = 26). Compared with Types I and II, patients classified as Type III demonstrated significantly higher P.A.D.U.A. and R.E.N.A.L. scores, longer operative times, increased warm ischemia times (WITs), and notably lower Trifecta achievement rates. Univariate and multivariate logistic regression analyses identified ASA score, tumor size, and the newly proposed CERT classification system as independent predictors of Trifecta achievement.

Conclusions: The imaging-guided CERT classification system effectively guides personalized surgical planning, enhances surgical precision, and promotes improved postoperative renal function recovery. Research registration unique identifying number (UIN): UNI:NCT06954571.