Clinical Surgical Oncology最新文献

{"title":"Breaking barriers: Pembrolizumab's role in overcoming targeted therapy resistance in BRAF-mutant melanoma","authors":"Omer A. Idris ,&nbsp;Abdulaziz Shebrain ,&nbsp;Ali Jawad ,&nbsp;Sabrina C. Pacione ,&nbsp;Delour Haj ,&nbsp;Hanin Bzizi ,&nbsp;Yaqub O. Ahmedfiqi ,&nbsp;Bahar Saadaie Jahromi ,&nbsp;Nicholas Deleon ,&nbsp;Tiantian Zhang ,&nbsp;Amanda Hunt ,&nbsp;Ramona Meraz Lewis ,&nbsp;Diana Westgate","doi":"10.1016/j.cson.2025.100095","DOIUrl":"10.1016/j.cson.2025.100095","url":null,"abstract":"<div><div>Melanoma, a malignancy of melanocytes, has increased globally, posing significant treatment challenges. BRAF mutations, particularly V600E and V600K variants, occur in approximately 40–60 ​% of cutaneous melanomas and activate the MAPK/ERK signaling pathway. Although BRAF and MEK inhibitors have improved response rates and survival, acquired resistance—due to genetic alterations, activation of alternative pathways, and phenotypic changes—remains a major hurdle.</div><div>Pembrolizumab, an anti-PD-1 immune checkpoint inhibitor, has emerged as a promising option to overcome resistance to targeted therapies. This review explores the rationale for using pembrolizumab post-resistance, emphasizing its ability to enhance immune recognition through the immunogenic effects of prior targeted therapies and its synergistic potential when combined with BRAF and MEK inhibitors. Clinical evidence from KEYNOTE trials and real-world studies demonstrates pembrolizumab's efficacy as monotherapy and in combination regimens, leading to improved progression-free and overall survival in patients with advanced melanoma. Mechanistic insights from preclinical studies suggest that targeted therapies modulate the tumor microenvironment and enhance antigen presentation, augmenting the effectiveness of pembrolizumab. Novel biomarkers such as tumor mutational burden (TMB), PD-L1 expression, and circulating tumor DNA (ctDNA) are examined for their potential to predict treatment response and guide personalized therapy. Challenges related to increased toxicity in combination therapies, economic impact, and patient heterogeneity are discussed, highlighting the need for careful patient selection and management strategies. Future directions include optimizing treatment sequencing, exploring novel therapeutic combinations, and advancing personalized medicine through integrative genomic and immunologic data. This review underscores the pivotal role of pembrolizumab in managing BRAF-mutant melanoma and emphasizes the importance of integrated therapeutic strategies to improve patient outcomes.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100095"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144988235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of patients scheduled for CRS and HIPEC yet only undergoing explorative laparotomy","authors":"Valentinus Valdimarsson,&nbsp;Ingvar Syk,&nbsp;Victor Verwaal","doi":"10.1016/j.cson.2025.100093","DOIUrl":"10.1016/j.cson.2025.100093","url":null,"abstract":"<div><h3>Background</h3><div>Some patients scheduled for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) only undergo explorative laparotomy (open/close procedure) due to extensive tumor spread or challenges in achieving complete cytoreduction (CC0). This study aimed to evaluate the surgical outcomes and overall survival in patients with peritoneal surface malignancy (PSM) who only undergo open/closed laparotomy.</div></div><div><h3>Methods</h3><div>All patients scheduled for CRS and HIPEC in Malmö, Sweden, between 2015 and 2023, who only underwent open/close laparotomy were included. Patients without malignant diagnoses were excluded. Clinical, survival, and complication data were analyzed.</div></div><div><h3>Results</h3><div>A total of 28 patients underwent open/closed laparotomy only. Before the laparotomy, 15 (54 ​%) patients had undergone diagnostic laparoscopy with a median PCI score of 13.0 (IQR 10.0–19.0). During the laparotomy, the median PCI score was found to be 29.0 (IQR 25.5–33.0). The most common reason for not proceeding with CRS and HIPEC surgery was a high PCI score (61 ​%). Three patients (11 ​%) experienced serious postoperative complications (Clavien-Dindo ≥3b), and one patient died during the first postoperative day. After the explorative laparotomy, twenty-one (78 ​%) patients received palliative chemotherapy (median survival of 13.4 months), whereas six received none (median survival of 3.5 months), with missing data from one patient.</div></div><div><h3>Conclusion</h3><div>Patients diagnosed with PSM who undergo only exploratory laparotomy (open/close) have a very poor prognosis. Exploratory laparotomy poses a significant risk of serious postoperative complications, as well as a lengthy hospital stay. Improved diagnostic tools are urgently needed to help identify the right patients for CRS and HIPEC treatment.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the quality and readability of AI-generated ophthalmic surgery education: A four model comparison","authors":"Rickvir S. Sidhu ,&nbsp;Arrane Selvamogan","doi":"10.1016/j.cson.2025.100092","DOIUrl":"10.1016/j.cson.2025.100092","url":null,"abstract":"","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100092"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant therapy for patients with advanced colon cancer: Analysis of the National Cancer Database (NCDB)","authors":"Guanming Chen ,&nbsp;Jesus C. Fabregas ,&nbsp;Zhigang Xie ,&nbsp;Ilyas Sahin ,&nbsp;Girish Mishra ,&nbsp;Jiamin Hu ,&nbsp;Rachel E. Liu-Galvin ,&nbsp;Young-Rock Hong","doi":"10.1016/j.cson.2025.100097","DOIUrl":"10.1016/j.cson.2025.100097","url":null,"abstract":"<div><h3>Background</h3><div>Few real-world studies have characterized the utilization pattern and overall survival (OS) benefits associated with neoadjuvant therapy (NAT) among patients diagnosed with colon cancer.</div></div><div><h3>Patients and methods</h3><div>In this retrospective cohort study, we identified adult patients diagnosed with stages II-IV colon cancer from 2015 to 2020 using the US National Cancer Database. Patients were grouped based on treatment modality and sequence: NAT and those treated by upfront surgery followed by adjuvant therapy (ADT). We examined utilization pattern of NAT by patients’ sociodemographic, medical, and facility characteristics. We then used Kaplan Meier method and Cox proportional hazards models to compare OS across cancer stages between two groups.</div></div><div><h3>Results</h3><div>Of the 116,905 patients who met inclusion criteria, 8110 (6.9 ​%) received NAT. Overall, patients underwent NAT were generally younger (age ≤64 years), privately insured, diagnosed with stage IV colon cancer, and with liver metastasis. Receipt of NAT was associated with significantly improved OS among patients with stage IV colon cancer after adjusting for covariates (hazard ratio, 0.79; 95 ​% CI: 0.76–0.83, <em>p</em> ​&lt; ​0.001). Subgroup analysis results showed that NAT was associated with better OS compared to those received ADT regardless of age, liver metastasis status, comorbidity score, and KRAS mutation status. For patients with stages II or III colon cancer, NAT was not associated with improved OS.</div></div><div><h3>Conclusion</h3><div>Neoadjuvant therapy was significantly associated with improved OS among patients with stage IV colon cancer. Future investigations are needed to understand the role of NAT in locally advanced colon cancer.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100097"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing the quality and readability of AI chatbot responses to frequently asked questions about basal cell carcinoma","authors":"Rickvir S. Sidhu ,&nbsp;Arrane Selvamogan","doi":"10.1016/j.cson.2025.100094","DOIUrl":"10.1016/j.cson.2025.100094","url":null,"abstract":"","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145104479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk factors for anastomotic fistula after total mesorectal excision: A monocentric retrospective study of 78 patients","authors":"Amine Majdoubi ,&nbsp;Anass El Aachi ,&nbsp;Mohammed El Hammouti ,&nbsp;Haïtam Aabalou ,&nbsp;Ayoub Kharkhach ,&nbsp;Tariq Bouhout ,&nbsp;Badr Serji","doi":"10.1016/j.cson.2025.100096","DOIUrl":"10.1016/j.cson.2025.100096","url":null,"abstract":"<div><h3>Introduction</h3><div>Anastomotic fistulas remain one of the most feared complications following rectal surgery, particularly after Total Mesorectal Excision (TME). They compromise prognosis, prolong hospitalization, and increase costs due to the additional interventions they necessitate.</div></div><div><h3>Aims</h3><div>To identify predictive factors for the occurrence of anastomotic fistulas, with the goal of personalizing and optimizing surgical management—particularly to guide decisions regarding the use of defunctioning stomas.</div></div><div><h3>Materials and methods</h3><div>We conducted a retrospective observational study on 78 patients who underwent TME with low rectal anastomosis for rectal adenocarcinoma at Hassan II University Hospital in Oujda, between December 2017 and May 2024.</div></div><div><h3>Results</h3><div>Of the 78 patients, 21 developed anastomotic fistulas, yielding an incidence rate of 26.9 ​%. Late-onset cases were predominant (16 cases, 76.19 ​%) compared to early-onset cases (five cases, 23.81 ​%). In univariate analysis, diabetes (p ​= ​0.002), intraoperative incidents (p ​= ​0.014) - particularly blood loss exceeding 150 ​cc (p ​= ​0.001) - and smoking (p ​= ​0.005) were significant risk factors for fistula development. In multivariate analysis, diabetes (OR ​= ​10.87; p ​= ​0.003) and intraoperative blood loss &gt;150 ​ml (OR ​= ​7.38; p ​= ​0.030) emerged as independent predictors of fistula development. Active smoking showed a borderline association (OR ​= ​6.46; p ​= ​0.056), suggesting a potential but not statistically confirmed impact on anastomotic fistula. These findings are consistent with the existing literature. In contrast, other factors commonly reported in the literature, such as male sex (p ​= ​0.530), ASA score (p ​= ​0.612), anemia (p ​= ​0.324), and preoperative (p ​= ​0.781) and postoperative albumin levels (p ​= ​0.119), did not show a significant association in our study.</div></div><div><h3>Discussion and conclusion</h3><div>While the identified risk factors are relevant, they alone are insufficient to warrant major modifications in our surgical strategy, particularly regarding the decision to perform a defunctioning stoma. Further studies are necessary to validate these findings.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144932187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic stoma in robotic radical surgery for low-to-intermediate rectal cancer","authors":"Zhekun Huang ,&nbsp;Songbin Lin ,&nbsp;Peiwen Zhou ,&nbsp;Yang Lv ,&nbsp;Guodong He ,&nbsp;Ye Wei ,&nbsp;Jianmin Xu ,&nbsp;Wentao Tang","doi":"10.1016/j.cson.2025.100091","DOIUrl":"10.1016/j.cson.2025.100091","url":null,"abstract":"<div><h3>Background</h3><div>Anastomotic leakage are common and serious complications after surgery for low and intermediate rectal cancers; a prophylactic stoma is thought to reduce the incidence of anastomotic leakage and alleviate its serious complications. However, it also comes with numerous risks. This study will investigate the value of prophylactic stomas in robot-assisted radical surgery for low and intermediate rectal cancers.</div></div><div><h3>Methods</h3><div>We included 670 patients with low-to-intermediate rectal cancer who underwent robot-assisted radical resection at two hospitals within Fudan University from June 2016 to October 2022 (77 underwent prophylactic stoma and 593 did not have prophylactic stoma). The clinical data of the patients were collected and analyzed using a propensity score matching method that matched the groups at a 1:1 ratio based on sex, diabetes mellitus, body mass index, neoadjuvant chemoradiotherapy, distance of the lower edge of the tumor from the anal verge, maximum diameter of the tumor, and preoperative incomplete obstruction.</div></div><div><h3>Results</h3><div>Patients in the prophylactic stoma group had a significantly lower incidence of symptomatic anastomotic leakage than the non-stoma group. There were no significant differences in the overall postoperative complication, unplanned readmission, or 30-day postoperative reoperation rates between the groups; however, the prophylactic stoma group had a lower number of postoperative hospital days and lower average hospital costs. Preoperative bowel obstruction was an independent risk factor for postoperative anastomotic leakage in the prophylactic stoma group.</div></div><div><h3>Conclusions</h3><div>Prophylactic stomas based on a robotic platform are beneficial for some high-risk patients with low-to-intermediate rectal cancer.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unusual lymphangioleiomyomatosis presenting as a pure perivascular growth pattern","authors":"Maria Angela D. Magpantay ,&nbsp;Corine Astroth ,&nbsp;Alfred Garcia ,&nbsp;Dong Ren ,&nbsp;Oliver Eng ,&nbsp;Michael P. O'Leary","doi":"10.1016/j.cson.2025.100089","DOIUrl":"10.1016/j.cson.2025.100089","url":null,"abstract":"<div><h3>Introduction</h3><div>Lymphangioleiomyomatosis (LAM) is a rare disease mainly affecting women of child-bearing age that primarily involves lung parenchyma smooth muscles with resulting cystic changes. This disease can present symptomatically as shortness of breath or as a recurrent pneumothorax. Rare instances of extrapulmonary manifestations involving the kidneys and other visceral organs have been reported. Herein, we describe an unusual case of LAM in a patient with a retroperitoneal mass showing pure perivascular growth pattern.</div></div><div><h3>Case presentation</h3><div>We report a case of a 41-year-old female who presented with abdominal pain and was found to have a left para-aortic mass. This was at the aortic bifurcation and concerning for a paraganglioma; however, laboratory analysis excluded a functional mass. The patient was lost to follow-up due to complications from the COVID-19 pandemic and established care 4 years later, at which time biopsy revealed the diagnosis of LAM. She ultimately underwent surgical resection.</div></div><div><h3>Conclusion</h3><div>This is a unique presentation of non-pulmonary, para-aortic LAM. This case reviews the relevant literature and presents a methodical histologic work up of this unusual mass.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-driven surgical oncology: Innovations, challenges, and the path ahead","authors":"Wen Yuan Chung","doi":"10.1016/j.cson.2025.100088","DOIUrl":"10.1016/j.cson.2025.100088","url":null,"abstract":"","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144685630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric and visualized analysis of fertility preservation in patients with gynecological malignancies from 2014 to 2023","authors":"Zhanghuan Li ,&nbsp;Wenqi Du ,&nbsp;Yufei Qin ,&nbsp;Yinghui Yang ,&nbsp;Yuxia Gao ,&nbsp;Jing Yang ,&nbsp;Xiaojie Feng ,&nbsp;Wenqiang Fan ,&nbsp;Wenxiang Wang","doi":"10.1016/j.cson.2025.100085","DOIUrl":"10.1016/j.cson.2025.100085","url":null,"abstract":"<div><h3>Objective</h3><div>Fertility preservation in patients with gynecological malignancies (FP-GM) has gained increasing attention. This study conducts a bibliometric analysis of FP-GM research, aiming to identify key themes, influential publications, major contributors, and emerging trends that have shaped the field over the last decade.</div></div><div><h3>Methods</h3><div>Data were sourced from the Web of Science Core Collection (WOSCC). Tools such as CiteSpace and VOSviewer were utilized to conduct a detailed bibliometric analysis, focusing on keyword co-occurrence, citation bursts, collaboration networks, and clusters of influential references.</div></div><div><h3>Results</h3><div>A total of 2029 original articles were identified, involving 11446 authors from 342 countries and 8693 institutions, and published across 417 academic journals. Annual Publication generally shows an increasing trend. The USA is leading much of the advancement in this field. <em>The International Journal of Gynecological Cancer</em> published the most articles, and the journal with the most citations was <em>Fertility and Sterility</em>. Grynberg, Michael was the author with the most publications, and Donnez, J was the author with the most citations. The most frequently occurring keywords were “fertility preservation”, “cancer”, “women” and “chemotherapy”. Clusters of references including “cryopreservation techniques”, “ovarian cancer”, “cervical cancer”, “endometrial cancer” and so on. Citation bursts underscored the impact of guidelines and experimental research on the evolution of FP-GM.</div></div><div><h3>Conclusion</h3><div>Research on FP-GM is dominated by cryopreservation techniques and the reproductive consequences of cancer treatments. Influential guidelines and experimental research have shaped the field, with emerging interest in fertility-sparing treatments and hormonal preservation strategies, indicating a continuous evolution in clinical practices.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144867119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}