Clinical Surgical Oncology最新文献

{"title":"Textbook outcomes among patients undergoing curative resection of pancreatic ductal adenocarcinoma in the era of neoadjuvant therapy","authors":"Lingyu Zhu ,&nbsp;Zhendong Fu ,&nbsp;Xinyu Liu ,&nbsp;Bo Li,&nbsp;Xiaohan Shi,&nbsp;Suizhi Gao,&nbsp;Xiaoyi Yin,&nbsp;Huan Wang,&nbsp;Meilong Shi,&nbsp;Penghao Li,&nbsp;Yikai Li,&nbsp;Jiawei Han,&nbsp;Yiwei Ren,&nbsp;Jian Wang,&nbsp;Kailian Zheng,&nbsp;Shiwei Guo,&nbsp;Gang Jin","doi":"10.1016/j.cson.2023.100012","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100012","url":null,"abstract":"<div><h3>Background</h3><p>Neoadjuvant therapy has been the standard care for borderline resectable or locally advanced pancreatic ductal carcinoma (BR/LA PDAC). The textbook outcome (TO) for curative resection after neoadjuvant therapy (NAT) remains understudied.</p></div><div><h3>Method</h3><p>Patients underwent curative resection for PDAC between 2019 and 2020 were confirmed from the multidisciplinary team (MDT) database prospectively maintained by the Department of Pancreatic Hepatobiliary Surgery of Changhai hospital. TO of patients received NAT was compared to those received upfront surgery (UFS), and multivariate analysis of clinicopathological parameters was performed to explore predictors for TO.</p></div><div><h3>Results</h3><p>Of 435 patients, 329(76%) patients received UFS whereas 106(24%) patients received NAT. The TO was 82.1% for the NAT cohort, 77.8% for pancreaticoduodenectomy (PD) and 86.8% for distal pancreatectomy (DP). In the UFS cohort, the TO was 73.3% overall, 70.6% for PD and 77.3% for DP. Patients in the NAT cohort had longer time of operation, more intra-operative blood loss and more vascular resection. However, TO of the NAT cohort were not statistically different compared to that in the UFS cohort (p ​= ​0.27 for PD and p ​= ​0.20 for DP). On multivariable analysis, only diabetes-free was predictive for a better TO rate after PD in the UFS cohort(p ​= ​0.003). There were no factors associated with TO after DP in the UFS cohort, nor after PD or DP in the NAT cohort.</p></div><div><h3>Conclusion</h3><p>As a composite indicator of desired surgical outcome, TO for curative resection after neoadjuvant therapy is similar to that in upfront surgery. All patients with stable or regressed tumors after NAT should be candidates for curative resection in an MDT setting.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 2","pages":"Article 100012"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49752961","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":"Which pancreaticoduodenectomy dunking conduit is optimal for very small pancreatic ducts?","authors":"Patricia C. Conroy ,&nbsp;Alexa Glencer ,&nbsp;Sarah Mohamedaly ,&nbsp;Lucia Calthorpe ,&nbsp;Joseph Lin ,&nbsp;Fernanda Romero-Hernandez ,&nbsp;Kenzo Hirose ,&nbsp;Eric Nakakura ,&nbsp;Carlos Corvera ,&nbsp;Kimberly S. Kirkwood ,&nbsp;Ajay V. Maker ,&nbsp;Adnan Alseidi ,&nbsp;Mohamed A. Adam","doi":"10.1016/j.cson.2023.100014","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100014","url":null,"abstract":"<div><h3>Background</h3><p>Pancreaticoduodenectomy data regarding the optimal technique for reconstruction of small pancreatic ducts, where duct-to-mucosa is technically difficult, are lacking. We sought to retrospectively evaluate outcomes of dunking pancreaticojejunostomy (DPJ) compared to dunking pancreaticogastrostomy (DPG) after pancreaticoduodenectomy.</p></div><div><h3>Methods</h3><p>Using NSQIP-targeted pancreatectomy data (2014–2019), we retrospectively identified patients undergoing elective pancreaticoduodenectomy with small pancreatic ducts (&lt;3 ​mm) who underwent DPJ or DPG. Outcomes between patients undergoing DPJ versus DPG were compared using multivariable regression.</p></div><div><h3>Results</h3><p>Among 780 patients, 79.8% underwent DPJ and 20.1% DPG. Patient comorbidities were similar. More patients who underwent DPG were Black, underwent vascular reconstruction (29.0% v. 10.5%; p ​&lt; ​0.001), and had shorter operative time (324 v. 377 ​min; p ​&lt; ​0.001). After adjustment, DPJ reconstruction was associated with higher likelihood of clinically-relevant postoperative pancreatic fistula (CR-POPF) (OR 2.1; p ​= ​0.024), deep abscess (OR 1.9; p ​= ​0.041), and postoperative percutaneous drainage (OR 2.2; p ​= ​0.027). There was no difference in delayed gastric emptying, postoperative sepsis, transfusions, reoperation, length of stay, or 30-day readmission.</p></div><div><h3>Conclusion</h3><p>Among patients with small pancreatic ducts where a dunking pancreaticoenteric anastomosis is performed, DPG was associated with decreased CR-POPF incidence compared to DPJ. Future clinical trials are needed to confirm the generalizability of this result across centers with varying DPG expertise.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 2","pages":"Article 100014"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49727483","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":"The evolution of treatment for resectable gastric cancer","authors":"George Z. Li ,&nbsp;Jiping Wang","doi":"10.1016/j.cson.2022.100008","DOIUrl":"https://doi.org/10.1016/j.cson.2022.100008","url":null,"abstract":"<div><p>The management of resectable gastric cancer has changed significantly over the past several decades and continues to evolve. For surgery, East Asian and Western lymphadenectomy practices have grown more convergent, with a consensus that D2 lymphadenectomy should be standard for most patients if it can be performed safely, but that more extensive lymphadenectomy or bursectomy should not be performed. Minimally invasive gastrectomy has also been established as a safe and oncologically equivalent approach to open gastrectomy, with potential short- and long-term morbidity benefits in appropriately selected patients. Moving forward, sentinel lymph node biopsy is under investigation as a possible way to de-escalate surgery for patients with early-stage gastric cancer, and other techniques such as adjuvant HIPEC are being investigated in patients with locally advanced gastric cancer. For stage 2 and 3 patients who are at high risk for recurrence with surgery alone, pre- and post-operative chemotherapy has evolved to become the standard of care in the West, while adjuvant chemotherapy has remained the standard of care in the East. There have been slow but steady incremental improvements in outcomes over the past several decades, but the timing and composition of multimodal therapy remain to be optimized. Furthermore, as our understanding of the molecular underpinnings of gastric cancer has continued to expand, exciting new systemic therapy strategies are under investigation for specific subgroups of gastric cancer, such as the use of perioperative immunotherapy for microsatellite unstable gastric cancers.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 1","pages":"Article 100008"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750582","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":"Breast radiation-associated secondary malignancies: A review","authors":"Sarah Poland ,&nbsp;Wataru Ebina ,&nbsp;Franco Muggia ,&nbsp;Amber Guth","doi":"10.1016/j.cson.2023.100010","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100010","url":null,"abstract":"<div><p>Secondary malignancies are a late complication of radiation treatment for primary cancer through DNA damage. Specifically after breast cancer radiation, a number of tissues are vulnerable to radiation damage and have increased risk for developing secondary malignancies including lung cancer, esophageal cancer, and contralateral breast cancer. Radiation dose must be minimized to healthy tissues, and patients monitored for potential complications as secondary malignancies can occur decades after original radiation. Through evaluation and examination of current literature, this review article aims to summarize molecular mechanisms of DNA damage and radiation-induced malignancies, and discuss the types of secondary neoplasms including radiation induced breast cancer and therapy-associated myeloid neoplasms.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 1","pages":"Article 100010"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750587","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":"The development and prospects of liver surgery","authors":"Hui-Chuan Sun ,&nbsp;Ying-Hao Shen ,&nbsp;Cheng Huang ,&nbsp;Xiao-Dong Zhu ,&nbsp;Chang-Jun Tan ,&nbsp;Zhao-You Tang ,&nbsp;Jia Fan ,&nbsp;Jian Zhou","doi":"10.1016/j.cson.2023.100009","DOIUrl":"https://doi.org/10.1016/j.cson.2023.100009","url":null,"abstract":"<div><p>Surgical treatment is the classic treatment modality for focal liver diseases. In 140 years, liver surgery is constantly evolving, along with advances in understanding anatomy, physiology, and emergence of technologies. During the last 30 years, many surgical techniques used in the modern ages became available since the 1990s, and liver surgery is becoming a routine procedure in many hospitals in China because of the significant decrease in surgical mortality. Furthermore, liver surgery is playing an increasingly important role in multimodality treatment for liver cancer while the treatment pattern is also changing because of progresses in systemic treatment. The progresses in liver surgery are summarized in the article.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"2 1","pages":"Article 100009"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750584","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":"Opportunities and challenges for young surgical oncologists","authors":"Ying-Hong Shi,&nbsp;Wei-Feng Qu,&nbsp;Jia Fan","doi":"10.1016/j.cson.2022.100001","DOIUrl":"10.1016/j.cson.2022.100001","url":null,"abstract":"","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"1 1","pages":"Article 100001"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X22000010/pdfft?md5=a59da0b5d3746f238ee76bf9eda10517&pid=1-s2.0-S2773160X22000010-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87361271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Propensity score analysis for the efficacy of preoperative antibiotics in patients with resected primary lung cancer: Levofloxacin versus cefazolin","authors":"Kenji Tomizawa ,&nbsp;Junichi Soh ,&nbsp;Hana Oiki ,&nbsp;Shota Fukuda ,&nbsp;Masaya Nishino ,&nbsp;Katsuaki Sato ,&nbsp;Tetsuya Mitsudomi","doi":"10.1016/j.cson.2022.100005","DOIUrl":"10.1016/j.cson.2022.100005","url":null,"abstract":"<div><h3>Objective</h3><p>The use of cefazolin (CEZ) is recommended as a preoperative prophylactic antibiotic, but other antibiotics may be used for various reasons. We adopted a fluoroquinolone (levofloxacin; LVFX) as a preoperative prophylactic antibiotic because of reduced supply of CEZ worldwide, while the efficacy of LVFX in preventing infectious complications including surgical site infection (SSI), empyema, and pneumonia has not been fully investigated.</p></div><div><h3>Methods</h3><p>The medical records of 260 patients who underwent primary lung cancer resection between April 2018 and July 2020 were retrospectively reviewed. Eighty-nine patients before May 2019 were intravenously received a single dose of CEZ with additional administration every 3 ​h during surgery (the CEZ group) and 171 patients after that date were orally received a preoperative single dose of LVFX (the LVFX group). The efficacy of preventing infectious complications was compared between two groups. The propensity score matching (PSM) method was also applied to minimize selection bias.</p></div><div><h3>Results</h3><p>Infectious complications were observed in 3.1% (8/260) of patients, with no significant difference between the LVFX group (2.9%) and the CEZ group (3.4%) regardless of subtypes such as SSI and empyema. After PSM, 77 patients each were matched from the two groups, and there was also no significant difference in the incidence of infectious complications (the LVFX group; 2.6% vs. the CEZ group; 3.9%).</p></div><div><h3>Conclusion</h3><p>LVFX has comparable efficacy to CEZ for preventing infectious complications, and may be an alternative to preoperative antibiotics for patients with primary lung cancer who underwent pulmonary resection.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"1 1","pages":"Article 100005"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X22000058/pdfft?md5=239aabd05cc2e1747bc4797cc804349f&pid=1-s2.0-S2773160X22000058-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91196468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Faster postoperative recovery by robotic-assisted surgery in elderly patients with sigmoid colon and rectal cancer","authors":"Pingping Xu ,&nbsp;Yang Lv ,&nbsp;Zhengchuan Niu ,&nbsp;Qi Lin ,&nbsp;Dexiang Zhu ,&nbsp;Ye Wei ,&nbsp;Jianmin Xu","doi":"10.1016/j.cson.2022.100007","DOIUrl":"10.1016/j.cson.2022.100007","url":null,"abstract":"<div><h3>Background</h3><p>Currently, no published studies have compared the short-term and long-term outcomes of robotic-assisted and open surgery for elderly patients (aged 65 years or older) with sigmoid colon and rectal cancer in China. Hence, our study was conducted to assess whether robotic-assisted surgery is superior to traditional approaches.</p></div><div><h3>Methods</h3><p>A total of 208 patients who received either open resection (n ​= ​93) or robotic-assisted resection (n ​= ​115) between October 2010 and October 2014 were included in the study. We compared clinical characteristic variables and patient demographics between the two approaches and assessed short- and long-term outcomes.</p></div><div><h3>Results</h3><p>Patient characteristics were not significantly different between the groups. First flatus postoperative days (<em>P ​&lt;</em> .001), less time to liquid diet (<em>P</em> ​= ​.004), and shorter postoperative hospital stay (<em>P</em> ​= ​.046) were found in the robotic-assisted surgery group. The operation time was also more in the robotic-assisted surgery group (<em>P</em> ​= ​.03). The 3-year overall survival rate was 83.0% in the robotic-assisted surgery group and 78.0% in the open surgery group (<em>P</em> ​= ​.938). The 3-year disease free survival rate was 76.0% and 72.0% in the robotic-assisted surgery and open surgery groups, respectively (<em>P</em> ​= ​.817). No significant difference was found in the overall survival and disease-free survival between the two approaches.</p></div><div><h3>Conclusions</h3><p>Robotic-assisted surgery is safe and feasible for elderly patients with sigmoid colon and rectal cancer and is associated with more operation time and faster recovery as compared to open surgery. No significant differences were found in 3-year survival outcomes between the two groups.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"1 1","pages":"Article 100007"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X22000071/pdfft?md5=be131bac9967df876a87cc7f314a5e18&pid=1-s2.0-S2773160X22000071-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72975350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of low molecular weight heparin on bleeding after radical gastrectomy: A retrospective study from a high-volume center in China","authors":"Peng Zhou ,&nbsp;Yan Hu ,&nbsp;Peili Jin ,&nbsp;Jinxin Zheng ,&nbsp;Fenglin Liu ,&nbsp;Zhenbin Shen ,&nbsp;Weidong Chen ,&nbsp;Kuntang Shen ,&nbsp;Zhaoqing Tang ,&nbsp;Yihong Sun ,&nbsp;Xuefei Wang","doi":"10.1016/j.cson.2022.100003","DOIUrl":"10.1016/j.cson.2022.100003","url":null,"abstract":"<div><h3>Background</h3><p>Although low molecular weight heparin (LMWH) is recommended to prevent venous thromboembolism (VTE) in patients with gastric cancer, it's difficult for surgeons to choose appropriate time to start anti-coagulation because of the risk of surgical field bleeding after radical gastrectomy. We compared the risk of VTE and bleeding between patients receiving LMWH within and beyond 48 ​h after surgery.</p></div><div><h3>Methods</h3><p>The medical records of consecutive cases receiving radical gastrectomy from November 1st, 2017 to October 31st, 2018 in Zhongshan Hospital Gastric Cancer Center were carefully reviewed. Patients receiving LMWH within and beyond 48 ​h after surgery were regarded as Early Group (EG) and Delayed Group (DG), respectively. Incidence of VTE and bleeding complications were compared and risk factors of bleeding were evaluated.</p></div><div><h3>Results</h3><p>Six hundred and sixty-five cases were enrolled, including 465 in EG and 200 in DG. No significant differences of clinicopathological or operative features were observed except for fewer combined resection (DG: 5.0%, EG: 1.9%, P ​= ​0.030) and shorter surgery duration (DG: 194min, EG: 168min, P ​&lt; ​0.001). No patients suffered from deep venous thrombosis or pulmonary embolism in our study. However, postoperative bleeding rate was higher in EG (DG: 1.5%, EG: 7.5%, P ​= ​0.002). Multivariate analysis suggested that EG was the independent risk factor of bleeding (OR: 3.744, 1.13–12.36, P ​= ​0.030).</p></div><div><h3>Conclusion</h3><p>Use of LMWH 48 ​h after radical gastrectomy maybe a good choice for clinical surgeons to reduce postoperative bleeding rate without increasing VTE risk in gastric cancer patients.</p></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"1 1","pages":"Article 100003"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X22000034/pdfft?md5=645f69d4f1cb432cec6ca807494e5ab3&pid=1-s2.0-S2773160X22000034-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83506953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Future trends in surgical oncology","authors":"Tibor Kovacs","doi":"10.1016/j.cson.2022.100006","DOIUrl":"10.1016/j.cson.2022.100006","url":null,"abstract":"","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"1 1","pages":"Article 100006"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2773160X2200006X/pdfft?md5=b00434ffd6934811324b3cf1cae9afb1&pid=1-s2.0-S2773160X2200006X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79959872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}