Surgical Oncology Insight最新文献

{"title":"Combining liver-directed and immunotherapy in advanced hepatocellular carcinoma: A review and future directions","authors":"","doi":"10.1016/j.soi.2024.100100","DOIUrl":"10.1016/j.soi.2024.100100","url":null,"abstract":"<div><div>Hepatocellular carcinoma (HCC) is a highly morbid tumor with diverse genomic heterogeneity that poses a major therapeutic barrier. Systemic immunotherapy is often considered in the treatment of advanced HCC, but immunotherapy has been limited by high rates of resistance and immune evasion. Newer studies have explored the combination of locoregional treatments (LRTs), a common approach to intermediate-stage HCC or as a bridge to transplant, with immunotherapy. This review explores the current evidence regarding combination systemic immunotherapy with locoregional transarterial, ablation, and histotripsy modalities, as well as leading theories on the mechanism of their synergistic effects. Combinations of transarterial or ablative therapy with multikinase (MKIs) or immune checkpoint inhibitors (ICIs) have been linked to prolonged survival and delayed tumor progression/recurrence, though treatment-induced adverse effects remain an important consideration. Ablation and histotripsy may augment the efficacy of immunotherapy through the abscopal effect, in which subsequent immune response to local tumor destruction may enhance immunogenic cell death, even in satellite, untreated lesions. Newer management strategies may utilize circulating tumor DNA (ctDNA) for improved surveillance and early detection of recurrence.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357650","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":"Timing of breast biopsy and axillary ultrasound does not affect the false positive rate of the axillary ultrasound","authors":"","doi":"10.1016/j.soi.2024.100098","DOIUrl":"10.1016/j.soi.2024.100098","url":null,"abstract":"<div><h3>Background</h3><div>The determination of axillary lymph node metastases is an important component of breast cancer treatment planning. Lymph node biopsies can be performed simultaneously with breast biopsy or at a later time. However, a post-breast biopsy ultrasound of the axilla may appear abnormal due to reactivity in the axillary lymph nodes. This study examined the timing of the axillary ultrasound (AUS) in relation to a breast biopsy to determine if it would affect patient management.</div></div><div><h3>Methods</h3><div>All newly diagnosed breast cancers from 2016 to 2017 were analyzed. We analyzed the timing of breast abnormality diagnosis, breast ultrasound, breast biopsy, AUS, and the AUS biopsy (AUSBx). An interval AUS was considered one that was not performed on the same day as a breast biopsy. True positive (TP), false positive (FP), true negative (TN), and false negative (FN) values were calculated. Chi-square analysis and Fisher exact test were performed on categorical data, and a student’s t-test was performed for continuous variables. Significance was determined to be p &lt; 0.05.</div></div><div><h3>Results</h3><div>Same-day TP and FP AUS rates were 66.5 % and 33.5 %, respectively, and interval TP and FP AUS rates were 60.1 % and 39.9 %, respectively (p = 0.4708). The same-day TN and FN AUS rates were 90.6 % and 9.4 %, respectively, and interval TN and FN rates were 82.4 % and 17.6 %, respectively (p = 0.3917).</div></div><div><h3>Conclusion</h3><div>Overall TP, FP, TN, and FN rates did not differ between patients who received same-day or interval AUS studies.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142357558","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":"Small bowel cancers: A population-based analysis of epidemiology, treatment and outcomes in Ontario, Canada from 2005-2020","authors":"","doi":"10.1016/j.soi.2024.100096","DOIUrl":"10.1016/j.soi.2024.100096","url":null,"abstract":"<div><h3>Introduction</h3><p>Small bowel cancers are uncommon malignancies comprised of several histologies with variable treatments and prognoses. The current study describes the epidemiology, treatment, and outcomes of a large, population-based cohort of patients with small bowel cancers.</p></div><div><h3>Methods</h3><p>We performed a retrospective cohort study using linked administrative healthcare data from Ontario, Canada. Patients diagnosed with a small bowel cancer between 2005–2020 were included. Trends in incidence, treatments, and survival were explored by histology (adenocarcinoma, neuroendocrine tumors (NET), gastrointestinal stromal tumors (GIST), and lymphoma).</p></div><div><h3>Results</h3><p>A total of 5306 patients with small bowel cancers were identified. The most common histologies were NET (40.5 %) and adenocarcinoma (31.6 %). Over the study period the annual incidence of small bowel cancers increased from 1.54 to 2.78 per 100 000 and the likelihoods of receiving surgery and systemic therapy within one year of diagnosis both increased for all histologic subtypes except lymphoma. Median overall survival from diagnosis was 1.0 year for adenocarcinoma, 13.2 years for NET, 14.2 years for GIST, and 10.1 years for lymphoma. There was no trend towards improved median survival for adenocarcinoma by year of diagnosis; 0.94 years (2005–2010), 1.07 years (2011–2015), and 0.98 years (2016–2020).</p></div><div><h3>Discussion</h3><p>Small bowel cancers are increasing in incidence, with increasing use of surgery and systemic therapies. While survival is favourable for many small bowel cancers, it remains poor for adenocarcinoma. Better availability of cancer stage data and detailed histopathology within the database would facilitate future research.</p></div><div><h3>Synopsis</h3><p>This study of small bowel cancer in Ontario from 2005 to 2020 demonstrated increasing incidence, use of surgery, and systemic treatments. The most common histologies are neuroendocrine tumors and adenocarcinoma, with median survivals of 13.2 and 1.0 years respectively.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024001051/pdfft?md5=73dcc6435f9f6c6d20ccd8bb1195a6b6&pid=1-s2.0-S2950247024001051-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163294","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":"Pelvic Floor Physical Therapy Prehabilitation (PrePFPT) for the prevention of low anterior resection syndrome","authors":"","doi":"10.1016/j.soi.2024.100097","DOIUrl":"10.1016/j.soi.2024.100097","url":null,"abstract":"<div><p>Low Anterior Resection Syndrome (LARS) is a syndrome of lifestyle-limiting defecatory dysfunction diagnosed after the treatment of rectal cancer that can afflict 41 % of patients one year after surgery. Currently, the treatment of LARS is reactionary to the development of symptoms, and post-treatment pelvic floor physical therapy (PFPT) is one form of treatment utilized to mitigate the symptoms of LARS and improve patient quality of life. Prehabilitation is the physical and/or lifestyle preparation that improves recovery following surgery. For rectal cancer patients, general prehabilitation while undergoing neoadjuvant chemoradiotherapy is safe and feasible. However, no studies have examined whether pelvic floor physical therapy prehabilitation, which we term “PrePFPT,” could mitigate the development of LARS. In this commentary, we argue that PrePFPT should become an active area of research in rectal cancer to improve functional and quality of life outcomes. We highlight two proposed international trials, which will evaluate pre- and postoperative PFPT as a strategy to reduce the incidence of LARS. We conclude with our own proposed PrePFPT study design.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024001063/pdfft?md5=1503e54387f16fc32d75bc1d4ded9c65&pid=1-s2.0-S2950247024001063-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163210","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":"Pepsinogen and Helicobacter pylori: Serum biomarkers for gastric cancer risk in a diverse United States population","authors":"","doi":"10.1016/j.soi.2024.100086","DOIUrl":"10.1016/j.soi.2024.100086","url":null,"abstract":"<div><h3>Background</h3><p>Serum Pepsinogen (PG) and <em>Helicobacter pylori</em> (Hp) have potential as biomarkers to identify persons at high risk for gastric cancer (GC) in low incidence populations. We explored the use of these biomarkers in a diverse US population.</p></div><div><h3>Methods</h3><p>Single institution study using serum samples from 32 newly diagnosed GC (before treatment) and 60 non-cancer participants. ELISA-based PG-I, PG-II, <em>Hp</em> IgG, and <em>Hp</em> virulence seromarker (CagA, VacA) tests were conducted to examine differences between GC and non-GC participants.</p></div><div><h3>Results</h3><p>Median age was 58 (IQR 48–68); 56 % were females; 30.1 % were white, 14.8 % black, 28.7 % Hispanic, 6.1 % Asian and 18.2 % other/unknown race/ethnicity. Median values of Hp (47.9 vs 12.6 U/mL, p = 0.003) and pepsinogen ratio (PGR=PGI/PGII) (4.0 vs 7.5, p = 0.003) differed between GC and non-GC. Performance of pepsinogen tests using “standard” cut-offs (PGI ≤ 70 ng/mL and PGR ≤ 3) were highly specific (91.7 %), but not sensitive (34.4 %), while Hp IgG test using “standard” cut-off (≥ 30 U/mL) was sensitive (78.8 %), but less specific (41.2 %). Optimized cut-off values identified in our population using Youden’s Index were PGR ≤ 5.2 and Hp ≥ 17.5 U/mL. Using a combination of these values resulted in a significant increase in test sensitivity (87.9 %) with lower specificity (50.8 %).</p></div><div><h3>Conclusion</h3><p>The combination of pepsinogens and Hp show promise as biomarkers of GC risk in a racially and ethnically diverse US population. Optimal biomarker cut-off points for US populations may differ from those established in East Asia. By adjusting cut-offs there is potential to design GC risk stratification tools tailored specifically for the diverse population within the US.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000951/pdfft?md5=e7731a8c74fbbf81ed7ca9176c736bcd&pid=1-s2.0-S2950247024000951-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096930","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":"How reliable are post-mastectomy breast reconstruction videos on YouTube?","authors":"","doi":"10.1016/j.soi.2024.100094","DOIUrl":"10.1016/j.soi.2024.100094","url":null,"abstract":"<div><h3>Background</h3><p>Social media platforms are a significant source of information for young women with breast cancer (YWBC) undergoing post-mastectomy breast reconstruction (PMBR). The emphasis on visual storytelling and building community in online spaces renders YouTube to be a common platform for discussions of BR. This study aims to assess the quality of YouTube videos about PMBR, identify themes related to the PMBR experience, and quantify suggestions of BR as an option PM.</p></div><div><h3>Methods</h3><p>YouTube was searched incognito with terms “young women breast cancer reconstruction” in 08/2022, in order from most to least viewed. Title, upload date, length, poster identity, number of likes and comments were collected. The Patient Education Materials Assessment Tool for audiovisual materials (PEMAT A/V) was used to evaluate understandability and actionability. DISCERN assessed quality and reliability. Presence of sponsorship, intended audience, patient and healthcare professional narratives, and suggestions of PMBR were collected. Reviewers noted whether PMBR was shown and how. Themes were collected inductively and deductively for thematic analysis.</p></div><div><h3>Results</h3><p>193 videos were identified. Mean video length was 14.6 min (SD 20.0 min). 87.1 % included sponsorships. 95.9 % of videos were posted by an organization. 60.6 % were information-based; 45.6 % experience-based. Mean PEMAT scores for understandability and actionability were 71.3 % (SD 13.4) and 35.7 % (SD 41.8), respectively. Mean DISCERN was 2.6/5 (SD 1.2). Patient narrative was present in 52.6 % and healthcare professionals’ in 68.4 %. PMBR was visually presented 22.8 % of the time. 13.5 % of videos explicitly recommended PMBR. 2.6 % explicitly discouraged it. Patients (77.7 %) represented the majority of the intended audience. Most common deductively identified themes included treatment (87.1 %), family relationship (17.1 %), motherhood (15.5 %), fertility (11.9 %). Inductively identified subthemes included differentiating between various options for PMBR surgery, BRCA genetic testing, psychosocial effects of breast cancer and PMBR, and recovery from surgery.</p></div><div><h3>Conclusion</h3><p>YouTube is a platform wherein various PMBR options are widely discussed and explained. PMBR videos are highly understandable but have moderate levels of actionability, quality, and reliability. Videos are highly sponsored, demonstrating significant institutional bias. Themes are overwhelmingly treatment and surgery-based. Personal themes were present but not dominant.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024001038/pdfft?md5=62a065ee51c87e594bdcc2000e6131dc&pid=1-s2.0-S2950247024001038-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150827","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":"Surgical management of peritoneal metastases from appendix and colon cancer in patients with inflammatory bowel disease","authors":"","doi":"10.1016/j.soi.2024.100092","DOIUrl":"10.1016/j.soi.2024.100092","url":null,"abstract":"<div><h3>Background</h3><p>Inflammatory bowel disease (IBD) may compromise outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for peritoneal metastases (PM) from appendix/colon cancer. We evaluated CRS/HIPEC outcomes in patients with concurrent IBD.</p></div><div><h3>Methods</h3><p>A matched cohort study using a prospective institutional CRS/HIPEC database (1998–2023) included appendix/colon cancer patients with PM. We matched IBD patients to IBD-free controls in a 1:5 ratio with nearest-neighbor propensity score for sex, age, and peritoneal cancer index (PCI), and exact matching for prior CRS/HIPEC and primary tumor. Perioperative variables, including Clavien-Dindo 90-day complications, were compared. Kaplan-Meier overall (OS) and progression-free survival (PFS) were compared using stratified Cox regression.</p></div><div><h3>Results</h3><p>Of 605 CRS/HIPECs for appendix/colon cancer, 14 (2.3%) had concurrent Crohn’s disease (n = 6) or ulcerative colitis (n = 8). Seventy IBD-free controls were matched. Nine (64.7%) IBD patients had an appendix primary. Complete cytoreduction (CC-0/1) was achieved in 10 (71.4%) IBD and 57 (81.4%) IBD-free patients (p = 0.468). IBD vs IBD-free patients tended to have more grade-III/IV complications (35.7% [n = 5] vs 15.7% [n = 11], p = 0.082) and had a higher rate of severe nausea/vomiting (35.7% vs 4.3 %, p &lt; 0.001) and diarrhea (28.6% vs 8.6%, p = 0.035). Rates of anastomotic leak (7.1% [n = 1] vs 1.4% [n = 1], p = 0.200) and intraabdominal infections (7.1% [n = 1] vs 2.9% [n = 2], p = 0.430) were similar for IBD vs IBD-free, respectively. IBD did not affect OS (HR [95% CI]: 1.1 [0.4, 2.9]) or PFS (HR [95% CI]: 1.2 [0.4, 3.9]).</p></div><div><h3>Conclusion</h3><p>IBD is associated with a higher rate of gastrointestinal complications after CRS/HIPEC for appendix/colon cancer; however, it does not affect OS or PFS.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024001014/pdfft?md5=5d30dbe9e2d5373a8c1c9cac5f48d2f9&pid=1-s2.0-S2950247024001014-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142168620","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":"Adjuvant breast radiation therapy practice patterns in the United States from 2012–2017","authors":"","doi":"10.1016/j.soi.2024.100093","DOIUrl":"10.1016/j.soi.2024.100093","url":null,"abstract":"<div><p>Factors associated with selection of proton therapy (PT) or intensity-modulated radiation therapy (IMRT) versus 3-dimensional conformal radiation in breast cancer were evaluated. As PT usage increases, data on local control, survival, long-term sequelae, and patient-reported outcomes of PT vs photon therapy are important to guide optimal application of radiation techniques.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024001026/pdfft?md5=1aea204f46e9b6050913330630a9d023&pid=1-s2.0-S2950247024001026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150828","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":"DNA mismatch repair deficiency as a biomarker in sarcoma","authors":"","doi":"10.1016/j.soi.2024.100091","DOIUrl":"10.1016/j.soi.2024.100091","url":null,"abstract":"<div><h3>Purpose</h3><p>Lynch syndrome (LS) is a cancer predisposition syndrome caused by a germline loss-of-function mutation in a mismatch repair (MMR) gene. While sarcomas are not classically considered LS cancers, we investigated the MMR status and clinical features of sarcomas in LS patients to help inform optimal treatment strategies.</p></div><div><h3>Methods</h3><p>A prospectively maintained institutional clinical cancer genetics database was queried for LS patients (defined by pathogenic germline mutation in a MMR gene) with a documented diagnosis of sarcoma between 1998–2022. Tumor MMR status was determined by immunohistochemistry (IHC) for MMR proteins and secondarily by PCR assay if IHC was normal or intact.</p></div><div><h3>Results</h3><p>Among the 30 LS patients with sarcoma, germline mutations were most common in <em>MSH2</em> (50 %). The most common sarcoma subtypes were undifferentiated pleomorphic sarcoma (40 %) and leiomyosarcoma (27 %). Median age at diagnosis was 49.2 years (interquartile range 40.4–62.4). 90 % presented with localized disease, and 10 % presented with synchronous metastatic disease. Among 10 patients with tissue available for biomarker determination, dMMR was confirmed in 4 (40 %), while the remaining (60 %) were pMMR. Three patients received immunotherapy. Two of these had confirmed dMMR tumor status: one demonstrated a sustained complete response on pembrolizumab monotherapy for 44 months; the other had a partial response on ipilimumab and nivolumab for 31 months but died from an unrelated cause. In the entire cohort of 30 patients at a median follow-up time of 68.2 months since sarcoma diagnosis (interquartile range 29.0–151.5 months), median overall survival and progression-free survival have not been reached.</p></div><div><h3>Conclusion</h3><p>While rare, sarcoma can be encountered in patients with LS, particularly those with germline <em>MSH2</em> mutation. LS-associated sarcomas occur significantly earlier, carry a favorable outcome, and demonstrate the potential for durable response with immunotherapy.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024001002/pdfft?md5=ab6d50594cef0801f725d56e6a363e9b&pid=1-s2.0-S2950247024001002-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142150826","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":"Laparoscopic versus robotic pancreaticoduodenectomy: A NSQIP analysis comparing trends in patient selection and outcomes over 5-years","authors":"","doi":"10.1016/j.soi.2024.100090","DOIUrl":"10.1016/j.soi.2024.100090","url":null,"abstract":"<div><h3>Background</h3><p>Comparison of laparoscopic (LPD) and robotic (RPD) pancreaticoduodenectomy over time remains limited. This study aims to compare LPD and RPD and to describe the demographics and outcomes of patients undergoing MIS pancreaticoduodenectomy over 5-years.</p></div><div><h3>Methods</h3><p>The ACS-NSQIP (2016–2021) database was used to evaluate patients undergoing MIS pancreaticoduodenectomy comparing LPD versus RPD. Patient characteristics, and outcomes were compared and multivariable modelling evaluated factors associated with serious complications, and mortality. MIS approach, demographics, and outcomes were assessed yearly to evaluate trends over time.</p></div><div><h3>Results</h3><p>We evaluated 1707 patients with 1148 (67.3 %) receiving RPD. Cohorts were similar with regards to demographic factors, however, patients undergoing RPD were less likely to be partially dependent (0.5 % vs. 1.6 %; p = 0.024), and more likely to receive neoadjuvant therapy (26.8 % vs. 21.7 %; p = 0.023).</p><p>Bivariate analysis demonstrated similar operative duration (444.1 vs 429.9 min; p = 0.074), but shorter LOS (8.5 vs. 9.8 days; p &lt; 0.001), and higher readmission rate (21.5 % vs. 15.6 %; p = 0.004) with RPD. Additionally, RPD required transfusion less often (10.5 % vs. 21.7 %; p &lt; 0.001). Multivariable analysis demonstrated that LPD was not independently associated with serious complications (OR 1.27 p = 0.094) or mortality (OR 0.82, p = 0.611).</p><p>Analysis of trends from 2016 to 2021 demonstrated similar patient selection and outcomes but a significant increase in MIS pancreaticoduodenectomy (281 to 428), primarily driven by an increase in RPD.</p></div><div><h3>Conclusions</h3><p>Comparing LPD and RPD there is no difference in serious complications or mortality. MIS pancreaticoduodenectomy has increased over the last 5 years but volumes remain small with similar demographics and outcomes over time.</p></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2950247024000999/pdfft?md5=c3a7ec9b70f7781d545673aca06a054e&pid=1-s2.0-S2950247024000999-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142040137","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}