Surgical Oncology Insight最新文献

{"title":"The tumour microenvironment score outperforms established molecular classifiers as a prognostic factor for disease-free interval and disease-specific survival in non-metastatic gastric cancer","authors":"D. Skubleny,&nbsp;S. Jatana,&nbsp;Z. Czarnecka,&nbsp;A. Rouhi,&nbsp;M. McCall,&nbsp;GR Rayat,&nbsp;D.E. Schiller","doi":"10.1016/j.soi.2025.100199","DOIUrl":"10.1016/j.soi.2025.100199","url":null,"abstract":"<div><h3>Introduction</h3><div>Molecular classification in gastric cancer has identified relevant disease heterogeneity with prognostic implications. However, limited comparative analysis of molecular classification systems has occurred. We assessed the effect of the Tumour Microenvironment Score (TME), the Cancer Genome Atlas (TCGA) and the Asian Cancer Research Group (ACRG) classification systems on disease-free interval (DFI) and disease-specific survival (DSS) in Stage I-III gastric cancer.</div></div><div><h3>Methods</h3><div>Previously characterized machine learning models were used to assign TCGA, ACRG and TME molecular classes to stage I-III patients in the ACRG and TCGA datasets (n = 523). DFI and DSS was assessed using univariable and multivariable Cox Proportional Hazards models.</div></div><div><h3>Results</h3><div>A multivariable Cox model including TCGA, ACRG and TME subtypes showed that only a high TME score was associated with improved DFI (HR 0.22 [95 % CI 0.10, 0.49]; p &lt; 0.001) and DSS (HR 0.2 [95 % CI 0.09–0.43]; p &lt; 0.001). The significant effect of TME High score was maintained after sensitivity analysis that adjusted for stage, age, sex, chemotherapy, radiation, tumour location, and study (DFI: TME High HR 0.33 [95 % CI 0.15, 0.73)]; p &lt; 0.01 and DSS: TME High HR 0.21 [95 % CI 0.08, 0.52)]; p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>In an integrated analysis comparing TCGA, ACRG and TME scores, a high TME score is the only independent molecular prognostic factor for DFI and DSS in non-metastatic gastric cancer. Additional investigation into implications of the heterogeneity of the TME score relative to the TCGA and ACRG classifications may yield additional insight into gastric cancer biology and treatment.</div></div><div><h3>Synopsis</h3><div>We compared the prognostic relevance of multiple molecular classification methods in gastric cancer using a previously developed machine learning model. The Tumour Microenvironment Score, which indicates an active immune microenvironment, was the only significant independent prognostic factor for disease-free interval and disease-specific survival.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100199"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145617843","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":"Facilitators to oncological care in foregut cancer: The patient perspective","authors":"Jaspinder S. Sanghera ,&nbsp;Michelle M. Holland ,&nbsp;Ioannis Liapis ,&nbsp;Rida Ahmad ,&nbsp;Katie West ,&nbsp;Manish Tripathi ,&nbsp;Larry Hearld ,&nbsp;Daniel I. Chu ,&nbsp;Krista Mehari ,&nbsp;Martin J. Heslin ,&nbsp;Smita Bhatia ,&nbsp;Annabelle L. Fonseca","doi":"10.1016/j.soi.2025.100192","DOIUrl":"10.1016/j.soi.2025.100192","url":null,"abstract":"<div><h3>Background</h3><div>Foregut cancers are best treated by specialized, multidisciplinary care, often delivered, at least in part, at tertiary centers. Patient perspectives on the factors that enhance access to and adherence to cancer treatment remain underexplored. This qualitative study explores patient-reported facilitators of care at a safety-net hospital in the Southeastern United States (US).</div></div><div><h3>Methods</h3><div>Patients with foregut cancer receiving care at a safety-net tertiary care institution in the Southeastern US were recruited. Interviews were recorded, transcribed, and analyzed using NVivo 14 Software. Grounded theory methodology was used to identify themes and subthemes. A comprehensive codebook was established, with a high interrater reliability rate of &gt; 90 % for all themes.</div></div><div><h3>Results</h3><div>Of the 30 patients interviewed, the majority were male (n = 23, 77 %) and Black (n = 18, 60 %), with an average age of 63 (IQR: 55–67). Facilitator themes were identified across four categories: (1) Individual/Interpersonal; (2) Provider/Care Team; (3) Healthcare Systems, and (4) Broader Policy. The most prevalent facilitators identified included faith and spirituality (87 %), support from immediate family (83 %), trust in the care team (90 %), and effective communication (97 %).</div></div><div><h3>Conclusion</h3><div>Understanding patient perspectives is essential for delivering high-quality care in foregut cancer. These facilitators should be actively promoted during the development of future interventions. An appreciation of patient beliefs, communication training for care providers, hiring necessary ancillary staff, use of written handouts, expanding financial aid services, and wider healthcare reform are all avenues to explore in the ongoing effort to improve comprehensive oncological care for patients.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 4","pages":"Article 100192"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145109490","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":"Survival in stage IV colorectal cancer at diagnosis","authors":"Jeremy Chang ,&nbsp;Carine Dornbush ,&nbsp;Sarah L. Mott ,&nbsp;Bradley Loeffler ,&nbsp;Kristina Guyton ,&nbsp;Jennifer Hrabe ,&nbsp;Irena Gribovskaja-Rupp","doi":"10.1016/j.soi.2025.100144","DOIUrl":"10.1016/j.soi.2025.100144","url":null,"abstract":"<div><h3>Background</h3><div>It is well established that the primary tumor anatomic location of colorectal cancer (CRC) affects tumor biology and disease course, however, there exist few large-scale studies investigating oncologic outcomes of metastatic CRC at diagnosis based on anatomic location of primary tumor and metastasis.</div></div><div><h3>Methods</h3><div>A retrospective analysis of the National Cancer Database (NCDB) from 2016 to 2019 was performed identifying patients with metastatic colorectal cancer at diagnosis based on ICD-10 codes divided into left colon, right colon, and rectal primary. Patient demographic, tumor characteristic, treatment and outcomes data were obtained. The primary outcome measure was overall survival. Multivariable Cox regression was performed.</div></div><div><h3>Results</h3><div>Intra-abdominal metastases are the most common metastases for all primary tumor locations, however, rectal cancer more frequently metastasizes to extra-abdominal organs. Regardless of primary tumor location, lung metastasis has improved overall survival compared with liver or M1b/1c disease. Compared with left colon and rectal primary, metastatic right sided colon cancer had the worst median overall survival. Receipt of any surgical management, radiation, or oncologic treatment to primary site or metastasis was associated with improved overall survival.</div></div><div><h3>Conclusions</h3><div>These findings underpin the heterogeneity of colorectal cancer tumor biology and highlight the importance of understanding primary tumor location and metastasis location for appropriate patient education and prognostication. Appropriate patients had improved survival and low mortality with surgery.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100144"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144580683","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":"Cancer care financing in Nigeria: A scoping review of the literature","authors":"Sophia Okeke ,&nbsp;Oluwasegun Afolaranmi ,&nbsp;Toluwanimi S. Aduloju ,&nbsp;Moyinoluwa Akinwumi ,&nbsp;Emmanuel Uduigwome ,&nbsp;Egide Abahuje ,&nbsp;Elieen Wafford ,&nbsp;Oluwafemi Akin-Adigun ,&nbsp;Kristina Diaz ,&nbsp;Funmilola Wuraola ,&nbsp;Chinenye Iwuji ,&nbsp;Gregory Knapp ,&nbsp;Shilpa Murthy ,&nbsp;Anna Dare ,&nbsp;Olusegun Isaac Alatise ,&nbsp;Peter Kingham ,&nbsp;Juliet S. Lumati","doi":"10.1016/j.soi.2025.100166","DOIUrl":"10.1016/j.soi.2025.100166","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer care presents a huge financial burden to patients globally. This burden is particularly significant in low- and middle-income countries (LMICs) with high poverty rates and minimal sustainable funding models. In Nigeria, the most populous country in Africa with over 100,000 new cancer cases yearly, out-of-pocket costs for cancer care exceed the GDP per capita. The objective of this scoping review is to describe the available options for cancer financing for patients in Nigeria and to make recommendations for researchers and policy makers based on a review of the literature.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive search of PUBMED, Economic Literature and African Medicus Index databases using a search strategy based on the core concepts of “healthcare financing”, “cancer patients” and “Nigeria”. There were no restrictions by publication timing or study design. However gray literature was excluded. Two independent reviewers conducted abstract screening and full-text review. Conflicts were reconciled by a third reviewer or by consensus where necessary. Data abstraction, synthesis, and analysis were performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.</div></div><div><h3>Results</h3><div>From 408 screened articles, 19 studies met the eligibility criteria, covering a time frame from 2008 to 2024. Most of the studies (14/19) were original research and based in urban (14/19) settings. The majority covered financing options for cancer treatment (16/19), while others covered screening and diagnosis. The available sources of cancer financing can be classified into out-of-pocket (OOP) insurance (public and private), family/relative support, loans, and non-governmental funding. Importantly, OOP was the predominant source of health care financing. Studies reported on the adverse impact of high OOP costs on catastrophic healthcare spending, delays in diagnosis as well as adherence to treatment. Studies unanimously recommended expanding private and public insurance coverage for improving financial risk protection against catastrophic health payments.</div></div><div><h3>Conclusion</h3><div>Evidence suggests that healthcare financing options are grossly limited for cancer patients in Nigeria with most patients paying OOP. We recommend the implementation of mandatory health insurance and expanded coverage for cancer care services. There is also a need for research into financing options available to patients across different settings, especially in rural and underserved regions. Furthermore, more rigorous study designs to capture financing options for both direct and indirect costs of cancer care are necessary.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100166"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557300","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":"Current status of intraoperative radiation therapy in rectal cancer: A national cancer database analysis","authors":"Amulya Vadlakonda ,&nbsp;Sara Sakowitz ,&nbsp;Nikhil Chervu ,&nbsp;Konmal Ali ,&nbsp;Troy Coaston ,&nbsp;Luigi Pianetti ,&nbsp;Peyman Benharash ,&nbsp;Aimal Khan ,&nbsp;Hanjoo Lee","doi":"10.1016/j.soi.2025.100175","DOIUrl":"10.1016/j.soi.2025.100175","url":null,"abstract":"<div><h3>Background</h3><div>Intraoperative radiotherapy (IORT) is used to target the tumor bed and threatened margin and evolved into a dose escalation technique in the treatment of rectal cancer. Given the limited use of IORT in specialized centers, we analyzed a national database to characterize temporal trends and utilization patterns for this treatment modality.</div></div><div><h3>Methods</h3><div>All adults (≥18 years) undergoing proctectomy for T3/4, any N rectal adenocarcinoma were identified in the 2004–2020 NCDB. Patients were stratified into those who received IORT and those who didn’t. Cuzick’s nonparametric test was used to assess the significance of temporal trends.</div></div><div><h3>Results</h3><div>Of 72,654 patients eligible for analysis, 137 (0.2 %) underwent IORT. 81 % of patients with IORT underwent resection with microscopically confirmed negative margin. There was no significant rise in utilization of IORT during the study period (nptrend=0.10). Of a total 1314 hospitals included in the study, 54 (4.1 %) performed IORT, with a cumulative volume ranging from 1 to 15 cases over the study period.</div></div><div><h3>Conclusions</h3><div>We note a significant variability in IORT practices with treatment primarily offered to patients with margin-negative resection. We found that only a small fraction of institutions performed IORT with no change in its utilization during the study period. Our findings underscore the need to reassess the utility of IORT in the contemporary era and call for improving current guidelines.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100175"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827606","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":"Neck dissection in the management of thyroid cancer: An overview","authors":"Hameeda Arif Arain,&nbsp;Azeem Izhar,&nbsp;Herbert Chen,&nbsp;C. Corbin Frye","doi":"10.1016/j.soi.2025.100161","DOIUrl":"10.1016/j.soi.2025.100161","url":null,"abstract":"<div><div>Lymph node metastases in thyroid cancer significantly influence staging, prognosis, and surgical management. The decision to perform a neck dissection primarily depends on the type of thyroid cancer. In differentiated thyroid cancer (papillary and follicular), neck dissections are typically only performed when lymph node metastases are present. In undifferentiated thyroid cancer (medullary and anaplastic), there is a role for prophylactic neck dissection in certain scenarios. One principle shared by all types of thyroid cancer is that neck dissections should be compartment-oriented and are guided by the location and extent of disease. This review outlines the cervical lymph node anatomy, indication for neck dissection, and surgical techniques.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100161"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144604648","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":"Europe’s First da Vinci SP™ robotic experience in endometrial cancer: A pilot study on feasibility, safety, and perioperative outcomes with practical tips & tricks","authors":"Benedetta Alberghetti ,&nbsp;Riccardo Oliva ,&nbsp;Elena Casetta ,&nbsp;Filippo Maria Capomacchia ,&nbsp;Antonella Biscione ,&nbsp;Stefano Cosma ,&nbsp;Giovanni Scambia ,&nbsp;Francesco Fanfani ,&nbsp;Luigi Carlo Turco","doi":"10.1016/j.soi.2025.100168","DOIUrl":"10.1016/j.soi.2025.100168","url":null,"abstract":"<div><h3>Purpose</h3><div>Endometrial cancer (EC) ranks as the second most prevalent gynecologic cancer worldwide. In presumed early-stage conditions, minimally invasive surgery (MIS) plays a pivotal role in this scenario, and robot-assisted surgery (RAS) shows benefits in learning curves, ergonomics, and precision, with equivalent oncologic outcomes compared to laparoscopy.</div><div>This study describes the first European experience using the da Vinci SP™ system (Intuitive Surgical, Sunnyvale, CA, United States) for the robotic surgical staging of EC, evaluating its feasibility, safety, and perioperative outcomes.</div></div><div><h3>Methods</h3><div>Ten consecutive patients were selected to undergo RAS surgical staging with the da Vinci SP™ system for presumed early-stage EC based on preoperative imaging. All patients were preoperatively evaluated with diagnostic hysteroscopy, CT-scan, and MRI. The surgical procedure included type A radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral sentinel lymph node (SLN) dissection.</div><div>Perioperative outcomes and complications were prospectively recorded.</div></div><div><h3>Results</h3><div>All procedures were successfully completed using a full RAS approach, with one conversion to open surgery for specimen integrity and retrieval. Median estimated blood loss was 50 mL (range: 50–250 mL), and median operative time was 127 min (range: 116–172 min). No major intraoperative complications were reported, and postoperative recovery was uneventful.</div><div>In 4 cases, unilateral pelvic lymphadenectomy was required due to failed SNL detection.</div></div><div><h3>Conclusion</h3><div>This study demonstrated that the da Vinci SP™ system was a feasible and safe alternative for the management of presumed early-stage EC. The single-port approach showed high reliability and potential benefits in terms of invasiveness, cosmesis, and postoperative recovery. Larger studies are necessary to further evaluate its role compared to conventional multiport robotic systems.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100168"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144679228","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":"Body composition and post-operative outcomes after minimally-invasive esophagectomy","authors":"V.Christian Sanderfer ,&nbsp;Ansley B. Ricker ,&nbsp;Alexis M. Holland ,&nbsp;Erin Donahue ,&nbsp;Reilly Shea ,&nbsp;Matigan Simpson ,&nbsp;Katelyn Cockerham ,&nbsp;Nicholas Mullis ,&nbsp;Sophia Bellavia ,&nbsp;Ella Schwarzen ,&nbsp;M.Hart Squires ,&nbsp;Kunal C. Kadakia ,&nbsp;Jonathan C. Salo","doi":"10.1016/j.soi.2025.100169","DOIUrl":"10.1016/j.soi.2025.100169","url":null,"abstract":"<div><h3>Objective</h3><div>Esophagectomy is a complex operation associated with significant morbidity for fit patients. Risk calculation is essential to guide pre-operative patient selection. This study used CT-derived body composition measures and age to develop a model for the prediction of postoperative mortality after minimally-invasive esophagectomy.</div></div><div><h3>Methods</h3><div>Patients who underwent minimally-invasive esophagectomy from 2010 to 2022 were identified. Preoperative CT scans at the L3-vertebral level were analyzed to calculate skeletal muscle gauge (SMG) as the product of skeletal muscle index and density. Patient demographics, clinical characteristics, and outcomes were collected. Patients were grouped based on SMG (low muscle = bottom quartile vs normal muscle = top 3 quartiles) and age (≥75 vs &lt;75 years). Ninety-day postoperative mortality was compared between risk groups.</div></div><div><h3>Results</h3><div>Of 399 patients<strong>,</strong> mean age was 62.8 years. Anastomotic leak occurred in 8.3 %, pneumonia in 17.0 %, discharge to home in 81.5 % and 90-day mortality in 5.5 %. Ninety-day mortality by risk group showed 1.8 % mortality for patients &lt; 75 years with normal muscle (n = 281), 10 % mortality for patients &lt; 75 years with low muscle (n = 72), 5.6 % mortality for patients ≥ 75 years with normal muscle (n = 18), and 32 % mortality among patients ≥ 75 years with low muscle (n = 28).</div></div><div><h3>Conclusions</h3><div>Low-risk patients (&lt;75 years with normal muscle), which comprised 70 % of our study cohort, had favorable outcomes with 1.8 % 90-day postoperative mortality. Contrastingly, patients ≥ 75 years with low muscle measures were at high risk with 32 % mortality. Predictive models including SMG and age can identify high-risk groups and predict postoperative mortality after minimally-invasive esophagectomy.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100169"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144756965","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":"Laparoscopic resection of a left retroperitoneal solitary fibrous tumor","authors":"Laura Benuzzi ,&nbsp;Alessandra Borghi ,&nbsp;Marco Baia ,&nbsp;Melissa Lillian Wood ,&nbsp;Elena Di Blasi ,&nbsp;Marco Fiore ,&nbsp;Chiara Colombo ,&nbsp;Stefano Radaelli ,&nbsp;Alessandro Gronchi ,&nbsp;Dario Callegaro","doi":"10.1016/j.soi.2025.100167","DOIUrl":"10.1016/j.soi.2025.100167","url":null,"abstract":"<div><h3>Introduction</h3><div>Retroperitoneal sarcomas (RPS) are rare tumors, comprising 15 % of all soft tissue sarcomas (STS). Surgery remains the cornerstone of treatment for localized RPS and is tailored to histologic type.<span><span>¹</span></span> In liposarcoma, the most common RPS, en-bloc resection of the tumor with adjacent organs (such as the colon, kidney, and psoas muscle) is performed to ensure complete clearance of ipsilateral retroperitoneal fat and minimize the risk of local recurrence. Conversely, solitary fibrous tumors (SFT) have a lower risk of local recurrence, and adjacent organs are resected only if invaded.<span><span>2</span></span>, <span><span>3</span></span> Minimally invasive surgery (MIS) may be considered for select patients with SFT at specialized sarcoma centers.<span><span>⁴</span></span></div></div><div><h3>Video</h3><div>This video presents a 67-year-old man with a 9 cm left retroperitoneal SFT treated with preoperative radiotherapy. The patient underwent laparoscopic en-bloc resection, including a marginal portion of the ipsilateral psoas and quadratus lumborum muscles, perirenal fat, and gonadal vessels, while the ipsilateral kidney, ureter, and femoral nerve were preserved.</div></div><div><h3>Results</h3><div>Following multidisciplinary discussion, and considering histologic type, preoperative radiotherapy, and initial imaging, complete en-bloc resection was achieved with a kidney-sparing procedure, resulting in negative microscopic margins. Oncological surgical principles for STS were upheld, with dissection performed outside anatomical planes to ensure clear margins. Postoperative recovery was uneventful, and the patient was discharged home on postoperative day 4. The patient is alive and disease-free one year after surgery.</div></div><div><h3>Conclusions</h3><div>This video demonstrates the feasibility and safety of MIS for select patients with retroperitoneal SFT treated at sarcoma referral centers, emphasizing adherence to oncological surgical principles.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100167"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144722591","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":"Total neoadjuvant therapy (TNT) improves completion rates of intended therapy and oncologic outcomes in locally advanced gastric cancer","authors":"EeeLN Buckarma ,&nbsp;Shelby Yee ,&nbsp;Robert A. Vierkant ,&nbsp;Emily Siegler ,&nbsp;Mojun Zhu ,&nbsp;Cornelius Thiels ,&nbsp;Mark Truty ,&nbsp;Michael Kendrick ,&nbsp;Travis E. Grotz","doi":"10.1016/j.soi.2025.100173","DOIUrl":"10.1016/j.soi.2025.100173","url":null,"abstract":"<div><h3>Background</h3><div>Perioperative chemotherapy (PC) is the standard for locally advanced gastric cancer (LAGC) but can be difficult to implement with many patients unable to complete adjuvant therapy. Total neoadjuvant therapy (TNT) may result in improved adherence and outcomes.</div></div><div><h3>Methods</h3><div>Single institution retrospective review of LAGC treated with chemotherapy and surgery (2008–2023). Therapy strategy, clinical, pathological, and perioperative outcomes were examined using multivariable regression. Kaplan-Meier curves and cox proportional hazards regression models were used for recurrence free survival (RFS) and (OS).</div></div><div><h3>Results</h3><div>202 patients included, 71(35 %) were treated with TNT and 131(65 %) PC. No differences in baseline demographics. TNT patients received more cycles of treatment (median 8, IQR 6–9) compared to PC (median 6, IQR 4–8) (p &lt; 0.001). 66 % of PC patients-initiated adjuvant chemotherapy and 46 % of those patients completed ≥ 3 cycles. There was no significant difference in postoperative morbidity between TNT and PC. There were similar (20 % vs 22 %) rates of pathologic complete response and margin negative resections (99 % vs 98 %). TNT approach was associated with improved 18-month RFS and five-year OS on univariate analysis. 94 % TNT patients received ≥ 6 cycles of chemotherapy compared to PC (50 %), p = 0.002. Patients who received ≥ 6 cycles of chemotherapy were found to have improved 18-month RFS and 5-year OS when compared to those who received ≤ 4 (RFS HR=2.93, 95 %CI 1.59–5.41, p &lt; 0.001, OS HR=2.32, 95 %CI 1.39–3.92, p = 0.002).</div></div><div><h3>Conclusion</h3><div>TNT strategy for LAGC results in a higher rate of completing intended therapy. The completion of ≥ 6 cycles of chemotherapy were independently associated with improved RFS and OS.</div></div>","PeriodicalId":101191,"journal":{"name":"Surgical Oncology Insight","volume":"2 3","pages":"Article 100173"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144827605","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}