Ejso最新文献

{"title":"Development of an optimized MRI protocol for a rapid preoperative identification of sentinel lymph nodes using superparamagnetic iron oxide - The Gothenburg fast acquisition sentinel lymph node tracking magnetic resonance imaging protocol (GO-FAST-MRI).","authors":"Pontus Zaar, Nushin Mirzaei, Oscar Jalnefjord, Erica de Coursey, Iva Johansson, Fredrik Wärnberg, Henrik Leonhardt, Roger Olofsson Bagge","doi":"10.1016/j.ejso.2024.109362","DOIUrl":"10.1016/j.ejso.2024.109362","url":null,"abstract":"<p><strong>Introduction: </strong>Determining sentinel lymph node (SLN) status is important for treatment decisions in patients with melanoma. Superparamagnetic iron oxide nanoparticles (SPIO) combined with MRI have emerged as an alternative to Technetium^99m lymphoscintigraphy for preoperative mapping of SLN, however, the MRI protocols so far are extensive with long in-camera time. This study aimed to evaluate an optimized MRI protocol for rapid identification of SLNs using SPIO as a tracer, without compromising diagnostic quality, the GOthenburg Fast Acquisition Sentinel lymph node Tracking MRI (GO-FAST-MRI).</p><p><strong>Materials and methods: </strong>In this prospective single-center pilot study, patients with confirmed melanoma on the trunk or limbs, without clinically suspected lymph node metastasis, were eligible. All patients received an injection of 0.1 mL SPIO divided into four quadrants around the scar. The GO-FAST-MRI protocol, using only T1-weighted and Dixon sequences over the axillary or inguinal basins, was conducted no earlier than 30 min post-injection. Technetium and lymphoscintigraphy were used according to routine. SLN-biopsy was performed using a handheld magnetometer and gamma probe for SLN-detection.</p><p><strong>Results: </strong>Twenty-one patients were enrolled, and SLNs were successfully identified in all with both methods. The GO-FAST-MRI protocol was performed in 4 min and detected more SLNs than lymphoscintigraphy (54 vs 42), but the number of SLNs identified during surgery with the magnetometer and gamma probe was the same (50 for both methods). Of the SLNs removed, five were found to have metastases, all of which showed uptake of SPIO and Tc99m.</p><p><strong>Conclusion: </strong>The novel GO-FAST-MRI protocol, with a 4-min scan-time, was feasible in detecting SLNs in all patients. Both the preoperative SLN-mapping and intraoperative SLN-detection using the magnetic technique was comparable to the radioactive technique.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 1","pages":"109362"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethical and legal issues regarding artificial intelligence (AI) and management of surgical data.","authors":"Alberto R Ferreres","doi":"10.1016/j.ejso.2024.108279","DOIUrl":"10.1016/j.ejso.2024.108279","url":null,"abstract":"<p><p>The advent of AI in surgical practice is representing a major innovation. As its role expands and due to its several implications, strict compliance with ethical, legal and regulatory good practices is mandatory. Observance of ethical principles and legal rules will be a professional imperative for the application of AI in surgical practice, both clinically and scientifically.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108279"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140329706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutritional status of early oral feeding for gastric cancer patients after laparoscopic total gastrectomy: A retrospective cohort study.","authors":"Leyao Han, Yihan Zhou, Yingqiao Wang, Haixia Chen, Weiping Li, Meishan Zhang, Juanjuan Zhou, Liping Zhang, Xinman Dou, Xinglei Wang","doi":"10.1016/j.ejso.2024.109379","DOIUrl":"10.1016/j.ejso.2024.109379","url":null,"abstract":"<p><strong>Background: </strong>After Laparoscopic total gastrectomy (LTG), gastric cancer (GC) patients often face malnutrition. Early oral feeding (EOF) has emerged as a key strategy in enhanced recovery after surgery (ERAS) protocols. However, the impact of EOF on post-LTG nutritional status requires further investigation. This study aimed to compare the nutritional status of EOF, nasogastric tube (NGT) and nasojejunal tube (NJT) to figure out the status of EOF.</p><p><strong>Methods: </strong>A retrospective comparative analysis of a single center (Second Hospital of Lanzhou University) of a total of 116 patients with LTG was performed. These included 40 NGT patients, 40 patients with NJT and 36 patients with EOF. Postoperative (7 days after surgery) nutritional status was examined as the primary endpoint, including weight, BMI, total protein, albumin, hemoglobin and total lymphocyte count (TLC). In addition, bowel sounds, abdominal distension and pain were evaluated as secondary endpoints.</p><p><strong>Results: </strong>The collective shows no significant differences between the three groups regarding various demographic and clinical information (All, p > 0.05). There was no significant difference in the patients' nutritional status and bowel sound recovery 7 days after surgery (All, p > 0.05). The rate of abdominal distension shows to be significantly reduced with EOF compared to NJT (mean difference = 0.342; p < 0.001). The incidence of abdominal pain was significantly different between EOF and NGT groups (mean difference = 0.228; p < 0.001).</p><p><strong>Conclusion: </strong>Among GC patients after LTG, EOF and traditional tube feeding had a similar risk of postoperative nutritional status. However, EOF was associated with a lower risk of abdominal distension.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109379"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical and oncologic outcomes for liver resections of cystic neuroendocrine tumor liver metastasis.","authors":"Markus Ammann, Stella K Adjei Antwi, Hallbera Gudmundsdottir, Hubert Hackl, Jonas Santol, Benedetto E Guillot, Giulia Pappalettera, Cornelius A Thiels, Susanne G Warner, Mark J Truty, Michael L Kendrick, Rory L Smoot, David M Nagorney, Sean P Cleary, Thorvardur R Halfdanarson, Patrick P Starlinger","doi":"10.1016/j.ejso.2024.109464","DOIUrl":"10.1016/j.ejso.2024.109464","url":null,"abstract":"<p><strong>Background: </strong>Cystic neuroendocrine tumor liver metastases (NETLM) are rare and dynamics in the liquid compartment often misinterpreted as rapid progression, affecting selection for liver resection candidates. This study retrospectively evaluates surgical and oncologic outcomes in patients with cystic versus solid NETLM from small bowel and pancreatic primaries.</p><p><strong>Methods: </strong>Between 2000 and 2020, 12 patients with cystic NETLM were identified among 464 patients who underwent >90 % tumor cytoreduction debulking hepatectomy at the Mayo Clinic. Tumor and patient characteristics, as well as surgical and oncologic outcomes, were compared with the total cohort of patients with solid NETLM, including a propensity-matched cohort.</p><p><strong>Results: </strong>Patients with cystic NETLM were similar in age (55.4 vs. 59.7 years; p = 0.113) and sex (58 % vs. 51 % men; p = 0.772) to those with solid NETLM. Synchronous metastases (92 % vs. 77 %; p = 0.314), bilobar distribution (83 % vs. 79 %; p = 1.000), lesion numbers (p = 0.547), Ki67 % expression (p = 0.311), and extrahepatic lesions (8 % vs. 18 %; p = 0.702) were similar. Cystic metastases were larger (7.3 vs. 3.8 cm; p < 0.001). Surgical risk did not differ, with major morbidity (25 % vs. 22 %; p = 0.729) and mortality (0 % vs. <2 %; p = 1.000). Median overall survival (OS) was 13.8 vs. 10.6 years (p = 0.513), and hepatic-progression-free survival (PFS) was 0.71 vs. 1.78 years (p = 0.507). Matched cohorts showed no significant difference in OS (13.80 vs. 8.57; p = 0.316) or hepatic-PFS (0.71 vs. 1.33; p = 0.620).</p><p><strong>Conclusion: </strong>Surgical risk and long-term outcomes do not significantly differ between cystic and solid NETLMs. Given excellent long-term survival rates with >90 % cytoreduction, radical debulking is advised for both phenotypes when clinically feasible.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109464"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial intelligence-powered clinical decision making within gastrointestinal surgery: A systematic review.","authors":"Mustafa Bektaş, Cevin Tan, George L Burchell, Freek Daams, Donald L van der Peet","doi":"10.1016/j.ejso.2024.108385","DOIUrl":"10.1016/j.ejso.2024.108385","url":null,"abstract":"<p><strong>Background: </strong>Clinical decision-making in gastrointestinal surgery is complex due to the unpredictability of tumoral behavior and postoperative complications. Artificial intelligence (AI) could aid in clinical decision-making by predicting these surgical outcomes. The current status of AI-based clinical decision-making within gastrointestinal surgery is unknown in recent literature. This review aims to provide an overview of AI models used for clinical decision-making within gastrointestinal surgery.</p><p><strong>Methods: </strong>A systematic literature search was performed in databases PubMed, EMBASE, Cochrane, and Web of Science. To be eligible for inclusion, studies needed to use AI models for clinical decision-making involving patients undergoing gastrointestinal surgery. Studies reporting on reviews, children, and study abstracts were excluded. The Probast risk of bias tool was used to evaluate the methodological quality of AI methods.</p><p><strong>Results: </strong>Out of 1073 studies, 10 articles were eligible for inclusion. AI models have been used to make clinical decisions between surgical procedures, selection of chemotherapy, selection of postoperative follow up programs, and implementation of a temporary ileostomy. Most studies have used a Random Forest or Gradient Boosting model with AUCs up to 0.97. All studies involved a retrospective study design, in which external validation was performed in one study.</p><p><strong>Conclusions: </strong>This review shows that AI models have the potentiality to select the most optimal treatments for patients undergoing gastrointestinal surgery. Clinical benefits could be gained if AI models were used for clinical decision-making. However, prospective studies and randomized controlled trials will reveal the definitive role of AI models in clinical decision-making.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108385"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140956732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in health-related quality of life following breast cancer surgery: A systematic review of the literature on the role of surgical approaches.","authors":"Theodora Fteropoulli, Eleni Tzounaka, Aliya Amirova, Georgios Nikolopoulos, Anneza Yiallourou","doi":"10.1016/j.ejso.2024.109467","DOIUrl":"10.1016/j.ejso.2024.109467","url":null,"abstract":"<p><strong>Background: </strong>This systematic review aimed to examine changes in health-related quality of life (HRQoL) in women with breast cancer from pre-to post surgery, comparing mastectomy (M), mastectomy with breast reconstruction (MBR), and breast conserving surgery (BCS).</p><p><strong>Methods: </strong>We included English-language randomised and non-randomised controlled trials and observational studies involving adult women, pre-operatively diagnosed with breast cancer (excluding metastatic cases). Studies needed to assess HRQoL pre- and post-surgery using validated questionnaires and include women undergoing M, MBR, and BCS. Searches in six electronic databases were supplemented by checking reference lists. Two independent researchers conducted the article selection, data extraction, and quality assessment. Narrative synthesis included categorisation of HRQoL in physical and psychosocial HRQoL domains with calculation and interpretation of minimally important differences (MID).</p><p><strong>Results: </strong>Six prospective studies of fair quality (n = 172 to n = 1178, follow-up: 1-120 months) were included. By 24 months, HRQoL, anxiety, and depression either returned to pre-surgery levels or improved for all surgical groups, with comparable outcomes. Physical HRQoL deteriorated following MBR and BCS at 6 months and 12 months post-surgery, respectively, while poor psychosocial HRQoL was prominent following M at 12 months. MBR fared worse in anxiety and depression compared with the other groups.</p><p><strong>Discussion: </strong>HRQoL challenges are evident following all surgical approaches, albeit at different timepoints along the treatment pathway. The evidence is limited due to a small number of studies and considerable methodological variation. Systematic assessment of HRQoL in routine care is recommended to monitor trajectories throughout the care pathway and guide psychological interventions.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109467"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy.","authors":"F Nickel, A Studier-Fischer, B Özdemir, J Odenthal, L R Müller, S Knoedler, K F Kowalewski, I Camplisson, M M Allers, M Dietrich, K Schmidt, G A Salg, H G Kenngott, A T Billeter, I Gockel, C Sagiv, O E Hadar, J Gildenblat, L Ayala, S Seidlitz, L Maier-Hein, B P Müller-Stich","doi":"10.1016/j.ejso.2023.04.007","DOIUrl":"10.1016/j.ejso.2023.04.007","url":null,"abstract":"<p><strong>Introduction: </strong>Esophagectomy is the mainstay of esophageal cancer treatment, but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Therefore, the objective of this work was to optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis.</p><p><strong>Material and methods: </strong>A live porcine model (n = 58) for MIE was used with gastric conduit formation and simulation of linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and simulation of anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic simulation site was evaluated using HSI and was validated with histopathology.</p><p><strong>Results: </strong>The tissue oxygenation (ΔStO₂) after the anastomotic simulation remained constant only for the short stapler in caudal position (-0.4 ± 4.4%, n.s.) while it was impaired markedly in the other groups (short-cranial: -15.6 ± 11.5%, p = 0.0002; long-cranial: -20.4 ± 7.6%, p = 0.0126; long-caudal: -16.1 ± 9.4%, p < 0.0001). Tissue samples from avascular stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7 ± 9.7% of the surface area.</p><p><strong>Conclusion: </strong>Tissue oxygenation at the site of anastomotic simulation of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the simulated anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. The experimental model with HSI and ML allow for systematic optimization of gastric conduit perfusion and anastomotic technique while clinical translation will have to be proven.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"106908"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9357172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative detection of hepatocellular carcinoma's microvascular invasion on CT-scan by machine learning and radiomics: A preliminary analysis.","authors":"Simone Famularo, Camilla Penzo, Cesare Maino, Flavio Milana, Riccardo Oliva, Jacques Marescaux, Michele Diana, Fabrizio Romano, Felice Giuliante, Francesco Ardito, Gian Luca Grazi, Matteo Donadon, Guido Torzilli","doi":"10.1016/j.ejso.2024.108274","DOIUrl":"10.1016/j.ejso.2024.108274","url":null,"abstract":"<p><strong>Introduction: </strong>Microvascular invasion (MVI) is the main risk factor for overall mortality and recurrence after surgery for hepatocellular carcinoma (HCC).The aim was to train machine-learning models to predict MVI on preoperative CT scan.</p><p><strong>Methods: </strong>3-phases CT scans were retrospectively collected among 4 Italian centers. DICOM files were manually segmented to detect the liver and the tumor(s). Radiomics features were extracted from the tumoral, peritumoral and healthy liver areas in each phase. Principal component analysis (PCA) was performed to reduce the dimensions of the dataset. Data were divided between training (70%) and test (30%) sets. Random-Forest (RF), fully connected MLP Artificial neural network (neuralnet) and extreme gradient boosting (XGB) models were fitted to predict MVI. Prediction accuracy was estimated in the test set.</p><p><strong>Results: </strong>Between 2008 and 2022, 218 preoperative CT scans were collected. At the histological specimen, 72(33.02%) patients had MVI. First and second order radiomics features were extracted, obtaining 672 variables. PCA selected 58 dimensions explaining >95% of the variance.In the test set, the XGB model obtained Accuracy = 68.7% (Sens: 38.1%, Spec: 83.7%, PPV: 53.3% and NPV: 73.4%). The neuralnet showed an Accuracy = 50% (Sens: 52.3%, Spec: 48.8%, PPV: 33.3%, NPV: 67.7%). RF was the best performer (Acc = 96.8%, 95%CI: 0.91-0.99, Sens: 95.2%, Spec: 97.6%, PPV: 95.2% and NPV: 97.6%).</p><p><strong>Conclusion: </strong>Our model allowed a high prediction accuracy of the presence of MVI at the time of HCC diagnosis. This could lead to change the treatment allocation, the surgical extension and the follow-up strategy for those patients.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"108274"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140305218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathological outcomes of transanal, robotic, open, and laparoscopic surgery for rectal cancer resection. A Bayesian network meta-analysis of randomized controlled trials.","authors":"Nicola de'Angelis, Carlo Alberto Schena, Danila Azzolina, Maria Clotilde Carra, Jim Khan, Caroline Gronnier, Sébastien Gaujoux, Paolo Pietro Bianchi, Antonino Spinelli, Philippe Rouanet, Aleix Martínez-Pérez, Patrick Pessaux","doi":"10.1016/j.ejso.2024.109481","DOIUrl":"10.1016/j.ejso.2024.109481","url":null,"abstract":"<p><strong>Background: </strong>While total mesorectal excision is the gold standard for rectal cancer, the optimal surgical approach to achieve adequate oncological outcomes remains controversial. This network meta-analysis aims to compare the histopathological outcomes of robotic (R-RR), transanal (Ta-RR), laparoscopic (L-RR), and open (O-RR) resections for rectal cancer.</p><p><strong>Materials and methods: </strong>MEDLINE, Embase, and the Cochrane Library were screened from inception to June 2024. Of the 4186 articles screened, 27 RCTs were selected. Pairwise comparisons and Bayesian network meta-analyses applying random effects models were performed.</p><p><strong>Results: </strong>The 27 RCTs included a total of 8696 patients. Bayesian pairwise meta-analysis revealed significantly lower odds of non-complete mesorectal excision with Ta-RR (Odds Ratio, OR, 0.60; 95%CI, 0.33, 0.92; P = .02; I²:11.7 %) and R-RR (OR, 0.68; 95%CI, 0.46, 0.94; P = .02; I²:41.7 %) compared with laparoscopy. Moreover, lower odds of positive CRMs were observed in the Ta-RR group than in the L-RR group (OR, 0.36; 95%CI, 0.13, 0.91; P = .02; I²:43.9 %). The R-RR was associated with more lymph nodes harvested compared with L-RR (Mean Difference, MD, 1.24; 95%CI, 0.10, 2.52; P = .03; I²:77.3 %). Conversely, Ta-RR was associated with a significantly lower number of lymph nodes harvested compared with all other approaches. SUCRA plots revealed that Ta-RR had the highest probability of being the best approach to achieve a complete mesorectal excision and negative CRM, followed by R-RR, which ranked the best in lymph nodes retrieved.</p><p><strong>Conclusion: </strong>When comparing the effectiveness of the available surgical approaches for rectal cancer resection, Ta-RR and R-RR are associated with better histopathological outcomes than L-RR.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109481"},"PeriodicalIF":3.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142709585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of recurrence after esophagectomy following neoadjuvant immunochemotherapy in patients with thoracic esophageal squamous cell carcinoma.","authors":"Qiuying An, Ping Zhang, Hongyan Wang, Zihan Zhang, Sihan Liu, Wenwen Bai, Hui Zhu, Chanjun Zhen, Xueying Qiao, Liwei Yang, Yajing Wang, Jun Wang, Yibing Liu, Hanyu Si, Yuhao Su, Xiaoli Xu, Fan Yang, Zhiguo Zhou","doi":"10.1016/j.ejso.2024.109546","DOIUrl":"https://doi.org/10.1016/j.ejso.2024.109546","url":null,"abstract":"<p><strong>Purpose: </strong>To explore the recurrence pattern and risk factors associated with the relapse of thoracic esophageal squamous cell carcinoma (TESCC) among patients who received esophagectomy following neoadjuvant immunochemotherapy (NICT).</p><p><strong>Methods: </strong>A total of 191 TESCC patients who received esophagectomy following NICT were retrospectively reviewed from 2019 to 2022. The first recurrence patterns were assessed. The postoperative recurrence-free survival (RFS) was determined using the Kaplan-Meier method. Multivariate recurrence risk factor analysis was performed using the logistic regression model.</p><p><strong>Results: </strong>As of the December 31, 2023 follow-up, 66 patients experienced recurrence, with a median time to recurrence of 10.8 months (1.2-37.3 months). The recurrence pattern included locoregional recurrence (LR), distant recurrence (DR), and LR + DR, accounting for 69.7 %, 16.7 %, and 13.6 %, respectively. Locoregional lymph node (LN) predominated the pattern of postoperative recurrence (40/66), particularly in the mediastinal station 2R (17.5 %) and 4R (16.5 %). The 2-year RFS rates for groups with dissected LN stations of ≤6, 7-9, and 10-14 were 50.5 %, 72.3 %, and 63.5 %, respectively (P = 0.04). Similarly, the 2-year RFS rates for groups with dissected LNs of <15, 15-29, and ≥30 were 49.7 %, 61.6 %, and 71.6 %, respectively (P = 0.28). Furthermore, tumor length >5 cm, the T-stage evaluation as clinically stable disease, dissected LN stations ≤6, and the ypN2-3 stage were unfavorable factors for postoperative failure in patients.</p><p><strong>Conclusions: </strong>The major pattern of LR may be LN recurrence after NICT in TESCC patients, particularly in the station 2R and 4R. In addition, less than 6 LN dissection stations or less than 15 LNs are not recommended.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 3","pages":"109546"},"PeriodicalIF":3.5,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142863805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}