Ejso最新文献

{"title":"Influence of lung metastases on outcomes of curative management of peritoneal metastases from colorectal cancer","authors":"Ajinkya Pawar ,&nbsp;Vahan Kepenekian ,&nbsp;Alhadeedi Omar ,&nbsp;Nicolas Bel ,&nbsp;Laurent Villeneuve ,&nbsp;Gabrielle Drevet ,&nbsp;Jean Michel Maury ,&nbsp;Guillaume Passot ,&nbsp;Olivier Glehen","doi":"10.1016/j.ejso.2025.109650","DOIUrl":"10.1016/j.ejso.2025.109650","url":null,"abstract":"<div><h3>Background</h3><div>Traditionally there has been a nihilistic approach towards patients with pulmonary metastases arising from colorectal cancer. However, emerging evidence highlights the benefit of curative intent treatment. Given the established individual roles of pulmonary metastectomy and CRS/HIPEC in the treatment of colorectal pulmonary and peritoneal metastases, respectively, we decided to combine these modalities and determine whether pulmonary metastases really influence the outcomes of curative intent treatment in CRC patients with peritoneal metastases.</div></div><div><h3>Methods</h3><div>This was a retrospective study of a prospectively maintained database of CRC patients with peritoneal metastases undergoing CRS and HIPEC with curative intent from Jan 1, 2005 to Aug 1, 2018. Patients were divided into two groups of without pulmonary metastases and with pulmonary metastases. Patients were followed up for a median 40.8 months.</div></div><div><h3>Results</h3><div>Of total 455 patients 19 had pulmonary metastases. The median RFS and OS of all patients was 14.26 months (95 % CI:12.71–16.2) and 56.96 months (95 % CI: 47.73–77.79) respectively. Median RFS and OS of patients with and without pulmonary metastases was 12 &amp; 49.8 months and 14.4 &amp; 57.9 months, respectively. On multivariate analysis, PCI, CC-0 rate, CEA, signet ring histology and retroperitoneal lymph node metastases significantly affected the OS. Presence of pulmonary metastases did not significantly affect the RFS or OS.</div></div><div><h3>Conclusion</h3><div>There has always been a skepticism in the management CRC with PM and extraperitoneal disease, especially pulmonary metastases with curative intent. Our study demonstrates that CRS and HIPEC improves OS in such patients and pulmonary metastases per se do not influence the outcomes of disease. Nevertheless, further prospective and multi centric studies are required to validate these findings.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109650"},"PeriodicalIF":3.5,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684372","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":"Enhancing feature importance analysis with Spearman's correlation with p-values: Recommendations for improving PHLF prediction","authors":"Haoqian Pan,&nbsp;Yoshiyasu Takefuji","doi":"10.1016/j.ejso.2025.109687","DOIUrl":"10.1016/j.ejso.2025.109687","url":null,"abstract":"","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109687"},"PeriodicalIF":3.5,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684375","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":"Risk of distant metastasis after local excision for near-complete response versus salvage surgery for local regrowth in rectal cancer: Results from an international registry","authors":"Constance Jehaes ,&nbsp;Yves Panis ,&nbsp;Laura Fernandez ,&nbsp;Bernard Lelong ,&nbsp;Guilherme Sao Julião ,&nbsp;Bruna Vailati ,&nbsp;Jeremie H. Lefevre ,&nbsp;Jean-Jacques Tuech ,&nbsp;José Azevedo ,&nbsp;Stéphane Benoist ,&nbsp;Amjad Parvaiz ,&nbsp;Mege Diane ,&nbsp;Angelita Habr- Gama ,&nbsp;Rodrigo Perez ,&nbsp;Quentin Denost ,&nbsp;GRECCAR Group","doi":"10.1016/j.ejso.2025.109761","DOIUrl":"10.1016/j.ejso.2025.109761","url":null,"abstract":"<div><h3>Aim</h3><div>Watch and Wait (WW) strategy is currently used for mid/low rectal adenocarcinoma after neoadjuvant treatment (NAT). Local regrowth (LR) is a well-known risk, but its impact on distant metastasis (DM) is increasingly debated. This study aimed to assess the rate of DM after local excision (LE) for near-complete clinical response (ncCR) at restaging versus salvage surgery for regrowth following WW.</div></div><div><h3>Method</h3><div>Retrospective analysis of DM rates from a prospective international registry, comparing patients with ncCR after NAT who underwent LE and patients with initial complete clinical response (cCR) and WW strategy, who underwent salvage surgery for regrowth. The primary endpoint was the 5-year distant metastasis-free survival (5y-DMFS). Univariate/Multivariate analysis were performed to identify risk factors of DM.</div></div><div><h3>Results</h3><div>Among 138 patients included, 59 had LE for ncCR and 79 had salvage surgery after regrowth including TME (n = 23), APR (n = 30) and LE (n = 26). The 5y-DMFS was lower in patients with surgery at regrowth, 71 % <em>vs.</em> 93 % (p = 0.006). LR was the only independent risk factor associated with DM (OR:3.89; 95 % CI:1.34–11.25; p = 0.012). When only patients managed by salvage LE for LR are considered, 5y-DMFS was equivalent to LE at restaging (87 <em>vs.</em> 93; p = 0.442).</div></div><div><h3>Conclusion</h3><div>Patients with rectal cancer undergoing LE for ncCR after NAT have a significantly lower rate of DM compared to patients undergoing salvage surgery after LR within WW approach. Patients managed by LE for regrowth may represent a distinct subgroup where the risk of subsequent DM is equivalent to patients managed by LE at restage.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109761"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684373","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":"Sentinel lymph node biopsy in gynecological malignancies: A modern approach to surgical staging - A narrative review.","authors":"Aleksandar Celebic, Mirjana Miladinovic, Marina Jakimovska Stefanovska, Jean Calleja Agius, Kristina Drusany Staric","doi":"10.1016/j.ejso.2025.109757","DOIUrl":"https://doi.org/10.1016/j.ejso.2025.109757","url":null,"abstract":"<p><p>Sentinel lymph node biopsy (SLNB) has emerged as a valuable alternative to traditional lymphadenectomy in the surgical management of gynecological cancers. This narrative review delves into the advantages, practical applications, and future research directions of SLNB in this context. Compared to the more extensive lymphadenectomy, SLNB offers a minimally invasive approach to lymph node staging, leading to reduced surgical morbidity, faster recovery times, and improved quality of life for the patients involved. This narrative review highlights the high detection rates and accuracy of SLNB in predicting lymph node metastasis, particularly in early-stage endometrial, cervical and vulvar cancers. By accurately assessing lymph node status, SLNB provides crucial information for treatment planning, potentially guiding decisions regarding adjuvant therapies and assessing the need for further lymph node dissection. From clinical practice guidelines, prospective studies, and relevant research articles, this review provides a thorough understanding the evolving role of SLNB in managing gynecological malignancies. The findings presented underscore the potential of SLNB to improve patient outcomes by providing accurate staging while minimizing surgical complications.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109757"},"PeriodicalIF":3.5,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673627","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":"Rare gynaecological cancers in Malta - An analysis of incidence between 2010 and 2021.","authors":"Miriam J Azzopardi, Jean Calleja-Agius, Neville Calleja, Darren Galea, Bridget Ellul, Rita Micallef, Sharon A O'Toole, Charles Savona Ventura","doi":"10.1016/j.ejso.2025.109971","DOIUrl":"https://doi.org/10.1016/j.ejso.2025.109971","url":null,"abstract":"<p><strong>Introduction: </strong>Whilst about 18 % of all cancers in females are gynaecological cancers, more than 50 % of these can be classified as rare tumours (defined as an annual incidence of <6 per 100,000). Such cancers represent an important challenge for small countries like Malta where the small caseload may limit the expertise of clinicians in the diagnosis and treatment of such cancers.</p><p><strong>Methodology: </strong>The study uses data from the Maltese population-based cancer registry to examine trends in incidence rate of the rare gynaecological cancers for the 12-year period between 2010 and 2021. It employs the RARECAREnet list to identify the rare gynaecological cancers by major rare gynaecological cancer categories and histological types and analyses the number of cases and incidence rates in Malta to monitor trends and provide an insight of the burden of such cancers.</p><p><strong>Results: </strong>A total of 709 new cases of rare gynaecological cancers were discovered during the 12-year period. Globally, these rare gynae cancers, constituted 42.6 % of all the gynae cancers that occurred during this period. Most of these rare cancers were ovarian (399 cases, 56.3 %), followed by rare cancers of the vulva and vagina (122 cases, 17.21 %), rare cancers of the corpus uteri (93 cases, 13.12 %) and rare cancers of the cervix uteri (73 cases, 10.3 %). Other rare gynaecological cancers (10 cases, 1.41 %) and cancers of the placenta (2 cases, 0.04 %) were much rarer. The outcomes in terms of 5-year survival was worse for the rare cancers compared with the commoner types of gynae cancers with an overall 5-year survival of 45.10 % and 45.48 % for rare gynae cancers for the 2010-2014 and 2015-2019 cohorts respectively and an overall 5-year survival of 69.94 % and 73.44 % for the common gynae cancers for the 2010-2014 and 2015-2019 cohorts respectively.</p><p><strong>Conclusion: </strong>The study shows that globally rare gynaecological cancers in a small state like Malta are in fact not so rare - with a total of 709 rare gynaecological cancers in 12 years for Malta. These cases are however few when considering that they are divided into over 30 different histopathological groups. Numbers are also small when it comes to accumulating statistical power for analysis. The caseload for the individual sub-categories is small and will often be shared amongst the different individual gynaecologists and/or their clinical team. Thus, it might be difficult for these specialists to gather enough technical expertise that is crucial for early diagnosis and the treatment of these rare cancers. This study provides a rationale for international collaboration where there is scope for joint research and sharing of expertise. Establishment of common databases for the various types of rare gynaecological tumours will provide statistical power, enabling analysis of outcomes for these rare cancers and establishment of guidelines.</p>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":" ","pages":"109971"},"PeriodicalIF":3.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729159","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":"Risk of recurrence following transanal endoscopic microsurgery without neoadjuvant or adjuvant treatment in T2 rectal cancer","authors":"Erik Wetterholm,&nbsp;Carl-Fredrik Rönnow,&nbsp;Henrik Thorlacius","doi":"10.1016/j.ejso.2025.109974","DOIUrl":"10.1016/j.ejso.2025.109974","url":null,"abstract":"<div><h3>Background</h3><div>Transanal endoscopic microsurgery (TEM) is only curative treatment for T1 rectal cancer with low-risk features. In T2 cancer, TEM is not recommended but could be used as a palliative procedure and/or in patients unfit for surgery. Few studies exist investigating recurrence after TEM for T2 rectal cancer.</div></div><div><h3>Method</h3><div>Retrospective, population-based study using the Swedish Colorectal Cancer Registry. Included patients had T2 rectal adenocarcinoma treated with TEM or surgery without neoadjuvant or adjuvant therapy between 2009 and 2021. Patients lost to follow-up, with syn/metachronous tumours or unknown recurrence status were excluded. Patient characteristics, perioperative morbidity, local and distant recurrence were compared.</div></div><div><h3>Results</h3><div>63 patients treated with TEM and 894 with surgery. Median age was 81 and 70 (<em>p</em> &lt; 0.01). 59 % and 23 % respectively were ASA III-IV (<em>p</em> &lt; 0.01). TEM tumours were more distal, 37 % vs 16 % in the lower third of the rectum (<em>p</em> &lt; 0.01). There were no severe complications after TEM compared to 6 % following surgery (<em>p</em> = 0.04). 5-year local recurrence was 33 % after TEM and 2 % after surgery (HR = 25.58, (<em>p</em> &lt; 0.01). 5-year distant recurrence rate was 9 % after TEM and 7 % after surgery (HR = 0.49, (<em>p</em> = 0.27). Mean time to local recurrence was 16 months after TEM, 34 months after surgery, time to distant recurrence 22 months after both.</div></div><div><h3>Conclusion</h3><div>TEM for T2 rectal cancer has high risk of local recurrence and cannot be recommended when intent is curative. TEM could be an option for patients unfit for surgery.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109974"},"PeriodicalIF":3.5,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143684374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Worse oncological impact of preoperative anemia in patients with locally advanced gastric cancer after curative gastrectomy: A retrospective cohort study","authors":"Ryota Matsui,&nbsp;Manabu Ohashi,&nbsp;Motonari Ri,&nbsp;Rie Makuuchi,&nbsp;Tomoyuki Irino,&nbsp;Masaru Hayami,&nbsp;Takeshi Sano,&nbsp;Souya Nunobe","doi":"10.1016/j.ejso.2025.109762","DOIUrl":"10.1016/j.ejso.2025.109762","url":null,"abstract":"<div><h3>Background</h3><div>The impact of preoperative anemia on long-term survival outcomes after gastrectomy remains unclear. This study determined the effect of preoperative anemia on long-term survival outcomes in patients undergoing gastrectomy for gastric cancer.</div></div><div><h3>Methods</h3><div>This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary pStages I–III gastric cancer between May 2006 and March 2017. According to the World Health Organization hemoglobin classification, ≥13.0 g/dL for men and ≥12.0 g/dL for women are considered normal, 11.0–12.9 g/dL for men and 11.0–11.9 g/dL for women as mild anemia, 8.0–10.9 g/dL moderate anemia, and &lt;8.0 g/dL as severe anemia. The primary outcome was overall survival (OS). Comparisons were made using the log-rank test, and prognostic factors were identified using Cox proportional hazards regression analysis.</div></div><div><h3>Results</h3><div>The median follow-up duration was 60 months. Of 4730 patients, 3066 (64.8 %) were classified as normal, 1093 (23.1 %) as mild, 540 (11.4 %) as moderate, and 31 (0.7 %) as severe anemia. Patients with anemia had poorer survival outcomes than those without anemia (P &lt; 0.001). No differences were found among survival outcomes in OS based on severity. When stratified by pStage, patients with anemia had a poorer survival outcome than those without anemia in each pStage. Multivariate analysis showed that preoperative anemia was an independent poor prognostic factor for OS regardless of blood transfusion (hazard ratios: 1.650, 95 % confidence interval: 1.432–1.902, P &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>Preoperative anemia, independent of perioperative blood transfusions, may worsen OS in patients with gastric cancer after curative gastrectomy.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109762"},"PeriodicalIF":3.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143637216","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":"Long-term functional outcomes after Transanal Transection and Single-Stapled (TTSS) anastomosis for rectal cancer measured by electronic Patients Reported Outcome Measures (ePROMs)","authors":"Caterina Foppa ,&nbsp;Annalisa Maroli ,&nbsp;Michele Carvello ,&nbsp;Carlotta La Raja ,&nbsp;Antonio Luberto ,&nbsp;Federico Zangrandi ,&nbsp;Maria Rocca ,&nbsp;Antonino Spinelli","doi":"10.1016/j.ejso.2025.109759","DOIUrl":"10.1016/j.ejso.2025.109759","url":null,"abstract":"<div><h3>Background</h3><div>The transanal transection and single-stapled anastomosis (TTSS) is gaining interest as a reconstructive technique whenever a restorative procedure after a total mesorectal excision (TME) is planned. TTSS, allowing lower anastomoses than the conventional DS technique, may raise discussion about its functional outcomes. The aim of this study was to compare long-term functional outcomes of TTSS and DS techniques performed after TME for rectal cancer (RC).</div></div><div><h3>Methods</h3><div>This was a prospective, observational, two-parallel cohort study. Consecutive patients undergoing stoma closure after TME for RC with either TTSS or DS approach were included. The Low Anterior Resection Syndrome (LARS) questionnaire was delivered at 6, 12, and 24 months after stoma closure through a web link embedded in a Short Message System (SMS) or email using an electronic system (Esosphera Srl).</div></div><div><h3>Results</h3><div>According to sample size calculation, 116 patients (58 per cohort) were included. No difference in the LARS score was found at 6 and 12 months, while a significantly lower median LARS was reported in TTSS cohort at 24 months (p = 0.034). The rate of patients with LARS and LARS sub-domains were comparable except for a lower fractioning in TTSS at 24 months (p = 0.005). Anastomoses in the TTSS cohort were significantly lower (p = 0.027), anastomotic leak rate was higher in the DS (p = 0.016).</div></div><div><h3>Conclusions</h3><div>Although lower anastomoses in TTSS cohort, functional outcomes were not inferior of those after DS technique.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109759"},"PeriodicalIF":3.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143611093","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":"Palliative management of patients with locally recurrent rectal cancer: Clinical presentation, treatment strategies, and overall survival","authors":"E. Banken ,&nbsp;D.M.J. Creemers ,&nbsp;F.E.C. Vande Kerckhove ,&nbsp;S.H.J. Ketelaers ,&nbsp;I.E.G. van Hellemond ,&nbsp;H.M.U. Peulen ,&nbsp;H.J.T. Rutten ,&nbsp;J.W.A. Burger","doi":"10.1016/j.ejso.2025.109758","DOIUrl":"10.1016/j.ejso.2025.109758","url":null,"abstract":"<div><h3>Introduction</h3><div>Locally recurrent rectal cancer (LRRC) occurs in 6–12 % of the patients after curative treatment for primary rectal cancer. Palliative treatment plays a critical role, as over half of the patients are ineligible for curative treatment. However, data on patients treated with palliative intent is limited. This study aims to evaluate palliative treatment strategies and overall survival (OS) in LRRC patients.</div></div><div><h3>Methods</h3><div>We retrospectively included all LRRC discussed at the multidisciplinary team in a tertiary referral center, between May 2018 and June 2023. Patients treated with palliative intent were categorized as palliative due to locally unresectable disease, metastatic disease, frailty, or patient preference. Outcomes were OS, treatment response, duration of treatment effect, and hospital admissions. Local control was defined as response or stable disease on imaging.</div></div><div><h3>Results</h3><div>Out of 188 patients, 58 (30.9 %) were treated with palliative intent. Palliative treatments included systemic therapy, chemoradiotherapy and radiotherapy. The median OS for patients treated with palliative intent was 22 months. 3-year OS was 27.1 %, compared to 73.1 % for curative intent patients. Patients with locally unresectable disease had a significantly better OS compared to patients with distant metastases (31 versus 12 months). Local control was achieved in 53.3 % of patients after any palliative treatment, with a median effect duration of 9 months. Chemoradiotherapy was associated with best results for local control.</div></div><div><h3>Conclusion</h3><div>LRRC patients treated with palliative intent can experience substantial survival, particularly those with unresectable disease. Local control due to palliative treatment is feasible, possibly improving survival. Individualized palliative treatment is crucial.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109758"},"PeriodicalIF":3.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143629436","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":"A deep-learning model to predict the completeness of cytoreductive surgery in colorectal cancer with peritoneal metastasis☆","authors":"Qingfeng Lin ,&nbsp;Can Chen ,&nbsp;Kangshun Li ,&nbsp;Wuteng Cao ,&nbsp;Renjie Wang ,&nbsp;Alessandro Fichera ,&nbsp;Shuai Han ,&nbsp;Xiangjun Zou ,&nbsp;Tian Li ,&nbsp;Peiru Zou ,&nbsp;Hui Wang ,&nbsp;Zaisheng Ye ,&nbsp;Zixu Yuan ,&nbsp;Chinese Peritoneal Tumor Collaborative Group (CPTCG)","doi":"10.1016/j.ejso.2025.109760","DOIUrl":"10.1016/j.ejso.2025.109760","url":null,"abstract":"<div><h3>Background</h3><div>Colorectal cancer (CRC) with peritoneal metastasis (PM) is associated with poor prognosis. The Peritoneal Cancer Index (PCI) is used to evaluate the extent of PM and to select Cytoreductive Surgery (CRS). However, PCI score is not accurate to guide patient's selection for CRS.</div></div><div><h3>Objective</h3><div>We have developed a novel AI framework of decoupling feature alignment and fusion (DeAF) by deep learning to aid selection of PM patients and predict surgical completeness of CRS.</div></div><div><h3>Methods</h3><div>186 CRC patients with PM recruited from four tertiary hospitals were enrolled. In the training cohort, deep learning was used to train the DeAF model using Simsiam algorithms by contrast CT images and then fuse clinicopathological parameters to increase performance. The accuracy, sensitivity, specificity, and AUC by ROC were evaluated both in the internal validation cohort and three external cohorts.</div></div><div><h3>Results</h3><div>The DeAF model demonstrated a robust accuracy to predict the completeness of CRS with AUC of 0.9 (95 % CI: 0.793–1.000) in internal validation cohort. The model can guide selection of suitable patients and predict potential benefits from CRS. The high predictive performance in predicting CRS completeness were validated in three external cohorts with AUC values of 0.906(95 % CI: 0.812–1.000), 0.960(95 % CI: 0.885–1.000), and 0.933 (95 % CI: 0.791–1.000), respectively.</div></div><div><h3>Conclusion</h3><div>The novel DeAF framework can aid surgeons to select suitable PM patients for CRS and predict the completeness of CRS. The model can change surgical decision-making and provide potential benefits for PM patients.</div></div>","PeriodicalId":11522,"journal":{"name":"Ejso","volume":"51 7","pages":"Article 109760"},"PeriodicalIF":3.5,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143737888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}