Journal of Surgical Oncology最新文献

{"title":"Case Series: Natural History and Treatment of Thoracic Aortic Sarcoma.","authors":"Calvin L Chao, Nicola M Habash, Mark K Eskandari","doi":"10.1002/jso.28150","DOIUrl":"https://doi.org/10.1002/jso.28150","url":null,"abstract":"<p><p>Aortic sarcoma is a rare and aggressive malignancy with a poor prognosis despite surgical resection and vascular reconstruction. We present a case series of patients with thoracic aortic sarcoma, highlighting three distinct clinical scenarios: primary resection, resection following prior thoracic aortic endograft, and nonoperative management. Our findings underscore key aspects of aortic sarcoma management, including its embolic potential, diagnostic challenges, and surgical considerations, particularly when endograft explant is required. Despite limited survival, we advocate for complete resection and vascular reconstruction with adjunctive chemoradiotherapy when feasible. Multidisciplinary collaboration remains paramount to optimize postoperative outcome in this complex pathology.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decision-Making in Surgical Patients: Discarding \"Heroic Measures\" in Favor of Goal-Oriented Care at the End of Life.","authors":"Erin Yu, Baddr A Shakhsheer, Sean C Wightman","doi":"10.1002/jso.28125","DOIUrl":"https://doi.org/10.1002/jso.28125","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty Is an Independent Marker of Post-Operative Mortality Following Colorectal Cancer Resection Surgery in Older Adults.","authors":"Maria Normann, Niklas Ekerstad, Eva Angenete, Mattias Prytz","doi":"10.1002/jso.28137","DOIUrl":"https://doi.org/10.1002/jso.28137","url":null,"abstract":"<p><strong>Background and objectives: </strong>Frailty is a prognostic factor of post-operative death and complications following colorectal cancer surgery. Frailty assessment is not routinely performed, hence, the prevalence is unknown. The aim of this study was to establish the presence of frailty in patients aged ≥ 70 years, and to analyse differences in post-operative outcome comparing frail and non-frail elderly patients.</p><p><strong>Method: </strong>Data of patients aged ≥ 70 years who underwent colorectal cancer surgery during 2016-2020 were retrospectively obtained from the Swedish Colorectal Cancer Registry. A cohort of 500 patients was assessed for frailty using the Clinical Frailty Scale (CFS-9). Post-operative mortality rates, complications, readmissions, and length of stay (LOS) were compared between frail and non-frail patients.</p><p><strong>Results: </strong>The prevalence of frailty (CFS-9 score ≥ 4) was 56%. The 90-day mortality rate was higher in frail patients (OR 4.97 [95% CI 1.06-23.28], p 0.042), as well as 1-year mortality (OR 4.39 [95% CI 1.86-10.34], p 0.0007). Frail patients had longer post-operative LOS (7.63 vs. 11.0 days, p < 0.001), were more often treated in ICU and more often discharged to a nursing home.</p><p><strong>Conclusion: </strong>Frailty is a common condition in patients ≥ 70 years and a significant risk factor of post-operative mortality and morbidity.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anemia, Abnormal Body Mass Index, and Sarcopenia Increase Complication Risk in Patients Undergoing Surgical Treatment for Metastatic Bone Disease.","authors":"Joseph Ippolito, Ashley Castan, Rosamaria Dias, Yazan Kadkoy, Katie Gotoff, Jennifer Thomson, Kathleen Beebe, Joseph Benevenia","doi":"10.1002/jso.28135","DOIUrl":"https://doi.org/10.1002/jso.28135","url":null,"abstract":"<p><strong>Background and objectives: </strong>Metastatic bone disease (MBD) is a common complication of primary cancers and is typically managed surgically. Overall health status and nutritional optimization are essential in surgical outcomes. The objective of this study was to report the intersectionality of previously studied laboratory, imaging, and clinical characteristics on postoperative complications.</p><p><strong>Methods: </strong>Patients treated surgically for metastatic disease of the femur or tibia from 2001 to 2022 were reviewed. Age, gender, diagnosis, perioperative BMI, hemoglobin, albumin, method of surgical treatment, history of chemotherapy, history of radiation to the site, return to the operating room (OR), and complication type were collected for analysis. Psoas cross-sectional area was measured.</p><p><strong>Results: </strong>Following review, 119 patients (61 F, 58 M) treated at 128 anatomic sites, with mean age 61.9 ± 15.6 and mean follow-up 23.7 ± 9.3 met the inclusion criteria. The rate of wound dehiscence was 7/128 (5.47%) and infection was 7/128 (5.47%). Hemoglobin < 12 [OR 1.091 (95% CI 1.023-1.164, p < 0.05)] and abnormal BMI [OR 9.000 (95% CI 0.962-84.208, p < 0.05)] were both associated with an increased risk of deep infection. Hemoglobin < 12 [OR 1.091 (95% CI 1.023-1.164, p < 0.05)] was also associated with increased risk in superficial infection. Abnormal BMI [OR 3.783 (95% CI 1.209-11.831, p < 0.05)] was associated with an increased risk of return to the OR. History of chemotherapy [OR 2.965 (95% CI 1.173-7.493, p < 0.05)] was associated with an increased risk in overall complications. There was no association found between history of diabetes and complications. No statistically significant difference was found between the method of fixation when comparing complications between those that received an endoprosthesis, intramedullary nail (IMN), or plate.</p><p><strong>Conclusions: </strong>The complication risk for patients with metastatic disease is multifactorial, with anemia, abnormal BMI, and sarcopenia as measured by psoas cross-sectional area increasing risk for nononcologic complications. In the future, large-scale studies can help quantify the impact of each factor to allow for preoperative optimization to reduce complications.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are Access Costs and Income Associated With Treatment Decision-Making and Clinical Outcomes in Rural Patients Presenting With Upper Gastrointestinal Malignancy?","authors":"Simon S Park, Raymond A Verm, Zaid M Abdelsattar, Fred A Luchette, Talia B Baker, Marshall S Baker","doi":"10.1002/jso.28140","DOIUrl":"https://doi.org/10.1002/jso.28140","url":null,"abstract":"<p><strong>Background and objective(s): </strong>Few studies evaluate the price elasticity of demand or the relationships between costs of access, patient income, treatment decision making and outcome in rural patients with upper gastrointestinal malignancy.</p><p><strong>Methods: </strong>We queried the National Cancer Database to identify rural patients presenting with clinical stages I-III esophagus, stomach, pancreas, hepatocellular (HCC) and cholangiocarcinoma between 2004 and 2020. Access cost was defined as (distance to treating center) × (regional gas price)/(regional vehicle fuel efficiency). Patients within the highest (HAC) and lowest (LAC) cost quintiles were selected for analysis. These were subcategorized based on income quartile: High income/High Access Cost (HI/HAC), High Income/Low Access Cost (HI/LAC), Low Income/High Access Cost (LI/HAC), Low Income/Low Access Cost (LI/LAC).</p><p><strong>Results: </strong>A total of 9582 patients met inclusion criteria. Median access cost was $26.61 (IQR: [$10.57-$73.70]). Patients in the HI/HAC cohort were more likely to undergo treatment at academic centers (79.5%, HI/HAC, 49.6%, HI/LAC, 78.5%, LI/HAC, 38.0%, LI/LAC), undergo neoadjuvant chemotherapy (23.8%, 12.6%, 17.7%, 10.4%) undergo surgery (46.6%, 29.6%, 39.7%, 20.8%), undergo liver transplantation for HCC (30.2%, 5.86%, 18.1%, 2.04%) and demonstrated higher rates of 5-year overall survival (42.4%, 25.6%, 32.2%, 19.0%) than those with HI/LAC, LI/HAC, and LI/LAC cohorts (all p < 0.01).</p><p><strong>Conclusions: </strong>Among rural patients undergoing treatment for upper gastrointestinal malignancy elasticity of demand for service varies. Patients willing and able to pay for travel are more likely to receive neoadjuvant chemotherapy, undergo resection and demonstrate improved overall survival.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Skip Lesions in Chondrosarcoma: Is Whole Bone Imaging Necessary?","authors":"Samuel E Broida, Mikaela H Sullivan, Emmett J Cleary, Peter S Rose, Doris E Wenger, Matthew T Houdek","doi":"10.1002/jso.28139","DOIUrl":"https://doi.org/10.1002/jso.28139","url":null,"abstract":"<p><strong>Background: </strong>Skip lesions in bone sarcoma are a poorly described entity. Reports on skip lesions in osteosarcoma and Ewing sarcoma suggest that whole bone MRI should be obtained to evaluate for additional tumor foci given the association with worse outcomes. However, there is limited evidence to support whole bone imaging in chondrosarcoma.</p><p><strong>Methods: </strong>Between 1995 and 2022, 129 patients with long bone chondrosarcoma were evaluated at our institution. Lesions were located most commonly in the femur in 64 patients and the humerus in 54 patients. All imaging studies and pathology reports were reviewed to determine the presence of skip lesions, defined as an area of histology-confirmed chondrosarcoma that was separated from the primary lesion by normal bone on pathology.</p><p><strong>Results: </strong>Whole bone imaging was obtained during initial staging in 107 patients with two-thirds of patients receiving MRI, CT, or bone scan. Five patients (3.9%) were found to have skip lesions in the same bone as the primary tumor. There were no transarticular skip lesions. Skip lesions were detected in three patients with low grade chondrosarcoma (4.6%) and two patients with high grade chondrosarcoma (3.2%). All lesions were within 2 cm of the primary tumor. All were visible on MRI and CT of the primary site and one was visible on plain radiographs. The presence of skip lesions did not alter the type of surgical treatment in any patients.</p><p><strong>Conclusion: </strong>Skip lesions in long bone chondrosarcoma are rare. All skip lesions in this study were in close proximity to the primary tumor and the same grade as the main lesion. Our results suggest that advanced imaging of the whole bone may be of low utility for evaluating the presence of skip lesions. The clinical significance of skip lesions in chondrosarcoma remains unclear, however, their presence did not impact the treatment plan in this series.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical Presence of Plastic Surgeons in Relation to Breast Surgeons in the United States for Breast Reconstruction.","authors":"Carly Wareham, Brittany Bertaux, Elsa Chahine, Christopher Homsy, Dylan Perry, Sarah Persing, Salvatore Nardello, Abhishek Chatterjee","doi":"10.1002/jso.28144","DOIUrl":"https://doi.org/10.1002/jso.28144","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in oncoplastic breast surgery, barriers to breast reconstruction remain, particularly in rural and suburban areas. We aimed to assess the presence of plastic surgeons performing breast reconstruction relative to breast surgeons or general surgeons performing breast cancer surgery within urban, suburban, and rural populations.</p><p><strong>Methods: </strong>Data were collected from the 2024 membership of the American Society of Breast Surgeons and American Society of Plastic Surgeons. Breast and plastic surgeons were totaled by state, and each breast surgeon's zip code was searched for proximity to a plastic surgeon performing reconstructive surgery within 10 or 20 miles. Zip codes were categorized by population density to determine surgeon distribution.</p><p><strong>Results: </strong>There are 1.8 times more plastic surgeons than breast surgeons. In total, 14% of breast surgeons had no plastic surgeons within 10 miles and 7% had none within 20 miles, compared to 25% and 10% in 2018. In total, 43% of breast and plastic surgeons practice in urban areas, whereas only 25% of breast surgeons and 19% of plastic surgeons practice in rural areas.</p><p><strong>Conclusions: </strong>While access to breast reconstruction continues to improve, there are still disparities in rural areas. Efforts directed toward improving access to breast reconstruction in more rural areas should be pursued.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006227","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified Frailty Index Predicts Prognosis in Patients With Gastric Cancer After Gastrectomy: A Systematic Review and Meta-Analysis.","authors":"Xinyao Zhou, Yunlan Jiang, Heyao Xu, Siyu Lin, Ting Xu, Xiaodi Bai, Shulan Liu","doi":"10.1002/jso.28136","DOIUrl":"https://doi.org/10.1002/jso.28136","url":null,"abstract":"<p><strong>Background: </strong>The predictive ability of the modified frailty index (mFI) for postoperative outcomes and survival in patients with gastric cancer (GC) remains uncertain.</p><p><strong>Methods: </strong>Studies were retrieved from 11 electronic databases. Odds ratio (OR) and 95% confidence intervals (CIs) were used to report surgical outcomes, including overall survival (OS), complications, mortality, readmission, and nonhome discharge. The fixed or random effects model was used depending on the heterogeneity. Subgroup and meta-regression analyses were performed to determine the source of heterogeneity.</p><p><strong>Results: </strong>This meta-analysis of 13 studies, including 15 359 GC patients, showed that high mFI scores were associated with reduced OS (OR = 1.35) and increased risk of poor postoperative outcomes (OR = 2.61). The older patients with higher mFI scores had a higher risk of worse OS after gastrectomy (OR = 1.69).</p><p><strong>Conclusions: </strong>This study demonstrated that high mFI scores were strongly associated with reduced OS and increased risk of poor outcomes following surgery in patients with GC, with a more than two-fold increase in the overall risk of poor outcomes. Compared to other tools, the mFI is easy to operate, making it an effective tool for prognosis assessment and personalized treatment and care planning.</p><p><strong>Trial registration: </strong>PROSPERO (Registration Number: CRD42024613727).</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indocyanine Green Fluorescence Angiography Versus Visual Assessment for Assessing Perfusion of Gastric Conduit and Esophageal Stump in Post Esophagectomy Patients: A Pilot Randomized Controlled Study.","authors":"Subramanyeshwar Rao Thammineedi, Sujit Chyau Patnaik, Pratap Reddy, Ajesh Raj Saksena, Srijan Shukla, Makayla E Schissel, Lynette M Smith, Chandrakanth Are, Syed Nusrath","doi":"10.1002/jso.28145","DOIUrl":"https://doi.org/10.1002/jso.28145","url":null,"abstract":"<p><strong>Background and objective: </strong>Anastomotic leak (AL) is a serious complication following esophagectomy and is often linked to poor perfusion of the gastric conduit (GC) and esophageal stump (EC). The aim of this study is to compare the efficacy of intraoperative Indocyanine green fluorescence angiography (ICG-FA) versus visual assessment VA) to assess perfusion status and its impact on the rate of AL.</p><p><strong>Methods: </strong>Fifty-eight esophageal or gastroesophageal junction carcinoma patients were randomized to ICG-FA (28) and VA (30) groups. Perfusion status was assessed with VA alone in the VA group and with VA followed by ICG-FA in the ICG-FA group.</p><p><strong>Results: </strong>The ICG-FA group had a lower leak rate of 4% when compared to 27% in the VA group (p = 0.03). ICG-FA identified nine cases where VA misjudged the GC tip vascularity, thereby avoiding unnecessary resections. ICG-FA necessitated revision of the GC tip in one case missed by VA and also identified poor perfusion of ES tip in three cases mandating revision which were deemed well-perfused by VA.</p><p><strong>Conclusion: </strong>ICG-FA demonstrated superiority over VA in assessing perfusion adequacy of the GC and ES, which resulted in a statistically significant decrease in the rate of anastomotic leaks.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of Mobilization Within 24 Hours Based on the ICU Mobility Scale in Cancer Patients: A Randomized Controlled Clinical Trial \"Mobilization Based on the ICU Mobility Scale\".","authors":"Flaviana Santos de Sousa Silva, Giérisson Brenno Borges Lima, Gabriel Santos de Castro E Lima, Denise Carvalho Torres, Michel Monteiro Macedo, Carlos Eduardo Neves Amorim","doi":"10.1002/jso.28142","DOIUrl":"https://doi.org/10.1002/jso.28142","url":null,"abstract":"<p><strong>Background and objective: </strong>Abdominal cancer surgery leads to loss of functional capacity. The objective was to evaluate the effects of mobilization within 24 h applied to patients with abdominal neoplasms undergoing major surgery.</p><p><strong>Methods: </strong>A randomized controlled clinical trial was carried out in the Intensive Care Unit. The intervention group performed mobility activities guided by the ICU mobility scale (IMS) in the first 24 h after surgery and the control group performed conventional physiotherapy. Dynamometry was evaluated in the preoperative, 1st POD and postoperative period, as well as the Timed up and go test (TUG).</p><p><strong>Results: </strong>Patients in the intervention group had greater initial mobility (IMS Scale intervention group: 6.67 ± 0.69; IMS Scale control group: 2.23 ± 0.52; p = 0.001). There was greater level of mobility until discharge from the ICU in patients in the intervention group compared to the control group (IMS at discharge from the ICU in the intervention group: 8.53 ± 0.33; IMS at discharge from the ICU in the control group: 3 ± 0.64). Both groups showed worsening in the TUG test, but it was significant only in the control group.</p><p><strong>Conclusion: </strong>Early mobilization in patients with abdominal neoplasms undergoing major surgery proved to be effective in maintaining mobility and functional markers.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}