Journal of Surgical Oncology最新文献

{"title":"Optimal Choice of Radiotherapy in Locally Advanced, Low Rectal Cancer: A Propensity Matched Analysis Comparing Short-Course Radiation With Long-Course Chemoradiation From a Tertiary Cancer Center.","authors":"Tejas Vispute, Devesh S Ballal, Raj Kapadia, Ashwin Desouza, Ankit Sharma, Mufaddal Kazi, Akshay Baheti, Vikas Ostwal, Avanish P Saklani","doi":"10.1002/jso.70019","DOIUrl":"https://doi.org/10.1002/jso.70019","url":null,"abstract":"<p><strong>Aim: </strong>To compare oncological outcomes of short-course radiation therapy (SCRT) versus long-course chemoradiation (LCRT) in patients with low rectal cancer, particularly in a high-volume center with expertise in extended total mesorectal excision (TME).</p><p><strong>Methods: </strong>This was a single-institution, retrospective propensity-matched study using a prospectively maintained database. Patients with low rectal cancer (≤ 5 cm from the anal verge) who underwent neoadjuvant radiation (SCRT or LCRT) followed by TME between January 2014 and January 2021 were included. A 3:1 propensity score match was performed based on key clinical variables. Patients with metastatic disease or prior pelvic radiation were excluded. SCRT (25 Gy in 5 fractions) ± chemotherapy was followed by immediate or delayed surgery, while LCRT (50-50.4 Gy in 25-28 fractions) was given with capecitabine ± chemotherapy, followed by surgery. Extended resections were performed as indicated.</p><p><strong>Results: </strong>After matching, 466 LCRT and 157 SCRT patients were analyzed. Three-year disease-free survival (DFS) was similar (62% LCRT vs. 64% SCRT, p = 0.8), with no significant differences in overall survival (OS), local recurrence-free survival (LRFS), pathological complete response (pCR: 18% vs. 20%, p = 0.5), or circumferential resection margin (CRM) positivity (6.4% vs. 10%, p = 0.12). Complication rates and local recurrence were also comparable. However, among clinical T4 tumors, SCRT was associated with significantly lower 2-year DFS (41.2% vs. 58.7%, p = 0.03) and a trend toward worse OS.</p><p><strong>Conclusion: </strong>SCRT provides comparable oncological outcomes to LCRT in low rectal cancer when appropriately selected. However, in clinical T4 tumors, LCRT appears.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144497402","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":"Culture Impacts Sexual Well-Being in Autologous Breast Reconstruction: A Multi-Continental Examination.","authors":"Minji Kim, Jeske Bubberman, Uchechukwu Amakiri, Yun Seo Kim, Jacob Levy, Lillian A Boe, Stefanie Tuinder, Dong Won Lee, Jonas A Nelson, Carrie S Stern","doi":"10.1002/jso.70016","DOIUrl":"https://doi.org/10.1002/jso.70016","url":null,"abstract":"<p><strong>Introduction: </strong>Sexual health concerns are prevalent in breast cancer patients, yet are difficult to address given the stigma, sensitivity, and cultural differences. This study aims to assess the impact of culture on Sexual Well-being after autologous breast reconstruction (ABR) by examining three different countries from different continents: South Korea for Asia, Netherlands for Europe, and United States of America (USA) for North America.</p><p><strong>Methods: </strong>Patients who underwent autologous (ABR) breast reconstruction between 2016 and 2022 and completed at least one BREAST-Q Sexual Well-being either preoperative and/or up to 2-year postoperative were included. Sexual Well-being was measured by BREAST-Q, a gold standard patient-reported outcome measure for breast cancer patients undergoing surgery.</p><p><strong>Results: </strong>A total of 1726 ABR patients were included, of which 173 were from Korea, 231 from Netherlands, and 1322 from USA. There were significant differences in BREAST-Q Sexual Well-being between the three countries at all timepoints (preoperative, 6-month, 1-year, and 2-year postoperative). In the linear regression model, relative to patients from USA, patients from Korea scored 13 points lower (β = -13, 95% confidence interval [CI]: -17, -8.5, p < 0.001) while patients from the Netherlands scored 4.5 points higher (β = 4.5, 95% CI: 1.7, 7.3, p = 0.002).</p><p><strong>Conclusion: </strong>In this multi-continental study, we found that Sexual Well-being among ABR patients significantly differs by culture. Additional insight and interventions into the lower Sexual Well-being among Asian patients at all timepoints and American patients postoperatively may be beneficial.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484879","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":"Epitrochlear and Humeral Lymph Nodes: A Biomarker for Deep Lymphatic Function and Implications for Breast Cancer-Related Lymphedema Risk.","authors":"James E Fanning, Angela Chen, Sarah Thomson, Elizabeth Tillotson, Aaron Fleishman, John A Parker, Kevin Donohoe, Dhruv Singhal","doi":"10.1002/jso.70002","DOIUrl":"https://doi.org/10.1002/jso.70002","url":null,"abstract":"<p><strong>Background: </strong>Superficial to deep system rerouting of lymph protects against breast cancer-related lymphedema (BCRL). Humeral lymph nodes are a marker for deep lymphatic drainage. Epitrochlear lymph nodes are a site of superficial to deep collateralization based on cadaveric dissections. Functional connectivity between epitrochlear and humeral lymph nodes remains unexamined with in vivo imaging. We utilized lymphoscintigraphy to document epitrochlear and humeral lymph node drainage in healthy volunteers.</p><p><strong>Methods: </strong>Healthy female volunteers received four intradermal hand/wrist injections of 99-Tcm sulfur colloid to each upper extremity and were imaged with SPECT/CT at 2 h. Two nuclear medicine physicians independently reviewed the SPECT/CT scans to document lymph nodes with tracer uptake. A Chi-square test was performed to assess the correlation between functional epitrochlear and humeral lymph node drainage.</p><p><strong>Results: </strong>A total of 72 arms of 36 volunteers were included. Drainage to epitrochlear and humeral lymph nodes was observed in 57% (41/72) and 51% (37/72) of arms, respectively. Drainage to both epitrochlear and humeral lymph nodes was observed in 40% (29/72) of arms. Epitrochlear and humeral lymph node drainage were absent in 32% (27/72) of arms. The proportion of arms with humeral lymph node drainage was significantly greater in arms with (71%, 29/41) versus without (26%, 8/31) epitrochlear lymph node drainage [χ² = 14.262 (1), p < 0.001].</p><p><strong>Conclusions: </strong>Epitrochlear and humeral lymph node drainage are significantly correlated, suggesting a superficial to deep pathway may function at baseline in 40% of arms. The absence of epitrochlear and humeral lymph node drainage may represent a biomarker for BCRL risk.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475703","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":"Evaluating the Role of an Objective Lower Gastrointestinal Assessment as Part of ERAS Pathway Following hRAMIE.","authors":"Arham Aslam, Madhan Kuppusamy, Joel Sternbach, Michal Hubka","doi":"10.1002/jso.70018","DOIUrl":"https://doi.org/10.1002/jso.70018","url":null,"abstract":"<p><strong>Background: </strong>Postoperative esophagram is commonly employed following hybrid robotic-assisted minimally invasive esophagectomy (hRAMIE) to assess proper gastric conduit emptying. However, we hypothesize that the passage of enteric contents through the entire gastrointestinal tract is equally critical for patient recovery. This study aims to assess the utility of lower gastrointestinal contrast studies-such as jejunostomy tube imaging and abdominal X-rays-as part of the enhanced recovery after surgery (ERAS) pathway following hRAMIE for esophageal cancer.</p><p><strong>Methods: </strong>This retrospective study evaluated 139 patients who underwent hRAMIE between September 2018 and November 2024, following completion of neoadjuvant chemoradiotherapy for esophageal cancer. Inclusion criteria consisted of patients with confirmed stage T2 or higher esophageal cancer who had completed chemoradiotherapy. Exclusion criteria included patients requiring emergency surgery or those with metastatic disease. All patients received a routine postoperative Day 2 esophagram in addition to a lower gastrointestinal assessment. The primary outcomes were length of hospital stay, time to nasogastric tube removal, return of bowel function, time to initiation of oral intake, and time to initiation of jejunostomy tube feeds.</p><p><strong>Results: </strong>Patients with normal postoperative esophagrams demonstrated a significantly shorter time to first oral intake, reduced hospital length of stay, and quicker removal of the nasogastric tube. In contrast, lower gastrointestinal radiography, including jejunostomy contrast studies and abdominal X-rays, did not significantly impact early postoperative outcomes, with the exception of a prolonged time to first oral intake in patients with abnormal lower gastrointestinal findings.</p><p><strong>Conclusion: </strong>The inclusion of radiographic jejunostomy contrast studies did not significantly affect key postoperative outcomes, such as length of stay, time to nasogastric tube removal, return of bowel function, or initiation of jejunostomy tube feeds. However, abnormal lower gastrointestinal studies were associated with delayed oral intake. Based on these findings, we do not recommend including lower gastrointestinal studies in routine incorporation into institutional ERAS protocols for esophagectomy.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475715","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":"Analysis of Sentinel Lymph Node Adoption Compared to Systematic Lymphadenectomy in Staging Early Endometrial Cancer at a Tertiary Center: An Ambispective Study.","authors":"Rodrigo Pinto Fernandes, Cristina Anton, Marilia Bertolazzi, Maria Luiza Genta, André Lopes, Rossana Veronica Mendonza Lopez, José Antônio Orellana Turri, Raphael Paschoalini, Ricardo Dos Reis, Arnaud Wattiez, Edmund Chada Baracat, Jesus Paula Carvalho","doi":"10.1002/jso.70008","DOIUrl":"https://doi.org/10.1002/jso.70008","url":null,"abstract":"<p><strong>Objective: </strong>The purpose of this study was to assess the impact of changing endometrial carcinoma staging from systematic lymph node dissection to the sentinel lymph node approach.</p><p><strong>Methods: </strong>This is an ambispective study including patients with endometrial carcinoma (EC) limited to the uterus (FIGO 2018 IA/IB). From December 2015 to October 2021, a group of patients underwent systematic staging with lymph node dissection (LND). From December 2021 to April 2024, another group of patients underwent surgical staging with the sentinel lymph node-indocyanine green (SLN) algorithm and pathology ultrastaging analisys. The groups were matched (1 LND: 1 SLN) based on age, body mass index (BMI), tumor type, tumor size, and myometrial invasion. The primary endpoints were lymph node involvement, length of surgery, and complications. Complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.</p><p><strong>Results: </strong>Two hundred fifty-seven patients were surgically treated during the study period (156 in the LND cohort, 101 in the SLN cohort). Propensity score matching revealed two equivalent groups containing 84 patients each. The rate of positive lymph nodes was similar between the LND group (3.6%) and the SLN group (8.3%) (OR: 2.46, 95% CI: 0.61-9.84; p = 0.205). The length of surgery was significantly lower in the SLN group (152.2 ± 51.9 min) compared to the LND group (304 ± 77.8 min) (p < 0.001). Intraoperative blood loss greater than 100 mL was significantly lower in the SLN group (9.5%) compared to the LND group (29.8%) (p < 0.001). CTCAE grades requiring intervention (grades 3, 4, and 5) were higher in the LND group (14.3%) compared to the SLN group (4.8%) (p = 0.049).</p><p><strong>Conclusion: </strong>The transition from LND to SLN approach was similar compared to systematic lymphadenectomy, allowing the reduction of surgical length, blood loss and severity of complications without compromising surgical complications and lymph node positivity.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144475702","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":"An Increasing Role for Cytoreductive Surgery in Metastatic Colorectal Cancer-National Trends in the Era of More Effective Systemic Therapy.","authors":"Stephanie Young, Julia Greene, Daniel Milgrom, Jessica Weiss, Melanie Goldfarb, Anton Bilchik","doi":"10.1002/jso.70012","DOIUrl":"10.1002/jso.70012","url":null,"abstract":"<p><strong>Background and objectives: </strong>Treatment guidelines on cytoreductive surgery (CRS) for metastatic colorectal cancer (mCRC) continue to have variability. This study investigated survival outcomes and utilization trends of CRS on mCRC.</p><p><strong>Methods: </strong>Patients from the National Cancer Database with mCRC who received systemic chemotherapy 2004-2015 were categorized by colectomy, colectomy and metastasectomy (CRS), and no surgery (NS). Kaplan-Meier analyses with inverse probability of treatment weighting (IPTW) were performed.</p><p><strong>Results: </strong>Of 88 593 patients in the study cohort, 39 028 had a colectomy, 21 462 CRS, and 28 103 NS. CRS utilization increased from 33.1% (2004) to 38.3% (2015). CRS (aHR = 0.36) and colectomy (aHR = 0.47) were associated with significantly improved OS compared to NS. Median OS with IPTW remained longer in CRS versus colectomy versus NS (34.4 months vs. 26.7 vs. 13.2) (p < 0.001). Patients who received hyperthermic intraperitoneal chemotherapy (HIPEC) had improved OS compared to non-HIPEC patients (aHR = 0.55, p < 0.001).</p><p><strong>Conclusions: </strong>National utilization of CRS for mCRC is steadily increasing and associated with improved OS, supporting the use of more aggressive surgical approaches in select patients.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333405","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":"Predicting Breast Reconstruction Readmission, Reoperation, and Prolonged Length of Stay: A Machine Learning Approach.","authors":"Ariel J Gabay, Jonlin Chen, Carrie S Stern, Chris Gibbons, Babak Mehrara, Jonas A Nelson","doi":"10.1002/jso.70015","DOIUrl":"10.1002/jso.70015","url":null,"abstract":"<p><strong>Background: </strong>Predicting short-term postoperative complications after breast reconstruction is critical for improving patient outcomes and reducing costs. This study investigated the utility of machine learning (ML) algorithms to predict complications in breast reconstruction patients.</p><p><strong>Methods: </strong>Data were collected from patients who underwent autologous, implant, and tissue expander-based reconstruction in the National Surgical Quality Improvement Program (NSQIP) database (2020-2022). Six ML models were trained to predict 30-day readmission, 30-day reoperation, and prolonged length of stay (LOS). Model performance was assessed using the area under the receiver operating characteristic curve, sensitivity, specificity, and Brier score. SHapley Additive exPlanations (SHAP) values ranked predictors influencing model outcomes.</p><p><strong>Results: </strong>A total of 27 718 patients (5584 autologous; 8170 implant; 13 964 TE) were included. Top-performing models showed moderate to strong predictive performance across cohorts for all complications. AUCs ranged from 0.614 to 0.861. The highest AUCs were achieved for prolonged LOS in implants patients (AUC 0.861) and for 30-day readmission in the delayed autologous cohort (AUC 0.859). Key predictors of complications included operative time, BMI, age, reconstruction timing, and ASA class.</p><p><strong>Conclusion: </strong>ML can predict short-term postoperative outcomes in breast reconstruction patients. With further model refinement and data quality optimization, these models may improve preoperative risk stratification and patient outcomes in breast reconstruction.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333406","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":"Understanding Trends in Incidence and Management of Pregnancy-Associated Breast Cancer in a National Sample Using Claims Data.","authors":"Kaamya Varagur, Joseph G Ribaudo, Matthew Keller, Nicholas R Fadell, Cameron Martin, Kevin He, Justin M Sacks, Rebecca Aft, Rachel Anolik, Joani M Christensen","doi":"10.1002/jso.70010","DOIUrl":"https://doi.org/10.1002/jso.70010","url":null,"abstract":"<p><strong>Background and objectives: </strong>Breast cancer incidence in young women is increasing globally. Here, we examine trends in incidence, management, and reconstruction for pregnancy-associated breast cancer (PABC) in women 18-45.</p><p><strong>Methods: </strong>Females aged 18-45 with breast cancer between 2007 and 2021 were identified in the Merative MarketScan Commercial and Multi-State Medicaid Databases. We analyzed trends in incidence of PABC, treatments, and latency to treatments for PABC versus non-PABC.</p><p><strong>Results: </strong>A total of 1189 patients with PABC and 36 683 with non-PABC were included. Over the study period, the proportion of breast cancer cases classified as PABC increased (2.36% of cases from 2007 to 2009, to 3.94% from 2019 to 2021; p < 0.001). Patients with PABC experienced higher rates of neoadjuvant chemotherapy, mastectomy, trastuzumab, and ovarian suppression therapy than patients with non-PABC, and lower rates of adjuvant radiation and breast conserving surgery (p ≤ 0.001). PABC status did not independently predict increased latency from diagnosis to tumor resection surgery when controlling for receipt of neoadjuvant chemotherapy (p = 0.154). Patients with PABC experienced comparable rates of delayed or immediate implant and autologous reconstruction as patients with non-PABC, but experienced increased latency to delayed implant reconstruction (p < 0.001).</p><p><strong>Conclusions: </strong>PABC rates are increasing among women 45 and younger. Patients with PABC experience differences in types of medical/surgical treatments received and timing of post-mastectomy reconstruction.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326097","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":"AI at the Forefront: Navigating Oncologic Care for Six Gastrointestinal Cancers According to the NCCN Guidelines Utilizing Gemini-1.0 Ultra and ChatGPT-4.","authors":"Tamir E Bresler, Tyler Wilson, Tadevos Makaryan, Shivam Pandya, Kevin Palmer, Ryan Meyer, Zin M Htway, Manabu Fujita","doi":"10.1002/jso.70005","DOIUrl":"https://doi.org/10.1002/jso.70005","url":null,"abstract":"<p><strong>Background and objectives: </strong>We explored the ability of large language models (LLMs) ChatGPT-4 and Gemini 1.0 Ultra in guiding clinical decision-making for six gastrointestinal cancers using the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines.</p><p><strong>Methods: </strong>We reviewed the NCCN Guidelines for anal squamous cell carcinoma, small bowel, ampullary, and pancreatic adenocarcinoma, and biliary tract and gastric cancers. Clinical questions were designed and categorized by type, queried up to three times, and rated on a Likert scale: (5) Correct; (4) Correct following clarification; (3) Correct but incomplete; (2) Partially incorrect; (1) Absolutely incorrect. Subgroup analysis was conducted on Correctness (scores 3-5) and Accuracy (scores 4-5).</p><p><strong>Results: </strong>A total of 270 questions were generated (range-per-cancer 32-68). ChatGPT-4 versus Gemini 1.0 Ultra score differences were not statistically-significant (Mean Rank 278.30 vs. 262.70, p = 0.222). Correctness was seen in 77.78% versus 75.93% of responses, and Accuracy in 64.81% versus 57.41%. There were no statistically-significant differences in Correctness or Accuracy between LLMs in terms of question or cancer type.</p><p><strong>Conclusions: </strong>Both LLMs demonstrated a limited capacity to assist with complex clinical decision-making. Their current Accuracy level falls below the acceptable threshold for clinical use. Future studies exploring LLMs in the healthcare domain are warranted.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326094","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":"Decreasing Complications After Ivor-Lewis Esophagectomy: Is a Totally Minimally Invasive Approach the Solution?","authors":"Parit T Mavani, Caitlin Sok, Pranay S Ajay, Yichun Cao, Alicia M Bonanno, Kenneth Cardona, Felix G Fernandez, Seth D Force, Onkar V Khullar, Maria C Russell, Charles A Staley, Mihir M Shah, David A Kooby, Manu S Sancheti","doi":"10.1002/jso.70011","DOIUrl":"https://doi.org/10.1002/jso.70011","url":null,"abstract":"<p><strong>Background: </strong>Despite improvements over time, Ivor Lewis Esophagectomy (ILE), a potentially curative surgical option for patients with invasive esophageal cancer, carries high morbidity and mortality. We analyzed postoperative outcomes in patients undergoing ILE at our institution, comparing open (OE), hybrid (HE), and totally minimally invasive (TMIE) approaches.</p><p><strong>Methods: </strong>We reviewed the records of patients who underwent elective ILE for benign or malignant pathology at our institution (2018-2022). Patients who underwent transhiatal or McKeown esophagectomy, as well as those undergoing emergent procedures, were excluded. Factors associated with major postoperative complications (Clavien-Dindo Grade ≥ 3) were assessed using multivariable analysis (MVA).</p><p><strong>Results: </strong>Of 260 patients, 135 met the inclusion criteria: 40 (29.6%) underwent OE, 50 (37.0%) underwent HE, and 45 (33.3%) underwent TMIE. Median length of stay was shorter for patients undergoing TMIE compared to OE and HE (9 vs. 12 and 13 days, p < 0.001). A higher major postoperative complication rate was noted in patients undergoing OE and HE compared to TMIE (32.5% and 36% vs. 13.3%) (p = 0.03). This result persisted on MVA (OE: aOR 3.4, p = 0.04; HE: aOR 5.5, p = 0.002; reference:TMIE).</p><p><strong>Conclusion: </strong>A totally minimally invasive approach to Ivor-Lewis Esophagectomy is associated with lower major postoperative complications and shortened length of stay at our institution. Prospective evaluations in the United States population are warranted to optimize and standardize surgical approaches.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326095","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}