Journal of Surgical Oncology最新文献

{"title":"Age Is Not a Limit: Postoperative Outcomes in Elderly Patients With Colorectal Liver Metastases.","authors":"Judy Li, Giacomo Waller, Yunyun Qin, Camilo Correa-Gallego, Spiros Hiotis, Ganesh Gunasekaran, Joshua Leinwand, Neha L Lad, James Oh Park, Noah A Cohen","doi":"10.1002/jso.70418","DOIUrl":"https://doi.org/10.1002/jso.70418","url":null,"abstract":"<p><strong>Background: </strong>Most colorectal cancers are diagnosed in patients aged 65 years and older, with nearly 50% developing liver metastases (CRLM). This study explores postoperative and oncologic outcomes in elderly and very elderly patients with CRLM who receive curative-intent treatment.</p><p><strong>Methods: </strong>A retrospective analysis of patients with CRLM who underwent surgical resection assessed associations with clinical outcomes. Groups were stratified by age at hepatic metastasectomy, defined as adults < 65 years, elderly 65-75 years, and very elderly > 75 years.</p><p><strong>Results: </strong>We identified 346 patients, including 95 (27%) elderly and 38 (11%) very elderly patients. These patients had more medical comorbidities but comparable functional status. Elderly and very elderly patients had more right-sided tumors (p < 0.001), more pN1 disease (p = 0.009), and more often found to have metachronous liver metastases (p < 0.001). Significantly fewer elderly and very elderly patients received systemic treatment (p < 0.001). All groups underwent similar operative management with no differences in 30-day readmission, reoperation, and complication rates. Recurrence-free (p = 0.232) and overall survival (p = 0.418) were similar across groups. Age was not significantly associated with survival on univariate analysis.</p><p><strong>Conclusion: </strong>Well-selected elderly and very elderly patients can undergo hepatic metastasectomy without increased postoperative morbidity. Despite receiving less systemic treatment, these patients can achieve similar oncologic outcomes to adults.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127939","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":"Diagnostic Accuracy and Clinical Outcomes of the Intraoperative Intelligent Knife (REIMS) in Adult Oncologic Surgery: A Systematic Review.","authors":"Mohammad Alatoom, Lina Abdelhadi, Abdulrahman Al-Majmuei, Leema M F Alqawasmi, Salim Fredericks","doi":"10.1002/jso.70417","DOIUrl":"https://doi.org/10.1002/jso.70417","url":null,"abstract":"<p><p>Rapid intraoperative distinction between malignant and non-malignant tissue may improve resection completeness and reduce reoperation in cancer surgery. The intelligent knife (iKnife) integrates rapid evaporative ionisation mass spectrometry with electrosurgery to provide real-time tissue classification during surgery. This systematic review assessed the diagnostic accuracy and reported clinical outcomes of intraoperative iKnife use in adults undergoing oncological surgery. The review was prospectively registered in PROSPERO (CRD420251049162) and written according to PRISMA 2020 and PRISMA-DTA, given the primary focus on diagnostic test accuracy. PubMed, Embase, Scopus, Web of Science, the Cochrane Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform were searched to 10 March 2026. Two reviewers independently screened records, extracted data, and assessed risk of bias and certainty of evidence. Nineteen studies across nine tumour types were included, most of which were small prospective observational or feasibility cohorts. Reported sensitivity ranged from 60% to 100% and specificity from 80.7% to 100%, with high point estimates in ovarian, breast, colorectal and soft-tissue sarcoma settings. Downstream clinical outcome data were limited to margin status in 10 studies, reoperation in 3, complications in 4 and recurrence in 1, with no report of survival. The iKnife shows promise as a real-time intraoperative diagnostic adjunct, but evidence that it improves patient outcomes remains limited. Larger prospective multicentre studies with standardised outcomes and follow-up are required.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111328","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":"Histology of Recurrence Following CRS-HIPEC for Low-Grade Peritoneal Metastases From Mucinous Appendiceal Neoplasms.","authors":"Sohini Khan, Jula Veerapong, Andrew M Lowy, Joel M Baumgartner","doi":"10.1002/jso.70394","DOIUrl":"https://doi.org/10.1002/jso.70394","url":null,"abstract":"<p><strong>Background: </strong>Low-grade (LG) mucinous carcinoma peritonei (LGMCP) arising from mucinous appendiceal neoplasms is typically treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC). Although these patients can recur after CRS-HIPEC, the histology and outcomes of recurrence have not been well-documented.</p><p><strong>Methods: </strong>A retrospective study of CRS-HIPECs from 2007 to 2024 at our institution was performed for patients with LG primary and peritoneal histology. Recurrence was defined as LG or high-grade (HG), with HG histology defined as high-grade mucinous carcinoma peritonei (HGMCP) or adenocarcinoma (AC). Overall (OS) and progression-free survival (PFS) were measured by Kaplan-Meier survival analysis.</p><p><strong>Results: </strong>We identified 246 CRS-HIPEC procedures performed for LG peritoneal histology: 171 (69.5%) LGMCP, 69 (28%) acellular mucin, and six (2.4%) with benign peritoneal histology. Median follow-up time was 67 months (range 0.3-199.2 months). Seventy-six (30.9%) patients recurred: 39/61 (63.9%) had LG histology and 22/61 (36.1%) had HG histology. Median PFS was 166.8 months (95% CI 114.6-219). For those who recurred, PFS was no different for patients with LG versus HG recurrence (21.1 months (95% CI 11.6-30.6) vs. 21.4 months (95% CI 15.2-27.6); p = 0.53). Median OS was not reached and 10-year OS was 63.2% with LG recurrence versus 25.0% with HG recurrence (p = 0.07).</p><p><strong>Conclusion: </strong>Approximately one-third of patients undergoing CRS-HIPEC for LG peritoneal metastases from mucinous appendiceal neoplasms recurred; one-third of recurrences had HG histology. Those with LG recurrence trended improved survival versus HG recurrence. These findings impact patient counselling, management, and further investigation of risk factors and mitigation strategies.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081074","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":"Radiotherapy-to-Surgery Interval After Induction Total Neoadjuvant Therapy for Rectal Cancer: Perioperative Outcomes and Oncologic Quality of Total Mesorectal Excision.","authors":"José M Aguilar-Romero, Itzel Vela-Sarmiento, Leonardo S Lino-Silva, Estefanía Aguilar-Romero, Javier Melchor-Ruan, Jorge L Aguilar-Frasco, Rosa A Salcedo-Hernández","doi":"10.1002/jso.70413","DOIUrl":"https://doi.org/10.1002/jso.70413","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The interval from radiotherapy completion to surgery may affect pelvic fibrosis, operative difficulty, postoperative morbidity, and quality of rectal cancer resection. In total neoadjuvant therapy (TNT), however, this interval has different clinical content according to treatment sequence. We evaluated whether radiotherapy-to-surgery timing after induction TNT was associated primarily with perioperative morbidity and surgical oncologic quality.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We performed a retrospective cohort study of patients with locally advanced rectal adenocarcinoma treated at a tertiary cancer center from January 2020 through December 2024. The primary analysis included 94 patients receiving induction TNT, in whom systemic chemotherapy preceded radiotherapy. The radiotherapy-to-surgery interval was modeled continuously per 4-week increase; categories of ≤ 8, &gt; 8-12, and &gt; 12 weeks were retained for descriptive reporting only because the early strata were sparse. The primary endpoint was Clavien-Dindo grade ≥ III morbidity within 30 days. Secondary endpoints included reoperation, readmission, anastomotic leak, conversion, operative time, blood loss, length of stay, mesorectal quality, resection margins, and lymph-node yield. Pathological complete response (pCR) and recurrence-free survival were exploratory oncologic endpoints. Consolidation TNT was examined separately because its measured interval contains post-radiotherapy chemotherapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 94 patients treated with induction TNT, the median radiotherapy-to-surgery interval was 143.5 days (IQR 104.8-259.3). Major morbidity occurred in 17/94 (18.1%), reoperation in 12/93 (12.9%), and readmission in 9/94 (9.6%). Median operative time was 279.5 min, blood loss 100 mL, and length of stay 4 days. Complete or near-complete mesorectal quality was documented in 73/91 (80.2%), R0 resection in 88/94 (93.6%), and median lymph-node yield was 9 (IQR 6-15). Each additional 4 weeks was not associated with major morbidity (adjusted OR 0.886, 95% CI 0.748-1.050; p = 0.164), reoperation (OR 0.910, 95% CI 0.755-1.096; p = 0.320), incomplete mesorectal excision (OR 1.113, 95% CI 0.971-1.275; p = 0.125), operative time (adjusted β - 0.4 min, 95% CI -5.5 to 4.8; p = 0.893), blood loss (1.4% change, 95% CI -4.8% to 7.9%; p = 0.668), or length of stay (-0.1% change, 95% CI -3.0% to 2.9%; p = 0.958). Exploratory analyses found no association with pCR or recurrence-free survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;After adjustment for radiotherapy course, variation in radiotherapy-to-surgery timing was not associated with major postoperative morbidity, operative burden, or incomplete mesorectal excision. R0 resection was achieved in 93.6% of patients, while margin events were too infrequent for stable adjusted modeling. Lymph-node yield showed no statistically significant association with interval duration. pCR and recurrence analyses were explorator","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081071","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":"The Effect of Glucagon-Like Peptide 1 Receptor Agonists on Peri- and Postmenopausal Breast Cancer Outcomes.","authors":"Jennifer Den, Nicole Nelson, Raj Vaghjiani, V Suzanne Klimberg","doi":"10.1002/jso.70411","DOIUrl":"https://doi.org/10.1002/jso.70411","url":null,"abstract":"<p><strong>Introduction: </strong>Studies have shown that obesity increases the risk of postmenopausal breast cancer (BC) by 30%-60% and is associated with poorer outcomes. This is believed to be related to continued exposure to estrogen and prolonged inflammation. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have been suggested to significantly lower the risk of several obesity-associated cancers (OACs). We hypothesize that GLP-1RAs can improve outcomes in peri- and postmenopausal BC patients with obesity.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using the TriNetX database to compare the outcomes of female BC patients ≥ 45 years old with a BMI of ≥ 35 kg/m². We created two cohorts: those who took GLP-1RAs with a Stage I-III BC diagnosis and those who never had exposure to GLP-1RAs. Patients' propensity score was matched based on age, BMI, diabetes, socioeconomic status, and genetic carrier status. Our outcomes of interest were 10-year overall survival (OS) and local recurrence (LR).</p><p><strong>Results: </strong>We identified 10 498 patients who used GLP-1RAs and 93 174 patients who did not. After matching, 19 348 patients were identified, with 9674 per cohort. 10-year OS with the Kaplan-Meier analysis was significantly greater in patients on GLP-1RAs (79%) compared to those not on GLP-1RAs (71%), log-rank test p < 0.0001. The HR for OS was 0.54, 95% CI (0.49-0.60). The risk of LR was significantly lower (HR 0.481, 95% CI (0.425-0.546)).</p><p><strong>Conclusions: </strong>Among peri- and postmenopausal breast cancer patients with BMI ≥ 35 kg/m², GLP-1RA use after diagnosis was associated with improved 10-year OS and lower LR. These findings are hypothesis-generating but suggest a potential therapeutic role for GLP-1RAs, warranting prospective investigation in this high-risk population.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081125","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":"Brazilian Society of Surgical Oncology Guideline for Bloodless Surgery (Part 3: Postoperative Strategies).","authors":"Ronald Enrique Delgado Bocanegra, Alexandre Ferreira Oliveira, Vandre Cabral Gomes Carneiro, Reitan Ribeiro, Romilton Machado, Luis Fernando Johnson, Daniel Cesar, Roberta Oliveira de Almeida, Marcio Sanctos Costa, Augusto Fernandes Mendes, Larissa de Jesus Almeida, Thomas Augusto Rodrigues de Magalhães, Carlos Eduardo Santa Ritta Barreira, Kleuber Moreira Lemos, Felipe Jose Fernandez Coimbra, Joyce Sant'Anna Barros Lyra, Paulo Henrique de Sousa Fernandes, Angelo Atalla, Nathalia Moreira Ramalho, Marcelo Bentancor Lontra, Marcos Gonçalves Adriano Junior, Suellen Riccio Simões, Luccas Melo Chagas, João Rosa de Almeida, Vinicius La Rocca Vieira, Jorge Soares Lyra, Arthur Foinquinos Krause Goncalves, Elves Maciel, Vicente Faraon Fonseca, Abraão Elias Hallack Neto, Luiz Carlos Von Bahten, Adroaldo Guimarães Rossetti Junior, Murilo Pereira Flores, Yan Vitor Gomes Silva de Jesus, Giovani Alves Monteiro, Pedro Eder Portari Filho, Heladio Feitosa E Castro Neto, Diego Venicio Santos Argolo, Rinailda de Cascia Santos Torres, Rodrigo Nascimento Pinheiro","doi":"10.1002/jso.70348","DOIUrl":"https://doi.org/10.1002/jso.70348","url":null,"abstract":"<p><strong>Objective: </strong>To present postoperative strategies for bloodless surgery in oncologic patients, focusing on anemia management, bleeding control, oxygen delivery, and recovery without allogeneic blood transfusion.</p><p><strong>Methods: </strong>The Brazilian Society of Oncologic Surgery developed national recommendations for the rational use of blood products in surgical care. Between June and December 2024, a multidisciplinary panel of specialists reviewed the literature and formulated key questions covering preoperative, intraoperative, and postoperative management. Recommendations were graded using an adapted evidence classification system and validated through expert consensus.</p><p><strong>Results: </strong>Postoperative bloodless care should prioritize judicious laboratory testing to reduce iatrogenic anemia, targeted iron replacement, selective use of erythropoiesis-stimulating agents, individualized hemostatic therapy, early recognition and control of hemorrhage, and optimization of oxygen delivery. General postoperative measures, including mobilization, analgesia, infection prevention, rehabilitation, and discharge planning, should be retained when directly related to anemia tolerance, blood conservation, or recovery in patients managed without transfusion.</p><p><strong>Conclusion: </strong>Postoperative bloodless surgery requires coordinated multidisciplinary care, early bleeding control, anemia treatment, oxygen delivery optimization, and careful follow-up. These strategies may improve safety and recovery in oncologic patients who decline or require avoidance of allogeneic blood transfusion.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081045","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":"Pelvic Exenteration for Cervical Cancer: Oncological, Morbidity and Quality of Life Outcomes.","authors":"Alexandra M Peacock, Kilian G M Brown, Peter J M Lee, Kirk K S Austin, Christopher M Byrne, Daniel Steffens, Michael J Solomon","doi":"10.1002/jso.70396","DOIUrl":"https://doi.org/10.1002/jso.70396","url":null,"abstract":"<p><strong>Background and objectives: </strong>One third of patients who undergo definitive chemoradiotherapy for locally advanced cervical cancer develop disease recurrence. Salvage surgery in the form of pelvic exenteration (PE) may offer improved survival and possibly cure in carefully selected patients, however robust data is scarce. This study aimed to describe margin status, morbidity, survival and quality of life (QOL) outcomes following PE for cervical cancer at a high-volume center. Primary outcome was histological margin clearance; secondary outcomes were postoperative complications, overall survival (OS) and QOL.</p><p><strong>Methods: </strong>Retrospective review of prospectively collected data for all adult patients undergoing PE for cervical cancer at Royal Prince Alfred Hospital, Sydney, between 1994 and 2024. Physical and mental QOL were measured quantitatively at 6-monthly intervals using the SF-36, FACT-G and FACT-C scores.</p><p><strong>Results: </strong>A total of 24 exenterations were performed for persistent or recurrent cervical cancer, median age 44 years, 87.5% curative intent. Total PE performed in 58.3%; bone resection in 29.2%; common and/or external iliac vascular resection in 20.8%; major nerve resection in 33.3%. Clavien-Dindo III-IV complications occurred in 37.5%, including unplanned return to theatre in 25.0%. R0 resection was achieved in 81% of curative intent PE. Median OS was 45.6 months; 1-year, 3-year and 5-year OS 74%, 62% and 48%, respectively. Survival after palliative PE ranged from 5.6 to 9.0 months. Improved QOL was demonstrated at 6 months and sustained until 30 months post-operatively.</p><p><strong>Conclusion: </strong>PE for carefully selected patients with cervical cancer can offer encouraging R0 resection rates, acceptable QOL, and the potential for long-term survival. Morbidity and oncological outcomes are comparable to international data.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081040","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":"Metastatic Status Modifies the Survival Association of Neoadjuvant Radiotherapy in Malignant Peripheral Nerve Sheath Tumors: A Nationwide Analysis.","authors":"Shilp Shah, Shivam Singh, Vikas N Vattipally, David Barreto, Taha Khalilullah, Melanie Alfonzo Horowitz, Liam P Hughes, Joseph M Dardick, Jawad M Khalifeh, Yuanxuan Xia, Ali Bydon, Nicholas Theodore, Daniel Lubelski","doi":"10.1002/jso.70400","DOIUrl":"https://doi.org/10.1002/jso.70400","url":null,"abstract":"<p><strong>Purpose: </strong>Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive sarcomas with poor overall survival (OS). Radiotherapy timing is extrapolated from other soft-tissue sarcomas, and no prior MPNST-specific analysis has formally tested whether neoadjuvant radiotherapy (NRT) effects are modified by metastatic status. We evaluated NRT's association with R0 resection and OS by metastatic status.</p><p><strong>Methods: </strong>Retrospective cohort of MPNST patients in the National Cancer Database (2005-2023). Multivariable logistic regression evaluated NRT and R0 resection. Cox proportional hazards models tested an NRT-by-metastatic status interaction, with hospital-level frailty terms addressing inter-facility correlation. Propensity score matching (1:1) reduced confounding. Sensitivity analyses addressed guarantee-time bias and confounding. Causal mediation evaluated R0 as a mediator of the NRT-survival relationship.</p><p><strong>Results: </strong>Of 2241 patients, 24.2% received NRT. NRT increased the odds of R0 resection (OR 2.17, 95% CI 1.60-2.98; p < 0.001) but was not associated with improved survival overall. The NRT-survival association was modified by metastatic status (interaction p < 0.001): metastatic patients receiving NRT had better survival (matched HR 0.41, 95% CI 0.23-0.72; p = 0.004), whereas no survival benefit was seen in localized disease (worse in some analyses). This signal was consistent across guarantee-time sensitivity analyses but was not mediated by margins.</p><p><strong>Conclusion: </strong>NRT improves the odds of R0 resection in MPNST, but improved margins do not yield a uniform survival benefit. The NRT-survival association is modified by metastatic status; the metastatic signal, though robust to guarantee-time bias, was not mediated by margins and rests on a small subgroup. These findings are hypothesis-generating and warrant a prospective study.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149081100","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":"Sarcopenia After Neoadjuvant Radiation Is Associated With Increased Length of Stay Following Resection of Retroperitoneal Sarcoma.","authors":"Leah E Hendrick, Jae Hwan Choi, Rikesh J Makanji, Rachel K Voss, Ricardo J Gonzalez, John E Mullinax","doi":"10.1002/jso.70412","DOIUrl":"https://doi.org/10.1002/jso.70412","url":null,"abstract":"<p><strong>Background: </strong>Sarcopenia, defined as loss of muscle mass and function, has been identified as a negative prognostic factor in outcomes of major abdominal cancer operations. We sought to understand the impact of sarcopenia, using the psoas muscle index (PMI) as a surrogate, during neoadjuvant radiation (NR) on perioperative outcomes in patients with retroperitoneal sarcoma (RPS).</p><p><strong>Methods: </strong>We performed a single-institution retrospective review of patients with RPS undergoing resection between 2017 and 2024. Data were extracted for patient demographics, details of NR, surgical resection, length of stay (LOS), and 30-day postoperative complications (Clavien-Dindo Scale). PMI was defined as total psoas muscle area at the 3rd lumbar vertebrae divided by height squared, measured on preoperative imaging. PMI was stratified by quartile, and patients were evaluated for PMI loss during NR. Data were analyzed using Chi-square/Fisher's exact test for categorical variables, Student t-test/one-way ANOVA for continuous variables. Logistic regression model was built by backward elimination.</p><p><strong>Results: </strong>We identified 163 patients who underwent resection for RPS following NR and 51 of these had pre- and post-NR images available for review. Patients were 52.2% male, and 42.2% had at least one comorbidity (HTN, DM, or coronary artery disease). Subtype diagnoses included dedifferentiated liposarcoma (36.8%), well-differentiated liposarcoma (27.0%), leiomyosarcoma (18.4%), and other (17.8%). Lowest quartile PMI patients were older (71.2 vs. 59.5 years, p < 0.001) than highest quartile PMI patients, without differences in comorbidity rates (p = 0.747). Patients with PMI loss during NR did not have more (p = 0.291) or worse (p = 0.490) 30-day complications; however, after adjusting for covariates, lowest quartile PMI patients had significantly longer hospital LOS (8.8 vs. 6.4 days, p = 0.048) compared to those in the highest quartile.</p><p><strong>Conclusions: </strong>In patients with RPS, sarcopenia is associated with longer hospital LOS. Loss of PMI during NR is an objective measure of poor radiation tolerance and is an independent variable that stratifies those at risk for a prolonged postoperative course. Prospective calculation of preoperative PMI can inform a targeted prehabilitation program or stratified ERAS pathways. Validation of these findings with larger, multi-institutional studies may significantly impact the perioperative cost of care.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149111380","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":"Radical Hysterectomy for Non-Endometrioid Endometrial Cancer With Cervical Involvement: A Retrospective Cohort Study","authors":"Yu Xu,&nbsp;Yi Du,&nbsp;Zhaojuan Qin,&nbsp;Ai Zheng,&nbsp;Yuedong He,&nbsp;Xu Shuai,&nbsp;Chen Cheng,&nbsp;Yong Tian","doi":"10.1002/jso.70337","DOIUrl":"10.1002/jso.70337","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the survival impact of radical hysterectomy versus simple hysterectomy on non-endometrioid endometrial cancer with cervical involvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multicenter retrospective cohort study of 422 women with uterine serous carcinoma or uterine clear cell cancer treated between 2013 and 2020 at four tertiary teaching hospitals. We classified the patients by the type of hysterectomy. Overall survival and disease-free survival were analyzed and compared using the Kaplan–Meier method and the log-rank test. To adjust for the potential confounders, the Cox proportional hazards regression model was employed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our cohort included 275 women who underwent radical hysterectomy and 147 women who underwent simple hysterectomy. The baseline characteristics of the two groups did not differ significantly. There was no statistical difference in recurrence between the two groups (23.8% vs. 20.4%, <i>p</i> = 0.456). Compared with a simple hysterectomy, a radical hysterectomy was not associated with improved overall survival (hazard ratio 0.93, 95% confidence interval 0.69–1.26, <i>p</i> = 0.652), and improved disease-free survival (hazard ratio 0.96, 95% confidence interval 0.72–1.26, <i>p</i> = 0.745). After adjusting for potential confounders, the analysis showed that the type of hysterectomy did not affect overall survival (hazard ratio 0.99, <i>p</i> = 0.968) and disease-free survival (hazard ratio 1.01, <i>p</i> = 0.985) in non-endometrioid endometrial cancer with cervical involvement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Radical hysterectomy was not associated with a survival benefit in non-endometrioid endometrial cancer with cervical involvement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"684-691"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455351","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}