Journal of Surgical Oncology最新文献

{"title":"Incidence of Deleterious Genetic Mutations in Newly Diagnosed Breast Cancer Patients Over the Age of 65: Is It Time to Expand Testing Parameters?","authors":"Gwendolyn E Daly, Krystle L Collins, Susan E Malone, Jennifer Garreau, Nathalie Johnson","doi":"10.1002/jso.28151","DOIUrl":"https://doi.org/10.1002/jso.28151","url":null,"abstract":"<p><strong>Background: </strong>National Comprehensive Cancer Network guidelines do not recommend routine genetic testing for women > 65 with newly diagnosed breast cancer.</p><p><strong>Methods: </strong>We performed a retrospective review of data from the Legacy Cancer Institute Tumor Registry of women with a new diagnosis of breast cancer between January 2017 and December 2022. Primary endpoint was the incidence of deleterious mutation.</p><p><strong>Results: </strong>4548 women with a diagnosis of breast cancer were identified. 2059/4548 (45.3%) were older than 65 at the time of diagnosis. 42.8% of women > 65 (881/2059) received genetic testing compared to 74.1% (1844/2489) who were ≤ 65 (p < 0.0001). In the cohort > 65 who received genetic testing, 107/881 had at least one deleterious mutation (12.1%) compared to 258/1844 women ≤ 65 (14.0%) (p = 0.2). 70/128 (54.7%) patients > 65 with triple negative breast cancer (TNBC) received genetic testing compared to 182/206 ≤ 65 (88.3%) (p < 0.0001). The rate of detection of deleterious mutations in the > 65 group with TNBC was slightly higher than the younger age group (25.7% (18/70) versus 21.4% (39/182), p = 0.45).</p><p><strong>Conclusions/discussion: </strong>The incidence of actionable deleterious mutations among women >65 with newly diagnosed breast cancer may be higher than previously reported, warranting consideration of genetic testing for all breast cancer patients regardless of age.</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":"144026793","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":"Optimizing Lymphedema Management After Breast Cancer: Predictive Risk Models in Clinical Practice.","authors":"Enrique Cano-Lallave, Elisa Frutos-Bernal, María Anciones-Polo, Esther Serrano-Sánchez, Ian Rodríguez-Guerrero, Paula Cuenda-Gamboa, Luis Muñoz-Bellvis, Marta Eguía-Larrea","doi":"10.1002/jso.28146","DOIUrl":"https://doi.org/10.1002/jso.28146","url":null,"abstract":"<p><strong>Background and objectives: </strong>Lymphedema secondary to multimodal breast cancer treatment is a relatively common complication that significantly impacts patients' quality of life. Despite identifying several associated risk factors, accurately assessing individual risk remains challenging. This study aims to develop predictive tools integrating patient characteristics, tumor attributes, and treatment modalities to optimize clinical surveillance, enhance prevention, and enable earlier diagnosis.</p><p><strong>Methods: </strong>Data were analyzed from 309 patients referred to the Lymphedema Unit of Rehabilitation Service who underwent lymphadenectomy for breast cancer between January 2016 and December 2021. Collected variables included patient demographics, tumor clinicopathological features, and treatment details. A lymphedema incidence study was conducted, complemented by univariate and multivariate regression analyses to identify risk factors. A nomogram was developed to predict high-risk patients, facilitating personalized prevention and management strategies.</p><p><strong>Results: </strong>The cumulative incidence of lymphedema was 18.4%. Independent risk factors included high body mass index, sedentary lifestyle, number of positive nodes (N stage), and radiotherapy, particularly targeting the breast, axilla, and supra-infraclavicular regions. The logistic regression model demonstrated an area under the ROC curve (AUC) of 0.75, with acceptable calibration, validating the predictive model.</p><p><strong>Conclusions: </strong>The predictive tools developed provide healthcare professionals with a means to identify patients at elevated risk of lymphedema, supporting individualized prevention and management.</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":"143978556","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 Cost-Effective Strategies for Asymptomatic Microhematuria Diagnosis: A Risk-Based Alternative to the American Urological Association Guidelines.","authors":"Krishay Sridalla, Hiten D Patel, Dustin D French, Joshua J Meeks, Lili Zhao, Yuying Xing, David J Bentrem","doi":"10.1002/jso.28148","DOIUrl":"https://doi.org/10.1002/jso.28148","url":null,"abstract":"<p><strong>Background and objectives: </strong>The American Urological Association (AUA) guidelines recommend evaluating asymptomatic microhematuria (MH) at ≥ 3 red blood cells per high powered field (RBCs/hpf), resulting in significant costs with limited bladder cancer detections. This study evaluates alternative diagnostic strategies to improve the cost-effectiveness of asymptomatic MH evaluation.</p><p><strong>Methods: </strong>The cost-effectiveness analysis compared three alternative strategies: Strategy 1 (cystoscopy at ≥ 26 RBCs/hpf) was compared to a 3 RBCs/hpf threshold, while Strategy 2 (cystoscopy and renal ultrasound at ≥ 3 RBCs/hpf) and Strategy 3 (cystoscopy and renal ultrasound at ≥ 26 RBCs/hpf) were compared to the AUA guidelines. Total costs, cost per patient evaluated, costs per cancer detected, and incremental cost-effectiveness ratios (ICERs) were calculated.</p><p><strong>Results: </strong>Strategy 3 minimized costs without significantly reducing early cancer detection rates. It was cost-effective for females (ICER = $120,649) and the total sample (ICER = $50,648) but not specifically for males (ICER = $23,326). Strategies 1 and 2 yielded lower cost savings and were less efficient.</p><p><strong>Conclusions: </strong>Strategy 3-performing cystoscopy and renal ultrasound for higher-risk patients ( ≥ 26 RBCs/hpf)-offers a more cost-effective approach than the AUA guidelines, particularly for women. Future studies should incorporate additional patient variables and diagnostic test characteristics.</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":"144010456","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":"Higher Rates of New Colon Neoplasm in Interval vs. Primary Appendectomies-A Coarsened Exact Matching Analysis.","authors":"Anneliese Markus, Rachel Lippman, Adam H Abbas, Csaba Gajdos, Nader D Nader","doi":"10.1002/jso.28138","DOIUrl":"https://doi.org/10.1002/jso.28138","url":null,"abstract":"<p><strong>Background and aims: </strong>While there is low risk of emergent appendectomy patients becoming diagnosed with a neoplasm, the rates are much higher in patients undergoing interval appendectomies. This study compares the incidence rates of new primary right colon neoplasms and postoperative complications between interval and primary appendectomies.</p><p><strong>Methods: </strong>We performed a retrospective cohort study from 2001 to 2020 involving patients from 92 healthcare organizations within TriNetX. Patients' diagnosis and procedure were extracted from ICD and CPT codes. Primary and interval appendectomy (IA) cohorts were defined as having an appendectomy procedure 0-14 and 15-90 days from the initial diagnosis, respectively. Patients in each cohort were matched 1:1 on demographics via Coarsened Exact Matching (CEM). Postoperative complications and oncological outcomes were defined by specific ICD and/or CPT codes.</p><p><strong>Results: </strong>Post-matching, there were 2803 patients included in each cohort. IA patients were associated with 3.07 times greater incidence rates of malignant neoplasm of the right colon and appendix (p < 0.001). However, IA patients were associated with 2.63 times lower postoperative complication rates (p < 0.001).</p><p><strong>Conclusion: </strong>IA patients are more likely to be diagnosed with new right-sided neoplasms postoperatively. Future studies are necessary to determine appropriate cancer screening methods for IA candidates.</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":"143989193","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":"What Are the Long-Term Clinical and Functional Outcomes After Hemicortical Allograft Reconstruction for Primary Bone Tumors?","authors":"Marcos R Gonzalez, Erhan Okay, Joseph O Werenski, Joseph J Connolly, Andrew Pfeiffer, Erik T Newman, Kevin A Raskin, Santiago A Lozano-Calderón","doi":"10.1002/jso.28147","DOIUrl":"https://doi.org/10.1002/jso.28147","url":null,"abstract":"<p><strong>Background: </strong>Hemicortical allograft reconstruction is associated with low short-term complication rates and excellent functional outcomes. However, data on their long-term complication profile and patient-reported outcomes is scarce to non-existent.</p><p><strong>Methods: </strong>Patients with hemicortical resection and allograft reconstruction for primary bone tumors were included. The Henderson classification for biologic reconstruction was used to classify allograft failures. Functional outcomes at a minimum of 10 years postoperatively were assessed.</p><p><strong>Results: </strong>Twenty-four patients with femur hemicortical allograft and 20 with tibia allograft were included. Allograft failure and reoperation occurred in 39% and 52% of patients, respectively. The main causes of allograft failure were infection, soft-tissue failure, and structural failure (9% each). Tibia allografts had a higher rate of failure due to infection (p = 0.02) and nonunion (p = 0.049) compared to femur allografts. There were no differences in allograft failure-free survival based on bone (tibia vs. femur) and osteosynthesis type (plate vs. screw and plates). Median TESS-LE and LEFS scores were 98.8% and 87.5% for tibia allografts, and 98.1% and 97.5% for femur allografts, respectively.</p><p><strong>Conclusion: </strong>Long-term allograft failure-free survival was excellent, with infection and soft-tissue failures as the main failure mechanisms. At last follow-up, patients who still had the hemicortical allograft displayed excellent functional outcomes.</p><p><strong>Level of evidence: </strong>Level IV.</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":"143988966","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":"Neoadjuvant Immunotherapy for Resectable Dedifferentiated Liposarcoma: A National Cohort Analysis.","authors":"Mohammad S Farooq, Neha Shafique, Gracia M Vargas, Jennifer Guo, John T Miura, Daniel S Lefler, Giorgos C Karakousis","doi":"10.1002/jso.28155","DOIUrl":"https://doi.org/10.1002/jso.28155","url":null,"abstract":"<p><strong>Background: </strong>Neoadjuvant immunotherapy (NIT) with checkpoint blockade has been increasingly studied for soft tissue sarcomas, however, survival outcomes data are limited, and dedifferentiated liposarcoma (DDLPS) histology remains underrepresented in recent trial cohorts. We assessed the impact of NIT with or without radiation therapy (RT) on overall survival (OS) for resectable DDLPS.</p><p><strong>Methods: </strong>The National Cancer Database (NCDB) was used to identify patients diagnosed with nonmetastatic DDLPS who received NIT and underwent surgical resection between 2016 and 2022. Primary outcome was 5-year OS.</p><p><strong>Results: </strong>A total of 3414 patients with DDLPS met the inclusion criteria and NIT was administered to 31 (1%) patients. Factors associated with receipt of NIT were receipt of neoadjuvant RT (NRT, odds ratio [OR]: 5.75, p < 0.001) and male sex (OR: 3.33, p = 0.036). NIT was associated with a hazard ratio (HR) for mortality of 0.89 (p = 0.786). No difference was found in 5-year OS in the overall cohort (NIT 72% vs. 61% no NIT, p = 0.320) or in the propensity-matched cohort (68% vs. 65%, p = 0.848). Subanalysis between NIT with NRT versus NRT-only also did not find any significant difference in 5-year OS (88% vs. 59%, p = 0.331).</p><p><strong>Conclusion: </strong>In this retrospective NCDB analysis of patients with resectable DDLPS, administration of NIT did not significantly affect OS.</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":"144023510","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":"Benefits of Additional Liposuction in Lymphatic Reconstructive Surgery.","authors":"Lisanne Grünherz, Nick Ferrer, Carlotta Barbon, Carmen Elena Zurfluh, Epameinondas Gousopoulos, Semra Uyulmaz, Pietro Giovanoli, Nicole Lindenblatt","doi":"10.1002/jso.28134","DOIUrl":"https://doi.org/10.1002/jso.28134","url":null,"abstract":"<p><strong>Background and objectives: </strong>The goal of this study was to examine the benefits of immediate adjunctive liposuction in patients undergoing lymphatic reconstructive surgery with a focus on complications, limb volume, and patient-reported outcome measurements (PROMs).</p><p><strong>Methods: </strong>We conducted a single-center prospective study on patients receiving reconstructive lymphatic surgery at the Department of Plastic Surgery and Hand Surgery of the University Hospital Zurich. Besides patients characteristics and operation details, volume measurements and PROMs were assessed pre- and postoperatively.</p><p><strong>Results: </strong>We included 73 patients with upper extremity lymphedema (UEL) or lower extremity lymphedema (LEL). A total of 41 patients received lymphatic reconstruction only, while in 32 patients, an additional liposuction in case of fat accumulation was performed. Mean percentage volume reduction for all limbs was -10.1% (±10.0%) in UEL and -9.3% (±6.9%) in LEL. Volume reduction in the additional liposuction group was not statistically different from reconstruction only. Although patients with liposuction had a significantly lower hemoglobin postoperatively (p = 0.03), there was no difference in length of rehabilitation. Regardless of the surgical technique, PROMs confirmed improvements in a broad range of different domains.</p><p><strong>Conclusion: </strong>Combining reconstructive lymphatic surgery with immediate liposuction is effective for patients with a significant lymphedema-associated fat accumulation without increasing postoperative complications.</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":"144041333","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":"Correction to \"Systematic Review of Robotic-Assisted Peripheral and Central Lymphatic Surgery\".","authors":"","doi":"10.1002/jso.28152","DOIUrl":"https://doi.org/10.1002/jso.28152","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988537","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":"Correction to \"Comparison of Treatment Strategies Based on Clinical and Pathological Nodal Status in Resectable Gastric Adenocarcinoma\".","authors":"","doi":"10.1002/jso.28154","DOIUrl":"https://doi.org/10.1002/jso.28154","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027854","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":"Is Prepectoral Implant Reconstruction Associated With Better Physical Well-Being?","authors":"Kanad Ghosh, Kristine Kuchta, Duanny Alva, Akhil K Seth, Mark Sisco","doi":"10.1002/jso.28087","DOIUrl":"https://doi.org/10.1002/jso.28087","url":null,"abstract":"<p><strong>Background: </strong>Improvements in mastectomy techniques, implants, and devices for implant support have enabled a resurgence in prepectoral implant reconstruction. One of the drivers of this shift is a perception among patients and physicians that retropectoral implants cause more physical morbidity. Although studies have shown more rapid early recovery among patients who undergo prepectoral reconstruction, little is known about whether this approach improves long-term physical outcomes.</p><p><strong>Methods: </strong>A prospectively maintained database was used to identify patients who underwent immediate implant-based postmastectomy reconstruction from October 2017 to March 2020. Patients who underwent radiation treatment or who failed to complete implant reconstruction were excluded. Demographic and clinical characteristics, including postoperative complications, were analyzed. BREAST-Q surveys were sent to patients 12-24 months following the completion of reconstruction. Bivariate independent t-test and chi-square analysis were used to compare prepectoral and retropectoral cohorts.</p><p><strong>Results: </strong>168 patients were identified. 78 (46.4%) completed questionnaires and met the inclusion criteria for the study. 33 patients had subpectoral implants and 45 patients had prepectoral implants. Nonresponders had a similar proportion of implant positions to responders (p = 0.32). The median time between mastectomy and completion of the BREAST-Q survey was 21 months (IQR, 20-23 months). Patients with subpectoral reconstruction were older (56 ± 13 vs. 50 ± 13 years, p = 0.048) and had higher BMIs (27.8 ± 7.3 vs. 24.2 ± 3.8 kg/m², p = 0.012) and were less likely to have undergone direct-to-implant reconstruction (18.2% vs. 51.5%, p = 0.003). There were no other significant clinical or demographic differences between groups. BREAST-Q chest well-being data showed no significant difference in long-term chest wall morbidity among retropectoral and prepectoral cohorts.</p><p><strong>Conclusions: </strong>For many patients, prepectoral reconstruction confers esthetic benefits, including better projection and more stable implant and nipple position. However, there remain patients for whom a retropectoral approach is more suitable due to the risks of rippling and implant visibility. Surgical decision-making should continue to be individualized according to anatomic and disease-specific factors as well as surgeon and patient preference. However, patients should be reassured that their long-term physical well-being is unlikely to be affected by which technique is chosen.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016514","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}