Journal of Surgical Oncology最新文献

{"title":"Contralateral Prophylactic Mastectomy at the Time of Therapeutic Mastectomy for Local Recurrence of Breast Cancer: Influence of Genetic Testing and Other Factors","authors":"Candice N. Santoro,&nbsp;Courtney N. Day,&nbsp;Jenna L. Sturz-Ellis,&nbsp;Tina J. Hieken,&nbsp;Mary M. Mrdutt","doi":"10.1002/jso.70339","DOIUrl":"10.1002/jso.70339","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Surgical management of ipsilateral breast tumor recurrence (IBTR) is often mastectomy. No guidelines specifically address contralateral prophylactic mastectomy (CPM) for this population. We assessed factors associated with CPM at the time of IBTR mastectomy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients undergoing mastectomy for IBTR (10/2008-5/2024) were identified. Demographics, tumor characteristics, and treatment details were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 381 eligible IBTR patients, 221 (58.0%) had a unilateral therapeutic mastectomy and 160 (42.0%) underwent mastectomy with CPM. CPM patients were younger (<i>p</i> &lt; 0.0001), with lower clinical T category tumors (<i>p</i> &lt; 0.001) and less HR + HER2- invasive disease (<i>p</i> = 0.004). CPM patients were more likely to undergo germline genetic testing (63.1% vs 41.6%, <i>p</i> &lt; 0.0001) and were twice as likely to have immediate breast reconstruction (<i>p</i> &lt; 0.0001). On multivariable analysis, younger age, HR-HER2 + IBTR subtype, pathogenic variants known at the time of surgery (relative to negative testing and/or no genetic testing), immediate breast reconstruction, and prior radiation for index cancer were each associated with CPM (all <i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In our series of 381 patients treated with mastectomy for IBTR, 42% also had a CPM. Multiple factors, including age, tumor stage and biology, immediate breast reconstruction, and genetic testing may impact CPM choice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"664-672"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536065","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":"Impact of Neoadjuvant Approach and Tumor Response on Survival in Pancreatic Adenocarcinoma","authors":"Mohammed O. Suraju,&nbsp;Brian Longbottom,&nbsp;Jasmine A. Peterson,&nbsp;Terry Hayes,&nbsp;Kiers Brevik,&nbsp;Sean Y. Kim,&nbsp;Paolo Goffredo,&nbsp;Imran Hassan,&nbsp;Hassan Aziz,&nbsp;Carlos H. F. Chan","doi":"10.1002/jso.70329","DOIUrl":"10.1002/jso.70329","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Neoadjuvant therapy for pancreatic adenocarcinoma (PDAC) has evolved from single-agent to multi-agent approaches, largely informed by metastatic disease studies demonstrating improved survival; albeit at the price of increased toxicity. It remains unclear how response to varied neoadjuvant regimens impact survival. We hypothesized that tumor response to different neoadjuvant approaches reflects underlying tumor biology, and achieving a pathologic complete response (pCR) with single-agent neoadjuvant may signal favorable biology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult PDAC patients (2010–2021) who received neoadjuvant therapy were identified in the National Cancer Database. Tumor response was categorized as pCR (pT0N0), moderate (≥ 2 T-stage reduction), or minimal/no response (≤ 1 T-stage reduction). Patients with stage IV disease, margin positive, or nodal involvement on final pathology were excluded; sensitivity analyses including these patients were performed. Neoadjuvant regimens were classified as single-agent, multi-agent, or multi-agent therapy plus adjuvant chemotherapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1923 patients, 9.8% achieved pCR, 19.1% had moderate response and 71.1% had minimal/no response. The 3-year overall survival (OS) was 74% [68–81] for pCR, 56% [51–62] for moderate, and 50% [47–52] for minimal/no response. Notably, 11% of pCR patients received single-agent therapy and had a 3-year OS comparable to those who received more intensive regimens, even after adjusting for confounders. Conversely, single-agent therapy in moderate or minimal/no responders was associated with significantly worse survival. Sensitivity analyses including patients with nodal metastasis and positive margins demonstrated consistent trends.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Most PDAC patients benefit from multi-agent neoadjuvant, although a small subset achieve pCR with single-agent therapy and experience excellent outcomes. Response to varied neoadjuvant approaches merits further investigation in biomarker-driven studies and may inform opportunities for therapy personalization in appropriately selected PDAC patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"631-638"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70329","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehabililtation in Retroperitoneal Sarcomas","authors":"Eyal Mor,&nbsp;Hayden Snow,&nbsp;Jenelle Loeliger,&nbsp;Bernhard Riedel,&nbsp;Maria Ftanou,&nbsp;Linda Denehy,&nbsp;Emily Traer,&nbsp;Tara Dehm,&nbsp;Hilmy Ismail,&nbsp;David E. Gyorki,&nbsp;The Centre for Prehabilitation Peri-operative Care (CPPOC)","doi":"10.1002/jso.70335","DOIUrl":"10.1002/jso.70335","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Retroperitoneal sarcoma (RPS) requires complex surgery with high post-operative morbidity. Prehabilitation aims to optimize the physical, psychological, and nutritional status of high-risk patients before surgery. This study outlines our experience with a multimodal prehabilitation program for RPS patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed 41 patients who underwent RPS resection and participated in prehabilitation (2020–2023) at a tertiary center, describing assessment findings and peri-operative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 41 patients were included in the analysis out of 132 patients who had surgery for RPS during the specified time period. All participated in a multimodal prehabilitation program, including physical, nutritional, and psychological support. The average program duration was 57 days (range, 42–132). Among 36 (88%) who completed cardiopulmonary exercise testing, the mean respiratory exchange ratio was 1.15 (±0.2), and peak vO2 was 14.9 (±4.1) mls/kg/min. Mean Australia-modified Karnofsky Performance Status (AKPS) was 85 (±10). Seventeen (41%) had an MST score ≥2, indicating malnutrition risk. Mean operative time was 5.7 (±2.4) hours; hospital and ICU stays averaged 12.5 (±8.1) and 1.3 (±1.6) days. Major post-operative complications (Clavien-Dindo ≥ 3) occurred in 9 patients (21%), with 2 (4%) requiring re-operation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A Multimodal prehabililtation program in retroperitoneal sarcoma is feasible and may be worthwhile for patients at high-risk of perioperative complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"654-663"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430801","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 and Addressing Delays in Endocrine Surgery: Insights From a Mixed-Methods Study and a Pilot Educational Intervention","authors":"Stella Kim,&nbsp;Maxwell Foote,&nbsp;Sophia Zhang,&nbsp;Audrey Twyford,&nbsp;Abigail Fox,&nbsp;Jennifer E. Rosen","doi":"10.1002/jso.70341","DOIUrl":"10.1002/jso.70341","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Delays in endocrine surgical care contribute to adverse events, patient dissatisfaction, and mortality. Communication is an overlooked contributor. This study identified multi-level drivers of delay and piloted a provider-focused intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted an IRB-approved mixed-methods study. A retrospective analysis of 898 patients who underwent thyroid, parathyroid, and adrenal surgery at a single academic center between January 2023 and August 2024 quantified referral (first abnormal lab or imaging to first surgical consultation) and treatment (consultation to surgery) delays, evaluating sociodemographic, patient portal, and interoperability factors. Semi-structured interviews with patients and staff explored patient-, provider-, and system-level barriers. A pilot educational intervention for primary care providers (PCPs) assessed pre-post changes in referral-related knowledge and comfort caring for primary hyperparathyroidism.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median referral delay (157 days) exceeded treatment delay (62 days), suggesting delays occurred primarily during the referral phase of care. Older age, female sex, and thyroid disease independently predicted longer referral delays. Our educational intervention improved PCP recognition and referral confidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Delays in endocrine surgical care are multifactorial, spanning patient-, provider-, and system-level factors. Provider-focused interventions are promising, but prospective studies are needed to confirm impact on delays and outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"702-709"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Colorectal Cancer Diagnosis in Older Adults: A SEER-Medicare Analysis of Health and Economic Impact of Missed Screening Opportunities","authors":"Eshetu B. Worku,&nbsp;Selamawit A. Woldesenbet,&nbsp;Odysseas P. Chatzipanagiotou,&nbsp;Timothy M. Pawlik","doi":"10.1002/jso.70338","DOIUrl":"10.1002/jso.70338","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess how diagnostic pathways affect clinical outcomes and healthcare costs among older adults diagnosed with colorectal cancer (CRC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Summary of Background Data</h3>\u0000 \u0000 <p>Many CRC cases in the United State are diagnosed during an emergency presentation, which have been linked to worse outcomes. Understanding how diagnostic routes may impact a cancer diagnosis may be critical for improving care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analyzed SEER-Medicare data (2005–2019) for patients aged ≥ 65 years with CRC. Diagnostic routes were classified as screening, inpatient/outpatient (IP/OP), or emergency presentation (ER) based on encounters within 30-day to 6-months before diagnosis. Multivariable regression evaluated associations between route and outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 79,251 CRC patients (colon: 72.4%, rectum: 27.6%), diagnoses occurred via ER (13.7%), IP/OP (60.6%), and screening (25.7%). Compared with screened patients, ER-diagnosed patients were older (median age: 79 vs. 75), had higher comorbidity (22.5% vs. 8.1%), and lower income (29.1% vs. 23.9%). ER diagnosis was associated with urgent surgery (59.7% vs. 20.1%), complications (29.8% vs. 14.2%), extended stay (37.2% vs. 14%), inpatient mortality (7.4% vs. 2.1%), lower discharge to home (32.2% vs. 62.4%), and higher 90-day mortality (16.8% vs. 5%). Multivariable analysis confirmed ER diagnosis as the strongest predictor of stage IV disease (OR 1.75, 95% CI: 1.66–1.84), urgent surgery (OR 5.14, 95%CI: 4.83–5.48), and 90-day mortality (OR 1.80, 95%CI: 1.62–1.99; all <i>p</i> &lt; 0.001). Costs were higher for ER versus screening: index surgery ($13,802 vs. $11,458) and postoperative care ($9,470 vs. $3,655).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Emergency CRC diagnosis was associated with worse outcomes and higher costs, emphasizing the need for targeted screening and earlier detection strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"673-683"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148456198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Adjuvant Chemotherapy on Overall Survival in Early-Onset Stage II-III Mucinous Adenocarcinoma of The Colon: A Propensity-Based Analysis","authors":"Usama Waqar,&nbsp;Manali Rupji,&nbsp;Musa Salar,&nbsp;Hashim Salar,&nbsp;Courtney L. Devin,&nbsp;Terrah J. Paul Olson,&nbsp;Yuan Liu,&nbsp;Patrick Sullivan,&nbsp;Seth A. Rosen","doi":"10.1002/jso.70344","DOIUrl":"10.1002/jso.70344","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Incidence of early-onset colon cancer is rising. Younger patients often present with advanced disease and distinct molecular profiles. Mucinous adenocarcinoma (MAC) represents a biologically unique subtype that may demonstrate limited responsiveness to adjuvant chemotherapy (AC). This study evaluated association between AC and overall survival (OS) in patients with early-onset stage II and III MAC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged &lt; 50 years diagnosed with stage II-III MAC were identified from NCDB (2006-2020). Stage II was categorized as high- or low-risk, with high-risk defined by presence of ≥ 1 of: &lt; 12 lymph nodes retrieved, lymphovascular/perineural invasion, poor differentiation, or pT4 disease. Stabilized inverse probability of treatment weighting, Kaplan-Meier analysis, and multivariable Cox regression were performed to assess the association between AC and OS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 3333 patients, 42.9% were stage II and 57.1% stage III. AC was administered to 70.1% of patients, including 41.3% with stage II and 91.7% with stage III disease. AC was not associated with improved OS in either high-risk or low-risk stage II subgroups but was significantly associated with improved OS in stage III disease (HR 0.71, 95% CI 0.54–0.93).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>AC was associated with improved survival in stage III but not stage II early-onset MAC, including those with high-risk features.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"720-729"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592356","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":"Comparative Outcomes of Kiss Latissimus Dorsi Flap Versus Extended Thoracoabdominal Hatchet Flap for Large Chest Wall Reconstruction: A Retrospective Cohort Study","authors":"Giuseppe A. G. Lombardo,&nbsp;Paolo Marchica,&nbsp;Isidoro Musmarra,&nbsp;Barbara Martino,&nbsp;Giuseppe Garozzo,&nbsp;Giovanna Malara,&nbsp;Martina Rapisarda,&nbsp;Francesca Catalano","doi":"10.1002/jso.70351","DOIUrl":"10.1002/jso.70351","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Reconstruction of chest wall defects after oncologic resection requires techniques that minimize wound morbidity and preserve timely access to adjuvant therapy. The Kiss Latissimus Dorsi (LD) flap offers robust, well-vascularized tissue with reliable healing, while extended thoracoabdominal hatchet flaps provide a muscle-sparing alternative based on local perforators. Comparative data between these approaches remain limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted including female patients who underwent chest wall reconstruction between 2015 and 2023 using either a Kiss LD flap (<i>n</i> = 11) or an extended thoracoabdominal hatchet flap (<i>n</i> = 12). Groups were comparable in demographic and clinical characteristics. The primary endpoint was time to complete wound healing. Secondary endpoints included wound complications, delayed healing (&gt; 30 days), need for reintervention, and timing of adjuvant therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Healing occurred significantly earlier in the Kiss LD group compared with the hatchet group (21.7 ± 5.2 vs. 34.5 ± 8.7 days; <i>p</i> &lt; 0.001). Delayed healing was less frequent in the Kiss LD flap group (9.1% vs. 50.0%; <i>p</i> = 0.02). Overall wound complications were lower in the Kiss LD cohort (18.2% vs. 41.7%; <i>p</i> = 0.048), and no reinterventions were required, whereas one patient in the hatchet group required debridement. Patients in the Kiss LD group initiated adjuvant therapy earlier than those in the hatchet group (33.4 ± 6.5 vs. 47.8 ± 9.9 days; <i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The Kiss Latissimus Dorsi flap was associated with faster and more reliable healing than the extended thoracoabdominal hatchet flap, alongside earlier initiation of adjuvant therapy. The Kiss LD flap may represent a reliable reconstructive strategy for oncologic patients when treatment sequencing is essential.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"739-747"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604323","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":"Peri-Operative Systemic Inflammatory Responses Predict Post-Operative Complications in Patients Undergoing Pelvic Exenterative Surgery for Primary Locally Advanced Sigmoid and Rectal Cancer","authors":"Tin-Ning Wong,&nbsp;Chia Yew Kong,&nbsp;Peter Ishak,&nbsp;Norman Galbraith,&nbsp;Toby Provan,&nbsp;Reza Tahmid,&nbsp;Kevin Ki-Feng Shu,&nbsp;Peter Chong,&nbsp;Martha Quinn,&nbsp;Paul G. Horgan,&nbsp;Campbell S. Roxburgh,&nbsp;Donald C. McMillan,&nbsp;Colin W. Steele","doi":"10.1002/jso.70332","DOIUrl":"10.1002/jso.70332","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>The systemic inflammatory response (SIR) is a recognized determinant of outcome in standard colorectal resections, yet its role in exenterative surgery remains unclear. The study aims to evaluate the relationship between peri-operative SIR biomarkers and post-operative complications in pelvic exenterative surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of consecutive patients undergoing pelvic exenteration (PE) or beyond total mesorectal excision (bTME) for primary locally advanced sigmoid and rectal cancers at a tertiary referral center. Clinicopathological variables, peri-operative complications, and SIR biomarkers (C-reactive protein [CRP], albumin, modified Glasgow Prognostic Score [mGPS] and neutrophil) were analyzed. Peri-operative SIR biomarkers and post-operative CRP were assessed as predictors of complications using Firth's penalized logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>114 patients were included; major and infective complications occurred in 29 (25.4%) and 49 (43.0%), respectively. Pre-operatively, high mGPS was associated with ASA ≥ 3, sigmoid tumor location and neutrophilia, whereas neutrophilia was associated with advanced tumor features (T stage and Extramural Venous Invasion), higher CRP, hypoalbuminemia, and ASA ≥ 3. Post-operative-day-3 (POD3) CRP &gt; 150 mg/L independently predicted major (OR 7.40; 95% CI, 2.45–29.80; <i>p</i> &lt; 0.001) and infective (OR 2.42; 95% CI, 1.09–5.58; <i>p</i> = 0.03) complications.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>POD3 CRP &gt; 150 mg/L provides dynamic stratification of peri-operative morbidity and may facilitate early detection and targeted management of complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"639-653"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430726","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":"‘Posterior (SMA-first) Approach’ Versus ‘Standard Approach’ in Terms of Resection Margin and Long-Term Survival After Pancreaticoduodenectomy for Periampullary and Pancreatic Carcinoma: A Randomized Trial","authors":"Hemant Ashok Jain,&nbsp;Gursagar Singh Sahota,&nbsp;Anand Narayan Singh,&nbsp;Rajni Yadav,&nbsp;Prasenjit Das,&nbsp;Nihar Ranjan Dash,&nbsp;Kumble Seetharama Madhusudhan,&nbsp;Siddhartha Dattagupta,&nbsp;Sujoy Pal","doi":"10.1002/jso.70347","DOIUrl":"10.1002/jso.70347","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>SMA-first-approach in pancreaticooduodenectomy (PD) was found to be associated with better oncological outcomes as compared to the standard approach both in our pilot study and a few retrospective studies. Hence, we performed a randomized controlled trial to compare these two approaches in terms of resection margins, lymph node-retrieval, and long-term survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between January 2014 to December 2018, all the consecutive patients undergoing PD for periampullary cancer at the Department of Gastrointestinal Surgery, AIIMS, New Delhi were assessed for randomization. Primary outcomes were R0 resection rate and number of lymph nodes retrieved. The secondary outcomes were operating time, blood loss, postoperative complications, recurrence free and overall survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 299 patients assessed, 203 were randomized and 183 analyzed (20: excluded after randomization, 90: patients-SMA, 93: patients-classical). The median age of the study population was 56 (14-78) years, with predominantly male (138, 68%) and with periampullary tumors (89%). The demographic profile, preoperative clinical and laboratory parameters were comparable. The blood loss was significantly higher in SMA first group (675 vs 600 ml, <i>p</i> = 0.02), however the operating time and the need for blood transfusion were comparable in both groups. ISGPS Grade B/C pancreatojejunostomy leak (20 vs 24.7%, <i>p</i> = 0.68), post-pancreatectomy hemorrhage (8.8 vs 14%, <i>p</i> = 0.38), delayed gastric emptying (37.8 vs 40.9%, <i>p</i> = 0.67) and Clavien–Dindo grade ≥III complications(27.7 vs 31.2, <i>p</i> = 0.85) were similar in both the groups. The R0 resection rates (82.2 vs 78.5%, <i>p</i> = 0.53) and total lymphnodes retrieved (18 vs 17, <i>p</i> = 0.63) were similar between the two groups. Both groups were comparable in terms of median recurrence free (48 vs 44 months, <i>p</i> = 0.85) and overall survival (53 vs 51 months, <i>p</i> = 0.69).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>‘Posterior (SMA-first) approach’ and ‘Standard approach’ for pancreatoduodenectomy for periampullary cancer yielded equivalent results in terms of R0 resection rate, number of lymph nodes retrieved, recurrence-free and overall-survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"730-738"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148887811","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":"Extended Versus Non-Extended Lymphadenectomy in Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis","authors":"Maria Fernanda Dias Azevedo,&nbsp;Pedro Henrique Souza Brito,&nbsp;Lucas Kallas-Silva,&nbsp;Bruno Liebl,&nbsp;Beatriz Taveira Constantinou,&nbsp;Bianca Caroline Benedicto,&nbsp;Lucas Paschoalino de Oliveira,&nbsp;Mauricio Dener Cordeiro,&nbsp;William Carlos Nahas,&nbsp;Walid Shabana,&nbsp;Walid Shahrour,&nbsp;Leopoldo Alves Ribeiro-Filho,&nbsp;Caio Vinicius Suartz","doi":"10.1002/jso.70334","DOIUrl":"10.1002/jso.70334","url":null,"abstract":"<p>Pelvic lymph node dissection is an essential component of radical cystectomy (RC) for bladder cancer (BC), but the optimal extent of lymphadenectomy remains uncertain. We conducted a systematic review and meta-analysis to compare oncologic and perioperative outcomes between extended and non-extended lymphadenectomy during RC for BC. PubMed/MEDLINE, Embase, and ClinicalTrials. gov were searched up to October 2025 following PRISMA guidelines and PROSPERO registration. Randomized controlled trials (RCTs) and observational studies comparing extended versus non-extended lymphadenectomy in adults undergoing RC were included. Outcomes included surgery duration, intraoperative blood loss, overall survival (OS), disease-free survival (DFS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Random-effects meta-analyses were performed, reporting hazard ratios (HRs) or mean differences (MDs) with 95% confidence intervals (CIs). Risk of bias was assessed using RoB 2.0 and ROBINS-I, and certainty of evidence using GRADE. Fifteen studies including 5671 patients were analyzed, of which two were RCTs. Extended lymphadenectomy was associated with longer operative time (MD + 26.2 min) and improved DFS (HR: 1.47), but no significant benefit in OS or CSS. Non-extended lymphadenectomy was associated with higher RFS (HR: 0.79). Heterogeneity was moderate to high, and certainty of evidence was very low for most outcomes and low for OS considering only RCTs. Extended lymphadenectomy during RC increases operative time and may improve DFS; however, the available evidence does not clearly support a consistent oncologic benefit.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"617-630"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70334","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148829634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}