Journal of Surgical Oncology最新文献

{"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}

{"title":"Outcomes of Pediatric Non-Rhabdomyosarcoma Soft-Tissue Sarcomas of the Extremities","authors":"Mikaela H. Sullivan,&nbsp;Lainey G. Bukowiec,&nbsp;Wendy Allen-Rhoades,&nbsp;Peter J. Schoettler,&nbsp;Nadia N. Laack,&nbsp;Anita Mahajan,&nbsp;Peter S. Rose,&nbsp;Matthew T. Houdek","doi":"10.1002/jso.70350","DOIUrl":"10.1002/jso.70350","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) account for less than 4% of pediatric cancers. Treatment and outcomes have been described in adults, but pediatric data are lacking. The purpose of this study is to review our institution's outcomes of extremity NRSTS in pediatric patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ninety-eight (56 male: 42 female) pediatric patients with NRSTS of the extremity at our institution were reviewed. Mean age at diagnosis was 11 ± 5 years, and mean follow-up was 12 ± 10 years. The most common diagnosis was synovial sarcoma (27%), and 60% were high-grade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Treatment included surgical resection in all patients, with 33% receiving radiation and 37% receiving systemic therapy. 20-year local recurrence- (LRFS) and metastatic disease-free survival (MDFS) were 91% and 91%, respectively, with 92% disease specific survival (DSS). High grade tumors were associated with lower LRFS (<i>p</i> = 0.02) and DSS (<i>p</i> = 0.03). Tumor size &lt; 5 cm demonstrated improved MDFS (<i>p</i> = 0.03), and stage 3 tumors showed worse MDFS (<i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Treatment of pediatric NRSTS was variable, with large, deep, high-grade tumors more likely to receive neoadjuvant and adjuvant treatments. Multidisciplinary treatment was associated with high rates of local control and durable survival. This study provides an extended follow-up of pediatric patients to identify late complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"748-755"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148604410","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":"How I Do It: Vascular Reconstruction of Ileo-Jejunal Venous Tributaries in Setting of Caudal Involvement of the Superior Mesenteric Vein by Pancreatic Tumor","authors":"Francesco Cobellis,&nbsp;Gustavo S. Oderich,&nbsp;Matthew H. G. Katz,&nbsp;Rebecca A. Snyder","doi":"10.1002/jso.70343","DOIUrl":"10.1002/jso.70343","url":null,"abstract":"<div>\u0000 \u0000 <p>This article presents a technical description of a vascular reconstruction involving two distinct second order SMV tributaries, developed to manage complex caudal SMV involvement during pancreatic surgery. The approach includes the use of a temporary meso-caval shunt and an interposition graft to enable safe resection. High-quality anatomical illustrations and a literature-based discussion support the rationale and reproducibility of the technique.</p></div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"756-765"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148520306","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":"Treatment Variation Impacts Survival Among Patients With Early-Onset Metastatic Colorectal Cancer","authors":"George Q. Zhang,&nbsp;Ezra S. Brooks,&nbsp;Nelya Melnitchouk,&nbsp;Jennifer L. Irani,&nbsp;Ronald Bleday,&nbsp;Joel E. Goldberg","doi":"10.1002/jso.70340","DOIUrl":"10.1002/jso.70340","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>The incidence of early-onset colorectal cancer (eoCRC) is rising, yet optimal management in the metastatic setting remains unclear. We characterized and compared treatment patterns among patients with early-onset and later-onset (loCRC) metastatic CRC, and evaluated outcomes by treatment regimen among patients with eoCRC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective analysis of patients diagnosed with stage IV CRC between 2004 and 2022. Patients were stratified by age (eoCRC, &lt; 50 years; loCRC, 50–59.9 [reference], 60–69.9, and ≥ 70). Utilization of systemic chemotherapy (CT), primary resection (PR), immunotherapy (IO), and metastasis resection (MR) were compared across age groups. Among patients with eoCRC, overall survival was compared by treatment regimen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 259,435 patients with stage IV CRC, 15.6% were classified as eoCRC. Compared with patients with loCRC, those with eoCRC were more likely to undergo multimodal treatment regimens including CT/PR, CT/PR/MR, and CT/PR/IO (<i>p</i> &lt; 0.05 for all). Among patients with eoCRC, CT/PR (adjusted HR 0.49, 95% CI 0.47–0.51), CT/PR/MR (HR 0.36, 95% CI 0.34–0.38), and CT/PR/IO (HR 0.52, 95% CI 0.49–0.55) were associated with the greatest survival benefit, versus CT alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with metastatic eoCRC more frequently received aggressive, multimodal therapy, which was associated with improved survival.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"692-701"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148455733","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 Serious Mental Illness and Dementia-Related Disorders on Post-Parathyroidectomy Healthcare Utilization and Cost","authors":"Jasmine Hwang,&nbsp;Shane Williams,&nbsp;James Sharpe,&nbsp;Jesse E. Passman,&nbsp;Rachael Acker,&nbsp;Danielle Brown,&nbsp;Douglas L. Fraker,&nbsp;Heather Wachtel,&nbsp;Rachel R. Kelz","doi":"10.1002/jso.70342","DOIUrl":"10.1002/jso.70342","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Serious mental illness and dementia-related disorders are associated with worse postoperative outcomes. We evaluated the impact of pre-existing neuropsychiatric disorders on post-parathyroidectomy healthcare utilization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients who underwent parathyroidectomy for primary hyperparathyroidism were identified in the Healthcare Cost and Utilization Project State Inpatient and Ambulatory Surgery Databases (2016–2021). Neuropsychiatric disorders were classified. The primary outcome was 30-day readmission. Secondary outcomes were length of stay and costs (2021USD). Balancing weights were used for covariate adjustment. Subgroup analyses were performed in serious mental illness and dementia-related disorder groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 10,733 parathyroidectomy patients, 1,249 (11.6%) had neuropsychiatric disorders: 60.5% mood, 58.8% anxiety, 5.1% dementia-related, and 1.8% schizophrenia-type disorders. Patients with neuropsychiatric disorders were younger and more likely to undergo emergent/urgent parathyroidectomy (<i>p</i> &lt; 0.001).</p>\u0000 \u0000 <p>There was no difference in adjusted odds of readmission between patients with and without neuropsychiatric disorders (0.91[95%CI 0.55, 1.49], <i>p</i> = 0.710). Adjusted length of stay was 0.20 days longer among patients with neuropsychiatric disorders ([95%CI: + 0.11, + 0.30]; <i>p</i> &lt; 0.001). Adjusted encounter costs were similar between groups (median[IQI]: neuropsychiatric disorder $6767[5290,8589] vs. no neuropsychiatric disorder $6511[5259, 8550]; <i>p</i> = 0.080). Subgroup analyses showed similar results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patients with neuropsychiatric disorders have similar parathyroidectomy readmission and cost. They have slightly longer length of stay that may ameliorate the risk of readmission.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 5","pages":"710-719"},"PeriodicalIF":1.9,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549566","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":"Adjuvant Chemotherapy Is Not Associated With Improved Overall Survival in Patients With Pancreatic Ductal Adenocarcinoma With Persistent Lymphovascular Invasion or Lymph Node Involvement After Neoadjuvant Chemotherapy.","authors":"Valerie L Armstrong, Yu-Hui Chang, Chee-Chee H Stucky, Akash Kartik, Mitesh Borad, Tanios S Bekaii-Saab, Richard Bold, Nabil Wasif, Zhi Ven Fong","doi":"10.1002/jso.70414","DOIUrl":"https://doi.org/10.1002/jso.70414","url":null,"abstract":"<p><strong>Background and objectives: </strong>There is increasing use of neoadjuvant treatment (NAT) for patients with pancreatic adenocarcinoma (PDAC). The role of additional adjuvant chemotherapy (AT) is not well-defined. This study aims to determine the impact of lymphovascular invasion (LVI) and lymph node (LN) involvement on overall survival (OS) in patients with resected PDAC and determine the impact of AT after NAT.</p><p><strong>Methods: </strong>This is an observational cohort study of patients with PDAC who underwent NAT and surgical resection. A multivariable model was used to assess for differences in OS. An interaction term between LVI or LN involvement and AT use was utilized to test the benefit of additional AT.</p><p><strong>Results: </strong>Seven thousand four hundred and fourteen patients were included; group A (LVI-, LN-) had 2787 patients, B (LVI + , LN-) 652, C (LVI-, LN + ) 1,712, and D (LVI + , LN + ) 2263. Median OS differed significantly between groups, A had the most favorable survival (34.1 months), followed by B (27.8 months), C (26.3 months), and D (21.2 months, p < 0.001). In patients with persistent LVI or LN involvement after NAT, additional AT was not associated with OS (group A, HR: 0.94, p = 0.4; B and C, HR: 1.0, p = 0.99; D, HR: 0.94, p = 0.32).</p><p><strong>Conclusions: </strong>LVI and LN involvement were independently associated with worse OS. After NAT, the use of AT in patients with persistent LVI and LN involvement was not associated with improved OS.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069039","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":"Missed Opportunities for Multimodality Therapy in Resectable Pancreatic Cancer: National Disparities and Consequences for Survival.","authors":"John Johnson, Derek Erstad, Jose Euberto Mendez Reyes, Eric Silberfein, George Van Buren, William Fisher, E Ramsay Camp","doi":"10.1002/jso.70408","DOIUrl":"https://doi.org/10.1002/jso.70408","url":null,"abstract":"<p><strong>Background: </strong>Multimodal therapy (MMT) combining surgery and chemotherapy remains the optimal management strategy irrespective of sequence for resectable pancreatic ductal adenocarcinoma (PDAC). Determinants of MMT receipt and sequencing remain incompletely understood, particularly regarding neoadjuvant strategies. We aimed to identify modifiable characteristics contributing to differences in MMT receipt and sequencing in the surgical PDAC population.</p><p><strong>Methods: </strong>Using the 2023 National Cancer Database, we analyzed 11 202 adults with non-metastatic resectable PDAC (2010-2020). Patients were grouped into four treatment categories: surgery only, neoadjuvant chemotherapy plus surgery, adjuvant chemotherapy plus surgery, and combined neoadjuvant plus adjuvant chemotherapy with surgery. Outcomes included 5-year overall survival and multivariable logistic regression for chemotherapy receipt.</p><p><strong>Results: </strong>Of 11 202 patients, 3605 (32.2%) underwent surgery alone, 6347 (56.7%) received adjuvant chemotherapy, 626 (5.6%) neoadjuvant chemotherapy, and 624 (5.6%) both. Surgery-only patients were older, Medicare-insured, and treated at community, low-volume centers, while MMT patients were younger and privately insured (p < 0.001). Five-year survival was highest with combined neoadjuvant and adjuvant therapy (31.9%). Older age, Medicaid insurance, community centers, low/intermediate-volume facilities, and higher comorbidity burden were associated with reduced odds of MMT receipt (p < 0.05).</p><p><strong>Conclusion: </strong>Disparities continue to exist for MMT in the PDAC surgical population, highlighting opportunities for improved patient education and enhanced multidisciplinary care.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069026","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":"Gallbladder Cancer: A NCDB Analysis of Outcomes Predictors.","authors":"Rayner P Cardoso, Eman Zineldin, Yara Sakr, Ali Abdelhady, Joshua J Horns, Courtney L Scaife, Marshall S Baker, Erin P Ward, T Clark Gamblin","doi":"10.1002/jso.70373","DOIUrl":"https://doi.org/10.1002/jso.70373","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder cancer (GBC) is a rare but aggressive malignancy with poor long-term survival after resection. National data describing temporal changes in adjuvant therapy, surgical quality metrics, and facility-level outcomes remain limited.</p><p><strong>Methods: </strong>A retrospective cohort study was performed using the National Cancer Database from 2004 to 2022. Patients with primary GBC who underwent surgical resection and had no documented metastatic disease, T1a disease, or R2 resection were included. Adjuvant therapy was defined as chemotherapy and/or radiotherapy initiated within 90 days after surgery. Survival was estimated using Kaplan-Meier methods, and predictors of overall survival (OS) were evaluated using multivariable Cox proportional hazards regression.</p><p><strong>Results: </strong>A total of 31 812 patients were included. Median age was 65 years; 64.4% were older than 70 years, and 69.2% were female. Adenocarcinoma was the most common histology (74.2%). Median OS was 23.3 months, with 1-, 3-, and 5-year survival rates of 65.4%, 38.1%, and 26.4% respectively. R0 resection was associated with longer median OS than R1 resection (39.8 vs. 9.9 months; p < 0.001). Adjuvant chemotherapy increased from 24.8% before BILCAP to 32.7% after BILCAP, whereas radiotherapy decreased from 9.1% to 3.1% (both p < 0.001). Older patients were less likely to receive adjuvant therapy than younger patients (23.8% vs. 36.6%; p < 0.001). Academic centers had higher rates of R0 resection (69.4% vs. 64.3%), lymph node evaluation (59.9% vs. 42.9%), and ≥ 6-node examination (16.9% vs. 7.7%) compared with community facilities (all p < 0.001). In complete-case Cox regression, age > 65 years, lymph node positivity, larger tumor size, R1 margin, and treatment at non-academic facilities were associated with worse survival, whereas adjuvant therapy was associated with improved survival (HR: 0.82; 95% CI: 0.78-0.87).</p><p><strong>Conclusions: </strong>Survival after resection of GBC remains poor. Margin-negative resection, nodal evaluation, adjuvant therapy, and treatment facility type were associated with outcomes. Chemotherapy use increased after BILCAP, but older patients remained less likely to receive postoperative therapy. These findings support improved surgical staging, greater adherence to adjuvant therapy guidelines, and multidisciplinary care for resected GBC.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069031","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}