Journal of Surgical Oncology最新文献

{"title":"Disparities in Triple Negative Breast Cancer Among Hispanic Population Living in Latin America Versus the United States.","authors":"Gabriel De la Cruz Ku, Anshumi Desai, Alanna Hickey, Bryan Valcarcel, Carly Wareham, Alexandra Hernandez, Eva Esperanza Arias-Rivera, Diego Chambergo-Michilot, David Linshaw, Gonzalo Ziegler-Rodriguez, Sarah M Persing, Christopher Homsy, Abhishek Chatterjee, Salvatore M Nardello","doi":"10.1002/jso.28088","DOIUrl":"https://doi.org/10.1002/jso.28088","url":null,"abstract":"<p><strong>Introduction: </strong>Triple-negative breast cancer (TNBC) has a prevalence of 12%-24% in the Hispanic population. Previous research has demonstrated that disparities in healthcare access significantly influence patient outcomes. We aimed to compare the clinicopathological characteristics and outcomes of Hispanic females with TNBC living in Latin America (HPLA) to the Hispanic population in the United States (HPUS).</p><p><strong>Methods: </strong>We evaluated two retrospective cohorts: patients diagnosed with TNBC at the Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru, during 2000-2015, and HPUS patients with TNBC from the Surveillance, Epidemiology, and End Results Program (SEER).</p><p><strong>Results: </strong>A total of 2007 HPLA and 8457 HPUS patients were included. The HPLA patients were younger and more frequently lived in nonmetropolitan areas. HPLA had higher T and N (p < 0.001) stages. HPLA patients were more likely to present with Stage III disease (51.6% vs. 20.8%), while Stage IV presentations were similar 6.6% vs. 6.8%. HPLA patients with Stages I and II more frequently underwent mastectomy compared to HPUS (56.2 vs. 48.0%). HPLA patients received neoadjuvant chemotherapy (p < 0.001), adjuvant chemotherapy (p < 0.001), and radiotherapy (p < 0.001) more often. While early breast cancer stages had similar overall survival (OS) rates for both populations, HPLA patients had worse 5-year OS rates compared to HPUS patients in Stages III (39.9% vs. 52.3%, p < 0.001) and IV (4.6% vs. 10.7%, p < 0.001).</p><p><strong>Conclusions: </strong>Hispanic females living in Latin America were more frequently diagnosed with advanced stages of TNBC and more often underwent mastectomy, even in early-stage disease. When analyzing advanced stages, HPLA had worse OS rates compared to HPUS.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971451","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 Chemotherapy on Perioperative Morbidity in Combined Resection of Rectal Cancer and Liver Metastases.","authors":"Joy Z Done, Angelos Papanikolaou, Miloslawa Stem, Shannon N Radomski, Sophia Y Chen, Jay R Maturi, Chady Atallah, Bashar Safar","doi":"10.1002/jso.28078","DOIUrl":"https://doi.org/10.1002/jso.28078","url":null,"abstract":"<p><strong>Background and objectives: </strong>Little is known about the relationship between neoadjuvant chemotherapy (NAC) and perioperative morbidity for patients undergoing combined resection of rectal cancer and sLM. The purpose of this study is to determine the impact of NAC on 30-day morbidity for patients who undergo combined resection of primary rectal cancer and sLM.</p><p><strong>Materials and methods: </strong>A retrospective cohort study of patients undergoing combined resection of primary rectal cancer and sLM between 2016 and 2020 at participating NSQIP hospitals. Multivariate logistic regression models were used to assess the relationship between NAC and 30-day morbidity rates.</p><p><strong>Results: </strong>Among 878 patients who underwent combined resection of primary rectal cancer and sLM, 672 (76.54%) received NAC. There were no significant differences in the rates of 30-day overall morbidity between patients who received NAC and those who did not (37.65% vs. 37.68%, p = 0.95). On adjusted analysis, there was no association between receipt of NAC and rates of overall morbidity (adjusted OR = 1.10, 95% CI 0.78-1.56, p = 0.95).</p><p><strong>Conclusions: </strong>The receipt of NAC does not appear to be associated with increased perioperative morbidity in patients undergoing combined resection of primary rectal cancer and sLM.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142971496","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":"Complications in CRS and HIPEC: From Reduction to Effective Management.","authors":"Zakaria El Mouatassim, Amine Souadka","doi":"10.1002/jso.28089","DOIUrl":"https://doi.org/10.1002/jso.28089","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950450","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":"Complications Following Open Versus Minimally Invasive Resection of Gastric Adenocarcinoma.","authors":"Kelly R Bates, Whitney Jones, Marjorie R Liggett, Norah N Zaza, Dominic J Vitello, David J Bentrem","doi":"10.1002/jso.28073","DOIUrl":"https://doi.org/10.1002/jso.28073","url":null,"abstract":"<p><strong>Background and objectives: </strong>Gastric adenocarcinoma (GA) is commonly treated with open or minimally invasive surgery (MIS). The preferred surgical approach remains unclear. This study sought to assess utilization over time, compare complication rates by surgical approach, and identify predictors of experiencing complications.</p><p><strong>Methods: </strong>Patients who underwent GA resection from 2016 to 2022 were identified in the American College of Surgeons National Surgical Quality Improvement Program and compared based on receipt of open gastrectomy versus MIS. Complication rates were compared with χ² tests. Predictors of experiencing complications or receiving MIS were assessed using multivariable Poisson regressions with robust variance.</p><p><strong>Results: </strong>Out of 4,429 patients, most underwent open gastrectomy versus MIS (84.2% vs. 15.9%). MIS uptake did not increase. Open gastrectomy patients experienced more major complications (18.5% vs. 13.1%), higher perioperative mortality (1.53% vs. 0.57%), and longer hospital stays (7 vs. 5 days) compared to MIS patients (all p values < 0.01). MIS patients had a decreased risk of experiencing any complications (RR: 0.7, 95% CI: 0.5-0.8). Non-white patients were less likely to receive MIS.</p><p><strong>Conclusions: </strong>MIS is associated with a decreased risk of experiencing complications compared to open gastrectomy for GA, yet its utilization has plateaued. Sociodemographic predictors of receipt of MIS indicate potential disparities in accessing certain treatments.</p><p><strong>Summary: </strong>The preferred surgical approach for gastric cancer is unclear. This analysis of the American College of Surgeons National Surgical Quality Improvement Program compared complication rates of open gastrectomy with minimally invasive surgery (MIS). MIS was associated with a decreased risk of experiencing complications, yet utilization has plateaued.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950446","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 Therapy for Resettable Pancreatic Adenocarcinoma: It's Time to Define High-Risk Factors.","authors":"Xiang Zhou, Shunqi Xie","doi":"10.1002/jso.28082","DOIUrl":"https://doi.org/10.1002/jso.28082","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950478","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 Reaching the Medicare Part D Drug Benefit Threshold on Surgical Care and Health Outcomes Among Patients Newly Diagnosed With Gastrointestinal Cancer.","authors":"Eshetu Worku, Selamawit Woldesenbet, Mujtaba Khalil, Timothy M Pawlik","doi":"10.1002/jso.28083","DOIUrl":"https://doi.org/10.1002/jso.28083","url":null,"abstract":"<p><strong>Background: </strong>Medicare Part D covers outpatient prescription drugs for elderly beneficiaries, but requires full cost coverage once the coverage gap threshold is reached. We assessed the impact of reaching Medicare Part D threshold on out-of-pocket costs (OOP), timely treatment, and outcomes for patients with gastrointestinal (GI) cancer.</p><p><strong>Methods: </strong>Individuals newly diagnosed with GI cancer between 2007 and 2019 were identified from the SEER-Medicare database. OOP costs were calculated for the year of diagnosis. Multivariable regression models compared timely surgical care and mortality risk among patients who did and did not reach the coverage gap threshold.</p><p><strong>Results: </strong>Among 35 745 Medicare beneficiaries diagnosed with colorectal (50.7%), pancreatic (19%), and liver (30.4%) cancer, median age was 76 years (IQR: 71-82), and 56.6% were female. Notably, 48.9% (17 479) of patients reached the Medicare Part D threshold in the year of cancer diagnosis. Mean OOP cost for patients who reached the threshold was $1060 (SD: $1417) vs. $268 (SD: $270, p < 0.0001) for individuals who did not. On multivariable analysis, patients who reached the threshold were more likely to delay [OR: 1.13, 95% CI: 1.03-1.24] or not receive surgery [OR: 1.40, 95% CI: 1.27-1.54], and had a higher risk of 5-year mortality [HR 5-year: 1.12, 95% CI: 1.09-1.15, p < 0.0001] regardless of comorbidity status, cancer site, and disease stage.</p><p><strong>Conclusion: </strong>Reaching the coverage gap threshold was associated with delayed or non receipt of surgical treatment, which resulted in increased long-term mortality. Lowering the Part D threshold through policy adjustments may reduce financial strain and improve health outcomes for cancer patients.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950367","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":"Reducing Postoperative Opioid Use: A Comparison of Open Versus Ultrasound-Guided Regional Anesthesia for Patients Undergoing Open Pancreatoduodenectomy.","authors":"Parit T Mavani, Caitlin Sok, Pranay S Ajay, Tarrant McPherson, Jeffrey Switchenko, David A Kooby, Mihir M Shah","doi":"10.1002/jso.28074","DOIUrl":"10.1002/jso.28074","url":null,"abstract":"<p><strong>Background: </strong>Opioid crisis is a national issue with significant economic burden and marked increase in opioid-related deaths, particularly following surgical procedures. Reducing opioid requirements while maintaining effective analgesia is critically challenging, perioperatively. Multimodal drug regimens and guided regional anesthesia (RA) have been adopted to address this issue. We aimed to assess postoperative opioid consumption in patients undergoing open pancreatoduodenectomy based on the routes of RA administration: open versus ultra-sound guided.</p><p><strong>Methods: </strong>This retrospective cohort study was conducted at Emory University Saint Joseph's Hospital, encompassing patients who underwent open pancreatoduodenectomy (PD) from 2020 to 2022 who received ultrasound-guided RA (U-RA) or open RA (O-RA). Patient demographics, surgical details, and postoperative outcomes, including opioid consumption measured in morphine milligram equivalents (MME) at 24, 48, and 72 h, were analyzed. Multivariable linear regression identified predictors of postoperative opioid use.</p><p><strong>Results: </strong>Of 95 patients, 47 met inclusion criteria: 27 received U-RA and 20 O-RA. Preoperative and intraoperative characteristics were similar between patients receiving O-RA and U-RA. A lower opioid requirement was noted in the O-RA group compared to the U-RA group at all time points. (24 h: 6.5 vs. 18, p = 0.004; 48 h: 18 vs. 37, p = 0.001; 72 h: 30.5 vs. 57, p = 0.002). On multivariable analysis, only route of regional anesthesia was independently associated with reduced opioid use across all time points (24 h: mean difference = -5.75, 95% CI: -11.3, -0.18; 48 h: mean difference = -16.95, 95% CI: -27.5, -6.4; 72 h: mean difference = -20.39, 95% CI: -35.4, -5.3) Patient age, gender, race, obesity, neoadjuvant chemotherapy, small pancreatic duct, and pancreatic fistula were not independently associated with opioid use.</p><p><strong>Conclusions: </strong>O-RA may offer a better approach than U-RA in minimizing opioid consumption after open PD. These findings suggest the incorporation of O-RA for upper abdominal surgeries to decrease the necessity of postoperative opioids.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950479","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":"Income and Insurance-Based Disparities in Primary Soft Tissue Sarcoma of the Extremities.","authors":"Charlotte F Wahle, Sara Sakowitz, Nicole J Newman-Hung, Nicholas M Bernthal, Peyman Benharash, Lauren E Wessel","doi":"10.1002/jso.28077","DOIUrl":"https://doi.org/10.1002/jso.28077","url":null,"abstract":"<p><strong>Background and objectives: </strong>Soft tissue sarcomas (STSs) are rare but can be devastating. Paradigm shifts in adjuvant treatment have expanded the availability of limb salvage; however, a subset of patients still require amputation. The aim of this study was to examine the impact of patient, disease, and practice-related factors on rates of amputation in STS.</p><p><strong>Methods: </strong>All adults undergoing resection for STS of the extremities were tabulated from the 2004-2021 National Cancer Database (NCDB). Multivariable models were utilized to evaluate risk factors for undergoing amputation.</p><p><strong>Results: </strong>Of 31 805 patients, 1880 (6%) underwent amputation. Those who underwent amputation were younger (57 vs. 60, p < 0.001), more commonly Black (12% vs. 9%, p < 0.00), and more frequently Medicaid insured (11% vs. 6%, p < 0.001). Amputation patients experienced a longer time from diagnosis to surgery, compared to limb salvage patients (46 [23-91] vs. 37 days [9-93], p < 0.001). Amputation was associated with a significantly greater hazard of overall mortality over 10 years following resection (HR 1.66, p < 0.001).</p><p><strong>Conclusion: </strong>We report significant race-, income-, and insurance-based disparities in amputation risk and overall survival for patients with STS of the extremities. We also report a significantly increased risk of amputation for patients with delayed clinical presentation. Multidisciplinary sarcoma care teams should be aware of these disparities.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950372","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":"Adults and Adolescents With Neuroblastoma: An Analysis of the National Cancer Database.","authors":"Charbel Chidiac, Katherine M McDermott, Caitlyn Ramdat, Matthew D Price, Jonathan B Greer, Brian H Ladle, Daniel S Rhee","doi":"10.1002/jso.28076","DOIUrl":"https://doi.org/10.1002/jso.28076","url":null,"abstract":"<p><strong>Background and objectives: </strong>Neuroblastoma, the most common extracranial solid tumor in children, is rare in adults. This study compares patient characteristics, disease patterns, and treatments among adults, adolescents, and children with neuroblastoma.</p><p><strong>Methods: </strong>We queried the National Cancer Database (2004-2019) for neuroblastoma cases. Patient and tumor characteristics, treatments, and 5-year overall survival (5-OS) were compared between adults (≥ 18 years), adolescents (10-17 years), and children (0-9 years). Kaplan-Meier curves and Cox regression assessed survival differences.</p><p><strong>Results: </strong>Among 6350 neuroblastoma patients, 256 (4.0%) were adults, 222 (3.5%) were adolescents, and 5872 (92.5%) were children. Tumors were largest in adolescents (9.7 cm), followed by adults (8.0 cm) and children (6.7 cm) (p < 0.001). Adults were less likely to have tumors in the adrenal glands (34.0% vs. children: 54.7%, adolescents: 43.2%, p < 0.001) and had lower rates of metastasis (10.9% vs. 19.3% and 19.4%, p < 0.001). Compared to children, adults received less chemotherapy, immunotherapy, and bone marrow transplants (p < 0.001). 5-OS was worse in adults (65.8%), followed by adolescents (70.4%) and children (78.2%) (p < 0.001). After adjustment, adults (aHR: 2.27; 95% CI, 1.71-3.01) and adolescents (aHR: 2.02; 95% CI, 1.54-2.64) had higher hazards of death compared to children.</p><p><strong>Conclusions: </strong>Adults and adolescents with neuroblastoma have distinct clinical features and lower survival than children, underscoring the need for tailored treatment approaches for older patients.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950416","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":"Economic Toxicity Associated With Cancer Treatments: Commentary on \"Relationship of Surgical Approach With Financial Toxicity in Patients With Resected Lung Cancer\".","authors":"Yongmei Feng, Huan Feng, Jianfeng Ye","doi":"10.1002/jso.28040","DOIUrl":"https://doi.org/10.1002/jso.28040","url":null,"abstract":"","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950364","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}