Journal of Surgical Oncology最新文献

{"title":"Monitoring Treatment Response in Rectal Cancer through Circulating Tumor Cell Dynamics: A Pilot Clinical Study","authors":"Peter Ihnát,&nbsp;Josef Srovnal,&nbsp;Pavel Stejskal,&nbsp;Monika Vidlařová,&nbsp;Eva Skácelíková,&nbsp;Branislav Šnajder,&nbsp;Ádám Varga,&nbsp;Lucia Ihnát Rudinská","doi":"10.1002/jso.70073","DOIUrl":"10.1002/jso.70073","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Circulating tumor cells (CTCs) are increasingly recognized as a minimally invasive biomarker with significant potential in oncologic monitoring and prognostication. This study aimed to assess the dynamics of CTC levels in patients with rectal cancer undergoing multimodal treatment and evaluate their potential role in therapeutic decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective, observational study of 56 patients with histologically confirmed rectal adenocarcinoma. Patients underwent either primary surgical resection or neoadjuvant chemoradiotherapy (CRT) followed by surgery. Peripheral blood samples were collected at defined intervals and analyzed using the CytoTrack CT11™ system to detect and quantify CTCs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Pretreatment CTCs were detected in 16.1% of patients. In the primary surgery group, all preoperatively positive CTC cases became negative postoperatively, although transient positivity was observed in two cases at 1 week post-surgery. In the CRT group, 35.7% of patients exhibited detectable CTCs during treatment, with complete clearance after surgery. The dynamic change in CTC levels correlated with therapeutic response and potential recurrence risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This pilot study highlights the clinical relevance of CTC monitoring in rectal cancer. CTC dynamics appear to reflect treatment efficacy and may serve as an early indicator of response. These findings support the development of a randomized clinical trial comparing rectal cancer treatments with and without neoadjuvant therapy, using CTC trends as a primary outcome measure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 6","pages":"1052-1057"},"PeriodicalIF":1.9,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958183","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":"Lymph Node Mapping in Gallbladder Cancers: Analysis to Assess the Impact of Location and Number of Lymph Nodal Stations","authors":"Abhay K. Kattepur,&nbsp;Swapnil Patel,&nbsp;Shraddha Patkar,&nbsp;Mufaddal Kazi,&nbsp;Mahesh Goel","doi":"10.1002/jso.70072","DOIUrl":"10.1002/jso.70072","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>The current staging for gallbladder cancer (GBC) considers only the number of metastatic lymph nodes without addressing their location. This study evaluates the prognostic impact of lymph node mapping (both number and location) in node positive GBC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospectively maintained operative database of operated GBC patients from April 2010 to March 2022 with positive lymph nodes was analyzed. Nodal burden was assessed by the number and meticulous mapping of the involved nodal stations. Outcomes were evaluated using Cox regression analysis. A new nodal staging system was formulated and compared with the current American Joint Committee for Cancer Care (AJCC) staging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>222 node positive patients were included. Multivariate analysis showed that multi-station involvement was significantly associated with poor disease-free survival (DFS) (Hazard ratio [HR]: 0.522 [95% CI: 0.354–0.770]; <i>p</i> = 0.001). The 5-year DFS of 42.9%, 35.5%, 17% and 13% (<i>p</i> = 0.023) respectively was observed for positive cystic node (N1a), single positive non-cystic node (N1b), 2 and 3 positive nodes (N2a and N2b) with multi-station involvement. The Concordance index for the new staging system was 0.588 reflecting a 6.9% absolute improvement in the prediction capability.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Station-based nodal assessment predicted for survival in our node positive cohort. Pathological assessment of involved stations, in addition to the number of involved nodes, could potentially provide superior prognostic information. However, this needs to be evaluated prospectively in larger cohorts.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 6","pages":"1097-1105"},"PeriodicalIF":1.9,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958238","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 Social Determinants on Melanoma Outcomes in Canada: A Single-Centre Retrospective Study","authors":"Aliyah King,&nbsp;Olivier Brandts-Longtin,&nbsp;Chandy Somayaji,&nbsp;James Ted McDonald,&nbsp;Heidi Li,&nbsp;Katherine Aw,&nbsp;Rebecca Lau,&nbsp;Alex Lee,&nbsp;Boaz Wong,&nbsp;Elysia Grose,&nbsp;Ahmad Abed,&nbsp;James Stevenson,&nbsp;Rahat Sheikh,&nbsp;Stephanie Johnson-Obaseki,&nbsp;Carolyn Nessim","doi":"10.1002/jso.70069","DOIUrl":"10.1002/jso.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Socioeconomic status (SES) and distance to nearest hospital are known social determinants impacting melanoma survival; however, few studies have investigated the effect in a universal healthcare setting, like Canada.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>This retrospective study at The Ottawa Hospital (1999–2023) investigated SES and distance lived from the hospital on overall survival, recurrence time, and stage at presentation in melanoma surgical patients. Income quintiles (InQs) were determined using postal codes linked to 2016 census data, and logistic regressions were conducted for the highest and lowest InQs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 959 patients, 277 were in the highest InQ group (mean age: 64; 57% males) and 114 were in the lowest (mean age: 60; 48% males). Higher InQ was significantly associated with lower odds of stage II-IV disease at presentation (<i>p</i> = 0.004, odds ratio: 0.865, 95% CI 0.784 to 0.954), but not with overall survival, recurrence time, or stage III-IV disease. Distance had no significant impact on outcomes. Female sex was protective against recurrence time (<i>p</i> = 0.020, hazard ratio: 0.705), stage II-IV (<i>p</i> = 0.049, odds ratio: 0.766, 95% CI: 0.587, 0.999), and III-IV (<i>p</i> = 0.009, odds ratio: 0.670, 95% CI: 0.496, 0.904) disease.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Higher SES reduced stage II-IV risk without affecting survival, stage III-IV risk, or recurrence time. Distance to nearest hospital had no significant effect. Females had longer time to recurrence and lower odds of advanced disease. Future research should explore potential educational and primary care barriers that may contribute to advanced stages in lower InQ populations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"869-875"},"PeriodicalIF":1.9,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957928","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":"Preventing Free Flap Complications: Key Factors to Keep in Mind","authors":"Jonas Kornmann,&nbsp;Rasmus Schug,&nbsp;Lena Huber,&nbsp;Anne Lammert,&nbsp;Frederic Jungbauer,&nbsp;Annette Affolter,&nbsp;Nicole Rotter,&nbsp;Lena Zaubitzer,&nbsp;Luis Bugia,&nbsp;Grietje Beck,&nbsp;Claudia Scherl","doi":"10.1002/jso.70067","DOIUrl":"10.1002/jso.70067","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Reconstruction of head and neck defects using free flaps is successful, but complications occur. This study aims to identify factors preventing complications to support clinical decision-making.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective study for free flap reconstructions (2019 to 2022, tertiary referral center). Univariate and multivariate regression models assessed predictors of complication-free survival (CFS) and odds ratios (OR) measured risk correlations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 125 identified cases, most patients were male (71.8%) with a median age of 66 years (37–93 years). Common complications were wound healing disorders (10.9%), hematoma (10%), total (7.3%) or partial (1.8%) flap necrosis, cardiovascular events (5.5%), and pulmonary artery embolism (4.5%). 30-day CFS was 63%. On multivariable analysis, female gender (HR: 9.4, CI: 2.6–33.5), alcohol abuse (HR: 3.5, CI: 1.4–8.4), N2-3 (HR: 2.4, CI: 1.3–4.4), obesity (HR: 2.1, CI: 0.9–5.1), preoperative anticoagulation (HR: 2.5, CI: 1.1–5.9) were significant prognosticators. Positive factors increasing CFS included high albumin (OR 0.21, <i>p</i> = 0.02), intraoperative i.v. heparin bolus (OR 0.15, <i>p</i> = 0.08), intraoperative catecholamine treatment (OR 0.15, <i>p</i> = 0.009), and nonsmoking (OR 0.18, <i>p</i> = 0.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Key preventive measures against complications include optimizing nutritional status and albumin levels, administering intraoperative heparin and catecholamines, and abstaining from alcohol. Females should also be screened for undiagnosed cardiovascular risks.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"945-958"},"PeriodicalIF":1.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958251","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":"Conversion Therapy for Locally Advanced Intrahepatic Cholangiocarcinoma: A Retrospective Cohort Study","authors":"Jienan Lu,&nbsp;Lusha Zhou,&nbsp;Shuai Zhang,&nbsp;Junxiu Li,&nbsp;Tanrong Liu,&nbsp;Bingying Huang","doi":"10.1002/jso.70068","DOIUrl":"10.1002/jso.70068","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Intrahepatic cholangiocarcinoma (iCCA) is a highly malignant biliary tumor associated with a poor prognosis. Here, we explored conversion therapy (CT) for the treatment of locally advanced iCCA (LA-iCCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively enrolled 115 patients with LA-iCCA at our single center from January 2019 to June 2024, with the final follow-up conducted in January 2025. The primary outcome measured was overall survival (OS), while the secondary outcome focused on progression-free survival (PFS). We utilized a propensity score matching (PSM) approach to adjust for potential confounders between the CT group and the systemic therapy (ST) group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Before PSM, the median OS was 34.57 months (95% CI: 19.22–49.91), while the median PFS was 17.30 months (95% CI: 12.89–21.71) in the CT group. Both OS and PFS were significantly longer than those in the ST group (both <i>p</i> &lt; 0.001). After PSM, both groups were successfully matched, resulting in 31 patients in each group. In the CT group, the median OS and PFS were 45.53 months (95% CI: 29.19–61.87) and 18.23 months (95% CI: 7.02–29.45), respectively. Both values were significantly higher than those in the ST group, with <i>P</i> values of less than 0.001 for OS and 0.002 for PFS. Furthermore, CT was identified as an independent factor associated with improved outcomes, both before and after PSM.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CT was an effective approach for improving outcomes in patients with LA-iCCA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"917-923"},"PeriodicalIF":1.9,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70068","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958634","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":"Limitations of Currently Available Sarcoma Prediction Tools in a Large Contemporary Upper Extremity Soft Tissue Sarcoma Cohort","authors":"Nicole J. Newman-Hung,&nbsp;Kameel Khabaz,&nbsp;Ruiwen Ding,&nbsp;Derek Pham,&nbsp;Nicholas J. Jackson,&nbsp;William Hsu,&nbsp;Nicholas M. Bernthal,&nbsp;Lauren E. Wessel","doi":"10.1002/jso.70043","DOIUrl":"10.1002/jso.70043","url":null,"abstract":"<div>\u0000 \u0000 <p>Soft tissue sarcomas (STS) of the upper extremity (UE) are rare but can lead to devastating outcomes. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, Sarculator, and PERSARC predict local recurrence (LR), distant metastases (DM), and overall survival (OS) in extremity STS. We retrospectively reviewed 211 UE STS patients (2012–2022) at a single tertiary center, recording demographics, tumor factors, treatments, and outcomes. External validation employed concordance indices (C). The mean clinical follow-up was 4.9 years. Ninety-three patients (44%) presented after unplanned excision, and 168 patients (80%) underwent neoadjuvant or adjuvant therapy. LR occurred in 49 patients (23%), and DM in 47 patients (22%). Thirty-five patients (17%) expired at an average of 41.0 months post-presentation. C-indices for MSKCC nomograms were 0.28 (0.08, 0.52) and 0.30 (0.10, 0.54) for 3- and 5-year LR. C-indices for Sarculator were 0.64 (0.54, 0.73) and 0.63 (0.54, 0.72) for 5- and 10-year DM and 0.79 (0.67, 0.89) and 0.79 (0.67, 0.89) for 5- and 10-year OS. C-indices for PERSARC were 0.70 (0.59, 0.80) for 5-year LR and 0.81 (0.68, 0.91) for 5-year OS. Prognostic tools may underperform in UE STS due to small development cohorts and unique tumor characteristics.</p></div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"959-967"},"PeriodicalIF":1.9,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144957907","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":"Characteristics of “Very Early” Intrahepatic Cholangiocarcinoma Undergoing Liver Resection and Its Relationship With Carbohydrate Antigen 19-9","authors":"Yutaka Endo,&nbsp;Jun Kawashima,&nbsp;Selamawit Woldesenbet,&nbsp;Miho Akabane,&nbsp;Andrea Ruzzente,&nbsp;Luca Aldrighetti,&nbsp;Matthew J. Weiss,&nbsp;Todd W. Bauer,&nbsp;Irinel Popescu,&nbsp;George A. Poultsides,&nbsp;Minoru Kitago,&nbsp;Federico Aucejo,&nbsp;Hugo P. Marques,&nbsp;Guillaume Martel,&nbsp;Carlo Pulitano,&nbsp;Feng Shen,&nbsp;François Cauchy,&nbsp;Bas Groot Koerkamp,&nbsp;Itaru Endo,&nbsp;Timothy M. Pawlik","doi":"10.1002/jso.70071","DOIUrl":"10.1002/jso.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The concept of “very early” ICC ( ≤ 2 cm, single tumor) has been introduced in the context of LT. Due to the limited number of patients in this subset, the characteristics and long-term outcomes have been ill-defined. We sought to assess long-term outcomes of very early ICC patients undergoing liver resection using a large, multi-institutional database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients who underwent curative-intent hepatectomy for ICC between 1993 and 2023 were identified from the International Intrahepatic Cholangiocarcinoma Study Group database. Multivariable Cox regression analysis was performed to identify the risk factors related to overall survival (OS) and recurrence-free survival (RFS).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1868 ICC patients, 86 (4.6%) met the criteria for very early ICC. While patient and tumor characteristics were similar between very early and non-very early ICC, 1-, 3-, and 5-year OS among patients with very early ICC was 92.3% (IQR 86.6−98.4), 72.6% (IQR 62.7−84.1), and 58.0% (IQR 45.9−73.5), respectively, versus 80.8% (IQR 78.9−82.7), 51.0% (IQR 48.4−53.8), and 38.9% (IQR 36.1−41.9), respectively, among non-very early ICC patients (<i>p</i> &lt; 0.01). On multivariable Cox regression analysis, elevated CA19-9 levels were associated with worse OS (HR 3.05, IQR 1.28−7.30, <i>p</i> = 0.01) and RFS (HR 2.88, IQR 1.24−6.66, <i>p</i> = 0.01). Very early ICC patients with higher CA19-9 level were more likely to have metastatic nodal disease (N1: ≥ 40 U/mL <i>n</i> = 11, 40.7%, vs. <i>n</i> = 3, 5.1%, <i>p</i> &lt; 0.001), microvascular invasion ( ≥ 40 U/mL <i>n</i> = 10, 37.0%, vs. <i>n</i> = 4, 6.8%, <i>p</i> &lt; 0.001), and major vascular invasion ( ≥ 40 U/mL <i>n</i> = 8, 29.6%, vs. <i>n</i> = 2, 3.4%, <i>p</i> &lt; 0.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Very early ICC was associated with favorable long-term outcomes; however, elevated CA19-9 levels identified a subgroup with a much worse prognosis and more aggressive tumor features. CA19-9 may help guide perioperative treatment decisions, including additional treatment after surgical interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"924-934"},"PeriodicalIF":1.9,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70071","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958664","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":"Factors Associated With Residual Positive Lymph Nodes With Targeted Axillary Lymph Node Dissection for Breast Cancer and Accuracy of Clipped Node Retrieval in Non-Mapping Patients","authors":"Danielle E. Brabender,&nbsp;Alexa Griffiths,&nbsp;Kaye A. Lu,&nbsp;Katharine Armstrong,&nbsp;Maria E. Nelson,&nbsp;Fumito Ito,&nbsp;Azadeh A. Carr,&nbsp;Emily L. Siegel,&nbsp;Stephen F. Sener","doi":"10.1002/jso.70070","DOIUrl":"10.1002/jso.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The current study aimed to determine whether results could justify whether axillary lymph node dissection (ALND) could be further de-escalated in selected patients having neoadjuvant chemotherapy (NAC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Retrospective analyses were performed for breast cancer patients treated with NAC from 2015 to 2023. Abnormal axillary nodes evaluated by pretreatment ultrasound had core biopsies with microclip placement. Patients assigned to ALND had histologically positive SLND (ypN+), were clinically node-positive (ycN+) post-NAC, did not map, or did not have a clipped node retrieved.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 274 predominantly Hispanic (78%) patients, the median age was 51 years, and the follow-up was 38.1 months. Of 198 pN+ patients, 120 were clinically node-negative (ycN0) post-NAC and had wire-directed (WD) SLND, whereas 78 were ycN+ and had planned ALND. Sixty percent of pN+ patients converted to ypN0 post-NAC. Fifty-eight percent of patients with ypN+ status had additional positive non-sentinel lymph nodes in the ALND specimen.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ALND was avoided in approximately half of patients who presented with axillary node metastases and became ycN0 post-NAC. Response to NAC correlated with node status at surgery. Patients who do not map may not need ALND if a pN+ clipped node is retrieved and converts to ypN0.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"853-859"},"PeriodicalIF":1.9,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144958592","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":"Patient Regret After Gastrointestinal Surgery for Cancer: A Narrative Review","authors":"Jacquelyn E. Fitzgerald,&nbsp;Pierce Austin,&nbsp;Olivia Monton,&nbsp;Avery C. Bechthold,&nbsp;Kimberly E. Kopecky","doi":"10.1002/jso.70066","DOIUrl":"10.1002/jso.70066","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Understanding what factors contribute to postoperative regret is crucial for improving clinical decision-making, enhancing patient communication, and increasing patient satisfaction. This narrative review evaluates the limited but growing body of literature focused on patient experiences of regret following gastrointestinal (GI) cancer surgery in the adult patient population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A narrative review was conducted using the following keywords: “gastrointestinal”, “cancer”, “surgery”, and “regret”. PubMed was searched from inception to July 1, 2024, for articles written in English. Included studies assessed and reported decisional or postoperative regret in adult patients who had undergone curative-intent surgical resection of any GI cancer. Study variables were extracted from the included studies, and a narrative synthesis was conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 174 studies screened for eligibility, 5 met the inclusion criteria and were included in the analysis. Postoperative complications and psychosocial comorbidities were consistently associated with regret, while associations between regret and overall physical health, postoperative symptom burden, quality of life, and perceived choice were inconsistent across studies. Preference-concordant decision-making and trust in the surgeon emerged as potentially modifiable factors linked to regret.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Postoperative regret is influenced by postoperative complications, psychosocial risk factors, shared decision-making, and patient trust in their surgeon. Future research should explore longitudinal changes in postoperative regret over time and incorporate both patient and caregiver perspectives to obtain a holistic understanding of postoperative regret. This understanding will help develop evidence-based strategies to mitigate postoperative regret in GI cancer care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 6","pages":"1003-1010"},"PeriodicalIF":1.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873756","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":"Sexual Health in Postmastectomy Breast Reconstruction Patients and Value of an Intervention: A Qualitative Study","authors":"Minji Kim,&nbsp;Jaime L. Gilliland,&nbsp;Charles Z. Jiang,&nbsp;Mei-fan Parnes,&nbsp;Jeanne Carter,&nbsp;Audree B. Tadros,&nbsp;Babak J. Mehrara,&nbsp;Jonas A. Nelson,&nbsp;Carrie S. Stern","doi":"10.1002/jso.70056","DOIUrl":"10.1002/jso.70056","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In this qualitative study, we assessed patients' perception of how postmastectomy breast reconstruction (PMBR) impacts sexual health and the perceived value of consultations with the sexual medicine team.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PMBR patients were recruited for four focus groups, two with patients who had sexual medicine consultations and two with patients who did not. Patients completed two surveys, BREAST-Q Sexual Well-being and Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual function and satisfaction (SexFS). Focus groups were audio-taped, transcribed, and analyzed thematically.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 35 participants, 17 patients who received sexual medicine consultations and 18 patients who did not. The median Sexual Well-being score was 48 (Interquartile range: 31, 53) and PROMIS SexFS scores were lower than the United States adults' scores. Analysis identified six major themes: (1) patient experience of physical and nonphysical impacts of diagnosis and treatment that lead to a decline in sexual health, (2) utilization of clinical and nonclinical strategies to address sexual health concerns, (3) patient perception of importance of sexual health and how it is often overlooked in oncology care broadly and in plastic surgery specifically, (4) desired information about sexual health, (5) patient desire for a dedicated place to discuss their sexual health concerns, and (6) desired aspects of sexual medicine consultations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients perceive a decline in their sexual health as a result of breast cancer diagnosis and treatment, with specific challenges associated with PMBR. Patients desire a dedicated space to discuss sexual health concern, and sexual medicine consultations are one possible approach.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 5","pages":"825-835"},"PeriodicalIF":1.9,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144873757","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}