Journal of Surgical Oncology最新文献

{"title":"Impact of Revised American Joint Committee on Cancer Staging Guidelines on Upstaging and Treatment of Oral Cavity Squamous Cell Carcinoma","authors":"Fergal G. Kavanagh,&nbsp;Alana Eagan,&nbsp;Lillian A. Boe,&nbsp;Sean M. McBride,&nbsp;Nancy Y. Lee,&nbsp;Marc A. Cohen,&nbsp;Jennifer R. Cracchiolo","doi":"10.1002/jso.70327","DOIUrl":"10.1002/jso.70327","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In 2018, the American Joint Committee on Cancer (AJCC) updated TNM (Tumor, Nodes, Metastasis) staging for oral cavity cancers, incorporating depth of invasion into T-staging, but the impact of this change is unclear. We aimed to assess trends in upstaging and adjuvant radiation therapy use among patients with T1-3 oral cavity tumors using the National Cancer Database (NCDB).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>NCDB data were analyzed on the staging and treatment of patients with T1-3 histologically confirmed squamous cell carcinoma of the oral cavity treated with surgery from 2013 to 2021. Treatment periods were defined as 2013–2017 and 2018–2021 to reflect use of the 7th and 8th editions of the AJCC staging system. Trends were analyzed using Cochran-Armitage tests, univariable/multivariable logistic regression, and Kaplan-Meier survival plots, and adjusted for sociodemographic, tumor, and hospital variables when relevant. The primary outcome was treatment modality (surgery alone vs. surgery with adjuvant therapy). The secondary outcome was change in tumor staging following the AJCC revision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We analyzed NCDB data on the staging and treatment of 17,349 patients. The proportion of patients with pathological T1 tumors dropped from 42% to 29% between 2013 and 2017 and 2018–2021, while T3 cases rose from 5.5% to 15% (<i>p</i> &lt; 0.001). The proportion of stage I tumors decreased from 26% to 17%, and stage III tumors increased from 10% to 15% (<i>p</i> &lt; 0.001). Tumor size remained relatively stable. The proportion of patients treated with surgery and adjuvant radiation therapy increased from 29% to 34% (<i>p</i> &lt; 0.001). The increased use of adjuvant radiation after the AJCC revision was confirmed by the Cochran-Armitage test and by multivariable logistic regression, which showed that patients diagnosed in 2018–2021 had higher odds of receiving radiation therapy (odds ratio, 1.33; <i>p</i> &lt; 0.001) than those diagnosed in 2013–2017, after adjustment for covariates. Forty-eight-month overall survival did not differ between cohorts (64% in both groups).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Although the 2018 AJCC revision for oral cavity cancer staging led to significant upstaging and increased use of adjuvant radiation therapy, overall survival remained unchanged. The benefits of increased adjuvant therapy use remain unclear and warrant further investigation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"555-563"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536044","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 Analysis of CEM and Breast MRI: A Retrospective Study","authors":"Joanna Tomala,&nbsp;Neil Upadhyay","doi":"10.1002/jso.70315","DOIUrl":"10.1002/jso.70315","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Breast cancer is a prevalent malignancy where accurate preoperative assessment is crucial for treatment planning. Breast MRI is a highly sensitive imaging modality for breast cancer detection. It is widely used preoperatively and can assist with local staging, tumour size assessment, detection of additional tumour foci and assessment of treatment response in patients receiving neoadjuvant chemotherapy. Contrast-enhanced spectral mammography (CEM) is an emerging alternative with comparable diagnostic performance and shorter examination times. This study retrospectively compares CEM and MRI in measuring breast cancer extent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective study conducted at Imperial College Healthcare NHS Trust, 58 patients with histologically confirmed breast cancer who underwent both CEM and MRI between January 2020 and July 2023 were included. Lesion sizes were evaluated on both modalities and compared with the postoperative histopathology specimen using the Wilcoxon signed-rank test and Pearson correlation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no statistically significant difference in average tumour size between CEM and MRI (28.8 mm (SD = 22.8) on CEM and 31.8 mm (SD = 24.2) on MRI; <i>p</i> = 0.1058). Both imaging modalities demonstrated similar measurement precision when compared with the surgical specimen (12.9 mm <i>vs.</i> 12.2 mm absolute mean difference between histopathological and radiological measurement – MRI and CEM respectively). Pearson analysis demonstrated a good correlation with postoperative histopathology in size measurement, with CEM showing slightly stronger correlation (r = 0.7858, <i>p</i> &lt; 0.0001, n = 45) compared with MRI (r = 0.6726, <i>p</i> &lt; 0.0001, n = 46).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>CEM appears to be a viable alternative to MRI. This study demonstrates high sensitivity of CEM and MRI for breast cancer detection, with no statistically significant difference in maximum diameter of enhancing abnormalities. Both modalities strongly correlate with histopathology. Further studies are required to validate the role of CEM in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"518-524"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148376192","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":"Durable Cancer Control and Extended Long-Term Survival Following Salvage Surgery for Squamous Cell Carcinoma of the Anal Canal: A Cohort Study","authors":"Paul Savage,&nbsp;David P. Cyr,&nbsp;Dan E. Schiller,&nbsp;Bernard J. Cummings,&nbsp;Alexandra M. Easson,&nbsp;Andrew J. Smith,&nbsp;Carol J. Swallow","doi":"10.1002/jso.70331","DOIUrl":"10.1002/jso.70331","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Salvage surgery is the standard-of-care for patients with squamous cell carcinoma of the anal canal (SCCa) who experience isolated locoregional failure after upfront chemoradiotherapy. While perioperative morbidity and short-term survival outcomes have been described, long-term outcomes of surgical salvage are unknown. This study examines recurrence patterns and survival in a cohort of patients with extended follow-up.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective chart review was performed on a cohort of consecutive patients who underwent salvage surgery at two specialized cancer centers between 1987 and 2006. Overall, disease-specific and re-recurrence-free survival (OS, DSS, RRFS) were estimated using the Kaplan-Meier method. Prognostic variables were evaluated using univariate and multivariable Cox models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty patients were included (29 female, 11 male; median age 56). Median follow-up was 16.5 years (IQR 15.0−20.5) for patients alive at last follow-up. Re-recurrence developed in 52% of patients, 95% of which occurred within 3 years of salvage surgery; re-recurrence was associated with a 91% risk of subsequent SCCa-specific mortality. DSS was 45% (95% CI 30−61) at 5 years, after which point conditional 5-year DSS was 100%.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Approximately half of patients who undergo salvage surgery for persistent/recurrent SCCa experience durable cancer control with extended long-term survival. Emerging treatment options such as immunotherapy should be evaluated relative to this benchmark.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"604-612"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70331","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549504","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":"Brazilian Society of Oncologic Surgery Guideline for Bloodless Surgery (Part 1: Preoperative Strategies)","authors":"Ronald Enrique Delgado Bocanegra,&nbsp;Alexandre Ferreira Oliveira,&nbsp;Vandre Cabral Gomes Carneiro,&nbsp;Reitan Ribeiro,&nbsp;Romilton Machado,&nbsp;Luis Fernando Johnson,&nbsp;Daniel Cesar,&nbsp;Roberta Oliveira de Almeida,&nbsp;Marcio Sanctos Costa,&nbsp;Augusto Fernandes Mendes,&nbsp;Larissa de Jesus Almeida,&nbsp;Thomas Augusto Rodrigues de Magalhães,&nbsp;Carlos Eduardo Santa Ritta Barreira,&nbsp;Kleuber Moreira Lemos,&nbsp;Felipe Jose Fernandez Coimbra,&nbsp;Joyce Sant'Anna Barros Lyra,&nbsp;Paulo Henrique de Sousa Fernandes,&nbsp;Angelo Atalla,&nbsp;Nathalia Moreira Ramalho,&nbsp;Marcelo Bentancor Lontra,&nbsp;Marcos Gonçalves Adriano Junior,&nbsp;Suellen Riccio Simões,&nbsp;Luccas Melo Chagas,&nbsp;João Rosa de Almeida,&nbsp;Vinicius La Rocca Vieira,&nbsp;Jorge Soares Lyra,&nbsp;Arthur Foinquinos Krause Goncalves,&nbsp;Elves Maciel,&nbsp;Vicente Faraon Fonseca,&nbsp;Abraão Elias Hallack Neto,&nbsp;Luiz Carlos Von Bahten,&nbsp;Adroaldo Guimarães Rossetti Junior,&nbsp;Murilo Pereira Flores,&nbsp;Yan Vitor Gomes Silva de Jesus,&nbsp;Giovani Alves Monteiro,&nbsp;Pedro Eder Portari Filho,&nbsp;Heladio Feitosa e Castro Neto,&nbsp;Diego Venicio Santos Argolo,&nbsp;Rinailda de Cascia Santos Torres,&nbsp;Rodrigo Nascimento Pinheiro","doi":"10.1002/jso.70333","DOIUrl":"10.1002/jso.70333","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Brazilian Society of Surgical Oncology (SBCO) developed national guidelines for the rational use of blood concentrates in surgical procedures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between June and December 2024, a multidisciplinary team of 42 experts formulated 48 key questions on the rational use of blood concentrates in surgery. The guidelines were structured in three phases: preoperative, intraoperative, and postoperative. Expert groups performed literature reviews and proposed preliminary recommendations, which were later refined by the coordinators. An adapted grading system was used to assess the level of evidence, and an online voting process determined consensus among experts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Implementing a bloodless surgery protocol requires a meticulous and coordinated approach across multiple medical disciplines. Essential elements for success include patient and staff education, comprehensive preparation, and the use of advanced surgical techniques and technologies to optimize outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"594-603"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430630","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":"Institutional Learning Curve in Esophagectomy: Technical Standardization of Gastric Conduit Formation and Conduit-Related Outcomes in 187 Consecutive Patients","authors":"Mayank Tripathi,&nbsp;Reshma R. Balachandran,&nbsp;Kumar Vineet,&nbsp;Dhaval Vadodaria,&nbsp;Vaibhav Kushwaha,&nbsp;Mohd Irfan Ansari,&nbsp;Piyush Shukla","doi":"10.1002/jso.70317","DOIUrl":"10.1002/jso.70317","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Learning curves in esophagectomy are often described in terms of procedural volume, but institutional maturation also reflects progressive standardization of reconstruction, operative choreography, and team-based decision-making. Gastric conduit viability remains central to safe esophageal reconstruction, with conduit ischemia, torsion, and tension contributing substantially to leak and necrosis. We examined the institutional learning curve of a high-volume esophageal cancer program, focusing on technical standardization of gastric conduit formation and conduit-related outcomes.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We retrospectively analyzed 187 consecutive patients who underwent esophagectomy for locally advanced esophageal cancer between 2019 and 2025 at a tertiary cancer center. For descriptive temporal comparisons, the cohort was divided into two pragmatic phases corresponding to institutional practice before and after routine formalization of the conduit protocol: up to 2022 (&lt;i&gt;n&lt;/i&gt; = 101) and 2023–2025 (&lt;i&gt;n&lt;/i&gt; = 86). During program maturation, a standardized gastric conduit protocol was formalized, emphasizing preservation of conduit vascularity, controlled conduit geometry, minimal omental bulk, cervical-first dissection, torsion-free transposition, and selective pyloric management. The primary outcome was composite major conduit-related morbidity, defined per patient as major anastomotic leak, major conduit necrosis, or conduit-related re-exploration. Secondary outcomes included overall leak, vocal cord palsy, chyle leak, Clavien-Dindo grade, 30-day mortality, R0 resection, and lymph node yield. Outcomes were interpreted within the broader context of institutional maturation rather than as a simple calendar-era comparison.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Composite major conduit-related morbidity declined from 8.9% in the earlier phase of the program to 2.3% in the later phase. Within this composite, major conduit necrosis declined from 5% to 0%, while overall leak rates remained stable. Thirty-day mortality was 4.3%, and most complications were minor. Oncologic adequacy was preserved, with R0 resection in 94.7% and a median lymph node yield of 25. Improvements in pathological complete response and recurrence over time paralleled broader changes in neoadjuvant treatment intensity and lymphadenectomy and should not be attributed solely to conduit protocolization.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Institutional maturation in esophagectomy was associated with tr","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"548-554"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70317","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148391395","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":"The Treatment Efficacy for Patients Undergoing Combined Transanal-Transabdominal Endoscopic Resection of Rectal Anastomosis Stenosis","authors":"Taixuan Wan,&nbsp;Yunxing Shi,&nbsp;Yihang Zhou,&nbsp;Haoqi Zheng,&nbsp;Hao Xie,&nbsp;Fujin Ye,&nbsp;Pinzhu Huang,&nbsp;Maram Alenzi,&nbsp;Zhanzhen Liu,&nbsp;Yonghua Cai,&nbsp;Shuangling Luo,&nbsp;Liang Kang,&nbsp;Liang Huang","doi":"10.1002/jso.70316","DOIUrl":"10.1002/jso.70316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Combined transanal and transabdominal resection for anastomotic stenosis may provide an opportunity to restore bowel continuity in patients with colorectal anastomotic stenosis. This study aimed to evaluate the therapeutic efficacy of combined transanal-transabdominal resection in patients with rectal anastomotic stenosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively analyzed a consecutive cohort of patients who underwent combined transanal-transabdominal endoscopic resection for rectal anastomotic stenosis between August 2019 and March 2023. Data on intraoperative variables, mortality, postoperative complications, and stoma closure were collected. Functional outcomes were evaluated using the Low Anterior Resection Syndrome (LARS) score and the Wexner incontinence score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 54 patients, including 46 men and 8 women, met the inclusion criteria. In all patients, anastomotic stenosis developed secondary to either anastomotic leakage or preoperative radiotherapy. The median length of hospital stay was 15 days (11–24 days). No postoperative mortality occurred, and the overall morbidity rate was 15%. During a median follow-up of 48 months, stoma closure was achieved in 49 patients after a median interval of 3.8 months (2.5–11 months). At the end of follow-up, stoma closure had failed in 2 patients because of poor anastomotic functional outcomes, and 3 patients developed recurrent anastomotic stenosis. Among the 49 patients available for functional assessment, 35 (71.4%) reported no or minor LARS. The median Wexner incontinence score was 8 (0–18), and 13 patients had a score of 0. Erectile function was evaluated in 28 male patients, of whom 18 reported normal postoperative erectile function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Combined transanal-transabdominal endoscopic resection appears to be an effective treatment for rectal anastomotic stenosis, with a high rate of stoma closure, low morbidity, and acceptable long-term functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Registration Number</h3>\u0000 \u0000 <p>NCT06036862.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"531-538"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368787","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":"AI Risk Prediction Tools for Autologous Breast Reconstruction","authors":"Jonlin Chen,&nbsp;Ariel Gabay,&nbsp;Abbas M. Hassan,&nbsp;Francis D. Graziano,&nbsp;Lillian A. Boe,&nbsp;Arielle N. Roberts,&nbsp;Ronnie L. Shammas,&nbsp;Carrie S. Stern,&nbsp;Robert J. Allen Jr.,&nbsp;Babak J. Mehrara,&nbsp;Jonas A. Nelson","doi":"10.1002/jso.70318","DOIUrl":"10.1002/jso.70318","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Autologous breast reconstruction offers patients a durable and natural-appearing option after mastectomy. However, complication risks include flap loss, infection, and delayed wound healing. This study developed both traditional statistical and machine learning (ML) models to predict the risk of developing a 90-day postoperative complication after autologous reconstruction.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patient data were retrospectively collected for patients who underwent abdominal-based autologous breast reconstruction at Memorial Sloan Kettering Cancer Center (January 2015-September 2024). Multivariable logistic regression models and supervised ML models were developed to predict infection, hematoma, seroma, delayed wound healing, and flap compromise.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>2,128 patients (3,249 flap reconstructions) were included. Overall, 90-day complications occurred in 475 (22.3%) patients, including infection (10%), hematoma (6%), delayed healing (4.1%), seroma (3.9%), and flap compromise (2.8%). AUCs ranged from 0.60 to 0.66 (logistic regression) and 0.64 to 0.73 (ML). Higher BMI was associated with increased risk for seroma (OR: 1.1, 95% CI: 1.04–1.13) and neoadjuvant chemotherapy for infection (OR:1.72, 95% CI: 1.17–2.51). Key ML model predictors on SHAP analysis included age, BMI, and pre-reconstruction radiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Individualized risk prediction models for complications after autologous breast reconstruction were developed using traditional statistics and ML. These models may help personalize treatment; however, further research is needed to enhance model predictive performance and clinical utility.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"539-547"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549535","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":"Plotting the Path to Recovery: Group-Based Trajectory Modelling of Physical Activity After Major Oncological Surgery to Predict Postoperative Outcomes.","authors":"Ella Jansen, Carlos de Miguel Llorente, Petra Bor, Jan Willem van den Berg, Karin Valkenet","doi":"10.1002/jso.70398","DOIUrl":"https://doi.org/10.1002/jso.70398","url":null,"abstract":"<p><strong>Background and methods: </strong>The role of early and increased activity on postoperative recovery is well established, yet the impact of its day-to-day variability remains unclear. This retrospective cohort study examined associations between early in-hospital postoperative physical activity trajectories and postoperative outcomes among 218 surgical oncology patients from the University Medical Center Utrecht. Group-based trajectory modelling identified subgroups based on daily activity patterns over the first five postoperative days. Primary analysis assessed associations between trajectory and length of stay (LOS), complications, and 30-day readmission. Secondary analysis explored sociodemographic and clinical predictors of trajectory.</p><p><strong>Results: </strong>Three trajectories were identified: Minimal (n = 72), Moderate (n = 97), and Rapid Activity Recovery (n = 49). Compared with the Minimal group, Rapid Activity Recovery patients had a 38% shorter LOS (MR: 0.62, 95% CI: 0.50-0.77). Trajectory was not associated with complications or readmissions. Female sex and higher American Society of Anesthesiologists Physical Status Classification were associated with lower odds of belonging to the Rapid Activity Recovery group (OR: 0.33, 95% CI: 0.14-0.78 and OR: 0.38, 95% CI: 0.17-0.84, respectively).</p><p><strong>Conclusions: </strong>Favorable early postoperative activity trajectories were associated with shorter hospital stay.</p><p><strong>Discussion: </strong>Further exploration of real-time trajectory-based assessment towards the improvement of postoperative care is needed.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148963140","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":"A Tale of Two Pathways: Same-Surgeon Versus Different-Surgeon Resection After Second Surgical Opinion","authors":"Areesh Mevawalla,&nbsp;Selamawit Woldesenbet,&nbsp;Azza Sarfraz,&nbsp;Qaidar Alizai,&nbsp;Meher Angez,&nbsp;Abdulaziz Elemosho,&nbsp;Odysseas P. Chatzipanagiotou,&nbsp;Timothy M. Pawlik","doi":"10.1002/jso.70313","DOIUrl":"10.1002/jso.70313","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The role of second surgical opinions (SSOs) in gastrointestinal (GI) cancer care is not well-defined. While SSOs are common, the impact may depend on whether patients ultimately undergo resection with the same surgeon or with a different surgeon after the SSO. We sought to characterize perioperative outcomes relative to SSO among older adults with GI cancers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using SEER–Medicare data (2000–2019), patients aged 66–90 with primary GI were identified. Cancer-directed resections were categorized into three claims-observed pathways: surgery without SSO, SSO with same-surgeon resection, and SSO with different-surgeon resection. Multivariable regression models assessed the association between operative pathway and perioperative outcomes including complications, extended length of stay (LOS), 90-day readmission and mortality, discharge disposition, and achievement of a composite “textbook outcome.”</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 40,603 surgical patients, 56.2% underwent surgery without SSO, 5.3% underwent SSO with same-surgeon resection, and 38.5% underwent SSO with different-surgeon resection. Compared with no SSO, SSO followed by resection with a different surgeon was associated with lower odds of 90-day readmission (aOR 0.92, 95%CI 0.88–0.97), any complications (aOR 0.90, 95%CI 0.84–0.95), extended LOS (aOR 0.93, 95%CI 0.88–0.98), and mortality (aOR 0.67, 95%CI 0.58–0.78), as well as higher discharge-home (aOR 1.05, 95%CI 1.01–1.12) and textbook outcome (aOR 1.12, 95%CI 1.07–1.17). In contrast, SSO with same-surgeon resection was associated with higher complications (aOR 1.14, 95%CI 1.01–1.29), longer LOS (aOR 1.21, 95%CI1.09–1.35), and lower home discharge (aOR 0.77, 95%CI 0.70–0.85) with no survival advantage.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Among older adults undergoing GI cancer surgery, SSO followed by resection with a different surgeon was associated with improved perioperative safety and recovery, whereas SSO followed by resection with the same surgeon was not associated with similar benefit. These findings suggest that the value of SSO may lie in its role as a pathway to a different surgical team when clinically appropriate.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"508-517"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70313","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345628","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":"Prognostic Factors in Primary Head and Neck Cutaneous Squamous Cell Carcinoma: A Large-Scale, Multi-Institutional Competing-Risks Analysis","authors":"Fábio Muradás Girardi,&nbsp;Cristian David Cardona Machado,&nbsp;Ashley Wysong,&nbsp;Nina A. Ran,&nbsp;Emily E. Granger,&nbsp;Shlomo A. Koyfman,&nbsp;Allison T. Vidimos,&nbsp;David R. Carr,&nbsp;Kathryn T. Shahwan,&nbsp;Kelsey E. Hirotsu,&nbsp;John A. Carucci,&nbsp;Joi B. Carter,&nbsp;Aaron R. Mangold,&nbsp;Divya Srivastava,&nbsp;David G. Brodland,&nbsp;John A. Zitelli,&nbsp;Tyler J. Willenbrink,&nbsp;Anokhi Jambusaria-Pahlajani,&nbsp;Rajiv I. Nijhawan,&nbsp;Emily S. Ruiz,&nbsp;Javier Cañueto","doi":"10.1002/jso.70325","DOIUrl":"10.1002/jso.70325","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Current staging systems for head and neck cutaneous squamous cell carcinoma (HNCSCC), such as AJCC8 and BWH, often fail to adequately stratify high-risk patients, particularly due to the exclusion of important biological and host factors. This study aimed to identify independent prognostic factors for HNCSCC outcomes in the largest multi-institutional retrospective series to date.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>De-identified data from 8,610 primary HNCSCC tumors, treated with curative intent surgery across multiple international centers, were analyzed. Outcomes included local recurrence (LR), locoregional metastasis (LM), distant metastasis (DM), and disease-specific death (DSD). Multivariable Fine–Gray subdistribution hazard regression models with robust standard errors clustered at the patient level were fitted to generate exploratory hypotheses regarding independent hazard determinants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a median follow-up of 31.4 months (IQR 14.2–52.8), the cumulative incidence was 3.3% for LR, 2.7% for LM, 0.5% for DM, and 1.2% for DSD. Multivariable analysis confirmed that tumor diameter, poor differentiation, deep invasion, and large-caliber perineural invasion (LCPNI) were the strongest predictors, being significantly associated with at least three of the four outcomes. Notably, factors currently excluded from or weighted differently in staging systems also proved critical: Immunosuppression was significantly associated with LR (SHR 2.03) and DSD (SHR 1.70); and lymphovascular invasion (LVI) was independently associated with LM (SHR 3.00). Poor differentiation demonstrated high prognostic impact, being a significant predictor for all four endpoints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Tumor diameter, poor differentiation, deep invasion, LCPNI, immunosuppression status, and LVI are the most critical independent factors for HNCSCC prognosis. Our multi-institutional data provide a robust framework for hypothesis generation, highlighting that incorporating host biological features and non-anatomic variables could significantly refine future staging system discussions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"134 4","pages":"584-593"},"PeriodicalIF":1.9,"publicationDate":"2026-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148430146","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}