Journal of Surgical Oncology最新文献

{"title":"P53 Function Status Correlates With Overall Survival in Patients With Resected Pancreatic Cancer.","authors":"Hui Chen, Alisha Agarwal, Sreekanth Yellanki, Harish Lavu, Richard Zheng, Wilbur B Bowne, Charles J Yeo, Aditi Jain, Avinoam Nevler","doi":"10.1002/jso.70060","DOIUrl":"https://doi.org/10.1002/jso.70060","url":null,"abstract":"<p><strong>Background: </strong>The P53 gene is the most common tumor-suppressor gene mutated in pancreatic ductal adenocarcinoma (PDAC). The gene's normal function is critical for regulation of replication, DNA repair, and apoptosis. The purpose of our study is to determine the impact of the various P53 mutation subtypes on survival in resected PDAC.</p><p><strong>Methods: </strong>This is a retrospective cohort study assessing patients that underwent curative-intent resection for PDAC between the years of 2016-2022. Next generation sequencing (NGS) was performed on patient tumors. P53 tumor genotypes were grouped into wild-type (WT), gain-of-function (GOF) mutations (R175H, R248W, R248Q, R273H, R282W, G245S) and all other non-GOF mutations.</p><p><strong>Results: </strong>The study included a total of 330 patients with resected PDAC. P53 mutations were found in tumors of 243 patients (74%), and 87 (26%) patients had WT P53. Among patients with mutant P53 tumors, 58 patients (24%) had a GOF mutation, and 185 patients (76%) had a non-GOF mutation. Survival analysis showed that non-GOF P53 mutations were associated with the shortest overall survival compared with WT and GOF (25.6 ± 2.4 months vs. 32.2 ± 3.6 months, vs. 36.2 ± 4.4 months, respectively. p = 0.038). Similarly, non-GOF mutations were associated with the shortest disease-free survival (14.6 ± 1.2 months, vs. 19.6 ± 3.5 months, vs. 18.3 ± 3.6 months, respectively. p = 0.039).</p><p><strong>Conclusions: </strong>Our data suggest that P53 mutations grouped by functional status may hold differential prognostic value regarding survival and recurrence of patients with PDAC. Further investigations are required to validate these findings.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":1.9,"publicationDate":"2025-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144794799","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":"Risk of Contralateral Central Compartment Recurrence Following Unilateral Therapeutic Neck Dissection for Papillary Thyroid Carcinoma","authors":"Keren Kaminer,&nbsp;Tal Rozenblat,&nbsp;Itay Shavit,&nbsp;Inbar Finkel,&nbsp;Liat Sasson,&nbsp;Ilan Shimon,&nbsp;Dania Hirsch,&nbsp;Gideon Bachar,&nbsp;Eyal Robenshtok","doi":"10.1002/jso.70063","DOIUrl":"10.1002/jso.70063","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>The utility of bilateral central compartment neck dissection (CCND) in patients with papillary thyroid carcinoma (PTC) and unilateral clinically node-positive disease remains debatable. Previous studies evaluated contralateral occult lymph-node metastases, which do not necessarily correlate with clinical recurrences. The objective of our study was to evaluate whether unilateral CCND is sufficient, specifically evaluating recurrence in the contralateral central neck.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with PTC treated with total thyroidectomy and therapeutic unilateral CCND with at least 2 years of follow-up were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 118 patients had unilateral therapeutic CCND, 58% with lateral neck dissection, 63% female, mean age of 48.1 ± 16.3 years. Mean follow-up was 6.2 ± 3.9 years, tumor size 17.6 ± 12 mm, 39% had minimal extrathyroidal extension (ETE) and 4% had gross ETE. A mean of 2.6 ± 2.6 LN were involved in the central compartment (size 9.4 ± 6.5 mm) and 4.4 ± 4 involved in the lateral neck (size 24.9 ± 14.3 mm). Recurrence on the ipsilateral side was detected in 6 patients (5%), while contralateral central compartment recurrence (the primary outcome) was detected in only 1 patient (1%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In patients with PTC and unilateral clinically node-positive central compartment disease, unilateral therapeutic CCND is sufficient, with only 1% risk of recurrence in the contralateral central compartment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"633-639"},"PeriodicalIF":1.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Patient Income and Insurance on Postoperative Mortality After Total Pancreatectomy for Pancreatic Neoplasms","authors":"Gracia Maria Vargas,&nbsp;Mohammad Saad Farooq,&nbsp;Neha Shafique,&nbsp;Major Kenneth Lee,&nbsp;Charles M. Vollmer,&nbsp;John T. Miura,&nbsp;Giorgos C. Karakousis","doi":"10.1002/jso.70062","DOIUrl":"10.1002/jso.70062","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Total pancreatectomies (TP) are rare high-risk operations requiring complex postoperative management. Hospital factors are known to impact pancreatectomy outcomes, but the role of patient socioeconomic status on TP outcomes remains poorly understood. This retrospective study assesses the impact of income and insurance on 90-day mortality after TP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults (≥ 18 years) who underwent TP for pancreatic neoplasms were identified in the National Cancer Database (2008–2022). Kaplan–Meier analysis assessed 90-day survival stratified by income and insurance. Univariable and multivariable Cox proportional hazards analyses were performed. Multivariable Cox models adjusting for clinical, oncologic, and facility characteristics assessed the impact of income and insurance on postoperative survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 11 321 patients, 90-day mortality was 8.0%. Facility volume and Commission on Cancer designation were associated with 90-day mortality (<i>p</i> &lt; 0.001), as were patient insurance and income (<i>p</i> &lt; 0.01). High-volume facilities had more male, non-Hispanic White, privately insured, and high-income patients than low-volume facilities (<i>p</i> &lt; 0.001). Ninety-day survival differed significantly between high- and lower-income patients with each insurance type (<i>p</i> &lt; 0.001). On adjusted Cox analysis, high income was associated with better 90-day survival for patients with Medicaid or no insurance (HR 0.42, <i>p</i> = 0.049) and Medicare (HR 0.77, <i>p</i> = 0.008). Ninety-day mortality did not differ between high- and lower-income patients with private insurance (HR 1.09, <i>p</i> = 0.597). Private insurance was associated with better 90-day survival versus patients with Medicaid or no insurance among lower-income patients (HR 0.57, <i>p</i> = 0.002), but not high-income patients (HR 1.43, <i>p</i> = 0.413).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Patient insurance and income influence 90-day mortality after TP, independent of clinical and facility factors. These findings suggest that financial burdens meaningfully impact postoperative recovery following TP, highlighting the need for careful preoperative screening and planning to ensure adequate support for at-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"706-716"},"PeriodicalIF":1.9,"publicationDate":"2025-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144789431","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":"Optimizing Perioperative Management of Pancreatic Ductal Adenocarcinoma: Insights Into Modified FOLFIRINOX Relative Dose Intensity and CA 19-9 Dynamics","authors":"Jiage Qian,&nbsp;Nikhil V. Tirukkovalur,&nbsp;Janie Y. Zhang,&nbsp;Anwaar Saeed,&nbsp;Sebastiaan Ceuppens,&nbsp;Robin Schmitz,&nbsp;Aatur Singhi,&nbsp;Kenneth K. Lee,&nbsp;Amer H. Zureikat,&nbsp;Alessandro Paniccia","doi":"10.1002/jso.70057","DOIUrl":"10.1002/jso.70057","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Many patients with resectable pancreatic ductal adenocarcinoma (PDAC) treated with modified FOLFIRINOX (mFOLFIRINOX) require dose reduction due to adverse effects. This study explores the optimal threshold for mFOLFIRINOX relative dose intensity (RDI) and characterizes RDI's correlation with CA 19-9.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A single-institution retrospective analysis of 97 patients with PDAC treated with mFOLFIRINOX and pancreatectomy from 2017 to 2022. RDI was calculated by dividing the delivered dose intensity by the intended dose intensity over 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median overall RDI was 73.8% (fluorouracil 75.5%, irinotecan 74.5%, oxaliplatin 70.6%). An RDI cutoff of ≥ 70% (<i>n</i> = 57) was associated with significantly improved overall survival (median OS: 62.6 vs. 43.7 months, <i>p</i> = 0.034). Compared to patients with &lt; 70% RDI who did not achieve CA 19-9 normalization, those with ≥ 70% RDI and normalization had significantly improved survival (HR: 0.27; 95% CI: 0.11–0.73). No significant benefit was observed with ≥ 70% RDI without CA 19-9 normalization or &lt; 70% RDI with normalization. In the multivariable model, RDI ≥ 70% remained independently associated with improved OS (HR = 0.37, 95% CI: 0.18–0.79) but not disease-free survival (HR = 0.50, 95% CI: 0.24–1.03).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Receiving ≥ 70% RDI of mFOLFIRINOX and CA 19-9 normalization independently improves survival in resected PDAC. The greatest benefit is observed when both are achieved.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"695-705"},"PeriodicalIF":1.9,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70057","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144753682","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":"Implications of an Isolated Positive Vascular Groove After Whipple for Pancreatic Adenocarcinoma: A Single Institution, Retrospective Analysis","authors":"Callie A. Hlavin,&nbsp;Sebastiaan Ceuppens,&nbsp;Nikhil Tirukkovalur,&nbsp;Jiage Qian,&nbsp;Aatur D. Singhi,&nbsp;Nathan Cook,&nbsp;Ibrahim Nassour,&nbsp;Kenneth K. Lee,&nbsp;Amer H. Zureikat,&nbsp;Alessandro Paniccia","doi":"10.1002/jso.70052","DOIUrl":"10.1002/jso.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objective</h3>\u0000 \u0000 <p>The vascular groove (VG) is no longer considered a resection margin but rather a surface of involvement. The clinical significance of an isolated VG+ remains debated. Therefore, this study evaluates the impact of isolated VG+, with or without vein resection, on overall survival (OS) and disease-free survival (DFS) following pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective analysis of 247 patients (2006–2019) was conducted. Patients were categorized into three groups: R0 resection (tumor &gt; 1 mm from all margins, <i>n</i> = 168), VG+ without vein invasion (+VGnoVI, <i>n</i> = 66), and positive vein involvement with direct tumor invasion into the vein wall (+VGwithVI) (<i>n</i> = 13). Kaplan-Meier estimates assessed OS and DFS, while multivariable analyses identified recurrence and survival predictors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>+VGnoVI group showed higher rates of local recurrence (OR 2.68, <i>p</i> = 0.002) compared to the R0 group. However, no significant differences were observed in DFS (R0: 17 months; +VGnoVI: 18 months; +VGwithVI: 21 months, <i>p</i> = 0.68) or OS (R0: 27 months; +VGnoVI: 29 months; +VGwithVI: 30 months, <i>p</i> = 0.98) across groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A positive vascular groove, whether isolated or associated with vein invasion, does not compromise OS or DFS compared to R0 resections.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"684-694"},"PeriodicalIF":1.9,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144742365","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":"Surgery in Ovarian Cancer—Brazilian Society of Surgical Oncology Consensus","authors":"Audrey Tieko Tsunoda,&nbsp;Ricardo dos Reis,&nbsp;Renato Moretti-Marques,&nbsp;Glauco Baiocchi,&nbsp;Leonardo Martins Campbell,&nbsp;Angelica Nogueira Rodrigues,&nbsp;Fabio Fin,&nbsp;Carlos Eduardo Mattos da Cunha Andrade,&nbsp;Bruno Roberto Braga Azevedo,&nbsp;Rosilene Jara Reis,&nbsp;Thales Paulo Batista,&nbsp;Reitan Ribeiro,&nbsp;Deraldo Falcao,&nbsp;Gustavo Guitmann,&nbsp;Suzana Arenhart Pessini,&nbsp;Paulo Henrique Zanvettor,&nbsp;João Soares Nunes,&nbsp;José Clemente Linhares,&nbsp;José Augusto Belotti,&nbsp;Alexandre Oliveira,&nbsp;Rodrigo Nascimento Pinheiro","doi":"10.1002/jso.70055","DOIUrl":"10.1002/jso.70055","url":null,"abstract":"<p>Surgical management in epithelial ovarian cancer (EOC) has a significant impact on overall survival (OS) and progression-free survival (PFS). The Brazilian Society of Surgical Oncology (BSSO) supported an expert-led task force for consensus: the best EOC surgery is provided by experienced and specialized trained surgeons in cancer centers. Laparoscopic or radiological staging can predict the possibility of complete cytoreduction (CC0) and help to reduce unnecessary laparotomies. Carcinomatosis and nodal extension should be evaluated at imaging. Multidisciplinary input is essential for determining the need for the selection of patients for surgery and adjuvant chemotherapy in patients with EOC. The BSSO proposes quality assurance criteria and the need for national consensus. Genetic counseling was deemed mandatory for all patients with EOC. This consensus states the final recommendations from BSSO for the management of EOC.</p>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"640-653"},"PeriodicalIF":1.9,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70055","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731942","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":"Analysis of the Incidence of Lymph Node Metastases in High-Risk Early Stage (T1) Esophageal Adenocarcinomas: A Single-Institution Experience","authors":"Adrienne B. Shannon,&nbsp;Marwa A. Mohammed,&nbsp;Gregory Y. Lauwers,&nbsp;Luis R. Pena,&nbsp;Shaffer R. Mok,&nbsp;Andrew J. Sinnamon,&nbsp;Cyrillo R. Araujo,&nbsp;Jose M. Pimiento","doi":"10.1002/jso.70050","DOIUrl":"10.1002/jso.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The incidence of lymph node metastasis (LNM) in early stage esophageal adenocarcinoma (EAC) is up to 45% based on high-risk pathologic features. This risk has not been determined following external validation of staging and pathologic features.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients with clinical T1 EAC who underwent surgical resection at a single institution from 1999 to 2023 were included. Before inclusion, all retrospective data was validated by an external reviewer within the institution. Patients were categorized into low-risk and high-risk categories. Incidence of LNM was examined using univariate analyses. Survival analysis was performed with Kaplan Meier survival estimates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>66 patients underwent esophagectomy and had multidisciplinary validation of staging and pathologic data; 28 (42.4%) patients had pT1b and 11/28 (39.3%) had SM3 tumors. The LNM rate was 10.6%; the incidence of LNM was higher for T1b compared to T1a (17.9%, <i>N</i> = 5/28 vs 5.3%, <i>N</i> = 2/38, p 0.10) tumors. Low-risk pT1a and high-risk pT1b patients had a LNM rates of 3.3% and 21.7%, respectively. Following a median follow-up of 46 months, there was no significant difference in overall survival and recurrence-free survival across risk stratification groups and comparing patients with and without LNM. Sensitivity for staging of T1b tumors was poor (40.9%, 50%, and 82.1%, respectively) for chest/abdominal CT, PET/CT, and EUS.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>T1 EAC patients retrospectively reviewed for multidisciplinary validation of staging and pathologic data have a LNM risk up to 21.7% when stratified by risk factors with a clinical trend toward worse survival. High-risk T1b patients may warrant neoadjuvant chemoradiotherapy before surgical resection.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"754-762"},"PeriodicalIF":1.9,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731940","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":"Minimally Invasive Versus Open Resection for Solid Pseudopapillary Tumors of the Pancreas: A Propensity Score-Matched Analysis","authors":"Paul Wong,&nbsp;Letizia Todeschini,&nbsp;Tommaso Pollini,&nbsp;Sophia Hernandez,&nbsp;Marco Zampese,&nbsp;Luis Laurean Aguilar,&nbsp;June S. Peng,&nbsp;Lucas W. Thornblade,&nbsp;Mohamed A. Adam,&nbsp;Adnan Alseidi,&nbsp;Carlos U. Corvera,&nbsp;Kenzo Hirose,&nbsp;Kimberly S. Kirkwood,&nbsp;Eric K. Nakakura,&nbsp;Ajay V. Maker","doi":"10.1002/jso.70054","DOIUrl":"10.1002/jso.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and Objectives</h3>\u0000 \u0000 <p>Solid pseudopapillary tumors (SPTs) of the pancreas occur predominantly in young females and possess low malignant potential. In this study, clinicopathologic, perioperative, and long-term outcomes are compared in SPT patients that received open or minimally invasive (MIS) resection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The National Cancer Database (2010-2020) was queried to identify all patients with SPTs that underwent an open or MIS surgical resection. Propensity score matching analysis was conducted through 1:1 matching based on the nearest neighbor method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 835 patients, 59.7% received an open approach and 40.3% were performed MIS. Over the decade, MIS approach increased from 7.7% to 60.0% for distal pancreatectomy (DP) and 15.4% to 30.2% for pancreaticoduodenectomy (PD) (both <i>p</i> &lt; 0.05). There were no differences in lymphadenectomy (&gt;15 nodes) or resection margin positivity. Shorter length of stay was noted for MIS resections (PD: 5 vs. 8 days, <i>p</i> &lt; 0.001; DP: 5 vs. 6 days, <i>p</i> = 0.022), and no difference was appreciated in 30-day readmission rates. There was no difference in overall survival between open and MIS approaches for PD and DP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Minimally invasive resections for SPTs have increased by ~40% over a decade and may offer a safe and feasible alternative to open resection that provides similar perioperative and long-term oncologic outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"676-683"},"PeriodicalIF":1.9,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144731941","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":"Open Thoracotomy Approach for Hyperthermic Intrathoracic Chemotherapy: How I Do It","authors":"Rachid Eduardo Noleto da Nobrega Oliveira,&nbsp;Juliana Giorgi,&nbsp;Laureano Molins López-Rodó,&nbsp;Vinicius de Lima Vazquez","doi":"10.1002/jso.70051","DOIUrl":"10.1002/jso.70051","url":null,"abstract":"<div>\u0000 \u0000 <p>Open thoracotomy remains a fundamental approach for hyperthermic intrathoracic chemotherapy (HITHOC), particularly in patients with extensive pleural disease or complex anatomical challenges. This article explores the step-by-step technique for performing HITHOC via open thoracotomy, highlighting patient selection criteria, procedural nuances, and postoperative management. While associated with greater invasiveness and prolonged recovery, open thoracotomy provides unmatched access and control, ensuring optimal cytoreduction and effective chemotherapy distribution.</p></div>","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 4","pages":"773-777"},"PeriodicalIF":1.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144675071","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: A Two-Stage Nephrectomy and Caval Thrombectomy for Renal Cell Carcinoma With Level IV Thrombus Complicated by Budd–Chiari Syndrome","authors":"Georgi Atanasov,&nbsp;Samith M. Alwis,&nbsp;Dixon Woon,&nbsp;Joseph Ischia,&nbsp;Sara Qi,&nbsp;Graham Starkey,&nbsp;Siven Seevanayagam,&nbsp;Marcos V. Perini","doi":"10.1002/jso.70049","DOIUrl":"10.1002/jso.70049","url":null,"abstract":"&lt;p&gt;We aim to visually present our two-stage approach to nephrectomy and caval thrombectomy for patients with renal cell carcinoma complicated by Level IV tumour thrombus (TT) and Budd–Chiari syndrome (BCS) [&lt;span&gt;1, 2&lt;/span&gt;] (Video S1). Additionally, we discuss the anatomical and pathophysiological considerations needed for safe and satisfactory performance of this technique.&lt;/p&gt;&lt;p&gt;Supra-diaphragmatic TT extension is associated with significant perioperative risks including major haemorrhage from coagulopathy and potential for massive pulmonary embolism (PE) [&lt;span&gt;3, 4&lt;/span&gt;]. This risk is exacerbated in patients with BCS. Our technique aims to mitigate these risks, thereby improving perioperative morbidity and mortality.&lt;/p&gt;&lt;p&gt;High-level IVC thrombus can cause secondary BCS and acute liver failure due to hepatic venous outflow obstruction [&lt;span&gt;5&lt;/span&gt;]. A thorough preoperative evaluation for BCS is essential and should include clinical assessment, liver function tests, computed tomography (CT), and Doppler ultrasonography.&lt;/p&gt;&lt;p&gt;Congestive hepatopathy in BCS can complicate intraoperative liver mobilisation and, when combined with cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) for supra-diaphragmatic thrombectomy, predisposes to severe hepatic coagulopathy and bleeding [&lt;span&gt;3&lt;/span&gt;]. By staging the procedures, our transthoracic approach minimises liver mobilisation while debulking TT from the hepatic veins and retro-hepatic IVC restores hepatic venous outflow. This facilitates liver function recovery, preventing hepatic decompensation. The second stage, which involves significant bleeding risk due to liver mobilisation, nephrectomy, and IVC resection and reconstruction, is then performed under improved coagulation conditions without the additional impact of CPB and DHCA.&lt;/p&gt;&lt;p&gt;Although perioperative PE is uncommon, it can carry substantial mortality risk, particularly during liver mobilisation and IVC manipulation [&lt;span&gt;6&lt;/span&gt;]. To mitigate risk between stages, we utilise an occlusive endoluminal IVC purse-string suture just below the hepatic vein ostia during the first stage (Figure 1B). This is made feasible by the development of a well-formed collateral circulation due to chronic IVC occlusion, which is routinely assessed preoperatively on CT. Importantly, the suture must not impede hepatic venous outflow.&lt;/p&gt;&lt;p&gt;The second stage is performed within 2 weeks and aims to achieve complete abdominal tumour clearance. The procedure is performed via a Makuuchi incision, utilising the Cattell–Braasch manoeuvre for optimal retroperitoneal and IVC exposure. Vascular control is achieved through early ligation of the renal artery and accessory veins (lumbar, renal and para-renal), minimising blood loss by collapsing the collateral circulation [&lt;span&gt;7&lt;/span&gt;]. Diaphragmatic attachments to the liver are dissected, fully exposing the abdominal IVC for vascular control through clamping [&lt;span&gt;8&lt;/span&gt;]. The liver is t","PeriodicalId":17111,"journal":{"name":"Journal of Surgical Oncology","volume":"132 3","pages":"565-567"},"PeriodicalIF":1.9,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jso.70049","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144682769","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}