{"title":"Timing of TS1 adjuvant chemotherapy as a prognostic factor in recurrent pancreatic cancer after surgery","authors":"Kyohei Abe , Kenei Furukawa , Mizuki Fukuda , Takeshi Gocho , Masashi Tsunematsu , Ryoga Hamura , Yoshihiro Shirai , Koichiro Haruki , Shuichi Fujioka , Toru Ikegami","doi":"10.1016/j.suronc.2024.102179","DOIUrl":"10.1016/j.suronc.2024.102179","url":null,"abstract":"<div><h3>Aim</h3><div>Prognosis of pancreatic cancer is improved by combining postoperative adjuvant chemotherapy and preoperative adjuvant chemotherapy with surgery, while the importance of extended dissection surgery has decreased. To better understand prognostic factors of recurrence, we focused on the timing of postoperative adjuvant chemotherapy in patients with pancreatic cancer.</div></div><div><h3>Methods</h3><div>One hundred patients who underwent pancreatectomy or pancreaticoduodenectomy and chemotherapy for pancreatic cancer were classified into early and late postoperative adjuvant therapy initiation groups. Prognosis was evaluated retrospectively using known prognostic factors.</div></div><div><h3>Results</h3><div>On receiver operating characteristic analysis, optimum cut-off between the early (<52 days; n = 60) and late adjuvant initiation groups (≥52 days; n = 40) was 52 days. The two groups were well-matched, except the early initiation group had more surgeries with D2 lymph node dissection (75 % vs 48 %; p = 0.01); fewer postoperative complications (17 % vs 59 %; p = 0.04), including less postoperative pancreatic fistula (13 % vs 35 %; p = 0.03); and longer disease-free survival (0.7 years v 0.5 years; p = 0.02). On multivariate evaluation, early initiation and completion of adjuvant therapy were associated with increased overall survival, while early initiation was associated with prolonged disease-free survival.</div></div><div><h3>Conclusions</h3><div>Prognosis of patients with pancreatic cancer is improved by earlier rather than later initiation of postoperative adjuvant therapy.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102179"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hamadalnile , M. Mariathasan , Mahmud Riad , A.G. Patel , S. Atkinson , A.A. Prachalias , P. Srinivasan , L. Jiao , R.H. Bhogal , K. Menon , C. Schneider
{"title":"Delayed surgery during the Covid-19 pandemic did not affect long-term outcomes of pancreatic adenocarcinoma","authors":"A. Hamadalnile , M. Mariathasan , Mahmud Riad , A.G. Patel , S. Atkinson , A.A. Prachalias , P. Srinivasan , L. Jiao , R.H. Bhogal , K. Menon , C. Schneider","doi":"10.1016/j.suronc.2024.102169","DOIUrl":"10.1016/j.suronc.2024.102169","url":null,"abstract":"<div><h3>Background</h3><div>During the Covid-19 pandemic cancer surgery was severely affected due to relocation of healthcare resources and the resulting restructuring of cancer pathways. Although this potentially affected rapidly progressing malignancies like pancreatic cancer the most, little is known about long-term outcomes following pancreatectomy.</div></div><div><h3>Materials and methods</h3><div>Survival data from two pancreatic surgery centres in the UK was analysed with patients being compared across pre-pandemic (C19-) and intra-pandemic (C19+) groups. Demographic, pathological and surgical pathway parameters were evaluated with multivariate analysis and propensity score matching.</div></div><div><h3>Results</h3><div>Out of 123 patients, 60 had surgery during the pandemic. The main strategy to reduce disruptions to pancreatic surgery was relocation of services to private sector facilities without emergency medicine departments. Although time to surgery was delayed by almost 20 days during the pandemic, there were no significant differences in overall survival at 22 months vs. 24 months or disease free survival at 15 months vs. 16 months for the C19+ and C19- groups, respectively. Adjuvant chemotherapy, Charlson comorbidity score, tumour stage and resection margin status were found to be independent predictors for overall survival whereas only adjuvant chemotherapy and Charlson comorbidity score were predictive of disease free survival.</div></div><div><h3>Conclusion</h3><div>This article provides a template for the effective restructuring of pancreatectomy pathways during a pandemic with associated lockdowns and provides the first evidence that the quality of outcomes can be maintained in this difficult environment. It is hoped that these results will provide a framework for addressing surgical oncology challenges in future pandemics.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102169"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142787566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eman A. Toraih , Siva Paladugu , Rami M. Elshazli , Mohammad M. Hussein , Hassan Malik , Humza Pirzadah , Ahmed Abdelmaksoud , Salem I. Noureldine , Emad Kandil
{"title":"Comparative efficacy, safety, and oncological outcomes of percutaneous thermal and chemical ablation modalities for recurrent metastatic cervical lymphadenopathy from thyroid cancer","authors":"Eman A. Toraih , Siva Paladugu , Rami M. Elshazli , Mohammad M. Hussein , Hassan Malik , Humza Pirzadah , Ahmed Abdelmaksoud , Salem I. Noureldine , Emad Kandil","doi":"10.1016/j.suronc.2024.102180","DOIUrl":"10.1016/j.suronc.2024.102180","url":null,"abstract":"<div><h3>Background</h3><div>Thermal and chemical ablation techniques may consolidate recurrent metastatic cervical lymph nodes as alternatives to repeat neck dissection in thyroid cancer patients. This meta-analysis aims to compare the efficacy and safety across modalities.</div></div><div><h3>Methods</h3><div>Four databases were searched for studies on radiofrequency (RFA), microwave (MWA), laser (LA), and ethanol ablation (EA) treating metastatic cervical nodes from thyroid cancer. The outcomes analyzed included treatment response, oncologic control, and complications. Random effects meta-analytical pooling was conducted.</div></div><div><h3>Results</h3><div>There were 25 studies (n = 1061 nodes) examining the four ablation methods. Patients showed comparable baseline characteristics and initial lymph node sizes ranging from 0.96 to 1.28 cm. All modalities achieved substantial node volume reduction (88.4 %) and disappearance (62.8 %), with significant biochemical decline (from 6.01 to 1.13 ng/ml, <em>p</em> = 0.18 between groups). MWA showed the highest volume reduction (99.4 %) and disappearance rate (87.6 %) versus slower efficacy of RFA (93.0 %, 72.1 %), LA (77.9 %, 62.5 %), and EA (81.8 %, 58.4 %). New malignancy/metastases risks ranged from 0.03 % to 1.3 % without between-group differences (<em>p</em> = 0.52). Major complications were absent; transient voice changes (0.05%–10.6 %) and neck pain (0.0%–5.9 %) were the main overall complaints. However, overall complication rates significantly varied by modality (1.1%–10.6 %; <em>p</em> = 0.003).</div></div><div><h3>Conclusions</h3><div>Thermal and chemical ablation is effective in controlling the metastatic disease burden in patients with thyroid cancer, offering a potentially less morbid and non-surgical alternative to re-operation. Additional prospective data could confirm the long-term equivalent of revision neck dissection and stratify patients based on concomitant Hashimoto's and genomic mutations. Clarifying optimal patient selection and standardizing prognostic indexing could further enhance utilization.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102180"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Friederike Baehr , Johanna Teloh-Benger , Alexander Damanakis , Florian Gebauer , Hans Schlößer , Wolfgang Schroeder , Christiane J. Bruns , Alexander Quaas , Thomas Zander
{"title":"Impact of structured surveillance of patients with esophageal cancer following surgical resection with curative intent","authors":"Friederike Baehr , Johanna Teloh-Benger , Alexander Damanakis , Florian Gebauer , Hans Schlößer , Wolfgang Schroeder , Christiane J. Bruns , Alexander Quaas , Thomas Zander","doi":"10.1016/j.suronc.2024.102184","DOIUrl":"10.1016/j.suronc.2024.102184","url":null,"abstract":"<div><h3>Background</h3><div>Esophageal cancer (EC) is a disease with a poor prognosis. While treatment options have been improved, there is no consensus for surveillance strategies following therapy with curative intent. As the incidence of EC is rising and a large fraction of patients will experience disease recurrence, the need for evidence-based treatment and optimal surveillance is evident.</div></div><div><h3>Study design</h3><div>Included were 1128 patients with esophageal and gastroesophageal junction cancer (squamous cell/adenocarcinoma) that underwent surgical resection at the University Hospital Cologne (UHC) between 2012 and 2021. Patients were retrospectively split into two groups: monitored structured surveillance at the center (n = 635) (MSS) and not monitored surveillance (n = 493) (NMS).</div></div><div><h3>Results</h3><div>In the MSS group, we identified 292 (45.98 %) cases of recurrence while 66 (13.39 %) cases of recurrence were identified in the NMS group. Overall survival (OS) was not significantly longer in MSS than in NMS, yet a positive trend can be seen (p = 0.108). Progression free survival (PFS) was significantly different between groups (p ≤ 0.05). Almost a third of recurrences diagnosed in MSS were limited to a singular location. About 35 % of recurrences in MSS were treated or were intended to be treated with local treatment options like surgery or curative intended radiotherapy, by times in combination with sensitizing chemotherapy. The correlation of time of recurrence and time of death was stronger within NMS than in MSS.</div></div><div><h3>Conclusions</h3><div>Structured surveillance leads to detection of more patients with singular recurrence but no clear sign of prolonged survival. Further prospective trials are warranted to define the clinical benefit of structured surveillance.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102184"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ignacio Aguirre-Allende , Fernando Pereira-Pérez , Israel Manzanedo-Romero , Paula Fernandez-Briones , María Muñoz-Martín , Ángel Serrano-Moral , Estibalitz Perez-Viejo
{"title":"Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases: A pragmatic comparison of oncological outcomes in synchronous versus metachronous disease","authors":"Ignacio Aguirre-Allende , Fernando Pereira-Pérez , Israel Manzanedo-Romero , Paula Fernandez-Briones , María Muñoz-Martín , Ángel Serrano-Moral , Estibalitz Perez-Viejo","doi":"10.1016/j.suronc.2024.102183","DOIUrl":"10.1016/j.suronc.2024.102183","url":null,"abstract":"<div><h3>Background</h3><div>disease burden (PCI), completeness of cytoreduction or histological features, are known to influence survival after CRS-HIPEC for colorectal peritoneal metastases (CPM). However, there is still debate about influence of CPM onset. The aim of this study is to determine the impact of CPM onset on oncological outcomes after CRS-HIPEC.</div></div><div><h3>Methods</h3><div>all patients with CPM scheduled for CRS-HIPEC at one reference center between December 2007 and September 2022 were included. s-PM were defined as those diagnosed at primary disease treatment; m-PM were considered those diagnosed during follow-up. Survival outcomes and recurrence rates were compared using a pragmatic analysis.</div></div><div><h3>Results</h3><div>125 patients with s-CPM and 170 patients with m-CPM were analyzed. Median follow-up was 58.6 and 50.6 months in s-CPM and m-CPM groups(p = 0.11). Complete cytoreduction (CCS-0/-1) rates were comparable: 84 % s-CPM vs. 88.2 % m-CPM(p = 0.190). Overall survival (OS) was significantly shorter in s-CPM: 24.7 vs. 46.6 months (p = 0.024). Conversely, median disease-free survival was similar in both groups, 10 months vs. 11 months(p = 0.155). Patients in the s-CPM group presented more pN+(p = 0.001), higher histologic grade(p = 0.007) and PCI(p = 0.04), and higher rate of concurrent liver metastases(p = 0.004). RAS/BRAF gene mutations and microsatellite instability did not differ significantly. Perioperative chemotherapy regimens and tolerance were also similar.</div></div><div><h3>Conclusions</h3><div>despite s-CPM being associated with impaired OS after CRS-HIPEC, the onset of PM was not found to be an independent determinant for survival. High-risk molecular and histological features strongly influence oncological outcomes after CRS-HIPEC. This is valuable data that could aid in preoperative patient selection process for CRS-HIPEC.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102183"},"PeriodicalIF":2.3,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Machine learning in cancer prognostication: Limitations and opportunities","authors":"Giorgos C. Karakousis","doi":"10.1016/j.suronc.2024.102164","DOIUrl":"10.1016/j.suronc.2024.102164","url":null,"abstract":"","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102164"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The evolution of melanomology: a tale of giants’ shoulders and bold hypotheses","authors":"John F. Thompson","doi":"10.1016/j.suronc.2024.102094","DOIUrl":"10.1016/j.suronc.2024.102094","url":null,"abstract":"","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102094"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141237451","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Austin Yu , Linus Lee , Thomas Yi , Michael Fice , Rohan K. Achar , Sarah Tepper , Conor Jones , Evan Klein , Neil Buac , Nicolas Lopez-Hisijos , Matthew W. Colman , Steven Gitelis , Alan T. Blank
{"title":"Development and external validation of a machine learning model for prediction of survival in extremity leiomyosarcoma","authors":"Austin Yu , Linus Lee , Thomas Yi , Michael Fice , Rohan K. Achar , Sarah Tepper , Conor Jones , Evan Klein , Neil Buac , Nicolas Lopez-Hisijos , Matthew W. Colman , Steven Gitelis , Alan T. Blank","doi":"10.1016/j.suronc.2024.102057","DOIUrl":"10.1016/j.suronc.2024.102057","url":null,"abstract":"<div><h3>Purpose</h3><div><span>Machine learning (ML) models have been used to predict cancer survival in several sarcoma subtypes. However, none have investigated extremity </span>leiomyosarcoma (LMS). ML is a powerful tool that has the potential to better prognosticate extremity LMS.</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results (SEER) database was queried for cases of histologic extremity LMS (n = 634). Patient, tumor, and treatment characteristics were recorded, and ML models were developed to predict 1-, 3-, and 5-year survival. The best performing ML model was externally validated using an institutional cohort of extremity LMS patients (n = 46).</div></div><div><h3>Results</h3><div>All ML models performed best at the 1-year time point and worst at the 5-year time point. On internal validation within the SEER cohort, the best models had c-statistics of 0.75–0.76 at the 5-year time point. The Random Forest (<em>RF</em>) model was the best performing model and used for external validation. This model also performed best at 1-year and worst at 5-year on external validation with c-statistics of 0.90 and 0.87, respectively. The <em>RF</em> model was well calibrated on external validation. This model has been made publicly available at <span><span>https://rachar.shinyapps.io/lms_app/</span><svg><path></path></svg></span></div></div><div><h3>Conclusions</h3><div>ML models had excellent performance for survival prediction of extremity LMS. Future studies incorporating a larger institutional cohort may be needed to further validate the ML model for LMS prognostication.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"57 ","pages":"Article 102057"},"PeriodicalIF":2.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140095005","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrick Soldath , Philip Ryom , René Horsleben Petersen
{"title":"Long-term survival after sleeve lobectomy versus pneumonectomy for non-small cell lung cancer","authors":"Patrick Soldath , Philip Ryom , René Horsleben Petersen","doi":"10.1016/j.suronc.2024.102168","DOIUrl":"10.1016/j.suronc.2024.102168","url":null,"abstract":"<div><h3>Background</h3><div>To compare short-term mortality and long-term overall survival between sleeve lobectomy and pneumonectomy for centrally located non-small cell lung cancer (NSCLC).</div></div><div><h3>Methods</h3><div>We retrospectively reviewed patients who had been radically resected for NSCLC by sleeve lobectomy with or without pulmonary arterioplasty at our institution between 2009 and 2023. We then propensity score-matched the patients with pneumonectomy counterparts from a national registry and compared their 30- and 90-day mortality and long-term overall survival before and after matching. The mortality was compared using independence tests and the overall survival using Kaplan-Meier estimates and the log-rank test.</div></div><div><h3>Results</h3><div>The study included 109 sleeve lobectomy patients and 315 pneumonectomy patients, of whom 60 patients from each group were matched. The 30- and 90-day mortality was similar between both the unmatched and matched groups (unmatched: 3.7 % vs 5.1 % and 5.5 % vs 9.2 %; matched: 5.0 % vs 6.7 % and 5.0 % vs 12 %. All p-values >0.05). The overall survival was longer in both the unmatched and matched sleeve lobectomy patients (unmatched: hazard ratio [HR] 0.52, 95 % confidence interval [CI] 0.37–0.73, p < 0.001; matched HR 0.55, 95 % CI 0.34–0.90, p = 0.018). The 5-year overall survival was 68 % and 49 % for the unmatched sleeve lobectomy and pneumonectomy patients, respectively, and 61 % and 42 % for the matched ones.</div></div><div><h3>Conclusions</h3><div>Sleeve lobectomy yields non-inferior short-term mortality and superior long-term overall survival compared with pneumonectomy and should be the resection of choice for centrally located NSCLC when feasible.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"58 ","pages":"Article 102168"},"PeriodicalIF":2.3,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}