Annals of Surgical Oncology最新文献

{"title":"Robotic Right Hepatectomy for Peri-Hilar Cholangiocarcinoma after Liver Venous Deprivation.","authors":"Simone Conci, Giuseppe Calderone, Andrea Ruzzenente","doi":"10.1245/s10434-025-18422-2","DOIUrl":"https://doi.org/10.1245/s10434-025-18422-2","url":null,"abstract":"<p><strong>Background: </strong>Recent innovations such as robotic platforms and liver venous deprivation (LVD) have the potential to improve the management and surgical treatment of peri-hilar cholangiocarcinoma (Ph-CCA). Robotic platforms integrate the operative field view with intraoperative ultrasound and preoperative 3D planning. ^1-4 LVD is increasingly preferred over portal vein embolization for better liver hypertrophy outcomes in both speed and percentage.⁵ This video demonstrates the feasibility of fully robotic right hepatectomy with common bile duct resection and reconstruction for Ph-CCA after LVD.</p><p><strong>Patients: </strong>A Bismuth 3a Ph-CCA was diagnosed in a 74-year-old female with jaundice. Preoperatively, the patient underwent 3D volumetry and planning and percutaneous drainage of left biliary ducts. The future remnant liver volume increased from 38 to 53% of total liver volume after LVD.</p><p><strong>Technique: </strong>Four robotic trocars and one laparoscopic port were placed, and the da Vinci Xi system was docked. En-bloc regional lymphadenectomy was performed, followed by isolation of the hepatic pedicle elements. After mobilization of the caudate lobe and section of the distal common bile duct, the en-bloc right hepatectomy was carried out. A single biliodigestive anastomosis was performed on B2-3-4 on an antecolic Roux-&-Y jejunal loop. The operative time was 810 min. The blood loss was 500 mL. The patient was discharged on postoperative day 16. The pathology confirmed pT2b N0 (0/11 nodes) R0r R0b^6,7 G2 Ph-CCA.</p><p><strong>Conclusion: </strong>Although this was a very demanding and challenging approach for both the patient and the surgical team, this video demonstrates the feasibility of this management and probably sets the goal for a new standard of care.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145197907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Evaluation of Nozzle Designs for Enhanced Oxaliplatin Delivery in Pressurized IntraPeritoneal Aerosol Chemotherapy: An In Vivo Study of a Porcine Model.","authors":"Elias Karam, Fabian Kockelmann, Petru Bucur, Nicolas Michot, Ali Ouaissi, Sarah Barbay, Laila Ouguerri, Valentina Romdhane, Sébastien Roger, Urs Giger-Pabst, Mehdi Ouaissi","doi":"10.1245/s10434-025-17684-0","DOIUrl":"10.1245/s10434-025-17684-0","url":null,"abstract":"<p><strong>Background: </strong>Various nozzle designs are used in pressurized intraperitoneal aerosol chemotherapy (PIPAC), but comparative in vivo data on their pharmacologic effects are limited.</p><p><strong>Methods: </strong>Three groups of four pigs each received PIPAC with oxaliplatin (92 mg) using nebulizers with different designs: group 1 (full-spray-cone single directional), group 2 (hollow-spray-cone single directional), and group 3 (full-spray-cone multidirectional). Oxaliplatin concentrations (µg/g) were measured in blood, peritoneal tissue, and intra-abdominal fluid using inductively coupled plasma mass spectrometry.</p><p><strong>Results: </strong>No significant differences in mean oxaliplatin concentrations in peritoneal tissue were observed: group 1 (12.37 ± 10.81 µg/g), group 2 (5.83 ± 6.18 µg/g), group 3 (9.46 ± 6.10 µg/g) ( p = 0.1002). However, group 3 had a significantly higher mean total oxaliplatin concentration in visceral peritoneal tissue (3.97 ± 0.63 µg/g) than group 1 (2.6 ± 0.56 µg/g) or group 2 (2.15 ± 0.37 µg/g ( p = 0.028). The mean total tissue uptake was also higher in group 3 (41.98 mg) than in group 1 (28.14 mg) or group 2 (36.65 mg) (p = 0.05). Pairwise comparisons showed no significant differences (group 1 vs group 2 [p = 0.1000], group 2 vs group 3 [p = 0.700]). No significant differences in blood absorption were noted (p = 0.106).</p><p><strong>Conclusion: </strong>The full-spray-cone multidirectional nebulizer design in group 3 resulted in significantly higher oxaliplatin concentrations in the small bowel peritoneum with greater total oxaliplatin tissue uptake than with the two other designs.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7990-7998"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periarterial Divestment of the Superior Mesenteric Artery Utilizing Dual Artery First Approach for Locally Advanced Pancreatic Cancer.","authors":"Thanh Khiem Nguyen, Ham Hoi Nguyen, Tuan Hiep Luong, Dinh Dung Tran, Van Duy Le, Dinh Toi Do, Viet Anh Do, Pisey Chantha","doi":"10.1245/s10434-025-17751-6","DOIUrl":"10.1245/s10434-025-17751-6","url":null,"abstract":"<p><strong>Background: </strong>For locally advanced pancreatic cancer (LAPC) involving the superior mesenteric artery (SMA), periarterial and sub-adventitial divestment offers oncologic efficacy while minimizing postoperative complications and mortality. However, safe and standardized techniques for circumferential SMA dissection remain limited.^1,2 We adopted a dual SMA-first strategy-posterior and left-sided approaches-to improve arterial control, enhance surgical exposure, and ensure procedural safety.</p><p><strong>Patients and methods: </strong>Two patients (a 70-year-old female and a 30-year-old male) with pancreatic uncinate process tumors measuring 34-36 mm, both encasing 180° of the SMA and invading the superior mesenteric vein (SMV), underwent conversion pancreaticoduodenectomy with SMA adventitial divestment and SMV resection. Key operative steps included the Cattell-Braasch maneuver for wide exposure; posterior SMA-first approach for early control and mobilization of a 3-4 cm avascular segment of the artery; and left-sided approach from below the mesentery to access the distal SMA. The inferior pancreaticoduodenal artery (IPDA) and first jejunal artery (JA1) were ligated at their origins to facilitate dissection. A combined proximal-down and distal-up pathway allowed for safe and effective circumferential sub-adventitial divestment. Sharp dissection with angled scissors was employed to minimize vascular trauma, aneurysm formation, or stenosis. The dual approach provided excellent visualization of arterial landmarks and optimal access to the tumor-infiltrated mesopancreas.³ RESULTS: Both patients had uneventful postoperative courses. One developed grade A lymphatic leakage; neither experienced bleeding or pancreatic fistula. Both were discharged within 2 weeks and remained recurrence-free at 20-month follow-up. Literature comparisons highlight lower morbidity and comparable survival in periarterial divestment versus arterial resection.^4,5 CONCLUSIONS: The dual posterior and left-sided SMA-first approach provides a safe, effective, and anatomically strategic method for circumferential SMA divestment in LAPC. Larger series are needed to validate long-term oncologic outcomes.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7448-7449"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144566941","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASO Author Reflections: Toward Precision Imaging: Preoperative Prediction of Early Recurrence in Resected Pancreatic Cancer.","authors":"Xiao Guan, Jinsong Liu, Lei Xu, Wenwen Jiang, Chengfeng Wang","doi":"10.1245/s10434-025-17830-8","DOIUrl":"10.1245/s10434-025-17830-8","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7666-7667"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144616038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intratumoral Lipopolysaccharide Positivity Related to Tumor-Associated Macrophage Infiltration and Poor Prognosis in Esophageal Squamous Cell Carcinoma.","authors":"Shintaro Uchida, Takehiko Yokobori, Kota Yanagisawa, Bilguun Erkhem-Ochir, Gendensuren Dorjkhorloo, Haruka Okami, Chika Katayama, Yuta Shibasaki, Nobuhiro Nakazawa, Chika Komine, Takuya Shiraishi, Takuhisa Okada, Katsuya Osone, Akiharu Kimura, Akihiko Sano, Makoto Sakai, Nobuo Sasaki, Ken Shirabe, Hiroshi Saeki","doi":"10.1245/s10434-025-17773-0","DOIUrl":"10.1245/s10434-025-17773-0","url":null,"abstract":"<p><strong>Background: </strong>Prognosis in esophageal squamous cell carcinoma (ESCC) is influenced by the tumor microenvironment, where CD163-positive M2-like tumor-associated macrophages promote immune suppression and tumor progression. Lipopolysaccharide (LPS), markers of intratumoral microbiota, activate nuclear factor-kappa B (NF-κB) signaling and inflammation. Inflammation-based prognostic scores, such as the lymphocyte-to-monocyte ratio (LMR), are poor prognostic factors in various types of cancers. This study evaluated the impact of intratumoral LPS on systemic inflammation and the tumor microenvironment in ESCC.</p><p><strong>Methods: </strong>Surgical specimens from 134 patients with ESCC were analyzed. Immunohistochemical staining was performed to evaluate intratumoral LPS positivity and its associations with clinicopathological factors, prognosis, inflammation-based prognostic scores, including LMR, CD163-positive TAM infiltration, and nuclear NF-κB expression, and tumoral vimentin expression as an epithelial-mesenchymal transition/mesenchymal marker in patients with ESCC.</p><p><strong>Results: </strong>LPS was identified in ESCC cell nuclei and cytoplasm. High intratumoral LPS positivity was associated with N factor progression, high NF-κB nuclear positivity, low LMR, and high stromal CD163-positive TAM infiltration, and it served as an independent poor prognostic factor. Lipopolysaccharide positivity was significantly related to poor prognosis in CD163-positive TAM cases, compared with LPS negativity.</p><p><strong>Conclusions: </strong>Detection of LPS in resected ESCC tissues could be a reliable biomarker for identifying high-risk patients with aggressive tumor characteristics, systemic inflammation, and impaired tumor immunity.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"8013-8023"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144590329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Precision Surgery: Totally Laparoscopic Transduodenal Ampullectomy : A Combined Approach Aims for Margin Resection Success.","authors":"Nuria Blanco, Daniel Aliseda, Gabriel Zozaya, Pablo Martí-Cruchaga, Adriana Uriz, Lucas Sabatella, Alberto Benito, Fernando Rotellar","doi":"10.1245/s10434-025-17780-1","DOIUrl":"10.1245/s10434-025-17780-1","url":null,"abstract":"<p><strong>Introduction: </strong>Adenomas are premalignant lesions of the ampulla of Vater and should therefore be resected.¹ Three approaches are accepted: pancreatoduodenectomy and surgical and endoscopic ampullectomy.^2,3 When endoscopic management is not amenable, a transduodenal minimally invasive ampullectomy is the less aggressive option. Complete resection is paramount to avoid local recurrence. We present a combined approach to maximize the precision of this demanding procedure.</p><p><strong>Patient and methods: </strong>A 64-year-old female patient, following an episode of acute pancreatitis, was diagnosed with a lesion of the ampulla of Vater. An endoultrasound-guided biopsy revealed an ampullary adenoma with low-grade dysplasia. Its growth along the duct made it not amenable for endoscopic resection. Consequently, a laparoscopic ampullectomy was then proposed. To obtain optimal free margins, a combined strategy was designed: the use of a choledochoscope (allowing for a direct view of the lesion limits), intraoperative ultrasound (to rule out possible intramural tumor growth), and indocyanine green (used to identify the bile duct and also in the filling of a Fogarty Catheter² inserted in the common bile duct to do a traction of the tumor/ampulla to expose the free margins).</p><p><strong>Results: </strong>Operative time was 416 min. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. Pathology reported a well-demarcated ampullary adenoma with low-grade dysplasia and free margins. Twenty-four months after surgery, the patient is asymptomatic with no evidence of recurrence.</p><p><strong>Conclusions: </strong>Transduodenal minimally invasive ampullectomy is a demanding procedure. The combined use of technologies herein presented warrants a precision surgery allowing for a free-margin anatomical resection.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7446-7447"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648323","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASO Author Reflections: Perioperative 5-Fluorouracil and Portal Vein Infusion Chemotherapy Followed by Adjuvant S-1 for Resected Pancreatic Cancer (TOSPAC-02)-A Phase 2 Clinical Trial.","authors":"Minoru Kitago, Yutaka Endo, Yuko Kitagawa","doi":"10.1245/s10434-025-17876-8","DOIUrl":"10.1245/s10434-025-17876-8","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7452-7453"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ASO Author Reflections: Diabetic and Nutritional Management After Total or Completion Pancreatectomy: Current Status and Future Perspectives.","authors":"Tomotaka Kato, Yoshihiro Ono, Toru Kitazawa, Kosuke Kobayashi, Atsushi Oba, Takafumi Sato, Hiromichi Ito, Yosuke Inoue, Akio Saiura, Yu Takahashi","doi":"10.1245/s10434-025-17885-7","DOIUrl":"10.1245/s10434-025-17885-7","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7465-7466"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Impact of Multidisciplinary Conference on Clinicians.","authors":"Elizabeth Clement, Armaghan Alam, Claire Lange, Wenjie Lin, Amandeep Ghuman, Ahmer A Karimuddin, P Terry Phang, Manoj J Raval, Carl Brown","doi":"10.1245/s10434-025-17979-2","DOIUrl":"10.1245/s10434-025-17979-2","url":null,"abstract":"<p><strong>Background: </strong>Multidisciplinary conferences (MDC) for rectal cancer yield benefits to patients; however, whether they confer benefits to clinicians has not been explicitly investigated. This qualitative study evaluates the impact of our local rectal cancer MDC on physician participants.</p><p><strong>Materials and methods: </strong>Semi-structured interviews were conducted via a virtual video-calling platform and recorded and transcribed. Participants included staff clinicians and fellowship-level trainees from medical oncology, radiation oncology, surgery, radiology, and pathology, all of whom participate in our weekly rectal cancer MDC. Qualitative analysis using NVivo was completed, and themes and subthemes were coded and tabulated using a constant comparative method.</p><p><strong>Results: </strong>A total of 21 clinicians participated in the study, representing all five disciplines. Four major themes were identified: benefits, challenges, successes, and improvements. The most significant major theme was benefits, discussed by all 21 participants. Subthemes in this category were benefits to clinicians, which included academic opportunities and strengthening of interdisciplinary communication and collegiality. Major themes also included challenges and successes, mentioned in all interviews, as well as improvements, which were mentioned in most interviews. Subthemes in the challenges category included timing of meetings and workload. Subthemes for successes included the virtual platform as well as adequate representation and administrative support.</p><p><strong>Conclusions: </strong>Multidisciplinary conference has added value beyond that which is experienced by patients. This includes enhanced interdisciplinary communication and collegiality, which in turn can impact overall physician satisfaction. Challenges are inherent, including workload and accessibility; however, these can be balanced with administrative support and virtual platform.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7344-7350"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144783348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Lymph Node Staging in Extremity Rhabdomyosarcoma: The EpSSG RMS 2005 Trial Experience.","authors":"Sheila Terwisscha van Scheltinga, Johannes H M Merks, Florent Guerin, Timothy Rogers, Ross J Craigie, Gabriela Guillén, Federica De Corti, Patrizia Dall'Igna, Raquel Dávila Fajardo, Gianni Bisogno, Andrea Ferrari, Daniel Orbach, Meriel Jenney, Julia C Chisholm, Véronique Minard-Colin, Maya Cesen, Nina Jehanno, Laura S Hiemcke-Jiwa, Ilaria Zanetti, Beatrice Coppadoro, Alida F W van der Steeg, Max M van Noesel, Marc H W A Wijnen","doi":"10.1245/s10434-025-17908-3","DOIUrl":"10.1245/s10434-025-17908-3","url":null,"abstract":"<p><strong>Background: </strong>The European pediatric soft tissue Sarcoma Study Group (EpSSG) RMS 2005 study recommends a lymph node biopsy for extremity rhabdomyosarcoma (RMS). The aim of our study was to analyze the results of the lymph node sampling strategies used, such as sentinel node biopsy (SNB) and nodal sampling (NS), and compare the outcome of patients undergoing different nodal staging techniques.</p><p><strong>Methods: </strong>All non-metastatic (M0) patients registered in the EpSSG RMS 2005 study with an RMS of the extremity, presenting between 2005 and 2016, were included for analysis of the lymph node sampling techniques used. The secondary objective was to compare the results and outcome for the different sampling procedures.</p><p><strong>Results: </strong>Of 198 patients, 144 had clinically/radiologically negative nodes (cN0), and 72/144 underwent a biopsy (26 SNB/46 NS). Final nodal status was upstaged to pN1 in 11/72 (15.3%) patients-6 after SNB and 5 after NS. In 54 radiologically malignant/suspicious-appearing nodes, 34 NS biopsies were performed, resulting in downstaging to N0 in 9/34 (26.5%) patients. 5-years overall survival (OS) of N0 patients versus N1 patients was 82.5% (95% confidence interval CI 74.7-88.0) versus 46.5% (95% CI 32.2-59.7). 5-years OS in N0 patients was not significantly different in biopsied and non-biopsied patients (p = 0.88). However, in N1 patients, survival was significantly better in biopsied compared with non-biopsied patients (p = 0.006).</p><p><strong>Conclusion: </strong>Lymph node staging plays a crucial role in determining appropriate treatment strategies. Pathology of sampled lymph nodes can upstage or downstage the lymph node status, guiding treatment decisions based on the stage.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7751-7761"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454586/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}