Annals of Surgical Oncology最新文献

{"title":"The Landmark Series: Evaluation and Management of Adrenal Incidentalomas.","authors":"Lily Owei, Heather Wachtel","doi":"10.1245/s10434-025-17296-8","DOIUrl":"10.1245/s10434-025-17296-8","url":null,"abstract":"<p><p>Adrenal incidentalomas are adrenal masses ≥ 1 cm discovered on imaging studies for unrelated clinical conditions. The prevalence of adrenal incidentalomas has increased as a byproduct of the widespread use of cross-sectional imaging, particularly in older adults. The clinical significance of adrenal incidentalomas varies based on tumor size, hormonal activity, and imaging characteristics. While most adrenal incidentalomas are benign and asymptomatic, a significant minority are hormonally active or malignant, necessitating careful evaluation and management. Adrenal hormone secretion can have significant clinical implications. Biochemical testing is crucial to assess for hormone excess, including steroid hormones (mineralocorticoids, glucocorticoids, and androgens), which are made in the adrenal cortex, as well as catecholamines, which are made in the adrenal medulla. Non-contrast computed tomography (CT) is the preferred modality for evaluating adrenal nodules as it allows for assessment of tissue density in Hounsfield units (HU). Benign lesions typically have an homogeneous appearance with HU ≤ 10. Contrast-enhanced CT with delayed washout can help differentiate benign tumors from malignant tumors. Tumors ≥ 4 cm, or those with indeterminate features may require further imaging, such as magnetic resonance imaging (MRI) or positron emission tomography (PET)/CT. The management of adrenal incidentalomas is determined by hormonal secretion and imaging characteristics. Surgical resection is recommended for functional tumors and those that are suspicious for malignancy, including tumors ≥ 4 cm in size and those with rapid growth. Non-functional tumors < 4 cm may undergo imaging surveillance. The goal of this review is to summarize the contemporary literature and guidelines on adrenal incidentalomas, and to describe the key principles regarding evaluation and management.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4712-4719"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975094","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}

{"title":"Surgical Strategy for Pediatric Liver Tumors Involving the Hepatic Venous Confluence and the Inferior Vena Cava.","authors":"Juri Fuchs, Lucas Rabaux-Eygasier, Geraldine Hery, Virginie Fouquet, Florent Guerin, Stephanie Franchi-Abella, Sophie Branchereau","doi":"10.1245/s10434-025-17245-5","DOIUrl":"10.1245/s10434-025-17245-5","url":null,"abstract":"<p><strong>Background: </strong>Pediatric liver tumors presenting as centrally located masses with contact to or even invasion of all three hepatic veins (HVs) and the inferior vena cava (IVC) present significant surgical challenges. While liver transplantation may be indicated in truly unresectable tumors, extended liver resection with vascular reconstruction can be an organ-preserving alternative.</p><p><strong>Objective: </strong>This study aimed to present a reference center's strategy for children with liver tumors involving the hepatic venous confluence or the retrohepatic IVC who underwent extended liver resection with vascular reconstruction.</p><p><strong>Methods: </strong>All pediatric patients undergoing major hepatectomy with reconstruction of an HV or the IVC over a 10-year study period were included. Preoperative imaging, surgical techniques, and short- and long-term postoperative data were analyzed.</p><p><strong>Results: </strong>From a total of 125 pediatric major hepatectomies, 17 children (15 hepatoblastoma, two undifferentiated embryonal sarcoma) underwent liver resection with vascular reconstruction of an HV or the IVC. In nine cases an HV was reconstructed, and in eight children, a partial resection of the IVC was performed. Total vascular exclusion of the liver was applied in 16/17 cases. No 90-day postoperative mortality, no major postoperative complication, and no local relapse occurred; 16/17 patients are alive without relapse at a median follow-up of 44 months (range 19-111).</p><p><strong>Conclusion: </strong>This is the largest single-center series to report major hepatectomies with HV or IVC reconstruction in children. In specialized centers, these complex procedures are associated with excellent outcomes. Successful tumor resection can be achieved in selected cases even in locally advanced tumor stages.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5327-5337"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12130149/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727155","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}

{"title":"Is Laparoscopic Microwave Ablation Truly Noninferior to Percutaneous Ablation in Early Stage Hepatocellular Carcinoma? A Critical Reassessment.","authors":"Ahmad Reza Badali, Nariman Nezami","doi":"10.1245/s10434-025-16922-9","DOIUrl":"10.1245/s10434-025-16922-9","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5037-5038"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999118","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":"Comment on \"Prevalence and Association of Sarcopenia with Mortality in Patients with Head and Neck Cancer: A Systematic Review and Meta-analysis\".","authors":"Erkan Topkan, Efsun Somay, Uğur Selek","doi":"10.1245/s10434-025-17023-3","DOIUrl":"10.1245/s10434-025-17023-3","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5279-5280"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143424749","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":"A Systematic Review of Surgical Strategies for Managing Major Thoracic Vessels in Thoracic Oncology.","authors":"Leonardo Duranti, Luca Tavecchio, Rolli Luigi, Matteo Calderoni, Piergiorgio Solli","doi":"10.1245/s10434-025-17159-2","DOIUrl":"10.1245/s10434-025-17159-2","url":null,"abstract":"<p><strong>Background: </strong>The management of locally advanced thoracic malignancies, particularly those involving critical vascular structures, presents substantial surgical challenges. Surgery remains a cornerstone of treatment for these conditions, yet the involvement of the superior vena cava (SVC), pulmonary artery (PA), aorta, and thoracic outlet vessels complicates the process.</p><p><strong>Methods: </strong>The literature search was performed from January 1990 to January 2025 in PubMed, Embase, and Cochrane according to PRISMA guidelines.</p><p><strong>Results: </strong>Through the process of evidence acquisition, 78 types of research were identified: 27 focusing on SVC, and 25 focusing on PA, 15 focusing on the aorta, and 11 focusing on thoracic outlet vessels. The findings indicated that surgical management of the SVC and PA, although feasible, carries significant risks. The perioperative mortality for SVC surgeries ranged from 0 to 17%, with morbidity varying between 0 and 50%. For PA surgeries, the perioperative mortality ranged from 0 to 17.2% and morbidity ranged from 0 to 62%. Extended resections, including partial and total aortic resections, offered long-term survival rates of 25% to 40% for carefully selected patients.</p><p><strong>Conclusion: </strong>Vascular reconstructions, such as subclavian artery resection followed by bypass, demonstrated a 70% success rate with a 35% 5-year survival rate. Vascular reconstructive techniques significantly extend surgical resection options, offering lung-sparing procedures for patients with bulky mediastinal masses and avoiding pneumonectomy in functionally challenging cases. Although advancements such as aortic endografting and cardiopulmonary bypass have improved outcomes, challenges such as hemorrhage, vascular injury, and neurologic deficits persist.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4690-4704"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646831","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: Removing the Element of Surprise: Reducing Unplanned Excisions to Enhance Dermatofibrosarcoma Protuberans Outcomes.","authors":"Leah K Winer, Jeffrey M Farma, Anthony M Villano","doi":"10.1245/s10434-025-17177-0","DOIUrl":"10.1245/s10434-025-17177-0","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5367-5368"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690890","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":"Pre-existing Mental Health Disorders are Associated with Disparities in Gastric Cancer Care: An American Combined Safety Net and Teaching Hospital Experience.","authors":"Morgan F Pettigrew, Andres A Abreu, Amr I Al Abbas, John D Karalis, Rodrigo E Alterio, Cecilia G Ethun, Patricio M Polanco, John C Mansour, Adam C Yopp, Herbert J Zeh, Sam C Wang, Matthew R Porembka","doi":"10.1245/s10434-025-17232-w","DOIUrl":"10.1245/s10434-025-17232-w","url":null,"abstract":"<p><strong>Introduction: </strong>Delay in gastric cancer diagnosis is associated with inferior outcomes. The effects of pre-existing mental health disorders (MHDs) on delays in gastric cancer diagnosis and treatment disparities are not well-understood. In this study, we evaluated the impact of MHDs on time to gastric cancer diagnosis and receipt of guideline-concordant treatment.</p><p><strong>Methods: </strong>We performed a retrospective review of patients diagnosed with gastric adenocarcinoma between 2015 and 2022. Patients with pre-existing diagnoses of mood, affective, and substance use disorders were classified as having an MHD. Univariable and multivariable regression were used to analyze the association between MHDs and delay in diagnosis. The association between MHD and receipt of guideline-concordant care was also evaluated.</p><p><strong>Results: </strong>Overall, 460 patients diagnosed with gastric cancer were included in the analytic group. Seventy patients (15%) had an MHD prior to their cancer diagnosis, of whom 34 (49%) experienced a delay in diagnosis, compared with 109 (28%) without an MHD. On multivariable regression, patients with an MHD were more likely to experience a delay in diagnosis (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.58-5.11; p < 0.001) and have more than one visit to a provider prior to diagnosis (OR 2.71, 95% CI 1.37-5.37; p = 0.004). Patients with an MHD were also less likely to receive guideline-concordant care for their gastric cancer (OR 0.29, 95% CI 0.12-0.67; p = 0.004).</p><p><strong>Conclusions: </strong>MHD is a patient-level factor that negatively impacts gastric cancer care. Addressing provider knowledge gaps and increasing efforts to counter the social stigma and implicit bias associated with MHD may improve the time to diagnosis and receipt of guideline-concordant care in this at-risk population.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5154-5164"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750867","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":"Pancreatoduodenectomy with En Bloc Superior Mesenteric Artery and Vein Resection Under Temporary Mesenterico-Portal Venous Shunt: The Strasbourg Technique.","authors":"Philippe Bachellier, Pierre de Mathelin, Pietro Addeo","doi":"10.1245/s10434-025-17271-3","DOIUrl":"10.1245/s10434-025-17271-3","url":null,"abstract":"<p><strong>Background: </strong>Pancreatectomies with superior mesenteric artery (SMA) resection are technically challenging.¹ With the advent of FOLFIRNOX chemotherapy, resection of the SMA is performed in selected patients with locally advanced pancreatic cancer (LAPC),^2-10 in centers of excellence by highly skilled pancreatic-vascular surgeons treating a large volume of LAPCs.^4-10 METHODS: The patient was a 64-year-old female with an LAPC treated with 11 cycles of FOLFIRINOX induction chemotherapy. The SMA, the superior mesenteric vein (SMV), and a replaced right hepatic artery (r-RHA) were encased. A temporary mesenterico-portal shunt (TMPS), using a 25 cm Goretex tube between the origin of the SMV and the right side of the portal vein,¹¹ was used. This TMPS (1) lessens portal hypertension in case of SMV obstruction; (2) maintains adequate liver venous perfusion during dissection; (3) gives the mesentery enough mobility to avoid graft for SMA resection; and (4) avoids simultaneous venous and arterial clamping. A mesenteric approach was performed to isolate the SMA.¹² Upon heparin bolus, the r-RHA was re-implanted on the gastroduodenal artery stump, the SMA on the aorta, the SMV on the portal vein, and the splenic vein on the left renal vein.</p><p><strong>Results: </strong>Postoperative course was uneventful. Pathology showed pT4N0R1 pancreatic adenocarcinomas. Three years later, the patient recurred on the left adrenal gland and was treated by external radiotherapy. Five years later, the patients is alive under chemotherapy.</p><p><strong>Conclusions: </strong>Pancreaticoduodenectomy with SMA and SMV using a transitory mesentericoportal shunt (The Strasbourg technique) is a standardized technique used to manage patients with LAPC at our unit.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5104-5105"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762855","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":"Axillary Surgery After Neoadjuvant Chemotherapy for Breast Cancer: Population-Based Trends Over Time.","authors":"Ekaterina Kouzmina, Matthew Castelo, Nicole J Look Hong, Julie Hallet, Natalie Coburn, Frances C Wright, Lena Nguyen, Sonal Gandhi, Katarzyna J Jerzak, Andrea Eisen, Amanda Roberts","doi":"10.1245/s10434-025-17236-6","DOIUrl":"10.1245/s10434-025-17236-6","url":null,"abstract":"<p><strong>Background: </strong>Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NAC) is recommended for patients initially presenting with cN1 disease and evidence of clinical/imaging response after NAC. We aimed to describe real-world population changes in management.</p><p><strong>Methods: </strong>We completed a population-based cohort study including adult women undergoing NAC followed by surgery for cT1-3N1 breast cancer between 1 April 2012 and 31 January 2020 in Ontario, Canada. Axillary surgeries (SLNB, axillary lymph node dissection [ALND], or SLNB followed by ALND) were studied over time using the Cochran-Armitage test, while multivariable logistic regression evaluated factors associated with surgery type.</p><p><strong>Results: </strong>Overall, 2563 patients were analyzed (37.9% were HER2-positive [HER2+ve], 42.3% were hormone receptor-positive and HER2-ve [HR+/HER2-ve], and 19.8% were triple-negative [TN]). 593 (23.1%) patients underwent SLNB and 1860 (72.6%) underwent ALND, while 110 (4.3%) patients underwent SLNB + ALND. From 2012 to 2020, SLNB increased from 5.7 to 29.9% (p < 0.01) and SLNB + ALND increased from 1.7 to 4.7% (p < 0.01), while ALND decreased from 92.6 to 65.4% (p < 0.01). Similar trends were identified across all receptor groups. After adjustment, patients who underwent SLNB had fewer comorbidities (odds ratio [OR] 1.82, 95% confidence interval [CI] 1.03-3.19), smaller tumors (T2 vs. T3: OR 1.52, 95% CI 1.21-1.92; T1 vs. T3: OR 1.56, 95% CI 1.14-2.13), and had surgery later in the study period (OR 1.32, 95% CI 1.25-1.38).</p><p><strong>Conclusion: </strong>In alignment with current practice guidelines, de-escalation of axillary surgery to SLNB has increased over time for patients after breast cancer NAC.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4865-4873"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143778963","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":"Invited Editorial About: Tailored Surgery for Medullary Thyroid Cancer (MTC) Based on Pretherapeutic Basal Calcitonin and Intraoperative Diagnosis of Desmoplastic Stroma Reaction: A Proposal for a New Surgical Concept.","authors":"Gabriela L Aitken, Olivia M DeLozier, Paxton V Dickson","doi":"10.1245/s10434-025-17283-z","DOIUrl":"10.1245/s10434-025-17283-z","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4575-4577"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143959129","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}