Annals of Surgical Oncology最新文献

{"title":"Resectable Pancreatic Cancer with CA19-9 > 500 U/mL: A Biological Indicator for Survival Benefit with Intensive Neoadjuvant Chemotherapy.","authors":"Kojiro Omiya, Atsushi Oba, Kota Sugiura, Aya Maekawa, Takafumi Mie, Kosuke Kobayashi, Yoshihiro Ono, Takashi Sasaki, Masato Ozaka, Naoki Sasahira, Hiromichi Ito, Yosuke Inoue, Yu Takahashi","doi":"10.1245/s10434-025-17407-5","DOIUrl":"10.1245/s10434-025-17407-5","url":null,"abstract":"<p><strong>Background: </strong>While anatomical resectability guides pancreatic cancer treatment, carbohydrate antigen (19-9 (CA19-9) serves as a biological indicator of disease burden. Current guidelines suggest considering neoadjuvant chemotherapy (NAC) for cases with markedly elevated CA19-9, but specific threshold values and treatment strategies remain undefined. This retrospective study aimed to evaluate the efficacy of intensive NAC using gemcitabine plus nab-paclitaxel or fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) for anatomically resectable pancreatic cancer with elevated CA19-9 (> 500 U/mL).</p><p><strong>Patients and methods: </strong>We analyzed patients with anatomically resectable pancreatic cancer and CA19-9 > 500 U/mL treated between 2014 and 2022. Initial planned treatments were either 4-month intensive NAC followed by surgery (NAC group) or upfront surgery (UPS group). Survival outcomes were evaluated using retrospective intention-to-treat analysis.</p><p><strong>Results: </strong>Among 184 included patients, 46 received NAC and 138 underwent upfront surgery. The NAC group demonstrated significantly improved overall survival compared with the UPS group (median 52.7 vs. 22.7 months, P < 0.001). Resection rates were 89.1% and 76.1% in the NAC and UPS groups, respectively. Among resected cases, the NAC group achieved higher lymph node-negative resection rates (53.7% vs. 23.8%, P < 0.001) and better post-resection CA19-9 normalization rates (75.6% vs. 56.1%, P = 0.037). Survival benefits were maintained even in cases with CA19-9 > 2000 U/mL (median OS 52.7 vs. 18.9 months, P = 0.025).</p><p><strong>Conclusions: </strong>CA19-9 > 500 U/mL serves as an effective indicator for implementing intensive NAC in anatomically resectable pancreatic cancer. This biomarker-based strategy effectively extracts the beneficial group from NAC, prolonging survival outcomes through better systemic disease control.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5411-5420"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967766","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":"Editorial: Highlighting Repeat Diagnostic Laparoscopy After Chemotherapy in Initially Unresectable Colorectal and Appendiceal Peritoneal Metastases.","authors":"Michael G White, Oliver S Eng","doi":"10.1245/s10434-025-17373-y","DOIUrl":"10.1245/s10434-025-17373-y","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5380-5381"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143974626","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: Deciphering Cytologic Uncertainty in Bile Duct Strictures.","authors":"Kayla R Lieb, Muizz Zaman, Mashaal Dhir","doi":"10.1245/s10434-025-17382-x","DOIUrl":"10.1245/s10434-025-17382-x","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5722-5723"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971402","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: A New Proposal for Therapeutic Strategies in Patients with High-Grade Pancreatic Intraepithelial Neoplasia at the Pancreatic Transection Margin in Pancreatic Ductal Adenocarcinoma.","authors":"Kei Kobayashi, Yu Sawada, Kota Sahara, Yutaro Kikuchi, Kentaro Miyake, Yasuhiro Yabushita, Yuki Homma, Takafumi Kumamoto, Ryusei Matsuyama, Itaru Endo","doi":"10.1245/s10434-025-17508-1","DOIUrl":"10.1245/s10434-025-17508-1","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5432-5433"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172539","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":"Longitudinal Trajectory of Patient-Reported Fatigue in Patients Undergoing Thoracoscopic Lung Cancer Surgery.","authors":"Zijie Li, Junhan Wu, Chaojian Chen, Chaofan Liu, Rixin Chen, Shujie Huang, Cheng Deng, Qiuling Shi, Guibin Qiao","doi":"10.1245/s10434-025-17444-0","DOIUrl":"10.1245/s10434-025-17444-0","url":null,"abstract":"<p><strong>Background: </strong>Postoperative fatigue is widely recognized as one of the most prevalent adverse effects of surgery, representing a critical determinant of functional recovery and quality of life. However, fatigue is commonly measured at a single time point, failing to capture its dynamic nature. This study aimed to characterize the longitudinal trajectories of postoperative fatigue and identify the potential factors.</p><p><strong>Methods: </strong>This retrospective study included patients with lung cancer who underwent thoracoscopic surgery between March 2021 and October 2023. Patients completed the Perioperative Symptom Assessment for Lung Surgery Scale (PSA-Lung) daily for 7 days after surgery. Latent class mixed modeling was used to analyze the longitudinal patient-reported data and identify subgroups based on trajectory features.</p><p><strong>Results: </strong>A total of 1,096 patients were included. Three-cluster trajectory model provided the best fit, consisting of deterioration-fatigue group (17.7%), recovery-fatigue group (31.4%) and mild-fatigue group (50.9%). Compared with the mild-fatigue group, patients with comorbidities had a higher risk of being categorized into the recovery-fatigue group (odds ratio 1.44, 95% confidence interval 1.02-2.04; p = 0.040). The presence of recovery-fatigue was associated with lower preoperative hemoglobin level (p = 0.025). Moreover, lower preoperative body mass index and albumin level increased the likelihood of being classified as the deterioration-fatigue group (p = 0.022 and p = 0.026, respectively).</p><p><strong>Conclusions: </strong>This study elucidated the heterogeneity of fatigue trajectories, with half of the patients experiencing either recovery-fatigue or deterioration-fatigue. The severity of postoperative fatigue was found to be worse in patients with comorbidities or poor nutritional status.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5957-5964"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144092572","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: Cancer Surgery in Infants and Children: Developing an International Consensus.","authors":"Elisabeth T Tracy, Peter F Ehrlich, Jennifer H Aldrink, David Rodeberg","doi":"10.1245/s10434-025-17548-7","DOIUrl":"10.1245/s10434-025-17548-7","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5772-5773"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191370","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":"National Guidelines for Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Peritoneal Malignancies: A Worldwide Systematic Review and Recommendations of Strength Analysis.","authors":"Marco Tonello, Carola Cenzi, Elisa Pizzolato, Manuela Martini, Pierluigi Pilati, Antonio Sommariva","doi":"10.1245/s10434-025-17518-z","DOIUrl":"10.1245/s10434-025-17518-z","url":null,"abstract":"<p><strong>Background: </strong>National guidelines (GLs) for surgical cytoreduction (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in the management of peritoneal malignancies (PMs) vary across countries, scientific societies, and government agencies. This study aimed to systematically review and compare the recommendations for CRS/HIPEC in the treatment of ovarian cancer (EOC), gastric cancer, colorectal cancer (CRC), mesothelioma, and pseudomyxoma peritonei (PMP).</p><p><strong>Methods: </strong>Medical databases, search engines, and national websites of 193 countries were queried using artificial intelligence (AI)-powered software for scientific societies and/or government agencies guidelines. The study excluded consensus statements and guidelines without appropriate references. Non-English guidelines were translated, and data, including GRADE strength of recommendations, were extracted.</p><p><strong>Results: </strong>The study analyzed 138 guidelines, 24 for gastric cancer, 36 for colorectal cancer, 29 for primary ovarian cancer (p-)EOC, 28 for recurrent ovarian cancer (r-)EOC, 10 for mesothelioma, and 11 for PMP. Guidelines were retrieved from 51 (26.4%) nations, mostly from developed countries (62.1%; p < 0.001). The CRS procedure received robust positive recommendations (GRADE I/IIa) for CRC (74.2%), p-/r-EOC (100%/78.5%), PMP (90.9%), and mesothelioma (90.0%). Conversely, CRS was not indicated for gastric cancer (61.6%, GRADE III; p < 0.001). The HIPEC procedure had robust positive recommendations for PMP (90.9%) and mesothelioma (90.0%), but was controversial for p-EOC (42.3%) and CRC (38.0%) and contraindicated for r-EOC (80.0%) and gastric cancer (62.4%) (p < 0.001).</p><p><strong>Conclusion: </strong>National guidelines concordantly recommend CRS for colorectal cancer, ovarian cancer, PMP, and mesothelioma. In contrast, HIPEC recommendations are less homogeneously shared, except for PMP and mesothelioma. No positive concordance exists among guidelines on gastric cancer for CRS nor HIPEC. Furthermore, high-level evidence is needed to strengthen future guidelines on peritoneal metastases.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5795-5806"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141308","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":"ASO Author Reflections: Tumor Size as a Determinant of Anatomic Resection Benefit in Intrahepatic Cholangiocarcinoma.","authors":"Jun Kawashima, Miho Akabane, Timothy M Pawlik","doi":"10.1245/s10434-025-17315-8","DOIUrl":"10.1245/s10434-025-17315-8","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5720-5721"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143952319","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":"Post-Mastectomy Flat Closure: A Mixed-Methods Analysis of Patient Outcomes and Perspectives.","authors":"Daniel Soroudi, Nisha Parmeshwar, Aileen Gozali, Merisa Piper","doi":"10.1245/s10434-025-17288-8","DOIUrl":"10.1245/s10434-025-17288-8","url":null,"abstract":"<p><strong>Background: </strong>Understanding the psychosocial impact of mastectomy is crucial for guiding patient decisions on breast reconstruction. The BREAST-Q survey has been instrumental in assessing patient satisfaction. This study examines patient-reported outcomes and experiences with post-mastectomy flat closure, aiming to refine decision-making support for this option.</p><p><strong>Methods: </strong>A retrospective review analyzed flat closure outcomes post-mastectomy, examining patient demographics, surgical details, and complications. Following consent, patients completed the BREAST-Q survey, rating satisfaction and factors influencing their choice for flat closure. The study also included qualitative analysis from patient emails, employing an inductive, triangulated approach to extract themes and provide a multifaceted understanding of the post-surgical experience.</p><p><strong>Results: </strong>Overall, 252 patients underwent flat closure post-mastectomy. The overall postoperative complication rate was 17.5% (n = 44); 19.8% (n = 50) completed the BREAST-Q survey, reporting high satisfaction with their surgeons, moderate satisfaction with their breasts, and high physical well-being. Survey results illuminated reasons for choosing flat closure, such as lower complication rates and avoidance of foreign objects. Furthermore, qualitative feedback from 15 email correspondents revealed some limitations of the survey's relevance and language, highlighting emotional impacts and a desire to improve future surveys.</p><p><strong>Conclusions: </strong>This study distills the flat closure experience post-mastectomy, highlighting its viability and alignment with patient preferences for fewer complications and quicker recovery. It reveals the BREAST-Q's limitations in fully capturing patients' nuanced experiences, underscoring the necessity for more tailored data collection methods. Future research must refine patient-reported outcome measures (PROMs) and ensure flat closure is a routinely discussed option in post-mastectomy care.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5827-5837"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961498","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":"Usefulness of Geriatric Parameters in Preoperative Evaluation of Patients Undergoing Minimally Invasive Surgery for Endometrial Cancer: A Retrospective Cohort Study.","authors":"Jonas Jean Mathieu Vibert, Franziska Siegenthaler, Flurina A M Saner, Stefan Mohr, Michael D Mueller, Sara Imboden","doi":"10.1245/s10434-025-17376-9","DOIUrl":"10.1245/s10434-025-17376-9","url":null,"abstract":"<p><strong>Introduction: </strong>Patients operated for endometrial cancer (EMCA) are typically elderly with multiple comorbidities, potentially impacting surgical outcomes and survival. This study evaluated the prognostic value of frailty and frailty-related scores in predicting perioperative morbidity and survival in EMCA patients undergoing minimally invasive surgery.</p><p><strong>Methods: </strong>This retrospective cohort study included 289 patients from the Sentinel Database treated for EMCA at Bern University Hospital (2012-2020). Patients underwent minimally invasive hysterectomy with sentinel lymph node dissection (39%) or additional radical lymphadenectomy (61%). Frailty was assessed using the Age-Adjusted Charlson Comorbidity Index (ACCI), modified Frailty Index (mFI), 5-item mFI (mFI-5), American Society of Anesthesiologists (ASA) scores, and independent parameters. Primary outcomes included perioperative complications, hospital stay, recurrence-free survival (RFS), and overall survival (OS).</p><p><strong>Results: </strong>Median age was 65 years (range 26-94) and median follow-up was 41 months (0-105). ACCI > 4 (23.2%) was the strongest predictor of postoperative complications (p = 0.025), prolonged hospitalization (p = 0.03), and reduced OS (hazard ratio [HR] 2.57, 95% confidence interval [CI] 1.18-5.60; p = 0.018). Multivariable analysis confirmed ACCI > 4 (HR 2.24, 95% CI 1.02-4.90; p = 0.044), European Society for Medical Oncology (ESMO) risk group (HR 1.61, 95% CI 1.24-2.07; p < 0.001), hemoglobin (HR 1.03, 95% CI 1.00-1.05; p = 0.033), and congestive heart failure (HR 6.29, 95% CI 1.35-29.27; p =0.019) were significant predictors of OS. Radical lymphadenectomy (p < 0.001), ACCI > 4 (p = 0.025), and age > 70 years (p = 0.034) increased complication risks.</p><p><strong>Conclusions: </strong>ACCI > 4 is a practical tool for preoperative risk assessment and predicting surgical tolerance and survival, and is therefore applicable for guiding surgical decisions and personalized care in patients with EMCA.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5603-5615"},"PeriodicalIF":3.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12222292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085680","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}