Annals of Surgical Oncology最新文献

{"title":"Joint Nasogastric Tube Versus Traditional Decompression Nasogastric Tube to Guided OGT-Overlap Esophagojejunostomy in Laparoscopic Total Gastrectomy: A Randomized Controlled Trial.","authors":"Xinhua Chen, Zhijing Yang, Huilin Huang, Chuanjin Xu, Guoxin Li, Yanfeng Hu, Tian Lin, Jiang Yu","doi":"10.1245/s10434-025-17302-z","DOIUrl":"10.1245/s10434-025-17302-z","url":null,"abstract":"<p><strong>Background: </strong>Our team pioneered the use of a joint nasogastric tube (JNT) for pairing overlap-esophagojejunostomy guiding tube (OGT) in an OGT-overlap esophagojejunostomy, demonstrating its safety and efficacy.</p><p><strong>Objective: </strong>We aimed to compare the safety and efficacy of a novel technique, the JNT, with traditional nasogastric tubing (TNT) in guiding OGT-overlap esophagojejunostomy.</p><p><strong>Methods: </strong>From January 2023 to January 2024, a total of 108 gastric/gastroesophageal junction (G/GEJ) cancer patients undergoing laparoscopic total gastrectomy (LTG) were eligible for inclusion in this study; however, 2 patients were excluded as they underwent hyperthermic intraperitoneal chemotherapy (HIPEC) after surgery. Patients were randomized into two groups: the JNT-OGT-overlap esophagojejunostomy group (JNT group; n = 53) or the TNT-OGT-overlap esophagojejunostomy group (TNT group; n = 53).</p><p><strong>Results: </strong>The JNT group had a significantly higher success rate for nasogastric tube (NT) insertion into the esophageal stump on the first attempt (90.6% vs. 58.5%; p < 0.001). Additionally, the insertion times were reduced by 6/7 of their original duration (15 [21] vs. 100 [120] sec; p < 0.001)], and connection times for OGT and NT were shortened to 2/5 of their original duration (90 [63] vs. 220 [130] sec; p < 0.001). Esophagojejunostomy time was also shorter in the JNT group (17.4 vs. 21.7 min; p < 0.001). Two cases were converted from TNT to JNT due to the failure of TNT to guide the esophageal stump entry hole for more than 5 min, which was resolved promptly by the JNT. Postoperative complications (18.9% vs. 20.8%; p = 0.807), particularly esophagojejunal anastomotic leakage (EJAL; 5.7% vs. 3.8%; p =1.000), and complication severity classification (p = 0.315) were comparable between the two groups.</p><p><strong>Conclusions: </strong>The JNT technique significantly and safely improved the efficiency of OGT-overlap esophagojejunostomy compared with TNT, suggesting a well-tolerated and efficient new strategy for esophagojejunostomy.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5173-5182"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143953074","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":"Disparities in Timeliness of Breast Cancer Treatment in a Rural Setting: Breast Cancer Treatment Disparities.","authors":"Carolina Orsi, Tyler Davis, Rebecca Swindall, Carly Wadle, Alan Cook, Hishaam Ismael","doi":"10.1245/s10434-025-17291-z","DOIUrl":"10.1245/s10434-025-17291-z","url":null,"abstract":"<p><strong>Background: </strong>Evidence-based benchmarks have been established to assess the quality of breast cancer care, as delays in treatment correlate with poor clinical outcomes. Our aim was to identify factors influencing the timeliness of care within a rural East Texas healthcare system.</p><p><strong>Patients and methods: </strong>Patients diagnosed with invasive breast cancer were identified and monitored from January 2015 to October 2022. Timeliness of care was assessed retrospectively across three intervals: diagnostic imaging to biopsy, biopsy to surgical treatment, and mammogram to surgical treatment. We analyzed correlations between demographic and clinical factors influencing timely initiation of treatment in our population against recommendations from the National Consortium of Breast Centers (NCBC).</p><p><strong>Results: </strong>A total of 278 cases were included over the 5-year study period. Nearly half met the recommended timeline from diagnostic imaging to biopsy, 13.3% from mammogram to surgical treatment, and 10.3% from biopsy to surgical treatment. A delay in the \"diagnostic imaging to biopsy\" interval or \"biopsy to surgical treatment\" interval predicted delays in the mammogram to treatment interval. Hispanics were more likely to present with stage 3 cancer and had a 4.5 times higher likelihood of mortality compared with Non-Hispanic whites.</p><p><strong>Conclusions: </strong>Delay in one phase of care predicted delays in subsequent phases. Timeliness of treatment also influenced survival rates among Hispanic patients. Understanding factors influencing the timeliness of breast cancer treatment may guide targeted interventions in the future for patients at greater risk of care delays.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4883-4889"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143966827","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: Shifting Paradigms in the Management of Locally Advanced Pancreatic Cancer with Ablative Radiation.","authors":"Alex B Blair, Alice C Wei","doi":"10.1245/s10434-025-17343-4","DOIUrl":"10.1245/s10434-025-17343-4","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5128-5129"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967081","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":"Preoperative Chemoradiotherapy for Esophageal Carcinoma: A Single-Center 10-Year Experience of Low Versus High-Dose Neoadjuvant Chemoradiation.","authors":"Mohamed Elsheikh, Thomas L Sutton, Ranish K Patel, Ashley Yoo, Cymon Kersch, Jason Burton, Nima Nabavizadeh, Stephanie G Wood","doi":"10.1245/s10434-025-17300-1","DOIUrl":"10.1245/s10434-025-17300-1","url":null,"abstract":"<p><strong>Background: </strong>While neoadjuvant chemoradiotherapy (CRT) is considered the standard of care for patients with locally advanced esophageal or gastroesophageal junction (GEJ) cancer, the optimal radiation dosing remains undefined. We aimed to assess the perioperative and long-term outcomes comparing patients treated with low-dose (LD-RT) versus high-dose (HD-RT) radiation therapy.</p><p><strong>Methods: </strong>Our institutional database was queried for patients with cT2-T4 or node-positive esophageal or GEJ cancer, who underwent surgery with neoadjuvant chemoradiation from 2010 through 2019. LD-RT and HD-RT regimens were defined as receiving total radiation dose ≤45 Gy and ≥50 Gy, respectively. Kaplan-Meier analysis, Cox proportional hazard modeling, and logistical regression were utilized for statistical analysis.</p><p><strong>Results: </strong>A total of 287 patients were identified: 77 (27%) received LD-RT; 210 (73%) received HD-RT. Median follow-up from diagnosis to death or last contact was 37.1 months for the study cohort. Older age at diagnosis (odds ratio [OR] 1.03/year, p = 0.02) and year of diagnosis (OR 0.77/year, p < 0.001) were independently associated with receipt of HD-RT relative to LD-RT. Compared with HD-RT, LD-RT was associated with improved 5 year overall survival (OS; 55.1 vs. 44.1%, p = 0.03). On multivariate hazard modeling, receipt of HD-RT was independently associated with worse OS (hazard ratio [HR] 1.79, 95% 1.19-2.68, p = 0.005), disease-free survival (HR 1.78, 95% CI 1.09-2.88, p = 0.02), and recurrence-free survival (HR 1.68, 95% CI 1.11-2.55, p = 0.01) compared with those treated with LD-RT.</p><p><strong>Conclusions: </strong>Despite less frequent utilization than HD-RT strategies, LD-RT is associated with improved survival in those treated with neoadjuvant CRT for esophageal or GEJ cancer.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4681-4689"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967765","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: Successful Radar-Guided Localization for Targeted Melanoma Metastasectomy After Neoadjuvant Immunotherapy.","authors":"Michelle M Dugan, Kate E Beekman, Jonathan S Zager","doi":"10.1245/s10434-025-17427-1","DOIUrl":"10.1245/s10434-025-17427-1","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5319-5320"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960750","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":"Reply to the Letter to the Editor Regarding \"Optimizing Outcomes in Gallbladder Cancer: Identifying Predictors of Futile Up-Front Surgery in a Global Multi-Center Study\".","authors":"Matteo Serenari, Belen Rivera, Eduardo A Vega","doi":"10.1245/s10434-025-17391-w","DOIUrl":"10.1245/s10434-025-17391-w","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5035-5036"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960236","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":"Machine Learning Model for Predicting Pheochromocytomas/Paragangliomas Surgery Difficulty: A Retrospective Cohort Study.","authors":"Yubing Zhang, Qikun Guo, Shurong Li, Zhiqiang Zhang, Fangzheng Xiang, Wenhui Su, Yukun Wu, Jiajie Yu, Yun Xie, Cheng Luo, Fufu Zheng","doi":"10.1245/s10434-025-17346-1","DOIUrl":"10.1245/s10434-025-17346-1","url":null,"abstract":"<p><strong>Objective: </strong>We aimed to develop a machine learning (ML) model to preoperatively predict surgical difficulty for pheochromocytomas and paragangliomas (PPGLs) using clinical and radiomic features.</p><p><strong>Methods: </strong>In this study, 212 patients with pathologically confirmed PPGLs were retrospectively enrolled and divided into training (n = 148) and validation cohorts (n = 64). Seven ML models (Classification and Regression Tree, K-Nearest Neighbors, Least Absolute Shrinkage and Selection Operator, Naïve Bayes, Random Forest, Support Vector Machine (SVM), and Extreme Gradient Boosting) were trained using clinical parameters alone or combined with radiomics. Model performance was evaluated and compared through accuracy, sensitivity, specificity, F1 score, area under the curve (AUC), calibration curves, and decision curve analysis. Through comprehensive assessment, the optimal integrated model (clinical + radiomics) was identified and its predictive efficacy was subsequently compared with that of the clinical parameter model. Finally, SHapley Additive exPlanations (SHAP) was applied to enhance the interpretability of the optimal model by visualizing feature contributions.</p><p><strong>Results: </strong>Among all integrated models, the SVM model exhibited the most prominent performance, achieving AUC values of 0.96 in the training cohort and 0.85 in the validation cohort, while demonstrating statistically significant superiority over the clinical parameter model (p < 0.05). The SHAP analysis revealed that radiomic signature (Rad score) exerted the most substantial influence on the predictive outcomes, with age, body mass index, maximum tumor diameter, and preoperative heart rate also demonstrating statistically significant contributions to the model predictions.</p><p><strong>Conclusion: </strong>The SVM model integrating clinical and radiomic features effectively predicts PPGL surgical difficulty, aiding preoperative risk stratification and personalized surgical planning to reduce operative risks.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4790-4803"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970470","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":"Meta-analysis on Cytoreductive Surgery Plus HIPEC in Recurrent or Newly Diagnosed Advanced Epithelial Ovarian Cancer: Food for Thoughts in a Period of Novelties.","authors":"V Ghirardi, G Scambia, A Fagotti, D Querleu","doi":"10.1245/s10434-025-17338-1","DOIUrl":"10.1245/s10434-025-17338-1","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4586-4587"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143972687","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":"Difficult Decisions in the Multidisciplinary Treatment of Resectable Non-small Cell Lung Cancer.","authors":"Wara Naeem, Arsalan A Khan, Oluwamuyiwa W Adebayo, Minha Ansari, Nicole Geissen, Gillian Alex, Michael J Liptay, Mary Jo Fidler, Gaurav Marwaha, Christopher W Seder","doi":"10.1245/s10434-025-17345-2","DOIUrl":"10.1245/s10434-025-17345-2","url":null,"abstract":"<p><p>The management of resectable non-small cell lung cancer (NSCLC) has evolved dramatically over the past three decades. Once limited to surgery, treatment strategies now include chemotherapy, immunotherapy, radiation, and targeted therapies. Despite advances in clinical trials and updated guidelines, several gray areas persist in practice. This review highlights two commonly encountered dilemmas, framed by recent trial data. The first dilemma is centered on the question: for a patient with a 4.1 cm node-negative tumor, is the optimal approach neoadjuvant, adjuvant, or perioperative chemoimmunotherapy? CheckMate 816 demonstrated improved pathological complete response and event-free survival with neoadjuvant chemoimmunotherapy. Perioperative approaches, combining neoadjuvant and adjuvant immunotherapy, showed promising outcomes in KEYNOTE-671, AEGEAN, and CheckMate 77T, whereas IMpower010 and KEYNOTE-091 demonstrated benefit with adjuvant therapy. Moreover, for patients with EGFR or ALK mutations, targeted therapies have shifted the treatment paradigm, as shown in the ADAURA and ALINA trials. However, no head-to-head comparisons among these strategies exist, limiting decision-making. The second dilemma involves a hypothetical scenario of a patient a with biopsy-proven T1cN2 disease: should treatment involve neoadjuvant chemoimmunotherapy followed by surgery, or chemoradiation followed by consolidation immunotherapy (durvalumab) or targeted agents (such as osimertinib)? The PACIFIC and LAURA trials support the latter approach for unresectable disease, while CheckMate 816 supports surgery for resectable N2 cases. Yet defining resectability remains subjective, especially with multistation or bulky N2 disease. While the upcoming AJCC 9th edition proposes a subdivision of N2 into N2a (single-station) and N2b (multi-station), offering a potential step forward, this refinement has yet to translate into clear clinical guidance. These scenarios highlight the need for prospective, stage stratified trials, designed to address these pertinent questions so that improved guidelines may help clinical decision making in borderline cases.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"4633-4640"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143975090","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":"Clinical Significance of Tumor-Infiltrating Lymphocytes in Malignant Peritoneal Mesothelioma: A Single-Center Study of 143 Cases.","authors":"He-Liang Wu, Rui Yang, Xin-Li Liang, Ru Ma, Yan-Dong Su, Zhi-Ran Yang, Yu-Run Cui, Xue-Mei Du, Yi-Tong Liu, Yan Li","doi":"10.1245/s10434-025-17437-z","DOIUrl":"10.1245/s10434-025-17437-z","url":null,"abstract":"<p><strong>Background: </strong>Malignant peritoneal mesothelioma (MPM) is a rare malignant tumor with high mortality rate and extremely poor prognosis. The tumor immune microenvironment, particularly tumor-infiltrating lymphocytes (TILs), plays a critical role in disease progression and treatment response. This study aimed to analyze the correlation between the level of TILs and the main clinicopathological characteristics and prognosis of MPM.</p><p><strong>Patients and methods: </strong>A total of 143 postoperative specimens from patients with MPM following cytoreductive surgery were collected. Postoperative specimens were stained with hematoxylin and eosin (H&E). The level of TILs was quantitatively analyzed by QuPath 0.3.2 software. Univariate and multivariate analyses were conducted to investigate the correlation between TILs level and other conventional clinicopathological characteristics.</p><p><strong>Results: </strong>Among the 143 patients with MPM, 73 were male (51.0%) and 70 were female (49.0%), with a median age of 55 (range 24-73) years. There were 72 (50.3%) cases with low TILs, and 71 (49.7%) cases with high TILs. Univariate analysis showed that TIL level (low versus high) was negatively correlated with the following seven clinicopathological factors: surgery history, Ki-67 index, preoperative CA125 level, peritoneal cancer index (PCI) index, bleeding volume, red blood cell (RBC) transfusion volume, and ascites volume (all P < 0.05). Multivariate analysis indicated that TIL level was independently negatively correlated with preoperative carbohydrate antigen (CA)125 level (odds ratio 0.394, 95% CI 0.179-0.866, P = 0.020). Cox regression analysis suggested that high TILs was independently associated with better prognosis of MPM. Moreover, a cohort of patients who received preoperative chemotherapy combined with targeted therapy were evaluated for response. Kaplan-Meier curve showed that high infiltration of TILs predicted better overall survival in patients undergoing treatment.</p><p><strong>Conclusions: </strong>TILs could be a useful indicator for predicting prognosis and guiding personalized treatment strategies in patients with MPM.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"5051-5062"},"PeriodicalIF":3.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144075588","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}