Annals of Surgical Oncology最新文献

{"title":"The APROVE (Anti-coagulation/Platelet Treatment in Pancreatic Resections Involving Vascular Reconstruction) Study: Results from a Worldwide Survey.","authors":"Alessio Marchetti, Jonathan Garnier, Joseph R Habib, Ingmar F Rompen, Paul C M Andel, Camila Hidalgo Salinas, Molly Ratner, Matteo De Pastena, Roberto Salvia, D Brock Hewitt, Katherine Morgan, Michael D Kluger, Karan Garg, Ammar A Javed, Christopher L Wolfgang, Greg D Sacks","doi":"10.1245/s10434-025-17686-y","DOIUrl":"10.1245/s10434-025-17686-y","url":null,"abstract":"<p><strong>Background: </strong>Antithrombotic therapy (AT) aims to strike a balance between preventing thromboembolic and hemorrhagic complications. However, evidence for AT management after pancreatectomy with vascular reconstruction is lacking. We aimed to provide an overview of the current use of AT for pancreatic surgery with vascular reconstructions.</p><p><strong>Patients and methods: </strong>A web-based survey was distributed to 123 surgeons from high-volume pancreas centers (>50 pancreatic resections/year). AT management after different types of vascular reconstruction were investigated. An \"aggressive\" protocol was defined as the use of any AT protocol other than prophylactic heparin, aspirin, or their combination.</p><p><strong>Results: </strong>The survey was completed by 80 surgeons (59% Europe, 30% USA, 11% Asia). In Europe/Asia, prophylactic heparin was the most commonly reported protocol after partial venous resection/end-to-end anastomosis/human graft (71%/65%/50%, respectively), and an \"aggressive\" protocol (86%) was the most frequently used after prosthetic graft reconstruction. Conversely, in the USA, prophylactic heparin + aspirin was the most commonly reported protocol after all types of venous reconstruction. Following arterial reconstruction, heparin + aspirin was the most commonly reported protocol, regardless of region. An \"aggressive\" protocol was more frequently used in Europe/Asia (odds ratio (OR) 1.28; p < 0.001) and following vein reconstruction with either human graft (OR 1.2; p = 0.007) or prosthetic graft (OR 1.56, p <0.001), while ultrasound (OR 1.65; p < 0.001) and arterial reconstruction (OR 1.64; p < 0.001) were significantly associated with antiplatelet use.</p><p><strong>Conclusions: </strong>In an international cohort of high-volume pancreas surgeons, significant variation in the use of AT following pancreatectomy with vascular reconstruction was observed. This variation was driven by geographical differences and the type of vascular reconstructions performed. In an international cohort of high-volume pancreas surgeons, this Worldwide Snapshot Survey analyzed the current use of antithrombotic therapy for pancreatic surgery with vascular reconstruction. A significant heterogeneity in antithrombotic practice was found and it was mainly driven by geographical differences and the type of vascular reconstructions performed.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7400-7409"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144526190","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":"Comparison of Local Recurrence Rates Between Wide Resection and Expanded Marginal Excision in Atypical Lipomatous Tumors.","authors":"Hitha V Segu, Sanjeev Rampam, Marcos R Gonzalez, Nicholas M Gebhardt, Ivan Chebib, Yin P Hung, Santiago A Lozano-Calderon","doi":"10.1245/s10434-025-17606-0","DOIUrl":"10.1245/s10434-025-17606-0","url":null,"abstract":"<p><strong>Background: </strong>Atypical lipomatous tumors (ALTs) are lipomatous neoplasms of the trunk and extremities with higher local recurrence rate than lipomas. Although wide resection is no longer routinely performed, there remains considerable variability in the extent of tissue resection during marginal excision.</p><p><strong>Methods: </strong>We retrospectively identified patients with histologically proven ALT of the trunk or extremities treated with surgery between 1993 and 2021. We compared wide resection, expanded marginal excision, and simple marginal excision. Expanded marginal excision involved the removal of tissue infiltrated by fat, which can include the fascia, epimysium, or even muscle if it was involved.</p><p><strong>Results: </strong>We included 105 patients with median follow-up of 5.5 years. Local recurrence occurred in 15 patients (14.3%). Dedifferentiation occurred in 13% of recurrent patients (2/15), and none of these metastasized. Five- and 10-year local recurrence-free survival (LRFS) were 88.6% and 75.6%, respectively, and did not improve with the use of radiation therapy (RT). Five-year LRFS was 100% for both wide resection and expanded marginal excision. When compared with simple marginal excision, expanded marginal excision showed a trend toward higher 5-year LRFS (100% vs. 86.9%, p = 0.2). Risk factors for local recurrence included sclerosing subtype (adjusted odds ratio (aOR) 5.47) and tumors with previous recurrence (aOR 4.92).</p><p><strong>Conclusion: </strong>Expanded marginal excision showed noninferior local control rates to wide resection without the additional morbidity of the latter, while suggesting to be superior to simple marginal resection. Future investigations featuring longer follow-up times should compare long-term local control rates by use of RT, type of resection, and ALT subtype.</p><p><strong>Level of evidence: </strong>III.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7808-7816"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144257260","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 Assessment of Lymph Node Metastasis in Rectal Cancer Using Deep Learning: Investigating the Utility of Various MRI Sequences.","authors":"Jiayue Zhao, Peng Zheng, Teng Xu, Qingyang Feng, Siyu Liu, Yi Hao, Manning Wang, Chenxi Zhang, Jianmin Xu","doi":"10.1245/s10434-025-17717-8","DOIUrl":"10.1245/s10434-025-17717-8","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to develop a deep learning (DL) model based on three-dimensional multi-parametric magnetic resonance imaging (mpMRI) for preoperative assessment of lymph node metastasis (LNM) in rectal cancer (RC) and to investigate the contribution of different MRI sequences.</p><p><strong>Patients and methods: </strong>A total of 613 eligible patients with RC from four medical centres who underwent preoperative mpMRI were retrospectively enrolled and randomly assigned to training (n = 372), validation (n = 106), internal test (n = 88) and external test (n = 47) cohorts. A multi-parametric multi-scale EfficientNet (MMENet) was designed to effectively extract LNM-related features from mpMR for preoperative LNM assessment. Its performance was compared with other DL models and radiologists using metrics of area under the receiver operating curve (AUC), accuracy (ACC), sensitivity, specificity and average precision with 95% confidence interval (CI). To investigate the utility of various MRI sequences, the performances of the mono-parametric model and the MMENet with different sequences combinations as input were compared.</p><p><strong>Results: </strong>The MMENet using a combination of T2WI, DWI and DCE sequence achieved an AUC of 0.808 (95% CI 0.720-0.897) with an ACC of 71.6% (95% CI 62.3-81.0) in the internal test cohort and an AUC of 0.782 (95% CI 0.636-0.925) with an ACC of 76.6% (95% CI 64.6-88.6) in the external test cohort, outperforming the mono-parametric model, the MMENet with other sequences combinations and the radiologists.</p><p><strong>Conclusions: </strong>The MMENet, leveraging a combination of T2WI, DWI and DCE sequences, can accurately assess LNM in RC preoperatively and holds great promise for automated evaluation of LNM in clinical practice.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7304-7314"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473913","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: Reasonable Doubt: The Case for Somatostatin Analogs in Pancreas Surgery Remains Unsettled.","authors":"Kristin E Goodsell, Jonathan G Sham","doi":"10.1245/s10434-025-17730-x","DOIUrl":"10.1245/s10434-025-17730-x","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7459-7460"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473864","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":"Neoadjuvant Treatment Based on Gastric Cancer Molecular Subtyping: Chemotherapy, Immunotherapy, or Targeted Therapy?-A Retrospective Analysis.","authors":"Hua-Long Zheng, Li-Li Shen, Qiao-Ling Zheng, Jian-Xian Lin, Chang-Ming Huang, Zheng-Deng Lei, Chao-Hui Zheng","doi":"10.1245/s10434-025-17738-3","DOIUrl":"10.1245/s10434-025-17738-3","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to identify the most effective drug therapeutics for patients with the mesenchymal subtype of advanced gastric cancer (AGC). Extensive research employing diverse omics methodologies has unveiled a varied landscape of AGC. Recent progress in next-generation sequencing and other genomic technologies has facilitated a more intricate exploration of AGC at the molecular level. Nonetheless, the optimal treatment for patients with the mesenchymal subtype of gastric cancer remains elusive. Lei's molecular classification of AGC is based on gene expression profiles named \"mesenchymal,\" \"immunogenic,\" \"classical,\" and \"metabolic.\"</p><p><strong>Patients and methods: </strong>Based on RNA-seq transcriptome, 234 patients were divided into four molecular subtypes: mesenchymal (n = 96), immunogenic (n = 37), metabolic (n = 61), and classic (n = 40).</p><p><strong>Results: </strong>Among those with mesenchymal-subtype AGC, compared with non-Apatinib group, the Apatinib treatment group demonstrated a significant increase in objective response rate (ORR 89.3% versus 69.3%, p = 0.038; odds ratio (OR) 0.269, 95% confidence interval (CI) (0.073-0.989)); overall survival (OS) 89.3% versus 60.2%, p = 0.010; hazard ratio (HR) 0.241, 95% CI (0.073-0.796)) and disease-free survival (DFS 78.6% versus 52.9%, p = 0.031; HR 0.400, 95% CI (0.167-0.956)). Furthermore, Apatinib significantly reduced the risk of death and recurrence in patients with mesenchymal subtype (OS: HR 0.129, 95% CI (0.030-0.563), p = 0.006; DFS: HR 0.340, 95% CI (0.138-0.833), p = 0.018). However, no significant differences were observed in the ORR, OS, or DFS between patients with metabolic and classical subtypes who underwent combination chemotherapy with additional Apatinib or camrelizumab.</p><p><strong>Conclusions: </strong>Our analysis has revealed that, for neoadjuvant therapy in AGC, the mesenchymal subtype stands out as the ideal patient population benefiting from Apatinib.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7999-8012"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144551719","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":"Sleeve Lobectomy, Pulmonary Artery Plasty, and Superior Vena Cava Reconstruction for Locally Advanced Non-small Cell Lung Cancer: A Single-Center Retrospective Study.","authors":"Kaili Huang, Pengfei Li, Qiang Wu, Xiaojun Tang, Wen Li, Qinghua Zhou","doi":"10.1245/s10434-025-17652-8","DOIUrl":"10.1245/s10434-025-17652-8","url":null,"abstract":"<p><strong>Background: </strong>Reconstruction of the superior vena cava (SVC) and sleeve resection of the bronchus and pulmonary artery (PA) simultaneously for right upper lobe central-type non-small cell lung cancer (NSCLC) present technical challenges for surgeons. Here, we described our experience with this surgical procedure and the clinical outcomes.</p><p><strong>Patients and methods: </strong>We retrospectively collected clinical data of 15 patients from 31 January 2014 to 30 December 2023 who underwent SVC resection combined with sleeve resection of the bronchus and/or PA. The surgical approaches were described from two typical patients and the overall survival (OS) of those patients was reported.</p><p><strong>Results: </strong>Among the 15 patients, 9 (60%) patients received neoadjuvant therapy, and all the patients received adjuvant therapy. All resections were completely resectable (R0). Histologically, seven patients (46.7%) had adenocarcinoma and eight (53.3%) patients had squamous cell carcinoma. In addition, 1 (6.7%) patient was classified as having stage pT4N0M0-IIIA, 12 (80%) were pT4N2M0-IIIB, and 2 were pT4N3M0-IIIC. No perioperative deaths occurred. The major complication rate was 40% after surgery. The median follow-up duration was 29 months, with survival times ranging from 3 to 64 months, and the median survival time was 18 months. In addition, the OS rates at 1, 3, and 5 years were 80%, 28.6%, and 28.6%, respectively.</p><p><strong>Conclusions: </strong>Combined resection of the bronchus, PA, and SVC is technically feasible and safe for patients with locally advanced NSCLC. For carefully selected patients, this extended resection surgery may lead to favorable long-term survival.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7929-7939"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144803299","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: How we Capture Safety Net Status in Large Database Research Matters: Evaluating Hepatobiliary and Pancreatic Surgery Patients using the National Cancer Database.","authors":"Anays Murillo, Teviah E Sachs","doi":"10.1245/s10434-025-18077-z","DOIUrl":"10.1245/s10434-025-18077-z","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7786-7787"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833819","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: Medicaid's Impact on Breast Cancer.","authors":"Simran Malhotra, Daniel X Choi, Varadan Sevilimedu, Rachel A Greenup, Audree B Tadros","doi":"10.1245/s10434-025-18107-w","DOIUrl":"10.1245/s10434-025-18107-w","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7776-7777"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881947","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: Examining the Outcomes of Adding Immunotherapy to Adjuvant Chemoradiation in Pathologic Stage II-IIIB Non-Small Cell Lung Cancer.","authors":"Natasha Venugopal, Jorge Raul Vazquez-Urrutia, Junjia Zhu, Asato Hashinokuchi, Shinkichi Takamori, Takefumi Komiya","doi":"10.1245/s10434-025-17879-5","DOIUrl":"10.1245/s10434-025-17879-5","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7940-7941"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454484/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144688774","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":"Prehabilitation in Frail Patients Undergoing Cancer Surgery: A Systematic Review and Meta-analysis.","authors":"Zirong Bai, Cherry Koh, Michael Solomon, Rihan Shahab, Nicholas Hirst, Kate Alexander, Leani Souza Maximo Pereira, Ana Paula Drumond Lage, Daniel Steffens","doi":"10.1245/s10434-025-17589-y","DOIUrl":"10.1245/s10434-025-17589-y","url":null,"abstract":"<p><strong>Background: </strong>The evidence of prehabilitation in frail patients with cancer is lacking. This systematic review and meta-analysis aimed to determine the effectiveness of prehabilitation on postoperative complications, and hospital length of stay (LOS) in this population.</p><p><strong>Methods: </strong>A comprehensive search was performed in MEDLINE, Embase, Cochrane, CINAHL, AMED, and PsycINFO, encompassing all records from inception to December 2023. The outcomes of interest included postoperative complications and LOS. Risk of bias was assessed using the revised Cochrane risk of bias tool (RoB2) and GRADE was used to determine the quality of evidence. Relative risk (RR) or mean difference (MD) along with its 95% confidence interval (CI) were calculated by using random-effects meta-analysis.</p><p><strong>Results: </strong>Five randomised controlled trials (four trials in colorectal or colon cancer), including 466 patients (230 patients undergoing prehabilitation and 236 standard of care controls), were included. Prehabilitation reduced any postoperative complications (RR = 0.82; 95% CI = 0.71-0.95; four trials, N = 465), but no effect was observed for major postoperative complications (RR = 0.89: 95% CI = 0.71-1.11; two trials, N = 226) and LOS (MD = 0.3, 95% CI = -0.68 to 1.28; three trials, N = 349). A single trial (including 57 patients) investigated the effect of exercise-only on a range of postoperative complications, with no significant difference between groups observed.</p><p><strong>Conclusions: </strong>In our systematic review and meta-analysis, we found that prehabilitation significantly decreased the rate of any postoperative complications in frail patients with cancer undergoing surgery. The role of prehabilitation in improving major postoperative outcomes is unclear owing to the limited amount of evidence.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"7707-7722"},"PeriodicalIF":3.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12454461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144214765","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}