Annals of Surgical Oncology最新文献

{"title":"Decreasing Time to Definitive Breast Reconstruction: National Trends and Patient-Level Predictors.","authors":"Chanel R Varney, Tara Pillai, Nicholas C Oleck, Yue Jiang, Neill Y Li, Ash Patel, Brett T Phillips","doi":"10.1245/s10434-026-20384-y","DOIUrl":"10.1245/s10434-026-20384-y","url":null,"abstract":"<p><strong>Background: </strong>The time interval between mastectomy and breast reconstruction reflects the speed of care delivery and has been associated with patient quality of life. This study evaluates 2010-2020 trends in the reconstructive interval and additional metrics of care delivery, including length-of-stay and outpatient setting utilization.</p><p><strong>Patients and methods: </strong>A retrospective cohort study of 2010-2020 mastectomy patients was conducted using national insurance claims data. Trends in the reconstructive interval were analyzed for recipients of nonimmediate breast reconstructions via linear regression. Multivariable analysis was used to identify predictors of interval durations. Trends in inpatient length-of-stay and outpatient surgery utilization were assessed via linear regression for nonimmediate reconstructions, immediate reconstructions, and mastectomy-only surgeries.</p><p><strong>Results: </strong>350,243 patients (median age, 59.0) were included. From 2010 to 2020, the median reconstructive interval decreased from 187 to 168 days for nonimmediate implant reconstructions (β = - 1.92; p < 0.001) and from 337 to 288 days for nonimmediate autologous reconstructions (β = - 5.00; p = 0.002). Predictors of prolonged reconstructive intervals were interval radiation therapy (β = 130.87; p < 0.001), interval chemotherapy (β = 70.30; p < 0.001), autologous reconstruction technique (β = 38.33; p < 0.001), and Medicaid insurance (β = 28.84; p < 0.001). From 2010 to 2020, mean inpatient length-of-stay decreased for four of the six surgery types, including immediate implant reconstructions (2.00 to 1.65 nights; β = - 0.03; p = 0.009) and immediate autologous reconstructions (4.00 to 3.06 nights; β = - 0.08; p = 0.006). Outpatient utilization increased for all nonautologous surgeries, accounting for 82.2-98.0% of such cases in 2020.</p><p><strong>Conclusions: </strong>Nationally, decreasing reconstructive intervals coincided with decreasing inpatient length-of-stay and increasing outpatient surgery utilization. Collectively, these trends reflect a dramatic acceleration in breast reconstruction care delivery over the past decade.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10564-10573"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787550","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: From Fluorescence to Action: Standardizing Intraoperative Mastectomy Flap Assessment.","authors":"Yizhuo Shen, Lauren Valentine, Renee Gao, Stav Brown, Felix J Klimitz, Samira Glaeser-Khan, Meera Nair, Rohan Kumaran, Geronimo Salcedo, Nikita Singh, Luccie Wo, Siba Haykal","doi":"10.1245/s10434-026-20438-1","DOIUrl":"10.1245/s10434-026-20438-1","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10584-10585"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787582","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":"Assessing Graded Histological Regression as Basis for Treatment Modification after Neoadjuvant Therapy in LAGC: An Exploratory Phase II Study.","authors":"Dongfeng Song, Yajie Rong, Yining Fu, Yan You, Wenze Wang, Xiaoyuan Li, Xiaolei Gong, Zhiyang Zhang, Yuping Ge, Xiang Wang, Lin Zhao, Chunmei Bai, Yi Ba","doi":"10.1245/s10434-026-20322-y","DOIUrl":"10.1245/s10434-026-20322-y","url":null,"abstract":"<p><strong>Background: </strong>Whether to change adjuvant regimen after ineffective neoadjuvant chemotherapy in locally advanced gastric cancer (LAGC) remains unclear. We conducted an exploratory study on whether graded histologic regression (GHR) < 50% was a potential indicator for regimen modification.</p><p><strong>Patients and methods: </strong>The study was a prospective, single-center, open-label, randomized, phase II trial. Patients were randomly assigned to group A (paclitaxel-modified regimen) and group B (original regimen) for adjuvant chemotherapy. The primary endpoint was disease-free survival (DFS), with secondary endpoints of overall survival (OS) and safety.</p><p><strong>Results: </strong>Between May 2017 and August 2025, 58 patients with postoperative GHR < 50% were enrolled and randomly allocated to group A (n = 28) or group B (n = 30). After a median of 19.3 months follow-up, group A had longer median DFS (25.2 months versus 11.4 months) (hazard ratio [HR] 0.4711, 95% confidence interval [CI] 0.2501-0.8874; P = 0.020) and median OS (32.0 months versus 18.0 months) (HR 0.5088, 95% CI 0.2667-0.9708; P = 0.040) than group B. Regimen modification was identified as independent prognostic factor for DFS and OS. In subgroup analysis, compared with ypN0-2, patients with ypN3 stage (P = 0.047) were more likely to experience OS benefits by regimen modification. Patients with ypTNM III stage (P = 0.046) had more DFS benefits from regimen alteration than ypTNM I-II. Regarding adverse events, except higher nausea incidence, chemotherapy change did not significantly increase other adverse reactions.</p><p><strong>Conclusions: </strong>GHR < 50% may indicate the need to adjust adjuvant chemotherapy regimen in LAGC. A larger study is needed to validate its final survival impact.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10690-10702"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683363","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":"Fibrotic Interstitial Lung Abnormalities on Preoperative CT Images Predict Cause-Specific Mortality after Stage I Non-Small Cell Lung Cancer Resection.","authors":"Takaki Akamine, Takuya Hino, Mototsugu Shimokawa, Tomoyuki Hida, Fumihiko Kinoshita, Taichi Matsubara, Kazuki Takada, Koji Sagiyama, Kousei Ishigami, Tomoyoshi Takenaka, Tomoharu Yoshizumi","doi":"10.1245/s10434-026-20495-6","DOIUrl":"10.1245/s10434-026-20495-6","url":null,"abstract":"<p><strong>Background: </strong>Interstitial lung abnormalities (ILAs) and preclinical interstitial lung disease (ILD) are associated with an increased incidence of lung cancer and high mortality. However, their impact on cause-specific mortality following surgical resection of clinical stage I non-small-cell lung cancer (NSCLC) remains unclear. We evaluated the relationship between preoperative ILAs and postoperative mortality in patients with clinical stage I NSCLC who underwent surgical resection.</p><p><strong>Methods: </strong>In this retrospective study, we included patients who underwent complete resection for clinical stage I NSCLC between 2006 and 2018 and excluded those with ILD. Preoperative computed tomography (CT) images were classified as no ILA, non-fibrotic ILA, or fibrotic ILA.</p><p><strong>Results: </strong>Of the 704 included patients, 75 (10.6%) had ILAs, including 24 (3.4%) with non-fibrotic ILA and 51 (7.2%) with fibrotic ILA. Patients with fibrotic ILAs were older (median age, 75 years) and predominantly male (88.2%), whereas 629 patients had no ILA (median age, 69 years; male, 49.1%). The 5-year overall survival rates were 90.0%, 71.0%, and 35.1% in patients with no, non-fibrotic, and fibrotic ILAs, respectively (log-rank p < 0.001). Fibrotic ILAs were independently associated with poorer overall survival (hazard ratio [HR] 4.50; 95% confidence interval [CI] 2.86-7.09) and higher mortality (lung cancer-specific: HR 7.64; 95% CI 4.03-14.46; other cause: HR 2.79; 95% CI 1.44-5.42) than no ILAs.</p><p><strong>Conclusion: </strong>Fibrotic ILAs were associated with increased lung cancer-specific and other-cause mortality after resection for stage I NSCLC, suggesting that fibrotic ILAs, although often subtle on routine CT, may serve as clinically meaningful imaging prognostic markers.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10384-10394"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817536","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":"Salvage Surgery After Proton Beam-Based Chemoradiotherapy for Esophageal Squamous Cell Carcinoma: A Case Series Study.","authors":"Hirohito Kakinuma, Michitaka Honda, Soshi Hori, Ryuya Yamamoto, Kazuki Nishino, Yoshiaki Takagawa, Nobuyasu Suzuki, Yoshinao Takano","doi":"10.1245/s10434-026-20416-7","DOIUrl":"10.1245/s10434-026-20416-7","url":null,"abstract":"<p><strong>Background: </strong>Although salvage surgery after photon-based chemoradiotherapy for esophageal squamous cell carcinoma (ESCC) is high risk, the safety of salvage surgery after proton beam-based chemoradiotherapy (PBC) remains unclear. This study aimed to evaluate the short- and long-term outcomes of salvage surgery after PBC.</p><p><strong>Methods: </strong>This single-arm retrospective case series included patients who underwent curative-intent salvage surgery for residual or recurrent ESCC after PBC between June 2009 and February 2020. Salvage surgery included esophagectomy with lymph node dissection or resection of recurrent lymph nodes. The primary outcome was major morbidity (Clavien-Dindo grade ≥III).</p><p><strong>Results: </strong>The study enrolled 19 patients with a median age was 64 years. Of the 19 patients, 12 underwent esophagectomy, and 7 underwent lymph node resection. Major morbidity occurred for 9 patients (47.3%). No operative mortality occurred. The median overall survival was 16.2 months. The 1-, 3-, and 5-year overall survival rates were 68.0%, 43.1%, and 35.9%, respectively.</p><p><strong>Conclusion: </strong>Salvage surgery after PBC for ESCC remains a high-risk procedure, and its feasibility should be carefully assessed on a case-by-case basis.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10346-10355"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148756860","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 Personalized Surgery for Locally Advanced Mid-Transverse Colon Cancer.","authors":"Ernesto De Giulio, Paolo Delrio","doi":"10.1245/s10434-026-20476-9","DOIUrl":"10.1245/s10434-026-20476-9","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10653-10654"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787566","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: Thoughts on the Changing Trends of Perioperative Depressive Symptoms: Differences Between Breast/Prostate Cancer and Other Solid Tumors.","authors":"Eli Johnson, Ellen O'Callaghan, Tara Dalton, Maria E Garcia, Melissa Erickson, C Rory Goodwin","doi":"10.1245/s10434-026-20335-7","DOIUrl":"10.1245/s10434-026-20335-7","url":null,"abstract":"","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10770-10771"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863348","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":"Bright Visualization of Primary and Metastatic Medullary Thyroid Cancer in an Orthotopic Nude Mouse Model Using a Fluorescent Humanized Anti-CEA Antibody for More Accurate Staging and Improved Resection.","authors":"Javier Bravo, Sohee Lee, Blackberrie Eddins, Sunidhi Jaiswal, Siamak Amirfakhri, Grace Lin, Kristin E Cox, Thinzar M Lwin, Robert M Hoffman, Hak Soo Choi, Paul J Yazaki, Michael Bouvet","doi":"10.1245/s10434-026-20387-9","DOIUrl":"10.1245/s10434-026-20387-9","url":null,"abstract":"<p><strong>Background: </strong>The standard treatment for medullary thyroid cancer (MTC) is total thyroidectomy with cervical lymph node dissection. Cure depends on complete surgical resection; however, intraoperative identification of tumor margins and involved lymph nodes remains challenging.</p><p><strong>Methods: </strong>The CEA-expressing MTC cell line TT was used to establish orthotopic thyroid tumor models (n = 7), whereas the non-CEA-expressing papillary thyroid cancer (PTC) cell line TPC-1 was used to establish subcutaneous negative control tumor models (n = 3). Orthotopic MTC models were established by injecting TT cells (1x10⁷) into the thyroid gland of athymic nude mice, whereas subcutaneous models were established by implanting TT and TPC-1 tumors into the flanks of nude mice. The humanized anti-CEA antibody M5A was conjugated to the near infrared fluorophore IRDye800CW to generate M5A-IR800. Mice received 50 µg of M5A-IR800 via tail vein injection and were imaged under bright light and fluorescence using a LI-COR Pearl Imaging System. Tumor-to-background ratios (TBR) were calculated as the ratio of mean tumor fluorescence intensity to surrounding tissue. Tumor specimens were analyzed by histology and immunohistochemistry.</p><p><strong>Results: </strong>The mean TBR of orthotopic MTC tumors treated with M5A-IR800 was 6.85 (±3.75) at 96 hours post injection. Mice bearing subcutaneous TT tumors also achieved high TBRs of 4.23, 3.59, and 3.3 at 96 hours. In contrast, non-CEA-expressing TPC-1 tumors demonstrated no detectable fluorescence. Hematoxylin and eosin staining and immunohistochemistry confirmed accurate tumor targeting by M5A-IR800 and strong CEA expression in MTC tumors.</p><p><strong>Conclusions: </strong>M5A-IR800 specifically and brightly targets MTC in preclinical mouse models and represents a promising approach to enhance intraoperative visualization of MTC.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10454-10460"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148720706","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":"Missed Opportunities for Neoadjuvant Immunotherapy in Melanoma: Is it Time to Consider Ultrasound Staging for Newly Diagnosed Patients?","authors":"Laurence E McCahill, Kent Grosh, Christine Schmitt, Amanda Hunt, Ingrid Kenyon, Sam Coster, Megan Baxter, Mason Gonzales, Theresa McGoff, Austin Brubaker","doi":"10.1245/s10434-026-20382-0","DOIUrl":"10.1245/s10434-026-20382-0","url":null,"abstract":"<p><strong>Background: </strong>Melanoma treatment for patients with clinical adenopathy has improved outcomes with neoadjuvant immunotherapy (NAI). Some sentinel lymph node (SLN)-positive patients have larger pathologic metastases that might be identified on ultrasound (US) preoperatively. We sought to identify SLN-eligible patients with larger nodal metastases and identify characteristics to estimate patients who might have nodal metastases identified by staging US.</p><p><strong>Patients and methods: </strong>Patients with clinical stage IB/II melanoma who underwent a SLNB for which the pathological size of the metastases were retrospectively identified. Comparative statistics were performed for patients with macrometastases (≥ 10 mm) compared with micrometastases (< 10 mm), as well as for 0-4 mm and 4 to < 10 mm metastases.</p><p><strong>Results: </strong>There were 198 patients with clinical stage IB/II melanoma who underwent SLNB for which 41 (20.7%) had a positive node, and 39 (19.7%) had metastasis size recorded. There were 6/39 (15.4%) with a macro metastasis identified, of which 5 were clinical stage II. Median body mass index (BMI) was higher in the macro metastases group versus the micro metastases group (42.0 versus 28.9, p = 0.0307). There were 11/91 (12.1%) clinical stage II patients with metastases ≥ 4 mm.</p><p><strong>Conclusions: </strong>In our patients with stage IB/II melanoma, 15.4% had a SLN metastasis ≥ 10 mm and were more likely to be obese, suggesting physical exam was less sensitive for these patients. With a 4 mm cutoff, staging US might upstage 12% of clinical stage II to pathologic stage III. We recommend consideration of staging US for all clinical stage II patients.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10785-10790"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711139","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":"Intraoperative Prediction of Mastectomy Skin Flap Necrosis using Standardized ICG Grading and Quantitative Perfusion Mapping.","authors":"Yizhuo Shen, Lauren Valentine, Renee Gao, Stav Brown, Felix J Klimitz, Samira Glaeser-Khan, Meera Nair, Rohan Kumaran, Geronimo Salcedo, Nikita Singh, Luccie Wo, Siba Haykal","doi":"10.1245/s10434-026-20280-5","DOIUrl":"10.1245/s10434-026-20280-5","url":null,"abstract":"<p><strong>Background: </strong>Mastectomy skin flap necrosis (MSFN) remains a common complication after immediate breast reconstruction. Indocyanine green (ICG) angiography enables real-time perfusion assessment, but lack of standardized interpretation limits clinical utility. This study evaluates a standardized qualitative grading system combined with quantitative perfusion (QP) mapping for intraoperative risk stratification.</p><p><strong>Patients and methods: </strong>A single-center cohort study was conducted in patients undergoing skin- or nipple-sparing mastectomy with immediate reconstruction. Intraoperative ICG angiography was performed, with QP measurements obtained across breast quadrants and the nipple-areolar complex (NAC). A five-point qualitative \"Yale Grade\" was assigned. The primary outcome was MSFN within 30 days. Model performance was assessed via receiver operating characteristic analysis and multivariable logistic regression.</p><p><strong>Results: </strong>The cohort included 185 reconstructions (104 patients), with an MSFN rate of 24.3%. MSFN incidence and severity decreased stepwise with improving Yale Grade (p < 0.001). Breasts with MSFN demonstrated significantly lower QP across all quadrants (p ≤ 0.001), with progressive decline by necrosis severity. Average QP demonstrated the highest discrimination (AUC 0.792) with a threshold of 49.0 (63.6% sensitivity, 83.2% specificity). Minimum QP also performed well (AUC 0.759) at 33.5 (72.7% sensitivity, 73.0% specificity). Yale Grade ≤ 3 demonstrated high specificity (89.2%). For NAC necrosis, average QP demonstrated the highest accuracy (AUC 0.899). On multivariable analysis, perfusion metrics remained independently predictive, whereas clinical variables were not.</p><p><strong>Conclusions: </strong>A standardized ICG grading system combined with QP mapping reliably predicts MSFN. Thresholds of average QP ≥ 49 and minimum QP < 33.5, integrated with Yale Grade ≤ 3, provide a practical, tiered framework for intraoperative decision-making.</p>","PeriodicalId":8229,"journal":{"name":"Annals of Surgical Oncology","volume":" ","pages":"10522-10533"},"PeriodicalIF":3.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148535077","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}