BACKGROUND:The marginal mandibular nerve (MMN) is vulnerable during neck dissection for head and neck cancer. This study documents its anatomical variations and evaluates postoperative functional and quality-of-life outcomes. METHODS:A prospective observational study was conducted with fifty-one patients undergoing neck dissection for primary head and neck malignancy. Preoperative and postoperative assessments carried out at 1 and 3 months after surgery included clinical evaluation of lip symmetry, electromyography (EMG) of the depressor anguli oris, and quality-of-life (QoL) using FACT-H&N and Distress Inventory for Cancer (DIC) version-2 questionnaire. Intraoperative MMN anatomy was systematically recorded. RESULTS:MMN was identified in all the 51 neck dissections carried out. Mean number of branches was 1.05 ± 0.23, and mean distance from the mandibular border was 1.67 mm. Lip asymmetry was observed in over 50% of patients at 1 month, decreasing to 20% at 3 months. EMG showed complete denervation in 13 patients at 1 month, which continued till 3 months with no recovery, the branch was sacrificed in 11 of these for oncological clearance. FACT-H&N scores and DIC2 scores improved at 6 months follow-up. CONCLUSION:Meticulous identification and preservation of the MMN minimize transient dysfunction, with most patients achieving functional recovery and QOL improvement by 3 months.
OBJECTIVES:To evaluate the impact of postoperative chronic pleural effusion (CPE) at 1 year on long-term prognosis and host nutritional and physical status following anatomic resection for non-small cell lung cancer. METHODS:This single-center retrospective study included 372 patients (2017-2021). CPE was defined as pleural fluid volume ≥80 mL on computed tomography scan at 1 year postoperatively, while no pleural fluid or pleural fluid volume <80 mL was defined as non-CPE. Inverse probability of treatment weighting (IPTW) was performed to adjust for preoperative baseline confounding factors between the two groups. The primary endpoint was overall survival. Secondary endpoints included cancer-specific death and changes in nutritional/physical indicators. RESULTS:CPE was observed in 36 patients (9.7%), all of whom had demonstrated persistent effusion since 6 months postoperatively. In the IPTW-adjusted analysis, CPE was identified as an independent prognostic factor for poor OS (Hazard ratio 3.38; 95% confidence interval (CI), 1.57-7.26; p = 0.002). Competing-risk analysis revealed that CPE was a significant independent predictor of non-cancer death (Subdistribution HR 4.76; 95% CI, 1.56-14.41; p = 0.006), whereas no significant association was found with cancer-specific death. Analysis of non-cancer deaths showed that respiratory diseases, predominantly pneumonia, were the leading cause of death in the CPE group (9 of 12 patients, 75.0%). Weighted competing-risk analysis confirmed that CPE was a significant independent predictor specifically for pneumonia-related death (Subdistribution HR 5.26; 95% CI, 1.07-25.91; p = 0.041), with a 5-year weighted cumulative incidence of 11.89% in the CPE group versus 2.2% in the non-CPE group. Furthermore, patients with CPE exhibited significantly greater declines in Prognostic Nutritional Index (-4.1% vs 2.3%, p = 0.003), body weight (-5.4% vs -1.2%, p = 0.001), and Pectoralis Muscle Index (-11.5% vs -6.3%, p = 0.055) during the first postoperative year. CONCLUSIONS:Postoperative CPE was identified as an independent risk factor for non-cancer death, especially pneumonia-related death, and was associated with significant nutritional and physical deterioration. These findings suggest that CPE represents a clinical indicator of systemic wasting and physiological decline rather than merely a local fluid retention.
BACKGROUND:Treatment for pancreatic Ductal Adenocarcinoma (PDAC) remains a major challenge despite recent advancements. Selecting biological subgroups could improve stratification and address targeted therapies. Metabolomic analysis of pancreatic juice (PJ) is a promising technology to identify disease-specific profiles. The aim of this study is to evaluate the association of PJ metabolomics with PDAC patients' clinical profiles, prognostic characteristics and long-term outcomes. METHODS:Data of patients undergoing pancreatic resection for PDAC at Humanitas Research Hospital were prospectively collected. PJ samples were retrieved intraoperatively and processed through flow injection-high resolution mass spectrometry analysis (FIA-HRMS). Untargeted and targeted analysis were performed. Univariable and multivariable models assessed associations between metabolites and clinicopathologic variables. Survival analyses evaluated correlations with long-term outcomes. RESULTS:Fifty-eight patients were included; metabolomic analysis of PJ revealed three metabolic clusters with comparable demographic characteristics. Cluster 2 showed higher levels of amino acids, phospholipids, sphingomyelin and cholesteryl esters compared to Cluster 3. Cluster 2 showed higher likelihood of T3-T4 tumours (OR 10.68, CI 1.84-61.93, p = 0.01) and lymph nodal involvement (OR 14.02, CI 1.58-124.2, p = 0.02). Even though Kaplan-Meier curves did not show clear survival separation across clusters, higher cholesteryl ester concentrations were associated with improved DFS. CONCLUSION:The correlation between metabolomic clusters and cancer staging, along with the association of specific metabolites with survival outcomes, suggest that PJ composition might reflect PDAC aggressiveness. The feasibility of preoperative PJ endoscopic collection underscores its possible clinical application for patients' stratification and potential identification of therapeutic targets. Larger cohorts' analyses are needed to validate these findings.
BACKGROUND:Malignancy is a leading cause of mortality after liver transplantation (LT), yet its long-term incidence and outcomes remain incompletely defined. METHODS:We performed a retrospective single-center cohort study of 1841 adult LT recipients transplanted between 1990 and 2025 to characterize the spectrum, and outcomes post-transplant malignancy. Competing-risk methods accounting for non-cancer mortality were used to estimate cumulative incidence, and Fine-Gray regression identified independent predictors. RESULTS:Over a median follow-up of 10.6 years, the 25-year cumulative incidence of non-hepatocellular carcinoma (HCC) solid organ malignancy was 18%, while skin malignancy occurred in 29% of recipients. Post-transplant lymphoproliferative disorder developed in 4%, non-PTLD hematologic malignancies in 1%, and post-transplant or recurrent HCC in 18%. Malignancy related mortality accounted for 20% of deaths, second only to infection (23%). Lung, prostate, head and neck, colorectal, and renal cell carcinomas were the most common solid organ malignancies. Increasing age at transplantation independently increased solid organ malignancy risk (hazard ratio 1.22 per decade), while female sex was protective. Survival after malignancy varied substantially by cancer type, with particularly poor outcomes following solid organ malignancy and post-transplant HCC. DISCUSSION:ost-transplant malignancy represents a substantial and enduring burden after LT and is a major contributor to late mortality. These findings support the need for lifelong, risk-adapted cancer surveillance strategies tailored to individual patient risk.
BACKGROUND:Osteoporosis is a common complication among long-term breast cancer (BC) survivors. Assessment of osteoporosis risk of patients before therapy is essential for timely intervention and long-term health management. METHODS:We included female BC patients treated between 2018 and 2022 at a tertiary hospital in China. Baseline characteristics, hematologic parameters, and pathological subtypes were collected and stratified into four molecular groups based on hormone receptor and HER2 status. Twelve machine learning (ML) algorithms were developed, and the best-performing models were interpreted using SHAP analysis. RESULTS:Among 1314 patients, 546 (41.6%) were diagnosed with osteoporosis, predominantly in HR-positive subtypes. Random Forest achieved the best performance in HR-/HER2-patients (validation AUC = 0.773), with platelet count, LDH, age, γ-GTP, uric acid, and globulin as key predictors. In HR-/HER2+ patients, Gradient Boosting performed optimally (AUC = 0.942), with hematologic and metabolic markers as major contributors. For HR+/HER2-and HR+/HER2+ groups, Boosting models reached AUCs of 0.832 and 0.771, respectively, with nodal stage, age, platelet count, uric acid, and liver/renal indices as leading predictors. SHAP dependence plots revealed critical interactions, such as age with platelet count and nodal stage with bilirubin. CONCLUSIONS:Osteoporosis risk varies substantially across molecular subtypes of BC and is shaped by both clinical and biochemical factors. ML combined with explainable AI provides accurate prediction and highlights key risk determinants, offering a potential evaluated tool for personalized bone health management in BC survivors.
BACKGROUND:Bone loss after gastrectomy is a clinically important but often underestimated complication, particularly in elderly patients with gastric or esophagogastric junction (EGJ) cancer. Total gastrectomy (TG) has been associated with postoperative deterioration of bone health. Appetite-preserving gastrectomy (APG) preserves the ghrelin-secreting region of the stomach and maintains appetite and lean body mass; however, its impact on postoperative bone health remains unclear. METHODS:This retrospective observational study included 28 patients with EGJ cancer who underwent curative gastrectomy between April 2023 and October 2025 (APG, n = 22; TG, n = 6). Bone mineral content (BMC) was assessed using bioelectrical impedance analysis, and vertebral bone attenuation was evaluated using CT-based L1 Hounsfield unit (HU) measurements preoperatively and at 6 and 12 months postoperatively. Nutritional parameters, serum ghrelin levels, and body composition were analyzed. RESULTS:Baseline characteristics were comparable between groups. Changes in BMC did not differ significantly postoperatively. At 6 months, changes in L1 attenuation were similar between APG and TG. At 12 months, L1 attenuation was preserved in the APG group but declined markedly in the TG group (median ΔL1: +7.7 HU vs -30.9 HU, p = 0.0076). Postoperative serum ghrelin levels were partially preserved after APG, and postoperative reductions in body weight and lean body mass tended to be less pronounced. CONCLUSIONS:APG may attenuated early postoperative deterioration of vertebral bone quality compared with TG. Preservation of the ghrelin-secreting region may mitigate early postoperative catabolic effects on musculoskeletal tissues, supporting APG as an endocrine-preserving surgical strategy for EGJ cancer.
Background Breast cancer patients with ipsilateral supraclavicular lymph node (ISLN) metastasis often experience poor prognosis. A non-invasive method for preoperative diagnosis of ISLN metastasis is warranted. Methods This study included breast cancer patients with suspected ISLN involvement. After randomly dividing patients into training and validation groups at 3:2 ratio, radiomic models were constructed using ultrasound (US) images of the breast, axilla, and ISLN. A radiomic score (radscore) was developed using Student's t-test, Fisher's correlation coefficient, and LASSO regression, with 5-fold cross-validation (CV) applied during model construction. Model performance was evaluated using Receiver Operating Characteristic (ROC) curves in the validation group. A nomogram combining the radscore (from the optimal radiomic model) and clinicopathological variables was developed in the training group. Results The study involved 547 ultrasound images from 186 eligible patients (112 in the training group and 74 in the validation group). The model combining radiomic features of breast and axillary ultrasound images based on LASSO regression demonstrated superior performance. A nomogram incorporating clinicopathological characteristics (including T-stage, HER2 status and CA15-3) and radscore (comprising 10 radiomic features) was constructed. The area under the ROC curve (AUC) for ISLN diagnosis were 0.876 (95% CI 0.818-0.941, P<0.001) and 0.837 (95% CI 0.733-0.952, P=0.026) in the CV and validation groups, respectively. Conclusion Radiomic features derived from breast and axillary US images are valuable for assessing ISLN metastasis in breast cancer patients. The preoperative US-based radiomic-clinical nomogram effectively predicts ISLN metastasis non-invasively.
BACKGROUND:Distal gastric cancer with gastric outlet obstruction (GOO) poses challenges to multimodal treatment. The optimal management strategy in patients undergoing curative-intent treatment remains unclear. This study aimed to characterize real-world management pathways and outcomes in patients with distal gastric cancer presenting with clinically significant GOO. METHODS:All consecutive patients undergoing curative-intent resection for distal gastric adenocarcinoma with GOO between 2006 and 2024 at two Swedish tertiary centers were identified from national registry and institutional databases with chart validation. Patients were categorized according to treatment strategy: neoadjuvant chemotherapy or up-front surgery. Primary outcome was overall survival. Survival was analyzed using Kaplan-Meier estimates and multivariable Cox regression adjusting for age, ASA class, clinical T stage and nodal status. RESULTS:A total of 103 patients were included; 36 (35.0%) received neoadjuvant chemotherapy and 67 (65.0%) underwent up-front surgery. Patients receiving neoadjuvant therapy were younger (median 63.7 vs 77 years, p < 0.001) and more frequently had cT3-4 and cN + disease (p < 0.001). Most patients completed planned neoadjuvant treatment. R1 resection rates were high and comparable between groups (30.6% vs 28.4%, p = 0.75). Median overall survival was 19.6 months after neoadjuvant therapy and 19.2 months after up-front surgery (log-rank p = 0.38). On multivariable analysis, treatment strategy was not independently associated with overall survival (HR 0.86, 95% CI 0.47-1.57; p = 0.63). CONCLUSION:GOO in distal gastric cancer should not be considered an absolute contraindication to neoadjuvant therapy when adequate nutritional and supportive strategies are employed. However, feasibility does not equal justification - in the absence of a survival benefit and in the context of increased severe postoperative complications, treatment decisions should be individualized through careful multidisciplinary assessment until better powered prospective studies are performed.
BACKGROUND:Emerging immune checkpoint inhibitor (ICI)-combined chemotherapy may increase the opportunities for conversion surgery in patients with locally advanced (LA) biliary tract cancer. A major challenge in chemotherapy aimed at conversion surgery for LA perihilar cholangiocarcinoma (LA PHCC) is the difficulty in accurately evaluating tumor response on contrast-enhanced computed tomography due to biliary stent-induced inflammation and artifacts. To address this issue, the biliary stent-based strategy was devised and implemented in patients undergoing gemcitabine-cisplatin (GC) with ICI therapy. To improve assessment of tumor spread, this strategy includes repeated endoscopic retrograde cholangiopancreatography during chemotherapy and intentional stent removal when functional biliary patency was achieved. We reviewed the outcomes of treatment combined with the strategy. METHODS:Patients with LA PHCC who received GC with ICI therapy with the aim of conversion surgery between 2023 and 2025 were retrospectively reviewed. Clinical course and treatment outcomes were evaluated. RESULTS:Six patients were identified. The biliary stent-based strategy was helpful in preoperative assessment of tumor spread and clinical decision making. Curative-intent resection was performed in 5 patients (83.3%) and R0 resection was achieved in all 3 patients in whom functional biliary patency was confirmed in the strategy. CONCLUSIONS:The biliary stent-based strategy may have potential clinical utility in the management of patients with LA PHCC receiving GC with ICI therapy with the aim of conversion surgery. The strategy not only facilitates preoperative assessment but also may serve as one criterion for proceeding with conversion surgery.
PURPOSE:Accurate intraoperative localization of small intestinal neuroendocrine tumors (SI-NETs) remains a surgical challenge, with standard staging protocols frequently missing small primary or metastatic lesions. ICG has shown utility in other highly vascularized tumors, including pituitary and pancreatic neuroendocrine tumors and non-small cell lung cancer. We conducted a prospective feasibility study to evaluate the potential of near-infrared (NIR) fluorescence imaging (FI) using indocyanine green (ICG) to enhance intraoperative detection of SI-NETs. METHODS:The initial aim was to include at least 26 patients; however, after analysis of the first two patients, we decided to terminate the study prematurely. Therefore, we present data from two patients who underwent abdominal surgery. Each patient received 2.5 mg/kg of ICG intravenously 18 h before surgery, utilizing the second-window ICG (SWIG) technique. Intraoperative imaging was performed using the Quest Spectrum V2 camera system. The primary endpoint was fluorescence positivity of primary tumors, defined as a tumor-to-background ratio (TBR) ≥ 1.5. RESULTS:All primary tumors (n = 2) were identified via palpation and inspection, but none were fluorescence positive (median TBR 0.67, range 0.47-0.87). No occult primary or metastatic lesions were detected by fluorescence imaging. Metastatic lymph nodes and peritoneal nodules (n = 3, confirmed malignant) were also fluorescence negative. Strong non-specific background signal was observed in bowel and liver tissue, reflecting non-tumor-specific ICG uptake. Based on low tumor contrast and expert consensus, the study was terminated early without dose escalation. CONCLUSION:These findings demonstrate that ICG-based NIR FI did not enhance intraoperative detection of SI-NETs or metastases in this feasibility cohort and is limited by non-specific background fluorescence. Our data suggest that passive EPR-based accumulation may not be sufficient for reliable visualization of SI-NETs. Our results underscore the need for tumor-specific tracers targeting neuroendocrine markers to improve surgical precision in SI-NETs.
Objective To investigate the safety and clinical efficacy of the Enhanced Recovery After Surgery (ERAS) protocol specifically in patients undergoing pancreaticoduodenectomy (PD) combined with vascular reconstruction. Patients and methods A retrospective analysis was conducted on 47 patients who underwent PD with vascular reconstruction (including portal vein and superior mesenteric vein resection) between 2015 and 2024. Patients were divided into the ERAS cohort (n=20) and the pre-ERAS control cohort (n=27). We focused on markers of organ congestion recovery, inflammatory stress response, and specialized postoperative complications. Results The ERAS protocol was successfully implemented without increasing the incidence of major postoperative complications (such as pancreatic fistula, hemorrhage, or biliary leakage) or 30-day readmission rates. Notably, the incidence of delayed gastric emptying (DGE) was significantly lower in the ERAS group compared to the control group (5% vs. 33.3%, P < 0.05). The ERAS cohort demonstrated a significantly shorter postoperative hospital stay [17.5(16.9,18.6) days vs. 20.4(19.4,21.5) days, P < 0.001] and reduced medical expenses. Biochemically, the ERAS group showed a more rapid normalization of NLR and a higher maintenance of PNI during the first postoperative week (P < 0.05), reflecting mitigated inflammatory response and better-preserved immune-nutritional reserves. Conclusions Implementation of the ERAS protocol in PD with vascular reconstruction is safe and feasible, showing preliminary evidence in mitigating surgical stress and accelerating hepatic and gastrointestinal functional recovery.The ERAS cohort experienced a significant reduction in DGE and shorter hospital stays without increasing postoperative complications. These findings support ERAS as a standardized perioperative framework even for PD with vascular reconstruction.
INTRODUCTION:Indocyanine green (ICG)-guided lymphadenectomy has been shown to be a promising tool in enhancing nodal retrieval during gastric cancer (GC) surgery. However, its efficacy in patients treated with neoadjuvant chemotherapy (NAC) remains unclear. This study evaluates the impact of tumor response to NAC, based on Mandard classification, on lymphadenectomy quality and surgical outcomes in patients undergoing minimally invasive gastrectomy with ICG guidance. MATERIALS AND METHODS:We conducted a retrospective observational study including 34 patients, from a Western tertiary center, with locally advanced GC who underwent NAC followed by ICG-guided minimally invasive gastrectomy. Patients were stratified into two groups: responders (TRG 1-2) and non-responders (TRG 3-5). The primary outcome was the total number of retrieved lymph nodes. Secondary outcomes included surgical outcomes and postoperative complications. RESULTS:ICG-guided lymphadenectomy was safe in both groups, with no significant differences in surgical complications, reoperation, mortality, or hospital stay. However, non-responders had a significantly higher lymph node yield (36.29 ± 20.90 vs. 24.65 ± 7.93; p = 0.011). This trend remained across surgical types and histological subtypes. All duodenal stump leaks occurred in responders, suggesting greater fibrotic changes post-NAC. CONCLUSION:The application of ICG for lymphatic mapping in gastric cancer is both safe and feasible in patients receiving NAC. Poor tumor response is associated with higher lymph node retrieval, potentially due to preserved lymphatic architecture and better tracer diffusion. This finding supports the hypothesis that lymphatic fibrosis induced by treatment impairs tracer diffusion.
BACKGROUND:Urination dysfunction is a known late sequela after rectal cancer surgery. Although it negatively affects the quality of life for these patients, evidence of rate is missing. METHODS:The aim was to report the rate of late urination dysfunction in patients undergoing mesorectal excision, transanal microsurgery, or abdominoperineal excision for rectal cancer. This was a prospective cohort study conducted at Herlev Hospital, Denmark. Patients with primary or recurrent rectal cancer who underwent rectal cancer operations between September 2019 and May 2023 were invited to answer an electronic questionnaire 3-12 months postoperatively. The primary outcome included urination dysfunction, incontinence, retention, and increased urinary frequency, divided by operative method. Subgroup analyses compared patient characteristics, cancer location, and operative features. RESULTS:This study included 121 mostly male patients in their sixties, with the most common procedure being robot-assisted surgery. Overall, 49% experienced urination dysfunction, more frequently in males (p = 0.02), patients undergoing oncologic therapy (p = 0.04), and those who had open surgery compared to robot-assisted or laparoscopic procedures (p = 0.01). The dysfunction was most common in patients with midrectal tumors, and symptoms did not improve over time. The extent of the tissue resection varies depending on the surgical procedures, introducing variability in the details of the pathological report. Further, there is a risk of recall bias for preoperative symptoms. CONCLUSION:Half of the rectal cancer surgery patients at our center experienced moderate to severe urinary dysfunction, particularly men and those who had oncologic therapy or open surgery.
Introduction Conversion surgery, enabling curative resection in initially unresectable tumors post-chemotherapy, has gained traction across various cancers. In gastric cancer, particularly HER2-negative cStage IV, integrating immune checkpoint inhibitors (ICIs) like nivolumab with chemotherapy presents a promising strategy. This study evaluates the efficacy and safety of minimally invasive conversion surgery following ICI-combined chemotherapy for these patients. Materials and Methods Patients with HER2-negative cStage IV gastric cancer treated at our institution (2022-2024) were retrospectively reviewed. Diagnosis involved contrast-enhanced CT and staging laparoscopy. Treatment options included SOX+Nivo or FOLFOX+Nivo regimens for eligible candidates aged 20-80 years. Conversion surgery eligibility was assessed after initial and additional treatment cycles, guided by established diagnostic and re-staging criteria. Minimally invasive surgical techniques were applied unless contraindicated. Results Of 42 patients, 28 were cStage IV, with 18 HER2-negative. Conversion surgery was successful in 14 cases; 12 employed minimally invasive methods. The cohort comprised mainly males with a median age of 70. Post-treatment analysis showed significant improvements in performance status and nutritional markers. Grade 2 postoperative complications were minimal, with no severe events. The median postoperative hospital stay was nine days, and high rates of tumor response were observed. The 1-year relapse-free survival and 1-year overall survival were both 100.0% Conclusion The study underscores the potential of ICI-combined chemotherapy to achieve control of metastatic disease and enable minimally invasive curative surgery in stage IV gastric cancer, thereby offering improved prognosis for this patient cohort. Further research is advocated to confirm long-term survival benefits.
Introduction Borderline ovarian tumors (BOT) and low-grade serous carcinoma (LGSC) are rare epithelial ovarian neoplasms with distinct clinicopathologic features and generally more favorable outcomes than high-grade epithelial tumors. This study aimed to describe the clinical, pathologic, and treatment characteristics of BOT and LGSC treated in Argentine and Uruguayan oncology centers, and to report oncologic outcomes. Materials and Methods A multicenter retrospective study was conducted including 369 adult patients diagnosed between 2009 and 2020 in 19 hospitals in Argentina and 1 in Uruguay. Clinical, pathologic, surgical, treatment, and survival data were collected from medical records. Results Of the 369 patients, 336 (91.1%) had BOT and 33 (8.9%) had LGSC. Most tumors were diagnosed at an early stage. BOT was more frequently associated with stage I disease, conservative surgery, and very limited use of systemic treatment, whereas LGSC showed more bilateral disease, ascites, neovascularization, invasive pathologic features, greater use of staging-related procedures, and more frequent systemic treatment. In BOT, 5-year overall survival (OS) and recurrence-free survival (RFS) were 98.9% and 90.2%, respectively. In LGSC, the corresponding rates were 91.4% and 75.5%. Conclusions BOT and LGSC showed clearly different clinical, pathologic, treatment, and survival profiles in this South American multicenter cohort. BOT was usually diagnosed at an early stage and had excellent oncologic outcomes, whereas LGSC was associated with more aggressive clinicopathologic features, more frequent systemic treatment, and poorer survival.
BACKGROUND:Early recurrence post-resection for hepatocellular carcinoma (HCC) occur within one year of surgery. They are "true" recurrences. Our aim is to identify factors associated with early recurrence and explore potential strategies to improve long-term oncological outcomes. METHODS:Patients undergoing liver resection for HCC during the period from July 2011 to June 2023 at Tata Memorial Centre, Mumbai were included in the study. Survival was analyzed based on recurrence timing and treatment modalities used. RESULTS:Recurrences were noted in 166/336(49.4%) patients. Patients were divided into the early recurrence (ER) (n = 79, 47.6%), late recurrence (LR) (n = 60, 36.1%) and extrahepatic recurrence (EHD) groups (n = 27, 16.3%). There was a significant survival difference between ER, LR and EHD (0.001; 16.8 vs 82.1 vs 44.8 months). On multivariable analysis factors such as satellite tumors (HR 2.164; 95% CI 1.093-4.285; p = 0.027), LVE (HR 1.852; 95% CI 1.013-3.386; p = 0.045) and BCLC B and C stage (HR 1.644; 95% CI 1.163-2.325; p = 0.005) were significantly associated with ER. CONCLUSION:Surgery for HCC is fraught with a high recurrence rate with almost half of the recurrences occurring within one year which are mainly local and are associated with lymphovascular emboli, poorer differentiation, satellite nodules and higher BCLC stage.
BACKGROUND:Several publications have shown that cancers of the colon and of the rectum are significantly different, and tumor location is a major prognostic factor for survival. However, colorectal peritoneal metastases (CRPM) is still considered as a homogeneous and a single disease without differentiating between colonic or rectal origin. We asked whether the primary tumor location influences the survival and surgical outcomes of patients with colonic (C_PM) and rectal peritoneal metastases (R_PM) following cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS:Between January 2013 and March 2024, data from 1237 CRS/HIPEC procedures in 1152 patients with CRPM were analysed (C_PM, n = 1129; R_PM, n = 108). Overall survival (OS), recurrence-free survival (RFS), and day-30 morbi-mortality were compared. RESULTS:The 3-year and 5-year OS rates were 68.9% and 52.5% respectively and were significantly better for C_PM than for R_PM patients: (69.8% vs 61%; p = 0.036) and (53.4% vs 43.6%; p = 0.031) respectively. Stratification according to left (LC_PM) and right colonic (RC_PM) subgroups resulted in better 3-year OS for LC_PM than for RC_PM (73.9% vs 63.2%; p ≤ 0.001). Multivariate analysis of 5-year survival identified PCI >15 (HR = 2.09), R_PM (HR = 1.46) and RC_PM (HR = 1.29) as significant risk factors of death. The C_PM group had fewer re-interventions at day-30 (17.6% vs 36.1%; p ≤ 0.001) and shorter surgery time (330 vs 390 min; p ≤ 0.001), ICU-stay (3 vs 4 days; p ≤ 0.001) and hospital length-of-stay (14 vs 17 days; p = 0.002). CONCLUSION:Patients presenting with colonic PM have significantly better OS at 3 and 5 years with fewer re-interventions at day-30 and, shorter surgery time, ICU and hospital stay than those presenting rectal PM. Left-side colonic PM has a significantly better OS at 3-years than right-side colonic PM. PCI >15, rectal and right colonic origin are linked to earlier mortality. When deciding on CRS/HIPEC treatment, designing a study, or reporting data, the CRPM primary tumour site should be taken into account.
OBJECTIVE:To evaluate the impact of initial surgery location on prognosis among patients with endometrial carcinoma. METHODS:We conducted a retrospective cohort study of patients treated at the National Cancer Institute of Mexico between 2006 and 2023. Two groups were compared: patients who underwent primary surgery at the cancer center (Group 1) and those initially treated surgically at noncancer centers and later referred for management (Group 2). Survival outcomes were analyzed using Kaplan-Meier estimates and compared by log-rank test. Cox proportional hazards models were used for univariate and multivariate analyses. Temporal trends were evaluated using joinpoint regression. Statistical significance was set at p < 0.05. RESULTS:Among 1887 patients reviewed, 1204 (63.8%) were initially operated on at the cancer center and 683 (36.2%) elsewhere. Patients in Group 2 had more incomplete pathology reports, more advanced stages, and more frequent use of adjuvant therapy. The mean follow-up was 50.7 months. Five-year overall survival (88.5% vs 77.2%, p < 0.001) and disease-free survival (86.0% vs 71.4%, p < 0.001) were significantly lower in Group 2. Initial surgery performed outside the cancer center was independently associated with poorer overall survival (HR 15.75; 95% CI, 9.22-26.9; p < 0.001) and disease-free survival (HR 24.01; 95% CI, 14.62-39.43; p < 0.001). The proportion of patients initially treated elsewhere increased markedly from 2021 to 2023 (APC 67.97). CONCLUSIONS:Patients with endometrial carcinoma undergoing primary surgery at nononcologic institutions experience significantly poorer survival, likely related to incomplete surgical staging and limited pathological data to guide adjuvant therapy.
OBJECTIVE:To compare perioperative and early oncologic outcomes between open and robot-assisted retroperitoneal lymph node dissection (RPLND) for testicular germ cell tumors in a tertiary referral center in Latin America. PATIENTS AND METHODS:We retrospectively analyzed a prospectively maintained database of consecutive patients undergoing RPLND between January 2020 and December 2025. Patients treated with open or robot-assisted RPLND were included; laparoscopic cases were excluded. Baseline characteristics, perioperative outcomes, and oncologic outcomes were collected. To address baseline imbalances, 1:1 propensity score matching (PSM) was performed using clinically relevant preoperative covariates. Perioperative outcomes included operative time, estimated blood loss (EBL), length of stay (LOS), transfusion, ICU admission, complications, and readmission. Recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier analysis. RESULTS:A total of 66 patients were included (28 open, 38 robotic). After PSM, 20 well-matched pairs were analyzed. In the matched cohort, robot-assisted RPLND was associated with lower EBL (median 100 vs 200 mL, p = 0.01) and shorter LOS (median 1.0 vs 2.0 days, p < 0.001) compared with open RPLND. Operative time was similar between approaches (median 240 min, p = 0.39). Rates of transfusion, ICU admission, overall complications, major complications (Clavien-Dindo ≥3), and 30- and 90-day readmission did not differ significantly between groups. With follow-up censored at 21 December 2025, RFS and OS were comparable between open and robotic RPLND (log-rank p > 0.05 for both). CONCLUSIONS:In this contemporary cohort from a tertiary referral center in Latin America, robot-assisted RPLND was associated with reduced blood loss and shorter hospitalization, without differences in perioperative safety or early oncologic outcomes in comparison to open access. These findings support the feasibility of robotic RPLND as a perioperatively efficient surgical approach when performed in experienced centers.
Objective Outpatient surgery is currently considered as “best practice” for breast cancer surgery. To develop same-day outpatient surgery, France introduced a “single price” incentive that was applied to breast cancer surgery from 2014 on: hospital reimbursement was set at the same level for inpatient and outpatient surgery. The aim of our survey was to assess whether patient’s social deprivation was associated with an impaired access to outpatient surgery (vs. inpatient surgery) for the treatment of a breast cancer. Methods We conducted a retrospective multicentre study on three hospitals in North-West France, using data from the hospital discharge databases.Based on the estimation of a multivariate binary logit model, we analysed factors associated with outpatient surgery (vs. inpatient surgery) in breast cancer patients, including social deprivation measured by the patient’s European Deprivation Index (EDI) observed at a small area-level. Results We analysed 1859 hospitalisations. The most deprived patients (4th (Q4) and 5th (Q5) EDI quintiles) were less likely to have outpatient surgery, with absolute risk differences respectively equal to -0.08 (IC95% [-0.13; -0.03]) and -0.10 (IC95% [-0.16; -0.05]) compared to patients belonging to EDI Q1 (i.e. the least deprived). Conclusions In our data, social deprivation was associated with a lower probability of outpatient surgery in breast cancer patients. As inpatient surgery is costlier for hospitals than outpatient surgery, the single price incentive is likely to penalize hospitals that admit more socially deprived patients and eventually induce hospitals to select patients.
