OBJECTIVES:To compare long-term survival outcomes between primary debulking surgery (PDS) and neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) in patients with advanced ovarian cancer. METHODS:We conducted a retrospective cohort study of 400 patients with FIGO stage III-IV epithelial ovarian cancer between 2013 and 2024. Propensity score matching (PSM) was employed to balance baseline characteristics, resulting in 124 patients in each treatment group. Progression-free survival (PFS) and overall survival (OS) were the primary endpoints. RESULTS:In the matched cohort, PDS was associated with improved survival outcomes compared to NACT-IDS. Median PFS was 31.6 months for PDS versus 20.17 months for NACT-IDS (HR 0.6503, 95%CI 0.4734-0.8932, P = 0.0071). Median OS was 49.67 months for PDS versus 40.5 months for NACT-IDS (HR 0.6333, 95%CI 0.4425-0.9064, P = 0.0124). In multivariable analysis, NACT-IDS remained independently associated with poorer PFS (adjusted HR 1.59, 95% CI 1.14-2.22; P = 0.006) and OS (adjusted HR 1.62, 95% CI 1.11-2.37; P = 0.013). In the subgroup analysis, CC0/R0 resection was significantly associated with improved survival. CONCLUSIONS:In conclusion, in this single-institution retrospective real-world cohort, PDS was associated with longer PFS and OS than NACT-IDS after adjustment for measured baseline characteristics. Regardless of treatment strategy, CC0/R0 resection was associated with improved survival outcomes, highlighting the importance of individualized treatment selection aimed at achieving safe complete cytoreduction whenever feasible.
INTRODUCTION:Pathological T4 (pT4) renal cell carcinoma (RCC) is defined by adjacent organ invasion. The rate of pT4 and its associated clinicopathological characteristics received little attention in non-metastatic (M0) RCC. METHODS:Within the Surveillance, Epidemiology, and End Results (SEER) database (2004-2022), we identified M0 RCC nephrectomy patients and assessed pT4 rates. RESULTS:Of 129,075 M0 RCC nephrectomy patients, 733 (0.6%) harbored pT4 stage. Annual pT4 rates decreased from 1.4% in 2004 to 0.4% in 2022 (p < 0.001). According to tumor size, the pT4 rate was 0.1% in tumors <7 cm and increased from 0.7% in 7-7.9 cm tumors to 6.4% in ≥15 cm tumors (p < 0.001). In patients undergoing radical nephrectomy for tumors ≥7 cm, pT4 rate was 2.5% (578/22,981). According to histology, pT4 rates were 2.3% (376/16,703) in clear-cell RCC, 3.0% (81/2682) in papillary RCC, 1.2% (27/2274) in chromophobe RCC, 6.7% (75/1119) in sarcomatoid dedifferentiated tumors, 13.2% (7/53) in collecting duct carcinomas, and 8.0% (12/150) in other variant histologies (p < 0.001). Compared to pT2-3 patients, pT4 patients more frequently underwent lymphadenectomy (63.3% [366/578] vs. 30.0% [6724/22,403], p < 0.001). Among patients who underwent lymphadenectomy, lymph node invasion was more common in pT4 than in pT2-3 stage (83.6% [298/366] vs. 54.8% [3901/6724], p < 0.001). CONCLUSION:In M0 RCC, pT4 is rare. It is virtually non-existent in tumors <7 cm. The highest pT4 rates are observed in variant histologies. Compared to pT2-3, pT4 is associated with higher lymphadenectomy use and lymph node invasion rates. Collectively, these findings provide descriptive population-level benchmarks.
OBJECTIVE:Three-dimensional (3D) reconstruction model is an emerging technology that significantly enhanced perioperative metrics. This work aimed to delineate the contribution of preoperative 3D reconstruction model to robot-assisted radical nephrectomy (RARN) and IVC thrombectomy. METHODS:A retrospective cohort study was conducted on consecutive patients with RCC and IVC tumor thrombus (Mayo level 1-3) who underwent robotic surgery by a single surgeon (January 2023-January 2026). Preoperative computed tomography urography (CTU) images were used to generate 3D reconstruction models, enabling detailed visualization of tumor-vessel relationships and quantitative measurement of tumor parameters. The primary oncological endpoint was recurrence-free survival (RFS); overall survival (OS) was also evaluated as a secondary endpoint. Postoperative complications were graded using Clavien-Dindo (≥III defined as major), and renal function was assessed by eGFR. A two-sided p value < 0.05 was considered significant. RESULTS:Among 71 patients, those with preoperative 3D reconstruction (n = 27) versus without (n = 44) showed significantly shorter postoperative hospital stay (8.0 vs 10.0 days, P = 0.04) and higher postoperative estimated glomerular filtration rate (eGFR) (76.0 vs 60.0, P = 0.01). Other perioperative benefits (blood transfusion, major complications) were not statistically significant. RFS and OS did not differ significantly between groups. CONCLUSIONS:Preoperative 3D reconstruction helps facilitate RARN and IVC thrombectomy and improves perioperative outcomes. This technique holds promise for broader application in complex urological surgery.
BACKGROUND:Technetium-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) scintigraphy is a useful method for assessing liver function and its heterogeneity. We evaluated its predictive usefulness for post-hepatectomy liver failure (PHLF) in liver resection for biliary tract cancer. METHODS:Between 2013 and 2024, 95 patients underwent major hepatectomy with bile duct resection for biliary tract cancer and had preoperative 99mTc-GSA scintigraphy. The GSA-K value was defined using established reduction formulas of indocyanine green plasma clearance rate (ICG-K) values based on LHL15 value (99mTc-GSA uptake ratio of the liver to the liver plus heart at 15 min) from 99mTc-GSA scintigraphy. Functional remnant liver volume (f-RLV) ratio was estimated by dividing scintillation counts of the future remnant liver by total counts of the whole liver. We compared volumetric (ICG-Krem: ICG-K x RLV ratio) and functional (GSA-Krem: GSA-K x f-RLV ratio) assessment methods of the future remnant liver for predicting PHLF. RESULTS:PHLF was observed in 34 patients (35.8%) and a receiver operating characteristic curve revealed cut-off values for predicting PHLF of 0.088 for ICG-Krem and 0.086 for GSA-Krem. Positive predictive values for PHLF were 53.2% (ICG-Krem) and 87.6% (GSA-Krem). In patients with portal vein embolization (PVE), GSA-Krem showed 89.1% of positive predictive value for PHLF, and ICG-Krem was very low (53.3%). The multivariate analysis identified GSA-Krem as one of independent predictors of PHLF. CONCLUSIONS:GSA-Krem derived from 99mTc-GSA scintigraphy is a valuable predictor of PHLF.
BACKGROUND:Intraoperative ultrasound-guided surgery (IOUS) is an effective technique for invasive breast cancer, offering advantages over wire localization (WL), such as smaller resection volumes, lower rates of involved margins, and better patient satisfaction. However, evidence for ductal carcinoma in situ (DCIS) is limited. This study aimed to compare specimen margins and excision volume in DCIS treated with IOUS versus WL. MATERIAL AND METHODS:From February 2018 to December 2023, women diagnosed with DCIS and eligible for breast-conserving surgery guided by IOUS or WL were prospectively recorded. For IOUS, a US-visible clip was placed at the biopsy site. During surgery, the distance between the clip and the end of mammographic microcalcifications was measured to guide excision. A specimen mammogram confirmed complete removal. Margin status, need for re-excision, and volume of excess healthy tissue-estimated through the calculated resection ratio (CRR)-were compared. RESULTS:A total of 188 patients were included: 55 (29.25%) in the IOUS group and 133 (70.75%) in the WL group. IOUS patients were younger (p = 0.01). Tumor size (p = 0.11) and grade (p = 0.46) were similar between groups. IOUS achieved higher rates of negative margins (>2mm, p = 0.005) and fewer close margins (0.1-2mm, p = 0.03). Surgical volumes did not differ (p = 0.39). Re-excision rates were lower with IOUS (p = 0.05). Multivariate analysis showed IOUS significantly reduced re-excisions (OR 0.1; 95% CI 0.01-0.6) and close/positive margins (OR 0.1; 95% CI 0.02-0.5). Disease-free survival was similar between groups. CONCLUSIONS:IOUS is an accurate localization method for DCIS surgery, reducing re-excisions by increasing rates of negative margins compared with WL.
