Surgical Oncology-Oxford最新文献_第3页

The impact of the timing of adjuvant treatment initiation in patients with upfront resection of pancreatic cancer 胰腺癌前期切除术患者开始辅助治疗时机的影响

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-11-10 DOI: 10.1016/j.suronc.2025.102329

Sydney McManus , Aimée Galatas , Sarah Hemelt , Sanchit Sachdeva , Kevin Sullivan , Bolni Marius Nagalo , Denise Danos , Omeed Moaven

Introduction

This study evaluates the association between timing of adjuvant chemotherapy and overall survival in resectable pancreatic ductal adenocarcinoma (PDAC). It also examines whether the adoption of modern chemotherapy regimens in recent years has influenced this relationship, reflecting evolving treatment practices.

Methods

Cases of resectable primary invasive PDAC were identified using the National Cancer Database (NCDB). Overall survival (OS) was visualized using Kaplan Meier survival plots and Cox proportional hazard models. Covariat adjustment and propensity score matched cohort were analyzed. The matched cohort was analyzed with Cox proportional hazard models and logistic models.

Results

31,949 patients were included in the study. 26.4 % received no chemotherapy, 66.4 % received chemotherapy within 12 weeks, and 7.2 % received chemotherapy after 12 weeks. There was significant improvement in mOS. Between 2015 and 2019, there was a significant difference in OS for patients receiving chemotherapy within 12 weeks, compared to >12 weeks.

Conclusion

While adjuvant chemotherapy in patients with resectable PDAC is associated with improved OS compared to no adjuvant therapy, it is worth considering that those who are well enough to receive chemotherapy inherently have better prognoses. Importantly, the survival association persists regardless of the timing of chemotherapy initiation, suggesting that late administration of adjuvant chemotherapy may still be beneficial in appropriately selected patients.

本研究评估了可切除胰导管腺癌（PDAC）的辅助化疗时间与总生存期之间的关系。它还研究了近年来现代化疗方案的采用是否影响了这种关系，反映了不断发展的治疗实践。方法采用美国国家癌症数据库（NCDB）对可切除的原发性侵袭性PDAC病例进行鉴定。采用Kaplan Meier生存图和Cox比例风险模型可视化总生存期（OS）。分析协变量调整和倾向评分匹配的队列。采用Cox比例风险模型和logistic模型对匹配队列进行分析。结果31,949例患者纳入研究。26.4%的患者未接受化疗，66.4%的患者在12周内接受化疗，7.2%的患者在12周后接受化疗。mOS有显著改善。2015年至2019年期间，12周内接受化疗的患者的OS与12周内接受化疗的患者相比有显著差异。结论虽然可切除PDAC患者的辅助化疗与无辅助治疗相比可改善OS，但值得考虑的是，那些足够健康接受化疗的患者本身具有更好的预后。重要的是，无论化疗开始的时间如何，生存相关性仍然存在，这表明在适当选择的患者中，晚期辅助化疗可能仍然有益。

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引用次数: 0

Cranial-to-caudal approach in laparoscopic surgery for left-sided colon cancer: Longer specimens and higher lymph node yield 左侧结肠癌腹腔镜手术颅尾入路：更长的标本和更高的淋巴结率。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2026-02-02 DOI: 10.1016/j.suronc.2026.102354

Beslen Goksoy , Cem B. Ofluoglu , Ibrahim F. Azamat , Gorkem Uzunyolcu , Serra Z. Akkoyunlu , Ilker Ozgur , Feza Ekiz

Background

Medial-to-lateral (ML) approach is the standard technique in laparoscopic surgery for left-sided colon cancer. However, it can be technically challenging; such as in patients with intra-abdominal adhesions or during splenic flexure mobilization. To overcome these difficulties, we adopted a cranial-to-caudal (CC) approach as an alternative technique. This study aimed to compare the CC and ML approaches in terms of short-term clinical and mid-term oncological outcomes.

Methods

Patients performed laparoscopic surgery for left-sided colon cancer between October 2018 and November 2022 were retrospectively analyzed. Patients were classified into two groups. The primary outcome was the length of the resected specimen. Secondary outcomes were pathological parameters, perioperative outcomes, recurrence-free survival (RFS) and overall survival (OS).

Results

Seventy-four patients were included (ML, n = 39; CC, n = 35). The CC group had longer specimen lengths compared with the ML group (32.9 ± 6.8 cm vs 28.9 ± 6.4 cm; p = 0.022), and longer proximal margin (11.8 ± 3.3 cm vs 9.9 ± 2.3 cm; p = 0.004). Lymph node yield was also higher in the CC group (26.4 ± 8.7 vs 22.3 ± 6.5; p = 0.033). On multivariable analysis, specimen length was independently associated with lymph node yield (β = 0.73; 95% CI, 0.47–1.20; p < 0.001). During a mean follow-up of 44 months, RFS (88.6% vs 89.7%; p = 0.84) and OS (88.6% vs 87.2%; p = 0.67) were similar between the groups.

Conclusions

In laparoscopic surgery for left-sided colon cancer, the CC approach yielded longer resected specimens and more lymph node counts compared with the ML approach, but did not improve oncologic outcomes.

背景：中外侧入路是左侧结肠癌腹腔镜手术的标准技术。然而，这在技术上可能具有挑战性；如腹腔粘连或脾屈曲活动时。为了克服这些困难，我们采用颅尾（CC）入路作为替代技术。本研究旨在比较CC和ML方法在短期临床和中期肿瘤预后方面的差异。方法：回顾性分析2018年10月至2022年11月行左侧结肠癌腹腔镜手术的患者。患者分为两组。主要结果是切除标本的长度。次要结局包括病理参数、围手术期结局、无复发生存期（RFS）和总生存期（OS）。结果：纳入74例患者（ML, n = 39； CC, n = 35）。与ML组相比，CC组的标本长度更长（32.9±6.8 cm比28.9±6.4 cm, p = 0.022），近端缘更长（11.8±3.3 cm比9.9±2.3 cm, p = 0.004）。CC组淋巴结率也较高（26.4±8.7 vs 22.3±6.5;p = 0.033）。在多变量分析中，标本长度与淋巴结产率独立相关（β = 0.73; 95% CI, 0.47-1.20; p）。结论：在腹腔镜下左侧结肠癌手术中，与ML入路相比，CC入路切除的标本更长，淋巴结计数更多，但并没有改善肿瘤预后。

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引用次数: 0

Surgical management of primary hepatic neuroendocrine tumors: A 20-year population-based analysis 原发性肝脏神经内分泌肿瘤的外科治疗：一项基于20年人群的分析。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2026-01-29 DOI: 10.1016/j.suronc.2026.102358

Alexandra H. Helbing , Tony Boualoy , Ambria S. Moten

Background

Primary hepatic neuroendocrine tumors (PHNETs) are rare neoplasms with limited population-level data to guide treatment. We evaluated clinical, pathologic, and treatment factors associated with surgical intervention and survival using a contemporary national cohort.

Methods

Patients diagnosed with PHNETs from 2000 to 2021 were identified within the Surveillance, Epidemiology, and End Results (SEER) database. Demographic, tumor, and treatment characteristics were analyzed. Multivariable logistic regression identified predictors of surgical resection. Kaplan-Meier and Cox models evaluated overall survival (OS) and cause-specific survival (CSS).

Results

A total of 669 patients met inclusion criteria. Surgical resection was performed in 16.4 % of cases. Compared with localized disease, regional disease was associated with significantly lower odds of surgery (OR 0.25, 95 % CI: 0.14–0.45). Ten-year OS was 21.8 % for localized, 12.5 % for regional, and 4.8 % for distant disease (p < 0.001). Well differentiated tumors were associated with superior 5- and 10-year OS and CSS compared to poorly differentiated tumors (p < 0.001). Among patients with localized or regional disease, surgical resection was associated with a 10-year OS of 44.9 % versus 9.2 % without surgery (p < 0.001). On multivariable analysis, poorly differentiated histology (HR 2.69, 95 % CI: 1.93–3.77) and larger tumor size (HR 1.01, 95 % CI: 1.00–1.01) were associated with increased mortality, while surgical resection remained protective (HR 0.23, 95 % CI: 0.15–0.37).

Conclusions

Surgical resection is associated with significantly improved survival in patients with localized or regional PHNETs. Tumor grade, stage, and size remain key prognostic factors in this rare malignancy.

背景：原发性肝神经内分泌肿瘤（PHNETs）是一种罕见的肿瘤，在人群水平上的数据有限，无法指导治疗。我们使用当代国家队列评估了与手术干预和生存率相关的临床、病理和治疗因素。方法：在监测、流行病学和最终结果（SEER）数据库中确定2000年至2021年诊断为PHNETs的患者。分析人口统计学、肿瘤和治疗特点。多变量logistic回归确定了手术切除的预测因素。Kaplan-Meier和Cox模型评估总生存期（OS）和病因特异性生存期（CSS）。结果：669例患者符合纳入标准。16.4%的病例行手术切除。与局部疾病相比，局部疾病与手术的几率显著降低相关（OR: 0.25, 95% CI: 0.14-0.45）。局限性PHNETs的10年总生存率为21.8%，局部疾病为12.5%，远处疾病为4.8%(结论：手术切除与局限性或区域性PHNETs患者的生存率显著提高相关。肿瘤分级、分期和大小仍然是这种罕见恶性肿瘤的关键预后因素。

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引用次数: 0

Histologic subtypes and divergent differentiations of urothelial carcinoma: Prognostic implications and clinical insights 尿路上皮癌的组织学亚型和分化：预后意义和临床见解

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-12-23 DOI: 10.1016/j.suronc.2025.102344

Kadir Can Sahin , Muhammed Fatih Simsekoglu , Sami Berk Ozden , Birgi Ercili , Ahmet Vural , Iclal Gurses , Cetin Demirdag

Introduction

Bladder cancer is a major global health concern, and urothelial carcinoma (UC) often presents with diverse histologic subtypes and differentiations associated with aggressive behavior and poorer survival with no standardized treatment recommendations. This study aimed to compare clinicopathologic characteristics and survival outcomes between patients with histologic/divergent UC subtypes and those with pure UC at initial presentation.

Patients and methods

We retrospectively analyzed 506 patients with de novo UC identified at initial transurethral resection of the bladder (TUR-BT) between 2015 and 2023. Demographic and clinical characteristics, pathologic features, treatment strategies, and survival outcomes were compiled and compared between groups. Treatment strategies, including radical cystectomy and neoadjuvant chemotherapy, were also evaluated to examine how histologic subtypes influenced clinical decision-making.

Results

Median follow-up period was 71 months (95 % CI, 68.0–74.0). Patients with histologic subtypes and divergent differentiations demonstrated significantly more aggressive tumor features at diagnosis, including higher rates of muscle invasion (46.1 % vs. 28.8 %, p < 0.001) and lymphovascular invasion (LVI) (38 % vs. 13.5 %, p < 0.001). Both overall survival (OS) and metastasis-free survival (MFS) were significantly worse in the UC with histologic subtype and differentiation group (five-year OS: 48.1 % vs. 73.1 %, p < 0.001; five-year MFS: 58.3 % vs. 87.4 %, p < 0.001). In multivariate analyses, presence of histologic subtypes and LVI were independently associated with poorer OS and MFS across all models. Age remained a significant factor for OS in all categories. ASA score ≥2 and surgical margin positivity were also associated with OS in the overall and muscle invasive patient cohorts.

Conclusion

Histologic subtypes of UC are associated with more aggressive clinicopathologic features and significantly worse survival outcomes. Early and accurate recognition of these subtypes and divergent differentiations at initial TUR-BT is critical, highlighting the need for tailored management strategies to improve patient prognosis.

膀胱癌是一个主要的全球健康问题，尿路上皮癌（UC）通常表现为不同的组织学亚型和分化，与侵袭性行为和较差的生存率相关，没有标准化的治疗建议。本研究旨在比较组织学/分化型UC和单纯UC患者的临床病理特征和生存结果。患者和方法我们回顾性分析了2015年至2023年间506例首次经尿道膀胱切除术（turt - bt）发现的新发UC患者。统计和比较两组间的人口学和临床特征、病理特征、治疗策略和生存结果。治疗策略，包括根治性膀胱切除术和新辅助化疗，也被评估，以检查组织学亚型如何影响临床决策。结果中位随访时间为71个月（95% CI, 68.0 ~ 74.0）。组织学亚型和分化不同的患者在诊断时表现出更强的肿瘤特征，包括更高的肌肉侵袭率（46.1%比28.8%,p < 0.001）和淋巴血管侵袭（LVI）（38%比13.5%,p < 0.001）。总生存率（OS）和无转移生存率（MFS）在具有组织学亚型和分化的UC组中均明显较差（5年OS: 48.1% vs. 73.1%, p < 0.001； 5年MFS: 58.3% vs. 87.4%, p < 0.001）。在多变量分析中，所有模型中组织学亚型和LVI的存在与较差的OS和MFS独立相关。在所有类别中，年龄仍然是OS的重要因素。ASA评分≥2和手术切缘阳性也与总体和肌肉侵袭性患者队列的OS相关。结论UC的组织学亚型与更具侵袭性的临床病理特征和明显较差的生存结果相关。早期和准确识别这些亚型和早期turt - bt分化是至关重要的，强调需要量身定制的管理策略，以改善患者预后。

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引用次数: 0

Usefulness and safety of salvage surgery with reconstruction for recurrent head and neck cancer with a history of reconstruction surgery and radiation therapy 有重建手术和放射治疗史的复发性头颈部癌的挽救性手术重建的有效性和安全性。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-12-13 DOI: 10.1016/j.suronc.2025.102340

Saki Akita , Masashi Kuroki , Ryota Iinuma , Tatsuhiko Yamada , Ryo Kawaura , Hiroshi Okuda , Kousuke Terazawa , Kenichi Mori , Hirofumi Shibata , Natsuko Obara , Keishi Kohyama , Hisakazu Kato , Takenori Ogawa

Background

Salvage surgery is one of the treatment options for recurrent metastatic head and neck cancer (RMHNC). Salvage surgery with reconstruction for patients with a history of reconstructive surgery and radiation therapy (RT) is especially difficult and carries a high risk of complications.

Methods

This study included patients with RMHNC who had a history of reconstructive surgery and RT. The prognosis and complications were evaluated by dividing patients into those who underwent salvage surgery with reconstruction and those who underwent non-surgical treatments.

Results

Fifty-seven patients were enrolled. The overall survival (OS) of the salvage surgery with reconstruction group was better than that of the non-surgical treatment groups (median OS; 50.6 months vs. 21.6 months, p = 0.0373), but the progression-free survival (PFS) was similar (median PFS; 14.5 months vs. 12.9 months, p = 0.48). The salvage surgery with reconstruction group also showed a better prognosis than the immune checkpoint inhibitor (ICI) group (median OS; 50.6 months vs. 30.9 months, p = 0.209). In the salvage surgery with reconstruction group, 85.8 % of cases experienced postoperative complications, while in the patients who underwent non-surgical treatments, 58.8 % experienced adverse events (p = 0.0724). There were no cases of Grade IIIb or higher that required general anesthesia.

Conclusion

Salvage surgery with reconstruction showed a better prognosis than other non-surgical treatments, including ICI. Furthermore, with careful case selection and thorough postoperative care, salvage surgery with reconstruction can be performed relatively safely without any serious complications.

背景：挽救性手术是复发性转移性头颈癌（RMHNC）的治疗选择之一。对于有重建手术和放射治疗（RT）史的患者进行重建手术尤其困难，并且并发症的风险很高。方法：本研究纳入有重建手术和rt病史的RMHNC患者，将患者分为修复手术合并重建组和非手术治疗组，评估预后和并发症。结果：57例患者入组。挽救性手术重建组的总生存期（OS）优于非手术治疗组（中位OS: 50.6个月vs. 21.6个月，p = 0.0373），但无进展生存期（PFS：中位PFS: 14.5个月vs. 12.9个月，p = 0.48）相似。挽救性手术重建组的预后也优于免疫检查点抑制剂（ICI）组（中位生存期：50.6个月vs 30.9个月，p = 0.209）。术后并发症发生率为85.8%，非手术组为58.8%，差异有统计学意义（p = 0.0724）。没有iii级及以上需要全身麻醉的病例。结论：挽救性手术重建预后优于包括ICI在内的其他非手术治疗。此外，通过仔细的病例选择和彻底的术后护理，可以相对安全地进行重建手术，没有严重的并发症。

{"title":"Usefulness and safety of salvage surgery with reconstruction for recurrent head and neck cancer with a history of reconstruction surgery and radiation therapy","authors":"Saki Akita , Masashi Kuroki , Ryota Iinuma , Tatsuhiko Yamada , Ryo Kawaura , Hiroshi Okuda , Kousuke Terazawa , Kenichi Mori , Hirofumi Shibata , Natsuko Obara , Keishi Kohyama , Hisakazu Kato , Takenori Ogawa","doi":"10.1016/j.suronc.2025.102340","DOIUrl":"10.1016/j.suronc.2025.102340","url":null,"abstract":"<div><h3>Background</h3><div>Salvage surgery is one of the treatment options for recurrent metastatic head and neck cancer (RMHNC). Salvage surgery with reconstruction for patients with a history of reconstructive surgery and radiation therapy (RT) is especially difficult and carries a high risk of complications.</div></div><div><h3>Methods</h3><div>This study included patients with RMHNC who had a history of reconstructive surgery and RT. The prognosis and complications were evaluated by dividing patients into those who underwent salvage surgery with reconstruction and those who underwent non-surgical treatments.</div></div><div><h3>Results</h3><div>Fifty-seven patients were enrolled. The overall survival (OS) of the salvage surgery with reconstruction group was better than that of the non-surgical treatment groups (median OS; 50.6 months vs. 21.6 months, p = 0.0373), but the progression-free survival (PFS) was similar (median PFS; 14.5 months vs. 12.9 months, p = 0.48). The salvage surgery with reconstruction group also showed a better prognosis than the immune checkpoint inhibitor (ICI) group (median OS; 50.6 months vs. 30.9 months, p = 0.209). In the salvage surgery with reconstruction group, 85.8 % of cases experienced postoperative complications, while in the patients who underwent non-surgical treatments, 58.8 % experienced adverse events (p = 0.0724). There were no cases of Grade IIIb or higher that required general anesthesia.</div></div><div><h3>Conclusion</h3><div>Salvage surgery with reconstruction showed a better prognosis than other non-surgical treatments, including ICI. Furthermore, with careful case selection and thorough postoperative care, salvage surgery with reconstruction can be performed relatively safely without any serious complications.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"64 ","pages":"Article 102340"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145795647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Analysis of the clinicopathological relevance and prognostic value of CDK1 in human malignancy: Insights from meta and bioinformatics analysis CDK1在人类恶性肿瘤中的临床病理相关性和预后价值分析：来自meta和生物信息学分析的见解

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-12-16 DOI: 10.1016/j.suronc.2025.102339

Mehran Pashirzad , Alexandra E. Butler , Prashant Kesharwani , Amirhossein Sahebkar

We conducted a comprehensive assessment of the prognostic significance of CDK1 expression in patients diagnosed with cancer. Pooled hazard ratios (HRs), odds ratios (ORs), and 95 % confidence interval (CI) were calculated to determine the associations between CDK1 expression and overall survival (OS), disease-free survival (DFS), as well as various clinicopathological characteristics. A total of 20 studies, comprising 2470 patients, were included in this meta-analysis. Elevated CDK1 expression was significantly associated with reduced OS in both univariate and multivariate analyses, with pooled HRs of 1.55 (95 % CI: 1.31–1.81) and 1.89 (95 % CI: 1.52–2.36), respectively. Furthermore, higher CDK1 expression levels correlated significantly with adverse pathological features, including tumor size (OR = 1.50; 95 % CI, 1.08–2.09), lymph node metastasis (LNM; OR = 2.41; 95 % CI, 1.69–3.44), higher histological grade (OR = 2.40; 95 % CI, 1.69–3.39) and advanced tumor stage (OR = 1.76; 95 % CI, 1.25–2.48). These findings suggest that CDK1 over-expression may serve as a robust prognostic biomarker associated with unfavorable clinical outcomes in patients with cancer.

我们对诊断为癌症的患者中CDK1表达的预后意义进行了全面评估。计算合并风险比（hr）、优势比（ORs）和95%置信区间（CI），以确定CDK1表达与总生存期（OS）、无病生存期（DFS）以及各种临床病理特征之间的关系。本荟萃分析共纳入了20项研究，包括2470名患者。在单因素和多因素分析中，CDK1表达升高与OS降低显著相关，合并hr分别为1.55 （95% CI: 1.31-1.81）和1.89 （95% CI: 1.52-2.36）。此外，较高的CDK1表达水平与肿瘤大小（OR = 1.50; 95% CI, 1.08-2.09）、淋巴结转移（LNM; OR = 2.41; 95% CI, 1.69-3.44）、较高的组织学分级（OR = 2.40; 95% CI, 1.69-3.39）和肿瘤分期（OR = 1.76; 95% CI, 1.25-2.48）等不良病理特征显著相关。这些发现表明，CDK1过表达可能是与癌症患者不良临床结果相关的强有力的预后生物标志物。

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引用次数: 0

Perioperative outcomes after robotic repeat hepatectomy: A systematic review 机器人重复肝切除术后围手术期预后：一项系统综述。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-12-13 DOI: 10.1016/j.suronc.2025.102342

Gianluca Cassese , Fabrizio Panaro , Fabio Giannone , Mariantonietta Alagia , Marco Palucci , Cristina Ciulli , Alessandro Fogliati , Mattia Garancini , Mauro Alessandro Scotti , Fabio Benedetti , Fabrizio Romano

Background

Robotic liver resection has widely spread in hepatopancreatobiliary surgery, with growing evidence even in challenging scenarios. However, the results of robotic hepatectomy in patients who have had previous liver operations (repeat Robotic Liver Resections, r-RLR) have not been deeply investigated so far.

Methods

A systematic review of the MEDLINE and SCOPUS databases was performed, including studies published until April 2025.

Results

A total of 4 studies including 118 patients met the inclusion criteria. Nineteen patients (16.1 %) had received 2 or more previous liver resections, with 92.4 % (n = 109) of the r-RLR that were performed for malignant lesions. Colorectal liver metastases represented the most common malignant indication (40.7 %), followed by recurrent hepatocellular carcinoma (36.4 %). Tumor size varied between 10 and 33 mm in the largest diameter. The weighted mean operative time was 200.8 min (SD: 112.3), and the weighted mean estimated blood loss was 134.3 mL (SD: 121.9). The weighted mean hospital length of stay was 4.7 days (SD: 4.7). One case of open conversion was reported (0.8 %). Six patients experienced major complications (5 %), with 1 (0.8 %) postoperative death.

Conclusion

Few retrospective studies investigating the outcomes of r-RLR are currently available in the literature. From published data, it may be a safe and feasible alternative to open and laparoscopic redo hepatectomy in selected patients in referral HPB centers. Further studies with larger sample sizes are needed to confirm such preliminary findings.

背景：机器人肝切除在肝胆胰手术中广泛应用，即使在具有挑战性的情况下也有越来越多的证据。然而，机器人肝切除术对既往肝手术患者的效果（重复机器人肝切除术，r-RLR）迄今尚未深入研究。方法：对MEDLINE和SCOPUS数据库进行系统回顾，包括截至2025年4月发表的研究。结果：共有4项研究118例患者符合纳入标准。19例（16.1%）患者曾接受过2次或2次以上的肝脏切除术，其中92.4% （n = 109）的r-RLR是针对恶性病变进行的。结直肠肝转移是最常见的恶性指征（40.7%），其次是复发性肝细胞癌（36.4%）。肿瘤最大直径在10 ~ 33mm之间。加权平均手术时间200.8 min (SD: 112.3)，加权平均估计失血量134.3 mL （SD: 121.9）。加权平均住院时间为4.7天（SD: 4.7）。报告1例（0.8%）。6例患者出现严重并发症（5%），1例（0.8%）术后死亡。结论：目前文献中很少有回顾性研究调查r-RLR的结果。从已发表的数据来看，对于转介HPB中心的选定患者，它可能是一种安全可行的替代开放式和腹腔镜重做肝切除术的方法。需要更大样本量的进一步研究来证实这些初步发现。

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引用次数: 0

Surgical management of breast cancer liver metastases: what indications and results in 2025? A narrative review 乳腺癌肝转移的手术治疗：2025年的适应证和结果？叙述性回顾

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-11-19 DOI: 10.1016/j.suronc.2025.102330

Lucia Paiano , René Adam , Nicolas Golse

Breast cancer liver metastases (BCLM) have historically been treated with chemotherapy and supportive care, and long-term survival in stage IV breast cancer remains rare despite advances in systemic therapies such as chemotherapy, hormonal and targeted therapies. Since the 2000s, many trials comparing surgery and systemic therapy have improved our understanding of the management of BCLM. Prognostic factors influencing outcome include disease-free interval from primary tumor, hormone receptor status, metastatic burden and tumor biology. Molecular profiling (e.g. BRCA1/2, PIK3CA, HER2, ESR1) has further refined the response to systemic therapy, enabling personalized treatment strategies. Recent evidence highlights the prognostic impact of surgery in combination with systemic therapy in highly selected patients, with a 5-year survival rate reaching 53 %. Optimal surgical candidates may include patients with small (<5 cm), solitary or easily resectable metastases, stable disease on neoadjuvant therapy and favorable tumor biology. However, preoperative imaging often underestimates tumor burden, leading to resection cancellation in ∼20 % of cases. Unlike colorectal liver metastases, BCLM rarely become resectable after systemic therapy, which is primarily aimed at disease control and reducing recurrence risk. Non-surgical interventions, including radiofrequency or microwave ablation and radioembolization, are typically reserved for patients who are ineligible for surgery due to frailty, comorbidities or challenging tumor locations. Multidisciplinary planning remains essential to optimize treatment, integrating systemic advances, tumor biology and surgical feasibility to improve long-term outcomes in the management of BCLM.

乳腺癌肝转移（BCLM）历来都是通过化疗和支持性治疗来治疗的，尽管化疗、激素和靶向治疗等系统性治疗取得了进展，但IV期乳腺癌的长期生存率仍然很低。自2000年代以来，许多比较手术和全身治疗的试验提高了我们对BCLM治疗的理解。影响预后的因素包括原发肿瘤无病期、激素受体状态、转移负荷和肿瘤生物学。分子分析（如BRCA1/2、PIK3CA、HER2、ESR1）进一步完善了对全身治疗的反应，实现了个性化的治疗策略。最近的证据强调了在高度选定的患者中，手术联合全身治疗对预后的影响，其5年生存率达到53%。最佳的手术候选者可能包括小（< 5cm），孤立或易于切除的转移，新辅助治疗稳定的疾病和良好的肿瘤生物学。然而，术前成像往往低估了肿瘤负荷，导致约20%的病例切除取消。与结直肠肝转移不同，BCLM在接受全身治疗后很少可以切除，其主要目的是控制疾病和降低复发风险。非手术干预，包括射频或微波消融和放射栓塞，通常用于因虚弱，合并症或肿瘤位置挑战性而不适合手术的患者。多学科规划对于优化治疗仍然至关重要，整合系统进展、肿瘤生物学和手术可行性，以改善BCLM管理的长期结果。

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引用次数: 0

Early closure of defunctioning ileostomy after low-pelvic surgery for rectal cancer: Systematic review and meta-analysis of safety and functional outcomes 直肠癌低盆腔手术后早期关闭失功能回肠造口：安全性和功能结局的系统回顾和荟萃分析

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-11-08 DOI: 10.1016/j.suronc.2025.102326

Parbatraj Regmi , Bikash Kumar Sah , Vijay Pratap Sah , Bhawani Khanal , Abhijeet Kumar , Tomas Janusonis , Zygimantas Juodeikis , Darius Cincikas , Alfredas Kilius , Narimantas Evaldas Samalavicius , Rakesh Kumar Gupta

Background

Preventive defunctioning ileostomy is widely used to prevent leaks in high-risk colorectal anastomosis, but here is no international consensus on the timing of stoma reversal. In this study we aim to evaluate the safety and functional outcomes of early versus late defunctioning ileostomy after low-pelvic surgery for rectal cancer.

Methods

Systematic literature search was performed in multiple electronic databases until September 30, 2025. Meta-analysis and trial-sequantial analysis (TSA) were performed using the RevMan 5.4 and Copenhagen Trial Unit TSA software.

Results

There was no significant difference in overall postoperative morbidity, major morbidity, operation time, blood loss, incidence of postoperative ileus/bowel obstruction, length of stay (LOS), and reoperation rate between two groups. Functional outcomes like the incidence of major low anterior resection syndrome (LARS) and the minor LARS were also similar in two groups.

Conclusion

There is no increased risk of morbidity with early closure of defunctioning ileostomy after colorectal cancer surgery and the functional outcomes were also similar. Therefore, early reversal may be a safe and feasible approach in precisely selected cases when the clinician feels supported in doing so.

背景：预防性失功能回肠造口术被广泛应用于预防高危结肠吻合术中的瘘漏，但对于造口逆转的时机，国际上尚无共识。在这项研究中，我们的目的是评估低盆腔手术后早期与晚期失功能回肠造口术的安全性和功能结果。方法于2025年9月30日在多个电子数据库进行系统文献检索。采用RevMan 5.4和Copenhagen Trial Unit TSA软件进行meta分析和试验序列分析（TSA）。结果两组患者术后总发病率、主要发病率、手术时间、出血量、术后肠梗阻发生率、住院时间（LOS）、再手术率差异无统计学意义。两组患者的功能预后，如主要前低位切除综合征（LARS）和次要前低位切除综合征的发生率也相似。结论结直肠癌术后功能失活回肠造口早期闭合未增加发病风险，功能结局相似。因此，早期逆转可能是一个安全可行的方法，在精确选择的情况下，临床医生认为支持这样做。

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引用次数: 0

Does Indocyanine Green define margins in Wilms tumour? A novel macroscopic and microscopic ex-vivo study 吲哚菁绿能确定肾母细胞瘤的边缘吗？一种新的宏观和微观离体研究。

IF 2.4 4区医学 Q3 ONCOLOGY

Surgical Oncology-Oxford

Pub Date : 2026-02-01 Epub Date: 2025-12-24 DOI: 10.1016/j.suronc.2025.102347

M. Pachl , C. Bowen

Introduction

Wilms tumor (WT) is the commonest renal cancer in children. It has excellent overall survival rates of >85 %, but relapsed disease is difficult to treat. Surgeons usually undertake a total nephrectomy but can occasionally perform nephron sparing surgery (NSS) in selected cases to preserve renal tissue. However, if margins are positive, the child then needs chemotherapy intensification and radiotherapy. Intraoperative guidance is limited to knowledge of the anatomy and intra-operative ultrasound, neither of which is perfect. This study uses an ex-vivo platform to study whether Indocyanine Green (ICG) can define tumor margins at a macroscopic and microscopic level.

Material and methods

UK Research Ethics committee approved the study. Patients having nephrectomy were eligible and parents were approached for enrolment. Patient demographics, anatomy of tumor and remaining kidney, ex-vivo macroscopic and microscopic white light and near infrared (NIR) findings were assessed. Microscopic pixel brightness was recorded as grayscale with peak and range. Final histopathology was also recorded.

Statistics were presented as median (range) and comparative data as Mann-Whitney U with a p of >0.01 taken as significant.

Results

Eleven consecutive patients having unilateral total nephroureterectomy for presumed WT. Two were excluded with nine kidneys (4F:5M) receiving ex-vivo intra-arterial injection of ICG.

In all specimen's normal renal parenchyma exhibited macroscopic and microscopic fluorescence. Low (n = 1) and intermediate risk tumors (n = 6) had obvious margins under NIR at macroscopic or microscopic levels. High risk blastemal tumors (n = 2) showed fluorescence throughout the tumor as well as the parenchyma with no obvious margins.

Grayscale readings showed blastemal was not significantly different to normal kidney (p = 0.477) but epithelial(E) (p = 0.01); stromal(S) (p = 0.003); combined E/S/necrotic(N) (p = 0.00018) and combined E/S/N/Tumor capsule (p = 0.00006) were.

Conclusion

ICG and NIR can be used to assess tumor margins in low and intermediate risk disease but not in blastemal high-risk tumors. It can act as an additional measure of safety but should not be used alone.

肾母细胞瘤（Wilms tumor， WT）是儿童最常见的肾癌。它的总生存率高达85%，但复发的疾病很难治疗。外科医生通常会进行全肾切除术，但偶尔也会在某些情况下进行保留肾组织的手术（NSS）。然而，如果边缘呈阳性，则需要化疗强化和放疗。术中指导仅限于解剖学知识和术中超声知识，两者都不是完美的。本研究采用离体平台研究吲哚菁绿（Indocyanine Green， ICG）是否能在宏观和微观水平上定义肿瘤边缘。材料和方法：英国研究伦理委员会批准了这项研究。接受肾切除术的患者符合条件，并与父母联系进行登记。评估患者的人口统计学、肿瘤和剩余肾脏的解剖结构、离体宏观和微观白光和近红外（NIR）结果。显微像素亮度记录为带峰值和范围的灰度。同时记录最终组织病理学结果。统计量以中位数（极差）表示，比较数据以Mann-Whitney U表示，p = 0.01为显著性。结果：11例患者连续接受单侧全肾输尿管切除术，推定为WT。2例患者排除了9个肾脏（4F:5M）接受体外动脉内注射ICG。所有正常肾实质均可见肉眼和显微镜下的荧光。低危肿瘤（n = 1）和中危肿瘤（n = 6）在宏观和微观上均有明显的近红外边缘。高危胚质肿瘤（n = 2）全肿瘤及实质可见荧光，无明显边缘。灰度读数显示胚质与正常肾无显著差异（p = 0.477），上皮与正常肾无显著差异（p = 0.01）；基质(S) (p = 0.003)；E/S/坏死(N)联合（p = 0.00018）和E/S/N/肿瘤（p = 0.00006）联合（p = 0.00006）。结论：ICG和NIR可用于低、中危性肿瘤的肿瘤边缘评估，但不适用于胚性高危肿瘤。它可以作为一种额外的安全措施，但不应单独使用。

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