The benefit of local control on the overall survival of patients with metastatic breast cancer remains controversial. This study aimed to evaluate the impact of locoregional treatment of the primary tumor (surgery and/or radiotherapy) in Mexican patients diagnosed with de novo metastatic breast cancer.
Materials and methods
This retrospective study evaluated 671 patients with de novo metastatic breast cancer, diagnosed between the years 2007–2015, using data from a local database of breast cancer patients. The decision for locoregional treatment was made by the attending physician.
Results
Among 671 patients, the median follow-up was 26.83 months. Patients who underwent locoregional control (surgery and/or radiotherapy) had a median survival of 41.57 months compared to 21.3 months in those without locoregional control (p < 0.001). Median survival was 51.5 months in patients treated with surgery versus 25,53 months in those without surgery (p < 0.001) and 40.1 months versus 25.23 months in patients receiving chemoradiotherapy (p < 0.001). Multivariate analysis confirmed that surgery significantly improved overall survival (HR 0.50; 95 % CI:0.32–0.77; p = 0.002). However, after adjusting for potential confounders using propensity score matching, the survival benefit associated with surgery did not reach statistical significance.
Conclusions
Our retrospective analysis shows no survival benefit from locoregional control after adjustment for potential confounders. However, given the observed survival differences, it is important to identify which patient subgroups may derive benefit in prospective studies.
{"title":"Overall survival improvement with locoregional control in patients with metastatic breast cancer. Single-institution experience","authors":"María Tereza Nieto-Coronel , Nancy Reynoso-Noveron , Ariana Tabares-Yañez , Claudia Haydee Arce- Salinas","doi":"10.1016/j.suronc.2025.102304","DOIUrl":"10.1016/j.suronc.2025.102304","url":null,"abstract":"<div><h3>Background</h3><div>The benefit of local control on the overall survival of patients with metastatic breast cancer remains controversial. This study aimed to evaluate the impact of locoregional treatment of the primary tumor (surgery and/or radiotherapy) in Mexican patients diagnosed with de novo metastatic breast cancer.</div></div><div><h3>Materials and methods</h3><div>This retrospective study evaluated 671 patients with de novo metastatic breast cancer, diagnosed between the years 2007–2015, using data from a local database of breast cancer patients. The decision for locoregional treatment was made by the attending physician.</div></div><div><h3>Results</h3><div>Among 671 patients, the median follow-up was 26.83 months. Patients who underwent locoregional control (surgery and/or radiotherapy) had a median survival of 41.57 months compared to 21.3 months in those without locoregional control (p < 0.001). Median survival was 51.5 months in patients treated with surgery versus 25,53 months in those without surgery (p < 0.001) and 40.1 months versus 25.23 months in patients receiving chemoradiotherapy (p < 0.001). Multivariate analysis confirmed that surgery significantly improved overall survival (HR 0.50; 95 % CI:0.32–0.77; p = 0.002). However, after adjusting for potential confounders using propensity score matching, the survival benefit associated with surgery did not reach statistical significance.</div></div><div><h3>Conclusions</h3><div>Our retrospective analysis shows no survival benefit from locoregional control after adjustment for potential confounders. However, given the observed survival differences, it is important to identify which patient subgroups may derive benefit in prospective studies.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102304"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145318727","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}
Pub Date : 2025-12-01Epub Date: 2025-05-22DOI: 10.1016/j.suronc.2025.102238
Hwee-Leong Tan , Darren W.Q. Chua , Brian K.P. Goh
Minimally-invasive liver resection (MILR) has been increasingly adopted across the world with improvements in surgical technique and instrumentation. While MILR has been shown to confer several perioperative benefits compared to open liver resection, the steep learning curve associated with MILR remains a significant hurdle. Robotic liver resection (RLR) leverages on inherent technical advantages the robotic platform has over conventional laparoscopy, holding the potential for RLR to achieve the perioperative advantages of MILR while overcoming the limitations of laparoscopic liver resection (LLR). In this review, we summarize the current evidence comparing the outcomes of RLR and LLR from the International Robotic and Laparoscopic Liver Resection Study Group.
{"title":"Current evidence for robotic and laparoscopic liver resections: Results from the international study group","authors":"Hwee-Leong Tan , Darren W.Q. Chua , Brian K.P. Goh","doi":"10.1016/j.suronc.2025.102238","DOIUrl":"10.1016/j.suronc.2025.102238","url":null,"abstract":"<div><div><span>Minimally-invasive liver resection<span> (MILR) has been increasingly adopted across the world with improvements in surgical technique and instrumentation. While MILR has been shown to confer several perioperative benefits compared to open liver resection, the steep learning curve associated with MILR remains a significant hurdle. Robotic liver resection (RLR) leverages on inherent technical advantages the robotic platform has over conventional </span></span>laparoscopy, holding the potential for RLR to achieve the perioperative advantages of MILR while overcoming the limitations of laparoscopic liver resection (LLR). In this review, we summarize the current evidence comparing the outcomes of RLR and LLR from the International Robotic and Laparoscopic Liver Resection Study Group.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102238"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188512","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}
<div><h3>Background</h3><div>To compare long term clinical outcomes after accelerated partial breast irradiation (APBI) versus whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy in women with breast cancer after breast conservation surgery (BCS).</div></div><div><h3>Materials and methods</h3><div>Women >35 years of age with invasive or noninvasive breast cancer ≤4 cm treated by BCS were randomized to 3D-CRT APBI (34 Gy/10 fractions/5 days) or WBI (40 Gy/16 fractions/3 weeks ± boost irradiation). The primary outcome was ipsilateral breast tumor recurrence. Important secondary outcomes were late toxicities using Radiation Therapy Oncology Group scores, Late Effects Normal Tissue Task Force and Subjective, Objective, Management, Analytic scales, adverse cosmetic outcome and distant metastases. The secondary endpoints of radiation toxicities and cosmesis were published in an interim analysis. Here we present the primary outcome and the late toxicities data. Patient and tumor characteristics, local recurrence and rates of adverse cosmetic outcomes were compared using Fisher exact tests. Locoregional recurrence free survival (LRRFS), disease free survival (DFS) and overall survival (OS) was calculated using Kaplan-Meier curves. All statistical tests were 2 sided, with <em>p</em> < 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>Between June 2011 and December 2015, 132 women with breast cancer were randomized to 3D-CRT APBI or WBI. Patient and tumor characteristics were balanced between the two arms. Median follow-up was 10.8 years (range, 3.2–13.6 years). Local recurrence was observed in 3 (4.6 %) and 2 (3 %) patients in APBI and WBI arms (p = 0.62), respectively. Distant metastases occurred in 5 (7.6 %) and 3 (4.4 %) patients in APBI and WBI arms (p = 0.35), respectively. The HR for locoregional recurrence was 1.62 (95 % CI, 0.27–9.67, p = 0.60) for APBI (65 patients, 3 local recurrences) vs. WBI (67 patients, 2 local recurrences). The 10-year LRRFS rates (95 % CIs) were 97 % (88–99 %) and 95 % (86–98 %), respectively.</div><div>The HR for disease-recurrence (local or distant) was 1.47 (95 % CI, 0.51–4.25, p = 0.47) for APBI (65 patients, 8 recurrences) vs. WBI (67 patients, 6 recurrences). The 10-year DFS rates (95 % CIs) were 92 % (83–97 %) and 88 % (77–94 %), respectively. The HR for death was 1.14 (95 % CI, 0.23–5.67, p = 0.87) for APBI (65 patients, 3 deaths) vs. WBI (67 patients, 3 deaths). The 10-year OS rates (95 % CIs) were 97 % (87–99 %) and 95 % (85–98 %), respectively. Adverse cosmesis was significantly higher in patients treated with WBI: 18 (30 %) compared with 3 (5 %) with APBI (<em>p</em> < 0.001). Late arm edema was observed in 1 (1.5 %) patients in APBI arm as compared to 4 (6 %) in WBI arm (p = 0.72).</div></div><div><h3>Conclusions</h3><div>In women with breast cancer after BCS, APBI was comparable to WBI in terms of LRRFS, DFS and OS. Cosmetic outco
{"title":"Ten-year outcomes of 3D-conformal accelerated partial vs. whole breast irradiation after breast-conserving surgery: A randomized study from India","authors":"Budhi Singh Yadav , Sofia Loganathan , Divya Dahiya , Arun Singh Oinam","doi":"10.1016/j.suronc.2025.102305","DOIUrl":"10.1016/j.suronc.2025.102305","url":null,"abstract":"<div><h3>Background</h3><div>To compare long term clinical outcomes after accelerated partial breast irradiation (APBI) versus whole breast irradiation (WBI) using 3-dimensional conformal external beam radiation therapy in women with breast cancer after breast conservation surgery (BCS).</div></div><div><h3>Materials and methods</h3><div>Women >35 years of age with invasive or noninvasive breast cancer ≤4 cm treated by BCS were randomized to 3D-CRT APBI (34 Gy/10 fractions/5 days) or WBI (40 Gy/16 fractions/3 weeks ± boost irradiation). The primary outcome was ipsilateral breast tumor recurrence. Important secondary outcomes were late toxicities using Radiation Therapy Oncology Group scores, Late Effects Normal Tissue Task Force and Subjective, Objective, Management, Analytic scales, adverse cosmetic outcome and distant metastases. The secondary endpoints of radiation toxicities and cosmesis were published in an interim analysis. Here we present the primary outcome and the late toxicities data. Patient and tumor characteristics, local recurrence and rates of adverse cosmetic outcomes were compared using Fisher exact tests. Locoregional recurrence free survival (LRRFS), disease free survival (DFS) and overall survival (OS) was calculated using Kaplan-Meier curves. All statistical tests were 2 sided, with <em>p</em> < 0.05 considered statistically significant.</div></div><div><h3>Results</h3><div>Between June 2011 and December 2015, 132 women with breast cancer were randomized to 3D-CRT APBI or WBI. Patient and tumor characteristics were balanced between the two arms. Median follow-up was 10.8 years (range, 3.2–13.6 years). Local recurrence was observed in 3 (4.6 %) and 2 (3 %) patients in APBI and WBI arms (p = 0.62), respectively. Distant metastases occurred in 5 (7.6 %) and 3 (4.4 %) patients in APBI and WBI arms (p = 0.35), respectively. The HR for locoregional recurrence was 1.62 (95 % CI, 0.27–9.67, p = 0.60) for APBI (65 patients, 3 local recurrences) vs. WBI (67 patients, 2 local recurrences). The 10-year LRRFS rates (95 % CIs) were 97 % (88–99 %) and 95 % (86–98 %), respectively.</div><div>The HR for disease-recurrence (local or distant) was 1.47 (95 % CI, 0.51–4.25, p = 0.47) for APBI (65 patients, 8 recurrences) vs. WBI (67 patients, 6 recurrences). The 10-year DFS rates (95 % CIs) were 92 % (83–97 %) and 88 % (77–94 %), respectively. The HR for death was 1.14 (95 % CI, 0.23–5.67, p = 0.87) for APBI (65 patients, 3 deaths) vs. WBI (67 patients, 3 deaths). The 10-year OS rates (95 % CIs) were 97 % (87–99 %) and 95 % (85–98 %), respectively. Adverse cosmesis was significantly higher in patients treated with WBI: 18 (30 %) compared with 3 (5 %) with APBI (<em>p</em> < 0.001). Late arm edema was observed in 1 (1.5 %) patients in APBI arm as compared to 4 (6 %) in WBI arm (p = 0.72).</div></div><div><h3>Conclusions</h3><div>In women with breast cancer after BCS, APBI was comparable to WBI in terms of LRRFS, DFS and OS. Cosmetic outco","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102305"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145314058","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}
Pub Date : 2025-12-01Epub Date: 2025-10-09DOI: 10.1016/j.suronc.2025.102301
Erwin Danil Yulian , Diani Kartini , I Gusti Ngurah Gunawan Wibisana , Nataniel Jeremy G. Siahaan
Background
Currently, endoscopic thyroidectomy techniques continue to evolve in response to the growing demand for better cosmetic outcomes. To date, transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) remains the only technique that leaves no visible external scar. However, this approach has certain limitations. The primary objective of this report is to present our initial experience with an alternative to TOETVA, namely the Transoral Endoscopic Thyroidectomy via Submental approach (TOETSA), in 38 patients at a single center.
Method
We performed the TOETSA procedure on 38 patients who met the inclusion criteria between January 2020 and Desember 2023. The procedure was successfully completed in 36 cases, while conversion to open thyroidectomy was required in 2 cases. Unlike conventional TOETSA, in which all instruments are introduced transorally, this approach utilizes two instruments inserted via the vestibular access and one instrument introduced through the submental crease.
Results
Among the 38 TOETSA procedures completed successfully, all specimens were extracted intact, with a mean maximum nodule size of 4.01 ± 0.80 cm (range: 2.50–6.40 cm). The mean operative time, which included procedures on large tumors and simultaneous training of novice surgeons, was 186.82 ± 19,46 (range: 147–226 Minutes). No life-threatening or permanent postoperative complications were observed. Cosmetic satisfaction after 6 months of follow-up was also favorable. However, a comprehensive assessment of oncologic safety could not yet be performed, as most patients were only monitored for 8.6 months in average.
Conclusion
TOETSA offers favorable therapeutic and cosmetic outcomes with low complication rates, even in larger specimens. Oncological safety should remain the main consideration in technique selection. TOETSA is also feasible as a training platform for novice surgeons.
{"title":"Single center experiences on 38 cases of transoral endoscopic thyroidectomy submental approach (TOETSA): What’s new?","authors":"Erwin Danil Yulian , Diani Kartini , I Gusti Ngurah Gunawan Wibisana , Nataniel Jeremy G. Siahaan","doi":"10.1016/j.suronc.2025.102301","DOIUrl":"10.1016/j.suronc.2025.102301","url":null,"abstract":"<div><h3>Background</h3><div>Currently, endoscopic thyroidectomy techniques continue to evolve in response to the growing demand for better cosmetic outcomes. To date, transoral endoscopic thyroidectomy via the vestibular approach (TOETVA) remains the only technique that leaves no visible external scar. However, this approach has certain limitations. The primary objective of this report is to present our initial experience with an alternative to TOETVA, namely the Transoral Endoscopic Thyroidectomy via Submental approach (TOETSA), in 38 patients at a single center.</div></div><div><h3>Method</h3><div>We performed the TOETSA procedure on 38 patients who met the inclusion criteria between January 2020 and Desember 2023. The procedure was successfully completed in 36 cases, while conversion to open thyroidectomy was required in 2 cases. Unlike conventional TOETSA, in which all instruments are introduced transorally, this approach utilizes two instruments inserted via the vestibular access and one instrument introduced through the submental crease.</div></div><div><h3>Results</h3><div>Among the 38 TOETSA procedures completed successfully, all specimens were extracted intact, with a mean maximum nodule size of 4.01 ± 0.80 cm (range: 2.50–6.40 cm). The mean operative time, which included procedures on large tumors and simultaneous training of novice surgeons, was 186.82 ± 19,46 (range: 147–226 Minutes). No life-threatening or permanent postoperative complications were observed. Cosmetic satisfaction after 6 months of follow-up was also favorable. However, a comprehensive assessment of oncologic safety could not yet be performed, as most patients were only monitored for 8.6 months in average.</div></div><div><h3>Conclusion</h3><div>TOETSA offers favorable therapeutic and cosmetic outcomes with low complication rates, even in larger specimens. Oncological safety should remain the main consideration in technique selection. TOETSA is also feasible as a training platform for novice surgeons.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102301"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362490","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}
Pub Date : 2025-12-01Epub Date: 2025-09-12DOI: 10.1016/j.suronc.2025.102293
Marco Tonello , Carola Cenzi , Paola Del Bianco , Elisa Pizzolato , Chiara Maria Biatta , Francesca Bergamo , Giulia Tasca , Anna Roma , Selma Ahcene Djaballah , Beatrice Bordignon , Giovanna Magni , Giacomo Moratello , Gaetano Ramondo , Sara Lonardi , Pierluigi Pilati , Antonio Sommariva , Gian Luca De Salvo
Introduction
Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising palliative treatment for patients with peritoneal malignancies who are not candidates for curative surgery. This study aimed to assess the efficacy and feasibility of implementing a PIPAC program at a single cancer center.
Methods
An open-label, single-arm, phase II study was conducted, enrolling patients with peritoneal tumors of various origins. Participants received bidirectional chemotherapy (intravenous and PIPAC). The primary endpoint was PIPAC efficacy measured as pathological response, while secondary endpoints included safety and feasibility of the technique, quality of life, and clinical outcomes.
Results
From March 2021 to March 2024, 32 patients were screened, and 25 were enrolled, resulting in 58 PIPAC procedures. The complication rate was low, with severe surgical complications occurring in 1.7 % of procedures and CTCAE grade 3 complications in 3.4 %. A major pathological response was observed in 56 % of cases, and seven patients (28.0 %) underwent curative-intent cytoreductive surgery after at least two PIPAC treatments. Both the Peritoneal Cancer Index (PCI) and the Peritoneal Regression Score (PRGS) decreased after repeated PIPAC (p = 0.016 and p = 0.047, respectively). Ascites volume also decreased significantly after the first PIPAC (p = 0.001). The median overall survival (OS) was 9.6 months, with responding patients (PRGS 1–2) showing better clinical outcomes (OS: 21.0 vs. 5.5 months,p < 0.001; PFS: 8.2 vs. 2.4 months,p < 0.001) and quality of life (p = 0.003).
Conclusion
PIPAC can be safely combined with systemic chemotherapy in patients with peritoneal malignancies, demonstrating efficacy in controlling ascites and achieving major pathological response. Further studies are necessary to determine its potential survival benefits.
{"title":"Pressurized intraperitoneal aerosol chemotherapy (PIPAC) in patients with peritoneal malignancies: a monocentric, single-arm open-label phase II clinical trial","authors":"Marco Tonello , Carola Cenzi , Paola Del Bianco , Elisa Pizzolato , Chiara Maria Biatta , Francesca Bergamo , Giulia Tasca , Anna Roma , Selma Ahcene Djaballah , Beatrice Bordignon , Giovanna Magni , Giacomo Moratello , Gaetano Ramondo , Sara Lonardi , Pierluigi Pilati , Antonio Sommariva , Gian Luca De Salvo","doi":"10.1016/j.suronc.2025.102293","DOIUrl":"10.1016/j.suronc.2025.102293","url":null,"abstract":"<div><h3>Introduction</h3><div>Pressurized intraperitoneal aerosol chemotherapy (PIPAC) is a promising palliative treatment for patients with peritoneal malignancies who are not candidates for curative surgery. This study aimed to assess the efficacy and feasibility of implementing a PIPAC program at a single cancer center.</div></div><div><h3>Methods</h3><div>An open-label, single-arm, phase II study was conducted, enrolling patients with peritoneal tumors of various origins. Participants received bidirectional chemotherapy (intravenous and PIPAC). The primary endpoint was PIPAC efficacy measured as pathological response, while secondary endpoints included safety and feasibility of the technique, quality of life, and clinical outcomes.</div></div><div><h3>Results</h3><div>From March 2021 to March 2024, 32 patients were screened, and 25 were enrolled, resulting in 58 PIPAC procedures. The complication rate was low, with severe surgical complications occurring in 1.7 % of procedures and CTCAE grade 3 complications in 3.4 %. A major pathological response was observed in 56 % of cases, and seven patients (28.0 %) underwent curative-intent cytoreductive surgery after at least two PIPAC treatments. Both the Peritoneal Cancer Index (PCI) and the Peritoneal Regression Score (PRGS) decreased after repeated PIPAC (p = 0.016 and p = 0.047, respectively). Ascites volume also decreased significantly after the first PIPAC (p = 0.001). The median overall survival (OS) was 9.6 months, with responding patients (PRGS 1–2) showing better clinical outcomes (OS: 21.0 vs. 5.5 months,p < 0.001; PFS: 8.2 vs. 2.4 months,p < 0.001) and quality of life (p = 0.003).</div></div><div><h3>Conclusion</h3><div>PIPAC can be safely combined with systemic chemotherapy in patients with peritoneal malignancies, demonstrating efficacy in controlling ascites and achieving major pathological response. Further studies are necessary to determine its potential survival benefits.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102293"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082172","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}
Pub Date : 2025-12-01Epub Date: 2025-09-01DOI: 10.1016/j.suronc.2025.102280
Alyssa Bailey , Tyler R. Wanke , Rhea Verma , Thomas Kurth , Conor Shanley , Erin Mohr , Scott Irving , V. Suzanne Klimberg , Luis Blanco , Swati Kulkarni , Kevin Bethke
Importance
Breast-conserving therapy (BCT) results in reoperation in ∼20 % of cases due to positive margins, and a 7–13 % recurrence risk at 5 years persists despite negative margins and radiation. Enhancing margin treatment is critical to reducing local recurrence and improving survival.
Objective
To optimize and evaluate the performance of a Saline-coupled Intraoperative Radiofrequency Ablation (SIRA) device in producing uniform 1 cm ablations in lumpectomy cavities and compare it to prior-generation RFA technology in previous clinical studies.
Design, setting, and participants
This case series (2018–2023) included 55 mock lumpectomies performed on prophylactic mastectomy or cadaver breasts under an IRB-approved protocol. Inclusion required disease-free, sufficient-volume breast tissue with patient consent.
Results
55 ablations were performed on breasts from 44 female patients. The SIRA produced an ablation depth of 1.0 ± 0.2 cm (mean, SD), no significant difference between margins (p = 0.056). No significant difference in ablation depth across the following: BI-RADS breast composition (p = 0.212), age (p = 0.188), height (p = 0.643), weight (p = 0.522), tissue volume removed (p = 1.000), breast surgery history (p = 0.246), chest chemotherapy/radiation history (p = 0.477), or surgeon (p = 0.579). Significant difference in depth and variance between the SIRA and previous-generation technology (p < 0.001 and p = 0.016), with SIRA significantly deeper and more uniform.
Conclusion
Lumpectomy followed by SIRA could reduce positive margin rates and treat additional tissue, resulting in reduction in re-excision rates and serve as a potential alternative to radiation therapy.
{"title":"A novel technology for margin extension and local control in breast conservation surgery: Saline-coupled intraoperative radiofrequency ablation (SIRA)","authors":"Alyssa Bailey , Tyler R. Wanke , Rhea Verma , Thomas Kurth , Conor Shanley , Erin Mohr , Scott Irving , V. Suzanne Klimberg , Luis Blanco , Swati Kulkarni , Kevin Bethke","doi":"10.1016/j.suronc.2025.102280","DOIUrl":"10.1016/j.suronc.2025.102280","url":null,"abstract":"<div><h3>Importance</h3><div>Breast-conserving therapy (BCT) results in reoperation in ∼20 % of cases due to positive margins, and a 7–13 % recurrence risk at 5 years persists despite negative margins and radiation. Enhancing margin treatment is critical to reducing local recurrence and improving survival.</div></div><div><h3>Objective</h3><div>To optimize and evaluate the performance of a Saline-coupled Intraoperative Radiofrequency Ablation (SIRA) device in producing uniform 1 cm ablations in lumpectomy cavities and compare it to prior-generation RFA technology in previous clinical studies.</div></div><div><h3>Design, setting, and participants</h3><div>This case series (2018–2023) included 55 mock lumpectomies performed on prophylactic mastectomy or cadaver breasts under an IRB-approved protocol. Inclusion required disease-free, sufficient-volume breast tissue with patient consent.</div></div><div><h3>Results</h3><div>55 ablations were performed on breasts from 44 female patients. The SIRA produced an ablation depth of 1.0 ± 0.2 cm (mean, SD), no significant difference between margins (p = 0.056). No significant difference in ablation depth across the following: BI-RADS breast composition (p = 0.212), age (p = 0.188), height (p = 0.643), weight (p = 0.522), tissue volume removed (p = 1.000), breast surgery history (p = 0.246), chest chemotherapy/radiation history (p = 0.477), or surgeon (p = 0.579). Significant difference in depth and variance between the SIRA and previous-generation technology (p < 0.001 and p = 0.016), with SIRA significantly deeper and more uniform.</div></div><div><h3>Conclusion</h3><div>Lumpectomy followed by SIRA could reduce positive margin rates and treat additional tissue, resulting in reduction in re-excision rates and serve as a potential alternative to radiation therapy.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102280"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144989444","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}
In this study, we present our institution's treatment outcomes and surgical strategies for patients with localized pancreatic ductal adenocarcinoma (PDAC).
Methods
The study retrospectively reviewed clinical data of 397 patients with localized PDAC who were enrolled in a gemcitabine and S-1 based chemoradiotherapy (GS-CRT) protocol between September 2011 and March 2023. Following GS-CRT, pancreatectomy was performed and concomitant vascular resection with subsequent reconstruction was done, if required, in order to achieve R0 resection margins.
Result
From the 397 patients, 366 (92.2 %) completed the GS-CRT. A total of 359 patients were adequately re-evaluated after GS-CRT and categorized as having resectable (R; n = 77), borderline resectable with superior mesenteric vein/portal vein involvement (BR-PV; n = 40), borderline resectable with arterial involvement (BR-A; n = 94), or unresectable locally advanced (UR-LA; n = 148) tumors, respectively. From these, 202 patients with R (n = 63), BR-PV (n = 31), BR-A (n = 56) and UR-LA (n = 52) PDAC underwent curative-intent pancreatectomy. The R0 resection rates and median survival times for disease-specific survival (DSS) according to resectability were favorable: 98.4 %, 93.5 %, 92.9 %, and 80.8 %, and 62.7, 66.1, 41.8, and 36.2 months, respectively. Prognostic factors for DSS among the 202 resected patients included performance status, pre-operative carbohydrate antigen 19-9 and carcinoembryonic antigen serum levels, pre-operative tumor resectability, pathological T factor and receipt of adjuvant chemotherapy. In the resected UR-LA patients, adjuvant chemotherapy was a significant prognostic factor of survival outcomes.
Conclusions
GS-CRT followed by pancreatectomy is feasible and a beneficial treatment strategy for PDAC. Therefore, a safe and reliable surgical approach that ensures R0 resection margins and enables subsequent adjuvant chemotherapy is essential.
{"title":"Surgical strategies for locally advanced pancreatic cancer following gemcitabine plus S-1-based chemoradiotherapy","authors":"Aoi Hayasaki, Shugo Mizuno, Benson Kaluba, Yuki Segi, Haruna Komatsubara, Tatsuya Sakamoto, Koki Maeda, Toru Shinkai, Takahiro Ito, Kazuyuki Gyoten, Takehiro Fujii, Yusuke Iizawa, Akihiro Tanemura, Yasuhiro Murata, Naohisa Kuriyama, Masashi Kishiwada","doi":"10.1016/j.suronc.2025.102269","DOIUrl":"10.1016/j.suronc.2025.102269","url":null,"abstract":"<div><h3>Background</h3><div>In this study, we present our institution's treatment outcomes and surgical strategies for patients with localized pancreatic ductal adenocarcinoma (PDAC).</div></div><div><h3>Methods</h3><div>The study retrospectively reviewed clinical data of 397 patients with localized PDAC who were enrolled in a gemcitabine and S-1 based chemoradiotherapy (GS-CRT) protocol between September 2011 and March 2023. Following GS-CRT, pancreatectomy was performed and concomitant vascular resection with subsequent reconstruction was done, if required, in order to achieve R0 resection margins.</div></div><div><h3>Result</h3><div>From the 397 patients, 366 (92.2 %) completed the GS-CRT. A total of 359 patients were adequately re-evaluated after GS-CRT and categorized as having resectable (R; n = 77), borderline resectable with superior mesenteric vein/portal vein involvement (BR-PV; n = 40), borderline resectable with arterial involvement (BR-A; n = 94), or unresectable locally advanced (UR-LA; n = 148) tumors, respectively. From these, 202 patients with R (n = 63), BR-PV (n = 31), BR-A (n = 56) and UR-LA (n = 52) PDAC underwent curative-intent pancreatectomy. The R0 resection rates and median survival times for disease-specific survival (DSS) according to resectability were favorable: 98.4 %, 93.5 %, 92.9 %, and 80.8 %, and 62.7, 66.1, 41.8, and 36.2 months, respectively. Prognostic factors for DSS among the 202 resected patients included performance status, pre-operative carbohydrate antigen 19-9 and carcinoembryonic antigen serum levels, pre-operative tumor resectability, pathological T factor and receipt of adjuvant chemotherapy. In the resected UR-LA patients, adjuvant chemotherapy was a significant prognostic factor of survival outcomes.</div></div><div><h3>Conclusions</h3><div>GS-CRT followed by pancreatectomy is feasible and a beneficial treatment strategy for PDAC. Therefore, a safe and reliable surgical approach that ensures R0 resection margins and enables subsequent adjuvant chemotherapy is essential.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102269"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692289","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}
Pub Date : 2025-12-01Epub Date: 2025-07-18DOI: 10.1016/j.suronc.2025.102268
Rachael A. Safyan , E. Gabriela Chiorean
Pancreatic ductal adenocarcinoma (PDA) is highly aggressive and has few treatment options. To personalize therapy, it is critical to delineate molecular subtypes and understand inter- and intra-tumoral heterogeneity. KRAS mutations are present in 90 % of PDA, while 10 % are KRAS wild type and are potentially targetable with epidermal growth factor receptor (EGFR) blockade. KRASG12C inhibitors have shown activity in G12C mutated cancers, and novel G12D and pan-RAS inhibitors are in clinical trials. Fewer than 1 % of PDA harbor microsatellite instability high (MSI-High) status and are susceptible to immune checkpoint blockade. Albeit rare, and occurring in KRAS wild type PDAs, BRAF V600E mutations, HER2 amplification, and RET, NTRK, and NRG1 fusions are targetable with cancer agnostic FDA approved therapies. In this review, we highlight clinically relevant molecular alterations and clinical trials with focus on targeted therapies that can improve pancreatic cancer patients’ outcomes through precision medicine.
{"title":"Updates on molecular targets and clinical trials with targeted therapies for pancreatic cancer","authors":"Rachael A. Safyan , E. Gabriela Chiorean","doi":"10.1016/j.suronc.2025.102268","DOIUrl":"10.1016/j.suronc.2025.102268","url":null,"abstract":"<div><div>Pancreatic ductal adenocarcinoma (PDA) is highly aggressive and has few treatment options. To personalize therapy, it is critical to delineate molecular subtypes and understand inter- and intra-tumoral heterogeneity. <em>KRAS</em> mutations are present in 90 % of PDA, while 10 % are <em>KRAS</em> wild type and are potentially targetable with epidermal growth factor receptor (EGFR) blockade. KRAS<sup>G12C</sup> inhibitors have shown activity in G12C mutated cancers, and novel G12D and pan-RAS inhibitors are in clinical trials. Fewer than 1 % of PDA harbor microsatellite instability high (MSI-High) status and are susceptible to immune checkpoint blockade. Albeit rare, and occurring in <em>KRAS</em> wild type PDAs, <em>BRAF V600E</em> mutations, HER2 amplification, and <em>RET</em>, <em>NTRK,</em> and <em>NRG1</em> fusions are targetable with cancer agnostic FDA approved therapies. In this review, we highlight clinically relevant molecular alterations and clinical trials with focus on targeted therapies that can improve pancreatic cancer patients’ outcomes through precision medicine.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102268"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719113","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}
Pub Date : 2025-12-01Epub Date: 2025-09-04DOI: 10.1016/j.suronc.2025.102276
Francisco Laxague , Naif Fnais , Dorsa Zabihi , Kevin Fung , Danielle MacNeil , Adrian Mendez , John Yoo , Pencilla Lang , Joe S. Mymryk , John W. Barrett , David A. Palma , Anthony C. Nichols
Background
We aimed to analyze the role of salvage surgery for local/locoregional OPSCC recurrences after primary radiotherapy ± chemotherapy (CRT).
Methods
From 1156 patients, we identified 38 patients undergoing salvage surgery for local/locoregional recurrences. We analyzed surgical and survival outcomes based on surgical approach and clinical variables.
Results
Thirty-eight patients underwent SS for a local/locoregional OPSCC recurrence. Patients undergoing SS experienced superior overall survival (3-year 62.1 % vs. 13 %; and OS: 5-year 34 % vs. 0 %; p < 0.01) and progression-free survival: 3-year 61.1 % vs. 0 %; and PFS: 5-year 28.6 % vs. 0 %; p < 0.01) compared with those undergoing non-surgical treatment. One year after the surgery, 12/27 surviving patients (44.4 %) were tracheostomy dependent, and 12/27 feeding tube dependent.
Conclusion
Salvage surgery for locoregional OPSCC recurrences after primary CRT is safe and feasible in selected patients. However, patients should be counselled about the possibility of long-term feeding tube and/or tracheostomy dependency post operatively.
背景：我们的目的是分析挽救性手术在初次放疗±化疗（CRT）后局部/局部区域OPSCC复发中的作用。方法从1156例患者中，我们确定了38例因局部/局部复发而接受补救性手术的患者。我们根据手术入路和临床变量分析手术和生存结果。结果38例局部/局部复发的OPSCC行SS治疗。接受SS治疗的患者总体生存率更高（3年62.1% vs. 13%； 5年OS: 34% vs. 0%; p < 0.01），无进展生存率：3年61.1% vs. 0%；PFS: 5年28.6% vs. 0%；P < 0.01)。术后1年存活患者中有12/27（44.4%）依赖气管造口，12/27依赖饲管。结论原发性CRT术后局部OPSCC复发的抢救手术是安全可行的。然而，应告知患者术后长期喂食管和/或气管造口依赖的可能性。
{"title":"Oncological and functional outcomes of salvage surgery for local oropharyngeal cancer recurrence after primary Radiation±Chemotherapy","authors":"Francisco Laxague , Naif Fnais , Dorsa Zabihi , Kevin Fung , Danielle MacNeil , Adrian Mendez , John Yoo , Pencilla Lang , Joe S. Mymryk , John W. Barrett , David A. Palma , Anthony C. Nichols","doi":"10.1016/j.suronc.2025.102276","DOIUrl":"10.1016/j.suronc.2025.102276","url":null,"abstract":"<div><h3>Background</h3><div>We aimed to analyze the role of salvage surgery for local/locoregional OPSCC recurrences after primary radiotherapy ± chemotherapy (CRT).</div></div><div><h3>Methods</h3><div>From 1156 patients, we identified 38 patients undergoing salvage surgery for local/locoregional recurrences. We analyzed surgical and survival outcomes based on surgical approach and clinical variables.</div></div><div><h3>Results</h3><div>Thirty-eight patients underwent SS for a local/locoregional OPSCC recurrence. Patients undergoing SS experienced superior overall survival <strong>(</strong>3-year 62.1 % vs. 13 %; and OS: 5-year 34 % vs. 0 %; <em>p</em> < 0.01) and progression-free survival: 3-year 61.1 % vs. 0 %; and PFS: 5-year 28.6 % vs. 0 %; <em>p</em> < 0.01) compared with those undergoing non-surgical treatment. One year after the surgery, 12/27 surviving patients (44.4 %) were tracheostomy dependent, and 12/27 feeding tube dependent.</div></div><div><h3>Conclusion</h3><div>Salvage surgery for locoregional OPSCC recurrences after primary CRT is safe and feasible in selected patients. However, patients should be counselled about the possibility of long-term feeding tube and/or tracheostomy dependency post operatively.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102276"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145049599","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}
Laparoscopic surgery with three-dimensional (3D) vision has recently been introduced, allowing enhanced visualization and improved suturing capabilities. However, its clinical impact has not been widely studied, particularly in laparoscopic pancreatoduodenectomy (LPD), where visualization and suturing are critical. In this study, we compared outcomes between 2D and 3D LPD.
Methods
In our center, the first 2D-LPD was performed in 2011, and 3D-LPD was introduced in 2019. To assess the impact of 3D vision while minimizing bias related to the learning curve, we compared two consecutive four-year periods before and after the implementation of 3D vision: a first period with 2D-LPD (2015–2018) and a second period with 3D-LPD (2019–2022). There were no major modifications in surgical technique between the two periods. Operative and postoperative outcomes were compared between 2D and 3D LPD, both before and after propensity score matching. A generalized linear mixed model (GLMM) was associated to account for the time-effect.
Results
During the study period, 162 LPDs were performed, including 79 with 2D-LPD and 83 with 3D-LPD. There was no significant difference in baseline clinical characteristics, except for ampullary tumors, which were more frequently operated on in the 2D-LPD group (16 % vs. 4.8 %; p = 0.016). Operative data and pancreatic characteristics were similar between groups. However, 3D-LPD was associated with a lower conversion rate (0 % vs. 6 %; p = 0.026) and a lower transfusion rate (0 % vs. 6 %; p = 0.027). After propensity score matching (2D-LPD: n = 39; 3D-LPD: n = 83), outcomes remained significantly better with 3D-LPD, with fewer grade C postoperative pancreatic fistulas (10 % vs. 2 %; p = 0.038) and lower readmission rates (10 % vs. 0 %; p = 0.009), while median hospital stay was similar between groups (14 vs. 15 days; p = 0.699).
Conclusion
This study shows that 3D-LPD, compared to 2D-LPD, is associated with a lower incidence of grade C postoperative pancreatic fistula and readmission. Given its availability and cost-effectiveness compared to robotic surgery, 3D-LPD should be promoted.
{"title":"Laparoscopic pancreatoduodenectomy with 3D vision compared to 2D vision is associated with less severe morbidity and improved results","authors":"Safi Dokmak , Charles de Ponthaud , Chihebeddine Romdhani , Béatrice Aussilhou , Thibaud Bertrand , Mickael Lesurtel , Alain Sauvanet , Fadhel Samir Ftériche","doi":"10.1016/j.suronc.2025.102297","DOIUrl":"10.1016/j.suronc.2025.102297","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic surgery with three-dimensional (3D) vision has recently been introduced, allowing enhanced visualization and improved suturing capabilities. However, its clinical impact has not been widely studied, particularly in laparoscopic pancreatoduodenectomy (LPD), where visualization and suturing are critical. In this study, we compared outcomes between 2D and 3D LPD.</div></div><div><h3>Methods</h3><div>In our center, the first 2D-LPD was performed in 2011, and 3D-LPD was introduced in 2019. To assess the impact of 3D vision while minimizing bias related to the learning curve, we compared two consecutive four-year periods before and after the implementation of 3D vision: a first period with 2D-LPD (2015–2018) and a second period with 3D-LPD (2019–2022). There were no major modifications in surgical technique between the two periods. Operative and postoperative outcomes were compared between 2D and 3D LPD, both before and after propensity score matching. A generalized linear mixed model (GLMM) was associated to account for the time-effect.</div></div><div><h3>Results</h3><div>During the study period, 162 LPDs were performed, including 79 with 2D-LPD and 83 with 3D-LPD. There was no significant difference in baseline clinical characteristics, except for ampullary tumors, which were more frequently operated on in the 2D-LPD group (16 % vs. 4.8 %; p = 0.016). Operative data and pancreatic characteristics were similar between groups. However, 3D-LPD was associated with a lower conversion rate (0 % vs. 6 %; p = 0.026) and a lower transfusion rate (0 % vs. 6 %; p = 0.027). After propensity score matching (2D-LPD: n = 39; 3D-LPD: n = 83), outcomes remained significantly better with 3D-LPD, with fewer grade C postoperative pancreatic fistulas (10 % vs. 2 %; p = 0.038) and lower readmission rates (10 % vs. 0 %; p = 0.009), while median hospital stay was similar between groups (14 vs. 15 days; p = 0.699).</div></div><div><h3>Conclusion</h3><div>This study shows that 3D-LPD, compared to 2D-LPD, is associated with a lower incidence of grade C postoperative pancreatic fistula and readmission. Given its availability and cost-effectiveness compared to robotic surgery, 3D-LPD should be promoted.</div></div>","PeriodicalId":51185,"journal":{"name":"Surgical Oncology-Oxford","volume":"63 ","pages":"Article 102297"},"PeriodicalIF":2.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145304400","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}
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