Surgical resection of a colorectal adenocarcinoma remains a cornerstone in its treatment. However, despite proper patient selection and neoadjuvant and/or adjuvant chemotherapy/radiation, up to 30% of patients thought to...Surgical resection of a colorectal adenocarcinoma remains a cornerstone in its treatment. However, despite proper patient selection and neoadjuvant and/or adjuvant chemotherapy/radiation, up to 30% of patients thought to be cured will develop a postoperative recurrence. Unfortunately, the outcomes in patients who develop a postoperative recurrence are poor and are associated with high morbidity and mortality. The gut microbiome has emerged to play a role in virtually all aspects of human health. In this manuscript, we critically examine the current literature implicating the gut microbiome's role in the pathogenesis of postoperative recurrence after attempted curative resection. We discuss how microbes can drive a more advanced stage and explore how surgery itself can precipitate a gut microenvironment with tumorigenic bacteria and bacterial-derived metabolites that can drive postoperative tumor formation. Finally, we review evidence as to how the gut microbiome can be manipulated to improve oncological outcomes.
BACKGROUND: Circulating tumor DNA (ctDNA) has been used to diagnose and monitor response to therapy in the setting of advanced pancreatic ductal adenocarcinoma (PDAC), but its utility in the adjuvant setting to monitor f...BACKGROUND: Circulating tumor DNA (ctDNA) has been used to diagnose and monitor response to therapy in the setting of advanced pancreatic ductal adenocarcinoma (PDAC), but its utility in the adjuvant setting to monitor for relapse after curative resection is less understood. METHODS: In this single-institution, retrospective study, we evaluated the use of ctDNA during the postoperative window (within 90 days from surgical resection and 30 days from the start of adjuvant therapy) and subsequent adjuvant/surveillance window (after the postoperative window) as prognostic biomarkers for relapse. We compared demographic and clinical characteristics among patients with radiographic disease relapse based on ctDNA positivity. RESULTS: We identified 51 patients with PDAC who underwent curative-intent surgical resection between 2013 and 2024 and completed postoperative ctDNA testing. Median follow-up was 635 days, and 28 patients (54.9%) experienced disease relapse. ctDNA during the postoperative window had a sensitivity of 35.7% and specificity of 88.9% for prognosticating disease relapse after resection, with a positive predictive value (PPV) of 79.6% and negative predictive value (NPV) of 53.2%. ctDNA during the adjuvant/surveillance window had a sensitivity of 62.5%, specificity of 95.5%, PPV of 94.4%, and NPV of 67.7%. Patients with disease relapse as liver metastases had the highest rate of ctNA positivity (n = 10 of 12; 83.3%), followed by resection bed recurrence (n = 4 of 7; 57.1%) and nonliver distant metastatic recurrence (n = 4 of 9; 44.4%). CONCLUSION: Positive ctDNA is a strong prognostic factor for relapse after resection for PDAC; however, ctDNA testing lacks sensitivity to replace conventional surveillance testing in patients with resected PDAC.
Shimizu T, Zheng S, Maeda S
… +17 more, Link J, Deranteriassian A, Premji A, King J, Girgis M, Hines OJ, Wainberg Z, Raldow A, He J, Burns W, Narang A, Qadan M, Castillo CF, Lillemoe KD, Wo J, Hong T, Donahue TR
J Gastrointest Surg
· 2026 Apr · PMID 41644009
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Full text
BACKGROUND: Stereotactic body radiation therapy (SBRT) is increasingly used in neoadjuvant chemoradiotherapy (NCRT) for borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PC), but head...BACKGROUND: Stereotactic body radiation therapy (SBRT) is increasingly used in neoadjuvant chemoradiotherapy (NCRT) for borderline resectable (BR) and locally advanced (LA) pancreatic ductal adenocarcinoma (PC), but head-to-head data on SBRT vs conventionally fractionated radiation therapy (CFRT) remain limited. We compared clinical and pathological outcomes of SBRT vs CFRT in BR/LA PC. METHODS: We retrospectively analyzed 312 patients with BR/LA PC who received NCRT followed by margin-negative (R0)/margin-positive surgery at 3 high-volume academic centers (2011-2021). To reduce selection bias, 1:1 propensity score matching (PSM) was applied based on baseline clinical variables. The primary outcome was overall survival (OS), and the secondary outcome was clinical and pathological response to NCRT. RESULTS: Of 312 patients, 177 (56.7%) received SBRT and 135 (43.3%) received CFRT. Before PSM, significant differences were observed in patient age, neoadjuvant chemotherapy regimen, and duration of the preoperative interval. After PSM, 180 patients were matched, with no significant differences in pretreatment variables between groups. Clinical and pathological outcomes were similar between the matched cohorts, including complete/near-complete pathological response rates (36.7% vs 45.6%; P =.56), node-positive disease (32.2% vs 36.7%; P =.53), and R0 resection rates (80.0% vs 82.2%; P =.70). The median OS was not significantly different (27.2 vs 40.6 months; P =.70). Patients in the SBRT cohort were more likely to receive adjuvant therapy than those in the CFRT cohort (60.0% vs 38.9%; P =.007). In subgroup analyses restricted to patients treated with neoadjuvant FOLFIRINOX (FFX), SBRT was associated with a significantly longer OS among those presenting with markedly elevated pretreatment carbohydrate antigen 19-9 (CA19-9) levels (≥1500 U/mL) (29.8 vs 12.1 months; P =.02). CONCLUSION: Neoadjuvant SBRT achieves oncologic outcomes comparable with CFRT in BR/LA PC and is associated with greater adjuvant therapy use. A potential survival signal for SBRT in patients receiving FFX with CA19-9 of ≥1500 U/mL is hypothesis generating and warrants validation and formal interaction testing.
BACKGROUND: The "difficult gallbladder" in acute cholecystitis can preclude safe achievement of the critical view of safety, prompting subtotal cholecystectomy (STC) as a guideline-supported bailout. We performed a conte...BACKGROUND: The "difficult gallbladder" in acute cholecystitis can preclude safe achievement of the critical view of safety, prompting subtotal cholecystectomy (STC) as a guideline-supported bailout. We performed a contemporary synthesis to clarify STC's safety effectiveness trade-offs vs total cholecystectomy (TC) and delineate technique-specific outcomes and patient factors that may influence risk. METHODS: We conducted a systematic review and meta-analysis of studies from 2010 to June 2025. Three comparisons were evaluated: (i) single-arm outcomes after STC, (ii) STC vs TC, and (iii) fenestrating STC (f-STC) vs reconstituting STC (r-STC). Random-effects models were applied, with prespecified subgroup analyses, leave-one-out sensitivity analyses, and exploratory meta-regression. RESULTS: In single-arm analysis, bile duct injury (BDI) occurred in 0.3%, bile leak in 13.5%, retained stones in 6.1%, and overall complications in 24.7% of patients. Readmission and reoperation occurred in 17.8% and 6.3%, whereas mortality was 0.8%. Postprocedural endoscopic retrograde cholangiopancreatography (ERCP) occurred in 16.2%, and percutaneous drainage in 5.7%. Compared with TC, STC had significantly higher bile leak, retained stones, overall complications, readmission, reoperation, and ERCP, with no significant difference in mortality, intensive care unit admission, or length of stay (LOS). Meta-regression linked diabetes with higher leak, complications, and ERCP, and male sex with higher surgical site infection. f-STC had significantly higher bile leak and longer LOS than r-STC, with ERCP trending higher. CONCLUSION: STC carries a very low BDI rate, but higher postoperative morbidity and secondary interventions than TC. r-STC demonstrated superior outcomes to f-STC. Diabetes and male sex were important risk modifiers. STC remains a rational bailout when the critical view cannot be achieved.
BACKGROUND: Management of pregnancy-associated cancers (PACs)-malignancies diagnosed during pregnancy or within 1 year postpartum-poses unique clinical challenges. Treatment decisions must balance maternal cancer control...BACKGROUND: Management of pregnancy-associated cancers (PACs)-malignancies diagnosed during pregnancy or within 1 year postpartum-poses unique clinical challenges. Treatment decisions must balance maternal cancer control with fetal safety, yet little is known about how cancer treatment timing varies between pregnant and nonpregnant individuals or how PACs affect obstetric and neonatal outcomes. Understanding these associations is critical to improve care strategies for this vulnerable population. METHODS: We conducted a retrospective cohort study using Epic Cosmos, a large multicenter United States electronic health record database. The primary "cancer" cohort included individuals aged 18 to 49 years diagnosed as having cancer between January 2018 and December 2022. These individuals were categorized by pregnancy status at diagnosis: gestational PAC, postpartum PAC, or nonpregnant. A secondary "maternal" cohort comprised individuals with viable deliveries during the same period; gestational PAC pregnancies were matched 1:4 with cancer-unexposed pregnancies. Primary outcomes were time from cancer diagnosis to initiation of surgery, radiotherapy, and chemotherapy. Secondary outcomes included 30-day surgical complications, mortality, readmissions, and obstetric and neonatal outcomes such as cesarean delivery, preterm birth, low birth weight, and 5-min appearance, pulse, grimace, activity, and respiration (Apgar) scores. RESULTS: Among 38,345 individuals in the cancer cohort (median age, 43 years; IQR, 38-47), most were White (n = 26,594; 71.3%) and married (n = 19,230; 51.5%). Gestational PAC was associated with 15% longer time to surgery (adjusted rate ratio [aRR], 1.15; 95% CI, 1.13-1.17), 28% longer time to radiotherapy (aRR, 1.28; 95% CI, 1.27-1.29), and 29% shorter time to chemotherapy initiation (aRR, 0.71; 95% CI, 0.70-0.72) than nonpregnant controls. Postpartum PAC was associated with 13% shorter time to surgery (aRR, 0.87; 95% CI, 0.86-0.88) and 30% shorter time to chemotherapy (aRR, 0.70; 95% CI, 0.70-0.71). In the maternal cohort, gestational PAC was associated with higher odds of cesarean delivery (adjusted odds ratio [aOR], 1.21; 95% CI, 1.04-1.41), preterm birth (aOR, 3.79; 95% CI, 3.15-4.56), low birth weight (aOR, 3.08; 95% CI, 2.50-3.77), and low 5-min Apgar scores (aOR, 1.86; 95% CI, 1.20-2.82). CONCLUSION: PAC was associated with delays in locoregional treatment and increased maternal and neonatal morbidity, underscoring the need for coordinated multidisciplinary care to optimize outcomes for women with PACs.
Kooij CD, van Haarlem I, Sanders ME
… +13 more, Lammes FE, van der Horst S, Kingma BF, Marsman M, Cremer OL, Steenhagen E, Kerst A, Schippers C, van den Berg JW, Preston SR, Cheong E, Ruurda JP, van Hillegersberg R
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care, accelerate recovery, and reduce length of hospital stay (LOS). This study aimed to evaluate the implementation and evolutio...BACKGROUND: Enhanced recovery after surgery (ERAS) protocols aim to optimize perioperative care, accelerate recovery, and reduce length of hospital stay (LOS). This study aimed to evaluate the implementation and evolution of an ERAS protocol for esophageal resection in a western high-volume tertiary center. METHODS: This retrospective cohort study analyzed all consecutive patients who underwent esophagectomy for esophageal cancer at the University Medical Center Utrecht between May 2015 and December 2023, divided into 4 cohorts based on protocol changes. Robot-assisted minimally invasive esophagectomy with cervical esophagogastrostomy and epidural pain management was the standard of care. An ERAS protocol, focused on preoperative optimization of nutritional and physical fitness, intrathoracic anastomosis, and multidisciplinary postoperative support, was implemented in October 2016. The first cohort served as the pre-ERAS baseline, with subsequent cohorts indicating a change in protocol. Data were extracted from a prospectively maintained database. The primary outcome was median LOS. Secondary outcomes included perioperative dietary, surgical, clinical, and physiotherapeutic measures. RESULTS: A total of 526 patients were included. Median LOS decreased from 16 days (IQR, 11-25) in the pre-ERAS cohort to 13 (IQR, 9-21), 11 (IQR, 8-15), and 11 days (IQR, 8-18) in successive cohorts (P <.001; hazard ratio [HR], 0.68; 95% CI, 0.52-0.90; P =.007). This reduction remained significant after adjusting for covariates (HR, 0.58; 95% CI, 0.44-0.77; P <.001). Median LOS of patients with a textbook outcome decreased from 11 days (IQR, 11-14) in the pre-ERAS cohort to 10 (IQR, 8-13), 10 (IQR, 8-12), and 8 days (IQR, 7-11) in subsequent cohorts (P <.001). Several secondary ERAS outcomes improved over the years (dietitian involvement, surgical approach, extubation in the operating room, drain/line management). A reduction in postoperative complications was observed (from 81% to 74%; P =.033), whereas mortality and readmission rates remained stable. CONCLUSION: After ERAS implementation for esophagectomy, median LOS decreased from 16 to 11 days over 7 years, with stable readmission rates. These results support ERAS as a valuable tool to optimize perioperative care, leading to a significant reduction in length of postoperative hospital stay.
BACKGROUND: Patients with cirrhosis face increased surgical risk. This study aimed to characterize real-world perioperative outcomes after cholecystectomy in patients with cirrhosis and identify independent predictors of...BACKGROUND: Patients with cirrhosis face increased surgical risk. This study aimed to characterize real-world perioperative outcomes after cholecystectomy in patients with cirrhosis and identify independent predictors of postoperative liver decompensation events (POLDEs) and mortality. METHODS: This was a population-based, retrospective cohort study that used administrative health data from Ontario, Canada. Patients with cirrhosis who underwent cholecystectomy between January 2009 and December 2018 were included. Perioperative outcomes were described, including POLDEs and mortality. Modified Poisson regression analysis was used to identify independent predictors of POLDEs and 90-day mortality while accounting for clustering at the institutional level. RESULTS: A total of 4769 patients were analyzed. The leading etiology of cirrhosis was metabolic dysfunction-associated steatotic liver disease (66%). Most patients (69%) underwent elective surgery. The mean hospital stay was 3.6 days, with a 13% complication rate. Within 90 days, 27% of patients returned to the emergency department, and 10% of patients required readmission. Moreover, 83 patients (1.7%) experienced POLDEs, and 91 patients (1.9%) died. Higher Model for End-Stage Liver Disease-Sodium scores were associated with both postoperative decompensation and mortality. Independent predictors of POLDEs included older age, alcohol-related cirrhosis, and previous decompensation. The predictors of 90-day mortality included advanced age, comorbidities, emergent surgery, and postoperative decompensation. CONCLUSION: Although early liver-related complications and mortality remain low overall, patients with advanced age, comorbidity, history of decompensation, and emergent surgery have significantly worse outcomes. Moreover, the high rates of emergency visits and readmissions highlight the substantial healthcare utilization in this population.
BACKGROUND: In the United States, perceived discrimination in healthcare settings (PDHS) has been linked with delayed care. Surgery represents a high-stakes, vulnerable period that can leave a lasting impression on futur...BACKGROUND: In the United States, perceived discrimination in healthcare settings (PDHS) has been linked with delayed care. Surgery represents a high-stakes, vulnerable period that can leave a lasting impression on future healthcare utilization. We sought to assess the association between PDHS and delayed care, as well as evaluate the mediating and moderating roles of patient-clinician communication (PCC) and sociodemographic factors on timing of healthcare delivery. METHODS: Adults who underwent gastrointestinal procedures before completing the Healthcare Access and Utilization Survey in the All of Us Research Program. Associations were examined using structural equation modeling (SEM). Variance decomposition was used to quantify the contributions of sociodemographic moderators. RESULTS: Among 1866 participants (46.4% hepatopancreatobiliary, 41.6% colorectal, and 12.0% esophagogastric) included in the study, median age was 62.0 years (IQR, 52.0-70.0). Most participants were female (1306 [70.3%]) and non-Hispanic White (1571 [84.2%]). Participants who delayed care were more often aged 18 to 44 years (39.0% vs 11.6%) and less frequently married (55.5% vs 63.5%) (both P <.05). In adjusted SEM, higher PDHS was associated with worse PCC (β, -0.46 [95% CI, -0.56 to -0.36]) and greater odds of delayed care (adjusted odds ratio [aOR], 1.55 [95% CI, 1.20-2.01]). PCC mediated 14.8% of the PDHS-delayed care association. PDHS (57.9%), age (9.6%), and income (4.3%) contributed most to PCC variance. Delayed care was associated with higher odds of poor quality of life (aOR, 2.65), poor mental health (aOR, 2.65), and poor physical health (aOR, 2.24) (all P <.001). CONCLUSION: PCC mediated the relationship between discrimination and healthcare delays with sociodemographic factors influencing this effect. Higher PDHS and worse PCC increased the odds of delayed care, leading to worse health and quality of life.
BACKGROUND: Thoracic epidural analgesia (EA) has historically been a key component of multimodal analgesia after open thoracotomy. EA use has decreased over time, however, and peripheral nerve blocks (PNBs) are increasin...BACKGROUND: Thoracic epidural analgesia (EA) has historically been a key component of multimodal analgesia after open thoracotomy. EA use has decreased over time, however, and peripheral nerve blocks (PNBs) are increasingly used as alternatives. This study aimed to compare outcomes among patients receiving EA versus PNB as part of a lung or esophageal operative procedure. METHODS: Adult patients who received EA or PNB as part of a lung or esophageal operative procedure from 2016 to 2020 were identified in the Nationwide Readmissions Database. Outcomes included complications, 90-day readmission, mortality, length of stay (LOS), and hospitalization costs. Patients were stratified according to analgesia type and 1:2 propensity score matching (PSM) adjusted for patient, surgical, and hospital characteristics. Multivariate regression was used to address residual confounding. RESULTS: Among 8668 patients, 738 (8.5%) received EA, and 7930 (91.5%) received PNB. After PSM (N = 2110; 721 in the EA group vs 1389 in the PNB group), EA remained associated with longer LOS (β = 1.12 days [95% CI, 0.85-1.39]) and higher index admission (β = $3630 [95% CI, $2061-5199]) and total 90-day costs (β = $4808 [95% CI, $3230-$6386]) (all P <.001). In site-stratified multivariate models, EA was associated with higher median 90-day costs after esophageal resection ($12,487) and lung resection ($2970) and longer LOS (esophagus: β = 1.93; lung: β = 1.00 days). In addition, EA was associated with higher odds of ileus after esophageal resection (adjusted odds ratio, 18.47). Other complications, readmission, and 90-day mortality did not differ (all P >.05). CONCLUSION: EA was associated with a longer hospital stay and higher median costs than PNB, with no differences in clinical outcomes. These findings support the use of PNB as an equally safe and more cost-conscious analgesic strategy in thoracic surgery.
BACKGROUND: Recent literature suggests that volume-outcome associations for pancreatectomy have attenuated over time, leading some researchers to question the continued relevance of volume thresholds. However, this perce...BACKGROUND: Recent literature suggests that volume-outcome associations for pancreatectomy have attenuated over time, leading some researchers to question the continued relevance of volume thresholds. However, this perceived attenuation may reflect the methodological limitations of single, binary cutoffs rather than a true weakening of the underlying relationship. Stratum-specific likelihood ratios (SSLRs) generate multiple empirically derived volume strata that may detect persistent gradients that are obscured by binary stratification. The objectives of this study were to (i) define volume strata for pancreatectomy using SSLR, (ii) assess the robustness of these strata across multiple outcomes, and (iii) examine whether the association persists in modern cohorts. METHODS: Patients who underwent pancreatectomy between 2004 and 2021 were identified using the National Cancer Database. The volume strata were defined by SSLR based on the 90-day postoperative mortality. The temporal threshold stability was assessed by stratified outcome analysis (chi-squared test). RESULTS: Overall, 61,920 patients underwent pancreatectomy at 982 facilities with a 90-day mortality rate of 5.4%. SSLR analysis yielded 6 volume strata: ≤3, 4 to 9, 10 to 20, 21 to 47, 48 to 120, and ≥121 procedures/year with decreasing 90-day mortality (≤3: 11%; 4-9: 7.3%; 10-20: 6.1%; 21-47: 4.2%; 48-120: 3.3%; ≥121: 2.3%; P <.001). The optimized threshold of 21 procedures/year was identified based on SSLR. Temporal stratification into 5-year periods (2006-2010, 2011-2015, and 2016-2020) demonstrated persistent volume-outcome associations across volume strata (P <.001). CONCLUSION: SSLR reveals persistent volume-outcome associations for pancreatectomy across multiple empirically derived strata, even in contemporary data. These findings suggest that reports of an attenuated volume-outcome relationship may reflect limitations of single, static cutoffs rather than true weakening of this association.
BACKGROUND: Laparoscopic choledocholithotripsy (or laparoscopic common bile duct exploration [LCBDE]) with laparoscopic cholecystectomy (LC) and preoperative endoscopic sphincterotomy (EST) followed by LC are established...BACKGROUND: Laparoscopic choledocholithotripsy (or laparoscopic common bile duct exploration [LCBDE]) with laparoscopic cholecystectomy (LC) and preoperative endoscopic sphincterotomy (EST) followed by LC are established treatment strategies for concomitant choledocholithiasis and cholelithiasis. However, the comparative efficacy, safety, and cost-effectiveness of these 1-stage vs 2-stage approaches remain uncertain, particularly with recent advances in minimally invasive interventions. METHODS: A systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials was conducted between January 2000 and December 2024. Randomized controlled trials (RCTs) comparing LCBDE + LC with EST + LC in patients with confirmed or suspected common bile duct (CBD) stones were included. Of note, 2 reviewers independently extracted data and assessed the risk of bias using the Cochrane Collaboration tool. Meta-analyses were performed using Review Manager software (version 5.4.1; Cochrane Informatics and Knowledge Management Department, Nordic Cochrane Centre) with random-effects models to calculate odds ratios (ORs) or mean differences (MDs) with 95% CIs. The study protocol was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42024610284). RESULTS: Overall, 16 RCTs involving 1576 patients were included (778 in the LCBDE + LC group and 798 in the EST + LC group). EST + LC achieved a higher CBD stone clearance rate (OR, 1.72 [95% CI, 1.14-2.60]; P =.01). No significant differences were observed in the overall complications (OR, 0.66 [95% CI, 0.42-1.03]; P =.07) or mortality (OR, 0.22 [95% CI, 0.02-1.93]; P =.17). LCBDE + LC resulted in lower recurrence (OR, 0.27 [95% CI, 0.11-0.69]; P =.006) and reduced costs (MD, -2059.35 United States dollar [95% CI, -2720.55 to -1398.16]; P <.00001). Hospital stay and residual stone rates were comparable between the 2 groups. CONCLUSION: EST + LC provides a higher rate of CBD stone clearance, whereas LCBDE + LC offers advantages in reducing recurrence and overall costs. Both approaches are safe and effective. Treatment choice should be individualized based on institutional expertise, resource availability, and patient-specific considerations.
BACKGROUND: Pancreatic metastases are rare, accounting for 2% to 5% of all pancreatic malignancies. Renal cell carcinoma (RCC) is the most common primary cancer that metastasizes to the pancreas and accounts for 30% to 4...BACKGROUND: Pancreatic metastases are rare, accounting for 2% to 5% of all pancreatic malignancies. Renal cell carcinoma (RCC) is the most common primary cancer that metastasizes to the pancreas and accounts for 30% to 40% of all pancreatic metastatic lesions. Most reported cases involve clear cell RCC (ccRCC), although data regarding pancreatic metastases from non-ccRCC subtypes remain limited. Unlike metastases from other primary tumors, pancreatic metastases from RCC (PM-RCC) often follow a more indolent clinical course and are associated with a relatively favorable prognosis, suggesting distinct underlying biological behavior. METHODS: A comprehensive literature review was conducted using the MEDLINE/PubMed, Google Scholar, Cochrane Library, and Web of Science databases (January 1993 to May 2025). Eligible studies included full-text articles, case reports, and original research describing RCC metastasis to the pancreas, with an emphasis on the mechanism, diagnosis, treatment, and outcomes. RESULTS: The disproportionate tendency of kidney cancer to metastasize to the pancreas is best explained by the "seed and soil" hypothesis, reflecting a selective affinity between RCC cells and the pancreatic microenvironment. PM-RCC are usually metachronous, often occurring many years after nephrectomy, and are frequently asymptomatic and discovered incidentally on surveillance imaging. Characteristic imaging findings include hypervascular lesions on contrast-enhanced computed tomography or magnetic resonance imaging. Histopathologic confirmation is crucial, as PM-RCC have a markedly better prognosis than primary pancreatic neoplasms. Surgical resection remains the mainstay of treatment of isolated disease, with a 5-year survival rate exceeding 50%. In the era of targeted immunotherapy, systemic treatments further improve outcomes, with the median overall survival surpassing that of patients with extrapancreatic metastases. CONCLUSION: PM-RCC are a unique clinical and biological entity characterized by indolent progression, favorable survival, and a strong response to surgical and targeted therapies. Understanding the molecular and microenvironmental mechanisms underlying this selective organotropism may refine therapeutic strategies and provide insights into the broader principles of metastatic disease.
Bellamkonda KS, Newton L, Korves C
… +11 more, Weinberger D, Zwain G, Eid M, Fowler X, Ponukumati A, Robertson DJ, Wilson MZ, Justice AC, Vashi A, Goodney PP, Davies L
PURPOSE: Colorectal cancer is the fourth most common cancer in the United States, and early detection decreases mortality. We evaluated recent trends in colon cancer incidence and changes in rates of presentation with bo...PURPOSE: Colorectal cancer is the fourth most common cancer in the United States, and early detection decreases mortality. We evaluated recent trends in colon cancer incidence and changes in rates of presentation with bowel obstruction before and during the COVID-19 pandemic. METHODS: This was a longitudinal study of United States veterans from 2017 to 2023. The primary exposure was the time period prepandemic (January 1, 2017, to February 29, 2020) compared with pandemic (March 1, 2020, to October 31, 2023). The primary outcome was new colon cancer diagnoses. We compared observed with expected diagnoses during the pandemic period. Malignant bowel obstruction at the index diagnosis date, American Joint Committee on Cancer tumor stage, and tumor size at the time of diagnosis were compared by period using standardized differences and bootstrapped CIs. RESULTS: There were 22,256 new colon cancer diagnoses made in United States Department of Veterans Affairs Medical Centers (VA): mean age of 71 ± 11 years, 96% male, and 72% White. Comparing the pandemic with prepandemic periods, the proportion of cancers >4 cm increased from 48.9% to 57.3% and the proportion with malignant bowel obstruction at presentation doubled from 2.7% to 5.3%. An estimated 619 cases were "missed" during the pandemic: they were expected but not observed diagnoses. There were greater observed than expected large cancers and fewer observed than expected small cancers during the pandemic according to forecast analyses. CONCLUSION: Interruptions in care after the onset of the COVID-19 pandemic had measurable consequences among United States veterans through the end of 2023. Among those diagnosed, the median size was larger and more presented with bowel obstruction. This may be because decreased screening activity combined with lower healthcare utilization changed the distribution of cancer size at diagnosis to be larger, underlining the importance of encouraging engagement or re-engagement of veterans in colorectal cancer screening.