INTRODUCTION: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with high rates of postoperative pulmonary embolism (PE). Rotational thromboelastometry (ROTEM) can detect hype...INTRODUCTION: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is associated with high rates of postoperative pulmonary embolism (PE). Rotational thromboelastometry (ROTEM) can detect hypercoagulability, but no consensus criteria exist in surgical populations. This study aimed to compare agreement between two ROTEM hypercoagulability definitions and their association with postoperative PE after CRS/HIPEC. METHODS: We performed a retrospective cohort study enrolling CRS/HIPEC patients with baseline ROTEMs from July 2019 to July 2024. Hypercoagulability was defined using Hincker et al. criteria (elevated maximum clot formation in EXTEM, INTEM, or FIBTEM) and Thorson et al. criteria (broader ROTEM abnormalities). Primary outcomes were PE at 7 and 30 days postoperatively. Agreement between definitions was assessed using Cohen's kappa. Associations with PE were analysed using frequentist and Bayesian logistic regression, with inverse probability of treatment weighting to control confounding. RESULTS: Of 137 patient-procedures, hypercoagulability was identified in 39% (Hincker) and 77% (Thorson) with poor agreement (κ = 0.219, p = 0.010). PE occurred in 11% at 7 days and 18% at 30 days. Frequentist analysis showed no significant associations due to insufficient power (maximum 30%). Bayesian analysis demonstrated consistently high posterior probabilities (98.9-100%) for increased PE risk in hypercoagulable patients, with risk ratios of 1.74-2.07 across both definitions and timeframes. Weighted analyses confirmed hypercoagulability as an independent risk factor. CONCLUSION: ROTEM-defined hypercoagulability was independently associated with increased postoperative PE risk in CRS/HIPEC patients, based on Bayesian analyses. Poor agreement between definitions highlights the need for developing standardised criteria. Prospective validation is required before using these findings to guide clinical risk stratification.
INTRODUCTION: Lauren's diffuse-type adenocarcinoma is less sensitive to chemotherapy, whether neoadjuvant chemotherapy (NAC) benefits this subtype remains uncertain. METHODS: We retrospectively reviewed patients with Lau...INTRODUCTION: Lauren's diffuse-type adenocarcinoma is less sensitive to chemotherapy, whether neoadjuvant chemotherapy (NAC) benefits this subtype remains uncertain. METHODS: We retrospectively reviewed patients with Lauren's diffuse-type adenocarcinoma, clinical stage T3/N+ or T4/Nany, who underwent curative surgery. Patients were divided into a NAC group and an upfront surgery group, and propensity score matching (PSM) was applied to compare the treatment outcome. RESULTS: 274 patients (NAC 194/upfront surgery 80) were initially included. After PSM, 91 patients remained in the NAC group and 59 in the upfront surgery group. Both groups received a total of 8 chemotherapy cycles, with comparable dosage exposure. In the NAC group, only 1 patient achieved a pathological complete response (pCR), with a major pathological response (MPR) rate of 15.4% (14/91), while the upfront surgery group had a slightly higher R0 resection rate (93.8% vs. 85.6%). Post-surgery, the NAC group showed a higher incidence of complications above Clavien-Dindo grade II (NAC 22% vs Upfront surgery 6.8%, p = 0.02). Regarding survival, after PSM, the upfront surgery group demonstrated superior 3-year disease free survival (62.0% vs. 29.5%, p = 0.005) and overall survival (77.3% vs. 52.5%, p = 0.04) compared to the NAC group. Sensitivity analysis confirmed the robustness of the association between NAC and poorer survival outcomes, with increased risks of recurrence (HR = 2.5) and mortality (HR = 1.88) in the multivariate cox model. CONCLUSION: Neoadjuvant chemotherapy was associated with inferior survival in this retrospective cohort. Its application for Lauren diffuse-type gastric cancer warrants careful re-evaluation.
Lauwereins L, D'Hoore A, Coeckelberghs E
… +12 more, Wolthuis A, Bislenghi G, Haustermans K, Rasschaert G, Dekervel J, Debrun L, Castro EM, Devoogdt N, De Groef A, Vanderheyden H, Geraerts I, Bowel Diary Research group
INTRODUCTION: Rectal cancer treatment has improved survival, but postoperative bowel dysfunction, known as Low Anterior Resection Syndrome (LARS), significantly impacts Quality of Life. However, current assessment tools...INTRODUCTION: Rectal cancer treatment has improved survival, but postoperative bowel dysfunction, known as Low Anterior Resection Syndrome (LARS), significantly impacts Quality of Life. However, current assessment tools lack granularity to assess all LARS symptoms. Therefore, this study developed a mobile application (S.Tool), designed to be patient-friendly and easy to interpret, tailored to monitor LARS. MATERIALS AND METHODS: This study followed eight phases: 1) literature review, 2) internal expert group, 3) pre-Delphi patient focus group, 4) international Delphi Survey (conducted in two rounds in Dutch and English with five stakeholder-groups including colorectal surgeons, radiation and medical oncologists, pelvic floor physiotherapists, colorectal clinical nurse specialists and patients), 5) post-Delphi patient focus group, 6) consensus meeting, 7) forward-backward translation, and 8) development of the application. Descriptive statistics, percentages and median (range), were used to present the data. RESULTS: A total of 122 participants, including 22 patients, participated in the international Delphi survey. Of these, 103 (84%) completed the first round and 97 (80%) the second round. After the Delphi rounds, 25 items were included in the bowel diary, 10 excluded and 8 discussed in the consensus meeting. Based on feedback from the post-Delphi patient focus group, the consensus meeting decided to include 6 of the 8 discussed items, resulting in 31 items. These guided the development of the S.Tool application. CONCLUSION: The S.Tool application is an innovative, multidisciplinary bowel diary for assessment and follow-up of patients with LARS. It generates visual summaries shareable with healthcare professionals to support clinical decision-making and personalized care.
OBJECTIVES: Intratumoral tertiary lymphoid structures (iTLSs) are prognostic biomarkers for hepatocellular carcinoma (HCC). This study aimed to develop a machine learning approach based on topologically distinct intratum...OBJECTIVES: Intratumoral tertiary lymphoid structures (iTLSs) are prognostic biomarkers for hepatocellular carcinoma (HCC). This study aimed to develop a machine learning approach based on topologically distinct intratumoral heterogeneity (ITH) scores derived from CT images to predict iTLS status and patient outcomes. METHODS: In this multicenter study, patients from Centers 1 and 2 were divided into training (n = 475) and internal validation (n = 204) cohorts, with an independent cohort (n = 208) used for external validation from Center 3. Two complementary ITH scores were developed: a 2D score integrating local radiomics with global pixel patterns on the largest cross-sectional slice, and a 3D score extending this quantification to the entire tumor volume. A stacking ensemble classifier (2D3D-TD-ITH-Ensemble) incorporating clinicoradiological features and ITH scores was constructed to predict iTLS status. Model performance was compared with clinical and traditional radiomics models. SHapley Additive exPlanations (SHAP) analysis was used for interpretability. Disease-free survival (DFS) was assessed using Kaplan-Meier analysis. RESULTS: The 2D3D-TD-ITH-Ensemble demonstrated superior diagnostic performance compared to reference models. In the internal validation cohort, the ensemble model achieved an AUC of 0.904, outperforming the radiomics (AUC 0.887) and clinical models (AUC 0.811). Consistent results were observed in the external validation cohort, where the ensemble model yielded an AUC of 0.890, versus 0.864 for the radiomics model and 0.817 for the clinical model. SHAP analysis identified the 3D ITH score as the most influential contributor to model output. Furthermore, HCC patients with the presence of iTLS and lower 3D ITH scores exhibited significantly better DFS (p < 0.05). CONCLUSIONS: The preoperative CT-based 3D ITH score serves as a robust non-invasive biomarker for predicting iTLS status and prognosis in HCC, potentially guiding stratified immunotherapy strategies.
BACKGROUND: The prognostic impact of vascular resection in intrahepatic cholangiocarcinoma (iCCA) remains uncertain, particularly in the context of advanced disease requiring complex surgery. This study evaluated the ass...BACKGROUND: The prognostic impact of vascular resection in intrahepatic cholangiocarcinoma (iCCA) remains uncertain, particularly in the context of advanced disease requiring complex surgery. This study evaluated the association between vascular resection and long-term survival and examined how tumor biology, assessed with tumor burden score (TBS) and CA19-9, influenced outcomes. METHODS: Patients who underwent upfront curative-intent hepatectomy for iCCA were identified from an international multi-institutional database. Multivariable Cox regression assessed overall (OS) and recurrence-free survival (RFS). Among patients undergoing vascular resection, biologic heterogeneity was explored using optimized TBS and CA19-9 cutoffs to define biologic risk subgroups. RESULTS: Among 1757 patients, 9.7% (n = 171) required major vascular resection. These patients were more likely to have bilateral tumors (29.2% vs. 21.3%), lymph node metastasis (33.9% vs. 24.8%), and T3/T4 tumors (57.3% vs. 27.6%) (all p < 0.05). Vascular resection was not an independent predictor of OS (aHR 1.11, 95% CI 0.82-1.51) or RFS (HR 1.02, 95% CI 0.81-1.27). Within the vascular resection cohort, higher TBS (aHR 1.11, 95% CI 1.03-1.19) and higher CA19-9 (log-transformed; aHR 1.16, 95% CI 1.02-1.32) were independently associated with worse OS. Five-year survival decreased stepwise from favorable to unfavorable biologic profiles. Patients with favorable biology demonstrated survival comparable to individuals undergoing hepatectomy without vascular resection. CONCLUSION: Major vascular resection did not independently worsen prognosis after iCCA hepatectomy. Instead, tumor biology-captured by TBS and CA19-9-was strongly associated with long-term outcomes, highlighting the importance of biologic risk stratification when considering vascular resection.
BACKGROUND: While tumour-free (R0) margins are essential in oesophageal cancer surgery, the ideal length of the proximal resection margin remains unclear. Although longer margins may improve oncological outcomes, they ca...BACKGROUND: While tumour-free (R0) margins are essential in oesophageal cancer surgery, the ideal length of the proximal resection margin remains unclear. Although longer margins may improve oncological outcomes, they can increase surgical complexity and morbidity. Current evidence is limited and inconsistent, mostly based on small retrospective studies. This population-based cohort study aimed to assess the association between proximal resection margin length and 5-year mortality following oesophagectomy for oesophageal cancer. METHODS: This binational, population-based cohort study included 1830 patients who underwent curatively intended oesophagectomy with tumour-free margins for oesophageal cancer in Sweden or Finland between 2006 and 2020. The main exposure was the length of the proximal resection margin, categorized as 0.1-<2.0 cm, 2.0-<5.0 cm, 5.0-<8.0 cm, and ≥8.0 cm. The outcomes were all-cause and disease-specific 5-year mortality. Multivariable Cox regression provided adjusted hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: There was a gradual decrease in the risk of 5-year mortality outcomes with increasing proximal resection margin lengths up until the category 5.0 to <8.0 cm, with HR 0.83 (95% CI 0.68-1.01) for all-cause mortality and HR 0.80 (95% CI 0.65-0.98) for disease-specific mortality. A longer resection margin (>8.0 cm) did not further decrease the all-cause 5-year mortality (HR 0.87, 95% CI 0.70-1.09) or disease-specific 5-year mortality (HR 0.85, 95% CI 0.67-1.07). CONCLUSIONS: A proximal resection margin of 5 to 8 cm may be appropriate to optimize the chance of 5-year survival in oesophageal cancer patients who undergo oesophagectomy, but further research is necessary to confirm its applicability.
INTRODUCTION: Traditional surgical teaching includes an extended hepatectomy for patients diagnosed with perihilar cholangiocarcinoma (pCCA). However, recent studies suggest it may not consistently lead to the best outco...INTRODUCTION: Traditional surgical teaching includes an extended hepatectomy for patients diagnosed with perihilar cholangiocarcinoma (pCCA). However, recent studies suggest it may not consistently lead to the best outcome. METHODS: A systematic review was conducted in PubMed, Embase, and Web of Science databases (inception - March 2025). Studies including at least 50 patients with pCCA who underwent liver and extrahepatic bile duct resection with caudate lobe were included. For each study, resections were reclassified as "Reference Surgery" (RS) or "Extended Surgery" (ES) according to the Kawaguchi-Gayet classification. Primary outcome was overall survival (OS). Secondary outcomes included: microscopic residual disease (R1), post-hepatectomy liver failure (PHLF), 90-day mortality rates. Hazard Ratios (HR), Odds Ratios (OR) with 95% Confidence Intervals (CI) represented outcome measures. Results after sensitivity analysis are reported. RESULTS: Overall, 4181 patients with resected pCCA from 17 retrospective studies were included. Proportion for Bismuth type was similar, except for type 3a (RS: 9.6%; ES: 41.6%). RS primarily comprised left hepatectomy (64.2%; n = 1090); ES mainly included right extended hepatectomy (35.7%; n = 1001). Overall, ES was negatively associated with OS (HR = 1.2; 95% CI = 1.07-1.34), did not improve R1 rate (OR = 0.91; 95% CI = 0.71-1.15), and was associated with a two-fold higher risk of PHLF and 90-day mortality. CONCLUSIONS: Accounting for confounding, this study shows no clear benefit of ES over RS for pCCA, suggesting non-inferiority of RS. Surgeons may consider a safer parenchymal sparing approach as long as radicality is not significantly compromised, especially for patients at higher risk of fatal PHLF.
BACKGROUND: Resection margin status and lymph node involvement are well-established predictors of recurrence following resection of perihilar cholangiocarcinoma (pCCA). However, even patients with favorable pathology inc...BACKGROUND: Resection margin status and lymph node involvement are well-established predictors of recurrence following resection of perihilar cholangiocarcinoma (pCCA). However, even patients with favorable pathology including negative surgical margins (R0) and node-negative disease (N0) may experience recurrence. We sought to develop a clinically relevant tool to risk stratify patients relative to tumor recurrence following an R0N0 resection of pCCA. METHODS: pCCA patients undergoing curative-intent resection with R0 and N0 tumor were identified from an international multi-institutional database. A pathology-based risk score was developed to predict recurrence-free survival (RFS). In addition, genomic profiling was performed in a subset of patients to evaluate the prognostic relevance of genetic alterations. RESULTS: Among 298 patients with resected R0N0 pCCA, 131 (44.0%) developed disease recurrence. Multivariable analysis identified advanced AJCC T category (T2b or T3/T4), perineural invasion, and poor tumor differentiation as independent predictors of inferior RFS. Based on these factors, a three-variable pathology-based risk score stratified patients into low-, intermediate-, and high-risk groups with corresponding 3-year RFS of 85%, 31%, and 27%, respectively. Both intermediate- and high-risk patients had worse RFS versus low-risk patients (high-risk vs. low-risk: median RFS, 15.0 vs. 92.9 months; intermediate-risk vs. low-risk: median RFS, 23.0 vs. 92.9 months; both p < 0.001). KRAS mutations occurred in 29% of profiled patients, which was associated with reduced RFS (mutant vs. wild-type KRAS: median RFS, 11.0 vs. 24.0 months, p = 0.011). CONCLUSIONS: Recurrence risk among patients with R0N0 pCCA was heterogeneous. The proposed risk score stratified patients into markedly different risk categories relative to recurrence, which may help guide utilization of adjuvant therapy as well as surveillance in the postoperative setting.
BACKGROUND: The high-pressure syringe pump (HP-SP) is the most widely applied device for PIPAC. However, HP-SP systems exhibited several limitations: relatively more drug assembly procedures and significant start-up dela...BACKGROUND: The high-pressure syringe pump (HP-SP) is the most widely applied device for PIPAC. However, HP-SP systems exhibited several limitations: relatively more drug assembly procedures and significant start-up delays. Herein, the performance of a high-pressure peristaltic pump (HP-PP) was compared to the existing HP-SP for PIPAC. METHODS: Mechanical and ex vivo experiments were conducted to compare the performance of the HP-PP and HP-SP for PIPAC. The evaluated parameters included (1) particle size distribution, operational pressure, and its influence on particle size distribution in the initial phase; (2) drug assembly time (DAT); (3) dead volume; (4) spray cone angle and deposition areas; and (5) doxorubicin (DOX) penetration depth and spatial distribution in a box model. RESULTS: Both systems produced aerosols with comparable median particle sizes (≈25 μm) and spray cone angles (≈70°). The HP-PP demonstrated significantly shorter start-up time (5 s vs. 34.7 ± 2.9 s) and DAT (15.1 ± 1.3 s vs. 54.8 ± 3.1 s for a 150 mL setup). The original dead volume of HP-PP was 2.4 ± 0.3 mL but was reduced to 0.44 ± 0.03 mL after optimization. Spray coverage was similar for both pumps across different nozzle heights. DOX penetration depths were similar between groups, except for marginally deeper penetration at obstructed (B) and lateral (C) positions for HP-PP (p < 0.01). CONCLUSION: The HP-PP performs comparably to the HP-SP in key aerosol and distribution parameters, while offering faster initiation and a simplified drug assembly process. This indicates its potential application for clinical PIPAC, despite no therapeutic advantage being observed at this stage.
Karhunen-Enckell U, Salminen A, Tolonen T
… +12 more, Joukainen S, Aaltonen R, Norja H, Repo H, Korpinen K, Metsola H, Lesonen T, Kronqvist P, Luukkaala T, Lepomäki M, Oksala N, Roine A
BACKGROUND: Achieving tumor-free margins without unintentional tissue loss is essential in breast-conserving surgery (BCS). Calculated resection ratio (CRR) and tumor eccentricity measuring tumor displacement from the sp...BACKGROUND: Achieving tumor-free margins without unintentional tissue loss is essential in breast-conserving surgery (BCS). Calculated resection ratio (CRR) and tumor eccentricity measuring tumor displacement from the specimen center have been proposed as complementary quality metrics to reoperation and mastectomy rates. The objective of this study was to identify factors influencing CRRs and reoperations in BCS. METHODS: The prospective, multi-center FIBRATIO study included 206 women undergoing unilateral BCS for invasive cancer and/or ductal carcinoma in situ across five Finnish centers. Tumor, specimen, and breast volumes were measured radiologically and histopathologically. CRRs, defined as total resection volume (TRV) divided by optimal resection volume, were calculated both radiologically (CRR) and histologically (CRR). Eccentricity and relative eccentricity (adjusted for tumor size) were also assessed. Associations with clinical and imaging variables, and reoperations were analyzed using multivariable analyses. RESULTS: Median CRR was 2.3 [interquartile range (IQR) 1.5-3.7] and CRR 2.4 (IQR 1.4-3.7). Relative eccentricity was 1.0 (IQR 0.5-2.0), higher in smaller tumors and correlated with CRRs. Reoperation occurred in 14% of patients and was associated with larger lesion size and lower CRRs. High CRRs were associated with large breast volume, non-dense breasts, and non-palpable tumors. CRRs decreased with increasing tumor size. Tumor spiculation was associated with higher CRR. Statistically significant inter-surgeon and inter-center variability in CRRs and reoperation rates was observed. CONCLUSIONS: BCS is associated with variable and often excessive resection of healthy tissue. Identifying patients at risk for over-resection may improve surgical planning. Incorporating CRR into quality metrics alongside reoperation and mastectomy rates could enhance benchmarking.
For women, breast cancer is a huge success story; many survivors go on to lead long, happy, and sometimes even better lives following treatment. Two-thirds of patients with invasive breast cancer have a Stage I diagnosis...For women, breast cancer is a huge success story; many survivors go on to lead long, happy, and sometimes even better lives following treatment. Two-thirds of patients with invasive breast cancer have a Stage I diagnosis, meaning that the 5-year relative survival rate in the Western world is close to 90%. This is in stark contrast to the lack of screening and outcomes in low-resource countries.(1) Achieving favorable results requires early detection and efficient treatments, such as radiation therapy, surgery, and targeted medicines. Multidisciplinary care and an emphasis on patient-reported outcomes have been championed by the increasing number of women surgeons. The advent of the "breast surgeon" has changed the face of breast cancer care and paved the way for many innovations in breast cancer treatment.
OBJECTIVE: European guidelines for endometrial carcinoma have shifted from selective to routine surgical lymph node assessment. This study evaluated the 2025 prognostic classification for its potential to identify patien...OBJECTIVE: European guidelines for endometrial carcinoma have shifted from selective to routine surgical lymph node assessment. This study evaluated the 2025 prognostic classification for its potential to identify patient subsets who could safely omit surgical staging. METHODS: This retrospective cohort study included patients treated at a single tertiary center. The predictive model incorporated preoperative histology, molecular classification, and estrogen receptor expression, in line with the European guidelines. RESULTS: A total of 1063 patients were included. Among those staged, the incidence of stage IIIC disease was 2.0% (6 out of 298) when the primary tumor met low-risk prognostic group criteria, accounting for 39.1% of all patients who underwent lymph node assessment (298 out of 762). The incidence of stage IIIC was 10.4% (19 out of 183) when intermediate-risk prognostic criteria were met and 12.2% (12 out of 98) when high-intermediate-risk prognostic criteria were met. Among staged patients, the incidence of stage IIIC disease was 7.9% in those who met the model-defined low-risk features for nodal involvement, and 266 out of 746 (35.7%) fulfilled these features (stage IV excluded). When pathologically assessed myometrial invasion was added as an additional parameter for no specific molecular profile carcinomas, the risk of stage IIIC disease was 3.3% among staged patients who met low-risk features for nodal involvement, and 181 out of 746 (24.3%) fulfilled these features (stage IV excluded). Stage IIIC1-2 accounted for 6.5% (6 out of 93) of all stage IIIC cases in the analysis. CONCLUSION: Pathologic and molecular evaluation according to European guidelines lacks accuracy in predicting nodal involvement in endometrial carcinoma, favoring routine staging when used alone. The small risk of nodal metastasis in carcinomas with features suggestive of low risk, combined with their substantial proportion, supports pursuing algorithms for selective staging. Incorporating myometrial invasion may enable a selective approach.
Galasso E, Delvecchio A, Tedeschi M
… +12 more, Ratti F, Magistri P, Belli A, Ceccarelli G, Izzo F, Spampinato MG, De Angelis N, Pessaux P, Piardi T, Di Benedetto F, Aldrighetti L, Memeo R
BACKGROUND: The state of the art for robotic liver metastasis resection is not yet well-defined and remains a topic of debate. While hepatic resection for colorectal liver metastases (CRLM) is recognized as a valuable ap...BACKGROUND: The state of the art for robotic liver metastasis resection is not yet well-defined and remains a topic of debate. While hepatic resection for colorectal liver metastases (CRLM) is recognized as a valuable approach for systemic disease control, hepatectomy for non-colorectal liver metastases (NCLM) has shown varied outcomes. MATERIALS AND METHODS: A retrospective analysis was conducted on patients who underwent robotic liver resections for NCLM from 2012 to 2023 across seven European hospital centers. Preoperative, intraoperative, and postoperative data were collected for each patient, including overall and disease-free survival. RESULTS: Distribution based on primary tumor histology revealed a prevalence of breast carcinoma (38%) and neuroendocrine tumors (NET) (17.7%) compared to other primaries. Among the hepatic resections, 58 (45.8%) were wedge resections, 8 (10%) were segmentectomies, 12 (9.5%) were bisegmentectomies, and 1 (0.8 %) was a major hepatectomy. The majority of liver resections were assessed on an intermediate level of difficulty based on Tampa Score. The mean operative time was 226 min (range 90-480). There were 3 conversions to the open approach (3.8%). Severe complications (Clavien Dindo ≥3) occurred in 3 patients (5.1 %). The mean hospital stay was 5.3 days. The 1,3 and 5-year overall survival (OS) was 100%, 70% and 50%, respectively. The 1,3 and 5-year disease-free survival (DFS) was 75%, 40% and 30%, respectively. CONCLUSIONS: The role of robotic liver resections for non colorectal metastasis remains challenging and unclear. Our findings indicate promising oncological outcomes that surpass existing literature, suggesting potential advantages of the robotic approach. Randomized controlled trials are still missing but essential to validate the safety and feasibility of the robotic approach for NCLM treatment.
Whilst the majority of cancer types affect both males and females, some are gender specific, (typically those linked to reproductive organs) or have differential incidence and survival rates between males and females. In...Whilst the majority of cancer types affect both males and females, some are gender specific, (typically those linked to reproductive organs) or have differential incidence and survival rates between males and females. In some cases, there is a biological basis for these differences, but in others, the underlying reason for these differences is sociocultural or economic. Historically in high income countries, and presently in low- and middle-income economies, women are often financially disadvantaged and disempowered, which may lead to reduced ability to access health care. In addition, social and cultural barriers may exist that may reduce women's ability, or desire, to seek timely health care. We present a narrative review of these issues with a focus on gender differences in certain key cancers, barriers to access care and strategies to improve cancer outcomes for women.
BACKGROUND: This study aimed to identify psychosocial subtypes among gastric cancer (GC) patients and examine their associations with quality of life (QoL) and survival outcomes. METHODS: A prospective cohort design was...BACKGROUND: This study aimed to identify psychosocial subtypes among gastric cancer (GC) patients and examine their associations with quality of life (QoL) and survival outcomes. METHODS: A prospective cohort design was adopted, including 455 newly diagnosed GC patients admitted to the Union Hospital of Fujian Medical University between January 2023 and August 2024. Depressive symptoms and sleep quality were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI), respectively. QoL was evaluated using the EORTC QLQ-C30 and QLQ-STO22 questionnaires. Latent class analysis (LCA) was performed based on social support, depressive symptoms, and sleep quality to identify distinct psychosocial subtypes. Between-group QoL differences at 6 months were examined with pairwise comparisons adjusted for baseline QoL (ANCOVA). RESULTS: Three psychosocial subtypes were identified: low-risk (37.6%), moderate-risk (40.4%), and high-risk (22.0%). At 6 months postoperatively, the low-risk group showed higher physical functioning than the high-risk group (94.02 ± 8.16 vs. 89.83 ± 14.10; P = 0.011) and higher cognitive functioning than the moderate-risk group (98.56 ± 3.68 vs. 96.08 ± 8.96; P = 0.001) on the EORTC QLQ-C30. Global health status/QoL was also higher in the low-risk group than in the moderate- and high-risk groups (68.47 ± 21.39 vs. 62.57 ± 22.95 vs. 61.89 ± 21.05; P = 0.023 and 0.027, respectively). Dysphagia symptom burden on the EORTC QLQ-STO22 was greater in the moderate- and high-risk groups than in the low-risk group (10.90 ± 11.54 and 11.71 ± 11.49 vs. 6.83 ± 10.17; P = 0.001 and 0.002, respectively). In multivariable Cox regression, the high-risk group had a higher risk of death than the low-risk group (HR = 3.95, 95% CI: 1.20-13.00; P = 0.024). CONCLUSIONS: Psychosocial subtypes identified by LCA were associated with 6-month postoperative QoL, and the high-risk subtype was an independent predictor of overall survival among GC patients. Early identification of high-risk patients may facilitate precision supportive care and inform multidimensional interventions to improve both QoL and survival.
INTRODUCTION: Accurate preoperative imaging is essential for improving the treatment of small lung cancers. Precise identification of non-invasive adenocarcinomas is critical for determining the suitability of sublobar r...INTRODUCTION: Accurate preoperative imaging is essential for improving the treatment of small lung cancers. Precise identification of non-invasive adenocarcinomas is critical for determining the suitability of sublobar resection. Conventional methodologies frequently demonstrate variability, particularly for small tumors or ground-glass nodules (GGNs). Artificial intelligence (AI) offers a consistent and objective alternative, enhancing non-invasive cancer diagnosis and facilitating more effective treatment decisions. MATERIALS AND METHODS: A retrospective analysis was conducted on 324 patients who underwent surgical resection for small-sized lung adenocarcinomas at Tokyo Medical University. The Synapse Vincent system (Fujifilm Corporation, Japan) was employed to measure tumor size and classify the nodules as GGN (AI-GGN) or non-GGN (non-AI-GGN) based on confidence scores. The ability of AI to predict pathological non-invasive adenocarcinomas was evaluated. RESULTS: AI-measured tumor sizes were significantly more accurate than those measured by thoracic surgeons (p < 0.001) AI-GGN demonstrated a high specificity of 98.3% for predicting pathological non-invasive adenocarcinoma, closely aligned with the 98.3% specificity of the traditional consolidation tumor ratio (CTR) method. The positive predictive values of AI-GGN and CTR were similarly high, (98.5% and 98.2%, respectively), confirming the effectiveness of both methods in identifying non-invasive adenocarcinomas. CONCLUSION: AI technology significantly enhances the precision of tumor size measurement and identification of non-invasive adenocarcinomas in small-sized lung tumors. By providing objective and automated evaluations, AI can refine surgical planning and decision-making. Further prospective multicenter studies are warranted to validate these findings and to fully integrate AI into clinical practice, ultimately improving patient outcomes.
Pollmann L, Zieren J, Pollmann NS
… +8 more, Giger-Pabst U, Rau B, Piso P, Ströhlein M, Cerasani N, Kockelmann F, Schmeding M, members of the StuDoQ | HIPEC registry of the German Society for General and Visceral Surgery (DGAV)
Digital Twins (DTs) are virtual representations of a patient's anatomy that can revolutionize surgery guidance when paired with augmented reality. However, accurate intraoperative alignment requires high-precision surfac...Digital Twins (DTs) are virtual representations of a patient's anatomy that can revolutionize surgery guidance when paired with augmented reality. However, accurate intraoperative alignment requires high-precision surface scanning. We developed an automatic 3D surface scan system based on two RGB-D cameras for breast cancer (BC) surgery. In a clinical study involving 30 BC patients, we compared our system to a manual, high-resolution scanner. The median deviation between systems was 3.0 (IQR 2.6 to 3.6) mm. Acquisition time was 1 s, compared with 84 s for the manual scanner. Five radiology technicians highlighted our system's high performance with an excellent user experience (System Usability Scale: 92.0 ± 4.5 vs 70.5 ± 17.5) with lower perceived effort and frustration. Intraoperative surface scanning of one patient demonstrated a successful adaptation to the surgical site, supporting potential integration into BC surgical workflows.
INTRODUCTION: Oxaliplatin (Ox) is one of the recommended agents in Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) that benefitted of several phase I trials. Based on these data, the dose of 120 mg/m was suggest...INTRODUCTION: Oxaliplatin (Ox) is one of the recommended agents in Pressurized Intraperitoneal Aerosol Chemotherapy (PIPAC) that benefitted of several phase I trials. Based on these data, the dose of 120 mg/m was suggested by an expert consensus for fit patients with peritoneal metastases (PM) of gastrointestinal cancers. The aim of the current study is to determine the real-life feasibility and safety profile of this regimen. MATERIAL AND METHODS: This retrospective study included all patients treated with PIPAC-Ox 120 mg/m in six referral centers specialized in PM. The patients were assessed for all potential toxicities associated to high dose oxaliplatin. Adverse events were expressed with the use of CTCAE for medical complications and Clavien-Dindo for surgical complications. Logistic regression and multivariate analysis were performed. RESULTS: 259 PIPAC procedures were performed in 91 patients (53 male) diagnosed with unresectable PM of various origins; most patients (n = 62) having colorectal PM. Concomitant IV 5FU was performed in 70 patients. All patients underwent the first PIPAC-Ox 120 mg/m, and 44 patients (48.3%) had ≥3 PIPAC. Abdominal pain was the most frequent grade III toxicity at the first PIPAC-Ox (n = 34) while 30 patients routinely received continuous IV opioids. Nausea-vomiting and ascites infection were the others grade III toxicity observed at PIPAC 1, one in each case respectively. After PIPAC 3, RECIST partial/stable response in 68.2%; PRGS 1-2 in 77.3% and negative cytology in 50% of patients. CONCLUSIONS: High-dose PIPAC-Ox is feasible and safe. Local and histological response are well identified. However abdominal pain remains a main concern and continuous IV protocols should be considered routinely.