BACKGROUND AND OBJECTIVE: Determining complete clinical response (cCR) after total neoadjuvant therapy (TNT) for the treatment of rectal cancer remains challenging. Post-treatment restaging can show discordant results be...BACKGROUND AND OBJECTIVE: Determining complete clinical response (cCR) after total neoadjuvant therapy (TNT) for the treatment of rectal cancer remains challenging. Post-treatment restaging can show discordant results between endoscopy and pelvic MRI. The aim of this study was to assess the outcomes of patients that had an endoscopic cCR upon restaging, but showed continued radiographical disease. METHODS: This is a retrospective study of rectal cancer patients treated at UChicago (2015-2022). Patients who received TNT, had a cCR on restaging endoscopy, and pursued nonoperative management (NOM) were included. Outcomes between patients with residual or no residual disease on restaging MRI were compared. RESULTS: Thirty patients were endoscopically negative on restaging and entered NOM. Of these, restaging MRI showed residual disease in 12 (40%) patients and no residual disease in 18 (60%) patients. After a mean follow-up of 4.8 years, nine patients (30%) experienced regrowth. There was no difference in regrowth rates between patients with negative versus positive restaging MRI (33% vs. 27.8%; p = 0.75). After a mean of 4.0 years, 67% of patients who had an initial positive restaging MRI did not develop a regrowth. CONCLUSION: Two-thirds of endoscopically negative patients with initially positive restaging MRIs showed no regrowth after 4 years.
BACKGROUND AND OBJECTIVES: While tranexamic acid (TXA) reduces blood loss in orthopedic surgery, thromboembolic concerns in cancer patients have limited adoption in orthopedic oncology. This study evaluated TXA efficacy...BACKGROUND AND OBJECTIVES: While tranexamic acid (TXA) reduces blood loss in orthopedic surgery, thromboembolic concerns in cancer patients have limited adoption in orthopedic oncology. This study evaluated TXA efficacy and safety in patients undergoing endoprosthetic reconstruction for oncologic indications. METHODS: This retrospective single-center study included 617 patients who underwent lower extremity endoprosthetic reconstruction for oncologic indications between 2000 and 2024. Patients were stratified by perioperative TXA administration (n = 166) versus no TXA (n = 451). The primary outcome was perioperative blood loss calculated using the Mercuriali method. Secondary outcomes included perioperative packed red blood cells (pRBC) transfusion, hospital length of stay, and 90-day venous thromboembolic (VTE) complications. RESULTS: TXA was associated with a 429 mL reduction in calculated perioperative blood loss (1878 ± 1168 mL vs. 2307 ± 1442 mL; p = 0.003). TXA was not associated with reduced intraoperative pRBC transfusion rates (31% vs. 33%; RR 0.96 [95% CI: 0.74-1.25], p = 0.752) but was associated with significantly reduced postoperative transfusion requirements (17% vs. 30%; RR 0.56 [95% CI: 0.39-0.81], p = 0.003). No significant differences existed in 90-day VTE complications, reoperation rates, or mortality. CONCLUSIONS: Perioperative TXA use was associated with reduced blood loss and postoperative transfusion requirements without a detectable increase in thromboembolic complications, supporting TXA as a beneficial adjunct in musculoskeletal oncology limb salvage procedures.
BACKGROUND: Local recurrence in retroperitoneal sarcomas (RPS) with high-risk surgical margins remains a significant clinical challenge. Previous randomized trials have evaluated neoadjuvant external beam radiation thera...BACKGROUND: Local recurrence in retroperitoneal sarcomas (RPS) with high-risk surgical margins remains a significant clinical challenge. Previous randomized trials have evaluated neoadjuvant external beam radiation therapy (EBRT) without intraoperative radiotherapy (IORT). Following multidisciplinary consensus, our institution employs neoadjuvant EBRT combined with IORT for the management of RPS. This study evaluates the safety and feasibility of this combined strategy. METHODS: A single-institution retrospective review was conducted of patients with RPS treated with neoadjuvant EBRT, surgical resection, and IORT between June 1, 2004, and June 30th, 2024. Postoperative complications and 90-day readmission rates were identified through electronic medical records, pathology reports, and death registries. Postoperative complications were graded by the Clavien-Dindo (CD) classification system. RESULTS: Twenty-eight patients underwent neoadjuvant EBRT followed by resection with IORT. The median age was 66 years (IQR 59.6-69.6 years) and 57% were female. Twenty-three patients (83%) were treated for primary disease, and five patients (17%) were being treated for recurrent disease, with one patient undergoing treatment for recurrence twice. Median number of neoadjuvant EBRT cycles was 25 (IQR 25). Patients received a median neoadjuvant EBRT dose of 4,500 cGy (IQR 45-4,500 cGy) and median IORT dose of 1375 cGy (IQR 1250-1500 cGy). The median tumor size was 11.9 cm (IQR 7-22.6 cm) and most commonly leiomyosarcoma (42%) and well-differentiated liposarcoma (29%). Multi-visceral resection was required in 71% of cases, most often involving the kidney (64%), adrenal gland (39%), and gallbladder (32%). Complete (R0) resection was achieved in 14 (54%) patients, while incomplete (R1) resection was achieved in 12 (46%) patients. Median hospital stay was 7 days (IQR 6-9 days). Postoperative morbidity occurred in 78% of patients, with 25% experiencing major (Clavien-Dindo III-V) complications. There was one mortality within 90 days of index operation. CONCLUSION: Neoadjuvant EBRT followed by resection with IORT is associated with frequent low-grade complications and a 25% rate of major complications, similar to neoadjuvant EBRT alone.
BACKGROUND AND OBJECTIVES: Metastatic bone disease (MBD) often necessitates orthopaedic surgical intervention, which occurs through either emergent or elective care pathways. This study compared post-operative outcomes b...BACKGROUND AND OBJECTIVES: Metastatic bone disease (MBD) often necessitates orthopaedic surgical intervention, which occurs through either emergent or elective care pathways. This study compared post-operative outcomes between patients undergoing elective versus emergent surgery for MBD involving the pelvis and appendicular skeleton. METHODS: We performed a retrospective, multicenter, propensity-matched cohort study of patients who underwent surgery for MBD. Emergent surgery was defined as an unplanned admission followed by unscheduled surgery, while elective surgery referred to cases with an outpatient orthopaedic consultation and scheduled procedure. Primary outcomes were overall survival (OS) from the time of surgery, hospital length of stay (LOS), and 30-day readmission. RESULTS: Following propensity matching, 296 patients were included with 148 in each group. OS was significantly shorter in the emergent group (5.0 months 95%CI: 3.0-6.0 vs. 16.9 months 95%CI: 11.1-21.2) [p < 0.001]. LOS was significantly longer in the emergent group (13 days, 95%CI: 6-28 vs. 6 days, 95%CI: 3-10 days) [p < 0.001]. There was a significantly greater rate of readmission in the emergent group (12.2% 95%CI: 10.3-17.6 vs. 6.1% 95%CI: 3.5-10.2) [p = 0.004]. CONCLUSION: Elective surgery for MBD was associated with significantly superior clinical outcomes. Interventions that reduce the need for emergent surgery could markedly improve outcomes in this population.
BACKGROUND: In patients with pancreatic adenocarcinoma, for whom complex pre- and postoperative therapy is necessary, the effects of social support by means of marital status have not been well studied. We therefore soug...BACKGROUND: In patients with pancreatic adenocarcinoma, for whom complex pre- and postoperative therapy is necessary, the effects of social support by means of marital status have not been well studied. We therefore sought to assess the relationship of marital status with treatment attainment in patients with pancreatic adenocarcinoma. METHODS: This retrospective national cohort analysis used the SEER database and included adult patients with stage I-III pancreatic adenocarcinoma from 2018 to 2022 (n = 24 540). Rates of treatment (surgery, chemotherapy, radiation), time to treatment, and treatment delay (> 6 weeks from diagnosis) were compared between married, divorced, single, and widowed patients. RESULTS: Of the eligible 24 540 patients, 14 280 (58.2%) were married, 2731 (9.7%) were divorced, 3665 (14.9%) were single, and 3864 (15.7%) were widowed. Multivariable analysis demonstrated decreased likelihood of undergoing surgery for divorced (aOR: 0.61, p < 0.001), single (aOR: 0.60, p < 0.001), and widowed (aOR: 0.37, p < 0.001) patients versus married patients. Likelihood of treatment delay was higher for divorced (aOR: 1.36, p < 0.001), single (aOR: 1.43, p < 0.001), and widowed (aOR: 1.46, p < 0.001) patients versus married patients as well. CONCLUSIONS: Married patients with pancreatic adenocarcinoma had higher rates of surgery and reduced likelihood of treatment delay compared to divorced, single, and widowed patients.
Isolated limb perfusion (ILP) has long been a cornerstone treatment for unresectable extremity malignancies, offering high local control while sparing the limb. Traditional hyperthermic ILP (HILP), though effective, requ...Isolated limb perfusion (ILP) has long been a cornerstone treatment for unresectable extremity malignancies, offering high local control while sparing the limb. Traditional hyperthermic ILP (HILP), though effective, requires open vascular access and carries significant morbidity. In contrast, isolated limb infusion (ILI) employs a percutaneous approach, but it compromises perfusion quality and treatment duration. This paper describes a hybrid technique that integrates the minimally invasive percutaneous access of ILI with the high-flow, oxygenated, hyperthermic circuit characteristic of HILP. Using advanced endovascular access, extracorporeal oxygenation, and rigorous real-time leakage monitoring, this method replicates the physiological parameters of open HILP while eliminating the need for surgical incisions. The technique expands access to high-efficacy regional chemotherapy for patients previously deemed unfit for open procedures. It represents a significant advancement in limb-sparing therapy, balancing oncologic efficacy with patient safety and procedural simplicity. This paper provides a step-by-step technical guide to its implementation.
BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significant morbidity. Enhanced Recovery After Surgery (ERAS) protocols may improve perioperative outcomes...BACKGROUND: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with significant morbidity. Enhanced Recovery After Surgery (ERAS) protocols may improve perioperative outcomes, but data from low- and middle-income countries (LMICs) remain limited. METHODS: We conducted an ambispective study comparing patients undergoing CRS-HIPEC before (January 2015-June 2022; n = 294) and after (July 2022-June 2024; n = 70) ERAS implementation at a high-volume tertiary cancer centre. ERAS compliance and perioperative outcomes, including length of stay (LOS), major morbidity (Clavien-Dindo III-IV), mortality, readmission, and reoperation, were analysed. RESULTS: Overall, ERAS compliance was 77.1%. Compliance was highest for preoperative and intraoperative components, while postoperative elements showed comparatively lower adherence. Median postoperative LOS decreased significantly from 8 to 5 days (p = 0.02). Major morbidity declined from 20.1% to 12.9%, although this was not statistically significant. Ninety-day mortality (4.6% vs 4.3%), readmission (15% vs 12.9%), and reoperation rates (13% vs 10%) were comparable between groups. CONCLUSION: Implementation of an ERAS pathway for CRS-HIPEC in a high-volume LMIC centre is feasible and safe, resulting in shorter hospital stay without increasing morbidity or mortality.
BACKGROUND: Patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) have a poor prognosis. Surgical resection provides the highest chance of improved survival. This study investigates the role of total pancreatec...BACKGROUND: Patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) have a poor prognosis. Surgical resection provides the highest chance of improved survival. This study investigates the role of total pancreatectomy (TP) in the surgical management of PDAC based on clinicopathologic characteristics and the effect these factors have on patients' outcomes. METHODS: Data from the National Cancer Database for patients undergoing TP or pancreaticoduodenectomy (PD) was analyzed. Statistical tests included Chi-square test, logistic regression, least squared means, and Cox proportional hazard model to determine frequency and percentage, odds ratios, and hazard ratio, respectively. RESULTS: Of patients receiving PDAC resection, more TP patients were uninsured. Tumors in the pancreatic body or an overlapping locations increase the odds of receiving TP. Most statistically significant differences in clinicopathologic characteristics between the groups were not clinically meaningful. Despite a slight increase in short-term mortality for stage 2 patients receiving a TP, there was no clinically meaningful difference in overall survival. CONCLUSION: TP conferred a minimally worsened short-term survival for stage 2 PDAC, but oncologic outcomes and OS were similar for TP and PD. Therefore, surgical approach should be guided by individual patient characteristics and comorbidities, as long-term oncologic outcomes between the two procedures are comparable.
BACKGROUND AND OBJECTIVES: ARX and PDX1 transcription factors have been considered indicators of the cell of origin for pancreatic neuroendocrine tumors (PanNETs). Some PanNETs show dense fibrosis (sclerosing morphology)...BACKGROUND AND OBJECTIVES: ARX and PDX1 transcription factors have been considered indicators of the cell of origin for pancreatic neuroendocrine tumors (PanNETs). Some PanNETs show dense fibrosis (sclerosing morphology) and an association with serotonin expression. This study aimed to explore ARX and PDX1 expression in these tumors. METHODS: Pathology archives were searched from 2005 to 2019 for PanNETs with dense stromal fibrosis. Immunohistochemical stains for ARX, PDX1, and serotonin were performed and reviewed with pertinent clinical findings. RESULTS: Fifty-one PanNETs were evaluated. Serotonin expression was identified in 19 (37%) tumors. The mean tumor size was smaller in the serotonin-expressing group compared to the non-expressing group (1.7 ± 1.1 vs. 2.5 ± 1.2 cm, p = 0.03). Serotonin-expressing tumors demonstrated a β-cell phenotype with absence of ARX expression in the majority of tumors (n = 16; 84.2%), while the non-expressing tumors demonstrated an α-cell phenotype with ARX expression (n = 24, 75%, p < 0.01). Synchronous/metachronous liver metastasis was more frequent in the serotonin non-expressing tumors (p = 0.020). Serotonin expression was associated with a better disease-free survival. CONCLUSIONS: Serotonin-expressing PanNETs more commonly showed a β-cell phenotype, while non-expressing tumors favored an α-cell phenotype with more frequent liver metastasis. The expression of serotonin suggests more indolent behavior in this variant of PanNETs. SYNOPSIS: This study explores ARX, PDX1, and serotonin expression in pancreatic neuroendocrine tumors with sclerosing morphology. Most neuroendocrine tumors with this morphologic pattern displayed either an α-cell (ARX predominant expression) or β-cell (PDX1 predominant expression) phenotype. Serotonin expression was associated with a β-cell phenotype and more indolent behavior.
Colorectal cancer is the third most common cancer worldwide, and the proportion of individuals diagnosed under the age of 50 years, referred to as early-onset colorectal cancer (EOCRC), is increasing. The aim of this stu...Colorectal cancer is the third most common cancer worldwide, and the proportion of individuals diagnosed under the age of 50 years, referred to as early-onset colorectal cancer (EOCRC), is increasing. The aim of this study was to evaluate how the demographic and clinical features of EOCR in northern Sweden and Finland have changed over time. All patient data were extracted from local hospital surgical department databases between 1995 and 2022. Two CRC cohorts, Study Cohort I (1995-2005) 1237 patients and Study Cohort II (2006-2022) 4526 patients, were compared for age, sex, disease stage, tumour grade, tumour location, and mismatch repair status. EOCRC patients comprised 7% of all CRCs in Study Cohort I and 4% in Study Cohort II. The mean ages were 42 and 43 years respectively, and 55% of patients were female. The vast part of EOCRC tumours were left-sided stage III-IV cancers. Most tumours (n = 204, 73%) were low grade, and 10% showed mismatch repair deficiency. No significant differences in demographic or tumour characteristics were seen over time. EOCRC in northern Sweden and Finland is characterised by advanced-stage, low tumour grade, a slight female predominance, and stable clinical and pathological features. These findings partly contrast with reports on EOCRC from other high-income countries, highlighting the need for further research on advanced molecular characteristics and potential gender differences in incidence and survival of this population.
BACKGROUND AND OBJECTIVES: This study aimed to evaluate the ability of perioperative inflammatory markers to discriminate postoperative complications within 6 months in patients with ovarian cancer-related peritoneal met...BACKGROUND AND OBJECTIVES: This study aimed to evaluate the ability of perioperative inflammatory markers to discriminate postoperative complications within 6 months in patients with ovarian cancer-related peritoneal metastasis undergoing cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). MATERIALS AND METHODS: This retrospective cohort study included patients with ovarian cancer-related peritoneal metastasis who underwent CRS and HIPEC between January 2011 and August 2022. Data were obtained from the Hospital Information Management System, patient medical records, and anesthesia charts. Systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) were assessed preoperatively (within 7 days before surgery) and on postoperative days 1, 3, and 5. Postoperative complications occurring within 6 months were graded according to the Clavien-Dindo classification; major complications were defined as Clavien-Dindo grade ≥III. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory performance of inflammatory markers. RESULTS: In the preoperative period, AUCs were 0.655 (95% CI: 0.568-0.742) for NLR, 0.655 (95% CI: 0.568-0.742) for PLR, and 0.689 (95% CI: 0.607-0.772) for SII. On POD3, AUCs were 0.638 (0.551-0.726), 0.619 (0.531-0.707), and 0.673 (0.589-0.758), respectively. On POD5, AUCs were 0.724 (0.645-0.803), 0.695 (0.612-0.779), and 0.740 (0.663-0.818), respectively. CONCLUSIONS: Perioperative NLR, PLR, and SII showed measurable discrimination for 6-month postoperative complications, with numerically higher AUCs on POD5.
BACKGROUND: There is debate regarding the optimal management of small-bowel neuroendocrine tumours (SBNETs), particularly concerning upfront resection in various clinical presentations. While symptom phenotypes are known...BACKGROUND: There is debate regarding the optimal management of small-bowel neuroendocrine tumours (SBNETs), particularly concerning upfront resection in various clinical presentations. While symptom phenotypes are known to influence survival, their impact on technical surgical quality, especially in the emergency setting, remains poorly defined. This study evaluates whether symptom phenotype compromises the delivery of guideline-concordant surgical care. METHODS: A retrospective analysis of 108 consecutive SBNET resections (2000-2023) at a specialized tertiary centre was performed. Patients were stratified into four phenotypes: obstructive/perforation (n = 54), carcinoid syndrome (22), asymptomatic/incidental (22), and other symptoms (9). Operative metrics, including lymph-node harvest (LNY) and margin status (R0/R1), were compared alongside overall survival (OS). RESULTS: Symptom phenotype was a predictor of operative urgency and approach. Obstructive cases required emergency surgery in 50% of instances compared to ≤ 11% in all other groups (p < 0.001). Synchronous liver metastases were most prevalent in the carcinoid syndrome phenotype (50%) and lowest in the asymptomatic group (5%) (p = 0.002). Despite these disparities in presentation and urgency, technical quality markers were uniform across all groups: median LNY ranged from 10 to 13 (p = 0.426), R1/R2 margin rates were statistically similar (p = 0.290), and median length of stay was 8 days for all cohorts (p = 0.311). Multivariable analysis identified the asymptomatic phenotype as independently protective for OS (HR 0.42, p = 0.032), while liver metastasis was the strongest adverse prognostic factor (HR 3.25, p < 0.001). CONCLUSIONS: Symptom phenotype dictates operative urgency and reflects disease burden but does not compromise the technical standards of surgery in a specialized unit. These findings suggest that high-quality, guideline-concordant lymphadenectomy is achievable even in emergency obstructive presentations, and correspondingly, access to specialized surgical oncology expertise may be sought even in obstructed patients to ensure technical quality is maintained.
BACKGROUND AND OBJECTIVES: Hemorrhage after oncologic breast surgery occurs in up to 11% of cases, remaining the leading cause of reoperation. Although antifibrinolytics are widely used in other surgical settings, their...BACKGROUND AND OBJECTIVES: Hemorrhage after oncologic breast surgery occurs in up to 11% of cases, remaining the leading cause of reoperation. Although antifibrinolytics are widely used in other surgical settings, their role in oncologic breast surgery is not well established. This study evaluated the efficacy and safety of aminocaproic acid (ACAc) in reducing postoperative hematoma following oncological mastectomies. METHODS: A prospective randomized study was conducted between July 2020 and May 2022, including women ≥ 18 years old undergoing mastectomy. Patients were randomized into three groups: (A) topical application of 5 g of ACAc; (B) intravenous 2.5 g administered 30 min before incision; and (C) no treatment (control). Statistical tests included ANOVA, Chi-square, and multivariable regression. RESULTS: A total of 166 patients were enrolled. Postoperative hematoma occurred in 3.6% of patients in group A, 1.8% patients in group B, and 12.7% in the control. Multivariable logistic regression demonstrated a protective effect of intravenous ACAc compared with control (p = 0.021). No differences in reoperation rates were observed. No thromboembolic events nor hepatic or renal toxicity occurred. Hypertension was identified as an independent risk factor for postoperative hematoma. CONCLUSIONS: Intravenous ACAc reduces postoperative hematoma in oncologic mastectomy and may represent a low-cost, effective adjunct to bleeding prevention in this setting.
We performed a scoping review on the quality of life (QoL) of patients with malignant bowel obstruction who underwent palliative surgery using PubMed, EBSCO, and Cochrane databases. In total, 20 articles were included (1...We performed a scoping review on the quality of life (QoL) of patients with malignant bowel obstruction who underwent palliative surgery using PubMed, EBSCO, and Cochrane databases. In total, 20 articles were included (1467 patients). Oral diet tolerance, stoma creation, and the ability to be discharged from the hospital were the main QoL outcomes reported. Most patients seem to benefit from an improved QoL. However, the QoL outcomes reported were surrogate and not patient-reported. Further prospective studies using validated QoL instruments are required.
INTRODUCTION: With rapid expansion of artificial intelligence (AI) in clinical documentation, responsible implementation of this tool is imperative in preserving the patient-physician relationship. Orthopaedic oncologist...INTRODUCTION: With rapid expansion of artificial intelligence (AI) in clinical documentation, responsible implementation of this tool is imperative in preserving the patient-physician relationship. Orthopaedic oncologists were surveyed to assess their utilization of, and attitudes towards, ambient listening software. METHODS: An anonymous, voluntary, IRB-exempt survey (Appendix) was reviewed and distributed to members of the MSTS via the society's email listserv and distributed in paper and electronic formats to attendees at the AAOS Oncology Subspeciality day from March 14 to May 22, 2025. RESULTS: Sixty-three orthopaedic oncologists responded to the survey. Most (93%) practiced in an academic setting. Twenty-seven percent reported using AI with a majority using Dax Copilot. Half of AI users noted a positive impact on clinical encounters, and one respondent reported a negative impact. Most AI users (86%) reported improved efficiency and accuracy in documentation and 40% reported saving 1-2 h per clinic day. Of non-users, 71% were considering implementation. CONCLUSION: Although most orthopaedic oncologists are not using AI, the majority are considering implementation. AI users reported improvements in their documentation efficiency and accuracy. Further research is needed to understand the risks and benefits of this clinical tool from both providers' and patients' perspectives to guide responsible, widespread implementation.
Bekki T, Shimomura M, Yano T
… +20 more, Imaoka K, Miguchi M, Sawada H, Hara T, Ono K, Kobayashi H, Sumi Y, Sada H, Sumitani D, Mukai S, Takakura Y, Yamaguchi M, Shiozaki S, Fujimori M, Taguchi K, Okuda H, Adachi T, Ishikawa S, Ohdan H, Hiroshima Surgical study group of Clinical Oncology (HiSCO)
BACKGROUND AND OBJECTIVES: Although multiple studies have reported the anti-tumor effects of aspirin on colorectal cancer, its benefit in patients with colorectal cancer following curative resection remains controversial...BACKGROUND AND OBJECTIVES: Although multiple studies have reported the anti-tumor effects of aspirin on colorectal cancer, its benefit in patients with colorectal cancer following curative resection remains controversial. This study aimed to evaluate the effect of aspirin administration in patients with stage I-III colorectal cancer following curative resection. METHODS: This multi-institutional retrospective study included 2,863 patients with stage I-III colorectal cancer who underwent curative resection between January 2017 and December 2019. Patients were classified into two groups according to aspirin use. Clinical characteristics and oncological outcomes were analyzed. RESULTS: The aspirin group was older, and fewer patients had advanced pathological tumor stages or received postoperative adjuvant chemotherapy than non-aspirin group. Aspirin use tended to be associated with improved postoperative prognosis in patients with stage I-III colorectal cancer (overall survival: 91.1% vs. 80.9%, hazard ratio = 0.646, 95% confidence interval = 0.32-1.30; recurrence-free survival: 82.6% vs. 73.7%, hazard ratio = 0.730, 95% confidence interval = 0.44-1.20). After propensity score matching to minimize bias between groups, aspirin use was associated with improved postoperative prognosis (overall survival: 91.0% vs. 69.8%, hazard ratio = 0.306, 95% confidence interval = 0.14-0.68; recurrence-free survival: 82.4% vs. 56.6%, hazard ratio = 0.350, 95% confidence interval = 0.19-0.62). Aspirin use significantly improved recurrence-free survival in patients with advanced cancer who were recommended to receive postoperative adjuvant chemotherapy. CONCLUSIONS: This study suggests that aspirin use is associated with improved postoperative prognosis in patients with stage I-III colorectal cancer after curative resection. Aspirin may be beneficial for advanced-stage patients, for whom postoperative adjuvant chemotherapy is recommended.
BACKGROUND: The optimal surgical extent for papillary thyroid carcinoma (PTC) with extrathyroidal extension (ETE) suspected on ultrasound or intraoperative exploration remains debated. This study evaluated the diagnostic...BACKGROUND: The optimal surgical extent for papillary thyroid carcinoma (PTC) with extrathyroidal extension (ETE) suspected on ultrasound or intraoperative exploration remains debated. This study evaluated the diagnostic accuracy of clinical ETE (cETE) assessment and compared oncologic outcomes after lobectomy between cETE-positive and cETE-negative patients. METHODS: This single-center retrospective study enrolled 213 patients with PTC who underwent lobectomy. cETE was defined as tumor extension beyond the thyroid capsule on preoperative ultrasound or intraoperative exploration. Pathologically confirmed ETE served as the gold standard for determining the sensitivity, specificity, and accuracy of both ultrasound and intraoperative ETE assessments. Recurrence-free survival was compared between groups by different ETE features. RESULTS: Preoperative/intraoperative ETE assessments exhibited limited sensitivity (12.3% and 33.6%), limited accuracy (49.3% and 55.9%), and high specificity (98.9% and 85.7%). With a mean follow-up duration of 63.5 ± 11.7 months, the recurrence rates were recorded at 1.6% (1/61) in Group cETE+ in comparison to 2.0% (3/152) in Group cETE- (p = 0.871). CONCLUSION: Clinical ETE assessment has limited accuracy but high specificity. Lobectomy offers comparable oncologic outcomes regardless of cETE status, supporting its feasibility in selected PTC patients without mandating total thyroidectomy.
BACKGROUND AND OBJECTIVES: Postoperative complications after cytoreductive surgery in ovarian cancer patients are associated with impaired survival. Here, we investigated the association between postoperative weight gain...BACKGROUND AND OBJECTIVES: Postoperative complications after cytoreductive surgery in ovarian cancer patients are associated with impaired survival. Here, we investigated the association between postoperative weight gain due to fluid retention and the development of complications and anastomotic leakage (AL). METHODS: N = 278 patients underwent cytoreductive surgery at the university hospital of Bonn in between 01/2013 and 03/2022. Postoperative weight gain on day 2 and day 5 was assessed and correlated to the occurrence of complications according to the MSKCC secondary event score and ALs. RESULTS: There were 227 surgeries (81.7%) for primary and 51 surgeries (18.3%) for recurrent ovarian cancer. Severe complications were significantly more frequent in patients with postoperative weight gain exceeding 4 kg on postoperative day 2 (26/90 vs. 13/76; p = 0.03) and exceeding 3 kg on postoperative day 5 (34/89 vs 30/134; p = 0.02). A weight gain of more than 6 kg on postoperative day 2 was significantly associated with the occurrence of AL (p = 0.021). Less weight gain on d2 and d5 was associated with a significant earlier first defecation (day-2 p-value: 0.01; day-5 p-value: 0.01). In multiple binary logistic regression analysis, the postoperative weight gain on day 2 (p = 0.0019) and the performance of an anastomosis (p = 0.0095) remained the only significant risk factors regarding severe complications. CONCLUSIONS: Postoperative weight gain, as a surrogate for fluid retention, and the creation of an anastomosis were associated with an increased risk of severe postoperative complications.