Afolaranmi O, Diehl TM, Salim Virani S
… +9 more, Yang Q, Christensen L, Okwunze K, Khan AH, Akhlaq Mughal N, Schroeder D, Pourdashti S, Khan S, Zafar SN
BACKGROUND AND OBJECTIVES: Surgery is the mainstay of treatment for localized colorectal cancer (CRC); however, little is known about survival outcomes following CRC surgery in low- and middle-income countries (LMICs). H...BACKGROUND AND OBJECTIVES: Surgery is the mainstay of treatment for localized colorectal cancer (CRC); however, little is known about survival outcomes following CRC surgery in low- and middle-income countries (LMICs). Here, we examine the available data on long-term outcomes following CRC resections in LMICs. METHODS: A systematic review and meta-analysis were conducted on primary research studies reporting survival data after CRC resection with curative intent in LMICs. Disease-free survival (DFS) and overall survival (OS) data were extracted, and random effects modelling was used to estimate the pooled survival rates. RESULTS: One hundred and fifty-four studies representing 20,589 CRC patients were analyzed. Notably, only 27 (20%) of the 137 LMICs were represented in the literature. The pooled 5-year OS estimate was 88% (95% CI: 77-95), 76% (69-81), and 57% (49-64) for Stages I, II, and III, respectively. 5-year DFS estimates were 82% (71-90), 76% (67-84), and 59% (51-65) for stages I, II, and III, respectively. Combined OS and DFS estimates for all three stages were 76% and 69%, respectively. Survival rates varied considerably across the included studies and between income groups. CONCLUSIONS: With the rising incidence of CRC globally, our work highlights the dearth of data on long-term outcomes following CRC operations in most LMICs and emphasizes the urgent need for research capacity building.
Kamio S, Ogura K, Sato K
… +12 more, Fujiwara T, Ozaki T, Nakayama R, Koike H, Nishida Y, Endo M, Imura Y, Tsuda Y, Yonemoto T, Morii T, Arakawa A, Kawai A
BACKGROUND: Postoperative infections remain a critical concern in the management of osteosarcoma, particularly after limb salvage surgery. While infections are often perceived as detrimental, emerging evidence suggests t...BACKGROUND: Postoperative infections remain a critical concern in the management of osteosarcoma, particularly after limb salvage surgery. While infections are often perceived as detrimental, emerging evidence suggests that under certain circumstances, localized infections may improve survival outcomes. This study evaluated the relationship between postoperative infection and survival in Japanese patients with osteosarcoma. METHODS: We retrospectively reviewed the medical records of patients diagnosed with osteosarcoma who underwent surgery between April 1990 and October 2021 at nine institutions. Patients with trunk or pelvic lesions, distant metastases at initial diagnosis, age over 60, or infections occurring more than 1 year postoperatively were excluded. RESULTS: Among 466 eligible patients, 34 (7.3%) developed postoperative infections. The 5-year overall survival rate was 84.4% in infected patients and 82.9% in non-infected patients, with no significant difference (p = 0.778). The proximal tibia was more susceptible to infection than other sites, with an odds ratio of 2.621 (p = 0.008), and larger tumors were more likely to develop infection (odds ratio, 1.093; p = 0.009). CONCLUSIONS: Postoperative infection did not improve survival in patients with osteosarcoma. Tumors in the proximal tibia and those with larger maximum diameters were more susceptible to infection.
Early-stage ALK-positive non-small cell lung cancer (NSCLC) represents a distinct molecular subset requiring individualized, multidisciplinary care. Advances in molecular testing and targeted therapies have transformed t...Early-stage ALK-positive non-small cell lung cancer (NSCLC) represents a distinct molecular subset requiring individualized, multidisciplinary care. Advances in molecular testing and targeted therapies have transformed treatment paradigms, as demonstrated in trials like ALINA and ADAURA. Emerging studies, including NAUTIKA1 and NeoADAURA, explore the potential of targeted therapies in neoadjuvant settings, as well. Proper surgical staging, timely biomarker testing, multidisciplinary collaboration, and clinical trial participation are essential to refine treatment strategies and improve survival for patients with ALK-positive NSCLC.
INTRODUCTION: Pancreaticoduodenectomy (PD) carries substantial risks in elderly patients, emphasizing the need for optimized perioperative care. Comprehensive geriatric assessments (CGAs) - evaluating medical, functional...INTRODUCTION: Pancreaticoduodenectomy (PD) carries substantial risks in elderly patients, emphasizing the need for optimized perioperative care. Comprehensive geriatric assessments (CGAs) - evaluating medical, functional, and psychosocial domains - may mitigate these risks. This study investigates the impact of a preoperative evaluation by a dedicated geriatric surgery service on outcomes in elderly patients undergoing PD. METHODS AND MATERIALS: This was a retrospective cohort study of elderly (age over 75 years) patients that underwent PD (GA + 75, n = 23) following preoperative workup by a specialized geriatric surgery service (GSS). Control groups included elderly patients without geriatric assessment (non-GA + 75, n = 73) and non-elderly patients ( < 75 years, n = 275). Short- and long-term outcomes were compared across the groups. RESULTS: While baseline demographics were similar between GA + 75 and non-GA + 75 groups, comorbidity profiles differed. Higher rates of chronic obstructive pulmonary disease (21.7% vs. 2.7%, p = 0.002) and asthma (26% vs. 1.4%, p < 0.001) were observed in the GA + 75 group. Despite this, GA + 75 patients had significantly lower rates of postoperative pneumonia (4.3% vs. 18.1%, p < 0.001), readmission (26.1% vs. 41.6%, p < 0.001; also lower than the non-elderly cohort), and delirium (4.3% vs. 36.1%, p < 0.001). There were no significant differences in overall major complications or 30-/90-day survival rates as well as long-term outcomes between the groups. CONCLUSIONS: Preoperative evaluation by a dedicated GSS was associated with improved postoperative outcomes in elderly patients undergoing PD. These findings support the integration of CGAs into perioperative planning to enhance recovery and reduce complications in older adults.
D.L. Vitello, C.D. Logan, N.N. Zaza, K.R. Bates, R. Jacobs, J. Feinglass, R.P. Merkow, and D.J. Bentrem, "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection," Journal of Sur...D.L. Vitello, C.D. Logan, N.N. Zaza, K.R. Bates, R. Jacobs, J. Feinglass, R.P. Merkow, and D.J. Bentrem, "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection," Journal of Surgical Oncology 130, no. 8 (2024): 1532-1538. The above article, published online on 10 October 2024 in Wiley Online Library (wileyonlinelibrary.com), has been retracted by agreement between the authors; the journal Editor-in-Chief, Laleh Melstrom; and Wiley Periodicals LLC. The retraction has been agreed after identifying this article as a duplicate of a previously published version[1]. The authors unintentionally resubmitted the manuscript, and this duplication was not detected prior to publication. In accordance with COPE and Wiley policies, duplicate publication is prohibited; therefore, the redundant article is being retracted. [1] D.L. Vitello, C.D. Logan, N.N. Zaza, K.R. Bates, R. Jacobs, J. Feinglass, R.P. Merkow, and D.J. Bentrem, "Comparison of a Risk Calculator With Frailty Indices in Patients Undergoing Lung Cancer Resection," Journal of Surgical Oncology 130, no. 5 (2024): 1111-1118, https://doi.org/10.1002/jso.27815.
Pepin A, Almeida ND, Fung-Kee-Fung S
… +3 more, Kassick M, Taunk NK, Freedman GM
J Surg Oncol
· 2026 May · PMID 41797304
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The use of breast conservation surgery for early-stage breast cancer is common, and adjuvant radiotherapy is often recommended to reduce the risk of ipsilateral breast tumor recurrence. Historical trials have used sequen...The use of breast conservation surgery for early-stage breast cancer is common, and adjuvant radiotherapy is often recommended to reduce the risk of ipsilateral breast tumor recurrence. Historical trials have used sequential boost techniques with favorable outcomes with reduction in local recurrence and acceptable cosmetic outcomes. In recent years, there has been renewed interest in incorporating a concurrent tumor bed boost to reduce the number of radiation treatments delivered. This focused review summarizes the literature surrounding the indications, outcomes, and treatment planning considerations for radiation tumor bed boost for early-stage breast cancer patients.
BACKGROUND: Endoscopic resection (ER) is increasingly utilized for early gastric cancer (EGC) due to its minimally invasive profile and comparable survival to gastrectomy (GR). However, concerns regarding oncologic effic...BACKGROUND: Endoscopic resection (ER) is increasingly utilized for early gastric cancer (EGC) due to its minimally invasive profile and comparable survival to gastrectomy (GR). However, concerns regarding oncologic efficacy and institutional volume impact persist. This study evaluates how ER volume quartiles impact outcomes and guideline adherence in EGC management. METHODS: A retrospective analysis of the NCDB from 2010 to 2021 for patients with cT1aN0M0 gastric adenocarcinoma was performed comparing ER and GR. Primary outcomes were oncologic outcomes, rates of guideline adherence, and survival stratified by institutional ER volume tertiles (high, mid, low). Multivariable logistic, linear regression, and Cox proportional hazards models were used. RESULTS: A total of 1461 patients were analyzed; 937 (61.4%) undergoing ER and 524 (35.7%) GR. 57.5% of ER occurred in the latter half of the study time period, and increasing proportional ER utilization in EGC was observed over time. When stratified by ER volume tertiles, margin positivity (14.6% high volume vs. 13.7% mid vs. 15.5% low, p = 0.85), LVI rates (6.3% high vs. 9.5% mid vs. 9.7% low, p = 0.32), guideline discordant care (22.6% high vs. 22.3% mid vs. 24.3% low, p = 0.82), and survival (vs. low volume: high HR 1.04, p = 0.87; mid HR 1.27, p = 0.39) did not differ by institutional ER volume. High-volume centers preferentially used ER (OR 1.76, p < 0.01) compared to low and mid-volume centers. Guideline-discordant ER correlated with earlier years (OR 0.69, p = 0.03) but not institutional volume (vs. low volume: high OR 0.94, p = 0.76; mid OR 0.90, p = 0.61). CONCLUSION: ER for EGC is rapidly expanding across US institutions at all volume levels. ER achieves comparable oncological outcomes and survival independent of ER volume when guideline-concordant criteria are met, suggesting centralization may be unnecessary for EGC. The guideline discordant care rate of ~24% across all institutions highlights the need for adherence to ER criteria for EGC.
BACKGROUND: Patients with early-stage cutaneous melanoma (CM) have low individual risk but account for most distant recurrences. The utility of gene expression profiling (GEP) in CM risk stratification and clinical manag...BACKGROUND: Patients with early-stage cutaneous melanoma (CM) have low individual risk but account for most distant recurrences. The utility of gene expression profiling (GEP) in CM risk stratification and clinical management remains unclear. METHODS: From 2015 to 2022, CM patients at a single center were universally referred for DecisionDx 31-GEP. Patients with prior recurrence or not undergoing excision were excluded. The Kaplan-Meier method and Cox proportional hazards models were used to evaluate primary outcomes of recurrence-free survival (RFS), distant metastasis-free survival (DMFS), and melanoma-specific survival (MSS). Secondary outcomes were sentinel lymph node biopsy (SLNB) positivity and recurrence subtype events. RESULTS: 689 patients were analyzed: 63% GEP Class 1A, 16.1% Class 1B/2A, 16.1% Class 2B, and 4.8% unclassified. After staging, 86.6% were stage I/II and 13.4% stage III. Median follow-up was 4.85 years. On multivariable analysis, GEP remained significantly predictive of RFS (Class 1B/2A HR = 4.022; Class 2B HR = 3.052), DMFS (Class 1B/2A HR = 4.403; Class 2B HR = 3.729), and MSS (Class 1B/2A HR = 6.656; Class 2B HR = 11.583) (p < 0.05 for all). Older Class 1A patients with indication for SLNB had lower SLNB positivity (2.8% ≥ 65 years, 0% ≥ 75 years). CONCLUSIONS: Our data show GEP remains a robust predictor of recurrence and MSS after adjusting for clinicopathologic factors overall but is not predictive for all outcomes in stage-stratified analyses, particularly Stage II disease. Stage IA patients should forgo GEP altogether testing due to its futility in this population. Older patients with low-risk GEP may be candidates for avoidance of SLNB given lower positivity rates. GEP Class 2B patients represent a relatively high-risk population regardless of SLNB status.
Bladder cancer, the most prevalent urinary system malignancy, is characterized by high recurrence rates and prolonged treatment. While therapeutic advances have substantially improved survival, they have also heightened...Bladder cancer, the most prevalent urinary system malignancy, is characterized by high recurrence rates and prolonged treatment. While therapeutic advances have substantially improved survival, they have also heightened the prominence of financial toxicity (FT)-a treatment-related economic burden that severely impairs the quality of life of patients and their families. This review synthesizes evidence on the prevalence, influencing factors, impact on health outcomes, and management strategies of FT in bladder cancer, offering insights for individualized clinical support and health policy refinement. Future research should broaden study populations, employ diverse methodologies, and develop healthcare system-specific interventions to establish a comprehensive FT management framework.
BACKGROUND AND OBJECTIVES: This study investigates the clinical characteristics, pathological features, immunohistochemical profiles, and prognostic factors of solitary fibrous tumors (SFTs) to provide insights into thei...BACKGROUND AND OBJECTIVES: This study investigates the clinical characteristics, pathological features, immunohistochemical profiles, and prognostic factors of solitary fibrous tumors (SFTs) to provide insights into their management and prognosis. METHODS: A retrospective analysis was conducted on 43 cases of SFTs diagnosed at a single center. Patient demographics, tumor characteristics, immunohistochemical (IHC) markers, and outcomes were collected. RESULTS: Among the 43 cases, the majority of tumors were infratentorial (81%), and 60% were classified as WHO Grade 1. IHC analyses revealed high expression rates of STAT6 (62.5%), CD34 (82.5%), and Ki-67 (100%). Ki-67 demonstrated the strongest correlation with tumor grade and risk scores (r = 0.62, p < 0.001; r = 0.68, p < 0.001), indicating its role as a significant prognostic marker. CD34 and STAT6 also showed moderate correlations with tumor aggressiveness. Metastatic presentations were noted in 57.5% of cases. The study highlights the heterogeneity of SFTs and the importance of IHC markers in risk stratification. CONCLUSION: The findings underscore the utility of IHC markers, particularly Ki-67, STAT6, and CD34, in assessing the aggressiveness and prognosis of SFTs. Future studies should focus on multicenter validations, integration of advanced molecular diagnostics, and long-term follow-up to refine risk models and therapeutic strategies.
Surgery remains curative for esophageal gastrointestinal stromal tumors (GISTs), while debates persist between minimally invasive enucleation and radical esophagectomy. Limited evidence from case reports and small cohort...Surgery remains curative for esophageal gastrointestinal stromal tumors (GISTs), while debates persist between minimally invasive enucleation and radical esophagectomy. Limited evidence from case reports and small cohorts necessitates a systematic evaluation to guide clinical decisions. This review showed that enucleation may be considered for small and low-mitotic-index esophageal GISTs with benign tendency. Despite higher R1 and tumor rupture rates, survival outcomes were comparable to esophagectomy. Enucleation, including endoscopic enucleation, was safe and effective in selected cases.
Klar M, Moubarak M, Harter P
… +17 more, Heitz F, Kommoss S, Grube M, Hartkopf AD, Roser E, Sehouli J, Braicu EI, Czogalla B, Burges A, Bossart M, Staebler A, Mayr D, Buderath P, Ihorst G, Hasanov MF, Link T, Hasenburg A
BACKGROUND: Malignant ovarian germ cell tumours (MOGCT) are rare tumours that disproportionally affect younger women. The Arbeitsgemeinschaft fuer Gynaekologische Onkologie (AGO) study group has established a clinico-pat...BACKGROUND: Malignant ovarian germ cell tumours (MOGCT) are rare tumours that disproportionally affect younger women. The Arbeitsgemeinschaft fuer Gynaekologische Onkologie (AGO) study group has established a clinico-pathological database (Current Ovarian geRm cell and SEx cord stromal Tumour Treatment strategies, CORSETT) to provide an overview of the current treatment strategies and survival of MOGCT patients. METHODS: Twenty German centres provided mixed retro- and prospective data of patients with tumour specimens treated between 2001 and 2014. A second opinion pathology board reviewed the tumour specimens. Descriptive analyses of the treatment strategies and fertility outcomes were conducted. Kaplan-Meier curves were plotted for disease-free and overall survival data. RESULTS: Seventy-seven MOGCT patients were included, 36 malignant dysgerminoma (MD), 21 malignant teratoma (MT) and 20 mixed MOGCT (MM) patients. Patients had a median age of 28 (MD), 38 (MT) and 33 (MM) years and fertility-sparing surgery (FSS) was offered in most (83% MD, 81% MT and 75% MM) patients. Final FIGO stage I disease was diagnosed in 78% (MD), 81% (MT) and 60% (MM) and adjuvant systemic treatment was given to 56% (MD), 53% (MT) and 70% (MM) patients. After a median observation time of 78.2 months, 5% (MD), 14% (MT) and 45% (MM) experienced disease recurrence. Overall survival was excellent in all groups (100% MD, 100% MT and 95% MM). DISCUSSION: In this descriptive analysis, FSS was the surgical method of choice for patients with MOGCT in AGO centres without negative impact on OS. MOGCTs appeared however as a heterogeneous group of tumours with particularly high recurrence rates for patients with MM.
BACKGROUND: Recent Danish literature examining stage III colorectal cancer patients identified microsatellite instability (MSI) as associated with an increased risk of positive surgical margins, suggesting positive margi...BACKGROUND: Recent Danish literature examining stage III colorectal cancer patients identified microsatellite instability (MSI) as associated with an increased risk of positive surgical margins, suggesting positive margins may reflect tumor biology rather than suboptimal technique. We sought to validate these observations using a US-based national registry. METHODS: Adults with pathologic stage I-III colon adenocarcinoma were identified in the National Cancer Database (2010-2020). RESULTS: Of 105 228 patients, 21% were stage I (24% MSI), 39% II (28% MSI), and 40% III (21% MSI). MSI status was independently associated with positive margins for stage III cancers (OR 1.10, 95% CI 1.00-1.20), but not stage I and II. Positive margins were associated with worse prognosis for stage II and III cancer (HR 1.26, 95% CI 1.17-1.36; HR 1.40, 95% CI 1.33-1.48; respectively), while MSI conferred lower risk of death for stage III cancer (HR 0.87, 95% CI 0.82-0.91), but not stage I (HR 1.02, 95% CI 0.93-1.12) or II (HR 0.96, 95% CI 0.91-1.01). CONCLUSIONS: This US cohort study confirmed prior European work suggesting MSI is associated with higher odds of positive margins in stage III colon cancer. Notwithstanding the limitations of a retrospective database, these findings suggest the need for quality improvement initiatives, including the evaluation of neoadjuvant treatments to mitigate this risk.
BACKGROUND AND OBJECTIVES: We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. METHODS: This single-center retrospec...BACKGROUND AND OBJECTIVES: We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. METHODS: This single-center retrospective cohort study included patients aged ≥ 75 years with pathological stage I-III disease after R0 resection who underwent surgery within September 2012-2022, stratified by CFS score. Univariate and multivariate analyses assessed risk factors for postoperative complications. Cox proportional hazards models identified prognostic factors for overall survival (OS) and disease-specific survival (DSS). RESULTS: Among 109 patients (median age: 78 [interquartile range, 76-82]; 65.1% male), the CFS 5-7 group (n = 17) had a higher stoma creation rate (70.6% vs. 43.5%; p = 0.063) than the CFS 1-4 group (n = 92), and none in this group underwent lateral pelvic lymph node dissection. No independent risk factors were identified for postoperative complications with Clavien-Dindo grade ≥ II. CFS 5-7 was independently associated with worse OS (hazard ratio [HR] = 10.073; p < 0.001) and DSS (HR = 9.135; p = 0.003), and 3-year OS (63.6% vs. 85.6%, p < 0.001) and DSS (74.3% vs. 90.7%, p = 0.035) were significantly poorer. CONCLUSIONS: CFS provides a simple and effective preoperative assessment tool for evaluating patient frailty that significantly influences long-term outcomes in patients undergoing minimally invasive rectal cancer surgery.
OBJECTIVE: Salvage laryngectomy is associated with significant reconstructive challenges related to pharyngocutaneous fistula (PCF) formation and need for secondary reconstruction. This retrospective study evaluates thes...OBJECTIVE: Salvage laryngectomy is associated with significant reconstructive challenges related to pharyngocutaneous fistula (PCF) formation and need for secondary reconstruction. This retrospective study evaluates these surgical outcomes by comparing free flap onlay technique with pedicled muscle and fascial flap onlay technique. METHODS: All patients underwent chemoradiation therapy with recommendations for salvage laryngectomy after being diagnosed with recurrent or persistent laryngeal malignant disease. Patients were excluded if the surgical defect required interposed flap tissue for pharyngeal closure. Subgroup analysis was performed to compare overall rates of fistula and need for secondary reconstructive surgery. RESULTS: A significant overall association (p = 0.014) between flap reconstruction type and presence of PCF was found. The odds of fistula formation was 55% lower in the pedicled pectoralis/latissimus muscle flap group and 70% lower for the free flap reconstruction group compared to the reference group that underwent only primary pharyngeal closure, without flap onlay (odds ratio = 0.3, p = 0.004). CONCLUSION: PCF rates and need for secondary reconstructive efforts are decreased when free tissue onlay is employed to reinforce the pharyngeal closure line compared to pedicled flaps.
OBJECTIVE: To evaluate apoptotic markers in tumor cells from hyperthermic intraperitoneal chemotherapy (HIPEC) effluent as a biomarker of treatment effectiveness. BACKGROUND: Cytoreductive surgery (CRS) combined with HIP...OBJECTIVE: To evaluate apoptotic markers in tumor cells from hyperthermic intraperitoneal chemotherapy (HIPEC) effluent as a biomarker of treatment effectiveness. BACKGROUND: Cytoreductive surgery (CRS) combined with HIPEC is used to treat peritoneal surface malignancies (PSM), yet no validated method exists to assess HIPEC efficacy in real time. We explored whether apoptosis in residual tumor cells present in post-HIPEC effluent correlates with oncologic outcomes. METHODS: Forty-four patients undergoing CRS-HIPEC were prospectively enrolled. CD45⁻ cells were stained for Annexin-PI by flow cytometry before and after HIPEC. The apoptotic response (Δapop) was defined as the increase in apoptosis post-HIPEC. Clinical and procedural variables were correlated with peritoneal disease-free survival (pDFS). RESULTS: Tumor histologies included colorectal (50%), appendiceal (18.2%), ovarian (15.9%), and gastric (11.4%) primaries. Complete cytoreduction was achieved in 81.8% of patients. Median Δapop = 8.5% (IQR: 0%-37%). Responders had significantly prolonged pDFS (median not reached vs. 16 months; p = 0.04). On multivariable analysis, apoptotic response remained a significant predictor of pDFS (HR = 0.22; 95% CI: 0.05-0.87; p = 0.03), independent of PCI and CCR. CONCLUSIONS: In this pilot study, apoptotic markers in HIPEC effluent are a histology-agnostic assay that correlates with recurrence risk. This biomarker may improve patient selection for adjuvant therapies.
Acker RC, Hwang J, Williams S
… +4 more, Sharpe J, Wachtel H, Karakousis GC, Kelz RR
J Surg Oncol
· 2026 Mar · PMID 41774551
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INTRODUCTION: Malignant obstructions are associated with morbidity, mortality, and impaired quality of life with limited population-based data on practice patterns. We characterized the association between prior cancer-r...INTRODUCTION: Malignant obstructions are associated with morbidity, mortality, and impaired quality of life with limited population-based data on practice patterns. We characterized the association between prior cancer-related hospitalizations and receipt of operative treatment for obstruction. METHODS: We performed a retrospective cohort study of patients hospitalized with malignant gastrointestinal obstructions from colorectal, gynecologic (GYN), and hepato-pancreatico-biliary (HPB) cancers in 12 states using the Healthcare Cost and Utilization Project State Inpatient Database, 2016-2020. The primary exposure was the number of cancer-related hospitalizations in the year prior to the first hospitalization for an obstruction. Risk-adjusted use of operative treatment during the index hospitalization, enrollment in hospice, length of stay, and inpatient mortality were examined using regression. RESULTS: Of 8665 patients, the median age was 67 years [Interquartile Range: 58,76]. There were 3789 patients with colorectal (43.7%), 2593 patients with GYN (29.9%), and 2337 patients (26.9%) with HPB cancers. The operative rate was 24.1%. Patients with prior hospitalizations were less likely to undergo operative treatment than those who were not previously hospitalized (operative rate difference: -7.8%, p < 0.001). Operative treatment was associated with longer median length of stay ( + 8.6 days, p < 0.001), lower rates of hospice enrollment (-3.0%, p = 0.002) and lower rates of inpatient mortality (operative rate difference -2.3%, p < 0.001). The time between readmissions also decreased with each recurrent obstruction in colorectal and GYN cancers. CONCLUSION: A greater number of previous cancer-related hospitalizations was associated with lower rates of operative treatment during the first hospitalization for a malignant obstruction. These data provide insight into the treatment trends for patients with malignant obstructions and may be helpful when counseling patients about the natural course of their disease.
BACKGROUND AND OBJECTIVES: The survival difference between recurrent pancreatic cancer (Rec-PC) and primary metastatic PC (PM-PC) remains inadequately understood. METHODS: Eligible participants received combination chemo...BACKGROUND AND OBJECTIVES: The survival difference between recurrent pancreatic cancer (Rec-PC) and primary metastatic PC (PM-PC) remains inadequately understood. METHODS: Eligible participants received combination chemotherapy with either gemcitabine plus nab-paclitaxel (GnP) or FOLFIRINOX. Overall survival (OS) was compared between patients with Rec-PC and those with PM-PC. RESULTS: Data from 147 participants (84 male and 63 female) were retrospectively analyzed. The Rec-PC group demonstrated significantly longer OS (median: 12.7 months) than the PM-PC group (median: 8.4 months) (p = 0.03). On multivariate analysis, Rec-PC (hazard ratio [HR]: 0.51; 95% confidence interval [CI]: 0.31-0.84; p < 0.01), presence of peritoneal dissemination (HR: 2.29; 95% CI: 1.42-3.69; p < 0.01), receipt of second-line chemotherapy (HR: 0.34; 95% CI: 0.21-0.55; p < 0.01), receipt of any local therapy (HR: 0.42; 95% CI: 0.23-0.77; p < 0.01), and prognostic nutritional index < 40 (HR: 2.50; 95% CI: 1.55-4.04; p < 0.01) were identified as independent prognostic factors. CONCLUSIONS: Rec-PC was identified as a favorable prognostic factor after adjusting for established prognostic indicators (registration number: NCT06921252).