Baril JA, Bilimoria KY, Ceppa EP
… +6 more, House MG, Maatman TK, Roch AM, Yang AD, Schmidt CM, Ellis RJ
J Surg Oncol
· 2026 Feb · PMID 41362960
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BACKGROUND AND OBJECTIVES: Adjuvant chemotherapy (AC) is considered for patients with stage II small bowel adenocarcinoma (SBA) with an inadequate lymphadenectomy; however, the prognostic role of additional high-risk fea...BACKGROUND AND OBJECTIVES: Adjuvant chemotherapy (AC) is considered for patients with stage II small bowel adenocarcinoma (SBA) with an inadequate lymphadenectomy; however, the prognostic role of additional high-risk features (T4 primary, positive resection margin, poorly differentiated tumor, or lymphovascular invasion) is unknown. The objectives were to describe utilization of AC among patients with stage II SBA with inadequate lymphadenectomy, identify factors associated with receipt of AC, and examine the association between AC and survival stratified by presence of additional high-risk features. METHODS: Patients with stage II SBA were identified using the National Cancer Database from 2004 to 2021. Inadequate lymphadenectomy was defined < 5 lymph nodes duodenal tumors and < 8 lymph nodes other sites. RESULTS: Of 1765 patients with stage II SBA and an inadequate lymphadenectomy, 525 (29.8%) received AC. T4 primary, poor grade tumor, and positive resection margin were associated with receiving AC. Receipt of AC was associated with improved 5-year survival in patients with additional high-risk features (49.9% vs 31.4%; HR 0.62, 95%CI 0.48-0.79) but not in patients without additional high-risk features (67.1% vs. 53.2%; HR 0.83, 95%CI 0.55-1.24). CONCLUSIONS: Receipt of AC was associated with improved survival in patients with inadequate lymphadenectomy and any additional high-risk feature. Multiple variables may be considered in decisions regarding AC.
BACKGROUND AND OBJECTIVES: Postoperative pancreatic fistula (POPF) is a serious complication following Pancreatoduodenectomy (PD). Accurate prediction of clinically relevant POPF (CR-POPF) is essential to reduce morbidit...BACKGROUND AND OBJECTIVES: Postoperative pancreatic fistula (POPF) is a serious complication following Pancreatoduodenectomy (PD). Accurate prediction of clinically relevant POPF (CR-POPF) is essential to reduce morbidity. Identifying objective, easily measurable preoperative risk factors may improve patient outcomes. Therefore, we aimed to identify significant predictive risk factors for CR-POPF. METHODS: We retrospectively analyzed data from 143 patients who underwent PD. Preoperative computed tomography (CT) or magnetic resonance cholangiopancreatography (MRCP) was used to measure the main pancreatic duct (MPD) diameter, the distance from the peritoneum to the anterior surface of the pancreas (PTP), and the abdominal wall thickness (AWT). The PTP/AWT ratio was calculated as a surrogate marker for the visceral-to-subcutaneous fat ratio (V/S ratio). The liver-to-pancreas mean CT attenuation ratio (late/early phase; L/E ratio) was also assessed. Univariate and multivariable analyses were performed to identify risk factors for CR-POPF. RESULTS: CR-POPF occurred in 33 (23.1%) patients. Multivariable analysis identified V/S ratio ≥ 3.5 (OR: 3.55, p = 0.041), and L/E ratio < 1.2 (OR: 6.07, p = 0.004) as independent risk predictors of CR-POPF. CONCLUSIONS: Simple, objective parameters from preoperative CT or MRCP images may help predict CR-POPF. Accurate risk assessment and early intervention may reduce complications and improve postoperative outcomes.
PURPOSE: There is limited evidence regarding the optimal timing of urosymphyseal fistula (USF) repair. Our aim was to conduct a comparative analysis evaluating the postoperative complications and surgical outcomes among...PURPOSE: There is limited evidence regarding the optimal timing of urosymphyseal fistula (USF) repair. Our aim was to conduct a comparative analysis evaluating the postoperative complications and surgical outcomes among patients undergoing surgery for USF, comparing those treated in an early versus delayed fashion. METHODS: Fifty-eight patients with diagnosis of USF and who underwent fistula decompression, pubic bone resection, and urinary tract reconstruction were included. Patients who underwent USF repair within 100 days of diagnosis were classified as having early repair, while those treated after 100 days were considered to have delayed repair. RESULTS: Thirty-one underwent delayed USF repair (53.4%), while 27 underwent early repair (46.6%). Most patients were male (96.8%). The median age (72 years vs. 69 years, p = 0.13) and mean BMI (28.7 vs. 28.6, p = 0.97) were comparable between groups. The rate of overall 90-day complications following USF repair was comparable between groups (77.4% vs. 63%, p = 0.228). We did not find a difference between the rates early complications among groups. The rates of long-term recurrent pain (46.7% vs. 11.1%, p = 0.004), recurrent osteomyelitis (20% vs. 0%, p = 0.014), and fistula (23.3% vs. 3.7%, p = 0.033) were higher in the delayed USF repair group compared to the early USF repair group. The follow up time was similar between groups too (25.43-months vs. 32.8-months, p = 0.257). CONCLUSION: While early USF repair might not affect the incidence of early complications within 90 days post-surgery, it is associated with reduced rates of long-term recurrent pain, recurrent osteomyelitis, and fistula recurrence compared to delayed USF repair.
Poirier JL, Richardson SM, Knox AM
… +2 more, Daniel Wurtz L, Collier CD
J Surg Oncol
· 2026 Jan · PMID 41319220
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BACKGROUND: Resection of extremity soft tissue tumors is common and frequently performed by orthopedic, plastic, and general surgeons. It is unknown if tumor location, Preoperative workup, and Postoperative care varies b...BACKGROUND: Resection of extremity soft tissue tumors is common and frequently performed by orthopedic, plastic, and general surgeons. It is unknown if tumor location, Preoperative workup, and Postoperative care varies by specialty, which is the aim of this study. METHODS: A retrospective review was performed of 4,223 soft tissue tumors resected from the extremities and pelvis within a large single-state health system between 2009 and 2019. A more detailed cross-sectional review was performed on 450 tumors resected in 2016. Demographic and tumor characteristics, surgeon specialty (orthopedic, plastic, general), Preoperative workup (imaging, biopsy), and Postoperative management were collected and analyzed. RESULTS: General surgeons were more likely to resect tumors superficial to fascia (82.1%), compared to plastic and orthopedic surgeons (53.7% and 27.9%). Orthopedic surgeons were more likely to resect malignant tumors (28.2%) than plastic and general surgeons (14.0% and 4.5%). 16.3% of tumors resected by general surgeons had either Preoperative MRI or tissue diagnosis, compared to 42.6% for plastic surgeons and 90.5% for orthopedic surgeons (p < 0.001). Of the tumors resected by general surgeons without Preoperative MRI or tissue diagnosis, 2.6% were malignant. Finally, Postoperative documentation of neurovascular status, range of motion, and referral to physical therapy were more likely performed by orthopedic surgeons (all p < 0.001). CONCLUSION: Practice patterns vary significantly among orthopedic, plastic, and general surgeons treating soft tissue tumors of the extremities and pelvis. These findings highlight the need for multidisciplinary engagement and standardization of treatment algorithms and training practices across the various surgical specialties.
BACKGROUND AND OBJECTIVES: Increasing evidence supports the oncologic safety of omitting axillary surgery for patients with early breast cancer undergoing breast conserving surgery (BCS). However, there is concern that s...BACKGROUND AND OBJECTIVES: Increasing evidence supports the oncologic safety of omitting axillary surgery for patients with early breast cancer undergoing breast conserving surgery (BCS). However, there is concern that sentinel lymph node biopsy (SLNB) is necessary to inform adjuvant radiotherapy and systemic therapy decisions. The aim was to assess the oncological and survival outcomes of omitting surgical axillary staging in early breast cancer. METHODS: A systematic literature search of relevant databases was performed. Eligible studies compared omission of axillary surgery with conventional axillary staging. A meta-analysis using the Mantel-Haenszel method was performed to calculate pooled risk ratios (RR) for axillary recurrence (AR), disease-free survival (DFS) and overall survival (OS) for omission of axillary surgery compared with conventional axillary surgery. RESULTS: Five studies involving 8108 patients were included. Omission of axillary surgery was associated with a higher risk of AR (RR 3.82 95% CI 1.48-9.82, p < 0.005). No significant differences were observed in in DFS (RR 1.09 95% CI 0.91-1.30, p = 0.33) or OS (RR 1.06 95% CI 0.72-1.55; p = 0.78). CONCLUSIONS: Axillary surgery may be safely omitted in a highly select group of older patients with favourable tumour biology undergoing BCS. Multidisciplinary team input remains essential to appropriately select adjuvant treatments when nodal staging is omitted.
INTRODUCTION: External hemipelvectomy and hip disarticulation represent some of the most complex oncologic procedures; however, the actual excess morbidity compared to matched controls remains poorly quantified. We aimed...INTRODUCTION: External hemipelvectomy and hip disarticulation represent some of the most complex oncologic procedures; however, the actual excess morbidity compared to matched controls remains poorly quantified. We aimed to quantify the excess risk and resource utilization associated with major amputations using a distance-weighted methodology. METHODS: We conducted a retrospective cohort study using National Surgical Quality Improvement Program (NSQIP) data (2019-2023). Patients undergoing external hemipelvectomy or hip disarticulation (major amputation cohort) (n = 52) were compared to composite controls created from patients undergoing other pelvic oncologic procedures (n = 152). Composite controls were generated using distance-weighted matching based on 16 variables, including demographics, comorbidities, laboratory values, and procedural complexity. Primary outcomes included length of stay, uncomplicated outcome (defined as the absence of major complications, readmissions, reoperations, mortality, and length of stay ≤75th percentile), and massive transfusion. RESULTS: The major amputation cohort demonstrated significant excess morbidity with 5.0 days longer length of stay (9.0 vs 4.0 days, p < 0.001), 40.3% lower uncomplicated outcome rate (34.6% vs 74.9%, p < 0.001), and a trend towards excess massive transfusion risk (5.8% vs 0.0%, p = 0.083). CONCLUSION: Distance-weighted matching demonstrated that major amputations carry excess morbidity and resource utilization with prolonged hospitalization and reduced uncomplicated outcome probability.
Effective communication in oncological reconstructive surgery is fundamental to ensuring patient comprehension, trust, and informed consent. Yet, the use of deviant terminology-language that is misleading, euphemistic, o...Effective communication in oncological reconstructive surgery is fundamental to ensuring patient comprehension, trust, and informed consent. Yet, the use of deviant terminology-language that is misleading, euphemistic, or excessively technical-can obstruct doctor-patient understanding. This article examines how such terminology, common across both clinical and promotional settings, affects patients' interpretation of reconstructive and restorative procedures following cancer treatment. Expressions such as "minimally invasive" or cosmetic marketing terms like "mommy makeover" may obscure the complexity and risk of interventions, while excessive jargon can alienate patients. These linguistic distortions risk undermining informed consent and shared decision-making. To address this, surgeons working within oncological contexts should prioritise plain language, apply the teach-back method, and adopt standardised terminology supported by professional associations. Furthermore, cultural competence and visual decision aids can enhance comprehension, particularly among diverse patient populations. By aligning terminology with medical accuracy and patient needs, reconstructive surgeons can promote transparency, safety, and patient-centred care throughout the oncological journey.
Alnajar A, Akcin M, Lew JI
… +1 more, Vaghaiwalla TM
J Surg Oncol
· 2026 Jan · PMID 41277750
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BACKGROUND: Patients with early-stage well-differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of healt...BACKGROUND: Patients with early-stage well-differentiated small bowel neuroendocrine tumors (sbNETs) experience favorable prognosis with timely diagnosis and treatment. However, the impact of social determinants of health (SDH) and care at Minority-Serving Hospitals (MSHs) on outcomes remains understudied. This study evaluates the combined influence of SDH and hospital type on long-term survival in sbNETs. METHODS: The 2010-2020 National Cancer Database was queried for adults with G1/G2 sbNETs, Stage I/II disease, who underwent surgical resection. Patients with G3 NETs, Stage III/IV disease, neuroendocrine carcinoma, duodenal primary tumors, or incomplete follow-up were excluded. A composite SDH score was developed using four sociogeographic factors: (1) low income, (2) low education, (3) rurality, (4) travel distance > 250 miles. Patients were categorized as SDH+ (score 0-1) or SDH- burden (score 2-4). Hospitals in the top decile for Black and Hispanic representation were classified as MSHs. Kaplan-Meier and Cox regression analyses were performed. RESULTS: Among 2688 patients (median age 64; 48% female), 57% were SDH-. Five-, 10-, and 15-year survival rates were 79%, 62%, and 49%, respectively. At MSHs, 5-year survival was 82% for SDH+ versus 63% for SDH-. At non-MSHs, survival was 82% for SDH+ versus 77% for SDH-. Median survival for SDH- patients was 11 years at MSHs versus 12 at non-MSHs. In regression analysis, SDH- status was linked to worse survival (HR 1.24, p < 0.001); treatment at non-MSHs predicted better survival (HR 0.41, p < 0.001). Black patients had higher mortality risk (HR 1.20, p = 0.002); no difference was observed for Hispanic patients. CONCLUSION: Higher SDH burden and treatment at MSHs were associated with decreased survival in early-stage sbNETs. Implementing a composite SDH score in clinical practice may provide a practical tool for risk stratification and guide equity-focused interventions for patients with sbNETs.
Li RA, Nguyen AT, Bajaj K
… +2 more, Coles BM, Galiano RD
J Surg Oncol
· 2026 Jan · PMID 41277703
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BACKGROUNDS AND METHODS: American Indian and Alaska Native (AI/AN) populations face significant health disparities across multiple cancer types, yet melanoma-specific outcomes remain under-investigated. A comprehensive s...BACKGROUNDS AND METHODS: American Indian and Alaska Native (AI/AN) populations face significant health disparities across multiple cancer types, yet melanoma-specific outcomes remain under-investigated. A comprehensive search of Embase, Scopus, and PubMed identified 20 studies meeting inclusion criteria. Three meta-analyses were conducted using random effects models to assess: (1) adjusted hazard ratios for mortality risk, (2) adjusted odds ratios for late-stage diagnosis, and (3) age-adjusted incidence rates. RESULTS: The meta-analysis revealed significant disparities in melanoma outcomes for AI/AN patients. AI/AN patients demonstrated a 43% higher mortality risk compared to white patients (pooled aHR = 1.43, 95% CI: 1.12-1.82, p = 0.0041) and a 75% higher likelihood of late-stage diagnosis (pooled adjusted OR = 1.75, 95% CI: 1.16-2.65, p = 0.0080). AI/AN patients consistently presented with worse prognostic factors including higher Breslow thickness, increased ulceration rates, and more advanced disease stages. CONCLUSION: This study provides the first meta-analytic evidence demonstrating statistically significant disparities in melanoma outcomes among AI/AN populations. Systemic barriers include insurance disparities, geographic isolation, treatment delays, and limited access to specialized dermatologic care. DISCUSSION: These findings justify targeted interventions including enhanced screening programs, improved healthcare infrastructure, and policy reforms to address insurance and access barriers affecting AI/AN communities.
Benseler A, Tanen A, May T
… +4 more, Avery L, Bouchard-Fortier G, Bernardini MQ, Hogen L
J Surg Oncol
· 2026 Jan · PMID 41277697
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BACKGROUND AND OBJECTIVE: Stage IVB high-grade serous ovarian cancer (HGSOC) carries a poor prognosis. We aimed to: (1) describe the characteristics and survival of patients treated with primary cytoreductive surgery (PC...BACKGROUND AND OBJECTIVE: Stage IVB high-grade serous ovarian cancer (HGSOC) carries a poor prognosis. We aimed to: (1) describe the characteristics and survival of patients treated with primary cytoreductive surgery (PCS), interval cytoreductive surgery (ICS) or chemotherapy alone, (2) investigate the correlation between disease distribution and treatment type, and (3) evaluate the impact of cytoreductive surgery (CS) "aggressiveness" and outcome on survival. METHODS: A single-center retrospective cohort study of Stage IVB HGSOC patients. Demographics, tumor characteristics, treatment including "aggressive" CS (upper abdominal and extraperitoneal procedures), and outcomes were analyzed using descriptive statistics and survival analysis, with nonparametric tests and Cox-proportional hazard models. RESULTS: Of 110 patients, 24 (22%) underwent PCS, 73 (66%) ICS, and 13 (12%) chemotherapy alone. Median overall survival (OS) was 76.2 (PCS), 36.9 (ICS), and 20.1 months (chemotherapy alone) (p = 0.014). Supradiaphragmatic lymph-node metastasis differed across groups (p = 0.042). "Aggressive" CS was performed in 53.6% of the surgical cohort, with 54.86% no-gross-residual (NGR), 34% optimal ≤ 1 cm ≤ and 11.3% suboptimal/aborted surgical outcome. Median OS post CS for NGR, optimal ≤ 1 cm, and suboptimal was 67.55, 35.26, and 20.97 months, respectively (p = 0.006). CONCLUSIONS: OS for Stage IVB HGSOC follows a hierarchical pattern: PCS, ICS, and chemotherapy. Disease distribution guides treatment and residual tumor after CS correlates with survival.
INTRODUCTION: Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, clas...INTRODUCTION: Procedural volume thresholds (VTs) for hospital quality reporting rely on expert consensus or analytic methods that may produce inconsistent VTs (e.g. restricted cubic splines (RCS), optimal cutpoints, classification and regression trees (CART), stratum specific likelihood ratios (SSLR)). The objective of this study was to compare variation in hospital-level VTs for pancreatectomy across multiple methodologies. METHODS: Patients undergoing pancreatectomy from 2004 to 2021 were identified using the National Cancer Database. RCS, optimal cutpoints, CART, and SSLR were used to compute VTs based on 90-day mortality. From a single clinical data set, VTs were derived multiple times for each method by varying statistical parameters within each model. RESULTS: Overall, 61,920 patients underwent pancreatectomy at 982 hospitals. VTs associated with reductions in 90-day mortality ranged from 9.2 to 26.1 cases/year (RCS), 15.7-33.8 cases/year (optimal cutpoints), and 11-18 cases/year (CART), all based on modifiable statistical parameters. SSLR analysis yielded a singular VT of 21 cases/year without variability due to lack of statistical input. CONCLUSION: Among 4 common strategies for identifying VT that we studied, SSLR required the fewest assumptions. This may make it ideal for enhancing transparency and standardization in outcomes reporting.
BACKGROUND: Breast cancer management requires complex decision-making and varies widely at international, national, and institutional levels. Our study evaluates the impact of nonpunitive, real-time reviews of individual...BACKGROUND: Breast cancer management requires complex decision-making and varies widely at international, national, and institutional levels. Our study evaluates the impact of nonpunitive, real-time reviews of individual surgeons' practice patterns within a single institution. METHODS: Data from a prospective breast cancer database from the prior 12-month period were reviewed every 6 months in unblinded sessions. Surgeons compared their practices with those of their colleagues during three review sessions, without any benchmarks or punitive measures. RESULTS: A mean of 663 cases were reviewed for each 12-month period. Significant changes in practice patterns were observed, including notable reductions in re-excision rates (20.1% vs. 11.2%, p < 0.001), sentinel lymph node (SLN) biopsy utilization in patients over 70 with favorable biology (24.2% vs. 12.2%, p = 0.037), intraoperative SLN analysis in surgery-first patients (28.7% vs. 2.7%, p < 0.001), and immediate breast reconstruction (46.2% vs. 34.7%, p = 0.027). Additionally, there were significant increases in the use of breast conserving therapy (75.3% vs. 83.1%, p = 0.006) and outpatient mastectomy (58.4% vs. 79.9%, p < 0.001). Clinical variation in intraoperative SLN analysis and prophylactic measures was notably reduced. These adjustments resulted in an estimated annual cost saving of $467 619. CONCLUSIONS: Practice pattern reviews significantly altered surgical practices, reducing clinical variation and demonstrating that strategic investments in quality initiatives can greatly enhance resource utilization and generate substantial cost savings.
Gastric outlet obstruction (GOO) in locally advanced pancreatic cancer (LAPC) can be managed with endoscopic duodenal stenting (EDS), gastrojejunostomy (GJ), or EUS-guided gastroenterostomy (EUS-GE). In our meta-analysis...Gastric outlet obstruction (GOO) in locally advanced pancreatic cancer (LAPC) can be managed with endoscopic duodenal stenting (EDS), gastrojejunostomy (GJ), or EUS-guided gastroenterostomy (EUS-GE). In our meta-analysis of LAPC patients, EDS enabled quicker recovery and chemotherapy but had higher re-intervention rates, while GJ offered greater durability. Our systematic review showed EUS-GE had high success and low re-intervention in malignant GOO, though LAPC-specific data were lacking. Further comparative studies are needed to guide individualized treatment.
J Surg Oncol
· 2026 Jan · PMID 41241871
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This integrative review examines the differential expression of miRNAs in breast cancer patients across various disease stages. Through analysis of 42 articles published between 2005 and 2023, the review identifies multi...This integrative review examines the differential expression of miRNAs in breast cancer patients across various disease stages. Through analysis of 42 articles published between 2005 and 2023, the review identifies multiple miRNAs with significant diagnostic, prognostic, and predictive potential in breast cancer management. These small noncoding RNAs, accessible through liquid biopsy, demonstrate notable potential for early detection, molecular subtype classification, treatment response prediction, and relapse monitoring. The findings highlight miRNAs as promising biomarkers for precision medicine approaches, potentially enhancing clinical decision-making and improving patient outcomes. Notably, miRNAs such as miR-21, miR-155, and members of the miR-200 family show consistent associations with clinical parameters across multiple studies. The accessibility of miRNAs in blood and other body fluids, combined with their stability and specificity, positions them as valuable tools that could complement conventional diagnostic methods and support more personalized treatment strategies in breast cancer care.