Major wound complications after conventional preoperative radiotherapy in STS patients: incidence, predictors, and timing.

Anastomotic leakage and anastomotic stenosis are among the most severe complications of rectal resection, among patients receiving neoadjuvant radiotherapy, the incidence of anastomotic stricture ranges from 3% to 6%. Anastomotic stricture can lead to abdominal pain and bowel obstruction, significantly affecting the quality of life and sometimes necessitating the creation of permanent stomas. This article reviews the definition of rectal anastomotic stricture. The development of anastomotic stricture is closely related to multiple factors, such as the healing characteristics of the bowel wall, local ischemia, anastomotic leakage, and the effects of preoperative radiotherapy. Furthermore, the choice of surgical anastomosis techniques significantly impacts the incidence of strictures. To enhance treatment outcomes for anastomotic strictures, this review summarizes different therapeutic strategies for membranous and tubular strictures. Transanal endoscopic resection and reconstruction surgery has significant advantages in the treatment of severe rectal anastomotic stenosis, providing standardized suggestions and guidance for the treatment of this clinical difficulty.

Postoperative vascular crisis is one of the most serious complications in patients with oral and maxillofacial malignant tumors. To date, no consensus has been reached regarding the factors influencing its occurrence. This study aimed to investigate the incidence and influencing factors of postoperative vascular crisis in patients with oral and maxillofacial malignant tumors through a meta-analysis. A systematic search of nine Chinese and English literature databases was conducted from database inception to August 31, 2025, to identify studies on the incidence and influencing factors of postoperative vascular crisis in patients with oral and maxillofacial malignant tumors. Two researchers independently performed literature screening, data extraction, and quality assessment. Data were analyzed using Stata 17.0 and RevMan 5.4.1 software. Sensitivity analysis, publication bias assessment, and subgroup analysis were also performed. A total of 27 studies identified 44 influencing factors, and 13 factors were reported in at least two independent studies with complete data. The average score of the Newcastle-Ottawa Scale included in the study was ≥ 7, indicating relatively high quality. Finally, the combined incidence of postoperative vascular crisis in patients with oral and maxillofacial malignant tumors was 14.4%, and 12 influencing factors were obtained: diabetes, hypertension, oral infection, decreased fibrinogen, decreased ALB, ALB < 35g/L, preoperative radiotherapy, surgical history in the recipient area, anastomotic veins < 2, history of alcohol abuse, smoking history, and gender. The pooled incidence of postoperative vascular crisis in patients with oral cancer was 14.41%, indicating a relatively high risk in this population. Clinicians should develop differentiated prevention and management strategies for high-risk patients based on relevant influencing factors to improve monitoring accuracy and reduce the occurrence of vascular crisis. CRD420251123018.

Postoperative pancreatic fistula (POPF) is a major contributor to morbidity and mortality after pancreaticoduodenectomy (PD)1. Externalized pancreatic stents decrease the incidence and severity of POPF after PD2-6, but their feasibility has not been demonstrated in robotic PD. We present our method of externalized pancreatic stent placement during robotic PD and report our initial experience. This video demonstrates our technique of using an externalized pancreatic stent during robotic PD. We conducted a retrospective review of patients who underwent robotic PD with externalized pancreatic duct stent placement at a single academic institution. Fistula risk was graded using the Fistula Risk Score (FRS)7 and the Alternative FRS8, and postoperative outcomes were recorded. Of 67 consecutive patients, 44.8% were female and the median age was 68 years. The most common indication for PD was pancreatic ductal adenocarcinoma (PDAC) (47.8%), followed by cystic neoplasms (22.4%) and neuroendocrine tumors (11.9%); 75% of patients with PDAC received neoadjuvant chemotherapy for borderline resectable disease, and 21.9% underwent preoperative radiation. Most (70.1%) had an intermediate risk of POPF using FRS, and 19.4% were classified as high risk based on the Alternative FRS. The overall POPF rate was 17.9% (biochemical leak9 16.4%; grade B 1.5%; grade C 0%). The median length of stay was 5 days, and the 90-day readmission rate was 22.4%. Stents were removed, on average, at 29 days postoperatively. We report the placement of an externalized pancreatic stent during robotic PD, which has not been previously described in robotic surgery. This method is technically feasible and is associated with very low rates of fistula-related complications.

The benefits of preoperative neoadjuvant radiotherapy (NART) for breast cancer are not conclusive and there are no well-established guidelines for NART. We aimed to analyze the difference in survival benefit between NART and postoperative adjuvant radiotherapy (PORT) and screening patients who are suitable for NART. A retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER) from 2010 to 2021 was performed. We comprehensively assessed trends in the management of NART in the population during the past decade. The factors associated with NART were then explored using logistic regression. We also compared BC patients with preoperative neoadjuvant radiotherapy (NART) or postoperative adjuvant radiotherapy (PORT) for overall survival (OS) and breast cancer-specific survival (BCSS) after propensity score matching (PSM), and attempted to identify precise subgroups of patients that could benefit from NART. 1785 patients receiving NART were identified from a total of 274,199 patients between 2010 and 2021, with a median follow-up time of around 58 months. NART utilization in higher tumor stages shows a slight upward trend. Based on the multivariate logistic regression model, age more than 50 years old (OR = 0.86; 95% CI 0.78 to 0.94), stage II-III (II: OR = 1.49; 95% CI 1.28 to 1.74 III: OR = 2.44; 95% CI 1.98 to 3.00), T4 (OR = 1.52; 95% CI 1.25 to 1.84), HR-/HER2- (OR = 0.8; 95% CI 0.70 to 0.92) were independently correlated with NART. PORT was significantly associated with better survival (P < 0.001, HR = 0.6709; 95% CI 0.5898-0.7630 for OS) after propensity score matching (PSM). Subgroup analyses showed that for patients of HR-/HER2- subtype, AJCC stage I category or patients receiving breast-conserving surgery (BCS), NART and PORT resulted in similar OS and BCSS. We also identified risk factors for second primary malignancies development after breast cancer and found that NART were related to the lower risk of developing second primary malignancies following breast cancer. Over time, an increasing number of breast cancer patients received NART. We cannot affirm that NART is as effective as PORT in the treatment of BC, however we can consider NART as an alternative option in some contexts such as patients of AJCC stage I category and patients receiving BCS, given its potential advantages of reducing second primary malignancies risk.

BackgroundSome centres advocate preoperative radiotherapy in patients with pancreatic cancer and arterial involvement despite a lack of Level 1 evidence on survival benefit. Although it has been suggested that preoperative radiotherapy may increase the risk of postpancreatectomy haemorrhage (PPH) and morbidity, evidence is again lacking. This study investigated the association between preoperative radiotherapy and both PPH and major morbidity following arterial divestment/resection during pancreatic adenocarcinoma resection after chemotherapy.MethodsConsecutive patients diagnosed with pancreatic adenocarcinoma and > 180° arterial involvement who were treated with preoperative chemotherapy with or without radiotherapy followed by pancreatic resection with arterial divestment/resection were included in the study. Logistic regression analyses including propensity score-based overlap weighting were performed to investigate associations between radiotherapy and in-hospital PPH grade B/C and major morbidity, expressed as adjusted risk differences (aRDs).ResultsOverall, 246 patients undergoing pancreatic resection with arterial resection (169, 69%) or divestment (77, 31%) were included. Radiotherapy was not associated with PPH (aRD 6%; 95% confidence interval (c.i.) −3 to 14), regardless of arterial divestment (aRD 3%; 95% c.i. −5 to 11) or arterial resection (aRD 12%; 95% c.i. 1 to 23; Pinteraction = 0.189). Radiotherapy was associated with a 14% (95% c.i. 2 to 25) higher risk of major morbidity, especially after arterial resection (aRD 27%; 95% c.i. 11 to 43) compared with arterial divestment (aRD −12%; 95% c.i. −35 to 11; Pinteraction = 0.006) and after external beam radiotherapy (aRD 21%; 95% c.i. 8 to 32) compared with stereotactic body radiotherapy (aRD −12%; 95% c.i. −27 to 6; Pinteraction = 0.0001). Ninety-day mortality was increased, albeit not significantly, after preoperative radiotherapy (10 (8%) versus 3 (3%) deaths with versus without preoperative radiotherapy, respectively; P = 0.067).ConclusionsRadiotherapy before resection of pancreatic cancer with > 180° arterial involvement was associated with an increased risk of postoperative major morbidity when arterial resection, but not arterial divestment, was performed. This risk should be taken into account when considering preoperative radiotherapy in patients who may require arterial resection.

Association of Community-Level Economic Distress With Perioperative Outcomes Following Hepato-Pancreato-Biliary Cancer Surgery.

Soft tissue sarcoma (STS) is a heterogeneous disease characterized by high prevalence of structural variants (SV). Despite surgery and radiation, ~50% of localized STS recur; the role of adjuvant systemic therapy remains controversial. We assessed circulating tumor DNA (ctDNA) tracking tumor-informed SVs throughout the perioperative course and surveillance to detect molecular residual disease. Patients with localized, high-risk STS (size ≥5cm, grade ≥2) were enrolled. Bespoke assays targeting 4-16 SV-breakpoints per patient were generated to detect ctDNA. Blood was collected at diagnosis, post-radiation, postoperatively (≤8-weeks), and during follow-up with radiologic surveillance; ctDNA dynamics were correlated with clinical outcomes. 228 plasma samples from 32 patients were analyzed with a median ctDNA surveillance spanning 20.1 months and a median clinical follow-up of 43.8 months. Sensitivity of the assay was 97% (31/32) at baseline. 22 patients received preoperative radiation and had blood collected within the 8-week postoperative window. ctDNA was detectable within this period in 4/22 patients (18%). All 4 (100%) developed metastatic disease within 1 year (median 153 days). 3/18 patients (17%) who were ctDNA-negative in the 8-week window, developed metastatic recurrence (median 521 days), which was preceded by detectable ctDNA. Longitudinal assessment of the entire cohort showed that ctDNA concentration correlated with oncologic treatment and radiologic response. SV-based personalized ctDNA detection is feasible and highly sensitive in localized STS. In this proof-of-principle study, ctDNA detection in the 8-week postoperative window was associated with early recurrence. These data inform future trial-design of personalized adjuvant systemic therapy for localized STS.

Phase 1 trial of pre-operative image guided intensity modulated photon radiotherapy with simultaneously integrated boost to the high-risk margin for patients with retroperitoneal sarcoma.

Any impact of pre-operative radiotherapy on renal function in retroperitoneal soft tissue sarcomas? A secondary ancillary analysis of the EORTC 62092 STRASS 1 trial.

Despite success rates exceeding 90% with microsurgical reconstruction, flap failure remains a serious complication. This study aims to identify risk factors for flap failure based on real-world data from a single Taiwanese center. A retrospective analysis was conducted on 1015 patients who underwent their first free flap surgery for head and neck cancer at Taichung Veterans General Hospital from 2013 to 2021. Variables included demographics, comorbidities, preoperative radiotherapy or chemotherapy, and intraoperative ischemia time. Outcomes included flap failure, complications, take-back surgery, and hospital stay. Logistic and linear regression analyses were used to identify risk factors. Among 1015 patients, flap failure occurred in 3.19%, complications in 16.85%, and take-back procedures in 8.80%. Longer ischemia time increased the risk of failure (odds ratio [OR] = 1.01, P < 0.001), complications (OR = 1.01, P = 0.023), and longer hospital stay (β = 0.08, P < 0.001). Preoperative radiotherapy or chemotherapy was associated with more complications (OR = 1.90, P = 0.002) and longer hospitalization (β = 6.91, P < 0.001). This study, based on 1015 cases from a single institution over nearly a decade, minimizes systematic bias and confirms ischemia time as a key predictor of flap failure and prolonged hospitalization. Although preoperative radiotherapy or chemotherapy increases complication rates and length of hospital stay, it does not affect flap survival, providing valuable data for surgical planning and patient counseling.

Acellular dermal matrix (ADM) has improved aesthetic and structural outcomes in implant-based postmastectomy breast reconstruction. However, outcomes in patients receiving postmastectomy radiotherapy (PMRT) remain inconsistent due to radiation-induced fibrosis and vascular compromise. This meta-analysis evaluates complication rates associated with ADM use in irradiated implant-based reconstruction. A PRISMA-guided search was conducted to identify studies reporting outcomes of ADM-assisted, irradiated postmastectomy breast reconstruction. Eligible studies were analyzed using proportional meta-analysis with subgroup comparisons based on ADM type, implant placement plane, and timing of radiotherapy. Across all included studies, pooled complication rates were 16.8% for capsular contracture, 8.3% for infection, 5.8% for seroma, and 10.6% for implant loss. Implant plane significantly affected outcomes: prepectoral reconstruction demonstrated significantly lower rates of capsular contracture and infection compared with submuscular or mixed approaches, whereas mixed-plane placement was significantly associated with higher rates of implant malposition. Radiotherapy timing significantly influenced long-term outcomes: postoperative PMRT was associated with the highest rates of capsular contracture, implant loss, and reoperation, whereas preoperative PMRT demonstrated the lowest rates. ADM type also showed significant differences in capsular contracture, implant loss, and reoperation, with bovine matrices demonstrating significantly lower complication rates and porcine matrices showing favorable satisfaction outcomes. Overall patient satisfaction reached 80.8%. ADM-assisted implant reconstruction in irradiated patients is associated with variable complication rates influenced by ADM type, implant plane, and radiotherapy timing. Preoperative radiation and selected ADM materials, particularly bovine matrices, were associated with more favorable outcomes, whereas postoperative radiation was linked to higher long-term complication rates.

Management of primary rectal cancer presenting with synchronous liver metastases (CRLM) is debated as there several treatment strategies to consider. The aim of this study was to evaluate the strategies used in an unselected cohort. An observational, population-derived cohort of patients treated for synchronous CRLM and rectal cancer within a prospective biomarker trial (ACROBATICC). Of 192 patients operated for CRLM, 35 (18%) had rectal cancer and synchronous CRLM. A total of 22 patients (63%) were treated with liver-first followed by primary resection, while 13 patients (37%) had the primary-first approach. Four patients having liver-first developed further metastasis and did not proceed to rectal surgery. A significantly higher rate of pre-operative primary tumour radiation occurred in the liver-first group, 19 (86%) vs 6 (46%) in the primary first (P=0.038), suggesting a more advanced stage for the primary rectal cancer with planned liver surgery-first as part of operating in the "window" between radiation and eventual primary rectal cancer surgery. Also, the liver-first group received fewer cycles of chemotherapy (median 4 (4-8) vs median 8 (5-11) cycles; P=n.s.), indicating need to 'control' or 'convert' liver metastasis in the primary-first group prior to hepatectomy. Follow-up time for the cohort was 36 months (IQR 21-69), with 21 (96%) recurrences in the liver first group and 7 (58%) in the primary first (P=0.014). Treatment sequencing reflects overall tumour presentation at diagnosis. The liver-first strategy was preferentially used in patients with more advanced rectal disease and was associated with high recurrence, reflecting tumour biology rather than treatment sequence.

Surgery with radiotherapy is a standard choice for high-grade soft-tissue sarcoma; however, the indication of radiotherapy for low-grade soft-tissue sarcoma remains controversial due to an inherent low risk of distant metastasis and recurrence after surgery, as well as potential complications after surgery. Between 2007 and 2020, a total of 132 patients with low-grade soft-tissue sarcoma treated with pre-operative radiotherapy followed by surgical resection were examined. Pre-operative radiotherapy was administered with 50.4Gy in 1.8Gy fractions, with definitive surgery performed 4-8 weeks after completing pre-operative radiotherapy to allow inflammation to subside. Optimal methods for wound closure were performed by plastic surgeons, with the selective use of flap reconstructions (pedicled or free), skin grafts or direct closure. Diagnoses included well-differentiated liposarcoma/atypical lipomatous tumors (n = 66), myxoid liposarcoma (n = 31), leiomyosarcoma (n = 22), and others. After en-bloc (wide) resections, 78.8% (104/132) underwent plastic reconstruction, including free flaps (51.5%), pedicled flaps (25.8%), and skin grafts (1.5%). The resection margins were R0 in 93.2% (123/132), R1 or R2 in 6.8% (9/132). The 5-year local recurrence-free rate was 99.1%, and distant metastasis-free survival was 90.6%, with nine metastases observed, mainly in myxoid liposarcoma. The disease-specific survival at 5 years was 99.2%. Wound complication-related reoperations occurred in 21.2% (28/132), with similar rates between direct closure (21.4%, 6/28) and plastic reconstruction (21.2%, 22/104, p = 0.705). Although surgical and oncological outcomes were favourable, the efficacy and invasiveness of pre-operative radiotherapy should be carefully balanced based on the patients' individual background, due to the potential post-operative complications.

Preoperative radiotherapy negatively affects early hypertrophy but has no effect on graft survival and union in patients treated with vascularized fibular grafts for bone tumors.

Pre-operative Radiation for Resectable Retroperitoneal Sarcoma: Where are we With Risk-benefit Calculus?

Anastomotic leakage is a major complication after minimally invasive anterior resection for rectal cancer. The number of stapler firings for rectal transection has been suggested as a modifiable risk factor, but its independent role and optimal threshold remain unclear. To evaluate the impact of the number of stapler firings on anastomotic leakage after rectal surgery and to assess the influence of surgical and patient-related variables. A comprehensive search of PubMed, Cochrane Library, and Ovid MEDLINE was performed. Studies reporting anastomotic leakage rates stratified by stapler firing count (one, two, or three or more) were included. Rectal transection with one or more stapler firings during minimally invasive anterior resection for rectal cancer. Incidence of anastomotic leakage according to stapler firing (SF) count. Twenty two studies including 8,725 patients and 784 anastomotic leakage events were analyzed. A single stapler firing was associated with a significantly reduced risk of anastomotic leakage compared with two stapler firings (odds ratio 0.57, 95% confidence interval 0.39-0.83), three or more stapler firings (odds ratio 0.28, 95% confidence interval 0.16-0.51), and two or more stapler firings (odds ratio 0.46, 95% confidence interval 0.34-0.63). The risk of anastomotic leakage was lower with fewer than three stapler firings compared with three or more stapler firings (odds ratio 0.38, 95% confidence interval 0.30-0.48). Meta-regression identified low rectal transection and preoperative radiotherapy as significant effect modifiers. All included studies were observational, introducing potential bias and increased heterogeneity and the certainty of evidence was low across all comparisons. Three or more stapler firings were consistently associated with a higher risk of anastomotic leakage. However, because the certainty of evidence was low and owing to exploratory meta-regression findings, stapler firing number appears to reflect operative complexity more than a definitively established independent causal risk factor.

Objective: To investigate the clinicopathological characteristics, perioperative complications, and survival prognosis of patients with locally advanced gastric cancer complicated with diabetes mellitus (DM). Methods: A retrospective cohort study was conducted. Inclusion criteria: (1) local advanced gastric adenocarcinoma confirmed by postoperative pathology; (2) radical gastrectomy for gastric cancer (R0 resection); (3) follow-up time of at least 36 months. Exclusion criteria: (1) preoperative neoadjuvant chemotherapy, radiotherapy, chemoradiotherapy, or immunotherapy; (2) remnant gastric cancer; (3) distant metastasis; (4) severe autoimmune disease; (5) other malignant tumors; (6) severe organic heart, lung, or renal diseases; (7) incomplete clinicopathological or follow-up data. According to the above criteria, clinicopathological data of 1552 patients with locally advanced gastric cancer who underwent radical gastrectomy at the Gastric Cancer Center, West China Hospital, Sichuan University between January 2010 and December 2020 were collected. Patients were divided into a DM group and a non-DM group according to preoperative DM status. A 1:1 propensity score matching (PSM) was performed to control for confounding factors including age, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, TNM stage and tumor location. After PSM, 162 patients were included in each group. Baseline characteristics were well balanced between the two groups (all P > 0.05). The primary endpoint was overall survival (OS), and the secondary outcomes were intraoperative and postoperative parameters. Results: After PSM, the DM group had longer operative time [(251.4±61.3) minutes vs. (227.4±51.7) minutes, t=-3.81, P<0.001], greater intraoperative blood loss [100 (30-150) ml vs. 80 (20-100) ml, Z=-2.17, P=0.030], longer total hospital stay [(18.2±9.9) days vs. (16.1±7.0) days, t=-2.20, P=0.024], and longer postoperative hospital stay [(11.6±6.6) days vs. (10.2±4.5) days, t=-2.23, P=0.029]. However, there were no significant differences in 30-day postoperative mortality, or perioperative complication rate (all P > 0.05). There was also no significant difference in OS between the two groups (median OS in DM group: not reached (74.0-not reached) months vs non-DM group: 105.7(87.5-not reached) months,P=0.865). Multivariate Cox regression analysis showed that DM was not independently associated with OS (P = 0.767), while advanced TNM stage (stage III vs stage I: HR = 3.974, 95%CI: 1.842-8.571, P < 0.001) and tumor location (gastric antrum vs. gastric fundus/esophagogastric junction: HR=0.652, 95%CI: 0.454-0.936, P=0.020) were independent risk factors for OS. Conclusion: Among patients with locally advanced gastric cancer undergoing radical surgery, those with DM have longer operative time, greater intraoperative blood loss, longer total hospital stay, and longer postoperative hospital stay. However, 30-day postoperative mortality, perioperative complication rate and long-term prognosis are comparable to those without DM.

Anatomic distribution of postoperative recurrence and radiotherapy target volume optimization in rectal cancer: A large-scale real-world study.

Contemporary colorectal cancer (CRC) epidemiology reveals evolving risk factors have reconfigured CRC as a societally-modulated, quasi-age-dependent disease. Nevertheless, temporal drivers of incidence/incidence-based mortality (IBM) patterns and longitudinal trends in clinicopathological profiles, therapeutic modalities, and 5-year survival (5-YS) remain incompletely defined, necessitating methodologically rigorous studies. The Surveillance, Epidemiology, and End Results Program data (1975-2019) were analyzed using the National Cancer Institute's (NCI's) Age-Period-Cohort Analysis Tool to examine temporal drivers of US CRC epidemiology. Longitudinal trends in clinicopathological profiles, therapeutic modalities, and 5-YS were further assessed via NCI's Joinpoint Regression Program. The relative risk (RR) of incidence increased exponentially in sequentially younger birth cohort, with the annual percentage change (APC) peaking at 6.11% in 20 - 24 years, while the RR of IBM declined in successively older birth cohorts and showed no improvement in younger birth cohorts. Early-onset CRC with regional- or distant-predominant disease (notably hepatic) showed a marked shift from adjuvant to neoadjuvant therapy, including a notable increase in preoperative radiotherapy for regional rectal cancer from 19.7% (2000) to 53.8% (2019), and preoperative systemic therapy for distant colon cancer from 5.5% (2007) to 17.6% (2019). Correspondingly, stage-specific 5-YS was also superior in early-onset CRC (e.g., regional rectal cancer: 82.5% vs. 67.8%; distant colon cancer: 22.9% vs. 14.7%), with greater annual improvement (e.g., APC for regional rectal cancer: 1.60% vs. 1.46%; APC for distant colon cancer: 3.59% vs. 2.55%). However, over 50% of distant metastatic patients, especially those with late-onset disease, still received no effective treatment. While overall CRC burden decreased in the US, extreme early-onset CRC surged with poor prognosis. Despite higher regional/metastatic burden, early-onset CRC showed better survival owing to aggressive treatment and adherence. Urgent actions are needed to address the rising risk in youth and therapeutic gaps in metastatic disease.