Surgery For Stage Research Articles

Nomogram for predicting 10-year postoperative recurrence of stage I gastric cancer.

With the advancement of various auxiliary examination techniques, the detection rate of stage I gastric cancer has gradually increased, and its clinical first-choice treatment is surgery. Although patients with stage I gastric cancer generally have a good postoperative survival rate, there is still a certain probability of recurrence. Given the large number of gastric cancer cases, there is a vast population of patients with stage I disease. We are aiming to identify the risk factors for postoperative recurrence of stage I gastric cancer and to establish a reliable predictive model to assess the risk of recurrence in the population for clinical practice. In this retrospective cohort study, we utilized the Surveillance, Epidemiology, and End Results (SEER) database to investigate predictive factors for recurrence among stage I gastric cancer patients who underwent curative gastrectomy between 2000 and 2018. The cohort was divided into training and validation sets for the development and validation of a nomogram. Prognostic factors were evaluated through univariate and multivariate Cox regression analyses. Significant variables identified by the concordance index (C-index) and calibration plots were used to construct nomograms predicting the probability of 5- and 10-year recurrence. Risk factors for recurrence included sex, age, race, histology, tumor size, American Joint Committee on Cancer Tumor (AJCC T) and primary site, which were used to construct the nomogram. The C-index for both the training and validation cohorts indicated that the nomogram possessed good calibration and discrimination abilities in predicting the probability of 5- and 10-year recurrence after curative surgery for stage I gastric cancer. This study established a reliable predictive model for recurrence following curative gastrectomy in stage I gastric cancer based on a population cohort. The findings of this study have the potential to significantly impact clinical practice by providing clinicians with tools for personalized risk assessment and for making informed treatment decisions.

Ten-year survival outcomes of video-assisted thoracic surgery vs. open major lung resection for stage I-III non-small cell lung cancer: a large cohort study in China.

Despite the widespread adoption of video-assisted thoracoscopic surgery (VATS) for major lung resection, the 10-year long-term survival outcomes of non-small cell lung cancer (NSCLC) treated with VATS compared with open major lung resection is lacking. The purpose of this study was to analyze the short- and long-term outcomes of VATS vs. open major lung resection for NSCLC. The perioperative outcomes and long-term survival of p-stage I-III NSCLC patients who underwent major lung resection via VATS vs. open major lung resection in the Western China Lung Cancer Database (WCLCD) between May 2006 and June 2018 were studied using propensity score matching (PSM). Of the 10,167 patients who underwent surgery for lung malignancies, 6,405 patients with stage I-III NSCLC were included in the study, including 4,224 in the VATS group and 2,181 in the open group. PSM resulted in 1,487 patients in both the VATS and open groups. The patients were matched by patient demographics, Charlson comorbidity index (CCI), tumor histology and TNM stage. Compared with open surgery, major lung resection via VATS resulted in less blood loss (median: 50 vs. 100 mL, P<0.001) and a shorter postoperative hospital stay (7.6±6.0 vs. 8.6±4.9 days, P<0.001) but higher total hospital costs (52.5±21.2 vs. 45.0±16.4 kRMB, P<0.001). The matched cohort showed that patients who underwent major lung resection via VATS had better overall survival (OS) and recurrence-free survival (RFS) than did patients who underwent major lung resection via open surgery (5-year survival: 64.9% vs. 57.7%, P<0.001; 5-year RFS: 50.3% vs. 45.3%, P=0.003). Patients who underwent VATS had a better 10-year OS rate (47.8% vs. 42.6%). According to the subgroup analysis, patients with stage II NSCLC who underwent major lung resection via VATS had better OS and RFS (OS: P<0.001; RFS: P=0.004), while there were no significant differences in OS or RFS between stage I and III NSCLC patients. Major lung resection via the VATS should be the preferred surgical option for stage I-III NSCLC patients due to its superior long-term survival outcome and advantages of less blood loss and shorter postoperative hospital stays.

Effects of different surgical extents on prognosis of patients with malignant ovarian sex cord-stromal tumors: a retrospective cohort study.

Malignant ovarian sex cord-stromal tumors are rare neoplasms that account for approximately 5-7% of all ovarian malignancies, and they are primarily treated with surgery. The prognosis of patients with different surgical extents remains controversial. Therefore, the effects of different surgical extents on the prognosis of patients were explored in this retrospective cohort study. Patients with malignant ovarian sex cord-stromal tumors who underwent surgical treatment from January 2000 to December 2019 were selected. Disease-freesurvival and overall survival rates werecalculatedbytheKaplan-Meier method andcompared by thelog-rank test. Prognosis factors were identified by Coxregression analysis. P < 0.05 was considered a statistically significant difference. A total of 278 patients with an average age at onset of 42 (8-78) years old were enrolled. The median follow-up time was 73months. There was no significant difference in disease-free survival and overall survival rates between patients who underwent fertility-sparing surgery and those who underwent Non-fertility-sparing surgery, and between patients underwent staging surgery and those underwent Non-staging surgery.Age < 40years (P = 0.024), stage II-III (P = 0.038), a high CA125 level (P = 0.035) and WT-1 (+) (P = 0.016) were independent risk factors for recurrence. In conclusion, different surgical extents have no significant influence on recurrence and survival status of patients with malignant ovarian sex cord-stromal tumors.

DDB2 expression lights the way for precision radiotherapy response in PDAC cells, with or without olaparib

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers. Therapeutic options for PDAC are primarily restricted to surgery in the early stages of the disease or chemotherapy in advanced disease. Only a subset of patients with germline defects in BRCA1/2 genes can potentially benefit from personalized therapy, with the PARP inhibitor olaparib serving as a maintenance treatment for metastatic disease. Although the role of radiotherapy in PDAC remains controversial, the use of radiosensitizers offers hope for improving cancer management. Previously, we have shown that damage-specific DNA binding protein 2 (DDB2) is a potential prognostic and predictive biomarker for chemotherapy response in PDAC. In this study, we investigated the function of DDB2 in radiotherapy response, with and without radiosensitization by olaparib in PDAC cells. Our findings demonstrated DDB2 resistance to radiation effects, thereby improving cell survival and enhancing the repair of ionizing radiation-induced DNA double-strand breaks. We observed that DDB2 expression enhances the cell cycle arrest in the G2 phase by phosphorylating Chk1 and Chk2 cell cycle checkpoints. Additionally, we identified a novel link between DDB2 and PARP1 in the context of radiotherapy, which enhances the expression and activity of PARP1. Our findings highlight the potential of low-DDB2 expression to potentiate the radiosensitization effect of olaparib in PDAC cells. Collectively, this study provides novel insights into the impacts of DDB2 in the radiotherapy response in PDAC, enabling its employment as a potential biomarker to predict resistance to radiation. Furthermore, DDB2 represents a significant step forward in precision radiotherapy by widening the scope of patients who can be benefiting from olaparib as a radiosensitizer. Hence, this research has the potential to enrich the limited use of radiotherapy in the care of patients with PDAC.

Comparison of postoperative prognoses for resectable colorectal cancer with vs. without oncologic emergency using propensity score‑matched analyses: A single-center retrospective observational study.

While oncological emergencies in colorectal cancer present distinct challenges, existing literature offers conflicting evidence regarding long-term outcomes. Therefore, the present study compared the postoperative prognoses between patients with and without oncological emergencies. A retrospective evaluation was conducted on patients who had undergone radical surgery for pathological stages II and III colorectal cancer at a single center between January 2012 and December 2020. Patients were classified into the non-emergency and oncological emergency groups. The status of oncologic emergency was divided into obstruction and perforation. The outcomes were compared using propensity score matching. The primary objective was to compare the postoperative prognoses between non-emergency and oncological emergency situations. The secondary objectives included comparing prognoses between obstruction and perforation, identifying the type of recurrence depending on the status of oncologic emergency, and assessing the effect of adjuvant chemotherapy for oncologic emergencies. This study included 524 patients. After propensity score matching, the prognoses of oncological emergencies were worse compared with those without any emergency, whereas those of obstruction and perforation did not significantly differ. Regarding the type of recurrence, peritoneal dissemination in obstruction and local recurrence in perforation was more common compared with that in non-emergency cases. Adjuvant chemotherapy improved the recurrence-free survival for cases with oncological emergencies. The prognoses in cases with oncological emergencies could be worse compared with those without any emergency, whereas obstruction and perforation outcomes can be comparable. The administration of adjuvant chemotherapy should be strongly considered for oncological emergencies.

The role of radical cystectomy and lymphadenectomy in the management of bladder cancer with clinically positive lymph node involvement.

The role of radical cystectomy and pelvic lymph node dissection in muscle-invasive bladder cancer (MIBC) with clinically positive lymph nodes is debated. This review examines the role of surgery in treating patients with clinical N1 and more advanced nodal involvement (N2-N3) within a multimodal treatment approach. For clinical N1 disease, guidelines typically recommend neoadjuvant chemotherapy followed by surgery. However, for N2-N3 disease, guidelines vary. Advances in diagnostics, systemic therapies, and surgical recovery have improved the prognosis for these patients. Research is increasingly identifying MIBC patients, including those with positive nodes, who may achieve complete pathologic response and long-term survival, supporting the role of surgery even in advanced nodal stages. Managing MIBC with clinically positive lymph nodes, especially in N2-N3 disease, requires a tailored approach. While neoadjuvant chemotherapy followed by radical cystectomy is standard for N1 disease, the role of surgery in advanced nodal stages is growing because of better patient selection and treatment strategies. Emerging evidence suggests that consolidative surgery may improve outcomes in these complex cases.

Oncological and reproductive outcomes after fertility-sparing surgery in patients with stage Ⅱ-Ⅲ borderline ovarian tumor

Objective: To evaluate oncological and reproductive outcomes of women ≤40 years undergoing fertility-sparing surgery (FSS) for stage Ⅱ or Ⅲ borderline ovarian tumor (BOT). Methods: The patients with BOT and ≤40 years old with stage Ⅱ-Ⅲ BOT who underwent FSS enrolled from the First Affiliated Hospital of Zhengzhou University between January 2011 and March 2023 were analyzed retrospectively. The clinical data and follow-up results were obtained and analyzed. The univariate and multivariate Cox proportional hazard regression analysis were used to explore high-risk factors associated with prognosis. Additionally, pregnancy outcomes were also analyzed. Results: (1) A total of 79 patients with stage Ⅱ-Ⅲ BOT who have been treated with FSS were conducted, with an average age of (27.5±6.7) years old. The median tumor maximum diameter were 10.4 cm (range: 4.8-90.0 cm). The International Federation of Gynecology and Obstetrics (FIGO) stage was stage Ⅱ in 45 cases and stage Ⅲ in 34 cases. According to the pathological types, there were 48 cases of serous tumor, 21 cases of mucinous tumor, 1 case of endometrioid tumor, and 9 cases of mixed types. There were 41 cases of unilateral ovarian involvement, 38 cases of bilateral ovarian involvement. There were 5 cases of microinvasion, 17 cases of micropapillary subtype. Extra-ovarian invasive implants were found in 5 cases, and there were 31 cases of merged ascites. (2) Tumor outcomes: the median follow-up time from primary cytoreduction were 58 months (range: 8-146 months). At the end of the observation period, 24 cases (30%, 24/79) recurred, among them 5 cases had two recurrences and 2 cases had three recurrences. There were 2 cases (3%, 2/79) of death and 1 case (1%, 1/79) of survival with tumor. (3) Analysis of prognostic risk factors: the results of univariate analysis showed that mucinous tumor, tumor maximum diameter >13.15 cm, FIGO stage Ⅲ, merged ascites, micropapillary subtype, invasive implantation, and bilateral ovarian involvement were independent risk factors (all P<0.05) for disease-free survival (DFS). FIGO stage Ⅲ (HR=4.555, 95%CI: 1.525-13.607; P=0.007) and micropapillary subtype (HR=2.396, 95%CI: 1.003-5.725; P=0.049) were found to be related to DFS through the multivariable Cox proportional hazard regression analysis. (4) Pregnancy outcomes: among the patients with fertility intentions 36 cases (46%,36/79), 29 cases (81%, 29/36) had successful pregnancies, and 27 cases (75%, 27/36) had successful births. Conclusions: Patients with stage Ⅱ-Ⅲ BOT underwent FSS have favorable survival and pregnancy rates. Micropapillary subtypes and FIGO staging (stage Ⅲ) are the significant risk factors of DFS.

Combined robotic surgery for concomitant treatment of endometrial cancer and obesity.

Endometrial Cancer (EC) is strongly linked to obesity. Bariatric surgery is recognized as a long-term solution for weight loss in severely obese patients. This pilot study investigates the feasibility, intraoperative and 30-day morbidity outcomes of integrating gynecological surgical staging and bariatric robotic surgery in class II and III obese patients affected by early EC or Endometrial Intraepithelial Neoplasia (EIN). Patients aged over 18years old with early EC or EIN and class II and III obesity (Body mass index (BMI) ≥ 35kg/m2) who are surgical and anesthesiologic candidates. Standard robotic surgery for early EC staging performed alone (THBSO group) or in conjunction with sleeve gastrectomy (THBSO + SG group) for obesity management was proposed. Of the 13 patients who met the inclusion criteria, 5 (38.46%) opted for combined surgery. The groups showed a significant difference in preoperative BMI (49.68kg/m2 vs. 40.24kg/m2 p = 0.017 with and without SG), preoperative weight (143.92kg vs. 105.62kg p = 0.004 with and without SG), preoperative (p = 0.01) and postoperative (p = 0.005) aspartate transaminase (AST). The THBSO + SG group had higher anesthesia induction end-tidal carbon dioxide (ETCO2) (p = 0.05), final Partial pressure of carbon dioxide (PaCO2) (p = 0.044), anesthesia induction lactate (p = 0.001) and final lactate (p = 0.011) without a significant difference in final pH (p = 0.31). Operative time was longer in the THBSO + SG group (p < 0.001), but this did not result in longer ICU (p = 0.351), total hospital stays (p = 0.208), nor increased blood loss and transfusion. The simultaneous combined approach had an 80% success rate. At 6months, the THBSO + SG group achieved significantly greater weight loss than the THBSO group (ΔBMI -11.81kg/m2 vs -1.72kg/m2, p = 0.003, with and without SG). Integrating robotic EC staging with SG in obese women with early EC increased the operative time without increasing intraoperative risks, early and 30days post-surgery complication and offering a promising approach to simultaneously treating both conditions.

Laparoscopic versus open colectomy for locally advanced colon cancer in obese patients: a nationwide, multicenter, propensity score-based analysis of short- and long-term outcomes

Abstract Objective This study evaluated the short-and long-term outcomes of laparoscopic colectomy versus open surgery in obese patients (body mass index ≥25 kg/m2) with locally advanced colon cancer to ascertain the non-inferiority of laparoscopic surgery to open surgery. Methods In this large cohort study (UMIN-ID: UMIN000033529), we retrospectively reviewed prospectively collected data from consecutive patients who underwent laparoscopic or open surgery for pathological stage II–III colon cancer between 2009 and 2013. A comparative analysis was performed after propensity score matching between the laparoscopic and open surgery groups. The primary endpoint was the 3-year relapse-free survival (RFS). Results We identified 1575 eligible patients from 46 institutions. Each group comprised 526 propensity score-matched patients. Comparing the laparoscopic versus open surgery group, laparoscopic surgery was significantly associated with increased median operating time (225 vs. 192.5 min; P &amp;lt; .0001) and decreased median estimated blood loss (20 vs. 140 ml; P &amp;lt; .0001). Lymph node retrieval (20 vs. 19; P = 0.4392) and postoperative complications (4.6% vs. 5.7%; P = 0.4851) were similar, postoperative hospital stay was shorter (10 vs. 12 days; P &amp;lt; .0001), and the 3-year RFS rates were similar (82.8 vs. 81.2%). The hazard ratio (HR) for relapse-free survival for laparoscopic versus open surgery was 0.927 (90% confidence interval [CI], 0.747–1.150, one-sided P for non-inferiority = .001), indicating that for obese patients with colon cancer, laparoscopic surgery was non-inferior to open surgery. Conclusion Laparoscopic surgery in obese patients with colon cancer offers advantages in terms of short-term outcomes and no disadvantages in terms of long-term outcomes.

Characteristics and prognostic implications of a cohort of 50 Sertoli-Leydig cell tumors at a single center.

The aim of the study was to investigate the clinical characteristics, therapy strategies and prognosis of Sertoli-Leydig cell tumors (SLCTs). A total of 50 cases of ovarian SLCTs were retrospectively analyzed. We performed descriptive statistics to describe baseline characteristics. A total of 70% of SLCT patients were below the age of 45 years. The dominant pathologic types were poor (40%) and moderate (40%) differentiation. Retiform variant tumor is more aggressive and tends to appear in children. According to the 2014 FIGO (the International Federation of Gynecology and Obstetrics) classification, tumors were classified as Stage I (n = 46: well differentiated, n = 4; moderately differentiated, n = 19; poorly differentiated, n = 18; and retiform, n = 5), Stage II (n = 1, moderately differentiated), Stage III (n = 1, poorly differentiated), and Stage IV (n = 2: poorly differentiated, n = 1; and retiform, n = 1). Median follow-up was 58.1 months (2-132 months). A total of 45 patients (90%) achieved clinical remission. Four patients experienced a relapse (34.5 months, range: 7-58) and one patient died of the tumor at 10 months after initial treatment. All patients in grossly Stage IA achieved complete response, irrespective of the presence or absence of staging surgery or chemotherapy. After treatment, five patients successfully gave birth to healthy babies. The prognosis for women diagnosed with early stage (I-II) SLCT is generally favorable, especially Stage IA. while those with advanced stages, poorly differentiated, retiform variant, or tumors containing heterologous components exhibit a more aggressive clinical course. Fertility sparing surgery appears to represent a feasible treatment approach for early stage SLCTs.

VNOTES scarless and painless endometrial cancer staging surgery.

Sentinel lymph node dissection is performed in endometrial cancer surgery instead of staging surgery, particularly when the disease is advanced and confined to the uterus. The aim of this study is to share our sentinel lymph node detection rates via the vaginal natural orifice transluminal endoscopic surgery method with the literature and to demonstrate a safer and more comfortable surgical treatment process. The analysis includes the patients who underwent surgery sentinel lymph node dissection for endometrial cancer utilizing indociyanin green in our center between January 2022 and June 2024. In all, of 24 endometrial cancer patients underwent surgery sentinel lymph node dissection, nonendometrioid (serous) pathology was observed in only 1 (4%) patient, our other patients (96%) had endometrioid adenocarcinoma pathology. The rates of our sentinel lymph node dissection bilateral and symmetric are 96% (23/24), 94% (22/24), and 79% (19/24), respectively. We would like to emphasize that we successfully used vaginal natural orifice transluminal endoscopic surgery approach on four of our patients who were unsuitable for laparoscopic and robotic surgery due to pain scores of 2 at the 12th hour after surgery and low lung capacity. Vaginal natural orifice transluminal endoscopic surgery and sentinel lymph node dissection will be considered as surgical options in other gynecological cancers due to the comfort it brings to the patient in endometrial cancer.

Real-world outcomes of stage II and III colorectal cancers treated by postoperative adjuvant chemotherapy based on the mismatch repair status.

In Japan, immunohistochemistry for mismatch repair (MMR) proteins targeted at stage II and III colorectal cancers (CRCs) has been covered by national insurance since October, 2022. This study aimed to clarify the long-term outcomes of patients with stage II and III CRCs receiving postoperative adjuvant chemotherapy based on their MMR status. The outcomes of 640 patients who underwent radical surgery for stage II and III CRCs were analyzed retrospectively. Deficient MMR (dMMR) was diagnosed in 41 (13.3%) patients with stage II and 28 (9.1%) patients with stage III CRC. The overall survival and recurrence rates were not significantly different between the patients with stage II and those with stage III CRC. The risk factors for recurrence among those with stage II CRC were tumors on the left side, T4 disease, and the presence of BRAF wild type. The recurrence rates were lower in the stage II CRC patients with sporadic dMMR than in those with suspected Lynch syndrome (LS). The first site of recurrence was more frequently the peritoneum or distant lymph node in patients with dMMR. Stage IICRC patients with sporadic dMMR were found to have a very good prognosis. On the other hand, peritoneal dissemination or distant lymph node metastasis tended to develop in patients with dMMR.

Clinicopathological and survival analysis for patients with uterine sarcoma treated following surgery for presumed benign disease

ObjectivesTo investigate the clinicopathological characteristics and prognosis of patients with uterine sarcoma treated following surgery for presumed benign disease.MethodsWe identified all patients with uterine sarcoma found incidentally after primary surgery for presumed benign disease who presented to our institution and received re-exploration for completion surgery from January 1, 2004 to January 1, 2021. We analyzed the clinicopathological characteristics and prognosis.ResultsOverall, 95 patients were included in our study. For the initial surgery, myomectomy was performed in 50 (52.6%, 50/95) patients, hysterectomy was performed in 45 (47.4%, 45/95) patients. All patients were re-explored to complete the staging operation. The median time to the staging surgery was 40 days (range 15–90 days). There were 29 patients (30.5%, 29/95) had remnant sarcomas, with 17 patients (17/95, 17.9%) on the remaining uterus, 9 patients (9/95, 9.5%) had disseminated diseases, and 4 patients (4/95, 4.2%) had positive lymph nodes. About 40 patients (42.1%) received adjuvant chemotherapy, 55.2% (16/29) and 36.4% (24/66) patients with/without remnant diseases received adjuvant chemotherapy, respectively (P = 0.087). The median follow-up duration was 76.7 months (IQR: 34.8-118.1 months). And 17 patients (17.9%) had recurrence following re-exploration surgery. 5-year progression-free survival (PFS) and 5-year overall survival (OS) for the entire cohort was 81.7% and 92.1%, respectively. Patients with remnant sarcomas had a tendency towards a worse 5-year PFS and 5-year OS, compared with those without (5-year PFS: 75.6% vs. 84.5%, P = 0.224; 5-year OS: 85.5% vs. 95.1%, P = 0.217). Patients with disseminated diseases had a worse 5-year OS (62.5% vs. 95.1%, P = 0.007) and non-significantly worse 5-year PFS (64.8% vs. 83.4%, P = 0.153) compared with those without.ConclusionsPatients with uterine sarcoma treated following surgery for presumed benign disease have a favorable survival. Patients with disseminated diseases had a worse 5-year OS compared with those without. Surgical re-exploration may be valuable for removing remnant sarcomas and disseminated diseases.

Prognosis and treatment of uterine sarcoma found incidentally after myomectomy

ObjectiveTo determine prognosis and factors associated with survival of women with uterine sarcoma found incidentally after myomectomy. MethodsWe performed a retrospective study for patients who had previously undergone myomectomy for presumed benign uterine fibroid disease and were found to have uterine confined sarcoma after myomectomy surgery. ResultsIn total, 50 patients were identified. There were 23 (46.0 %) patients undergoing myomectomy were performed by minimal invasive surgery: laparoscopic (Lap, n = 22, 44.0 %) or transvaginal (TV, n = 1, 2.0 %) approach; while, 24 (48.0 %) and 3 (6.0 %) patients had myomectomy through abdominal (Abd) or hysteroscopic (Hys) approach. All patients received the re-exploration and staging surgery in our center. The median time from myomectomy to the staging surgery was 43 days (range 15–90 days). 17 patients had remnant sarcomas on the remaining uterus and 6 patients had disseminated disease after re-exploration. In the entire cohort, 5-year RFS and 5-year OS was 79.4 % and 88.0 %, respectively. Patients who received initial Lap/TV myomectomy had a tendency towards a worse 5-year RFS compared with Abd/Hys approach (63.0 % vs 88.9 %, P = 0.080). No difference in 5-year OS was found between the two groups (90.3 % vs 91.8 %, P = 0.768). For stage I disease (n = 44), patients who received Lap/TV myomectomy had a worse 5-year RFS compared with Abd/Hys approach (58.3 % vs 95.7 %, P = 0.009). No difference in 5-year OS was found (P = 0.121). ConclusionPatients with incidental uterine sarcoma who received primary Lap/TV myomectomy may have a worse RFS. Re-exploration can detect remnant or disseminated sarcomas.

549. CLINICAL IMPLICATIONS OF SELECTIVE RIGHT PARATRACHEAL LYMPH NODE DISSECTION IN PATIENTS WITH EARLY-STAGE ESOPHAGEAL CANCER: PROPENSITY-SCORE MATCHED ANAYLSIS

Abstract Background The optimal extent of lymph node dissection in esophageal squamous cell carcinoma (Sqcc) still remains a topic of debate without specifying the lymph node stations. This study aimed to evaluate the clinical impact of selective right paratracheal lymph node (RtPTLN) dissection in patients with esophageal squamous cell carcinoma (SQCC). Methods We included the patients who underwent curative surgery for clinical stage I esophageal SQCC (cT1N0) at our institution between January 2010 and December 2021. Patients who underwent neoadjuvant therapy were excluded. A total of 1,484 patients underwent surgery for esophageal cancer at our institution during the study period. Among these, 658 patients (mean age 63.1±7.7 years, 46 [7.0%] women) were identified, categorized into RtPTLN+ (dissection performed, n = 88) and RtPTLN- (no dissection, n = 570) groups. The RtPTLN+/- groups were matched in a 1:3 ratio using propensity scores. Results Median follow-up was 48.8 (24.2–85.2, interquartile) months. Five-year overall survival (OS, RtPTLN+ vs. RtPTLN-, 75.8% vs. 79.0%, P = 0.38) and recurrence-free survival (RFS, 70.0% vs. 72.5%, P = 0.55) rates showed no significant differences. Propensity-score matching yielded 313 patients: RtPTLN+ (n = 83) and RtPTLN- (n = 230). OS and RFS rates did not significantly differ between RtPTLN+ and RtPTLN- groups (OS: 77.2% vs. 79.9%, P = 0.57; RFS: 72.1% vs. 74.7%, P = 0.79) after adjustment (Figure). Multivariate analysis confirmed that RtPTLN dissection was not a significant predictor for OS or RFS (Table). Conclusion In this propensity-score matched analysis, there was no significant difference in OS and RFS between patients with and without RtPTLN dissection. These findings discreetly suggest that the routine RtPTLN dissection may not be necessary, and selective dissection could be considered acceptable.

539. ASSOCIATION BETWEEN WAITING PERIOD FOR RADICAL SURGERY AND POSTOPERATIVE RELAPSE IN CLINICAL STAGE I ESOPHAGEAL CANCER

Abstract Background Esophagectomy with locolegional lymphanedectomy based on potential lymph node metastatic risk is the current standard treatment for clinical Stage I thoracic esophageal cancer. Local excision by endoscopic submucosal dissection (ESD) is the standard treatment for clinical Stage 0, however surgery is considered as an additional treatment for pathological T1b cases due to potential metastatic risk. Cases of additional resection after ESD are those pathologically demonstrated to have a high risk of metastasis based on tumor depth and vascular invasion, etc. Compared to cases of surgery for clinical Stage I, many of these cases have a high risk of metastasis, and therefore a poor prognosis is generally expected. Addionally, the prolonged waiting time between initial diagnosis and radical surgery due to ESD may be a factor in poor prognosis, but there is currently no consensus on the risk. Therefore, we conducted a study to clarify the effect of waiting period before surgery (WP) on the risk of recurrence in clinical Stage I esophageal cancer surgery. Methods We retrospectively evaluated the association between WP and 3-year postoperative recurrence-free survival (3y-RFS) in 65 patients who underwent primary esophagectomy and gastric tube reconstruction for clinical Stage I esophageal cancer and 22 patients who underwent additional resection after ESD at our hospital. Results The WP of 87 patients was 2.12 ± 1.43 months (mean± SD), and 13 patients had postoperative recurrence (3y-RFS 85.1%). A 2-arm comparison of short or long WP with a cutoff value of 2.83 months (mean+0.5 SD) showed no clear association with 3y-RFS (100% vs 81.4%, p=0.071). A strong correlation was shown between WP and ESD (r=0.647, p&amp;lt;0.01). WP was 1.69±1.20 months (mean± SD) in 65 patients who underwent surgery as initial treatment, and 12 patients had postoperative recurrence (3y-RFS 81.5%). A 2-arm comparison of short or long WP with a cutoff value of 2.29 months (mean+0.5 SD) suggested an association with 3y-RFS (85.7% vs 55.6%, p=0.018). Conclusion Although this is a single-center, retrospective study of a small number of cases and only a univariate study due to the small number of events, it suggests that a longer waiting period before surgery may be a risk factor for postoperative recurrence.

Surgical outcomes of patients with locally advanced thymic epithelial tumor undergoing induction therapy followed by surgery: a narrative review.

Thymic epithelial tumors (TETs), including thymomas and thymic cancers, are relatively rare malignancies originating from the thymus. Although complete surgical resection is the cornerstone of treatment for these tumors, the optimal management strategy for locally advanced cases remains uncertain. Neoadjuvant therapies, with their potential to improve the likelihood of complete resection, are promising, particularly in marginally operable cases. However, the current evidence supporting this approach is lacking. This review of the existing literature on the efficacy of induction therapy followed by surgical resection for stage III or IV locally advanced TETs aimed to provide an up-to-date perspective and highlighting directions for future clinical research. PubMed was searched using the keywords "surgery," "survival", "thymoma", "thymic cancer", and "induction therapy". Relevant articles including case series, retrospective studies, prospective studies, and review articles were reviewed and selected for this comprehensive narrative review. This review included primarily revealed retrospective studies and a limited number of prospective phase II trials on induction therapy followed by surgery for stage III or IV locally advanced TETs. No randomized phase III studies were identified, indicating that a comprehensive evaluation of the benefits of induction therapy on overall survival (OS) has not yet been conducted. Induction therapies for both invasive thymoma and thymic cancer included chemotherapy, radiotherapy, and chemoradiotherapy, with anthracycline-based combination chemotherapies being the primary option. For exclusively invasive thymomas, the median rate of complete surgical resection and the 5-year OS rate were reported as 76% and 85%, respectively. Literature focusing on induction therapy for TETs, which includes both thymoma and thymic cancers, indicates that the rates of complete resection and 5-year OS are 76% and 70%, respectively. Our narrative review of retrospective and prospective studies highlighted promising long-term OS rates in patients with advanced TETs who underwent induction therapy followed by surgical resection. These findings support this multimodal treatment strategy in selected patients with stage III and IV TETs.

Investigating age and ethnicity as novel high-risk phenotypes in mucinous ovarian cancer: retrospective study in a multi-ethnic population

ObjectivesPrimary mucinous ovarian carcinoma represents 3% of ovarian cancers and is typically diagnosed early, yielding favorable outcomes. This study aims to identify risk factors, focussing on the impact of age...

Visual prognostic factors following surgery for stage 3 idiopathic epiretinal membrane by Govetto classification.

To investigate the visual prognosis of metamorphopsia in patients undergoing surgery for stage 3 idiopathic epiretinal membrane (ERM) by Govetto classification using preoperative optical coherence tomography (OCT) parameters. Retrospective clinical study. This study included 45 eyes of 45 patients with a minimum follow-up period of 3 months. The best-corrected visual acuity (BCVA) and metamorphopsia score using the M-CHARTS were recorded. Central foveal thickness (CFT), inner nuclear layer thickness (INL), ectopic inner retinal layer thickness (EIFL), outer retinal layer thickness, disruption of the ellipsoid zone, cotton ball sign, and intraretinal cystoid changes were measured based on spectral domain OCT. Preoperative and postoperative values and conditions were compared, and correlations between the preoperative values or conditions and postoperative metamorphopsia scores or BCVA were analyzed. After surgery, the horizontal, vertical, and mean metamorphopsia scores, as well as BCVA, CFT, INL, and EIFL significantly improved (p < 0.001). Using multivariate analysis, only preoperative CFT was a significant explanatory parameter for both the postoperative horizontal metamorphopsia scores and mean values of the postoperative horizontal and vertical metamorphopsia scores (p = 0.019 and p = 0.011, respectively). Age (p = 0.011) and preoperative CFT (p = 0.026) were significant explanatory parameters of postoperative BCVA. Preoperative CFT significantly correlated with postoperative metamorphopsia in patients undergoing surgery for stage 3 idiopathic ERM. This finding might help surgeons predict postoperative visual outcomes and make timely surgical decisions.

A report of twenty cases of ovarian Brenner tumor and literature review: a case series study

BackgroundTo explore the clinical characteristics of ovarian Brenner tumors and provide some basis for the treatment regimen of ovarian Brenner tumors.MethodsA retrospective analysis of the pathology database of surgical specimens at the Huzhou Maternal and Child Health Hospital from September 2008 to February 2023 was conducted. Patients who were pathologically diagnosed with ovarian Brenner tumors were included. Clinical data of patients was collected, and their diagnostic and treatment characteristics were summarized and analyzed.ResultsA total of 20 cases were included in this study, all of which were histologically confirmed by surgical pathology. Among them, 8 cases (40%) were combined with serous, mucinous cystadenoma, or simple cyst. One case presented with a benign ovarian Brenner tumor combined with mucinous cystadenoma, underwent right adnexectomy, and relapsed 5 years later as a malignant Brenner tumor (MBT) coexisting with ovarian squamous cell carcinoma. Multiple tumor markers were elevated malignantly, with CA199 being the most significant. Treatments included unilateral adnexectomy in 7 cases, bilateral adnexectomy in 3 cases, total hysterectomy with bilateral adnexectomy in 7 cases, radical hysterectomy in 1 case, and 2 cases underwent ovarian staging surgery. MBT patients received three cycles of postoperative chemotherapy with the carboplatin-paclitaxel (TC) regimen. Follow-up: One case with concomitant cervical cancer was lost to follow-up after surgery in an external hospital; one case with concomitant ovarian cancer received no further treatment after surgery and was lost to follow-up after 2 years; one case with concomitant endometrial cancer received no further treatment after surgery, and had no recurrence after 4 years of follow-up. Regular follow-up for MBT patients continued for 5 years without recurrence. The remaining 16 cases were followed up for a period ranging from 6 months to 7 years, with no reported recurrences.ConclusionClinical manifestations and auxiliary examinations of ovarian Brenner tumors lack obvious specificity. When necessary, a combination of tumor markers and imaging examinations can aid in diagnosis. Surgical strategies should be selected according to the patient's menopausal status.Trial registrationNot applicable.