Surgical Margin Rate Research Articles

Exploring the Role of Intracorporeal Ultrasound in Partial Nephrectomies: A Systematic Review.

Renal cell carcinoma accounts for the sixth most common cancer in the United Kingdom. With the increasing application of cross-sectional imaging, the frequency of incidental renal masses has increased over time. Laparoscopic and robot-assisted partial nephrectomy has become the standard of care in the management of size and stage-appropriate renal masses. The objective of this systematic review was to analyse the surgical outcomes when intracorporeal ultrasound was utilised as an adjunct in partial nephrectomy. A comprehensive search in PubMed and Google Scholar was performed in July 2024 for publications in the English language. The primary endpoint was to evaluate the role of intracorporeal ultrasound as an adjunct in robotic partial nephrectomies and its impact on tumour clearance. After identifying 609 records, 52 records were screened and 44 records were sought for retrieval. Eight publications were included in this systematic review comprising 765 patients. Seven of the eight studies reported outcomes from single centres. The mean percentage of negative surgical margins was 97.6% (range = 92.1-100%). The use of intracorporeal ultrasound as an adjunct in partial nephrectomy for T1 renal cell cancer has proven to improve the rates of negative surgical margins thereby reducing the incidence of local recurrence and distant metastasis.

Biochemical recurrence after open radical prostatectomy in a single-center cohort with a minimum follow-up of 10 years

Purpose: To investigate the long-term oncological outcomes and report biochemical recurrence (BCR)-free survival for men who underwent open radical prostatectomy at a single center. Materials and methods: A total of 360 patients who underwent open radical prostatectomy at our institution between 2003 and 2011 were included in this study. The BCR-free survival rates were calculated by Kaplan-Meier method and log-rank analysis. Multivariable Cox regression models were used to test the effect of other factors such as age, preoperative prostate-specific antigen (PSA), Gleason score, and surgical margins on BCR. Results: Median patient age was 65.4 years, with a median preoperative PSA level of 6.21 ng/ml. Operating time had a median duration of 155.1 minutes, ranging from 104 to 301 minutes. Nerve-sparing surgery was achievable in 48.1% of patients, including 34.2% undergoing bilateral procedures and 13.9% unilateral. In terms of surgical precision and outcomes, the overall rate of positive surgical margins was 23.6%, which decreased significantly to 11.1% in patients with localized prostate cancer. Lymph node involvement occurred in 3.6% of cases. Postoperative care statistics revealed a median catheterization duration of 9.1 days (range: 4–30 days) and a low rate of significant complications (4.4%). The early continence rate in a standardized pad test was 80.6%. At a median follow-up of 150.5 months, the 5-year and 10-year BCR-free survival rates for the entire cohort were 91.4% and 77.5%, respectively. The 10-year BCR-free survival rates were 84.8%, 81.5%, and 68.5% for low-, intermediate-, and high-risk patients, respectively. Furthermore, the 10-year BCR-free survival rates were 78.8% and 62.8% for localized and locally advanced prostate cancer, respectively. Preoperative PSA >20 ng/ml, postoperative Gleason sum ≥3 + 4, and positive surgical margins were associated with increased risk of BCR on multivariable Cox regression analysis. Conclusion: Our long-term oncological results match or exceed those previously published in similar contemporary cohorts with long follow-up.

Outcomes after robot-assisted radical cystectomy with orthotopic neobladder in women

PurposeTo investigate functional, oncological and complication outcomes in women undergoing robot-assisted cystectomy (RARC) with intracorporeal orthotopic neobladder.MethodsFrom a multi-institutional database, we identified females with bladder cancer treated with RARC and intracorporeal orthotopic neobladder. We evaluated the continence rate, short-term oncological outcomes, and complication rates. Analyses were repeated and stratified by the status of preserving gynecological organs.ResultsThe study involved 146 patients with the median age 60 years (IQR, 51–66 years). Pelvic organ-preserving procedure (POP) was performed in 77 patients (53%). Overall daytime and nighttime continence rates were 54% and 53%, respectively. For POP, the continence rate was 58% for both daytime and nighttime continence. In the non-POP cohort, the continence rate was 50% for daytime and 49% for nighttime continence. Both groups had balanced positive surgical margin rates (5,3% for POP and 4,7% for non-POP). In the whole cohort, high-grade (Clavien-Dindo ≥3) early and late complication rate was 7,5% and 7,5%, respectively.ConclusionsRobot-assisted radical cystectomy with intracorporeal orthotopic neobladder in females demonstrate excellent functional and complication outcomes. Pelvic organ-preserving cystectomy enhances urinary continence rates without adversely affecting surgical margins. Orthotopic neobladder in selected women with bladder cancer, along with pelvic organ-preserving cystectomy may be used for improved functional outcomes without compromising oncological results.

Robotic surgery of the urothelial carcinoma of the upper urinary tract single surgeon initial experience, 66 consecutive cases

PurposeRobotic surgery is increasingly utilized in the treatment of urothelial carcinoma of the upper urinary tract (UTUC). This study investigates the advantages and burden of robot-assisted surgical treatment of the urothelial carcinoma of the upper urinary tract in a referral urological department, along with their functional and oncological results.MethodsThe study included 66 prospectively enrolled patients who were surgically treated by a single, robotically specialized surgeon between July 2019 and December 2023. Patients were divided into three groups. Group 1: 50 patients underwent robot-assisted radical Nephroureterectomy (RANU) with bladder cuff excision, Group 2: 11 patients underwent RANU simultaneously with robot-assisted radical cystectomy (RARC), and Group 3: 5 patients underwent robot-assisted segmental ureterectomy (RASU). Clinical and oncological parameters were compared. Perioperative morbidity according to Clavien-Dindo was the primary endpoint of our study. The secondary endpoint was oncologic outcomes.Results37.8% of patients had locally advanced carcinomas. The average console time of RANU with bladder cuff excision was 69 min. The rate of positive surgical margins was n = 1/66 (2%). Lymphadenectomy (LAD) was performed on 30% of patients, with a mean of 13.7 lymph nodes removed. Of those who received LAD, 33% had lymph node metastasis. n = 6/66 (9%) patients received blood transfusion. The overall complication rate was 24%. The readmission rate was 7.5%. With a median follow-up of 26 months, the 2-year recurrence-free survival rate was 84.4%, and the 2-year overall survival rate was 94%.ConclusionRobotic surgery is a feasible option for treating UTUC that can be adapted to meet the surgical needs of each patient. Prospective studies are warranted to confirm its benefits.

Racial Disparities in Preoperative Breast MRI Use and Surgical Margin Outcomes among Patients with Recently Diagnosed Breast Cancer.

Purpose To evaluate racial disparities in preoperative breast MRI use and surgical margin outcomes among patients with recently diagnosed breast cancer. Materials and Methods This retrospective study included patients with breast cancer who presented to a single cancer center between 2008 and 2020, underwent breast surgery, and self-identified as White or Black. Patients were divided into MRI or no-MRI cohorts based on preoperative MRI use. MRI use and positive surgical margin rates were determined for all patients and racial subgroups. Data were collected from the electronic medical record and analyzed using the χ2 test for significance. Results The study included 28 384 female patients (mean age, 56 years ± 13 [SD]) with recently diagnosed breast cancer who self-identified as White (90.36%, n = 25 647) or Black (9.64%, n = 2737). Of the entire cohort, 32.78% (9305 of 28 384) underwent preoperative MRI. Black patients had a lower rate of preoperative MRI use than White patients (29.85% [817 of 2737] vs 33.10% [8488 of 25 647], respectively; P < .001). The MRI cohort had a lower positive margin rate compared with the no-MRI cohort (2.90% [133 of 4592] vs 4.78% [539 of 11 271], respectively; P = .03). In the no-MRI cohort, Black patients had a higher positive margin rate than White patients (6.17% [68 of 1103] vs 4.63% [471 of 10 168], respectively; P = .03). In the MRI cohort, there was no evidence of a difference in positive margin rates between Black and White patients (3.17% [12 of 379] vs 2.87% [121 of 4213], respectively; P = .90). Conclusion Compared with White patients, Black patients with breast cancer were less likely to undergo preoperative MRI and had a higher positive surgical margin rate. Keywords: MR Imaging, Breast Cancer, Breast MRI © RSNA, 2024 See also the commentary by Tran and Miles in this issue.

Improving postoperative survival in cholangiocarcinoma: development of surgical strategies with a screening program in the epidemic region

BackgroundThe Cholangiocarcinoma Screening and Care Program (CASCAP) has been launched since 2013 to detect early-stage cholangiocarcinoma and reduce the disease death. However, the clinical utility of the CASCAP remains unclear. To compare survival outcomes between two time periods: before and after 2013, when significant changes in treatment strategies were implemented, and to evaluate the efficacy of the ultrasound-based screening program, in an Asian region endemic for cholangiocarcinoma.MethodsA single-center retrospective review was conducted in curative-intended resection cholangiocarcinoma from 2002 to 2021. Patents characteristics and survival outcomes were compared between 2002 and 2013 (early period) and 2014 to 2021 (later period).ResultsA total of 1091 patients with intrahepatic (n = 624) or perihilar (n = 467) cholangiocarcinoma was included (early period, n = 658; later period, n = 433). Of 66 (15.2%) patients in the later period were referred by the CASCAP. The incidence of early-staged disease (Stage 0 and 1) was lower in early period compared to later period 16.0% versus 29.1% (p < 0.001); that of positive surgical margin was higher in early period 53.7% versus 40.0% (p < 0.001). A median survival time (MST) was 14 months in early and 40 months in later period (p < 0.001). Subgroup analysis by tumor location, the MST was 13 versus 60 months in early and late periods for intrahepatic tumor (p < 0.001), respectively. While MST in perihilar tumor was 18 versus 31 months in early and late periods(p < 0.001), respectively. By presentation, the MST was 51 vs. 38 months, respectively, with screening and usual presentation (p = 0.06).ConclusionPostoperative survival in CCA patients improved more than doubled during the study period. Moreover, the late period demonstrated enhanced early-stage detection, a higher rate of negative surgical margins, and improved survival outcomes.

Study of Complete Surgical Response of Stage III Oral Carcinoma Patients in Comparison to Primary Surgery Versus Neoadjuvant Methotrexate With Surgery.

Objective This study aims to compare the efficacy of neoadjuvant methotrexate therapy followed by surgery versus primary surgical management in patients with stage III oral carcinoma. Methods Thirty patients diagnosed with stage III oral carcinoma were enrolled in this prospective study at a tertiary cancer research center. The patients were divided into two groups: 15 patients received neoadjuvant methotrexate therapy followed by surgery, while 15 underwent primary surgical management. Outcomes were evaluated based on tumor downstaging, surgical margins, postoperative complications, and the requirement for adjuvant radiotherapy. Results Patients in the neoadjuvant methotrexate group demonstrated significant tumor downstaging, allowing for less extensive surgical procedures, with 33.3% (n=5) undergoing wide local excision (WLE) compared to 13.3% (n=2) in the primary surgery group. Negative surgical margins were achieved in 93.33% (n=14) of patients in the neoadjuvant group versus 53.33% (n=8) in the surgical group. Additionally, only 13.3% (n=1) of patients in the neoadjuvant group required postoperative radiotherapy, compared to 53.33% (n=8) in the surgical group. The recurrence rate over a six-month follow-up period was comparable between the two groups. Discussion Neoadjuvant methotrexate therapy resulted in better surgical and oncological outcomes by downstaging the tumor, reducing the extent of surgery, and minimizing the need for postoperative radiotherapy. The findings suggest that methotrexate, as a neoadjuvant agent, is effective in improving patient outcomes with fewer side effects compared to standard cisplatin-based regimens. Conclusion Neoadjuvant methotrexate therapy offers a viable treatment option for stage III oral carcinoma, demonstrating improved oncological and surgical outcomes, including less invasive surgery, higher rates of negative surgical margins, and reduced postoperative radiotherapy requirements. Further research with long-term follow-up is necessary to validate these findings and explore the long-term impact on survival and recurrence rates.

Association between maximal urethral length preservation and postoperative continence after robot-assisted radical prostatectomy: a meta-analysis and systematic review.

Urinary incontinence is a common complication following robot-assisted radical prostatectomy (RARP). Urethral length has been identified as a factor affecting postoperative continence recovery. In this meta-analysis, we examined the association between use of the maximal urethral length preservation (MULP) technique and postoperative urinary continence in patients undergoing RARP. We conducted a comprehensive search of PubMed, Web of Science, Embase, and the Cochrane Library up to December 31, 2023. The quality of the literature was assessed using the Newcastle-Ottawa Scale. A random-effects meta-analysis was performed to synthesize data and calculate the odds ratio (OR) from eligible studies on continence and MULP. Six studies involving 1869 patients met the eligibility criteria. MULP was positively associated with both early continence (1 month after RARP; Z = 3.62, P = 0.003, OR = 3.10, 95% confidence interval [CI]: 1.68-5.73) and late continence (12 months after RARP; Z = 2.34, P = 0.019, OR = 2.10, 95% CI: 1.13-3.90). Oncological outcomes indicated that MULP did not increase the overall positive surgical margin rate or the positive surgical margin status at the prostate apex (both P > 0.05). In conclusion, the use of the MULP technique in RARP significantly improved both early and late postoperative continence outcomes without compromising oncological outcomes.

Pathologic Characteristics and Surgical Outcomes of Pediatric Versus Adult Well-Differentiated Thyroid Cancer.

Despite the rising incidence of pediatric differentiated thyroid cancer (DTC), postoperative outcomes for such tumors have not been well-characterized. The objective of this study was to compare pathologic tumor characteristics and treatment outcomes for pediatric and adult patients with DTC. Retrospective case-control study. National database. Pediatric (<18 years old) and adult (≥18 years old) patients who underwent surgery for DTC in the National Cancer Database (2004-2020) were included. Multivariable logistic, negative binomial, and linear regressions were used to compare pathologic tumor characteristics, treatment characteristics, and short-term surgical outcomes. 337,864 patients with DTC met the study eligibility criteria; 3584 (1.1%) were pediatric patients and 334,280 (98.9%) were adults. After adjustment, pediatric patients were found to have higher rates of pathologic T upstaging (adjusted odds ratio [ORadj]: 1.40, 95% confidence interval [CI]: 1.23-1.59), N upstaging (ORadj: 2.53, 95% CI: 2.23-2.88), and extrathyroidal extension (ORadj: 1.58, 95% CI: 1.29-1.94), compared to adult patients. Pediatric patients were also more likely to receive neck dissection (ORadj: 2.80, 95% CI: 2.55-3.07) and radioactive iodine (ORadj: 1.42, 95% CI: 1.30-1.55). Pediatric patients had higher rates of positive surgical margins (ORadj: 1.25, 95% CI: 1.11-1.41) and 30-day readmissions (ORadj: 1.26, 95% CI: 1.00-1.58) than adult patients. These findings demonstrate that pediatric DTC is associated with more aggressive disease presentations, more radical treatment, and worse short-term surgical outcomes compared to DTC in adults. Pediatric DTC should be considered a unique clinical entity that requires personalized evaluation and multidisciplinary treatment by specialized providers.

Early oncological outcomes of delayed radical prostatectomy: A prospective, international, follow‐up analysis of the COVIDSurg‐Cancer study

AbstractObjectivesThe objective of this study is to compare the early oncological outcomes of delayed (&gt;90 days) versus scheduled (≤90 days) radical prostatectomy (RP).Patients and methodsPatients with prostate cancer due to undergo surgery between March 2020 and June 2020 who were enrolled in the COVIDSurg‐Cancer international, observational study were prospectively followed up for 1 year. Time to surgery was defined as the difference between the operation date and the multi‐disciplinary team decision to offer surgery. The primary outcome was the positive surgical margin (PSM) rate. Biochemical recurrence (BCR), upgradation and upstaging were secondary oncological outcomes. The Independent t‐test and Mann Whitney U test were used to compare means between groups and regression models and were used to investigate factors associated with the primary outcome.ResultsFour hundred seventy‐six (78.7%) patients underwent RP from 605 that were eligible. Three hundred seven (64.5%) patients underwent scheduled RP, and 169 (35.5%) underwent delayed RP. A small proportion of men (n = 35, 6.8%) did not undergo RP within the 1‐year follow‐up period. More men with high‐risk disease (72.8%) underwent scheduled RP compared to men with intermediate‐risk disease (60.2%) (p &lt; 0.05). There was no statistically significant difference in the PSM rate between the two groups (p = 0.512). Delay in surgery was not associated with an increased PSM or BCR on univariable or multivariable analyses. There was statistically significantly greater upstaging (p &lt; 0.05) in the delayed group but no difference in upgradation.ConclusionHigh‐risk men were prioritised for surgery during the COVID‐19 pandemic. Our prospective data support previous retrospective, cancer‐registry evidence suggesting no adverse oncological impact after delaying RP across all risk groups. Our study is limited by the short follow‐up period, and therefore, longer term conclusions cannot be drawn.

ASO Author Reflections: Can Adequate Surgical Margin Rates after Mastectomy Be Improved?

ASO Author Reflections: Can Adequate Surgical Margin Rates after Mastectomy Be Improved?

The Controlling Nutritional Status (CONUT) Score as a Predictor of Local Recurrence in Patients Underwent Partial Nephrectomy Alongside the R.E.N.A.L. Nephrometry Score.

This study aims to assess the utility of the CONUT (Controlling Nutritional Status) Score and R.E.N.A.L. (Renal Nephrometry Score) Score in predicting tumor recurrence in patients with kidney cancer. Additionally, we investigated which parameters contributed to these scores. In total, 115 patients who underwent partial nephrectomy between January 2015 and August 2023 at a single tertiary center were enrolled. After the exclusion criteria, data from 88 patients were analyzed. Age, gender, body mass index (BMI), comorbidities (hypertension, diabetes), smoking status, tumor characteristics, CONUT Scores, and R.E.N.A.L. scores were retrospectively recorded. Statistical analyses were performed, and significant p was p < 0.05. The presence of diabetes and hypertension showed a statistically significant association with tumor recurrence (p = 0.033 and p = 0.003, respectively). A high BMI significantly increased the risk of recurrence (p < 0.05). There was a strong positive relationship between the high tumor stage and positive surgical margins with recurrence (p < 0.001). Patients with high R.E.N.A.L. Scores and high CONUT Scores had a higher risk of recurrence (42.1% and 8.7%, respectively), and this difference was statistically significant (p < 0.001). CONUT and R.E.N.A.L. scores may be used to predict tumor recurrence after partial nephrectomy. Additionally, diabetes, hypertension, high BMI, and positive surgical margin rate might affect surgical success rate for recurrences. Clinicians should consider all these parameters and coring systems to gather more successful results after partial nephrectomy.

The impact of surgical technique on very early functional outcomes after radical prostatectomy.

To determine the very early functional as well as oncological outcomes after robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) at a single institution. We identified patients who underwent RARP or ORP at our institution between August 2021 and July 2023. The main criterion for surgical technique selection was patient preference. Primary endpoints included anastomosis leakage rate, very early continence rate reported by standardized pad-test, and positive surgical margin rate. Furthermore, we analyzed operation time, hospital stay, postoperative analgesia, and complication rates. In this prospective study, we analyzed data from 222 radical prostatectomies (111 RARP and 111 ORP). There were no significant differences in preoperative age, prostate size, and risk stratification among the groups. Patients who underwent RARP had lower anastomosis leakage rates (8.1% vs. 18.9%) and slightly lower early continence rates (76.6% vs. 78.4%) when compared to patients who underwent ORP. Positive surgical margin rates were similar, and complication rates were also comparable. Operation time was similar for both techniques, but the hospital stay was significantly shorter in the RARP group (6.3 vs. 9.1 days, p=0.03). The ORP group experienced significantly higher opioid administration postoperatively (p<0.001). From a functional and oncological point of view, both techniques are safe and provide excellent outcomes when performed by experienced surgeons. Nevertheless, patients are likely to benefit from a shortened hospital stay and reduced postoperative pain after RARP.

Detection of Apical Cancer with Novel Imaging Modalities to Predict Apical Margin Positivity in Robotic Assisted Radical Prostatectomy

ObjectivesTo evaluate margin positivity at apex utilizing preoperative magnetic resonance imaging [MRI], micro-ultrasound [MUS], prostate specific membrane antigen positron emission tomography PSMA PET] scan, biopsy location and intraoperative timing of deep venous complex [DVC] ligation during robot assisted radical prostatectomy [RARP]. MethodsInstitution review board approved retrospective study underwent RARP between November 2022 to March 2024. All patients underwent preoperative MRI, MUS and PSMA PET scan. Patients underwent RARP using either standard DVC [done prior apical dissection] ligation or delayed DVC [after prostate removal] technique. All patients underwent intra operative frozen section analysis by an experienced genitourinary pathologist. Descriptive statistics were performed. Data analyzed using R software version 4.3.3. ResultsTotal 619 prostate cancer patients underwent RARP. Of these, 365 men underwent RARP using delayed DVC ligation technique and 254 men using standard DVC ligation technique. There was no statically significant difference in two groups on demographic parameters, MRI, MUS and PSMA-PET scan features. Sensitivity of MRI, MUS, PSMA-PET and prostate biopsy for detection of apical positive margin were 66%, 81%, 81% and 73% respectively. Specificity of MRI, MUS, PSMA-PET and prostate biopsy for detection of apical positive margin were 45%, 14%, 16% and 30% respectively. When all modalities are used accumulatively, apical cancer was missed only in 1% of cases. ConclusionsWith proper preoperative understanding of apical lesion location, timing of DVC ligation [standard vs delayed] doesn't impact apical positive surgical margins. Combination of MRI, MUS, PSMA-PET and prostate biopsy reduce apical positive surgical margin rates significantly.

Impact of oral antithrombotic agents on urinary continence recovery following robot-assisted radical prostatectomy: a retrospective cohort study

BackgroundRobot-assisted radical prostatectomy (RARP) is a preferred minimally invasive surgical treatment for prostate cancer. The number of elderly patients and those with cardiovascular and/or cerebrovascular issues undergoing surgery is increasing, and many of them are taking antithrombotic (AT) agents. However, the effect of AT agents on postoperative urinary recovery has not been adequately studied. In this study, we analyzed the differences in the postoperative recovery of urinary continence and oncological outcomes in patients undergoing RARP for localized prostate cancer between AT agent adherents and non-adherents.MethodsA total of 394 patients who underwent conventional anterior RARP between February 2015 and February 2021 were categorized into two groups: those taking oral AT agents (AT group) and the control group. Urinary continence recovery, complications, and oncological outcomes were compared between the groups. A Cox proportional hazards analysis was performed to identify clinical factors that affect urinary continence recovery.ResultsThe background data and bleeding complications did not differ significantly between the groups. The recovery of continence was significantly poorer in the AT group in terms of complete pad free (HR: 0.53 [95% CI: 0.39–0.71]) and use of ≤ 1 safety pad (HR: 0.74 [95% CI: 0.59–0.94]). The rate of anastomotic leakage on cystography was significantly higher in the AT group (20.9% vs. 6.7%). A univariate analysis revealed that taking antithrombotic agents, higher prostate-specific antigen levels, and a more advanced clinical stage were associated with a poor urinary continence recovery; a multivariate analysis showed that taking AT agents was an independent factor negatively associated with urinary continence recovery. There was no significant difference between the groups in the positive surgical margin rate (19.0% vs. 23.8%) or the biochemical-recurrence-free rate.ConclusionTaking oral AT agents may be associated with poor urinary continence recovery after RARP.

Dorsal venous complex ligation-free and parietal endopelvic fascia preserving in laparoscopic radical prostatectomy: A prospective study of single centre.

This study aims to describe a novel dorsal venous complex (DVC) ligation-free and parietal endopelvic fascia preserving technique for laparoscopic radical prostatectomy and to evaluate its post-operative outcomes. From April 2020 to May 2021, a total of 125 patients with localized prostate cancer received laparoscopic radical prostatectomy by a single surgeon. In the procedure, a novel technique of DVC ligation-free and parietal endopelvic fascia preserving was used. Preoperative characteristics of patients and perioperative results were recorded. In this study, continence was defined as zero to one pad per day. Oncological outcomes were evaluated based on positive surgical margin. Five patients required a blood transfusion. Mean post-operative hospital stay was 3.9days (2-5), and the catheter could be removed on post-operative day 7 to 9. Final pathologic evaluations were 87 stage pT2, 22 stage pT3a, and 7 pT3b, 9 stage pT4, respectively. The positive surgical margin rate was 10.4% in total. Ninety-three patients (74.4%) returned to urinary continence 2months post-operatively, and 11 patients (11/125) developed biochemical recurrence 6months post-operatively. The DVC ligation-free and parietal endopelvic fascia preserving technique provides early recovery from incontinence without adversely affecting the oncological outcome.

Primary site surgical resection in cM1 oral cavity squamous cell carcinoma.

To investigate primary site surgical resection and overall survival (OS) in clinically distantly metastatic (cM1) oral cavity squamous cell carcinoma (OCSCC). The 2006-2018 National Cancer Database was queried for patients presenting with cM1 OCSCC who underwent chemotherapy. Binary logistic, Kaplan-Meier, and multivariable Cox proportional hazards regression models were implemented. Of 278 patients satisfying inclusion criteria, 139 (50.0%) underwent chemotherapy alone, 80 (28.8%) underwent chemoradiotherapy, 25 (9.0%) underwent surgical resection + adjuvant chemotherapy, and 34 (12.2%) underwent surgical resection + adjuvant chemoradiotherapy; 5-year OS was 9.4%, 15.2%, 8.3%, and 23.8%, respectively (p < .001). Compared with those not undergoing surgical resection, patients undergoing surgical resection underwent radiotherapy more frequently (57.6% vs. 36.5%) but multiple-agent chemotherapy less frequently (40.7% vs. 74.4%) (p < .005). Twenty-one (36.2%) patients undergoing surgical resection had positive surgical margins. Academic facility (adjusted odds ratio [aOR] 3.19, 95% CI 1.54-6.62) and Charlson-Deyo comorbidity score ≥1 (aOR 2.82, 95% CI 1.25-6.32, p < .025) were associated with increased odds of undergoing surgical resection. Compared with chemotherapy alone, chemoradiotherapy (adjusted hazard ratio [aHR] 0.56, 95% CI 0.38-0.83) and surgical resection + adjuvant chemoradiotherapy (aHR 0.37, 95% CI 0.21-0.66) were associated with higher OS (p < .005). Immunotherapy (aHR 0.48, 95% CI 0.28-0.81, p = .006) was also independently associated with higher OS. A minority of patients with cM1 OCSCC underwent primary site surgical resection. Despite the high rate of positive surgical margins, surgical resection + adjuvant chemoradiotherapy was associated with higher OS than chemotherapy alone, chemoradiotherapy, or surgical resection + adjuvant chemotherapy. Definitive local therapy may benefit select patients with cM1 OCSCC.Level of evidence: 4.

Robot-assisted nephroureterectomy: surgical and mid-term oncological outcomes in over 1100 patients (ROBUUST 2.0 collaborative group).

To analyse surgical, functional, and mid-term oncological outcomes of robot-assisted nephroureterectomy (RANU) in a contemporary large multi-institutional setting. Data were retrieved from the ROBotic surgery for Upper tract Urothelial cancer STtudy (ROBUUST) 2.0 database, an international, multicentre registry encompassing data of patients with upper urinary tract urothelial carcinoma undergoing curative surgery between 2015 and 2022. The analysis included all consecutive patients undergoing RANU except those with missing data in predictors. Detailed surgical, pathological, and postoperative functional data were recorded and analysed. Oncological time-to-event outcomes were: recurrence-free survival (RFS), metastasis-free survival (MFS), cancer-specific survival (CSS), and overall survival (OS). Survival analysis was performed using the Kaplan-Meier method, with a 3-year cut-off. A multivariable Cox proportional hazard model was built to evaluate predictors of each oncological outcome. A total of 1118 patients underwent RANU during the study period. The postoperative complications rate was 14.1%; the positive surgical margin rate was 4.7%. A postoperative median (interquartile range) estimated glomerular filtration rate decrease of -13.1 (-27.5 to 0) mL/min/1.73 m2 from baseline was observed. The 3-year RFS was 59% and the 3-year MFS was 76%, with a 3-year OS and CSS of 76% and 88%, respectively. Significant predictors of worse oncological outcomes were bladder-cuff excision, high-grade tumour, pathological T stage ≥3, and nodal involvement. The present study contributes to the growing body of evidence supporting the increasing adoption of RANU. The procedure consistently offers low surgical morbidity and can provide favourable mid-term oncological outcomes, mirroring those of open NU, even in non-organ-confined disease.

Lower survival for surgical treatment of human papillomavirus–related oropharynx cancer at community cancer centers

Abstract Background The rate of primary surgery for human papillomavirus (HPV)–related oropharynx cancer has recently declined, whereas use of transoral robotic surgery has lagged at community cancer centers. We hypothesize that differences in overall survival exist between patients undergoing surgery for HPV-related oropharynx cancer at community centers and low transoral robotic surgery volume (&amp;lt;15 transoral robotic surgeries per year) academic centers and high transoral robotic surgery volume (≥15 transoral robotic surgeries per year) academic centers. Methods Patients from the US National Cancer Database with a diagnosis of HPV-related oropharynx cancer from 2010 to 2019 who underwent primary surgical treatment were included. Trends in transoral robotic surgery use, rates of positive surgical margins, quality of adjuvant treatment, and 5-year overall survival were compared between community centers, low transoral robotic surgery volume academic centers, and high transoral robotic surgery volume academic centers. Results A total of 5406 patients met study criteria. A clinically and statistically significantly lower proportion of patients at community centers underwent transoral robotic surgery than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers (26.2% vs 44.0% vs 73.9%, respectively; P &amp;lt; .001). The rate of positive surgical margins was clinically and statistically significantly higher at community centers than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers (25.7% vs 15.3% vs 9.2%, respectively; P &amp;lt; .001). A greater proportion of patients undergoing adjuvant radiotherapy (RT) received prolonged courses (23.6% vs 13.1% vs 8.8%; P &amp;lt; .001) or excessive doses (16.5% vs 11.5% vs 8.7%; P &amp;lt; .001) of RT at community centers than at low transoral robotic surgery volume academic centers or high transoral robotic surgery volume academic centers, respectively. Five-year overall survival was lowest at community centers (85.2%, 95% confidence interval [CI] = 81.7% to 88.2%), intermediate at low transoral robotic surgery volume academic centers (88.9%, 95% CI = 87.2% to 90.4%), and highest at high transoral robotic surgery volume academic centers (91.4%, 95% CI = 89.5% to 92.9%; Plog-rank &amp;lt; .01). Conclusions Clinically and statistically significant differences in the type and quality of surgical and adjuvant treatment for HPV-related oropharynx cancer exist between facility types based on transoral robotic surgery volume. Overall survival was lowest at community centers, intermediate at low transoral robotic surgery volume academic centers, and highest at high transoral robotic surgery volume academic centers.

Local extension findings on MRI compensate for the ability of pathological staging to predict oncological outcome.

We investigated whether local extension findings on preoperative MRI and excisional pathology are associated with positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy. We identified 704 of our patients that underwent robot-assisted radical prostatectomy between 2012 and 2020, and extracted the 326 patients who had preoperative MRI scans and a radiologist reading. These patients were classified into groups according to the presence of local extension on MRI and pathological findings: ≤ cT2pT2 (195 cases), ≤ cT2pT3 (55 cases), cT3pT2 (31 cases), and cT3pT3 (45 cases). We compared positive surgical margin and biochemical recurrence between them. Median age was 69years, positive surgical margin rate was 20.2%, and five-year biochemical recurrence rate was 20.3%. Of the 226 patients without local invasion on excisional pathology, those with local extension on MRI (cT3pT2) had relatively higher positive surgical margin rate (29.0% vs. 14.4%, p = 0.05) and significantly higher five-year biochemical recurrence rate (25.8% vs. 9.3%, p = 0.01) than those without local extension on MRI (≤ cT2pT2). Similarly, among the 100 patients with local extension on excisional pathology, those with cT3pT3 had relatively higher positive surgical margin (37.8% vs. 21.8%, p = 0.08) and significantly higher five-year biochemical recurrence (53.3% vs. 29.3%, p = 0.01) than those with ≤ cT2pT3. In multivariate analysis, local extension on MRI was an independent predictor of biochemical recurrence (OR 2.1, 95%CI 1.1-3.9, p = 0.01). Local extension on MRI is a prognostic factor independent of pathological stage. The use of MRI may complement the prognostic value of excisional pathology of prostate cancer.