Surgical Treatment Of Cancer Research Articles

A successful shift from thoracotomy to video-assisted thoracoscopic lobectomy for non-small cell lung cancer in a low-volume center.

Although video-assisted thoracoscopic surgery (VATS) lobectomy has become the gold standard for pulmonary resections of non-small-cell lung cancer (NSCLC), lobectomy is still performed via thoracotomy in many European and North American centres. VATS lobectomy was implemented overnight from thoracotomy in our low-volume centre in early 2019, after 1 senior surgeon undertook observership VATS-training overseas, and immediately became the mainstay of surgical treatment for NSCLC in Iceland. We aimed to investigate our short-term outcomes of VATS lobectomy. This was a retrospective study on all pulmonary resections for NSCLC in Iceland 2019-2022, especially focusing on VATS lobectomies, all at cTNM stage I or II. Data were retrieved from hospital charts, including information on perioperative complications, mortality, length of stay and operation time. Out of 204 pulmonary resections, mostly performed by a single senior cardiothoracic surgeon, 169 were lobectomies (82.9%) with 147 out of 169 (87.0%) being VATS lobectomies. Anterolateral thoracotomy was used in 34 cases (16.7%), including 22 lobectomies (64.7%), and 5 (3.4%) conversions from VATS lobectomy. The median postoperative stay for VATS lobectomy was 4 days and the average operating time decreased from 155 to 124 min between the first and last year of the study (P < 0.001). The rate of major and minor complications was 2.7% and 15.6% respectively. One year survival was 95.6% and all patients survived 30 days postoperatively. The implementation of VATS lobectomy has been successful in our small geographically isolated centre, serving a population of 390000. Although technically challenging, VATS lobectomy was implemented fast for most NSCLC cases, with short-term outcomes that are comparable to larger high-volume centres.

Anxiety and Depression as Potential Predictors for Shorter Time to Undergo Initial Surgical Treatment for Papillary Thyroid Cancer

(1) Background: A pre-existing psychiatric condition may impact decision making by patients and/or physicians following a thyroid cancer diagnosis, such as potentially electing surgery over active surveillance, thus shortening the time to cancer removal. This is the first study to investigate the association between pre-existing anxiety and/or depression and time to receive surgical treatment for thyroid cancer. (2) Methods: Retrospective data were collected from 652 surgical thyroid cancer patients at our institution from 2018 to 2020. We investigated the time between thyroid cancer diagnosis and surgery, comparing patients with pre-existing anxiety and/or depression to those without. (3) Results: Patients with anxiety, depression, and both anxiety and depression had a significantly shorter time between diagnosis and surgery (51.6, 57, and 57.4 days, respectively) compared to patients without (111.9 days) (p = 0.002, p = 0.004, p = 0.003, respectively). (4) Conclusions: Although little is known about the impact of pre-existing psychiatric conditions in the decision-making process for thyroid cancer surgery, this present study showed that anxiety and/or depression may lead to more immediate surgical interventions. Thus, psychiatric history may be an important factor for physicians to consider when counseling patients with thyroid cancer.

Results of surgical treatment of papillary thyroid cancer with lymph node metastasis - review of our data in a 5-year period

A papillaris pajzsmirigyrák prognózisát a gyakori nyaki nyirokcsomóáttét-képzés befolyásolja. Sebészi kezelésük minősége a betegek túlélését és a recidíva előfordulási gyakoriságát is meghatározza. Az Országos Onkológiai Intézet Fej-Nyaki Daganatok Multidiszciplináris Központjában a fej-nyak sebész szerzők által 2013 és 2018 között operált, nyaki áttétet adó papillaris carcinomás betegek adatait vizsgáltuk. 130, nyaki áttétet adó papillaris pajzsmirgy-carcinomás beteg esetében az ATA (American Thyroid Association) 2015. évi irányelvei alapján teljes pajzsmirigy-eltávolítást és nyaki nyirokcsomó-dissectiót végeztünk. Az eltávolított anyagokat szövettani feldolgozásra küldtük, vizsgáltuk a nyirokcsomóáttét(ek) arányát az életkor, a nem, a tumor-multifokalitás, a kétoldaliság, a tokon kívüli terjedés, a nyirok-, érinvázió függvényében. Elemeztük a műtét után fellépő szövődményeket is. 43 betegnél thyreoidectomia, totális és centrális nyaki dissectio (VI. régió), 87 esetben centrális (VI. régió) és laterális (II–V. régió) nyaki dissectio történt. Átmeneti (6 hónapon belül normalizálódó) hypocalcaemia 30 betegnél (23%), permanens hypocalcaemia 4 betegnél (3%) fordult elő. Átmeneti nervus recurrens bénulás 12 esetben (9,2%), permanens bénulás 3 (2,3%) esetben történt. A szövettani értékeléskor érbetörés és tokinvázió 75 betegnél (57,7%), nyirokér-invázió 63 betegnél (48,5%), Hashimoto-thyreoiditis 51 betegnél (39,2%) igazolódott. Microcarcinoma (1 cm-nél kisebb daganat) 43 esetben fordult elő (33%). Az eltávolított nyirokcsomók átlagosan 48%-a volt áttétes. Ez csak a tumormérettel mutatott szignifikáns korrelációt, az életkorral nem találtunk összefüggést. Az oldaliság, a többgócúság, valamint a tok-, nyirokér- és érinvázió, a Hashimoto-status és a beteg neme nem mutatott összefüggést az áttétes nyirokcsomók számával. A túlélést befolyásolta a tok-, ér- és nyirokér-invázió, valamint a tumorméret is. A nyaki áttétet adó, differenciált pajzsmirigyrákos beteganyagunk kezelésében a kivizsgálási protokollt követően a teljes pajzsmirigy-eltávolítás és a megfelelő régiókat tartalmazó nyaki dissectio döntő fontosságú, a radiojód-terápiával kiegészítve az irányelveknek megfelelő kezelési modul. A pajzsmirigydaganat a leggyakoribb endokrin daganatos megbetegedés, melynek sebészi kezelése a multidiszciplináris terápia legfontosabb eleme. 5 év alatt operált, nyaki áttétet is adó, differenciált pajzsmirigyrákos beteganyagunkat feldolgozva ismertetjük eredményeinket az olvasóval. Orv Hetil. 2024; 165(3): 83–88.

Protocol for open-label, randomised, controlled trial of intensive surveillance vs. standard postoperative follow-up in patients undergoing surgical resection for oesophageal and gastric cancer (SARONG trial).

TPS416 Background: Despite recent improvements in oncological and surgical treatment for patients with oesophageal and gastric cancer, 60% of patients with locally advanced disease who are treated with a curative intent will develop tumour recurrence and die within three years of completing treatment. In the absence of robust scientific evidence national or international guidelines have failed to reach consensus on the optimal surveillance strategy after primary treatment of oesophageal or gastric cancer. Methods: The primary research question of the proposed randomised controlled trial (RCT) is does the routine use of a structured follow-up program with regular radiological and endoscopic investigations improve survival in patients who have had surgical treatment for oesophageal or gastric cancer with curative intent? We aim to assess whether structured follow-up, including radiological and endoscopic investigations after completing curatively intended treatment, improves survival in patients with oesophageal or gastric cancer. The secondary aims of this RCT are to determine the impact of a structured post-treatment surveillance upon the detection and treatment of cancer recurrence and health-related quality of life, including anxiety and to assess the cost-effectiveness. We will undertake a national prospective, multi-centre, randomised controlled trial of structured follow-up including radiological and endoscopic investigations versus standard clinical follow-up. The setting will be at least 24 large oesophago-gastric cancer UK cancer centres. We will aim to recruit 952 oesophageal and gastric cancer patients receiving surgical resection for curatively intended treatment of oesophageal or gastric cancer +/- neoadjuvant/adjuvant chemo(radio or immuno)therapy. At 4-12 weeks after surgery for oesophageal or gastric cancer, patients will be assessed for eligibility for inclusion in the trial. Patients will be randomised 1:1 to receive either intensive follow-up for up to 3-years, with clinical and computerised tomography (CT) investigation every 6 months, and an endoscopy at 12 months or to current standard NHS follow-up, i.e. clinical review at 6 and 12 months followed by targeted investigation as required based upon the onset of new symptoms. The primary outcome is 3-year all-cause mortality and secondary outcomes include health-related quality of life (including anxiety), 3-year disease-specific mortality, pattern and treatment of tumour recurrence, and cost-effectiveness of follow-up in both study arms. The findings of this RCT will inform national and international guidelines for patients with oesophageal and gastric cancer, as this will be the first RCT to provide robust evidence concerning the value of surveillance in this population. Clinical trial information: 14417629.

Expert consensus on anesthesia in Enhanced Recovery after Surgery for esophageal cancer surgery

Esophageal cancer is one of the common malignant tumors of the digestive system in China. Surgical intervention is a frequently employed method for treating esophageal cancer. However, esophagectomy is a complex surgical procedure with a relatively high incidence of complications and mortality. In recent years, enhanced recovery after surgery (ERAS) as a novel medical concept, has gradually gained acceptance among healthcare professionals and been widely applied. It has also demonstrated significant efficacy in the surgical treatment of esophageal cancer. This article summarizes evidence-based medicine (EMB) in the perioperative period of ERAS for esophageal cancer treatment and formulates a clinical pathway for ERAS in esophageal cancer treatment throughout the perioperative period, aiming to provide guidance for clinical practice. Preoperatively, the following measures are advocated: preoperative education, preoperative nutrition assessment and risk assessment, individualized fasting and fluid restriction, optimal timing of surgery after neoadjuvant therapy, and the establishment of a multidisciplinary team (MDT) collaborative diagnostic and treatment model. Intraoperatively, optimization of anesthesia strategies, maintenance of optimal fluid balance, implementation of protective lung ventilation strategies, prevention of intraoperative hypothermia, and the selection of appropriate surgical techniques are essential. Postoperatively, effective pain management, thrombosis prevention, early mobilization, early removal of nasogastric tubes, drainage tubes, and urinary catheters, prevention of postoperative complications, and proactive enteral nutrition should be emphasized. It is important to note that the ERAS protocol is not static and continues to undergo improvement, with ongoing systematic training and promotion in the hope of wider adoption in more medical centers.

Absence of thoracotomy by intrathoracic manual suture and transabdominal removal of surgical specimen during Ivor Lewis robotic esophagectomy

In the surgical treatment of esophageal cancer, robotic surgery allows performing an intrathoracic handsewn anastomosis in a simpler, faster and more comfortable way for the surgeon than open surgery and traditional minimally invasive surgery. With this, we avoid the use of self-suture instruments, some of which require a small thoracotomy for their introduction. However, the retrieval of the specimen requires the practice of this thoracotomy, of variable size, that can be associated with intense chest pain. We describe a technical modification of the classic robotic Ivor Lewis that allows removal of the surgical piece through a minimal abdominal incision, thus avoiding controlled rib fracture, as well as the possible sequelae of making an incision in the chest wall.

Retracted: Efficacy and Safety of rCCK96-104PE38 Targeted Drug in the General Surgical Treatment of Colon Cancer.

[This retracts the article DOI: 10.1155/2022/7145606.].

Scalp myiasis associated with soft tissue sarcoma lesion: a case report and review of relevant literature

BackgroundSarcophagidae is one of the main fly families that is attracted to open wounds, ulcers, lesions, and other injuries for depositing their larvae. The presence of larvae of flies in human tissues makes myiasis. Myiasis on the scalp could be more frightening in comparison with myiasis on the other parts of the body. It is a rare myiasis case that shows the ability of myiasis agents to attack various parts of the body. On the other hand, reporting of myiasis cases by Sarcophagidae larvae is not common due to difficulties in their identification. This study aimed to emphasize the importance of Sarcohagidae larvae in producing myiasis by describing the first case of soft tissue sarcoma infestation and provides a review of human myiasis by larvae of the Sarcophagidae family during 2010–2023 and also a review of wound myiasis cases associated with malignancy during 2000–2023.Case presentationA case of sarcoma cancer myiasis is reported on the scalp of a 43-year-old man who referred to one of Tehran’s hospitals for surgical treatment of cancer. Before surgery, insect larvae were observed in the area of ​​sarcoma. The larvae were isolated, examined morphologically, and identified as Sarcophaga spp.ConclusionsMyiasis has been considered as a neglected disease. Publishing of myiasis cases could be useful to alert health policy-makers about its danger and appearance in the community. It is not usual but can be expected even on the scalp of the human head. Exact daily supervision and dressing of the wound could be recommended to prevent cutaneous myiasis.

Improved method of hemostasis for the middle rectal artery

Objective. To obtain data on the comparative characteristics of traditional and improved methods of hemostasis for the middle rectal artery (MRA).Materials and methods. The material for the sectional study was 206 corpses of men (the age of the deceased was from 22 to 82 years, the average age was 57 years) and 113 corpses of women (the age of the deceased was from 32 to 93 years, the average age was 63 years). To achieve the purpose of the study, the following methods were used: vascular injection, dissection, statistical processing. 85 patients of both sexes aged from 57 to 75 years were selected to conduct the clinical part of the study at Gomel Regional Specialized Clinical Hospital. Among them, 50 people were in the comparison group and 35 people were in the main group. All patients were diagnosed with stage I or II rectal cancer. The operative technique for performing hemostasis on the MRA during anterior rectal resection in the comparison group included sequential ligation and stitching between the clamps first of the distal third of the length of this artery, and then its proximal third. In the main group, the method of hemostasis for MRA was supplemented by ligation and stitching of this vessel in the middle third of its length. Statistical data processing included parametric and nonparametric methods of comparative analysis.Results. On cadaveric material, it was found that most of the extraorgan anastomoses of the MRA both in men and women have been localized in the middle third of this artery. The results obtained during the clinical study demonstrate the superiority of the improved hemostasis method for MRA over the traditional method. The proposed method includes additional ligation and stitching of the middle third of the MRA.Conclusion. The improved hemostasis method for MRA in anterior rectal resection is highly effective, which makes it possible to recommend it as the method of choice in the surgical treatment of upper ampullary rectal cancer of stage I or II.

Early results of fluorescence lymphatic mapping for right colon cancer: a case-matched study

Objectives: The complete mesocolic excision (CME) technique has been described to improve the surgical outcomes of colon cancer. Collecting more lymph nodes is one of the goals of CME. In our study, indocyanine green (ICG) injection was applied to the anterior and posterior walls at certain levels of the right colon. The aim of this study is to determine the impact of lymphangiography in right colon cancer surgery. Methods: The data of patients were analyzed who underwent colectomy surgery between 1.1.2018-1.1.2022 and using our mapping technique. A case-match study was performed at a ratio of 1:2 (Study group [group S; n =10], Control group [group C; n = 20]). Case-matched criteria were age +/-10, T stage +/-1, and tumor location. Results: There were no differences in terms of age, the American Society of Anesthesiologists score, tumor location, tumor T and N stages, and pathological markers affecting prognosis between the groups. Although 10% of intraoperative complications were seen in group C, it was not statistically significant (p = 0.540). After lymphangiography, lymph nodes containing ICG were detected in the resection site and these lymph nodes were sent to pathology in separate containers. Considering the number of lymph nodes sent separately, it was determined that significantly more lymph nodes were sent in the group S (p = 0.001). Conclusions: We have shown that the ICG mapping can be applied safely in the surgical treatment of right colon cancer.

Cervicothoracotomy for right upper sleeve lobectomy with carinal resection in the treatment of central lung cancer

We demonstrated successful treatment of patients with complicated central lung cancer, who underwent right upper sleeve lobectomy with carinal resection. We have used the following options for carinal reconstruction: anastomosis of trachea with the left main bronchus and anastomosis of intermediate bronchus with the left main bronchus (clinical case No. 1) or with trachea (clinical case No. 2). Cervicothoracotomy provided correct N-staging and mobilization of trachea with left main bronchus. This approach provided compliance with oncological principles of surgical treatment of lung cancer and significantly reduced tension of anastomosis. These aspects are important for satisfactory immediate functional and oncological results after right upper sleeve lobectomy with carinal resection.

Efficiency of the estimation of physiologic ability and surgical stress (E-PASS) score in predicting postoperative complications after robot-assisted radical prostatectomy.

Robot-Assisted Radical Prostatectomy (RARP) is increasingly becoming the standard surgical treatment for prostate cancer. While some risk factors for postoperative complications of RARP have been identified, no scoring model that incorporates both preoperative physical status of the patient and intraoperative risk factors has been developed. The Estimation of Physiologic Ability and Surgical Stress (E-PASS) score was initially described to predict postoperative complications after gastrointestinal surgical procedures. This study aims to assess the effectiveness of the E-PASS score in predicting postoperative complications of RARP. A retrospective evaluation was conducted on 204 patients who underwent RARP between 2019 and 2022. Demographic data, parameters indicating patients' preoperative physical condition, and intraoperative risk factors were analyzed. The E-PASS score and subscores were calculated for each patient. Of the patients, 164 (80.4%) were discharged without any postoperative complications (Group 1), and 40 (19.6%) experienced various degrees of complications (Group 2). Patients in Group 2 had higher rates of previous abdominal surgery, elevated Eastern Cooperative Oncology Group (ECOG) performance scores, longer surgical durations, and higher E-PASS scores. To assess the effectiveness of the Comprehensive Risk Score (CRS) as a predictive factor for postoperative complications, a receiver operating characteristic (ROC) curve was constructed with a 95% confidence interval (CI), and a cut-off value was established. The cut-off value for CRS was determined to be -0.0345 (area under the curve [AUC]=0.783, CI: 0.713-0.853; p<0.001). Patients with a CRS higher than the cut-off value had a 16.4 times higher rate of postoperative complications after RARP (95% CI: 5.58-48.5). The E-PASS scoring model successfully predicts postoperative complications in patients undergoing RARP by using preoperative data about the physical status of the patient and surgical risk factors. The E-PASS score and its subscores could be utilized as objective criteria to determine the risk of postoperative complications before and immediately after surgery.

First Uniportal VATS Sleeve Lobectomy Case in Turkey

Introduction: In recent years, VATS (Video-assisted thoracic surgery) has become the gold standard approach in the surgical treatment of early-stage Non-small Cell Lung Cancer. In August 2022, we presented the first case of Uniportal VATS right bronchial sleeve upper lobectomy for right main bronchial invasion, which was successfully managed following oncologic principles and reported in our country. Case: A patient who had been in remission for five years with a diagnosis of laryngeal carcinoma complained of cough. Computed thoracic tomography showed hilar peribronchial thickening and an endobronchial lesion extending from the right upper lobe bronchus to the main bronchus, almost completely obstructing the upper lobe bronchus. Bronchoscopic biopsy was reported as squamous cell carcinoma.The thorax was entered through an approximately 3 cm incision in the right fifth intercostal space. Firstly, the right upper lobe pulmonary arteries and superior pulmonary vein were dissected and cut. The main bronchus was divided until the intermediate bronchus. With the help of endoscissor, the main and intermediate bronchus were incised with appropriate surgical margins, and the lobectomy material was removed.The mediastinal pleura was opened, and lymph nodes 7, 9, 10 were dissected. Before anastomosis, the azygos vein was turned and fixed to the chest wall with a tying suture, and the azygos vein was removed from the anastomosis line, and appropriate exposure was provided. One suture was passed through the lateral cartilage from the inside out, and the needle was fixed to the posterior pleura. Membranous and cartilage parts were continuously anastomosed with double-needle 3/0 prolene suture at 2-3 mm intervals. Pathological evaluation was reported as squamous cell carcinoma, hilar 1/11 lymph node metastasis, and negative surgical margin. Conclusion: Adhering to oncologic principles, sleeve resections, which are difficult even with the currently known open techniques, can be performed effectively and safely with uniportal VATS in experienced centers

Prevalence of postoperative complications in oncologic gastro-esophageal surgeries: a cross-sectional study.

This study evaluated the prevalence of complications in the postoperative period of esophagogastric oncological surgeries. We conducted a retrospective cross-sectional study, adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. The study size implied 163 patients who underwent surgical treatment for esophageal and gastric cancer and experienced postoperative complications between January 2018 and December 2022. These patients were treated at the Liga Norte Riograndense Contra o Câncer, a high-complexity oncology center and a reference for cancer treatment in Northeast Brazil. The prevalence found was 88.3%. The most prevalent complications were Clavien-Dindo I and II, and infection was the most common. According to our statistics analysis, hypoalbuminemia showed a positive correspondence with the occurrence of postoperative complications (odds ratio = 8.60; 95% confidence interval 1.35-54.64, p = 0.0358). Postoperative complications of gastroesophageal surgeries increase patient morbidity and mortality.

Symptomatic Lymphocele After Robot-Assisted Pelvic Lymphadenectomy as Part of the Primary Surgical Treatment for Cervical and Endometrial Cancer: A Retrospective Cohort Study

Pelvic lymph node dissection (PLND) is part of the primary treatment for early-stage cervical cancer and high-intermediate risk or high-risk endometrial cancer. Pelvic lymphocele is a postoperative complication of PLND and when symptomatic, lymphoceles necessitate treatment. The aim of this study was to investigate the incidence and risk factors of symptomatic lymphocele after robot-assisted laparoscopic PLND in cervical and endometrial cancer. Retrospective cohort study. Single-center academic hospital. Two hundred and fifty-eight patients with cervical cancer and one hundred and twenty-nine patients with endometrial cancer. Pelvic lymphadenectomy by robot-assisted laparoscopic surgery. We retrospectively included all patients with early-stage cervical cancer and high- intermediate risk or high-risk endometrial cancer who underwent pelvic lymphadenectomy by robot-assisted laparoscopic surgery between 2008 and 2022. Medical records were reviewed for the occurrence of a symptomatic lymphocele. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for developing a symptomatic lymphocele. In total 387 patients, 258 with cervical cancer and 129 with endometrial cancer, were included in the study. The overall incidence of symptomatic lymphoceles was 9.6% with a median follow-up of 47 months [IQR 23-61]. For the entire cohort, smoking was the only significant risk factor for symptomatic lymphoceles identified in univariate (OR 2.47, 95% CI 1.19-5.11) and multivariate analysis (OR 2.42, 95% CI 1.16-5.07). For cervical cancer, BMI (OR 1.09, 95% CI 1.00-1.17) and prior abdominal surgery (OR 2.75, 95% CI 1.22-6.17) were also identified as significant independent risk factors. For endometrial cancer, age was identified as significant independent risk factor (OR 0.90, 95% CI 0.83-0.97). This single-center cohort study demonstrated an incidence of almost 10% of symptomatic lymphoceles after robot-assisted laparoscopic PLND for cervical cancer and endometrial cancer, with a higher risk observed among patients who smoke at the time of diagnosis. Furthermore, risk factors differ between the two populations, necessitating further studies to establish risk models.

Evaluation of the gastric conduit perfusion using indocyanine green in thoracoscopic esophagectomy for esophageal cancer.

Indocyanine green has been used in the assessment of the gastric conduit perfusion in thoracoscopic esophagectomy to prevent malperfusion-associated anastomotic leak. This study aims to evaluate the initial results of investigating the gastric conduit perfusion with indocyanine green in the surgical treatment of esophageal cancer. This cross-sectional descriptive study was carried out on 54 esophageal cancer patients undergoing thoracoscopic esophagectomy and gastric conduit reconstruction. The blood flow in the gastric conduit was observed using an infrared camera and indocyanine green after completion of the conduit and after tunneling the conduit through the mediastinum to the neck. The gastric conduit width and length were 5.2 ± 0.3 cm, and 31.5 ± 1.6 cm, respectively. The length of the gastric conduit from the junction between the right and left gastroepiploic to the point where the distal end of the gastric conduit still has a vascular pulse was 11.9 ± 4.3 cm. Seventeen patients (31.5%) had poor blood supply at the distal end of the gastric conduit, with indocyanine green appearance time ⩾ 60 s, in whom anastomotic leaks occurred in five patients (9.3%). The lack of connection between the right and left gastroepiploic vessels was associated with poor blood supply of the distal gastric conduit (p = 0.04). Multivariable logistic regression analysis showed association between the time of indocyanine green appearance at the distal gastric conduit and the risk of anastomotic leak (OR = 1.99, 95% CI = 1.10-3.60, p = 0.02). Investigation of gastric conduit perfusion using indocyanine green in gastric conduit reconstruction detected 31.5% of patients with poor blood supply at the distal end of the conduit, in whom 9.3% had anastomotic leak. The longer indocyanine green appearance time in the distal gastric conduit (segment BC), was associated with the higher rate of the anastomotic leak.

Real-world Nationwide Outcomes of Minimally Invasive Surgery for Advanced Gastric Cancer Based on Korean Gastric Cancer Association-Led Survey.

The study aimed to investigate real-world surgical outcomes of minimally invasive surgery (MIS) for advanced gastric cancer using Korean Gastric Cancer Association (KGCA)-led nationwide data. A nationwide survey of patients who underwent surgical treatment for gastric cancer in 2019 was conducted by the KGCA. A total of 14,076 patients from 68 institutions underwent surgery, and 4,953 patients diagnosed with pathological stages IB-III gastric cancer were included. Among them, 1,689 patients who underwent MIS (MIS group) and 1,689 who underwent the open approach (open group) were matched using propensity score in a 1:1 ratio. Surgical outcomes were compared, and multivariate analysis was performed to identify the independent factors for overall morbidity. The MIS group had a lower proportion of D2 lymphadenectomy, total omentectomy, and combined resection. However, the number of harvested lymph nodes was higher in the MIS group. Better surgical outcomes, including less blood loss and shorter hospital stay, were observed in the MIS group, and the overall morbidity rate was significantly lower in the MIS group (17.5% vs. 21.9%, P=0.001). The mortality rates did not differ significantly between the 2 groups. In the multivariate analysis, the minimally invasive approach was a significant protective factor against overall morbidity (odds ratio, 0.799; P=0.006). Based on the Korean nationwide data, MIS for stage IB-III gastric cancer had better short-term outcomes than the open approach, including lower rates of wound complications, intra-abdominal abscesses, and cardiac problems.

Update on surgical treatment of colorectal cancer -latest preoperative treatment and the subsequent non-operative management

Update on surgical treatment of colorectal cancer -latest preoperative treatment and the subsequent non-operative management

Factors related to Nursing workload in the Oncology assistance provided to hospitalizedwomen.

to evaluate the Nursing workload and its related factors in the assistance provided to hospitalized women with gynecological and breast cancers, according to the Nursing Activities Scores adapted for cancer patients. a cross-sectional and epidemiological study. The participants were women with gynecological and/or breast cancer, over 18 years of age, and hospitalized for a minimum period of 24 hours. The following was collected from the medical records: sociodemographic and clinical data, Karnofsky Performance Status and workload, according to the adapted Nursing Activities Score. The factors related to workload were analyzed by means of multiple linear regression. the mean Nursing Activities Scores was 29.3%, denoting seven hours of daily care per patient. The factors related to workload differed according to the breast or gynecological cancer diagnosis (β=-0.01; p<0.001), clinical or surgical treatment (β=-0.03; p<0.001) and functional capacity at admission (β=0.07; p<0.001), as per the Karnofsky Performance Status. there was greater workload for the care of women with gynecological cancer undergoing clinical treatment and with lower functional capacity at admission. The findings reveal directions for optimization of resources and improvements in work processes and flows, in order to promote a favorable work environment and good quality assistance. (1) A pioneer study in using the NAS instrument, adapted for Hospital Oncology. (2) The clinical treatment of gynecological/breast cancer demands a greater workload. (3) Functional capacity at the admission of women with cancer influences workload. (4) Gynecological cancer demands a greater Nursing workload than breast cancer.

Environment-responsive dendrobium polysaccharide hydrogel embedding manganese microsphere as a post-operative adjuvant to boost cascaded immune cycle against melanoma.

Rationale: Surgical resection is a primary treatment for solid tumors, but high rates of tumor recurrence and metastasis post-surgery present significant challenges. Manganese (Mn2+), known to enhance dendritic cell-mediated cancer immunotherapy by activating the cGAS-STING pathway, has potential in post-operative cancer management. However, achieving prolonged and localized delivery of Mn2+ to stimulate immune responses without systemic toxicity remains a challenge. Methods: We developed a post-operative microenvironment-responsive dendrobium polysaccharide hydrogel embedded with Mn2+-pectin microspheres (MnP@DOP-Gel). This hydrogel system releases Mn2+-pectin microspheres (MnP) in response to ROS, and MnP shows a dual effect in vitro: promoting immunogenic cell death and activating immune cells (dendritic cells and macrophages). The efficacy of MnP@DOP-Gel as a post-surgical treatment and its potential for immune activation were assessed in both subcutaneous and metastatic melanoma models in mice, exploring its synergistic effect with anti-PD1 antibody. Result: MnP@DOP-Gel exhibited ROS-responsive release of MnP, which could exert dual effects by inducing immunogenic cell death of tumor cells and activating dendritic cells and macrophages to initiate a cascade of anti-tumor immune responses. In vivo experiments showed that the implanted MnP@DOP-Gel significantly inhibited residual tumor growth and metastasis. Moreover, the combination of MnP@DOP-Gel and anti-PD1 antibody displayed superior therapeutic potency in preventing either metastasis or abscopal brain tumor growth. Conclusions: MnP@DOP-Gel represents a promising drug-free strategy for cancer post-operative management. Utilizing this Mn2+-embedding and ROS-responsive delivery system, it regulates surgery-induced immune responses and promotes sustained anti-tumor responses, potentially increasing the effectiveness of surgical cancer treatments.