Featured Articles Archive

Jónsdóttir, B., Lomnytska, M., Poromaa, I.S. et al.

Ann Surg Oncol 28, 244–251 (2021).

Citation: Jónsdóttir, B., Lomnytska, M., Poromaa, I.S. et al. The Peritoneal Cancer Index Is a Strong Predictor of Incomplete Cytoreductive Surgery in Ovarian Cancer. Ann Surg Oncol 28, 244–251 (2021).

Synopsis: The Peritoneal Cancer Index (PCI) is an excellent predictor of incomplete cytoreductive surgery. A PCI
higher than 24 was associated with a lower rate of surgery success and a higher rate of major complications.
Neoadjuvant chemotherapy could be considered with a PCI above this PCI cutoff.

Lagergren, J., Bottai, M. & Santoni, G.

Ann Surg Oncol 28, 159–166 (2021).

Citation: Lagergren, J., Bottai, M. & Santoni, G. Patient Age and Survival After Surgery for Esophageal Cancer. Ann Surg Oncol 28, 159–166 (2021).

Synopsis:  This population-based cohort study in Sweden included 1,737 patients having undergone surgery for esophageal cancer. Compared with patients aged <70 years, those aged ≥75 years had higher odds of 90-day mortality, 5-year all-cause mortality, and 5-year disease-specific mortality.

Citation: Kim, R.Y., Christians, K.K., Aldakkak, M. et al. Total Neoadjuvant Therapy for Operable Pancreatic Cancer. Ann Surg Oncol 28, 2246–2256 (2021).

Synopsis: We compared total neoadjuvant therapy (TNT) to shorter course neoadjuvant therapy (SNT) for operable pancreatic cancer and found TNT was associated with an increased likelihood of receiving at least 5 months of non-surgical therapy without negatively impacting the ability to undergo surgery.

Dokmak, S., Aussilhou, B., Levenson, G. et al.
Ann Surg Oncol 28, 2028–2029 (2021).

Citation: Dokmak, S., Aussilhou, B., Levenson, G. et al. Staged Double Hepatectomy, Double Total Vascular Exclusion, and Double Venous Reconstruction by Peritoneal Patches in One Patient with Colorectal Liver Metastases. Ann Surg Oncol (2021).

Synopsis: A 47-year-old female with colorectal liver metastases treated by chemotherapy underwent two staged liver resections. Each hepatectomy was done total vascular exclusion and venous reconstruction of the vena cava and the hepatic vein were achieved by the peritoneum.

Mertens, A.C., Kalff, M.C., Eshuis, W.J. et al. 

Ann Surg Oncol 28, 175–183 (2021). 

Citation: Mertens, A.C., Kalff, M.C., Eshuis, W.J. et al. Transthoracic Versus Transhiatal Esophagectomy for Esophageal Cancer: A Nationwide Propensity Score-Matched Cohort Analysis. Ann Surg Oncol 28, 175–183 (2021). 

Synopsis:  While providing a higher lymph node yield, the transthoracic group showed higher morbidity and mortality rates. (y)pN stage was higher in the transthoracic group, potentially indicating residual lymph node metastases during transhiatal resection. 

Colombo, C., De Leo, S., Di Stefano, M. et al. 

Ann Surg Oncol (2021). 

Citation: Colombo, C., De Leo, S., Di Stefano, M. et al. Total Thyroidectomy Versus Lobectomy for Thyroid Cancer: Single-Center Data and Literature Review. Ann Surg Oncol (2021). 

Synopsis: Lobectomy  can  be  safely  proposed  for  low  risk  thyroid  cancer  patients  and  total  thyroidectomy should be favored in intermediate risk tumors. In patients treated with lobectomy the final outcome is confirmed after a longer follow up. In  patients  submitted  to  lobectomy,  serum  thyroglobulin/TSH  increasing  trend  associates  with persistence/relapse.

Mudgway, R., Chavez de Paz Villanueva, C., Lin, A.C. et al.

Citation: Mudgway, R., Chavez de Paz Villanueva, C., Lin, A.C. et al. The Impact of Primary Tumor Surgery on Survival in HER2 Positive Stage IV Breast Cancer Patients in the Current Era of Targeted Therapy. Ann Surg Oncol 27, 2711–2720 (2020).

Synopsis:  Observational data from the National Cancer Database demonstrate that surgery of the primary site for metastatic HER2+ breast cancer is associated with improved overall survival in the current era of targeted therapy.

Kuipers, H., de Savornin Lohman, E.A.J., van Dooren, M. et al.

Citation: Kuipers, H., de Savornin Lohman, E.A.J., van Dooren, M. et al. Extended Resections for Advanced Gallbladder Cancer: Results from a Nationwide Cohort Study. Ann Surg Oncol 28, 835–843 (2021). 

Synopsis: Significant post-operative morbidity and mortality were found in patients with advanced gallbladder cancer undergoing extended resection.  However, long-term survival was achieved in a subset. Therefore, extended resections do not preclude long-term survival and a subgroup of patients benefit from surgery.

Cardenas G, Valentini M, Mellado B, et al. 

Citation: Cárdenas, G., Valentini, M., Mellado, B. et al. Laparoscopic Right Adrenalectomy in a Large Right Adrenal Oncocytic Carcinoma. Ann Surg Oncol (2020).

Synopsis:  In this multimedial article, the authors report on a step-by-step laparoscopic approach for an unusual large right adrenal oncocytic carcinoma and description of its anatomo-pathological features.

Altomare M, Sposito C, Regalia E, et al 

Citation: Altomare, M., Sposito, C., Regalia, E. et al. Resection of Retro-Hepatic Vena Cava (RHVC) En-bloc with Caudate Lobe without Vascular Exclusion for a Low Grade Leiomyosarcoma of Inferior Vena Cava. Ann Surg Oncol (2021). 

Synopsis: The video of this multimedia articles shows removal of a leiomyosarcoma of the vena cava en-bloc with caudate lobe. With hybrid 3Dsuperimposition of vascular anatomy of the region, splanchnic circulation and liver venous outflow were maintained throughout surgery, allowing parenchyma-sparing hepatectomy and cava reconstruction. 

Marc D. Moncrieff, Riti A. Sharma, Esther Gathura, and Martin J. Heaton 

Citation: Moncrieff, M.D., Sharma, R.A., Gathura, E. et al. Improved Perioperative Seroma and Complication Rates Following the Application of a 2-Layer Negative Pressure Wound Therapy System After Inguinal Lymphadenectomy for Metastatic Cutaneous Melanoma. Ann Surg Oncol 27, 3692–3701 (2020). 

Synopsis:  Inguinal lymphadenectomy is associated with a high incidence of perioperative morbidity. A twolayer negative pressure wound therapy system significantly reduced the incidence of seroma, return to theatre rate and the drainage period compared to traditional closed suction drainage technique.

J.F. Huisman, I.J.H. Schoenaker, R.M. Brohet, O. Reerink, H. van der Sluis, F.C.P. Moll, E. de Boer, J.C. de Graaf, W.H. de Vos tot Nederveen Cappel, G.L. Beets, and H.L. van Westreenen 

Citation: Huisman, J.F., Schoenaker, I.J.H., Brohet, R.M. et al. Avoiding Unnecessary Major Rectal Cancer Surgery by Implementing Structural Restaging and a Watch-and-Wait Strategy After Neoadjuvant Radiochemotherapy. Ann Surg Oncol (2020). 

Synopsis: This study demonstrated a significant decline in unnecessary surgery due to a Watch & Wait strategy for selected patients with good tumor response after neo-adjuvant chemoradiotherapy. Major total mesorectal excision surgery was avoided in more than 20% of the cases.

Leonie T. Jonker, Matthijs Plas, Geertruida H. de Bock, Erik Buskens, Barbara L. van Leeuwen, and Maarten M. H. Lahr 

Citation: Jonker, L.T., Plas, M., de Bock, G.H. et al. Remote Home Monitoring of Older Surgical Cancer Patients: Perspective on Study Implementation and Feasibility. Ann Surg Oncol 28, 67–78 (2021).

Synopsis:  Elderly patients in the study setting considered postoperative home monitoring following oncological surgery acceptable and usable. These results provide a  valuable contribution to the discussion on the feasibility of home monitoring after surgery and are relevant for future studies.

Alessandro Vanoli, Federica Grillo, Camilla Guerini…Antonio Di Sabatino 

Citation: Vanoli, A., Grillo, F., Guerini, C. et al. Prognostic Role of Mismatch Repair Status, Histotype and High-Risk Pathologic Features in Stage II Small Bowel Adenocarcinomas. Ann Surg Oncol 28, 1167–1177 (2021). 

Synopsis: In patients with stage  II  small bowel adenocarcinomas,  mismatch repair deficiency and celiac disease represent favorable prognostic markers, whereas poorly cohesive histology and  pT4  are associated with a  worse prognosis.  These features may help in selecting patients for adjuvant chemotherapy.

Tran CG, Sherman SK, Scott AT, et al.

Citation: Tran, C.G., Sherman, S.K., Scott, A.T. et al. It Is Time to Rethink Biomarkers for Surveillance of Small Bowel Neuroendocrine Tumors. Ann Surg Oncol 28, 732–741 (2021).

Synopsis:  Chromogranin A is the most commonly monitored tumor biomarker in small bowel neuroendocrine tumors. In this study, pancreastatin provided more information on survival and was more sensitive and specifi c in detecting recurrence.

Adileh M, Yuval JB, Walch HS, et al.

Citation: Adileh, M., Yuval, J.B., Walch, H.S. et al. Primary Tumor Location and Outcomes After Cytoreductive Surgery and Intraperitoneal Chemotherapy for Peritoneal Metastases of Colorectal Origin. Ann Surg Oncol 28, 1109–1117 (2021).

Synopsis: In patients with peritoneal metastases of colorectal origin, location of the primary tumor was an independent predictor of survival. Worse outcomes were observed in patients with right-sided tumors. The genetic alterations were different in left-sided and right-sided tumors.

Pedone Anchora L, Turco LC, Bizzarri N, et al.

Citation: Pedone Anchora, L., Turco, L.C., Bizzarri, N. et al. How to Select Early-Stage Cervical Cancer Patients Still Suitable for Laparoscopic Radical Hysterectomy: a Propensity-Matched Study. Ann Surg Oncol 27, 1947–1955 (2020).

Synopsis:  The main determinant factor in the choice of surgical approach is a tumor diameter of 20 mm. Women with > 20 mm disease should undergo open surgery while in case of tumor < 20 mm both approaches appear safe.

Chicago Consensus Working Group., Schuitevoerder, D., Plana, A. et al. 

Citation: Chicago Consensus Working Group., Schuitevoerder, D., Plana, A. et al. The Chicago Consensus on Peritoneal Surface Malignancies: Management of Appendiceal Neoplasms. Ann Surg Oncol 27, 1753–1760 (2020).

Synopsis: The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of appendiceal neoplasms specifically related to the management of peritoneal surface malignancies.

Griffin, S.M., Jones, R., Kamarajah, S.K. et al. 

Citation: Griffin, S.M., Jones, R., Kamarajah, S.K. et al. Evolution of Esophagectomy for Cancer Over 30 Years: Changes in Presentation, Management and Outcomes. Ann Surg Oncol (2020). 

Synopsis:  The presentation, management and outcomes of esophageal cancer have changed greatly over the last 30 years. This study highlights these changes through the lens of a single high volume center and illustrates the huge improvement in patient survival.

Blanco, B.A., Poulson, M., Kenzik, K.M. et al. 

Citation: Blanco, B.A., Poulson, M., Kenzik, K.M. et al. The Impact of Residential Segregation on Pancreatic Cancer Diagnosis, Treatment, and Mortality. Ann Surg Oncol (2020).

Synopsis: This study highlights the impact of residential segregation on pancreatic cancer outcomes and shows that with reduction in segregation, disparities in stage at diagnosis, surgical resection, and overall mortality disappear. 

Robert Sucher MD, Uwe Scheuermann MD & Daniel Seehofer MD 

Citation: Sucher, R., Scheuermann, U. & Seehofer, D. Total Laparoscopic Resection of Hilar Cholangiocarcinoma Type 3b: Applying a Parachute Technique for Hepaticojejunostomy. Ann Surg Oncol (2020). 

Synopsis:  With the implementation of novel surgical techniques and strategies, laparoscopic liver surgery has gained momentum also in the field of perihilar cholangiocarcinoma (pCCA) surgery. To accomplish the most delicate part of the procedure – the hepatico-jejunostomy – the authors applied a parachute suturing technique, which allowed for a good view on both components of the anastomosis, the posterior wall of the hepatic duct as well as the jejunal segment which the authors intended to anastomose. This strategy hence allowed for a successful total laparoscopic operation without the need for an “open surgery service incision” to accomplish biliary reconstruction. 

Marcel Autran Machado, Bruno V. Mattos, Murillo Macedo Lobo Filho, and Fabio Makdissi

Citation: Machado, M.A., Mattos, B.V., Lobo Filho, M.M. et al. Robotic Resection of Hilar Cholangiocarcinoma. Ann Surg Oncol 27, 4166–4170 (2020). 

Synopsis: This video shows a robotic radical resection of hilar cholangiocarcinoma which consisted in left hepatectomy, caudate lobe resection, resection of bile duct, lymphadenectomy and Roux-en-Y hepaticojejunostomy. Robotic approach has some technical advantages over laparoscopic technique for this procedure.

Angarita, S., Ye, L., Rünger, D. et al. 

Citation: Angarita, S., Ye, L., Rünger, D. et al. Assessing the Burden of Nodal Disease for Breast Cancer Patients with Clinically Positive Nodes: Hope for More Limited Axillary Surgery. Ann Surg Oncol (2020). 

Synopsis:  This article assesses the burden of nodal disease in breast cancer patients who present with clinically positive axillary nodes. The data reported demonstrate that over 40% of patients have minimal pN1 disease. Palpable lymphadenopathy does not predict for higher nodal stage. 

Bartlett, D.L., Howe, J.R., Chang, G. et al. 

Citation: Bartlett, D.L., Howe, J.R., Chang, G. et al. Management of Cancer Surgery Cases During the COVID-19 Pandemic: Considerations. Ann Surg Oncol 27, 1717–1720 (2020).

Synopsis: In these unprecedented times of COVID-19, surgical oncologists are being forced to consider triage and rationing of cancer surgery cases. This article presents recommendations for managing care in respective areas of cancer specialties, assuming a 3- to 6-month delay in care.

Featured Articles ArchiveDe Andrade, J.P., Wong, P., O’Leary, M.P., et al. 

Citation: De Andrade, J.P., Wong, P., O’Leary, M.P. et al. Multidisciplinary Care for Melanoma of Unknown Primary: Experience in the Era of Molecular Profiling. Ann Surg Oncol 27, 5240–5247 (2020). 

Synopsis:  Melanoma of unknown primary (MUP) is melanoma with locoregional or distant metastases without evidence of a primary lesion. In this article, the authors review the diagnosis, treatment, and outcomes of a modern cohort of patients with MUP.

Featured Articles ArchiveTsilimigras, D.I., Hyer, J.M., Paredes, A.Z., et al. 

Citation: Tsilimigras, D.I., Hyer, J.M., Paredes, A.Z. et al. A Novel Classification of Intrahepatic Cholangiocarcinoma Phenotypes Using Machine Learning Techniques: An International Multi-Institutional Analysis. Ann Surg Oncol 27, 5224–5232 (2020). 

Synopsis: The current study identified 3 distinct clusters of ICC patients based purely on phenotype: common, proliferative and inflammatory ICC. Patients with inflammatory ICC had the worst long-term outcomes following resection and should be considered candidates for alternative treatment therapies such as neoadjuvant chemotherapy.

Featured Articles ArchiveCitation: Gruber, E.S., Jomrich, G., Kaider, A. et al. The Prognostic Index Independently Predicts Survival in Patients with Pancreatic Ductal Adenocarcinoma Undergoing Resection. Ann Surg Oncol 27, 2017–2024 (2020). 

Synopsis:  Cancer-related inflammation drives tumor development.  The Prognostic Index is a simple inflammation score, that combines CRP and white blood count, whilst other prognostic scores require extended laboratory analysis. Further on, it has proven as a strong  independent  tool  for  survival  prognostication  in  357  patients  with  pancreatic cancer undergoing resection.

Featured Articles ArchiveCitation: Yang, Wf., Choi, W.S., Wong, M.CM. et al. Three-Dimensionally Printed Patient-Specific Surgical Plates Increase Accuracy of Oncologic Head and Neck Reconstruction Versus Conventional Surgical Plates: A Comparative Study. Ann Surg Oncol (2020). 

Synopsis: In this comparative study, 3D-printed patient-specific surgical plates increase accuracy of oncological head and neck reconstruction versus conventional surgical plates, concerning the entire maxilla or mandible,  bilateral mandibular angles, and reconstructed bone grafts. This constitutes the highest level of evidence to date.

Featured Articles ArchiveRidner SH, Dietrich MS, Cowher MS, et al.

Citation: Ridner, S.H., Dietrich, M.S., Cowher, M.S. et al. A Randomized Trial Evaluating Bioimpedance Spectroscopy Versus Tape Measurement for the Prevention of Lymphedema Following Treatment for Breast Cancer: Interim Analysis. Ann Surg Oncol 26, 3250–3259 (2019). 

Synopsis:  An interim analysis is reported of a randomized controlled trial comparing lymphedema progression rates using volume measurements calculated from circumference using tape measure (TM) to bioimpedance spectroscopy (BIS). Interim results demonstrate that post-treatment surveillance with BIS reduced absolute rates of progression of BCRL by approximately 10%, a clinically meaningful improvement.

Featured Articles ArchiveAquina CT, Truong M, Justiniano CF, et al. 

Citation: Aquina, C.T., Truong, M., Justiniano, C.F. et al. Variation in Adequate Lymph Node Yield for Gastric, Lung, and Bladder Cancer: Attributable to the Surgeon, Pathologist, or Hospital?. Ann Surg Oncol 27, 4093–4106 (2020). 

Synopsis: This study investigated trends, factors, and sources of variation related to adequate lymph node yield (ALNY) for gastric, lung, and bladder cancer resection.  ALNY remains low, and the relative contributions of the surgeon/pathologist/hospital in attaining ALNY differ across organ systems.

Featured Articles ArchiveArielle Stafford, Austin Williams, Kirsten Edmiston, Costanza Cocilovo, Robert Cohen, Sara Bruce, Kahyun Yoon-Flannery, and Lucy De La Cruz

Citation: Stafford, A., Williams, A., Edmiston, K. et al. Axillary Response in Patients Undergoing Neoadjuvant Endocrine Treatment for Node-Positive Breast Cancer: Systematic Literature Review and NCDB Analysis. Ann Surg Oncol 27, 4669–4677 (2020). 

Synopsis:  The  utility  of neoadjuvant  endocrine therapy  (NET)  on axillary  downstaging  in clinically  node-positive breast cancer is unclear. Using the National Cancer Database, the authors found that complete pathologic response in the axilla occurs after NET more frequently than previously reported.

Featured Articles ArchiveLizhi Shao, Zhenyu Liu, Lili Feng, Xiaoying Lou, Zhenhui Li, Xiao-Yan Zhang, Xiangbo Wan,Xuezhi Zhou, PhD2,8, Kai Sun, Da-Fu Zhang, Lin Wu, Guanyu Yang, Ying-Shi Sun, Ruihua Xu, Xinjuan Fan, and Jie Tian

Citation: Shao, L., Liu, Z., Feng, L. et al. Multiparametric MRI and Whole Slide Image-Based Pretreatment Prediction of Pathological Response to Neoadjuvant Chemoradiotherapy in Rectal Cancer: A Multicenter Radiopathomic Study. Ann Surg Oncol 27, 4296–4306 (2020).

Synopsis: This is a multicenter study combining radiological information of whole tumor and pathological information of local lesions to specifically differentiate response prior to nCRT, taking advantage of the complementary information provided by mp-MRI and WSI.

Featured Articles ArchiveBrittany L. Murphy, Min Yi, Banu K. Arun, Angelica M. Gutierrez Barrera, and Isabelle Bedrosian

Citation: Murphy, B.L., Yi, M., Arun, B.K. et al. Contralateral Risk-Reducing Mastectomy in Breast Cancer Patients Who Undergo Multigene Panel Testing. Ann Surg Oncol 27, 4613–4621 

Synopsis:  Among patients with unilateral breast cancer who underwent multi-gene panel testing,  patients with a  BRCA 1/2 mutation were thirteen times more likely than those without a germline mutation to undergo CRRM, patients with a non-BRCA mutation were four times as likely, and a VUS were twice as likely.

Featured Articles ArchiveTracy-Ann Moo, Kate R. Pawloski, Varadan Sevilimedu, Jillian Charyn, Brett A. Simon, Lisa M. Sclafani, George Plitas, Andrea V. Barrio, Laurie J. Kirstein, Kimberly J. Van Zee, and Monica Morrow 

Citation: Moo, T., Pawloski, K.R., Sevilimedu, V. et al. Changing the Default: A Prospective Study of Reducing Discharge Opioid Prescription after Lumpectomy and Sentinel Node Biopsy. Ann Surg Oncol 27, 4637–4642 (2020). 

Synopsis: The authors examine outcomes following a change in standard discharge prescription from opioid/NSAID to an NSAID/acetaminophen, and conclude  that  most  patients  undergoing  lumpectomy  with  SLNB  can  be  discharged with an NSAID/acetaminophen, reducing the number of unused opioids in the community.

Featured Articles ArchiveLaparoscopic Suprapancreatic Lymph Node Dissection Using a Systematic Mesogastric Excision Concept for Gastric Cancer

Tsutomu Kumamoto, Yasunori Kurahashi, Hirotaka Niwa, et al.

Citation: Kumamoto, T., Kurahashi, Y., Niwa, H. et al. Laparoscopic Suprapancreatic Lymph Node Dissection Using a Systematic Mesogastric Excision Concept for Gastric Cancer. Ann Surg Oncol 27, 529–531 (2020). 

Synopsis:  Laparoscopic suprapancreatic lymphadenectomy using SME takes advantage of the surgical anatomy and achieves en bloc removal of the primary tumor and gastric mesentery. This series provides evidence that this procedure can be performed in a timely manner and is feasible.

Featured Articles ArchiveAlessandra Marano, Fabrizio Allisiardi, Enrico Perino, et al.

Citation: Marano, A., Allisiardi, F., Perino, E. et al. Robotic Treatment for Large Duodenal Gastrointestinal Stromal Tumor. Ann Surg Oncol 27, 1101–1102 (2020). 

Synopsis: The adoption of a robotic approach could facilitate a duodenal sparing resection of large duodenal gastrointestinal stromal tumors amenable to a conservative R0 resection.

Featured Articles ArchiveForsythe SD, Sasikumar S, Omeed Moaven, et al. 

Citation: Forsythe, S.D., Sasikumar, S., Moaven, O. et al. Personalized Identification of Optimal HIPEC Perfusion Protocol in Patient-Derived Tumor Organoid Platform. Ann Surg Oncol (2020).

Synopsis:  Tumor organoid HIPEC platform for determination of optimal systemic and intraperitoneal chemotherapy at the level of the individual patient, suggesting that not only type of chemotherapy, but also application of hyperthermia should be personalized. 

Featured Articles ArchiveLeimkühler M, Hentzen JEKR, Hemmer PHJ. et al.

Citation: Leeds, I.L., Meyers, P.M., Enumah, Z.O. et al. Psychosocial Risks are Independently Associated with Cancer Surgery Outcomes in Medically Comorbid Patients. Ann Surg Oncol 26, 936–944 (2019). 

Synopsis: The effect of psychosocial risks on cancer surgery remains understudied. In comorbid patients, multiple psychosocial risks conferred a three times increase in the odds of a complication. These findings support the use of psychosocial risk assessment and potential preoperative optimization.

Featured Articles ArchiveFraune C, Burandt E, Simon R, et al.

Citation: Fraune, C., Burandt, E., Simon, R. et al. MMR Deficiency is Homogeneous in Pancreatic Carcinoma and Associated with High Density of Cd8-Positive Lymphocytes. Ann Surg Oncol 27, 3997–4006 (2020). 

Synopsis:  Immune checkpoint inhibition can be effective in microsatellite instable tumors. Here, we found that about 1 percent of 597 pancreatic cancers showed microsatellite instability, which was detectable throughout the entire tumor bulk. Our data suggest that microsatellite instability can be reliably assessed in small pancreatic cancer biopsies to select patients for therapy.

Featured Articles ArchiveLeimkühler M, Hentzen JEKR, Hemmer PHJ. et al.

Citation: Leimkühler, M., Hentzen, J.E.K.R., Hemmer, P.H.J. et al. Systematic Review of Factors Affecting Quality of Life After Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 27, 3973–3983 (2020). 

Synopsis: Quality of life deteriorates in the 6 months after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, returning to baseline by 12 months. This is negatively influenced by age, operation times, extensive disease, residual disease, adjuvant chemotherapy, complications, stoma placement, and recurrence.

Featured Articles ArchiveNeal Bhutiani, Yan Li, Qianqian Zheng, Harshul Pandit, Xiaoju Shi, Yujia Chen, Youxi Yu, Zachary R. Pulliam, Min Tan, and Robert C. G. Martin II 

Citation: Bhutiani, N., Li, Y., Zheng, Q. et al. Electrochemotherapy with Irreversible Electroporation and FOLFIRINOX Improves Survival in Murine Models of Pancreatic Adenocarcinoma. Ann Surg Oncol 27, 4348–4359 (2020). 

Synopsis: Electrochemotherapy (ECT) with IRE and FOLFIRINOX resulted in increased tumor-cell apoptosis in mice models. In five patients, ECT with either FOLFIRINOX or gemcitabine was well tolerated and resulted in no dose-limiting toxicities.

Featured Articles ArchiveGiacomo Montagna, Anita Mamtani, Andrea Knezevic, Edi Brogi, Andrea V. Barrio, and Monica Morrow 

Citation: Montagna, G., Mamtani, A., Knezevic, A. et al. Selecting Node-Positive Patients for Axillary Downstaging with Neoadjuvant Chemotherapy. Ann Surg Oncol 27, 4515–4522 (2020). 

Synopsis: Here we evaluate how often node-positive patients avoid ALND with NAC and identify predictors of retrieval of ≥3 SLNs and ALND avoidance. ALND was spared in 41% of patients; this was associated with receptor status, grade, and LVI.

Featured Articles ArchiveAnita Mamtani, Andrea V. Barrio, Debra A. Goldman, Hannah Y. Wen, Alain Vincent, and Monica Morrow

Citation: Mamtani, A., Barrio, A.V., Goldman, D.A. et al. Extranodal Tumor Deposits in the Axillary Fat Indicate the Need for Axillary Dissection Among T1–T2cN0 Patients with Positive Sentinel Nodes. Ann Surg Oncol 27, 3585–3592 (2020). 

Synopsis: Among T1-T2cN0 patients with SLN metastases, the presence of extranodal tumor deposits in the axillary fat is strongly associated with ≥4 positive NSLNs. Even in patients meeting ACOSOG Z0011 criteria for omission of ALND, this finding may warrant completion ALND.

Featured Articles ArchiveCitation: Ibrahim, A.M., Le May, M., Bossé, D. et al. Imaging Intensity and Survival Outcomes in High-Risk Resected Melanoma Treated by Systemic Therapy at Recurrence. Ann Surg Oncol 27, 3683–3691 (2020).

Synopsis: The authors examined 353 high-risk melanoma patients over a 10-year period for imaging surveillance intensity and symptom status at recurrence. Asymptomatic detection of metastatic recurrence was associated with lower burden of disease, higher rates of systemic treatment, and improved overall survival outcomes.

Featured Articles ArchivePercutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Ocular Melanoma Metastases Confined to the Liver: A Prospective Phase II Study

Susanna Meijer, Mark C. Burgmans, Eleonora M. de Leede…Alexander L. Vahrmeijer

Citation: Meijer, T.S., Burgmans, M.C., de Leede, E.M. et al. Percutaneous Hepatic Perfusion with Melphalan in Patients with Unresectable Ocular Melanoma Metastases Confined to the Liver: A Prospective Phase II Study. Ann Surg Oncol (2020). 

Synopsis: The liver is the predominant site of metastases from ocular melanoma. This study shows that percutaneous hepatic perfusion with melphalan can achieve a high overall response rate and median overall survival well beyond 1 year in patients with liver-only ocular melanoma metastases.

Featured Articles ArchiveAmanda R. Kupstas, Tanya L. Hoskin, Courtney N. Day, Elizabeth B. Habermann, and Judy C. Boughey

Citation: Kupstas, A.R., Hoskin, T.L., Day, C.N. et al. Effect of Surgery Type on Time to Adjuvant Chemotherapy and Impact of Delay on Breast Cancer Survival: A National Cancer Database Analysis. Ann Surg Oncol 26, 3240–3249 (2019). 

Synopsis: Using the National Cancer Database, we evaluated how the type of breast surgery impacted the timing to adjuvant chemotherapy and factors that infl uenced any delay in therapy, and furthermore, evaluated the impact of any delay in adjuvant chemotherapy on patient outcome. Initiation of chemotherapy greater than 120 days after diagnosis was associated with poorer overall survival. The time interval from diagnosis to surgery had the greatest impact on the time from diagnosis to chemotherapy, with reconstruction resulting in the greatest delay

Featured Articles ArchiveIrbaz Hameed,  Piyush Aggarwal, and Martin R. Weiser 

Citation: Hameed, I., Aggarwal, P. & Weiser, M.R. Robotic Extended Right Hemicolectomy with Complete Mesocolic Excision and D3 Lymph Node Dissection. Ann Surg Oncol 26, 3990–3991 (2019). 

Synopsis: This video provides a step-by-step demonstration of a robotically assisted extended right hemicolectomy with complete mesocolic excision and D3 lymphadenectomy in a 62-year-old male with hepatic flexure adenocarcinoma. The use of robotics facilitates visualization and instrument dexterity.

Featured Articles ArchiveJi Hoon Kim MD and Hyeyoung Kim 

Citation: Kim, J.H., Kim, H. Pure Laparoscopic Anatomic Resection of the Segment 8 Ventral Area Using the Transfissural Glissonean Approach. Ann Surg Oncol 26, 4608–4609 (2019).

Synopsis: The most difficult and critical step of anatomical resection of segment 8 ventral area is the determination of boundary. The transfissural Glissonean approach is a feasible and effective technique for laparoscopic anatomical segmentectomy. The parenchymal transection along the main portal fissure allows easy and direct access to the segment 8 ventral branch.

Featured Articles ArchiveRuben Ciria, Irene Gomez-Luque, Sira Ocaña…Mohammed Abu Hilal

Citation: Ciria, R., Gomez-Luque, I., Ocaña, S. et al. A Systematic Review and Meta-Analysis Comparing the Short- and Long-Term Outcomes for Laparoscopic and Open Liver Resections for Hepatocellular Carcinoma: Updated Results from the European Guidelines Meeting on Laparoscopic Liver Surgery, Southampton, UK, 2017. Ann Surg Oncol 26, 252–263 (2019). 

Synopsis: Laparoscopic approach for liver resection of hepatocellular carcinoma (HCC) improves short-term outcomes without compromising long-term outcomes. In specific sub-analyses, the main improvement is observed in hospital stay and complications. Minimally invasive approach should be considered an adequate strategy for resection of HCC. 

Featured Articles ArchiveDiamantis I. Tsilimigras, Fabio Bagante, Kota Sahara…Timothy M. Pawlik 

Citation: Tsilimigras, D.I., Bagante, F., Sahara, K. et al. Prognosis After Resection of Barcelona Clinic Liver Cancer (BCLC) Stage 0, A, and B Hepatocellular Carcinoma: A Comprehensive Assessment of the Current BCLC Classification. Ann Surg Oncol 26, 3693–3700 (2019). 

Synopsis: This study assessed the prognosis of patients undergoing surgery for BCLC stage 0, A, and B hepatocellular carcinoma (HCC). Patients with a single large tumor had long-term outcomes comparable with patients with BCLC-B HCC following liver resection. Surgery after resection for BCLC-B HCC provided a 5-year overall survival of 49.9%.

Featured Articles ArchiveRittal Mehta, Diamantis I. Tsilimigras, Anghela Z. Paredes…Timothy M. Pawlik

Citation: Mehta, R., Tsilimigras, D.I., Paredes, A.Z. et al. Is Patient Satisfaction Dictated by Quality of Care Among Patients Undergoing Complex Surgical Procedures for a Malignant Indication? Ann Surg Oncol 27, 3126–3135 (2020).

Synopsis: Higher patient satisfaction was strongly associated with hospital structural measures such as bed number, urban location as well as nurse-to-bed ratio. Patients who had an “optimal” TO following cancer surgery had higher odds of ranking the hospital within the highest HCAPS category. High quality of care can directly lead to improved patient satisfaction among surgical patients with cancer.

Featured Articles ArchiveCitation: Kobayashi, S., Takahashi, S., Takahashi, N. et al. Survival Outcomes of Resected BRAF V600E Mutant Colorectal Liver Metastases: A Multicenter Retrospective Cohort Study in Japan. Ann Surg Oncol 27, 3307–3315 (2020). 

Synopsis: A multicenter retrospective cohort study to investigate the survival outcomes of resected BRAF V600E mutant CRLM was conducted. A clinicopathological analysis was performed, and the future treatment strategy for this disease is discussed.

Featured Articles ArchiveHannah Deborah  Müller, Florian Posch, Christoph Suppan…Marija Balic

Citation: Müller, H.D., Posch, F., Suppan, C. et al. Validation of Residual Cancer Burden as Prognostic Factor for Breast Cancer Patients After Neoadjuvant Therapy. Ann Surg Oncol 26, 4274–4283 (2019). 

Synopsis: In a clinical, independent setting the value of the residual cancer burden (RCB) predictive performance was assessed. The authors confirm the RCB score as externally valid prognostic marker independent of molecular subtype for relapse-free survival and overall survival.

Featured Articles ArchiveHatem Soliman, Susanne Wagner, Darl D. Flake II…William Gradishar

Citation: Soliman, H., Wagner, S., Flake, D.D. et al. Evaluation of the 12-Gene Molecular Score and the 21-Gene Recurrence Score as Predictors of Response to Neo-adjuvant Chemotherapy in Estrogen Receptor-Positive, HER2-Negative Breast Cancer. Ann Surg Oncol 27, 765–771 (2020). 

Synopsis: Neo-adjuvant chemotherapy may facilitate complete surgical resection in breast cancer. Using microarray data, two commercial breast cancer prognostic scores (12-gene MS and 21-gene RS) were significant predictors of response to neo-adjuvant chemotherapy, though the 12-gene MS outperformed the 21-gene RS.

Featured Articles ArchiveCitation: Yin, K., Liu, Y., Lamichhane, B. et al. Legacy Genetic Testing Results for Cancer Susceptibility: How Common are Conflicting Classifications in a Large Variant Dataset from Multiple Practices?. Ann Surg Oncol 27, 2212–2220 (2020).

Synopsis: By analyzing a large multipractice variant dataset, we found that 21.2% (n = 783) of the variants had discordance between lab-reported and ClinVar classifications. Of all unique variants, 2.5% (n = 121) had within-practice lab-reported discordances, and 1.2% (n = 56) had lab-reported discordances across practices.

Featured Articles ArchiveDiamantis I. Tsilimigras, Fabio Bagante, Dimitrios Moris…Timothy M. Pawlik

Citation: Tsilimigras, D.I., Bagante, F., Moris, D. et al. Recurrence Patterns and Outcomes after Resection of Hepatocellular Carcinoma within and beyond the Barcelona Clinic Liver Cancer Criteria. Ann Surg Oncol 27, 2321–2331 (2020).

Synopsis: In this multi-institutional study, 602 (79.6%) and 154 (20.4%) patients underwent resection within (i.e. BCLC-0/A) and beyond (i.e. BCLC B/C) the current BCLC resection criteria. Recurrences in both BCLC 0/A and BCLC B/C groups were mostly intrahepatic. Surgery provided a 5-year OS of 51.6% among select patients with BCLC B/C HCC.

Featured Articles ArchiveMarcel Autran C. Machado, Rodrigo C. Surjan, Fabio Makdissi

Citation: Machado, M.A.C., Surjan, R.C. & Makdissi, F. Robotic ALPPS. Ann Surg Oncol 27, 1174–1179 (2020). 

Synopsis: This streaming video article presents a robotic ALPPS procedure to treat synchronous colorectal liver metastases. The first and second stages were totally robotic as well as the colon resection. The use of the Xi da Vinci system was useful to complete this procedure. 

Featured Articles ArchiveJune S. Peng, Steven J. Nurkin, Steven N. Hochwald, Moshim Kukar

Citation: Peng, J.S., Nurkin, S.J., Hochwald, S.N. et al. Technique for Robotic Ivor Lewis Esophagectomy with 6-cm Linear Stapled Side-to-Side Anastomosis. Ann Surg Oncol 27, 824 (2020). 

Synopsis: Minimally invasive esophagectomy offers decreased postoperative complications compared with open esophagectomy, with equivalent oncologic outcomes. This streaming video article presents a technique for a completely robotic Ivor Lewis esophagectomy with a 60-mm side-to-side intrathoracic anastomosis, which is associated with low stricture and leak rates.

Featured Articles ArchiveDominik Paul Modest, Volker Heinemann, Gunnar Folprecht…Ingrid Ricard

Citation:  Modest, D.P., Heinemann, V., Folprecht, G. et al. Factors That Influence Conversion to Resectability and Survival After Resection of Metastases in RAS WT Metastatic Colorectal Cancer (mCRC): Analysis of FIRE-3- AIOKRK0306. Ann Surg Oncol 27, 2389–2401 (2020). 

Synopsis:  Achievement of secondary resectability of metastases from colorectal cancer is associated with disease characteristics (BRAF mutation, presence of lung lesions etc) and with early response parameters. Resection of metastases is associated with improved post-best response survival.

Featured Articles ArchiveAngela Horvath, Augustinas Bausys, Rasa Sabaliauskaite…Kestutis Strupas

Citation: Horvath, A., Bausys, A., Sabaliauskaite, R. et al. Distal Gastrectomy with Billroth II Reconstruction is Associated with Oralization of Gut Microbiome and Intestinal Inflammation: A Proof-of-Concept Study. Ann Surg Oncol (2020).

Synopsis: This study investigates the gut microbiome composition after subtotal gastrectomy with Billroth II reconstruction. Surgery results in gut microbiome oralization and intestinal inflammation. These changes are associated with gastrointestinal symptoms. 

Featured Articles ArchiveMonica Polcz, Cameron Schlegel, Gretchen C. Edwards…Christina E. Bailey

Citation:  Polcz, M., Schlegel, C., Edwards, G.C. et al. Primary Tumor Resection Offers Survival Benefit in Patients with Metastatic Midgut Neuroendocrine Tumors. Ann Surg Oncol 27, 2795–2803 (2020). 

Synopsis:  The aim of this study was to evaluate prevalence and survival impact of primary tumor resection (PTR) in patients with unresectable metastatic midgut neuroendocrine tumors. PTR was associated with improved overall survival, however 40% of patients did not undergo PTR.

Featured Articles ArchiveCarlos Eduardo Barbosa de Carvalho, Renato Capuzzo, Camila Crovador…Vinicius L. Vazquez

Citation: de Carvalho, C.E.B., Capuzzo, R., Crovador, C. et al. Near Infrared (NIR) Fluorescence is Not a Substitute for Lymphoscintigraphy and Gamma Probe for Melanoma Sentinel Node Detection: Results from a Prospective Trial. Ann Surg Oncol 27, 2906–2912 (2020). 

Synopsis: This prospective trial of 121 melanomas shows that a combined sentinel node detection approach using blue dye, radiocolloids and fluorescent tracers is the most efficient. Only radiocolloids provided sufficient sensitivity to be used alone.

Featured Articles ArchiveKonstantinos I. Votanopoulos, Steven Forsythe, Hemamylammal Sivakumar…Aleksander Skardal

Citation:  Votanopoulos, K.I., Forsythe, S., Sivakumar, H. et al. Model of Patient-Specific Immune-Enhanced Organoids for Immunotherapy Screening: Feasibility Study. Ann Surg Oncol 27, 1956–1967 (2020). 

Synopsis: The authors describe a patient-specific organoid platform, where melanoma and lymph node from the same patient are cocultured and used to predict tumor response to immunotherapy and generate adaptive immunity, by presenting tumor neoantigens on patient’s own nodal antigen-presenting cells (APCs). 

Featured Articles ArchiveKorrel, J. van Hilst, A. Alseidi…M. G. Besselink

Citation: Korrel, M., Lof, S., van Hilst, J. et al. Predictors for Survival in an International Cohort of Patients Undergoing Distal Pancreatectomy for Pancreatic Ductal Adenocarcinoma. Ann Surg Oncol (2020). 

Synopsis: It is unclear which predictors related to surgical technique are associated with improved overall survival after distal pancreatectomy for pancreatic ductal adenocarcinoma. In this international cohort including 1200 patients, predictors for improved overall survival included Gerota’s fascia resection, R0-resection, and decreased lymph node ratio.

Feasibility Study of a Novel Protease-Activated Fluorescent Imaging System for Real-Time, Intraoperative Detection of Residual Breast Cancer in Breast Conserving SurgeryBarbara L. Smith, Conor R. Lanahan, Michelle C. Specht…Michele A. Gadd

Citation: Smith, B.L., Lanahan, C.R., Specht, M.C. et al. Feasibility Study of a Novel Protease-Activated Fluorescent Imaging System for Real-Time, Intraoperative Detection of Residual Breast Cancer in Breast Conserving Surgery. Ann Surg Oncol 27, 1854–1861 (2020). 

Synopsis: Real-time, intraoperative breast lumpectomy margin assessment was performed using LUM015, a protease-activated fluorescent imaging agent. The tumor was distinguished from benign tissue across all tumor histology, breast density, and menopausal status. 

Featured Articles ArchivePim B. Olthof, Luca Aldrighetti, Ruslan Alikhanov…Thomas M. van Gulik

Citation: Olthof, P.B., Aldrighetti, L., Alikhanov, R. et al. Portal Vein Embolization is Associated with Reduced Liver Failure and Mortality in High-Risk Resections for Perihilar Cholangiocarcinoma. Ann Surg Oncol 27, 2311–2318 (2020). 

Synopsis: Using data on 1667 patients who underwent resection of suspected perihilar cholangiocarcinoma across 20 centers, it was shown in a propensity matched comparison that the use of peroperative portal portal vein embolization was associated with major reductions in liver failure and mortality rates.

Intraoperative Fluorescent AngiographyRebecca Hoesli, Julia R. Brennan, Andrew J. Rosko…Matthew E. Spector

Citation: Hoesli, R., Brennan, J.R., Rosko, A.J. et al. Intraoperative Fluorescent Angiography Predicts Pharyngocutaneous Fistula After Salvage Laryngectomy. Ann Surg Oncol 26, 1320–1325 (2019). 

Synopsis: Intraoperative usage of indocyaine green imaging can predict the formation of post-operative fistulas, allowing for more tailored reconstructive options depending on risk of fistula.

Oncology Navigator Activity Pie ChartLaura M. Enomoto, Joyce Fenstermaker, Rodwige J. Desnoyers…Perry Shen

Citation: Enomoto, L.M., Fenstermaker, J., Desnoyers, R.J. et al. Oncology Navigation Decreases Time to Treatment in Patients with Pancreatic Malignancy. Ann Surg Oncol 26, 1512–1518 (2019). 

Synopsis: Significant delays in care may exist due to the complexity of multidisciplinary care in patients with pancreatic malignancy. Implementing an oncology navigation program significantly decreased the time to treatment in patients with pancreatic malignancy.

Featured Articles ArchiveStephanie A. Valente, Chirag Shah

Citation: Valente, S.A., Shah, C. The Landmark Series: Adjuvant Radiation Therapy for Breast Cancer. Ann Surg Oncol (2020). 

Synopsis: This landmark series evaluating radiation therapy for breast cancer is a review of milestone trials which have established treatment paradigms to improve both local control and survival for breast cancer patients.

Featured Articles ArchiveK. Kamarajah, M. Navidi, S. Wahed…A. W. Phillips

Citation: Kamarajah, S.K., Navidi, M., Wahed, S. et al. Anastomotic Leak Does Not Impact on Long-Term Outcomes in Esophageal Cancer Patients. Ann Surg Oncol (2020). 

Synopsis: The impact of anastomotic leak after esophagectomy is unclear. Long-term outcomes of patients who experienced a leak after transthoracic esophagectomy over 20 years from a single unit were reviewed. Anastomotic leak, and severe leak did not impact on longterm survival

Featured Articles ArchiveNikita M. Shah, Dana M. Scott, Pridvi Kandagatla …Jacqueline S. Jeruss

Citation: Shah, N.M., Scott, D.M., Kandagatla, P. et al. Young Women with Breast Cancer: Fertility Preservation Options and Management of Pregnancy-Associated Breast Cancer. Ann Surg Oncol 26, 1214–1224 (2019).

Synopsis: Young breast cancer patients face the potential impact of treatment on future fertility. Additionally, a subset of patients will navigate the challenges of breast cancer treatment during pregnancy or during the postpartum period. Suggested guidelines are provided to address reproductive health in conjunction with a breast cancer diagnosis.

Featured Articles ArchiveArjona-Sanchez, L. Rodriguez-Ortiz, D. Baratti…J. Briceno

Citation: Arjona-Sanchez, A., Rodriguez-Ortiz, L., Baratti, D. et al. RAS Mutation Decreases Overall Survival After Optimal Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy of Colorectal Peritoneal Metastasis: A Modification Proposal of the Peritoneal Surface Disease Severity Score. Ann Surg Oncol 26, 2595–2604 (2019).

Synopsis: Adding the RAS mutations status to traditional PSDSS changes the traditional patient selection for CRS and HIPEC for peritoneal carcinomatosis from colorectal cancer scoring by adding the biological feature of the tumor to clinical-pathologic score.

Featured Articles ArchiveStephanie Downs-Canner, Emily C. Zabor,Tyler Wind…Alexandra Heerdt

Citation: Downs-Canner, S., Zabor, E.C., Wind, T. et al. Radiation Therapy After Breast-Conserving Surgery in Women 70 Years of Age and Older: How Wisely Do We Choose?. Ann Surg Oncol 26, 969–975 (2019).

Synopsis: Despite evidence that omission of RT in women with small estrogen receptor positive tumors is safe, use remains high. Neither factors consistent with risk of local recurrence or competing risk of death in 10 years predicted use of adjuvant radiation.

Featured Articles ArchiveSong Ryo, Mitsuro Kanda, Seiji Ito…Yasuhiro Kodera

Citation: Ryo, S., Kanda, M., Ito, S. et al. The Controlling Nutritional Status Score Serves as a Predictor of Short- and Long-Term Outcomes for Patients with Stage 2 or 3 Gastric Cancer: Analysis of a Multi-institutional Data Set. Ann Surg Oncol 26, 456–464 (2019).

Synopsis: The authors evaluated the preoperative Controlling Nutritional Status (CONUT) score’s predictive value among patients with stage II/III gastric cancer. A multicenter dataset analysis revealed that the preoperative CONUT score may be a useful predictor of postoperative short-term and long-term outcomes.

Fluorescent-Image Guidance in Robotic Subtotal GastrectomyBy Naruhiko Ikoma, Brian D. Badgwell, Paul Mansfield

Citation: Ikoma, N., Badgwell, B.D. & Mansfield, P. Fluorescent-Image Guidance in Robotic Subtotal Gastrectomy. Ann Surg Oncol (2020).

Synopsis: Robotic surgery technology has significant advantages, but its limitations include a lack of tactile feedback. Fluorescent-imaging technology, part of the da Vinci robotic surgery system, helps to overcome this lack of feedback and improve safety.

Superior Mesenteric Vein-First Approach for Robotic Salvage Surgery with Indocyanine Green Fluorescence AngiographyBy Yun Yang, Oliver Peacock, Songphol Malakorn, Thitithep Limvorapitak, Syed Nabeel Zafar, George J. Chang,

Citation: Yang, Y., Peacock, O., Malakorn, S. et al. Superior Mesenteric Vein-First Approach for Robotic Salvage Surgery with Indocyanine Green Fluorescence Angiography. Ann Surg Oncol (2020).

Synopsis: Following the SMV-first approach principles provide a safe plane for dissection, and in conjunction with ICG, facilitates the delineation of the vascular anatomy, to enable robotic salvage surgery for recurrent disease within residual mesocolon to be performed.

The Chicago Consensus Guidelines for Peritoneal Surface Malignancies: IntroductionChicago Consensus Working Group

Citation: Turaga, K., Ahuja, N., Richard Alexander, H. et al. The Chicago Consensus Guidelines for Peritoneal Surface Malignancies: Introduction. Ann Surg Oncol 27, 1737–1740 (2020).

Synopsis: The Chicago Consensus Working Group provides multidisciplinary recommendations for the management of peritoneal surface malignancies of various causes. These guidelines recognize and address the emerging need for increased awareness of the appropriate management of peritoneal surface disease.

Textbook Outcome Following Hepatopancreatic SurgeryRittal Mehta, Diamantis I. Tsilimigras, Anghela Z. Paredes…Timothy M. Pawlik

Citation: Mehta, R., Tsilimigras, D.I., Paredes, A.Z. et al. Dedicated Cancer Centers are More Likely to Achieve a Textbook Outcome Following Hepatopancreatic Surgery. Ann Surg Oncol 27, 1889–1897 (2020). 

Synopsis: Among 21,234 Medicare patients, 8.2% patients underwent hepatopancreatic (HP) surgery at a dedicatedcancer center (DCC), whereas 32.1% underwent surgery at a National Cancer Institute affiliated cancer center (NCI-CC), and 60% underwent an operation at neither DCCs nor NCI-CCs. Even though DCC more frequently took care of patients with higher comorbidity burden, the likelihood of achieving a textbook outcome following HP surgery at DCCs was higher versus NCI-CCs and other US hospitals. The data suggest that DCCs provide higher-value surgical care for patients with HP malignancies.

Featured Articles ArchiveHester C. van Wyk, Antonia Roseweir, Peter Alexander…Joanne Edwards

Citation: van Wyk, H.C., Roseweir, A., Alexander, P. et al. The Relationship Between Tumor Budding, Tumor Microenvironment, and Survival in Patients with Primary Operable Colorectal Cancer. Ann Surg Oncol 26, 4397–4404 (2019).

Synopsis: Findings from this study indicate that tumor budding effectively stratifies patient’s survival independent of recognized tumor factors, including TNM stage. Therefore, the combination of T stage and tumor budding should form the basis of a new staging system for primary operable colorectal cancer.

Featured Articles ArchiveGiampaolo Perri, Laura Prakash, Giuseppe Malleo…Matthew H. G. Katz

Citation: Perri, G., Prakash, L., Malleo, G. et al. The Sequential Radiographic Effects of Preoperative Chemotherapy and (Chemo)Radiation on Tumor Anatomy in Patients with Localized Pancreatic Cancer. Ann Surg Oncol (2020).

Synopsis: Less than one third of patients experienced either RECIST partial response or radiographic downstaging in response to preoperative therapy. The incidence of tumor downstaging was higher and the magnitude of tumor volume loss was greater following chemotherapy than after (chemo)radiation.

Featured Articles ArchiveWilliam H. Ward, Lyudmila DeMora, Elizabeth Handor…Richard J. Bleicher

Citation: Ward, W.H., DeMora, L., Handorf, E. et al. Preoperative Delays in the Treatment of DCIS and the Associated Incidence of Invasive Breast Cancer. Ann Surg Oncol 27, 386–396 (2020).

Synopsis: A population-based study of data derived from women with clinical DCIS was conducted using the National Cancer Database. Delays to surgery impaired overall survival and was an independent predictor of invasive cancer found on surgical pathology.

Featured Articles ArchiveSjors Klompmaker, Niek A. Peters, Jony van Hilst…Marc G. Besselink

Citation: Klompmaker, S., Peters, N.A., van Hilst, J. et al. Outcomes and Risk Score for Distal Pancreatectomy with Celiac Axis Resection (DP-CAR): An International Multicenter Analysis. Ann Surg Oncol 26, 772–781 (2019).

Synopsis: Distal pancreatectomy with celiac axis resection (DP-CAR) is occasionally performed for locally-advanced pancreatic cancer. In this study (n=191), DP-CAR was associated with 5.8% 90-day mortality in high volume centers and 19 (15-25) months survival. The authors propose a mortality risk score to improve patient selection and outcomes, with DP-CAR-volume as dominant predictor.

Featured Articles ArchiveDhaval Patel, John E. Phay, Tina W. F. Yen…Lawrence T. Kim

Citation: Patel, D., Phay, J.E., Yen, T.W.F. et al. Update on Pheochromocytoma and Paraganglioma from the SSO Endocrine/Head and Neck Disease-Site Work Group. Part 1 of 2: Advances in Pathogenesis and Diagnosis of Pheochromocytoma and Paraganglioma. Ann Surg Oncol 27, 1329–1337 (2020). 

Synopsis: This is the first part of a two-part review on pheochromocytoma and paragangliomas that addresses clinical presentation, diagnosis, management, treatment, and outcomes. In this first part, the epidemiology, prevalence, genetic etiology, clinical presentation, biochemical and radiologic workup is discussed.

Featured Articles ArchiveEric A. Deckers, Josette E. H. M. Hoekstra-Weebers, Samantha Damude…Harald J. Hoekstra

Citation: Deckers, E.A., Hoekstra-Weebers, J.E.H.M., Damude, S. et al. The MELFO Study: A Multicenter, Prospective, Randomized Clinical Trial on the Effects of a Reduced Stage-Adjusted Follow-Up Schedule on Cutaneous Melanoma IB–IIC Patients—Results After 3 Years. Ann Surg Oncol 27, 1407–1417 (2020).

Synopsis: A reduced stage-adjusted follow-up schedule seems an appropriate, safe, and cost effective alternative to the follow-up regime as currently advised in the Dutch Melanoma guideline.

Featured Articles Archive

  1. K. Kamarajah, M. Navidi, S. Wahed…A. W. Phillips

Citation: Kamarajah, S.K., Navidi, M., Wahed, S. et al. Significance of Neoadjuvant Downstaging in Carcinoma of Esophagus and Gastroesophageal Junction. Ann Surg Oncol (2020).

Synopsis: Pathological stage after neoadjuvant treatment is a better predictor of survival in esophageal cancer than clinical stage. Further, survival of those down staged may be better than those who are neoadjuvant naïve with a comparable pathological stage.

Featured Articles Archive

Bobby K. Pranger, Dorine S. J. Tseng, Sander Ubels…Vincent E. de Meijer

Synopsis: The value of para-aortic lymph node sampling and the consequences of different strategies on survival remain unclear. With intraoperative para-aortic lymph node metastases, resection was associated with survival benefit as compared to double bypass, but with increased postoperative morbidity.

Featured Articles ArchiveJun Li, Mohamed Moustafa, Michael Linecker…Silvio Nadalin

Citation: Li, J., Moustafa, M., Linecker, M. et al. ALPPS for Locally Advanced Intrahepatic Cholangiocarcinoma: Did Aggressive Surgery Lead to the Oncological Benefit? An International Multi-center Study. Ann Surg Oncol (2020).

Synopsis: This international largest cohort confirmed the role of ALPPS in the treatment of advanced intrahepatic cholangiocarcinoma. The future liver remnant to body weight (FLR/BW) ratio before the stage-2 operation and the number of lesions had an essential impact on the surgical and oncological outcomes of ALPPS.

Featured Articles ArchiveAlexandra M. Anker, Lukas Prantl, Catharina Strauss… Silvan M. Klein

Citation: Anker, A.M., Prantl, L., Strauss, C. et al. Assessment of DIEP Flap Perfusion with Intraoperative Indocyanine Green Fluorescence Imaging in Vasopressor-Dominated Hemodynamic Support Versus Liberal Fluid Administration: A Randomized Controlled Trial With Breast Cancer Patients. Ann Surg Oncol 27, 399–406 (2020).

Synopsis: This prospective randomized controlled trial was the first to investigate the impact of distinct hemodynamic regimens in microvascular deep inferior epigastric perforator flap breast reconstruction after mastectomy for cancer patients. Despite the dogmatic denial of vasopressors in microsurgery, neither liberal fluid administration nor norepinephrine-dominated circulatory support impaired intraoperative flap perfusion as

Featured Articles ArchiveKatherine Mallin, Amanda Browner, Bryan Palis…Heidi Nelson

Citation: Mallin K, Browner A, Palis, B, et al. Incident cases captured in the national cancer database compared with those in U.S. population based central cancer registries in 2012–2014. Ann Surg Oncol. 2019; 26: 1604–1612.

Synopsis:  Incident cancer cases in the National Cancer Data Base (NCDB) were compared to national U.S. population based cancer registry data for 2012-2014 diagnosis years. NCDB coverage was 72% with some variation by cancer site and other factors.

Featured Articles ArchiveRebecca Knackstedt, Rafael A. Couto, Jennifer Ko, Cagri Cakmakoglu, Daisy Wu, Brian Gastman

Citation: Knackstedt, R., Couto, R.A., Ko, J. et al. Indocyanine Green Fluorescence Imaging with Lymphoscintigraphy for Sentinel Node Biopsy in Melanoma: Increasing the Sentinel Lymph Node-Positive Rate. Ann Surg Oncol 26, 3550–3560 (2019). 

Synopsis: With the largest cohort of patients reported who underwent a melanoma sentinel lymph node biopsy with lymphoscintigraphy and indocyanine green, we demonstrated that this technique results in higher sentinel lymph node-positive rates than predicted.

Related Image -Laparoscopic Segment 1 with Partial IVC Resection in Advanced Cirrhosis How to Do It SafelyEduardo A. Vega, MD, Diana C. Nicolaescu, MD, Omid Salehi, MD, Olga Kozyreva, MD, Usha Vellayappan, MD, David Ricklan, MD, Justin McCarty, DO, Fermin Fontan, MD, Frank Pomposelli, MD, and Claudius Conrad, MD, PhD

Synopsis: Laparoscopic caudate lobectomy in cirrhotic patients with partial IVC resection is technically demanding. In this video article the authors present a strategic and preplanned approach required to accomplish this type of surgery safely.

Laparoscopic Segment 1 with Partial IVC Resection in Advanced Cirrhosis: How to Do It Safely

Laparoscopic versus open hepatocellular carcinoma (HCC) resection reduces morbidity without a compromise in oncologic safety.1-4 Moreover, in the subgroup of cirrhotic patients, a decreased risk of prolonged postoperative ascites and liver decompensation has been reported.5-7 A 54-year-old homeless, deaf male with chronic alcoholism, hepatitis C, and advanced cirrhosis was referred with a caudate tumor from a critical access hospital.

Neoadjuvant Therapy is Associated with Improved Survival in Borderline-Resectable Pancreatic Cancer chartAkhil Chawla, George Molina, Linda M. Pak…Jiping Wang 

Citation: Chawla, A., Molina, G., Pak, L.M. et al. Neoadjuvant Therapy is Associated with Improved Survival in Borderline-Resectable Pancreatic Cancer. Ann Surg Oncol. 27; 4:1191–1200, 2020. 

Synopsis: Patients with borderline-resectable pancreatic adenocarcinoma treated with neoadjuvant therapy have survival similar to that of patients with resectable pancreatic cancer and better than that of patients with borderline-resectable disease treated with adjuvant therapy.

Graph - Opioid Use after Breast-Covering Surgery 02-2020Ko Un Park, Kristin Kyrish, Min Yi…Sarah M. DeSnyder

Citation: Park, K.U., Kyrish, K., Yi, M. et al. Opioid Use after Breast-Conserving Surgery: Prospective Evaluation of Risk Factors for High Opioid Use. Ann Surg Oncol 27, 730–735 (2020).

Synopsis: In this single-institution, prospective study of patients undergoing breast-conserving surgery, both patient and surgical factors were related to high postoperative opioid use.

Featured Articles ArchiveJing Su, Guangxu Jin, Konstantinos I. Votanopoulos…Edward A. Levine

Citation: Su, J., Jin, G., Votanopoulos, K.I. et al. Prognostic Molecular Classification of Appendiceal Mucinous Neoplasms Treated with Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol (2020).

Synopsis: Appendiceal mucinous neoplasm with peritoneal metastasis is a rare but deadly disease with few prognostic or therapy-predictive biomarkers to guide treatment decisions Specimens (n=138) derived from a single institution and uniformly treated with cytoreductive surgery with hyperthermic intraperitoneal chemotherapy were analyzed for gene expression using a custom-designed NanoString 148-gene panel. The authors’  findings suggest a greater role for the immune system for appendiceal mucinous neoplasms than previously recognized and genetic signatures which have clinical utility for predicting treatment outcomes.

Re-resection in Incidental Gallbladder Cancer: Survival and the Incidence of Residual Disease graphicAlexandra M. Anker, Lukas Prantl, Catharina Strauss… Silvan M. Klein

Citation: Anker, A.M., Prantl, L., Strauss, C. et al. Assessment of DIEP Flap Perfusion with Intraoperative Indocyanine Green Fluorescence Imaging in Vasopressor-Dominated Hemodynamic Support Versus Liberal Fluid Administration: A Randomized Controlled Trial With Breast Cancer Patients. Ann Surg Oncol 27, 399–406 (2020).

Synopsis: This prospective randomized controlled trial was the first to investigate the impact of distinct hemodynamic regimens in microvascular deep inferior epigastric perforator flap breast reconstruction after mastectomy for cancer patients. Despite the dogmatic denial of vasopressors in microsurgery, neither liberal fluid administration nor norepinephrine-dominated circulatory support impaired intraoperative flap perfusion as assessed via indocyanine green fluorescence imaging.

Featured Articles ArchiveSheraz R. Markar and Jesper Lagergren

Citation: Markar, S.R., Lagergren, J. Surgical and Surgeon-Related Factors Related to Long-Term Survival in Esophageal Cancer: A Review. Ann Surg Oncol 27, 718–723 (2020).

Synopsis:   Survival following esophagectomy is influenced by surgeon-related factors including surgeon volume, proficiency-gain period, surgeon age, and timing of surgery.  The role of the skills of the individual surgeon may have a greater prognostic role over variations in the surgical approach.

Picutre of Back Related to Technique for Robotic Transhiatal EsophagectomyJune S. Peng, MD, Moshim Kukar, MD, and Steven N. Hochwald, MD, MBA

Citation: Peng, J.S., Kukar, M. & Hochwald, S.N. Technique for Robotic Transhiatal Esophagectomy. Ann Surg Oncol (2020).

Synopsis: Minimally invasive esophagectomy is increasing performed for cancers of the esophagus and gastroesophageal junction. This video article demonstrates the setup and key steps for a robotic transhiatal esophagectomy with a cervical anastomosis.

Featured Articles ArchiveJay S. Lee, Ryan A. Howard, Michael P. Klueh…Lesly A. Dossett

Citation: Lee JS, Howard RA, Klueh MP, et al. The impact of education and prescribing guidelines on opioid prescribing for breast and melanoma procedures.  Ann Surg Oncol. 2019; 26 17–24, 2019.

Synopsis: In this study, the authors evaluated the impact of mandatory education and prescribing guidelines on opioid prescribing after breast and melanoma procedures. This intervention significantly reduced the quantity of opioid prescribed without increasing the frequency of opioid prescription refills. 

Landmark Article Image 02-2020Carla S. Fisher, Julie A. Margenthaler, Kelly K. Hunt, Theresa Schwartz

Citation: Fisher, C.S., Margenthaler, J.A., Hunt, K.K. et al. The Landmark Series: Axillary Management in Breast Cancer. Ann Surg Oncol 27, 724–729 (2020).

Synopsis: The management of the axilla in patients with newly diagnosed breast cancer has evolved over time with an overall de-escalation in surgical extent. The landmark trials that have contributed to this paradigm shift are discussed in this article.

Featured Articles ArchiveEliahu Bekhor, Jacquelyn Carr, Margaret Hofstedt…Deepa Magge

Citation: Bekhor, E., Carr, J., Hofstedt, M. et al. The Safety of Iterative Cytoreductive Surgery and HIPEC for Peritoneal Carcinomatosis: A High Volume Center Prospectively Maintained Database Analysis. Ann Surg Oncol (2019).

Synopsis: In this study, the authors aim to determine rates of major late complications following iterative CRS/HIPEC to provide more complete knowledge of the procedure’s safety profile to patients and clinicians.

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