Featured Articles Archive

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). https://doi.org/10.1245/s10434-020-08632-1 

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). https://doi.org/10.1245/s10434-020-08407-8

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). https://doi.org/10.1245/s10434-019-07741-w 

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). https://doi.org/10.1245/s10434-019-08039-7 

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).   https://link.springer.com/article/10.1245/s10434-019-08158-1 

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). https://link.springer.com/article/10.1245/s10434-019-07157-6 

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). https://link.springer.com/article/10.1245%2Fs10434-019-07262-6 

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). https://link.springer.com/article/10.1245/s10434-019-07157-6 

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). https://doi.org/10.1245/s10434-020-08450-5 

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). https://doi.org/10.1245/s10434-020-08199-x 

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). https://link.springer.com/article/10.1245/s10434-019-07156-7

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). https://link.springer.com/article/10.1245%2Fs10434-019-07378-9

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).https://link.springer.com/article/10.1245%2Fs10434-018-07151-4

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). https://link.springer.com/article/10.1245/s10434-018-07121-w

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). https://doi.org/10.1245/s10434-020-08523-5

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). https://doi.org/10.1245/s10434-020-08222-1

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). https://doi.org/10.1245/s10434-020-08318-8

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). https://doi.org/10.1245/s10434-020-08279-y 

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). https://link.springer.com/article/10.1245/s10434-019-07931-6

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).  https://link.springer.com/article/10.1245%2Fs10434-020-08427-4

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). https://doi.org/10.1245/s10434-019-07844-4

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). https://link.springer.com/article/10.1245%2Fs10434-018-07101-0

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). https://doi.org/10.1245/s10434-020-08220-3 

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). https://doi.org/10.1245/s10434-019-07825-7

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). https://doi.org/10.1245/s10434-020-08358-0

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). https://doi.org/10.1245/s10434-019-08192-z

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. https://doi.org/10.1245/s10434-019-07213-1

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). https://link.springer.com/article/10.1245%2Fs10434-019-07617-z 

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. https://doi.org/10.1245/s10434-019-08087-z 

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). https://doi.org/10.1245/s10434-019-08091-3

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). https://doi.org/10.1245/s10434-020-08210-5

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). https://doi.org/10.1245/s10434-019-07966-9

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). https://doi.org/10.1245/s10434-019-08186-x

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. https://doi.org/10.1245/s10434-018-6772-3

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). https://doi.org/10.1245/s10434-019-08154-5

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). https://doi.org/10.1245/s10434-019-08141-w

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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