ObjectiveTo understand the impact of preoperative nutritional status on the postoperative complications for patients with low/ultra-low rectal cancer undergoing extreme sphincter-preserving surgery following neoadjuvant therapy. MethodsThe patients with low/ultra-low rectal cancer who underwent extreme sphincter-preserving surgery following neoadjuvant therapy from January 2009 to December 2020 were retrospectively collected using the Database from Colorectal Cancer (DACCA), and then who were assigned into a nutritional risk group (the score was low than 3 by the Nutrition Risk Screening 2002) and non-nutritional risk group (the score was 3 or more by the Nutrition Risk Screening 2002). The postoperative complications and survival were analyzed for the patients with or without nutritional risk. The postoperative complications were defined as early-term (complications occurring within 30 d after surgery), middle-term (complications occurring during 30–180 d after surgery), and long-term (complications occurring at 180 d and more after surgery). The survival indicators included overall survival and disease-specific survival. ResultsA total of 680 patients who met the inclusion criteria for this study were retrieved from the DACCA database. Among them, there were 500 (73.5%) patients without nutritional risk and 180 (26.5%) patients with nutritional risk. The postoperative follow-up time was 0–152 months (with average 48.9 months). Five hundreds and forty-three survived, including 471 (86.7%) patients with free-tumors survival and 72 (13.3%) patients with tumors survival. There were 137 deaths, including 122 (89.1%) patients with cancer related deaths and 15 (10.9%) patients with non-cancer related deaths. There were 48 (7.1%) cases of early-term postoperative complications, 51 (7.5%) cases of middle-term complications, and 17 (2.5%) cases of long-term complications. There were no statistical differences in the incidence of overall complications between the patients with and without nutritional risk (χ2=3.749, P=0.053; χ2=2.205, P=0.138; χ2=310, P=0.578). The specific complications at different stages after surgery (excluding the anastomotic leakage complications in the patients with nutritional risk was higher in patients without nutritional risk, P=0.034) had no statistical differences between the two groups (P>0.05). The survival curves (overall survival and disease-specific survival) using the Kaplan-Meier method had no statistical differences between the patients with and without nutritional risk (χ2=3.316, P=0.069; χ2=3.712, P=0.054). ConclusionsFrom the analysis results of this study, for the rectal cancer patients who underwent extreme sphincter-preserving surgery following neoadjuvant therapy, the patients with preoperative nutritional risk are more prone to anastomotic leakage within 30 d after surgery. Although other postoperative complications and long-term survival outcomes have no statistical differences between patients with and without nutritional risk, preoperative nutritional management for them cannot be ignored.
ObjectiveTo summarize the value of imaging in the evaluation of non-surgical therapy for pancreatic cancer.MethodThe relevant literatures about imaging evaluation of non-surgical therapy for pancreatic cancer were collected to make an review.ResultsAt present, most of the imaging evaluation of non-surgical therapy for pancreatic cancer were based on the assessment of morphological characteristics of tumors, such as contrast-enhanced CT and MRI. However, only morphological changes of tumors could not accurately evaluate the response of pancreatic cancer after non-surgical treatment. A few studies had explored the value of functional imaging and artificial intelligence.ConclusionsNon-surgical therapy provides new treatment opportunities for unresectable pancreatic cancer, especially the proposed of neoadjuvant therapy, which provides the possibility of operation for patients with advanced pancreatic cancer. More imaging indicators with stronger objectivity, higher accuracy, and wider universality need to be improved and developed in the future.
Neoadjuvant therapy has become the standard treatment for locally advanced resectable esophageal cancer, significantly improving long-term survival compared to surgery alone. Neoadjuvant therapy has evolved to include various strategies, such as concurrent chemoradiotherapy, chemotherapy, immunotherapy, or targeted combination therapy. This enriches clinical treatment options and provides a more personalized and scientific treatment approach for patients. This article aims to comprehensively summarize current academic research hot topics, review the rationale and evaluation measures of neoadjuvant therapy, discuss challenges in restaging methods after neoadjuvant therapy, and identify the advantages and disadvantages of various neoadjuvant therapeutic strategies.
Objective To investigate the feasibility, safety, and short-term efficacy of minimally invasive McKeown esophagectomy (MIME) in patients with locally advanced thoracic esophageal squamous cell carcinoma (TESCC) after neoadjuvant immunotherapy. Methods The clinical data of the patients with locally advanced TESCC in the First Affiliated Hospital of University of Science and Technology of China from July 2022 to March 2023 were restrospectively analyzed. They were divided into a neoadjuvant immunotherapy (NI) group and a non-neoadjuvant immunotherapy (NNI) group according to different preoperative neoadjuvant therapy. The perioperative clinical data and 3-month follow-up data were compared between the two groups. Results A total of 47 patients were collected, including 31 males and 16 females with a mean age of (67.57±7.64) years. There were 29 patients in the NI group and 18 patients in the NNI group. There were no statistical differences in baseline data, perioperative complications, short-term complications, surgical time, intraoperative bleeding, postoperative adjuvant therapy, metastasis/recurrence within 3 months, R0 resection rate, postoperative pathological staging decline, or College of American Pathologists (CAP) tumor regression grade between the two groups (P＞0.05). Conclusion Neoadjuvant immunotherapy combined with minimally invasive McKeown esophagectomy can be safely and effectively performed for patients with locally advanced TESCC without increasing operation time, intraoperative blood loss and perioperative complications.
ObjectiveTo describe the constructive process of neoadjuvant therapy for colorectal cancer part in the West China Colorectal Cancer Database (DACCA).MethodWe used the form of text description.ResultsThe specific concept of neoadjuvant therapy for colorectal cancer including neoadjuvant treatment therapies, compliance of patients with neoadjuvant therapy, neoadjuvant therapy intensity scheme, the CEA value of patients during neoadjuvant therapy, changes of symptoms, changes of primary tumor size in colorectal cancer, and TRG grading of the DACCA in the West China Hospital were defined. Then the neoadjuvant therapies were detailed for their definition, label, structure, error correction, and update.ConclusionThrough detailed description and specification of neoadjuvant therapy for colorectal cancer in DACCA in West China Hospital, it can provide a reference for the standardized treatment of colorectal cancer and also provide experiences for the peers who wish to build a colorectal cancer database.
ObjectiveTo analyze the relationship between occupational type of patients with colorectal cancer (CRC) and decision-making and curative effect of neoadjuvant therapy in the current version of the Database from Colorectal Cancer (DACCA). MethodsThe eligible CRC patients were collected from June 29, 2022 updated DACCA according to the screening criteria, in which the data items analyzed included: gender, age, BMI, blood type, marriage, occupation, neoadjuvant therapy, symptomatic changes, imaging changes, and tumor regression grade (TRG), and the occupations were classified into the mental labour group, physical labour group, and the unemployed and resident groups according to the type of labour, then compared the decision-making and curative effect of neoadjuvant therapy among the 3 groups. ResultsA total of 2 415 eligible data were screened, of which 1 160 (48.0%) were the most in the manual labour group, followed by 877 (36.3%) in the unemployed and resident group, and finally 378 (15.7%) in the mental labour group. The proportion of those who did not use targeted drugs was higher in both patients ≤60 years old and >60 years old [75.6% (958/1 267) vs. 82.5% (947/1 148)], with both differences being statistically significant (P=0.004 and P=0.019), and among patients >60 years old, the different occupational types were associated with symptomatic changes and imaging changes after neoadjuvant therapy, with the highest number of both changes to partial remission [71.5% (161/225) vs. 66.7% (148/222)], both differences being statistically significant (P=0.001 and P=0.017). ConclusionThe analysis results of DACCA data reveal that the occupational type of CRC patients was associated with the choice of neoadjuvant therapy, and that different occupational types were associated with changes in curative effect before and after neoadjuvant therapy in CRC patients >60 years old, which needs to be further analysis for the reasons.
There is still a lack of experience in the perioperative strategy for esophageal cancer patients in China during the epidemic of COVID-19. In December 2022, a 59-year-old male patient with esophageal cancer was admitted to our department. He received 2 cycles of neoadjuvant therapy before surgery, and developed COVID-19 perioperatively. After treatment, the infection symptoms of the patient were improved, and the postoperative recovery was satisfactory.
ObjectiveTo explore the adjuvant treatment options for elderly patients or those with low cardiopulmonary function who cannot tolerate lobectomy for peripheral solid pathological stage ⅠA (pⅠA) non-small cell lung cancer (NSCLC). MethodsA retrospective analysis was conducted on the clinical data of patients with peripheral solid pⅠA stage NSCLC treated with lobectomy and compromised sublobar resection (CSR) in our center from 2018 to 2019. The incidence of postoperative complications and independent predictors of postoperative recurrence were analyzed. Patients in the CSR group were divided into a targeted therapy group, a chemotherapy group, and an observation group based on postoperative treatment measures. The 3-year recurrence-free survival (RFS) rate and 5-year overall survival (OS) rate of the three subgroups before and after propensity score matching (PSM) were compared. ResultsA total of 586 patients were included, including 288 males (49.15%) and 298 females (50.85%), with a median age of 64.00 years. There were 335 patients of lobectomy and 251 patients of compromised sublobar resection. There was no statistically significant difference in the incidence of postoperative complications between the lobectomy group and CSR group [RR=0.987, 95%CI (0.898, 1.085), P=0.789). Multivariate analysis showed that gender, tumor location, and size were independent risk factors for recurrence after CSR. After PSM, 17 patients were enrolled in each of the three subgroups of CSR. Kaplan-Meier survival curve analysis showed that there was no statistically significant difference in the 3-year RFS rate (P=0.115) and 5-year OS rate (P=0.101) between the targeted therapy group and the chemotherapy group after PSM, but both were significantly better than those in the observation group (P=0.041, P=0.009). Compared with lobectomy, there was no statistically significant difference in the 3-year RFS rate (P=0.069) and 5-year OS rate (P=0.540) in the targeted therapy group, while the chemotherapy group and observation group were significantly inferior to the lobectomy group (P<0.05). ConclusionCSR for treating elderly patients or those with low cardiopulmonary function with peripheral solid pⅠA stage NSCLC does not increase the incidence of postoperative complications. Gender, tumor location, and size are independent risk factors for postoperative recurrence. In terms of 3-year RFS rate and 5-year OS rate, adjuvant targeted therapy after CSR is not only superior to chemotherapy or observation but is also not inferior to lobectomy.
The progress of new therapies for solid tumors usually gradually transitions from late stage to early stage. Early treatment of Luminal breast cancer has entered the era of “endocrine therapy +”, with the strengthening of treatment duration and intensity, combined with targeted therapy and multi-gene detection, which still coexist with clinical parameters. For HER2-positive early breast cancer, neoadjuvant therapy has changed the treatment process, requiring exploration of precise strengthening and de-escalation of neoadjuvant therapy. “Neoadjuvant therapy changes adjuvant therapy, and early treatment affects recurrence treatment”. Although the early treatment of triple-negative breast cancer once showed a complicated state of “a hundred schools of thought contend”, today’s treatment strategy is far from focusing on the simple respond of those three negative markers. The core lies in precise diagnosis and classification for treatment! This article summarizes the progress of early breast cancer diagnosis and treatment, in order to provide valuable reference for clinicians’ practical application.
Objective To discuss the performance of multi-disciplinary team (MDT) of colorectal cancer treatment within West China Hospital in Sichuan University. Methods To compare the therapeutic effect between groups of MDT model and non-MDT model by retrospectively analyzing the data of patients who diagnosed colorectal cancer and accepted in-hospital therapy during December 2006 and May 2007. Results The in-hospital days of the MDT model group during the perioperative period and in the surgical ward were less than that of the non-MDT model group ( Plt; 0. 05) , but there was no significant difference between the two groups about the total hospitalization time. And the MDT model group had a higher rate of cancer resection ( P lt; 0. 05) . Although the incidence of anastomotic leakage and bleeding as early postoperative complications didn’t show any variations between the two groups , the non-MDT model groupencountered more early postoperative ileus ( Plt; 0. 05) . During the 5－ 10 months follow-up , there came out less cancer recurrence rate in the MDT model group than the other ( P lt; 0. 05) . And the morbidity of anastomotic stricture and ileus didn’t show any statistical difference between the two groups. Conclusion The combined-therapy st rategy ofcolorectal cancer has showed a priority to routine ways , not only the more reasonable time arrangement for therapy , but also the more satisfied surgical outcomes. However , the factors correlated to the efficacy of the MDT model are not clear ; the MDT model still needs to be improved that a morereasonable and effective perioperative MDT model may come t rue.