Endoscopic and robotic surgeries feature small incision and reducing surgical trauma, and minimized incision scars. However, the oncological safety of their application in breast-conserving surgery and breast reconstruction for breast cancer has always been a focal clinical concern. The breast-conserving surgery and breast reconstruction using the suspension, insufflation, and lipolysis methods could achieve precise tumor resection in the selected patients and under the specific surgical conditions, with the support of appropriate instruments. Meanwhile, the innovative application of the reverse-sequence method and auxiliary port technique has further enhanced surgical efficiency and the precision of tumor resection. Current studies suggest that endoscopic and robotic-assited breast-conserving surgery and breast reconstruction yield in terms of oncological outcomes comparable to those of conventional open breast-conserving surgery, including positive margins, local recurrence, regional recurrence, distant metastasis, and overall survival. These approaches offered advantages in minimally invasive techniques and aesthetic outcomes. However, existing research was limited by short follow-up period and small sample sizes. Future large-scale, long-term prospective randomized controlled trials are needed to further validate their oncological safety and long-term efficacy. These studies could help establish novel techniques as standard surgical approaches for breast cancer, particularly the efficient and streamlined reverse-sequence endoscopic and auxiliary port-assisted techniques.
(1) Surgery is the first method to cure early stage non-small cell lung cancer (NSCLC). Ground glass nodule (GGO) like lung adenocarcinoma should be regarded as a new clinical issue to avoid over-treatment. The deep meaning of multidisciplinary pathological classification of lung adenocarcinoma should be fully understood to avoid over-diagnosis. The T staging of lung adenocarcinoma mixed with GGO components should be correctly understood to avoid over-staging. We should carefully understand the new data of relationship between sublobectomy and prognosis to avoid excessive resection. Attention should be paid to the research progress of minimal residual disease (MRD) to avoid insufficient treatment. (2) The treatment strategy of resectable stage Ⅲ NSCLC should be surgery with individualized systemic treatment. Locally advanced NSCLC dominated by Ⅲa-N2 NSCLC is a kind of disease with high multi-dimensional heterogeneity. In theory, preoperative treatment is superior to postoperative treatment, and molecular diagnosis should be made along with pretreatment staging, so as to select preoperative treatment. The patients with negative driver gene mutation obtained better pathological complete response/major pathological response (PCR/MPR) from immunotherapy compared to those from chemotherapy, and the better PCR/MPR is expected to be transformed into overall survival (OS). The data of preoperative treatment in patients with positive driver gene mutation are few, whereas the data of postoperative targeted treatment are much better than those of postoperative chemotherapy. (3) The effective systemic treatment strategy has "created" many long-term survivors with stage Ⅳ NSCLC, and has changed the original concept and population of "oligometastasis". Attention should be paid to the individual ineffective lesions in stage Ⅳ patients with long-term survival. It is also necessary to explore how to intervene in the resection of "oligometastasis" of stage Ⅳ NSCLC at an appropriate time and in an appropriate way, which may be one of the main tasks of lung cancer surgery in the future.
Objective To summarize the research progress of transanal total mesorectal excision (TaTME) for rectal cancer. Methods The literatures about current status, limitations, and prospects of TaTME in China and abroad were collected to make an reviewe. Results TaTME is conformed to the principle of total mesorectal excision (TME), by using the ‘bottom-up’ approach and assisting in the laparoscopic technique platform, to ensure an adequate oncological distal margin, and it could improve the quality of the mesorectum specimens, reduce the circumferential margin involvement rate, afford more precise autonomic nerve preservation rate, and increase sphincter preservation rate. But it is also facing new complications, oncological and functional outcomes problems. Conclusions Although the experience with TaTME remains limited, the safety, feasibility, and short-term outcomes are acceptable. Nevertheless, there is a need for multicenter, large sample size, and long-term follow-up clinical studies focusing on the long-term outcomes to further improve the oncological safety of TaTME, before widespread application can be recommended.
The 2024 American Society of Clinical Oncology Gastrointestinal Cancers Symposium (ASCO-GI) was held in San Francisco, the USA from January 18th to 20th, 2024 (local time). The multiple studies presented in this symposium will have a significant impact on the clinical practice of esophageal cancer. This article will focus on the surgical methods of esophageal cancer, perioperative immunotherapy, drug therapy for advanced esophageal cancer, rescue treatment after immunotherapy resistance, and other relevant aspects. It aims to summarize and interpret the significant advancements in the field of esophageal cancer presented in this symposium.
Diffuse large B-cell lymphoma is highly heterogeneous and is diagnosed according to the 2016 World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. The decision of treatment should be upon age, International Prognostic Index score and the tolerability of chemotherapy. High-dose chemotherapy and autologous stem cell transplantation is the standard care for relapsed, chemotherapy sensitive patients. Clinical trials are recommended in specific conditions.
Objective To analyze the relationship between the residence and oncological characteristics of colorectal patients served by Sichuan University West China Hospital as a regional center in the current version of the Database from Colorectal Cancer (DACCA). Methods The DACCA version selected for this data analysis was the updated version on January 5, 2022. The data items analyzed included: residence, precancerous lesions, family history of cancer, tumor location, tumor morphology, tumor orientation, tumor pathology, tumor differentiation and preoperative TNM staging. According to the regional distribution of colorectal cancer patients' residence in the database, they were divided into Sichuan group and non-Sichuan group, and the Sichuan group was further divided into Sichuan-Chengdu group and Sichuan-non-Chengdu group. Results The DACCA database was filtered by conditions to obtain 7 232 valid data. ① The composition ratio of precancerous lesions in different places of residence: The difference between the Sichuan group and the non-Sichuan group was statistically significant (χ2=14.462, P=0.003), and the difference between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group was not statistically significant (χ2=7.591, P=0.101). ② Composition ratio of family history of cancer in different places of residence: In the family history of cancer in oneself, the difference between Sichuan group and non-Sichuan group as well as between Sichuan-Chengdu group and Sichuan-non-Chengdu group were not statistically significant (χ2=1.121, P=0.606; χ2=1.047, P=0.621). In the family history of cancer in relatives, the differences in the composition ratio of different tumor histories between the Sichuan group and the non-Sichuan group, and between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group were not statistically significant (χ2=0.813, P=0.692; χ2=2.696, P=0.262). ③ Tumor site composition ratios in different places of residence: The difference between Sichuan group and non-Sichuan group was not statistically significant (χ2=0.476, P=0.490), and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was statistically significant (χ2=36.216, P<0.001). ④ Tumor morphology composition ratio in different places of residence: The difference between Sichuan group and non-Sichuan group was statistically significant (χ2=19.560, P<0.001), and the difference between Sichuan-Chengdu group and Sichuan-non-Chengdu group was not statistically significant (χ2=5.377, P=0.247). ⑤ Composition ratio of tumor orientation in different places of residence: The differences in composition ratio of tumor orientation between Sichuan group and non-Sichuan group and between Sichuan-Chengdu group and Sichuan-non-Chengdu group were statistically significant (χ2=17.484, P=0.005; χ2=26.820, P<0.001). ⑥ Composition ratio of tumor pathological properties under different residence: The differences in the comparison of pathological properties between Sichuan group and non-Sichuan group as well as between Sichuan-Chengdu group and Sichuan-non-Chengdu group of CRC patients were not statistically significant (χ2=8.136, P=0.408; χ2=7.278, P=0.506). ⑦ Composition ratio of tumor differentiation degree under different residence groupings: the differences in the composition ratio of tumors with different degrees of differentiation were not statistically significant between Sichuan group and non-Sichuan group, and between Sichuan-Chengdu group and Sichuan-non-Chengdu group (H=0.289, P=0.591; H=0.156, P=0.693). ⑧ The composition ratio of TNM staging of tumors before operation in different places of residence: between the Sichuan group and the non-Sichuan group, the difference in the composition ratio of preoperative TNM staging of CRC patients was statistically significant (H=8.023, P=0.005); between the Sichuan-Chengdu group and the Sichuan-non-Chengdu group, the difference in the composition ratio of preoperative TNM staging of CRC patients was not statistically significant (H=0.218, P=0.640). Conclusions Data analysis in DACCA reveal multiple associations between the place of residence and oncological characteristics of CRC patients. There are differences in the composition of the types of precancerous lesions among CRC patients in different places of residence. The proportion of CRC is higher in the family history of cancer. In terms of the site of tumor occurrence, the proportion of tumors located in the rectum is higher than that in the colon. In the composition of tumor morphology in all regions, the ulcerative type is the most frequent. The composition of tumor orientation is different in patients with CRC, and those who has involved a circle of the intestinal wall are the most frequent. Most CRC patients are already in middle or late stage when the tumor is discovered, and the proportion of middle or late stage patients in non-Sichuan provinces was even higher.
Cancer remains a great challenge for mankind. The complex and diverse phenotypes, mechanisms, as well as therapeutic responsiveness of cancer have gradually been understood since the second half of the 20th century, which was a representative of entering the molecular era of oncology research. In 2000, the groundbreaking review “Hallmarks of Cancer” came out and it had been updated to the third version with 14 characteristics of cancer in 2022. These series of reviews helped to distil the increasingly complicated concepts of oncology into a logical science, which contributed to a more comprehensive understanding of the mechanisms for cancer genesis and development and applying the knowledges to the diagnosis and treatment of tumors. Mastering, applying, and exploring the hallmarks of cancer will help us face the challenges of cancer more confidently in the future.
To enhance the quality and transparency of oncology real-world evidence studies, the European Society for Medical Oncology (ESMO) has developed the first specific reporting guidelines for oncology RWE studies in peer-reviewed journals "the ESMO Guidance for Reporting Oncology Real-World Evidence (GROW)". To facilitate readers understanding and application of these reporting standards, this article introduces and interprets the development process and main contents of the ESMO-GROW checklist.
ObjectiveTo compare the differences in surgical efficiency, surgical safety, aesthetic outcomes, and oncological safety between axillary single-incision endocsopic breast-conserving surgery (ASIEBS) and conventional open breast-conserving surgery (COBS), and to evaluate the clinical value of ASILBCS based on the “HUAXI hole 3” technique. MethodsA retrospective cohort study was conducted on the clinicopathologic data of patients who underwent breast-conserving surgery for breast cancer at West China Hospital of Sichuan University from January 2021 to September 2024. The patients were assigned into an ASILBCS group and a COBS group based on the surgical approach. Both groups received standardized surgical treatment and postoperative follow-up. The observation indicators included baseline characteristics, intraoperative data, postoperative complications, aesthetic outcome (by Ueda score and Harris score evaluation), and oncological safety (local recurrence and distant metastasis). ResultsA total of 67 patients were enrolled, with 41 in the ASIEBS group and 26 in the COBS group. There was no statistically significant differences in the comparison of other baseline data between the two groups (P>0.05), except for the proportions of patients with diabetes mellitus and those positive for human epidermal growth factor receptor 2 (P＜0.05). The ASIEBS group showed superior aesthetic outcomes compared to the COBS group (Ueda score: P=0.013; Harris score: P=0.047). However, the ASIEBS group had higher median total hospitalization costs (12 779.00 yuan vs. 12 354.50 yuan, Z=–2.16, P=0.03). The median follow-up time was 31.43 months in the ASIEBS group and 21.20 months in the COBS group (Z=–2.36, P=0.02). During follow-up, only one patient with local recurrence occurred in the ASIEBS group, and no distant metastasis or death event was observed in both groups. ConclusionThe ASIEBS based on the “HUAXI hole 3” technique is comparable to COBS in terms of surgical efficiency, surgical safety, and oncological safety, while offering superior aesthetic outcomes.
Objective To determine the oncological outcomes following the intersphincteric resection (ISR) for lower rectal cancer and influencing factors. Methods Reviewed the reports on ISR for lower rectal cancer, and summarized the oncological outcomes and influencing factors. The oncological outcomes included local and distant recurrence rates, postoperative survival, and mortality rates. Tumor indicators, surgical techniques, and perioperative radiochemotherapy were included in the influencing factors. Results The recurrence, survival, and mortality rates following ISR resemble traditional operations. Higher stages, metastasis, and non-standard operations affect the oncological outcomes significantly. Preoperative radiochemotherapy could improve the efficacy, but probably at the cost of postoperative anal function. Conclusions The oncological outcomes following ISR are acceptable. The careful case selection and rational arrangements of radiochemotherapy will allow better outcomes.