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Background During the COVID-19 pandemic, prioritization of COVID-19 patients led to delays in oncological surgery, potentially impacting patient outcomes. This analysis examines the effects of surgical delays in various tumor entities on resectability and postoperative mortality. Methods Data from the COVIDSurg Cancer Collaborative, an international prospective cohort study with 19,676 patients, collected between March 26, 2020, and September 16, 2020, were analyzed. Postoperative mortality and complete resection (R0) were the outcomes, with tumor entity, stage and delay to surgery as key exposures. Results 17,486 patients underwent surgery during the study period, at a median time of three weeks after decision to operate (IQR = 4). 172 (1.0%) patients died within 30 days postoperatively. 15,143 (90.5%) patients had an R0 resection, 1352 (8.1%) an R1 resection and 230 (1.4%) had an R2 resection. Postoperative mortality was highest for oesophageal cancer (3.9%) and UICC stage IV (1.5%). For the overall population, there was no association between delay to surgery and resectability. There was an association between delay to surgery and postoperative mortality (p < 0.001), with the highest 30-day postoperative mortality observed for operations within two weeks following surgical decision. Conclusion Tumor resectability and postoperative mortality in oncological surgeries are influenced by various factors. During the COVID-19 pandemic, moderate delays in surgeries were observed, with differences across tumor types, UICC stages and regions. While no tangible effects on resectability were found, postoperative mortality was higher after a shorter delay to surgery.

To improve the quality of cancer operations, the American College of Surgeons published Operative Standards for Cancer Surgery, which has been incorporated into Commission on Cancer (CoC) accreditation requirements. We sought to determine if compliance with operative standards was associated with technical surgical outcomes. Oncologic operative reports from 2017 at a CoC and non-CoC institution were examined for documentation of Operative Standards essential steps. Lymph node (LN) yield for lung and colon cases and re-excision rates for breast cases were recorded. Correct documentation was poor for colon, breast, and lung cases with numerous elements documented in <10% of operative reports at both centers. For lung cases, there was no significant difference in meeting ≥10 LN benchmark or average LN yield between the 2 institutions. For colon cases, average lymph node yield was lower in the non-CoC facility, but there was no significant difference in meeting ≥12 LN benchmark. For breast cases, re-excision rates were similar in both programs. Many essential steps in Operative Standards were poorly documented in operative reports, regardless of CoC status. Achieving benchmark technical surgical outcomes was not associated with documented compliance with these standards. Whether improved documentation leads to better surgical outcomes requires further investigation.

Background The aim of this study was to assess the usefulness of protective negative-pressure wound therapy (NPWT) in the reduction of wound healing complications (WHC) and surgical site infections (SSI) after diverting ileostomy closure in patients who underwent surgery for colorectal cancer. Methods In this prospective randomized clinical trial in a tertiary academic surgical center, patients who had colorectal cancer surgery with protective loop ileostomy and were scheduled to undergo ileostomy closure with primary wound closure from January 2016 to December 2018 were randomized to be treated with or without NPWT. The primary endpoint was the incidence of WHC. Secondary endpoints were incidence of SSI, length of postoperative hospital stay (LOS), and length of complete wound healing (CWH) time. Results We enrolled 35 patients NPWT (24 males [68.6%]; mean age 61.6 ± 11.3 years), with NPWT and 36 patients (20 males [55.6%]; mean age 62.4 ± 11.3 years) with only primary wound closure (control group). WHC was observed in 11 patients (30.6%) in the control group and 3 (8.57%) in the NPWT group ( p  = 0.020). Patients in the NPWT group had a significantly lower incidence of SSI (2 [5.71%] vs. 8 [22.2%] in the control group; p  = 0.046) as well as significantly shorter median CWH (7 [7–7] days vs. 7 [7–15.5] days, p  = 0.030). There was no difference in median LOS between groups (3 [2.5–5] days in the control group vs. 4 [2–4] days in the NPWT group; p  = 0.072). Conclusions Prophylactic postoperative NPWT after diverting ileostomy closure in colorectal cancer patients reduces the incidence of WRC and SSI. Clinical trial registration clinicaltrials.gov (NCT04088162).

Around the world, cancer care services are facing many operational challenges. Operations management research can provide important solutions to these challenges, from screening and diagnosis to treatment. In recent years, the growth in the number of papers published on cancer care operations management (CCOM) indicates that development has been fast. Within this context, the objective of this research was to understand the evolution of CCOM through a comprehensive study and an up-to-date bibliometric analysis of the literature. To achieve this aim, the Web of Science Core Collection database was used as the source of bibliographic records. The data-mining and quantitative tools in the software Biblioshiny were used to analyze CCOM articles published from 2010 to 2021. First, a historical analysis described CCOM research, the sources, and the subfields. Second, an analysis of keywords highlighted the significant developments in this field. Third, an analysis of research themes identified three main directions for future research in CCOM, which has 11 evolutionary paths. Finally, this paper discussed the gaps in CCOM research and the areas that require further investigation and development.

Postoperative pneumonia is a serious problem for patients and medical staff. In Japan, many hospitals introduced perioperative oral care management for the efficient use of medical resources. However, a high percentage of postoperative pneumonia still developed. Therefore, there is a need to identify the specific respiratory pathogens to predict the incidence of pneumonia The purpose of this study was to find out the candidate of bacterial species for the postoperative pneumonia. This study applied case-control study design for the patients who had a cancer operation with or without postoperative pneumonia. A total of 10 patients undergoing a cancer operation under general anesthesia participated in this study. The day before a cancer operation, preoperative oral care management was applied. Using the next generation sequence, oral microbiome of these patients was analyzed at the time of their first visit, the day before and after a cancer operation. Porphyromonas gingivalis and Fusobacterium nucleatum group can be a high risk at first visit. Atopobium parvulum and Enterococcus faecalis before a cancer operation can be a high risk. Poor oral hygiene increased the risk of incidence of postoperative pneumonia. Increased periodontal pathogens can be a high risk of the incidence of postoperative pneumonia. In addition, increased intestinal bacteria after oral care management can also be a high risk for the incidence of postoperative pneumonia.

Breast-conserving surgery (BCS) is increasingly used for breast cancer treatment. One of the disadvantages of BCS is the risk of re-operation, associated with additional costs to the woman, health service and society. Hospital and surgeon caseload have been associated with better outcomes in breast cancer. Whether these are related to re-operation rates is not clear. In women who underwent BCS initially, we aimed to quantify re-operation rates and identify the factors related to the risk of undergoing subsequent (i) re-operation and (ii) total mastectomy (TM). From the National Cancer Registry Ireland, we identified women diagnosed with a first invasive breast cancer during 2002–2008, and who initially had BCS. Poisson regression with robust error variance was used to identify factors significantly associated with (i) re-operation (vs no re-operation) or (ii) re-operation by TM (vs re-operation by BCS). 16,551 women were diagnosed with invasive breast cancer and 8,318 underwent initial BCS. Of these, 17 % had one or more subsequent re-operations and, of these, 62 % had TM. Surgeon and hospital volume significantly predicted subsequent re-operation after adjustment for socio-demographic and clinical variables. Women having surgery in lower-volume hospitals by low-volume surgeons significantly increased the risk of re-operation [incidence rate ratio (IRR) = 1.56; 95 % CI 1.33–1.83] compared to those operated in higher-volume hospitals by a higher-volume surgeon. Risk of subsequent TM was increased by 22 % (95 % CI 1.10–1.35) and 21 % (95 % CI 1.09–1.33), if women were operated by a lower or intermediate-volume surgeon. The fact that factors related to healthcare organisation/service provision are associated with re-operations suggests that it may be possible to reduce the overall re-operation rate. The high frequency of subsequent TM raises questions about strategies for selecting women for initial BCS. Our results may inform the development of information strategies to help ensure that women are aware of risks of re-operation following BCS and hence, make appropriate treatment choices.

PurposeTo study the effects of smoking on the postoperative outcome of lung cancer surgery.MethodsThe subjects were 571 patients who underwent surgery for primary lung cancer. The patients were divided into the following groups according to their smoking history: a nonsmoker group (n = 218), a former smoker group (n = 140), and a current smoker group (n = 213).ResultsThe 5-year survival rates were 56.2%, 40.9%, and 34.0% in the nonsmoker, former smoker, and current smoker groups, respectively. These differences were significant. According to a multivariable analysis, smoking was a significant factor affecting the postoperative prognosis of patients undergoing surgery for lung cancer. In analyzing the causes of death, there were more deaths caused by other diseases such as multiple organ cancer, respiratory disorder, cardiovascular disease, and surgery-related events in the former smoker and current smoker groups than in the nonsmoker group.ConclusionsSmoking was significantly predictive of a poor prognosis after lung cancer surgery.

A 57-year-old man with an anomalous right aortic arch presented with cancer of the right lung. The right recurrent laryngeal nerve was found to be hooked around the right aortic arch. Right lower lobectomy with systematic mediastinal lymph node dissection was successfully performed using video-assisted thoracic surgery to provide close intraoperative attention to the branching of recurrent laryngeal nerve.

The first five sections of this chapter give an overview of the different kinds of surgical and nonsurgical therapies for tumors. Emphasis is given to the different combinations and regimens of therapy, and to the phenomena of partial responses, relapses, and acquired resistance of cases of disseminated malignant tumors. Mention is made of “personalized” therapies, i.e., the various ways in which therapies may be “tailored” to the particular patient and his/her particular tumor. The last three sections deal with how the effects of therapies can be assessed in patients with disseminated cancers, and what kinds of care are available when the maximum amounts of the specific treatments against the tumor cells have been given.

The aim of this meta-analysis is to provide recommendations for clinical practice and prevention of postoperative complications, such as circumferential resection margin (CRM) involvement, and compare the amount of intraoperative bleeding, safety, operative time, recovery, outcomes, and clinical significance of robot-assisted and conventional laparoscopic procedures in anus-preserving rectal cancer. A literature search (PubMed) was performed to identify biomedical research papers and abstracts of studies comparing robot-assisted and conventional laparoscopic procedures. We attempted to obtain the full-text link for papers published between 2000 and 2016, and hand-searched references for relevant literature. RevMan 5.3 software was used for the meta-analysis. Nine papers (949 patients) were eligible for inclusion; there were 473 patients (49.8%) in the robotic group and 476 patients (50.2%) in the laparoscopic group. According to the data provided in the literature, seven indicators were used to complete the evaluation. The results of the meta-analysis suggested that robot-assisted procedure was associated with lower intraoperative blood loss (mean difference [MD] -41.15; 95% confidence interval [CI] -77.51, -4.79; =0.03), lower open conversion rate (risk difference [RD] -0.05; 95% CI -0.09, -0.01; =0.02), lower hospital stay (MD -1.07; 95% CI -1.80, -0.33; =0.005), lower overall complication rate (odds ratio 0.58; 95% CI 0.41, 0.83; =0.003), and longer operative time (MD 33.73; 95% CI 8.48, 58.99; =0.009) compared with conventional laparoscopy. There were no differences in the rate of CRM involvement (RD -0.02; 95% CI -0.05, 0.01; =0.23) and days to return of bowel function (MD -0.03; 95% CI -0.40, 0.34; =0.89). The Da Vinci robot was superior to laparoscopy with respect to blood loss, open conversion, hospital stay, and postoperative complications during anus-preserving rectal cancer procedures; however, conventional laparoscopy had an advantage regarding operative time. The remaining indicators (CRMs and recovery from intestinal peristalsis) did not differ.