Endoscopic submucosal dissection (ESD) outperforms endoscopic papillectomy (EP) for ampullary tumors ≥20 mm in base size. ESD achieved 100% en bloc resection and 89.5% R0 rates compared to 71.7% and 30.2% for EP. ESD showed 0% residual disease versus 42.9% with EP during over a year of follow-up. Consider ESD for better outcomes despite its […]
Author: STITCHES Newsletter
Endoscopic approach shows high success for pancreatic stones
EUS-guided pancreaticogastrostomy followed by pancreatoscopy is effective for managing pancreatic head duct stones. 95% technical success rate for EUS-guided pancreaticogastrostomy in 20 patients. Complete stone clearance achieved in 89% of those treated with subsequent pancreatoscopy-guided lithotripsy. This method is safe, with only mild early adverse events and a 6% recurrence rate. No late adverse events […]
Comparison of Pocket-Creation and Conventional Methods in ESD
Pocket-creation method (PCM) is a noninferior option to conventional endoscopic submucosal dissection (ESD) for gastric tumors, with lower subsequent surgery rates. Overall post-ESD adverse event rates: 14.3% for PCM vs. 12.9% for conventional, demonstrating noninferiority with an absolute risk difference of 1.4%. Comparable resection rates: En bloc resection at 98.6% for both methods and complete […]
Percutaneous neuromonitoring cuts vocal cord palsy rates in thyroid surgery
A large study shows that percutaneous combined intraoperative neuromonitoring significantly reduces vocal cord palsy in transoral endoscopic thyroidectomy. Percutaneous-combined group had a temporary vocal cord palsy rate of just 0.2%, vastly lower than other techniques. Independent protective factor against vocal cord palsy, with odds ratio of 0.08; thyroid malignancy and Graves’ disease increase risk. Consider […]
Revision Rates in Robotic Hiatal Hernia Repair: Key Insights
Larger hiatal hernias substantially increase the risk of revision after robotic repair, informing surgical decision-making. The 5-year revision rate ranges from 0% to 5.7%, with a weighted average of about 3.2%. Large or giant hernias (≥5 cm) show revision rates up to 30%, while small hernias (<5 cm) have rates of 0-2%. Consider assessing hernia […]
External referrals for cytoreductive surgery yield significant insights for surgeons.
Out-of-system (OOS) patients had a higher peritoneal carcinomatosis index (PCI) of 18.5 versus 13.0 for in-system (IS) patients. OOS patients required longer operative times (518 minutes vs. 321 minutes) and had longer hospital stays (14 days vs. 9 days). Despite higher burdens, OOS patients achieved similar completeness of cytoreduction (85% OOS vs. 87.7% IS). Surgeons […]
Cytoreductive Surgery and HIPEC Extend Survival for Colorectal Metastases
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) can significantly improve outcomes for patients with colorectal peritoneal metastases. Median overall survival with complete cytoreductive clearance is 43 months, compared to 10-18 months with systemic chemotherapy alone. Patients with the KRAS G12V mutation have a median overall survival of 34 months, significantly lower than the wild-type […]
New AI Tool Predicts Anastomotic Leakage After Surgery
A machine learning model can predict anastomotic leakage within 24 hours post-minimally invasive colorectal surgery, enhancing patient selection and safety. Incidence of anastomotic leakage in the study was 9.8%. The model achieved an AUC of 0.819 and a negative predictive value of 97.9%. This reliable early warning system allows for safer discharges, even with a […]
Type 2 Diabetes Increases Risks in Esophagectomy Patients
Type 2 diabetes significantly worsens outcomes after minimally invasive esophagectomy for esophageal squamous cell carcinoma. Patients with diabetes had longer surgeries (225 min vs. 215 min) and more blood loss (100 mL vs. 60 mL). Higher complication rates were observed: 57% in the diabetes group compared to 39% in non-diabetics. Survival rates were also negatively […]
Surgical approach impacts outcomes in intrahepatic cholangiocarcinoma.
Only 38.8% of patients achieved R0 resection and lymphadenectomy, with open liver resection at 51.1%, robotic at 44.4%, and laparoscopic at just 14.5% (p < 0.001). Laparoscopic liver resection showed the best overall survival rates at 95% and 89% at 1 and 3 years, respectively, compared to open (79%/30%) and robotic (90%/81%) approaches (p < […]