Routine terminal ileal intubation in asymptomatic patients undergoing colon cancer screening shows minimal diagnostic value. Overall diagnostic yield for any ileal finding is just 1.74%. Yield for clinically significant pathology is only 0.28%, with Crohn’s disease detection at 0.1%. Surgeons should reconsider routine TII during screening and surveillance colonoscopies due to negligible benefit. Review by […]
Author: STITCHES Newsletter
New risk scoring for achalasia post-POEM reveals critical patterns.
The JAMS POEM score effectively predicts short-term clinical failure (AUROC 0.71) but loses accuracy long-term (AUROC 0.54). A three-tiered risk stratification identifies an intermediate-risk group with a 10-year failure rate of 35.8%, suggesting different follow-up strategies. Surgeons should consider long-term outcomes when applying the JAMS POEM score for better patient surveillance. In the low-risk group, […]
Surgeons Flourish Despite Challenges With Social Connectivity
Surgeons report high levels of professional flourishing, impacting well-being and burnout strategies. 30% of surveyed surgeons scored an average of 7.98 on a 10-point flourishing scale. Financial stability (8.57) and sense of purpose (8.50) were top-rated; social connections lagged (7.41). Surgeons working fewer hours and viewing their role as a calling showed significant flourishing increases. […]
New Metric Improves Outcomes in Intrahepatic Cholangiocarcinoma
Surgeons should consider the margin-to-size ratio (MSR) as a key factor for patient outcomes in resectable intrahepatic cholangiocarcinoma (ICC). Higher MSR significantly improves recurrence-free survival (RFS), with an HR of 0.59. An MSR threshold of 0.142 predicts better 3-year RFS: 55.7% for high MSR vs. 45.2% for low MSR. This approach may help tailor surgical […]
Effective outcomes for laparoscopic hiatal hernia repair with cTIF
Laparoscopic hiatal hernia repair combined with consecutive transoral incisionless fundoplication (cTIF) achieves high success rates in GERD patients. 92% of patients achieved complete clinical success within 12 months. Symptom improvement was reported by 90% and 84% normalized esophageal acid exposure. Most patients (84%) stopped daily proton pump inhibitors, enhancing long-term management potential for surgeons. Serious […]
Surgeon Sleep and Patient Risk Linked to Major Events
Surgeons’ inconsistent sleep timing significantly impacts patient safety, with notable implications for surgical outcomes. Social jet lag of 2 hours or more increases the risk of major adverse events by 36% compared to less than 1 hour. Nearly 20% of surgeries (1410 out of 7117) led to major complications. Surgeons who manage their sleep better […]
Documentation Gaps in Multidisciplinary Tumor Board Meetings
Tumor board documentation is inconsistent, impacting cancer patient care. Only 51.7% of cases had adequate documentation, significantly varying by cancer type (5.5% for breast vs. 97.0% for colorectal). Among documented cases, 44.7% of notes were unstructured, lacking important details like attendees’ specialties (29.3%) and clinical trial eligibility (15.8%). Improving documentation standards could enhance the quality […]
Colonic obstruction management redefined: SEMS trumps surgery.
Using self-expanding metal stents (SEMS) as bridge-to-surgery improved outcomes for obstructive left colon cancer. One-year stoma rates were lower with SEMS (44.4%) compared to emergency surgery (73.4%). Fewer readmissions (4.2% vs 15.9%) and faster chemotherapy initiation (76.1% vs 55.8%) were noted with SEMS. Consider SEMS for selected patients to reduce stoma rates and enhance quality […]
Robotic and Laparoscopic APR for Anal Cancer Show Lower Mortality
Minimally invasive surgery for anal cancer improves patient outcomes compared to open approaches. Robotic APR showed lower 30-day mortality rates (1.2% vs 2.2% for open) and reduced 90-day mortality (3.2% vs 4.9% for open). Laparoscopic APR also had lower mortality and similar survival rates to robotic APR, with a five-year survival of 54%. Choosing robotic […]
Neoadjuvant Serplulimab Improves Survival in PD-L1-Positive Gastric Cancer
Neoadjuvant serplulimab with chemotherapy enhances event-free survival in PD-L1-positive gastric cancer, making it a promising strategy for surgeons. Median event-free survival was longer with serplulimab (not reached) compared to placebo (42 months) for patients with PD-L1 CPS ≥10 (HR 0.65, p=0.0082). In the overall patient population, event-free survival was also improved (not reached vs. 35.9 […]