In resected pancreatic ductal adenocarcinoma (PDAC), preoperative circulating tumor DNA (ctDNA) positivity is a strong predictor of poor overall and recurrence-free survival. Preoperative ctDNA positivity is linked to worse overall survival (hazard ratio [HR] 2.53) and recurrence-free survival (HR 2.28). Postoperative ctDNA positivity shows even stronger associations with worse survival outcomes (HR 5.15 overall, HR […]
Author: STITCHES Newsletter
Timing of Appendectomy Impacts Outcomes in Perforated Appendicitis
In patients with perforated appendicitis, delaying appendectomy leads to significantly worse clinical outcomes compared to performing it at the time of admission. Elective interval appendectomy is associated with a nearly doubled risk of ileocecal resection compared to early appendectomy (adjusted OR 1.92). Both elective and failed interval appendectomies increase the risk of infectious complications (adjusted […]
Neighborhood Disadvantage Linked to 90-Day Mortality after Hepatectomy
An increased area deprivation index (ADI) correlates with a higher risk of 90-day mortality after major hepatectomy, particularly due to posthepatectomy liver failure. Patients in the upper tier of ADI had a 5.47-fold increased risk of 90-day mortality (p = .043) compared to lower tiers. 4.9% of patients died within 90 days post-surgery, predominantly from […]
Mesh Removal Strategy for Infection after Hernia Repair
Complete versus partial mesh removal in cases of mesh infection after inguinal hernia repair shows no significant difference in outcomes, but complete removal may lead to higher rates of organ injury. Among 72 patients, no significant differences were noted in operative time, complications, or recurrence rates between complete (n=59) and partial (n=13) mesh removal. Organ […]
Long-term Outcomes of Transanal TME Show Low Recurrence Rates
Transanal total mesorectal excision (TATME) offers promising long-term oncologic outcomes for rectal cancer patients, with a low local recurrence rate of 4.55% at five years. In a cohort of 220 patients, overall survival was 60.91% and disease-free survival was 58.6% at five years. Anastomotic leakage was identified as the strongest predictor of both local (HR: […]
Incisional Negative Pressure Wound Therapy Reduces SSIs
In a systematic review of 85 trials, incisional negative pressure wound therapy (INPWT) significantly lowered the risk of overall surgical site infections (SSIs) and related wound complications compared to standard dressings. INPWT reduced overall SSI risk by 36% (RR 0.64) and deep SSIs by 34% (RR 0.66). Associated lower risks were found for wound dehiscence […]
Rural Patients with Colorectal Liver Metastases Face Care Gaps
Rural residency correlates with lower treatment rates and worse outcomes for colorectal liver metastases (CRLM). Among nearly 35,000 CRLM patients, 21.7% were rural dwellers; they had 12% lower odds of receiving curative-intent liver-directed therapy and 14% lower odds of systemic chemotherapy. Despite higher odds of primary tumor resection (12%), rural patients experience significantly poorer overall […]
KRAS and TP53 ctDNA Predict Survival in Localized Pancreatic Cancer
Detecting circulating tumor DNA (ctDNA) in patients with localized pancreatic ductal adenocarcinoma (PDAC) can help predict outcomes and guide surgical decision-making. Mutant KRAS ctDNA was present in 19% of patients at diagnosis, with levels dropping to 4.6% after neoadjuvant chemotherapy (NAC). The presence of both KRAS and TP53 ctDNA at diagnosis was associated with a […]
R1 Margins in Colorectal Liver Metastasis Surgery: A New Perspective
Microscopically positive margins (R1) after colorectal liver metastasis resection indicate worse outcomes but require context for interpretation regarding recurrence and repeat surgeries. Among 1,060 patients, R1 margins occurred in 21.5% and were linked to a higher crude risk of recurrence or death, with a hazard ratio of 1.34 after adjustments. Isolated liver recurrence was less […]
Comparative Evaluation of Fibrosis in Chronic Pancreatitis
A study found that fibrosis scores significantly differ among pancreatic surgery patients with and without chronic pancreatitis (CP), suggesting that reliance on fibrosis for diagnosis may lead to overdiagnosis of CP. Median fibrosis scores increased from controls (0.33) to indeterminate CP (2.8), recurrent acute pancreatitis (6.5), and definite CP (8.5), with all groups differing significantly. […]