Frailty significantly raises the risk of death and readmission after pancreatic surgery, primarily through postoperative complications. 22.2% of 71,104 patients were frail, with 30-day mortality linked to frailty (aOR 1.29) and readmission (aOR 1.11). Complications mediated 80.72% of the frailty-mortality association, with unplanned reintubation and major infections among the top culprits. Focus on preventing complications […]
Author: STITCHES Newsletter
Optimize Postoperative Nutrition for Pancreatoduodenectomy
Early enteral nutrition (EEN) via nasojejunal tube reduces complications after pancreatoduodenectomy compared to oral nutrition (ON). EEN patients had a mean 90-day complication index of 25.5 vs. 35.8 for ON (p = .02). Overall morbidity was slightly higher in ON (51/59) vs. EEN (45/59), but not statistically significant. Implementing EEN in nutritionally at-risk patients can […]
Funnel-Shaped Mesh Reduces Parastomal Hernias After Colostomy
Using funnel-shaped mesh during rectal adenocarcinoma surgery cuts parastomal hernias significantly. At 3 years, CT-confirmed parastomal hernia occurred in 57% of the mesh group vs. 82% in controls, a 25% reduction. Clinically diagnosed hernias were 10% in the mesh group compared to 39% in the control group, marking a 29% difference. This supports funnel-shaped mesh […]
Watch and Wait for Rectal Cancer: Surveillance Gaps Identified
Surgeons need to know that only 62% of patients on watch and wait for rectal cancer adhered to optimal surveillance, raising concerns about early regrowth detection. 53 patients studied, median follow-up of 17 months. Younger patients (median age 54) were more likely to follow optimal surveillance (p = .04). Surveillance failures commonly occurred within the […]
Minimally invasive gastric cancer surgery outperforms open approach
Minimally invasive techniques, especially robotic surgery, yield better results for gastric cancer patients. Textbook outcome achieved in 31.4% of open cases, 56.8% of laparoscopic, and 68.6% of robotic. Hospital stays were shorter for laparoscopic and robotic procedures. Achieving a textbook outcome is linked to improved 1-year survival rates across all techniques. Robotic gastrectomy showed superior […]
Gallbladder cancer survival improves with liver resection
Surgeons should consider liver resection for patients with incidental gallbladder cancer (gbc) to enhance survival outcomes. 5-year disease-free survival is 41.5%, overall survival is 45.1% after incidental gbc diagnosis. Patients who underwent liver resection showed significantly improved disease-free survival (51 vs. 15 months) and overall survival (72 vs. 26 months). Completion of adjuvant chemotherapy further […]
Machine learning distinguishes MD-IPMN from chronic pancreatitis
A new model helps surgeons accurately differentiate main-duct intraductal papillary mucinous neoplasms from chronic pancreatitis when imaging results are unclear. Among 123 patients, intraductal nodules were found in 20% of MD-IPMN cases vs 2.4% in chronic pancreatitis (p=0.003). Ductal stones were present in 77.1% of chronic pancreatitis cases compared to just 2.5% in MD-IPMN (p<0.001). […]
Wearable Devices Surge Among Chronic Disease Patients
Surgeons need to know that wearable device use is skyrocketing among adults with chronic diseases, offering new avenues for patient monitoring. 107 million U.S. adults used a wearable device in 2024, a 58% increase since 2019. 74 million report using devices regularly; 78 million are willing to share data with healthcare providers. Integrating this continuous […]
Shared Decision-Making Improves IPMN Management
Managing intraductal papillary mucinous neoplasms (IPMN) is complex, with surgical outcomes hinging on nuanced patient preferences. Clinicians and patients often interpret malignancy risks and surgical outcomes differently, leading to care inconsistencies. Implementing shared decision-making (SDM) frameworks can enhance risk communication and align treatment with patient values. SDM may help reduce unnecessary surgeries and improve patient […]
Laparoscopic Resection of HCC with Portal Vein Thrombosis Feasible
Surgeons can achieve successful resection in patients with hepatocellular carcinoma and portal vein tumor thrombus despite resistance to first-line therapy. A patient responded to second-line therapy with notable reduction in tumor size and portal vein thrombus, allowing for laparoscopic surgery. The procedure took 340 minutes with minimal blood loss (100 ml) and resulted in extensive […]