High attrition during neoadjuvant therapy (NAT) complicates surgical candidacy for localized pancreatic cancer, affecting patient outcomes. Out of 427 patients receiving NAT, 57% did not proceed to pancreatectomy due to disease progression (21%) and persistent inoperability (22%). Resectable patients had an attrition rate of 23%, compared to 44% for borderline resectable and 73% for locally […]
Author: STITCHES Newsletter
Predictors of Successful Pelvic Exenteration in Rectal Cancer
Pelvic exenteration for locally recurrent rectal cancer can achieve high rates of R0 resection, with important predictors identified for optimizing outcomes. R0 resection was accomplished in 81% of patients (244/300). Neoadjuvant radiotherapy significantly improved R0 resection rates (OR=2.773). Age influences overall survival, with a hazard ratio of 1.022 per year increase. Use these insights to […]
Consensus Guidelines for Perioperative Liver Surgery Care
New guidelines improve perioperative management for liver resection. Strong recommendations for prehabilitation, nutrition, and mobilization to enhance recovery. Identification of significant gaps in evidence, especially around thromboprophylaxis and post-hepatectomy liver failure management. Surgeons should standardize practices and collaborate on research to tackle these gaps and improve patient outcomes. Expert panel reached consensus through a modified […]
Predictors of Readmission After Esophagectomy for Cancer
Unplanned readmissions after esophagectomy are common and vary based on patient factors and surgical practices. Pooled readmission rate post-esophagectomy: 16.4%. Increased risk associated with comorbidities (diabetes, COPD, cardiovascular issues) and higher ASA status (III/IV). Longer hospital stays (>10 days) raise readmission odds by 35%. Neoadjuvant therapy may reduce readmission risk. Complications, especially anastomotic leaks and […]
Robotic Pancreatectomy Outcomes: East vs. West Insights
Robotic distal pancreatectomy shows regional disparities in outcomes for pancreatic cancer treatment. Western centers have shorter operative times (240 vs. 265 min) and lower conversion rates to open surgery (5% vs. 10%). Eastern centers boast higher R0 resection rates (85% vs. 75%) and greater lymph node yield (12 vs. 10 nodes). Despite these differences, survival […]
Lower Open Surgery Risk with Robotic Surgery in Abdominal Procedures
Robotic-assisted surgery cuts the risk of converting to open surgery compared to laparoscopy. Meta-analysis of 360 studies shows robotic surgery has lower odds of conversion to open surgery across 15 abdominal procedures. No significant impact from age, BMI, or sex on conversion rates. Surgeons can consider robotic options to enhance patient outcomes while being mindful […]
Predicting Resection Outcomes in ycT3 Esophageal Cancer
This study identifies the contact angle on preoperative CT images as a predictor for resection margins in ycT3 esophageal cancer patients, impacting surgical decision-making. Patients with positive resection margins had a contact angle of 130° vs. 93° for negative margins (p=0.0002). A contact angle ≥125° predicts positive margins with a sensitivity of 63% and specificity […]
Pathological complete response predicts better outcomes in gastric cancer
Achieving pathological complete response (pcr) after neoadjuvant chemotherapy significantly improves survival in gastric and esophagogastric junction cancers. Pcr correlates with a 63% lower risk of death (overall survival) using the Becker system. Progression-free survival is similarly improved, with a 38% reduction in risk of progression. Consider prioritizing pcr as a key goal in treatment, especially […]
Understanding Surgical Needs in Sigmoid Volvulus Patients
Nonoperative detorsion can often be effective for sigmoid volvulus, but some patients clearly need emergency surgery. 44.9% of patients required emergency surgery; previous volvulus history and shorter symptom duration were significant. Relative indicators for surgery include vomiting and hypokinetic bowel sounds; gangrenous stool and rebound tenderness are absolute indicators. Surgeons should evaluate these clinical features […]
Assess perineural invasion in stage II rectal cancer patients
Perineural invasion (PNI) signals poor outcomes in stage II rectal cancer and could guide chemotherapy decisions. 10.5% of analyzed patients showed PNI, linked to higher carcinoembryonic antigen levels and worse prognosis. Postoperative chemotherapy significantly improved overall and cancer-specific survival for PNI-positive patients. Surgeons should consider PNI when assessing treatment plans, as it identifies high-risk patients […]