Using endoscopic ultrasound-guided needle-based confocal laser endomicroscopy improves diagnostic accuracy for pancreatic cystic lesions, reducing unnecessary surgeries. Overall diagnostic accuracy improved from 73% to 85% with EUS-NCLE. Misclassification of lesions dropped, reducing unnecessary benign resections from 7.2 to 4.1 per observer. Combine EUS-NCLE with standard evaluation for better outcomes, especially for larger cysts. Mucinous versus […]
Author: STITCHES Newsletter
New Standard of Care for GEJ Adenocarcinoma Neoadjuvant Therapy
Neoadjuvant therapy now hinges on the FLOT regimen for resectable gastroesophageal junction adenocarcinoma, significantly impacting surgical outcomes. The FLOT regimen shows improved overall survival and pathologic complete response rates compared to ECF. Neoadjuvant chemoradiotherapy boosts local control but has limited effect on distant recurrence. Surgeons should prioritize FLOT to enhance patient outcomes and consider immunotherapy […]
Understanding Nutritional Risk Enhances ESCC Outcomes
Preoperative nutritional risk influences treatment tolerance and survival in resectable esophageal squamous cell carcinoma (ESCC). Higher nutritional risk correlates with decreased surgical completion rates: 97.1% for low risk vs. 76.7% for high risk (p < 0.001). High-risk patients face almost double the severe postoperative complications (38.2% vs. 18.0%; p < 0.001) and poorer overall survival […]
R0 Resection Critical for Node-Positive Pancreatic Cancer
R1 resection is linked to significantly worse survival in node-positive pancreatic ductal adenocarcinoma patients. R1 status increased the hazard of mortality by 38% (HR 1.38; 95% CI: 1.21-1.59). The overall R0 rate in node-positive cases was 61.1%, varying by adherence to the Royal College of Pathology guidelines. R0 resection should remain a key goal in […]
Robotic Cholecystectomy Shows Promising Outcomes Versus Open Surgery
Robotic cholecystectomy is gaining traction and appears to improve patient outcomes compared to open surgery. Robotic approach linked to 85% lower odds of bile duct injury (OR 0.15) and 74% lower odds of death (OR 0.26). Patients undergoing robotic cholecystectomy had a 3.4-day shorter postoperative stay but incurred $1,000 more in costs. Surgeons should consider […]
AI Research Lags Behind Growth of Ambulatory Surgery Centers
Surgeons need to address a significant gap in AI research affecting patient care in ambulatory surgery centers (ASCs). Over 60% of elective surgeries occur in ASCs, yet fewer than 10 studies focus on AI in these settings compared to over 500 in hospitals. Existing ASC research primarily targets workflow optimization, with no focus on intraoperative […]
Intrathecal Morphine Matches Continuous Wound Infiltration Pain Control
Intrathecal morphine is as effective as continuous wound infiltration for pain management after open pancreatoduodenectomy. In a study of 92 patients, intrathecal morphine had a mean coughing pain score of 5.7 vs. 6.1 for continuous wound infiltration. It provided better early pain relief, significantly reducing pain scores at 2 hours post-op and sustaining lower scores […]
Robotic Total Pancreatectomy After Robotic Pancreaticoduodenectomy
This study shows that robotic remnant total pancreatectomy (r-rtp) after robotic pancreaticoduodenectomy is a feasible option with promising outcomes. Mean operative time was 332 minutes, with a blood loss of 168 ml. All three patients had R0 resections and are alive without recurrence after the procedure. No postoperative complications or mortality were reported, indicating a […]
Pancreatic neck margin testing shows limited benefit in cancer surgery.
In a study of 403 patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma, checking pancreatic neck margins with frozen section did not improve recurrence-free or overall survival outcomes. Median pancreatic neck recurrence-free survival was longer in patients with negative initial results (23.1 months) vs. those with revision clearance (16.9 months). Surgical efforts to clear positive margins […]
Preoperative Chemotherapy for Perihilar Cholangiocarcinoma: No Negative Impact on Surgery
Preoperative chemotherapy in perihilar cholangiocarcinoma shows similar surgical outcomes to those who do not receive it. Chemotherapy group had 52% morbidity and 4% mortality, with main complications like surgical site infections (27%) and bile leakage (26%). No significant differences in operative time, blood loss, or pathology outcomes after matching 80 patients per group. Preoperative chemotherapy […]