Surgeons can now better assess resectability in pancreatic cancer by focusing on specific vascular targets. Introducing a clear definition: “suitable target” vessels determine anatomic resectability, improving clarity in patient selection. Emphasizes the importance of 3D CT imaging and intraoperative assessment of vascular isolation for successful reconstruction. Adopting this approach enhances surgical eligibility evaluations and has […]
Author: STITCHES Newsletter
Watch-and-wait safe for rectal tumors beyond exam reach
Watch-and-wait management is viable for rectal cancers not palpable on exam, keeping patient outcomes comparable. 3-year local regrowth-free survival rates: 81.4% for palpable vs. 74.3% for nonpalpable tumors. 3-year disease-free survival rates: 80.8% for palpable vs. 74.3% for nonpalpable tumors. Surgeons can confidently consider watch-and-wait for these cases without compromising efficacy. Initial clinical responses don’t […]
New Guidelines for Splanchnic Venous Thrombosis Post-Splenectomy
Splanchnic venous thrombosis is a critical yet often overlooked risk after splenectomy in hematologic patients. Incidence is 11.4%, rising to 20.7% with routine imaging and 15.1% in single-center studies. Major risk factors include splenic size and weight; age, BMI, and platelet count were not significant. Patients with myeloproliferative neoplasms, lymphoma, and thalassemia face the highest […]
Uncut Roux-en-Y Outperforms Billroth in Gastrectomy Recovery
Uncut Roux-en-Y significantly reduces bile reflux and enhances quality of life post-distal gastrectomy for gastric cancer. Bile reflux incidence at 3 months: uncut R-Y (6.8%) vs. Billroth-II (77.6%) and Billroth II Braun (63.6%), p < 0.001. Results held at 12 months: 10.5% for uncut R-Y compared to 86% for Billroth-II and 67.9% for Billroth II […]
Enhancing Laparoscopic Cholecystectomy Safety with Ultrasound
Intraoperative ultrasound significantly improves safety during complex laparoscopic cholecystectomy. Intraoperative ultrasound reduced intraoperative iatrogenic rupture from 17.11% to 3.95% (p = 0.017). It improved differentiation between cystic duct stones and adhered structures. Integrating ultrasound with the modified gallbladder reporting and data system enhances decision-making, especially in higher-risk cases. The rate of atypical hyperplasia increased significantly […]
Long-Term Success of Laparoscopic Nissen Fundoplication
Laparoscopic Nissen fundoplication shows strong long-term effectiveness for GERD with high patient satisfaction over 10 years. Heartburn prevalence dropped from 94% to 34% post-surgery. Overall patient satisfaction reached 87%, with 87% willing to repeat the procedure. Consider LNF for candidates seeking durable symptom relief, keeping in mind potential for gas-bloating and dysphagia in over half […]
Predicting Recurrence in Lymph Node-Negative Pancreatic Tumors
A new risk score for lymph node-negative pancreatic neuroendocrine tumors helps identify patients at risk for recurrence and guides postoperative surveillance. Recurrence rate for lymph node-negative patients was 10.6%, occurring at a median of 32.4 months post-surgery. Risk factors included male sex (2.2x), tumor size ≥3 cm (2.64x), grade 2 or higher (3.70x), and lymphovascular […]
Disparities Impact Pancreatic Cancer Outcomes
Multimodal treatment disparities in pancreatic cancer significantly affect patient survival and care. 8,466 patients analyzed; nonmetastatic cases had higher therapy rates than metastatic. Non-Hispanic black patients experienced longer delays to treatment compared to non-Hispanic whites. Uninsured and Medicaid patients showed the highest odds of not receiving therapy in metastatic cases. Primary resection strongly predicts improved […]
Predicting Pancreatic Fistula Risk with Elastography
Pre-operative shear wave elastography can effectively predict the risk of post-operative pancreatic fistula (POPF) after partial pancreatectomy, impacting surgical decision-making. In a study of 305 patients, lower elastography measurements correlated with a higher risk of POPF. An integrated prediction model using elastography, BMI, and pancreatic duct dilation accurately assessed POPF risk with AUC values over […]
Conversion Resection Improves Outcomes in Intermediate-Stage HCC
Preoperative conversion therapy significantly enhances surgical outcomes for intermediate-stage hepatocellular carcinoma. 23.2% of patients in the conversion resection group achieved a complete pathological response. Microvascular invasion rates were lower in the conversion group (17.9% vs. 58.6% in direct resection). Consider conversion therapy to improve pathology and survival before resection in select patients. 51.8% of the […]