Stent choice for preoperative biliary drainage in pancreatic cancer does not affect long-term survival. Among 6,429 patients, overall and recurrence-free survival were similar for plastic (PS) and metal stents (MS) after pancreaticoduodenectomy, even in those receiving neoadjuvant therapy. No significant difference in postoperative complications between PS and MS. Choose stents based on drainage duration and […]
Category: HPB & Spleen
New Peptide Strategy Outperforms Balloon for Post-ERCP Bleeding
A self-assembling peptide-first approach significantly enhances hemostasis for immediate post-sphincterotomy bleeding during ERCP. Successful initial hemostasis was achieved in 92.3% of the peptide group versus 76.9% in the balloon group (15.4% risk difference, p=0.027). The mean procedure time was shorter for the peptide strategy, and rescue devices were needed less often (7.7% vs 23.1%, p=0.033). […]
EUS-guided RFA shows promise for managing IPMNs
Endoscopic ultrasound-guided radiofrequency ablation (EUS-RFA) offers a safe, minimally invasive option for patients with branch-duct IPMNs who cannot undergo surgery. Technical success reached 100% across 62 procedures, with local control in 98% of lesions. Adverse events occurred in 27% of cases, mainly mild abdominal pain; no procedure-related deaths were reported. This approach maintains pancreas-wide disease […]
New Metric Improves Outcomes in Intrahepatic Cholangiocarcinoma
Surgeons should consider the margin-to-size ratio (MSR) as a key factor for patient outcomes in resectable intrahepatic cholangiocarcinoma (ICC). Higher MSR significantly improves recurrence-free survival (RFS), with an HR of 0.59. An MSR threshold of 0.142 predicts better 3-year RFS: 55.7% for high MSR vs. 45.2% for low MSR. This approach may help tailor surgical […]
Anastomotic Stenosis Risks in Pancreatoduodenectomy with Portal Vein Resection
Distal transection of the superior mesenteric vein significantly increases the risk of anastomotic stenosis during pancreaticoduodenectomy for cancer. Non-tumorous stenosis rate was 40.9% for distal vs. 1.7% for proximal transection (p < 0.01). Symptomatic complications like ascites and gastrointestinal bleeding were also higher in the distal group (15.9% vs. 1.2%, p < 0.01). Surgeons should […]
Intraoperative Radiation Therapy Enhances Outcomes in Pancreatic Cancer
Intraoperative radiation therapy (IORT) may significantly improve outcomes for patients with borderline resectable and locally advanced pancreatic cancer undergoing pancreatectomy. Local recurrence-free survival at 24 months improved to 79% with IORT vs. 53% without (p = .049). Overall survival at 24 months was 58% for IORT patients compared to 43% for controls (p = .058). […]
Laparoscopic Right Hepatectomy Advances Enhance Surgical Precision
A new vein-guided technique for laparoscopic right hepatectomy offers better outcomes for selected patients. A caudal, vein-guided approach improves anatomic orientation and the transection plane. Left semidecubitus positioning enhances exposure, making surgery safer. Improved techniques focus on minimizing trauma to hepatic structures. Post-transection mobilization reduces traction on critical veins, promoting safer resection. Journal Article by […]
Lower Hernia Rates with Stratafix in Open Hepatectomy
Inverted L-shaped incisions in hepatectomy have high hernia rates, but the stratafix-continuous closure method shows promise. Incisional hernia incidence at 1 year: stratafix 8.1% vs. polydioxanone-hybrid 21.5% (p = .001). Stratafix method associated with 69% lower odds of hernia (odds ratio 0.31; 95% CI 0.14-0.66; p = .002). Consider adopting the stratafix technique for better […]
Preferred Approach for Severe Pancreatic and Colon Injuries
Primary anastomosis is safe and may lead to better outcomes than ostomy for patients with severe pancreatic injuries and colon resection. Surgical site infections were similar: 10% for anastomosis vs 17.5% for ostomy (p = 0.184). Unplanned return to OR rates also showed no significant difference: 8.3% vs 14.2% (p = 0.260). Choosing primary anastomosis […]
Robotic Pancreaticoduodenectomy Training for Early-Career Surgeons
Early-career surgeons can safely and efficiently transition to robotic pancreaticoduodenectomy, achieving proficiency by case 23. Mean operative time dropped from 524 to 309 minutes (p < 0.001). Clinically relevant pancreatic fistula rates fell from 31.8% to 5.4% (p = 0.012). Emphasis on mentorship in high-volume settings is crucial for successful outcomes. Conversion to open surgery […]