Endoscopic submucosal dissection (ESD) outperforms endoscopic papillectomy (EP) for ampullary tumors ≥20 mm in base size. ESD achieved 100% en bloc resection and 89.5% R0 rates compared to 71.7% and 30.2% for EP. ESD showed 0% residual disease versus 42.9% with EP during over a year of follow-up. Consider ESD for better outcomes despite its […]
Category: HPB & Spleen
Endoscopic approach shows high success for pancreatic stones
EUS-guided pancreaticogastrostomy followed by pancreatoscopy is effective for managing pancreatic head duct stones. 95% technical success rate for EUS-guided pancreaticogastrostomy in 20 patients. Complete stone clearance achieved in 89% of those treated with subsequent pancreatoscopy-guided lithotripsy. This method is safe, with only mild early adverse events and a 6% recurrence rate. No late adverse events […]
Surgical approach impacts outcomes in intrahepatic cholangiocarcinoma.
Only 38.8% of patients achieved R0 resection and lymphadenectomy, with open liver resection at 51.1%, robotic at 44.4%, and laparoscopic at just 14.5% (p < 0.001). Laparoscopic liver resection showed the best overall survival rates at 95% and 89% at 1 and 3 years, respectively, compared to open (79%/30%) and robotic (90%/81%) approaches (p < […]
Robotic Pancreatoduodenectomy Shows Promise Post-Learning Curve
Robotic pancreatoduodenectomy (r-pd) may offer better outcomes compared to open surgery after the learning curve is overcome. Lower estimated blood loss: 200 ml for r-pd vs. 300 ml for open (p=0.0012). Shorter hospital stay: 12 days for r-pd vs. 14 days for open (p=0.038). Despite longer operative times (582 vs. 362 minutes), r-pd shows a […]
Integrated Response Metrics Enhance Prognosis in CRLM Surgery
Combining anatomical and histologic responses to neoadjuvant therapy improves predicting recurrence in colorectal liver metastases (CRLM) after hepatectomy. Median recurrence-free survival (RFS) was 15.87 months for 483 patients. Early recurrence occurred in 36.9%, linked to poor histologic and anatomical responses. Understanding these combined metrics helps tailor patient selection and surgical planning for better outcomes. Intrahepatic […]
Impact of Surgical Margins in Colorectal Liver Metastases
Surgical margins during liver resection for colorectal metastases are crucial, especially given tumor genetics. R1p margins significantly worsen survival (53% vs. 61% for R0; p < 0.0001), particularly in KRAS-mutated tumors. R1p margins also correlate with increased recurrence rates, whereas R1v margins showed no significant risk across molecular groups. Surgeons should prioritize achieving R0 resection, […]
Learning Curve in Laparoscopic Liver Resection: Controller Matters
Surgeon proficiency and scope type significantly impact laparoscopic liver resection outcomes. Beginners had longer operative times (178 vs. 139.5 min) and higher complication rates compared to experts. Using joystick-controlled scopes allowed beginners to close the skill gap more quickly. Choosing the right controller type can enhance outcomes, especially for less experienced surgeons. In minor hepatectomies, […]
Cholangiocarcinoma Subtypes: Implications for Surgical Practice
Understanding the molecular subtypes of cholangiocarcinoma (CCA) is crucial for optimizing surgical decisions and patient outcomes. CCA shows significant heterogeneity, with distinct genomic profiles linked to tumor location—this may affect surgical approach. Intrahepatic CCAs frequently harbor targetable mutations like FGFR2 fusions and IDH1/2 mutations, offering new avenues for therapy. Surgeons can enhance patient selection based […]
CYP2A6 Genotypes Affect Survival in Pancreatic Cancer Patients
Decreased-function CYP2A6 genotypes correlate with worse outcomes for pancreatic cancer patients on S-1 therapy. 56.6% of patients had decreased-function genotypes, increasing lymph node metastasis (78% vs. 52.4%, p=0.001). Median recurrence-free survival was significantly shorter for poor metabolizers (19.2 months vs. 32.3 months, p=0.040). Understanding genotype impact may guide treatment personalization and improve patient outcomes. Poor […]
Innovative Left-Sided Approach Improves Robotic Pancreatoduodenectomy
A left-sided uncinate-first method enhances surgical precision in complex robotic pancreatoduodenectomies. It provides better access to the superior mesenteric artery, especially beneficial for morbidly obese patients or those with bulky tumors. The technique allows for earlier vascular control and reduces traction on the superior mesenteric vein. This approach could become essential in cases where traditional […]