Frailty significantly raises the risk of death and readmission after pancreatic surgery, primarily through postoperative complications. 22.2% of 71,104 patients were frail, with 30-day mortality linked to frailty (aOR 1.29) and readmission (aOR 1.11). Complications mediated 80.72% of the frailty-mortality association, with unplanned reintubation and major infections among the top culprits. Focus on preventing complications […]

Early enteral nutrition (EEN) via nasojejunal tube reduces complications after pancreatoduodenectomy compared to oral nutrition (ON). EEN patients had a mean 90-day complication index of 25.5 vs. 35.8 for ON (p = .02). Overall morbidity was slightly higher in ON (51/59) vs. EEN (45/59), but not statistically significant. Implementing EEN in nutritionally at-risk patients can […]

Surgeons should consider liver resection for patients with incidental gallbladder cancer (gbc) to enhance survival outcomes. 5-year disease-free survival is 41.5%, overall survival is 45.1% after incidental gbc diagnosis. Patients who underwent liver resection showed significantly improved disease-free survival (51 vs. 15 months) and overall survival (72 vs. 26 months). Completion of adjuvant chemotherapy further […]

A new model helps surgeons accurately differentiate main-duct intraductal papillary mucinous neoplasms from chronic pancreatitis when imaging results are unclear. Among 123 patients, intraductal nodules were found in 20% of MD-IPMN cases vs 2.4% in chronic pancreatitis (p=0.003). Ductal stones were present in 77.1% of chronic pancreatitis cases compared to just 2.5% in MD-IPMN (p<0.001). […]

Managing intraductal papillary mucinous neoplasms (IPMN) is complex, with surgical outcomes hinging on nuanced patient preferences. Clinicians and patients often interpret malignancy risks and surgical outcomes differently, leading to care inconsistencies. Implementing shared decision-making (SDM) frameworks can enhance risk communication and align treatment with patient values. SDM may help reduce unnecessary surgeries and improve patient […]

Surgeons can achieve successful resection in patients with hepatocellular carcinoma and portal vein tumor thrombus despite resistance to first-line therapy. A patient responded to second-line therapy with notable reduction in tumor size and portal vein thrombus, allowing for laparoscopic surgery. The procedure took 340 minutes with minimal blood loss (100 ml) and resulted in extensive […]

Surgeons now have a new, validated tool to assess the complexity of robotic liver surgery, improving patient selection and outcomes. The International RoboLiver Difficulty Scoring System outperformed the Southampton model with an AUC of 0.719, indicating better prediction of intraoperative complications. Key predictors of prolonged operative time include neoadjuvant chemotherapy, lesion size >50 mm, and […]

Robotic pancreatoduodenectomy in patients 80 and older shows significant benefits over open surgery. Operative time was longer for robotic (441 min) vs. open (375 min), but with less blood loss (266 ml vs. 565 ml). Postoperative complications were lower with robotic surgery (52.2% vs. 70.6% for open, p = .013) as well as rates of […]

Dedicated hepatobiliary fellowship programs sharply boost surgical confidence and competence, crucial for today’s complex liver surgeries. Fellows showed a confidence jump from 2.5 to 9 out of 10 in performing right hemihepatectomies after training. Median surgical volume included 65 liver resections, with minimally invasive exposure rising from 10 to over 20 cases in five years. […]

In a study of 2,183 patients, postoperative pancreatic fistula (POPF) occurred in 32.9% of hand-sewn closures versus 21.0% for stapler closures. The reoperation rate was higher and hospital stays longer for hand-sewn patients. Surgeons should consider stapler closure to reduce POPF risk and improve patient outcomes. Findings were consistent across various pancreatic characteristics, reinforcing the […]