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 […]
Category: HPB & Spleen
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 […]
Study on T1 Ampullary Cancer Outcomes Guides Surgical Decisions
Surgeons treating T1 ampullary cancer need to consider high upstaging rates and significant survival disparities based on pathologic classification. In this cohort of 244 T1 ampullary cancer patients, 75% underwent resection, but 68% were upstaged to higher T classifications post-surgery. Five-year overall survival rates were starkly different: 36% for clinical T1N0 vs. 75% for pathologic […]
Understanding Chyle Leak Risk Factors After Pancreatic Surgery
A recent study highlights the critical need to adjust how we identify and manage chyle leak after pancreatic surgery. Chyle leak occurred in 11% of patients; risk factors included a minimally invasive approach and maximum drainage volume. Patients with high drainage volume (≥300 ml/day) and triglyceride-rich but non-milky drainage faced longer hospital stays (19 days) […]