Patient selection is critical in robotic hepatectomy for optimizing surgical outcomes. Major hepatectomy complications increase with cirrhosis, obesity, and tumor size ≥ 10 cm, leading to longer operative times (up to 310 min) and higher estimated blood loss (up to 242 ml). Minor hepatectomy faces similar trends, with cirrhosis and obesity extending operative times to […]
Category: HPB & Spleen
Surgery improves outcomes for gastroenteropancreatic neuroendocrine tumors with liver metastasis.
Patients undergoing primary resection and metastasectomy for small-bowel neuroendocrine tumors (sbnets) had a mean disease-specific survival of 97 months, compared to 71.6 months for pancreatic neuroendocrine tumors (pnets). Surgical candidates who refused surgery had notably worse outcomes, with mean survivals of 73.5 months for sbnets and 56.5 months for pnets. Surgeons should prioritize surgical intervention […]
Enhanced Biliary Brush Cytology Boosts Detection of Cholangiocarcinoma
Updated protocols for biliary brush cytology significantly improve sensitivity in diagnosing perihilar and intrahepatic cholangiocarcinoma. Sensitivity jumped from 50.5% to 88.3% after protocol changes, with first sample sensitivity reaching 78%. Specificity remained high at 100% across both prospective and historical cohorts. These results suggest that adopting optimized protocols can enhance diagnostic accuracy, potentially improving patient […]
Distinct Subtypes of Cholangiocarcinoma Demand New Strategies
Surgeons must recognize cholangiocarcinoma’s three subtypes to tailor patient care. Intrahepatic, perihilar, and distal cholangiocarcinoma show unique biology affecting diagnosis and treatment. Each subtype has distinct risk factors like chronic biliary diseases, impacting surgical outcomes. Understanding these differences enhances surgical decision-making and patient selection for better outcomes. Innovations in surgical techniques and strategies, guided by […]
Effective Adjuvant TACE Boosts HCC Outcomes After Surgery
Postoperative adjuvant transarterial chemoembolization (pa-TACE) significantly improves survival in hepatocellular carcinoma (HCC) patients after liver resection. Patients receiving pa-TACE had 30% lower recurrence risk (HR=0.70, p=0.04) and 35% better survival rates (HR=0.65, p=0.04) compared to controls. The benefits are pronounced in microvascular invasion-positive patients, with recurrence-free survival improved by 69% (HR=0.31, p<0.001) and overall survival […]
Avoid Feeding Jejunostomy in Pancreatoduodenectomy
Feeding jejunostomy (FJT) after pancreatoduodenectomy increases complications and length of stay. Delayed gastric emptying occurred in 55% of FJT patients vs. 25% in nasojejunal tube (NJT) patients (p = 0.006). FJT led to a longer hospital stay: 11 days compared to 9 days for NJT (p = 0.007). Omit FJT to reduce postoperative complications without […]
Advancing HPB Surgical Techniques Show Improved Outcomes
Minimally invasive and robotic-assisted surgeries enhance recovery in hepatopancreatobiliary procedures. Patients who underwent robotic-assisted gastrectomy had shorter hospital stays and less intraoperative bleeding than those who had open surgeries. Operative times differed among procedures due to technical complexity and learning curves. Surgeons should consider robotic techniques for better postoperative recovery in select patients. Overall, advances […]
Impact of Textbook Outcome on Biliary Tract Cancer Surgery
Achieving a textbook outcome (TO) significantly enhances overall survival in biliary tract cancer (BTC) post-hepatectomy. Patients who achieved TO had a 31% reduced hazard of mortality (HR 0.69, 95% CI 0.58-0.82). Thirteen predictors of TO were identified, including younger age (OR 1.61), lower ASA score (OR 1.83), and smaller tumor size (OR 1.08). Laparoscopic surgery […]
Optimal Management of Celiac Artery Stenosis in Surgery
Surgeons must prioritize preoperative identification of celiac artery stenosis in patients undergoing pancreaticoduodenectomy to reduce ischemic complications. Celiac artery stenosis occurs in 6.1% of patients undergoing the procedure; only 2.2% had preemptive median arcuate ligament release. Stenosis over 80% significantly increases the risk of postoperative ischemia. Identifying stenosis preoperatively results in fewer complications (5.8% vs. […]
Optimal Management of Celiac Artery Stenosis in Surgery
Surgeons must prioritize preoperative identification of celiac artery stenosis in patients undergoing pancreaticoduodenectomy to reduce ischemic complications. Celiac artery stenosis occurs in 6.1% of patients undergoing the procedure; only 2.2% had preemptive median arcuate ligament release. Stenosis over 80% significantly increases the risk of postoperative ischemia. Identifying stenosis preoperatively results in fewer complications (5.8% vs. […]