Resection of solitary colorectal liver metastases leads to excellent long-term survival, but outcomes depend on lymph node status and tumor size. Median overall survival is 10 years; 52% remain recurrence-free at 3 years. Salvage therapy for 51% of recurrences boosts overall survival significantly (5.89 years vs. 2.24 years; p<0.001). Patients with more than three positive […]
Category: HPB & Spleen
Angioembolization Equals Survival to Surgery in Liver Trauma
Angioembolization offers equivalent survival rates compared to surgery for penetrating liver trauma but leads to longer hospital stays. Mortality rates were similar: 2.0% for angioembolization vs 4.8% for surgery (p = .069). Hospital stay averages: 17.3 days for angioembolization vs 11.7 days for surgery (p < .001). Identifying patients who are at higher risk for […]
Novel bile leak test shows promise in liver resection outcomes
A prospective trial indicates a new ultrasound technique may improve detection of bile leaks during liver surgery. Contrast-enhanced intraoperative ultrasonic cholangiography was technically successful in 86.2% of patients. Postoperative bile leak rate was 17.2%, with most detected intraoperatively. This approach could enhance surgical safety but requires further validation to confirm its impact on patient outcomes. […]
Stent Choice in Malignant Biliary Obstruction Impacts Patency
Self-expanding metal stents outperformed plastic stents in patients with malignant hilar biliary obstruction, crucial for decision-making in palliative care. SEMs had a clinical success rate of 76.9% versus 51.1% for PS (p=0.015). Patency was significantly longer for SEMs (median 213 days) compared to PS (78 days; p=0.01). Choose SEMs for longer-lasting drainage but note overall […]
Enhanced Diagnosis of Pancreatic Cysts with EUS-NCLE
Using endoscopic ultrasound-guided needle-based confocal laser endomicroscopy improves diagnostic accuracy for pancreatic cystic lesions, reducing unnecessary surgeries. Overall diagnostic accuracy improved from 73% to 85% with EUS-NCLE. Misclassification of lesions dropped, reducing unnecessary benign resections from 7.2 to 4.1 per observer. Combine EUS-NCLE with standard evaluation for better outcomes, especially for larger cysts. Mucinous versus […]
R0 Resection Critical for Node-Positive Pancreatic Cancer
R1 resection is linked to significantly worse survival in node-positive pancreatic ductal adenocarcinoma patients. R1 status increased the hazard of mortality by 38% (HR 1.38; 95% CI: 1.21-1.59). The overall R0 rate in node-positive cases was 61.1%, varying by adherence to the Royal College of Pathology guidelines. R0 resection should remain a key goal in […]
Intrathecal Morphine Matches Continuous Wound Infiltration Pain Control
Intrathecal morphine is as effective as continuous wound infiltration for pain management after open pancreatoduodenectomy. In a study of 92 patients, intrathecal morphine had a mean coughing pain score of 5.7 vs. 6.1 for continuous wound infiltration. It provided better early pain relief, significantly reducing pain scores at 2 hours post-op and sustaining lower scores […]
Robotic Total Pancreatectomy After Robotic Pancreaticoduodenectomy
This study shows that robotic remnant total pancreatectomy (r-rtp) after robotic pancreaticoduodenectomy is a feasible option with promising outcomes. Mean operative time was 332 minutes, with a blood loss of 168 ml. All three patients had R0 resections and are alive without recurrence after the procedure. No postoperative complications or mortality were reported, indicating a […]
Pancreatic neck margin testing shows limited benefit in cancer surgery.
In a study of 403 patients undergoing pancreatoduodenectomy for pancreatic ductal adenocarcinoma, checking pancreatic neck margins with frozen section did not improve recurrence-free or overall survival outcomes. Median pancreatic neck recurrence-free survival was longer in patients with negative initial results (23.1 months) vs. those with revision clearance (16.9 months). Surgical efforts to clear positive margins […]
Preoperative Chemotherapy for Perihilar Cholangiocarcinoma: No Negative Impact on Surgery
Preoperative chemotherapy in perihilar cholangiocarcinoma shows similar surgical outcomes to those who do not receive it. Chemotherapy group had 52% morbidity and 4% mortality, with main complications like surgical site infections (27%) and bile leakage (26%). No significant differences in operative time, blood loss, or pathology outcomes after matching 80 patients per group. Preoperative chemotherapy […]