Accurate diagnosis of pancreatic cystic lesions (PCLs) is critical to avoiding unnecessary surgeries. Despite existing guidelines, many patients with benign cysts still undergo major resections. New endoscopic methods, including advanced imaging and minimally invasive treatments, show promise for enhancing diagnostic precision and offering organ-sparing options. Techniques like endoscopic ultrasound (EUS) and novel therapeutics are well-tolerated […]
Category: HPB & Spleen
Multidisciplinary team meetings significantly impact pancreatic cancer care
Evidence from 36 studies reveals that multidisciplinary team meetings (MDMs) for pancreatic cancer significantly affect care decisions, influencing initial diagnoses in 3.4%-21.7% of cases and altering treatment plans in 18.2%-72.2%. These meetings improve clinical trial participation but incur substantial preparation time (16.5 hours weekly) and financial costs ($240 per case). Best practices suggest standardization and […]
Biliary stenting with 125I seeds enhances survival and stent patency.
A meta-analysis of 14 studies involving 1,078 patients indicates that biliary stenting combined with intraluminal 125I seed brachytherapy significantly improves overall survival and stent patency compared to standard biliary stenting alone. The study found no increase in complications or severe liver damage associated with the combined treatment. With longer survival and better functionality of the […]
New machine learning model predicts cholangitis risk after ERCP
A novel interpretable machine learning model has been developed to predict post-ERCP cholangitis (PEC) in patients with malignant biliary obstruction (MBO). The model, utilizing data from 2831 patients, identified key risk factors including radiofrequency ablation and white blood cell count. Among various machine learning methods, the XGBoost model outperformed others, predicting PEC risk with accuracy […]
Preoperative weight loss lowers pancreatic fistula risk after surgery
In a study of 43,126 patients who underwent pancreatectomy, 16.3% developed postoperative pancreatic fistula (POPF). Preoperative weight loss correlated with reduced odds of developing POPF (odds ratio 0.87), whereas higher body mass index (BMI) increased risk. For patients experiencing weight loss, each BMI point increase resulted in a 67% rise in POPF odds, contrasting with […]
Machine learning excels at predicting post-pancreaticoduodenectomy hemorrhage
A machine learning model significantly improves risk stratification for post-pancreaticoduodenectomy hemorrhage (pph), identifying eight key predictors such as albumin levels and operative time. With an area under the curve (AUC) of 0.84 during training and 0.82 in validation, this model outperformed traditional logistic regression, enabling clinicians to classify patients into low, medium, and high-risk groups […]
Online Risk Models Aid in Identifying Surgical Candidates
Researchers developed online calculators to assess patients’ likelihood of benefiting from liver resection for intrahepatic cholangiocarcinoma. Among 889 patients studied, the 90-day mortality rate was 8.5%, with median overall survival at 24.1 months. Risk profiles categorized patients into three groups: favorable (90-day mortality 4.3%, survival 47 months), unfavorable (33.3% mortality, 11.9 months survival), and intermediate […]
Mastery of laparoscopic pancreaticoduodenectomy improves beyond initial learning curve
Cumulative sum analysis in laparoscopic pancreaticoduodenectomy showed that surgeon proficiency continues to evolve beyond the initial learning phase. In a review of 381 patients, significant improvements were noted across operative time, blood loss, length of stay, and postoperative complications over three defined phases. Notably, operative time and blood loss saw proficiency achieved after hundreds of […]
New model predicts pancreatic fistula risk after surgery
A predictive model for clinically relevant postoperative pancreatic fistula (cr-popf) was developed, showing a 29.1% occurrence rate among trained patients. Utilizing postoperative day 5 C-reactive protein and drain fluid amylase levels, the model achieved area under the ROC curves of 0.787 and 0.750, respectively. This index, validated through additional cohorts, assists surgeons in assessing risk […]
New criteria differentiate resectable and borderline resectable ICC
A study involving 953 patients identified four tumor-related factors that predict poor prognosis in intrahepatic cholangiocarcinoma (ICC): lymph node metastasis, tumor size over 5 cm, multinodular lesions, and major vascular invasion. A point system categorized patients as resectable or borderline resectable, significantly impacting overall survival rates. Patients classified as borderline resectable had a median survival […]