Identifying effective strategies for preventing postoperative pancreatic fistula (POPF) can significantly impact patient outcomes after pancreatoduodenectomy (PD). Overall POPF rate was 15.1%; drains alone showed no association with POPF. For moderate fistula risk score patients, drains alone reduced POPF from 19.8% to 13.1%. High-risk patients benefited most from a drain combined with a stent, lowering […]
Category: HPB & Spleen
New Prognostic Tool Enhances HCC Treatment Decisions
A new CT-based online calculator predicts survival benefits from adjuvant transarterial chemoembolization after surgical resection in hepatocellular carcinoma patients. 35.4% of patients evaluated may benefit from pa-tace, increasing 5-year overall survival probability by 19.4% and adding 22.5 months of restricted mean survival time. The tool outperforms traditional staging systems with a c-index of 0.694 and […]
Robotic Repair Outshines Open for Biliary Duct Injuries
Robotic repair of iatrogenic biliary duct injuries offers significant advantages over traditional open surgery. Significantly less blood loss with robotic repair: 51 ml vs. 314 ml (p < 0.001). Shorter hospital stays: 4 days vs. 16 days (p < 0.001). Robotic procedures had similar complication rates to open repairs with no bile leaks or strictures […]
Spleen-Saving Techniques in Distal Pancreatectomy: Key Findings
A study comparing Warshaw vs. Kimura techniques for spleen-preserving distal pancreatectomy shows crucial differences in outcomes. Warshaw is preferred for larger tumors (2.5 cm vs. 1.5 cm) and complex cases, while Kimura offers shorter operative times and is more often minimally invasive (73.1% vs. 44.1%). Long-term complications like splenic hypoperfusion are more frequent after Warshaw […]
Surgery + Chemotherapy Improves Survival in Stage IV Pancreatic Cancer
Integrating surgery with chemotherapy may extend survival for some patients with stage IV pancreatic cancer and liver metastases. Patients undergoing combined surgery and chemotherapy had a median overall survival of 18 months, whereas those on chemotherapy alone showed significantly less. Younger patients (under 65) had a reduced mortality risk (HR = 1.3), and tumor location […]
Neoadjuvant Therapy Outperforms Upfront Surgery for Pancreatic Cancer
Neoadjuvant chemotherapy with gemcitabine and S-1 significantly improves survival for patients with resectable pancreatic ductal adenocarcinoma compared to upfront surgery. Median overall survival: 37.0 months (nac-gs) vs. 26.6 months (ups); hazard ratio for mortality: 0.73. Median relapse-free survival: 14.3 months (nac-gs) vs. 11.3 months (ups); hazard ratio for relapse: 0.77. Consider neoadjuvant therapy in surgical […]
Effective biliary stenting improves choledocholithiasis outcomes
Using a self-detachable biliary stent for closure after choledochotomy enhances recovery. Patients with primary duct closure experienced a shorter hospital stay—reduced by several days—compared to those with t-tube drainage. Complication rates were significantly lower in the stent group, indicating a safer alternative to traditional methods. Surgeons may consider this approach to reduce postoperative issues and […]
Improved Technique Enhances Bile Duct Cannulation Success
Modified endoscopic ultrasound-guided rendezvous shows promise for challenging biliary access in benign cases. Higher technical success rate with modified technique: 95.3% vs. 83.7%, especially effective with CBD diameter ≤ 3 mm (96.9% vs. 61.1%, p=0.002). Reduced procedure time: median of 6.12 minutes vs. 10 minutes (p<0.001) and lower radiation exposure (median 208.93 vs. 345 mGy, […]
Lower Fistula Risk with Robotic Pancreatoduodenectomy
Robotic pancreatoduodenectomy (RPD) significantly lowers the risk of clinically relevant pancreatic fistula compared to open pancreatoduodenectomy (OPD). RPD reduced the incidence of clinically relevant pancreatic fistula by 40% (odds ratio 0.60, 95% CI 0.51-0.67). Over 24,000 patients were analyzed, with 5,000 undergoing RPD and 19,600 OPD. Surgeons should consider RPD in suitable patients at high-volume […]
Impact of Tumor Progression on Hepatectomy Outcomes in NETLM
Preoperative tumor progression significantly predicts early mortality in patients undergoing cytoreductive hepatectomy for neuroendocrine tumor liver metastases. 47% of short-term survivors had preoperative progression compared to 16.6% of long-term survivors (p < 0.001). Patients with pancreatic neuroendocrine tumors and progression faced a median overall survival of just 1.8 years (p = 0.042). Incorporating tumor progression […]