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 […]
Category: HPB & Spleen
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 […]
Minimally Invasive Surgery Cuts Costs and Improves Outcomes
Minimally invasive hepatopancreatobiliary surgery leads to significant cost savings and shorter recovery compared to open surgery. 1-year total expenditures were reduced by $33,255. Hospital stays were 2.6 days shorter, with a 30-day readmission rate of 29% lower (odds ratio 0.71). Surgeons should consider the benefits of minimally invasive techniques for enhanced patient outcomes and cost […]
Robotic Pancreatoduodenectomy Cuts Recovery Time
Robotic pancreatoduodenectomy (rpd) significantly accelerates postoperative recovery compared to open pancreatoduodenectomy (opd). Average recovery time was 12.1 days (rpd) versus 16.0 days (opd), a 3.9-day advantage (p<0.001). Operative time was longer for rpd (300 minutes) versus opd (270 minutes, p<0.001), but postoperative stay was shorter for rpd (13 days). Surgeons in high-volume centers can confidently […]
Robotic Liver Resection is Safe and Feasible for Selected Patients
Early experience with the da Vinci SP system shows promising outcomes for robotic liver resections. 20 patients studied; median age 74 years, tumor size 1.9 cm. No conversions or intraoperative transfusions; only one major complication (duodenal ulcer bleeding). Zero instances of bile leakage, posthepatectomy liver failure, or 30-day mortality. This technique may be beneficial in […]