Salvage treatment may be warranted after incomplete resection of rectal neuroendocrine tumors due to significant residual disease concerns. Incomplete resection rates: 73.1% for cold snare polypectomy; 29.8% for conventional EMR; 14.7% for endoscopic submucosal dissection. Residual tumor rate with salvage treatment is 25% (CI: 12%–40%). Individualized clinical decisions are crucial given the uncertainty in recurrence […]
Category: Intestine and Lower Gastrointestinal Tract
Liver-First Approach Improves Outcomes in Colorectal Cancer
A liver-first surgical approach in stage IV colorectal cancer with isolated liver metastases leads to better survival and fewer complications. Liver resection before colon/rectal resection increased from 5.37% in 2010 to 15.43% in 2020. Patients receiving the liver-first approach had a lower 90-day mortality (1.11% vs 4.47%) and fewer 30-day readmissions (3.69% vs 5.81%). Select […]
Transanal Surgery Offers R0 Resection for Rectal GISTs
Transanal endoscopic microsurgery (TEM) provides promising outcomes for rectal gastrointestinal stromal tumors (GISTs) while preserving function. High rates of R0 resection were achieved in 13 patients with rectal GIST, underscoring the technique’s efficacy. Tumor size should not automatically disqualify candidates for en-bloc excision with negative margins. Neoadjuvant imatinib may help select borderline cases, but more […]
Hepatic Artery Infusion Pump Shows Promise in Colorectal Liver Metastases
A small fraction of unresectable colorectal liver metastasis patients qualify for liver transplant, but HAIP chemotherapy can improve outcomes. Only 4.8% of patients in the study were liver transplant-eligible. After HAIP, the median overall survival was 61 months, with a 5-year survival rate of 53%. This suggests that HAIP may aid in patient selection for […]
Laparoscopic Surgery Reduces Complications for Strangulated SBO
Laparoscopic surgery may significantly lower postoperative complications in patients with strangulated small bowel obstruction (SSBO). Complications (Clavien-Dindo grade ≥ II) were 7.4% with laparoscopy versus 29.6% for open surgery (p = 0.036). Conversion to open surgery occurred in 25.6% of laparoscopic cases, primarily in those with prior laparotomies or gastrointestinal surgeries. Surgeons should consider laparoscopic […]
ESD outperforms TEM for early rectal tumors in cost-effectiveness.
ESD showed a significant net monetary benefit of €1,797 for complete resection at one year. The en-bloc excision rate was higher with ESD (99%) compared to TEM (92.5%). Choosing ESD could enhance surgical outcomes while managing costs effectively. Disease-free survival was better with ESD at 94.3%, versus 84.6% for TEM. Journal Article by Beyer-Berjot L, […]
Sustainable Choices Slash Costs in Colorectal Surgery
Shifting to reusable instruments in colorectal surgeries can save money and help the environment. Total savings across 65 laparoscopic resections: £14,239.03. Reusable harmonic devices offered savings of £24.7k-£28.5k and were cost-effective across various scenarios. Prioritize reusable textiles, which consistently outperformed disposables. Reusable ports showed no cost savings and should be evaluated against current pricing before […]
Indocyanine Green Reduces Anastomotic Leaks in Colorectal Surgery
Indocyanine green fluorescence significantly lowers anastomotic leak rates in colorectal surgery, crucial for surgical decision-making. Patients who received ICG had a 36% lower rate of anastomotic leaks compared to those with standard white light (OR=0.64; p<0.0001). Surgical strategy changes were more frequent in the ICG group (OR=7.50; p=0.02), indicating adaptability in approach. Consider implementing ICG, […]
Simultaneous Resection Improves Outcomes in Synchronous Rectal Cancer Metastases
Simultaneous resection of rectal and liver metastases is safe and linked to longer survival in high-risk patients. 92 patients showed no deaths; complications were seen in 15% with major issues like drainage (9%) and anastomotic dehiscence (3%). Median overall survival was 70 months, with recurrence-free survival at 10 months. Choose simultaneous resection judiciously; it can […]
Improved Outcomes with Robot-Assisted Pelvic Reconstruction
Robot-assisted pelvic reconstruction using rectus abdominis flaps shows promise for better surgical outcomes in pelvic cancer patients. Wound complications were significantly lower in robot-assisted surgeries compared to open approaches. One study noted a shorter length of hospital stay for robot-assisted patients. Surgeons may consider this technique to reduce complications and improve recovery times. Enhanced visualization […]