A recent study shows extensive lymph node metastases in esophageal carcinoma despite multimodality therapy, highlighting implications for surgical strategy. Lymph node metastases were found in 42% of patients, with a median of two positive nodes. Metastases were most common in the left gastric artery (22%), right paracardial (15%), and mediastinal regions. Ongoing systematic two-field lymphadenectomy […]
Category: General Surgery
Three-Tier Nodal Staging Cuts Through Intrahepatic Cholangiocarcinoma Prognosis
A new three-tier nodal classification improves survival predictions for intrahepatic cholangiocarcinoma patients post-surgery. Median overall survival drops significantly: 55.3 months (n0) to 19.0 months (n2) (p < 0.001). Node-positive patients (n1, n2) face worse outcomes (HR 2.01 and HR 2.59, respectively) compared to node-negative (n0). Use this refined staging to guide treatment decisions, especially for […]
Outcomes Improve for Hepatic Cytoreduction in Neuroendocrine Cancer
Neuroendocrine liver metastases are seeing better surgical outcomes as practices shift over the last two decades. In the later cohort (2009-2023), major hepatectomy dropped to 32.9%, compared to 60.0% (p < 0.001) in the earlier cohort (1998-2008). The 10-year overall survival improved significantly from 44.2% to 67.4% (p < 0.001). Surgeons should consider parenchyma-sparing approaches […]
New Grading System for Postoperative Acute Pancreatitis
Postoperative acute pancreatitis affects recovery after pancreatoduodenectomy—understanding its definitions can optimize patient management. Incidence of postoperative acute pancreatitis: 11.9% (ISGPS), 41.2% (Atlanta-adapted), and 17.6% (Connor’s definition). The Atlanta-adapted framework showed the best ability to predict severe complications (AUC 0.68). A new graded Atlanta-Helsinki classification correlates with complication rates: 12.3% (none), up to 56.3% (both criteria). […]
Burnout and Mistreatment Plague Female Surgeons
Surgeons face alarming rates of burnout and mistreatment, impacting retention and well-being. 34.9% of surgical faculty report weekly burnout symptoms. 66.2% have experienced workplace mistreatment, including significant bullying and discrimination. Female surgeons are particularly affected, with 88.6% reporting mistreatment compared to 55.7% of male faculty. Addressing these issues is crucial for improving surgical practice and […]
Quality of Life Recovery After Hepatectomy for Liver Metastasis
Postoperative health-related quality of life (HR-QoL) significantly improves in patients undergoing hepatectomy for high-risk colorectal liver metastases if they remain disease-free. HR-QoL, as measured by the QLQ-C30, dropped by 14.6 points post-surgery but returned to baseline by 12 months. Patients with no evidence of disease (NED) showed marked improvement, reporting higher HR-QoL scores 24 months […]
Opioid Agreements Fail to Reduce Leftover Meds After Surgery
A study shows opioid agreements don’t improve disposal or safety practices post-surgery. Among 450 patients, 143 (32%) had leftover opioids; only 13 (9.1%) disposed of them. Patients with agreements were less likely to dispose of leftover opioids (6.7% vs. 12%). Surgeons should consider alternative strategies for managing leftover opioids as agreements alone are ineffective. Journal […]
Compliance with Cancer Standard Improves Rectal Surgery Outcomes
Facility adherence to Commission on Cancer Standard 5.7 is linked to better surgical quality in rectal cancer. CRM positivity is lower at compliant facilities (12% vs 14%; adjusted OR 0.82, p=0.04). More patients achieved complete total mesorectal excision (TME) at compliant hospitals (adjusted OR 1.63, p=0.001); incomplete TME rates were also lower (9% vs 14%, […]
Gastric Ultrasound Post Gastrointestinal Surgery Shows Promise
Gastric point-of-care ultrasound (G-POCUS) can improve postoperative assessments for gastrointestinal surgery patients. 92% of G-POCUS assessments were conclusive, mostly prompted by signs of gastrointestinal distress. Nurses reported high acceptability and confidence when using G-POCUS. Patients experienced no change in pain or comfort during the procedure, indicating it’s well tolerated. 46% of patients had fluid content […]
Trauma-team actions improve major trauma definition
A new definition of major trauma that combines injury severity with urgent trauma-team interventions identified more high-risk patients and deaths than injury scoring alone. In 2.68 million National Trauma Data Bank patients, 22.4% met the combined definition, versus 17.8% with Injury Severity Score above 15. The combined definition had the best discrimination for 24-hour mortality […]