Combining anatomical and histologic responses to neoadjuvant therapy improves predicting recurrence in colorectal liver metastases (CRLM) after hepatectomy. Median recurrence-free survival (RFS) was 15.87 months for 483 patients. Early recurrence occurred in 36.9%, linked to poor histologic and anatomical responses. Understanding these combined metrics helps tailor patient selection and surgical planning for better outcomes. Intrahepatic […]
Category: General Surgery
Indocyanine Green Fluorescence Cuts Bile Duct Injury Risk in Cholecystectomy
Intraoperative indocyanine green (ICG) use significantly reduces common bile duct (CBD) injury rates during laparoscopic cholecystectomy. CBD injury decreased from 0.40% to 0.25% with ICG (RR 0.62; p < .001). Postoperative biliary interventions were lower with ICG (4.49% vs 5.39%; RR 0.83; p < .001). Conversion to open surgery also fell (0.84% vs 0.40%; RR […]
Impact of Surgical Margins in Colorectal Liver Metastases
Surgical margins during liver resection for colorectal metastases are crucial, especially given tumor genetics. R1p margins significantly worsen survival (53% vs. 61% for R0; p < 0.0001), particularly in KRAS-mutated tumors. R1p margins also correlate with increased recurrence rates, whereas R1v margins showed no significant risk across molecular groups. Surgeons should prioritize achieving R0 resection, […]
Learning Curve in Laparoscopic Liver Resection: Controller Matters
Surgeon proficiency and scope type significantly impact laparoscopic liver resection outcomes. Beginners had longer operative times (178 vs. 139.5 min) and higher complication rates compared to experts. Using joystick-controlled scopes allowed beginners to close the skill gap more quickly. Choosing the right controller type can enhance outcomes, especially for less experienced surgeons. In minor hepatectomies, […]
Learning curve impacts outcomes in gallstone surgery
Surgical outcomes and operation times improve significantly with experience in laparoscopic cholecystectomies. Mean operation time drops from 111 minutes to 75 minutes after 800 procedures. Complication rates are significantly lower with an assistant present, from 7.0% to 4.7% during the initial 50 procedures (p=0.007). Surgeons should prioritize mentorship and assistance during early cases to enhance […]
Cholangiocarcinoma Subtypes: Implications for Surgical Practice
Understanding the molecular subtypes of cholangiocarcinoma (CCA) is crucial for optimizing surgical decisions and patient outcomes. CCA shows significant heterogeneity, with distinct genomic profiles linked to tumor location—this may affect surgical approach. Intrahepatic CCAs frequently harbor targetable mutations like FGFR2 fusions and IDH1/2 mutations, offering new avenues for therapy. Surgeons can enhance patient selection based […]
CYP2A6 Genotypes Affect Survival in Pancreatic Cancer Patients
Decreased-function CYP2A6 genotypes correlate with worse outcomes for pancreatic cancer patients on S-1 therapy. 56.6% of patients had decreased-function genotypes, increasing lymph node metastasis (78% vs. 52.4%, p=0.001). Median recurrence-free survival was significantly shorter for poor metabolizers (19.2 months vs. 32.3 months, p=0.040). Understanding genotype impact may guide treatment personalization and improve patient outcomes. Poor […]
Intraoperative Cholangiography Use Doesn’t Lower Bile Duct Injury
Surgeons should know that increased use of intraoperative cholangiography (IOC) during cholecystectomy does not reduce bile duct injury rates, but it does lead to more postoperative ERCP procedures. Among 434,696 patients, BDI rates were low and similar across IOC use groups (0.5% for never, 0.4% for selective, and 0.4% for routine). Postoperative ERCP rates increased […]
Innovative Left-Sided Approach Improves Robotic Pancreatoduodenectomy
A left-sided uncinate-first method enhances surgical precision in complex robotic pancreatoduodenectomies. It provides better access to the superior mesenteric artery, especially beneficial for morbidly obese patients or those with bulky tumors. The technique allows for earlier vascular control and reduces traction on the superior mesenteric vein. This approach could become essential in cases where traditional […]
Fragility of NCCN Guidelines for Gastric Cancer Treatment
Recent analysis reveals significant concerns in the quality of evidence supporting NCCN guidelines for gastric cancer treatment. Only 40% of 30 randomized trials (13,765 patients) reported statistically significant outcomes, with a median fragility index of just 6. Adjuvant chemotherapy trials had the highest fragility index at 20, raising questions on their reliability. Surgeons should be […]