Prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) significantly enhances peritoneal metastasis-free survival and disease-free survival in patients with locally advanced colorectal cancer, though overall survival rates and complication rates remain unchanged. One-year peritoneal metastasis-free survival improved by 48% (HR 0.521), 3-year disease-free survival improved by 67% (HR 0.333), and 5-year disease-free survival improved by 29% (HR 0.714) […]
Category: General Surgery
Survey Shows Surgeons Hesitant on Cell Salvage in Liver Cancer
Surgeons are familiar with intraoperative cell salvage (ICS) but use it sparingly during liver resections for cancer due to concerns about tumor cell contamination, indicating a need for more robust oncological outcome data. 26 hepatopancreatobiliary surgeons reported moderate to high familiarity with ICS (23/26) and occasional use (23/26), but only 10 used it during liver […]
Artery-First Approach for Distal Pancreatectomy Shows Zero Mortality
Utilizing an artery-first approach for distal pancreatectomy with celiac axis resection can effectively manage blood loss and maintain low mortality in pancreatic cancer surgery. In a study of 14 patients, R0 resection was achieved in all cases, with a 90-day mortality rate of 0%. The median operation time was 469 minutes, and median blood loss […]
Improved Outcomes for Locally Recurrent Rectal Cancer Surgery
Curative surgery for locally recurrent rectal cancer (LRRC) is yielding better long-term outcomes, with a significant increase in the R0 resection rate and overall survival. The R0 resection rate increased from 59% to 78% from 2000 to 2023 (p < 0.001). Overall survival significantly improved in the recent cohort (2018-2023) with a hazard ratio of […]
Robot-assisted Esophagectomy: Managing Intraoperative Adverse Events
Intraoperative adverse events (IAEs) during robot-assisted minimally invasive esophagectomy (RAMIE) can occur in about 8.6% of cases, but most are managed robotically without conversion to open surgery. 41 patients experienced IAEs, with bleeding being the most common (69.6% of events). Major IAEs (4.2% of cases) led to significantly increased blood loss (average 1211 ml vs. […]
Dementia Complicates Surgical Decision-Making Dynamics
Clinicians face significant challenges when making surgical decisions for patients with dementia due to documentation and communication issues. Difficulty in identifying dementia and assessing patient capacity limits optimal decision-making, worsened by inconsistent electronic health record documentation. Caregivers often play a pivotal role but deal with misaligned expectations and burden, complicating the decision process. Clinicians frequently […]
Predictors of DVT After Gastric or Colorectal Surgery Identified
A nomogram can help predict early postoperative deep vein thrombosis (DVT) in gastric and colorectal cancer patients despite routine anticoagulant prophylaxis. In this study of 388 patients, 32% had DVT detected by screening, predominantly asymptomatic distal DVT. Key predictors for DVT included age, activated partial thromboplastin time, prothrombin time, and postoperative day 1 d-dimer. The […]
Consensus Framework Improves Appendiceal Abscess Management
A new consensus from Italian experts offers a standardized, physiology-driven approach to managing appendiceal abscesses, aiming to reduce variability in surgical practice. Early appendectomy remains the go-to for grade 1 phlegmons and small abscesses, while a short conservative trial can be considered for stable, low-risk patients. For abscesses >3-4 cm, image-guided drainage is recommended as […]
Achalasia Treatment: Heller’s Myotomy and POEM Lead Success
This systematic review shows that Heller’s myotomy and peroral endoscopic myotomy (POEM) outperform botulinum toxin for long-term symptom relief in primary achalasia. At 5 years, Heller’s myotomy and POEM have a treatment success rate that is significantly greater than botulinum toxin (odds ratios of 6.39 and 6.33, respectively). Botulinum toxin showed less treatment success at […]
Cost and Effectiveness of Robotic vs. Open Pancreatoduodenectomy
A randomized trial reveals no significant cost benefit of robotic pancreatoduodenectomy compared to open surgery, despite higher intraoperative costs. Total hospital costs were similar: €30,956 for robotic vs. €28,271 for open (p=0.538). Robotic technique had significantly higher intraoperative costs (€11,906 vs. €6,451, p<0.001) but lower postoperative costs (€19,051 vs. €21,856). Health-related quality of life scores […]