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Guidelines for Fluorescence Imaging in GI Surgery Released

Fluorescence image-guided surgery with indocyanine green (ICG) enhances precision for gastrointestinal procedures.

  • Strong recommendations for using ICG in detecting non-regional metastases and identifying primary cancers.
  • Supported use for lymph node identification in GI cancers and assessing anastomosis quality in esophageal and left-sided colorectal surgeries.

Consider integrating ICG into practice where evidence supports its use to improve surgical outcomes and decision-making.

  • Lack of evidence for thoracic duct and certain bariatric applications highlights need for further research.

Journal Article by Calabrese EC, Kumar S (…) Keller DS et 12 al. in Surg Endosc

© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Prediction Tool for Timing of Cholecystectomy After PTGBD

A new machine learning tool helps surgeons determine the optimal timing for cholecystectomy after transcutaneous gallbladder drainage in elderly acute cholecystitis patients, improving surgical outcomes.

  • Random forest model achieved an AUC of 0.914, outperforming other models for predicting surgery delays.
  • Key predictors for delayed surgery include age, gallbladder wall thickness, and white blood cell count.

Using this online calculator can enhance patient selection and streamline decision-making for timely surgical intervention.

Journal Article by Zhang W, Che B (…) Zhang W et 2 al. in Langenbecks Arch Surg

© 2025. The Author(s).

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Increased Postoperative Delirium Risk in Prior COVID-19 Patients

Older adults with a history of COVID-19 face higher rates of postoperative delirium after major surgery, impacting surgical outcomes.

  • Patients with prior COVID-19 have a 3.09 times greater risk of delirium (p = 0.02).
  • Acute postsurgical pain increases the risk of delirium (odds ratio of 1.51; p = 0.02) while vaccination significantly reduces this risk (odds ratio of 0.47; p = 0.01).

Consider promoting COVID-19 vaccinations pre-surgery to mitigate delirium risk in at-risk patients.

  • No significant link was found between prior COVID-19 and delayed neurocognitive recovery post-surgery.

Journal Article by Cui K, Yao X (…) Fang B et 4 al. in Int J Surg

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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Rising Early-Onset Pancreatic Cancer Burden in Asia

Early-onset pancreatic cancer is surging, demanding attention from surgeons.

  • In 2021, there were 31,531 new cases and 26,996 deaths worldwide.
  • Asia, particularly East Asia, accounts for the highest burden, with developing nations like China and India leading.
  • Risk factors differ; high fasting plasma glucose is not a primary risk for early-onset cases.

Surgeons should prioritize screening and tailored interventions for older males and high-risk populations.

Journal Article by Ye X, Jiang M (…) He Y et 18 al. in Int J Surg

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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Preventing Acute Kidney Injury Cuts Complications After Major Surgery

A preventive care strategy can significantly reduce the risk of acute kidney injury (AKI) in high-risk surgical patients.

  • Moderate or severe AKI occurred in 14.4% of patients receiving the intervention versus 22.3% in the control group (odds ratio 0.57, p=0.0002).
  • Number needed to treat to prevent one case of AKI is 12.

Adverse event rates were similar between the two groups, suggesting safety of the strategy.

  • Common adverse events like atrial fibrillation and significant bleeding were not statistically different between groups.

Journal Article by Zarbock A, Ostermann M (…) von Groote T et 32 al. in Lancet

Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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Transforming HCC Surgery with Biology-Driven Approaches

Surgeons need to adapt to evolving strategies for hepatocellular carcinoma (HCC) that prioritize biological insights and dynamic eligibility criteria.

  • Curative treatments offer optimal long-term outcomes, yet 5-year recurrence rates remain at about 70%.
  • New methods in immunogenomic profiling and liquid biopsy enhance patient selection beyond traditional staging.

These advances enable personalized surgical strategies and improve outcomes.

  • Innovations in perioperative immunotherapy and graft preservation techniques may further reduce recurrence risk and broaden curative options.

Review by Malik AK, Geh D (…) White SA et 3 al. in Nat Rev Gastroenterol Hepatol

© 2025. Springer Nature Limited.

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Effective Oral Care Cuts Surgical Site Infections

Perioperative oral management significantly reduces surgical site infections (SSIs) and shortens hospital stays.

  • Oral care interventions lowered SSI risk by 36% in experimental studies (RR=0.64) and 51% in observational studies (OR=0.49).
  • Modest effects were noted in patients with cardiovascular disease (OR=0.72) and non-oncology patients (OR=0.66).

Implement tailored oral management plans to optimize preoperative care.

  • Protocols lacking chemical or mechanical cleaning showed no benefit (OR=0.76).
  • Patients experienced 1.88 fewer days in the hospital following effective oral care.

Review by Lin Y, Li E (…) Yu X et 3 al. in ANZ J Surg

© 2025 Royal Australasian College of Surgeons.

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Postoperative Analgesia: Emphasizing Oral Over IV

A study reveals a major disconnect in postoperative analgesia practices, highlighting a need for surgeons to consider oral routes for efficiency and cost savings.

  • Intravenous (IV) analgesia was used in 86% of non-opioid patients and 39% for opioids, while the oral route was utilized in only 1%.
  • Transitioning to oral analgesia can cut costs per patient from 822.3 RSD ($7.84) to 124.5 RSD ($1.19), achieving 85% savings.

This shift could enhance recovery times and reduce resource strain in surgical wards.

  • Among patients where oral administration was feasible, IV was still the choice for 86% of non-opioid and 38% of opioid cases.

Journal Article by Bojic S, Ladjevic N (…) Stamenkovic D et 7 al. in Front Med (Lausanne)

Copyright © 2025 Bojic, Ladjevic, Palibrk, Rancic, Bezmarevic, Meissner, Zaslansky, Stamer, Baumbach and Stamenkovic.

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Guided Classification Improves Outcomes in Pancreatic Surgery

A new intraoperative classification system enhances pancreatic surgery for benign and low-grade tumors.

  • 122 patients underwent robotic resections with IPDECT; type I defects had a 10.6% overall complication rate including 8.5% for postoperative pancreatic fistula.
  • Type IV defects had longer operations (mean 127.6 min) yet only 5.9% complications.

Standardizing decision-making may enhance patient outcomes and preserve pancreatic function.

  • No tumor recurrence or metabolic issues were reported within 1 to 4 years post-surgery.

Journal Article by Huang Y, Hu H (…) He T et 2 al. in J Robot Surg

© 2025. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.

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NSAID Timing Impacts Early Leak Risk in Rectal Surgery

Early use of NSAIDs post-proctectomy increases the risk of early anastomotic leaks.

  • 8.7% overall rate of anastomotic leaks, with early NSAID use linked to higher rates (7.7% vs. 4.7%, p = 0.030).
  • Non-selective NSAIDs and multiple doses significantly heighten early leak risk (OR 1.717, p = 0.012; OR 1.687, p = 0.016).

Consider timing and drug selection when prescribing NSAIDs to minimize complications.

  • Increased perioperative bleeding noted with NSAID use (4.0% vs. 1.2%, p = 0.003).
  • Male patients and those without diverting stomas are at greater risk for early leaks related to NSAIDs.

Journal Article by Hu Z, Tan K (…) Tong W et 6 al. in Ann Surg Oncol

© 2025. Society of Surgical Oncology.

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