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How Cognitive Load Affects Novice Surgical Performance

Cognitive overload in novice surgeons significantly impacts performance during surgical tasks.

  • Subjective cognitive load rose sharply with task complexity (p<0.00001), while performance dropped (p<0.00001).
  • Neural activation increased in key brain areas as cognitive load escalated, indicating differing responses for those who maintained performance versus those who declined.

Awareness of these dynamics can guide training approaches to enhance patient safety and surgical proficiency.

  • “Maintainers” showed increased activation in the dorsolateral prefrontal cortex, while “decliners” exhibited greater frontal deactivation.

Journal Article by Caterson J, Goble MSL (…) Leff DR et 4 al. in Ann Surg

Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC.

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Advancements in Biliary Tract Cancer Therapies

Biliary tract cancers are now seeing transformative therapies that enhance patient outcomes.

  • Chemo-immunotherapy is the new first-line standard of care.
  • Targeted therapies, especially for intrahepatic cholangiocarcinoma with FGFR2 fusions, show high response rates with drugs like pemigatinib and futibatinib.
  • IDH1-mutant cholangiocarcinoma can be treated effectively with ivosidenib.

Surgeons should prioritize biomarker testing to personalize treatment strategies and overcome barriers in accessibility and resistance.

  • HER2-targeted options are also promising for patients with HER2 amplification.

Review by Lamarca A, Harding JJ and Oh DY in J Hepatol

Copyright © 2026 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

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EUS-Guided Gastroenterostomy Outperforms Surgical Options in MGO

EUS-guided gastroenterostomy (EUS-GE) shows superior outcomes for malignant gastric outlet obstruction (MGO) compared to traditional surgical approaches.

  • EUS-GE has a re-intervention rate of just 17% compared to 30% for surgical gastrojejunostomy (SGJ) and significantly lower than enteral stenting.
  • Clinical success rates are higher with EUS-GE (20% more successful than enteral stenting).
  • EUS-GE shortens hospital stay by an average of 6 days and time to oral intake by 2 days compared to SGJ.

Surgeons should consider EUS-GE as the preferred option for MGO to improve patient outcomes and reduce recovery times.

  • Technical success rates were similar across all methods, with minor inconsistencies noted.

Review by Peng YN, Faucher-Jabado G (…) Chen YI et 13 al. in Gastrointest Endosc

Copyright © 2026 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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Reducing Routine Use of Nasogastric Tubes in Surgery

Nasogastric (NG) tubes may not be necessary for every gastrointestinal surgery, impacting patient comfort and outcomes.

  • NG tubes are critical for decompression in uncomplicated small-bowel obstructions.
  • Evidence suggests routine placement after elective GI surgery can be minimized, improving recovery.
  • Surgeons should assess individual patient needs to optimize NG tube use and enhance surgical outcomes.
  • Consider alternative management strategies based on recent findings for better patient care.

Journal Article by Alverdy JC, Boermeester MA, Salminen P and Zuckerbraun BS in JAMA Surg

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Genomic Insights Enhance Gastric Cancer Outcome Predictions

Molecular profiling of gastric cancer tumors can improve risk stratification for recurrence post-surgery.

  • In a study of 438 patients, 179 experienced recurrence after resection.
  • Alterations in the KRAS gene (HR 1.54) and PIK3CA (HR 2.15) were linked to poorer disease-free survival.
  • Patients with hematogenous recurrence had significant chromosomal instability, suggesting personalized surveillance may be beneficial.
  • Genomic stability was associated with bone metastases, indicating histological types may guide treatment strategies.

Journal Article by Coffey MR, Xu J (…) Strong VE et 13 al. in JAMA Surg

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Rising Liver Cancer Rates Demand Surgical Vigilance

Primary liver cancer cases are increasing rapidly, demanding enhanced screening and surgical readiness.

  • Incidence and deaths have surged 59.4% and 55.8% from 2000 to 2023, respectively.
  • Hepatitis B and C remain key causes, but rates have rebounded since 2020 despite prior declines.

Surgeons must prioritize patient selection and intervention strategies, especially for patients with metabolic liver disease.

  • Cholangiocarcinoma incidence is also rising, indicating the need for focused research and management approaches.

Review by Khan SA, Vithayathil M, Yip TCF and El-Serag HB in J Hepatol

Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.

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Assessing Secondary Cytoreductive Surgery for Colorectal Cancer

Secondary cytoreductive surgery with hyperthermic intraperitoneal chemotherapy improves survival for select patients with recurrent colorectal cancer peritoneal metastases.

  • Patients undergoing secondary surgery had an overall survival of 51.0 months compared to 24.0 months for those with initial treatment alone.
  • No difference in postoperative complications was observed between initial and secondary procedures.

Consider secondary surgery for well-selected patients to potentially enhance outcomes after recurrence.

  • Patients undergoing secondary treatment had similar survival to those receiving initial surgery (27.0 months vs. 24.0 months).

Journal Article by Oppat KM, Bennett FJ (…) Concors SJ et 17 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Neoadjuvant Strategies Yield Similar Results in Pancreatic Cancer

A meta-analysis finds that neoadjuvant chemoradiotherapy and chemotherapy have comparable outcomes for pancreatic ductal adenocarcinoma.

  • Surgical resection rates were nearly identical: 68.9% for chemoradiotherapy versus 71.5% for chemotherapy.
  • R0 resection rates were also similar: 70.7% for chemoradiotherapy and 64.2% for chemotherapy.

Both treatment modalities produced similar one-year survival rates (71.3% versus 72.4%) and overall survival (HR 0.79).

Surgeons can consider both options without significant differences in surgical or survival outcomes.

Journal Article by Hajibandeh S, Hajibandeh S (…) Chatzizacharias N et 8 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Urine DNA Enhances Diagnosis of IPMN

A new study shows urine cell-free DNA can aid in diagnosing intraductal papillary mucinous neoplasms (IPMN), which may improve patient management.

  • Urine cfDNA detected GNAS mutations in 32% and KRAS mutations in 58% of IPMN cases, compared to just 10% and 19% in plasma, respectively.
  • Main pancreatic duct diameter ≥10 mm and urine mutations significantly correlate with IPMN malignancy (OR 12.70 for GNAS, OR 8.10 for KRAS).

Incorporating urine liquid biopsies could refine surgical decision-making and enhance patient selection for intervention.

Journal Article by Sato M, Kitahata Y (…) Kawai M et 11 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Resecting Colorectal Liver Metastases in Progressive Disease Improves Survival

Surgery for colorectal liver metastases after chemotherapy failure can offer survival benefits.

  • Patients with progressive disease underwent hepatectomy showed a 5-year overall survival rate of 42.7%.
  • This is lower than those with controlled disease (62.0% in complete/partial response and 55.5% in stable disease, p<0.001).
  • However, resected progressive disease patients had better survival (46.5%) than non-resected partial response patients (11.4%, p<0.001).
  • Preoperative carcinoembryonic antigen (CEA) ≥100 ng/ml and metachronous liver metastases are key risk factors for poor outcomes.

Consider surgical options cautiously in progressive disease cases.

Journal Article by Kobayashi K, Kishi Y (…) Kawai K et 10 al. in Ann Surg Oncol

© 2026. The Author(s).

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