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Postoperative ctDNA Predicts Recurrence in Rectal Cancer

Postoperative circulating tumor DNA (ctDNA) testing could transform management for rectal cancer patients undergoing surgery.

  • 14.2% of patients were ctDNA-positive shortly post-surgery, with a significantly higher recurrence risk (HR: 9.96, p<0.0001).
  • ctDNA-positive patients benefited from adjuvant chemotherapy (HR: 0.28, p=0.031), while ctDNA-negative patients did not (HR: 0.59, p=0.211).

Monitoring ctDNA can guide treatment decisions, optimizing outcomes for high-risk patients and avoiding unnecessary therapies for low-risk individuals.

  • Recurrence risk escalated for patients whose ctDNA status worsened from negative to positive (HR: 8.22, p=0.0055) and for those consistently positive (HR: 45.48, p<0.0001).

Journal Article by Ando K, Hamabe A (…) Oki E et 25 al. in Ann Surg

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

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Endoscopic gastroenterostomy outperforms surgical method in obstruction

A randomized trial shows that endoscopic ultrasound-guided gastroenterostomy (EUS-GE) significantly improves outcomes for patients with malignant gastric outlet obstruction over traditional surgical gastrojejunostomy (SGJ).

  • Primary endpoint success occurred in only 7.9% of EUS-GE patients compared to 38.9% for SGJ (risk difference -31.0%).
  • Patients on EUS-GE advanced to a solid diet in a median of 2 days vs. 5 days for SGJ, with shorter hospital stays (3 days vs. 9 days).

EUS-GE also resulted in improved quality of life and lower treatment costs (approximately $33,934 vs. $51,437).

  • These findings suggest that EUS-GE could be the preferred approach for palliation in this patient population, enhancing recovery and reducing healthcare costs.

Journal Article by Bang JY, Puri R (…) Varadarajulu S et 20 al. in Gut

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.

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Duodenum-Preserving Resection is Safe and Effective

Duodenum-preserving pancreatic head resection shows promising outcomes for patients with benign and premalignant neoplasms.

  • 90-day mortality is only 0.47% across 1063 patients.
  • Recurrence rates are low: 5.61% for intraductal papillary mucinous neoplasms, with no recurrences noted among those treated for micro-carcinoma.

Consider this technique for appropriate patients to enhance surgical management of pancreatic head neoplasms.

  • Disease-specific survival rates stand at 99.3% at 2 years and 97.3% at 5 years.

Review by Beger HG, Mayer B and Poch B in HPB (Oxford)

Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.

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New approaches in acute pancreatitis management

Early intervention and minimally invasive techniques are changing outcomes for acute pancreatitis.

  • Early endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is critical for gallstone pancreatitis with cholangitis, followed by laparoscopic cholecystectomy.
  • Interventional radiology enhances outcomes through percutaneous drainage and angiographic embolization for severe cases, reducing morbidity and hospital stay.

Collaboration between surgery, gastroenterology, and interventional radiology improves patient care and outcomes.

  • Dual-modality drainage is gaining traction for complex fluid collections, reinforcing the need for a multidisciplinary approach.

Review by Masood M, Vedamurthy A (…) Kozarek R et 3 al. in J Clin Med

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Simulation Training Enhances Robotic Surgery Skills in Trainees

A systematic review confirms that simulation training significantly boosts robotic surgical proficiency for trainees.

  • Simulation improves performance metrics like gears (SMD 1.22) and OSATS (SMD 1.08).
  • Task completion times improve (SMD -0.95), along with reduced error rates (SMD -1.03).

Integration of expert feedback and defined proficiency standards accelerates learning.

  • Notable performance plateaus occur after 15 to 35 training sessions, with a median of 22.

Review by Coco D and Leanza S in J Robot Surg

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

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Intracholecystic ICG offers faster biliary visualization

Intracholecystic indocyanine green (ICG) provides quicker and clearer views of biliary anatomy during laparoscopic cholecystectomy.

  • Cystic duct visibility improved from 70% pre-dissection (IV-ICG) to 85% (IC-ICG), reaching 95% post-dissection.
  • Common hepatic duct visibility was 85% (IV-ICG) versus 45% (IC-ICG).

Surgeons can use IC-ICG immediately, bypassing the delay associated with IV-administered ICG.

  • Minor bile leakage occurred in 2 IC-ICG cases.

Journal Article by Vindal A, Gogoi DJ, Vats M and Lal P in Surg Endosc

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

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Outcomes of Pancreatic Tumors Differ by Cancer Type

Surgeons need to know how outcomes differ between pancreatic neuroendocrine tumors (pnet) and ductal adenocarcinoma (pdac) after surgery.

  • After pancreatoduodenectomy, ideal outcomes were lower for pnet (44.2%) vs. pdac (56.9%), with significantly higher severe complications (31.2% vs. 19.0%) and readmission rates (23.6% vs. 15.3%).
  • In distal pancreatectomy, pnet had better ideal outcomes (60.1% vs. 57.1%), despite higher pancreatic fistula rates (19.2% vs. 13.4%).

Consider patient-specific predictors like obesity and male sex to tailor surgical approaches and improve outcomes.

Journal Article by Qian J, Ceuppens S (…) Paniccia A et 3 al. in Eur J Surg Oncol

Copyright © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.

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Effective Strategies Reduce Parastomal Hernia Incidence

Prophylactic measures can significantly lower parastomal hernia rates, impacting surgical choices and patient outcomes.

  • Funnel mesh is the most effective intervention, reducing hernia incidence by 91% (OR 0.09, 95% CI 0.05-0.17).
  • Stapled mesh and abdominal wall strengthening exercises also show promise, with incidence reductions of 84% (OR 0.16) and 82% (OR 0.18), respectively.

Selecting the right prophylactic approach is crucial for high-risk patients.

  • Results are consistent across study types but vary in ileal conduits due to limited data.

Review by Martín-Arévalo J, López-Callejon VA (…) Pla-Martí V et 7 al. in Tech Coloproctol

© 2025. The Author(s).

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Guidelines for Better Surgical Outcomes in Hepatocellular Carcinoma

Surgical resection outperforms other treatments for hepatocellular carcinoma in survival and recurrence rates, but patient selection is critical.

  • Expert consensus emphasizes that careful patient selection leads to better outcomes and fewer complications.
  • Surgical resection achieves the lowest local recurrence rate and the highest survival rate, especially in suitable candidates.

Optimize surgical results by adhering to standardized guidelines and managing liver function effectively pre- and post-operation.

  • The recommendations address variations in clinical environments and key considerations for minimally invasive techniques.

Journal Article by Park MS, Cho JY (…) Kim KS et 8 al. in Ann Surg Treat Res

Copyright © 2025, the Korean Surgical Society.

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New Triage Model Enhances Mass Casualty Outcomes

A new principles-based two-pass triage system aims to improve decision-making and efficiency in military mass casualty scenarios.

  • 93% of assessed cases relied on simplified categorization over formal triage, highlighting the need for operationally relevant systems.
  • The two-pass model allows for quick identification of casualties needing urgent care, followed by sorting into urgency levels for evacuation planning.

Surgeons should consider adapting this streamlined approach for faster, more effective patient management in complex scenarios.

  • Enhanced communication and rapid assessment tools support better casualty flow and training among personnel.

Journal Article by Remley MA, Shackelford SA (…) Deaton TG et 7 al. in J Spec Oper Med

2025.

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