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New Staging System Cuts Risks in Perihilar Cholangiocarcinoma

This study introduces the ABC scoring system for preoperative staging in perihilar cholangiocarcinoma, aiming to improve patient selection for curative surgery.

  • Patients with a score of 3 had a 21% 90-day mortality rate versus 6% for score 0.
  • Six-month recurrence rates were 18% for score 3 compared to 5% for score 0.
  • Median overall survival was 13 months for score 3 versus 39 months for score 0.

Surgeons should carefully consider the ABC score, especially for high-risk patients, to potentially avoid unnecessary surgery and improve outcomes.

Journal Article by Ten Haaft BHEA, Bonomi AM (…) Erdmann JI et 26 al. in J Hepatol

Copyright © 2026. Published by Elsevier B.V.

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Rural Surgical Access at Risk as Workforce Declines

Osteopathic surgeons are critical for rural access but their numbers are dwindling.

  • 18.3% of DO surgeons vs. 9.7% of MD surgeons practice in rural areas.
  • DO surgeons have twice the odds of working in rural communities compared to their MD counterparts (OR 2.05).

The trend shows worrying declines in rural practice among newer surgeons, with about half the odds for those trained after 2010.

  • Rural areas have only 13.8 surgeons per 100,000 residents, compared to 23.6 in metropolitan areas.

Journal Article by Alexander VS, Jacobsen N (…) Wallen TJ et 6 al. in J Am Coll Surg

Copyright © 2026 by the American College of Surgeons. Published by Wolters Kluwer Health, LLC. All rights reserved.

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Log Odds of Lymph Nodes Enhance Risk Prediction Post-Esophagectomy

Researchers found that the log odds of positive lymph nodes significantly improve risk stratification for early recurrence after radical esophagectomy in cT3 esophageal squamous cell carcinoma.

  • Higher log odds predict early recurrence; significant cut-off at -2.69.
  • Patients with log odds > -2.69 have a 30% 5-year survival rate versus 66% for those ≤ -2.69 (p < 0.001).

This metric can guide tailored follow-ups and treatment decisions for better patient outcomes.

  • Lymph node counts and tumor location further refine risk assessments.

Journal Article by Park BJ, Hong TH (…) Kim DJ et 4 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Surgery for Gastroesophageal Junction Cancers May Be Omitted

New data raises the question of whether surgery can be skipped for certain gastric and gastroesophageal junction cancers with high pathologic complete response rates.

  • Patients with mismatch-repair deficient tumors have a 60% pathologic complete response to neoadjuvant immunotherapy.
  • Those with mismatch repair intact tumors show about 20% pathologic complete response with chemo-immunotherapy.

Surgeons should consider omitting surgery in select patients while emphasizing shared decision-making, especially given the high morbidity and mortality associated with surgical procedures.

  • Long-term data supporting surgery omission remains limited.

Journal Article by Gunder MA, Badgwell BD and Kelly KJ in Ann Surg Oncol

© 2026. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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Long-term Outcomes of Pancreaticojejunostomy Techniques

A study comparing invagination versus duct-to-mucosa pancreaticojejunostomy shows similar long-term anastomotic patency and pancreatic function.

  • Remnant pancreatic duct dilatation occurred in 18.6% of invagination and 9.8% of duct-to-mucosa patients, with no significant clinical impact.
  • Cumulative incidences of benign stricture at 3 and 5 years were 9.3% and 19.9% for invagination, compared to 9.5% and 13.4% for duct-to-mucosa, indicating no difference.

Surgeons can consider either method for pancreatoduodenectomy, as both appear to yield comparable outcomes in the long term.

Journal Article by Ojio H, Natsume S (…) Abe T et 7 al. in BMC Surg

Copyright © 2026 Elsevier Inc. All rights reserved.

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Ergonomics Matter: Improving OR Conditions Reduces Staff Injury Risks

Poor ergonomics in the OR can lead to injuries for surgical staff, affecting patient outcomes and workforce sustainability.

  • 100% of surgeons and 98% of anesthesiologists report muscle or joint problems, indicating a critical need for change.
  • Physical hazards like clutter and tripping risks contribute to staff discomfort and potential surgical errors.

Effective solutions require better team collaboration and institutional support for a safer work environment.

  • Hierarchical dynamics affect communication about risks, leaving junior staff reluctant to speak up.

Journal Article by Mah A, Kalocsai C (…) Hallet J et 7 al. in Br J Surg

© The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.
© The Author(s) 2026. Published by Oxford University Press on behalf of BJS Foundation Ltd. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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Effective Techniques for Difficult Biliary Cannulation in ERCP

Advanced techniques yield 100% final success in difficult biliary cannulation, crucial for ensuring effective ERCP outcomes.

  • Initial cannulation success: 72% (double-guidewire), 68% (trans-pancreatic sphincterotomy), 68% (precut fistulotomy).
  • Precut technique used less contrast dye (p<0.005).

Consider individualizing the technique based on patient anatomy and operator skill for optimal outcomes.

  • Post-ERCP pancreatitis rates were 10% (dgt), 22% (tps), and 24% (precut) with no significant differences in other adverse events.

Journal Article by Elhoseeny MM, Alhaddad O (…) Othman AAA et 5 al. in Gastrointest Endosc

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

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Early Onset Colorectal Cancer Reveals Distinct Genomic Profile

Surgeons should note that early onset colorectal cancer (diagnosed before age 50) is distinct from late-onset cases, significantly impacting risk assessment and treatment.

  • Analyzed data from nearly 20,000 patients showed a higher prevalence in distal and rectal sites, particularly among Hispanic and Asian populations.
  • Early onset cases exhibit diverse genomic alterations, including higher rates of TP53 mutations and different signaling pathway vulnerabilities compared to late-onset cases.

Recognizing these differences can enhance age-specific screening and precision therapies for younger patients.

  • Notable comutation patterns and unique immediate-early gene expression further differentiate this cancer type.

Review by Kyrochristou I, Kyrochristou G (…) Lianos GD et 4 al. in BMC Surg

Copyright © 2026 Elsevier Inc. All rights reserved.

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Novel Approach in Gastric Cancer: Clean-Net Technique Study

The Clean-Net technique shows promising long-term outcomes for select gastric cancer patients.

  • No recurrence of gastric cancer in the 19 patients analyzed over a median follow-up of 6.2 years, with a maximum of 16.8 years.
  • 73.7% of patients were reclassified post-surgery due to higher risk factors, underscoring the importance of careful selection.
  • Metachronous gastric cancer occurred in 2 patients, emphasizing the need for ongoing surveillance.

While results are encouraging, Clean-Net does not replace standard gastrectomy and should inform future studies on function-preserving techniques.

Journal Article by Onimaru M, Inoue H (…) Yokoyama N et 3 al. in Surg Endosc

© 2026. The Author(s).

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NPWT after Stoma Reversal: Less Healing Time, No SSI Benefit

Negative pressure wound therapy (NPWT) doesn’t cut surgical site infections but speeds up healing after stoma reversal.

  • No significant difference in surgical site infection rates (odds ratio: 1.02).
  • Complete wound healing time reduced by about 2.72 days with NPWT.

Consider NPWT for high-risk patients, as it can enhance recovery time without increasing infection risk.

  • No impact on length of hospital stay or hematoma rates.

Review by Ahmed AI, Davey MG, Donlon NE and Carton E in Am J Surg

Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.

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