A comprehensive analysis of 7,855 esophageal cancer cases in Denmark reveals crucial survival outcomes based on treatment strategies. Definitive chemoradiotherapy offers lower overall survival compared to surgery, yet outperforms palliative care. Interestingly, stage IVB patients undergoing surgery showed unexpectedly favorable survival. This research leverages the Union for International Cancer Control staging system to refine prognostic accuracy, aiming to enhance individualized treatment protocols and clinical decision-making in esophageal cancer management.
Low skeletal muscle gauge (SMG) significantly predicts higher 30-day and 90-day mortality following emergency laparotomy, with odds ratios of 2.12 and 2.64, respectively. Patients presenting with acute abdominal pain should undergo routine computed tomography reporting of body composition, as low SMG also correlates with prolonged hospital stays. With a study cohort of 1,090 patients, this analysis underscores the necessity of incorporating body composition assessments into risk prediction models for surgical outcomes.
A patient-centered program targeting low anterior resection syndrome (LARS) significantly enhances postoperative quality of life. In a multicenter trial, participants who engaged with the LARS patient-centered program reported a mean global quality of life of 79.7, compared to 67.8 in standard care, six months after surgery. This improvement continued at the 12-month mark. Additionally, the program reduced the incidence of major LARS complications one month post-surgery, underscoring the effectiveness of guided self-management.
Initiating pharmacologic venous thromboembolism (VTE) prophylaxis within 24 hours of major trauma admission dramatically lowers VTE risk by 42%, according to a large cohort study. Among 6,569 patients, those receiving early treatment experienced significantly fewer VTE events (2.8% compared to 7.8%) and showed reduced mortality rates (0.6% vs. 1.8%). Crucially, early initiation did not increase the risk of bleeding complications, supporting a shift towards this practice as standard care.
A new surgical method—reverse-sequence dissection—dramatically reduces chylous fistula occurrences after lateral neck lymph node dissection for thyroid cancer. In a study of 989 patients, those undergoing the novel technique showed a chylous fistula rate of just 0.81%, compared to 5.05% in the traditional method cohort. This advancement not only enhances surgical safety but also offers a promising avenue for further refining thyroid cancer operations.
In a comprehensive analysis of over 26,000 patients, fully covered self-expandable metal stents (FCSEMS) with endoscopic retrograde cholangiopancreatography (ERCP) emerged as the safest preoperative biliary drainage method, boasting fewer adverse events than plastic stents. However, they showed a higher incidence of pancreatitis. Plastic stents are linked to more complications, while internal stents are optimal for perihilar obstructions. ERCP remains the preferred technique, but percutaneous options are also viable alternatives.
GNAS droplet digital PCR effectively enhances the diagnosis of mucinous pancreatic cystic neoplasms (MPCNs) in fine-needle aspiration samples. In a cohort of 140 patients, this method achieved a 62% detection rate for MPCNs and identified 33% of inconclusive lesions as MPCNs, all with 100% specificity. Compared to traditional diagnostic methods, GNAS ddPCR markedly reduced diagnostic costs by 24%, positioning it as a valuable, cost-effective tool for clinicians.
Why knowing when not to place a drain may matter more than how to manage one.
The Bottom Line:
Routine prophylactic abdominal drainage after pancreatoduodenectomy (PD) is no longer universally necessary and may even increase certain risks in low-risk patients. A selective, risk-based approach—reserving drains for high-risk scenarios and removing them early when placed—yields equal or better outcomes and fewer complications.
For decades, the placement of intra-abdominal drains after PD was considered a kind of insurance policy. Something you left behind when the work was done — a whisper of presence, a plastic promise that you hadn’t just stitched and hoped. You drained because you were careful. Because you were thorough. Because textbooks said so. Because this was pancreatic surgery, and no one wanted to be the cowboy who left the belly dry and got burned. Because if a leak happened and the drain wasn’t there, the blame would be.
But over the past decade, multiple randomized trials and meta-analyses have challenged that assumption, showing:
Selective omission of drains is safe in low-risk patients, especially in high-volume centers with experienced teams (Liu et al., 2021; Lyu et al., 2020).
Yet, for patients with established high-risk features—soft gland texture, small duct diameter, or high intraoperative blood loss—drain omission may increase mortality, making selective drainage beneficial in these cases (Van Buren et al., 2014; Hou et al., 2025; Kunstman et al., 2017).
Active vs. Passive Drains: No major difference in overall complications, POPF, or length of stay; choice can be guided by surgeon preference and specific procedure, with active suction potentially lowering fistula risk after distal pancreatectomy (Zhou et al., 2023; Marchegiani et al., 2018).
Who Benefits from a No-Drain Strategy?
Ideal candidates for omitting routine drains tend to share these features:
High-volume center: experienced pancreatic teams, established fast-track pathways
Reliable postoperative monitoring: access to serial labs, imaging, and clinical follow-up
By contrast, patients with soft pancreas, small duct, high BMI, or significant blood loss remain better served by selective drain placement to guard against delayed recognition of leaks (Liu et al., 2021; Hou et al., 2025).
Optimizing Drain Management
When drains are used, timing is everything: early removal (POD 3–5) in low-risk patients with low drain amylase leads to fewer infections and shorter stays (Beane et al., 2019; Linnemann et al., 2019).
This approach turns drains from a blanket precaution into a precision tool—used only when benefit outweighs risk, and removed as soon as safety allows.
Where Do We Go from Here?
The era of “drain by default” is ending. Evidence supports a personalized drainage strategy:
Not every patient needs a drain, and routine omission can lower fistula and infection rates in low-risk cases.
Selective drainage remains crucial for those at high risk of POPF, ensuring timely intervention where it matters most.
Early removal protocols further minimize complications when drains are placed.
This isn’t just a technical shift—it’s a cultural one. Surgeons must move from automatic drain placement to nuanced decision-making, aligning intraoperative judgment with each patient’s risk profile and postoperative support.
By embracing a selective, evidence-based approach, we enrich our toolkit—ensuring that every decision, drain or no drain, is tailored to optimize outcomes and patient recovery.
Artificial intelligence now enhances surgical trial design by generating synthetic data that mirrors real-world outcomes with high fidelity. In evaluating transanal transection and single-stapled anastomosis, the AI approach yielded a balanced cohort of 1,200 patients, verifying a significantly lower anastomotic leak rate in the new technique compared to traditional methods (p<0.0001). This advancement promises improved clinical trials while ensuring patient data privacy and maintaining statistical rigor.
Hypothetical interventions targeting nutrition, anxiety, and family cohesion significantly lower frailty risk among older gastric cancer patients. A single focus on nutrition proved most effective, reducing risk by 21%. Joint interventions yielded even greater results, with all-factor combinations slashing risk by over 31%. These findings underscore the importance of tailored support systems in enhancing recovery and overall well-being in this vulnerable group, informing future intervention strategies.
