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Laparoscopic pancreatoduodenectomy shows improved outcomes compared to open surgery

A network meta-analysis of seven randomized controlled trials involving 1,336 patients revealed that laparoscopic pancreatoduodenectomy (LPD) offers shorter hospital stays and reduced intraoperative blood loss compared to open pancreatoduodenectomy (OPD). However, LPD was associated with longer operative durations. In contrast, robotic pancreatoduodenectomy (RPD) showed no significant advantages over OPD. While LPD indicated potential better outcomes, the evidence remains underpowered, underscoring the need for further randomized trials to validate these findings.

Journal Article by Joseph N, Varghese C (…) Pandanaboyana S et 9 al. in Ann Surg Open

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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Nomograms effectively predict survival and recurrence in rectal cancer patients.

Nomograms developed from a multi-institutional study accurately forecast overall survival and recurrence for treatment-naïve rectal cancer patients post-surgery. Age predicted survival while venous invasion indicated recurrence. The model demonstrated strong discrimination, with Harrell’s c-index values of 0.77 for survival and 0.75 for recurrence in the internal validation cohort. Notably, adjuvant chemotherapy significantly enhanced 5-year survival rates in middle-risk patients but had no effect on low-risk patients, highlighting tailored treatment applications.

Journal Article by Kanemitsu Y, Uotani T (…) Sugihara K et 5 al. in Ann Surg Open

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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Perihilar resection increases risk of biliary leakage post-surgery

In a study analyzing data from 724 patients undergoing biliary anastomosis, researchers reported a 5.6% bile leak rate in distal malignant obstruction cases, while the rate increased to 14.6% in proximal malignant cases. Mortality varied significantly between anastomotic failure (26%) and no failure (2.6%). Advanced comorbidities and elevated preoperative bilirubin levels correlated with higher leak rates, although these trends lacked statistical significance. Conservative treatment methods were effective, but surgery was often necessary.

Journal Article by Kokas B, Ulmann L (…) Szücs Á et 3 al. in BMC Surg

© 2024. The Author(s).

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Machine learning models effectively predict appendicitis in emergencies

This proof-of-concept study reveals that machine learning models can predict appendicitis in patients with acute abdominal pain more accurately than traditional methods. With AUROCs of 0.919 and 0.923 when including laboratory test results, the models outperformed the Alvarado scoring system (AUROC of 0.824) and matched or exceeded the performance of emergency department physicians. These findings suggest that integrating machine learning into emergency workflows could significantly enhance early diagnosis and treatment for suspected appendicitis cases.

Journal Article by Schipper A, Belgers P (…) Rutten M et 7 al. in World J Emerg Surg

© 2024. The Author(s).

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Muscle mass-to-fat ratio predicts outcomes in pancreatic cancer surgery

A study evaluating the muscle mass-to-fat ratio (mmfr) in pancreatic cancer patients revealed significant prognostic implications. Among 191 patients undergoing pancreaticoduodenectomy, those in the low-mmfr group faced shorter overall survival and higher incidences of postoperative pancreatic fistula compared to their high-mmfr counterparts. The optimal mmfr cutoff values were identified at 0.688 for males and 0.382 for females, establishing mmfr as an independent predictor of both postoperative complications and overall survival.

Journal Article by Xu LJ, Zhang SQ and Cao C in Kaohsiung J Med Sci

© 2024 The Author(s). The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University.

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Anterior gastropexy significantly reduces 1-year recurrence of hernia

Findings indicate that incorporating anterior gastropexy during minimally invasive paraesophageal hernia repair significantly lowers the 1-year recurrence rate. In a clinical trial involving 240 participants, the recurrence rate was 15% for those receiving anterior gastropexy compared to 36% for those without it, indicating a notable risk difference. While patient satisfaction and quality-of-life outcomes remained consistent across groups, fewer reoperations for recurrence were noted in the gastropexy group, supporting its routine adoption in surgical practice.

Journal Article by Petro CC, Ellis RC (…) Rosen MJ et 12 al. in JAMA Surg

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Deep learning model predicts early recurrence in gastric cancer

A deep learning model (DLRMLP) integrating clinical factors outperformed traditional methods in predicting early recurrence of locally advanced gastric cancer (LAGC) post-gastrectomy. In a study involving 620 patients, DLRMLP achieved an AUC of 0.891 compared to 0.797 with conventional models. This model effectively stratified early recurrence-free survival, disease-free survival, and overall survival (all p < 0.001), linking high scores to tumor proliferation pathways and immune cell infiltration, thus optimizing treatment strategies.

Journal Article by Guo X, Chen M (…) Ji J et 10 al. in Int J Surg

Copyright © 2024. Published by Wolters Kluwer Health, Inc.

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Robotic pancreaticoduodenectomy shows promising safety and feasibility

Analysis of 425 patients in Japan demonstrates that robotic pancreaticoduodenectomy (RPD) can be safely introduced, achieving a low conversion rate to open surgery (3.8%) and high minimally invasive surgery completion rate (91.1%). The median operative time was 617 minutes, with a median blood loss of 160 grams. While the complication rate was 20.5%, mortality rates at 30 and 90 days were very low, at 0.2% and 0.5%, respectively, confirming RPD’s potential benefits.

Journal Article by Nakamura S, Nakata K (…) Nakamura M et 18 al. in J Hepatobiliary Pancreat Sci

© 2024 The Author(s). Journal of Hepato‐Biliary‐Pancreatic Sciences published by John Wiley & Sons Australia, Ltd on behalf of Japanese Society of Hepato‐Biliary‐Pancreatic Surgery.

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Laparoscopic repair reduces hernia recurrence and hospital stay

A comprehensive analysis of 20 studies involving 16,247 patients revealed laparoscopic mesh repair for ventral and incisional hernias significantly lowers hernia recurrence and postoperative complications compared to open repair techniques. Patients undergoing laparoscopic procedures also experienced shorter hospital stays. While retro-muscular repairs showed lower hernia recurrence compared to laparoscopic approaches, the difference was not statistically significant. This meta-analysis supports laparoscopic repair as a preferred method due to its notable clinical advantages.

Review by Elhadidi A, Shetiwy M and Al-Katary M in Updates Surg

© 2024. The Author(s).

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Surgical complications from CRS and HIPEC in cancer patients

A narrative review assessed complications linked to cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in patients battling peritoneal metastasis. It cataloged categories of complications, including surgical, chemotherapy-related, and systemic issues, emphasizing the high morbidity associated with these interventions. The findings advocate for stringent patient selection, precise surgical techniques, and robust intraoperative care. Interdisciplinary collaboration is highlighted as essential to enhance safety and tailor treatment approaches, guiding future clinical practices in managing colorectal cancer metastases effectively.

Review by Karimi M, Shirsalimi N and Sedighi E in Front Surg

© 2024 Karimi, Shirsalimi and Sedighi.

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