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High hospital volume lowers mortality in esophageal and gastric surgery

Higher hospital surgical volume leads to significantly better outcomes for esophagectomy and gastrectomy patients.

  • 30-day mortality drops to 51% lower (odds ratio 0.51) at high-volume hospitals performing 4-239 resections/year.
  • 90-day mortality reduced by 35% (odds ratio 0.65) and fewer complications observed (odds ratio 0.83).

Surgical teams should consider hospital volume when planning procedures.

  • Optimal volume thresholds identified: 43 cases/year for esophagectomy and 15 for gastrectomy, beyond which outcomes plateau.

Journal Article by Kooij CD, Zuin IS (…) Goense L et 4 al. in Ann Surg Oncol

© 2026. The Author(s).

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Omitting antibiotics in mild cholecystitis reduces unnecessary use.

  • Perioperative antibiotics did not significantly lower infectious complications: 9% with antibiotics vs. 12% without.
  • Surgical site infections were also similar: 5% vs. 8%.

Surgeons can consider forgoing antibiotics in healthy patients with mild-moderate acute cholecystitis.

  • No differences in length of hospital stay or mortality were observed.
  • Further research is needed for high-risk patient populations.

Review by Jensen PUD, Graabæk F, Tolstrup MB and Shabanzadeh DM in Am J Surg

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

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Risk Factors for Reoperation After Ileostomy in Colorectal Cancer

Diverting ileostomy significantly reduces the risk of anastomotic leakage during colorectal cancer surgery, but specific risk factors can complicate outcomes.

  • Anastomotic leakage occurred in 17.5% of patients, with lower rectal tumors as the sole significant risk factor (p=0.0095).
  • Reoperation due to leakage was necessary for 19% of these cases, particularly in patients with T4 tumors (p=0.022) and stenosis (p<0.001).

Surgeons should weigh these factors carefully when deciding on ileostomy in colorectal cancer surgeries, as some patients may benefit more from alternative approaches.

  • High-output stomas were seen in 30%, with outlet obstruction in 15.8%; severe complications in stoma reversal were rare (1.7%).

Journal Article by Takeda K, Yamada T (…) Yoshida H et 8 al. in Int J Colorectal Dis

© 2026. The Author(s).

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Predicting Malignancy in Pancreatic Mucinous Cystic Neoplasms

Surgeons can now identify high-grade dysplasia in pancreatic mucinous cystic neoplasms using an effective risk prediction model.

  • In a study of 198 patients, 16% had high-grade dysplasia, with 7% showing invasive carcinoma.
  • Key risk factors include older age (median 52.5 years), symptomatic presentation (72%), cyst size (average 85 mm), and mural nodules (56%).

Utilize the validated nomogram and online calculator for smarter surgical decisions versus surveillance strategies.

  • The nomogram demonstrated 89% accuracy with 85% sensitivity at a 10% risk threshold.

Journal Article by Aguilera Munoz L, Laurent L (…) Rebours V et 27 al. in HPB (Oxford)

Copyright © 2026 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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Minimally Invasive Surgery Improves Outcomes in Esophageal Cancer

Conversion minimally invasive esophagectomy is a viable option for cT4b esophageal cancer patients previously deemed unresectable, offering significant benefits.

  • Patients undergoing conversion minimally invasive esophagectomy (c-mie) experienced less intraoperative blood loss (79 ml vs. 470 ml, p < 0.001) and a lower risk of anastomotic leakage (4.8% vs. 24%, p = 0.04).
  • ICU stays were shorter for c-mie patients (3 days vs. 4 days, p = 0.03).

This approach yields acceptable short-term outcomes and similar long-term survival rates compared to open surgery.

  • Three-year overall survival was 63.0% for c-mie versus 39.6% for c-oe, though not statistically significant (p = 0.08).

Comparative Study by Ishiyama K, Nozaki R (…) Daiko H et 6 al. in Dis Esophagus

© The Author(s) 2026. Published by Oxford University Press on behalf of the International Society for Diseases of the Esophagus. 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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Comparative Outcomes in Rectal Cancer Procedures Revealed

Laparoscopy, robotic-assisted, and transanal techniques showed mixed success in high-risk rectal cancer patients, all falling short of expected outcomes.

  • Primary outcome rates: 82.4% (laparoscopy), 64.3% (laparotomy), 74.7% (robotic), and 80.3% (transanal).
  • 96% R0 resection rate across all techniques; no significant difference found.
  • Conversion rates for minimally invasive methods remained consistent at 4.5%.

Surgeons should consider that while minimally invasive options are viable, none consistently met benchmarks for success, emphasizing the need for careful patient selection.

Observational Study by Rouanet P, Guerrieri M (…) Dubois A et 7 al. in Ann Surg

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

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Robotic Resection Outperforms Laparoscopic for Minor Liver Surgery

Robotic minor liver resection shows significant benefits over laparoscopic approaches for anterolateral segment surgeries.

  • Median blood loss: 75 ml for robotic versus 100 ml for laparoscopic (p < 0.001).
  • Major morbidity rates: 2.5% for robotic compared to 4.6% for laparoscopic (p = 0.004).

Consider integrating robotic techniques to improve patient outcomes, especially for those with cirrhosis.

  • Open conversions decreased: 1.2% robotic versus 4.5% laparoscopic (p < 0.001).
  • Shorter hospital stays: 4 days post-robotic vs. 5 days post-laparoscopic (p < 0.001).

Comparative Study by Hu J, Guo Y (…) Goh BKP et 74 al. in Ann Surg

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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New Tool Improves Fistula Risk Prediction in Pancreatoduodenectomy

A newly optimized classification model better predicts postoperative pancreatic fistula risk in patients undergoing pancreatoduodenectomy for periampullary tumors.

  • Overall, the rate of clinically relevant pancreatic fistula was 22.2%, rising to 25.8% specifically for periampullary tumors.
  • The original model showed moderate predictive performance (AUC = 0.632), but the adjusted version improved this to 0.672.

Understanding these risk factors helps tailor preoperative assessment and decision-making for surgeons managing these complex cases.

  • Key predictors included a soft pancreas, BMI ≥ 23 kg/m², and a pancreatic duct diameter ≤ 3 mm.

Validation Study by Kapoor D, Desiraju Y (…) Shrikhande SV et 5 al. in Ann Surg

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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Critical Margin Assessment in Pancreatic Cancer Surgery

Surgeons must prioritize evaluating specific resection margins in pancreatic cancer for better patient outcomes.

  • Three key margins—superior-mesenteric vein (HR 1.48), medial (HR 1.92), and posterior (HR 1.65)—are significantly linked to disease-free survival.
  • R1 status worsens survival in gemcitabine-treated patients (HR 1.97) but not with mFOLFOXIRI.

Aim for thorough margin assessment focusing on these three areas to enhance surgical decision-making and patient prognoses.

Randomized Controlled Trial by Lambert A, Salleron J (…) Conroy T et 8 al. in Ann Surg

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

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Watch-and-Wait for Rectal Cancer: Key Thresholds Identified

Watch-and-wait may be an option for rectal cancer patients, but specific conditions must be met to avoid worse outcomes.

  • Salvage rates below 75% threaten disease-free survival; rates must stay above this for safety.
  • Ten-year overall survival rates are similar: 83.0% for watch-and-wait vs. 81.5% for surgery.

Monitoring regrowth rates is essential; if it exceeds 10% every six months or near-complete responders exceed 68%, immediate surgery is likely safer.

  • Utilize these thresholds for patient counseling and surgical decision-making.

Journal Article by Kazi M, Sharma A, Desouza A and Saklani A in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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