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Transatlantic disparities in minimally invasive pancreatoduodenectomy outcomes

An analysis of 44,076 pancreatoduodenectomy patients reveals significant variability in the adoption and outcomes of minimally invasive pancreatoduodenectomy (mipd) across North America, Germany, the Netherlands, and Sweden. Usage rates of mipd ranged from 0.1% in Sweden to 17% in the Netherlands, with higher rates attributed to robotic techniques. Mortality rates were notably different, with mipd mortality at 2% in North America versus 7% in Germany. These findings underscore the need for international collaboration to improve patient outcomes.

Journal Article by de Graaf N, Augustinus S (…) Keck T et 21 al. in Surg Endosc

© 2024. The Author(s).

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Endoscopic ultrasound effectively diagnoses unexplained bile duct dilation.

Endoscopic ultrasound (EUS) demonstrated significant diagnostic yield for patients with unexplained common bile duct (CBD) dilation, particularly among those with negative prior imaging. In a cohort of 109 patients, 41 tested positive for various conditions, including choledocholithiasis and chronic pancreatitis. Factors such as older age and symptoms like jaundice increased the likelihood of positive findings. EUS proved a useful tool even after negative magnetic resonance cholangiopancreatography, highlighting its role in managing CBD issues.

Journal Article by Ferreira AI, Xavier S (…) Cotter J et 3 al. in Dig Dis Sci

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Neoadjuvant chemotherapy shows promise for survival in rectal cancer

A national database study of locally advanced rectal adenocarcinoma patients reveals that neoadjuvant chemotherapy (NAC) combined with chemoradiation (CRT) leads to better overall survival (OS) outcomes than CRT alone. Those receiving NAC alone exhibited poorer pathologic outcomes, specifically lower rates of R0 resection and pathologic complete response. The results underscore the potential benefits of an individualized treatment approach for rectal cancer, showing NAC with CRT offers significant advantages in patient survival compared to other strategies.

Journal Article by Buchheit JT, Janczewski LM (…) Chawla A et 5 al. in J Surg Oncol

© 2024 The Author(s). Journal of Surgical Oncology published by Wiley Periodicals LLC.

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Intracorporeal anastomosis enhances recovery in laparoscopic surgeries

A systematic review of 720 patients revealed that while intracorporeal and extracorporeal anastomosis in laparoscopic right hemicolectomy presented no significant differences in anastomotic leakage (RR 0.93), the former showcased notable advantages. Intracorporeal anastomosis led to reduced postoperative ileus and surgical site infections, alongside quicker bowel function recovery and shorter hospital stays. This suggests that intracorporeal anastomosis is both safe and effective, offering improved outcomes over its counterpart.

Systematic Review by Wei P, Li Y (…) Zhang Z et 4 al. in Dig Surg

S. Karger AG, Basel.

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Increased NSAID use correlates with higher marginal ulcer risk.

A retrospective study of 6,888 patients with gastrojejunostomy revealed a dose-dependent relationship between nonsteroidal anti-inflammatory drug (NSAID) prescriptions and the development of marginal ulcers. Among those studied, 45.2% were exposed to NSAIDs, with 10.12% developing ulcers. The odds of ulcer increased significantly with the number of NSAID exposures, from 1.67 for 1-2 prescriptions to 2.42 for over eight. Acid-suppressing therapy was identified as protective against ulcer formation.

Journal Article by Gross A, Gentle C (…) Augustin T et 4 al. in BMC Surg

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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ERAS reduces hospitalization time for trauma patients post-laparotomy

A randomized controlled trial demonstrated that modified enhanced recovery after surgery (ERAS) significantly decreased length of hospitalization (LOH) for trauma patients undergoing laparotomy, with a median LOH of 6 days compared to 8 days in conventional care (p = 0.007). The ERAS group also experienced quicker recovery of bowel function and earlier removal of catheters and drains. Notably, complications remained similar between groups, except for significantly fewer deep surgical site infections in the ERAS group (p = 0.009).

Journal Article by Jain V, Irrinki S (…) Kaman L et 7 al. in Am J Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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MRI effectively assesses peritoneal cancer index in patients.

Results indicate that diffusion-weighted MRI (dw-MRI) demonstrates significant accuracy in evaluating the peritoneal cancer index (PCI) in colorectal cancer patients with peritoneal metastases. In a cohort of 87 patients, a strong correlation was found between MRI-derived PCI and histopathology (0.77), with surgical PCI showing excellent agreement with histopathology at 0.87. These findings support MRI’s potential as a non-invasive method for PCI assessment, crucial for optimizing treatment strategies like cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.

Journal Article by Rijsemus CJV, Kok NFM (…) Lahaye MJ et 6 al. in Eur J Surg Oncol

Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

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A novel nomogram improves prediction of HCC recurrence post-surgery

A new prognostic nomogram has been developed to predict tumor recurrence in hepatocellular carcinoma (HCC) patients post-liver resection. Analyzing 726 patients, the research identified independent factors such as alpha-fetoprotein and portal vein tumor thrombosis affecting recurrence-free survival (RFS). The nomogram achieved strong predictive performance, with 1-year and 3-year AUCs of 0.813 and 0.739, respectively. Kaplan-Meier analysis confirmed that high-risk patients experienced significantly shorter RFS compared to low-risk counterparts in both training and testing cohorts.

Journal Article by Zhang ZJ, Wei BJ (…) Zheng SS et 3 al. in Hepatobiliary Pancreat Dis Int

Copyright © 2024 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved.

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HALP score effectively predicts complicated acute diverticulitis

In a study involving 190 patients, the HALP score demonstrated significant potential in assessing the severity of acute diverticulitis. Key inflammatory markers and HALP scores were notably higher in complicated cases compared to uncomplicated ones, indicating robust prognostic value. ROC analysis revealed that the HALP score can reliably identify disease complexity, achieving an AUC of 0.723. The sensitivity and specificity for predicting complications at a cutoff of ≤44.1 were 66.7% and 75.0%, respectively.

Journal Article by Barlas AM, Altıner S (…) Ünal Y et 4 al. in Asian J Surg

Copyright © 2024 Asian Surgical Association and Taiwan Society of Coloproctology. Published by Elsevier B.V. All rights reserved.

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Delirium is the most common complication in older surgical patients.

In a study of over 9,000 older adults undergoing inpatient general surgery, delirium emerged as the leading complication, occurring in 11.9% of patients. Including geriatric-pertinent complications raised the overall complication rate by 20.4%. Key findings revealed significant ties between complications like delirium and pressure ulcers, with both contributing to over 50% of postoperative functional decline rates. The research underscores the need for targeted improvements in care to address these critical complications.

Journal Article by Kazaure HS, Johnson KS, Rosenthal R and Lagoo-Deenadayalan S in World J Surg

© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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