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Preoperative risk assessment benefits from accounting for liver condition

The study assessed the ACS NSQIP Risk Calculator’s accuracy in predicting postoperative complications based on surgery type and underlying liver disease. In a cohort of 376 patients, the calculator effectively predicted outcomes such as surgical site infections and mortality, but its accuracy diminished for those with cirrhosis, fibrosis, and steatosis, particularly undergoing major liver resections. Incorporating liver parenchyma quality into preoperative evaluations improved prediction accuracy and highlighted the need for tailored risk assessments.

Journal Article by Aegerter NLE, Kümmerli C (…) Kollmar O et 7 al. in J Gastrointest Surg

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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Machine learning model predicts unplanned reoperation risk in rectal cancer

An optimized machine learning model was developed to predict the risk of unplanned reoperation (uro) after anterior resection for rectal cancer, utilizing data from 2,384 patients. The Random Forest model showed exceptional performance, achieving an accuracy of 84.2% and an AUC of 0.889. Key factors influencing uro risk included tumor location, previous surgeries, and operative time. An online platform for real-time risk assessment has been created, potentially aiding clinical decision-making and enhancing patient outcomes.

Journal Article by Su Y, Li Y (…) Chen L et 2 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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Powered circular stapler reduces complications in colorectal surgery

The systematic review and meta-analysis encompassing five studies and 2,379 patients reveals that using powered circular staplers (PCS) significantly lowers the rates of anastomotic leak (AL) and bleeding (AB) compared to manual circular staplers (MCS), with risk ratios of 0.44 and 0.23, respectively. However, no significant differences in conversion or reoperation rates were observed. The findings highlight the need for further randomized clinical trials to enhance surgical strategies in left-sided colonic resection.

Meta-Analysis by Scardino A, Riva CG (…) Rausa E et 9 al. in Int J Colorectal Dis

© 2024. The Author(s).

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A new classification improves outcomes for hepatocellular carcinoma patients

A novel resectability classification for hepatocellular carcinoma (HCC) categorizes patients into resectable, borderline resectable, and unresectable groups. Analysis of 409 patients showed that those classified as borderline demonstrated significantly worse progression-free and overall survival compared to resectable patients, with p-values indicating strong significance (p < 0.0001). This classification aids in predicting outcomes and may inform preoperative treatment decisions for borderline cases, enhancing patient management strategies in HCC.

Journal Article by Nakamura I, Yoh T (…) Hatano E et 11 al. in Hepatol Res

© 2024 The Author(s). Hepatology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Hepatology.

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Transoral robotic thyroidectomy shows favorable outcomes in 1,000 cases

A cohort of 1,000 patients undergoing transoral robotic thyroidectomy demonstrated promising results, particularly in cosmetic outcomes and postoperative recovery. The most common procedure was lobectomy (89.4%), with minimal complications (3.6%) and manageable postoperative pain scores. Average hospital stays were 2.6 days, and no recurrence was noted during a median follow-up of 39 months. A discernible learning curve was evident, emphasizing the importance of surgical expertise in achieving these outcomes.

Journal Article by Oh MY, Park D (…) Kim HY et 2 al. in BMC Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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AI model predicts futility of surgery in cholangiocarcinoma patients

An artificial intelligence model effectively predicted “futile” surgeries in intrahepatic cholangiocarcinoma patients, utilizing ten preoperative factors. In a study of 827 cases, 378 (45.7%) experienced insufficient surgical outcomes, with notable rates of recurrence (78.6%) and mortality (21.4%) within 12 months. The model achieved high accuracy, with a training area under the curve of 0.830 and a testing area of 0.781, thus providing clinicians with a reliable preoperative tool to avoid ineffective surgeries.

Journal Article by Altaf A, Endo Y (…) Pawlik TM et 15 al. in BMC Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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Significant research trends in frailty and surgery identified

A comprehensive bibliometric analysis conducted from 1978 to 2024 highlights the extensive global research on perioperative frailty, involving 4,119 published papers by 21,879 authors from 95 countries. The United States leads in publication volume, with the University of California system producing the most papers. Key research areas identified include preoperative risk assessment, postoperative complications, and the relationship between frailty and sarcopenia. These insights will aid in understanding the knowledge framework and future research directions in this field.

Journal Article by Guo Z, Wang F, Xu J and Shan Z in Langenbecks Arch Surg

© 2024. The Author(s).

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Laparoscopic surgery shows advantages for gastrointestinal perforations

In a study involving 219 patients, laparoscopic surgery for lower gastrointestinal perforations demonstrated significant advantages over open surgery. Median operative time was reduced (126 vs. 146 minutes), with far less intraoperative blood loss (50.4 ml vs. 400.1 ml). Patients undergoing laparoscopic procedures had a lower rate of postoperative complications (20% vs. 66.5%), particularly wound infections (0% vs. 26.3%). Additionally, hospital stays were shorter for laparoscopic patients (14 days vs. 24 days), with no recorded hospital mortality.

Validation Study by Kudou K, Aoyama R (…) Yoshizumi T et 11 al. in Asian J Endosc Surg

© 2024 The Author(s). Asian Journal of Endoscopic Surgery published by Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.

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Preoperative oral nutritional supplements improve outcomes for gastrointestinal cancer surgery

A systematic review and meta-analysis of 12 studies involving 1,201 patients revealed that preoperative oral nutritional supplements (ONS) significantly reduce infectious complications and improve nutritional and immune status in gastrointestinal cancer patients. Key findings included a reduction in white blood cell count and C-reactive protein levels, alongside improved albumin and prealbumin levels. However, no significant differences were noted in noninfectious complications or length of hospital stay, suggesting targeted benefits of ONS.

Meta-Analysis by Zou Q, Yin Z (…) Li W et 9 al. in Medicine (Baltimore)

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

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EUS-FNA/B shows strong diagnostic performance for PANNETs

A meta-analysis involving 2,978 patients confirms that endoscopic ultrasound-guided fine needle acquisition (EUS-FNA/B) is an effective method for diagnosing and pre-operatively grading pancreatic neuroendocrine tumors (PANNETs). The overall concordance rate with surgical grading was 0.77, with a notable increase in the G1 subgroup (0.88). Notably, fine needle biopsy (FNB) outperformed fine needle aspiration (FNA) in both sample adequacy and fewer passes required. Adverse events were minimal, indicating a safe procedure.

Journal Article by Ye X, Hua H (…) Shen Z et 4 al. in J Clin Gastroenterol

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

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