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Standardized protocol reduces complications in pancreatic surgery

An observational cohort study evaluated a standardized perioperative protocol for pancreatic oncological surgery from 2015 to 2022, finding significant reductions in postoperative complications. The rate of grade B and C pancreatic fistulas was 4.2%, while postoperative hemorrhage and delayed gastric emptying occurred in 2.5% and 9.2% of patients, respectively. These results demonstrate that implementing a fail-safe protocol can enhance surgical outcomes and lower postoperative morbidity in patients undergoing pancreatoduodenectomy.

Journal Article by Herzberg J, Strate T (…) Honarpisheh H et 3 al. in Visc Med

© 2024 S. Karger AG, Basel.

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Women are more likely to undergo cancer surgery than men.

In a comprehensive study of 367,887 patients, findings reveal that women are 44% more likely than men to receive cancer surgery. However, the likelihood decreases for both sexes with age and increasing co-morbid conditions, particularly among women. Men display higher rates of 90-day reoperations (21.2%) and mortality (1.2%) compared to women (18.8% and 0.9%, respectively), yet bladder cancer presents higher mortality for women. Adjusted analyses show persistent disparities warranting gender equality strategies in surgical treatment access.

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Observational Study by Jochum F, Hamy AS (…) Akladios C et 16 al. in Br J Surg

© The Author(s) 2024. Published by Oxford University Press on behalf of BJS Foundation Ltd.

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Social-environmental injustice affects surgical outcomes for patients.

Social-environmental inequalities significantly impact surgical outcomes, as revealed by the analysis of 1,052,040 Medicare beneficiaries. Patients from areas marked by greater environmental injustice showed reduced chances of achieving textbook surgical outcomes (odds ratio 0.95) and lower likelihood of safe discharge (odds ratio 0.97). Both outcomes highlight the critical role of socio-environmental factors in healthcare, indicating that integrated policies addressing these disparities are essential for improving patient outcomes.

Journal Article by Catalano G, Munir MM (…) Pawlik TM et 5 al. in J Surg Res

Copyright © 2024 Elsevier Inc. All rights reserved.

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Nomogram predicts postoperative complications in rectal cancer surgery

A nomogram was developed to predict postoperative complications in 207 patients with middle and low rectal cancer undergoing transanal total mesorectal excision (TATME). Findings indicated that 27.5% of patients experienced complications. Key predictors included operation time, smoking history, anastomotic technique, and ASA score, each significantly influencing risk. The model’s accuracy was validated through multiple statistical analyses, showcasing its value for clinicians in identifying higher-risk patients and improving surgical outcomes through timely interventions.

Validation Study by Jingtao Z, Bin W (…) Jun Y et 5 al. in Int J Colorectal Dis

© 2024. The Author(s).

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Indocyanine green fluorescence reduces anastomotic leak rates.

A systematic review and meta-analysis of six randomized trials, including 1949 patients, demonstrated that indocyanine green (ICG) fluorescence significantly reduces anastomotic leak rates in left-sided colorectal resections. The pooled odds ratio showed a 4.7% absolute reduction in leak rates (OR: 0.586, 95% CI: 0.434-0.792), indicating moderate confidence in its efficacy. ICG may serve as a standard of care, enhancing surgical outcomes and patient safety in colorectal procedures.

Review by Kazi M, Ajith A, Bhoyar A and Yelamanchi R in ANZ J Surg

© 2024 The Author(s). ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.

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Achieving textbook outcomes in laparoscopic pancreatoduodenectomy is feasible.

A study involving 200 patients undergoing laparoscopic pancreatoduodenectomy demonstrated that 82.5% achieved a textbook outcome, indicating a smooth recovery without specified complications. Key independent risk factors included a higher likelihood for female patients and those with hard pancreatic texture. These findings suggest that specific patient characteristics can enhance the chances of achieving favorable surgical outcomes in a high-volume center.

Randomized Controlled Trial by Cai H, Lu F (…) Cai Y et 6 al. in BMC Surg

© 2024. The Author(s).

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Higher provider density correlates with reduced hepatobiliary cancer rates.

Higher county-level provider density significantly correlates with lower hepatobiliary cancer incidence and mortality. Analysis across 1,359 counties revealed that areas with low provider density suffered higher rates of all-stage and late-stage cancer incidence, along with increased mortality rates. Notably, moderate and high provider density were linked to lower odds of these outcomes. The findings advocate for initiatives aimed at enhancing healthcare provider accessibility, potentially improving cancer outcomes and health equity.

Journal Article by Khan MMM, Munir MM (…) Pawlik TM et 8 al. in World J Surg

© 2024 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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Preoperative carbohydrate loading improves surgical outcomes in colorectal surgery.

Oral carbohydrate loading before elective colorectal surgery significantly reduces postoperative insulin resistance, inflammatory markers, and improves patient well-being. In a randomized controlled trial with 72 participants, the carbohydrate loading group showed a marked decrease in insulin resistance on the day of surgery and postoperatively. Additionally, patients experienced less thirst, hunger, and dry mouth, contributing to a shorter length of hospital stay and an overall enhancement in clinical outcomes.

Journal Article by Kumar SM, Anandhi A (…) Kate V et 5 al. in J Gastrointest Surg

Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

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Increased complete response rates observed in total neoadjuvant therapy

Among 339 patients with locally advanced rectal cancer, 208 (61.3%) completed total neoadjuvant therapy, achieving a final complete response (CR) rate of 42.3%. Notably, 57 patients (27.4%) sustained clinical CR for over a year, while 42 patients showed pathologic CR post-surgery. Predictors of CR included low rectal tumor location, absence of extramural vascular invasion, and absence of mesorectal fascia involvement. Two-year disease-free survival and overall survival rates were significantly higher in patients with CR versus those with incomplete response.

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Journal Article by Erozkan K, Elamin D (…) Gorgun E et 11 al. in J Gastrointest Surg

Copyright © 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

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Conversion surgery enhances survival in previously unresectable pancreatic cancer

A multicenter study revealed that conversion surgery following FOLFIRINOX or gemcitabine plus nab-paclitaxel chemotherapy significantly improves overall survival in patients with initially unresectable pancreatic cancer. The surgery group demonstrated a median overall survival of 34.4 months, compared to 19.8 months in the control group (hazard ratio, 0.47). Postoperative complication rates were noted at 19.6%, with in-hospital mortality at 0.5%. Notably, chemotherapy duration did not influence overall survival outcomes.

Journal Article by Okano N, Kawai M (…) Furuse J et 19 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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