Blog

Robotic surgery reduces risk of positive circumferential resection margins.

This systematic review and meta-analysis of 18 studies shows that robotic surgery (rs) significantly decreases the risk of circumferential resection margin (crm) positivity in rectal cancer patients undergoing mesorectal excision, with a relative risk of 0.82 (95% CI, 0.73-0.92; p=0.001). The combined data from 4 randomized controlled trials and 14 propensity score matching studies, encompassing 9,203 patients, illustrate the benefits of rs over conventional laparoscopic surgery (ls) in achieving better postoperative outcomes.

• Why it matters: Uncertainty remains whether robotic surgery reduces circumferential margin positivity in rectal cancer.

Review by Ishizuka M, Shibuya N (…) Mizushima T et 11 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.

read the whole article in Eur J Surg Oncol

open it in PubMed

Liver venous deprivation enhances surgery outcomes over portal vein embolization

In a meta-analysis involving 588 patients, liver venous deprivation (LVD) improved liver resection rates (OR, 1.89), accelerated liver growth rates, and shortened time to surgery compared to portal vein embolization (PVE). Notably, LVD resulted in lower post-hepatectomy liver failure (OR, 0.45) without increasing complications or mortality rates. Thus, LVD not only proves effective for liver surgeries but also introduces a safer alternative, minimizing adverse events for patients undergoing major liver resection.

• Why it matters: The study clarifies whether liver venous deprivation or portal vein embolization is safer.

Review by Yang L, Yang M (…) Wang W et 3 al. in HPB (Oxford)

Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

read the whole article in HPB (Oxford)

open it in PubMed

Imaging model improves risk stratification for HCC treatment

An imaging-derived biomarker effectively stratified mvi-positive HCC patients for adjuvant hepatic arterial infusion chemotherapy (HAIC). In a study of 470 patients, key imaging features distinguished prognostic subgroups, leading to significantly different recurrence-free survival rates (RFS) (median RFS, 6.00 vs. 66.00 months, p<0.01). The model exhibited robust predictive performance with AUC values of 0.83, 0.84, and 0.73 across various cohorts, thus supporting the individualization of treatment strategies for better patient outcomes.

• Why it matters: Enables precise risk stratification for hepatocellular carcinoma with microvascular invasion.

Journal Article by Ma L, Zhang C (…) Lu L et 15 al. in Int J Surg

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

read the whole article in Int J Surg

open it in PubMed

Prognostic models enhance survival predictions for gastric carcinoma

Development and validation of prognostic models for gastric carcinoma were achieved using data from 1,650 patients post-gastrectomy. The nomogram for node-negative lymphatic metastasis (c-index 0.719) and node-positive metastasis (c-index 0.674) outperformed the AJCC 8th edition TNM staging. Key variables included age, tumor stage, and maximum diameter for node-negative cases, while additional factors like neural invasion and HER-2 expression were included for node-positive cases. These models effectively stratified patient risk, aiding in targeted therapy decisions.

• Why it matters: Improving survival predictions for gastric cancer based on lymphatic metastasis.

Journal Article by Qu W, Li L, Ma J and Li Y in World J Surg Oncol

© 2024. The Author(s).

read the whole article in World J Surg Oncol

open it in PubMed

Near-infrared autofluorescence differentiates parathyroid glands effectively

Parathyroid glands in primary hyperparathyroidism exhibit distinct near-infrared autofluorescence (NIRAF) signatures, with normal glands showing higher intensity (2.68 vs 2.09 pixels, p<.0001) and lower heterogeneity (0.11 vs 0.18, p<.0001). A deep learning model developed with these parameters achieved 83.3% precision and recall, and an area under the precision-recall curve of 0.908. These findings suggest that NIRAF imaging and machine learning can significantly assist in differentiating normal from diseased parathyroid glands during surgery.

• Why it matters: Improves differentiation of diseased and normal parathyroid glands intraoperatively.

Journal Article by Akgun E, Ibrahimli A and Berber E in J Am Coll Surg

Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

read the whole article in J Am Coll Surg

open it in PubMed

Higher frailty predicts serious complications in gastric cancer surgery

Increased frailty, as measured by the modified 5-item frailty index (mFI-5), significantly predicts adverse postoperative outcomes for gastric cancer patients undergoing gastrectomy. Among 7,438 patients, those with an mFI-5 score of 2 or higher faced a 1.43 times greater risk of overall complications and a 2.91 times increased risk of myocardial infarction. This correlation underscores mFI-5’s potential as a valuable tool for identifying high-risk patients and guiding preoperative optimization.

• Why it matters: Identifying high-risk patients reduces complications after surgery.

Journal Article by Tran A, Putnam LR, Lipham JC and Shiraga S in Surg Endosc

© 2024. The Author(s).

read the whole article in Surg Endosc

open it in PubMed

Participating hospitals show reduced mortality after esophagectomy.

Higher-level care at hospitals participating in the ACS NSQIP targeted registry significantly improves esophagectomy outcomes. Analysis indicated targeted centers had a lower mortality rate (2% vs. 4%) and failure-to-rescue rate (11% vs. 17%), alongside a greater likelihood of optimal outcomes (62% vs. 58%). Notably, Ivor Lewis esophagectomies at these facilities were linked to approximately half the risk of mortality (OR 0.57) and failure-to-rescue (OR 0.54) compared to standard centers.

• Why it matters: Enhanced care reduces significant risks after esophagectomy procedures.

Journal Article by Harris LB, Vyas V (…) Mavros MN et 3 al. in World J Surg

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

read the whole article in World J Surg

open it in PubMed

Proximal gastrectomy with double-tract offers viable surgical option.

The meta-analysis examined outcomes of proximal gastrectomy versus total gastrectomy in 1154 patients. Results indicated that while proximal gastrectomy had a slightly longer operating time, it yielded better results in hemoglobin levels and reduced need for vitamin B12 supplementation. Early and late-phase complications were comparable between both groups. Importantly, the 5-year overall survival rates were similar, suggesting that proximal gastrectomy with double-tract reconstruction is a safe and effective approach for upper gastric cancer.

• Why it matters: Optimizing treatment options for upper gastric cancer patients.

Journal Article by Zhu G, Jiao X (…) Qu J et 13 al. in BMC Gastroenterol

© 2024. The Author(s).

read the whole article in BMC Gastroenterol

open it in PubMed

Amino acid supplementation reduces post-surgery infection rates.

A high-dose amino acid supplementation in patients undergoing gastrointestinal tumor surgery was associated with a significant reduction in infection incidence during hospitalization and within 30 days post-surgery compared to standard care. The amino acid intake was higher in the supplementation group (1.81 g/kg vs. 0.94 g/kg, p<0.001), while energy intake remained similar. Although postoperative complications did not differ significantly, the supplementation correlated with shorter hospital stays, highlighting its potential as a promising strategy in surgical recovery.

• Why it matters: Reducing infection rates post-surgery is crucial for recovery.

Journal Article by Wang J, Chen Y (…) Jing C et 9 al. in Int J Surg

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

read the whole article in Int J Surg

open it in PubMed

Higher resilience and perceived control protect older adults post-surgery

A study involving 3,778 older adults showed significant associations between depression, resilience, and perceived control of health with mortality and functional decline following surgery. Postoperative mortality was 18.5%, while 9.4% experienced a decline in instrumental activities of daily living (IADL). Depression increased mortality risk (26% vs. 16%), while high resilience and perceived control lowered it (9% vs. 21%). Improving psychosocial factors post-surgery could enhance recovery outcomes for older patients.

• Why it matters: Addressing psychosocial factors can improve surgical outcomes in older adults.

Journal Article by Miller MJ, Cenzer I (…) Tang VL et 3 al. in Ann Surg

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

read the whole article in Ann Surg

open it in PubMed