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Access to total neoadjuvant therapy shows improvement, yet disparities remain.

Significant increases in access to total neoadjuvant therapy for rectal cancer were noted in California, rising from 36.6% in 2010 to 66.3% in 2020, with no disparity in growth between racial and ethnic groups. However, Latino patients were less likely to receive this treatment compared to non-Latino white patients. While survival rates among treated patients did not show racial disparities, non-Latino black patients exhibited lower risk-adjusted survival overall, highlighting persistent inequalities.

• Why it matters: Inequities in cancer treatment access and survival persist today.

Journal Article by Chan M, Rajasekar G (…) Dawes AJ et 2 al. in BMC Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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AI-driven gaming enhances laparoscopic cholecystectomy training effectiveness

An AI-powered mobile game, LapBot, was validated for teaching safe laparoscopic cholecystectomy skills. Among 903 global participants, increased game difficulty led to lower scores (p<0.0001) and confidence (p<0.0001). Player scores correlated positively with case volume (p=0.0002) and training level (p=0.0003). Most participants (64.1%) endorsed LapBot as a valuable adjunct to surgical training, enhancing critical reflection on feedback received during procedures. This suggests serious games can significantly support skill development and learner engagement.

• Why it matters: Enhancing surgical training addresses skill gaps for future surgeons.

Journal Article by St John A, Khalid MU (…) Madani A et 7 al. in Surg Endosc

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

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Single-vessel transection reconstruction reduces surgery time and bleeding

The clinical study revealed that single-vessel transection Roux-en-Y reconstruction following total gastrectomy significantly shortened operation time (162.5 min vs. 178.5 min) and reduced intraoperative bleeding (167.2 ml vs. 207.8 ml) compared to conventional Roux-en-Y reconstruction in patients with proximal gastric cancer. No notable differences were found in baseline characteristics, mesentery tension, peritoneal drainage durations, postoperative hospital stays, and early complications, underscoring its feasibility and safety for clinical practice.

• Why it matters: It simplifies complex surgical procedures for gastric cancer patients.

Journal Article by Han Y, Guo J, Huang Y and Xu D in J Gastrointest Surg

Copyright © 2024. Published by Elsevier Inc.

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Surgical intervention can lead to statistical cures for HPB cancers.

A systematic review of eleven studies indicates curative-intent surgery for hepato-pancreato-biliary (HPB) cancers can yield statistically significant cures. Hepatocellular carcinoma showed cure fractions of 63.4% to 75.8% with liver transplantation and 31.8% to 40.5% with hepatic resection. Intrahepatic cholangiocarcinoma demonstrated a cure fraction of 9.7% based on tumor stage, while pancreatic neuroendocrine tumors and pancreatic ductal adenocarcinoma had cure fractions of 57.1% and 20.4%, respectively, emphasizing tumor type’s impact on survival.

• Why it matters: Surgery improves survival rates for patients with HPB cancers.

Review by Maspero M, Sposito C (…) Cucchetti A et 2 al. in Dig Liver Dis

Copyright © 2024 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

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No Nasogastric Tube, Early Mobilization Improve Colorectal Surgery Outcomes

Researchers found that adherence to specific components of an enhanced recovery program, including no nasogastric tube, early mobilization, early regular diet, postoperative multimodal analgesia, and early discontinuation of maintenance intravenous fluids, significantly reduced length of stay, readmission rates, and complication rates in colorectal surgery patients. These components showed a decrease in length of stay by up to 7.1 days, a 4.1% reduction in readmission rates, and up to a 28.2% reduction in complication rates.

• Why it matters: Optimal recovery components in colorectal surgery remain unclear.

Journal Article by Jones BA, Brock B (…) Chu DI et 6 al. in BMC Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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Adrenal Cysts Under 10 cm Can Be Safely Observed

Clinicians found that simple adrenal cysts smaller than 10 cm can be safely monitored without surgery. In a study of 77 patients, cysts under 10 cm grew slowly (0.3 cm/year) and showed no signs of malignancy or complications. Conversely, cysts over 10 cm grew significantly faster (13.2 cm/year) and were more likely to require surgical intervention. This suggests a 10 cm threshold for deciding between observation and surgery for asymptomatic adrenal cysts.

• Why it matters: Identifying safe observation thresholds for adrenal cysts prevents unnecessary surgeries.

Journal Article by Rodriguez E, Fedorova T (…) Morris-Wiseman LF et 10 al. in World J Surg

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

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Parathyroidectomy Lowers Neuropsychiatric Disorder Risks

Among 3,728 primary hyperparathyroidism patients, those undergoing parathyroidectomy had reduced risks of new-onset cognitive impairment (HR: 0.65), somnolence (HR: 0.45), and schizophrenia (HR: 0.08) compared to nonoperative management. No significant risk reduction was observed for anxiety, depression, or suicidal ideation. Additionally, surgical patients were less likely to require inpatient care for neuropsychiatric disorders (0.3% vs. 1.8%, p<0.001). These findings suggest the potential neuropsychiatric benefits of parathyroidectomy in managing primary hyperparathyroidism.

• Why it matters: Neuropsychiatric disorders frequently manifest in primary hyperparathyroidism.

Journal Article by Song Z, Balachandra S (…) Chen H et 6 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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Intraoperative Parathyroid Hormone Level Decrease Predicts Malignancy Excision

A >50% decrease in intraoperative parathyroid hormone (iPTH) levels into the normal reference range predicts complete excision of malignancy in patients with parathyroid carcinoma. 93% of patients achieving normal iPTH levels had operative success, compared to only 50% of those with a >50% iPTH decrease alone. This study suggests that iPTH monitoring, particularly when guiding towards normal levels, can better predict successful removal of malignant tissue during surgery.

• Why it matters: The utility of iPTH monitoring for parathyroid carcinoma is unclear.

Journal Article by Armstrong VL, Vaghaiwalla TM (…) Lew JI et 5 al. in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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AI-Based Study Uncovers Tumor Heterogeneity in Papillary Thyroid Carcinoma

AI-based multimodal multi-tasks analysis of 1,011 PTC patients reveals molecular subtypes, impact of BRAF mutations on lymph node metastasis and prognosis. Deep learning model predicts metastasis with high accuracy (AUC 0.86-0.93) and generates heatmaps to aid clinicians in identifying high-risk areas. Offers valuable insights for precise risk stratification and personalized treatment decisions in PTC.

• Why it matters: Precise prediction of metastasis improves treatment for thyroid cancer.

Journal Article by Yu Y, Ouyang W (…) Long M et 15 al. in Int J Surg

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

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Reduced-Dose Floxuridine Improves Treatment for Unresectable Colorectal Liver Metastases

A modified dosing protocol (MDP) for hepatic arterial infusion (HAI) with reduced floxuridine starting dose resulted in fewer dose holds and reductions compared to the standard dosing protocol (SDP). MDP patients completed more cycles before dose reduction, received more overall cycles, and had fewer instances of treatment-ending biliary toxicity. Conversion to hepatic resection was similar between the groups.

• Why it matters: Reducing disruptions in treatment for unresectable colorectal liver metastases improves outcomes.

Journal Article by Schwantes IR, Patel RK (…) Mayo SC et 8 al. in Ann Surg Oncol

© 2024. Society of Surgical Oncology.

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