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Enhancing Training for Surgical Oncology Excellence

Complex General Surgical Oncology (CGSO) fellowship graduates, while generally feeling prepared for practice, expressed concerns about research and specific clinical areas like thoracic, hyperthermic intraperitoneal chemotherapy (HIPEC), and hepato-pancreato-biliary surgery. The study reveals potential gaps between trainee expectations and surgical oncology practice realities, suggesting opportunities to refine the training model. Improvements, such as increased autonomy, case volumes, and enhanced research infrastructure, could better align fellowship training with the needs of practicing surgical oncologists.

Journal Article by Behrens S, Lillemoe HA (…) Davis JL et 6 al. in Ann Surg Oncol

© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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Navigating Neoadjuvant Uncertainty: Ampullary and Duodenal Adenocarcinoma Management

The study delves into the uncertain territory of neoadjuvant therapy (NAT) for ampullary (AA) and duodenal adenocarcinoma (DA). Analyzing 15 retrospective studies, no clear survival differences were found between NAT and upfront surgery. While some studies hinted at benefits like increased pathologic response, overall evidence supporting NAT for AA and DA is weak. The research urges for more robust data, emphasizing the need to better comprehend the multidisciplinary management of these periampullary malignancies.

Review by Zhang C, Lizalek JM (…) Reames BN et 3 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Social Vulnerability Delays Treatment: Impact on Primary Hyperparathyroidism Evaluation

In a Massachusetts study on primary hyperparathyroidism, researchers found that patients in socially vulnerable groups faced delays in surgeon evaluation, contributing to heightened risks of long-term complications. Among 1,082 patients, those in the highest vulnerability quartile had a 33% lower surgeon evaluation rate and were seen 67 days later than those in the lowest quartile. This underscores the need to address social factors influencing healthcare access, ensuring timely interventions and preventing complications in vulnerable populations.

Journal Article by Collins RA, Broekhuis JM (…) James BC et 3 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Remote Ischemic Preconditioning Falls Short in Liver Protection Post-Hepatectomy

In a randomized trial involving 102 patients with chronic liver disease undergoing hepatectomy, remote ischemic preconditioning’s anticipated liver-protective benefits were not realized. Despite inducing preconditioning through upper extremity cycles of ischemia and reperfusion, the study showed no significant reduction in postoperative transaminase levels. The results suggest limited efficacy in mitigating ischemia-reperfusion injury, challenging the application of this technique in hepatectomy for patients with chronic liver conditions.

Journal Article by Hardt JLS, Pohlmann P, Reissfelder C and Rahbari NN in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Prophylactic Mesh Fails to Halt Long-Term Parastomal Hernias

In a comprehensive review of eight randomized trials with 537 patients, the long-term efficacy of prophylactic mesh during end colostomy creation was debunked. Contrary to prior expectations, the incidence of parastomal hernia showed no significant reduction, challenging the strategy’s effectiveness. Both parastomal hernia repair rates and mortality remained comparable between mesh and non-mesh groups, with some caution on result reliability due to trial heterogeneity.

Review by Verdaguer-Tremolosa M, Garcia-Alamino JM (…) López-Cano M et 2 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Shrinking Tumors, Elevating Hope: FOLFIRINOX Impact on Pancreatic Cancer Resectability and Survival

In pancreatic cancer patients receiving FOLFIRINOX, tumor size reduction significantly increased resectability and pathologic response. Normalization of carbohydrate antigen 19-9 levels predicted resectability, lower recurrence risk, and improved survival. Postoperative antigen 19-9 rise, following prior normalization after neoadjuvant therapy, signaled heightened recurrence risk and poorer survival. Tailoring treatment response assessments can guide personalized strategies for pancreatic ductal adenocarcinoma management.

Journal Article by Servin-Rojas M, Fong ZV (…) Qadan M et 7 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Sarcopenia Signals Poor Outcomes in Recurrent Hepatocellular Carcinoma

Patients with early-stage recurrent hepatocellular carcinoma and sarcopenia face significantly lower overall and recurrence-free survival rates, regardless of treatment type. Sarcopenia emerges as an independent prognostic factor, suggesting a crucial role in long-term outcomes. Notably, impaired host immunity, evidenced by low levels of tumor-infiltrating lymphocytes, may contribute to the unfavorable prognosis. This study underscores the clinical impact of sarcopenia and its association with immune function in recurrent hepatocellular carcinoma patients.

Journal Article by Doi S, Yasuda S (…) Sho M et 7 al. in Langenbecks Arch Surg

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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Optimizing Laparoscopic Pancreaticoduodenectomy: ‘1+2’ Stitch Shows Superiority in Pancreaticojejunostomy

In a game-changing move, researchers explored the “1+2” technique for pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy. Among 184 cases, this approach exhibited success in all 95 “1+2” cases, showcasing advantages over the traditional method. The new technique boasted shorter operation and pancreaticojejunostomy times, reduced complications, lower infection rates, and briefer hospital stays. Results suggest that this innovative single-layer continuous duct-to-mucosa approach with two figure-of-eight sutures is a safe and efficient alternative in total laparoscopic pancreaticoduodenectomy.

Journal Article by Li D, Du C (…) Wang W et 3 al. in Langenbecks Arch Surg

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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Appendicitis Complexity Impacts Cancer Type

Analyzing 4 studies with 4,962 appendicitis patients, the meta-analysis found a 1.98% neoplasm incidence. No overall difference emerged between complicated (3.29%) and uncomplicated (1.49%) cases. Neuroendocrine tumors (NET) were common (49.21%), with higher rates in uncomplicated cases, while adenocarcinomas were more prevalent in complicated appendicitis (50% vs. 13%). Despite similar overall neoplasm rates, the study highlights nuanced cancer type variations, emphasizing the need for tailored appendectomy considerations based on appendicitis complexity.

Journal Article by Solis-Pazmino P, Oka K (…) Nasseri Y et 8 al. in Langenbecks Arch Surg

© 2023. The Author(s).

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DNA Methylation Classifier Illuminates Sarcoma Diagnoses and Molecular Markers

Researchers evaluated a sarcoma DNA methylation classifier for soft tissue and bone tumors, including 619 cases. The classifier exhibited high sensitivity and specificity for fusion sarcomas (Ewing, synovial, cic-rearranged, bcor-rearranged), leiomyosarcoma, MPNST, and malignant vascular tumors. However, sensitivity was low for desmoid fibromatosis, neurofibroma, and schwannoma, with low specificity for certain diagnoses. MDM2 amplification and RB1 loss aided lipomatous tumor diagnosis. The classifier, though valuable, may evolve with additional entities and refine methylation classes, providing insights into sarcoma interrelationships.

Journal Article by Miettinen M, Abdullaev Z (…) Aldape KD et 7 al. in Am J Surg Pathol

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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