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Higher burden and inequality in pancreatic cancer among older adults globally

Between 1990 and 2019, the number of pancreatic cancer deaths in older adults, age-standardized death rate, disability-adjusted life years, and age-standardized DALY rate increased globally. The burden is highest in southern Latin America and has grown fastest in the Caribbean. Males aged 65 to 74 years have a higher burden than females. Proportions of deaths attributed to smoking, high fasting plasma glucose, and high body mass index are significant. Inequalities declined but remain at medium-high levels, and deaths are expected to increase over the next 11 years, highlighting the need for targeted interventions.

Journal Article by Wang X, Liu C (…) Yu J et 2 al. in J Gastrointest Surg

Copyright © 2023 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

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Can Endoscopic Gallbladder Stenting Prevent Recurrent Cholecystitis in Deferred Cholecystectomy?

Endoscopic gallbladder stenting significantly reduced the rate of recurrent cholecystitis at 3 months compared to patients who did not receive stenting. At 3-6 months, the stenting group also showed a lower, though not statistically significant, rate of recurring cholecystitis. The majority of recurrences in the non-stenting group occurred within 3 months, indicating that endoscopic stenting could effectively prevent recurrent cholecystitis in patients with deferred cholecystectomy.

Journal Article by Ridtitid W, Karuehardsuwan J (…) Rerknimitr R et 7 al. in Gastroenterology

Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.

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Total neoadjuvant therapy increases risk of breached mesorectal excision but reduces disease progression in rectal cancer

Total neoadjuvant therapy for rectal cancer is associated with higher rates of breached total mesorectal excision compared to standard long-course chemoradiation, but no significant differences in surgical mortality or major complications. However, it significantly lowers the risk of disease progression to an unresectable stage during neoadjuvant treatment. Further research is needed to identify patients who will benefit from this approach.

Journal Article by Lin W, Li C (…) Phang PT et 5 al. in Ann Surg

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

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Risk of Anastomotic Leak Higher with Early Ileostomy Closure

Early closure of diverting loop ileostomy after proctectomy is associated with a higher risk of anastomotic leak, particularly when closure is done within 2 weeks of ileostomy formation. Factors such as diabetes mellitus, smoking, and early closure within 2 weeks are significantly associated with postoperative complications. Routine early ileostomy closure cannot be recommended based on these findings.

Journal Article by Emile SH, Horesh N (…) Wexner SD et 3 al. in Ann Surg

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

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Comparable Long-term Survival Between Laparoscopic and Open Pancreaticoduodenectomy for Pancreatic Tumors

In a randomized clinical trial comparing laparoscopic and open pancreaticoduodenectomy for pancreatic or periampullary tumors, researchers found similar 3-year overall survival rates between the two groups. Quality of life, depression, and other outcomes also showed no significant differences. Laparoscopic pancreaticoduodenectomy, when performed by experienced surgeons, demonstrated comparable long-term outcomes to open surgery.

Journal Article by Qin T, Zhang H (…) Qin R et 30 al. in Ann Surg

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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Robotic Pancreaticoduodenectomy Shows Lower Blood Loss and Higher Complication-Free Rates compared to Open Procedure

Researchers compared robotic pancreaticoduodenectomy (RPD) and open pancreaticoduodenectomy (OPD) outcomes in a high-volume center. RPD showed lower blood loss, higher rates of no complications, longer operative time, and fewer harvested lymph nodes in patients with ductal adenocarcinoma compared to OPD. No significant differences were found for major complications, reoperation rate, postoperative pancreatic fistula, or patients with the textbook outcome. RPD can be implemented safely and may offer improved perioperative outcomes over OPD.

Journal Article by Nickel F, Wise PA (…) Hackert T et 12 al. in Ann Surg

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

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Antibiotic Duration Unaffected by Biliary Stents in Pancreatoduodenectomy

Antibiotic duration did not impact infection rates in pancreatoduodenectomy patients with biliary stents. A retrospective cohort study found similar composite infection rates among patients receiving short, medium, or long-duration antibiotics, with no significant differences in other outcomes. Postoperative pancreatic fistula and male sex were associated with the primary outcome. The study suggests an opportunity to de-escalate antibiotic coverage based on risk, promoting tailored antibiotic stewardship in high-risk patients with biliary stents.

Journal Article by Boyev A, Arvide EM (…) Tzeng CD et 10 al. in Ann Surg

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

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Operative Management of Emergency General Surgery Conditions: Higher Costs Which Persist Over Time

Operative management of emergency general surgery conditions leads to higher in-hospital costs compared to nonoperative management, with costs remaining higher or equivalent through 180 days. Out-of-pocket costs are similar for both approaches. For hepatopancreaticobiliary conditions, costs for operative management start higher but become equivalent at 90 and 180 days. These findings have implications for decision-making by clinicians, patients, and health systems when clinical outcomes are similar.

Journal Article by Kaufman EJ, Wirtalla CJ (…) Kelz RR et 8 al. in Ann Surg

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

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Ampicillin-Sulbactam Prophylaxis Benefits Esophagectomy

Antimicrobial prophylaxis with ampicillin-sulbactam was associated with significantly lower rates of surgical site infection, anastomotic leakage, and respiratory failure compared to cefazolin in esophagectomy patients. This choice of antibiotic also led to reduced respiratory complications, shorter hospital stays, and lower total hospitalization costs, with no increase in noninfectious complications. Propensity score matching and instrumental variable analyses confirmed these findings.

Journal Article by Hirano Y, Konishi T (…) Kitagawa Y et 10 al. in Ann Surg

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

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Identifying Pre-surgical Factors Affecting Long-term Weight Loss Trajectories After Bariatric Surgery

The study analyzed pre-surgical factors affecting latent trajectories of 5-year weight loss in a bariatric surgery population. Researchers identified three distinct trajectories of weight loss for gastric sleeve and bypass operations, influenced by factors such as BMI, environmental factors, comorbidity burden, race, and weight control strategies. Monitoring real-time patient-reported outcomes post-surgery is crucial for tailoring intervention strategies for patients experiencing suboptimal weight loss or weight regain.

Journal Article by Shen E, Baecker A (…) Coleman KJ et 10 al. in Surg Obes Relat Dis

Copyright © 2024 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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