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Esophageal Washout with Povidone-Iodine Reduces Intraluminal Tumor Cells in Carcinoma Resection

Intraoperative esophageal washout with povidone-iodine solution significantly reduces the presence of free intraluminal tumor cells during esophageal and cardiac carcinoma resection. Neoadjuvant treatment decreases the likelihood of malignant cells in the esophagus. Repetitive washout decreases detectable malignant cells, with a significant reduction after 10 maneuvers. This novel, feasible procedure can help eliminate tumor cells and may be particularly beneficial for patients without neoadjuvant therapy.

Journal Article by Maurer CA, Walensi M (…) Egger C et 3 al. in Eur J Surg Oncol

© 2024 Elsevier Ltd, BASO ∼ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

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Deficiencies in Reporting Clinical Significance in Contemporary CER

Contemporary Comparative Effectiveness Research (CER) often lacks explicit specification of clinically significant differences in study outcomes, as revealed in a systematic review of 307 studies from prominent medical journals. Only 8.5% of studies specified clinical significance, with 2.3% recommending changes in clinical decision-making based on statistical significance alone. Authors frequently defined clinical significance using validated standards. The inverse correlation between sample size and effect size in statistically significant randomized controlled trials highlights the need for clearer distinctions between clinical and statistical significance in CER.

Journal Article by Gikandi A, Hallet J (…) Fong ZV et 12 al. in Ann Surg

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

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ICG-Guided Lymphadenectomy in LAGC: RCT Results

Indocyanine Green (ICG)-guided lymph node (LN) dissection during laparoscopic radical gastrectomy significantly improves the quality of lymphadenectomy in locally advanced gastric cancer (LAGC) patients post-neoadjuvant chemotherapy (NAC). A randomized controlled trial with 236 patients demonstrates that ICG increases LN retrieval and decreases non-compliance rates, particularly in cases without baseline measurable LNs and in those with a complete response to NAC. Surgical outcomes remain comparable between ICG-guided and non-guided groups.

Journal Article by Huang ZN, Tang YH (…) Huang CM et 11 al. in Ann Surg

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

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PORSHA for Paraesophageal Hernias: Phase 2a Results

Posterior Rectus Sheath Hiatal Flap Augmentation (PORSHA) exhibits promise as a surgical innovation for large and recurrent paraesophageal hernias. In a study of 27 cases, PORSHA, after technical modifications, demonstrated safety and success in repairing type III, IV, and recurrent paraesophageal hernias. At an 11-month follow-up, there were no radiologic recurrences, abdominal eventrations, or hernias at the donor site, with only one patient experiencing occasional solid food dysphagia, resolving with dilation.

Journal Article by Vigneswaran Y, Hussain M (…) Alverdy JC et 3 al. in Ann Surg

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

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Pediatric Pancreatic Surgery: Safe, Effective, and Centralized

Pediatric pancreatic surgery, analyzed in a 73-patient study, demonstrated safety and effectiveness. Distal pancreatectomy was the most common procedure, addressing indications like chronic pancreatitis, tumors, and trauma. Postoperative morbidity occurred in 34.2%, with no 90-day mortality. The 5-year overall survival was 90.5%, emphasizing the feasibility of pediatric pancreatic surgery. Centralization in specialized pancreatic centers ensures tailored surgical expertise for children.

Journal Article by Fuchs J, Loos M (…) Büchler M et 11 al. in Ann Surg

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

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Crucial Role of EUS in LT Workup for Unresectable pCCA

EUS plays a crucial role in the liver transplantation (LT) workup for patients with unresectable perihilar cholangiocarcinoma (pCCA). In a nationwide study, EUS identified malignant nonregional lymph nodes (LNs) in 4% of patients potentially eligible for LT. Surgical staging confirmed malignancy in 14% of patients with nonregional LNs. The study emphasizes the limited but clinically significant yield of EUS in precluding further LT screening due to malignant LNs, suggesting potential improvements in systematic screening criteria.

Journal Article by de Jong DM, den Hoed CM (…) van Driel LMJW et 11 al. in Gastrointest Endosc

Copyright © 2023 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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Patient Engagement Technologies in Colorectal Surgery: Improving Outcomes Through Interaction

Patients engaging with patient engagement technologies (PETs) during colorectal surgery showed improved outcomes. In a retrospective study, 89.1% activated PETs, completing surveys and health-checks. Those engaging more frequently experienced shorter lengths of stay, lower readmission rates, and fewer post-operative complications. Notably, patients who completed more post-discharge health-checks had a lower complication rate, emphasizing the positive impact of PETs on perioperative experiences and outcomes.

Journal Article by Irfan A, Smith B (…) Chu DI et 5 al. in Am J Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

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TSLG versus LTH for Siewert Type II AEG: Advantages and Efficacy

Transthoracic single-port-assisted laparoscopic gastrectomy (TSLG) demonstrates technical safety and feasibility in comparison to laparoscopic transhiatal approach (LTH) for Siewert type II adenocarcinoma of the esophagogastric junction. In a retrospective study, TSLG showed advantages, including increased harvested lymph nodes, reduced lower mediastinal lymph nodes, and longer proximal margins. The R0 gastrectomy rate was higher in the TSLG group, highlighting its potential as an effective addition to LTH surgery, especially when lower mediastinal lymph node metastases are suspected.

Journal Article by Li J, Xiong W (…) Wang W 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 Anastomosis Duodeno-Ileal Bypass (SADI-S) Shows Comparable Outcomes in Primary and Two-Stage Approaches

Comparing outcomes of primary single anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-S) to two-stage SADI-S after sleeve gastrectomy (SG), a Canadian bariatric study with 179 laparoscopically treated patients (2016–2020) revealed both approaches as efficient in achieving weight loss and comorbidity reduction at short and mid-term follow-ups. Preoperative criteria are crucial for surgeon decision-making between primary and two-stage strategies, highlighting the need for personalized approaches in bariatric surgery.

Journal Article by Deffain A, Denis R (…) Studer AS et 3 al. in Obes Surg

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

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Procedure-Specific Risk of Postoperative Nausea

In a cross-sectional study analyzing data from 152 German and Austrian hospitals, researchers determined procedure-specific, risk-adjusted probabilities of postoperative nausea for 72 types of operations. The adjusted absolute risk ranged from 6.2% to 36.2%, with laparoscopic bariatric operations having the highest risk. Factors such as male sex, antiemetic prophylaxis, regional anesthesia, and preoperative opioids influenced nausea risk. The study emphasizes the considerable variation in nausea risk among surgical procedures and highlights the need for tailored prevention strategies.

Journal Article by Komann M, Rabe Y (…) Meißner W et 4 al. in BMJ Open

© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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