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Preoperative pancreatic radiologic characteristics predict postoperative pancreatic complications

Post author By STITCHES Newsletter
Post date 29/02/2024
Categories In General Surgery, HPB & Spleen

High acinar pancreatic content on preoperative CT scans is associated with increased risk of postpancreatectomy acute pancreatitis and pancreatic fistula formation. A simple radiological score combining pancreatic density, wirsung caliber, and pancreatic thickness predicts patients at higher risk for these complications, with male gender and obesity also contributing to the risk. Understanding these radiologic factors preoperatively could help identify patients at high risk of developing pancreatic-specific complications after pancreaticoduodenectomy.

Journal Article by Addeo P, de Marini P (…) Bachellier P et 7 al. in HPB (Oxford)

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Perioperative Risk Stratification: Cirrhosis-Hospital Frailty Risk Score Outperforms Original in Predicting Mortality

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Creating a modified tool, the Cirrhosis-Hospital Frailty Risk Score (CHFRS), for improved perioperative risk stratification in cirrhosis patients undergoing abdominal operations. This simplified index, based on 12 icd-10 codes within the existing Hospital Frailty Risk Score, was found to have superior predictive accuracy for in-hospital mortality compared to the original 109-component score. The CHFRS more accurately reflects the comorbidity burden of cirrhosis patients undergoing general surgery procedures.

Journal Article by Calthorpe L, Chiou SH (…) Lai J et 3 al. in Hepatology

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Impact of Private Equity on Surgical Practice Consolidation: Analysis of 1,542 Transactions

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Private equity investments have substantially impacted surgical specialties, leading to increased practice consolidation. Among 1,542 transactions involving surgical practices from 2015-2019, 539 were financed by private equity. Activity peaked in 2017 with 63 practices involved, predominantly in digestive disease, urology, and orthopedic surgery. Anesthesiology, ambulatory surgery centers, and surgical staffing firms were also affected, with medical service organizations playing a key role in facilitating private equity investment in surgical care.

Journal Article by Sievers MT, Neevel A (…) Chhabra KR et 5 al. in Ann Surg

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Roux-en-Y Gastric Bypass Shows Continued Diabetes Remission Despite Weight Recurrence

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, Metabolic and Bariatric Surgery

Roux-en-Y gastric bypass (RYGB) patients display higher rates of continued diabetes remission (CDR) compared to sleeve gastrectomy (SG) patients, even with weight recurrence (WR). The odds of Type 2 diabetes mellitus (T2DM) recurrence were 5.5 times higher in the SG group. Baseline insulin use, higher preoperative HbA1c, and longer preoperative T2DM duration were associated with T2DM recurrence, while WR was not. RYGB provides weight-loss independent metabolic benefits likely due to bypassing the proximal small-intestine.

Journal Article by Ghanem OM, Abi Mosleh K (…) Abu Dayyeh BK et 3 al. in J Am Coll Surg

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Novel SLE Index Enhances Prognostic Evaluation in Pancreatic Cancer Post Neoadjuvant Treatment

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, HPB & Spleen

Patients with modest radiologic response to neoadjuvant treatment (NAT) for pancreatic cancer face operative eligibility uncertainties. A novel Sialyl-Lewis Antigen-related Index (SLE Index) combining CA19-9 and Dupan-II reveals significant prognostic value. An SLE Index below 45.25 correlates with favorable disease-free survival, proving superior in predicting recurrence within 24 months compared to individual tumor markers. This index, assessing multiple biologic factors, offers a simplified and effective tool for enhancing patient selection post-NAT.

Journal Article by Miyahara S, Takahashi H (…) Eguchi H et 11 al. in Ann Surg Oncol

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Disparities in Presentation and Treatment of Medullary Thyroid Cancer by Sex and Race/Ethnicity

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In Endocrine Surgery, General Surgery

Male and non-white patients with medullary thyroid cancer (MTC) are more likely to present with advanced disease, including larger tumors and distant metastases. They also experience longer delays in receiving surgical treatment and are less likely to undergo guideline-concordant surgery. Black patients, in particular, are at a higher risk of disparities in disease presentation and management compared to white patients.

Journal Article by Kalva S, Ginzberg SP (…) Wachtel H et 5 al. in Am J Surg

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Incidence and Risk Factors of Marginal Ulcers Post-Pancreaticoduodenectomy

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, HPB & Spleen

Researchers analyzed data from 190 post-pancreaticoduodenectomy patients with upper gastrointestinal symptoms and found a 10.5% incidence of marginal ulcers. Factors associated with an increased risk of marginal ulcers included advanced age, alcohol consumption, smoking, longer surgery time, and postoperative bleeding, while regular use of antacids was a protective factor. This study highlights the importance of considering age, lifestyle factors, surgical complications, and postoperative management in the development of marginal ulcers.

Journal Article by Fan S, Chen G (…) Xiao B et 12 al. in Am J Surg

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Endoscopic Treatment Outperforms Surgery in Necrotizing Pancreatitis

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, HPB & Spleen, Surgical Endoscopy

The study compared endoscopic and surgical treatment in acute necrotizing pancreatitis, showing that endoscopic treatment resulted in lower peri-interventional morbidity, shorter hospital stays, and lower mortality rates. Endoscopic treatment also led to better long-term outcomes with reduced renal insufficiency, ventilation dependency, and recurrence rates, along with improved exocrine functionality. These findings suggest a preference for endoscopic intervention whenever possible.

Journal Article by Timmermann L, Schönauer S (…) Jürgensen C et 4 al. in Langenbecks Arch Surg

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Can a Crosshair Improve Communication in Laparoscopic Surgeries?

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

Using a crosshair on the video monitor during laparoscopic surgeries improved novices’ understanding of anatomical structures, as shown by better global operative assessment scores. Although operating time and confidence levels did not significantly change, participants found the crosshair to be non-disruptive and beneficial. The simple, inexpensive tool can enhance communication between instructors and novices in everyday training.

Journal Article by Paschold M, Kneist W (…) Zimniak L et 5 al. in Langenbecks Arch Surg

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Superior tumor response and survival with triple therapy regimen in hepatocellular carcinoma

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, HPB & Spleen

Triple therapy regimen (ICI+TKI+TACE) showed higher disease control rate and overall survival compared to other treatments in patients with advanced hepatocellular carcinoma. It had a higher disease control rate than ICI+TACE, ICI+TKI, and TKI+TACE, as well as improved overall survival compared to ICI+TKI and TKI+TACE. However, it also had a greater incidence of adverse events. The combination of immune checkpoint inhibitors, tyrosine kinase inhibitors, and trans-arterial chemoembolization should be considered for select patients with advanced HCC.

Review by Dawood ZS, Brown ZJ (…) Pawlik TM et 8 al. in HPB (Oxford)

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