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Variability in Treatment Strategies for Upfront Resectable Colorectal Liver Metastases

Post author By STITCHES Newsletter
Post date 28/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

European hepato-pancreato-biliary surgeons generally agree on the definition of upfront resectable colorectal liver metastases based on future liver remnant volume and tumor biology. However, there is significant variability in the use of thermal ablation as an adjunct to surgery and perioperative systemic therapy. The survey highlights the need for further evidence and consensus in treatment strategies for upfront resectable colorectal liver metastases throughout Europe.

Journal Article by Kuiper BI, Abu Hilal M (…) Gruenberger T et 14 al. in HPB (Oxford)

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Medicaid Expansion Increases Access for PDAC Patients in Southern States

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In General Surgery, HPB & Spleen

Medicaid Expansion in southern states significantly increased insurance access for underserved groups with pancreatic ductal adenocarcinoma (PDAC). Expanded states had a 36% higher odds of Medicaid insurance and increased proportions of insured black, rural, and impoverished patients. However, the odds of receiving radiation therapy decreased annually in expanded states. Although ME did not impact the diagnosis of early stage disease or the receipt of chemotherapy or surgery significantly, access to care for disadvantaged populations improved.

Journal Article by Venkatesh H, Li T (…) Chu QD et 4 al. in Ann Surg Oncol

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Adjuvant Therapy Benefits Pancreatic Cancer Patients with Short Neoadjuvant Duration or Microscopic Margins

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In General Surgery, HPB & Spleen

A retrospective study on 529 pancreatic cancer patients after neoadjuvant therapy reveals adjuvant therapy’s survival benefit. For the entire cohort, no significant overall survival difference was observed. However, subgroup analysis shows a survival advantage with adjuvant therapy for those with less than 4 months of neoadjuvant treatment or microscopic margin positive surgical resections. This insight underscores the nuanced impact of adjuvant therapy in specific pancreatic cancer patient subsets.

Journal Article by Shimizu T, Maeda S (…) Donahue T et 16 al. in BMC Surg

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Similar Pain and Opioid Use in Benign and Malignant Colorectal Resections

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Comparing 641 benign and 276 malignant colorectal resection patients, initial unadjusted analysis showed higher pain scores and more opioids for benign cases. Yet, in an enhanced recovery pathway emphasizing non-opioid strategies, regression analysis nullified the differences. Notably, both groups exhibited comparable pain levels and opioid prescriptions postoperatively. This challenges previous inconclusive findings, suggesting that pain and opioid needs may align in enhanced recovery settings, irrespective of disease type.

Journal Article by Diaz S, Brockhaus KK (…) Cleary RK et 3 al. in Am J Surg

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Implication of Geriatric Assessment in Colorectal Surgery

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Colorectal surgery among older adults is increasing, with geriatric conditions posing risks for poor outcomes. A systematic review found 25 cohort studies but no randomized trials on geriatric assessment in this context. Few studies focused on the domain of what matters most to geriatric patients, revealing a gap in evidence for tailored management strategies. Evidence lacks on the impact of geriatric assessment on improving outcomes in colorectal surgery.

Review by Cauley CE, Samost-Williams A (…) Ritchie CS et 3 al. in J Surg Res

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Effectiveness of REBOA as a Bridge to Hemostasis in Massive Gastrointestinal Bleeding

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In Appendix, Gallbladder and Surgical Emergencies, General Surgery

Resuscitative endovascular balloon occlusion of the aorta (REBOA) was used in five cases of severe gastrointestinal bleeding, providing temporary hemorrhage control and enabling additional hemostatic maneuvers. Systolic blood pressure increased post-REBOA placement, and three patients survived beyond 24 hours. Although all patients ultimately succumbed to hemorrhagic shock, REBOA proved effective as a bridging tool for resuscitation and definitive hemorrhage control in massive gastrointestinal bleeding.

Journal Article by Rodríguez-Holguín F, Salcedo A (…) Ordoñez CA et 8 al. in J Surg Res

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LMIC Perspectives on Global Surgery Partnerships

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In General Surgery, Perspectives, Opinions and Curiosities

LMIC surgeons value clinical and educational partnerships in global surgery collaborations with HICs. They express the need for a formal process to assess resources and needs at the beginning of partnerships and cite a lack of structure for long-term collaborations. Despite challenges during the COVID-19 pandemic, most partnerships continued, with some partners reporting weaker relationships. A structured partnership initiation process could benefit all parties involved.

Journal Article by Krakauer KN, Wong LY (…) Krishnaswami S et 9 al. in J Surg Res

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Vacuum External Fixation Outperforms Chest Strap in Treating Multiple Rib Fractures in Polytrauma Patients

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In Appendix, Gallbladder and Surgical Emergencies, General Surgery

Vacuum external fixation showed superior therapeutic efficacy compared to chest strap in polytrauma patients with multiple rib fractures. Patients with vacuum external fixation had significantly lower pain scores, reduced pleural drainage, lower risk of complications, improved lung function, and shorter hospital stays. Overall, vacuum external fixation demonstrated benefits in reducing complications and improving clinical outcomes in polytrauma patients with multiple rib fractures.

Journal Article by Wang D, Gu S (…) Liao Y et 5 al. in Postgrad Med J

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Long-term Mortality Risk in Total Pancreatectomy Patients with Islet Autotransplant

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In General Surgery, HPB & Spleen, Transplant Surgery

Total pancreatectomy with islet autotransplant (TPIAT) for pancreatitis patients has a 10-year survival rate of 85.2% and a 15-year rate of 76.2%. Most deaths (53 out of 89) were possibly related to TPIAT, with causes including chronic gastrointestinal issues, malnutrition, and diabetes. Younger age, longer disease duration, and recent procedures were linked to lower mortality. This suggests that managing comorbidities post-TPIAT could reduce common causes of mortality in these patients.

Journal Article by Hooks G, Lu H (…) Bellin MD et 9 al. in HPB (Oxford)

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Impact of KRAS and Histopathological Growth Patterns on Resection Margins in Colorectal Liver Metastases

Post author By STITCHES Newsletter
Post date 27/02/2024
Categories In General Surgery, HPB & Spleen, Intestine and Lower Gastrointestinal Tract

In colorectal liver metastases (CRLM), the review investigates the association between KRAS status, histopathological growth patterns (HGPs), and their impact on resection margins around major vasculature and bile ducts. The study emphasizes the importance of balancing negative margins and preserving vascular and biliary structures during surgery. While parenchymal sparing is crucial, the review explores how KRAS and HGPs contribute to prognostication after resection, shedding light on their influence on overall survival and recurrence rates.

Review by Wong P, Wong GYM (…) Hugh TJ et 2 al. in ANZ J Surg

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