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The impact of diabetes mellitus on outcomes in patients undergoing surgical pancreatectomy for pancreatic diseases

Post author By STITCHES Newsletter
Post date 01/01/2024
Categories In General Surgery, HPB & Spleen

A retrospective analysis of 370 patients who underwent pancreatic resection surgery in Austria revealed that the incidence of postoperative diabetes mellitus (postopdm) was 29%. Postopdm occurred significantly more frequently in patients with malignant pancreatic diseases compared to benign diseases (31.3% vs. 16.7%). The study highlights the prominence of diabetes mellitus as a risk factor for both malignant and non-malignant pancreatic diseases and its unfavorable impact on outcomes, particularly in patients with pancreatic cancer.

Journal Article by Schranz A, Sternad C (…) Aberer F et 9 al. in J Clin Med

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Age-Dependent Disparities in General Surgery Outcomes: Variations in Hospital Performance

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

Hospital performance for general surgery varies between younger and older adults, with in-hospital mortality rates showing significant differences. Failure-to-rescue rates drive the variation in older adults, while both complication and failure-to-rescue rates contribute to high mortality rates in younger adults. Correlations between observed-to-expected mortality ratios suggest distinct hospital performance in each age group. Low-mortality hospitals in older and younger adults do not overlap. Further investigation is needed to understand the factors causing these age-based differences in surgical outcomes.

Journal Article by Brooks ES, Wirtalla CJ (…) Kelz RR et 2 al. in Ann Surg

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Portal Hypertension Assessment Crucial for Hepatocellular Carcinoma Resection Decision

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, HPB & Spleen

Indirect signs of portal hypertension (pht) don’t raise complications risk in hepatocellular carcinoma (HCC) patients undergoing liver resection (LR). However, in patients with hepatic venous pressure gradient (HVPG) ≥10 mmHg, LR significantly increases overall morbidity and liver-related complications risk. Transjugular HVPG assessment is crucial for LR decisions, with a minimally invasive approach showing favorable outcomes, especially in HVPG ≥10 mmHg patients. Despite elevated risks, LR results in a 5-year overall survival rate of 55.2%.

Journal Article by Aliseda D, Zozaya G (…) Rotellar F et 8 al. in Ann Surg

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Pathological Response is not a Reliable Surrogate for Overall Survival in Neoadjuvant Studies for Esophageal Cancer

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Upper Gastrointestinal Tract

The study evaluates the validity of using pathological response as a surrogate marker for overall survival (OS) in neoadjuvant studies for esophageal cancer. A meta-analysis comprising 40 trials and 55,344 patients shows that the surrogacy between pathological complete response (PCR) and OS is moderate. The study establishes a lack of surrogacy at the trial level and cautions against relying solely on PCR as the primary endpoint in neoadjuvant studies for esophageal cancer.

Journal Article by Su F, Yang X (…) Tan L et 2 al. in Ann Surg Oncol

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Accurate Prediction of Anti-TNF Treatment Failure in Perianal Crohn’s Disease Using MRI-Based Model

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Researchers developed an MRI-based prediction model for anti-TNF treatment failure in perianal Crohn’s disease. The model, based on clinical and radiologic parameters, accurately predicts the likelihood of treatment failure and outperforms existing imaging-based indices. The study included 221 patients, with treatment failure occurring in 46% of cases. The prediction model included age at diagnosis, time to initiate treatment, smoking, and eight MRI characteristics. The full and simplified MRI models had fair discriminatory capacity for treatment failure.

Journal Article by McCurdy J, Munir J (…) Macdonald B et 16 al. in Clin Gastroenterol Hepatol

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Predictive factors for successful same-day discharge following minimally invasive colorectal surgery

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

A prospective cohort study conducted at a tertiary colorectal center aimed to identify predictive factors for successful same-day discharge following minimally invasive colorectal surgery. Out of 175 patients, 161 (78.5%) were discharged on the day of surgery without complications, while 44 (21.5%) experienced same-day discharge failure. Factors associated with failure included higher comorbidities, prolonged post-anesthesia care unit stays, and higher rates of readmissions and complications. Conversely, patients who received a regional-nerve-block and did not consume postoperative opioids were more likely to have successful same-day discharge. These findings can inform future protocols to enhance recovery after colorectal surgery.

Journal Article by Paradis T, Robitaille S (…) Lee L et 7 al. in Dis Colon Rectum

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Nonoperative Management Shows Promising Results for Anal Adenocarcinoma

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Anal adenocarcinoma can be effectively treated with total neoadjuvant therapy and nonoperative management, according to a retrospective analysis conducted at a comprehensive cancer center. The study included 70 patients, out of which 77% received neoadjuvant therapy. Patients who underwent total neoadjuvant therapy had a higher proportion of successful watch-and-wait management compared to those who received single neoadjuvant modality therapy. Tumor regrowth rate was 22% in the total neoadjuvant therapy group. The 5-year overall survival rate for the total neoadjuvant therapy group was 61% and colostomy was avoided in 50% of these patients.

Journal Article by Feferman Y, Rosen R (…) Pappou EP et 15 al. in Dis Colon Rectum

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Temporary Stoma Does Not Impact Long-Term Functional Outcomes in Rectal Cancer Patients

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

Rectal cancer patients who undergo surgical resection with or without a temporary stoma were compared in terms of long-term functional outcomes. The study, conducted at seven Dutch hospitals with 656 patients, found that those with a temporary ileostomy experienced less constipation but more fecal incontinence and major low anterior resection syndrome compared to those without a temporary stoma. Patients with a temporary colostomy had a higher occurrence of major low anterior resection syndrome. However, the reason for creating a temporary stoma, rather than the stoma itself, seemed to be the main factor impacting functional outcomes.

Journal Article by Verkuijl SJ, Jonker JE (…) Broens PMA et 7 al. in Dis Colon Rectum

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No Significant Hernia Recurrence, but Increased Complications: Impact of Smoking on Minimally Invasive Paraesophageal Hernia Repair Outcomes

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Hernia, Upper Gastrointestinal Tract

The impact of active smoking on outcomes of minimally invasive paraesophageal hernia repair (PEHR) was assessed in this cohort study. There was no significant difference in rates of death or serious morbidity (DSM) or hernia recurrence between smokers and non-smokers. However, on further analysis using the National Surgical Quality Improvement Program (NSQIP) database, smoking status was found to be independently associated with increased risk of DSM, respiratory complications, 30-day readmission, and discharge to a higher level of care.

Journal Article by Wang TN, An BW (…) Sweigert PJ et 6 al. in Surg Endosc

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Increased Use of Z Codes in Ambulatory Surgery Reveals Socioeconomic Needs

Post author By STITCHES Newsletter
Post date 31/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

Researchers analyzed data from 41,827 ambulatory surgery encounters from 2016 to 2019 and found a 16.1% increase in the use of International Statistical Classification of Diseases and Health Related Problems, tenth revision (ICD-10) Z codes. The most commonly documented health determinants were multiparity or unwanted pregnancy, homelessness, and incarceration. The study suggests that rates of Z code use in the ambulatory surgery setting are rising, indicating a growing recognition of socioeconomic needs; however, current documentation remains specific but not sensitive enough to capture the full extent of these needs.

Journal Article by Das RK, Galdyn IA (…) Terhune KP et 2 al. in Am J Surg

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