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Long-term Outcomes of Endoscopic Submucosal Dissection in T1 CRC

Endoscopic submucosal dissection (ESD) offers compelling insights into managing T1 colorectal cancer (CRC), shaping surgical strategies.

  • Of 383 T1 CRC patients, 3.6% had recurrences and 1.8% died in the high-risk group; none occurred in low-risk patients.
  • In high-risk cases, local recurrence was 6.8% without surgery versus 0% with surgery (p < .001).

Consider ESD alone for low-risk T1 CRC, but opt for additional surgery in high-risk patients to minimize local recurrence.

  • Five-year overall survival was significantly better with surgery (95.2%) compared to follow-up (79.7%) in high-risk patients (p < .001).

Journal Article by Hamada T, Kuwai T (…) Oka S et 11 al. in Clin Gastroenterol Hepatol

Copyright © 2026 The Authors. Published by Elsevier Inc. All rights reserved.

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Rationalizing Surgical Trays Cuts Costs and Emissions

Rationalizing surgical trays for elective procedures can save money and reduce environmental impact.

  • 39% reduction in tools for rectal procedures, from 53 to 16 items.
  • Open hernia repair trays reduced from 53 to 43 items and from 75 to 60 items.
  • Annual savings estimated at £16,863 and reduced carbon emissions by 42.6 kgCO2.

This approach enhances OR efficiency and supports sustainable practices in surgery.

  • Laparoscopic trays for hernia repairs and cholecystectomies streamlined from 55 to 45 items.

Journal Article by Shrestha P, Roylance J (…) Gray WK et 8 al. in World J Surg

© 2026 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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Endoscopic Therapy in Chronic Pancreatitis: Key Insights

Targeted endoscopic approaches offer symptom relief in chronic pancreatitis but surgery is preferred for long-term outcomes.

  • Endoscopy is effective for small pancreatic duct stones; larger stones require extracorporeal shock wave lithotripsy or pancreatoscopy.
  • Main pancreatic duct strictures should be treated with dilation and single large-caliber plastic stents; avoid fully covered metal stents due to higher risks.

Surgery remains the gold standard for durable pain control and improved quality of life in select patients.

  • Endoscopic ultrasound-guided celiac plexus block provides short-term pain relief for refractory cases.

Review by Prado R, Chatterjee A (…) Chahal P et 12 al. in Dig Dis Sci

© 2026. The Author(s).

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Postoperative Complications Raise Risks in Colon Cancer Surgery

Patients with stage I-III colon cancer face higher locoregional recurrence and lower survival rates when complications occur.

  • 28% of patients had postoperative complications; 4.9% developed anastomotic leakage needing re-intervention.
  • The 5-year locoregional recurrence rate was 13.5% for those with any complications versus 6.8% for those without.

Anastomotic leakage is the only complication independently linked to increased recurrence risk.

  • 5-year overall survival was 78.9% without complications, dropping to 62.7% for patients with non-surgical complications only.

Journal Article by Rademaker E, Aktas BC (…) Van Westreenen HL et 8 al. in Ann Surg Oncol

© 2026. The Author(s).

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Total Neoadjuvant Therapy Has Similar Outcomes for Rectal Cancer

Total neoadjuvant therapy does not change the selection criteria for lateral pelvic lymph node dissection in rectal cancer.

  • 25% of patients undergoing lateral pelvic lymph node dissection had pathologically positive nodes.
  • Key risk factors for positive nodes include CT4b stage (odds ratio 2.60) and multiple enlarged lymph node stations (odds ratio 3.82).
  • Three-year local recurrence-free survival rates were comparable: 90% for total neoadjuvant therapy and 85% for long-course chemoradiotherapy.

Surgeons can use existing selection criteria without modification regardless of the neoadjuvant therapy approach.

Journal Article by Nariampalli Karthyarth M, Manohkaran S (…) Saklani A et 4 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Impact of Pancreatic Fistula on Chemo After Surgery

Postoperative pancreatic fistula (POPF) significantly hampers chemotherapy delivery in pancreatic cancer patients.

  • 16.8% of patients developed POPF, leading to lower chemotherapy administration rates at 72.1% and a median delay of 56 days.
  • Independent predictors for chemotherapy omission include age ≥ 70 (odds ratio 2.48) and chronic renal failure (odds ratio 4.55) when POPF occurs.
  • In patients without POPF, factors like venous contact and tumor size also influence chemotherapy delivery.

Assessing POPF risk preoperatively can refine patient selection for surgery and enhance treatment outcomes.

Journal Article by Giannone F, Palucci M (…) Panaro F et 39 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Same-Admission Cholecystectomy Cuts Risks for Cholangitis Patients

Performing cholecystectomy at the same admission for patients with choledocholithiasis-associated cholangitis significantly lowers complications and readmissions.

  • Same-admission cholecystectomy led to a 1.3% 30-day readmission rate versus 13.8% for deferred surgery (p=0.0023).
  • Recurrence of biliary events was virtually eliminated (0%) in those treated same-admission compared to 56.5% in deferred cases (p<0.001).

Surgical delay poses increased risks, even in grade III cholangitis. Consider immediate surgery following clinical stabilization to improve outcomes.

  • Deferred surgery was often due to perceived high surgical risk (21.3%) or patient preference (14.9%).

Journal Article by Chandrashekar A, Jajoo AN (…) Akshintala VS et 7 al. in Dig Dis Sci

© 2026. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Transforming Gallbladder Drainage for Acute Cholecystitis

Endoscopic ultrasound-guided gallbladder drainage is now more effective than traditional methods for patients unfit for surgery.

  • EUS-guided drainage shows higher technical success rates and better patient outcomes compared to percutaneous methods.
  • Fewer complications and reinterventions are reported with EUS compared to previous techniques.

Surgeons should consider EUS for optimal patient selection in non-surgical candidates, balancing drainage effectiveness with long-term considerations.

  • Individualized approaches in multidisciplinary teams are essential for managing complex cases.

Journal Article by Ko SW, Oh D and Song TJ in J Gastroenterol

© 2026. The Author(s).

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New Insights on DNR Orders in Elderly Surgical Patients

In older adults undergoing surgery, new Do Not Resuscitate (DNR) orders often indicate significant risk factors and timing that can guide surgical decision-making.

  • Only 2.3% of 47,564 cases resulted in new perioperative DNR orders.
  • Key predictors of DNR orders: ASA IV/V (2.6x), disseminated cancer (3.3x), and emergent surgery (3.5x).

DNR orders typically occur early post-surgery; 32.5% were placed within 24 hours.

  • Among patients who died, DNR was commonly set 5.2 days prior to death, emphasizing a need for prompt goals-of-care conversations.

Journal Article by Remer SL, Smolkin C (…) Russell MM et 2 al. in J Am Coll Surg

Copyright © 2026 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Navigating Surgical Responsibilities in Acute GI Care

Surgeons must clarify roles between acute care and colorectal surgeons for better patient outcomes in acute lower gastrointestinal conditions.

  • Consensus reached on service assignment for only 10 of 20 conditions (50%).
  • Key determinants for service allocation include surgeon expertise, patient status, and institutional resources.

Understanding these factors can enhance triage protocols and improve patient management in dual-coverage settings.

  • Emergency management skills were prioritized for unstable patients, indicating the need for flexibility in assignments.

Journal Article by Myers S, Murillo A (…) Davids JS et 6 al. in J Am Coll Surg

Copyright © 2026 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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