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Surgeon-Driven Cost Variability in Gastrointestinal Operations

Cost aspects of care episodes attributable to surgeons’ management decisions were evaluated in a tertiary academic cancer center. A study involving 1540 patients undergoing gastrointestinal operations revealed significant variations in total direct costs between surgeons. The main drivers of cost differences included operating room (OR) supplies, central medical supply, laboratory, and supportive care. This study highlights the importance of surgeons’ variable utilization of ORs and medical supplies in determining care-related costs, emphasizing the need for cost-effective practices and supply optimization to enhance value generation.

Journal Article by Sarkar J, Roehner RP, Proulx MJ and Schwarz RE in J Surg Res

Copyright © 2023 Elsevier Inc. All rights reserved.

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Estimating the Rate of Low-Yield Surgery in Pancreatic Cancer Surveillance

The prevalence meta-analysis aimed to determine the rate of low-yield surgery in pancreatic cancer surveillance. A systematic search of relevant studies was conducted, including 5027 patients from 23 articles. The pooled prevalence of low-yield surgery was found to be 2.1%, with a slightly higher prevalence among familial pancreatic cancer subjects without known pathogenic variants. The overall prevalence of subjects under surveillance who had pancreatic resection with target lesions was 0.8%. The rate of low-yield surgeries decreased over time and stabilized at around 1%.

Journal Article by Paiella S, Secchettin E (…) Capurso G et 17 al. in Ann Surg

Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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Racial Disparity in Esophageal Cancer Treatment and Survival

Black individuals with esophageal squamous cell carcinoma (ESCC) have a lower survival rate compared to white individuals. This disparity could be attributed to presenting at a later stage of the disease and differences in treatment received, including chemotherapy, radiation, and surgery. Black individuals were less likely to receive these treatments even when diagnosed at the same stage as white individuals. Further investigation is required to determine the factors contributing to these treatment disparities, such as structural racism, social determinants of health, implicit bias, or patient preferences.

Journal Article by Noureldin M, Rubenstein JH (…) Waljee AK et 5 al. in Am J Gastroenterol

Copyright © 2023 by The American College of Gastroenterology.

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Standardized Technique and Assessment Tool for Minimally Invasive Right Hemicolectomy

Researchers achieved national consensus on the optimal and standardized technique for minimally invasive right hemicolectomy (MIrh) in colon cancer. The study involved formulating consensus statements and conducting three rounds of the Delphi technique with 76 colorectal surgeons. The development and validation of a video-based competency assessment tool (CAT) for MIrh showed high consistency among surgeons, with an overall intraclass correlation coefficient of 0.923. This nationwide quality improvement project is an important step towards standardizing and optimizing MIrh procedures.

Journal Article by Grüter AAJ, Toorenvliet BR (…) Tuynman JB et 10 al. in Br J Surg

© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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Safety and Efficacy of Percutaneous Jejunostomy Tube Placement Outperforms Surgical Methods

A retrospective analysis comparing direct percutaneous endoscopic jejunostomy (DPEJ) tube placement with laparoscopic (Lap-J) and open laparotomy (Open-J) surgical methods revealed similar procedural success rates and complication rates in all three approaches. However, patients who underwent DPEJ experienced significantly lower rates of tube dysfunction within 90 days compared to surgical groups, primarily due to reduced instances of tube clogging and dislodgement. DPEJ is a safe and effective alternative to surgical jejunostomy, providing eligible patients with improved outcomes and decreased complication rates.

Journal Article by Locke J, Norwood D (…) Peter S et 6 al. in Gastrointest Endosc

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

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Low Accuracy of Preoperative Imaging in Detecting Lymph Node Metastasis in Pancreatic Neuroendocrine Tumors

A multi-institutional study investigated the accuracy of preoperative imaging in detecting lymph node metastasis (lnm) in patients with pancreatic neuroendocrine tumors (pnets). They found that traditional imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET)-CT, and octreoscan had low sensitivities to determine nodal status. Preoperative imaging indicating nodal involvement (in1) was associated with a higher number of lymphadenectomies and a higher risk of recurrence compared to preoperative imaging indicating no nodal involvement (in0).

Journal Article by Zhang N, He J (…) Pawlik TM et 9 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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The Impact of Food Insecurity on Surgical Outcomes in Colorectal Cancer Patients

The study assessed the association between food insecurity and surgical outcomes in colorectal cancer patients. It found that high levels of food insecurity were linked to higher odds of nonelective surgery, 90-day readmission, extended length-of-stay, and complications. Patients with high food insecurity also had decreased odds of being discharged to home and achieving textbook outcomes. Additionally, high food insecurity minority patients had increased odds of complications and longer hospital stays compared to low food insecurity white patients.

Journal Article by Azap L, Woldesenbet S (…) Pawlik TM et 9 al. in Dis Colon Rectum

Copyright © The ASCRS 2023.

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Laparoscopic Surgery Attenuates Early Inflammatory Response in Colorectal Cancer

Researchers conducted a systematic review and meta-analysis comparing laparoscopic surgery (LS) to open surgery (OS) in patients with colorectal cancer. They found that LS resulted in milder proinflammatory reactions, as indicated by lower concentrations of inflammatory markers such as interleukins and C-reactive protein. The difference was particularly notable within the first 9 hours after surgery. These findings support the hypothesis that LS may have clinical benefits due to reduced operative trauma and its impact on humoral immunity.

Review by Bohne A, Grundler E (…) Fürst A et 2 al. in Surg Endosc

© 2023. The Author(s).

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Minimally invasive repeat hepatectomy is a safe alternative to open repeat hepatectomy

A cohort study comparing minimally invasive repeat hepatectomy (MIRH) and open repeat hepatectomy (ORH) revealed that MIRH is a feasible and safe approach after previous open hepatectomy. Among 46 patients included in the study, 43% underwent MIRH and 57% underwent ORH. MIRH was associated with less blood loss and shorter length of stay compared to ORH, while postoperative complications were similar between the two groups. These findings suggest that MIRH can be considered as a viable option for patients with liver tumors after previous open liver resections.

Journal Article by Birgin E, Abdelhadi S (…) Rahbari NN et 5 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Fibrin Sealant Effectively Closes Mucosal Penetrations during Gastrointestinal Submucosal Tumor Resection

The study aimed to assess the efficacy and safety of using a fibrin sealant for closing mucosal penetrations at the esophagus or cardia during submucosal tunnelling endoscopic resection (STER) for gastrointestinal submucosal tumors. A total of 31 mucosal penetrations were identified in 30 patients who received the fibrin sealant. The results showed that the fibrin sealant was both safe and effective in closing the mucosal penetrations, which had a mean size of 0.08 ± 0.06 cm. Further research is needed to evaluate the use of the sealant for wider mucosal penetrations.

Journal Article by Wang J, Zhang W (…) Linghu E et 5 al. in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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