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Higher rates of unplanned surgery, longer hospital stays, and increased costs among people experiencing homelessness who undergo surgery for malignancy

People experiencing homelessness (PEH) who undergo surgery for malignancy face significant barriers to access care and experience poorer outcomes compared to housed patients. This retrospective cohort study of 67,034 patients in three US states found that PEH more frequently underwent unplanned surgery (65.3% vs 23.7%) and had longer hospital stays (67.7% longer) compared to housed patients. Furthermore, PEH had higher odds of facility discharge, readmission, and 32.7% higher costs. These findings highlight the need for improved access to oncologic care for PEH.

Journal Article by Silver CM, Janczewski LM (…) Merkow RP et 6 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Near-Infrared Fluorescence Identification of Thoracic Duct: Feasible and Safe in Various Patient Populations

The study evaluated the efficacy and safety of near-infrared fluorescence identification of the thoracic duct during left lateral neck dissection. Results showed that near-infrared fluorescence visualization successfully identified the thoracic duct in a higher percentage of patients compared to ambient light. The procedure was feasible and safe, even in patients with prior neck surgery or radiation. The optimal timing of indocyanine green administration was found to be within 3 minutes of injection. No chylous fistulas were observed postoperatively. These findings highlight the potential of near-infrared fluorescence as a reliable intraoperative imaging modality.

Journal Article by Owusu-Brackett N, Chakedis JM (…) Phay JE et 6 al. in BMC Surg

Copyright © 2023. Published by Elsevier Inc.

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Perioperative Oral Care Management Reduces Surgical Site Infections after Pancreaticoduodenectomy

A retrospective multicenter analysis involving 503 patients who underwent pancreaticoduodenectomy revealed that perioperative oral care management significantly reduces the incidence of organ/space surgical site infections. Patients who received oral care management had a lower rate of complications compared to those who did not. The study also identified hypertension and lack of perioperative oral management as independent risk factors for surgical site infections. The findings suggest that perioperative oral care management should be recommended to prevent infections after pancreaticoduodenectomy.

Journal Article by Yamguchi T, Mori K (…) Nakahara H et 12 al. in BMC Surg

Copyright © 2023. Published by Elsevier Inc.

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58.2% of Distal Pancreatectomies Achieve Textbook Outcomes

The study aimed to determine the textbook outcome in distal pancreatectomy by analyzing a multicenter database. The specific definition of textbook outcome included factors such as hospital stay, complications, mortality, readmission, and absence of pancreatic fistula. Among the 450 patients included, 58.2% achieved textbook outcomes. Prolonged hospital stay was the most common factor associated with failure to achieve textbook outcomes. The results showed that several preoperative, operative, and postoperative factors were significantly associated with either achieving or failing to achieve textbook outcomes.

Journal Article by Villodre C, Del Río-Martín J (…) Ramia JM et 19 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Quantitative Indocyanine Green Metrics Reliable for Intestinal Margin Acceptance in Colorectal Surgery

A study conducted at a tertiary academic center investigated the correlation between quantitative indocyanine green metrics and subjective indocyanine green perfusion assessment in determining the acceptance or rejection of anastomotic margins. The study included 89 perfusion assessments in 156 intestinal segments. The results showed that higher maximum fluorescence intensity and earlier time to maximum fluorescence were associated with accepted perfusion. Increased body mass index also correlated with higher maximum fluorescence. However, no correlation was found between maximum fluorescence or time to maximum fluorescence and anastomotic leaks. The study suggests that quantitative indocyanine green metrics can enhance intraoperative intestinal perfusion assessment, and further studies can explore its correlation with anastomotic leaks.

Journal Article by Adams ED, Salem JF (…) Zaghiyan KN et 2 al. in Dis Colon Rectum

Copyright © The ASCRS 2023.

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Prognosis of Laparoscopic Hepatectomy for BCLC Stage 0/A HCC with Clinically Significant Portal Hypertension

Patients with BCLC stage 0/A hepatocellular carcinoma (HCC) and clinically significant portal hypertension (CSPH) who underwent laparoscopic hepatectomy had worse overall and recurrence-free survival rates compared to those without CSPH. However, CSPH patients treated laparoscopically had better short- and long-term prognoses than those treated with open surgery. This study highlights the importance of careful patient selection for laparoscopic hepatectomy in BCLC stage 0/A HCC patients with CSPH.

Journal Article by Xia F, Zhang Q (…) Xia G et 4 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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Robotic Pancreatoduodenectomy Improves Oncologic Outcomes in Pancreatic Duct Adenocarcinoma

After the learning curve, robotic pancreatoduodenectomy (RPD) demonstrated improved oncologic outcomes in patients with pancreatic duct adenocarcinoma (PDAC) compared to open pancreatoduodenectomy (OPD). A retrospective analysis of 548 patients revealed that RPD had longer overall survival (33.2 months vs. 25.7 months) and disease-free survival (18.5 months vs. 14.0 months) than OPD. RPD also had a lower incidence of local recurrence compared to OPD. Multivariate analysis confirmed RPD as an independent factor associated with improved survival. Prospective randomized trials are needed to validate these findings.

Journal Article by Chen H, Weng Y (…) Shen B 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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Strategies to Enhance Trainee Engagement in Surgical Trainee Research Collaboratives

Trainee surgeons engaged in surgical trainee research collaboratives (TRCs) to improve patient care, surgical evidence, and progress their careers. The study revealed that building relationships with key stakeholders, maximizing multi-disciplinary working, and offering training and career development opportunities were effective strategies to enhance trainee engagement in TRCs. Challenges included limited time and confidence, recognition, and competing priorities. Consultant support, initial simple rapid studies, transparency of involvement, and recognition for trainees (including authorship policies) were identified as key strategies to enhance TRCs. Trainee engagement in TRCs can be valuable through wider patient access and improvements in surgical practice.

Journal Article by Clement C, Coulman K (…) Lane JA et 14 al. in BMJ Open

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

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Addressing Inequities in Global Cancer Surgery: Solutions for Improved Access and Outcome

Access and quality disparities in surgical cancer care between high and low resource settings have a direct impact on oncological outcomes. As cancer rates continue to rise worldwide, this study investigates the factors contributing to these inequities and proposes potential solutions to overcome the challenges. The findings emphasize the urgent need for global efforts in order to ensure fair access to surgical cancer care and improve long-term outcomes.

Review by Ranganathan P, Dare A (…) Pramesh CS et 5 al. in J Surg Oncol

© 2023 Wiley Periodicals LLC.

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Optimizing Polyp Recurrence Prevention: Comparing Techniques in Colorectal EMR

A study compared different techniques for reducing recurrence rates after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps. The direct and indirect comparisons showed that EMR combined with submucosal tunneling endoscopic submucosal dissection (EMR+STSC) and underwater EMR (U-EMR) had significantly lower odds of polyp recurrence compared to EMR alone. The p-score ranking indicated that EMR+STSC is a potential first method for reducing polyp recurrence, followed by U-EMR, EMR+APC, and EMR alone. Standardization of methods to detect and prevent polyp recurrence at the time of EMR is necessary.

Review by Radadiya D, Desai M (…) Sharma P et 6 al. in Gastrointest Endosc

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

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