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Advanced Surgical Treatment of Pancreatic Ductal Adenocarcinoma: Current Challenges and Opportunities

Recent advancements in chemo/radiotherapy have rendered previously inoperable patients with pancreatic ductal adenocarcinoma (PDAC) potentially resectable. This narrative review highlights the current state of surgical treatment for borderline resectable, locally advanced, and synchronous or metachronous oligometastatic PDAC. Neoadjuvant therapy (NAT) is recommended before surgery, although the best response rate is still limited. Methods for selecting NAT responders and identifying non-responders early remain uncertain. Imaging techniques like multidetector computed tomography have some limitations, while CA 19-9 and positron emission tomography show promise. High-level evidence supporting the surgical benefit in these cases is lacking, emphasizing the need for specialized interdisciplinary teams in high-volume centers.

Review by Pedrazzoli S in J Clin Med

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Individualized Age Cessation in IPMN Surveillance: A Cost-Effectiveness Analysis

Researchers conducted a simulation study to determine the optimal age to discontinue long-term surveillance of low-risk intraductal papillary mucinous neoplasms (IPMNs). Using a markov model and clinical cohort data, they calculated the cost-effectiveness of continued versus discontinued surveillance at different ages. They found that the optimal age to stop surveillance varied based on sex and IPMN types, with suggested ages ranging from 70 to 84 years. The study emphasized the importance of considering individual factors, such as comorbidity levels, in the decision-making process for IPMN surveillance.

Journal Article by Hamada T, Oyama H (…) Fujishiro M et 8 al. in Gut

© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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Indocyanine Green-Guided Laparoscopic RLPS: Safe and Feasible for Synchronous Liver Metastases

Laparoscopic right posterior sectionectomy (RLPS) with an extrahepatic Glissonian approach and modified hanging maneuver, guided by indocyanine green fluorescence imaging, proves safe and feasible for a patient with mid-rectum adenocarcinoma and synchronous liver metastases. The procedure involves selective clamping, indocyanine green injection, and precise parenchymal transection along a marked plane. Detaching a metastasis from the right hepatic vein ensures adequate venous drainage of the remaining liver, highlighting the oncological safety of this approach.

Journal Article by Livin M, Maillot B (…) Jeddou H et 2 al. in Ann Surg Oncol

© 2024. Society of Surgical Oncology.

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Laparoscopic Portal Vein Ligation and Embolization Facilitate Safe Second Hepatectomy for Unresectable Colorectal Liver Metastases

Laparoscopic two-stage hepatectomy with portal vein embolization ensures safe completion of surgery for initially unresectable colorectal liver metastases. Three patients received chemotherapy followed by laparoscopic colorectal resection and limited hepatectomies. After right portal vein ligation, laparoscopic portal vein embolization using ethanol facilitated the second hepatectomy. No postoperative complications occurred in six surgeries, suggesting the safety and efficacy of this approach.

Journal Article by Ono Y, Inoue Y (…) Takahashi Y et 6 al. in Ann Surg Oncol

© 2024. Society of Surgical Oncology.

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Adjuvant Therapy Trends Post Resection in Pancreatic Cancer

Approximately 25.2% of pancreatic cancer patients who underwent upfront resection did not receive adjuvant therapy (AT), according to a prospective observational study. The main reasons for AT omission were postoperative complications, oncologist’s choice, baseline comorbidities, patient’s choice, and early recurrence. Older age, comorbidities, and postoperative complications were the main factors associated with AT omission. Additionally, older age, early-stage disease, and postoperative major complications were linked to not receiving a specific AT regimen called folfirinox. Patients experiencing postoperative complications also had a higher likelihood of delayed AT administration.

Journal Article by Paiella S, Malleo G (…) Salvia R et 6 al. in Ann Surg Oncol

© 2024. The Author(s).

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Transoral thyroidectomy associated with higher postoperative pain levels compared to conventional thyroidectomy

The study compared postoperative pain levels between transoral and conventional transcervical thyroidectomy. After matching patients based on six covariates, the transoral group had higher pain scores than the conventional group from day 1 to day 6 post-surgery, with no significant difference at 1 month. Among transoral procedures, the endoscopic approach had significantly higher pain scores than the robotic approach on days 1 and 3 post-surgery. The study concluded that postoperative pain was significantly higher in transoral thyroidectomy compared to conventional thyroidectomy, particularly during the early postoperative period.

Journal Article by Park MK, Nguyen VC (…) Tae K et 4 al. in Surg Endosc

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Nonradiation-guided and Digital Cholangioscopy-assisted Endoscopic Intervention for Cholelithiasis Shows High Efficacy and Safety

This study evaluated the feasibility, efficacy, and safety of a digital cholangioscopy-assisted endoscopic intervention for cholelithiasis. The procedure achieved biliary access in 285 patients with a 100% success rate for exploring the common bile duct, cystic stump, hilar ducts, and secondary radicals. Stone clearance was successful for the majority of patients, including those with difficult-to-treat choledocholithiasis and hepatolithiasis. The technique had fewer complications and a lower risk of stone recurrence compared to conventional endoscopic procedures. This modality offers a feasible and effective approach for removing cholelithiasis.

Journal Article by Feng Y, Liang Y (…) Shi R et 6 al. in Surg Endosc

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Chewing Gum before Thyroid Surgery Reduces Postoperative Sore Throat

Chewing 2.8g of gum prior to total thyroidectomy surgery can significantly decrease the incidence of moderate/severe postoperative sore throat within 48 hours after the procedure. This finding was established through a randomized controlled trial involving 148 patients, with the 2.8g gum group demonstrating a lower incidence of postoperative sore throat compared to the control group. The reduction in sore throat occurrence highlights the potential benefits of chewing gum prior to surgery as a simple and inexpensive intervention.

Journal Article by Zou S, Guo L (…) Qi D et 4 al. in World J Surg

© 2023 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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Increased Mortality Associated with Myocardial Injury after Surgery in Acute High-risk Abdominal Surgery Patients

Mortality rates among patients undergoing acute high-risk abdominal surgery were significantly higher among those with myocardial injury after surgery (MINS), defined as elevated troponin I (TNI) levels. The incidence of MINS was 23.8%, and these patients had a 30-day mortality rate of 19.8%, compared to 2.7% in patients without MINS. TNI monitoring could potentially identify patients at increased risk of mortality, leading to improved care. No significant difference in mortality was found based on dynamic changes in TNI levels.

Journal Article by Kanstrup CTB, Serup CM (…) Bertelsen CA et 4 al. in World J Surg

© 2024 The Authors. World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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Risk factors for anastomotic dehiscence in patients receiving negative pressure wound therapy after intestinal anastomosis.

The use of negative pressure wound therapy (NPWT) during intestinal anastomosis has been controversial. A single-center cohort study was conducted to identify risk factors for anastomotic dehiscence in patients who received NPWT therapy. The study found that females, delayed fascial closure, use of vasopressors, and NPWT pressures >110 mmHg were associated with a higher risk of anastomotic dehiscence. These findings suggest that caution should be exercised when using NPWT in patients undergoing intestinal anastomosis.

Journal Article by Gómez Garnica DG, Rey Chaves CE (…) Falla A et 2 al. in J Surg Res

Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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