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Physical Prehabilitation Reduces Short-Term Outcomes in Patients Undergoing Major Abdominal Surgery

Physical prehabilitation is recommended before major abdominal surgery to improve short-term outcomes. A comprehensive systematic review and network meta-analysis of 25 studies found that aerobic exercise (AE) and a combination of AE with inspiratory muscle training (IMT) were the most effective approaches in reducing overall morbidity rate and pneumonia risk. The combination of AE and IMT yielded the best incremental improvement in patient outcomes. AE also showed benefits in reducing length of stay. These findings emphasize the importance of preoperative physical activity in abdominal surgery patients.

Journal Article by Ricci C, Alberici L (…) Casadei R et 6 al. in Ann Surg Oncol

© 2023. The Author(s).

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Lymph Node Tumor Regression Grade (lntrg) is a Better Prognostic Indicator for Esophageal Squamous Cell Carcinoma

Comparing different staging categories for esophageal squamous cell carcinoma, this study determined that lymph node tumor regression grade (lntrg) demonstrated superior prognostic value for disease-free survival prediction compared to pretreatment pathologic n stage (prepn) and posttreatment pathologic n (ypn) categories. lntrg showed significant prognostic stratification power and was an independent prognostic factor. Multivariable cox regression analysis confirmed the prognostic relevance of all three categories, while decision curve analysis supported the superior predictive capacity of lntrg. Comprehensive assessment of lntrg, ypn, and prepn provides improved prognostic stratification for patients with esophageal squamous cell carcinoma.

Journal Article by Huang X, Jiang D (…) Tan L et 7 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Nonoperative Management of Appendicitis in Multi-Morbid Patients: Concerns About Generalizability

The study compared outcomes of operative and nonoperative management of acute appendicitis in multi-morbid patients. Using national inpatient data, researchers found that nonoperative management was associated with a 3.5% decrease in complications for multi-morbid patients, but it resulted in a 1.5% increase in mortality. Costs and length of stay were lower for all patients treated with surgery. Concerns were raised regarding the generalizability of prior clinical trials, which predominantly enrolled young and healthy individuals, as outcomes differed in multi-morbid patients.

Journal Article by Lunardi N, Meier J (…) Balentine CJ et 5 al. in BMC Surg

Published by Elsevier Inc.

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Indocyanine green fluorescence-guided lymphadenectomy improves lymph node retrieval in gastric cancer

The study evaluated the impact of indocyanine green (ICG) fluorescence-guided lymphadenectomy during laparoscopic gastrectomy for gastric cancer. It included 142 patients, with 42 receiving preoperative ICG injection. The ICG group exhibited a higher number of retrieved lymph nodes compared to the non-ICG group, regardless of neoadjuvant treatment or tumor stage. The use of ICG was found to be safe and feasible, with no associated complications. These findings highlight the potential of ICG-guided lymphadenectomy as a routine practice for improving lymph node dissection in gastric cancer patients.

Journal Article by Senent-Boza A, García-Fernández N (…) Morales-Conde S et 3 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Strategies to Reduce Ileus After Colorectal Surgery: Key Findings on Effective Interventions

Researchers conducted an umbrella review of 26 systematic reviews to determine strategies for reducing postoperative ileus after colorectal surgery. The most effective interventions included early oral feeding, chewing gum, and alvimopan. Early oral feeding accelerated bowel function return, while gum chewing reduced postoperative ileus by 45% and shortened time to first flatus and defecation. Coffee intake had inconsistent results. Medications such as alvimopan, intravenous lidocaine, dexamethasone, probiotics, and oral antibiotics helped hasten bowel function return. Acupuncture positively impacted recovery of bowel function.

Review by Emile SH, Horesh N (…) Wexner SD et 3 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Managing human capital in a surgical department improves productivity and well-being

Effective management of human capital in a surgical department is crucial for enhancing the well-being and productivity of all team members. This study highlights the importance of an ongoing, communication-heavy approach based on fairness and transparency. By being aware of and tending to the needs of team members, clinicians can elevate departmental and organizational productivity and wellness. The results emphasize the significance of constantly managing human capital rather than treating it as an episodic or reactive effort.

Journal Article by Cameron AM in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Contrast-enhanced computed tomography can predict metastatic potential of small nonfunctioning pancreatic neuroendocrine tumors.

Tumor vascularity on contrast-enhanced computed tomography was studied for its predictive value in determining metastatic potential in small nonfunctioning pancreatic neuroendocrine tumors. The study included 77 patients who underwent pancreatectomy for nonfunctioning pancreatic neuroendocrine tumors, with a focus on small tumors (≤2.0 cm). The results showed that the computed tomography a/e ratio was a useful predictor of the metastatic potential of these tumors, specifically in relation to the degree of fibrosis and the presence of microscopic venous invasion. These findings can potentially guide decision-making regarding the observation of small tumors.

Journal Article by Kubo H, Ohgi K (…) Sugiura T et 6 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Virtual Interviews for General Surgery Residency Applicants: Saving Time and Money, But Limiting Exposure

The study evaluates the impact of virtual recruitment and interviewing platforms on general surgery residency applicants. The results show that more than half of the applicants applied to more programs and accepted more interviews due to the virtual format, citing advantages such as saving money, time, and avoiding travel risks. However, limitations of virtual interviews included less exposure to current residents and faculty, difficulty comparing programs, and limited knowledge of the city or location. The supplemental application did not improve most applicants’ overall applications. Future efforts must balance the benefits of virtual interviews with the importance of human interaction and observing program culture.

Journal Article by Quinn KM, Runge LT (…) Abbott AM et 4 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Global Telemedicine for Surgical Wound Assessment: Lower SSIs Found in International Cohort and Meta-analysis

Using telemedicine for remote wound reviews can be upscaled globally and may help reduce the risk of SSI after surgery. In an international cohort study of over 15,000 patients from 66 countries, telemedicine follow-up resulted in slightly lower SSI rates compared to in-person review. This association persisted after risk adjustment and was consistent across sensitivity and subgroup analyses. Meta-analysis also showed that telemedicine had a lower SSI rate compared to in-person follow-up, although there was a high risk of bias in the included studies. Standardized tools for remote assessment of SSI should be evaluated and adopted as telemedicine becomes more widely used.

Journal Article by None None in Ann Surg

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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Intraoperative AI in Robotic Surgery: Scoping Review of Development and Autonomy

The scoping review identified 129 studies on intraoperative artificial intelligence (AI) applications in robotic surgery. The majority of these applications (75%) provided robot assistance, while a smaller percentage (23%) enabled task autonomy. Only a few studies (2%) achieved conditional autonomy. All studies were in early stages of development, with no clinical investigations on humans. The evaluation focus shifted from AI-specific metrics to process outcomes as the level of autonomy increased. Common standards are needed for comparison between systems in the evaluation of AI applications for robotic surgery.

Research Support, Non-U.S. Gov’t by Vasey B, Lippert KAN (…) McCulloch P et 7 al. in Ann Surg

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

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