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Improved Risk Models for Emergency Bowel Cancer Surgery Using Electronic Health Records

Linked electronic health records were used to develop a risk model for 90-day mortality in patients undergoing emergency colorectal cancer (CRC) surgery. The selected model, which included additional physiological and surgical measures along with patient and tumor characteristics, showed considerably better discrimination compared to the basic model. The inclusion of these measures improved the accuracy of predicting mortality risk for CRC patients having emergency surgery, allowing for more accurate performance monitoring and enhanced clinical care planning.

Journal Article by Blake HA, Sharples LD (…) Walker K et 7 al. in Int J Surg

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.

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Video-Based Indocyanine Green Fluorescence Enables Safe and Effective Robotic Duodenum-Preserving Pancreatic Head Resection

Robotic duodenum-preserving pancreatic head resection (DPPHR) utilizing video-based indocyanine green fluorescence imaging was successfully performed on a 48-year-old patient with pancreatic duct stones and chronic pancreatitis. The surgery lasted 265 minutes with minimal blood loss. Postoperative pathology confirmed the diagnoses, and the patient was discharged without complications after 13 days. This technique, employed in four total cases, proved to be secure and feasible, offering new possibilities for patients with uncertain delineation between pancreatic and biliary ductal structures.

Journal Article by Li Y, Zong K (…) Zhou B et 3 al. in Ann Surg Oncol

© 2024. Society of Surgical Oncology.

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Normal CEA Levels Predict Improved Survival in Colorectal Peritoneal Metastases

Normal CEA levels (≤ 2.5 ng/ml) after neoadjuvant chemotherapy (NACT) and cytoreductive surgery with hyperthermic intraperitoneal chemoperfusion (CRS/HIPEC) are associated with better survival in patients with colorectal peritoneal metastases (CRPM). A retrospective study on 253 CRPM patients showed that those with normal CEA levels after NACT had a median overall survival of 45.2 months, compared to 26.4 months for those with elevated CEA. Patients who normalized CEA levels post-surgery had similar survival to those with normal preoperative levels and better survival than those with elevated CEA postoperatively.

Journal Article by Wach MM, Nunns G (…) Ongchin M et 10 al. in Ann Surg Oncol

© 2024. Society of Surgical Oncology.

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SMG: A Novel Muscle Parameter Predicts Prognosis in Resectable Gastric Cancer

The study included 717 patients and found that the new muscle parameter, SMG, obtained by multiplying the skeletal muscle index (SMI) and skeletal muscle radiation attenuation (SMRA), can predict the prognosis of patients with gastric cancer. The findings showed that SMG can effectively predict both short-term outcome and long-term prognosis, suggesting its potential as a valuable tool in clinical practice. Further study of SMG as a muscle parameter index is warranted.

Journal Article by Zhong Q, Huang JB (…) Li P et 7 al. in Ann Surg Oncol

© 2024. The Author(s).

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Comparison of outcomes in different approaches to unilateral groin hernia repair in the United States

Researchers conducted a multicenter analysis using the Abdominal Core Health Quality Collaborative database to compare the outcomes of unilateral groin hernia repair approaches in the United States. The study included patients who underwent open inguinal hernia repair, laparoscopic transabdominal preperitoneal, laparoscopic total extraperitoneal, and robotic transabdominal preperitoneal repair. The results showed that there were no significant differences in hematoma, surgical site infection, readmission, reoperation, or hernia recurrence at 30 days or 1 year. However, laparoscopic transabdominal preperitoneal was associated with a higher seroma rate, and the robotic approach had the lowest recurrence rate but did not reach statistical significance.

Journal Article by Lima DL, Nogueira R (…) Sreeramoju P et 4 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Direct oral anticoagulants are effective and safe for extended thromboprophylaxis after major abdominal/pelvic cancer surgery

The use of direct oral anticoagulants (DOACs) as an alternative to low-molecular-weight heparin (LMWH) for extended thromboprophylaxis after major abdominal/pelvic cancer surgery is effective and safe. A systematic review and meta-analysis of 9 studies, including 2651 patients, found that DOACs had a similar incidence of venous thromboembolism (VTE) compared to LMWH. These findings suggest that DOACs can be a suitable option for extended thromboprophylaxis in these patients.

Review by Zhou H, Ye LL (…) Zhang JH et 3 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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Higher Mortality Rates and Complications Found in Cirrhotic Trauma Patients Undergoing Emergency Laparotomy

This retrospective cohort study analyzed the outcomes of adult trauma patients with liver cirrhosis (lc) who underwent laparotomy or non-operative management (nom). Among 929 patients, 38.2% underwent laparotomy and 61.7% received nom. Patients who underwent laparotomy had higher in-hospital mortality rates (52.3% vs 20.0%), increased rates of acute renal failure, required more blood transfusions, and had longer ICU stays compared to those who received nom. Therefore, cirrhotic trauma patients undergoing emergency laparotomy face higher mortality rates and complications than those managed non-operatively.

Journal Article by Elkbuli A, Breeding T (…) Rhodes H et 6 al. in Am Surg

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Implications of precursor lesions and early cancerous changes in the gallbladder and bile ducts

The study explores terminology, classification, and significance of dysplasia and early carcinoma in the gallbladder and bile ducts. Most precursor lesions and early cancerous changes are clinically undetectable. Low-grade dysplasia is challenging to define and lacks clinical significance, but additional sampling is required to exclude significant lesions. High-grade dysplasia (carcinoma in situ) necessitates complete sampling to rule out invasion. Visible masses (intracholecystic and intraductal neoplasms) account for 5% to 10% of invasive cancers. Different subtypes of neoplasms exhibit varying clinical behavior, with some having a protracted clinical course and others leading to mortality.

Review by Adsay NV and Basturk O in Gastroenterol Clin North Am

Copyright © 2023 Elsevier Inc. All rights reserved.

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Operative outcomes and complication rates are similar for open and minimally invasive repair of Spigelian hernias

A retrospective chart review of 43 cases of Spigelian hernias over a 10-year period found that a laparoscopic approach was the preferred method of repair in 74% of cases. The predominant hernial content was fat only, and 65% of cases had a history of prior abdominal surgery unrelated to the Spigelian belt location. Complications occurred in 19% of cases, but there was no statistically significant difference in operative outcomes, complication rates, or predisposing factors between open and minimally invasive case groups.

Journal Article by Clark CR, Kelly ML and Palamuthusingam P in Hernia

© 2024. Crown.

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Prophylactic mesh augmentation reduces incisional hernia incidence in emergency laparotomy closure

Prophylactic mesh augmentation in emergency laparotomy closure was evaluated through a meta-analysis of randomized controlled trials. After reviewing 33 studies, four were included in the analysis, involving 464 patients. The results showed a significant decrease in incisional hernia incidence when mesh reinforcement was used (OR 0.18; 95% CI 0.07-0.44; p < 0.001). Despite the risk of seroma, prophylactic mesh augmentation was deemed safe and could be considered for emergency laparotomy closure. Further long-term studies are necessary to assess outcomes.

Review by Marcolin P, Mazzola Poli de Figueiredo S (…) Moffett JM et 4 al. in Hernia

© 2024. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.

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