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Low Reliability of Complications and Patient Satisfaction Measures among Surgeons Performing Common Surgical Procedures

Outcomes of complications and patient satisfaction are frequently used to evaluate surgeons, but this study finds that these measures have low reliability. The research involved 333 surgeons who performed cholecystectomy, colectomy, and hernia repair on 23,533 patients. The reliability of complication rates was only 0.27, while the reliability of high satisfaction rates was 0.53. Reliability increased with case volume, but the majority of surgeons did not have enough cases to achieve acceptable reliability. These findings suggest that current outcomes measures may not provide meaningful information for decision-making.

Journal Article by Howard R, Thumma J and Englesbe M in Ann Surg

Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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Odor Enrichment Mitigates Surgery-Induced Cognitive Impairment

Patients with delayed neurocognitive recovery (DNCR) exhibited worse odor identification compared to those without DNCR. Anesthesia/surgery induced olfactory and cognitive impairment, increased levels of interleukin-6 (IL-6), reduced olfactory receptor neurons and synapses in mice. Odor enrichment and IL-6 antibody alleviated these effects. The study suggests that anesthesia/surgery-induced olfactory impairment may contribute to DNCR in patients and postoperative cognitive impairment in mice. Odor enrichment could be a potential intervention for mitigating these cognitive impairments.

Journal Article by Zhang C, Han Y (…) Xie Z et 11 al. in Ann Surg

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

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Adjuvant Therapy Timing Impact on PDAC Prognosis: Significance in Transitional Circulating Tumor Cells

The study found that a delay in the initiation of adjuvant therapy in patients with pancreatic ductal adenocarcinoma (PDAC) is associated with worse recurrence-free survival only in those who have transitional circulating tumor cells (trCTCs) after surgical resection. The presence of trCTCs and the absence of adjuvant therapy were both linked to poorer prognosis. However, timely initiation of adjuvant chemotherapy in patients with trCTCs did not impact recurrence-free survival. These results suggest that a delay in adjuvant therapy may provide an opportunity for residual systemic disease to recover.

Journal Article by Javed AA, Floortje van Oosten A (…) Wolfgang CL et 12 al. in Ann Surg

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Total Pancreatectomy with Islet Autotransplantation: A Safer Alternative to Pancreaticoduodenectomy in High-risk Patients

In a prospective randomized trial, researchers compared pancreaticoduodenectomy (PD) and total pancreatectomy (TP) with islet autotransplantation (IAT) in high-risk patients. They found that TP-IAT had a lower morbidity rate and shorter postoperative stay compared to PD. PD was associated with a higher risk of complications, while TP-IAT had a higher risk of diabetes. However, most TP-IAT patients maintained good metabolic control and sustained c-peptide production over time. These results suggest that TP-IAT may be a viable alternative for high-risk patients.

Journal Article by Balzano G, Zerbi A (…) Piemonti L et 16 al. in Ann Surg

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

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Laparoscopic pancreatoduodenectomy (LPD) is feasible and as safe and efficient as open pancreatoduodenectomy (OPD) when performed by highly skilled surgeons in high-volume centers

LPD and OPD were compared in this study, and it was found that LPD is feasible and equally safe and efficient as OPD when performed by highly skilled surgeons in high-volume centers. LPD has a shorter length of hospital stay, shorter ICU stay, lower blood loss, lower blood transfusion rate, and lower surgical site infection rate. However, LPD has a longer duration of operation. The overall certainty of the evidence was moderate.

Journal Article by Sattari SA, Sattari AR (…) He J et 2 al. in Ann Surg

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Surgical Principles for Small Bowel Neuroendocrine Tumor Resection

Small bowel neuroendocrine tumors (SB-NETs) are increasingly identified and have become the most frequent entity among small bowel tumors. Surgical treatment goals include control of tumor volume, endocrine secretion, and prevention of locoregional complications. The study presents eight steps for systematic surgical planning and execution of resection. The role of primary tumor resection in the presence of liver metastasis is still unclear. Feasibility of minimally invasive surgery is emerging, with undetermined selection criteria and long-term outcomes. Resection of SB-NETs should be considered in all eligible patients, following appropriate surgical oncological control principles.

Review by Søreide K, Stättner S and Hallet J in Ann Surg Oncol

© 2023. The Author(s).

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Long-term Survival in Patients with Colorectal Peritoneal Carcinomatosis Treated with CRS/HIPEC

Actual 5-year survival rates after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) for patients with peritoneal carcinomatosis (PC) of colorectal origin were reported in this study. A total of 103 patients were analyzed, with a median follow-up of survivors at 88 months. The 5-year overall survival (OS) was 36%, and the median OS was 42.5 months. Factors associated with poor survival included high peritoneal cancer index (PCI) and incomplete CRS. However, patients with low PCI who underwent complete surgical resection achieved favorable long-term survival with a 5-year OS of 60.7%.

Journal Article by Sarfaty E, Khajoueinejad N (…) Cohen NA et 5 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Definition of Textbook Outcome in Liver Surgery (TOLS)

Renowned international liver surgeons achieved consensus on the definition of Textbook Outcome in Liver Surgery (TOLS) using a modified Delphi method. The TOLS definition includes the absence of intraoperative incidents, postoperative complications, bile leakage, liver failure, readmission due to major complications, mortality within 90 days, and the presence of a clear resection margin. This consensus-based definition of TOLS allows for standardized evaluation of patient outcomes and facilitates international comparisons to improve overall surgical results.

Journal Article by Görgec B, Benedetti Cacciaguerra A (…) Abu Hilal M et 50 al. in Ann Surg

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

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Safety and Efficacy of Pancreatectomy with Vein Resection for Pancreatic Head Cancer

Pancreatectomy with resection of the portal vein and/or superior mesenteric vein, along with jejunal vein resection, is a safe procedure for patients with pancreatic ductal adenocarcinoma. The study found that postoperative complications and mortality rates were similar across all groups. Overall survival did not significantly differ between patients who underwent pancreatectomy with portal vein and/or superior mesenteric vein resection alone and those who had jejunal vein resection as well. Adjuvant therapy and achieving complete resection were identified as independent factors affecting survival.

Journal Article by Nagakawa Y, Jang JY (…) Endo I et 22 al. in Ann Surg

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Perioperative Circulating Tumor DNA Dynamics Impact Outcomes for Colorectal Liver Metastases Patients Undergoing Hepatectomy

Perioperative circulating tumor DNA (ctDNA) dynamics have been found to correlate with outcomes in patients undergoing hepatectomy for colorectal liver metastases (CLM). In this prospective study, 48 patients were analyzed for ctDNA presence before and after surgery. It was found that patients with ctDNA detected both before and after surgery had worse recurrence-free survival (RFS) compared to those with ctDNA detected only before surgery or not at all. These findings suggest that monitoring perioperative ctDNA dynamics can help identify patients at high risk of recurrence and guide treatment decisions and surveillance strategies.

Journal Article by Newhook TE, Overman MJ (…) Vauthey JN et 19 al. in Ann Surg

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