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Thoracic duct resection does not improve survival in patients with esophageal cancer

Post author By STITCHES Newsletter
Post date 07/12/2023
Categories In General Surgery, Upper Gastrointestinal Tract

Thoracic duct (td) resection does not improve the prognosis of patients with esophageal cancer, according to a study analyzing 12,237 patients who underwent esophagectomy between 2007 and 2012 in Japan. The study found that td-resected patients had similar overall survival and cause-specific survival rates compared to td-preserved patients. However, td-resected patients had more retrieved mediastinal nodes and fewer lymph node recurrences, but also a significantly higher number of distant metastatic organs. Based on these findings, prophylactic td resection should not be recommended for patients with esophageal cancer.

Journal Article by Oshikiri T, Numasaki H (…) Doki Y et 5 al. in Ann Surg

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Factors Influencing Surgeon Adoption of Quality Standards in Advanced Cancer Care

Post author By STITCHES Newsletter
Post date 07/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

Surgeons demonstrated low adherence to documenting care preferences and surrogate decision-makers, while maintaining high adherence to discussing goals of surgery without documentation. Conflicting views arose concerning the relevance of care preferences and documentation of surrogate decision-makers. Participants questioned the direct connection between documentation of quality standards and improved patient care value. Factors influencing the adoption of quality standards included organizational culture, workflow, and multidisciplinary collaboration. Adherence to standards could be enhanced through institutional standardization, evidence linking standards to higher-value care, and improved multidisciplinary collaboration.

Journal Article by Hu FY, Tabata-Kelly M (…) Cooper Z et 5 al. in Ann Surg

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Surgeon Opioid Prescribing and Persistent Use Risk in Surgery Patients

Post author By STITCHES Newsletter
Post date 07/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

This study aimed to analyze the connection between surgeon opioid prescribing intensity and patients’ subsequent persistent opioid use post-surgery. The results indicate that patients with surgeons in the highest intensity quartile were more likely to fill opioid prescriptions within 7 days after surgery compared to those with surgeons in the lowest quartile. While the primary analysis showed a rare incidence of persistent opioid use in both quartiles, stricter definitions revealed a significant association between surgeon quartile and persistent use. Surgeons’ prescribing practices may contribute to persistent opioid use and should be targeted for improvement.

Journal Article by Wunsch H, Hill AD (…) Neuman MD et 5 al. in Ann Surg

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Antibiotic Duration for Complicated Intraabdominal Infection Unchanged Despite Landmark Study

Post author By STITCHES Newsletter
Post date 07/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

Researchers conducted a population-based study to determine if the publication of the STOP-IT randomized controlled trial influenced antibiotic prescribing for patients with complicated intraabdominal infection (CIAI). The study analyzed data from four hospitals in Calgary, Canada, between July 2012 and December 2018. The results showed that antibiotic duration for appendix or biliary tract sources of CIAI aligned with the experimental arm of the STOP-IT trial, while for other sources, antibiotic duration remained high and did not change significantly after publication. The findings highlight the need for improved antibiotic stewardship in clinical practice.

Journal Article by Ng-Kamstra JS, Soo A (…) Niven DJ et 6 al. in Ann Surg

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No significant difference in patient outcomes between trainee-led and consultant-led emergency laparotomy

Post author By STITCHES Newsletter
Post date 07/12/2023
Categories In Appendix, Gallbladder and Surgical Emergencies, General Surgery

Based on a population dataset analysis, this study compared the outcomes of trainee-led emergency laparotomy surgeries with consultant-led surgeries. The study included 111,583 patients and found that mortality rates at discharge were equivalent between the two groups after adjusting for various factors. Trainee-led operations reported fewer cases of significant blood loss, and the length of hospital stay was similar between the groups. These findings suggest that appropriately skilled trainees can safely perform major laparotomy without negatively impacting patient outcomes.

Journal Article by Rahman SA, Pickering O (…) Pucher PH et 2 al. in Ann Surg

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Colorectal Surgery Postdischarge App: Enhancing Satisfaction, Impact on 30-Day Readmission Limited

Post author By STITCHES Newsletter
Post date 07/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

A randomized controlled trial evaluated the effectiveness of a postdischarge mobile app in reducing 30-day readmissions and improving patient-reported outcomes after elective colorectal surgery. The app did not significantly reduce readmissions or emergency room visits, but it led to significant improvements in patient satisfaction, well-being, and reduced anxiety levels. While the app may not reduce readmission rates, it can be a valuable tool to support patients during their recovery from colorectal surgery.

Journal Article by Pooni A, Brar MS (…) Kennedy ED et 6 al. in Ann Surg

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Total Neoadjuvant Therapy for Rectal Cancer: Impact on Surgical Outcomes and Pathology

Post author By STITCHES Newsletter
Post date 06/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

In a meta-analysis of 11 randomized controlled trials involving 3,185 rectal cancer patients, researchers compared total neoadjuvant therapy (TNT) to standard long course chemoradiotherapy (LCRT). TNT did not significantly differ in mortality or major complications but increased the risk of breached total mesorectal excision (TME). However, TNT showed a lower risk of disease progression during neoadjuvant treatment. While TNT raised concerns about local recurrence, its systemic control benefits warrant further investigation to identify suitable candidates for this approach.

Journal Article by Lin W, Li C (…) Phang PT et 5 al. in Ann Surg

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Perioperative Chemotherapy Improves Overall Survival in Synchronous Colorectal Liver Metastases

Post author By STITCHES Newsletter
Post date 06/12/2023
Categories In General Surgery, HPB & Spleen, Intestine and Lower Gastrointestinal Tract

Analyzing 72,376 patients with colorectal liver metastases (CRLM) from the National Cancer Database, researchers found that liver-only CRLM patients undergoing perioperative chemotherapy had a superior median overall survival (OS) of 44.7 months. Resection of both primary and metastatic sites also correlated with better OS (38.9 months) compared to metastatic site alone (30.2 months) or primary tumor alone (22.3 months). These findings support combining resection with perioperative systemic therapy for improved outcomes in CRLM patients.

Journal Article by Sarkar J, Attwood K and Schwarz RE in Ann Surg Oncol

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Predictive Scoring Model Identifies Risks for Unplanned ICU Readmission in Surgical Patients

Post author By STITCHES Newsletter
Post date 06/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

Analyzing 1,112 surgical ICU patients, researchers identified congestive heart failure, high SOFA-hepatic score, carbapenem use, and pre-discharge factors (inadequate glycemic control, positive fluid balance, low PaO2/FiO2 ratio, and total parenteral nutrition) as predictors for unplanned ICU readmission. The developed scoring model showed good discrimination, with an AUC of 0.74. Patients with scores ≥4 points had a significantly higher observed unplanned readmission rate (20.2%) compared to those with scores <4 points (4%), emphasizing the model's potential for risk assessment.

Journal Article by Lin TL, Chen IL (…) Lee IK et 8 al. in BMC Surg

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Laparoscopy Safely Manages Anterior Abdominal Stab Wounds

Post author By STITCHES Newsletter
Post date 06/12/2023
Categories In Appendix, Gallbladder and Surgical Emergencies, General Surgery

In a retrospective study spanning 25 years, researchers evaluated laparoscopic surgery’s role in diagnosing and treating anterior abdominal stab wounds (AASWs). Among 142 surgical patients, laparoscopy (62.7%) proved safe, with only 2 cases of overlooked injuries. For stable patients without significant injuries, laparoscopy demonstrated advantages, including reduced blood loss and shorter hospital stays compared to laparotomy. This study suggests laparoscopy’s efficacy in managing AASWs, potentially minimizing unnecessary laparotomies for stable patients.

Journal Article by Wu C, Lin KL, Chang YJ and Lin HF in Surg Endosc

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