Blog

Organ-preserving pancreatectomy offers long-term advantages in endocrine and exocrine functions

Studies comparing organ-preserving pancreatectomy procedures have shown that central pancreatectomy (CP) leads to a lower incidence of new-onset or exacerbated diabetes compared to distal pancreatectomy (DP). However, CP is associated with increased morbidities such as pancreatic fistula. Spleen-preserving DP using the Kimura procedure reduces the risk of postoperative gastric varices and splenic infarction, but its effect on post-splenectomy infection prevention is unclear. Duodenum-preserving pancreatic head resection (DPPHR) has low postoperative cholangitis rates. While organ-preserving pancreatectomy may increase complications, it offers significant long-term advantages in endocrine and exocrine functions, suggesting wider adoption in the future.

Review by Kato H, Asano Y (…) Horiguchi A et 2 al. in Ann Gastroenterol Surg

© 2023 The Authors. Annals of Gastroenterological Surgery published by John Wiley & Sons Australia, Ltd on behalf of The Japanese Society of Gastroenterological Surgery.

read the whole article in Ann Gastroenterol Surg

open it in PubMed

Intra-tumoral Cell Neighborhoods Shape PDA Outcomes

Distinct intra-tumoral cell neighborhoods were identified in pancreatic ductal adenocarcinoma (PDA), with variations in immune and tumor cell subsets based on neighboring cells. Tumors from long-term survivors had a higher presence of stromal-associated macrophages, while short-term survivors had more immune-excluded tumor cells. Chemotherapy-treated tumors showed lower quantities of tumor-associated T cells and macrophages, but higher amounts of proliferating tumor cell subsets with immune-rich neighborhoods. Furthermore, a composite index incorporating lower levels of immune-excluded tumor cells and higher spatially distinct immune cell subsets was associated with improved survival in patients treated with neoadjuvant chemotherapy.

Journal Article by Wattenberg MM, Colby S (…) Beatty GL et 16 al. in Gastroenterology

Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.

read the whole article in Gastroenterology

open it in PubMed

Discontinuous growth pattern is an independent adverse predictor of survival outcomes in esophageal adenocarcinoma.

Discontinuous growth (DG) in esophageal adenocarcinoma (EAC) is associated with adverse clinicopathologic features and worse patient outcomes. DG was found to be an independent adverse predictor of survival outcomes in EAC, even after adjusting for other factors such as tumor size and stage. This multi-institutional study highlights the significance of DG and emphasizes the need to consider it in the evaluation and staging of both treatment-naïve and treated EAC tumors.

Journal Article by Kmeid M, Lee G (…) Lee H et 8 al. in Am J Surg Pathol

Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.

read the whole article in Am J Surg Pathol

open it in PubMed

Variation in the Definition of ‘Failure to Rescue’ Limits Comparisons in Postoperative Studies

Researchers conducted a systematic review and analyzed 359 studies involving 212,048,069 patients to examine the variation in the definition of ‘failure to rescue’ from postoperative complications. They found that there was a wide range of complications included in the failure to rescue denominator, with a median of 10 complications per study. Studies that included more complications reported lower failure-to-rescue rates. Furthermore, death was included as a complication in 18% of the studies. Complications and mortality were predominantly measured in-hospital and within 30 days after surgery. The study highlights the need for standardized definitions for failure to rescue in order to facilitate comparisons between studies and improve perioperative quality indicators.

Journal Article by Wells CI, Bhat S (…) Bissett IP et 6 al. in BMC Surg

Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

read the whole article in BMC Surg

open it in PubMed

Endoscopy Training Trends Among General Surgery Residents in the United States

The study analyzed operative case logs of general surgery residents in the United States from 2010 to 2023. It found that the mean overall endoscopy procedures per resident remained stable during this period, with the majority performed by surgeon juniors. Colonoscopy and esophagogastroduodenoscopy were the most common procedures, with a stable volume for colonoscopy and a significant increase in volume for esophagogastroduodenoscopy. Other procedures, such as endoscopic retrograde cholangiography and bronchoscopy, decreased significantly. The study suggests further research to investigate the relationship between procedural volume and learning curve requirements for endoscopy.

Journal Article by Sohail AH, Martinez C (…) Goyal A et 10 al. in Surg Endosc

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

read the whole article in Surg Endosc

open it in PubMed

Prealbumin-bilirubin score provides more accurate prognostic predictions for long-term survival after hepatectomy for hepatocellular carcinoma

A multicenter study developed and validated the prealbumin-bilirubin (preALBI) score as an alternative to the widely used albumin-bilirubin (ALBI) score for predicting long-term survival after hepatectomy for hepatocellular carcinoma (HCC). The preALBI score, incorporating serum prealbumin and bilirubin levels, showed superior performance in predicting survival compared to the ALBI score and Child-Pugh grade. Leveraging the stability of prealbumin, the preALBI score represents a promising tool for better patient stratification and more accurate prognostic predictions in HCC patients undergoing hepatectomy.

Journal Article by Li C, Wang MD (…) Huang DS et 13 al. in Am J Surg

Copyright © 2024 Elsevier Inc. All rights reserved.

read the whole article in Am J Surg

open it in PubMed

Long-term outcomes of endoscopic or surgical resection in T1 colorectal cancer patients

A retrospective cohort study compared the long-term outcomes of T1 colorectal cancer (CRC) patients after endoscopic resection (ER) and surgery. The study found that ER can be a comparable treatment option to surgery for T1 CRC patients with deep submucosal invasion (DSI) when other high-risk factors are absent. The most important long-term prognostic factors for T1 CRC patients included resection margin, tumor budding, sex, and Charlson comorbidities index (CCI). These findings provide valuable insights into personalized treatments for T1 CRC patients.

Journal Article by Song S, Dou L (…) Wang G et 4 al. in Surg Endosc

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

read the whole article in Surg Endosc

open it in PubMed

Outcomes of Induction Chemotherapy and Esophagectomy for Advanced Esophageal Cancer

Induction chemotherapy followed by response evaluation and esophagectomy in patients with advanced esophageal cancer showed promising results in terms of survival. A total of 238 patients were treated with taxane/platinum-based chemotherapy, with 64.7% undergoing surgical exploration. Resection was performed in 53.4% of patients, resulting in a median survival of 26.3 months and a 5-year overall survival rate of approximately 30%. The presence of t4b and poorly differentiated tumors was associated with worse survival. Induction chemotherapy followed by esophagectomy may be a feasible curative treatment option for carefully selected patients.

Journal Article by van der Zijden CJ, van der Sluis PC (…) Wijnhoven BPL et 8 al. in Eur J Surg Oncol

© 2024 Published by Elsevier Ltd.

read the whole article in Eur J Surg Oncol

open it in PubMed

Liver Resection Techniques: Efficacy and Safety in Modulating Future Liver Remnant

In a systematic review and network meta-analysis of 23 studies comprising 1557 patients, lvd was found to achieve the greatest increase in flr, while alpps was most effective in preventing dropout before completion hepatectomy. Pvl tended to be associated with a longer time to completion hepatectomy, and liver failure occurred less frequently after lvd, compared to pve and alpps. These findings indicate that lvd and alpps are the most efficacious and safe techniques for liver resection in patients with insufficient flr volume.

Review by Bozkurt E, Sijberden JP, Kasai M and Abu Hilal M in HPB (Oxford)

Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

read the whole article in HPB (Oxford)

open it in PubMed

General Surgery Textbooks Lack Thorough Understanding of Racial Disparities in Healthcare

General surgery textbooks lack thorough understanding of racial disparities in healthcare, potentially contributing to inequities experienced by minority patients. A study analyzed 13 textbooks and found that the majority of passages discussing medical differences among racial/ethnic groups did not address systemic causes or the role of racism. Only a small percentage of passages indicated that race was the cause of medical differences, and even fewer explicitly discussed racism or discrimination. The study emphasizes the need for textbooks to provide more comprehensive and accurate information on health disparities.

Journal Article by Borowsky PA, Yoon K (…) Bliton JN et 5 al. in J Natl Med Assoc

Copyright © 2024 National Medical Association. Published by Elsevier Inc. All rights reserved.

read the whole article in J Natl Med Assoc

open it in PubMed