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Optimal Timing for Gastric Cancer Surgery: Impact on Lymph Node Upstaging and Survival

Analyzing clinically node-negative gastric cancer patients, the study investigated the influence of time from diagnosis to surgery. Among 1824 patients, those with a longer interval (≥ 8 weeks) experienced less lymph node upstaging. Although overall survival differences appeared in Kaplan-Meier curves, multivariable analysis didn’t associate timing with survival. The findings suggest extended intervals don’t predict lymph node upstaging or survival, emphasizing the importance of preoperative optimization in early-stage gastric cancer management.

Journal Article by Riascos MC, Greenberg JA (…) Zarnegar R et 10 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Optimizing Surgical Approach in Synchronous Colorectal Liver Metastases

Analyzing data from 976 patients with synchronous colorectal liver metastases, researchers compared simultaneous and staged resections. Simultaneous resection, beneficial for low to moderate tumor burden and node-negative right-sided primary tumors, showed increased complications in high tumor burden cases. Staged resection demonstrated better outcomes for patients with node-positive left-sided primaries and higher tumor burden scores. Tailoring the approach based on preoperative tumor burden enhances postoperative outcomes in synchronous colorectal liver metastases.

Journal Article by Endo Y, Alaimo L (…) Pawlik TM et 16 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Innovative Imaging for Anastomotic Site Assessment in Esophagectomy

In a prospective study on esophageal cancer patients undergoing thoracic esophagectomy, researchers compared tissue oxygen saturation and indocyanine green measurements. Tissue oxygen saturation imaging proved valuable in identifying the anastomotic site, overcoming limitations of indocyanine green. In 57 patients, decreased tissue oxygen saturation at the conduit tip correlated with congestion and an increased risk of anastomotic leakage. This novel approach offers a practical and repeatable alternative for assessing blood perfusion in the gastric conduit during thoracic esophagectomy.

Journal Article by Fujita T, Sato K (…) Daiko H et 3 al. in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Surgery in Acute Lower Gastrointestinal Bleeding

In a cohort study of 10,342 acute lower gastrointestinal bleeding (ALGIB) cases, surgery was performed in 1.3%. Colonoscopy (87.7%) and endoscopic hemostasis (26.7%) were common. Surgery indications included diverticular bleeding (24%) and colorectal cancer (22%). Sixty-four percent were for severe refractory bleeding. Postoperative rebleeding rates were 22% (presumptive/obscure source) and 12% (definitive identification). Thirty-day mortality was 1.5% with surgery and 0.8% without. Transfusion need, in-hospital rebleeding, small bowel bleeding, colorectal cancer, and hemorrhoids were surgery-related risk factors. Emphasizing endoscopic hemostasis may reduce unnecessary ALGIB surgeries.

Journal Article by Omori J, Kaise M (…) Iwakiri K et 44 al. in J Gastroenterol

© 2023. Japanese Society of Gastroenterology.

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Postoperative Atrial Fibrillation and Warfarin: Impact on Mortality

In the Regroup trial focusing on coronary artery bypass grafting (CABG), 28.6% developed postoperative atrial fibrillation (POAF). Among 269 POAF patients, 85 received oral anticoagulation (OAC) with warfarin, and 184 did not. During active follow-up, stroke rates were similar (3.5% OAC vs. 5.4% no-OAC), but major adverse cardiac events were higher with OAC (20% vs. 11.4%). Longer follow-up revealed increased all-cause mortality in the OAC group (20% vs. 11.4%). The study suggests a need to reassess the risk-benefit ratio of OAC in post-CABG POAF patients.

Journal Article by Almassi GH, Quin JA (…) Zenati MA et 5 al. in J Surg Res

Published by Elsevier Inc.

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Margin Clearance and Survival in Ampullary Adenocarcinoma After Pancreaticoduodenectomy

Examining 128 patients undergoing pancreaticoduodenectomy for ampullary adenocarcinoma, Danish researchers found that a margin clearance of ≥1 mm was independently associated with significantly improved survival compared to <1 mm. Notably, posterior and anterior margins held isolated prognostic significance, emphasizing their particular importance in predicting outcomes. The study underscores the prognostic relevance of margin clearance in this context, shedding light on critical factors influencing survival after surgery for ampullary adenocarcinoma.

Journal Article by Aaquist T, Fristrup CW (…) Detlefsen S et 5 al. in HPB (Oxford)

Copyright © 2023 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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Hidden Crisis: England’s Elective Procedure Backlog Unveiled

England’s NHS waiting lists hide a daunting truth. A modeling study, dissecting data from Jan 1, 2020, to Dec 31, 2022, revealed a staggering elective procedure backlog of 4,519,467. Shockingly, 80.3% lurked in the hidden waiting list—3,621,423 procedures unnoticed. General surgery and orthopedics bore the brunt. Startlingly, 49.3% affected those aged 16-59. The majority, 84.7%, were day-case procedures. Urgent action, funding, and workforce expansion are imperative to tackle this crisis, emphasizing the need for resilience against future disruptions.

Journal Article by None None in Lancet

Copyright © 2023 Elsevier Ltd. All rights reserved.

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Reassessing Permanent Hypoparathyroidism After Thyroidectomy

In a Swedish cohort of 1636 total thyroidectomy patients, researchers found an alarming 8.7% developed permanent hypoparathyroidism. Notably, 23.2% with low parathyroid hormone levels post-surgery faced a 6.7% risk of permanency. Critically, discrepancies between quality registers and comprehensive chart reviews signal underestimation of the condition’s prevalence. Overtreatment concerns arise due to inadequate attempts to cease treatment. This study urges improved follow-up protocols and highlights the substantial, often overlooked, risk of long-term parathyroid dysfunction post-thyroid surgery.

Journal Article by Annebäck M, Osterman C (…) Norlén O et 6 al. in Br J Surg

© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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Enhancing Cancer Care: Tailored Interventions for Concerning Patient-Reported Outcomes

A systematic review analyzed 16 studies involving 144,496 cancer patients, focusing on gastrointestinal, lung, and head and neck cancers. The study found that interventions triggered by patient-reported outcomes (PROs) were diverse, including referrals, medication changes, and self-management advice. Notably, in three studies, these interventions significantly improved cancer-related care and patient outcomes, emphasizing the potential of PRO-triggered interventions to enhance the quality of life for individuals undergoing resource-intensive cancer treatments.

Journal Article by Sampieri G, Li H (…) Eskander A et 9 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Resecting M1 Lymph Nodes Improves Outcomes in Advanced Esophageal Carcinoma

Examining 682 esophageal carcinoma cases, researchers found resecting metastatic lymph nodes (rm1ln) in stage IVB, especially in specific locations, showed feasibility and improved overall survival without compromising short-term safety. Notably, patients with rm1ln metastasis who underwent curative surgery demonstrated comparable short-term outcomes and overall survival to those without such metastasis. The study emphasizes the potential benefit of surgery for select M1 lymph node metastases, challenging traditional treatment paradigms for advanced esophageal carcinoma.

Journal Article by Igaue S, Nozaki R (…) Daiko H et 8 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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