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Negative Prognostic Impact of Splenic Vein Involvement in Resectable Pancreatic Body or Tail Cancer

Patients with resectable pancreatic body or tail cancer who have splenic vein (SPV) involvement, particularly radiological SPV encasement, experience significantly worse overall survival (OS) and recurrence-free survival (RFS). Independent poor prognostic factors include higher pre-operative carcinoembryonic antigen levels, larger tumor size, pathological SPV invasion, and non-completion of adjuvant therapy. Multidetector-row computed tomography shows relatively high accuracy in detecting pathological SPV invasion. Neoadjuvant therapy’s prognostic impact remains inconclusive. Innovative treatments and effective neoadjuvant therapy regimens are necessary for patients with SPV involvement.

Journal Article by Kuriyama N, Mizuno S (…) Kishiwada M et 12 al. in Langenbecks Arch Surg

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

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Limited Pain Benefit: Epidural vs. Intravenous Analgesia after Open Hepatectomy

Patient-controlled epidural analgesia (PCEA) did not significantly improve postoperative pain during ambulation compared to intravenous patient-controlled analgesia (IV PCA) following open hepatectomy. There was a small difference in pain scores on postoperative day 2, but it did not meet the pre-specified definition of clinical significance. PCEA was safe with a low incidence of epidural failure and no related complications. Secondary outcomes, including pain scores at rest, were similar between the PCEA and IV PCA groups.

Journal Article by Arslan-Carlon V, Qadan M (…) D’Angelica MI et 8 al. in Ann Surg

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

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Development of Pancreatic Surgery Composite Endpoint (PACE) Enables Lower Sample Sizes and Enhanced Feasibility in Future Trials

Researchers developed and validated a new clinically relevant endpoint, Pancreatic Surgery Composite Endpoint (PACE), for pancreatic surgery. PACE incorporates postoperative pancreatic fistula, post-pancreatectomy hemorrhage, reoperation, and reinterventions. It demonstrated high predictive value for prolonged length of hospital stay (LOS) and mortality in both the development and validation cohorts. PACE allowed for significant reduction in sample sizes and can be effectively used in future prospective trials, offering improved feasibility compared to single outcome measures.

Journal Article by Nickel F, Kuemmerli C (…) Büchler MW et 9 al. in Ann Surg

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

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Benchmarking Hepatectomy in Intrahepatic Cholangiocarcinoma

Researchers identified benchmark values for hepatectomy in intrahepatic cholangiocarcinoma (ICC) across international institutions. Out of 1,193 patients, 600 (50.3%) were included in the benchmark group. The benchmark values encompassed criteria such as lymph node retrieval, blood loss, transfusion rate, operative time, achievement rates for postoperative outcomes, resection margin, complications, mortality, and hospital stay. Establishing these benchmarks enables comparisons, identification of variations, and improvement of surgical and oncologic outcomes in ICC liver resections.

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

© 2024. The Author(s).

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Early antibiotic treatment is superior to observation for avoiding surgical exploration in acute appendicitis

Acute appendicitis patients were randomly assigned to receive either antibiotic treatment with active observation or classic observation without antibiotic treatment. The study found that early antibiotic treatment was more effective in avoiding surgical exploration and appendectomy compared to the observation group. The antibiotic group had a lower rate of appendectomy at the first hospital stay (28% compared to 53% in the observation group).

Journal Article by Iresjö BM, Blomström S (…) Lundholm K et 2 al. in BMC Surg

Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.

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Improved Predictive Value: GLIM Criteria and HGS Test in Overweight Colorectal Cancer Patients

The retrospective study, which enrolled 850 overweight colorectal cancer patients, found that the incidence of malnutrition was 12.4% in the GLIM group and 6.4% in the HGS-GLIM group. Both malnutrition groups had a significantly higher incidence of complications compared to the control group. Patients in the HGS-GLIM-malnutrition group had worse overall survival and disease-free survival. HGS-GLIM was also independently associated with postoperative complications, overall survival, and disease-free survival. Overall, the combined GLIM criteria and HGS test showed better predictive value for postoperative complications and long-term survival in overweight colorectal cancer patients compared to the standard GLIM criteria alone.

Journal Article by Chen W, Yu D (…) Yu Z et 5 al. in J Gastroenterol Hepatol

© 2024 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

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Low Physical Activity Linked to Postoperative Outcomes in Major Abdominal Cancer Surgery

According to a single-center prospective cohort study, physical activity levels are far from optimal following major abdominal cancer surgery. The study found that postoperative physical activity was low, with a median daily step count ranging from 71 steps on the first postoperative day to 918 steps on the seventh day. Furthermore, the study identified several patient-related factors associated with low physical activity, such as age, preoperative weight loss, and operation duration. Importantly, low physical activity was found to be associated with increased complication rates and prolonged hospital stays. These findings highlight the importance of encouraging physical activity in this patient population and identifying individuals at risk of low activity levels.

Journal Article by Hogenbirk RNM, Wijma AG (…) Klaase JM et 5 al. in Eur J Surg Oncol

© 2024 Published by Elsevier Ltd.

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Frailty Index in Colorectal Cancer: Assessing Surgical Complications and Prognosis

Frailty Index (FI) is a comprehensive tool for assessing frailty in the elderly population with colorectal cancer (CRC). This review evaluates methods for frailty assessment and presents modifications of the FI to accurately evaluate surgical complication risk and prognosis in CRC patients. The research findings highlight the FI’s role in predicting surgical complications, postoperative recovery, and survival rates. However, limitations in the modified frailty index (MFI) and future research directions are discussed. Overall, this study emphasizes the clinical application of the MFI and offers valuable references for understanding frailty in CRC patients.

Review by Jiang W, Yu H (…) Wang H et 5 al. in Am Surg

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A Delayed Diagnosis: Tuberculosis Mimicking Colorectal Malignancy

Gastrointestinal tuberculosis is a rare manifestation that often imitates various gastrointestinal diseases. In this case study of an 85-year-old male patient, a cecal mass initially suspected to be malignant was removed through colonic resection. Acid-fast staining of the surgical specimen later revealed acid-fast bacilli and necrotizing granulomas in multiple lymph nodes. The study highlights the significance of considering gastrointestinal tuberculosis as a potential diagnosis in patients with suspected colorectal malignancy, particularly when initial biopsy results do not indicate malignant characteristics.

Journal Article by Nawras M, Bosio R (…) Pannell SM et 2 al. in Am Surg

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Modified pancreaticoduodenectomy: A viable alternative to hepatopancreaticoduodenectomy for middle-third cholangiocarcinoma

The study compared the outcomes of patients with middle-third cholangiocarcinoma who underwent modified pancreaticoduodenectomy (MPD) or hepatopancreaticoduodenectomy (HPD). The MPD group exhibited advantages such as shorter operation time, less blood loss, and fewer complications compared to the HPD group. Overall survival rates did not significantly differ between the groups. The study identified positive surgical margins as the sole independent prognostic factor and noted that five-year survival rates improved for MPD patients with grossly tumor-free margins ≥15 mm, comparable to that of HPD patients. MPD may be recommended based on preoperative radiological imaging results.

Journal Article by Onoe S, Mizuno T (…) Ebata T et 7 al. in HPB (Oxford)

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

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