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Impact of Intraoperative Neural Monitoring on Thyroidectomy Completeness and Thyroglobulin Response in Papillary Thyroid Cancer Patients

In a study evaluating the effect of intraoperative neural monitoring (IONM) during papillary thyroid cancer surgery, researchers found that IONM significantly improved the completeness of thyroidectomy and reduced postoperative levels of stimulated thyroglobulin. Patients who underwent IONM had lower thyroglobulin levels and a higher percentage of patients with levels below 1ng/ml. This information can help clinicians in determining whether radioactive iodine ablation is necessary in selected patients and adjusting low ablative doses for remnant ablation.

Journal Article by Iscan Y, Sengun B (…) GilesSenyurek Y et 7 al. in Acta Chir Belg

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Disparities in Emergency General Surgical Procedures for HIV and HCV Patients in the US

People living with HIV (PLWHIV) and people living with hepatitis C virus (PLWHCV) are less likely to receive emergency general surgical procedures (EGS) than similar patients without these conditions. This is the main result of a study analyzing data from over 500,000 non-elective admissions in the United States between 2016 and 2019. Specifically, PLWHIV had lower odds of undergoing EGS procedures, including cholecystectomy, and PLWHCV had reduced odds for cholecystectomy and appendectomy. Efforts to address these disparities and promote equitable access to EGS care for PLWHIV and PLWHCV are needed.

Journal Article by Himmelstein KEW, Afif IN, Beard JH and Tsai AC in Ann Surg

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Robotic limited liver resections show superior perioperative outcomes compared to laparoscopic limited liver resections for posterosuperior segments

Robotic limited liver resections (RLLR) resulted in superior perioperative outcomes compared to laparoscopic limited liver resections (LLLR) for posterosuperior liver segments, including reduced open conversion rate, blood loss, and operative time. These benefits were observed in both the overall population and in patients with cirrhosis. Postoperative outcomes regarding readmission, morbidity, and mortality were similar between the two approaches.

Journal Article by Krenzien F, Schmelzle M (…) Goh BKP et 80 al. in Ann Surg

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Neoadjuvant Chemotherapy Improves Survival in Resectable Pancreatic Adenocarcinoma Patients

Multiagent neoadjuvant chemotherapy (NAC) followed by surgery is associated with improved overall survival compared to upfront surgery or single-agent NAC in patients with resectable pancreatic adenocarcinoma. A nationwide study conducted on 5,216 patients found that multiagent NAC led to longer median overall survival (35.8 months) compared to upfront surgery (27.1 months) and single-agent NAC (27.4 months). This study emphasizes the potential benefits of NAC in the treatment of resectable pancreatic adenocarcinoma.

Journal Article by Sugawara T, Rodriguez Franco S (…) Del Chiaro M et 9 al. in Ann Surg

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Procedure-specific Risks of Thrombosis and Bleeding in Abdominal Surgery Vary Significantly

This systematic review and meta-analysis of 285 studies, including over 8 million patients, evaluated the procedure-specific risks of symptomatic venous thromboembolism (VTE) and major bleeding in general abdominal, colorectal, upper gastrointestinal, and hepatopancreatobiliary surgeries. The risk of VTE varied widely among procedures, with VTE rates ranging from <0.1% in laparoscopic cholecystectomy to 10.0% in emergency open total proctocolectomy. Thromboprophylaxis provided a net benefit in reducing VTE but was associated with a small increase in bleeding in some procedures, emphasizing the need for individualized risk prediction and patient preferences.

Journal Article by Lavikainen LI, Guyatt GH (…) Tikkinen KAO et 35 al. in Ann Surg

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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Prognostic Relevance of Primary Tumor Sidedness in Early-stage Colorectal Cancer

The study analyzed data from four randomized controlled trials to determine the significance of primary tumor sidedness (PTS) in early-stage colorectal cancer. The results showed that PTS had no impact on the risk of recurrence in stage II/III colorectal cancer. Treatment stratification based on PTS is unnecessary for early-stage colorectal cancer. However, PTS was significantly associated with overall survival after recurrence, indicating its relevance in post-recurrence prognosis.

Journal Article by Ouchi A, Sadachi R (…) Kanemitsu Y et 17 al. in Ann Surg

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Impact of Omitting Additional Surgery on Prognosis in Patients with High-Risk T1 Colorectal Cancer

For patients with high-risk T1 colorectal cancer, the need for additional surgery after local excision (LE) is uncertain. A study analyzed patients who had received LE between 2009 and 2016. Comparing those who received additional surgery and those who did not, researchers found that regional lymph node metastasis occurred in 7.7% of the surgery group. However, the incidence of oncologic adverse events was low in the group that omitted additional surgery. Cancer-specific survival rates were similar between the two groups, suggesting the importance of risk assessment for personalized treatment decisions.

Journal Article by Ouchi A, Komori K (…) Ueno H et 30 al. in Ann Surg

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Metabolic surgery effectively resolves nonalcoholic steatohepatitis and improves fibrosis in patients with obesity

Metabolic surgery has been found to facilitate the resolution of nonalcoholic steatohepatitis (NASH) and improve fibrosis in patients with obesity. A study comparing the histologic outcomes of metabolic surgery versus nonsurgical care in individuals with fibrotic NASH revealed that half of the surgical patients achieved simultaneous resolution of NASH and improvement in fibrosis, compared to only 12.1% in the nonsurgical group. Surgical patients also experienced significant weight loss. These findings indicate that metabolic surgery may offer a successful surgical cure for NASH in obese individuals.

Journal Article by Aminian A, Wilson R (…) Dasarathy S et 5 al. in Ann Surg

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Minimally Invasive Distal Pancreatectomy: Nationwide Uptake and Outcomes After Training Program and Trial

A nationwide audit-based study was conducted to evaluate the long-term uptake and outcomes of minimally invasive distal pancreatectomy (MIDP) following a training program and randomized trial. The study found that the implementation of MIDP increased from 48.6% to 63.0% over time, with a significant variation in usage between centers. MIDP resulted in shorter hospital stays and less blood loss compared to open distal pancreatectomy (ODP), but slightly higher rates of postoperative pancreatic fistula. The study suggests the need for future research to explore the differences in MIDP utilization between centers.

Journal Article by Korrel M, van Hilst J (…) Besselink MG et 17 al. in Ann Surg

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Elective Laparoscopic Hernia Repair Increases Life Expectancy in Asymptomatic Patients

Elective laparoscopic hernia repair (ELHR) is shown to lead to a greater life expectancy compared to watchful waiting (WW) in asymptomatic patients with a paraesophageal hernia (PEH). An updated Markov analysis revealed that ELHR resulted in maximum life-years gained for 40-year-old women and gradually diminished with increasing age. Alternative values in sensitivity analysis had modest effects on the difference in life-years gained, confirming ELHR as the preferred strategy. These findings indicate that ELHR should be considered for all asymptomatic patients with a PEH to maximize life expectancy.

Journal Article by DeMeester SR, Bernard L (…) Roth JS et 2 al. in Ann Surg

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