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Indocyanine Green Fluorescence in Minimally Invasive Esophagectomy: Predictive Potential and Complication Rates

Indocyanine green fluorescence (IGF) can be used to predict anastomotic complications during minimally invasive esophagectomy (MIE), although its use may be associated with an increased rate of anastomotic leaks and higher mortality. A study of 181 patients undergoing MIE found that patients who underwent IGF evaluation had a higher rate of anastomotic leak compared to those who did not. This suggests the potential predictive value of IGF but further investigation is needed regarding its physiological effects on the esophageal anastomosis.

Journal Article by Banks KC, Barnes KE (…) Velotta JB et 8 al. in Am Surg

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Differences in Pancreatic Cancer Treatment and Outcomes: USA vs. Ontario

Patients with pancreatic cancer in the USA and Ontario, Canada were compared in terms of treatment patterns and outcomes. The study found that US patients received more radiation and chemotherapy compared to Ontario patients. Multimodality therapy was also more common in the USA. Conversely, neoadjuvant chemotherapy was more frequent in the USA but uncommon in both groups. The 30- and 90-day postoperative mortality rates were lower in Ontario, while overall survival was similar between the two regions. These findings highlight the impact of healthcare systems on treatment practices and outcomes.

Journal Article by Saadat LV, Schofield E (…) Wei AC et 11 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Immunonutrition in Major Abdominal Surgery

The meta-analysis of 87 studies involving 8,375 patients revealed that perioperative oral/enteral immunonutrition containing arginine, glutamine, and polyunsaturated fatty acids significantly reduces morbidity rates (odds ratio of 0.32). Additionally, postoperative enteral immunonutrition with RNA, arginine, and polyunsaturated fatty acids may lower mortality rates, but with less certainty (odds ratio of 0.59). However, the impact of immunonutrition on infectious disease rates, length of stay, and heterogeneity remains unclear. It was determined that the use of 2 or 3 components in oral/enteral immunonutrition is crucial for reducing morbidity rates among patients undergoing major abdominal surgery.

Journal Article by Ricci C, Serbassi F (…) Casadei R et 8 al. in BMC Surg

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

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Comparative Analysis of Single-Port Robotic and Single-Incision Laparoscopic Surgery for Colorectal Cancer

The study compared outcomes of single-port robotic (SP) and single-incision laparoscopic surgery (SILS) in colorectal cancer patients. Propensity score-matched cohorts of 50 SP robotic and 50 SILS patients were analyzed. The two platforms had similar operative times, with comparable intraoperative conversion rates but more SILS cases requiring additional ports. Intraoperative complications, total mesorectal excision rates, and lymph node yield were similar. Postoperatively, both groups had comparable bowel function, morbidity, and discharge destination. However, SP robotics had significantly shorter hospital stays compared to SILS. The study suggests that SP robotics offers technical and cosmetic benefits in addition to high-quality oncologic surgery.

Journal Article by Keller DS, Reif de Paula T (…) H Marks J et 3 al. in Surg Endosc

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

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Higher social vulnerability linked to increased postoperative complications in surgical patients

A study aimed to investigate the association between social vulnerability and risk-adjusted complications in a diverse surgical patient population. The research involved a retrospective cohort analysis of 31,224 patients from five hospitals. Patients with high social vulnerability were more likely to have various medical comorbidities and experience adverse postoperative outcomes, such as higher rates of mortality, morbidity, complications, and readmissions. After adjusting for preoperative clinical factors, the association between high social vulnerability and mortality and unplanned readmission remained significant. The findings suggest the need for targeted interventions to mitigate complications in this high-risk population.

Journal Article by Dyas AR, Carmichael H (…) Velopulos CG et 7 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Enhanced Detection of the Recurrent Laryngeal Nerve Using Fluorescence Imaging during Thyroidectomy Procedures

Fluorescence imaging during thyroidectomy procedures significantly enhances the detection of the recurrent laryngeal nerve (RLN) with 100% sensitivity and specificity. All 81 RLNs observed were more clearly visualized under fluorescence compared to thyroid or background tissue. Fluorescence imaging also allowed for the visualization of all 30 RLNs and 45 nerve branches, whereas white light only visualized 17 RLNs and 22 nerve branches. In addition, visible nerve length was 2.5 times greater with fluorescence imaging.

Journal Article by Dip F, Falco J, White K and Rosenthal R in Surg Endosc

© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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The “Superior Mesenteric Artery First” Approach Shows Comparable Outcomes to Conventional Approach in Pancreaticoduodenectomy

A comparative study evaluated the short-term and long-term outcomes of the “superior mesenteric artery first” (SMA-first) approach versus the conventional approach in pancreatic ductal adenocarcinoma (PDAC) patients undergoing laparoscopic pancreaticoduodenectomy. The SMA-first approach demonstrated a higher number of harvested lymph nodes and a lower involvement of the superior mesenteric artery (SMA) margin. No significant differences were observed in surgical complications, mortality, or overall survival between the two groups. The study concludes that the SMA-first approach is safe and feasible for PDAC patients, with comparable outcomes to the conventional approach.

Journal Article by Wang X, Luo Q (…) Qin R et 6 al. in Surg Endosc

© 2023. The Author(s).

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Muscular Quality, Not Quantity, Determines Outcome in Colorectal Cancer Surgery

A retrospective study of 207 colorectal cancer patients found that muscle quality, rather than quantity, significantly impacts surgical outcomes. The study demonstrated that patients with higher muscle radiation attenuation (MRA), a measure of muscle quality, experienced fewer postoperative complications, shorter hospital stays, and improved survival rates. In contrast, no significant associations were found between the skeletal muscle index (SMI) and surgical outcomes. This suggests that MRA is a more reliable tool for identifying high-risk patients who may benefit from prehabilitation interventions before colorectal surgery.

Journal Article by Kemper M, Melling N (…) Molwitz I et 7 al. in Eur J Surg Oncol

© 2023 Published by Elsevier Ltd.

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Preoperative Immunocyte-Derived Ratios Predict Postoperative Recovery of Gastrointestinal Motility after Colorectal Cancer Surgery

The study aimed to evaluate the role of immunocyte-derived ratios (IDRs) as potential markers for postoperative recovery of gastrointestinal function after colorectal cancer surgery. The retrospective analysis of 260 patients revealed a positive correlation between IDRs (systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio) and the i-feed score, indicating improved gastrointestinal motility. IDRs, along with other factors such as multiorgan resection, hemoglobin, and protein levels, were found to affect nasogastric tube reinsertion, while the systemic immune-inflammation index and multiorgan resection were the main determinants for toleration of liquids after surgery. These IDRs could potentially serve as predictors for postoperative gastrointestinal functional recovery following colorectal cancer surgery.

Journal Article by Firut A, Margaritescu DN (…) Surlin V et 8 al. in J Clin Med

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Fredet’s Fascia: Implications for Safer Right Hemicolectomies in the CME Era

The study reviewed medical literature to assess the use and clinical significance of Fredet’s fascia in complete mesocolic excision (CME) for right-sided colon adenocarcinoma. The results showed limited utilization of the term “Fredet’s fascia” in English medical literature and conflicting definitions and boundaries. The researchers emphasized the importance of understanding Fredet’s fascia in surgical procedures to prevent vascular pedicle injuries during minimally invasive right hemicolectomies with CME. They proposed renaming it as “sub-mesocolic pre-duodenopancreatic fascia” to avoid confusion and provide a more descriptive term.

Review by Brachini G, Cirillo B (…) De Santis E et 11 al. in J Clin Med

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