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Low-Volume Elective Surgery at US Hospital Networks Associated with Inferior Outcomes

Most US hospital networks have low-volume hospitals performing elective surgeries that are associated with inferior outcomes. However, within these networks, there are other hospitals that meet volume standards and are located within a reasonable distance from patients’ homes. The study found significant variation in rates of low-volume surgery across different procedures. Surgical outcomes, including postoperative complications and mortality, were worse at low-volume hospitals compared to hospitals meeting volume standards.

Journal Article by Kalata S, Schaefer SL (…) Nathan H et 2 al. in JAMA Surg

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Textbook Oncologic Outcomes Enhance Survival in CRS and HIPEC for Colorectal Peritoneal Metastasis

Expert consensus was achieved on the definition of textbook oncologic outcomes (TOO) in cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal metastasis. The consensus criteria included the absence of unplanned re-operations, severe postoperative complications, unplanned readmissions, 90-day postoperative mortality, and contraindications for chemotherapy within 12 weeks. In a cohort of 251 patients, 60% met the TOO criteria and had significantly better overall survival and disease-free survival compared to those who did not meet the criteria. This study highlights the importance of achieving TOO for improved outcomes in CRS and HIPEC.

Journal Article by Zohar N, Nevler A (…) Bowne WB et 6 al. in J Am Coll Surg

Copyright © 2023 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.

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Neoadjuvant Chemotherapy Increases Risk of Postoperative DVT in Distal Pancreatectomy for Pancreatic Adenocarcinoma

Patients with pancreatic adenocarcinoma who undergo distal pancreatectomy and receive neoadjuvant chemotherapy (NAT) are 73% more likely to develop postoperative deep venous thrombosis (DVT) compared to those who undergo upfront resection. This association is significant and highlights the need to prioritize high-risk patients for extended duration prophylaxis. The study analyzed data from 4327 patients using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database, emphasizing the importance of considering NAT when assessing postoperative morbidity and implementing preventive measures.

Journal Article by Robbins KJ, Newcomer KF (…) Hawkins WG et 3 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Precision Surgery Shows Promise for Colorectal Liver Metastases with Mutras Tumors

Patients with mutras colorectal liver metastases (crlm) may benefit from anatomic resection (AR) compared to nonanatomic resection (NAR), according to a systematic review and meta-analysis. The study found that AR was associated with a significant improvement in liver-specific disease-free survival and overall disease-free survival among patients with mutras tumors, but not among those with wild-type ras tumors. Differences in outcomes may be attributed to a lower incidence of incomplete resection in mutras tumors undergoing AR. These findings suggest that precision surgery could be relevant for crlm and advocate for individualized treatment strategies.

Review by Pikoulis E, Papaconstantinou D (…) Margonis GA et 12 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Delta Radiomic Features Predict Resection Margin and Survival in Pancreatic Cancer after Neoadjuvant Treatment

The study demonstrates that delta radiomic features (DRFs), when combined with clinical variables, are effective in predicting resection margin status (RMS) and overall survival (OS) in neoadjuvant-treated pancreatic cancer patients. The models outperform clinical feature-based and other radiomics feature-based models in predicting OS, disease-free survival (DFS), and RMS. These externally validated, predictive/prognostic DRF models provide valuable insights into treatment dynamics and offer a promising tool in preoperative predictions for pancreatic ductal adenocarcinoma patients.

Journal Article by Wang K, Karalis JD (…) Ligorio M et 18 al. in Ann Surg Oncol

© 2023. The Author(s).

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Impact of Tumor Size on Survival Outcome in Esophageal Squamous Cell Carcinoma

The study evaluated the influence of tumor size on the prognosis of patients with esophageal squamous cell carcinoma (ESCC) undergoing esophagectomy after neoadjuvant chemotherapy. A total of 272 patients were categorized based on tumor size, with 36mm being the cut-off. Patients with tumor size ≥ 36mm had worse histological response and deeper tumor invasion. In patients with stage pt0-1, pt2, and pt4 ESCC, there were no significant differences in overall survival rates between the two groups. However, in patients with stage pt3 ESCC, tumor size ≥ 36mm was an independent risk factor for poorer survival, especially when accompanied by lymph node metastasis.

Journal Article by Koterazawa Y, Oshikiri T (…) Kakeji Y et 9 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Upfront Surgery Valid for cT1-2N1 Esophageal Squamous Cell Carcinoma

The study analyzed the efficacy of neoadjuvant chemoradiation therapy (ncrt) in patients with completely resectable esophageal squamous cell carcinoma (escc) and minimal lymph node involvement (cN1). The researchers conducted a retrospective review of 247 patients who underwent upfront radical esophagectomy followed by adjuvant treatment. They found that upfront surgery provided accurate nodal staging information, potentially sparing some cN1 patients from unnecessary ncrt, while demonstrating comparable 5-year disease-free survival rates for both cN0 and cN1 groups. The study suggests that upfront radical surgery may be a valid treatment option for ct1-2n1 escc.

Journal Article by Yang YH, Park BJ (…) Kim DJ et 2 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Neoadjuvant Chemotherapy Does Not Increase Postoperative Complications in Gastric Adenocarcinoma

The study compared postoperative complications between neoadjuvant chemotherapy and upfront surgery in gastric adenocarcinoma patients in Finland. Analyzing data from 769 patients, the study found that neoadjuvant chemotherapy did not increase major postoperative complications, including pneumonia, anastomotic complications, wound complications, or other complications. The results suggest that neoadjuvant therapy is not associated with increased postoperative complications, reoperations, or short-term mortality in gastric adenocarcinoma patients.

Journal Article by Putila E, Helminen O (…) Kauppila JH et 20 al. in Ann Surg Oncol

© 2023. The Author(s).

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Minimum Number of Lymph Nodes Required for Staging Adenocarcinoma of the Appendix

Researchers aimed to determine the minimum number of lymph nodes (lns) needed to accurately stage adenocarcinoma of the appendix. They analyzed data from 3,602 patients and found that harvesting at least ten lns was necessary to minimize the risk of missing lymph node positive (lnp) disease. Failing to evaluate at least ten lns was also associated with a negative impact on overall survival.

Journal Article by Lopez-Ramirez F, Sardi A (…) Gushchin V et 5 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Cholangitis and interruptions of neoadjuvant chemotherapy decrease survival in pancreatic cancer

Patients with pancreatic cancer who experience cholangitis have reduced overall survival (OS) and progression-free survival (PFS). Interrupting neoadjuvant chemotherapy (NAT) also decreases OS and PFS. Biliary decompression with metallic stents reduces the rate of chemotherapy interruptions and cholangitis compared to plastic stents. However, the choice of stent type does not affect OS or PFS. This study underscores the importance of managing cholangitis and avoiding interruptions in NAT to improve the survival outcomes of patients with pancreatic cancer.

Journal Article by Vehviläinen S, Kuuliala A (…) Seppänen H et 5 al. in Ann Surg Oncol

© 2023. The Author(s).

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