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Early Prediction of PHLF: Clinical Risk Factors Outperform Lactate Levels

The study aimed to compare the accuracy of prediction models in detecting clinically relevant post-hepatectomy liver failure (PHLF) following major hepatectomy. The researchers evaluated the use of arterial lactate measurements as an early predictor of PHLF in a subgroup of major hepatectomies, finding that lactate levels on postoperative day 1 were inferior to clinical risk factors and bilirubin levels in predicting PHLF. A multivariable logistic regression model comprising clinical risk factors and bilirubin on postoperative day 1 had the highest diagnostic accuracy and could be applied early on, with potential implications for patient outcomes.

Journal Article by Baumgartner R, Engstrand J (…) Gilg S et 4 al. in Br J Surg

© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

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A Video-Based Procedure-Specific Competency Assessment Tool Improves Evaluation of Minimally Invasive Esophagectomy

The study developed and validated a procedure-specific competency assessment tool (CAT) for minimally invasive esophagectomy (MIE). The CAT consists of 8 procedural phases, with 4 quality components per phase, assessed using a 1-4 Likert scale. Peer-reviewed MIE videos were evaluated by 18 international experts. Results showed good intrarater reliability and moderate interrater reliability. Construct validity was demonstrated, with CAT performance scores correlating with surgical team experience and clinical parameters. The improved version of CAT enhanced usability. The tool can be used clinically, for training, and in research to evaluate MIE performance.

Journal Article by Ketel MHM, Klarenbeek BR (…) van Workum F et 21 al. in JAMA Surg

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Local Therapy Improves Survival for Early Recurrence After Resection of Colorectal Liver Metastases

A study evaluated whether local therapy benefits patients who experience early recurrence after hepatectomy for colorectal liver metastases (CLM). Clinicopathologic data of 671 patients were analyzed, with 81% experiencing recurrence. Local therapy, including ablation, resection, or radiation, resulted in improved survival for patients with early, intermediate, or later recurrence. Treatment with local therapy, liver and extrahepatic recurrence, and certain gene mutations were independently associated with overall survival. Somatic mutational profiling can guide the consideration of local therapy in the multidisciplinary management of CLM recurrence.

Journal Article by Boyev A, Tzeng CD (…) Newhook TE et 11 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Improved Prognosis in Rectal Cancer: Pathological-Features-Modified TNM Staging

A retrospective population-based study developed a pathological-features-modified tumor node metastasis (TNM) staging system using machine learning ensemble methods to improve the prognostic accuracy for rectal cancer patients. The study cohort included 14,468 patients diagnosed between 2010 and 2015. Patients were categorized into four pathological groups based on the number of pathological features. The proposed staging system outperformed the TNM staging in both the development and validation cohorts, indicating its potential to complement the current TNM staging in accurately estimating survival for rectal cancer patients.

Journal Article by Yang Y, Yang Z (…) Li Y et 4 al. in Dis Colon Rectum

Copyright © The ASCRS 2023.

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International Consensus Defines Quality Measures for Minimally Invasive Gastrectomy

Researchers conducted an international Delphi consensus study to determine expert agreement on the key technical steps of minimally invasive total gastrectomy (MITG) for gastric cancer. A final consensus of 41 statements was reached, outlining crucial steps for performing high-quality MITG for oncological indications. The findings provide a foundation for developing and validating surgical quality assessment tools to improve clinical outcomes and standardize surgical quality in MITG.

Journal Article by Cizmic A, Romic I (…) Mitra AT et 35 al. in Surg Endosc

© 2023. The Author(s).

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Dehydration Slows Laparoscopic Tasks and Reduces Precision in Novices

Prolonged dehydration has limited impact on fundamental laparoscopic tissue handling skills, with no significant differences in force exertion. However, dehydrated participants demonstrated slower task times and increased errors in speed and precision, emphasizing the importance of hydration in maintaining optimal laparoscopic performance.

Journal Article by Bereuter JP, Geissler ME (…) Oehme F et 8 al. in Surg Endosc

© 2023. The Author(s).

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Guidelines Favor Single-Operator Cholangioscopy for Biliary Strictures and Stones

Researchers conducted a systematic review to develop clinical practice guidelines on the use of single-operator cholangioscopy (SOC) as a diagnostic and therapeutic alternative for indeterminate biliary strictures and difficult biliary stones. The guidelines recommend SOC with stricture pattern characterization for adult patients with indeterminate biliary strictures, and SOC over endoscopic retrograde cholangiopancreatography with large-balloon dilation of papilla for adult patients with difficult biliary stones. Further research is needed on the economic implications and implementation of SOC intervention in local contexts.

Journal Article by Rey Rubiano AM, González-Teshima LY (…) Yepes-Nuñez JJ et 15 al. in Surg Endosc

© 2023. The Author(s).

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Success of Cholecystectomy for Functional Gallbladder Disorder

Interim analysis of a prospective cohort study on functional gallbladder disorder (fgbd) reveals promising results for cholecystectomy as a treatment option. Despite ejection fraction and pain reproduction not predicting success, the majority of enrolled patients experienced significant improvement in biliary pain and quality of life after surgery. 83.9% reported rapid improvement and 93.3% reported sf12 improvement at 3- or 6-month follow-up. These findings suggest that fgbd should no longer be considered a controversial indication for cholecystectomy, warranting further investigation through larger-scale studies or randomized trials.

Journal Article by Xu KJ, Brock JC (…) Cunningham SC et 2 al. in Am J Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Hiatal Hernia Repair Post-Laparoscopic RYGB: Short-Term Symptom Relief

Symptomatic hiatal hernia (HH) with pouch migration is a rare complication after laparoscopic Roux-en-Y gastric bypass (RYGB), and there is limited evidence on the utility of surgical repair. In this retrospective review of 44 patients who underwent isolated HH repair after previous RYGB, researchers found that common symptoms were dysphagia and reflux. Surgical repair resulted in a high rate of symptom resolution in the short term. However, longer follow-up is needed to assess the long-term effectiveness of this intervention.

Journal Article by Vaughan T, Romero-Velez G (…) Kroh M et 7 al. in Surg Obes Relat Dis

Copyright © 2023 American Society for Metabolic and Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

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Long-term tube feeding after minimally invasive esophagectomy helps prevent skeletal muscle loss

Long-term tube feeding intervention after minimally invasive esophagectomy was found to effectively prevent skeletal muscle loss and aid in preventing sarcopenia. The study compared short-term and long-term outcomes of tube feeding intervention in patients who underwent esophagectomy. While there were no significant differences in postoperative albumin levels, body weight, or psoas muscle area between the feeding and nonfeeding jejunostomy tube groups, significant recovery in psoas muscle volume was observed in the long-term jejunostomy tube group at 6 months postoperatively. However, the long-term group also experienced a higher incidence of anastomotic leakage and left laryngeal nerve palsy.

Journal Article by Kato T, Oshikiri T (…) Kakeji Y et 9 al. in Surg Today

© 2023. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.

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