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Enhancing Cancer Care: Tailored Interventions for Concerning Patient-Reported Outcomes

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

A systematic review analyzed 16 studies involving 144,496 cancer patients, focusing on gastrointestinal, lung, and head and neck cancers. The study found that interventions triggered by patient-reported outcomes (PROs) were diverse, including referrals, medication changes, and self-management advice. Notably, in three studies, these interventions significantly improved cancer-related care and patient outcomes, emphasizing the potential of PRO-triggered interventions to enhance the quality of life for individuals undergoing resource-intensive cancer treatments.

Journal Article by Sampieri G, Li H (…) Eskander A et 9 al. in Ann Surg Oncol

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Resecting M1 Lymph Nodes Improves Outcomes in Advanced Esophageal Carcinoma

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In General Surgery, Upper Gastrointestinal Tract

Examining 682 esophageal carcinoma cases, researchers found resecting metastatic lymph nodes (rm1ln) in stage IVB, especially in specific locations, showed feasibility and improved overall survival without compromising short-term safety. Notably, patients with rm1ln metastasis who underwent curative surgery demonstrated comparable short-term outcomes and overall survival to those without such metastasis. The study emphasizes the potential benefit of surgery for select M1 lymph node metastases, challenging traditional treatment paradigms for advanced esophageal carcinoma.

Journal Article by Igaue S, Nozaki R (…) Daiko H et 8 al. in Ann Surg Oncol

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Improved Insulin Resistance Post-Parathyroidectomy in Primary Hyperparathyroidism Patients with Prediabetes

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In Endocrine Surgery, General Surgery

In a study spanning 2016 to 2021, 231 patients underwent parathyroidectomy for primary hyperparathyroidism. Preoperatively, 32% had prediabetes, and 47% had insulin resistance. Twelve months postoperative, insulin resistance significantly decreased in both prediabetes (-0.69; p = .04) and insulin resistance groups (-0.85; p < .001). In prediabetes patients, 64% reduced insulin resistance, with 31% achieving fasting glucose normalization. Preoperative prediabetes or insulin resistance >2.5 independently predicted reduced insulin resistance, advocating for their consideration in surgery selection criteria.

Journal Article by Nomine-Criqui C, Bihain F (…) Brunaud L et 5 al. in BMC Surg

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Optimizing Rectal Cancer Surgery: Benefits of Transanal Total Mesorectal Excision

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract

In a meta-analysis of four randomized controlled trials (1,339 patients), researchers compared laparoscopic total mesorectal excision (TME) with and without transanal dissection for lower rectal cancers. Those undergoing laparoscopic TME with transanal dissection exhibited lower conversion rates, a higher likelihood of achieving complete TME, and fewer harvested lymph nodes compared to the group without transanal dissection. Both groups showed similar outcomes in operative times, complications, and margin status. The study suggests the advantages of incorporating transanal dissection in rectal cancer surgery.

Review by Emile SH, Wignakumar A (…) Wexner SD et 5 al. in BMC Surg

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Functional Evaluation After Sleeve Gastrectomy: Nuclear Scintigraphy Outperforms Volumetric Analysis

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In General Surgery, Metabolic and Bariatric Surgery

In evaluating post-sleeve gastrectomy patients, this study compared nuclear scintigraphy gastric emptying with three-dimensional multi-detector computed tomography (3D-MDCT) gastric volumetry. Poor weight loss group exhibited delayed gastric emptying compared to optimal weight loss group. Gastric emptying time correlated with weight loss parameters, while gastric volume did not. Nuclear scintigraphy, especially with a threshold of 21.2 minutes, proved highly discriminant, highlighting its potential superiority in functional assessment over volumetric analysis for identifying sleeve gastrectomy complications and suboptimal weight loss outcomes.

Journal Article by Wickremasinghe A, Ferdinands J (…) Burton P et 10 al. in Obes Surg

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Evolution of Primary Care Practitioners’ Views on Bariatric Surgery Over a Decade

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In General Surgery, Metabolic and Bariatric Surgery

Over 10 years, a survey involving 452 primary care practitioners in Scotland revealed increased awareness of local bariatric referral criteria, with more making referrals. Despite recognizing the impact of bariatric surgery on weight and related diseases, knowledge gaps persisted regarding national guidelines. Comfort levels in managing post-operative patients remained unchanged. Referral hesitancy was attributed to slow progress in weight management services and rejecting potential candidates. Findings emphasize the need for improved primary-to-secondary care interfaces and tailored educational interventions for practitioners.

Journal Article by Douglass B, Lau SH (…) Kynaston J et 2 al. in Obes Surg

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ERCP Shows High Effectiveness in Managing Malignant Biliary Obstruction: Real-world Analysis of 596 Cases

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In General Surgery, HPB & Spleen, Surgical Endoscopy

In a real-world study at Oslo University Hospital, ERCP was assessed as the initial management for malignant biliary obstruction (MBO). Of 596 patients, the primary outcome was achieved in 62%, with an 80% overall technical success rate. Distal extrahepatic MBO had an 85% success rate. Reinterventions were performed in 27%, and complications occurred in 15%, including post-ERCP pancreatitis in 9%. The study concludes that ERCP is a valid first-line option for managing MBO, showcasing high clinical effectiveness and technical success.

Journal Article by Mikalsen IM, Breder S (…) Ånonsen KV et 3 al. in Scand J Gastroenterol

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Hepatectomy with Bile Duct Resection Hinders Adjuvant Chemotherapy in Biliary Tract Cancer Patients

Post author By STITCHES Newsletter
Post date 04/12/2023
Categories In General Surgery, HPB & Spleen

In a retrospective analysis of 168 biliary tract carcinoma patients post-surgery, 83.9% received adjuvant chemotherapy, while 16.1% did not. Notably, hepatectomy with extrahepatic bile duct resection (BDR) significantly hindered chemotherapy administration compared to other surgeries. Refractory bile leak, primarily post hepatectomy with BDR, was a common reason for non-administration. Multivariate analysis identified hepatectomy with BDR and preoperative anemia as independent factors associated with the difficulty of adjuvant chemotherapy, emphasizing the need for alternative strategies in such cases.

Journal Article by Sumiyoshi T, Uemura K (…) Takahashi S et 9 al. in Langenbecks Arch Surg

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Lymphatic Venous Anastomosis Reduces Cellulitis in Lower Extremity Lymphoedema: Randomized Trial

Post author By STITCHES Newsletter
Post date 03/12/2023
Categories In General Surgery, Perspectives, Opinions and Curiosities

In a multicenter randomized trial, researchers investigated the impact of lymphatic venous anastomosis (LVA) on cellulitis prevention in lower extremity lymphoedema. Patients undergoing LVA with non-operative decongestive therapy showed a significant reduction in cellulitis frequency over 6 months compared to those receiving only non-operative decongestive therapy. Limb circumference and pain did not significantly differ, but LVA contributed to reduced thigh area hardness. LVA combined with non-operative decongestive therapy effectively prevents cellulitis in secondary lower extremity lymphoedema.

Journal Article by Mihara M, Hara H (…) Naito M et 4 al. in Br J Surg

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Innovative Closure Strategy for Rectal Defects Post-Endoscopic Submucosal Dissection

Post author By STITCHES Newsletter
Post date 03/12/2023
Categories In General Surgery, Intestine and Lower Gastrointestinal Tract, Surgical Endoscopy

Researchers introduced an endoscopic hand-suturing with clips strategy (EHS-clips) for closing rectal defects after endoscopic submucosal dissection (ESD) or ESD with myectomy. All 49 defects achieved complete closure, with 71.4% through EHS alone and 28.6% with additional clips. Zero cases experienced delayed bleeding. Sustained closure reached 73.5% on postoperative days 3-5, with a stitch margin of ≥ 5 mm identified as the sole independent factor favoring sustained closure. EHS-clips effectively prevent delayed bleeding, and a wider stitch margin enhances sustained closure reliability.

Journal Article by Song S, Dou L (…) Wang G et 3 al. in Gastrointest Endosc

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