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Piperacillin-tazobactam outperforms cefoxitin for pancreatoduodenectomy

Switching to piperacillin-tazobactam for prophylaxis significantly lowers surgical site infections and pancreatic fistula rates in open pancreatoduodenectomy.

  • Patients on piperacillin-tazobactam had 30% fewer surgical site infections and pancreatic fistulas compared to those on cefoxitin.
  • The switch is backed by data from over 4,000 patients, with a clear trend toward piperacillin-tazobactam usage increasing.

Consider adopting piperacillin-tazobactam to enhance perioperative outcomes for your patients.

Journal Article by Tsilimigras DI, Woldesenbet S (…) Pawlik TM et 5 al. in HPB (Oxford)

Copyright © 2025 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.

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Reassessing Surgery for Mucinous Cystic Neoplasms

Surgical interventions for mucinous cystic neoplasms (MCN) should be more selective based on updated risk factors.

  • The pooled rate of high-grade dysplasia (HGD) or invasive carcinoma (IC) in resected MCNs is just 17%.
  • Cyst size is crucial: a threshold of 65 mm best differentiates high-risk from low-risk lesions.
  • Key risk factors linked to HGD/IC include elevated CA 19-9 levels, mural nodules, and cyst wall thickening.

Surgeons should adopt a refined approach, focusing on cyst size and specific biomarkers to optimize patient outcomes and reduce unnecessary surgeries.

Journal Article by Yun WG, Seo Y (…) Jang JY et 8 al. in Int J Surg

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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Minimally Invasive CME Outperform Conventional Hemicolectomy

Minimally invasive complete mesocolic excision (CME) shows improved outcomes in right-sided colon cancer surgery.

  • 6.09 more lymph nodes retrieved with CME (p < 0.001)
  • Anastomotic leakage is lower with CME (0.87% vs. 1.86%, RR: 0.49)
  • 3-year overall survival improves with CME (85.4% vs. 82.2%)

CME offers better oncological results and safety in short-term outcomes, suggesting a shift in surgical practice for this patient group.

  • Operative time is longer for CME (+67.84 minutes), but no difference in major complications or blood loss.

Review by Zhuang XY, Zhang JL, Yang XF and Liu ZH in BMC Surg

© 2025. The Author(s).

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Audit Reveals Improved Outcomes in Acute GI Bleeding

A recent UK audit on acute upper gastrointestinal bleeding shows improved patient outcomes despite higher comorbidities and inappropriate transfusion practices.

  • Comorbidities rose from 50% to 67%, with 15% of patients having cirrhosis.
  • Transfusion rates increased to 50%, and 24% of early transfusions were deemed inappropriate, linked to higher adjusted mortality at hemoglobin thresholds above 80 g/l.
  • Lower rebleeding rates (9.7% vs 13.3%) and reduced in-hospital mortality (8.8% vs 10.0%) were observed, indicating better management strategies.

Surgeons should prioritize risk stratification and adopt restrictive transfusion practices to enhance patient safety.

Journal Article by Nigam GB, Oakland K (…) Douds A et 14 al. in Gut

© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.

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Guidelines for Fluorescence Imaging in GI Surgery Released

Fluorescence image-guided surgery with indocyanine green (ICG) enhances precision for gastrointestinal procedures.

  • Strong recommendations for using ICG in detecting non-regional metastases and identifying primary cancers.
  • Supported use for lymph node identification in GI cancers and assessing anastomosis quality in esophageal and left-sided colorectal surgeries.

Consider integrating ICG into practice where evidence supports its use to improve surgical outcomes and decision-making.

  • Lack of evidence for thoracic duct and certain bariatric applications highlights need for further research.

Journal Article by Calabrese EC, Kumar S (…) Keller DS et 12 al. in Surg Endosc

© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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Prediction Tool for Timing of Cholecystectomy After PTGBD

A new machine learning tool helps surgeons determine the optimal timing for cholecystectomy after transcutaneous gallbladder drainage in elderly acute cholecystitis patients, improving surgical outcomes.

  • Random forest model achieved an AUC of 0.914, outperforming other models for predicting surgery delays.
  • Key predictors for delayed surgery include age, gallbladder wall thickness, and white blood cell count.

Using this online calculator can enhance patient selection and streamline decision-making for timely surgical intervention.

Journal Article by Zhang W, Che B (…) Zhang W et 2 al. in Langenbecks Arch Surg

© 2025. The Author(s).

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Increased Postoperative Delirium Risk in Prior COVID-19 Patients

Older adults with a history of COVID-19 face higher rates of postoperative delirium after major surgery, impacting surgical outcomes.

  • Patients with prior COVID-19 have a 3.09 times greater risk of delirium (p = 0.02).
  • Acute postsurgical pain increases the risk of delirium (odds ratio of 1.51; p = 0.02) while vaccination significantly reduces this risk (odds ratio of 0.47; p = 0.01).

Consider promoting COVID-19 vaccinations pre-surgery to mitigate delirium risk in at-risk patients.

  • No significant link was found between prior COVID-19 and delayed neurocognitive recovery post-surgery.

Journal Article by Cui K, Yao X (…) Fang B et 4 al. in Int J Surg

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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Rising Early-Onset Pancreatic Cancer Burden in Asia

Early-onset pancreatic cancer is surging, demanding attention from surgeons.

  • In 2021, there were 31,531 new cases and 26,996 deaths worldwide.
  • Asia, particularly East Asia, accounts for the highest burden, with developing nations like China and India leading.
  • Risk factors differ; high fasting plasma glucose is not a primary risk for early-onset cases.

Surgeons should prioritize screening and tailored interventions for older males and high-risk populations.

Journal Article by Ye X, Jiang M (…) He Y et 18 al. in Int J Surg

Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.

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Preventing Acute Kidney Injury Cuts Complications After Major Surgery

A preventive care strategy can significantly reduce the risk of acute kidney injury (AKI) in high-risk surgical patients.

  • Moderate or severe AKI occurred in 14.4% of patients receiving the intervention versus 22.3% in the control group (odds ratio 0.57, p=0.0002).
  • Number needed to treat to prevent one case of AKI is 12.

Adverse event rates were similar between the two groups, suggesting safety of the strategy.

  • Common adverse events like atrial fibrillation and significant bleeding were not statistically different between groups.

Journal Article by Zarbock A, Ostermann M (…) von Groote T et 32 al. in Lancet

Copyright © 2025 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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Transforming HCC Surgery with Biology-Driven Approaches

Surgeons need to adapt to evolving strategies for hepatocellular carcinoma (HCC) that prioritize biological insights and dynamic eligibility criteria.

  • Curative treatments offer optimal long-term outcomes, yet 5-year recurrence rates remain at about 70%.
  • New methods in immunogenomic profiling and liquid biopsy enhance patient selection beyond traditional staging.

These advances enable personalized surgical strategies and improve outcomes.

  • Innovations in perioperative immunotherapy and graft preservation techniques may further reduce recurrence risk and broaden curative options.

Review by Malik AK, Geh D (…) White SA et 3 al. in Nat Rev Gastroenterol Hepatol

© 2025. Springer Nature Limited.

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