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Digital Frailty Index Flags Surgical Risks: A Tech Boost for Patient Safety

In a study involving 33,449 patients, the Electronic Frailty Index (EFI) — a tech-driven health record tool — categorized individuals as fit, prefrail, or frail based on preoperative data. Prefrail and frail statuses significantly increased the likelihood of postoperative adverse events compared to fit individuals. Even after adjusting for various factors, each 0.03-unit increase in EFI raised the odds of adverse events by 1.06. Utilizing EFI in electronic health records could enhance risk screening and management, especially for high-risk surgeries.

Journal Article by Khanna AK, Motamedi V (…) Segal S et 4 al. in JAMA Netw Open

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Navigating the Robot: RAMIG Practices and Outcomes Unveiled Globally

Researchers explored the global landscape of robot-assisted minimally invasive gastrectomy (RAMIG) for gastric cancer in a 2020-2023 registry spanning 25 centers. In 759 cases, RAMIG showcased varying techniques and excellent outcomes. Anastomotic leakage rates after total and distal gastrectomy reflected high surgical quality. The study sets a RAMIG quality standard, offering an international reference for surgical practices and perioperative benchmarks. Notably, shorter hospital stays sans perianastomotic drains signify potential improvements in postoperative care.

Journal Article by de Jongh C, Cianchi F (…) Ruurda J et 30 al. in Ann Surg

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

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New Subtypes in Intrahepatic Cholangiocarcinoma

Researchers classified intrahepatic cholangiocarcinoma (ICC) into perihilar and peripheral subtypes, revealing distinctive features and survival outcomes. Among 1264 patients, 84.3% were ICC-peripheral, while 15.7% were ICC-perihilar. The perihilar subtype exhibited aggressive characteristics and poorer survival than the peripheral subtype. Interestingly, ICC-perihilar behaved akin to bile duct carcinoma, while ICC-peripheral resembled primary liver malignancies. This novel classification provides crucial insights for tailored treatment strategies and a nuanced understanding of ICC subtypes.

Journal Article by Wei T, Lu J (…) Pawlik TM et 16 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Screening Saves: Total Colonoscopy’s Crucial Role in Gastric Cancer Patients

In a study of 796 preoperative gastric cancer patients, 5.4% had synchronous colorectal cancer (SCRC). Endoscopic treatments were successful, and all SCRC patients underwent curative treatment, with no attributed deaths. Cumulative mortality rates showed 12.6% for gastric cancer-related deaths but none for SCRC. Screening total colonoscopy proved effective, suggesting its vital role. Cost-effectiveness analysis revealed a screening cost of 5.86 million yen to prevent one colorectal cancer death compared to non-screened patients.

Journal Article by Koseki Y, Hikage M (…) Bando E et 8 al. in Ann Surg Oncol

© 2023. Society of Surgical Oncology.

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Histopathologic Insights into Median Arcuate Ligament Syndrome

In a breakthrough study, researchers introduced the first histopathologic grading system for Median Arcuate Ligament Syndrome (MALS). Examining specimens from 36 patients who underwent robotic MALS surgery, the team identified unique nerve and lipogranuloma findings. Histopathologic abnormalities correlated with postoperative improvement, supporting nerve compression and inflammation as key contributors to MALS pain. The study advocates for celiac ganglia resection to alleviate symptoms and emphasizes ongoing histopathologic analysis for a deeper understanding of MALS.

Journal Article by DeCicco J, Raja F, Ganesan S and El-Hayek K in BMC Surg

Copyright © 2023 Elsevier Inc. All rights reserved.

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Shifting Tides: Embracing Total Neoadjuvant Therapy for Advanced Rectal Cancer

Examining trends from 2012 to 2020, researchers unveil that over 50% of 51,407 patients with locally advanced rectal cancer received total neoadjuvant chemoradiation (TNT). Factors like age and comorbidities influenced TNT rates, with stage III patients more likely to undergo it. Notably, TNT usage increased by 38% post-guideline inclusion in 2018. This study not only captures evolving treatment patterns but also establishes a benchmark for future assessments, reflecting a substantial adoption of TNT in rectal cancer care.

Journal Article by Unuvar M, Blansfield J, Wang S and Hoffman RL in Am J Surg

Copyright © 2023. Published by Elsevier Inc.

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Anastomosis Matters: Kono-S Offers Edge in Reducing Recurrence in Crohn’s Disease

Delving into Crohn’s disease post-ileocolic resection, this meta-analysis (17 studies, 2087 patients) compares anastomotic techniques. Endoscopic postoperative recurrence (epor) risk at ≥6 months was 37.2%. Kono-S anastomosis (17.7% cases) outshone conventional methods (81% cases), showing a lower epor incidence (24.7% vs. 42.6%). Results suggest Kono-S reduces epor risk, emphasizing its potential for challenging cases. While promising, larger randomized trials are urged for confirmation, presenting a pivotal shift toward Kono-S for improved Crohn’s postoperative outcomes.

Journal Article by Nardone OM, Calabrese G (…) Iacucci M et 6 al. in Inflamm Bowel Dis

© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn’s & Colitis Foundation. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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Cracking the Code: Gastrojejunal Anastomosis Holds Clues to Weight Regain in Gastric Bypass Graduates

Researchers delved into the post-gastric bypass world, unraveling the mystery of weight regain (WR). Examining 34 Roux-en-Y gastric bypass alumni, they discovered a correlation between the gastojejunal anastomosis (GJA) diameter and WR. However, excluding outliers with GJA over 30 mm nullified the link. The study highlights the potential of visual GJA estimation and emphasizes that more pliable GJAs (with higher distensibility index) in a subset of patients correlate with reduced WR rates, unlocking insights for clinical management pending larger confirmatory studies.

Journal Article by Razzak FA, Kerbage A (…) Dayyeh BA et 7 al. in Obes Surg

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

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Robotic Surgery Linked to Lower Postoperative Infections and Shorter Hospital Stays in Pancreatoduodenectomy

In a retrospective study spanning 2013 to 2022, researchers delved into healthcare-associated infections (HAIs) post-pancreatoduodenectomy (PD). Among 2632 patients, HAIs decreased over time, especially in open PD (OPD). Robotic PD (RPD) exhibited significantly fewer HAIs (5.8% vs. 9.6% in OPD). RPD correlated with reduced infections, shorter hospital stays, and higher costs. Notably, attention should be directed at curbing infections in OPD, while efforts to trim RPD expenses persist.

Journal Article by Yu ZH, Du MM (…) Yao HW et 7 al. in J Gastroenterol Hepatol

© 2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

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Gallbladder Polyps: Size Matters in Predicting Cancer Risk

In this cohort study on 438 patients with gallbladder polyps (GPs), the risk of gallbladder cancer was 0.7% for all polyps, escalating to 5.9% for those ≥10 mm. GP size emerged as the sole predictor of malignancy (p = 0.0001), with a 21 mm cutoff indicating cancer risk. Patient’s age, symptoms, number of polyps, and changes in size were not predictive. The mean polyp growth rate was 0.3 mm/year, and 16% disappeared, prompting protocol adjustments favoring reduced scans and early discharge.

Journal Article by Hajibandeh S, Ashar S (…) Kumar N et 2 al. in J Gastroenterol Hepatol

© 2023 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

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