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Dementia Complicates Surgical Decision-Making Dynamics

Clinicians face significant challenges when making surgical decisions for patients with dementia due to documentation and communication issues.

  • Difficulty in identifying dementia and assessing patient capacity limits optimal decision-making, worsened by inconsistent electronic health record documentation.
  • Caregivers often play a pivotal role but deal with misaligned expectations and burden, complicating the decision process.
  • Clinicians frequently perceive dementia as detrimental to surgical outcomes, yet lack evidence-based references to substantiate these beliefs.

Improving EHR documentation and enhancing caregiver involvement could facilitate better surgical decisions for patients living with dementia.

Journal Article by Adler RR, Chunga RE (…) Traeger L et 18 al. in JAMA Surg

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Predictors of DVT After Gastric or Colorectal Surgery Identified

A nomogram can help predict early postoperative deep vein thrombosis (DVT) in gastric and colorectal cancer patients despite routine anticoagulant prophylaxis.

  • In this study of 388 patients, 32% had DVT detected by screening, predominantly asymptomatic distal DVT.
  • Key predictors for DVT included age, activated partial thromboplastin time, prothrombin time, and postoperative day 1 d-dimer.
  • The nomogram demonstrated strong predictive capability with an AUC of 0.854 in the validation cohort, suggesting it could enhance postoperative monitoring, although further validation is needed before clinical use.

Journal Article by Ma Y, Sun X and Wang Q in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Consensus Framework Improves Appendiceal Abscess Management

A new consensus from Italian experts offers a standardized, physiology-driven approach to managing appendiceal abscesses, aiming to reduce variability in surgical practice.

  • Early appendectomy remains the go-to for grade 1 phlegmons and small abscesses, while a short conservative trial can be considered for stable, low-risk patients.
  • For abscesses >3-4 cm, image-guided drainage is recommended as a temporary measure for high-risk candidates, not definitive treatment.
  • Immediate surgery is mandated for patients with clinical instability or generalized peritonitis, regardless of abscess size or type.

This framework provides specific criteria for management, potentially improving care consistency and outcomes.

Journal Article by Cirocchi R, Matteucci M (…) Pesce A et 55 al. in BMC Surg

Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.

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Achalasia Treatment: Heller’s Myotomy and POEM Lead Success

This systematic review shows that Heller’s myotomy and peroral endoscopic myotomy (POEM) outperform botulinum toxin for long-term symptom relief in primary achalasia.

  • At 5 years, Heller’s myotomy and POEM have a treatment success rate that is significantly greater than botulinum toxin (odds ratios of 6.39 and 6.33, respectively).
  • Botulinum toxin showed less treatment success at one year (odds ratio of 0.10).
  • Pneumatic dilatation resulted in higher lower esophageal sphincter pressure and greater abnormal acid exposure, indicating potential complications.

Patient selection should be individualized based on clinical factors and available expert techniques, as further high-quality trials are warranted.

Journal Article by Morrison JP, Davey MG and Donlon NE in J Gastrointest Surg

Copyright © 2026 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.

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Cost and Effectiveness of Robotic vs. Open Pancreatoduodenectomy

A randomized trial reveals no significant cost benefit of robotic pancreatoduodenectomy compared to open surgery, despite higher intraoperative costs.

  • Total hospital costs were similar: €30,956 for robotic vs. €28,271 for open (p=0.538).
  • Robotic technique had significantly higher intraoperative costs (€11,906 vs. €6,451, p<0.001) but lower postoperative costs (€19,051 vs. €21,856).
  • Health-related quality of life scores were slightly worse at 6 months for robotic patients, leading to a less than 30% probability of it being cost-effective.

Surgeons should weigh the potential benefits of robotic surgery against its costs, particularly since outcomes show a slight decline in quality of life after 6 months.

Journal Article by Menso JE, Bruna CL (…) Fretland ÅA et 28 al. in Ann Surg

Copyright © 2026 The Author(s). Published by Wolters Kluwer Health, LLC.

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Neoadjuvant Chemoradiation Improves Pathologic Response in ESCC

Neoadjuvant chemoradiation-immunotherapy offers better pathologic complete response rates compared to neoadjuvant chemoimmunotherapy alone in patients with locally advanced esophageal squamous cell carcinoma, but it comes with increased postoperative pulmonary complications without improving long-term survival.

  • Pathologic complete response (PCR) for nCRI was 41.1% vs. 19.4% for nCIT (p < 0.001).
  • Postoperative pulmonary complications were significantly higher with nCRI (37.1%) compared to nCIT (16.9%, p < 0.001).

Consider the risk of pulmonary complications when discussing neoadjuvant therapy options with patients.

Journal Article by Xiao X, Fang P (…) Yuan Y et 6 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Neoadjuvant Chemoimmunotherapy Improves Survival in Esophageal Cancer

In patients with locally advanced esophageal squamous cell carcinoma, neoadjuvant chemoimmunotherapy (ncit) significantly improves three-year overall survival compared to standard chemoradiotherapy (ncrt).

  • Three-year overall survival rate was 79.7% for ncit versus 68.2% for ncrt (HR 0.51, p = 0.023).
  • ncit also showed lower rates of overall recurrence (15.8% vs 28.8%, p = 0.033) and distant metastases (6.6% vs 17.0%, p = 0.006) within two years postoperatively.

Surgeons may consider ncit as a preferable neoadjuvant strategy for enhancing long-term outcomes in eligible patients.

Journal Article by Ao Y, Leng C (…) Fu J et 9 al. in Ann Surg Oncol

© 2026. Society of Surgical Oncology.

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Prophylactic Negative Pressure Therapy Cuts Infection Risk in Emergency Laparotomy

In patients undergoing emergency laparotomy, incisional negative pressure wound therapy (INPWT) significantly decreases the risk of surgical site infections (SSI) compared to standard dressings.

  • INPWT is linked to lower odds of overall SSI (OR 0.36), superficial and deep infections, and seroma formation.
  • Hospital length of stay was reduced by about 1.5 days with INPWT (MD -1.49), although wound dehiscence results were less certain.

Despite concerns about higher follow-up mortality associated with INPWT, this was not confirmed in randomized controlled trials. Surgeons may consider INPWT in the emergency setting to improve outcomes related to SSI and recovery time.

Review by Menegat ALRS, Menegat BLRS (…) Wiederkehr H et 2 al. in World J Surg

© 2026 The Author(s). World Journal of Surgery published by John Wiley & Sons Ltd on behalf of International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).

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Nomogram Identifies Early Recurrence Factors After Gastrectomy

A new study identifies key predictors of early recurrence in gastric cancer patients after curative gastrectomy, developed specifically for a non-East Asian cohort.

  • Among 367 patients, the early recurrence rate was 18.3%, linked to variables including perineural invasion and elevated CA 19-9 levels.
  • A nomogram developed from postoperative data achieved an AUC of 0.826, aiding in preoperative risk assessment.

This tool could help tailor postoperative surveillance strategies based on individual anatomical risk profiles and recurrence patterns.

Journal Article by Goldes Y, Lotan T (…) Nevo Y et 2 al. in J Gastrointest Surg

Copyright © 2026. Published by Elsevier Inc.

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Sphincter-Sparing Preclosure Technique Cuts Complications in Endoscopic Papillectomy

Sphincter-sparing preclosure technique-assisted endoscopic papillectomy significantly reduces delayed bleeding and shortens hospital stays compared to conventional methods.

  • Delayed bleeding rate dropped to 0% in the preclosure group versus 17.95% in the conventional group (p = .017).
  • Immediate bleeding rates were also lower in the preclosure group (37.93% vs 66.67%; p = .027).
  • Cannulation time and post-procedure hospitalization were shorter with preclosure (6 days vs 7 days, p = .048).

This technique could be a valuable addition to your practice to improve patient outcomes.

Journal Article by Liu FQ, Ren LN (…) Liu WH et 3 al. in Gastrointest Endosc

Copyright © 2026 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

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