STITCHES - the Best Papers in General Surgery

Surgical Sabermetrics Framework Enhances Training Outcomes

by Dick L, Howie E (...) Yule S et 7 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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ASO Education and Training: Taking the Next Step in Surgical Oncology Health Disparities Research: Identifying Root Causes and Targets for Actionable Change - Annals of Surgical Oncology The Society of Surgical Oncology and its membership are committed to reducing and eliminating cancer disparities. Over the past several decades, plentiful research has identified marginalized populations who are at an elevated risk of developing cancer, are less likely to receive recommended cancer screenings and guideline-concordant care, and populations who have inferior oncologic outcomes after cancer treatment. Despite monumental strides in improving cancer outcomes, cancer disparities unfortunately remain a reality. Continued strategic efforts are needed to identify the root causes of these disparities and develop interventions to ensure equitable cancer care for all patients. This monumental task requires multidisciplinary and transdisciplinary team collaboration, input from community and patient stakeholders, investments from healthcare and hospital administrative leadership, and financial sponsorship to ensure sustainability. In this review, we discuss tools that surgical oncologists can use in developing programs and interventions to champion eliminating cancer disparities to ensure equitable oncologic outcomes for all patients at risk or diagnosed with cancer.

Addressing Cancer Disparities in Surgical Oncology

by Cortina CS, Molina G (...) Willis A et 9 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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Risk Factors for Early Disease-Related Mortality Among Patients with Localized Pancreatic Cancer Resected After Neoadjuvant Treatment - Annals of Surgical Oncology Background Following neoadjuvant treatment (NAT) and resection with radical intent, not all patients with pancreatic ductal adenocarcinoma (PDAC) seem to achieve a meaningful survival benefit, as some experience very-early recurrence and succumb shortly thereafter. This study aimed to identify preoperative risk factors of mortality within 1-year after NAT and surgery. Patients and Methods Retrospective analysis of all patients who underwent radical resection for PDAC after at least 3-months of NAT between January 2015 and March 2023. Early-death (ED) was defined as disease-related mortality within 12-months of surgery, excluding surgery-related mortality. Receiver operating characteristic (ROC) curve analysis was used to determine statistically derived thresholds for continuous variables. Multivariable logistic regression was conducted to identify factors associated with ED, which were subsequently evaluated in an external cohort. Results Overall, 418 patients were included. After a median follow-up of 37 months (95%CI 34–39), 44 patients (10.5%) experienced ED, with a median survival from diagnosis of 17 months (95%CI 15–18) and a disease-free survival of 4 months (95%CI 3–4). Radiological tumor size ≥ 25 mm (OR 3.81, 95%CI 1.84–7.91, p < 0.001) and CA19-9 ≥ 100 U/mL (OR 2.93, 95%CI 1.41–6.05, p = 0.004) were independently associated with ED. These associations were confirmed in the external cohort of 473 patients (OR 3.93, 95%CI 2.39–6.45, p < 0.001 and OR 1.81, 95%CI 1.08–3.03, p = 0.023, respectively). Conclusions In this study, post-treatment CA19-9 ≥ 100 U/mL and tumor size ≥ 25 mm were associated with an increased risk of early-death after resection following NAT, representing warning signs in surgical decision-making and preoperative counselling.

Risk Factors for Early Mortality in Resected Localized Pancreatic Cancer

by De Stefano F, Belfiori G (...) Falconi M et 17 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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Immediate Endoscopic Necrosectomy Cuts Recovery Time in Pancreatitis

by Saito T, Fujisawa T (...) Nakai Y et 46 al. in Gastroenterology #Surgery #SurgSky #GeneralSurgery #MedSky

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New Approaches for Refractory GERD Management

by Zuo XY and Chen QQ in World J Gastroenterol #Surgery #SurgSky #GeneralSurgery #MedSky

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Synergistic Effects of Psychological Resilience Training and Nutritional Support on Postoperative Recovery, Nutritional Reconstitution, Sleep Quality, and Long-Term Survival in Gastric Cancer: A Randomized Controlled Trial - Annals of Surgical Oncology Background Psychological distress and malnutrition are common among gastric cancer patients and are associated with poor postoperative recovery and long-term prognosis. However, these modifiable factors are rarely addressed in an integrated manner. This study was designed to evaluate whether a combined intervention of psychological resilience training and nutritional support improves postoperative recovery, systemic inflammation, sleep quality, nutritional status, and survival in gastric cancer patients undergoing curative surgery. Methods In this randomized controlled trial, 260 patients undergoing curative gastrectomy were randomly assigned to receive either standard care or an integrated intervention combining cognitive–behavioral resilience training and individualized nutritional support. Primary outcomes included changes in psychological resilience (Connor–Davidson Resilience Scale), sleep quality (Pittsburgh Sleep Quality Index), emotional distress (Hospital Anxiety and Depression Scale), and nutritional indices (albumin, prealbumin, body mass index). Secondary outcomes included inflammatory markers (C-reactive protein, interleukin-6, tumor necrosis factor-alpha), postoperative complications, hospital stay, and 2-year disease-free survival and overall survival. Results Compared with controls, the intervention group showed significantly greater improvements in resilience, sleep quality, emotional well-being, and nutrition (all p < 0.001). Inflammatory markers were reduced, and complication rates were lower (16% vs. 28%, p = 0.015). Hospital stay was shorter (8.9 vs. 10.4 days, p < 0.001). Two-year DFS and OS were significantly higher (disease-free survival: 79.3% vs. 64.2%; overall survival: 84.6% vs. 69.2%), with multivariable Cox models confirming the intervention as an independent prognostic factor. Conclusion Integrated psychological and nutritional interventions enhance recovery and survival in gastric cancer, offering a promising adjunct to standard perioperative care.

Integrated Training Enhances Recovery in Gastric Cancer Patients

by Wang G and Pan S in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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Radiation and chemotherapy improve rectal cancer outcomes

by Imam I, Nilsson PJ (...) Glimelius B et 2 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Volume of EMS Clinicians Linked to Lower Trauma Mortality

by Beiriger J, Martin-Gill C (...) Brown JB et 14 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Long-Term Outcomes: Laparoscopic vs Open Adhesiolysis

by Räty P, Mentula P (...) Sallinen V et 9 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Trends and Outcomes of the Liver-First Surgical Approach for Patients with Colorectal Cancer and Isolated Liver Metastases - Annals of Surgical Oncology Background The optimal sequencing for resection of primary and liver metastases in stage IV colorectal cancer (CRC) remains debated. This study evaluated utilization trends and outcomes of liver resection before colon/rectal resections. Methods A retrospective analysis was performed using the National Cancer Database (2010–2020) for patients with stage IV CRC and isolated liver metastases who underwent resection of primary CRC and liver metastases. The study identified two cohort groups: a group that underwent liver resection before colon/rectal resection (LRCR) and a group that underwent colon/rectal resection synchronous with or before liver resection (CRLR). Overall survival (OR) was evaluated using Cox proportional hazard models, whereas logistic regression was used for binary outcomes. Results Among 10,959 patients, 1178 underwent LRCR and 9781 underwent CRLR. Utilization of LRCR increased from 5.37% in 2010 to 15.43% in 2020. Predictors of LRCR utilization included rectal primary sites (OR, 5.88; 95% confidence interval [CI], 4.55–7.60) and academic treatment facilities (OR, 2.74; 95% CI, 1.25–6.00). Predictors of lower LRCR included lymphovascular invasion (OR, 0.69; 95% CI, 0.54–0.87) and moderate (OR, 0.61; 95% CI, 0.39–0.95) to poorly differentiated (OR, 0.47; 95% CI, 0.27–0.81) pathology. Patients undergoing the LRCR approach were associated with better overall survival than those undergoing CRLR (hazard ratio, 0.87; 95% CI, 0.77–0.99). The 90-day mortality (1.11% vs 4.47%; p < 0.01) and 30-day readmissions (3.69% vs 5.81%; p<0.01) after primary tumor resection were lower in the LRCR group. Conclusion The LRCR approach has been increasingly used over time. Compared with CRLR, the LRCR approach was associated with better overall survival, lower postoperative mortality and fewer readmissions after colon/rectal resection.

Liver-First Approach Improves Outcomes in Colorectal Cancer

by Morocho B, Lightfoot S, Somasundar P and Kwon S in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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EUS-Guided Biopsy for Pancreatic Cysts: Key Outcomes and Risks

by Lee HS, Song TJ (...) Seo DW et 3 al. in Gastrointest Endosc #Surgery #SurgSky #GeneralSurgery #MedSky

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New Guidelines Transform Acute Appendicitis Management

by Podda M, Ceresoli M (...) Catena F et 47 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Adenosquamous Carcinoma of the Pancreas: Outcomes of a Multicenter European Study (ADESQUPAN Project) - Annals of Surgical Oncology Background Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer. Compared with other pancreatic tumors, ASCP has a notably poorer prognosis and shorter survival rates. The optimal therapeutic approaches to ASCP have yet to be defined. Methods This retrospective, multicenter European study included all consecutive patients who underwent elective pancreatic surgery for ASCP at participating centers between 2010 and 2024. The inclusion criteria encompassed all patients who underwent scheduled surgery for ASCP during the study period. The exclusion criteria ruled out patients without a confirmed pathologic diagnosis of ASCP, those who did not undergo surgery, and patients with extra-pancreatic disease. Results The study analyzed 194 patients from 29 hospitals in 11 European countries. The overall survival rates were 56.2% at 1 year, 26.3% at 3 years, and 9.8% at 5 years. The disease-free survival rates at the same intervals were 36.6%, 16.5%, and 6.7%, respectively. In the multivariate analysis, significant associations with shorter survival were R2 resections, lymphatic stromal invasion, T4 stage, no adjuvant chemotherapy, and recurrence. Conclusions Patients who undergo resection for ASCP experience very low 5-year survival rates (10%). It is advisable to avoid resecting T4 tumors in patients with significant comorbidities or R2 resections. Additionally, failure to provide adjuvant chemotherapy, often due to severe postoperative complications, further deteriorates the prognosis.

Adenosquamous Carcinoma's Grim Prognosis for Surgical Patients

by Ramia JM, Villodre C (...) Serradilla-Martín M et 40 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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Single-port robotic cholecystectomy using the da Vinci SP system versus single-port laparoscopic cholecystectomy: comparative clinical outcomes - Surgical Endoscopy Introduction Single-port surgery has been emphasized, with a focus on its technical challenges, patient satisfaction, and advances in the field, especially since the advent of single-port robotic systems. Our aims in this study were to compare the clinical outcomes of single-port cholecystectomy between the laparoscopic and robotic da Vinci SP approaches. Materials and methods We analyzed data from patients who underwent single-port cholecystectomy for symptomatic gallstones or gallbladder polyps. We compared 176 patients who underwent single-port laparoscopic cholecystectomy with 243 patients who underwent single-port robotic cholecystectomy. Results Operation time, conversion rate, confirmation rate of a critical view of safety, complication rate, and pathologic results did not differ significantly between the two groups. The mean operative time was comparable between both groups (59.0 ± 36.1 vs 54.3 ± 22.9 min, p = 0.134). Hospital stay was shorter in the robotic group, although it was not significant after adjustment. The robotic group showed significantly lower postoperative pain scores and reduced opioid use. Although the robotic group included more cases with inflammatory or adhesive changes, the rate of achieving a critical view of safety and the overall complication rate did not differ between groups. Gallbladder perforation occurred more frequently in the laparoscopic group. Bile duct–related complications were rare and successfully managed by endoscopic retrograde cholangiopancreatography. Conclusion We conclude that single-port robotic cholecystectomy and single-port laparoscopic cholecystectomy are both feasible and safe surgical techniques. However, single-port robotic cholecystectomy has clinical advantages, primarily lower postoperative pain and a reduced analgesic requirement than the laparoscopic technique.

Single-port robotic cholecystectomy shows clear patient benefits.

by Kim SM, Kim SJ, Song TJ and Han H in Surg Endosc #Surgery #SurgSky #GeneralSurgery #MedSky

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Multimodal Prehabilitation Reduces Complications in Frail Elderly with Gastric Cancer

by Sun Y, Tian Y (...) Zhou Y et 18 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Liver Fibrosis Increases Recurrence Risk in Colorectal Metastases

by Morita S, Okabayashi K (...) Kitagawa Y et 9 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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Reducing Water Waste at OR Scrub Sinks

by Hu CJ, Reilly M (...) Ho KJ et 3 al. in Ann Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Diagnostic insights for colorectal laterally spreading tumors

by Amioka Y, Tanaka H (...) Oka S et 14 al. in Gastrointest Endosc #Surgery #SurgSky #GeneralSurgery #MedSky

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AI in Surgery: Bridging Expectation and Reality

by Thornton M, Cher BAY (...) Balentine CJ et 5 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Operating Room Communication Impacts Surgical Outcomes

by Armstrong VL, Lu PG (...) Stucky CH et 8 al. in BMC Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Emergency Surgery Models Cut Deaths for High-Risk Patients

by Nantais J, Saskin R (...) Baxter NN et 2 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Antibiotics as a Safe Alternative for Appendicitis Treatment

by Salminen P, Salminen R (...) Rautio T et 9 al. in JAMA #Surgery #SurgSky #GeneralSurgery #MedSky

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Novel Arterial Reconstruction of the Left Gastric Artery Supplying the Replaced Left Hepatic Artery in Distal Pancreatectomy with Celiac Axis Resection - Annals of Surgical Oncology Background Distal pancreatectomy with celiac axis resection (DP-CAR) with reconstruction of the left gastric artery (LGA) is a technically challenging procedure. The middle colic artery is commonly used for LGA reconstruction. This study highlights our novel arterial reconstruction of the LGA using the common hepatic artery (CHA) supplying the replaced left hepatic artery (rLHA) during DP-CAR. Patient and Methods A 65-year-old man diagnosed with locally advanced unresectable pancreatic body cancer underwent DP-CAR following systemic chemotherapy. As a rLHA arising from the LGA was present, arterial reconstruction was necessary. Results After confirming resectability, the CHA and LGA were encircled. Following division of the pancreas and radical lymphadenectomy, the origin of the celiac axis (CA) was divided. Subsequently, the CHA and LGA were transected and anastomosed. An indocyanine green fluorescence system was used to confirm adequate arterial blood supply and satisfactory tissue perfusion. Operative time was 215 min, with an estimated blood loss of 35 mL. Conclusions This study demonstrated a novel arterial reconstruction of the LGA supplying the rLHA during DP-CAR. The CHA may be a candidate for the reconstruction of the LGA in DP-CAR.

Novel Technique for LGA Reconstruction in Distal Pancreatectomy

by Takagi K, Ito A (...) Fujiwara T et 5 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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Laparoscopic surgery yields similar outcomes for colorectal peritoneal metastases.

by Park SY, Kwak SG (...) Choi GS et 7 al. in Surg Endosc #Surgery #SurgSky #GeneralSurgery #MedSky

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Robotic Surgery for Groin Hernia Doesn't Reduce Pain

by Angehrn FV, Süsstrunk J (...) Steinemann DC et 4 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Improved Survival with Delayed Surgery at High-Volume Centers Versus Early Surgery at Low-Volume Centers for Pancreatic Cancer - Annals of Surgical Oncology Background Although the relationship between higher surgical volume and improved outcomes for pancreatic operations is well established, centralizing care to high-volume centers (HVC) may prolong the interval from diagnosis to surgery. This study sought to compare outcomes of patients who had longer wait times for upfront surgery for pancreatic cancer (PDAC) at HVCs with those of patients who underwent earlier surgery at low-volume centers (LVCs). Methods Patients undergoing upfront pancreatic surgery for T1-3N0-2M0 PDAC were identified from the 2004–2023 National Cancer Database. High-volume centers were defined using Leapfrog criteria as centers performing ≥ 20 pancreatic resections/year, with others defined as LVCs. Patients who waited more than 28 days for resection at HVCs were classified as “long wait/high volume,” whereas those who underwent surgery in ≤ 14 days at LVCs were classified as “short wait/low volume.” Results Among 15,310 patients meeting the inclusion criteria, 9598 (63%) were short wait/low volume and 5712 (37%) were long wait/high volume. In unadjusted analysis, long wait/high volume demonstrated superior 5-year survival (23% vs. 19%, P < 0.001, log-rank). After comprehensive risk adjustment, waiting for surgery at an HVC remained associated with reduced mortality hazard during 5 years of follow-up evaluation (hazard ratio [HR], 0.81; 95% CI, 0.77–0.85; P < 0.001). Considering acute endpoints, the long-wait/high-volume group demonstrated greater likelihood of complete (R0) resection and reduced 30-day mortality, but higher risk of nodal disease and upstaging at resection. Conclusion Waiting for surgery at an HVC is associated with improved acute outcomes and superior overall survival compared with earlier operations at an LVC. These findings assuage concerns regarding the potential longer wait times for surgery associated with centralization of surgical care for PDAC.

High-Volume Centers Improve Pancreatic Cancer Survival

by Sakowitz S, Yamashita M, Hammons M and Donahue TR in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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New TNM Staging for Intrahepatic Cholangiocarcinoma Enhances Prognosis

by Yamamoto Y, Kosaka H (...) Kaibori M et 12 al. in BMC Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Cost Drivers in Laparoscopic Hiatal Hernia Repair Identified

by Liu X, Ma Q (...) Yang H et 3 al. in BMC Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Octogenarians and Right Hemicolectomy: A Risky Balance

by Taffurelli G, Montroni I (...) Ugolini G et 5 al. in BMC Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Variability in Informed Consent Undermines Patient Autonomy

by Harrington CL, Bosco CM, Wightman SC and Shakhsheer BA in Am J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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