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Essential Surgical Knowledge

Papers from the recent literature which are of interest to residents and practicing surgeons
Jayachidambaram Ambalavanan, Diana Isaacs, M Cecilia Lansang
Diabetes technology is evolving rapidly and is changing the way both patients and clinicians approach the management of diabetes. With more devices gaining US Food and Drug Administration approval and insurance coverage expanding, these new technologies are being widely adopted by people living with diabetes. We provide a summary of the commonly available devices in the market today that clinicians will likely encounter. This includes continuous glucose monitors (CGMs); connected insulin pens, caps, and buttons; and insulin pumps...
June 3, 2024: Cleveland Clinic Journal of Medicine
Ian Judson, Robin L Jones, Newton A C S Wong, Palma Dileo, Ramesh Bulusu, Myles Smith, Max Almond
BACKGROUND: British Sarcoma Group guidelines for the management of GIST were initially informed by those published by the European Society of Clinical Oncology. This update was written by a group of experts to includes a discussion of the highlight improvements in our knowledge of the disease and recent treatment developments. The guidelines include sections on Incidence, Aetiology, Diagnosis, including risk assessment, Treatment and Follow-up. METHODS: A careful review of the literature was performed to ensure that wherever possible recommendations are supported by the results of clinical trials or substantive retrospective reports...
June 5, 2024: British Journal of Cancer
Chase J Wehrle, Mir Shanaz Hossain, Breanna Perlmutter, Jenny H Chang, Daniel Joyce, Robert Simon, Toms Augustin, R Matthew Walsh
OBJECTIVE: We aim to quantify the rate of progression in surveilled cysts and assess what factors should indicate delayed resection. SUMMARY BACKGROUND DATA: Side-branch intraductal papillary mucinous neoplasms (SB-IPMNs) are increasingly discovered, making it challenging to identify which patients require resection, thus avoiding inappropriate treatment. Most incidental lesions are surveyed, yet the consequences of that decision remain uncertain. METHODS: A prospectively maintained database of pancreatic cystic neoplasms was queried for patients with SB-IPMN...
June 6, 2024: Annals of Surgery
Guido Fiorentini, Juliane Bingener, Kristine T Hanson, Patrick Starlinger, Rory L Smoot, Susanne G Warner, Mark J Truty, Michael L Kendrick, Cornelius A Thiels
BACKGROUND: The absence of surgical complications has traditionally been used to define successful recovery after pancreas surgery. However, patient-reported outcome measures as metrics of a challenging recovery may be superior to objective morbidity. This study aims to evaluate the use of patient-reported outcomes in assessing recovery after pancreas surgery. METHODS: Patients scheduled for pancreatoduodenectomy were prospectively enrolled between 2016 to 2018...
May 21, 2024: Surgery
Huseyin Naci, Yichen Zhang, Steven Woloshin, Xiaodong Guan, Ziyue Xu, Anita K Wagner
BACKGROUND: New cancer drugs can be approved by the US Food and Drug Administration (FDA) on the basis of surrogate endpoints while data on overall survival are still incomplete or immature, with too few deaths for meaningful analysis. We aimed to evaluate whether clinical trials with immature survival data generated evidence of overall survival benefit during the period after marketing authorisation, and where that evidence was reported. METHODS: In this retrospective analysis, we searched Drugs@FDA to identify cancer drug indications approved between Jan 1, 2001, and Dec 31, 2018, on the basis of immature survival data...
May 13, 2024: Lancet Oncology
Joshua M K Davis, Muhammad Khalid Khan Niazi, Ansley B Ricker, Thomas E Tavolara, Jordan N Robinson, Bayram Annanurov, Kaylee Smith, Rohit Mantha, Jimmy Hwang, Ruchi Shrestha, David A Iannitti, John B Martinie, Erin H Baker, Metin N Gurcan, Dionisios Vrochides
BACKGROUND AND OBJECTIVES: Deep learning models (DLMs) are applied across domains of health sciences to generate meaningful predictions. DLMs make use of neural networks to generate predictions from discrete data inputs. This study employs DLM on prechemotherapy cross-sectional imaging to predict patients' response to neoadjuvant chemotherapy. METHODS: Adult patients with colorectal liver metastasis who underwent surgery after neoadjuvant chemotherapy were included...
May 7, 2024: Journal of Surgical Oncology
Ammar A Javed, Omar Mahmud, Asad Saulat Fatimi, Alyssar Habib, Mahip Grewal, Jin He, Christopher L Wolfgang, Marc G Besselink
BACKGROUND: Improved systemic therapy has made long term (≥ 5 years) overall survival (LTS) after resection of pancreatic ductal adenocarcinoma (PDAC) increasingly common. However, a systematic review on predictors of LTS following resection of PDAC is lacking. METHODS: The PubMed, Embase, Scopus, and Cochrane CENTRAL databases were systematically searched from inception until March 2023. Studies reporting actual survival data (based on follow-up and not survival analysis estimates) on factors associated with LTS were included...
May 6, 2024: Annals of Surgical Oncology
Sirkku Ahlström, Paula Bergman, Ritva Jokela, Klaus T Olkkola, Mari A Kaunisto, Eija Kalso
BACKGROUND: Propofol is a widely used intravenous hypnotic. Dosing is mostly based on weight with great interindividual variation in consumption. Suggested factors affecting propofol requirements include age, gender, ethnicity, anxiety, alcohol consumption, smoking, and concomitant valproate use. Genetic factors have not been widely explored. METHODS: We studied 1000 women undergoing breast cancer surgery under propofol and remifentanil anesthesia. Depth of anesthesia was monitored with State Entropy TM...
May 3, 2024: Anesthesiology
Hannah Groenen, Nathan Bontekoning, Hasti Jalalzadeh, Dennis R Buis, Yasmine E M Dreissen, Jon H M Goosen, Haitske Graveland, Mitchel Griekspoor, Frank F A IJpma, Maarten J van der Laan, Roald R Schaad, Patrique Segers, Wil C van der Zwet, Ricardo G Orsini, Anne M Eskes, Niels Wolfhagen, Stijn W de Jonge, Marja A Boermeester
IMPORTANCE: Surgical site infections (SSIs) are common postoperative complications and associated with significant morbidity, mortality, and costs. Prophylactic intraoperative incisional wound irrigation is used to reduce the risk of SSIs, and there is great variation in the type of irrigation solutions and their use. OBJECTIVE: To compare the outcomes of different types of incisional prophylactic intraoperative incisional wound irrigation for the prevention of SSIs in all types of surgery...
April 24, 2024: JAMA Surgery
Olivia A Sacks, Jason Hall
IMPORTANCE: Care of patients with diverticulitis is undergoing a paradigm shift. This narrative review summarizes the current evidence for left-sided uncomplicated and complicated diverticulitis. The latest pathophysiology, advances in diagnosis, and prevention strategies are also reviewed. OBSERVATIONS: Treatment is moving to the outpatient setting, physicians are forgoing antibiotics for uncomplicated disease, and the decision for elective surgery for diverticulitis has become preference sensitive...
April 17, 2024: JAMA Surgery
Tasnim Hasan, Michelle Lynch, Catherine King, Charbel Wehbe, Martin Plymoth, Md Saiful Islam, Theodore Iannuzzi, Aiken Dao, Jana Lai, Alexandra Martiniuk, Shalini Desai, Meru Sheel
BACKGROUND: Outbreaks of vaccine preventable diseases (VPDs) in health care workers (HCWs) can result in morbidity and mortality and cause significant disruptions to health care services, patients and visitors as well as an added burden on the health system. This scoping review is aimed to describe the epidemiology of VPD outbreaks in HCW, caused by diseases which are prevented by the ten vaccines recommended by World Health Organization (WHO) for HCWs. METHODS: In April 2022 CINAHL, MEDLINE, Global Health and EMBASE were searched for all articles reporting on VPD outbreaks in HCWs since the year 2000...
April 17, 2024: Clinical Infectious Diseases
Tina Bharani, Claire Yuan, Karina Mahida, Suheila Mukhtar, Hudson Bosch, Mia Linson, Eric Sheu, Divyansh Agarwal
OBJECTIVE: To evaluate the accuracy of self-reported conflicts of interest (COIs) for articles published in prominent minimally invasive and general surgical journals. BACKGROUND: Accurate reporting of industry relationships and COIs is crucial for unbiased assessment of a particular study. Despite the enactment of COI laws, such as the Physician Payments Sunshine Act in 2010, prior work suggests that 40-70% of self-reported COIs have discrepancies. METHODS: We utilized three public databases -- Open Payments (USA), Disclosure UK, and Disclosure Australia -- to assess the accuracy of COI disclosures among authors of 918 published articles from these respective countries...
April 19, 2024: Annals of Surgery
Ali Yasen Mohamedahmed, Shafquat Zaman, Niloy Das, Georgios Kakaniaris, Stelios Vakis, James Eccersley, Pradeep Thomas, Najam Husain
BACKGROUND: To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis. METHODS: A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis...
April 5, 2024: International Journal of Colorectal Disease
(no author information available yet)
OBJECTIVE: This study investigated if hybrid oesophagectomy with minimally invasive gastric mobilization and thoracotomy enabled faster recovery than open surgery. METHODS: In eight UK centres, this pragmatic RCT recruited patients for oesophagectomy to treat localized cancer. Participants were randomly allocated to hybrid or open surgery, stratified by centre and receipt of neoadjuvant treatment. Large dressings aimed to mask patients to their allocation for six days post-surgery...
March 2, 2024: British Journal of Surgery
J Cleo Kenington, Gianluca Pellino, Muhammad R Iqbal, Nauman Ahmed, V Chandima Halahakoon, Alexandra M Zaborowski, Ramprasad Rajebhosale, Jonathan Gabriel, Christina Coroyannakis, Matthew Cauldwell, Lila Mayahi, Kara Dent, Chris Elton, Kamal Mahawar, Aali J Sheen, Christian Macutkiewicz, Sonia Lockwood
No abstract text is available yet for this article.
March 2, 2024: British Journal of Surgery
Kavin Sugumar, Henry Stitzel, Victoria Wu, David Bajor, Sakti Chakrabarti, Madison Conces, Lauren Henke, Melissa Lumish, Amit Mahipal, Amr Mohamed, Jordan M Winter, Jeffrey M Hardacre, John B Ammori, Jennifer E Selfridge, Lee M Ocuin
BACKGROUND: Treatment of unresectable colorectal liver metastases (UCRLM) includes locoregional and systemic therapy. A comprehensive analysis capturing long-term outcomes of these treatment options has not been performed. OBJECTIVE: A systematic review and meta-analysis was performed to calculate pooled outcomes of hepatic artery infusion with systemic chemotherapy (HAI-S), transarterial chemoembolization with systemic chemotherapy (TACE-S), transarterial radioembolization with systemic chemotherapy (TARE-S), doublet (FOLFOX, FOLFIRI), and triplet chemotherapy (FOLFOXIRI)...
March 19, 2024: Annals of Surgical Oncology
Abraham Hernández-Blanquisett, Valeria Quintero-Carreño, María Cristina Martínez-Ávila, María Porto, María Carolina Manzur-Barbur, Emiro Buendía
Pancreatic cancer is one of the most lethal neoplasms worldwide; it is aggressive in nature and has a poor prognosis. The overall survival rate for pancreatic cancer is low. Most patients present non-specific symptoms in the advanced stages, which generally leads to late diagnosis, at which point there is no option for curative surgery. The treatment of metastatic pancreatic cancer includes systemic therapy, in some cases radiotherapy, and more recently, molecular targeted therapies, which can positively impact cancer control and improve quality of life...
2023: Oncology Reviews
Hanna Kakish, Mohammed O Suraju, Erik S Davis, Abhinav Seth, Yong K Kwon, Hassan Aziz
INTRODUCTION: The management of T2 multifocal hepatocellular carcinoma (MHCC) is controversial, and the comparative impact of liver resection (LR) versus tumor ablation (TA) on survival continues to be debated. The aim of our study was to examine short- and long-term survival for LR and TA in a nationally representative cohort. We hypothesized that patients who underwent LR would have improved survival. METHODS: We utilized the National Cancer Database (2004-2015) to identify patients diagnosed with non-metastatic T2 MHCC...
February 9, 2024: Journal of Surgical Oncology
Nine de Graaf, Maurice J W Zwart, Jony van Hilst, Bram van den Broek, Bert A Bonsing, Olivier R Busch, Peter-Paul L O Coene, Freek Daams, Susan van Dieren, Casper H J van Eijck, Sebastiaan Festen, Ignace H J T de Hingh, Daan J Lips, Misha D P Luyer, J Sven D Mieog, Hjalmar C van Santvoort, George P van der Schelling, Martijn W J Stommel, Roeland F de Wilde, I Quintus Molenaar, Bas Groot Koerkamp, Marc G Besselink
BACKGROUND: Although robotic pancreatoduodenectomy has shown promising outcomes in experienced high-volume centres, it is unclear whether implementation on a nationwide scale is safe and beneficial. The aim of this study was to compare the outcomes of the early experience with robotic pancreatoduodenectomy versus open pancreatoduodenectomy in the Netherlands. METHODS: This was a nationwide retrospective cohort study of all consecutive patients who underwent robotic pancreatoduodenectomy or open pancreatoduodenectomy who were registered in the mandatory Dutch Pancreatic Cancer Audit (18 centres, 2014-2021), starting from the first robotic pancreatoduodenectomy procedure per centre...
January 31, 2024: British Journal of Surgery
Kanika G Nair, Suneel D Kamath, Nivan Chowattukunnel, Smitha S Krishnamurthi
Neoadjuvant chemotherapy is safe for patients with locally advanced colon cancer (LACC). The FOxTROT trial demonstrated a reduction in residual and recurrent cancer at 2 years with neoadjuvant chemotherapy for patients with cT3-4 LACC. Preoperative chemotherapy should be avoided, if possible, for patients with dMMR LACC, as over 50% of dMMR cancers have no pathologic response. Early universal testing of MMR status is critical to selecting the appropriate neoadjuvant therapy. Concerns about CT staging of LACC have limited uptake of neoadjuvant chemotherapy, as approximately 25% of patients with cT3-T4 cancer on CT have low-risk stage II disease...
February 13, 2024: Current Treatment Options in Oncology
2024-02-18 18:17:06
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