BACKGROUND: Accurate identification of the midplane (Cantlie's line) is essential for anatomical liver resections, but conventional inflow control is often challenging because of adhesions, tumors, or anatomical variatio...BACKGROUND: Accurate identification of the midplane (Cantlie's line) is essential for anatomical liver resections, but conventional inflow control is often challenging because of adhesions, tumors, or anatomical variations. We developed a simple technique involving temporary clamping of the right side of the hilar plate using a laparoscopic grasper, covering at least the posterior extremity of the cystic plate anteriorly and the right half of the hepatoduodenal ligament posteriorly, for early identification of the midplane. METHODS: This study analyzed 62 patients undergoing laparoscopic hepatectomy. Without hilar dissection, the right Glissonean pedicle was gently clamped using a laparoscopic curved grasper. Success rates of midplane demarcation were compared between patients with normal portal vein (PV) anatomy (type 1) and those with variations (types 2 and 3). RESULTS: The overall success rate of midplane identification was 80.6% (50 of 62). Patients with a type 1 PV common trunk had a significantly higher success rate (92%, 46 of 50) than those with type 2 or 3 variations (50%, 6 of 12; P =.002). The technique was feasible in cirrhotic livers and was effective for identifying the right portal fissure in type 3 variations. CONCLUSION: Temporary clamping of the right hilar plate is a minimally invasive and efficient method for early midplane identification. By avoiding hilar dissection, it enhances the safety and precision of anatomical liver resections.
BACKGROUND: The Affordable Care Act's (ACA's) Medicaid expansion (ME) has improved cancer surgery access in urban states. However, its impact in the Midwest, home to a large rural population, remains under-studied. Pancr...BACKGROUND: The Affordable Care Act's (ACA's) Medicaid expansion (ME) has improved cancer surgery access in urban states. However, its impact in the Midwest, home to a large rural population, remains under-studied. Pancreatic surgery requires access to high-volume hospitals (HVH), often found in urban areas. This study examined how ME affected rates of pancreatic surgery in the Midwest. STUDY DESIGN: Data from State Inpatient Databases (2010-2022) of nine expansion or non/late-expansion Midwest states from Medicaid-eligible patients who underwent pancreatectomy for neoplasm were included. Interrupted time-series models were estimated for pancreatic surgery rates per 100,000 people across pre-expansion (2010-2013) and post-expansion (2014-2022), stratified by expansion status, and separately evaluated by payor, rurality, and HVH status (≥20 pancreatic cases/year). RESULTS: A total of 10,168 pancreatectomies were identified, with 75% in expansion states, including 39% among rural patients and 79% performed at high volume hospitals. The ACA did not significantly increase pancreatic surgery rates (expansion states p= 0.325, non-expansion states p= 0.904). Among Medicaid beneficiaries, surgery rates showed a slight increase prior to ME in non-expansion states but not within other payer types. The growth in use of HVH preceded the ACA and continued with this trajectory after ME (expansion states p= 0.356, non-expansion states p= 0.413). CONCLUSIONS: Medicaid beneficiaries in the Midwest did not experience increased rates of pancreatic surgery following ME suggesting insurance coverage alone is insufficient to increase receipt of surgical care. Future investigations should examine barriers beyond healthcare coverage that may limit rural patients' ability to receive pancreatic surgery in the Midwest.
BACKGROUND: The prognostic utility of carbohydrate antigen 19-9 (CA19-9) may vary based on clinical and gene[A1] tic factors, including FUT2/FUT3 mutations or UGT1A1 alleles. We sought to examine early postoperative chan...BACKGROUND: The prognostic utility of carbohydrate antigen 19-9 (CA19-9) may vary based on clinical and gene[A1] tic factors, including FUT2/FUT3 mutations or UGT1A1 alleles. We sought to examine early postoperative changes in CA19-9 relative to prognosis after resection of pancreatic ductal adenocarcinoma (PDAC). [A1]AU: Please ensure that genes (not proteins) are italicized, per journal style. METHODS: Patients undergoing resection of PDAC were identified from the All of Us Research Program. Patients were categorized into neoadjuvant therapy (NAT) followed by resection (NAT-to-resection) and surgery-first. The primary endpoint was real-world time-to-treatment failure (rwTTF). Genomic and sensitivity analyzes excluded post-treatment draws with total bilirubin levels >2 mg/dL and were restricted to CA19-9 producers. RESULTS: Among 283 patients who underwent pancreatic resection, 48 underwent NAT-to-resection and 235 underwent surgery-first. Index years ranged between 1999 and 2023. Baseline CA19-9 distributions differed markedly by pathway. Patients in the NAT-to-resection group had a median pretreatment CA19-9 of 273 U/mL, whereas patients in the surgery-first group had a median pretreatment CA19-9 of 19 U/mL, with 68.7% of patients demonstrating normal values. Carcinoembryonic antigen (CEA) levels were available preoperatively in 88 patients and postoperatively in 41 patients; among phenotypic CA19-9 nonproducers, few individuals had an elevated CEA level. In CA19-9 trajectory analysis, median rwTTF was 1185.5 days with normal-to-normal values, 693 days for elevated-to-normalized, and 138 days for those with elevated-to-persistently-elevated values. After excluding planned adjuvant therapy from the rwTTF endpoint, higher pretreatment CA19-9 and greater postoperative CA19-9 change were independently associated with rwTTF, whereas binary postoperative normalization alone was not. CONCLUSION: Basing a prognosis on a single CA19-9 value or percent drop may be insufficient, particularly because many surgery-first patients had normal baseline CA19-9 values. Perioperative CA19-9 trajectories provided a more clinically informative framework, with persistent postoperative elevation identifying the highest-risk group after PDAC resection.
BACKGROUND: High heterogeneity in postoperative recurrence patterns of early-onset gastric cancer (EOGC) has been reported, but few studies have comprehensively compared the recurrence risk factors and patterns between E...BACKGROUND: High heterogeneity in postoperative recurrence patterns of early-onset gastric cancer (EOGC) has been reported, but few studies have comprehensively compared the recurrence risk factors and patterns between EOGC and late-onset gastric cancer (LOGC) after radical resection. This study aimed to evaluate the postoperative recurrence patterns and independent risk factors in both cohorts. METHODS: Patients were classified as having EOGC or LOGC based on their age at diagnosis, with EOGC defined as age <50 years and LOGC as age ≥50 years. A retrospective analysis of 1868 patients (369 EOGC and 1499 LOGC) who underwent radical gastrectomy at The Sixth Affiliated Hospital of Sun Yat-sen University (July 2016 to June 2024) was performed. Univariate and multivariate Cox regression analyses identified recurrence risk factors, and restricted cubic spline curves were used to explore age-related nonlinear trends. RESULTS: Peritoneal recurrence (59.2%) and multiple recurrence (21.4%) were predominant in EOGC, whereas LOGC demonstrated lower rates of peritoneal recurrence (35.9%) and multiple recurrence (25.2%). EOGC's unique independent risk factors included tumor size >3 cm, lymphovascular invasion, and elevated preoperative carbohydrate antigen (CA)19-9. LOGC's unique predictors were positive tumor deposits, diffuse type, perineural invasion, human epidermal growth factor receptor 2 positivity, high lymph node ratio, and elevated preoperative CA125. Restricted cubic spline identified optimal age cutoffs (EOGC, 42 years; LOGC, 63 years). Subgroup analysis showed a higher recurrence risk in patients with EOGC aged <42 years with positive perineural invasion and in patients with LOGC aged 50 to 62 years with multicentric tumors. CONCLUSION: EOGC and LOGC have distinct recurrence patterns and independent risk factors. These findings suggest that postoperative surveillance strategies may be better tailored according to individualized recurrence risk rather than being uniformly intensified across all patients.
BACKGROUND: Helicobacter pylori infection is associated with a reduced risk of developing Barrett's esophagus. However, its impact on the progression of established nondysplastic Barrett's esophagus (NDBE) to dysplasia a...BACKGROUND: Helicobacter pylori infection is associated with a reduced risk of developing Barrett's esophagus. However, its impact on the progression of established nondysplastic Barrett's esophagus (NDBE) to dysplasia and esophageal adenocarcinoma (EAC) remains uncertain. METHODS: We queried a large USs clinical database to identify adults with NDBE between 2015 and 2023. The primary exposure was H pylori infection; controls were uninfected patients with NDBE. A 1:1 propensity score matching was performed. The primary outcome was progression to dysplasia or EAC, defined as a new diagnosis during follow-up. Among patients infected with H pylori, subgroup analyses examined the association between eradication therapy, esophagitis, sex, age, and smoking and progression. RESULTS: We identified 266,856 adults with NDBE, of whom 6262 had H pylori infection. After matching, progression to dysplasia or EAC was significantly higher in controls than in the H pylori cohort (8.3% vs 3.9%; P <.001; odds ratio [OR], 2.23; 95% CI, 1.91-2.61), with a similar result for progression to high-grade dysplasia and EAC alone. Among H pylori-infected patients, those who underwent eradication therapy had a higher progression to dysplasia or EAC compared with untreated individuals (6.0% vs 3.5%; P <.001; OR, 1.75; 95% CI, 1.35-2.26). The prevalence of esophagitis was similar between treated and untreated patients with H pylori. CONCLUSION: H pylori infection was associated with a substantially lower risk of progression from NDBE to dysplasia or EAC. This association was attenuated after eradication therapy, but esophagitis was similar between the cohorts, suggesting that reflux severity did not explain the association. These findings support H pylori as a potential risk-stratification marker in NDBE.
BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted in pancreatic surgery; however, substantial variation exists in their implementation and in reported outcomes. A comprehensive e...BACKGROUND: Enhanced recovery after surgery (ERAS) protocols have been increasingly adopted in pancreatic surgery; however, substantial variation exists in their implementation and in reported outcomes. A comprehensive evidence map of ERAS guideline components and their global application in pancreatic surgery is lacking. Therefore, this systematic review aimed to map current ERAS protocols, evaluate compliance, and summarize associated clinical outcomes. METHODS: Following PRISMA(Preferred Reporting Items for Systematic Reviews and Meta-Analyzes) guidelines, a systematic search of PubMed, Scopus, Web of Science, and international trial registries was conducted for studies published between 1980 and December 2025. Eligible studies included original, peer-reviewed English-language reports describing ERAS protocols in pancreatic surgery. Data were extracted and synthesized descriptively. RESULTS: A total of 32 studies comprising 3930 patients were included. ERAS protocols demonstrated marked heterogeneity across centers and countries. Consistently implemented components included preoperative counseling, antimicrobial prophylaxis, thoracic epidural analgesia, early nasogastric tube removal, early mobilization, and structured discharge criteria. Compliance varied widely (approximately 35%-100%), with higher adherence generally being associated with a shorter length of stay (LOS). Most studies reported LOS ranging between 7 and 15 days. Morbidity ranged from 30% to 60%; mortality remained low (0.0-4.0%), and readmission rates varied from 0% to 19%. Limited cost analyzes suggested potential savings. Favorable predictors of recovery included early solid intake, early drain removal, avoidance of nasogastric tubes, early mobilization, low drain fluid amylase, and robotic surgery, whereas postoperative complications, higher body mass index or American Society of Anesthesiologists class, and intraoperative transfusion were associated with prolonged LOS or ERAS failure. CONCLUSION: ERAS is widely used in pancreatic surgery with favorable outcomes, yet marked heterogeneity and variable compliance indicate a need for more standardized and consistently implemented protocols.
BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is widely adopted as the principal treatment for selected patients with pseudomyxoma peritonei from low-grade appendiceal mucinous neoplasm...BACKGROUND: Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is widely adopted as the principal treatment for selected patients with pseudomyxoma peritonei from low-grade appendiceal mucinous neoplasms. Prognostic uncertainty persists in patients with a very high peritoneal tumor burden. This study assessed predictors of survival in the overall cohort and explored whether established prognostic factors remain applicable in patients with super-extended disease and a very high Peritoneal Cancer Index (PCI). METHODS: Consecutive patients with pseudomyxoma peritonei from low-grade appendiceal mucinous neoplasms who underwent cytoreductive surgery with or without hyperthermic intraperitoneal chemotherapy were retrospectively analyzed. Survival analyses were performed in the overall cohort. An exploratory threshold analysis identified the most discriminative cut-off for the PCI. In the super-extended PCI subgroup, compartmental disease saturation and additional complexity-enhancing resections were assessed. Restricted mean survival time at 36 months was estimated with bootstrap CIs. RESULTS: A total of 73 patients were included. In the overall cohort, a higher PCI and incomplete cytoreduction independently predicted poorer overall survival; a higher PCI, incomplete cytoreduction, and intraoperative complications predicted worse disease-free/progression-free survival. The optimal prognostic threshold was PCI 30. Among the 20 patients with a PCI greater than 30, the prognostic discrimination of PCI and completeness of cytoreduction attenuated, whereas supramesocolic complexity-enhancing resections were associated with poorer overall survival and reduced restricted mean survival time at 36 months. CONCLUSION: Beyond a PCI of 30, global burden metrics become less informative. Outcomes appear to be more closely linked to disease topography, particularly in cases of extensive supramesocolic compartment involvement. This may identify a distinct high-risk phenotype.
Soelling SJ, Rubio-Chavez A, Thurman LB
… +7 more, McDermott C, Philpotts L, Brindle M, Vranceanu AM, Cooper Z, Ritchie CS, Cauley CE
J Gastrointest Surg
· 2026 May · PMID 42140309
·
Full text
BACKGROUND: Patients undergoing fecal ostomy surgery often struggle to adapt to life, particularly when the surgery is performed for colorectal cancer. Maladaptation to life with an ostomy is associated with psychosocial...BACKGROUND: Patients undergoing fecal ostomy surgery often struggle to adapt to life, particularly when the surgery is performed for colorectal cancer. Maladaptation to life with an ostomy is associated with psychosocial challenges that affect daily quality of life (QoL). The aim of this systematic review was to identify interventions that address the self-care education and psychosocial needs of patients with colorectal cancer living with an ostomy and to examine their efficacy and effectiveness. METHODS: A systematic search was conducted in Ovid MEDLINE, American Psychological Association PsycInfo, Cochrane Clinical Trials, Cumulative Index to Nursing and Allied Health Literature, Embase, and Web of Science on September 10, 2025. Randomized controlled trials, prospective cohort studies, case studies, and retrospective studies of tested interventions used before or after ostomy surgery with a specific focus on patients with colorectal cancer were included. Patient-reported outcomes, including QoL, were summarized. RESULTS: A total of 14 of the 21 included studies reported a positive outcome in QoL for the intervention group. The remaining studies reported mixed results or did not use validated QoL measures. Several studies used additional resources, such as trained nurses. No study reported harm associated with the intervention. CONCLUSION: Interventions designed to improve QoL in patients with colorectal cancer after ostomy surgery showed promising improvements in patient-centered outcomes; however, these interventions are resource-intensive. Most studies reported improved QoL or no harm. Future work is needed to understand the scalability of these interventions to better support this patient population.
Abosheisha M, Nasr E, Asaad A
… +13 more, Kandeel M, Alqasem M, Bylapudi S, Omran MA, Kortobi G, Boalot A, Wahb M, Terra M, Swealem A, Abdelglil M, Ismaiel M, Wilson J, Magee C
BACKGROUND: Bariatric surgery, primarily laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), is an effective treatment for obesity. As the demand for healthcare increases, same-day di...BACKGROUND: Bariatric surgery, primarily laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB), is an effective treatment for obesity. As the demand for healthcare increases, same-day discharge (SDD) supported by remote monitoring (RM) is being explored to optimize resources without compromising safety. This systematic review and meta-analysis aimed to evaluate the safety and clinical outcomes of SDD with RM for primary bariatric surgery. METHODS: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and PROSPERO registration (CRD420251124540), a comprehensive search was conducted across PubMed, Scopus, and Web of Science. Six observational studies involving 1581 patients (LSG: 1164; LRYGB: 417) met the inclusion criteria. Outcomes included pooled readmission and complication rates, which were analyzed using a generalized linear mixed model. RESULTS: The overall pooled readmission rate for the RM subgroup was 3.35% (95% CI, 2.57%-4.36%). Subgroup analysis revealed a significantly lower readmission rate for LSG (2.66%) than for LRYGB (5.28%, P = .012). Major complications (Clavien-Dindo grade ≥3) were rare at 1.58% and were comparable between procedures. The overall complication rate was 3.80%. Meta-regression indicated that surgery type was not a significant moderator for major or overall complications, suggesting that the higher readmission rate for LRYGB was largely driven by manageable functional issues, such as dehydration. CONCLUSION: Both LSG and LRYGB appear to have favorable safety profiles in an outpatient setting with RM, with LSG demonstrating an advantage of significantly fewer readmissions in the early postoperative period.
BACKGROUND: Depression is common among individuals with cancer and has been associated with impaired quality of life, reduced treatment adherence, and increased morbidity and mortality. We sought to characterize the timi...BACKGROUND: Depression is common among individuals with cancer and has been associated with impaired quality of life, reduced treatment adherence, and increased morbidity and mortality. We sought to characterize the timing and predictors of early-onset and late-onset depression among adults with gastrointestinal (GI) cancer. METHODS: Adults aged 18 years or more with a diagnosis of GI cancer were identified from the All of Us Research Program, version 8. Incident depression was defined as a new clinical diagnosis after cancer diagnosis, and onset was categorized as early (<5 years) or late (≥5 years). Multinomial logistic regression and Cox proportional hazards models were used to evaluate the association with sociodemographic factors, cancer subtype, baseline anxiety, and treatment. RESULTS: Among 4349 individuals, 68.2% (n = 2964) patients developed incident depression with 54.3% (n = 2360) of patients classified as having early-onset depression. On multivariable analysis, younger age was associated with lower odds of both early-onset (adjusted odds ratio [aOR], 0.99; 95% CI, 0.98-0.99) and late-onset depression (aOR, 0.97; 95% CI, 0.96-0.98), whereas female sex was associated with higher odds of early-onset (aOR, 1.20; 95% CI, 1.01-1.44) and late-onset depression (aOR, 1.31; 95% CI, 1.01-1.70). Compared with colorectal cancer, esophageal (aOR, 1.74; 95% CI, 1.19-2.56), pancreatic (aOR, 1.59; 95% CI, 1.25-2.02), and liver/hepatic bile duct (aOR, 1.51; 95% CI, 1.23-1.86) cancers were associated with higher odds of early-onset depression. DISCUSSION: Depression was common among GI cancer survivors and frequently emerged years after diagnosis. These findings underscore the importance of longitudinal, risk-stratified mental health screening throughout GI cancer survivorship, extending beyond periods of active treatment.
BACKGROUND/PURPOSE: In China, locally advanced gastric cancer (LAGC) is frequently diagnosed, yet the 5-year overall survival rate after surgery alone remains unsatisfactorily low. Although the combination of chemotherap...BACKGROUND/PURPOSE: In China, locally advanced gastric cancer (LAGC) is frequently diagnosed, yet the 5-year overall survival rate after surgery alone remains unsatisfactorily low. Although the combination of chemotherapy and immune checkpoint inhibitors (ICIs) has recently demonstrated substantial efficacy in treating advanced gastric cancer, data regarding the combination of neoadjuvant chemotherapy and ICIs specifically for patients with LAGC are still sparse. This study aimed to evaluate the short-term efficacy and safety of neoadjuvant chemotherapy plus ICIs vs neoadjuvant chemotherapy alone in patients with LAGC in Gansu Province using a bicenter retrospective propensity score-matched analysis. METHODS: This was a bicenter retrospective propensity score-matched (PSM) study. Patients with LAGC receiving neoadjuvant chemotherapy plus ICIs (combined group) or chemotherapy alone (control group) were included. A 1:1 PSM with a caliper of 0.05 was performed to balance baseline characteristics. Short-term efficacy (pCR, MPR, ORR) and safety (drug-related, surgical) were compared between groups. RESULTS: The combined treatment group had significantly higher pathological complete response rates (29.5% vs 4.5%), major pathological response (MPR) rates (35.7% vs 10.7%), and objective response rates (31.3% vs 9.8%) than those of the chemotherapy-alone group (all P <.001). No significant differences were observed between groups in hematologic complication grades, severe hematologic complication rates, liver injury grades, or severe surgical complication rates (all P <.05). No grade 3 to 4 immune-related adverse events occurred in the combined treatment group. The combined treatment group had shorter postoperative recovery time (P =.003) and lower gastric tube indwelling rate (P <.001). CONCLUSION: Neoadjuvant chemotherapy combined with ICIs significantly increases pathological complete response and MPR rates, reduces postoperative recovery time, and lowers the need for nasogastric tube placement, without increasing adverse events. These findings support chemoimmunotherapy in the neoadjuvant treatment of LAGC. Future work should include multicenter, prospective, randomized trials with biomarker analyses to validate these results.