Digestive Surgery[JOURNAL]
Sun
200 papers
Pharmacological Management for Prevention and Treatment of Posthepatectomy Liver Failure.
Gerritsen A, de Boer MT, Buis CI … +4 more , Blokzijl H, Smit M, Boldingh JHL, de Meijer VE
Dig Surg · 2025 · PMID 41105553 · Full text
BACKGROUND: Posthepatectomy liver failure (PHLF) remains a leading cause of morbidity and mortality following major liver resection. Despite advances in surgical techniques and perioperative care, treatment options for P...
BACKGROUND: Posthepatectomy liver failure (PHLF) remains a leading cause of morbidity and mortality following major liver resection. Despite advances in surgical techniques and perioperative care, treatment options for PHLF are limited. Pharmacological interventions targeting ischemia-reperfusion injury and portal flow modulation have gained interest as potential therapeutic strategies. SUMMARY: This review provides a clinically applicable overview of the current evidence on pharmacological management of PHLF. Perioperative glucocorticoids may reduce inflammatory complications and lower PHLF incidence, though patient selection is crucial. N-acetylcysteine demonstrates antioxidant effects in experimental models and omega-3 fatty acids reduce inflammation, but both lack clinical efficacy. Somatostatin and terlipressin, which modulate portal hemodynamics, have shown promise in preclinical and early-phase clinical studies; however, randomized trials have yet to confirm their benefit in reducing PHLF. Nonselective β-blockers impair liver regeneration in preclinical models and are not recommended posthepatectomy. Early postoperative heparin administration and hyperinsulinemic-normoglycemic strategies have been associated with reduced PHLF but require further validation. KEY MESSAGES: While perioperative glucocorticoids may reduce PHLF risk in selected patients, other pharmacological agents show theoretical or preliminary promise, but cannot be routinely recommended based on current evidence. Prospective clinical trials are needed to establish effective pharmacological strategies for the prevention and treatment of PHLF.
Non-Colorectal Liver Metastases Undergoing Liver Resection: The NONCOLMET Study Group.
Di Martino M, Ercolani G, Cipriani F … +17 more , Baiocchi G, Bordonaro R, Cescon M, Frena A, Giuliante F, Grazi G, Gruttadauria S, Marchegiani G, Memeo R, Panaro F, Romano F, Ruzzenente A, Spampinato M, Tiberio GA, Torzilli G, Troisi R, Donadon M
Dig Surg · 2025 · PMID 40986447 · Publisher ↗
INTRODUCTION: While the resection of colorectal liver metastases is a well-established procedure, with survival rates superior to chemotherapy alone, controversial data still exist on liver resection for non-colorectal l...
INTRODUCTION: While the resection of colorectal liver metastases is a well-established procedure, with survival rates superior to chemotherapy alone, controversial data still exist on liver resection for non-colorectal liver metastases (NCRLM). These patients comprise a diverse and heterogeneous group usually excluded from surgery. To date, only few retrospective reports are available on the surgical treatment of NCRLM. The NONCOLMET study aimed to build a comprehensive registry of patients undergoing liver resection for NCRLM, providing robust retrospective and prospective data to describe clinical practices, outcomes, and identify prognostic factors. METHODS: The study consists of two phases: (1) retrospective collection of data from patients treated between 2010 and 2024 and (2) prospective enrolment from 2025. Patients aged ≥18 years with histologically confirmed NCRLM undergoing liver resection will be included. Data will be recorded via a standardized electronic case report form on the RedCap platform. The following endpoints will be evaluated: oncological outcomes including overall survival, disease-free survival, and disease relapse; post-operative mortality at 30 and 90 days with causes of death; post-procedural complications; predictor variables of short- and long-term outcomes. These outcomes will be used to elaborate a risk score model. CONCLUSIONS: NONCOLMET will offer crucial insights into the surgical management of NCRLM, helping refine patient selection criteria and informing future clinical guidelines.
Circulating Cell-Free DNA as a Potential Diagnostic Tool in Pancreatic Cancer: A Comparative Analysis.
Riauka R, Kupcinskaite-Noreikiene R, Grabauskyte I … +5 more , Gulbinas A, Barauskas G, Jasukaitiene A, Gruodyte V, Ignatavicius P
Dig Surg · 2025 · PMID 40986445 · Publisher ↗
INTRODUCTION: Liquid biopsies enable noninvasive tumor material sampling in patients with pancreatic ductal adenocarcinoma (PDAC). Genetic information, especially alterations in circulating free DNA (cfDNA) levels, might...
INTRODUCTION: Liquid biopsies enable noninvasive tumor material sampling in patients with pancreatic ductal adenocarcinoma (PDAC). Genetic information, especially alterations in circulating free DNA (cfDNA) levels, might help predict poorer tumor differentiation, disease progression, and might be used as treatment efficacy evaluator. However, the data on this topic are insufficient. METHODS: Newly diagnosed, PDAC patients without prior systemic treatment and chronic pancreatitis patients treated at the tertiary university hospital and healthy controls were included in this prospective study. Blood samples were collected pretreatment, and cfDNA was extracted and measured using necessary equipment according to manufacturer's protocols. RESULTS: Fifty-seven patients (47 PDAC and 10 chronic pancreatitis) and 8 healthy controls were included. cfDNA levels were significantly higher in cancer patients compared to chronic pancreatitis (p = 0.032) and healthy controls (p < 0.001). The determined cfDNA cut-off value for distinguishing PDAC from chronic pancreatitis was 23.65 ng/mL and for distinguishing PDAC from healthy controls - 22.9 ng/mL. However, no distinctions in cfDNA levels were noted concerning tumor characteristics or survival rates. CONCLUSION: Liquid biopsies and alterations in cfDNA levels could aid in distinguishing PDAC from benign inflammatory diseases or healthy patients. Nonetheless, further studies are necessary for more comprehensive validation.
Surgery for Multifocal Intrahepatic Cholangiocarcinoma.
Andzelytė A, Tveragaitė I, Ignatavicius P
Dig Surg · 2025 · PMID 40966174 · Publisher ↗
INTRODUCTION: Multifocal intrahepatic cholangiocarcinoma (m-iCCA) is a complex and aggressive form of primary liver cancer, often associated with poor outcomes. Although surgical resection is considered the only curative...
INTRODUCTION: Multifocal intrahepatic cholangiocarcinoma (m-iCCA) is a complex and aggressive form of primary liver cancer, often associated with poor outcomes. Although surgical resection is considered the only curative treatment for intrahepatic cholangiocarcinoma (iCCA), multifocality is frequently regarded as a contraindication due to the high risk of recurrence and limited survival benefits. Advances in surgical techniques and evolving treatment strategies have reopened discussions about the feasibility of resection in these cases. METHODS: We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database. We systematically searched PubMed, Web of Science, MEDLINE, and ScienceDirect databases up to July 30, 2024, for studies analyzing surgical treatment outcomes for m-iCCA. We assessed the quality of the included studies according to the Newcastle-Ottawa Scale (NOS). RESULTS: After our initial search, 2,482 articles were found related to this topic and 381 articles were left for screening. We checked each article against the eligibility criteria and selected for the full-text analysis. Ten articles with 2,392 patients who had m-iCCA were included in our review. The reviewed studies reported extensive surgical procedures, such as extended hemihepatectomy and associating liver partition and portal vein ligation for staged hepatectomy, with median survival ranging from 18.9 to 27 months. Recurrence rates were higher in m-iCCA patients (67.8-74.3%) compared to solitary iCCA cases (52.4-60.5%), with recurrence-free survival as short as 4.5 months. Adjuvant chemotherapy was frequently used, although its effectiveness in terms of survival was inconsistent. One study reported a 5-year survival rate of 12.9% for surgical patients compared to 0% for non-operated patients. Survival outcomes were influenced by adverse prognostic indicators such as lymph node metastases and perineural invasion. CONCLUSION: Surgical resection for m-iCCA, while associated with high recurrence rates (67.8-74.3%), provides a survival advantage over nonsurgical management (median overall survival: 18.9-27 months vs. 8 months; 5-year survival: 12.9% vs. 0%) for carefully selected patients. More studies are needed to improve patient selection and refine treatment approaches to enhance long-term outcomes.
Association between Textbook Outcomes of Liver Surgery and Overall Survival in Gallbladder Cancer Patients Treated with Curative-Intent Resection: A Multicenter Study.
Li ZM, Ouyang HY, Gong Y … +23 more , Dai HS, Bai J, Jiang Y, Yin XY, Chen ZY, Zheng SG, Li YF, Yu C, Huang F, Wu ZP, Zhou JX, Yin DL, Ding R, Guo W, Zhu Y, Chen W, Lin KC, Yue P, Cheng Y, Zhang D, Zhang YQ, Liu ZP, Qin T
Dig Surg · 2025 · PMID 40934133 · Publisher ↗
INTRODUCTION: This study investigated the relationship between textbook outcomes of liver surgery (TOLS) and overall survival (OS) in patients who underwent curative-intent resection of GBC. METHODS: Patients with GBC wh...
INTRODUCTION: This study investigated the relationship between textbook outcomes of liver surgery (TOLS) and overall survival (OS) in patients who underwent curative-intent resection of GBC. METHODS: Patients with GBC who underwent curative-intent resection between 2014 and 2021 were selected from 16 hospitals. Patients were divided into either the TOLS group or the non-TOLS group, according to whether TOLS were observed. Patients who died within 90 days of surgery were excluded prior to the survival analysis. Log-rank test was used to compare the difference in the OS rate between TOLS and non-TOLS groups. Univariate and multivariate analyses were performed using Cox regression analysis to identify factors independently associated with OS. RESULTS: A total of 913 patients were selected, 565 (61.9%) exhibited TOLS. The 5-year OS rate in the TOLS group was significantly higher than that in the non-TOLS group (45.4% vs. 21.9%; p < 0.001). Multivariate Cox regression analysis confirmed TOLS, total bilirubin level >54 µmol/mL, carcinoembryonic antigen level >5 µg/mL, CA 19-9 level >37 U/L, poor differentiation, stages T2 and T3/4 according to the 8th edition AJCC T staging manual, N1 and N2 according to the 8th edition AJCC N staging manual, and adjuvant chemotherapy as independent risk factors that affect OS after curative-intent resection of GBC. CONCLUSION: Among patients who undergo curative-intent resection of GBC, approximately 61.9% experience TOLS. TOLS are not only the optimal short-term outcome but also associated with long-term survival.
Role of Intestinal Fatty Acid Binding Protein in Diagnosing Adhesive Small Bowel Obstruction: A Pilot Study.
van Dam JS, Leenarts CAJI, van Oudheusden TR … +2 more , Derikx JPM, Luyer M
Dig Surg · 2025 · PMID 40815114 · Full text
UNLABELLED: <p>Introduction: The incidence of adhesive small bowel obstruction (ASBO) after abdominal surgery is 2.4%. Delay in surgery increases morbidity and mortality. Plasma intestinal fatty acid binding protein (I-F...
UNLABELLED: <p>Introduction: The incidence of adhesive small bowel obstruction (ASBO) after abdominal surgery is 2.4%. Delay in surgery increases morbidity and mortality. Plasma intestinal fatty acid binding protein (I-FABP) levels indicate intestinal damage and may guide treatment. The aim of this study was to investigate whether plasma I-FABP levels may optimize selection of patients requiring surgery presenting with ASBO. METHODS: Patients with suspected ASBO underwent a contrast swallow. If bowel transit was absent after 8 h, surgery was performed. I-FABP levels were assessed at several moments. Data were analyzed by comparing groups based on bowel transit, ischemia, and positive or negative laparotomies. Furthermore, a true operative group (patients with mechanical obstruction during surgery and patients needing operative treatment who deceased due to non-operative treatment) was compared to a true non-operative group (patients with negative laparotomies and patients successfully treated with non-operative treatment). RESULTS: Median I-FABP levels were higher in patients without bowel transit (1,207 pg/mL) than in patients with bowel transit (589 pg/mL, p = 0.01). Median I-FABP levels in the negative laparotomy group (301 pg/mL) showed a trend to significance compared to the positive laparotomy group (1,177 pg/mL, p = 0.05). There was no significant difference between the true operative group (1,150 pg/mL) and the true non-operative group (664 pg/mL) or between proven ischemia (975 pg/mL) and no ischemia (921 pg/mL). CONCLUSION: I-FABP might help identify ASBO patients in whom surgery can be postponed. </p>.
Are There Any Differences in Clinical Outcome after the Surgical Management of Patients with Stomach versus Duodenal Perforation?
Lahes S, Wagenpfeil G, Glanemann M
Dig Surg · 2025 · PMID 40784348 · Full text
UNLABELLED: <p>Introduction: Free perforation of the stomach or the duodenum usually requires emergency surgery. In fact, perforation is associated with short-term mortality and morbidity in up to 30 and 50% of patients,...
UNLABELLED: <p>Introduction: Free perforation of the stomach or the duodenum usually requires emergency surgery. In fact, perforation is associated with short-term mortality and morbidity in up to 30 and 50% of patients, respectively, due to secondary peritonitis and sepsis. We hypothesized that postoperative clinical outcomes with duodenal perforation (DP) are worse than those with stomach perforation (SP). This retrospective study aimed to compare the early postoperative clinical outcomes of patients with SP and DP, focusing on morbidity and mortality, to identify differences that could indicate potential changes in surgical management. METHODS: A total of 110 patients underwent emergency surgery between 2012 and 2022 for free SP or DP. We compared the demographic, intra-, and postoperative data, including morbidity and mortality during primary hospitalization in the two groups of patients. One group consisted of patients with SP and the second group consisted of patients with DP. RESULTS: The incidence of any postoperative complication, the rate of planned reoperation, median operation time, as well as the median hospital stay after surgery were significantly increased in patients with DP compared to those with SP. In addition, surgical and nonsurgical complications, as well as mortality were common in the total patient population, and higher in DP than in SP patients; however, these differences were not statistically significant. CONCLUSION: Common postoperative problems occurring after surgery for DP or SP are similar and often life-threatening in both situations. However, patients with DP experienced these problems significantly more often, indicating a more complex injury that required considerably more medical intervention and extended treatment. </p>.
Organ-Sparing Approach after Neoadjuvant Treatment in Oesophageal Cancer.
Pittacolo M, Khoma O, Lagarde SM … +2 more , Mostert B, Wijnhoven BPL
Dig Surg · 2025 · PMID 40730139 · Full text
<p>Background: Neoadjuvant chemoradiotherapy (nCRT) or perioperative chemotherapy followed by surgical resection is the standard of care for oesophageal and gastroesophageal junction cancer. Up to a third of patients wil...
<p>Background: Neoadjuvant chemoradiotherapy (nCRT) or perioperative chemotherapy followed by surgical resection is the standard of care for oesophageal and gastroesophageal junction cancer. Up to a third of patients will have a pathological complete response to neoadjuvant treatment. Given the significant morbidity associated with surgery, active surveillance is considered as a potential alternative for patients with clinical complete response post-nCRT. Summary: The preSANO and preSINO trials have validated a multimodal diagnostic strategy combining oesophagogastroduodenoscopy with bite-on-bite biopsies, endoscopic ultrasonography with fine-needle aspiration of suspicious lymph nodes, and PET-CT to detect residual disease. The SANO trial is assessing whether active surveillance leads to non-inferior overall survival compared to planned surgery. Early results of randomized studies support previous retrospective reports of comparable oncological outcomes, with improved quality of life in the surveillance group. Despite concerns of increased morbidity of postponed surgery upon recurrence, recent data indicate comparable surgical outcomes of delayed oesophagectomy. Ongoing trials, including SANO-2, CELEAC, and NEEDS, aim to rationalize surveillance protocols, while SANO-3 is investigating the role of adding immunotherapy in improving response durability. Key Messages: Active surveillance represents a promising alternative to surgery for oesophageal cancer patients achieving complete clinical response after neoadjuvant therapy. While it can spare patients the morbidity of oesophagectomy and significantly improve quality of life, it requires accurate response assessment and structured follow-up. Future developments, including immunotherapy and non-invasive diagnostics, may further refine this approach and expand its safe applicability. </p>.
Retrospective Analysis of Risk Factors Associated with Incidental Appendiceal Neoplasms in Patients with Acute Appendicitis.
Doita S, Taniguchi F, Mouri K … +7 more , Miyake E, Ogawa T, Watanabe M, Arata T, Katsuda K, Tanakaya K, Aoki H
Dig Surg · 2025 · PMID 40730034 · Publisher ↗
INTRODUCTION: As the nonoperative management of acute appendicitis becomes more widespread, identifying patients at high risk of appendiceal tumors is increasingly important. This study aimed to clarify the predictive fa...
INTRODUCTION: As the nonoperative management of acute appendicitis becomes more widespread, identifying patients at high risk of appendiceal tumors is increasingly important. This study aimed to clarify the predictive factors of appendiceal tumors before appendectomy. METHODS: We retrospectively analyzed 434 patients diagnosed with acute appendicitis who underwent emergency or interval appendectomy. RESULTS: Appendiceal neoplasms were found in 3.9% of patients. Patients with tumors were significantly older (64.4 vs. 49.6 years, p < 0.001). The tumor group exhibited a lower appendicolith incidence (48% vs. 12%, p = 0.011) and larger appendiceal diameters (18.0 vs. 12.3 mm, p < 0.001). Multivariate analysis demonstrated that age ≥60 years, absence of appendicolith, and an appendiceal diameter ≥12 mm were independent risk factors of appendiceal tumors. Among patients who underwent interval appendectomy, only the non-tumor group exhibited significant improvement in appendiceal diameter after nonoperative management (tumor, +1.6 mm vs. no tumor, -3.5 mm, p < 0.001). CONCLUSIONS: Advanced age, absence of appendicolith, and an enlarged appendiceal diameter may be significant predictive factors of appendiceal tumors. These factors will aid in the selection of appropriate appendicitis treatment strategies.
Retraction Statement.
Dig Surg · 2025 · PMID 40671321 · Publisher ↗
Abstract loading — click title to view on PubMed.
Current Approaches to Diagnosis and Management of Acute Mesenteric Ischaemia: A Scoping Review.
Costello L, Duggan WP, Flanagan M … +2 more , Toale C, Kavanagh DO
Dig Surg · 2025 · PMID 40664174 · Publisher ↗
BACKGROUND: Acute mesenteric ischaemia (AMI) is a life-threatening condition with mortality exceeding 50%. This scoping review evaluates current diagnostic and management strategies, comparing endovascular and open surgi...
BACKGROUND: Acute mesenteric ischaemia (AMI) is a life-threatening condition with mortality exceeding 50%. This scoping review evaluates current diagnostic and management strategies, comparing endovascular and open surgical approaches. SUMMARY: Following Arksey and O'Malley's framework, a systematic search was conducted in OVID MEDLINE, Embase, and Web of Science (2005-2024). English-language studies on AMI were included. Data on diagnostic methods, mortality, hospital/ICU stay, and surgical outcomes were extracted. Thirty-nine studies (20,991 patients) were analysed. CT angiography was the primary diagnostic tool, with diagnostic delays ranging from 13.9 to 48 h. Endovascular interventions demonstrated lower 30-day mortality (0%-53.8%) versus open surgery (21%-81%). Hospital (5-15.35 vs. 5.7-27.26 days) and ICU stays (0-5.35 vs. 2-13 days) were shorter with endovascular management. Bowel resection and re-laparotomy rates were also reduced. KEY MESSAGES: Endovascular management is associated with improved outcomes, including reduced mortality and shorter hospital stays. Timely diagnosis and patient selection remain critical. A multidisciplinary approach is essential, though further prospective studies are needed to standardise protocols.
Long-Term Outcomes of Zenker's Diverticula Treatment: Invasive Procedures Ensure Sustained Quality of Life despite Higher Short-Term Morbidity.
Nitsche U, Seitz M, Friess H … +3 more , Feussner H, Hüser N, Jell A
Dig Surg · 2025 · PMID 40484007 · Publisher ↗
INTRODUCTION: There is a lack of sufficient evidence-based data to support personalized treatment decisions for Zenker's diverticulum. This study evaluates not only short-term outcomes of different treatment approaches b...
INTRODUCTION: There is a lack of sufficient evidence-based data to support personalized treatment decisions for Zenker's diverticulum. This study evaluates not only short-term outcomes of different treatment approaches but also identifies prognostic factors for long-term recurrence-free survival and quality of life. METHODS: We retrospectively analyzed all patients diagnosed with Zenker's diverticulum at our center between 2001 and 2021. Long-term follow-up data, including validated quality-of-life scores (EAT-10 and GIQLI), were evaluated. RESULTS: Overall, 97 patients underwent open surgery (OS), 37 received endoscopic surgery (ES), and 17 patients were treated conservatively. Treatment-related morbidity was 25% for OS, 5% for ES, and nil for conservative management (p = 0.004). After a median follow-up of 107 months, patients treated with OS or ES experienced less dysphagia (p < 0.001) and regurgitation (p < 0.001) compared to initial presentation. ES patients had a more favorable quality-of-life score than those treated conservatively (GIQLI: 125 vs. 106; p = 0.010 but not EAT-10: 2 vs. 6; p = 0.207). Recurrence rates were 28% for OS, 62% for ES, and 65% for conservative treatment (p < 0.001). OS was identified as an independent prognostic factor for improved recurrence-free survival. CONCLUSION: Despite higher short-term morbidity, OS was associated with the best recurrence-free survival. Long-term symptoms and quality-of-life outcomes were favorable and comparable between OS and ES.
Robot-Assisted Minimally Invasive Esophagectomy: Current Best Practice.
Kooij CD, Goense L, Kingma BF … +2 more , van Hillegersberg R, Ruurda JP
Dig Surg · 2025 · PMID 40472821 · Full text
BACKGROUND: Esophagectomy, the cornerstone in the multimodal treatment of esophageal cancer, has evolved from open surgery to minimally invasive esophagectomy (MIE) in recent decades. MIE reduces complications, facilitat...
BACKGROUND: Esophagectomy, the cornerstone in the multimodal treatment of esophageal cancer, has evolved from open surgery to minimally invasive esophagectomy (MIE) in recent decades. MIE reduces complications, facilitates faster recovery, and provides comparable or superior oncologic outcomes and survival rates compared to open surgery. SUMMARY: Since the early 2000s, robot-assisted minimally invasive esophagectomy (RAMIE) has emerged, offering enhanced precision over MIE through features such as three-dimensional visualization, improved instrument dexterity, tremor filtration, and motion scaling. These innovations help overcome the challenges of MIE, particularly in the thoracic phase, where limited access and reduced instrument dexterity hamper the procedure. RAMIE is associated with lower complication rates, particularly pulmonary complications, improved recovery, and comparable oncological outcomes. Despite higher initial costs, its potential to reduce complications makes it financially comparable to other approaches. Moreover, mastering RAMIE requires navigating a significant learning curve, making collaboration and training vital. The integration of artificial intelligence and advancements in robotic platforms, including single-port systems, will broaden patient eligibility and improve outcomes. KEY MESSAGES: RAMIE has established itself as an integral part of modern surgical practice and will continue to evolve, driving further innovation. Collaboration and training are essential for refining techniques and ensuring safe and effective implementation.
Routine Endoscopic Evaluation of Colorectal Anastomoses for Early Detection of Anastomotic Leakage (REAL Study): Protocol for a Multicenter Prospective Study.
Nijssen DJ, Laméris W, Denost Q … +5 more , Spinelli A, Espín-Basany E, Kinross J, Tuynman J, Hompes R
Dig Surg · 2025 · PMID 40393444 · Full text
INTRODUCTION: Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a...
INTRODUCTION: Early detection and timely treatment of anastomotic leakage (AL) following rectal surgery are crucial for improving outcomes. However, no standardized early detection pathway exists. This study evaluates a multicenter clinical care pathway integrating bedside endoscopy to reduce time to diagnose AL. METHODS: This international, multicenter, prospective observational study evaluates early endoscopic inspection for AL detection. Endoscopic assessments are performed at the bedside using a point-of-care digital rectoscope. Eligible patients include those undergoing colorectal resection for cancer with a colorectal or coloanal anastomosis within 15 cm of the anorectal junction. The clinical pathway includes bedside endoscopic inspection 3-6 days post-surgery, C-reactive protein-guided CT scans with rectal contrast, and follow-up endoscopy at 2-3 weeks. The primary outcome is time to AL diagnosis. Secondary outcomes include diagnostic accuracy, patient-reported comfort (Modified Gloucester Scale), stoma rate, anastomosis healing at 1 year, and cost-effectiveness. A propensity score-matched historical cohort will be used for comparison. Based on previous reports, we hypothesize this pathway will reduce the median diagnosis time from 15 to 5 days. With 95% confidence and 80% power, 130 patients are needed, with 153 total to account for a 15% maximum dropout rate. CONCLUSION: The REAL study is designed to evaluate whether a clinical pathway incorporating routine endoscopic assessment of colorectal anastomoses reduces time to diagnosis of AL and initiation of treatment.
The Association between the Number of Retrieved Lymph Nodes and Survival in Gastric Cancer Surgery: A Dutch Population-Based Study.
Ooi WK, van Hootegem SJM, Kuan Yean L … +4 more , van der Werf LR, van der Sluis PC, Lagarde SM, Wijnhoven BPL
Dig Surg · 2025 · PMID 40388892 · Full text
INTRODUCTION: This study aimed to evaluate whether the retrieval of 15 or more lymph nodes (LN) during gastrectomy for cancer is associated with better survival and more accurate pathological staging. METHODS: Patients t...
INTRODUCTION: This study aimed to evaluate whether the retrieval of 15 or more lymph nodes (LN) during gastrectomy for cancer is associated with better survival and more accurate pathological staging. METHODS: Patients that underwent gastrectomy between 2011 and 2016 were reviewed from the Dutch Upper Gastrointestinal Cancer Audit. Patients with <15 and ≥15 LN retrieved were compared after propensity-score matching based on patient and tumor characteristics. The primary endpoint was 3-year overall survival. RESULTS: A total of 2,047 patients were included in the study. After propensity score matching, 522 patients with ≥15 LNs were matched to 522 patients with <15 LNs. There was no statistically significant difference in overall survival between both groups with 3-year survival rates of 56% versus 59%, respectively. Patients with ≥15 LNs had a more advanced pN-category. While median survival was higher for patients with ≥15 LNs versus <15 LNs in the subgroups pN2, pN3a, and pN3b, no statistically significant differences were found. Similar results were found in the propensity score matched cohort using 23 LNs as cut-off. CONCLUSION: ≥15 LNs retrieved during gastrectomy for cancer was associated with higher pN-stage, likely as a result of stage migration. Three-year overall survival was comparable for patients with ≥15 LNs and patients with <15 LNs retrieved.
Total Pancreatectomy with "Superior Mesenteric Artery-First Approach".
Takagi K, Fuji T, Yasui K … +6 more , Yamada M, Nishiyama T, Nagai Y, Kanehira N, Fujiwara T, Takagi K
Dig Surg · 2025 · PMID 40349693 · Publisher ↗
INTRODUCTION: Total pancreatectomy (TP) is a technically demanding procedure for patients with multifocal pancreatic diseases. Although the benefits of the superior mesenteric artery (SMA)-first approach for pancreatic c...
INTRODUCTION: Total pancreatectomy (TP) is a technically demanding procedure for patients with multifocal pancreatic diseases. Although the benefits of the superior mesenteric artery (SMA)-first approach for pancreatic cancer (PC) have been reported in pancreatic surgery, few studies have demonstrated surgical techniques of SMA-first approach in TP. METHODS: This report presents our novel SMA-first approach for PC in TP, including six steps. First, the resectability was confirmed (step 1). Next, SMA approach was applied (step 2). In this step, the anterior and left sides of the SMA were dissected, and the left renal vein was confirmed. Following retroperitoneal dissection (step 3), the pancreatic body and tail were completely mobilized (step 4). Subsequently, Whipple procedure was performed with lymphadenectomy around the right side of the SMA (step 5). Finally, hepaticojejunostomy and gastrojejunostomy were performed (step 6). Using SMA-first approach, en bloc resection with adequate lymphadenectomy around the SMA and retroperitoneal dissection was performed. CONCLUSION: The present study presents surgical techniques of TP using the SMA-first approach for PC. This unique approach may be useful to perform TP for PC to obtain negative resection margins.
PhotoNodes Protocol: A Multicenter Prospective Study for the Assessment of Proper Lymphadenectomy in Minimally Invasive Gastric Cancer Surgery Using Intraoperative Photographs.
Marchesi F, Valente M, Giacopuzzi S … +5 more , Baiocchi GL, Morgagni P, Torroni L, Dalmonte G, Italian Research Group for Gastric Cancer (GIRCG)
Dig Surg · 2025 · PMID 40262552 · Publisher ↗
INTRODUCTION: In gastric cancer surgery, an adequate D2 lymphadenectomy is associated with improved cancer-specific survival. The aim of this study was to test the reliability of a new score (PhotoNodes Score [PNS]) conc...
INTRODUCTION: In gastric cancer surgery, an adequate D2 lymphadenectomy is associated with improved cancer-specific survival. The aim of this study was to test the reliability of a new score (PhotoNodes Score [PNS]) conceived to rate the quality of lymphadenectomy in minimally invasive gastrectomy. The primary outcome of the study was to assess the inter-observer agreement among the reviewers assigning the score. The secondary outcome was the association between PNS and survival. METHODS: This is a multicentric observational prospective study enrolling patients undergoing minimally invasive gastrectomy for gastric cancer with D2 lymphadenectomy. A set of laparoscopic/robotic images will be collected from each patient. Based on each set of images, the quality of lymphadenectomy performed will be rated with the new PNS by three surgeons. Fleiss' Kappa measure of agreement will be used to study the rating agreement among examining surgeons. The PNS score will correlate with disease-free and overall survival. CONCLUSION: The spread of minimally invasive approaches in oncologic gastric surgery made the collection of intraoperative images easier; for this reason, we believe that PNS could represent a new and efficient tool to assess the quality of D2 lymphadenectomy in clinical practice. The PhotoNodes study was registered at <ext-link ext-link-type="uri" xlink:href="http://ClinicalTrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link> #NCT06466902.
Is the Risk of Developing a Crohn's Disease Increased after Appendectomy? A Systematic Review of the Literature and Meta-Analysis.
Uhe I, Gialamas E, Combescure C … +5 more , Toso C, Liot E, Meurette G, Ris F, Meyer J
Dig Surg · 2025 · PMID 40262544 · Publisher ↗
INTRODUCTION: The effect of appendectomy on the development of Crohn's disease (CD) is a matter of debate. The aim of this systematic review and meta-analysis was to gather the latest published data to determine whether...
INTRODUCTION: The effect of appendectomy on the development of Crohn's disease (CD) is a matter of debate. The aim of this systematic review and meta-analysis was to gather the latest published data to determine whether patients with a history of appendectomy have an increased risk of developing CD or not. METHODS: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for case-control and cohort studies assessing the risk of developing CD after appendectomy. The pooled adjusted and not adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated for case-control studies. Heterogeneity was assessed. Studies were ranked using the Newcastle-Ottawa Scale (NOS) and were all of good quality. RESULTS: Fourteen case-control studies and 6 cohort studies were included. Meta-analysis of case-control studies (33,243 patients) of raw OR shows a positive association between appendectomy and CD (OR: 1.51, 95% CI: 0.97-2.36, I2 = 87%), which was not statistically significant (p = 0.069). The meta-analysis of adjusted OR shows that appendectomy represents a statistically significant risk factor for the development of CD (OR: 1.86, 95% CI: 1.01-3.45, p = 0.047, I2 = 89%). CONCLUSION: Appendectomy appears to be a risk factor for the development of CD. However, the discrepant results obtained by meta-analysis of unadjusted OR, the heterogeneity between studies, and the lack of precision of the magnitude of the association mandate confirmation by a large epidemiological study.
Current Practice in the Treatment of Colorectal Liver Metastases by Irreversible Electroporation: An International Questionnaire Survey (LIVERMET-IRE-Q).
Spiers HVM, Jamdar S, Jegatheeswaran S … +13 more , De Liguori Carino N, Stathakis P, Nadarajah V, Menon KV, Pandanaboyana S, Frampton AE, Wah TM, Farid S, Malik HZ, Jones RP, Evans J, Siriwardena AK, LIVERMET-IRE Collaborative
Dig Surg · 2025 · PMID 40239634 · Publisher ↗
INTRODUCTION: Irreversible electroporation (IRE) is a form of non-thermal ablation that delivers pulses of high-voltage electric current between electrodes. Although IRE has been demonstrated to achieve tumor necrosis, i...
INTRODUCTION: Irreversible electroporation (IRE) is a form of non-thermal ablation that delivers pulses of high-voltage electric current between electrodes. Although IRE has been demonstrated to achieve tumor necrosis, its role in the treatment of colorectal hepatic metastases is unestablished. This study is an international questionnaire survey on the use of IRE for patients with colorectal hepatic metastases. METHODS: A questionnaire addressing views on the use of IRE for colorectal liver metastases was circulated to clinicians with an interest and/or expertise in this technique. The questionnaire addressed indications for the use of IRE in a range of scenarios: methods of use, assessment of treatment response, and outcome. RESULTS: 64 clinicians from 17 different countries replied to the questionnaire. The preferred mode of delivery of IRE was percutaneous treatment under computed tomographic guidance. Thirty-three (70% of 47 respondents) used IRE exclusively for lesions in proximity to inflow or outflow structures. Twenty (43% respondents) used IRE as their sole ablative treatment, while 19 (40% of 47 respondents) used IRE in combination with thermal ablation. The maximum number of lesions that could be treated by IRE was two and the preferred size of lesion was <3 cm. CONCLUSION: Respondents to this international questionnaire survey indicate that IRE is an acceptable ablative option for small colorectal liver metastases (<3 m in diameter) close to inflow/outflow structures.
Intratumoral Holmium-166 Microsphere Injection in Patients with Unresectable Pancreatic Ductal Adenocarcinoma: A Single-Center, Single-Arm, Open-Label Feasibility and Safety Study.
Willink CY, Jenniskens SFM, Stommel MWJ … +6 more , Janssen MJR, Hermans JJ, Westdorp H, van Laarhoven CJHM, Fütterer JJ, Nijsen JFW
Dig Surg · 2025 · PMID 40228480 · Publisher ↗
INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis and lacks local treatment options. This study aimed to assess the feasibility and safety of the first-in-human intraoperative ultrasound-guided i...
INTRODUCTION: Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis and lacks local treatment options. This study aimed to assess the feasibility and safety of the first-in-human intraoperative ultrasound-guided intratumoral injection of radioactive holmium-166 microsphere in patients with PDAC. METHODS: Patients with proven PDAC eligible for open surgical resection were included. If resection was abandoned during exploration, study intervention was performed. Feasibility was defined by injection success and on-/off-target radiation. Safety was based on adverse event (AE) monitoring for 12 weeks categorized by severity grade and study attribution. RESULTS: Three of the thirteen included patients received study intervention. Injection was successful in all 3 patients. Mean tumor doses of 5.0, 17.0, and 39.0 Gy and maximum tumor doses of 25.0, 41.0 and 256.0 Gy were achieved. Off-target radiation was found once in the lungs and once in the colon with a mean dose <1.0 Gy. There were no AEs with high study attribution, 16, 14, and 19 AEs with low study attribution, including 3, 2, and 4 AEs with grade ≥3. Holmium-166 microspheres appeared hyperdense on CT. CONCLUSION: Intratumoral injection of holmium-166 microspheres in patients with unresectable PDAC seems feasible and safe. Research into minimally invasive image-guided application is advised.
About
- Frequency
- Sun
- Papers found
- 200
- RSS feed
- Subscribe