#generalsurgery

Ontario Association of General Surgeons

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17 hours ago

Just in! 📢 2 x PT #endoscopy #generalsurgery vacancies at #CanadianPlaceEndoscopy #MississaugaOntario. #SurgeonJob #SurgeonJobs Details: rebrand.ly/x0g7kfj

Ontario Association of General Surgeons

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21 hours ago

Attn. Ontario General Surgeons🍁: @sunnybrookhsc.bsky.social Research Institute is seeking consultant #GeneralSurgery participants for research on surgeon personality traits and pt outcomes. Check our site for this and more #AcademicSurgery #SurgResearch surveys: rebrand.ly/6m190lr

STITCHES - the Best Papers in General Surgery

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1 day ago

Navigating Role Ambiguity in Surgical Education

by Cha JS, Tucker EL, Lauer KV and Smith B in J Am Coll Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Cureus Journal of Medical Science

@cureusmedical.bsky.social

2 days ago

This case preserved most of the sigmoid and allowed safe reversal later. Takeaway: Sometimes less surgery = better outcome. Would you try this approach?

Read more: www.cureus.com/articles/463...

#Cureus #GeneralSurgery #Colorectal #MedSky

Medical Education

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2 days ago

Murphy’s sign evaluates for acute cholecystitis.

Read: wikism.org/Murphys_Sign

Watch: www.youtube.com/watch?v=AWEf...

#medicine #Surgery #generalsurgery #emergencymedicine #meded #MedicalEducation #FOAMed #clinicalpearls

Ontario Association of General Surgeons

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4 days ago

Just in! 📢 FT permanent #generalsurgery vacancy
#SouthBruceGreyHealthCentre #WalkertonOntario in the beautiful #ExploreTheBruce region.🍁 #SurgeonJob #SurgeonJobs Details: rebrand.ly/x0g7kfj

Ontario Association of General Surgeons

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6 days ago

Just in! 📢 FT permanent & locum #generalsurgery vacancies #DrydenRegionalHealthCentre #DrydenOntario in beautiful #northernlights #sunsetcountry.🍁 #SurgeonJob #SurgeonJobs Details: rebrand.ly/x0g7kfj

STITCHES - the Best Papers in General Surgery

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1 week ago

Prehospital Whole Blood Transfusion Not Superior in Trauma

by Smith JE, Cardigan R (...) Green L et 22 al. in N Engl J Med #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Preoperative Low-Energy Diets May Reduce Surgical Risks

by McKechnie T, Kuszaj O (...) Bhandari M et 15 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Pre-hospital deaths dominate trauma fatalities in urban systems

by Nijhawan A, Ter Avest E (...) Perkins ZB et 6 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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Ontario Association of General Surgeons

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1 week ago

Just in! 📢 FT permanent #generalsurgery vacancy @OSMH_News @OrilliaSoldiersMemorialHospital
#OrilliaOntario. Application deadline: April 30. #SurgeonJob #SurgeonJobs Details:http://rebrand.ly/x0g7kfj

STITCHES - the Best Papers in General Surgery

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1 week ago

Obesity Linked to Higher Cancer Rates: Significant Implications for Surgery

by Shen S, Brown KA, Green AK and Iyengar NM in JAMA #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Gravity Modeling to Predict Patient Choice of Hospital for Pancreaticoduodenectomy - Annals of Surgical Oncology Background Prior studies simulating how regionalization of complex surgeries such as pancreatoduodenectomy (PD) would affect access to care assumed that patients travel to their closest hospital. The validity of this assumption had not been evaluated. Our objectives were to assess the accuracy of a distance-only model in predicting where a patient received PD and determine whether incorporating hospital characteristics improved accuracy. Methods Data on patients undergoing PD from 2016 to 2017 in New York or Florida were obtained from the Statewide Inpatient Databases. We assessed three models: distance alone (model 1), distance and hospital volume (model 2), and distance, hospital volume, rurality, cancer accreditation, medical school affiliation, and centralization taxonomy of the health system (model 3). Model accuracy was determined by comparing the predicted hospital and the actual hospital where the patient received care. Results Among the 2949 included patients, model 1 was accurate for only 16.3%; model 2 was accurate for 32.9%, and model 3 was accurate for 24.3%. Patients who were accurately classified with models 2 or 3 but not 1 were more likely to live in major metropolitan areas (74.7% vs. 61.0%, p < 0.001), more likely to be non-Hispanic white (71.3% vs. 68.3%, p = 0.04), more likely to have private insurance (35.0% vs. 27.8%, p < 0.001), and had lower in-hospital mortality (1.3% vs. 3.3%, p = 0.03). Conclusions Distance-only models were largely inaccurate for predicting where patients received PD. Simulations of patient redistribution should incorporate volume, distance, and additional patient- and provider-level factors.

New Models for Predicting Hospital Choice in Pancreatic Surgery

by Ross-Driscoll K, Huber S (...) Ellis RJ et 5 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Retroperitoneal-First Laparoscopic Approach (Retlap) for Bile Duct Resection in Pancreaticobiliary Maljunction (PBM): A Novel and Reasonable Approach to Intrapancreatic Bile Duct - Annals of Surgical Oncology Background Pancreaticobiliary maljunction (PBM) is a congenital anomaly in which the pancreatic and bile ducts join outside the duodenal wall.1,2 Reflux of pancreatic juice induces chronic inflammation and epithelial regeneration, promoting carcinogenesis. Biliary dilation increases the risk of cholangiocarcinoma, and prophylactic resection of the extrahepatic bile duct and gallbladder is recommended even for asymptomatic patients.3,4 To prevent postoperative carcinogenesis, the intrapancreatic bile duct should be transected just above the pancreatobiliary junction. The authors describe a novel dorsal approach to the pancreatic head using the retroperitoneal-first laparoscopic approach (Retlap).5–7 Methods A 73-year-old woman under follow-up evaluation for choledocholithiasis-associated cholangitis was found to have a gallbladder tumor. Evaluation showed PBM with biliary dilation. Computed tomography exhibited wall-thickening of the gallbladder fundus. Magnetic resonance cholangiopancreatography demonstrated a common bile duct diameter of 13 mm and a common channel length of 12 mm, whereas endoscopic retrograde cholangiopancreatography measured both as 15 mm. Biliary amylase was elevated. The preoperative diagnosis was gallbladder carcinoma with PBM and biliary dilation. After an explanation of the procedure and her informed consent, the woman underwent extrahepatic bile duct and gallbladder resection with lymphadenectomy using Retlap. Results The operative time was 480 min, including 210 min for Retlap, with 40 mL blood loss. The postoperative course was uneventful, and she was discharged on postoperative day 14. Pathology confirmed gallbladder carcinoma with single-node metastasis. At this writing, after adjuvant chemotherapy, the woman has remained recurrence-free 3 years. Conclusion Although additional trocars and steps are required, Retlap for PBM may enable safe bile duct transection just above the pancreatobiliary junction and facilitate lymphadenectomy, providing excellent visualization and stable maneuverability.

Novel Laparoscopic Method for Bile Duct Resection in PBM

by Karasuyama T, Kiguchi G (...) Takeyama O et 2 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Fluorescence Lymphography Using Indocyanine Green During Esophagectomy for Cancer to Prevent Chyle Leakage: A Propensity Score Matched Analysis - Annals of Surgical Oncology Background This study evaluated the efficacy of intraoperative fluorescent lymphography with indocyanine green (ICG) to reduce the incidence of chyle leakage post-esophagectomy. Methods This prospective observational cohort study was conducted among patients who underwent fluorescence lymphography during esophagectomy for cancer between May 2022 and August 2023 at a single tertiary referral center. After 1:3 propensity score matching, the results were compared between 59 patients who underwent fluorescence lymphography (ICG group) and a historical cohort who did not (non-ICG group). The primary outcome was the incidence of postoperative chyle leakage. Results The study included 59 patients in the ICG group and 177 non-ICG controls. ICG was ultrasound guided bilaterally injected into inguinal lymph nodes in 26 patients (44%), the small bowel mesentery in 30 patients (51%), and both sites in three patients (5%). Thoracic duct visualization was successful in 85%. Fluorescence lymphography influenced intraoperative management in 21 patients (36%), with placement of additional clips. The incidence of chyle leakage was 17% (10/59) in the ICG group and 10% (18/177) in the non-ICG group (p = 0.163). All patients with chyle leakage in the ICG group were treated conservatively versus two re-interventions in the non-ICG group (p=0.271). Conclusions Real-time ICG fluorescence lymphography is a promising tool for the intraoperative detection and management of chyle leakage during esophagectomy, although no reduction in chyle leakage was demonstrated. Further studies are required to elucidate the efficacy of fluorescence lymphography with ICG in reducing the incidence of postoperative chyle leakage.

Fluorescence Lymphography in Esophagectomy Shows No Chyle Leakage Benefit

by Henckens SPG, van der Aa DC (...) Gisbertz SS et 4 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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@med-news.bsky.social

1 week ago

Sanford Health is now offering both pediatric and adult general surgery outreach services in Dickinson, expanding access to specialized care for patients in the region.

buff.ly/oEW2Cbr

#MED #SanfordHealth #PediatricSurgery #GeneralSurgery

STITCHES - the Best Papers in General Surgery

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1 week ago

AI-Driven Marker Improves Outcomes for Pancreatic Cancer Nonproducers

by Thalji SZ, Aldakkak M (...) Kothari AN et 18 al. in JAMA Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Occult Nodal Disease in Gallbladder Cancer: An International Multi-institutional Analysis and Preoperative Risk Stratification - Annals of Surgical Oncology Introduction Accurate preoperative nodal staging remains challenging in gallbladder cancer (GBC), and a substantial proportion of patients presumed to be clinically node-negative have nodal metastasis at surgery. This study aimed to quantify the burden of occult nodal disease (OND)—defined as pathologic node-positive disease among clinically node-negative patients—and to identify preoperative factors associated with OND. Methods Patients who underwent upfront curative-intent resection with regional lymphadenectomy for GBC were identified from an international multi-institutional database. Among patients staged as clinically node-negative (cN0) on preoperative imaging, multivariable logistic regression was used to identify preoperative predictors of OND. CA19-9 and the systemic immune-inflammation index (SII) were log-transformed for modeling purposes. Results Among 187 patients, 142 (75.9%) were classified as cN0 preoperatively, among whom 47 (33.1%) had OND on final pathology. On multivariable analysis, higher ln(SII) (odds ratio [OR] 1.69, 95% confidence interval [CI] 1.05–2.86), higher ln(CA19-9) (OR 1.30, 95% CI 1.12–1.53), and preoperative jaundice (OR 3.68, 95% CI 1.21–11.76) were independently associated with OND. The observed OND rate increased stepwise with the number of elevated preoperative markers (SII > 890.2, CA19-9 > 37 U/mL, and jaundice): 17.1% with 0 markers, 44.8% with 1 marker, and 73.6% with 2–3 markers. Conclusions OND was present in approximately one-third of clinically node-negative GBC patients undergoing lymphadenectomy. Preoperative jaundice, elevated CA19-9, and elevated SII independently predicted OND and provided simple risk stratification. Incorporating these readily available markers into preoperative assessment may improve risk enrichment for OND and help guide additional staging and treatment sequencing.

Occult Nodal Disease in Gallbladder Cancer: Critical Insights

by Kawashima J, Yuza K (...) Pawlik TM et 9 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

High Variation in Expert Assessment of Peritoneal Malignancy

by Bhatt A, Sharma V (...) Glehen O et 42 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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📖 read the article: link.springer.com/article/10.1245/s10434-0...

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1 week ago

Improved Technique for Chronic Anal Fissures

by Liu R, Li J (...) Zhong S et 3 al. in Dis Colon Rectum #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Surveillance strategies for colorectal cancer need improvement

by Samur S, Gursel E (...) Neugut AI et 8 al. in BMJ Open #Surgery #SurgSky #GeneralSurgery #MedSky

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📖 read the article: https://bmjopen.bmj.com/content/16/3/e111289

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1 week ago

Tumor Debulking in Multiorgan Metastatic Colorectal Cancer Fails to Improve Survival

by Gootjes EC, Bakkerus L (...) Verheul HMW et 17 al. in JAMA #Surgery #SurgSky #GeneralSurgery #MedSky

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1 week ago

Gastric Cancer Peritoneal Metastasis Management Consensus Established

by Boshier PR, Ann Chia DK (...) So JB et 40 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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2 weeks ago

New Checklist for Surgical Prehabilitation Reporting

by Gillis C, McIsaac DI (...) Fiore JF et 30 al. in Br J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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2 weeks ago

Prognostic Significance of Radiological Adjacent Organ Invasion in Resectable Left-Sided Pancreatic Cancer - Annals of Surgical Oncology Background The resectability of pancreatic cancer depends on the extent of vascular involvement. Left-sided pancreatic cancer (LPC) rarely invades major vessels but frequently involves adjacent organs. This study aimed to assess the prognostic significance of radiological adjacent organ invasion (RAOI) in resectable LPC. Methods This study included 162 patients who underwent distal pancreatectomy for resectable LPC between 2002 and 2020. Radiological adjacent organ invasion was defined as contact of the primary tumor or a continuous soft tissue density to the adjacent organs (stomach, adrenal gland, colon, or liver) on computed tomography. Clinicopathological factors and survival outcomes were compared between the RAOI (+) (n = 17) and RAOI (−) (n = 145) groups. Results The RAOI (+) group had significantly higher CA19-9 levels (279 vs. 33 U/mL, p = 0.005), larger radiological tumor sizes (37 vs. 21 mm, p < 0.001), and more frequently positive peritoneal cytology results (41% vs. 8%, p = 0.002). Overall survival (OS) in the RAOI (+) group was significantly worse than that in the RAOI (−) group (median survival time [MST], 25.9 vs. 67.2 months, p < 0.001). Among patients with negative cytology results (n = 141), OS was still significantly worse in the RAOI (+) group (MST, 33.5 vs. 71.9 months, p = 0.001). Multivariate analysis revealed CA19-9 levels ≥37 U/mL and RAOI as independent risk factors for poor OS. Conclusions Radiological adjacent organ invasion is an independent negative prognostic factor in resectable LPC and is associated with early systemic dissemination and worse survival outcomes. Radiological adjacent organ invasion (+) LPC may be considered a borderline resectable disease that requires intensive multimodal treatment strategies.

Radiological Organ Invasion Signals Poor Outcomes in Pancreatic Cancer

by Kitahama T, Ohgi K (...) Sugiura T et 6 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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2 weeks ago

Integrated Liquid Biopsy and Tumor Tissue Genomic Profiling of Appendiceal Cancer: cfDNA Burden, Mutation Landscapes, and Clinical Outcomes - Annals of Surgical Oncology Background Appendiceal cancer (AC) is a rare malignancy that often presents at advanced stages with significant histological variability influencing clinical outcomes. Precise genomic profiling is essential for accurate diagnosis and personalized patient management. This study interrogated DNA from appendiceal tumor tissue, buffy coat cells, and the cell-free DNA component of plasma using a 523-gene panel for comprehensive genomic profiling (CGP) to identify cancer-related genetic mutations in tumor and blood, evaluate tumor mutation burden, and determine genetic markers associated with histologic grade. Patients and Methods A total of 73 patients provided blood samples comprising cell-free DNA (cfDNA) and germline buffy coat cells (bcDNA) for analysis compared with tumor tissues available from 56 of these patients. Concordance of mutations between matched tumor tissue and plasma samples (n = 51) was assessed and tumor-specific and germline variants were classified using OncoKB™ clinical criteria to delineate oncogenic and therapeutically actionable variants [level 1 mutations with U.S. Food and Drug Administration (FDA)-approved therapy]. Additionally, cfDNA concentrations were tested for association with clinical and pathologic features and oncologic outcome including disease-specific (DSS) and progression-free (PFS) survival. Results Circulating tumor DNA (ctDNA) from plasma cell-free DNA demonstrated high concordance with tumor genomic profiling, reaching 98.4% concordance [median, interquartile range (IQR) 13.5, 21.5] overall and 85.7% (IQR 64.6, 100) for therapeutically actionable level 1 mutations. Prevalent appendiceal tumor-specific mutations included KRAS proto-oncogene, GTPase (KRAS) (41%), GNAS complex locus (GNAS) (30%), tumor protein p53 (TP53) (30%), and SMAD family member 4 (SMAD4) (29%). Tumor-specific TP53, SMAD4, and spectrin alpha, erythrocytic 1 (SPTA1) mutations strongly correlated with intermediate and high-grade histology, whereas GNAS mutations predominated in low-grade tumors. Germline analysis identified coding mutations shared among this patient cohort in notch receptor 4 (NOTCH4) (55%) and BRCA1 associated RING domain 1 (BARD1) (48%) genes, with zinc finger homeobox 3 (ZFHX3) (29%) and adhesion G protein-coupled receptor A2 (ADGRA2), DNA polymerase epsilon (POLE), and transcription factor 3 (TCF3) mutations (all = 23%) specifically enriched in intermediate and high-grade AC. Both histological grade and cfDNA stratified by concentration tertiles independently predicted progression-free and disease-specific survival. Plasma samples exhibited consistently lower variant allele frequencies than solid tumors, limiting sensitivity for discovery of novel mutations exclusively from plasma. Conclusions This study supports integrating comprehensive ctDNA assays into standard diagnostic and treatment pathways for AC using large gene panels. TP53, SMAD4, SPTA1, and GNAS mutations serve as prospective tumor-specific molecular classifiers for histological grade, while germline variants in NOTCH4 and BARD1 may further influence disease biology, with ZFHX3, ADGRA2, POLE, and TCF3 affecting grade stratification. Overall cfDNA concentration may serve as a potential prognostic biomarker in AC.

High Concordance of cfDNA and Tumor Profiling in Appendiceal Cancer

by Patel S, Petrosko P (...) LaFramboise WA et 16 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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2 weeks ago

Disparities in Surgical Care of Patients with Colorectal Cancer Liver Metastases - Annals of Surgical Oncology Background Up to 25% of patients with colorectal cancer present with liver metastases (CRLM), and 50% develop metastases over time. Surgical and ablative management of CRLM can be curative, but certain demographic and socioeconomic factors disproportionately hinder vulnerable patient populations from receiving advanced local therapies. Methods We queried the 2011–2021 National Cancer Database for cases of CRLM. We explored patient and facility characteristics associated with receipt of local intervention versus no intervention for metastatic liver lesions. Results Of 72,273 cases, 18.0% underwent hepatectomy or ablation. Controlling for patient- and center-level factors, non-Hispanic Black and Hispanic/Latino patients were less likely to undergo liver intervention than were non-Hispanic white patients (odds ratio [OR] 0.83 [95% confidence interval (CI) 0.78–0.88] vs. OR 0.92 [95% CI 0.85–0.99]). Patients treated at academic programs had significantly higher odds of liver intervention than did those in community cancer programs (OR 2.24 [95% CI 2.06–2.43]). Patients with private, Medicaid, Medicare, or other government insurance had higher odds of liver intervention than did uninsured patients (OR 2.07 [95% CI 1.86–2.30], OR 1.40 [95% CI 1.24–1.58], OR 1.81 [95% CI 1.61–2.03], OR 2.20 [95% CI 1.81–2.66], respectively). Patients in the highest income quartile were more likely to have liver intervention than those in the lowest quartile (OR 1.18 [95% CI 1.10–1.27]). Patients receiving liver intervention traveled farther than those receiving non-surgical care (p<0.001). Conclusion Surgical or local ablative management of CRLM is necessary to achieve cure for appropriately selected patients. However, this advanced liver interventional care is not equally distributed among patient populations. Significant socioeconomic and demographic disparities exist in the receipt of local liver interventional management among patients with CRLM and require further exploration to improve resource allocation.

Colorectal Cancer Liver Metastases Reveal Care Disparities

by Martinez AE, Webber A (...) DiBrito S et 3 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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2 weeks ago

Minimally Invasive Surgery Reduces Risks in Hepatectomy

by Shindoh J, Kobayashi Y (...) Matsumura M et 7 al. in World J Surg #Surgery #SurgSky #GeneralSurgery #MedSky

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2 weeks ago

Tissue Factor as a Prognostic and Therapeutic Biomarker in Resected Pancreatic Cancer - Annals of Surgical Oncology Background Tissue factor (TF), a key initiator of the coagulation cascade, is frequently overexpressed in pancreatic cancer and linked to tumor progression and thrombosis. While TF has been recognized as a prognostic biomarker, its clinical relevance in surgically treated patients remains unclear. Methods We retrospectively analyzed TF expression in resected pancreatic cancer specimens from 265 patients, including those with and without preoperative therapy, using immunohistochemistry. Tissue factor expression was semiquantitatively classified as negative, low, or high. Associations with clinicopathological features, treatment response, and survival were evaluated. Results High TF expression was observed in 17.4% of cases and was significantly associated with elevated CA19-9, biologically borderline resectable disease, and lymph node metastases. These patients had shorter overall survival (median overall survival: 20.6 vs. 38.8 vs. 53.6 months, p < 0.001). High TF expression remained an independent predictor of poor prognosis (hazard ratio [HR]: 2.21, p = 0.0002). Tissue factor-negative tumors were associated with favorable outcomes, including long-term survival despite recurrence. Tissue factor expression decreased following preoperative therapy but did not correlate with histological response. Conclusions Tissue factor expression stratifies pancreatic cancer into biologically and prognostically distinct subgroups. While high TF expression indicates aggressive disease and poor survival, TF-negative tumors represent an indolent, treatment-sensitive subtype. These findings underscore the biological heterogeneity of pancreatic cancer and support TF as a clinically relevant prognostic biomarker.

Tissue Factor Levels Predict Survival in Pancreatic Cancer Surgery

by Kamiya M, Koizume S (...) Miyagi Y et 14 al. in Ann Surg Oncol #Surgery #SurgSky #GeneralSurgery #MedSky

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2 weeks ago

Vasopressin's Role in Edema Post-Liver Resection

by Aoki Y, Kawano Y (...) Yoshida H et 4 al. in World J Gastroenterol #Surgery #SurgSky #GeneralSurgery #MedSky

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📖 read the article: www.wjgnet.com/1007-9327/full/v32/i10/1...