General Surgery — Weekly Evidence Brief

The landscape of complex surgical procedures is rapidly evolving, with a significant shift towards minimally invasive approaches, particularly in pancreatectomy. Minimally Invasive Distal Pancreatectomy (MIDP) utilization rose dramatically from 25.9% in 2010 to 58.9% in 2021, with Robotic Distal Pancreatectomy (RDP) showing consistent growth. These approaches are linked to shorter hospital stays and lower mortality rates compared to open procedures 1. Similarly, robotic radical cystectomy (RARC) has demonstrated continuous improvement over two decades, resulting in reduced operative times, shorter hospital stays, and fewer grade 3-4 complications 2. Even for octogenarian patients, robotic pancreatectomy appears safe, with comparable major complication rates to younger patients, suggesting age alone is not a contraindication for carefully selected elderly patients 3.

Neoadjuvant therapy (NAT) is increasingly recognized for its benefits in pancreatic ductal adenocarcinoma (PDAC), offering advantages like early systemic control, improved multimodal treatment delivery, and increased R0 resection rates, particularly for borderline resectable cases 4. For non-small cell lung cancer (NSCLC) initially deemed unresectable, salvage surgery after chemo-immunotherapy presents a promising new pathway, achieving 100% R0 resection rates with zero 30-day mortality in a small cohort 5. Conversely, in advanced clear cell ovarian cancer (OCCC), neoadjuvant chemotherapy did not significantly improve resectability or survival over primary cytoreductive surgery, underscoring the critical importance of maximal surgical cytoreduction for improved overall survival 6. For small cell lung cancer (SCLC) discovered incidentally during resection, segmentectomy may offer comparable outcomes to lobectomy, potentially supporting less extensive surgery 7.

Consolidation of surgical expertise demonstrably improves patient outcomes. Merging two high-volume pancreatic surgery centers led to significant reductions in complication-related mortality, major morbidity, and postoperative pancreatic fistula rates 8. Furthermore, specialized and centralized care is crucial for patients with non-functional well-differentiated pancreatic neuroendocrine tumors (WD-PanNETs), with patients treated at academic or integrated hospitals experiencing significantly higher 15-year survival rates compared to those at non-academic centers 9. These findings highlight that even traveling longer distances for care at high-volume or specialized centers can lead to substantially improved outcomes.

Integrated perioperative care and predictive tools are pivotal for improving patient safety and outcomes. Nurse practitioner interventions during the pre-operative and post-hospital phases have been shown to significantly shorten hospital stays, reduce emergency department visits, and lower 30-day readmission rates 10. Recognizing the prevalence of perioperative depressive symptoms is also crucial, with some surgical subtypes showing notable reductions post-surgery, emphasizing the need for mental health screening 11. Moreover, a scalable, interpretable prediction model using preoperative EHR features can effectively forecast acute kidney injury, postoperative respiratory failure, and in-hospital mortality, enabling proactive risk management 12. Addressing health equity remains vital, as evidenced by higher long-term mortality risks among Hispanic patients following bariatric surgery compared to non-Hispanic White patients, highlighting a disparity that warrants clinical attention and targeted interventions 13.