Six versus three years of adjuvant imatinib in patients with localized GIST at high risk of relapse

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“Gastrointestinal stromal tumor (GIST) is the most common sarcoma and also a paradigmatic model for precision medicine in solid tumors, with the tyrosine kinase inhibitor
imatinib as a standard first-line treatment in the advanced phase and as adjuvant treatment in KIT- or PDGFRA-mutated GIST.”
Whether a longer duration of imatinib treatment improves disease-free survival (DFS) has not been explored in a randomized setting. The randomized IMADGIST study was initiated in 2014 with the aim to determine whether the prolongation of adjuvant imatinib during 3 additional years improves the outcome of high-risk GIST patients versus a standard total duration of 3 years as recommended by clinical practice guidelines. The primary endpoint was DFS. We report here the results of this clinical study.”

Figure 2 Disease-free survival in the in the 3-years and 6-years arms. (A) DFS in the entire series; (B) DFS in the stratification subgroup with a risk of relapse of 35%-70%; (C) DFS in the stratification subgroup with a risk of relapse >70%; (D) DFS in the stratification subgroup with a risk of relapse >70%, with (solid lines) or without (dotted lines) tumor rupture. CI, confidence interval; DFS, disease-free survival; Est, estimate; HR, hazard ratio; KM, Kaplan-Meier.
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Long-term outcomes after extrahepatic excision of congenital choladocal cysts

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“Congenital choladocal cysts are generally treated by resection of the dilated extrahepatic biliary duct followed by hepaticojejunostomy, but it is associated with postoperative complications, including postoperative cholangitis, intrahepatic calculi, pancreatitis, and carcinogenesis, in the remnant bile duct. We investigated the most common long-term complications and identified the factors implicated in their development.”

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Pancreatitis after Biliary Tract Surgery (Historical article)

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“Acute pancreatitis after operation on the biliary tract is a serious complication. This study was undertaken in an attempt to determine predisposing factors which might exist in patients undergoing operation for biliary tract disease. A large number of patients have been studied by postoperative serum amylase determinations and correlations have been made between the performance of various procedures and the occurrence of clinical and subclinical pancreatitis.”

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Does the use of staple line reinforcement during sleeve gastrectomy and Roux-en-Y gastric bypass affect Clinical Outcomes?

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“The efficacy of bariatric surgery in facilitating sustained weight loss and managing obesity-related comorbidities has been consistently reported in the medical/scientific literature. Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are widely accepted bariatric procedures. However, complications, such as gastric leakage, bleeding, stricture, and surgical infection, can lead to significant morbidity and mortality, posing a formidable challenge to bariatric surgeons.
In order to reduce the incidence of complications associated with bariatric surgery, some surgeons have advocated the use of gastric incision staple line reinforcement with the
aim of improving structural integrity and reducing edge tension. However, others have suggested that the reinforcement of the incision edge may compromise suture stability, thereby raising concerns about the overall effectiveness of staple line reinforcement in preventing postoperative complications.”

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Risk of Major Nonemergent Inpatient General Surgical Procedures in Patients on Long-term Dialysis

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“More than half a million individuals in the United States undergo dialysis, a number that has been forecasted to increase by 7% annually. End-stage renal disease requiring dialysis is associated with poor health care outcomes, including a 10-fold increase in risk of hospitalization and an expected lifespan between one-fourth and one-sixth of that of the general population. Despite the well-described outcomes of the effect of end-stage renal disease on community-dwelling individuals, little is known about the contribution of long-term dialysis to the risks of postoperative complications and death.”

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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for Ostomy Surgery

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“Statistics regarding ostomy-related metrics remain elusive in the United States because of underreporting and coding limitations. The estimated number of ostomates in the United States is 750,000 to 1 million, with approximately 150,000 new ostomies created each year. Stoma creation has a relatively high rate of associated morbidity, ranging from 20% to 80%; peristomal skin complications and parastomal hernia (PSH) are the most common associated morbidities. A population-based study using the Michigan Surgical Quality Collaborative, which included 4250 patients, identified a 37% unadjusted surgical complication rate for elective cases involving an ostomy and 55% unadjusted surgical complication rate for emergency cases involving an ostomy. In this study, risk-adjusted stoma-related morbidity rates varied significantly among hospitals, indicating a potential to improve outcomes in outlying institutions.”

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Survival, Healthcare Utilization, and End-of-life Care among Older Adults with Malignancy-associated Bowel Obstruction

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“Among patients with cancer, the estimated prevalence of malignancy-associated bowel
obstruction (MBO) is 3-15%, including up to 51% in ovarian cancer and up to 28% in
cancers of the gastrointestinal tract. MBO is among the most common palliative
indications for surgical consultation5 and typically signifies a poor prognosis, with mean
survival of 3-8 months in surgical cases and 4-5 weeks in those with inoperable MBO.
Managing the considerable symptom burden associated with MBO frequently
requires hospitalization and contributes to high-intensity healthcare utilization.1, In light
of national efforts to address the poor quality and high cost of care near the end of life, it is
critical to understand the relationship between treatment for complications of terminal
cancer, such as MBO, and end-of-life (EOL) care.”

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