General Surgery

HAIP chemotherapy offers transplant-comparable survival in highly selected unresectable CRLM

Among 483 unresectable colorectal liver metastasis patients treated with HAIP, 23 (4.8%) met liver transplant eligibility criteria by modified TransMet/SECA-II rules. These patients had median overall survival of 61 months and 5-year overall survival of 53% from HAIP placement. Conversion to resection occurred in 78% after a median of five HAIP chemotherapy cycles, with median progression-free survival of 13 months. In transplant-eligible unresectable CRLM, HAIP-based strategies can achieve survival approaching that of recent liver transplant randomized trials. 1

ESD is more cost-effective than TEM for early rectal tumors with better local control

This multicenter comparative study analyzed 213 ESD and 117 TEM procedures for early rectal tumors resectable by either technique. At 1 year, ESD had a significantly higher net monetary benefit than TEM across willingness-to-pay thresholds from €0 to €6000. ESD achieved higher en bloc resection rates than TEM (99.0% vs 92.5%) with no increase in overall or major morbidity. Three-year overall survival and quality of life were similar, but disease-free survival was higher after ESD (94.3% vs 84.6%). 2

Early SSRF improves length of stay and pulmonary complications in older adults

This NTDB cohort included 5129 patients aged 65 years or older undergoing surgical stabilization of rib fractures between 2018 and 2022. Early SSRF within 72 hours occurred in 59.8% and was associated with shorter hospital stay (9 vs 14 days), ICU stay (6 vs 9 days), and ventilation (5 vs 9 days). Early fixation also reduced unplanned intubation, tracheostomy, acute respiratory distress syndrome, and pneumonia, without changing mortality (4.7% vs 5.3%). Multivariable analysis confirmed late fixation independently increased hospital and ICU length of stay and ventilation duration, supporting early SSRF when feasible. 3