What actually survives pancreatic resection, and a stoma change that cuts hernias

The edition in brief

Today's general surgery edition opens on prognosis that can be given honestly. Among 660 patients with localized pancreatic ductal adenocarcinoma treated at two high-volume centres with neoadjuvant therapy and curative-intent resection, actual five-year survival was 34.5%, rising to 62% and 82% for those still recurrence-free at one and two years, and falling from 42.5% in resectable to 17.5% in locally advanced disease. A US Multi-Society Task Force consensus addresses serrated polyposis syndrome, the commonest polyposis syndrome and the most often missed, reserving surgery for cancer or an endoscopically unmanageable polyp burden. A propensity-matched trauma study found a 1-g tranexamic acid bolus alone gave mortality comparable to the full bolus-plus-infusion CRASH-2 regimen, though the study was retrospective and underpowered and the point estimates numerically favoured the infusion. A clinic pearl restates the surgical site infection prevention bundle. The practice-changer is the UNSEAL randomised trial: at the specimen-extraction-site loop ileostomy after laparoscopic low anterior resection, an unsutured composite technique with a supporting rod and a smaller tailored aperture reduced parastomal hernia before reversal to 4.8% from 13.5% (risk ratio 0.35) and shortened stoma formation, though its several components mean no single one can be credited.