The edition · General Surgery
Robotic oesophagectomy retrieves more nodes in a four-centre trial, while pancreatic radiotherapy shows no survival gain
A randomised trial found a modestly higher lymph node yield with robotic oesophagectomy at similar safety. Also: preoperative radiotherapy for pancreatic cancer in a matched cohort, low-pressure pneumoperitoneum in cholecystectomy, and defect closure in minimally invasive hernia repair.
The edition in brief
A phase 3 trial in 202 patients with oesophageal or junctional adenocarcinoma found a higher median lymph node count with robotic than conventional minimally invasive oesophagectomy (36 vs 32, P=.005), with similar complications and no 1-year survival difference. A propensity-matched cohort of 452 patients with resected pancreatic cancer found that adding radiotherapy to neoadjuvant chemotherapy was linked to more R0 resections and node-negative disease but no difference in event-free or overall survival. A randomised trial of 160 patients found that 8 mmHg pneumoperitoneum did not significantly reduce pain after cholecystectomy, though paracetamol use was lower. A registry cohort of 4,209 minimally invasive direct inguinal hernia repairs linked defect closure to fewer wound complications but more cardiac readmissions from very few events, supporting selective closure.
Robotic oesophagectomy retrieves more lymph nodes, with similar safety
Robotic oesophagectomy gave a higher node yield at similar safety; treat survival benefit as unproven.
Radiotherapy added to neoadjuvant chemotherapy in pancreatic cancer: better pathology, no survival gain
Weigh preoperative radiotherapy against the lack of survival difference in this matched cohort.
Low-pressure pneumoperitoneum at 8 mmHg did not clearly reduce pain after cholecystectomy
Low-pressure pneumoperitoneum is a reasonable option if exposure allows, but pain benefit is unproven.
Do not rely on a single view of the cystic structures
Confirm the critical view of safety every time, and choose a bailout when it cannot be achieved.
Direct inguinal hernia repair: consider closing the defect selectively
Consider selective defect closure in direct hernias, especially large medial defects, while awaiting randomised data.
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