Video: Intervention versus surveillance in patients with common bile duct stones detected by intraoperative cholangiography

The use of venous resection (portal or superior mesenteric vein [PV-SMV]) during pancreatoduodenectomy is increasing.1-4 In a recent international survey, we found that most pancreatic surgeons prefer a segmental resection with primary anastomosis over a partial wedge resection, because of a lower perceived risk of complications.5 The impact of the type of venous resection (wedge or segmental) on postoperative morbidity and survival is poorly understood in current literature.

Post-hepatectomy liver failure (PHLF) represents the major determinant for death after liver resection. Early recognition is essential. Early postoperative lactate values are powerful, readily available markers for clinically relevant PHLF and associated complications after hepatectomy with potential for guiding postoperative care. This video explains the recent study published in BJS.

Early in the pandemic, it was recognised that patients had a higher rate of death associated with pulmonary complications if they become infected with SARS-CoV-2 in the perioperative period 1. However, the key question is why? Was this solely down to SARS-CoV-2 infections, was this due to differences in who was prioritised for surgery, or due to some other reason? These are difficult questions to answer, especially without comparable data from the pre-pandemic period. 

To address this, our paper published in the BJS pools together two large-scale, prospective and multi-specialty international cohorts 2: one from the pre-pandemic period from the STARSurg Collaborative 3 and another from during the pandemic from the COVIDSurg collaborative 4. Since these projects both included elective abdominal cancer surgery patients, and collected similar data on them and their postoperative outcomes, we were able to make a fair comparison between these cohorts. 

Overall, there was only a minority of patients with a perioperative SARS-COV-2 infection (4.3%), which is reassuring that most patientsundergoing surgery during this period were safeguarded. Interestingly, when postoperative outcomes were compared between the periods, the pulmonary complication rate observed was relatively similar (7.1% [before] vs 6.3% [during], p=0.158) but the 30-day mortality was much higher (0.7% [before] versus 2.0% [during], p<0.001). This was perhaps due to more “severe” pulmonary complications during the pandemic, e.g. a higher proportion of patients with acute respiratory distress syndrome.