Robotic versus open surgery for simultaneous resection of rectal cancer and liver metastases: a randomized controlled trial.

Koskenvuo L, Lunkka P, Varpe P, Hyoty M, Satokari R, Haapamaki C et al.

JAMA Surg 2024; 159: 606-614.  

In this study that included 565 procedures, the addition of oral antibiotics reduced the rate of surgical site infections (odds ratio 0.45, 95 per cent confidence interval 0.27 to 0.77) and anastomotic leaks (0.39, 0.21 to 0.72).

Comment: The authors suggest this should be the standard of care.

Traeger L, Bedrikovetski S, Fitzsimmons T, Nguyen T-M, Moore JW, Lewis M et al.

Br J Surg 2024; 111: znae121.

Pyridostigmine 60mg given orally twice daily after surgery reduced the duration of ileus by one day, measured by the GI-2 tool (P=0.015) in this study that included 130 patients, but did not affect the duration of hospital stay.

Comment: Apart from speeding return of bowel function, it is not clear what the benefit is overall.

Kumar M, Patil NS, Mohapatra N, Sindwani G, Dhingra U, Yadav A et al.
Ann Surg 2024; 279: 932-944.

A temporary shunt reduced intra-operative blood loss (P=0.004) and need for transfusion in this study of 60 procedures. The shunted patients were also more haemodynamically stable in the anhepatic phase, requiring less vasopressor support, with better postoperative renal function. There were no other differences in postoperative outcomes.

Comment: The observed advantages should improve outcomes, but perhaps the study was too small to be definitive.