Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 27 appraisals
Langenbeck's archives of surgery
The role of large language models in the writing of surgical reviews: fact or fantasy?
BACKGROUND: Amidst the current enthusiasm concerning artificial intelligence and its possible application in the composition of different kinds of scientific and non-scientific written documents, we evaluated the usage of artificial intelligence for writing surgical short reviews. METHODS: In order to assess the formal and content quality of AI-generated texts compared to human written texts, ten AI-based text generators (five chatbots and five content creators) and four surgeons in training received the same prompt for a short scientific article on a liver surgery theme. All texts were anonymized and subsequently evaluated by three experienced liver surgeons based on a pre-defined scoring scheme, as well as for quality of references and readability according to readability indices. Furthermore, all texts were tested for plagiarism using PlagScan. RESULTS: Overall percentage of correct assessment for AI/non-AI generation by experienced surgeons lay at 78.57%. Human written text had a mean word count of 1054 versus 874 in AI-generated text, with a higher mean Flesh Reading Ease Score (FRE, 26.2 ± 5.1 versus 17.7 ± 6.1). References were PubMed-listed in 100% for human versus 46% for AI-generated text, with only one non-human text reaching 100% formally correct citation of references. PlagScan found 6.4%±1.3 mean resemblance to existing texts for human versus 7.6%±4.5 for AI-generated text. DISCUSSION: Overall, AI could already mislead experienced scientific surgeons in 26.7% of cases into believing it to be human. However, formal requirements, especially considering referencing, are still in great need of improvement with only one of AI-generated articles fulfilling our quality requirements.
4 July 2026
Read appraisal →Journal of pediatric surgery
Artificial intelligence in rare pediatric solid tumor research and clinical care: A scoping review
BACKGROUND: Clinical and research advances for children with solid tumors are limited by their rare nature. Artificial intelligence (AI) and machine learning (ML) hold potential for advancing diagnosis, risk stratification, and treatment in rare diseases where individual patients contribute high-dimensional data. This review characterizes current AI/ML applications in rare pediatric solid tumors. METHODS: PubMed, Embase, and Web-of-Science Core Collection databases were queried for relevant articles published before February 10, 2025. Eligible studies applied AI/ML methods to study rare tumors in pediatric populations (≤19 years). Articles were evaluated for tumor diagnosis, AI/ML methods, clinical applications, comparators, effectiveness, and interpretability. RESULTS: Twenty-three studies (2009-2025) were included. Hepatoblastoma (12/23) and pediatric thyroid cancers (4/23) were most frequently studied. Supervised learning predominated (20/23), followed by unsupervised (9/23), deep learning (4/23), and hybrid/ensemble models (6/23). Applications included diagnosis (12/23), prognosis (10/23), and risk stratification (9/23). Twenty studies reported effectiveness measures, with many models achieving AUCs >0.85. In comparative analysis (17/23), AI/ML often equaled or exceeded expert consensus, traditional models, or alternative algorithms. Eight studies reported external validation. CONCLUSIONS: Current AI/ML research in rare pediatric extra-cranial solid tumors focuses on diagnosis, risk stratification, and prognosis, often outperforming traditional methods. Future work should prioritize external validation and clinical applicability.
1 July 2026
Read appraisal →Med (New York, N.Y.)
Sintilimab and lenvatinib plus hepatic arterial infusion chemotherapy and embolization as conversion therapy for uHCC: A phase 2 trial
BACKGROUND: Transarterial chemoembolization (TACE) or systemic treatments are recommended for unresectable hepatocellular carcinoma (uHCC) but have low conversion-to-resection rates. This single-arm phase II trial (PLATIC) aims to investigate the conversion efficacy of PD-1 inhibitor sintilimab, lenvatinib plus TACE and hepatic arterial infusion chemotherapy (TACE-HAIC) in uHCC. METHODS: 57 uHCC patients received 200 mg of sintilimab and lenvatinib (8/12 mg for body weight <60 kg or ≥60 kg) and TACE-HAIC every 3-4 weeks. The primary endpoint was conversion-to-resection rate. A historical-based cohort treated with TACE-HAIC was included as control. FINDINGS: After a median of three treatment cycles, 44 (77.2%; 95% confidence interval [CI], 0.64-0.87]) patients underwent conversion resection. The objective response rates were 80.7% (95% CI, 0.68-0.90) according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) and 43.8% (95% CI, 0.31-0.58) according to RECIST 1.1. Grade ≥ 3 treatment-related adverse events (TRAEs) occurred in 37 (64.9%) patients; no treatment-related deaths were reported. Among the 44 patients receiving resection, the median progression-free survival (PFS) was 17.3 months, and the median overall survival (OS) was unavailable. After inverse probability of treatment weighting analysis, the PLATIC cohort exhibited longer PFS (hazard ratio [HR] = 0.55, 95% CI, 0.33-0.94; p = 0.020) and OS (HR, 0.50, 95% CI, 0.28-0.92; p = 0.029) than the historical cohort. CONCLUSIONS: Sintilimab, lenvatinib, and TACE-HAIC demonstrated favorable conversion-to-resection rates and acceptable TRAEs in uHCC. FUNDING: Supported by grants from the National Natural Science Foundation of China (no. 82172815 and 82272887) and Cancer Innovative Research Program of Sun Yat-sen University Cancer Center (no. PT22040201).
14 June 2026
Read appraisal →Biochemical and biophysical research communications
Efferocytosis-related biomarkers and immune infiltration in pancreatic ductal adenocarcinoma based on single-cell sequencing and machine learning: a comprehensive bioinformatics analysis and experimental validation
BACKGROUND: Pancreatic ductal adenocarcinoma (PDAC) is a highly invasive and lethal malignancy, with its complex tumor microenvironment (TME) severely limiting therapeutic efficacy. Efferocytosis, a key process by which macrophages clear apoptotic cells, has been demonstrated to influence tumor initiation and progression by modulating immune responses, promoting M2 polarization, and facilitating immune evasion. Yet, the function and predictive significance of genes linked to efferocytosis in PDAC are still not fully understood. METHODS: This study integrated TCGA-PDAC, GTEx, and GEO datasets with single-cell transcriptomics to screen and analyze expression patterns and functions of efferocytosis-related genes (ERGs) in PDAC. Differential analysis, single-cell clustering, cell communication, and pseudo-time analysis revealed heterogeneity in macrophage efferocytosis. Subsequently, a six-gene prognostic model (CD36, ITGAV, PANX1, PPARG, S100A4, THBS1) was constructed and validated using Cox and LASSO regression. Concurrently, GSEA pathway analysis, immune infiltration assessment, and immunotherapy response prediction were conducted. Key gene functions were validated through molecular docking, RT-qPCR, western blotting, and functional experiments. RESULTS: Single-cell analysis revealed that macrophages exhibit the highest efferocytic activity within the PDAC microenvironment, demonstrating significant subpopulation heterogeneity. Differential analysis identified 23 key intersecting genes, ultimately yielding a risk model comprising six core genes. The model exhibited strong predictive accuracy in both the training and validation groups (notable AUC). Additional examination showed that patients at high risk showed a heightened presence of pathways linked to the reprogramming of energy metabolism and inflammatory reactions, along with heightened genomic instability and immunosuppressive TME traits, suggesting a grim prognosis. Experimental validation confirmed that knockdown of THBS1 significantly inhibited the proliferation, migration, and invasion of PDAC cells. CONCLUSION: The research clarifies the diverse nature of macrophage efferocytosis in PDAC and its crucial function in the restructuring of TME. It establishes and validates a six-gene risk prediction model, clarifying the functional significance of core genes, including THBS1. These findings provide novel molecular tools for PDAC prognosis assessment and identify potential targets for immunotherapy and personalized treatment strategies.
11 June 2026
Read appraisal →Journal of gastrointestinal cancer
Durable Survival Outcomes After Liver Transplantation for Colorectal Liver Metastases: A Systematic Review and Single-arm Meta-analysis of Prospective Clinical Trials
BACKGROUND: Liver transplantation (LT) has emerged as a potential treatment option for selected patients with colorectal liver metastases (CRLM), but existing meta-analyses are limited by heterogeneous populations and mixed treatment modalities. METHODS: A systematic review and single-arm meta-analysis were conducted in accordance with PRISMA guidelines. Studies reporting outcomes following LT for CRLM were included. Primary outcomes were overall survival (OS) and progression-free survival (PFS) at predefined time points. Secondary outcomes included adverse events. Pooled proportions were calculated using random-effects models with logit transformation and Hartung-Knapp adjustment. Heterogeneity was assessed using the I² statistic. RESULTS: Four prospective studies (1 RCT, 3 prospective cohorts) comprising 118 patients were included. Studies were conducted in Norway (SECA-I, n = 21; SECA-II, n = 15), the United Kingdom (n = 50), and a European multicentre RCT (TransMet, n = 32). Median age ranged from 55 to 58 years; all patients had liver-only metastases with resected primary tumors and had received pre-transplant chemotherapy. The pooled 3-year OS was 69% (95% CI, 52-82%; I² = 0.0%), and the pooled 5-year OS was 62% (95% CI, 36-83%; I² = 14.6%). The pooled 3-year PFS was 33% (95% CI, 7-76%), with substantial heterogeneity (I² = 62.8%). The pooled incidence of adverse events was 41% (95% CI, 25-60%; I² = 0.0%). Sensitivity analyses confirmed the robustness of pooled estimates. The retrospective literature also supported the finding that LT can achieve meaningful long-term survival in carefully selected patients. CONCLUSIONS: In carefully selected patients with CRLM, LT is associated with durable long-term survival and an acceptable safety profile, supporting further prospective evaluation and refinement of selection criteria.
31 May 2026
Read appraisal →Journal of robotic surgery
Global evolution of robot-assisted cholecystectomy research in the era of artificial intelligence: a bibliometric and knowledge-mapping study
OBJECTIVE: To systematically map the global evolution, collaborative networks, knowledge structure, and emerging research hotspots in robot-assisted cholecystectomy (RAC) using bibliometric and visualization techniques. METHODS: A comprehensive bibliometric analysis was conducted using the Web of Science Core Collection (2005-2025). Publications were retrieved using predefined search strategies and screened according to strict inclusion criteria. CiteSpace, VOSviewer, and R software were employed to analyze publication trends, co-authorship networks, institutional and national collaborations, co-citation patterns, keyword co-occurrence, and research bursts. Knowledge mapping techniques were used to visualize thematic evolution and intellectual structure. RESULTS: A total of 926 eligible publications were included. Global output demonstrated a continuous and marked increase, particularly after 2016, with citations following a similar upward trajectory, reflecting growing academic impact. The United States dominated both publication output and citation influence, while collaboration networks remained largely regionally clustered with limited cross-national integration. Research was primarily concentrated in high-impact surgical journals, with foundational contributions emphasizing feasibility, safety, and comparative effectiveness. Keyword and co-citation analyses revealed a knowledge structure centered on laparoscopic surgery, bile duct injury, and robotic systems, with emerging clusters highlighting artificial intelligence (AI) and surgical education. Evolutionary trajectory analysis demonstrated a transition from technical feasibility (early stage), to safety and evidence-based evaluation (middle stage), and to training and technological integration (recent stage). Burst detection further identified recent hotspots in AI, cost-effectiveness, and surgical training systems. Emerging evidence also indicates increasing integration of AI-driven systems into RAC, enabling intraoperative decision support, workflow recognition, and early-stage semi-autonomous surgical execution, particularly in standardized procedures such as cholecystectomy. CONCLUSION: RAC research has evolved from early exploratory studies toward increasing technological integration and methodological refinement. Although RAC is not currently among the most dominant clinical indications for robotic surgery, it provides a valuable model for studying surgical standardization, training systems, and emerging intelligent surgical technologies. While current applications remain largely assistive, emerging advances in AI and robotic technologies suggest the potential for future development toward more intelligent and partially automated surgical systems. However, most evidence currently remains experimental and has not yet translated into widespread clinical practice. Future research should focus on strengthening global collaboration, improving high-quality evidence generation, and carefully evaluating the safety, feasibility, and clinical applicability of emerging intelligent surgical technologies.
26 May 2026
Read appraisal →Journal of gastrointestinal cancer
Trend of Adjuvant Radiation in Resected Pancreatic Ductal Adenocarcinoma: Evaluation of RTOG 0848 with a Large National Database
PURPOSE: Adjuvant radiation (AR) remains a controversial treatment modality for pancreatic ductal adenocarcinoma (PDAC). This study aimed to evaluate the findings of the RTOG 0848 trial assessing the benefits of adjuvant radiation in node-negative disease utilizing a national database. METHODS: Utilizing the National Cancer Database, all patients diagnosed with non-metastatic PDAC, who underwent pancreatectomy, were included (2004-2019). The trend of adjuvant radiation utilization was evaluated. Overall survival in a cohort of patients mimicking the RTOG 0848 protocol was examined as were clinicodemographic and pathologic predictors of adjuvant radiation. RESULTS: Overall rates of adjuvant radiation decreased from 45 to 12%, while neoadjuvant radiation rates simultaneously increased from 4 to 12%. Positive margins and nodal disease were the strongest predictors of adjuvant radiation receipt (OR 1.7[ 95% CI: 1.6-1.7] p < 0.001 and OR: 1.1 [95% CI: 1.1-1.2] p < 0.001; respectively). Both high-risk pathologic groups experienced a decline in the use of adjuvant radiation over time, even after exclusion of patients who received neoadjuvant radiation. After application of the RTOG 0848 criteria, improved overall survival was observed in patients with node-negative and positive margins (adjuvant radiation: 28.6 [95% CI: 25.4-31.8] vs 23.0 [95% CI: 19.4-26.7] months; p = 0.005). In the margin positive cohort, adjuvant radiation was significantly associated with reduced mortality (HR: 0.791 [95% CI: 0.7-0.9]; p < 0.001). CONCLUSION: Evaluation of RTOG 0848 in the setting of real-world data indicates a role for adjuvant radiation for patients with margin-positive, node-negative pancreatic cancer. This highlights the essential role of multidisciplinary discussions regarding patients with PDAC care.
26 May 2026
Read appraisal →Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Randomized Phase II/III Trial Comparing Hepatectomy, Followed by mFOLFOX6 With Hepatectomy Alone for Liver Metastasis From Colorectal Cancer: Long-Term Results of JCOG0603
JCOG0603 demonstrated improved disease-free survival (DFS) with adjuvant mFOLFOX6 after hepatectomy compared with hepatectomy alone in colorectal liver-only metastasis (CRLM), but the overall survival (OS) data were immature. Here, we report OS after long-term follow-up. Eligible patients with colorectal adenocarcinoma and an unlimited number of liver metastases were randomized to adjuvant mFOLFOX6 or hepatectomy alone. DFS was the primary endpoint, and OS was a secondary endpoint. Between March 2007 and January 2019, 151 and 149 patients were randomized to adjuvant chemotherapy and hepatectomy alone, respectively. At a median follow-up of 7.7 years for disease-free surviving patients, 54 (35.8%) and 51 (34.2%) patients had died in the respective arms, (hazard ratio [HR], 1.07 [95% CI, 0.73 to 1.57]). Five-year OS was 73.4% (95% CI, 65.5 to 79.7) and 80.1% (95% CI, 72.6 to 85.7) and 7-year OS was 69.4% (95% CI, 61.2 to 76.2) and 72.4% (95% CI, 64.2 to 79.1), respectively. One patient in the adjuvant chemotherapy arm possibly died of protocol treatment-related toxicity, and one in the hepatectomy-alone arm died of post-protocol treatment complications. Five-year DFS was respectively 49.7% (95% CI, 41.5 to 57.3) and 40.5% (95% CI, 32.5 to 48.3) in the adjuvant chemotherapy and hepatectomy-alone arms (HR, 0.72 [95% CI, 0.54 to 0.97]). Long-term OS did not differ with adjuvant mFOLFOX6 compared with hepatectomy alone in resectable CRLM. Adjuvant mFOLFOX6 may delay recurrence but did not improve long-term survival.
20 May 2026
Read appraisal →Current oncology reports
Impact of 18-FDG PET/CT on Multidisciplinary Decision-Making and Management in Abdominal Malignancies: A Systematic Review and Meta-Analysis
PURPOSE: To systematically review and assess the impact of 18 F-FDG PET/CT on multidisciplinary team (MDT) decision-making and management in adults with abdominal malignancies. MATERIALS & METHODS: We searched Ovid MEDLINE, Ovid Epub, Cochrane CENTRAL, EMBASE, and Scopus upto August 31, 2024, for studies including 18-FDG PET/CT and MDT management in abdominal malignancies in adult patients and describing pre- and post-PET/CT treatment plans or MDT decisions. Data extraction followed by independent two reviewer assessment using ROBINS-I framework. A random-effects meta-analysis of proportions was performed for studies reporting management change attributable to PET/CT. RESULTS: Fourteen studies met inclusion criteria, of which seven provided sufficient quantitative data for meta-analysis. A random-effects meta-analysis of the seven eligible quantitative studies showed that 21.8% of patients (95% CI: 10.6%-33.0%, p < 0.001; range: 8-36%) experienced a management change directly attributable to PET-based imaging. Between-study heterogeneity was substantial (I² ≈ 85%, p < 0.001). Reported management changes included cancellation or addition of planned surgery, modification of surgical extent, change in treatment intent between curative and palliative strategies, and alteration of systemic therapy or radiotherapy plans. Evidence on downstream outcomes such as survival, quality of life, and cost-effectiveness was limited and heterogeneous, precluding quantitative synthesis. CONCLUSION: PET/CT leads to a change in MDT management in roughly one in five patients with abdominal malignancies, often through re-staging and identification of occult metastases that alter treatment intent or surgical strategy. The magnitude of impact varies widely by clinical context and tumor type. 1. PET/CT identifies occult metastases and clarifies disease extent, allowing MDTs to avoid futile surgeries and appropriately shift between curative and palliative strategies. 2. Approximately one in five patients experience a meaningful change in management after PET/CT, demonstrating its significant influence on real-world treatment planning. 3. Incorporating PET/CT into MDT discussions enhances diagnostic confidence and supports more coordinated, evidence-based care across surgical, oncologic, and radiologic teams. By highlighting which patients benefit most, the findings support more efficient use of PET/CT, emphasizing the need for standardized outcome measures and prospective data to refine patient selection.
19 May 2026
Read appraisal →Signal transduction and targeted therapy
HILL: the efficacy and safety of hepatic arterial infusion chemotherapy with the FOLFOX regimen combined with lenvatinib and the PD-L1 inhibitor durvalumab in unresectable hepatocellular carcinoma: a prospective, single-arm, phase 2 clinical trial
Despite numerous available treatment options, the overall prognosis for patients with unresectable hepatocellular carcinoma (uHCC) remains poor. This study aimed to evaluate the efficacy and safety of combining hepatic arterial infusion chemotherapy with FOLFOX (FOLFOX-HAIC), lenvatinib, and the PD-L1 inhibitor durvalumab in this population, with all uHCC patients receiving the triple-combination regimen as initial therapy. The primary objective was progression-free survival (PFS), and secondary outcomes included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. From August 2021 to September 2023, 40 uHCC patients were enrolled, with a median follow-up of 23.1 months (95% confidence interval [CI], 19.0-23.8); 3 deaths and 12 disease progressions were recorded. The median PFS was 15.8 months (95% CI, 8.3-23.3) with a 6-month PFS rate of 77.5% (95% CI, 63-90%), and 1- and 2-year OS rates were 97.5% and 94.0%, respectively. Per modified RECIST criteria, ORR was 75.0% (9 CR/pCR, 21 PR) and DCR was 95.0% (8 SD); median time to response (TTR) was 2.2 months and median duration of response (DOR) was 10.4 months. Seven patients (17.5%) underwent R0 conversion surgery, 3 (42.9%) achieving pCR. Safety was favorable: 85.0% had grade 1-2 adverse events, with grade 3 elevated alanine aminotransferase and thrombocytopenia each occurring in 2 patients (5.0%). No grade 4 adverse events were observed. Collectively, the triple-combination therapy of FOLFOX-HAIC, lenvatinib, and durvalumab exhibits promising therapeutic efficacy, favorable disease control, and a well-tolerated safety profile, providing a potential new treatment option for patients with uHCC. Trial number: NCT04961918.
18 May 2026
Read appraisal →Journal of gastrointestinal cancer
Long-term Outcomes of Protocol-based Neoadjuvant Selection and Liver Transplantation Versus Liver Resection for Perihilar Cholangiocarcinoma: A Systematic Review and Meta-analysis
BACKGROUND: Perihilar cholangiocarcinoma (CCA) is an aggressive malignancy that presents significant challenges in terms of diagnosis and treatment owing to its anatomical location. Liver resection and transplantation are the primary curative options; however, their long-term outcomes remain controversial. This study aimed to compare the long-term outcomes of protocol-based neoadjuvant selection and liver transplantation with liver resection for the management of perihilar cholangiocarcinoma. METHODS: A systematic review and meta-analysis were conducted according to the PRISMA guidelines. Electronic databases, including the Cochrane Library, PubMed/MEDLINE, and Embase, were searched for relevant clinical trials comparing liver transplantation with liver resection. RESULTS: Six studies comprising 768 patients (265 in the liver transplantation group and 503 in the liver resection group) were included. Liver transplantation was associated with significantly higher 5-year overall survival and 5-year disease-free survival. They also showed a higher 3-year disease-free survival rate. Patients in the liver transplantation group had a higher R0 resection rate. There were no significant differences in the 3- or 30-day postoperative mortality between the two groups. CONCLUSION: Liver transplantation was associated with improved long-term survival in highly selected patients; however, these findings are limited by significant selection bias and the retrospective study design. The apparent long-term benefit observed with LT must be interpreted cautiously because transplant series frequently report post-transplant rather than intention-to-treat outcomes.
18 May 2026
Read appraisal →Clinical cancer research : an official journal of the American Association for Cancer Research
Pembrolizumab Monotherapy in Sorafenib-Treated and Treatment-Naïve Advanced Hepatocellular Carcinoma: Long-Term Follow-up of the Open-Label, Phase II KEYNOTE-224 Study
PURPOSE: In the phase II KEYNOTE-224 study, pembrolizumab showed durable antitumor activity and manageable safety in participants with sorafenib-treated (cohort 1) or treatment-naïve (cohort 2) advanced hepatocellular carcinoma (HCC). We present data after a median follow-up of ∼7 years for cohort 1 and ∼5 years for cohort 2. PATIENTS AND METHODS: Adults with advanced HCC received pembrolizumab 200 mg intravenously every 3 weeks until disease progression or unacceptable toxicity for ≤35 cycles. The primary endpoint was objective response rate per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) by blinded independent central review. Secondary endpoints included overall survival (OS), progression-free survival (PFS), and safety. RESULTS: Overall, 155 participants received ≥1 dose of pembrolizumab (cohort 1, n = 104; cohort 2, n = 51). The median follow-up was 83 months (range, 79.3-87.3) for cohort 1 and 58.8 months (range, 55.3-60.8) for cohort 2. The median OS was 13.2 months [95% confidence interval (CI), 9.7-15.3] and 16.9 months (95% CI, 8.3-23.1), respectively; 24- and 48-month OS rates were 31%/17% and 34%/20%, respectively. The median PFS was 4.9 months (95% CI, 3.5-7) and 4.3 months (95% CI, 2.1-7.8), respectively. Treatment-related adverse events occurred in 76 participants [73.1%; grade 3-5, 27 (26%)] in cohort 1 and 28 participants [54.9%; grade 3-5, 8 (15.7%)] in cohort 2. CONCLUSIONS: Pembrolizumab continued to show durable response and manageable safety in participants with advanced HCC with or without prior systemic therapy, with long-term effects on OS lasting beyond 48 months in some participants despite receiving study treatment for ≤2 years.
17 May 2026
Read appraisal →Journal of robotic surgery
Comparative outcomes of da Vinci SP versus da Vinci Xi platforms in robotic cholecystectomy: a systematic review and meta-analysis
As robotic cholecystectomy adoption accelerates, the evidence comparing the perioperative outcomes of the Da Vinci Xi (DV-Xi) multiport platform to the Da Vinci Single-Port (DV-Sp) platform remains scarce. This meta-analysis provides the first systematic comparison of perioperative outcomes between these platforms. To compare perioperative safety and operative efficiency outcomes between the DV-Sp and the DV-Xi systems performing cholecystectomy. We thoroughly searched PubMed, Embase, Scopus, Cochrane Library, and ClinicalTrials.gov from inception till December 22, 2025. The key outcomes of interest included mean operative time, console time, docking time, pain scores on the day of the operation, pain scores after 24 h, estimated blood loss, and length of hospital stay. We conducted random-effects meta-analysis and leave-one-out sensitivity analysis using RStudio v 4.5.2. The ROBINS-I was used for the risk of bias assessment. A GRADE assessment through GRADEpro was performed. Four observational studies comprising 833 patients (DV-Sp: n = 416; DV-Xi: n = 417) met the set inclusion criteria, and no RCTs were found. The DV-Sp showed significantly decreased mean operative time (MD = -2.41 min; 95% CI - 4.09 to - 0.73, p = 0.0049) and console time (MD = - 7.24; 95% CI - 9.77 to - 4.72, P < 0.0001) with no heterogeneity (I² = 0%). Two studies reported reduced pain scores in the DV-SP group. There was no significant difference found in the pooled estimates of post-operative pain scores, blood loss, docking time, and length of hospital stay between the two platforms. The DV-Sp demonstrated modest but consistent reductions in operative and console time with comparable safety to the DV-Xi system. Pain scores on the day of surgery and after 24 h of operation were reported low in the DV-SP group. While the magnitude of time differences is unlikely to impact individual patient outcomes, cumulative reductions across high-volume operating centers may translate into meaningful gains in operating room efficiency. However, substantial heterogeneity, particularly in pain-related outcomes and docking time, warrants cautious interpretation of these outcomes.
17 May 2026
Read appraisal →Journal of robotic surgery
Robot-assisted versus laparoscopic distal pancreatectomy: an updated systematic review and meta-analysis including patient subgroups and meta-regression analyses
Robot-assisted distal pancreatectomy (RDP) was developed to overcome technical limitations of laparoscopic distal pancreatectomy (LDP), yet uncertainty persists regarding oncologic adequacy, learning-curve effects, and outcomes in high-risk subgroups. We synthesized current evidence to address these gaps. We systematically searched PubMed and EMBASE, in accordance with PRISMA guidelines, from inception to 2025 to identify comparative studies of RDP versus LDP. Using random-effects models, we calculated weighted mean differences (WMDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, and performed subgroup analyses, including pancreatic ductal adenocarcinoma (PDAC), along with meta-regression to explore heterogeneity sources. Sixty-four studies comprising 15,790 patients (5,723 RDP; 10,067 LDP; mean age 60.5 years; BMI 26.1 kg/m²) were included. RDP resulted in lower blood loss (WMD - 52.0 mL; p < 0.00001), fewer conversions (RR 0.49; p < 0.00001), and fewer unplanned splenectomies (RR 0.59; p < 0.0001). Operative time was longer (WMD + 24.06 min; p < 0.00001). Postoperative morbidity, POPF, PPH, infection, reintervention, and mortality were comparable. Length of stay was shorter with RDP (WMD - 0.57 days; p < 0.00001). Although lymph node yield appeared higher with LDP in the overall and PDAC cohorts, this difference was no longer significant in a sensitivity analysis, and R0 resection rates remained comparable. Costs were higher with RDP, with substantial heterogeneity. RDP and LDP demonstrate comparable safety and oncologic outcomes. RDP reduces blood loss, conversions, and splenectomy but increases operative time and cost. The operative time disadvantage likely reflects learning-curve. Selective use in high-risk and complex resections is supported; cost-effectiveness warrants further study.
15 May 2026
Read appraisal →European journal of cancer (Oxford, England : 1990)
Stereotactic body radiotherapy versus hepatic resection for recurrent small hepatocellular carcinoma: A post-hoc analysis with propensity score adjustment from two randomized trials
BACKGROUND: Stereotactic body radiotherapy (SBRT) has been proven effective for treating small hepatocellular carcinoma (sHCC); however, the comparative efficacy of SBRT and surgical resection remains unknown. This analysis aims to compare the outcomes of SBRT and resection in treating recurrent sHCC. METHODS: Two randomized controlled trials enrolled recurrent sHCC undergoing resection (NCT01833286) or SBRT (NCT04047173). Patients with single recurrent HCC ≤ 5 cm were included in this study. The primary endpoint was local progression-free survival (LPFS). RESULTS: A total of 158 patients were included, with 83 and 75 patients assigned to the SBRT and resection cohorts, respectively. The cumulative 3-year LPFS rates were 84.3% (95% CI, 76.1-92.5) with SBRT and 76.8% (95% CI, 67.2-86.4) with resection, respectively (HR, 0.70 [95% CI, 0.35-1.40]; P = 0.311). The median progression-free survival time of the SBRT and resection group was 37.6 (95% CI, 26.0-49.2) and 26.3 (95% CI, 18.8-33.8) months, respectively, with no significant differences (HR, 0.80 [95% CI, 0.53-1.21]; P = 0.287). The 3-year overall survival rates were 90.3% (95% CI, 83.4-97.2) in the SBRT group, and 81.1% (95% CI, 76.5-90.1) in the resection group (HR, 0.53 [95% CI, 0.23-1.20]; P = 0.118). The comparison results remained consistent after adjusting for confounding variables. The incidences of adverse events were similar between the two groups (P = 0.695). CONCLUSIONS: SBRT provides satisfactory tumor control and long-term outcomes, comparable to those of resection. SBRT could be a potential alternative to resection in recurrent sHCC.
10 May 2026
Read appraisal →Annual review of biomedical engineering
Artificial Intelligence-Based Analysis of Laparoscopic Imaging for Intraoperative Surgical Decision Support
Across surgical specialties, minimally invasive (laparoscopic) surgery has become a standard technique, as it is associated with less trauma, reduced postoperative complication rates, and quicker recovery for patients as compared with open surgery. Due to the limited field of view and limited haptic feedback, the surgical decision-making process in laparoscopic surgery is currently guided solely by surgeons' visual interpretation of the laparoscopic video stream. Modern artificial intelligence (AI) methods excel at the interpretation of visual data and find applications in clinical routine in fields such as radiology and endoscopy. AI methods could help augment laparoscopic surgery through objective real-time analysis of the laparoscopic video stream. Research studies have demonstrated the feasibility of AI-based surgical scene and process understanding. This review provides an overview of these AI applications, focusing on approaches that could, in the next decade, be translated into intraoperative surgical decision support tools for increased surgical quality and patient safety.
9 May 2026
Read appraisal →European journal of nuclear medicine and molecular imaging
Machine learning models classifiers enable a strong prediction of radioembolization-induced liver disease, and define a new bilirubin threshold for selection of patients.
PURPOSE: Selective Internal Radiotherapy (SIRT) is an established treatment option for hepatocellular carcinoma (HCC). However, a major complication is radioembolization-induced liver disease (REILD). METHODS: This retrospective study, analyzed patients treated with SIRT for HCC to identify clinical factors associated with REILD and to predict treatment response. Machine learning (ML) methods were applied to two distinct cohorts to determine predictors of toxicity and response. RESULTS: Among 138 patients analyzed for REILD, ML identified bilirubin as a key predictor. A refined threshold of 26.5 µmol/L (1.55 mg/dL) was associated with toxicity risk. In the response cohort (136 patients), predictive performance was limited, nevertheless tumor dose appeared as the most frequent feature selected by the models. CONCLUSIONS: Bilirubin was confirmed as a critical factor for REILD prediction with the identification of a new threshold that may improve patient risk stratification. While tumor dose appears as the main predictor of treatment outcome, robust response models require additional features.
5 May 2026
Read appraisal →Abdominal radiology (New York)
Deep learning-based combined noise reduction and contrast enhancement for post-neoadjuvant pancreatic cancer CT: does improved image quality translate to better resectability assessment?
PURPOSE: To evaluate whether deep learning-based combined noise reduction and contrast enhancement reconstruction (DLR) improves image quality and resectability prediction accuracy compared to conventional iterative reconstruction (IR) in post-neoadjuvant pancreatic cancer CT assessment. METHODS: This retrospective study included 114 patients with pancreatic cancer following neoadjuvant therapy. Contrast-enhanced CT images were reconstructed using conventional IR and vendor-neutral ClariACE. Three abdominal radiologists independently assessed image quality (based on 8 parameters: tumor conspicuity, tumor margin, image noise, sharpness of the main pancreatic duct, arterial depiction, venous depiction, plasticity and overall image quality) and determined tumor resectability with confidence levels. Quantitative analysis included aortic and portal venous attenuation measurements and pancreas-to-tumor contrast-to-noise ratio (CNR). Diagnostic performance was evaluated using the area under the receiver operating characteristic curve (AUC) with DeLong's test. Sensitivity, specificity, accuracy, and reader confidence were compared using McNemar's test. RESULTS: DLR demonstrated significantly superior vessel enhancement (p < 0.001) and improved CNR (p < 0.001) versus conventional IR. Two readers consistently rated DLR images higher across all qualitative categories (p < 0.001) except plasticity, while the third reader favored DLR in five of eight parameters (p < 0.001 to 0.020). However, all readers noted increased artificial appearance in DLR images (p < 0.001). Despite image quality improvements, no significant differences were observed in resectability assessment accuracy (62.3%-65.8%), AUC values (0.485-0.520), or high-confidence diagnosis rates between reconstruction methods. CONCLUSION: Although deep learning-based combined noise reduction and contrast enhancement reconstruction significantly improved quantitative and subjective image quality metrics, it did not enhance diagnostic accuracy for predicting R0 resectability in post-neoadjuvant pancreatic cancer patients.
5 May 2026
Read appraisal →Annals of medicine
Construction of an XGBoost-SHAP-based malignant transformation risk prediction model for gallbladder polyps
BACKGROUND: To develop and validate a risk prediction model for malignant transformation in patients with gallbladder polyps (GBPs) using an interpretable machine learning framework and evaluate its predictive accuracy. METHODS: A retrospective cohort of 1,027 surgical patients was enrolled from Yantai Yuhuangding Hospital (training set: n = 933) and Shanghai Eastern Hepatobiliary Surgery Hospital (validation set: n = 94). Feature selection for the training set was performed using the least absolute shrinkage and selection operator (LASSO) regression method. A predictive model was constructed with the XGBoost machine learning algorithm and evaluated using Shapley Additive exPlanation (SHAP). RESULTS: LASSO regression identified five significant risk factors for malignant transformation in GBPs: presence of concomitant cholecystitis, polyp count, polyp base width, age, and maximum polyp diameter. The area under the receiver operating characteristic curve (AUC) was 0.862 (95% confidence interval [CI]: 0.8342-0.8893) in the training set and 0.777 (95% CI: 0.6804-0.8737) in the validation set. SHAP analysis illustrated the contribution of each factor. CONCLUSION: This study developed and validated a risk prediction model for malignant transformation in patients with GBPs. The model demonstrated favorable discrimination, calibration, accuracy, and clinical applicability. Integration with SHAP technology may assist clinicians in optimizing treatment and management strategies.
27 Apr 2026
Read appraisal →Journal of investigative surgery : the official journal of the Academy of Surgical Research
Acupoint Stimulation After Anesthesia Induction Does Not Decrease Nausea and Vomiting After Hepatectomy: A Multi-Center Double-Blinded Clinical Trial
INTRODUCTION: This study evaluated whether adding transcutaneous electrical acupoint stimulation (TEAS) to a double-antiemetic regimen during hepatectomy reduces the incidence of postoperative nausea and vomiting (PONV). METHODS: In this multicenter double-blinded randomized controlled trial conducted across three tertiary hospitals in China, patients scheduled for elective hepatectomy were randomized to either the TEAS group (stimulation at PC6 during surgery) or the control group (no stimulation). The primary outcome was the incidence of PONV within 24 h postoperatively. Key secondary outcomes included the severity of PONV and pain after surgery. RESULTS: Among 161 randomized patients, 159 completed the study. No significant difference was observed in the incidence of PONV within 24 h postoperatively between the TEAS and control groups (23.8% vs. 26.6%; OR, 95% CI: 0.86, 0.42-1.76). However, the TEAS group exhibited less patient controlled analgesia (PCA) attempts (2.7 vs 3.5) or deliveries (2.6 vs 3.5) by 24 h postoperatively. Recovery outcomes, including time to ambulation and to gastrointestinal function recovery, did not differ between groups. CONCLUSION: Intraoperative TEAS did not significantly reduce PONV incidence in hepatectomy patients receiving antiemetic therapy. Nonetheless, its potential to decrease the need for analgesics warrants further investigation to refine its role in perioperative care. CLINICAL TRIAL REGISTRATION: ClinicalTrial.gov (NCT05396716), https://clinicaltrials.gov.
21 Apr 2026
Read appraisal →Medicine
Effect of parecoxib on postoperative anxiety and cognitive function after pancreaticoduodenectomy: A clinical trial
BACKGROUND: After pancreaticoduodenectomy, perioperative neurocognitive disorders (PND) are a common complication. Parecoxib, a selective cyclooxygenase-2 inhibitor, is used for its analgesic and antiinflammatory effects, but its impact on postoperative anxiety and cognitive function is not clear. METHODS: The patients undergoing laparoscopic pancreaticoduodenectomy at the Second Hospital of Hebei Medical University were enrolled in the study from November 1, 2020 to September 30, 2022 in this randomized controlled trial. Patients were randomly divided into Group P who received 20 mg of parecoxib intravenously 10 minutes before anesthesia and at the end of surgery and Group C who received an equal volume of normal saline at the same times. Primary outcomes included the effect of parecoxib on anxiety, cognitive impairment, and postoperative intestinal function recovery, with the incidence of PND calculated using the Z-value method. Secondary outcomes included pain control, length of hospital stay, postoperative recovery, complication rates, and analgesic use. RESULTS: 80 patients were enrolled and randomly divided into 2 groups of 40 equally: there were no significant differences in postoperative flatus passage, defecation time, hospital stay, or complication rates (P > .05). In terms of postoperative anxiety, the experimental group had significantly lower State Anxiety Inventory scores at 24 hours postoperatively (T2) (P < .05). Cognitive function, measured by Montreal Cognitive Assessment scores, did not show significant differences; however, cognitive decline was less pronounced in the experimental group. PND rates were 5% (2/40) in the experimental group versus 12.5% (5/40) in the control group, suggesting a possible clinical tendency toward reduced incidence, although the difference did not reach statistical significance. The rates of PND at 24 hours (T2) and 7 days (T3) postoperatively were 10% (4/40) and 5% (2/40) for the experimental group, compared to 15% (6/40) and 12.5% (5/40) for the control group using the Z-value method, Although the between-group differences did not reach statistical significance, a lower incidence was observed in the parecoxib group, suggesting a possible clinical tendency. CONCLUSION: Parecoxib, when used with pancreaticoduodenectomy, alleviates postoperative anxiety and neurocognitive disorders without affecting postoperative intestinal function recovery or increasing the incidence of postoperative complications.
19 Apr 2026
Read appraisal →BMJ open
Indocyanine green fluorescence for intraoperative detection of liver tumours in minimally invasive surgery: protocol for the LIVERGREEN phase IV multicentre clinical trial
INTRODUCTION: Liver tumours are a leading cause of global morbidity and mortality. Current diagnostic tools, including computed tomography (CT), magnetic resonance imaging (MRI) and intraoperative ultrasound (IOUS), have limitations in detecting liver neoplasms. Indocyanine green (ICG) has emerged as a promising tool for improving liver tumour detection. This study aims to assess the impact of preoperative ICG on intraoperative tumour detection in minimally invasive surgery and develop a machine-learning algorithm to enhance tumour detection using ICG fluorescence. METHODS AND ANALYSIS: This prospective, multicentre, phase IV clinical trial adheres to Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) guidelines. Patients with liver tumours eligible for minimally invasive surgery and a preoperative imaging test will be included. ICG will be administered intravenously 24 hours before surgery. Intraoperative procedures will include IOUS, ICG mapping and photographic documentation. Patients will be followed for 90 days to assess tumour progression, morbidity and mortality. The photographic analysis will enable the development of an artificial intelligence algorithm using machine learning and neural networks to identify lesions based on ICG fluorescence. The estimated sample size is 173 patients and the trial is predicted to accrue in 3 years. ETHICS AND DISSEMINATION: The trial will be conducted in accordance with the Declaration of Helsinki and the Spanish Agency of Medicines and Medical Devices (AEMPS) guidelines. Approved by the local institutional Ethics Committee and the AEMPS, the results will be shared with the scientific community through publications and conferences. EUDRACT NUMBER: 2023-5 08 316-27-00. TRIAL REGISTRATION NUMBER: NCT06398028. PROTOCOL VERSION: V.12, 18 March 2025.
18 Apr 2026
Read appraisal →Cancer research
Mutant and Wild-Type RAS Cross-talk and Stoichiometric Deficiencies Are Determinants of Sensitivity to Targeted Therapies in KRASG12R Pancreatic Ductal Adenocarcinoma
UNLABELLED: Therapies targeting the RAF-MEK-ERK pathway are generally considered to have limited efficacy in KRAS-mutant cancers. However, specific KRAS mutants exhibit distinct behaviors. Notably, KRASG12R pancreatic ductal adenocarcinoma (PDAC) tumors have shown sensitivity to MEK inhibitors (MEKi) in combination with autophagy inhibitors, but a better understanding of the underlying mechanisms is needed to optimize this treatment strategy. Using a systems-level approach, we uncovered a mechanistic explanation for this phenomenon. Due to distinct biophysical properties, KRASG12R had an impaired ability to activate wild-type HRAS and NRAS (WT-RAS) compared with other KRAS mutants, such as KRASG12D. This reduced activation stemmed from the weaker interaction between KRASG12R and guanine exchange factors (SOS), as well as the tumor suppressor neurofibromin (NF1), crucial in regulating WT-RAS activity. The impaired ability to activate WT-RAS led to weaker holistic MAPK signaling in KRASG12R-driven tumors, which conferred increased sensitivity to MEKi. To substantiate the preclinical findings, the utility of MEKi in combination with the autophagy inhibitor hydroxychloroquine was analyzed in patients with KRASG12R-mutated metastatic PDAC. Five of the eight (62.5%) patients treated in first- or second-line settings had a progression-free survival exceeding 6 months. Three patients had impressive disease control: two had stable disease of 11 and 22.7 months, and one achieved a partial response with an 83% decrease in tumor size that lasted for 8.9 months. Overall, this work highlights how systems-based approaches in precision medicine can uncover mechanistic insights to guide the identification of patients with PDAC most likely to benefit from tailored therapeutic strategies. SIGNIFICANCE: The unique sensitivity of KRASG12R-mutant cancers to MEK inhibitors offers a critical advancement in understanding MAPK signaling and paving the way for precision-targeted therapies in previously untreatable contexts. See related commentary by Tiriac and Engle, p. 1817 See related article by Burge et al., p. 1854 See related article by Burge et al., p. 1868.
17 Apr 2026
Read appraisal →Clinical cancer research : an official journal of the American Association for Cancer Research
A Multicenter Phase II Randomized Controlled Trial Comparing 177Lu-Dotatate/Capecitabine Combination Treatment with 177Lu-Dotatate Monotherapy in Patients with Neuroendocrine Tumors
PURPOSE: Peptide receptor radionuclide therapy (PRRT) with [177Lu]Lu-[DOTA0,Tyr3]octreotate (177Lu-Dotatate) is an effective and safe treatment for patients with metastatic gastroenteropancreatic neuroendocrine tumors (GEP NET). Whereas 177Lu-Dotatate prolongs progression-free survival (PFS) and preserves quality of life (QoL), objective response rates (ORR) remain limited. Capecitabine, as a radiosensitizer, could increase efficacy without increasing 177Lu-Dotatate activity. This phase II randomized controlled trial investigated the additional cytotoxic or radiosensitizing effect of capecitabine in combination with 177Lu-Dotatate. PATIENTS AND METHODS: Patients with advanced somatostatin receptor-positive GEP NET or bronchopulmonary NET were scheduled to receive four cycles of 7.4 GBq 177Lu-Dotatate and capecitabine or 177Lu-Dotatate alone. Capecitabine (1,650 mg/m2/day) was administered for 2 weeks from the start of each PRRT cycle. Primary endpoints were ORR, PFS, and median overall survival (OS). Secondary endpoints included biochemical response, adverse events, and QoL. RESULTS: A total of 111 of the 200 predefined patients were randomized for 177Lu-Dotatate/capecitabine (n = 50) or 177Lu-Dotatate (n = 61). According to the intention-to-treat analysis, the ORR was 32% for the 177Lu-Dotatate/capecitabine group versus 46% for the 177Lu-Dotatate group (P = 0.348). Treatment with 177Lu-Dotatate/capecitabine did not prolong median PFS (45.7 vs. 31.7 months, P = 0.629) or median OS (75.8 vs. 61.4 months, P = 0.530). Quality-adjusted life years (QALY) were lower in the 177Lu-Dotatate/capecitabine group (1.30 ± 0.48 vs. 1.47 ± 0.48, P = 0.014). CONCLUSIONS: In this prematurely closed phase II study, 177Lu-Dotatate/capecitabine did not improve ORR or prolong PFS and OS in patients with advanced NET compared with 177Lu-Dotatate alone and was associated with reduced QALY.
16 Apr 2026
Read appraisal →Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Transarterial Chemoembolization Combined With Camrelizumab and Rivoceranib for Unresectable Hepatocellular Carcinoma (CHANCE2005/CARES-005): A Randomized Phase II Trial
PURPOSE: Transarterial chemoembolization (TACE) alone has shown limited efficacy in improving survival among patients with unresectable hepatocellular carcinoma (HCC). This phase II trial compared TACE combined with camrelizumab (anti-PD-1 antibody) and rivoceranib (vascular endothelial growth factor receptor 2 inhibitor) versus TACE in unresectable HCC. METHODS: Patients with unresectable HCC (Barcelona Clinic Liver Cancer stage A to C without extrahepatic metastases) and Child-Pugh class A liver function were randomly assigned (1:1), stratified by macrovascular invasion, previous tyrosine kinase inhibitor treatment, and number of previous TACE procedures, to receive TACE combined with camrelizumab (200 mg once every 3 weeks) and rivoceranib (250 mg once daily; TACE-C-R) or TACE alone. The primary end point was progression-free survival (PFS) per composite criteria (progression per Response Evaluation Criteria in Cancer of the Liver version 5, transient deterioration to Child-Pugh class C, or TACE failure or refractoriness) in the intention-to-treat population. RESULTS: Between December 28, 2020, and October 29, 2023, 200 patients were randomly assigned (100 in each group). Median PFS per composite criteria was significantly longer with TACE-C-R than with TACE (10.8 months [95% CI, 8.8 to 13.7] v 3.2 months [95% CI, 2.4 to 4.2]; hazard ratio, 0.34 [95% CI, 0.24 to 0.50], P < .001). Grade ≥3 treatment-related adverse events occurred in 74.5% (70 of 94) of patients with TACE-C-R and 22.3% (23 of 103) of patients with TACE, with the most common being increased AST (29 [30.9%] and 13 [12.6%]) and increased ALT (23 [24.5%] and 14 [13.6%]). CONCLUSION: The addition of camrelizumab and rivoceranib to TACE showed statistically significant improvement in PFS for patients with unresectable HCC, with a manageable safety profile. Follow-up for further overall survival analysis is ongoing.
10 Apr 2026
Read appraisal →Gut
High versus gradually increasing energy nutrition in the early phase of acute pancreatitis (GOULASH): a multicentre double-blind randomised clinical trial
BACKGROUND: Acute pancreatitis (AP) is among the most common gastrointestinal diseases requiring hospitalisation, often with severe outcomes and no disease-specific therapy. Nutritional support has been proven to improve outcome, but little is known regarding optimal timing and composition. OBJECTIVE: This clinical trial aimed to compare high (30 kcal/kg/day, high energy (HE)) versus gradually increasing energy (0 increased to 30 kcal/kg/day over 4 days, low energy (LE)) strategies for enteral nutritional support in AP. DESIGN: This was a multicentric, double-blind, randomised clinical trial, enrolling patients with AP regardless of predicted severity (January 2017 to April 2023). The primary outcome was a combination of mortality and severe acute pancreatitis (Revised Atlanta Criteria); secondary outcomes included severity, rate of infection, organ failure and pain relapse. Interim analysis was planned after 50% enrolment. The Benjamini-Hochberg false discovery rate (FDR) method was used to correct p value for multiple testing. RESULTS: The trial was stopped early after enrolling 636 patients. Interim analysis showed that the primary outcome showed no difference between groups in the modified intention-to-treat (mITT) population (HE: 28/312, 9.0% vs LE: 18/307, 5.7%, p(uncorrected/corrected)=0.19/0.42). Secondary outcomes showed no difference in the mITT analysis. Without correction for multiplicity testing, results favoured a low gradual energy strategy in terms of organ failure (HE: 52/312, 16.7% vs LE: 28/307, 9.1%, p(uncorrected)=0.007) and pain relapse (80/312, 27.1% vs 54/307, 19.0% p(uncorrected)=0.03) but showed no differences between groups after correction for multiple testing (p=0.13 and p=0.23, respectively). It was determined that the superiority of the intervention would not be shown even with an increased sample size, and thus the trial was terminated based on a post hoc decision on ethics and futility. CONCLUSION: Based on this early terminated trial, a high-energy strategy for early nutrition in pancreatitis does not decrease mortality/severity, but potentially increases organ failure and pain relapse rate. TRIAL REGISTRATION NUMBER: ISRCTN63827758.
8 Apr 2026
Read appraisal →PloS one
Clinical impact of broad- versus narrow-spectrum empiric therapy in acute cholangitis: A Japanese claims database study
The clinical benefit of broad-spectrum empiric therapy in patients with acute cholangitis is unclear. We aimed to evaluate the impact of broad-spectrum and narrow-spectrum empiric therapies on patient outcomes using a Japanese claims database. The study included patients who were diagnosed with acute cholangitis between April 2014 and August 2022, aged 18-99 years, received antibiotics, had blood cultures collected, and underwent biliary drainage. Patients who received empiric therapy with carbapenems, piperacillin/tazobactam, or fourth-generation cephalosporins were included in the broad-spectrum group, whereas others were included in the narrow-spectrum group. Of the 4,755 eligible patients, 3,377 were categorized into the narrow-spectrum group and 1,378 into the broad-spectrum group. In the multivariate logistic regression analysis, older age, higher Charlson Comorbidity Index, the presence of sepsis, and intensive care unit admission were associated with increased 30-day in-hospital mortality, whereas the receipt of broad-spectrum empiric therapy was not (adjusted odds ratio, 1.37 [95% confidence interval {CI}, 0.84-2.23]). In the propensity score matching analysis, there was also no association between the receipt of broad-spectrum empiric therapy and 30-day in-hospital mortality (odds ratio, 1.43 [95% CI, 0.82-2.50]). Furthermore, in the propensity score-matched cohort, the broad-spectrum group had longer duration of intravenous antibiotic therapy (median interquartile range [IQR]: 8 [6 -11] day vs. 9 [7 -13] day; difference 1 day [95% CI, 0.31-1.69 day]) and length of hospital stay (median [IQR]: 13 [9 -20] day vs. 16 [11 -25] day; difference 3 day [95% CI, 1.87-4.13 day]), compared with the narrow-spectrum group. In this large-scale study using a Japanese claims database, broad-spectrum empiric therapy was not associated with improved clinical outcomes, compared with narrow-spectrum empiric therapy. Therefore, the necessity of broad-spectrum empiric therapy may be limited in clinical practice, and narrow-spectrum empiric therapy may represent an effective treatment strategy for acute cholangitis.
5 Apr 2026
Read appraisal →