Top Gastrointestinal Surgery Topics for Journal Committee — 2024–2026

🏆 1. Robotic vs Laparoscopic Surgery for Rectal Cancer — Long-Term Oncological Outcomes

• 3-year locoregional recurrence: 1.6% robotic vs 4.0% laparoscopic (HR 0.45, p=0.03)
• 3-year disease-free survival: 87.2% vs 83.4% (HR 0.74, p=0.04)
• Robotic patients had significantly better urinary, sexual, and defecation function at 3–12 months post-op
• No significant difference in overall survival at 3 years

2. Thermal Ablation vs Surgical Resection for Colorectal Liver Metastases — The COLLISION Trial

• Overall survival: non-inferior (median not reached in either group; HR 1.05, 95% CI 0.69–1.58)
• Adverse events: 19% ablation vs 46% surgery (p<0.0001)
• Serious adverse events: 7% vs 20%
• Local control: non-inferior

3. Perioperative FLOT Chemotherapy vs Preoperative Chemoradiotherapy in Esophageal Adenocarcinoma — The ESOPEC Trial

• 3-year overall survival: 57.4% FLOT vs 50.7% chemoradiotherapy (HR 0.70, p=0.01)
• 3-year progression-free survival: 51.6% vs 35.0% (HR 0.66, p<0.001)
• 90-day post-surgery mortality: 3.1% vs 5.6%

4. Neoadjuvant Chemotherapy (Gemcitabine + S-1) vs Upfront Surgery for Resectable Pancreatic Cancer — Prep-02/JSAP05 Trial

• Median OS: 37.0 months (NAC) vs 26.6 months (upfront surgery) (HR 0.73, p=0.018)
• Relapse-free survival: 14.3 vs 11.3 months (HR 0.77, p=0.030)

5. RYGB vs Sleeve Gastrectomy — 10-Year Outcomes (SM-BOSS Trial)

• %EBMIL at 10 years: 65.2% RYGB vs 60.6% SG (ITT, p=0.29; significant in per-protocol)
• Conversion rate from SG to other anatomy: 29.9% vs 5.5% for RYGB (p<0.001) — largely due to GERD or insufficient weight loss
• De novo GERD significantly higher after SG (p=0.02)

6. 2025 WSES Jerusalem Guidelines for Acute Appendicitis

• Nonoperative antibiotics: safe and effective in selected uncomplicated appendicitis patients
• Appendectomy can be safely delayed up to 24 hours without increasing adverse outcomes
• Laparoscopic appendectomy remains standard
• Short-course post-op antibiotics (2–3 days) for complicated disease
• Follow-up colonoscopy after nonoperative management of complicated appendicitis with abscess

7. ERAS After Gastrectomy — Updated Meta-analysis of 27 RCTs (2018–2025)

• ERAS significantly reduced length of stay and accelerated GI recovery
• Overall complication rate: RR 0.73 (95% CI 0.56–0.96) in high-quality sensitivity analyses
• No increase in readmission or mortality
• Cost reduction demonstrated

Summary Table

High-Impact Gastro Surgery Topics (Non-Oncology) — 2024–2026

1. 🏆 Appendicitis in Children: Surgery vs Antibiotics — The Lancet, 2025

• 1-year treatment failure: 34% antibiotics vs 7% appendicectomy (difference 26.7%, 90% CI 22.4–30.9)
• Antibiotics group had 4.3× more mild-to-moderate adverse events
• Antibiotic management was declared inferior to surgery — the non-inferiority margin was not met

2. Appendectomy vs Antibiotics in Adults — Cochrane Review 2024

• ~70% of adults on antibiotics avoided surgery at 1 year
• Antibiotics reduced wound infections (RR 0.25) and had shorter hospital stays
• But 30.7% eventually required appendicectomy within 1 year
• Uncomplicated appendicitis: antibiotics is a legitimate, shared-decision option

3. Robotic vs Laparoscopic Inguinal Hernia Repair — The ROGER RCT

• Postoperative pain at 24h: no significant difference (NRS 4 rTAPP vs 5 TEP, p=0.43)
• Complication rates: comparable (10% vs 11%)
• Operating time: longer for robotic (80 vs 64 min, p<0.001)
• Surgeon workload (NASA-TLX): significantly lower with robotic (18.4 vs 34.0, p<0.001)

4. Early Laparoscopic Cholecystectomy Beyond the 7-Day Barrier

• Operating time and hospital stay are longer after >7 days (by ~12 min and ~2.7 days)
• No significant increase in major complications (bile duct injury, bowel injury) or conversion rate
• Complications ≥Clavien-Dindo III: no significant difference

5. Surgical Management of Perforated Diverticulitis (Hinchey III/IV) — EAES/ESCP Network Meta-Analysis

• Laparoscopic peritoneal lavage (LPL): higher 30-day mortality vs both Hartmann's and primary resection + anastomosis (PRA)
• PRA vs Hartmann's: PRA gives significantly fewer permanent stomas (539 fewer per 1,000)
• Mortality between PRA and Hartmann's: no significant difference

6. Endoscopic Treatments for GERD — Network Meta-Analysis

• TIF (transoral incisionless fundoplication) and endoscopic band ligation (EBL) are the most effective — both superior to Stretta, EFTP, and EndoCinch
• TIF and EBL significantly improved quality of life scores vs PPIs
• Only TIF significantly increased lower esophageal sphincter pressure
• TIF was inferior to PPIs in reducing acid exposure time

Summary Table

Gastro Surgery — Journal Committee Topics: 2025–2026 Only

1. 🏆 APPAC Trial — 10-Year Follow-Up: Antibiotics for Appendicitis

• 10-year cumulative appendectomy rate in the antibiotics group: 44.3% → meaning 55.7% never needed surgery at 10 years
• True recurrence rate (histologically confirmed): 37.8%
• Complications at 10 years: 8.5% antibiotics vs 27.4% appendectomy (p<0.001)
• No significant difference in quality of life between groups
• No appendiceal tumors missed on long-term imaging follow-up

2. 2025 WSES Jerusalem Guidelines — Acute Appendicitis (All Populations)

• Antibiotics safe and effective in selected uncomplicated appendicitis
• Appendectomy can be safely delayed up to 24 hours
• Laparoscopic appendectomy = standard
• Post-op antibiotics for complicated disease: only 2–3 days
• Mandatory follow-up colonoscopy after abscess managed non-operatively

3. POEM vs Laparoscopic Heller Myotomy — 5-Year RCT Follow-Up

• Clinical success at 5 years: 75.0% POEM vs 70.8% LHM — non-inferior
• Symptom scores improved equally in both groups
• Reflux oesophagitis at 5 years: 41% POEM vs 31% LHM — persistent POEM disadvantage
• Significant oesophagitis (Grade B/C/D): 14% POEM vs 7% LHM
• Quality of life: no significant difference

4. Percutaneous Cholecystostomy vs Cholecystectomy in Acute Cholecystitis

• Cholecystectomy vs percutaneous cholecystostomy (PC): significantly lower mortality (OR 0.26, 95% CI 0.14–0.48) and lower readmission (OR 0.37, 0.18–0.75) with surgery
• Laparoscopic CC vs PC: mortality OR 0.17 in favour of surgery
• PC followed by delayed CC: no significant advantage over immediate CC
• PC remains viable in truly high surgical-risk patients

5. Robotic vs Laparoscopic TAPP for Inguinal Hernia — The DIRECT RCT (Denmark, 2025)

• Total operative time: shorter for robotic TAPP (p<0.05) for both simple and complex hernias
• Docking added only ~5 minutes, more than offset by faster dissection
• Advantage was larger for complex hernias (bilateral, scrotal, recurrent)
• Complication rates comparable between groups

6. Endoscopic vs Surgical Necrosectomy for Infected Pancreatic Necrosis — SR of RCTs

• Mortality: comparable (8–18% endoscopic vs 6–15% surgical)
• Pancreatic fistula: 8% endoscopic vs 34% surgical (p<0.01) — major advantage
• New-onset organ failure: lower with endoscopy
• Hospital stay: shorter with endoscopy in several trials
• Long-term pancreatic function and quality of life: similar
• Complex/anatomically unfavourable necrosis: may still need surgery

Summary Table — 2025–2026 Only

• Clinically relevant to your daily work (emergency surgery, common conditions)
• Not too narrow or technical (no highly specialized oncology trials)
• Has a clear debate angle — so discussion flows naturally
• Free full text — you can actually read and present the whole paper
• Not overwhelming to critique statistically

🥇 Best Pick — APPAC 10-Year Follow-Up

• Appendicitis is the most common emergency operation you're doing as a PG2
• Everyone in the room — seniors, consultants, faculty — has a strong opinion on this
• The question is simple: "Can we skip surgery?" — easy to explain and debate
• Results are clear and dramatic: 55% avoided surgery at 10 years, but complications much lower with surgery
• JAMA publication = high credibility, impresses faculty
• Free full text — read the whole paper tonight

🥈 Second Pick — Percutaneous Cholecystostomy vs Cholecystectomy

• Acute cholecystitis is something you assess, consent, and assist on every week
• The clinical question — drain it or operate? — is one you face in real time
• Meta-analysis format is easier to present than a complex RCT (summarise 27 studies in one slide)
• Results are practice-changing: surgery has lower mortality and readmission; PC only for truly high-risk patients
• Generates good discussion around patient selection — a realistic, bedside-relevant debate

🥉 Third Pick — POEM vs Heller Myotomy for Achalasia

• Achalasia is a focused, well-defined condition — easy to revise and explain background
• The surgical-vs-endoscopic question is highly topical and sparks debate between surgeons and gastroenterologists
• 5-year RCT data is robust and impressive
• The reflux trade-off after POEM is a genuinely unresolved clinical issue — great discussion point
• Shows you're engaging with upper GI surgery, which is relevant at PG2 level

My Recommendation for You

1. Background — appendicitis epidemiology, the surgery-vs-antibiotics story so far (5 min)
2. Paper walkthrough — design, patients, outcomes (8 min)
3. Key results — 3–4 slides with the main numbers (5 min)
4. Critical appraisal — limitations (open-label, Finnish population, exclusion of perforated cases) (3 min)
5. Take-home message + what it means for your unit (2 min)

✅ Article 1 — CONFIRMED

✅ Article 2 — CONFIRMED

Article 3 — Note

1) Gallbladder surgery (difficult cholecystectomy)

• Very practical for emergency/general surgery.
• Directly addresses difficult Calot’s triangle and bailout strategy.

• Subtotal cholecystectomy has very low bile duct injury (~0.3%) but higher bile leak/ERCP/readmission than total cholecystectomy.
• Reconstituting subtotal appears better than fenestrating in outcomes.

2) Pancreas (acute pancreatitis, early nutrition strategy)

• High-impact journal (Gut), modern RCT design.
• Changes bedside protocol decisions in surgical/ICU pancreatitis care.

• High early-calorie strategy did not improve primary outcomes; possible trend toward more organ failure/pain relapse.
• Supports cautious, gradual nutritional escalation.

3) Liver surgery (robotics vs laparoscopy)

• Timely “robotics in HPB” topic everyone wants to discuss.
• Strong comparative pooled data.

• Robotic liver resection showed lower conversion and lower severe morbidity in pooled analyses.
• No major mortality difference; helps discussion on cost-benefit and case selection.

4) Intestinal surgery (small bowel obstruction)

• Pure general surgery problem, very resident-relevant.
• RCT with 5-year outcomes (rare in emergency surgery literature).

• Laparoscopy had small short-term benefit, but no long-term superiority for recurrence, incisional hernia, or QoL versus open.

5) Hernia (recent advance/technique)

• Clearly “recent technique” topic.
• Excellent for discussing what is innovation vs true benefit.

• BTX-A reduced postoperative complications but did not clearly improve fascial closure or recurrence.
• Good discussion on selective use vs routine use.

6) Recent technical advance source (image-guided surgery)

• AR + ICG fluorescence is one of the newest intraoperative guidance trends.
• Gives objective outcomes (blood loss, transfusion, complications).

• AR-guided liver resection associated with reduced blood loss and transfusion, with promising safety profile.

Best presentation plan for you (2nd year PG)

“Modern decision-making in General Surgery: bailout, minimally invasive, and technology-guided strategies”

1. Difficult gallbladder subtotal chole meta-analysis (PMID 41644007)
2. LASSO SBO RCT (PMID 41706492)
3. AR-guided liver resection meta-analysis (PMID 41430466)

• a ready-made 20-minute slide structure for these papers,
• a critical appraisal template (PICO, bias, external validity),
• and likely viva questions your faculty may ask.