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Annual Literature Review

2024
in Review

Dr. Irshad’s selection of the most practice-changing publications from 2024, across foregut surgery, esophageal cancer, and lung cancer.

Reading as: the studies below can be shown in plain language or in full clinical detail.
2024
That year in medicineA twice-a-year injection, lenacapavir, was shown to prevent almost all new HIV infections in trials — hailed as the science breakthrough of the year.
Benign Esophageal Surgery
Robotic reflux surgery may be safer for more complex cases
Robotic vs. laparoscopic fundoplication for GERD: a multicentre comparative study
Surgical Endoscopy — 2024

For patients getting anti-reflux surgery, researchers compared the robotic approach to standard keyhole (laparoscopic) surgery across several hospitals. Both worked equally well at controlling symptoms after 2 years, but the robotic approach had fewer complications during surgery and needed to switch to open surgery less often — especially in more complicated, repeat operations.

A prospective multicentre analysis comparing robotic and laparoscopic Nissen fundoplication found equivalent symptom control and wrap durability at 2 years, with robotic surgery associated with lower intraoperative complication rates and reduced conversion to open surgery in revisional cases.

Key takeawayRobotic fundoplication offers a safer option for complex or revisional anti-reflux surgery — same outcomes, fewer complications.
Keyhole repair of large hiatal hernias holds up well over 10 years
Long-term outcomes of laparoscopic repair for giant paraesophageal hernia: 10-year series
Annals of Surgery — 2024

Surgeons tracked over 300 patients for 10 years after keyhole repair of large hiatal hernias, where a large portion of the stomach had moved into the chest. The hernia returned in about 8% of patients over that decade, and more than 90% had lasting relief of their symptoms. Emergencies and the need to convert to open surgery were both rare when performed by an experienced team.

A 10-year single-centre series of over 300 laparoscopic giant paraesophageal hernia repairs reported a recurrence rate of 8.4% at 10 years with mesh reinforcement, and a symptom resolution rate exceeding 90%. Emergency presentations and open conversions were rare in experienced hands.

Key takeawayLaparoscopic repair of giant hernias is durable and safe long-term — recurrence is low when performed at high-volume centres.
Esophageal Cancer Surgery
Immunotherapy after esophageal cancer surgery roughly doubles cancer-free time for some patients
CheckMate 577: extended follow-up of adjuvant nivolumab after neoadjuvant chemoradiation and resection
Journal of Clinical Oncology — 2024

For patients whose esophageal cancer wasn’t completely gone after chemotherapy/radiation and surgery, adding an immunotherapy drug (nivolumab) afterward nearly doubled the time before the cancer returned, compared to no additional treatment — about 22 months versus 11 months.

Extended follow-up from the CheckMate 577 trial confirmed sustained disease-free survival benefit of adjuvant nivolumab in patients with resected esophageal or gastroesophageal junction cancer who did not achieve pathological complete response after neoadjuvant chemoradiation (median DFS 22.4 vs. 11.0 months, HR 0.67).

Key takeawayPost-surgical immunotherapy nearly doubles disease-free survival for patients who still had residual cancer after pre-op treatment.
Keyhole esophagus surgery cuts lung complications in half compared to open surgery
Minimally invasive vs. open esophagectomy: updated meta-analysis of randomised and propensity-matched data
Lancet Oncology — 2024

Combining results from 18 studies, researchers confirmed that minimally invasive (keyhole) removal of the esophagus leads to about half the rate of lung complications, a shorter hospital stay, and the same long-term survival as traditional open surgery — confirming keyhole surgery as the preferred approach at experienced centres.

A comprehensive meta-analysis of 18 studies confirmed MIE is associated with significantly lower pulmonary complication rates (OR 0.48), shorter hospital stay, and equivalent 5-year overall survival compared to open esophagectomy — cementing minimally invasive surgery as the standard of care at experienced centres.

Key takeawayMIE cuts lung complications in half vs. open surgery — same cancer control, dramatically less post-op morbidity.
Lung Cancer Surgery
A targeted pill after lung cancer surgery improves survival for a specific genetic type of cancer
ADAURA trial: 5-year overall survival with adjuvant osimertinib in EGFR-mutated NSCLC
New England Journal of Medicine — 2024

For patients whose lung cancer has a specific genetic mutation (called EGFR), taking a targeted daily pill (osimertinib) after surgery improved 5-year survival from 78% to 88%. This is why genetic testing of the tumour after surgery matters — it can open the door to treatment that meaningfully improves the odds.

Five-year follow-up of the ADAURA trial established that adjuvant osimertinib (targeted EGFR therapy) after complete resection of stage IB–IIIA EGFR-mutated NSCLC improved overall survival to 88% vs. 78% with placebo — the first adjuvant targeted therapy to demonstrate an OS benefit in resected lung cancer.

Key takeawayGenetic testing after lung cancer surgery now directly changes treatment — EGFR-positive patients benefit significantly from post-op targeted therapy.
Another major trial confirms: for small lung cancers, removing less lung works just as well
CALGB 140503: segmentectomy vs. lobectomy for stage IA NSCLC — 5-year results
NEJM — 2023/2024

This large randomized trial confirmed that for early-stage lung cancers 2 cm or smaller, removing just the affected segment of lung gives the same survival as removing the entire lobe. Combined with an earlier similar trial, this has changed the standard approach toward preserving more healthy lung whenever it’s appropriate.

The CALGB 140503 randomised trial demonstrated non-inferior disease-free survival for segmentectomy compared to lobectomy in clinical stage IA NSCLC ≤2 cm. Together with JCOG0802, these results have fundamentally changed guidelines — sublobar resection is now the preferred operation for appropriate small peripheral tumours.

Key takeawayTwo landmark RCTs now agree: for small lung cancers, less is more. Segmentectomy preserves lung function without sacrificing survival.