Khyber Medical College

High morbidity and mortality make pancreaticoduodenectomy (PD) one of the most complicated surgical procedures. This meta-analysis aimed to compare the outcomes of robotic pancreaticoduodenectomy (RPD) versus open pancreaticoduodenectomy (OPD).

A comprehensive literature search of PubMed, Cochrane Central, and Google Scholar was conducted from inception to November 2024. Studies comparing RPD and OPD in adults aged ≥ 18 years were included. Data for the outcomes of interest were extracted.

Forty-one studies with a total of 54,287 patients were pooled. RPD is significantly superior to OPD in terms of overall postoperative complications (RR = 0.91, 95% CI: [0.86-0.97]; p = 0.001), wound infections (RR = 0.63, 95% CI: [0.49-0.81], p = 0.0004), estimated blood loss (WMD = -171.99 ml, 95% CI: [ -217.76 to -126.22], p < 0.01) and hospitalization duration (WMD = -1.33 days, 95% CI: [ -1.84 to -0.82], p < 0.01) with a longer operating time (WMD = 73.22 min, 95% CI: [56.20 to 90.23], p < 0.01).

In conclusion, RPD shows a lower risk of wound infections and overall postoperative morbidity compared to OPD. It has lower estimated blood loss, shorter hospitalization duration, and a longer operating time. The two approaches were comparable in terms of resection quality. More high-quality RCTs are required to draw definite conclusions.

Music therapy has been explored as a non-pharmacological intervention for anxiety in critically ill patients, but its effectiveness remains unclear. This meta-analysis synthesized evidence from five randomized controlled trials (RCTs) involving 325 participants. A comprehensive literature search across PubMed, Embase, and Cochrane databases ensured the inclusion of high-quality studies published between 2010 and 2025. Music therapy sessions ranged from 15 to 30 min. Anxiety was assessed using validated measures, and data were analyzed with a random-effects model to calculate the mean difference (MD) in anxiety scores with 95 % confidence intervals (CI). Heterogeneity was evaluated using the I2 statistic, and sensitivity analyses were conducted to address potential bias. The pooled analysis found an MD of -1.11 (95 % CI: -12.97 to 10.75, p = 0.85; I2 = 99 %), showing no significant anxiety reduction. Heterogeneity was substantial. A sensitivity analysis, excluding two influential studies, reduced heterogeneity (I2 = 30 %) but still showed no significant effect (MD = 0.69, 95 % CI: -2.15 to 3.53, p = 0.63). A funnel plot suggested possible publication bias, but the limited number of studies hindered formal assessment. Overall, current evidence does not support music therapy as an effective stand-alone intervention for anxiety reduction in critically ill patients. Further research with standardized protocols and larger sample sizes is necessary to clarify its role in critical care settings.

Hepatic angiosarcoma is a rare and aggressive tumor of the vascular endothelial cells with a poor prognosis. Due to its nonspecific symptoms and rapid progression, early diagnosis poses a significant challenge. Histopathology and immunohistochemistry are essential for confirmation; however, treatment options remain limited.

A 56-year-old male presented to us with right upper quadrant pain, anemia, and mild ascites. Computed Tomography (CT) imaging revealed multiple vascular liver and spleen lesions, initially suspected as metastatic. Tumor markers and Fine Needle Aspiration Cytology (FNAC) of a thyroid nodule were performed which turned out to be inconclusive. Due to internal hemorrhage, an emergency left lateral segmentectomy was performed. Cluster of Differentiation 34 (CD34) and Erythroblast transformation specific regulated gene (ERG) histopathology confirmed hepatic angiosarcoma. The patient was stable postoperatively and referred for oncology care. However, the patient deteriorated soon after and died due to massive intra-abdominal hemorrhage before initiating chemotherapy.

Hepatic angiosarcoma is often multifocal with rapid metastasis, making complete resection almost impossible. CT and Magnetic Resonance Imaging (MRI) aid in detection but histopathology with vascular markers CD34 and ERG are essential for definitive diagnosis. In light of lack of treatment options surgical resection offers the best survival for localized disease, while chemotherapy and Transarterial Chemoembolization (TACE) remain good palliative options. With a median survival of 6 months, the prognosis of this disease is highly dismal.

Hepatic angiosarcoma is a highly fatal condition with limited treatment options. Histopathology is crucial for diagnosis, and surgery remains the best option for localized cases. Early recognition is key to improving outcomes.