British Journal of Surgery最新文献

{"title":"Presacral Tumours: an international consensus on diagnosis and management.","authors":"William R G Perry,Kilian G M Brown,Elaine Burns,Quentin Denost,Frank Frizelle,Thomas E Glover,Tamara Glyn,Rondell P Graham,Alexander Heriot,Amit Merchea,Aaron Quyn,Peter Sagar,Michael J Solomon,Gregory Thomas,Jim P Tiernan,Gregory A Turner,Satish Warrier,Verity Wood, ,John T Jenkins,Eric Dozois","doi":"10.1093/bjs/znag053","DOIUrl":"https://doi.org/10.1093/bjs/znag053","url":null,"abstract":"BACKGROUNDPresacral tumours are rare and heterogeneous lesions arising within a complex anatomical space, resulting in variability in diagnosis and management. Increasing incidental detection and evolving surgical and oncological strategies have highlighted the need for contemporary guidance. This study develops an international expert consensus on the optimal diagnosis and management of presacral tumours.METHODSAn international panel of colorectal surgeons from high-volume units was convened. Evidence- and practice-based statements were developed after domain-based literature reviews and refined through five online and two in-person meetings. Consensus was achieved using a modified Delphi process with anonymous voting.RESULTSSixteen colorectal surgeons participated in the study. Ten domains were identified resulting in the development twenty-two statements based on expert opinion and retrospective studies. After two rounds, unanimous (100%) agreement was achieved for all statements. High-resolution MRI with structured synoptic reporting is endorsed as central to risk stratification. Selective image-guided transperineal or parasacral biopsy is recommended for high-risk lesions where histology would alter management. Complete surgical resection is defined as the operative goal, with approach tailored to tumour biology and anatomy; minimally invasive surgery is considered appropriate in selected cases. Non-operative surveillance is supported for carefully selected asymptomatic, low-risk cystic lesions. Postoperative surveillance is recommended in a risk-adapted manner according to histopathology and margin status.CONCLUSIONThis international consensus provides a pragmatic, risk-stratified framework for the multidisciplinary diagnosis and management of presacral tumours. These recommendations aim to reduce practice variation, support decision-making in specialised centres, and inform future prospective collaborative research.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"2 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147754570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modern Treatment for Achalasia: Endoscopic and Surgical therapies.","authors":"Andrew Conner,Melissa V Wills,Salvador Navarrete,Jerry T Dang,Robert Bechara,Biniam Kidane,Siva Raja,Matthew Kroh,Dennis Hong,Yung Lee","doi":"10.1093/bjs/znag046","DOIUrl":"https://doi.org/10.1093/bjs/znag046","url":null,"abstract":"Achalasia is a rare, progressive oesophageal motility disorder defined by impaired lower oesophageal sphincter relaxation and absent peristalsis, leading to dysphagia, regurgitation, chest pain, weight loss, and increased long-term risks of aspiration and malignancy. Management has evolved from open surgical myotomy to minimally invasive laparoscopic and robotic techniques and, more recently, peroral endoscopic myotomy (POEM). This review summarises contemporary diagnostic strategies, including high-resolution manometry, timed barium oesophagram, endoscopy, and emerging applications of impedance planimetry, and critically appraises current endoscopic and surgical therapies. The review compares outcomes of pneumatic dilation, botulinum toxin injection, minimally invasive Heller myotomy with fundoplication, POEM, POEM with fundoplication, and newer approaches for advanced disease such as per-oral oesophageal plication and oesophagectomy, integrating data from randomised trials and long-term cohort studies. Key issues including post-treatment gastroesophageal reflux, cancer surveillance, and management of recurrent or refractory symptoms are addressed. Treatment selection is emphasised as individualised, incorporating manometric subtype, oesophageal morphology, patient comorbidity, institutional expertise, procedural durability, complication profiles, and evolving guideline recommendations across international expert consensus groups. Contemporary multimodal therapy enables durable symptom control and meaningful quality-of-life improvement for most patients, while ongoing innovation and longer-term follow-up will continue to refine treatment algorithms and standards of care.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"13 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of incidental gallbladder cancer in a nationwide CAPBIL study.","authors":"Jane McClements,Wan Teng Lee,Amanda Koh,Harivinthan Sellappan,Lauren Blackburn,Adam Brooks,Gemma Nixon,Nabeel Merali,Adam Frampton,Danial Safavi,Brian Davidson,Michael Feretis,Bobby V M Dasari,Sirr Ling Chin,Dimitrios Karavias,Alistair Rowcroft,James Lucocq,Ewen M Harrison,Victoria Morrison-Jones,Fenella Welsh,Adithya Pathanki,Gabriele Marangoni,Paris Bruno,James Skipworth,Nicola Colucci,Vasilis Kosmoliaptsis,Lawrence O'Leary,Hassan Malik,Albasheer Hamadalnile,Krishna Menon,Waqqas Patel,Mohamed Bekheit,Lulu Tanno,Michael Silva,Christopher Brown,Nagappan Kumar,Joel Triance,Nehal Shah,Tareq Alsaoudi,Neil Bhardwaj,Hussein Nassar,Omar Mownah,Kai Tai Derek Yeung,Ricky Bhogal,Ruth Blanco-Colino,Shahid Farid,Rami Aljaberi,Sanjay Pandanaboyana,Omar Abdelmohsin,Somaiah Aroori,Daisy Evans,Tejinderjit Athwal,J Peter A Lodge,Dhanwant Gomez","doi":"10.1093/bjs/znag050","DOIUrl":"https://doi.org/10.1093/bjs/znag050","url":null,"abstract":"INTRODUCTIONTo provide contemporary, real-world data on the management approaches and survival outcomes of patients with incidental gallbladder cancer (GBC) following cholecystectomy in the United Kingdom. The secondary aim was to identify prognostic factors associated with survival.METHODSPatients diagnosed with incidental GBC following cholecystectomy between January 2014 and December 2022 across 24 centres were included. Data collected comprised demographics, treatment details, histopathological findings and survival outcomes.RESULTSDuring the study period, 285 patients had incidental GBC. Median follow-up was 31 months, with 5-year disease-free (DFS) and overall (OS) survival of 41.5% and 45.1%, respectively. Of the 193 (67.7%) patients who underwent liver resection, most (97.9%) underwent segment 4B/5 resection. Patients with incidental GBC who underwent liver resection had significantly improved DFS (51 vs 15 months, p<0.001) and OS (72 vs 26 months, p<0.001) compared with those who did not. In addition, patients who completed adjuvant chemotherapy had better DFS (35 vs 15 months, p=0.021) and OS (47 vs 26 months, p=0.009) compared to those who did not. On multivariable analysis, nodal metastases were independently associated with poorer DFS (HR 2.04, 95% CI 1.30-3.20, p=0.002), while advanced tumour (T3-T4) stage (HR 1.70, 95% CI 1.04-2.77, p=0.034) and nodal metastases (HR 2.15, 95% CI 1.33-3.48, p=0.002) predicted poorer OS.CONCLUSIONPatients who underwent liver resection after incidental GBC had significantly better survival than those who did not proceed to further surgery. Adverse tumour biology was associated with poorer survival.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"17 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparing multifocality to unifocal breast cancer and the relation to survival: a national cohort study.","authors":"Emma Söderberg,Fredrik Wärnberg,Anna-Karin Wennstig,Greger Nilsson,Hans Garmo,Lars Holmberg,Malin Sund,Charlotta Wadsten","doi":"10.1093/bjs/znag033","DOIUrl":"https://doi.org/10.1093/bjs/znag033","url":null,"abstract":"BACKGROUNDThe prognostic relevance of multifocal and multicentric breast cancer remains unclear and current staging systems do not consider focality. The aim was to explore whether women with multifocal breast cancer have less favourable tumour characteristics and worse survival compared to women with unifocal breast cancer.METHODSPatient and tumour characteristics were obtained from Breast Cancer Data Base Sweden 3.0 which include all Swedish women operated for invasive breast cancer between 2008 and 2019. Overall and breast cancer-specific survival rates were calculated using the Kaplan-Meier method, and multivariable analysis was used to identify independent predictors of survival using the Cox proportional hazard model.RESULTSIn 71,607 included women, 59,445 (83.2%) had unifocal breast cancer, 7,286 (10.2%) had multifocal breast cancer with 2 invasive foci, and 4,688 (6.6%) had ≥3 invasive foci. Multifocal breast cancer was associated with higher T- and N-categories, compared to unifocal breast cancer. Median follow-up time was 5.96 years (interquartile range 3.07-8.80 years). The breast cancer-specific 10-year survival probabilities were 86.1%, 86.5%, and 88.5% for multifocal breast cancer with ≥3 foci, multifocal breast cancer with 2 foci, and unifocal breast cancer, respectively. In a multivariable analysis adjusted for patient and tumour characteristics, the hazard ratio for breast cancer-specific death was 1.17 (95% confidence interval, 1.03-1.32) in cases of multifocal breast cancer with ≥3 foci compared to those with unifocal breast cancer. There was no statistically significant difference in overall survival between the three groups.CONCLUSIONThe current study suggests that multifocality when compared to unifocal breast cancer carries additional prognostic information over traditional tumour characteristics.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"48 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes Associated with Prior GLP-1 Exposure in Burned Patients.","authors":"Adam Boukind,Aviral C Sharma,Marco J Henriquez,Saif Badran","doi":"10.1093/bjs/znag048","DOIUrl":"https://doi.org/10.1093/bjs/znag048","url":null,"abstract":"INTRODUCTIONGlucagon-like peptide-1 (GLP-1) receptor agonists have anti-inflammatory and immunomodulatory properties beyond glycemic control. Their impact on burn injury outcomes remains unexplored. This study assessed the potential impact of prior GLP-1 exposure on mortality, infectious complications, and critical care utilisation in burn patients.METHODSUsing the TriNetX US Network, adult patients with thermal burns ≤20% total body surface area (TBSA) between January 2018 and November 2025 were identified. Patients with GLP-1 documentation within one year before burn injury were propensity score matched with controls for age, sex, race, comorbidities, TBSA, body mass index (BMI), and hemoglobin A1c (HbA1c). Outcomes included 1-year mortality, infectious complications, critical care utilisation, and wound management outcomes. Sensitivity analyses examined 6-month and 3-year exposure windows.RESULTSAfter matching, 8,307 patients per cohort were included. GLP-1 exposure was associated with 54% reduced odds of mortality (odds ratio [OR] 0.46, p<0.001), 35% reduced intensive care unit admission (OR 0.65, p<0.001), and 62% reduced intubation (OR 0.38, p<0.001). Infectious complications were significantly decreased, including sepsis (32% reduction), pneumonia (24% reduction), and methicillin-resistant Staphylococcus aureus (MRSA) infections (27% reduction). The odds of broad-spectrum antibiotic use decreased 21%. Benefits persisted across all exposure windows. The 3-year cohort demonstrated a 27% increase in hypertrophic scarring (OR 1.27, p=0.031).CONCLUSIONPrior GLP-1 receptor agonist use was associated with a significant decrease in mortality, infectious complications, and critical care utilisation among burn patients, independent of metabolic factors like BMI. These findings warrant prospective studies to optimize perioperative management strategies in this patient population.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"67 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Navigating Uncharted Territory in Surgical Innovation: A systematic review of non-standard Metabolic Bariatric Surgery procedures.","authors":"Francesco Saverio Papadia,Ottavio De Cian,Nicola Di Lorenzo,Ricardo Vitor Cohen","doi":"10.1093/bjs/znag047","DOIUrl":"https://doi.org/10.1093/bjs/znag047","url":null,"abstract":"BACKGROUNDSurgical innovation often outpaces robust evaluation. This study used metabolic bariatric surgery (MBS), a field of high-intensity innovation, as a case study to evaluate reporting standards and ethical oversight for experimental procedures within surgery.METHODSWe conducted a systematic review in accordance with PRISMA 2020 guidelines. We searched PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, and Embase from January 2000 to December 2024 using terms related to metabolic bariatric surgery, surgical innovation, and non-standard intestinal bypass procedures. We included original studies reporting first-in-human or early clinical series of non-standard primary MBS involving significant intestinal modification, and excluded reviews, editorials, conference abstracts, revisional surgery, purely restrictive procedures, and device-based interventions. Two reviewers independently screened studies, extracted data on publication timing, patient numbers, follow-up, ethical approval, and trial registration, and assessed risk of bias using the Newcastle-Ottawa Scale, Joanna Briggs Institute checklist, and ROBINS-I tool.RESULTSFrom 57 included studies (10,754 patients), the median time from first human operation to publication was 5 years (IQR 3-8 years). The median initial cohort size was 39 patients (range 1-1074 patients). Institutional review board or ethical approval was reported in 47/57 studies (82%), while prospective clinical trial registration was documented in only 6/57 studies (11%). Methodological quality was low (mean Newcastle-Ottawa Scale score 5.0/9), with 56 of 57 studies judged at high risk of bias. Out of 57, studies, only 15 (26%) reported outcomes at ≥3 years, and 8 studies (14%) at ≥5 years.CONCLUSIONThis MBS case study reveals delayed publication and a widespread lack of prospective trial registration, exposing over 10,000 patients to experimental procedures outside a transparent research framework. These findings highlight a systemic failure in surgical innovation governance and underscore an urgent need for a cultural shift towards mandatory, prospective oversight frameworks to ensure patient safety and credible evidence generation.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"13 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147695167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Presurgical levels of circulating tumour DNA in patients with resectable chemotherapy-naïve colorectal liver metastases: association with multiorgan recurrence and survival in the MIRACLE cohort.","authors":"Lissa Wullaert,Lotte van Leeuwen,Vanja de Weerd,Mai Van,Esther Oomen-de Hoop,Jaco Kraan,Maurice P H M Jansen,John W M Martens,Dirk J Grünhagen,Henk M W Verheul,Cornelis Verhoef,Saskia M Wilting","doi":"10.1093/bjs/znaf295","DOIUrl":"https://doi.org/10.1093/bjs/znaf295","url":null,"abstract":"BACKGROUNDAlmost half of patients with colorectal liver metastases (CRLM) experience disease recurrence within one year after treatment with curative intent. To improve treatment, upfront identification of patients with CRLM at high risk of rapid disease recurrence is crucial.METHODSIn this retrospective cohort-study, pretreatment ctDNA levels were determined by the modified fast aneuploidy screening test-sequencing system (mFast-SeqS) in 182 patients with resectable CRLM who did not receive perioperative chemotherapy. Resulting aneuploidy scores were dichotomized using a predefined threshold and associated with clinical outcome.RESULTSOf 182 analysed patients, 34 (19%) were classified as ctDNA high and 156 (81%) as ctDNA low. Recurrence-free (RFS) and overall survival (OS) were shorter in the ctDNA high versus low group, with 1-year RFS of 29% versus 52%, and 3-year OS of 48% versus 78% respectively (log-rank P = 0.029 and < 0.001 respectively). The cumulative incidence of multiorgan recurrence within the first year after local treatment was significantly higher in ctDNA-high patients (Gray's test P < 0.001). Multivariable Cox regression analysis revealed that the aneuploidy score is independently associated with RFS (HR = 1.94; 95% c.i. 1.19 to 3.18) and multiorgan RFS up to 1 year (HR = 2.56; 95% c.i. 1.41 to 4.65) and OS up to 3 years (HR = 3.28; 95% c.i. 1.79 to 6.01).CONCLUSIONSThis study shows that mFast-SeqS provides an affordable and minimally invasive test for the upfront recognition of patients with CRLM at increased risk of rapid (multiorgan) disease recurrence.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"51 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147663818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of perioperative anaemia - Five top tips.","authors":"Sandy Abeysiri,Sashini Iddawela,Toby Richards","doi":"10.1093/bjs/znag034","DOIUrl":"https://doi.org/10.1093/bjs/znag034","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"16 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Survival after breast-conserving surgery and radiotherapy versus mastectomy: a propensity score-matched analysis within a randomized anaesthesiology trial.","authors":"Charlotta Wadsten,Anders Berglund,Emma Söderberg,Greger Nilsson,Leif Bergkvist,Mats Enlund,Fredrik Wärnberg","doi":"10.1093/bjs/znag036","DOIUrl":"https://doi.org/10.1093/bjs/znag036","url":null,"abstract":"INTRODUCTIONLarge, randomized studies have shown equivalent survival after breast-conserving surgery (BCS) plus adjuvant radiotherapy (RT) when compared to mastectomy. In contrast, more recent observational studies suggest BCS+RT to be superior, but it is questionable if patients in these treatment arms are comparable. Here, overall survival (OS) and breast cancer-specific survival (BCSS) after BCS+RT and mastectomy are compared within a randomized trial comparing intravenous- and inhalation anaesthesia during breast cancer (BC) surgery.METHODThe patient cohort was recruited from the randomized CAN-study. Patients with tumours larger than 30 mm, smaller than 10 mm, and those undergoing BCS without RT were excluded. OS and BCSS were estimated using multivariable Cox regression analyses and three different propensity score models.RESULTSThe final study cohort included 830 women, of whom 601 were treated by BCS+RT (median age 64 years) and 229 by mastectomy (median age 68 years). Women undergoing mastectomy had more comorbidities and unfavourable tumour characteristics. Mastectomy was associated with a significantly less favourable OS in unadjusted, adjusted, and propensity score matched analyses. BCSS was inferior in the mastectomy group in the unadjusted analysis with a HR 2.27 (95% CI 1.20-4.30). In the adjusted and three propensity score matched models, BCSS was equal in the treatment groups with an adjusted HR 1.02 (95% CI 0.43-2.42).CONCLUSIONIn this study, which was designed to approximate a randomized trial as closely as possible, no significant difference in BCSS was observed between BCS+RT and mastectomy. Differences in OS likely reflect occult selection bias selection of patients with higher comorbidity burden to mastectomy.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"20 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a Standard Definition of \"No-option\" and \"Poor-Option\" for Revascularisation in Chronic Limb-Threatening Ischemia.","authors":"Mario Alejandro Fabiani,Jos C van den Berg,Oscar A De la Torre,Alfredo Verastegui,Anahita Dua, ","doi":"10.1093/bjs/znag040","DOIUrl":"https://doi.org/10.1093/bjs/znag040","url":null,"abstract":"INTRODUCTIONRevascularisation to prevent limb loss is not feasible or represents a very high risk in a significant proportion of patients with chronic limb-threatening ischaemia (CLTI). No standard definition currently exists to define this population of patients. The aim of this study was to develop a consensus-based, multidomain definition to improve clinical assessment and reporting of studies in people with 'no option' (NO) or 'poor option' (PO) CLTI.METHODSA modified Delphi process was conducted with 164 specialists from 30 countries. Two iterative survey rounds were used to reach consensus, defined as ≥70% agreement with a score of ≥7 on a nine-point scale.RESULTSSome 164 international vascular specialists participated in the study, averaging 19 years of experience. A multidomain framework including arterial disease anatomy, biology, risk, function, and context (ABRFC) achieved 83% consensus. A 'desert foot' was defined as the absence of distal arterial revascularisation targets on advanced non-invasive imaging, invasive digital subtraction angiography (DSA) and at least one failed endovascular revascularisation attempt (81.6% agreement). Inadequate autogenous bypass conduit was defined as the lack of usable autologous vein across all four limbs (85% agreement). Patients were classified as no option for revascularisation if they present with 'desert foot', prohibitive medical risk, a nonfunctional limb, or in those patients who refused arterial revascularisation. Poor option revascularization patients combined factors such as severe infection, lack of autologous vein, or treatment non-compliance (72.1% agreement).CONCLUSIONThis consensus study established a structured, expert-validated definition of no option or poor option for revascularisation of patients with CLTI. The multidomain ABRFC framework provides a foundation for standardised clinical assessment, trial design, and future guideline development.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"4 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147625820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}