British Journal of Surgery最新文献

{"title":"Routine anaesthesia ward-based patient visits in surgery: 1-year outcomes of the TRACE randomized clinical trial.","authors":"Valérie M Smit-Fun, Dianne de Korte-de Boer, Thomas Damen, Annick Stolze, Linda M Posthuma, Markus W Hollmann, Wolfgang F F A Buhre","doi":"10.1093/bjs/znaf019","DOIUrl":"10.1093/bjs/znaf019","url":null,"abstract":"<p><strong>Background: </strong>The TRACE (Routine posTsuRgical Anaesthesia visit to improve patient outComE) RCT did not show any perioperative benefit from ward-based visits by anaesthetists after surgery. The aim of this study was to evaluate the impact of this intervention on longer-term outcomes.</p><p><strong>Methods: </strong>Patients were followed up in the TRACE RCT to 1 year in nine hospitals in the Netherlands. Patients undergoing elective non-cardiac surgery, and at risk for adverse postoperative outcome, were included. Patients in the intervention group additionally received routine anaesthesia visits on postoperative days 1 and 3. Clinical outcome measures included 1-year mortality, hospital readmission, and reoperation. Functional recovery (FR) was measured using the patient-reported global surgical recovery (GSR) index, ability to perform activities of daily living (ADL), and functional recovery index (FRI). Quality of life (QoL) was measured using EQ-5D-5L.</p><p><strong>Results: </strong>Some 5473 adult patients were followed up. No differences were found between the control and intervention groups for clinical, FR, and QoL outcome measures. One-year mortality was 5.4% in the control group and 5.8% in the intervention group, readmission was 27% and 26% respectively, and reoperation was 20% and 18% respectively. At 1 year, FR and QoL had recovered to preoperative levels. However, 30% of patients were not able to fully perform ADL and 40%-51% of patients still reported a problem in the EQ-5D-5L dimensions mobility, usual activities, and pain/discomfort.</p><p><strong>Conclusion: </strong>Routine postoperative anaesthesia ward visits of patients did not improve clinical, functional, and QoL outcomes. A substantial proportion of patients still experienced health-related limitations in daily life 1 year after surgery. In conclusion, an early postoperative intervention with postoperative anaesthesia visits in the ward after non-cardiac surgery had no effect on 30-day or 1-year clinical outcome. Remarkably, TRACE shows that compared with data sampled 10 years ago, 1-year mortality has not improved in the Netherlands. At 1 year, functional recovery or QoL showed little improvement compared with baseline. Importantly, a substantial number of patients still reported incomplete recovery and problems that limit QoL, which indicate that there is still room for improvement.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11897594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laparoscopic total pelvic exenteration: a simplified procedure using the fascial space priority approach.","authors":"Hongjie Yang, Yuanda Zhou, Peishi Jiang, Jiafei Liu, Zhichun Zhang, Qingsheng Zeng, Peng Li, Yu Long, Xipeng Zhang, Yi Sun","doi":"10.1093/bjs/znae316","DOIUrl":"https://doi.org/10.1093/bjs/znae316","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661653","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":"Parathyroid vascular anatomy using intraoperative mapping angiography: the PARATLAS study.","authors":"Fares Benmiloud, Neil Tolley, Anne Denizot, Aimee Di Marco, Frederic Triponez","doi":"10.1093/bjs/znae307","DOIUrl":"10.1093/bjs/znae307","url":null,"abstract":"<p><strong>Background: </strong>Understanding vascular anatomy of the parathyroid glands (PG) is crucial during thyroidectomy. The aim of this study was to describe patterns and distribution of parathyroid vessels.</p><p><strong>Method: </strong>An analysis of all intraoperative mapping angiographies from indocyanine green injection and fluorescence imaging in patients undergoing thyroid surgery between February 2020 and September 2021. The parathyroid vessels were classified according to the pattern of contact with the thyroid. Data collection and analysis were carried out in accordance with MR004 reference methodology.</p><p><strong>Results: </strong>A total of 200 angiographies from 196 patients were analysed (159 female/37 male, mean(s.d.) age: 54.2 ± 13.7 years), and 320 PGs were assessed. The parathyroid vessels had no contact with the thyroid in 20 (6%; Type 0), a single-point of contact in 74 (23%; Type 1), a posterior path in 47 (15%; Type 2), a lateral path in 68 (21%; Type 3), an intrathyroidal path in 19 (6%; Type 4), and a possible medial path in 26 (8%; Type X1) cases. The course of the vessels was unclear in 36 cases (11%; Type X2). Spatial distribution analysis showed a concentration of superior parathyroid vessels around Zuckerkandl's tubercle, whereas the distribution of the inferior parathyroid vessels was anterior and sparse.</p><p><strong>Conclusion: </strong>Intraoperative mapping angiographies help to define the main patterns of the parathyroid vessels according to their contact with the thyroid and provide surgically useful information about spatial vessel distribution.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of PD1 blockade added to neoadjuvant chemoradiotherapy on rectal cancer surgery: post-hoc analysis of the randomized POLARSTAR trial.","authors":"Kai Pang, Xinzhi Liu, Hongwei Yao, Guole Lin, Yuanyuan Kong, Ang Li, Jiagang Han, Guoju Wu, Xin Wang, Yingjiang Ye, Jie Zhang, Guangyong Chen, Aiwen Wu, Yi Xiao, Yingchi Yang, Zhongtao Zhang","doi":"10.1093/bjs/znaf057","DOIUrl":"10.1093/bjs/znaf057","url":null,"abstract":"<p><strong>Background: </strong>The addition of PD1 blockade to neoadjuvant chemoradiotherapy (CRT) has been shown to significantly increase pCR rates in locally advanced rectal cancer (LARC). Yet, its impact on total mesorectal excision (TME) remains unknown.</p><p><strong>Methods: </strong>A post-hoc analysis of the randomized POLARSTAR trial, which enrolled patients with LARC at eight major colorectal cancer centres in Beijing to compare neoadjuvant CRT plus PD1 blockade with CRT alone, was undertaken. Patients received one of three combinations of neoadjuvant treatments before TME surgery: CRT plus concurrent PD1 blockade (concurrent group), CRT plus sequential PD1 blockade (sequential group), and CRT alone (control group). Several parameters related to TME surgery were studied.</p><p><strong>Results: </strong>For the concurrent group, the sequential group, and the control group, 52, 46, and 45 patients respectively were included in this analysis. The proportion of patients undergoing sphincter-saving plus one-stage anastomosis surgery was 92% (48 of 52), 96% (44 of 46), and 87% (39 of 45) respectively. The proportion of patients without a stoma was 21% (11 of 52), 17% (8 of 46), and 11% (5 of 45) respectively. The grade 3/4 surgical complication rate was 4% (2 of 52), 7% (3 of 46), and 4% (2 of 45) respectively. Significant differences were observed between the sequential group and the control group with respect to the proportion of patients with TRG0 (37% versus 18% respectively; P = 0.040), ypT0/is ypN0 (39% versus 20% respectively; P = 0.046), and a low neoadjuvant rectal (NAR) score (54% versus 31% respectively; P = 0.025).</p><p><strong>Conclusions: </strong>Neoadjuvant CRT plus PD1 blockade enhances pathological tumour regression and is beneficial to the successful implementation of TME in patients with LARC. Validations with larger sample sizes are warranted.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143676690","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":"Three-year follow-up of antibiotics versus placebo in adults with CT-confirmed uncomplicated acute appendicitis: a secondary analysis of the APPAC III randomized clinical trial.","authors":"Sami Sula, Suvi Sippola, Jussi Haijanen, Saija Hurme, Pia Nordström, Tero Rautio, Ville Sallinen, Paulina Salminen","doi":"10.1093/bjs/znaf016","DOIUrl":"https://doi.org/10.1093/bjs/znaf016","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603165","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":"Urinary retention after laparoscopic low rectal cancer resection: post-hoc analysis of predictive factors in the GRECCAR 10 trial.","authors":"Jean-Luc Faucheron, Fatah Tidadini, Antoine Vilotitch, Alison Foote, Bertrand Trilling","doi":"10.1093/bjs/znae315","DOIUrl":"https://doi.org/10.1093/bjs/znae315","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655707","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":"Patient and tumour factors influencing length of sarcoma diagnostic trajectory intervals: first results from the international QUEST study.","authors":"","doi":"10.1093/bjs/znaf021","DOIUrl":"https://doi.org/10.1093/bjs/znaf021","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727202","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":"International multicentre validation of the left pancreatectomy pancreatic fistula prediction models and development and validation of the combined DISPAIR-FRS prediction model.","authors":"Akseli Bonsdorff, Trond Kjeseth, Jakob Kirkegård, Charles de Ponthaud, Poya Ghorbani, Johanna Wennerblom, Caroline Williamson, Alexandra W Acher, Manoj Thillai, Timo Tarvainen, Ilkka Helanterä, Aki Uutela, Jukka Sirén, Arto Kokkola, Mushegh Sahakyan, Dyre Kleive, Rolf Hagen, Andrea Lund, Mette F Nielsen, Jean-Christophe Vaillant, Richard Fristedt, Christina Biörserud, Svein O Bratlie, Bobby Tingstedt, Knut J Labori, Sébastien Gaujoux, Stephen J Wigmore, Julie Hallet, Ernesto Sparrelid, Ville Sallinen","doi":"10.1093/bjs/znae313","DOIUrl":"10.1093/bjs/znae313","url":null,"abstract":"<p><strong>Background: </strong>Every fifth patient undergoing left pancreatectomy develops a postoperative pancreatic fistula (POPF). Accurate POPF risk prediction could help. Two independent preoperative prediction models have been developed and externally validated: DISPAIR and D-FRS. The aim of this study was to validate, compare, and possibly update the models.</p><p><strong>Methods: </strong>Patients from nine high-volume pancreatic surgery centres (8 in Europe and 1 in North America) were included in this retrospective cohort study. Inclusion criteria were age over 18 years and open or minimally invasive left pancreatectomy since 2010. Model performance was assessed with discrimination (receiver operating characteristic (ROC) curves) and calibration (calibration plots). The updated model was developed with logistic regression and internally-externally validated.</p><p><strong>Results: </strong>Of 2284 patients included, 497 (21.8%) developed POPF. Both DISPAIR (area under the ROC curve (AUC) 0.62) and D-FRS (AUC 0.62) performed suboptimally, both in the pooled validation cohort combining every centre's data and centre-wise. An updated model, named DISPAIR-FRS, was constructed by combining the most stable predictors from the existing models and incorporating other readily available patient demographics, such as age, sex, transection site, pancreatic thickness at the transection site, and main pancreatic duct diameter at the transection site. Internal-external validation demonstrated an AUC of 0.72, a calibration slope of 0.93, and an intercept of -0.02 for the updated model.</p><p><strong>Conclusion: </strong>The combined updated model of DISPAIR and D-FRS named DISPAIR-FRS demonstrated better performance and can be accessed at www.tinyurl.com/the-dispair-frs.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11926329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colorectal cancer staging-time for a re-think on TNM?","authors":"Jenny F Seligmann","doi":"10.1093/bjs/znaf047","DOIUrl":"https://doi.org/10.1093/bjs/znaf047","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603144","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":"Extended pharmacological thromboprophylaxis and clinically relevant venous thromboembolism after major abdominal and pelvic surgery: international, prospective, propensity score-weighted cohort study.","authors":"","doi":"10.1093/bjs/znaf005","DOIUrl":"10.1093/bjs/znaf005","url":null,"abstract":"<p><strong>Background: </strong>There is low-certainty evidence on the impact of extended pharmacological prophylaxis on venous thromboembolism-associated morbidity and mortality. The aim of this study was to determine the efficacy and safety of extended prophylaxis after major abdominopelvic surgery for the prevention of clinically relevant venous thromboembolism after hospital discharge.</p><p><strong>Methods: </strong>CArdiovaSCulAr outcomes after major abDominal surgEry (CASCADE) was a prospective, international, cohort study into which consecutive adult patients undergoing major abdominopelvic surgery were enrolled (January-May 2022). Extended prophylaxis was considered at least 28 days of anticoagulant prescription after surgery. The primary efficacy outcome was clinically relevant venous thromboembolism and the primary safety outcome was clinically relevant bleeding within 30 days after surgery (European Medicines Agency definitions). The independent association of these outcomes with extended prophylaxis was explored using mixed-effects logistic regression and propensity score weighting.</p><p><strong>Results: </strong>A total of 11 571 patients (median age of 58.0 years; 6399 (55.3%) women) from 29 countries were included. The extended prophylaxis prescription rate was 31.7% (3670 patients). The post-discharge venous thromboembolism and bleeding rates were 0.1% (12 patients) and 0.7% (85 patients) respectively. After weighting, extended prophylaxis was not significantly associated with increased bleeding risk (OR 1.07 (95% c.i. 0.64 to 1.81); P = 0.792) or decreased venous thromboembolism incidence, both in the overall cohort (OR 1.13 (95% c.i. 0.33 to 3.90); P = 0.848) and in a subgroup analysis of patients undergoing complex major surgery and with active cancer (OR: 1.36 (95% c.i. 0.33 to 5.57); P = 0.669).</p><p><strong>Conclusion: </strong>In modern practice, the incidence of postoperative venous thromboembolism is low. Extended prophylaxis appears safe, yet the clinical efficacy remains uncertain. Further work is required to define patients who stand to benefit.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 3","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}