British Journal of Surgery最新文献

{"title":"Tumour burden predicts outcomes after curative resection of multifocal intrahepatic cholangiocarcinoma.","authors":"Jun Kawashima, Miho Akabane, Mujtaba Khalil, Selamawit Woldesenbet, Yutaka Endo, Kota Sahara, François Cauchy, Federico Aucejo, Hugo P Marques, Rita Lopes, Andreia Rodriguea, Tom Hugh, Feng Shen, Shishir K Maithel, Bas Groot Koerkamp, Irinel Popescu, Minoru Kitago, Matthew J Weiss, Guillaume Martel, Carlo Pulitano, Luca Aldrighetti, George Poultsides, Andrea Ruzzenente, Todd W Bauer, Ana Gleisner, Itaru Endo, Timothy M Pawlik","doi":"10.1093/bjs/znaf050","DOIUrl":"https://doi.org/10.1093/bjs/znaf050","url":null,"abstract":"<p><strong>Background: </strong>Liver resection for multifocal intrahepatic cholangiocarcinoma (ICC) remains controversial due to a poor prognosis, driven by aggressive tumour biology. The aim of this study was to stratify multifocal ICC patients to identify those who are likely to benefit from resection.</p><p><strong>Methods: </strong>Patients who underwent upfront curative-intent hepatectomy for ICC were identified from an international multi-institutional database. Among patients with multifocal tumours, overall survival (OS) was analysed using multivariable Cox regression to identify prognostic factors. Tumour burden score (TBS) was used for stratification of multifocal ICC, with the optimal cut-off determined via restricted cubic spline (RCS) analysis.</p><p><strong>Results: </strong>Of 1502 patients, 208 (13.8%) had multifocal ICC. Among them, independent predictors of prognosis included TBS (HR 1.09), ASA grade >II (HR 1.48), cirrhosis (HR 2.05), periductal infiltrating/mass forming plus periductal infiltrating morphological subtype (HR 1.58), and receipt of adjuvant chemotherapy (HR 0.59). RCS analysis identified a TBS of 7.0 as the optimal cut-off. Notably, multifocal ICC patients with a low TBS (<7.0) demonstrated comparable 3-year OS to solitary ICC patients with AJCC stage II/III. In contrast, patients with a high TBS (≥7.0) and multifocal ICC exhibited the worst prognosis (3-year OS: stage I and solitary 67.1%, stage II/III and solitary 43.2%, low TBS and multifocal 43.4%, and high TBS and multifocal 17.8% (P < 0.001)).</p><p><strong>Conclusion: </strong>Whereas patients with high-TBS multifocal ICC had a poor prognosis, individuals with low-TBS multifocal ICC demonstrated survival outcomes comparable to solitary ICC patients. These findings emphasize the importance of stratifying patients by tumour burden to guide surgical decision-making and optimize treatment strategies for multifocal ICC.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741791","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":"Robotic right hemicolectomy with D3 lymphadenectomy using the Hugo™ RAS system.","authors":"Juan-Manuel Romero-Marcos, Carlota Cuenca-Gómez, Jaime-Gerardo Sampson-Dávila, Sandra González-Abós, Juan Altet-Torné, Julia Landaluce-Carrilero, Salvadora Delgado-Rivilla","doi":"10.1093/bjs/znaf063","DOIUrl":"https://doi.org/10.1093/bjs/znaf063","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762683","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":"Preoperative management and resectability criteria in perihilar cholangiocarcinoma.","authors":"Christian Sturesson,Kjetil Soreide","doi":"10.1093/bjs/znae329","DOIUrl":"https://doi.org/10.1093/bjs/znae329","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"183 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822672","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":"Pathological response guides adjuvant 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy in surgically resected gastro-oesophageal cancer (SPACE-FLOT): international cohort study.","authors":"","doi":"10.1093/bjs/znaf056","DOIUrl":"https://doi.org/10.1093/bjs/znaf056","url":null,"abstract":"<p><strong>Background: </strong>Many patients with locally advanced gastro-oesophageal cancers are unable to complete adjuvant 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy, raising questions about its therapeutic utility. The aim of this study was to examine whether pathological response to neoadjuvant FLOT can guide its adjuvant use.</p><p><strong>Methods: </strong>Patients with non-metastatic gastro-oesophageal adenocarcinoma who received neoadjuvant FLOT and underwent surgery from 1 January 2017 to 1 January 2022 from 43 hospitals across 12 countries were analysed. Pathological response was assessed using tumour regression grading systems, trichotomized into minimal responders (MR; worst category), complete responders (CR; pCR), and partial responders (PR; between MR and CR). Survival outcomes of patients who did and did not receive adjuvant FLOT were compared using Kaplan-Meier, Cox regression, propensity score matched, and sensitivity analysis.</p><p><strong>Results: </strong>A total of 1887 patients (459 MR, 221 CR, and 1207 PR) were evaluated. The median follow-up was 25.5 (interquartile range 15.0-39.1) months. In the MR group, there was no difference in disease-free survival (DFS; HR 1.03 (95% c.i. 0.78 to 1.36), P = 0.836) between those who did and did not receive adjuvant FLOT. Whilst there was a difference in non-adjusted OS, this became statistically non-significant after adjusting for baseline characteristics (HR 0.96 (95% c.i. 0.70 to 1.30), P = 0.801). In the CR group, there was no difference in DFS (HR 0.88 (95% c.i. 0.41 to 1.85), P = 0.724) or OS (HR 0.69 (95% c.i. 0.31 to 1.54), P = 0.343) between those who did and did not receive adjuvant FLOT. In the PR group, adjuvant FLOT conferred a significant DFS (HR 0.68 (95% c.i. 0.55 to 0.86), P < 0.001) and OS (HR 0.55 (95% c.i. 0.44 to 0.69), P < 0.001) benefit.</p><p><strong>Conclusion: </strong>Pathological response to neoadjuvant FLOT may guide the use of adjuvant FLOT, enabling personalized approaches to treatment.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741779","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":"Resection of multifocal intrahepatic cholangiocarcinoma.","authors":"Kjetil Søreide","doi":"10.1093/bjs/znaf048","DOIUrl":"10.1093/bjs/znaf048","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954584/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741786","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":"Efficacy of aqueous olanexidine compared with alcohol-based chlorhexidine for surgical skin antisepsis regarding the incidence of surgical-site infections in clean-contaminated surgery: a randomized superiority trial.","authors":"Masashi Takeuchi, Hideaki Obara, Tasuku Furube, Hirofumi Kawakubo, Minoru Kitago, Koji Okabayashi, Hiroto Fujisaki, Junya Aoyama, Yosuke Morimoto, Ryusuke Amemiya, Junichi Sano, Jumpei Nakadai, Rei Goto, Yasunori Sato, Yuko Kitagawa","doi":"10.1093/bjs/znaf065","DOIUrl":"https://doi.org/10.1093/bjs/znaf065","url":null,"abstract":"<p><strong>Background: </strong>Surgical-site antisepsis is used to prevent surgical-site infections (SSIs). Although several guidelines have indicated the efficacy of antiseptics, such as chlorhexidine, povidone-iodine, and olanexidine, in reducing the SSI rate, an optimal recommendation is still not established. The aim of this study was to evaluate the efficacy of aqueous olanexidine compared with chlorhexidine-alcohol as the optimal antiseptic for preventing SSI in clean-contaminated surgery.</p><p><strong>Methods: </strong>This multicentre randomized trial for surgical skin antisepsis in clean-contaminated gastrointestinal and hepatobiliary-pancreatic surgeries in five hospitals evaluated the efficacy of olanexidine and chlorhexidine-alcohol. The primary endpoint was 30-day SSI. Secondary outcomes included the occurrence of SSI types, intervention-related toxicity, and reoperation caused by SSI.</p><p><strong>Results: </strong>Overall, 700 patients from five institutions underwent randomization; 347 received olanexidine and 345 received chlorhexidine-alcohol in the full analysis set. The 30-day SSI rate was 12.4% (43 of 347) in the olanexidine group and 13.6% (47 of 345) in the chlorhexidine-alcohol group (adjusted risk ratio (aRR) 0.911 (95% c.i. 0.625 to 1.327); P = 0.626). No significant differences were observed between the groups regarding the secondary outcomes, including the occurrence of superficial incisional SSI, deep incisional SSI, organ/space SSI, and reoperation caused by SSI. Overall adverse effects were seen in two patients (0.58%) in the olanexidine group and in three patients (0.87%) in the chlorhexidine-alcohol group (aRR 0.663 (95% c.i. 0.111 to 3.951)).</p><p><strong>Conclusion: </strong>Olanexidine did not significantly reduce the occurrence of overall SSI compared with chlorhexidine-alcohol. Nevertheless, these findings provide valuable insights for developing novel surgical SSI management protocols.</p><p><strong>Registration number: </strong>UMIN 000049712 (University Hospital Medical Information Network Clinical Trials Registry).</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741766","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":"Evaluation and treatment of ruptured abdominal aortic aneurysm.","authors":"Maria Elisabeth Leinweber, Fajar S Rahmaditya, Robert J Hinchliffe","doi":"10.1093/bjs/znaf051","DOIUrl":"https://doi.org/10.1093/bjs/znaf051","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741770","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":"Impact of gross extrathyroidal extension to the recurrent laryngeal nerve alone on survival in papillary thyroid carcinoma.","authors":"Victoria Harries,Daniel W Scholfield,Alana Eagan,R Michael Tuttle,Ashok R Shaha,Jatin P Shah,Richard J Wong,Snehal G Patel,Ian Ganly","doi":"10.1093/bjs/znaf030","DOIUrl":"https://doi.org/10.1093/bjs/znaf030","url":null,"abstract":"BACKGROUNDGross extrathyroidal extension (ETE) is one of the most important predictors of survival in papillary thyroid carcinoma (PTC). The aim of this study is to determine the impact of gross ETE to the recurrent laryngeal nerve alone (RLNT4aETE) on survival.METHODSAfter institutional review board approval, adult PTC patients were identified from an institutional database undergoing initial surgery for well-differentiated thyroid carcinoma from 1986 to 2020. Patients were classified as having no gross ETE, gross ETE to strap muscles only (T3bETE), RLNT4aETE, or gross ETE involving other adjacent structures (otherT4aETE). Disease-specific survival (DSS) was calculated using the Kaplan-Meier method and groups were compared using the log-rank test.RESULTSThere were 8030 patients included in the analysis; 7578 patients (94.2%) with no gross ETE, 197 (2.4%) with T3bETE, 40 (0.5%) with RLNT4aETE, and 215 (2.7%) with otherT4aETE. The estimated 10-year DSS for patients with no gross ETE, T3bETE, RLNT4aETE, and otherT4aETE in the whole cohort were 99.2%, 95.7%, 96.9%, and 82.5% respectively (P < 0.0001). After controlling for age, nodal and distant disease stage, RLNT4aETE patients had a similar DSS to T3bETE patients, when compared to no gross ETE patients (HRs 2.91 versus 2.28 respectively). In the ≥55-year-old cohort, the 10-year DSS for patients with no gross ETE, T3bETE, RLNT4aETE, and otherT4aETE were 97.7%, 89.4%, 90.9% and 67.6% respectively.CONCLUSIONRLNT4aETE patients appear to have a similar DSS to T3bETE patients. This highlights the heterogeneity within the current T4a cohort and supports the downstaging of RLNT4aETE patients to the T3b classification.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"1 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819370","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":"Implementation and short-term outcomes of minimally invasive liver surgery in France.","authors":"Stylianos Tzedakis, Diana Berzan, Ugo Marchese, Alexandre Challine, Vincent Mallet, Anthony Dohan, Heithem Jeddou, Alexandra Nassar, Sandrine Katsahian, David Fuks","doi":"10.1093/bjs/znaf017","DOIUrl":"https://doi.org/10.1093/bjs/znaf017","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143741776","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":"Prehospital triage of trauma patients: predicting major surgery using artificial intelligence as decision support.","authors":"Andreas S Millarch, Fredrik Folke, Søren S Rudolph, Haytham M Kaafarani, Martin Sillesen","doi":"10.1093/bjs/znaf058","DOIUrl":"https://doi.org/10.1093/bjs/znaf058","url":null,"abstract":"<p><strong>Background: </strong>Matching the necessary resources and facilities to attend to the needs of trauma patients is traditionally performed by clinicians using criteria-directed triage protocols. In the present study, it was hypothesized that an artificial intelligence (AI) model should be able to predict the need for major surgery based on data available at the scene.</p><p><strong>Methods: </strong>Prehospital and in-hospital electronic health record data were available for 4578 patients in the Danish Prehospital Trauma Data set. Data included demographics (age and sex), clinical scores (airway, breathing, circulation, disability (ABCD) and Glasgow Coma Scale scores), and sequential vital signs (heart rate, blood pressure, and oxygen saturation). The data from the first 5, 10, and 20 min of prehospital contact were used for predicting the need for surgery up to 12 h after hospital arrival. Surgeries were stratified into all major surgical procedures and specialty-specific procedures (neurosurgery, abdominal surgery, and vascular surgery). The data set was split into training (70%), validation (20%) and holdout test (10%) data sets. Three hybrid neural networks were trained and performance was evaluated on the holdout test data set using the area under the receiver operating characteristic curve (ROC-AUC).</p><p><strong>Results: </strong>Overall, the model achieved an ROC-AUC of 0.80-0.86 for predicting the need for major surgery. For predicting the need for major neurosurgery the ROC-AUC was 0.90-0.95, for predicting the need for major vascular surgery the ROC-AUC was 0.69-0.88, and for predicting the need for major abdominal surgery the ROC-AUC was 0.77-0.84.</p><p><strong>Conclusion: </strong>Utilizing AI early in the prehospital phase of a trauma patient's trajectory can predict specialized surgical needs. This approach has the potential to aid the early triage of trauma patients.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 4","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810276","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}