British Journal of Surgery最新文献

{"title":"Consensus classification of biliary complications after liver transplantation: guidelines from the BileducTx meeting.","authors":"Hannah Esser,Iris E M de Jong,Floris M Roos,Christina Bogensperger,Stefan M Brunner,Benno Cardini,Philipp Dutkowski,Hasan Eker,Sofia Ferreira-Gonzalez,Stuart J Forbes,Peter J Friend,Yiliam Fundora,Henrik Junger,Felix J Krendl,Paulo N Martins,Vincent E de Meijer,Rupert Oberhuber,Gabriel C Oniscu,Damiano Patrono,Robert J Porte,Thomas Resch,Hatem Sadik,Andrea Schlegel,Nicola De Stefano,Mathias Vidgren,Christopher J E Watson,Annemarie Weißenbacher,Stefan Schneeberger","doi":"10.1093/bjs/znae321","DOIUrl":"https://doi.org/10.1093/bjs/znae321","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"55 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143903045","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":"Negative pressure wound therapy: does it suck?","authors":"Matthew J Lee,Thomas D Pinkney","doi":"10.1093/bjs/znaf093","DOIUrl":"https://doi.org/10.1093/bjs/znaf093","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"1 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914854","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":"Abdominal aortic aneurysm screening: current effectiveness and future perspectives.","authors":"Jonothan J Earnshaw,Sophie Mitra,Harriet Strachan,Philip Gardner,","doi":"10.1093/bjs/znaf094","DOIUrl":"https://doi.org/10.1093/bjs/znaf094","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"2 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143915156","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":"Negative pressure wound therapy for surgical wounds healing by secondary intention is not cost-effective.","authors":"Pedro Saramago,Athanasios Gkekas,Catherine E Arundel,Ian C Chetter,","doi":"10.1093/bjs/znaf077","DOIUrl":"https://doi.org/10.1093/bjs/znaf077","url":null,"abstract":"BACKGROUNDNegative pressure wound therapy (NPWT) has been used in clinical practice for surgical wounds healing by secondary intention (SWHSI), despite limited evidence regarding its clinical effectiveness and cost-effectiveness. The aim of this study was to evaluate the cost-effectiveness of NPWT for SWHSI, compared with standard dressings, from the perspective of the UK healthcare system.METHODSAn economic model was used to extrapolate the effectiveness results of a meta-analysis over a patient's lifetime and estimate the costs and outcomes (quality-adjusted life-years (QALYs)) of NPWT and standard dressings. The probability of NPWT being cost-effective was estimated, with extensive scenario analyses conducted to evaluate the robustness of results and the degree of uncertainty.RESULTSOn average, NPWT was associated with higher costs and marginally higher QALYs than standard dressings. The cost difference was mainly driven by the additional intervention costs associated with NPWT. The estimated probability of NPWT being cost-effective was <30%. There was considerable uncertainty in the findings, driven largely by uncertainty in the estimated pooled relative effect from the meta-analysis. Results were robust to different scenario analyses.CONCLUSIONNo evidence was found demonstrating that NPWT was a cost-effective alternative to standard dressings for SWHSI.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"100 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143914869","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":"Magnetic resonance-derived hepatic uptake index improves the identification of patients at risk of severe post-hepatectomy liver failure.","authors":"Wolf C Bartholomä, Stefan Gilg, Peter Lundberg, Peter N Larsen, Ville Sallinen, Malin Sternby Eilard, Jozef Urdzik, Gert Lindell, Torkel B Brismar, Eva Fallentin, Ali Ovissi, Andreas Socratous, Tomas Bjerner, Sophie Kollbeck, Jens Tellman, Fredrik Holmquist, Nils Dahlström, Mischa Woisetschläger, Bergthor Björnsson, Ernesto Sparrelid, Per Sandström","doi":"10.1093/bjs/znaf103","DOIUrl":"10.1093/bjs/znaf103","url":null,"abstract":"<p><strong>Background: </strong>Post-hepatectomy liver failure (PHLF) is a leading cause of mortality after major liver resection. Accurate preoperative risk assessment is essential, yet current methods have limitations. Gadoxetic acid-enhanced MRI (Gd-EOB MRI) enables both morphological and functional evaluation of the liver. The aim of this study was to evaluate the efficacy of the hepatic uptake index (HUI) obtained from routine preoperative Gd-EOB MRI for identifying patients at risk of severe PHLF.</p><p><strong>Methods: </strong>This observational retrospective multicentre study included 292 patients who underwent major hepatectomy between 2010 and 2020 in Sweden, Denmark, and Finland. Preoperative Gd-EOB MRI was performed for each patient and the HUI, hepatic uptake index of the standardized future liver remnant (sFLR-HUI), and Model for End-Stage Liver Disease Version 3 (MELD 3) score were evaluated. Statistical analyses included logistic regression and receiver operating characteristic (ROC) curve assessment to determine cut-off values and discriminative accuracies for severe PHLF (International Study Group of Liver Surgery grades B and C).</p><p><strong>Results: </strong>Among the 292 patients, 25 (8.6%) developed severe PHLF. Patients with severe PHLF had significantly lower HUI and sFLR-HUI values (P < 0.001). The HUI demonstrated superior discriminative performance for severe PHLF (area under the curve (AUC) 0.758) compared with volume-only assessments, such as the standardized future liver remnant (sFLR) (AUC 0.628). Combining the HUI with the MELD 3 score improved performance further (AUC 0.803).</p><p><strong>Conclusion: </strong>The HUI obtained from routine Gd-EOB MRI outperforms volume-based biomarkers (sFLR) for identification of patients at risk of severe PHLF. Incorporating image-derived functional assessments, such as the HUI, with independent biomarkers, such as the MELD 3 score, may optimize preoperative risk stratification for severe PHLF and improve outcomes after major hepatectomy.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"112 5","pages":""},"PeriodicalIF":8.6,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12120443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144172248","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":"Optimizing ward rounds: systematic review and meta-analysis of interventions to enhance patient safety.","authors":"Ellie C Treloar, Jesse D Ey, Matheesha Herath, Nicholas P R Edwardes, Suzanne Edwards, Martin H Bruening, Guy J Maddern","doi":"10.1093/bjs/znaf041","DOIUrl":"10.1093/bjs/znaf041","url":null,"abstract":"<p><strong>Background: </strong>Poor quality ward rounds contribute to a large proportion of patient complications, delayed discharge, and increased hospital cost. This systematic review investigated all interventions aiming to improve patient and process-based outcomes in ward rounds.</p><p><strong>Methods: </strong>This systematic review was prospectively registered in PROSPERO, the international prospective register of systematic reviews (CRD42023394325). MEDLINE, Embase, Emcare, and PsycInfo were searched for studies with interventions aiming to improve ward round processes or patient outcomes in hospital settings. Studies were excluded if there was no baseline comparator or they were not in the ward round setting. Interventions were coded as checklist interventions (that is electronic or paper-based pro formas, templates, and checklists), structure interventions (that is defined rules or protocol to guide or standardize conduct), or other interventions. Outcomes were assessed via meta-analyses using the I2 statistic, Cochran's Q P value, and random-effects models. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the Newcastle-Ottawa scale for non-randomized studies.</p><p><strong>Results: </strong>This review included 84 studies, from 18 countries, in 23 specialties, involving 43 570 patients. Checklist interventions significantly reduced ICU length of stay, improved overall documentation, and did not increase ward round duration. Structure interventions did not increase the time spent per patient or impact 30-day readmission rates or patient length of stay.</p><p><strong>Conclusion: </strong>This is the first systematic review with meta-analyses synthesizing the evidence of all ward round interventions targeted at improving patient and process outcomes. Results from this review should be used to inform guidelines for the 'ideal ward round'.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11979594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810271","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":"Application of transmesocolon pancreatic intestinal anastomosis in duodenal-preserving pancreatic head resection: video article.","authors":"Haoming Lin, Jingyun Ning, Qin Liu, Xiaokang Du, Rui Zhang","doi":"10.1093/bjs/znaf084","DOIUrl":"https://doi.org/10.1093/bjs/znaf084","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":"143957446","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":"External validation of a model to predict recurrence-free and melanoma-specific survival for patients with melanoma after sentinel node biopsy.","authors":"Robert C Stassen, Carolien C H M Maas, Stanley P Leong, Mohammed Kashani-Sabet, Richard L White, Barbara A Pockaj, Jonathan S Zager, Schlomo Schneebaum, John T Vetto, Eli Avisar, J Harrison Howard, Cristina O'Donoghue, Heidi Kosiorek, Alexander C J van Akkooi, Cornelis Verhoef, David van Klaveren, Dirk J Grünhagen, Roger Olofsson Bagge","doi":"10.1093/bjs/znaf037","DOIUrl":"https://doi.org/10.1093/bjs/znaf037","url":null,"abstract":"<p><strong>Background: </strong>Recently, a model to predict 5-year recurrence-free survival (RFS) and melanoma-specific survival (MSS) after sentinel lymph node biopsy (SLNB) was published. The aim of this study was to validate that model in a large independent international cohort.</p><p><strong>Methods: </strong>The database of the Sentinel Lymph Node Working Group (SLNWG) was analysed for patients with malignant melanoma who underwent SLNB. Patients with clinical stage III melanoma, a history of other malignancies, or receiving concomitant systemic therapies during follow-up were excluded. The model's predictive performance was evaluated using discrimination and calibration metrics in the eligible cohort. Decision curve analysis was performed to assess the clinical value of the model.</p><p><strong>Results: </strong>The external validation cohort consisted of 6174 patients of the SLNWG from the USA, Europe, and Israel. A positive sentinel node was found in 788 patients (12.8%). The area under the time-dependent receiver operating characteristic (ROC) curve of the external validation was 0.76 (95% c.i. 0.74 to 0.77) for RFS and 0.79 (95% c.i. 0.76 to 0.81) for MSS. The model was well calibrated, as the observed 5-year survival rates aligned closely with the predicted survival rates (calibration slope of 0.98 for RFS and calibration slope of 0.99 for MSS). The model provided a net benefit versus the 'treat all' and 'treat none' strategies at the predetermined probability threshold for recurrence of 45%.</p><p><strong>Conclusion: </strong>The model demonstrated good performance in a large heterogeneous independent cohort, emphasizing its robustness. Decision curve analysis revealed a clear net benefit of the model over a treat all strategy, highlighting its potential for clinical use.</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":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12004364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957724","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":"Respiratory complications after oesophagectomy using volatile or intravenous anaesthesia.","authors":"Yuki Hirano, Takaaki Konishi, Hidehiro Kaneko, Shotaro Aso, Satoru Matsuda, Hirofumi Kawakubo, Yuya Kimura, Hiroki Matsui, Kiyohide Fushimi, Hiroyuki Daiko, Osamu Itano, Hideo Yasunaga, Yuko Kitagawa","doi":"10.1093/bjs/znaf052","DOIUrl":"10.1093/bjs/znaf052","url":null,"abstract":"<p><strong>Background: </strong>The anaesthesia regimen may affect the risk of postoperative respiratory complications. However, the optimal anaesthetic choice for oesophagectomy remains unclear. This retrospective study compared the effect of desflurane, sevoflurane, and propofol anaesthesia on short-term outcomes after oesophagectomy.</p><p><strong>Methods: </strong>Data of patients who underwent oesophagectomy for cancer during April 2012-March 2022 were extracted from a nationwide Japanese inpatient database. Propensity score matching weight analysis was conducted to compare respiratory complications, ventilatory failure, and in-hospital mortality between desflurane, sevoflurane, and propofol anaesthesia, adjusting for potential confounders. Sensitivity analyses were performed using multivariable logistic regression and instrumental variable analyses.</p><p><strong>Results: </strong>Among 21 080 included patients (desflurane group 7823, sevoflurane group 8932, and propofol group 4325 patients), respiratory complications and ventilatory failure occurred in 3399 (16.1%) and 960 (4.6%) patients respectively. Upon matching weight analysis, sevoflurane and propofol anaesthesia were significantly associated with higher incidences of respiratory complications (OR 1.13, 95% c.i. 1.03 to 1.24 and OR 1.43, 95% c.i. 1.28 to 1.58 respectively) and ventilatory failure (OR 1.21, 95% c.i. 1.02 to 1.43 and OR 1.29, 95% c.i. 1.06 to 1.56 respectively) compared with desflurane anaesthesia. In-hospital mortality after desflurane anaesthesia was the lowest of the three anaesthesia (1.6% and 1.8% versus 1.2%; OR 1.30, 95% c.i. 0.98 to 1.73 and OR 1.49, 95% c.i. 1.08 to 2.06 respectively). Multivariable logistic regression and instrumental variable analyses demonstrated similar results.</p><p><strong>Conclusions: </strong>Sevoflurane and propofol anaesthesia for oesophagectomy were associated with worse respiratory outcomes compared with desflurane anaesthesia.</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":"143741787","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":"Molecular prognostic factors for liver transplantation of unresectable metastatic colorectal cancer.","authors":"Seyed H Moosavi, Kushtrim Kryeziu, Ina A Eilertsen, Luís Nunes, Merete Hektoen, Barbara Niederdorfer, Henrik M Reims, Trygve Syversveen, Harald Grut, Svein Dueland, Pål-Dag Line, Ragnhild A Lothe, Anita Sveen","doi":"10.1093/bjs/znaf072","DOIUrl":"https://doi.org/10.1093/bjs/znaf072","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/PMC12000646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143954025","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}