British Journal of Surgery最新文献

{"title":"Machine learning prediction of early recurrence after surgery for gallbladder cancer.","authors":"Giovanni Catalano, Laura Alaimo, Odysseas P Chatzipanagiotou, Andrea Ruzzenente, Federico Aucejo, Hugo P Marques, Vincent Lam, Tom Hugh, Nazim Bhimani, Shishir K Maithel, Minoru Kitago, Itaru Endo, Timothy M Pawlik","doi":"10.1093/bjs/znae297","DOIUrl":"10.1093/bjs/znae297","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder cancer is often associated with poor prognosis, especially when patients experience early recurrence after surgery. Machine learning may improve prediction accuracy by analysing complex non-linear relationships. The aim of this study was to develop and evaluate a machine learning model to predict early recurrence risk after resection of gallbladder cancer.</p><p><strong>Methods: </strong>In this cross-sectional study, patients who underwent resection of gallbladder cancer with curative intent between 2001 and 2022 were identified using an international database. Patients were assigned randomly to a development and an evaluation cohort. Four machine learning models were trained to predict early recurrence (within 12 months) and compared using the area under the receiver operating curve (AUC).</p><p><strong>Results: </strong>Among 374 patients, 56 (15.0%) experienced early recurrence; most patients had T1 (51, 13.6%) or T2 (180, 48.1%) disease, and a subset had lymph node metastasis (120, 32.1%). In multivariable Cox analysis, resection margins (HR 2.34, 95% c.i. 1.55 to 3.80; P < 0.001), and greater AJCC T (HR 2.14, 1.41 to 3.25; P < 0.001) and N (HR 1.59, 1.05 to 2.42; P = 0.029) categories were independent predictors of early recurrence. The random forest model demonstrated the highest discrimination in the evaluation cohort (AUC 76.4, 95% c.i. 66.3 to 86.5), compared with XGBoost (AUC 74.4, 53.4 to 85.3), support vector machine (AUC 67.2, 54.4 to 80.0), and logistic regression (AUC 73.1, 60.6 to 85.7), as well as good accuracy after bootstrapping validation (AUC 75.3, 75.0 to 75.6). Patients classified as being at high versus low risk of early recurrence had much worse overall survival (36.1 versus 63.8% respectively; P < 0.001). An easy-to-use calculator was made available (https://catalano-giovanni.shinyapps.io/GallbladderER).</p><p><strong>Conclusion: </strong>Machine learning-based prediction of early recurrence after resection of gallbladder cancer may help stratify patients, as well as help inform postoperative adjuvant therapy and surveillance strategies.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142680260","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 genetic alterations on long-term outcomes in resectable intrahepatic cholangiocarcinoma: meta-analysis.","authors":"Fabio Giannone, Fabio Del Zompo, Antonio Saviano, Erwan Pencreach, Catherine Schuster, Thomas F Baumert, Patrick Pessaux","doi":"10.1093/bjs/znae257","DOIUrl":"10.1093/bjs/znae257","url":null,"abstract":"<p><strong>Background: </strong>Intrahepatic cholangiocarcinoma is a public health threat because of its aggressiveness. Its genetic background differs from other biliary cancers. The aim of this study was to investigate the impact of genetic alterations on long-term outcomes.</p><p><strong>Methods: </strong>PubMed, MEDLINE, Scopus, and Cochrane Library databases were systematically searched for studies assessing long-term outcomes after resection of intrahepatic cholangiocarcinoma according to genetic mutational profiling until 31 May 2022. The main outcome was the impact of genetic alterations on long-term outcomes in these patients. HR (95% c.i.) was used for effect size. Publication bias was investigated.</p><p><strong>Results: </strong>A total of 24 retrospective studies were included. KRAS, IDH1/2, and TP53 were identified as the only three genes whose mutation correlated with survival (HR: 2.476, 95% c.i. 1.67-3.671, P < 0.01 for KRAS; HR: 0.624, 95% c.i. 0.450-0.867, P < 0.01 for IDH1/2; and HR: 2.771, 95% c.i. 2.034-3.775, P < 0.01 for TP53). The prevalence of KRAS and IDH1/2 mutations differed between western and eastern studies (P < 0.001 for both genes).</p><p><strong>Conclusion: </strong>Determining the overall prevalence of the most common actionable and undruggable mutations may help to expand target therapy indications in the adjuvant setting. Inconsistent results have been found for some infrequent gene alterations; their rare involvement could potentially bias their prognostic meaning.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692259","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":"Variation in surgery postponement rates in the NHS in England.","authors":"Emma McCone, Chris Snowden, Michael Swart, Tim W R Briggs, William K Gray","doi":"10.1093/bjs/znae280","DOIUrl":"10.1093/bjs/znae280","url":null,"abstract":"<p><strong>Introduction: </strong>Postponement of surgery at preoperative assessment in the days or weeks before the patient is admitted for surgery, as distinct from cancellation on the planned day of surgery, can be devastating for patients and an inefficient use of finite resources. However, postponements are often poorly recorded. The primary aim of this pilot study was to investigate elective surgical postponement rates during or after preoperative assessment across England, and the reasons for postponement for patients on an elective surgical pathway.</p><p><strong>Methods: </strong>A retrospective analysis of clinical audit data from 16 National Health Service (NHS) trusts in England was undertaken. Data were collected during a two-week period in March 2024 on all postponements within a service. The primary outcome of interest was the postponement rate.</p><p><strong>Results: </strong>Some 8000 case notes were reviewed. There were 583 (7.3%) postponements. Postponement rates across trusts varied from 31.9% to 1.0%. Significantly shorter time from referral to preoperative assessment was observed for day-case patients, urgent patients, patients without early screening and patients without a 'to come in' date in place. Of the 342 routine patients, 293 (85.7%) had postponements for medical rather than pathways or process reasons. Half of all routine patients waited over 94 days and a quarter of patients waited 198 days from being added to a patient tracking list to preoperative assessment.</p><p><strong>Conclusions: </strong>Minimizing postponements and improving preoperative assessment efficiency should be part of wider initiatives to streamline perioperative pathways.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613349","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":"Infrapyloric and gastroepiploic lymph node metastasis in right transverse colon cancer (InCLART study): multicentre, prospective, observational study.","authors":"Zheng-Hao Cai, Yin-Cong Guo, Kai Ye, Yi Xiao, Abraham Fingerhut, Wei-Dong Zang, Jun You, Xiao-Hui Du, Lin Fan, De-Qing Wu, En Li, Chun Zhuang, Su Yan, Chang-Qing Jing, Jia-Ming Zhu, Jian Zhang, Xin-Chun Liu, Ai-Wen Wu, Ying-Chi Yang, Feng-Lin Liu, Zheng Lou, Min-Zhe Li, Jun-Jun Ma, Quan Wang, Lu Zang","doi":"10.1093/bjs/znae272","DOIUrl":"https://doi.org/10.1093/bjs/znae272","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562613","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":"Assessing diversity among consultant paediatric surgeons in the UK: open science, education, and academic achievement.","authors":"Marianna Evangelia Kapsetaki","doi":"10.1093/bjs/znae261","DOIUrl":"https://doi.org/10.1093/bjs/znae261","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542321","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":"Achievements and challenges after a century of parathyroid surgery.","authors":"Radu Mihai","doi":"10.1093/bjs/znae268","DOIUrl":"https://doi.org/10.1093/bjs/znae268","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142643522","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":"Prevention of surgical-site infections: paradoxes in surgical dogma and sustainability.","authors":"Hilary Humphreys, Arnold D K Hill","doi":"10.1093/bjs/znae285","DOIUrl":"10.1093/bjs/znae285","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589563","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":"The role of yellow enhancement in laparoscopy.","authors":"Reuben C Suherman, Harpreet Singh, Darius K L Aw, Cheryl X Z Chong, Jia-Lin Ng, Sharmini Sivarajah, Winson J Tan, Fung-Joon Foo, Jasmine Ladlad, Nathanelle Khoo, Cheryl H M Tan, Frederick H Koh","doi":"10.1093/bjs/znae288","DOIUrl":"10.1093/bjs/znae288","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666495","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":"Chest wall perforator flaps are safe and can decrease mastectomy rates in breast cancer surgery: multicentre cohort study.","authors":"Andreas Karakatsanis, Farid Meybodi, Eirini Pantiora, Elisabeth Elder, Faustine Cabel, Jeremy Hsu, James French, Iliana Aristokleous, Olivia Sjökvist, Daniel Önefäldt, Jaime Navia, Rachel L O'Connell, Jennifer E Rusby, Peter A Barry","doi":"10.1093/bjs/znae266","DOIUrl":"10.1093/bjs/znae266","url":null,"abstract":"<p><strong>Background: </strong>Chest wall perforator flaps are emerging in oncoplastic breast conservation, mostly as an alternative to mastectomy. However, standardization and consensus on patient selection, techniques, and outcomes have not yet been reached. The aim of this international multicentre collaborative study was to explore practice patterns and outcomes in high-volume centres from different countries.</p><p><strong>Methods: </strong>Patients with both pre-invasive and invasive breast cancer treated at the Uppsala University Hospital in Uppsala, Sweden, the Royal Marsden Hospital in London, UK, and the Westmead Breast Cancer Institute in Sydney, Australia, were included in this study. The rationale for offering chest wall perforator flaps and surgical outcomes were prospectively documented.</p><p><strong>Results: </strong>In total, 603 patients were analysed median age of 54 (interquartile range (i.q.r.) 48-63) years, median BMI of 25.0 (i.q.r. 22.5-28.1) kg/m2, median tumour extent of 30 (IQR 19-45) mm, median breast volume of 280 (i.q.r. 216-430) ml, and median calculated resection ratio of 16% (i.q.r. 9%-28%). In 67.7%, the treating surgeon had offered chest wall perforator flaps to avoid mastectomy. The procedure was performed as day surgery in 69.5% of patients, with an overall complication rate of 8.6% and the majority of complications being classified as Clavien-Dindo grade I (5.3% of patients). The re-excision rate was 15.9%, with only 1.5% of patients converting to a mastectomy. There were no flap losses. At a median follow-up of 22 (range 12 to 98) months, rates of local recurrence, distant recurrence, and breast cancer-related mortality were 1.9%, 4.9%, and 1.7% respectively.</p><p><strong>Conclusion: </strong>Chest wall perforator flaps are a useful option to allow more women to avoid mastectomy. In experienced hands, the procedure is safe and should be offered to suitable patients.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562611","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":"Combined pedicled and free omentum flaps for chronic lower limb lymphoedema: novel approach with robotic surgery.","authors":"María Sánchez-Rodríguez, Patricia Tejedor, Jose Manuel Asencio, Adnan Alsourani, Álvaro García-Cañal, Yue Chen, Jose María Lasso-Vázquez","doi":"10.1093/bjs/znae276","DOIUrl":"https://doi.org/10.1093/bjs/znae276","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"111 11","pages":""},"PeriodicalIF":8.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142714780","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}