Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

{"title":"Twenty years of pancreatoduodenectomy at a tertiary low-volume hospital: A nationwide Icelandic study.","authors":"Karin Johansen, Gudjón Birgisson, Kristín Huld Haraldsdóttir","doi":"10.1016/j.surge.2025.04.051","DOIUrl":"https://doi.org/10.1016/j.surge.2025.04.051","url":null,"abstract":"<p><strong>Background: </strong>Due to its geographic isolation and limited population, Iceland inherently operates as a low-volume center for pancreatic surgery. To ensure high-quality health care, there is a long tradition of specialists training abroad. This retrospective cohort study aimed to evaluate pancreatic surgery outcomes in Iceland.</p><p><strong>Methods: </strong>Patients who had undergone pancreatoduodenectomy in Iceland between 2003 and 2022 were included and compared between early (2003-2012) and late (2013-2022) periods.</p><p><strong>Results: </strong>During the study period, 244 patients underwent a pancreatic procedure in Iceland, 122 of which were pancreatoduodenectomies. There was a notable increase in resection rates from the early to the late period, accompanied by significant reductions in the rates of pancreatic fistulas, postpancreatectomy hemorrhages, reoperations, length of hospital stay, and 30-day mortality. The rates of ideal outcome (54 %) and 90-day mortality (3 %) in the latter period were comparable to international rates. However, the total resection rates were low for the population size, and histopathological results revealed a high percentage of early-stage tumors.</p><p><strong>Discussion: </strong>The findings of this retrospective study indicate a satisfactory standard of pancreatic surgery over the past decade, suggesting that the existing educational framework is effective. With continued careful preoperative evaluation, more patients could undergo pancreatic surgery in Iceland.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"The positive effects of preoperative chlorhexidine rinse to reduce postoperative pneumonia after kidney transplantation surgery\" [Surgeon. (2025) 23(1) 18-22].","authors":"Murat Ferhat Ferhatoglu, Osman Z Sahin, Taner Kivilcim, Alp Gurkan","doi":"10.1016/j.surge.2025.04.001","DOIUrl":"https://doi.org/10.1016/j.surge.2025.04.001","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strain on the surgeon: a systematic review of the methods of measuring strain in abdominal and thoracic surgery.","authors":"Nainika Menon, Nadia Guidozzi, Sivesh Kathir Kamarajah, Rohan Gujjuri, Sheraz R Markar","doi":"10.1016/j.surge.2025.04.015","DOIUrl":"https://doi.org/10.1016/j.surge.2025.04.015","url":null,"abstract":"<p><strong>Introduction: </strong>Surgery can be arduous to the operating surgeon - both in terms of cognitive and physical strain. Ergonomic strain has been recognised to drive absenteeism, reduce career longevity and cause injuries. This systematic review aims to 1. Outline the nature of ergonomic strain in the context of abdominal and thoracic surgery, regardless of surgical approach 2. Identify the qualitative and quantitative measures of surgical strain.</p><p><strong>Methods: </strong>A systematic review was conducted using Pubmed, MEDLINE and Ovid EMBASE databases (date range: 1990 to Sep 2024). Of the initial 1288 articles identified, a final 71 studies were included in this review (quantitative measures = 36, qualitative measures = 49, of which 14 studies overlapped with the papers reviewed in the quantitative measures section).</p><p><strong>Results: </strong>The quantitative measures used to measure ergonomic strain included electromyography, electrocardiography, gravimetric position sensors, skin conductance and inertial measurement units. Laparoscopic surgery caused less physical strain than open surgery, however more cognitive strain during the learning curve. Robotic surgery yielded conflicting data in terms of muscle activation when compared to laparoscopic surgery however reported less cognitive and cardiovascular strain. The qualitative measures of strain included a range of self-reported questionnaires, demonstrating important gender differences and scores that typically correlated with objective physical strain.</p><p><strong>Discussion: </strong>The studies show wide variation in measuring ergonomic strain. Avenues for further research include measuring the impact of learning curves, patient factors on ergonomic strain and the impact of gender.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of ChatGPT plus (version 4.0) and pretrained AI model (Orthopod) on orthopaedic in-training exam (OITE)","authors":"Matthew L. Magruder ,&nbsp;Michael Miskiewicz ,&nbsp;Ariel N. Rodriguez ,&nbsp;Mitchell Ng ,&nbsp;Amr Abdelgawad","doi":"10.1016/j.surge.2025.04.004","DOIUrl":"10.1016/j.surge.2025.04.004","url":null,"abstract":"<div><h3>Introduction</h3><div>Recent advancements in large language model (LLM) artificial intelligence (AI) systems, like ChatGPT, have showcased ability in answering standardized examination questions, but their performance is variable. The goal of this study was to compare the performance of standard ChatGPT-4 with a custom-trained ChatGPT model taking the Orthopaedic Surgery In-Training Examination (OITE).</div></div><div><h3>Methods</h3><div>Practice questions for the 2022 OITE, made available on the AAOS-ResStudy website (aaos.org/education/examinations/ResStudy), were used for this study. Question stems were uploaded to both standard ChatGPT-4 and the custom-trained ChatGPT model (Orthopod), and the responses were documented as correct or incorrect. For questions containing media elements, screenshots were converted to PNG files and uploaded to ChatGPT. Evaluation of the AI's performance included descriptive statistics to determine the percent of questions answered correctly or incorrectly.</div></div><div><h3>Results</h3><div>Two-hundred and seven questions were analyzed with both ChatGPT 4.0 and Orthopod. ChatGPT correctly answered 73.43 % (152/207) of the questions, while Orthopod correctly answered 71.01 % (147/207) of the questions. There was no significant difference in performance of either language model based on inclusion of media or question category.</div></div><div><h3>Conclusion</h3><div>ChatGPT 4.0 and Orthopod correctly answered 73.43 % and 71.01 % of OITE practice questions correctly. Both systems provided well-reasoned answers in response to multiple choice questions. The thoughtfully articulated responses and well-supported explanations offered by both systems may prove to be a valuable educational resource for orthopedic residents as they prepare for upcoming board-style exams.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"23 3","pages":"Pages 187-191"},"PeriodicalIF":2.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The incidence and clinical significance of incidental findings seen on pre-operative CT planning scans for hip and knee robotic arthroplasty surgery.","authors":"Iain Rankin, James Dixon, Caitlin McGrane, Emma Macrae, Mostafa Beshr, Joshua Rutnagur, Mariam Sattar, Iain Stevenson","doi":"10.1016/j.surge.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.surge.2025.04.002","url":null,"abstract":"<p><strong>Aim: </strong>The incidence and clinical significance of incidental findings identified on preoperative computerised tomography (CT) planning scans for hip and knee robotic arthroplasty is disputed. This study aimed to determine this within a single hip and knee arthroplasty unit.</p><p><strong>Methods: </strong>A retrospective cohort study was performed for all patients that underwent CT planning scans for hip or knee arthroplasty at our institution over a 30-month period (Dec 2021-May 2024). CT scan reports were reviewed and incidental findings noted. Incidental findings were graded by independent reviewers into one of three categories: no action required, further action may be considered, urgent action required e.g. potential malignancy.</p><p><strong>Results: </strong>1452 CT arthroplasty planning scans were identified over a 30-month period. A radiologist report was not provided in 48 (3.3 %) cases, leaving 1404 (96.7 %) available for further analysis. 592 (42.2 %) incidental findings were noted, of which 244 (17.4 %) were graded further action may be considered and 16 (1.1 %) urgent action required. All patients identified as urgent action required received appropriate management.</p><p><strong>Conclusion: </strong>Pre-operative CT arthroplasty planning scans have a high incidence (N = 592, 42.2 %) of incidental findings, most of which most require no further management. A significant proportion (N = 244, 17.4 %) of scans have incidental findings for which further action may be considered, whilst a small proportion (N = 16, 1.1 %) have incidental findings for which urgent action is required. Pre-operative CT planning scans should be reported by a radiologist due to the high incidence of significant incidental findings.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring TikTok's influence on surgical patient education.","authors":"Sai Sandeep Singh Rowdhwal, Michael El Boghdady","doi":"10.1016/j.surge.2025.03.001","DOIUrl":"https://doi.org/10.1016/j.surge.2025.03.001","url":null,"abstract":"<p><strong>Introduction: </strong>Social media platforms, especially rapidly growing ones like TikTok, are increasingly used to disseminate health information. Its interactive features promote user participation, allowing for the sharing of experiences and raising awareness about specific medical conditions, while also simplifying complex procedures. This study aimed to explore the possible influence of TikTok short-video application on the education of surgical patients.</p><p><strong>Methods: </strong>A systematic search was performed in compliance with the PRISMA checklist. The research protocol was registered with the PROSPERO register (CRD42024551646). A search was performed in the PubMed and ScienceDirect databases from inception to 2024. The search terms used were \"TikTok AND Surgery,\" \"TikTok AND Surgical Education,\" and \"TikTok AND surgery AND patient.\"</p><p><strong>Results: </strong>The present systematic search resulted in 697 citations, of which 50 relevant citations were included. The search revealed that TikTok has widely used among patients from different surgical specialties and has an influence on their education. The platform facilitates public health awareness, allowing surgeons to share educational content, including surgical techniques and patient-oriented information.</p><p><strong>Conclusion: </strong>As one of the rapidly growing social media platforms, TikTok is increasingly utilised to disseminate health information. It has been adopted across various surgical specialties. While the platform presents a great opportunity to improve the education of surgical patients, it presents challenges related to the accuracy of information, potential misinformation, and lack of regulation. Surgeons and healthcare professionals should actively participate in creating accurate, evidence-based content that enhances patient education and promotes public health awareness.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multi-disciplinary teams for Crohn's disease: Who should be presented?","authors":"Meagan Derbyshire, Yaniv Zager, Katherine Carson, Lindsey Bridges, Leonardo Bustamante-Lopez, Norbert Garcia-Henriquez, Christopher T Aquina, Matthew R Albert, Mark Soliman, John Rt Monson","doi":"10.1016/j.surge.2025.03.002","DOIUrl":"https://doi.org/10.1016/j.surge.2025.03.002","url":null,"abstract":"<p><strong>Background: </strong>Multi-disciplinary team (MDT) conferences are used within the realm of colorectal surgery for both benign and malignant disease to assist in both diagnostic workup and to guide treatment. Usually, teams encompass colorectal surgery (CRS), gastroenterology (GE), pathology and radiology. Although it is believed that MDT discussion is associated with improved outcomes, there is a scarcity of evidence regarding the benefit or patient selection criteria among patients with inflammatory bowel disease (IBD). Due to advancements in both medical and surgical management in the management of IBD, clinical decision making may be challenging. Our aim is to identify which patients are currently being presented in MDT meetings and to assess compliance with the MDT's recommendations.</p><p><strong>Methods: </strong>We conducted a retrospective, observational, multiple campus study including all patients with Crohn's Disease (CD) treated within our system during a twelve-month period. Data was collected from a prospective database of MDT patients and retrospective chart review, including demographics, medical and surgical history, disease course and treatment provided. We compared patients presented at MDT to patients without conference review. Outcomes considered included medical versus surgical management. Analysis included chi square and student t-test, with p < 0.05 considered statistically significant.</p><p><strong>Results: </strong>From September 2022 to September 2023, 766 patients were presented to our hospital system for management of CD disease and 52 patients were reviewed at a multi-disciplinary conference for IBD. On comparison of the two groups, those presented at the conferences were on average younger (43.4 vs. 44.9 years; p < 0.05) and had lower body mass index (BMI) compared to those not presented (23.6 vs. 26.1; p < 0.05). There was no difference in gender (p = 0.55) or race distribution between the two groups (p = 0.07). Surgical intervention was more frequent in patients that were presented in MDT meetings (46.2 % vs. 23.2 %; p < 0.05).</p><p><strong>Conclusion: </strong>Multi-disciplinary conferences can be used in IBD and CD disease to guide treatment. Our results suggest a tendency to present younger, lower BMI patients for surgical management of CD disease. Further analysis will target the role of this conference in new diagnoses, in the setting of medical refractory disease or those with multiple prior operative interventions, and in patients who require additional consultants outside of gastroenterology and colorectal surgery. Prospective studies are warranted to establish criteria for presentation of CD Disease patients at MDT conferences.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the use of absorbable sutures versus sTaples versus tIssue glue in laparoscopic port skin closure (STILS) trial: A prospective, multi-centre randomised clinical trial (RCT).","authors":"Sinead E Ramjit, Matthew G Davey, Stephen Keelan, Emer Herlihy, Marie Dromey, Chris Garvey, Timothy S Nugent, Aisling Fawaz, Lauren O'Connell, Melanie Cunningham, Matthew Fahy, Eanna J Ryan, Brendan Moran, Lylas Aljohmani, Jeyanthi Narayanasamy, Michael E Kelly, Clara Healy, Claire Donohoe, Narayansamy Ravi, Paul Neary, John V Reynolds, Noel E Donlon","doi":"10.1016/j.surge.2025.02.015","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.015","url":null,"abstract":"<p><strong>Methods: </strong>This prospective, multi-centre RCT was conducted in accordance with the CONSORT guidelines for prospective, parallel group randomised studies. Adult patients undergoing elective laparoscopic surgery at two teaching hospitals in Dublin, Ireland were recruited and assigned to one of three closure methods (sutures (SU), staples (ST) or tissue glue (TG)) with primary outcome being cosmesis and secondary outcomes being closure speed, wound complications, cost effectiveness and sustainability outcomes being assessed by a blinded outcomes assessor.</p><p><strong>Results: </strong>A total of 147 patients were recruited and randomised with a total of 138 being examined in the final analysis (SU = 48, ST = 63, TG = 27). Patient demographics were similar across all groups for gender, mean age, body mass index and American Society of Anaesthesiologists grade (all p > 0.050). For cosmesis, SU had the lowest overall mean observer (p < 0.001) and patient (p = 0.005) scar scores. Furthermore, when evaluating the breakdown for Observer Scar Score (OSS), SU had the lowest vascularity (p = 0.001), pigmentation (p = 0.006), thickness (p < 0.001), relief (p = 0.003) and pliability (p < 0.001). For patient scar score (PSS), SU had the lowest irregularity (p = 0.035). SU was the most cost-effective (p < 0.001) and had the lowest total produced non-recyclable waste (p < 0.001). ST had the shortest closure time (p < 0.001). Overall, there was a no difference in wound complication rates (SU = 6.3 %, ST = 6.4 %, TG = 18.5 %; p = 0.130).</p><p><strong>Conclusion: </strong>In conclusion, SU was the most effective method for laparoscopic port site closure with regards to cosmesis, cost-efficiency and surgical sustainability. ST was the marginally quicker method of closure and demonstrated equipoise in terms of complication rate. We advocate for SU as the current 'gold standard' with reduced non-recyclable waste generated and a valuable training opportunity for junior trainees.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov Identifier: NCT03843866.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659543","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A joint effort: Evaluating the quality and readability of online resources relating to total hip arthroplasty.","authors":"Samher Jassim, Conor J Kilkenny, Alex Price, Thomas Moore, Niall P McGoldrick, John F Quinlan","doi":"10.1016/j.surge.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.016","url":null,"abstract":"<p><strong>Background: </strong>The internet serves as a major source of information for patients undergoing total hip arthroplasty (THA). However, prior research has shown that online medical information often exceeds recommended readability levels, posing a barrier to patient comprehension. The average reading level in the United States is between 7th and 8th grade, while leading health organizations recommend that patient information not exceed a 6th-grade level. This study aims to evaluate the readability and quality of information available online regarding THA.</p><p><strong>Methods: </strong>A systematic search was conducted on Google, Bing, and Yahoo using the terms \"total hip arthroplasty\" and \"hip replacement surgery,\" with the top 30 URLs from each search engine selected. Readability was assessed using three readability scores (Gunning FOG, Flesch-Kincaid Grade, and Flesch Reading Ease). Quality was evaluated based on HONcode certification and the JAMA benchmark criteria.</p><p><strong>Results: </strong>Ninety webpages were included in the analysis. The mean Flesch-Kincaid Grade level was 9.5 ± 2.4, the mean Gunning FOG grade was 11.1 ± 3.0, and the mean Flesch Reading Ease score was 48.5 ± 13.8. Only 6 webpages were at or below a 6th-grade reading level. The mean JAMA score was 1.4 ± 1.3 out of 4, and 13 websites were HONcode accredited.</p><p><strong>Conclusion: </strong>Online THA-related medical information is often too complex for the average patient, with inconsistent quality. This study assessed readability and credibility but did not evaluate medical accuracy or include hospital-based resources. Improving both readability and reliability is essential to enhance patient comprehension, support informed decision-making, and promote better health literacy.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143634799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early failure following pelvic exenteration: Who are the bad actors?","authors":"Ben Creavin, Michael Eamon Kelly, Jawed Noori, Greg Turner, Glen Guerra, Cori Behrenbruch, Helen Mohan, Joe Kong, Jacob McCormick, Satish Warrier, Alexander Heriot","doi":"10.1016/j.surge.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.surge.2025.02.010","url":null,"abstract":"<p><strong>Background: </strong>Pelvic exenteration for locally advanced (LARC) or recurrent rectal cancer (LRRC) is technically challenging with considerable morbidity for the patient. Though surgery can confer long-term survival in selected patients, early failure, defined as recurrence with one year, represents a major issue as both survival and quality of life are severely impacted. This study aims to highlight the \"bad actors\" associated with early failure.</p><p><strong>Methods: </strong>A retrospective study of patients who underwent exenteration for LARC & LRRC in a quaternary referral unit was performed. Specifically, characteristics of patients with early recurrence were identified and compared to those who recurred after one year.</p><p><strong>Results: </strong>159 and 85 patients underwent pelvic exenteration for LARC and LRRC, respectively. Of these, there were 61 (38.3 %) recurrences in the LARC and 74 (87.1 %) LRRC cohorts. For LARC, 18 patients had an early failure. Expectantly, these patients had a higher proportion of positive margins (R1) (50 % vs. 21 % in the remaining 141 patients, ∗p = 0.04). Interestingly, early failure was also associated with more genetic mutations (33 % vs. 22 %), extramural venous invasion (32 % vs. 24 %), lymphovascular invasion (38 % vs. 22 %), and other adverse histopathological features including poor-differentiation, signet-ring and/or mucinous disease (38 % vs. 21 %). Median and 3-year overall survival (OS) in the early failure group compared to the rest of the cohort was 96 months versus 30 months and 35 % versus 73 %, respectively (∗p = 0.003). There were 18 early failures in the LRRC cohort. Similarly, there were more patients with positive margins in the early failure group (55 % versus 39 %, ∗p = 0.02). The early failure group was also associated with extramural venous invasion (38 % versus 23 %) and adverse histopathological features (55 % versus 28 %). Median and 3-year overall survival (OS) in the early failure group compared to the non-early-failure group was 15 versus 0 months and 17 % versus 68 % respectively (∗p=<0.001).</p><p><strong>Conclusion: </strong>Tailoring treatment strategies according to tumour characteristics is increasingly important in the management of advanced rectal cancer. Multicentre data is needed to validate these findings and would have a profound impact to patient counselling and outcome expectations.</p>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}