The British journal of surgery最新文献

{"title":"IMMUNOREACT 13: immune features of healthy rectal mucosa as predictors of invasion risk in stage II rectal cancer.","authors":"Giorgio Rivella, Melania Scarpa, Andromachi Kotsafti, Ignazio Castagliuolo, Matteo Fassan, Marco Scarpa","doi":"10.1093/bjs/znaf245","DOIUrl":"https://doi.org/10.1093/bjs/znaf245","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145608676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decoding postoperative ileus.","authors":"Miriam Khalil, David G Jayne, Stephen J Chapman","doi":"10.1093/bjs/znaf237","DOIUrl":"https://doi.org/10.1093/bjs/znaf237","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of a novel artificial intelligence model to recognize vascular anatomy during robotic pancreatoduodenectomy.","authors":"Koichi Tomita, Masashi Takeuchi, Maho Takayama, Michael P Kim, Jessica E Maxwell, Rebecca A Snyder, Hop S Tran Cao, Ching-Wei D Tzeng, Jeffrey E Lee, Matthew H G Katz, Naruhiko Ikoma","doi":"10.1093/bjs/znaf255","DOIUrl":"https://doi.org/10.1093/bjs/znaf255","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145515039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomical basis for sensory preservation in robotic mastectomy.","authors":"Hunter A Holley, Sandra Hembrecht, Níamh M Smyth, Mathieu Colbert, Fabio Quondamatteo, Arnold D K Hill","doi":"10.1093/bjs/znaf232","DOIUrl":"10.1093/bjs/znaf232","url":null,"abstract":"<p><strong>Background: </strong>Sensory preservation of the nipple-areolar complex (NAC) is crucial for physical, psychological, and sexual health after mastectomy. Robotic-assisted nipple-sparing mastectomy (rNSM) techniques have shown promise in preserving NAC sensation, but there is limited detailed anatomical evidence supporting this observation. The aim of this study was to characterize the anatomical pathways and variability of sensory nerves innervating the NAC, particularly focusing on implications for the development of improved nerve-preserving techniques during breast surgery.</p><p><strong>Methods: </strong>A cadaveric anatomical study on three adult female cadaveric donors (six breasts) was undertaken, which was complemented by a systematic review of the existing literature using a modified PRISMA approach.</p><p><strong>Results: </strong>The anterior cutaneous branch (ACB) and the lateral cutaneous branch (LCB) of the fourth intercostal nerve (ICN) were consistently the primary cutaneous nerves innervating the NAC. The ACB of the fourth ICN, particularly its lateral division, followed a superficial and consistent subdermal route bypassing breast tissue in all cadavers. Conversely, the LCB of the fourth ICN, specifically its anterior division, traversed deeper breast tissue to reach the NAC. Variable supplementary contributions were observed from the second, third, and fifth ICNs, and previously undocumented ancillary branches. Significant inter-individual anatomical variability was noted.</p><p><strong>Conclusion: </strong>The consistent superficial pathway of the ACB of the fourth ICN provides a clear anatomical rationale for improved sensory preservation observed in rNSM, given the procedure's lateral incision and precise dissection capabilities. Recognition of anatomical variability and detailed nerve trajectories should guide surgical planning to optimize sensory outcomes in breast cancer surgery and reconstruction.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12624855/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative nutrition-ongoing challenges in the era of ERAS.","authors":"Rahel Maria Strobel, Arved Weimann, Maria Wobith","doi":"10.1093/bjs/znaf238","DOIUrl":"https://doi.org/10.1093/bjs/znaf238","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized clinical trial of intradermal suture and metallic stapling for incisional groin closure after vascular surgery (VASC-INF trial).","authors":"Albert González-Sagredo, Miquel Gil Olaria, Mario D'Oria, Paula López-García, Beatrice Grando, Begoña Gonzalo Villanueva, Emma Espinar Garcia, Thiago Carnaval, Secundino Llagostera, Sandro Lepidi, Ramon Vila, Elena Iborra, Sebastián Videla","doi":"10.1093/bjs/znaf256","DOIUrl":"10.1093/bjs/znaf256","url":null,"abstract":"<p><strong>Background: </strong>Surgical-site infection (SSI) is a relevant complication in vascular surgery due to its associated morbidity and mortality. However, the optimal type of skin closure (intradermal suture versus metallic staples) to minimize SSI rates has been scarcely studied. The aim of this study was to compare the incidence of SSI associated with intradermal suture versus metallic staples in patients undergoing arterial surgery through a groin femoral approach.</p><p><strong>Methods: </strong>A multicentre, open-label, superiority RCT was conducted between April 2022 and January 2024 across three tertiary hospitals (two in Spain and one in Italy). The last-patient, last-visit date was 31 March 2024. Patients were randomized (1 : 1) to receive intradermal sutures (experimental group) or metallic staples (control group) via a computer-generated random sequence prepared by an independent researcher not involved in other aspects of the trial. The primary outcome was the 28-day cumulative incidence of SSI after elective revascularization procedures with inguinal vertical incisions with or without concomitant incisions, assessed per the definitions of the US Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network.</p><p><strong>Results: </strong>In this trial, 112 patients were randomized to intradermal suture and 113 patients were randomized to metallic staples. SSIs occurred in eight patients in the intradermal suture group (cumulative incidence of 7.1% (95% c.i. 3.7% to 13.5%)) and six patients in the metallic staples group (cumulative incidence of 5.3% (95% c.i. 2.5% to 11.1%)). The relative risk (RR) of SSI was 1.4 (95% c.i. 0.5 to 3.8) times higher in the intradermal suture group, but the results were not statistically significant (P = 0.769). No additional SSIs occurred at 84 days after surgery, and the rates of lymphocele, haematoma, or lymphorrhoea did not differ significantly between groups.</p><p><strong>Conclusion: </strong>Intradermal sutures were not superior to metallic staples in preventing SSIs in patients undergoing vascular surgery through a groin femoral approach.</p><p><strong>Registration number: </strong>NCT05434182 (http://www.clinicaltrials.gov).</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145608665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rectus diastasis repair with and without mesh at 1 year: randomized clinical trial.","authors":"Reetta Tuominen, Julia Saxen, Tiina Jahkola, Jani Mikkonen, Jari Arokoski, Hannu Luomajoki, Jaana Vironen","doi":"10.1093/bjs/znaf231","DOIUrl":"10.1093/bjs/znaf231","url":null,"abstract":"<p><strong>Background: </strong>Rectus diastasis (RD) can cause functional impairment and pain. Surgical approaches vary regarding mesh use for linea alba restoration. The aim of this RCT was to compare plication supported by mesh (PSUM) with suture plication in patients with symptomatic postpartum RD.</p><p><strong>Methods: </strong>This single-centre superiority double-blind RCT was conducted in Finland from April 2018 to November 2022. The pre-specified primary outcome was RD recurrence at 1 year (inter-rectus distance (IRD) >20 mm) and a post-hoc primary outcome was absolute reduction in IRD. Secondary outcomes included health-related quality of life (HRQoL), low back disability (Oswestry Disability Index (ODI)), motor control, and complications. The date of the last follow-up was 30 November 2022.</p><p><strong>Results: </strong>In total, 86 normal-weight women (mean age of 38.7 (range 25-52) years) were randomized, with 84 patients (98%) available for follow-up (44 in the PSUM group and 40 in the suture plication group). At 1 year, there was no difference in RD recurrence between the PSUM group and the suture plication group (2 of 44 (5%) versus 2 of 40 (5%) respectively; P = 0.922). IRD reduction was greater in the PSUM group (52 (95% c.i. 48 to 56) mm) than in the suture plication group (44 (95% c.i. 40 to 47) mm) (P < 0.002). HRQoL, ODI, and enhanced performance test results all improved in both groups compared with baseline (P = 0.000-0.039). There was no difference in the complication rate between the PSUM group and the suture plication group (17 of 44 (39%) versus 13 of 40 (33%) respectively; P = 0.558).</p><p><strong>Conclusion: </strong>At 1 year, both PSUM and suture plication result in stable outcomes, with no difference in the RD recurrence rate, but the study was limited by both a small number of patients and a lower than anticipated overall RD recurrence rate. For the whole patient cohort, surgery was associated with improved motor control, low back function, and HRQoL compared with baseline.</p><p><strong>Registration number: </strong>NCT03509376 (http://www.clinicaltrials.gov).</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145608690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological outcome after robot-assisted versus open pancreatoduodenectomy for upfront resectable cancer in the pancreatic head: a nationwide cohort analysis.","authors":"Julia E Menso, Caro L Bruna, Mahsoem Ali, Bert Bonsing, Koop Bosscha, Lodewijk A A Brosens, Olivier R Busch, A Stijn L P Crobach, Freek Daams, Wouter Derksen, Maxime J L Dewulf, Michail Doukas, Arantza Fariña Sarasqueta, Sebastiaan Festen, Mohammad Abu Hilal, Ignace H J T de Hingh, Marjolein Y V Homs, Geert Kazemier, Daan J Lips, Misha D P Luyer, Vincent E de Meijer, J Sven D Mieog, Wouter W Te Riele, Hjalmar C van Santvoort, George P van der Schelling, Martijn Stommel, Joanne Verheij, Roeland F de Wilde, Johanna W Wilmink, I Quintus Molenaar, Bas Groot Koerkamp, Lydia G van der Geest, Marc G Besselink","doi":"10.1093/bjs/znaf153","DOIUrl":"10.1093/bjs/znaf153","url":null,"abstract":"<p><strong>Background: </strong>Robot-assisted pancreatoduodenectomy (RPD) aims to enhance postoperative recovery compared to open pancreatoduodenectomy (OPD). Although recent randomized trials confirmed the short-term safety of RPD, they did not confirm superiority or assess oncological safety. This nationwide observational cohort study compares oncological outcome after RPD versus OPD in patients with resectable pancreatic ductal adenocarcinoma (PDAC) and distal cholangiocarcinoma (DCC) without vascular contact.</p><p><strong>Methods: </strong>All consecutive patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact on preoperative imaging in the Netherlands were included. Data were obtained from the Netherlands Cancer Registry (2016-2023). Primary outcomes were overall survival (OS) and R0-resection rate.</p><p><strong>Results: </strong>Overall, 1675 patients after pancreatoduodenectomy for upfront resectable PDAC and DCC were included (375 RPD; 1300 OPD). Adjusted median OS was 23 months after RPD versus 22 months after OPD, with comparable 5-year survival rate (23.3% versus 22.4%, HR 0.96 [0.82-1.14], P = 0.665). The R0-resection rate was comparable (57.1% versus 59.7%, P = 0.368). RPD was associated with a shorter hospital stay (median 9 versus 11 days, P < 0.001) and comparable in-hospital/30-day (3.1% versus 2.6%, P = 0.618) and 90-day mortality rate (7.7% versus 6.2%, P = 0.276). In patients with PDAC, no differences in receipt (58.2% versus 58.7%, P = 0.900), time to start (median 54 versus 58 days, P = 0.107), or completion of adjuvant chemotherapy (30.4% versus 30.4%, P = 0.999) were observed.</p><p><strong>Conclusions: </strong>In this nationwide study, oncological outcome including 5-year survival was comparable between patients undergoing RPD and OPD for upfront resectable PDAC and DCC without vascular contact without differences in the use of adjuvant therapy for PDAC.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12661940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145644766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image-guided navigation in liver surgery.","authors":"Karin Olthof, Matteo Fusaglia, Niels Kok, Koert Kuhlmann","doi":"10.1093/bjs/znaf254","DOIUrl":"https://doi.org/10.1093/bjs/znaf254","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145544909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary analysis of data from the HeLiX trial regarding the association between estimated blood loss and post-hepatectomy outcomes: towards the definition of a minimal clinically significant difference.","authors":"Julie Hallet, Tiago Ribeiro, Zhi V Fong, Giampaolo Perri, Poya Ghorbani, Ernesto Sparrelid, Giovanni Marchegiani, Paul J Karanicolas","doi":"10.1093/bjs/znaf243","DOIUrl":"10.1093/bjs/znaf243","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"112 11","pages":""},"PeriodicalIF":8.8,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12604467/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}