The British journal of surgery最新文献

{"title":"A randomized controlled trial comparing non-selective versus selective TIRADS-based cytology in thyroid cancer diagnostics.","authors":"Jakob Dahlberg, Jeanette Carlqvist, Ann Örtoft, Lilian Hammarstedt, Ekaterina Aula, Mikael Hellström, Erik Elias, Andreas Muth","doi":"10.1093/bjs/znag076","DOIUrl":"10.1093/bjs/znag076","url":null,"abstract":"<p><strong>Introduction: </strong>Several ultrasound risk stratification systems have been developed mainly with the aim of identifying benign lesions and thereby avoiding unnecessary fine needle aspiration (FNA) cytology. This randomized controlled trial assessed whether the use of an ultrasound risk stratification system improved identification of lesions requiring surgical treatment.</p><p><strong>Material and methods: </strong>This was a multi-centre, unblinded and interventional randomized trial comparing selective and non-selective FNA in Western Sweden. Patients were randomized to either selective cytology according to EU-TIRADS criteria or non-selective cytology.</p><p><strong>Results: </strong>A total of 195 patients were included, 93 in the non-selective group and 102 in the selective group, between February 2022 and December 2023. The frequency of nodules with Bethesda category IV-VI (primary outcome) was higher in the selective group (26% versus 13%, P = 0.039). The rate of malignancy (secondary outcome) was similar in both groups; 8% in the selective group versus 5% in the non-selective group. The frequency of patients undergoing cytology was reduced from 83% in the non-selective group to 71% in the selective group. Considering only patients with at least one nodule yielding EU-TIRADS 3 or higher, cytology was omitted in 7% of patients in the selective group, whereas no cytology was omitted in the non-selective group.</p><p><strong>Conclusion: </strong>This randomized controlled trial supports the use of EU-TIRADS to correctly select neoplastic nodules for FNA without missing thyroid cancer. The proportion of patients where FNA can be safely omitted using EU-TIRADS may however be exaggerated, indicating a need for further refinement of risk stratification systems for thyroid cancer diagnostics.The trial was registered at ClinicalTrials.gov (NCT05583097).</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367576/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148285105","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":"Metastatic lymph node burden and invasive tumour features inform first recurrence patterns after curative-intent resection for intrahepatic cholangiocarcinoma.","authors":"Kizuki Yuza, Odysseas P Chatzipanagiotou, Christian Hobeika, Federico Aucejo, Hugo P Marques, Tom Hugh, Feng Shen, Shishir K Maithel, Bas Groot Koerkamp, Irinel Popescu, Matthew J Weiss, Guillaume Martel, Carlo Pulitano, George Poultsides, Andrea Ruzzenente, Todd W Bauer, Ana Gleisner, Itaru Endo, Timothy M Pawlik","doi":"10.1093/bjs/znag074","DOIUrl":"10.1093/bjs/znag074","url":null,"abstract":"<p><strong>Background: </strong>Recurrence is a major driver of poor long-term outcomes after curative-intent resection for intrahepatic cholangiocarcinoma (iCCA), yet the association between postoperative pathology, first recurrence patterns, and post-recurrence outcomes remains unclear.</p><p><strong>Methods: </strong>Patients who underwent curative-intent resection for iCCA (2000-2023) were identified from an international multi-institutional database. First recurrence patterns were classified as intrahepatic-only, extrahepatic-only, or combined intrahepatic and extrahepatic recurrence. Multivariable analyses assessed associations between postoperative pathological features, first recurrence patterns, post-recurrence survival (PRS), and post-recurrence curative-intent treatment.</p><p><strong>Results: </strong>Among 1328 patients, 763 patients (57.5%) developed a recurrence; 717 patients had a classifiable first recurrence pattern (381 patients developed intrahepatic-only recurrence, 171 patients developed extrahepatic-only recurrence, and 165 patients developed combined intrahepatic and extrahepatic recurrence). Three or more metastatic lymph nodes (adjusted OR (aOR) 3.47 (95% c.i. 1.56 to 7.72)) and microvascular invasion (aOR 2.49 (95% c.i. 1.61 to 3.85)) were associated with higher odds of combined recurrence compared with intrahepatic-only recurrence, whereas perineural invasion (aOR 2.24 (95% c.i. 1.35 to 3.71)) and the absence of pathological nodal evaluation (aOR 2.04 (95% c.i. 1.24 to 3.36)) were associated with extrahepatic-only recurrence. Compared with intrahepatic-only recurrence, combined recurrence was associated with worse PRS (adjusted HR 1.63 (95% c.i. 1.29 to 2.06)) and lower odds of receiving curative-intent treatment (aOR 0.14 (95% c.i. 0.06 to 0.29)).</p><p><strong>Conclusion: </strong>Pathological nodal burden and invasive tumour features were associated with distinct first recurrence patterns after iCCA resection. Combined recurrence, more common with ≥3 metastatic lymph nodes or microvascular invasion, was associated with worse PRS and lower receipt of curative-intent treatment. Among patients who develop recurrence, pathological prognostic factors available after surgery may help characterize first recurrence patterns and inform risk-adapted postoperative surveillance.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261336","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":"Preoperative multisystem circadian coupling and long-term outcomes after colorectal cancer surgery.","authors":"Shengjie Pan, Gang Wang","doi":"10.1093/bjs/znag073","DOIUrl":"10.1093/bjs/znag073","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261328","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":"Integrated biobanking for translational research: a surgical imperative.","authors":"Bijan Modarai","doi":"10.1093/bjs/znag060","DOIUrl":"10.1093/bjs/znag060","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13326945/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147944734","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":"Multimodal prehabilitation and perioperative immune function in patients undergoing abdominal cancer surgery.","authors":"Lotte M C Jacobs, Luuk D Drager, Lucas T van Eijk, Leonie S Helder, Leo A B Joosten, Dieuwke Strijker, Cornelis J H M van Laarhoven, Baukje van den Heuvel, Michiel C Warlé","doi":"10.1093/bjs/znag070","DOIUrl":"10.1093/bjs/znag070","url":null,"abstract":"<p><strong>Background: </strong>Prehabilitation is an emerging preoperative strategy designed to optimize patients' functional capacity before surgery to improve postoperative outcomes. Previous studies have demonstrated its clinical benefit, including enhanced recovery and reduced postoperative complications. However, the mechanisms underlying these benefits remain poorly understood. The aim of this exploratory study was to investigate the potential effects of prehabilitation on preoperative and postoperative immune function.</p><p><strong>Methods: </strong>This prospective study utilized data and material from a subgroup of patients participating in the F4S PREHAB trial (NL73777.091.20), which is a stepped-wedge trial investigating the effects of multimodal prehabilitation before major surgery. In this substudy, patients who underwent elective bladder, oesophageal, or rectal cancer surgery between June 2022 and November 2023 were included. Immune function was assessed at baseline, after the prehabilitation or usual care interval, and on postoperative day 1 (POD1) by examining ex vivo cytokine production capacity, plasma cytokine concentrations, and monocytic human leucocyte antigen DR (mHLA-DR) expression.</p><p><strong>Results: </strong>This substudy included 130 patients: 102 in the prehabilitation group and 28 in the control group. After prehabilitation, the ex vivo production of pro-inflammatory cytokines was reduced, whereas the ex vivo production of the anti-inflammatory cytokine interleukin 10 (IL-10) was increased. Plasma concentrations of interleukin 6 (IL-6) and IL-10 were lower after prehabilitation. On POD1, no significant differences in postoperative immune function were observed between the prehabilitation and control groups.</p><p><strong>Conclusion: </strong>This study suggests that multimodal prehabilitation influences basal immune function, leading to a less inflammatory state. However, as no significant differences in immune function were observed between the prehabilitation and control groups on POD1, the impact of prehabilitation on postoperative immune function may be limited.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367574/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148195361","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":"No increased risk of cancer death after endovascular aortic repair in a nationwide population-based cohort study.","authors":"Fredrik Lilja, Anders Wanhainen, Kevin Mani","doi":"10.1093/bjs/znag065","DOIUrl":"10.1093/bjs/znag065","url":null,"abstract":"<p><strong>Introduction: </strong>The short-term benefits of endovascular aortic repair (EVAR) compared with open repair for the treatment of abdominal aortic aneurysm (AAA) patients are well established. However, concerns have been raised regarding a potential increased long-term cancer risk associated with EVAR, related to procedural and surveillance-related radiation exposure. The aim of this nationwide population-based cohort study was to evaluate whether EVAR is associated with an increased long-term cancer risk compared with open repair.</p><p><strong>Methods: </strong>All patients undergoing primary AAA repair for an intact AAA (ICD-10: I71.4) from January 2005 to February 2024 were identified from the Swedish National Patient Register. Previous and subsequent cancer diagnoses, as well as previous co-morbidities, for this cohort were recorded. Cause of death was retrieved from the Cause of Death Register. Inverse probability of treatment weighting (IPTW) was applied using propensity scores derived from baseline characteristics and co-morbidities. Weighted Cox regression models, with EVAR as the sole regressor, were then fitted for the event of a new cancer diagnosis and cancer related death.</p><p><strong>Results: </strong>Some 15 509 patients were identified (mean age of 73 years, 16.8% female, and 23.7% with a previous cancer diagnosis). After weighting, standardized mean differences for co-morbidities, age, sex, and recent hospital admissions were all within ±0.1. The median survival was 8.7 (95% c.i. 8.4 to 8.9) years for EVAR patients and 9.4 (95% c.i. 9.1 to 9.6) years for open repair patients. The median follow-up time was 4.9 (interquartile range (i.q.r.) 2.3 to 8.4) years for new cancer and 5.9 (i.q.r. 3.0 to 9.4) years for cancer-related death. Freedom from new cancer was lower in EVAR patients (HR 0.92 (95% c.i. 0.86 to 0.98)), whereas cancer-related survival was similar (HR 0.93 (95% c.i. 0.85 to 1.02)).</p><p><strong>Conclusion: </strong>EVAR was not associated with an increased risk of dying of cancer, but with an increased risk of being diagnosed with a new cancer. This should be interpreted carefully, as there is a clear risk of detection bias of otherwise unknown tumours due to routine imaging during EVAR surveillance.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13327106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148160417","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":"Seeing the unseen: a theory of sexual misconduct perception in the surgical workplace.","authors":"Rebecca A Fisher, Philippa C Jackson, Greta McLachlan, Carrie Newlands, Christopher T Begeny, Rosalind Searle","doi":"10.1093/bjs/znag077","DOIUrl":"10.1093/bjs/znag077","url":null,"abstract":"<p><strong>Introduction: </strong>Sexual misconduct in surgery is recognized as widespread, yet individuals within the same departments report markedly different perceptions of prevalence. Quantitative data show gender differences in experiences, but reasons for this remain unclear. This study explored perceptions of sexual misconduct in the UK surgical workplace and developed a heuristic framework.</p><p><strong>Methods: </strong>Qualitative analysis was undertaken of free-text responses from 742 participants in a 2022 nationwide UK survey. Respondents included students, trainees and consultants. Inductive, reflexive thematic analysis within a constructionist paradigm was conducted, with iterative coding by two researchers and team discussions to refine themes and develop an explanatory framework.</p><p><strong>Results: </strong>Accounts diverged. Some participants described respectful workplaces with little misconduct, whereas others reported pervasive harassment, assault and inaction. Using an X-ray metaphor, the 'Lateral View X-ray' theory was developed to explain this. The 'AP View' reflects unawareness or minimization, sustained by limited exposure, normalization as banter, defensiveness, and seniority-related distancing. The 'Lateral View' reflects heightened awareness from personal or witnessed experiences, hypervigilance, frustration at inaction, and informal warning networks. Male victims described additional barriers to recognition and disclosure. Drawing on standpoint and epistemic injustice theory, this work demonstrates how social position, power, and language shape whether misconduct is recognized or obscured.</p><p><strong>Conclusion: </strong>The Lateral View X-ray theory explains how sexual misconduct can be simultaneously pervasive and invisible within surgery. Awareness depends on vantage point, where those least exposed perceive little problem, whereas those affected perceive structural harm. Embedding this framework in surgical education may widen perspective, improve responses and support cultural change.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13367572/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261337","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":"A conceptual roadmap towards precision emergency surgery in adhesional small bowel obstruction.","authors":"Matthew J Lee","doi":"10.1093/bjs/znag085","DOIUrl":"10.1093/bjs/znag085","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 7","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13419066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148623815","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":"Female patients expect more information when undergoing surgery: nationwide survey- and register-based study.","authors":"Evy Á Lakjuni Guttesen, Anders Gram-Hanssen, Hugin Reistrup, Jacob Rosenberg, Jason J Baker","doi":"10.1093/bjs/znag069","DOIUrl":"10.1093/bjs/znag069","url":null,"abstract":"<p><strong>Background: </strong>Good preoperative information is associated with reduced anxiety and improved postoperative pain, satisfaction, and quality of life. The aim of this study was to assess sex-based disparities in perceived sufficiency of perioperative information among patients undergoing ventral hernia repair.</p><p><strong>Methods: </strong>This study was part of the AFTERHERNIA Project, which included patients ≥18 years undergoing ventral hernia repair between January 2014 and March 2024. Patients identified via the Danish National Patient Register completed the questionnaire Abdominal Hernia-Q (AHQ), with responses linked to the Danish Ventral Hernia Database. Perceived sufficiency of perioperative information was assessed using three AHQ items: prepared for surgery, postoperative emotions, and recovery concerns. Multivariable analyses were adjusted for age, severe chronic pain, suspicion of recurrence, hernia characteristics, and surgical factors.</p><p><strong>Results: </strong>Among 26 384 patients (10 108 females and 16 276 males; 79.3% (26 384 of 33 267) response rate), crude rates indicated that females were more often dissatisfied across all three items: prepared for surgery (14.4% versus 8.9%), postoperative emotions (39.1% versus 21.7%), and recovery concerns (33.6% versus 21.7%). In adjusted analyses (23 201 patients), females were also found to be more dissatisfied: prepared for surgery (OR 1.40 (95% c.i. 1.28 to 1.53); P < 0.001), postoperative emotions (OR 2.00 (95% c.i. 1.88 to 2.13); P < 0.001), and recovery concerns (OR 1.61 (95% c.i. 1.51 to 1.71); P < 0.001). All three subgroup analyses showed similar patterns. Younger age, severe chronic pain, and suspicion of recurrence were independently associated with higher levels of dissatisfaction.</p><p><strong>Conclusion: </strong>These results show a possible sex-based disparity in perceived sufficiency of perioperative information, with higher dissatisfaction reported by females. These findings suggest that perioperative counselling may need to be tailored to better meet female patients' informational needs.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148221535","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":"Frailty and the efficacy and safety of surgical versus endovascular revascularization: post-hoc analysis of the BEST-CLI trial.","authors":"Darae Ko, Peter T Evans, Chan Mi Park, Bernet Kato, Maxwell Van Over, Michael S Conte, Mark Cziraky, Sachin J Shah, Ashvin N Pande, Naomi M Hamburg, Kenneth Rosenfield, Matthew T Menard, Alik Farber, Dae Hyun Kim","doi":"10.1093/bjs/znag067","DOIUrl":"10.1093/bjs/znag067","url":null,"abstract":"<p><strong>Background: </strong>Frailty is associated with mortality and adverse outcomes in chronic limb-threatening ischaemia (CLTI). Although prompt revascularization is recommended to reduce major adverse limb events (MALE), it is unclear whether frailty modifies the relative effectiveness of surgical versus endovascular therapy. The aim of this study was to assess whether the outcomes of these strategies differ by frailty status in the BEST-CLI randomized trial.</p><p><strong>Methods: </strong>A frailty index (FI; 0-1) was constructed using a deficit-accumulation approach; severe frailty was defined as an FI ≥0.45. The primary endpoint was MALE or death, and the safety endpoint was major adverse cardiovascular events (MACE). Patients with an adequate great saphenous vein (GSV) (cohort 1) and those requiring an alternative conduit (cohort 2) were analysed separately.</p><p><strong>Results: </strong>Of 1830 randomized patients, the FI was calculable for 1754 patients. Severe frailty was present in 654 patients (47.6%) in cohort 1 and 187 patients (49.3%) in cohort 2 and was associated with higher MALE or death regardless of treatment. In cohort 1, surgical bypass reduced the risk of MALE or death in both severely frail patients (51.0% versus 67.2%; HR 0.68 (95% c.i. 0.55 to 0.83)) and non-severely frail patients (35.4% versus 48.2%; HR 0.68 (95% c.i. 0.54 to 0.86)) versus endovascular therapy (interaction P = 0.95). In cohort 2, outcomes were similar between treatment groups across frailty strata. No interaction was observed between frailty and treatment strategy for MACE.</p><p><strong>Conclusion: </strong>In the BEST-CLI trial, severe frailty was associated with higher MALE or death. Among patients suitable for bypass with an adequate GSV, surgical bypass was more effective than endovascular therapy irrespective of frailty status.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13332751/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148146130","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}