The British journal of surgery最新文献

{"title":"Diagnostic accuracy of staging laparoscopy and development of a simple predictive score for peritoneal disease in advanced gastric cancer.","authors":"Kensuke Kudou, Tomoyuki Irino, Motonari Ri, Masaru Hayami, Souya Nunobe","doi":"10.1093/bjs/znag068","DOIUrl":"10.1093/bjs/znag068","url":null,"abstract":"<p><strong>Background: </strong>Staging laparoscopy (SL) enables direct detection of peritoneal disease (PD), including peritoneal dissemination (P1) and positive peritoneal cytology (CY1), which are often undetectable by preoperative imaging for patients with gastric cancer (GC). The aim of this study was to evaluate the diagnostic accuracy of SL and to develop a simple preoperative scoring system for predicting PD.</p><p><strong>Methods: </strong>A total of 889 patients with advanced GC who underwent SL were retrospectively reviewed. After excluding 128 post-chemotherapy patients, 761 treatment-naive patients were analysed. Clinicopathological variables were compared between PD- and PD+ groups, and predictors of PD were identified. A simple predictive score was constructed based on significant independent factors.</p><p><strong>Results: </strong>PD was detected by SL in 418 patients (54.9%). Positivity rates by indication were 61.7% for type 4 tumours, 51.1% for large type 3 tumours (diameter ≥8 cm), 24.2% for bulky lymph nodes or para-aortic lymph node enlargement, and 76.8% for CT-suspected peritoneal dissemination. The sensitivity, specificity, and overall accuracy of SL were 94.6%, 100%, and 96.8% respectively. Multivariate analysis identified four independent predictors of PD: carbohydrate antigen 19-9 (CA19-9) >37 U/ml; cancer antigen 125 (CA125) >35 U/ml; poorly differentiated or signet-ring cell histology; and pan-regional tumour involvement. A scoring system (range 0-6) based on these variables demonstrated a stepwise increase in PD incidence, from 32.4% for a score of zero to 100% for a score of six.</p><p><strong>Conclusion: </strong>SL demonstrates excellent diagnostic accuracy for detecting PD in advanced GC. The proposed four-factor predictive score provides a simple and practical tool for estimating PD risk, potentially allowing for more selective and rational use of SL.</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":"148195338","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":"Interventions to reduce postoperative mortality in low- and middle-income countries: systematic review.","authors":"Liam N Phelan, Anita E Agbeko, Alazar B Aregawi, Aneel A Bhangu, Parvez D Haque, Sivesh K Kamarajah, Maria Picciochi, Sandrine Zola, Dmitri Nepogodiev, James Glasbey","doi":"10.1093/bjs/znag038","DOIUrl":"10.1093/bjs/znag038","url":null,"abstract":"<p><strong>Background: </strong>Postoperative mortality is the third leading cause of death worldwide and disproportionately affects patients in low- and middle-income countries (LMICs). Although many deaths are potentially preventable, evidenced-based interventions remain limited. The aim of this systematic review was to consolidate randomized trial evidence on interventions designed to reduce postoperative mortality in LMICs.</p><p><strong>Methods: </strong>Medical databases from database inception to February 2025 were systematically searched for randomized trials evaluating interventions in any aspect of the patient pathway from admission to discharge that were designed to reduce postoperative mortality within 90 days of surgery in LMIC patients. Eligible studies included elective and emergency operations across all surgical specialties. The protocol was preregistered in PROSPERO, the international prospective register of systematic reviews (CRD42024604760).</p><p><strong>Results: </strong>From 10 877 search results, some 18 trials involving 95 521 patients were included. Three were multicountry trials and half were conducted in China. Trials spanned multiple specialties, with only 4 of 18 assessed as having a low risk of bias. Four trials showed a significant reduction in mortality, although the interventions were largely context specific (two neurosurgical trials centred on operative technique in China, one Brazilian trial investigating patient blood management, and one study evaluating maternal death reviews and implementation of best practice after caesarean deliveries in Senegal and Mali). Adherence to interventions was generally high and similar between simple and complex interventions (93.6% versus 96.8% respectively), although adherence varied substantially across trials.</p><p><strong>Conclusion: </strong>Few RCTs have targeted postoperative mortality in LMICs and no intervention demonstrated consistent effectiveness across multiple contexts. To maximize clinical impact, future research should prioritize the development of interventions in regions with the greatest need, particularly sub-Saharan Africa, and ensure they are co-developed with LMIC interest holders and evaluated across diverse clinical environments.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13273424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147966933","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":"Rectal cancer in the era of precision oncology: more options, more uncertainty.","authors":"Reza Mirnezami","doi":"10.1093/bjs/znag059","DOIUrl":"10.1093/bjs/znag059","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13235850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147871363","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":"Development of a robotic training curriculum for visceral and gastrointestinal surgical trainees: an international Delphi study.","authors":"Michael G Fadel, Josephine Walshaw, Marina Yiasemidou, Matthew Boal, Francesca Pecchini, Muhammed Elhadi, Lisa H Massey, Francesco M Carrano, Matyas Fehervari, Caoimhe M Walsh, Piers R Boshier, Jennifer Eckhoff, Peter Buckle, Suzanne S Gisbertz, Nicole Bouvy, Alberto Arezzo, Silvana Perretta, Felix Nickel, Jim Khan, George B Hanna, Barbara Seeliger, Stavros A Antoniou, Hans F Fuchs, Nader K Francis, Christos Kontovounisios","doi":"10.1093/bjs/znag054","DOIUrl":"10.1093/bjs/znag054","url":null,"abstract":"<p><strong>Background: </strong>The rapid adoption of robotic surgical systems globally has created a critical gap in training, assessment, and certification for visceral and gastrointestinal (GI) surgical trainees. This study, led by the European Association for Endoscopic Surgery (EAES), aimed to achieve an international consensus on a structured, platform-agnostic robotic training curriculum for GI surgical trainees.</p><p><strong>Methods: </strong>A 106-item Delphi questionnaire was developed with an international committee of surgical experts, trainees, methodologists, and patient representatives. It was disseminated to a multidisciplinary panel of 83 GI robotic surgeons, trainees, human factor experts, robotic theatre team members, and industry providers. Two Delphi survey rounds were conducted, with a priori consensus standard set at 70% or higher for agreement. A consensus meeting was subsequently held to discuss and finalise the items needed for a robotic training curriculum for GI surgery trainees.</p><p><strong>Results: </strong>Seventy-one (86%) participants from 15 countries completed round one. A total of 82 items (77%) reached consensus and 32 new items were generated from free-text comments. Seventy of these participants (99%) completed the 56-item round two questionnaire, with 36 items (64%) reaching consensus and 5 new items generated. All 143 statements were discussed in the meeting and consensus was reached in the following areas: (i) key knowledge requirements of the bedside assistant and console surgeon; (ii) training components; (iii) performance assessment; and (iv) certification and supervision.</p><p><strong>Conclusion: </strong>International surgical experts, trainees, and other key stakeholders reached consensus on the critical components of a platform-agnostic robotic training curriculum for GI surgical trainees. This will help shape the future of robotic surgical education and certification, promote standardised training practices, and ultimately benefit patient safety and outcomes.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 6","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13280418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280858","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":"Postoperative nausea and vomiting.","authors":"Joaquín Mascaró-Martínez, Nathalie Santana Castaño, Nicolas M González-Senac","doi":"10.1093/bjs/znag057","DOIUrl":"10.1093/bjs/znag057","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849363","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":"Clinical and economic impact of incisional negative pressure wound therapy in breast surgery: meta-analysis.","authors":"Christos Kollatos, Helena Sackey, Eirini Pantiora, Denise Vorburger, Nicola Rocco, Catarina Öhrn, Antonios Valachis, Staffan Eriksson, Andreas Karakatsanis","doi":"10.1093/bjs/znag056","DOIUrl":"10.1093/bjs/znag056","url":null,"abstract":"<p><strong>Background: </strong>Wound complications after breast surgery are common and contribute to morbidity and healthcare costs. The economic value of prophylactic incisional negative-pressure wound therapy (iNPWT) remains uncertain. This study evaluated the effectiveness and cost-effectiveness of iNPWT in preventing postoperative wound complications (freedom from complication) following breast surgery through a systematic review and meta-analysis.</p><p><strong>Methods: </strong>MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched without any restrictions up to 5 March 2025. Randomized trials and prospective or retrospective cohort studies comparing prophylactic iNPWT with standard dressings were included. Two reviewers independently extracted data, assessed risk of bias (RoB 2, ROBINS-I), and graded evidence certainty (GRADE). Random-effects meta-analyses were performed, and cost-effectiveness modelling focused on surgical site infection (SSI).</p><p><strong>Results: </strong>Twenty-nine studies including 4904 patients (1817 iNPWT; 3087 controls) were analysed. iNPWT was associated with higher rates of wound dehiscence prevention (RR 1.07, 95% c.i. 1.03 to 1.12), SSI prevention (RR 1.05, 95% c.i. 1.01 to 1.09), and skin necrosis prevention (RR 1.07, 95% c.i. 1.01 to 1.15). No significant differences were observed for seroma, nipple-areolar complex necrosis, or haematoma. Across outcomes, heterogeneity was substantial and 95% prediction intervals crossed the null, indicating uncertainty in the direction of effect in future settings. Evidence certainty ranged from low to moderate. Cost modelling suggested that iNPWT may be cost-saving only in settings with high SSI-related costs.</p><p><strong>Conclusions: </strong>Current evidence does not establish consistent clinical benefit of prophylactic iNPWT in breast surgery. Cost-effectiveness appears limited to high-risk or high-cost contexts, supporting selective use.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13244580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849340","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":"Economic evaluation of lymphaticovenous anastomosis versus conservative therapy for breast cancer-related lymphoedema: secondary outcome analysis of a randomized clinical trial.","authors":"Alieske Kleeven, Yasmine M J Jonis, Olivia Currie, Joost Wolfs, Merel Kimman, Hanneke Tielemans, René R W J van der Hulst, Stefan Hummelink, Shan Shan Qiu","doi":"10.1093/bjs/znag062","DOIUrl":"10.1093/bjs/znag062","url":null,"abstract":"<p><strong>Background: </strong>Lymphaticovenous anastomosis (LVA) is an increasingly applied microsurgical option for lymphoedema. The aim of this study was to evaluate the cost-effectiveness of LVA combined with complex decongestive therapy (CDT) versus CDT alone for breast cancer-related lymphoedema (BCRL).</p><p><strong>Methods: </strong>A cost-effectiveness analysis was performed as a pre-specified secondary outcome of an RCT comparing LVA combined with CDT versus CDT alone. The primary outcome of the trial was health-related quality of life (HRQoL). A societal perspective with a 2-year time horizon was adopted. Quality-adjusted life-years (QALYs) were derived from the EuroQol five-dimension, five-level (EQ-5D-5L) questionnaire. Uncertainty was assessed using bootstrapping and sensitivity analysis. Data were collected from four Dutch hospitals. The primary outcome was the incremental cost-effectiveness ratio (ICER).</p><p><strong>Results: </strong>One hundred female patients were included (mean age 58.5 years). Over 2 years, mean total costs were €16 234 (LVA) versus €14 293 (CDT); adjusted mean difference €78 (95% c.i. -€6044 to €6200). Mean(s.e.) QALYs were 1.636(0.003) (LVA) versus 1.579(0.002) (CDT); adjusted mean difference 0.045 (95% c.i. -0.021 to 0.112). The ICER from a societal perspective was €1716/QALY, with probabilities of cost-effectiveness of 0.60 and 0.71 at the €20 000 and €50 000 willingness-to-pay thresholds respectively. From a healthcare perspective, the ICER was €59 679/QALY, with probabilities of cost-effectiveness of 0.08 and 0.42 at the same thresholds respectively.</p><p><strong>Conclusion: </strong>LVA combined with CDT was more costly than CDT alone, but societal costs were limited during the 2-year follow-up interval. The LVA group acquired slightly more QALYs. From a societal perspective, LVA combined with CDT has the potential to be cost-effective, particularly when performed under local anaesthesia.</p><p><strong>Registration number: </strong>NCT02790021 (http://www.clinicaltrials.gov).</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13289813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147985095","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":"Rectus sheath catheters versus thoracic epidural analgesia for pain management after open surgery: systematic review and meta-analysis.","authors":"Christian D Fankhauser, Stefan Breitenstein, Hans Gelpke, Caveh Madjdpour, Gesine Meili, Leila Sultan-Beyer, Thomas R Wyss, Ernest Kaufmann","doi":"10.1093/bjs/znag058","DOIUrl":"10.1093/bjs/znag058","url":null,"abstract":"<p><strong>Background: </strong>Thoracic epidural analgesia (TEA) remains the 'gold standard' for postoperative pain management after major open surgery, but is potentially associated with hypotension, urinary retention, and delayed recovery. Rectus sheath catheters (RSCs) offer a simple regional alternative that avoids sympathetic blockade while maintaining somatic analgesia. The aim of this review was to compare analgesic efficacy, complications, recovery, patient satisfaction, and costs between RSCs and TEA in open surgical procedures.</p><p><strong>Methods: </strong>This systematic review was registered with PROSPERO, the international prospective register of systematic reviews (registration number: CRD420251234467). A systematic PubMed search was conducted to identify studies comparing continuous wound infusion via RSCs with TEA in adult patients undergoing open abdominal, pelvic, thoracic, or vascular surgery. RCTs, as well as prospective and retrospective comparative studies, were included. A meta-analysis was performed for randomized trials.</p><p><strong>Results: </strong>In total, 31 studies (21 prospective and 10 retrospective) involving 2162 patients were included. RSCs and TEA did not differ significantly with respect to postoperative pain (standardized mean difference -0.35 (95% c.i. -2.01 to 1.32)) or opioid consumption (standardized mean difference -0.32 (95% c.i. -1.71 to 1.07)). No differences were observed in recovery of bowel function, urinary retention, time to mobilization, or length of hospital stay. RSCs significantly reduced the risk of hypotension compared with TEA (risk ratio 0.40 (95% c.i. 0.26 to 0.60)) and were associated with lower costs with savings ranging from $500 to $6632 per case. Subgroup analyses suggested less urinary retention and earlier mobilization with RSCs in non-visceral surgery and non-laparotomy incisions.</p><p><strong>Conclusion: </strong>RSCs provide analgesia comparable to TEA with fewer complications, facilitating earlier recovery and potential cost savings. Considering the growing shift toward fast-track surgery, RSCs represent a pragmatic and resource-efficient alternative for postoperative pain management in open surgical procedures.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147937224","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":"Chemotherapy followed by pelvic reirradiation versus chemotherapy alone as preoperative treatment for locally recurrent rectal cancer (GRECCAR 15): superiority open-label phase III randomized clinical trial.","authors":"Quentin Denost, Laurent Ghouti, Jean-Jacques Tuech, Philippe Rouanet, Adeline Germain, Emmanuel Rio, Jean-Luc Faucheron, Mehrdad Jafari, Eddy Cotte, Laurent Mineur, Cécile De Chaisemartin, Jérémie H Lefevre, Aude Merdrignac, Remi Sitta, Eric Frison, Véronique Vendrely","doi":"10.1093/bjs/znag061","DOIUrl":"https://doi.org/10.1093/bjs/znag061","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147937176","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":"Primary tumour resection reduces the risk of major local morbidity in de novo stage IV breast cancer: secondary data analysis from the JCOG1017 randomized clinical trial.","authors":"Makoto Ishitobi, Kiyo Tanaka, Akihiko Shimomura, Takashi Yamanaka, Takahiro Tsukioki, Hiroji Iwata, Fumikata Hara, Tomomi Fujisawa, Keita Sasaki, Riku Kajikawa, Takehiko Sakai, Yasuaki Sagara, Hideo Shigematsu, Yukinori Ozaki, Kazuki Nozawa, Kazuki Sudo, Yoichi Naito, Kaori Terata, Toshiyuki Ishiba, Haruhiko Fukuda, Tadahiko Shien","doi":"10.1093/bjs/znag052","DOIUrl":"10.1093/bjs/znag052","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960385","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}