The British journal of surgery最新文献

{"title":"Effects of multimodal prehabilitation on surgery outcomes: prospective stepped-wedge, hospital-wide implementation study.","authors":"Luuk D Drager, Femke Atsma, Dieuwke Strijker, Linda A G van Heusden-Scholtalbers, Monique J M D van Asseldonk, Jonas Rosenstok, Joost P H Seeger, Sjors Verlaan, Laurien M Buffart, Cornelis J H M van Laarhoven, Baukje van den Heuvel","doi":"10.1093/bjs/znag013","DOIUrl":"10.1093/bjs/znag013","url":null,"abstract":"<p><strong>Background: </strong>Multimodal prehabilitation may improve surgical outcomes in selected populations, but its real-world effectiveness remains unclear. The aim of this study was to evaluate the effect of hospital-wide implementation of multimodal prehabilitation on postoperative complications and length of hospital stay in a diverse surgical population.</p><p><strong>Methods: </strong>This single-centre, non-randomized stepped-wedge study (F4S PREHAB) was conducted at Radboudumc, Nijmegen, The Netherlands from March 2019 to April 2024. Patients who underwent elective surgery across 20 clinical pathways received either standard preoperative care or multimodal prehabilitation comprising supervised exercise, nutritional support, psychological counselling, and smoking and alcohol cessation support. The primary outcome was the incidence and severity of postoperative complications within 30 days, with assessment of Clavien-Dindo (CD) grade ≥II complications and the dichotomized Comprehensive Complication Index (CCI). The secondary outcome was the length of hospital stay. Analyses used generalized linear models adjusted for time of inclusion and clinical pathway, as well as other confounders in some models. Subgroup analyses focused on patients who underwent high-risk gastrointestinal (GI) oncological surgery.</p><p><strong>Results: </strong>During the study interval, 4131 patients received usual care (2660 patients) or prehabilitation (1471 patients). A total of 367 patients (24.9%) attended at least nine exercise sessions, indicating partial adherence. No significant differences between groups were found with regard to postoperative CD grade ≥II complications (adjusted risk ratio 1.02 (95% c.i. 0.90 to 1.16)) and CCI >22.6 (adjusted risk ratio 1.03 (95% c.i. 0.86 to 1.23)) or length of hospital stay (adjusted incidence rate ratio 1.04 (95% c.i. 0.92 to 1.18)). In the high-risk GI oncological surgery subgroup (1230 patients), the relative reduction in CD grade ≥II complication risk was 9%, but this was not statistically significant (adjusted risk ratio 0.91 (95% c.i. 0.75 to 1.10)).</p><p><strong>Conclusion: </strong>Hospital-wide implementation of multimodal prehabilitation did not reduce postoperative complications or length of hospital stay. A greater effect in high-risk patients suggests a targeted approach may be more effective. Future research should identify such patients and evaluate effectiveness of prehabilitation in this population.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208583","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":"Surgery for interplanetary space missions.","authors":"Raghav Khanna, Yang Li, Matthew Cook, Preeti Sawant, Raymond Hounon, Danielle Carroll, Lakita Lowe, Lukas Lindenroth, Toktam Mahmoodi, Nicholas Raison, Alejandro Granados, Anu Ojha, Christos Bergeles, Alberto Breda, Sebastien Ourselin, Prokar Dasgupta","doi":"10.1093/bjs/znag005","DOIUrl":"10.1093/bjs/znag005","url":null,"abstract":"<p><p>As human spaceflight expands beyond low Earth orbit, the ability to deliver advanced surgical care in space becomes critical. Current medical provisions on board the International Space Station (ISS) are geared towards treating low-risk conditions, with a 'stabilize-and-evacuate' principle for more complex cases-an approach that is not viable for extended missions to the Moon and Mars. This review summarizes research conducted around space surgery, with a particular focus on surgical robotics. Experiments in parabolic flight and analogue environments demonstrate that, provided the operator, patient, and instruments are restrained, surgical skill is largely unaffected by reduced gravity. Robotic surgery has primarily been explored in remote undersea habitats and in limited flight studies. There are several challenges to the implementation of surgical systems in space, including size, weight, and power constraints, communication latency, and crew training. Means of fluid and debris containment, provision of anaesthesia, and postoperative recovery in altered physiology must also be considered. The key features of an ideal space surgery robotic set-up are outlined. It should be compact, multifunctional, adaptable, reliable, and optimized in technical design and material composition for use in habitable volumes. Such systems should incorporate artificial intelligence (AI)-driven decision-making support, variable autonomy, and human-in-the-loop control. Crew members must be trained and supported to deliver and recover from surgical care in space. Cloud and edge computing will mitigate latency while expanding on-board data processing capabilities. Although not yet operationally mature, robotic surgery is a critical capability for future exploratory space missions, but requires continued multidisciplinary development.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 3","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147446521","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":"Survival after pathological complete response following neoadjuvant chemotherapy versus chemoradiotherapy for oesophageal squamous cell carcinoma.","authors":"Jun Okui, Satoru Matsuda, Kengo Nagashima, Yasunori Sato, Hirofumi Kawakubo, Thomas Ruhstaller, Peter Thuss-Patience, Magnus Nilsson, Fredrik Klevebro, Lijie Tan, Shaoyuan Zhang, Thomas Aparicio, Guillaume Piessen, Charlène van der Zijden, Bianca Mostert, Bas P L Wijnhoven, Takahiro Tsushima, Hiroya Takeuchi, Ken Kato, Yuko Kitagawa","doi":"10.1093/bjs/znag012","DOIUrl":"10.1093/bjs/znag012","url":null,"abstract":"<p><strong>Background: </strong>Although several oesophageal squamous cell carcinoma (OSCC) studies have reported no definitive overall survival (OS) differences between neoadjuvant chemoradiotherapy (NACRT) and neoadjuvant chemotherapy (NAC), the higher pCR rate with NACRT has been viewed as a potential advantage. Beyond ongoing concerns about the validity of pCR as a surrogate endpoint, it remains uncertain whether survival differs between these modalities among patients with OSCC who achieve pCR.</p><p><strong>Methods: </strong>An integrated analysis of individual patient data (IPD) from phase III trials evaluating perioperative therapies for resectable OSCC was conducted, emphasizing prognostic differences between NAC and NACRT, particularly among patients who achieved pCR.</p><p><strong>Results: </strong>IPD from seven phase III RCTs across six countries included data for 1044 patients with OSCC (83.5% male; mean age of 62.3 years). Of these patients, 605 (58.0%) received NAC and 439 (42.0%) received NACRT, with R0 resection rates of 89.6% versus 84.7% and pCR rates of 6.9% versus 34.2% respectively. Among patients who achieved pCR (192 patients), 5-year OS was 97.5% in the NAC group and 70.4% in the NACRT group, while 5-year recurrence-free survival was 80.8% and 63.7% respectively. Multivariable analysis demonstrated a significant survival advantage for NAC among patients who achieved pCR.</p><p><strong>Conclusion: </strong>Among patients who achieved pCR, postoperative outcomes varied considerably by neoadjuvant treatment modality. The markedly favourable prognosis associated with pCR after NAC suggests that these patients may represent an optimal candidate cohort for future evaluation of surgery-avoidance and watch-and-wait strategies.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146208604","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 stakeholder-informed framework for the implementation of surgical sabermetrics to enhance training and education.","authors":"Lachlan Dick, Emma Howie, Joel Norton, Connor Boyle, Andrew Merriman, Victoria Ruth Tallentire, Roger D Dias, Douglas S Smink, Richard J E Skipworth, Steven Yule","doi":"10.1093/bjs/znag009","DOIUrl":"10.1093/bjs/znag009","url":null,"abstract":"<p><strong>Background: </strong>Surgical training relies heavily on subjective performance evaluation, which is resource-intensive and prone to assessor bias. Advances in digital surgery offer opportunities for objective assessment. While validity evidence for data-driven assessments increases, strategies for implementation in surgical training remain scarce. The aim of this study was to leverage stakeholder insights to develop an implementation framework for integrating data-driven surgical sabermetrics into training curricula.</p><p><strong>Methods: </strong>Structured workshops were conducted at two international surgical conferences (the Association of Surgeons of Great Britain and Ireland Congress, Edinburgh, May 2025 and the International Conference on Surgical Education and Training, Edinburgh, June 2025). Delegates participated in facilitated discussions, interactive polling, and group concept-mapping exercises to explore opportunities, delivery modalities, access rights, and contextualization for surgical performance metrics. Stakeholder perceptions were used to iteratively develop an implementation framework, balancing applicability to current training pathways and capturing the nuances of data-driven insights.</p><p><strong>Results: </strong>A total of 54 surgical trainees and trainers from 13 countries contributed. Opportunities centred on enhancing objective feedback, assessing non-technical skills, and tracking trainee progression. Video-based delivery and real-time feedback were prioritized for technical skills, dashboards were prioritized for non-technical and cognitive skills, and structured reports were prioritized for performance-based metrics. Supervising surgeons and training leads were identified as essential users of trainee data, with integration of multimodal data (for example surgeon physiology, case complexity) deemed essential for contextualization.</p><p><strong>Conclusion: </strong>This study presents an implementation framework for surgical sabermetrics in training. The framework provides practical guidance on delivery, access, and integration of performance metrics, supporting data-driven feedback to optimize trainee development, advance surgical education, and improve patient outcomes.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13016916/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146152085","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":"Stroke risk and mid-term survival by proximal extent of endovascular aortic repair.","authors":"Gisli Jonsson, Kevin Mani, Anders Wanhainen, David Lindström","doi":"10.1093/bjs/znag008","DOIUrl":"10.1093/bjs/znag008","url":null,"abstract":"<p><strong>Background: </strong>Recent advancements in endovascular aortic repair (EVAR) have expanded treatment to increasingly proximal aortic segments, including the thoracic and thoracoabdominal aorta as well as the arch. Coherent real-world data on stroke risk after EVAR, stratified by the proximal landing zone, and the impact of perioperative stroke on mid-term survival are scarce.</p><p><strong>Methods: </strong>A population-based multiregistry retrospective analysis was performed on prospectively collected data for all EVARs performed in Sweden between 15 May 2018 and 15 May 2023. Data were collected from the Swedish Vascular Registry (Swedvasc) and cross-referenced with the Swedish Patient Registry, the Swedish Cause of Death Registry, and the Swedish Stroke Registry. The effect of perioperative stroke on mid-term survival was analysed and the relationship between the incidence of stroke and the proximal landing zone was analysed.</p><p><strong>Results: </strong>Some 4842 EVARs were performed. Perioperative stroke occurred in 1.6% (79 of 4842). Stroke risk was associated with the proximal landing zone, with a stroke rate of 22% in zone 0. In multivariable analysis, the OR for stroke in zone 0 was 41.58 (95% c.i. 18.46 to 93.70); P < 0.001. The 30-day mortality rate was 24% (19 of 79) and 3.5% (169 of 4763) for patients with and without perioperative stroke respectively. This difference persisted over time, with a 4-year survival probability of 48.6% and 72.5% for patients with and without stroke respectively (HR 2.17 (95% c.i. 1.26 to 3.72); P < 0.001).</p><p><strong>Conclusion: </strong>Stroke is strongly associated with the proximal landing zone, being more likely when landing proximal to the supra-aortic vessels. Perioperative stroke impacts patient survival and should be taken into consideration during patient selection, and efforts should be made to reduce the risk of stroke during proximal repair.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146133973","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":"Acute cholangitis.","authors":"Erik von Seth, Mari Hult","doi":"10.1093/bjs/znag010","DOIUrl":"10.1093/bjs/znag010","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146159997","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":"Anal high-grade squamous intraepithelial lesions: identification, classification, and management.","authors":"Emanuel Cavazzoni, Mariangela Desantis, Carlo Vivaldi, Hartmut Schäfer, Massimiliano Mistrangelo","doi":"10.1093/bjs/znag006","DOIUrl":"10.1093/bjs/znag006","url":null,"abstract":"<p><p>Squamous intraepithelial lesions are premalignant conditions for anal cancer, the incidence of which is slowly increasing worldwide. These premalignant lesions are commonly found in high-risk individuals such as those who are immunosuppressed, and men who have sex with men. The development of squamous intraepithelial lesions is driven by chronic human papillomavirus infection that induces cellular proliferation and dysplastic modification in mucosal and cutaneous epithelia. Among a wide family of human papillomavirus strains, high-risk genotypes such as human papillomavirus 16 and 18 are responsible for most high-grade precancerous lesions and their subsequent progression to invasive cancer. Historically, premalignant lesions have been described by a variety of different classification systems that has changed as our understanding of their pathophysiology has evolved. Precancerous lesions are currently classified based on the degree of dysplasia in the anal epithelium. Anal intraepithelial neoplasia I or low-grade squamous intraepithelial neoplasia (LSIL) describes a low-grade dysplastic lesion capable of spontaneous regression, while anal intraepithelial neoplasia III or high-grade squamous intraepithelial neoplasia (HSIL) describes those lesions with capacity for infiltration and malignant change. The need for active screening in high-risk groups is now established, as proactive treatment of HSIL significantly reduces the development of anal cancer. High-resolution anoscopy is a diagnostic modality that allows for the identification and treatment of anal dysplasia, halting its progression to squamous cell carcinoma. Using vital dyes and dedicated instruments offering high magnification and resolution, it is possible to visualize and treat very small and/or flat premalignant lesions that would be invisible on standard diagnostic anoscopy. The evolution of artificial intelligence is set to further enhance its diagnostic ability, and shorten the learning curve for its implementation.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 3","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13034544/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147577578","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":"Correction to: International Federation for the Surgery and Other Therapies for Obesity (IFSO) global consensus recommendations for optimizing outcomes after sleeve gastrectomy.","authors":"","doi":"10.1093/bjs/znag011","DOIUrl":"10.1093/bjs/znag011","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":"113 3","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358740","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":"Generative AI for synthetic surgical training videos.","authors":"Daniel Caballero, Juan A Sánchez-Margallo, Francisco M Sánchez-Margallo","doi":"10.1093/bjs/znag017","DOIUrl":"10.1093/bjs/znag017","url":null,"abstract":"","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147292160","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":"Locoregional and systemic control after total neoadjuvant therapy with short-course radiotherapy for locally advanced rectal cancer: long-term outcomes from the LARCT-US study.","authors":"Israa Imam, Per J Nilsson, Tanweera Khan, Eva Angenete, Bengt Glimelius","doi":"10.1093/bjs/znag014","DOIUrl":"10.1093/bjs/znag014","url":null,"abstract":"<p><strong>Background: </strong>Total neoadjuvant treatment (TNT) results in more complete responses and less risk of distant metastasis (DM) compared with chemoradiotherapy in locally advanced rectal cancer (LARC). The best schedule and the most suitable patients are unknown. In Sweden, after the closure of the RAPIDO trial, all hospitals in five out of six healthcare regions treated LARC patients with an abbreviated RAPIDO schedule, LARCT-US. Long-term data are reported.</p><p><strong>Methods: </strong>Between July 2016 and June 2020, LARC patients with at least one high-risk criterion for recurrence according to staging MRI (cT4, cN2, mesorectal fascia involvement <1 mm, extramural vascular involvement, lateral node involvement) received TNT consisting of 5 × 5 Gy followed by four cycles of CAPOX/six cycles of FOLFOX.</p><p><strong>Results: </strong>Curatively treated patients (437 of 462) were analysed after a median of 6.5 (interquartile range 5.9-7.2) years of follow-up. cT4 was seen in 53.5%. Sixty-two patients with a cCR entered a watch-and-wait programme (21 patients with regrowth) and 375 patients underwent primary surgery. At 5 years, of the 437 patients, locoregional recurrence (LRR) occurred in 26 patients (5.9% (95% c.i. 3.7% to 8.2%)) and DM occurred in 108 patients (24.7% (95% c.i. 20.7% to 28.7%)). The distal resection margin was ≤10 mm in 8.3% of patients after a sphincter-saving procedure (a lower percentage than in RAPIDO). The 109 patients (24.9%) with a complete response (48 patients with a cCR sustained for >1 year after the start of radiotherapy and 61 patients with a pCR) had excellent outcomes (0% with LRR and 3.7% with DM).</p><p><strong>Conclusion: </strong>TNT consisting of 5 × 5 Gy followed by four cycles of CAPOX/six cycles of FOLFOX resulted in excellent locoregional and distant control, despite inclusion of more advanced tumours than previous TNT studies. The low LRR risk in LARCT-US could be explained by more adequate distal resection margins practiced at Swedish centres.</p>","PeriodicalId":520792,"journal":{"name":"The British journal of surgery","volume":" ","pages":""},"PeriodicalIF":8.8,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13017942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146222766","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}