Annals of the Royal College of Surgeons of England最新文献_第4页

Effectiveness of epidural anaesthesia induced by different dosages of ropivacaine combined with lidocaine in geriatric orthopaedic surgery. 不同剂量罗哌卡因联合利多卡因硬膜外麻醉在老年骨科手术中的效果观察。

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-29 DOI: 10.1308/rcsann.2025.0055

J Li, Q Yao, J Shi, P Jiang

{"title":"Effectiveness of epidural anaesthesia induced by different dosages of ropivacaine combined with lidocaine in geriatric orthopaedic surgery.","authors":"J Li, Q Yao, J Shi, P Jiang","doi":"10.1308/rcsann.2025.0055","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0055","url":null,"abstract":"Objective: This paper unravelled the effectiveness of epidural anaesthesia induced by different dosages of ropivacaine combined with lidocaine in geriatric orthopaedic surgery.Methods: Elderly orthopaedic surgical patients who underwent epidural anaesthesia were allocated into three groups: Group I (0.375% ropivacaine+1% lidocaine), Group II (0.50% ropivacaine+1% lidocaine) and Group III (0.75% ropivacaine+1% lidocaine), to compare the sensory and motor blockade effects, the occurrence of cognitive function and cognitive dysfunction, and the occurrence of adverse reactions.Results: The onset time of sensory blockade and the appearance time of the highest plane were significantly earlier and the maintenance time of the highest plane was significantly longer, the onset time of motor blockade was notably earlier, the maintenance time of the highest plane was markedly longer, and the modified Bromage score was distinctly higher in Group II and Group III in comparison with Group I (p<0.05). The postoperative 12- and 24-h Mini-Mental State Examination scores were higher and the incidence of postoperative 12h-cognitive impairment was lower in Group III than in Group I and Group II (p<0.05). There was no statistically significant difference in the incidence of adverse reactions in patients among the three groups (p>0.05).Conclusions: Epidural anaesthesia combining 0.75% ropivacaine with 1% lidocaine in elderly orthopaedic surgical patients has a rapid onset of action, a long duration of anaesthesia maintenance, a low overall impact on cognitive function, and good medication safety.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726879","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}

引用次数: 0

Effect of stump-preserving arthroscopic reconstruction or stump-eliminating arthroscopic reconstruction combined with exercise rehabilitation therapy on knee functional recovery in patients with anterior cruciate ligament injuries. 残肢保留关节镜重建或残肢消除关节镜重建联合运动康复治疗对前交叉韧带损伤患者膝关节功能恢复的影响

IF 1.7 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-29 DOI: 10.1308/rcsann.2025.0056

S Li, S Tang, B Zhu, Y Zhong, X Ren

{"title":"Effect of stump-preserving arthroscopic reconstruction or stump-eliminating arthroscopic reconstruction combined with exercise rehabilitation therapy on knee functional recovery in patients with anterior cruciate ligament injuries.","authors":"S Li, S Tang, B Zhu, Y Zhong, X Ren","doi":"10.1308/rcsann.2025.0056","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0056","url":null,"abstract":"Introduction: The aim of this study was to evaluate the effect of stump-preserving arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) combined with exercise rehabilitation therapy on knee functional recovery in patients with ACL injuries.Methods: Patients with ACL injuries (n = 120) were randomly divided into an observation group (60 patients; stump-preserving ACLR) or a control group (60 patients; stump-eliminating ACLR) using the randomised numerical table method. Both groups underwent a 12-week postoperative exercise rehabilitation treatment. Pain, swelling and range of motion (ROM) were recorded. Before reconstruction, and at 3, 6 and 12 months after reconstruction, proprioception was assessed by threshold to detection of passive motion (TTDPM) and passive angle regeneration test, and knee function was assessed using Lysholm and International Knee Documentation Committee (IKDC) function scores. Postoperative complications were recorded in both groups.Results: After ACLR, in both groups, pain and swelling were reduced, the ROM of knee flexion, extension, internal rotation and external rotation increased, the TTDPM and passive angle regeneration test results were reduced, and the Lysholm and IKDC function scores were increased. More significant improvements were seen in the observation group. The incidence of postoperative complications in the observation group was 13.33% (8 of 60), less than the 15.00% (9 of 60) in the control group (p > 0.05).Conclusions: Arthroscopic stump-preserving ACLR combined with exercise rehabilitation therapy can significantly reduce postoperative pain and swelling in patients with ACL injuries and improve postoperative knee mobility and proprioception.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726878","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}

引用次数: 0

Designing a new orthopaedic trauma meeting proforma to improve documentation in a large UK teaching hospital. 设计一种新的骨科创伤会议形式，以改善英国一家大型教学医院的文件。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-24 DOI: 10.1308/rcsann.2025.0043

D J Warrington, C R Yip, A Kassir, N Nadar, K Elcock, C Peach

{"title":"Designing a new orthopaedic trauma meeting proforma to improve documentation in a large UK teaching hospital.","authors":"D J Warrington, C R Yip, A Kassir, N Nadar, K Elcock, C Peach","doi":"10.1308/rcsann.2025.0043","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0043","url":null,"abstract":"Introduction: In England, around two million fractures occur annually, with 250,000 requiring hospital admission. At Wythenshawe Hospital, the Trauma and Orthopaedic service discusses 10-15 new patient cases every weekday. We aimed to design and implement a structured proforma for the trauma meeting to ensure clear documentation of trauma meeting discussions and orthopaedic plans for each new patient at Wythenshawe Hospital.Methods: Based on a literature search, input from orthopaedic surgeons and analysis of existing documentation, we created a proforma. We collected data in four phases: pre-implementation (1-10 October 2022), post-initial proforma (11-20 October 2022), post-updated proforma (20-30 October 2022) and long-term effectiveness (20-24 November 2023).Results: Phase 1: 90 cases reviewed; 64% had inadequate documentation. Key details were often missing. Phase 2: After proforma implementation, 98 cases reviewed; documentation increased to 94%. Significant improvements in recording consultant names (92%), imaging (59%) and diagnosis (80%). Phase 3: After feedback update, 108 cases reviewed; 88% had documentation. Improvements in documentation of imaging (85%) and weight-bearing status (57%). Phase 4: One year later, 85 cases reviewed; documentation at 84%. Key details such as consultant names and imaging reached 100% completion, diagnosis at 97%.Conclusions: This study proposes a standardised trauma meeting proforma to enhance the efficiency and accuracy of trauma meeting documentation. Our findings highlight the need for professional bodies to establish guidelines for trauma meeting handovers. We encourage further research into effective trauma meetings and suggest our proforma as a template for other orthopaedic departments to adapt to their needs.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697487","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}

引用次数: 0

Immersive robotic colorectal training in the United Kingdom is safe and efficient. 英国的沉浸式机器人结肠直肠训练安全高效。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-24 DOI: 10.1308/rcsann.2024.0105

J Franklyn, P Vaughn Shaw, M Abdalkoddus, R Coates, S Holtham, G Farook

{"title":"Immersive robotic colorectal training in the United Kingdom is safe and efficient.","authors":"J Franklyn, P Vaughn Shaw, M Abdalkoddus, R Coates, S Holtham, G Farook","doi":"10.1308/rcsann.2024.0105","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0105","url":null,"abstract":"Introduction: With increased utilisation of robotics in surgery, the demand for structured training is increasing. This paper presents the safety and efficacy profile of a robotic colorectal fellowship in the United Kingdom.Methods: This is a retrospective study conducted in a district general hospital between 2019 and 2023. Procedures performed using the Da Vinci robot were divided into two cohorts, those performed by robotic fellows and those performed by consultant surgeons. Each fellowship lasted on average six months and at the end of the fellowship the trainee had completed the mandatory requirements to be certified as a robotic surgeon. The objective of this study is to compare the outcomes of procedures performed by the fellows with those performed by consultants.Results: Of the 224 robotic procedures recorded, 117 were performed by consultants and 107 by fellows. The median time to complete the procedure was 315min vs 257min for consultants and fellows, respectively. The average postoperative length of stay was 6 and 7 days, the anastomotic leak rate was 4.3% and 5.6% and reoperation rate was 11% and 9% for procedures performed by consultants and fellows, respectively. The median lymph nodal yield was 17 in both groups and the margin positivity rate (R1) resection rate was 7% and 4% (p = 0.4) for procedures performed by consultants and fellows.Conclusion: It is possible to safely train in robotic colorectal surgery without compromising patient safety, oncological outcomes or adversely affecting theatre efficiency.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697488","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}

引用次数: 0

Suprapubic catheter insertion: a multicentre review on mortality during short-, medium- and long-term follow-up. 耻骨上置管：一项关于短期、中期和长期随访期间死亡率的多中心综述。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-24 DOI: 10.1308/rcsann.2025.0058

C Rao, M Taheem, I Nnorom, S Veer, T Mahesan, N Faure Walker, T Nitkunan

{"title":"Suprapubic catheter insertion: a multicentre review on mortality during short-, medium- and long-term follow-up.","authors":"C Rao, M Taheem, I Nnorom, S Veer, T Mahesan, N Faure Walker, T Nitkunan","doi":"10.1308/rcsann.2025.0058","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0058","url":null,"abstract":"Introduction: The aim of this study was to improve shared and informed decision making regarding real-world mortality rates caused by suprapubic catheter (SPC) insertion.Methods: We undertook tri-centric, retrospective data collection from all patients identified as having a SPC inserted between 2017 and 2022. Data including demographics, frailty scores, comorbidities, reason for SPC insertion and mortality information were collected and statistically analysed.Results: Sixty-eight patients were identified and included in this study. Mortality after SPC insertion at 30 days was 1.5%: 18.8% at 1 year and 30.4% at 2 years. Medium-term mortality rates were 45.2% at 3 years, rising to 54.5% at 4 years. Patients aged 71 or older at the time of SPC insertion had an overall mortality of 45.9% compared with 10.3% in those aged under 71 years (p < 0.01). Mortality was 53% in frail patients who underwent SPC insertion (Rockwood Clinical Frailty Score >3). Limits of the study include the small sample size and heterogeneity of the population.Conclusions: SPC insertion is associated with a significant mortality rate of 18.8% at 1 year rising to 45.2% at 3 years in our study cohort. Patients with increasing age and frailty may also be at a greater risk of mortality after SPC insertion. This information is in keeping with the limited data available in the published literature and should be highlighted to clinicians and patients when considering SPC insertion.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697490","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}

引用次数: 0

Radiofrequency and microwave ablation as promising minimally invasive treatment options for papillary thyroid micro-carcinoma: a systematic review. 射频和微波消融作为有前途的微创治疗选择甲状腺乳头状微癌：系统回顾。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-24 DOI: 10.1308/rcsann.2025.0048

I Chatzisouleiman, V Kolovou, N Tolley, G Mochloulis, M Katotomichelakis, K Chaidas

{"title":"Radiofrequency and microwave ablation as promising minimally invasive treatment options for papillary thyroid micro-carcinoma: a systematic review.","authors":"I Chatzisouleiman, V Kolovou, N Tolley, G Mochloulis, M Katotomichelakis, K Chaidas","doi":"10.1308/rcsann.2025.0048","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0048","url":null,"abstract":"Introduction: Ultrasound-guided thermal ablation has progressively emerged in the treatment of benign thyroid nodules. More recently, thermal ablation has also been proposed as a promising treatment alternative for papillary thyroid microcarcinoma (PTMC). This systematic review evaluates the efficacy and safety of ultrasound-guided radiofrequency ablation (RFA) and microwave ablation (MWA) for the treatment of PTMC.Methods: The PubMed and Cochrane databases were searched for relevant studies up to December 2023 following PRISMA guidelines. Volume reduction rate (VRR), complete disappearance rate (CDR), and associated complications following RFA and MWA were analysed.Findings: A total of 33 articles were included. Follow-up time ranged from 11 to 130 months. The efficacy of both MWA and RFA on PTMC was remarkable, with VRR reaching up to 99% at 12-month follow-up in the vast majority of patients, while CDR exceeded 80% in most studies. Following ablation, temporary complications at relatively low rates were reported including regional discomfort, voice change and haematoma, except for only one case with permanent recurrent laryngeal nerve injury.Conclusions: Ultrasound-guided thermal ablation of PTMC is a promising therapeutic approach for patients who are ineligible for, or refuse, surgery. Current research suggests that RFA and MWA provide favourable, low-cost outcomes, but larger multicentre, randomised studies are required to confirm the feasibility and safety of this new treatment modality.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697489","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}

引用次数: 0

Systematic review of bilateral epididymal leiomyomas. 双侧附睾平滑肌瘤的系统回顾。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-24 DOI: 10.1308/rcsann.2025.0022

K H Pang, M Walkden, A Haider, P Sangster, H M Alnajjar, A Muneer, W G Lee

{"title":"Systematic review of bilateral epididymal leiomyomas.","authors":"K H Pang, M Walkden, A Haider, P Sangster, H M Alnajjar, A Muneer, W G Lee","doi":"10.1308/rcsann.2025.0022","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0022","url":null,"abstract":"Purpose: Epididymal leiomyomas (LM) are rare benign tumours. Bilateral LM are even more uncommon and there are no management guidelines on LM. We performed a systematic review to update the number of epididymal LM cases reported, and to summarise how these tumours have been managed at different centres with a description of our own experience.Method: The systematic review was performed according to the PRISMA guidelines. The PubMed database was searched for articles on epididymal LM. Data extracted included patients' age, presenting complaint, diagnostic tests, management and follow-up. In addition, a case from our own institution was presented.Results: The systematic search identified 120 articles of which 29 articles including 32 patients were analysed. There were 27 (84.4%) unilateral cases and 5 (15.6%) bilateral cases. Surgical treatments included lesion excision, n = 14 (43.8%); orchidectomy, n = 10 (31.3%); partial epididymectomy, n = 5 (15.6%); and total epididymectomy, n = 3 (9.4%). Final histology revealed 21 LM (65.6%) and 11 leiomyoadenomatoid tumours (34.4%). At a median (interquartile range) follow-up of 14 (8-12) months, there were no cases of recurrence. Our patient, a 53-year-old man, presented with bilateral epididymal lesions for over 1 year and underwent ultrasound scan and positron emission tomography imaging. The imaging findings were indeterminate, hence an excisional biopsy on one side was performed which revealed an epididymal LM. Because LM are benign, further surgery on the contralateral side was not performed.Conclusion: Testis-sparing surgery appears to be feasible and safe, limiting the morbidity of radical orchidectomy. Because epididymal LM are rare, a multidisciplinary assessment and management are advised.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697491","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}

引用次数: 0

Adoption of nonwire localisation devices in UK breast units: an iBRA-NET survey to assess changes in practice. 在英国乳房单位采用非有线定位装置：一项评估实践变化的iBRA-NET调查。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-24 DOI: 10.1308/rcsann.2024.0106

F Mavor, S K Somasundaram, A R Carmichael, S Elgammal, R Foster, S Lowes, Y Masannat, R Milligan, J L Morgan, E R St John, R Vidya, R V Dave, J Harvey

{"title":"Adoption of nonwire localisation devices in UK breast units: an iBRA-NET survey to assess changes in practice.","authors":"F Mavor, S K Somasundaram, A R Carmichael, S Elgammal, R Foster, S Lowes, Y Masannat, R Milligan, J L Morgan, E R St John, R Vidya, R V Dave, J Harvey","doi":"10.1308/rcsann.2024.0106","DOIUrl":"https://doi.org/10.1308/rcsann.2024.0106","url":null,"abstract":"Introduction: A national practice questionnaire in 2020 collected data from UK breast surgeons on breast localisation device use, and found that wires were used most frequently. The current study aimed to assess the change in device use since the previous questionnaire, impact on logistics and clinician feedback.Methods: The 2020 national questionnaire was repeated, as well as adding qualitative questions to elicit themes important to clinicians in differentiating between the quality of localisation device experience. The electronic survey was distributed to UK breast surgeons and radiology members of the Association of Breast Surgery and British Society of Breast Radiology. The medians of the satisfaction responses for each device were compared with the median responses for wire.Results: There were 157 completed questionnaires, with 76 responses from surgeons and 81 from radiologists/radiographers, representing 84 UK breast units (August-December 2022). Localisation device use has changed; from 83% wire and 17% nonwire (5% radio-occult lesion localisation, 2% radioiodine seed and 9% Magseed) in 2020 to 18% wire and 82% nonwire (4% radioiodine seed, 49% Magseed, 6% SAVI SCOUT, 20% Hologic LOCalizer and 3% Sirius Pintuition) by 2022. In 2020 6% of patients had localisation performed before the day of surgery versus 65% by 2022 (p<0.05). Nonwire devices were preferred to wire in six themes for surgeons (p<0.05) and four for radiologists (p<0.05).Conclusions: UK breast surgery practice is shifting from use of guidewires towards newer localisation devices, with resultant logistical benefits and higher clinician satisfaction.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697486","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}

引用次数: 0

Incidence, risk factors and prevention of hypothyroidism following laryngectomy: a systematic review and meta-analysis. 喉切除术后甲状腺功能减退的发病率、危险因素和预防：一项系统回顾和荟萃分析。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0001

J Y Tan, E Westwood, O Edafe

{"title":"Incidence, risk factors and prevention of hypothyroidism following laryngectomy: a systematic review and meta-analysis.","authors":"J Y Tan, E Westwood, O Edafe","doi":"10.1308/rcsann.2025.0001","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0001","url":null,"abstract":"Introduction: Hypothyroidism following laryngectomy is a well-recognised complication. The symptoms are multisystemic and can cause significant morbidity in patients. We aim to characterise the incidence of hypothyroidism following laryngectomy, and identify risk factors and preventative measures.Methods: A systematic search of EMBASE and PubMed was performed. We appraised relevant articles as per the predefined eligibility criteria. A quality assessment of the included studies was done. A meta-analysis was performed to evaluate the association between reported risk factors and hypothyroidism.Results: Forty articles were included. This encompassed a total of 3,061 patients with a median age of 61 years. Overall incidence of hypothyroidism was 50% (interquartile range: 38.3-75.7). The following factors were significantly associated with hypothyroidism: hemithyroidectomy, odds ratio (OR) 4.84 (95% confidence interval [CI] 3.46-6.77); radiotherapy, OR 4.4 (95% CI 2.29-8.43); and neck dissection, OR 2.63 (95% CI 1.56-4.44). Age, sex, chemotherapy and tumour stage were not significant in the meta-analysis. Preventative measures were based on reducing the extent of thyroid dissection, attention to the preservation of blood supply, and pre- and postoperative thyroid function test monitoring.Conclusions: A significant proportion of patients develop hypothyroidism following laryngectomy. Utilising known risk factors may direct a preventative measure. Further well-designed multicentre observational studies exploring preventative measures including reducing hemithyroidectomy, monitoring intervals of thyroid function and utility of routine thyroxine replacement are required.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636018","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}

引用次数: 0

Decision making and outcomes in colorectal cancer and frailty: the DeCaF study. 结直肠癌和虚弱的决策和结果：DeCaF研究。

IF 1.1 4区医学

Annals of the Royal College of Surgeons of England Pub Date : 2025-07-15 DOI: 10.1308/rcsann.2025.0050

A Kler, J Tay, C Slawinski, C Welch, S Moug, S Blackwell, R Arnott, P Mitchell, N Heywood

{"title":"Decision making and outcomes in colorectal cancer and frailty: the DeCaF study.","authors":"A Kler, J Tay, C Slawinski, C Welch, S Moug, S Blackwell, R Arnott, P Mitchell, N Heywood","doi":"10.1308/rcsann.2025.0050","DOIUrl":"https://doi.org/10.1308/rcsann.2025.0050","url":null,"abstract":"Introduction: Surgical resection is the main treatment for non-metastatic colorectal cancer (CRC). However, 6% of patients do not undergo surgery owing to frailty, according to the National Bowel Cancer Audit (NBOCA). The impact of preoperative evaluation and decision making on outcomes in frail patients is underexplored. This study examines variation in decision making for frail, older patients and the availability/use of resources by colorectal multidisciplinary teams (MDTs) across United Kingdom (UK) hospitals.Methods: A UK-wide questionnaire was distributed to colorectal MDTs via the NBOCA newsletter and social media (18 May to 30 June 2021). Part A assessed MDT structure and resource use; Part B explored MDT decisions for two simulated 75-year-old patients with colonic and rectal cancer.Results: Twenty MDTs responded. Decisions were MDT-driven in 55% (n = 11) and surgeon-driven in 45% (n = 9). Clinical examination (85%) and performance status (90%) were most used. Resource utilisation during MDT meetings varied across sites; for example, echocardiogram results were available and considered in MDT decision making in only 15% of centres. Cardiopulmonary exercise testing was used in 75%, anaesthetic assessment in 80%, frailty scoring in 25%, and preoperative geriatric assessment in 5%. Management of right-sided cancer was more consistent; rectal cancer decisions were more variable.Conclusions: Variation exists across MDTs in the availability and use of resources when managing frail CRC patients. There is less consensus for rectal than caecal cancer. These findings highlight the need for standardised MDT protocols to support equitable, patient-centred care in complex cases.","PeriodicalId":8088,"journal":{"name":"Annals of the Royal College of Surgeons of England","volume":" ","pages":""},"PeriodicalIF":1.1,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636017","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}

引用次数: 0