BJS Open最新文献

{"title":"Liver transplantation as a treatment for cancer: comprehensive review.","authors":"Bobby V M Dasari, Pal-Dag Line, Gonzalo Sapisochin, Taizo Hibi, Prashant Bhangui, Karim J Halazun, Shishir Shetty, Tahir Shah, Christian T J Magyar, Conor Donnelly, Dev Chatterjee","doi":"10.1093/bjsopen/zraf034","DOIUrl":"10.1093/bjsopen/zraf034","url":null,"abstract":"<p><strong>Background: </strong>Liver transplantation for cancer indications has gained momentum in recent years. This review is intended to optimize the care setting of liver transplant candidates by highlighting current indications, technical aspects and barriers with available solutions to facilitate the guidance of available strategies for healthcare professionals in specialized centres.</p><p><strong>Methods: </strong>A review of the most recent relevant literature was conducted for all the cancer indications of liver transplantation including colorectal cancer liver metastases, hilar cholangiocarcinoma, intrahepatic cholangiocarcinoma, neuroendocrine tumours, hepatocellular carcinoma and hepatic epitheloid haemangioendothelioma.</p><p><strong>Results: </strong>Transplant benefit from the best available evidence, including SECA I, SECA II, TRANSMET studies for colorectal liver metastases, various preoperative protocols for cholangiocarcinoma patients, standard, extended selection criteria for hepatocellular carcinoma and neuroendocrine tumours, are discussed. Innovative approaches to deal with organ shortages, including machine-perfused deceased grafts, living donor liver transplantation and RAPID procedures, are also explored.</p><p><strong>Conclusion: </strong>Cancer indications for liver transplantation are here to stay, and the selection criteria among all cancer groups are likely to evolve further with improved prognostication of tumour biology using adjuncts such as radiomics, cancer genomics, and circulating DNA and RNA status. International prospective registry-based studies could overcome the limitations of smaller patient cohorts and lack of level 1 evidence.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084677/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144085908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting postoperative pancreatic fistula after robotic pancreatoduodenectomy using International Study Group on Pancreatic Surgery and fistula risk scores: European multicentre retrospective cohort study.","authors":"Anouk M L H Emmen, Mahsoem Ali, Bas Groot Koerkamp, Ugo Boggi, I Quintus Molenaar, Olivier R Busch, Thilo Hackert, Luca Moraldi, J Sven Mieog, Daan J Lips, Olivier Saint-Marc, Misha D P Luyer, Susan van Dieren, Geert Kazemier, Felix Nickel, Sebastiaan Festen, Hjalmar C van Santvoort, Emanuele F Kauffmann, Roeland F de Wilde, Mohammad Abu Hilal, Marc G Besselink","doi":"10.1093/bjsopen/zraf036","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf036","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistula represents the leading cause of morbidity and mortality after robotic pancreatoduodenectomy. Various scores have been proposed to stratify patients based on their postoperative pancreatic fistula risk, including three fistula risk scores, and two International Study Group for Pancreatic Surgery scores. This study compares the performance of these scores in patients undergoing robotic pancreatoduodenectomy.</p><p><strong>Methods: </strong>This is a multicentre European retrospective study in consecutive patients receiving robotic pancreatoduodenectomy for all indications (April 2014 to December 2021). The performance of the International Study Group for Pancreatic Surgery 4-tier (A-D) risk score, and its 3-tier (A-C) modification (International Study Group for Pancreatic Surgery 3-tier), fistula risk scores, alternative-fistula risk scores and the updated alternative-fistula risk scores in postoperative pancreatic fistula grade B/C prediction were compared based on their discrimination (area under the curve), calibration and clinical utility, evaluated through decision curve analyses.</p><p><strong>Results: </strong>Overall, 919 patients undergoing robotic pancreatoduodenectomy were included. The rate of grade B/C postoperative pancreatic fistula was 22.2% (n = 204). The area under the curve for the five scores differed only slightly: International Study Group for Pancreatic Surgery 0.63 (95% confidence interval (c.i.) 0.58 to 0.67), International Study Group for Pancreatic Surgery 3-tier 0.63 (95% c.i. 0.58 to 0.67), fistula risk scores 0.65 (95% c.i. 0.61 to 0.69), alternative-fistula risk scores 0.64 (95% c.i. 0.60 to 0.68) and updated alternative-fistula risk scores 0.65 (95% c.i. 0.60 to 0.69). The International Study Group for Pancreatic Surgery, International Study Group for Pancreatic Surgery 3-tier, fistula risk scores and alternative-fistula risk scores underestimated the risk of postoperative pancreatic fistula. In contrast, the updated alternative-fistula risk score was well-calibrated at low predicted risks, but overestimated postoperative pancreatic fistula risk for high-risk patients. In decision curve analyses, the updated alternative-fistula risk score showed a higher clinical utility compared with the four other risk scores.</p><p><strong>Conclusion: </strong>The clinical utility of the updated alternative-fistula risk score for robotic pancreatoduodenectomy slightly outperformed the four other fistula risk scores, and might be used for patient counselling and patient stratification in clinical practice and research.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Excision margins and prognosis in cutaneous melanoma: retrospective population-based cohort study.","authors":"Alessandra Buja, Massimo Rugge, Chiara Trevisiol, Anna Zanovello, Luigi Dall'Olmo, Manuel Zorzi, Antonella Vecchiato, Paolo Del Fiore, Matteo Paiola, Carlo Riccardo Rossi, Simone Mocellin","doi":"10.1093/bjsopen/zraf042","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf042","url":null,"abstract":"<p><strong>Background: </strong>The impact of surgical excision margin size on the survival of patients with cutaneous melanoma (CM) is controversial. The aim of this study was to assess the impact of excision margins on patient outcomes.</p><p><strong>Methods: </strong>This retrospective population-based follow-up study analysed data from patients presenting with CM without extranodal disease. The linear distance of CM from the excision margin was assessed microscopically. Regarding overall and melanoma-specific survival estimates, Kaplan-Meier analysis, the Cox proportional hazards model, and the subdistribution hazard ratio of the Fine-Gray model were applied.</p><p><strong>Results: </strong>Of 3262 patients, a total of 2698 (82.7%) with pathological (p) T1-2 and 564 (17.3%) with pT3-4 CM underwent wide local excision. Multivariable analyses, adjusting for melanoma incidence cohort, age, sex, anatomical site, ulceration, histotype, mitotic count, and tumour-infiltrating lymphocytes, demonstrated that, in pT1-2 CM, surgical excision > 1.1 cm resulted in significant CM-specific survival benefit. In pT4 disease, a CM distance to the surgical margins of < 1.6 cm significantly lowered CM-specific survival.</p><p><strong>Conclusion: </strong>This population-based study conducted in real-world clinical practice found that the prognosis of patients with pT1-2 CM may benefit from excision margins > 1.1 cm. In pT3-4 CM, margins < 1.6 cm were significantly associated with lower CM-specific survival rates. These findings highlight the need for further prospective studies to evaluate the safety of surgical excision margins in managing primary CM.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056717/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144062025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histology-driven tailoring of surgical approaches in retroperitoneal soft tissue sarcoma: retrospective cohort study.","authors":"Julian Musa, Franziska Willis, Ingmar F Rompen, Julian-Camill Harnoss, Thomas G P Grünewald, Mohammed Al-Saeedi, Markus W Büchler, Martin Schneider","doi":"10.1093/bjsopen/zraf050","DOIUrl":"10.1093/bjsopen/zraf050","url":null,"abstract":"<p><strong>Background: </strong>Histology-driven tailoring of surgical approaches for retroperitoneal soft tissue sarcoma is currently under debate. Compelling evidence assessing the role of histology-dependent extent of resection is lacking. The aim of this study was to assess outcomes of patients with primary retroperitoneal liposarcoma (LPS) or leiomyosarcoma (LMS) according to whether comprehensive (formerly 'compartmental') resection (CR) was performed.</p><p><strong>Methods: </strong>A retrospective study was conducted on data from patients undergoing surgical resection for LPS and LMS at Heidelberg University Hospital (2002-2019). Parameters were compared between groups with and without CR, with subgroup analyses for grading (LPS). Kaplan-Meier and Cox regression analyses were used to identify predictors of disease-specific survival (DSS), local recurrence-free survival, and distant metastasis-free survival.</p><p><strong>Results: </strong>In total, 119 patients with primary LPS and 46 patients with primary LMS were identified. DSS was improved in patients with LPS with CR (P = 0.049), and both DSS (P = 0.040) and distant metastasis-free survival (P = 0.041) were improved in the subgroup of patients with primary G3 LPS. In contrast, CR in patients with LMS was not associated with improved DSS, local recurrence-free survival, or distant metastasis-free survival. CR was associated with more severe postoperative complications (P = 0.021) and a longer hospital stay (P = 0.013) in patients with LPS, longer operation times (P < 0.010) in both patients with LPS and LMS, and increased blood loss (P = 0.008) in patients with LMS.</p><p><strong>Conclusion: </strong>CR is associated with improved DSS in patients with primary LPS, which is not the case in patients with primary LMS. Given the association between CR and increased perioperative morbidity, surgical strategies for retroperitoneal soft tissue sarcoma should be individualized according to the underlying histology.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070264/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143973697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial burden of complications in lung resection surgery: scoping review.","authors":"Suwandi Dewapura, Fabien Chu, Patryck Lloyd-Donald, Ella Francis, Junyan Zhao, Prabhashi Ratnayakemudiyanselage, Fawaz Ahmed Prem Navaz, Chin Jin Ker, Elizabeth P Hu, Sepideh Roshanaei, Jacques Elias, Nattaya Raykateeraroj, Ronald Ma, Stephen A Barnett, Dong-Kyu Lee, Simon Knight, Laurence Weinberg","doi":"10.1093/bjsopen/zraf057","DOIUrl":"10.1093/bjsopen/zraf057","url":null,"abstract":"<p><strong>Background: </strong>Lung resection surgery is a common procedure in the treatment of lung cancer. It has been associated with a high cost burden, with complications considered a substantial contributor to associated expenses. This review sought to understand and describe the financial burden associated with complications of lung resection surgery.</p><p><strong>Methods: </strong>Key databases (Ovid MEDLINE and Embase, Cochrane CENTRAL) were searched up to 14 October 2024. Studies reporting on costs of at least one complication of lung resection surgery, including lobectomy, wedge resection, segmentectomy, sleeve resection, pneumonectomy, or a combination of these, were included. Following identification of eligible articles, all relevant data were extracted. Quality assessment tools, including the Scottish Intercollegiate Guidelines Network Checklists for Economic Evaluations and Cohort Studies and the Risk Of Bias In Non-randomized Studies-of Interventions tool, were used to confirm articles for inclusion.</p><p><strong>Results: </strong>In all, 31 articles were identified for inclusion: 2 prospective and 29 retrospective studies. All lung-specific complications and all but one non-pulmonary complication were associated with increased hospitalization costs. Hospital expenses also increased with increasing numbers and grades of complications.</p><p><strong>Conclusion: </strong>Substantial variation in the definitions of costs and complications across studies has rendered a comparison of findings between studies challenging. Greater uniformity in definitions and classifications of costs and complications in future studies will facilitate further characterization of the cost burden of specific complications.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105937/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anatomically resectable versus biologically borderline resectable pancreatic cancer definition: refining the border beyond anatomical criteria and biological aggressiveness.","authors":"Giulio Belfiori, Federico De Stefano, Domenico Tamburrino, Giulia Gasparini, Francesca Aleotti, Paolo R Camisa, Claudia Arcangeli, Marco Schiavo Lena, Nicolo Pecorelli, Diego Palumbo, Stefano Partelli, Francesco De Cobelli, Michele Reni, Stefano Crippa, Massimo Falconi","doi":"10.1093/bjsopen/zraf033","DOIUrl":"10.1093/bjsopen/zraf033","url":null,"abstract":"<p><strong>Background: </strong>The anatomically resectable pancreatic ductal adenocarcinoma treatment sequence is still debated. Heterogeneity in patient characteristics within this group may explain literature discrepancies. To overcome these limits, a biologically borderline resectable pancreatic ductal adenocarcinoma category has been analysed according to institutional criteria. The aim of this study was to examine the characteristics and outcomes of patients with biologically borderline resectable pancreatic ductal adenocarcinoma and determine whether they represent a distinct clinical and prognostic subgroup.</p><p><strong>Methods: </strong>Data from all consecutive patients who underwent surgical resection for pancreatic ductal adenocarcinoma between 2015 and 2022 were retrospectively analysed. Biologically borderline resectable disease was classified by the presence of one or more of the following: carbohydrate antigen 19-9 ≥200 U/ml, cancer-related symptoms lasting >40 days, and radiological suspicion of regional lymph node metastases at diagnosis.</p><p><strong>Results: </strong>In total, 886 patients were included in the study and divided into anatomically borderline resectable (266 patients (30%)) and anatomically resectable (620 patients (70%)), which was further divided into resectable (R; 397 patients (64%)) and biologically borderline resectable (223 patients (36%)). Neoadjuvant treatment was administered in 245 patients (92.1%) in the anatomically borderline resectable group, 82 patients (20.7%) in the R group, and 135 patients (60.5%) in the biologically borderline resectable group. After a median follow-up of 45 (95% c.i. 42 to 48) months, the median disease-specific survival in the biologically borderline resectable group was 40 months compared with 59 months in the R group (P < 0.001) and 40 months in the anatomically borderline resectable group (P = 0.570). In the upfront surgery cohort, the median disease-specific survival was worse for biologically borderline resectable patients compared with R patients (27 versus 54 months respectively, P < 0.001). Biologically borderline resectable was also independently associated with worse disease-specific survival, together with age, tumour size at diagnosis, and anatomically borderline resectable. The same, except for age, were also predictors of worse event-free survival.</p><p><strong>Conclusion: </strong>Despite their identical anatomical appearance, resectable and biologically borderline resectable pancreatic ductal adenocarcinoma represent two distinct prognostic entities, warranting separate evaluation and, potentially, different treatment approaches.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical outcomes for necrotizing enterocolitis in Dutch infants born before 26 weeks' gestation.","authors":"Otis C van Varsseveld, Adinda G H Pijpers, Ceren Imren, Joep P M Derikx, Chris H P van den Akker, Joost van Schuppen, Claudia M G Keyzer-Dekker, Marijn J Vermeulen, Maarten Schurink, Maud Y A Lindeboom, Elisabeth M W Kooi, Jan B F Hulscher","doi":"10.1093/bjsopen/zraf060","DOIUrl":"10.1093/bjsopen/zraf060","url":null,"abstract":"<p><strong>Background: </strong>In infants born at < 26 weeks of gestational age (wGA) who develop necrotizing enterocolitis (NEC), medical and ethical considerations about whether surgery is the optimal treatment are complicated by a lack of group-specific outcome data. This study investigated nationwide 30-day mortality, surgical complications, and preoperative mortality risk factors in infants born at < 26 wGA who underwent surgery during the active phase of NEC.</p><p><strong>Methods: </strong>This retrospective nationwide multicentre study included all infants born at < 26 wGA undergoing surgery for Bell's stage II/III NEC in the Netherlands between 2008 and 2022, regardless of outcome. Severe NEC was defined as Bell's stage III (confirmed by laparotomy and/or leading to death). The primary outcome was postoperative 30-day mortality. The incidence of major postoperative complications (Clavien-Madadi III-IV) was determined after excluding infants undergoing open-close procedures for massive bowel necrosis. Potential risk factors for death after surgery were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Of 288 infants with NEC Bell's stage ≥ II, 80 (27.8%) survived without surgery, 66 (22.9%) died before laparotomy, and 142 (49.3%) underwent laparotomy. In 142 surgically treated infants with severe NEC (57.0% male), the median gestational age was 25 + 0 (range 23 + 6 to 25 + 6) weeks + days, the median birthweight was 750 (range 485-1070) g, and the median age at surgery was 14 (range 2-66) days. Primary open-close surgery was performed in 34 of 142 infants (23.9%). In the remaining 108 infants, surgical management included stoma creation (63.0%), primary anastomosis (27.8%), or both (9.3%). Overall, the 30-day mortality rate among 142 infants was 47.2% (67 deaths). Death occurred after a primary or second-look open-close procedure in 37 infants, after multiorgan failure in 17, and from other causes in the remaining 13. After excluding 37 infants who died after open-close procedures, 30-day complications occurred in 23 (21.9%) of 105 surgically treated infants. There were 29 events in total, including reoperation for bowel perforation (5, 17%) or anastomotic leak/stenosis (5, 17%). Regression analysis identified no risk factors for 30-day mortality.</p><p><strong>Conclusion: </strong>The 30-day mortality rate was 47.2% in infants born at < 26 wGA undergoing NEC surgery, most of whom died after an open-close procedure. Another 21.9% of infants experienced major complications.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intrathoracic versus cervical anastomosis after totally or hybrid minimally invasive transthoracic oesophagectomy for oesophageal cancer: cost-effectiveness analysis alongside the randomized ICAN trial.","authors":"Eric Matthée, Sander Ubels, Bastiaan Klarenbeek, Moniek H P Verstegen, Gerjon Hannink, Frans van Workum, Camiel Rosman, Janneke P C Grutters","doi":"10.1093/bjsopen/zraf061","DOIUrl":"10.1093/bjsopen/zraf061","url":null,"abstract":"<p><strong>Background: </strong>There is a worldwide trend towards minimally invasive oesophagectomy with intrathoracic anastomosis in oesophageal cancer surgery. Minimally invasive oesophagectomy with intrathoracic anastomosis has been shown to result in fewer anastomotic leaks, but cost-effectiveness is yet to be established. The aim of this study was to determine the cost-effectiveness of transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis compared with cervical anastomosis.</p><p><strong>Methods: </strong>A prospective economic evaluation was performed alongside the ICAN trial, a randomized clinical superiority trial. Patients with mid/distal oesophageal or gastro-oesophageal junction cancer were randomly assigned to transthoracic minimally invasive oesophagectomy with either intrathoracic or cervical anastomosis. Quality-adjusted life-years, mean healthcare, and societal costs were assessed for both groups at 9 and 21 months after surgery.</p><p><strong>Results: </strong>A total of 245 patients randomized for transthoracic minimally invasive oesophagectomy with either intrathoracic (122) or cervical (123) anastomosis were included in the cost-effectiveness analysis. After 9 months, the intrathoracic group yielded 0.58 (95% confidence interval (c.i.) 0.55 to 0.61) quality-adjusted life-years per patient, compared with 0.56 (0.52 to 0.58) quality-adjusted life-years for the cervical group. After 9 months, both mean healthcare costs (20 573 (95% c.i. 17 623 to 24 177) versus 28 039 (23 574 to 33 116) euros), and societal costs (24 590 (21 237 to 29 074) versus 33 383 (27 885 to 38 805) euros), per patient were lower in the intrathoracic anastomosis group. Similarly, at 21 months no statistically significant difference was found (mean difference 0.08 (-0.05 to 0.2) quality-adjusted life-years), whereas minimally invasive oesophagectomy with intrathoracic anastomosis was less costly than that with cervical anastomosis (mean difference -9930 (-16 301 to -2521) euros). The higher costs in the cervical anastomosis group were mainly due to longer lengths of stay owing to complications.</p><p><strong>Conclusion: </strong>Transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis was found to be cost-effective compared with transthoracic minimally invasive oesophagectomy with cervical anastomosis.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life in patients with permanent hypoparathyroidism after thyroidectomy for benign thyroid disease: population-based study with long-term follow-up.","authors":"Matilda Annebäck, Sofia Wachtmeister, Jakob Hedberg, Peter Stålberg, Olov Norlén","doi":"10.1093/bjsopen/zraf032","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf032","url":null,"abstract":"<p><strong>Background: </strong>In recent years, several studies have shown that permanent hypoparathyroidism has a negative impact on health-related quality of life. However, these results could have been affected by short-term follow-up, selection bias and confounding factors. The aim of this study was to investigate health-related quality of life in patients with and without permanent hypoparathyroidism after total thyroidectomy for benign thyroid disease, using a strict definition of permanent hypoparathyroidism and long-term follow-up data.</p><p><strong>Methods: </strong>All patients who underwent total thyroidectomy for benign thyroid disease in a region of Sweden between 1 January 2005 and 31 December 2015 were assessed for eligibility. Eligible patients were invited to participate in the study through a letter on 26 August 2021. The 36-item Short Form Health Survey version 2 was used to compare health-related quality of life in patients with and without permanent hypoparathyroidism.</p><p><strong>Results: </strong>Of 1636 patients, 1483 patients were invited to participate in the study. In total, 716 (48.3%) patients answered the Short Form Health Survey questionnaire and were included in the study cohort. Mean(s.d.) follow-up was 10.9(3.2) years. Patients with and without permanent hypoparathyroidism did not differ in baseline characteristics, with the exception that patients with permanent hypoparathyroidism were younger. There were no evident differences in health-related quality of life between the two groups, encompassing all health domains and summary component scores (P > 0.05).</p><p><strong>Conclusion: </strong>No difference in health-related quality of life was found between patients with and without permanent hypoparathyroidism after total thyroidectomy on long-term follow-up. These results challenge previous findings and highlight the need for comprehensive, long-term studies to better understand the impact of this condition on health-related quality of life.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143962450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Water-soluble contrast agents in adhesional small bowel obstruction: meta-analysis and PRECIS-2 assessment of trials.","authors":"Matthew Gowell, Daniel M Baker, Greta McLachlan, David N Naumann, Adam Peckham-Cooper, Neil J Smart, Matthew J Lee","doi":"10.1093/bjsopen/zraf049","DOIUrl":"10.1093/bjsopen/zraf049","url":null,"abstract":"<p><strong>Background: </strong>Adhesional small bowel obstruction is a common presentation to acute general surgical services. Initial management is typically conservative and includes the use of water-soluble contrast agents. Current trials assessing water-soluble contrast agents are limited by sample size and demonstrate contrasting results. The aim of this review was to systematically appraise the use of water-soluble contrast agents in adhesional small bowel obstruction.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was registered with PROSPERO (CRD42024573136) and conducted in line with PRISMA guidelines. Searches of Medline, Embase and Central databases were undertaken to include randomized clinical trials reporting the use of water-soluble contrast agents in adhesional small bowel obstruction. Searches were last updated on 26 July 2024. The primary outcome was the need for operative intervention. Secondary outcomes included the rate of intestinal ischaemia, the need for bowel resection, and mortality. A random-effects meta-analysis was conducted for outcomes reported in three or more studies. Risk of bias was assessed using the Cochrane Risk-of-Bias tool, and trial methods were appraised using the PRagmatic Explanatory Continuum Indicator Summary (PRECIS-2) tool.</p><p><strong>Results: </strong>In all, 11 randomized controlled trials were included with a median sample size of 88 (range 26-242), nine of which were single-centre studies; only one study used computed tomography imaging to diagnoses adhesional small bowel obstruction. Meta-analysis revealed no significant difference in operative intervention (odds ratio 0.63, 95% confidence interval 0.39 to 1.01; P = 0.053), small bowel ischaemia, small bowel resection, or mortality. Risk of bias raised concerns in several domains. PRECIS-2 assessment showed trials were pragmatic rather than explanatory designs.</p><p><strong>Conclusion: </strong>This review does not support the use of therapeutic water-soluble contrast agents in adhesional small bowel obstruction. Further adequately powered trials are needed. Standardization of diagnostic modality and consideration of explanatory designs should be considered.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12062880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143968118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}