BJS Open最新文献

{"title":"Long-term outcomes after total colonic aganglionosis: retrospective European multicentre cohort study.","authors":"Annika Mutanen, Alessio Pini Prato, Marta Erculiani, Cécile Lambe, Judith Lindert, Stefanie Märzheuser, Fabio Fusaro, Kjetil Juul Stensrud, Kristin Bjornland, Niels Qvist, Mark Bremholm Ellebæk, Merit M Tabbers, Joep P M Derikx, Rony Sfeir, Konrad Reinshagen, Johanna Ludwiczek, Lucie Poš, Tereza Bartošová, Marc Miserez, Anna Löf Granström, Tomas Wester, Johannes Hilberath, Arnaud Bonnard, Donatella Di Fabrizio, Anat Guz-Mark, Pierre Poinsot, Katrien Van Renterghem, Francesca Destro, Pernilla Stenström, Florian Friedmacher, Udo Rolle, Riccardo Coletta, Antonino Morabito, Francesco Fascetti Leon, Miriam Duci, Cornelius E J Sloots, Hendt Versteegh, Domingas Atouguia, Miguel Campos, Inna Spector Cohen, Stanko Cavar, Ivana Sabolic, Xavier Tarrado, Sophie Langer, Lorenzo Norsa, Mikko P Pakarinen","doi":"10.1093/bjsopen/zrag143","DOIUrl":"10.1093/bjsopen/zrag143","url":null,"abstract":"<p><strong>Background: </strong>Total colon aganglionosis (TCA), a severe form of Hirschsprung disease, is a rare and complex condition with variable management and limited outcome data. This retrospective cross-sectional multicentre study assessed current long-term outcomes of TCA in Europe.</p><p><strong>Methods: </strong>Patients with TCA under follow up at participating ERNICA and ESPGHAN centres were included. Data were collected on genetics, nutritional, functional, and surgical outcomes, intestinal inflammatory lesions, and mortality during the preceding 10 years.</p><p><strong>Results: </strong>Thirty-one centres from 15 countries contributed 401 patients (median age 7.9 years; interquartile range 4.0-13.6 years). Genetic testing was performed in 52% of patients, with pathogenic variants identified in 62%, mainly RET. Aganglionosis was limited to the colon in 26%, extended to the small bowel in 71%, and was total intestinal in 3%, without association with genetic status. At the latest follow-up, 25% of patients were receiving parenteral nutrition (PN); PN dependency was associated with small intestine extension of aganglionosis > 50 cm (72% of patients with >50 cm small bowel aganglionosis versus 15% of patients aganglionosis <50 cm small bowel or limited to the colon; P < 0.001). Overall, 77% of patients underwent pull-through, most commonly ileoanal anastomosis (62%) or Duhamel (31%). Complications included anastomotic leak (4%), strictures (12%), redo surgery (24%), recurrent enterocolitis (36%), obstructive symptoms (24%), and faecal incontinence (25%). Recurrent enterocolitis was associated with obstructive symptoms (P = 0.007). Endoscopy showed intestinal inflammatory lesions in 22% of patients, particularly those with recurrent enterocolitis (odds ratio (OR) 6.43; 95% confidence interval (c.i.) 3.27 to 12.63) and obstructive symptoms (OR 2.64; 95% c.i. 1.26 to 5.53). The 10-year mortality rate was 3.4%.</p><p><strong>Conclusion: </strong>TCA shows a high prevalence of genetic abnormalities and substantial postoperative and long-term morbidity, independent of surgical technique.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 6","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13732568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149317717","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":"Staging laparoscopy for radiographically non-metastatic pancreatic ductal adenocarcinoma: cytology-driven upstaging and the SENDAI-SL risk-enrichment score.","authors":"Daisuke Douchi, Shingo Yoshimachi, Naoki Rikiyama, Mika Ando, Yuichiro Umino, Hideaki Sato, Mitsuhiro Shimura, Koetsu Inoue, Masahiro Iseki, Shuichi Aoki, Takayuki Miura, Shimpei Maeda, Masaharu Ishida, Masamichi Mizuma, Atsushi Masamune, Michiaki Unno","doi":"10.1093/bjsopen/zrag176","DOIUrl":"10.1093/bjsopen/zrag176","url":null,"abstract":"<p><strong>Background: </strong>Cross-sectional imaging may miss occult metastatic disease in pancreatic ductal adenocarcinoma and cannot detect positive peritoneal lavage cytology. This study quantified the yield of staging laparoscopy (SL) with routine lavage cytology and developed the SENDAI-SL score for risk-based prioritization.</p><p><strong>Methods: </strong>Consecutive patients with radiographically non-metastatic pancreatic ductal adenocarcinoma who underwent SL at one centre from January 2013 to June 2025 were analysed retrospectively. SL positivity was defined as liver metastasis, macroscopic peritoneal metastasis, and/or positive cytology. Multivariable logistic regression identified predictors; internal validation used 2000 bootstrap resamples.</p><p><strong>Results: </strong>Of 504 patients, 141 (28.0%) had positive SL. Positivity rates were 21.3%, 16.0%, 32.3%, and 41.7% in resectable, borderline resectable with portal vein involvement, borderline resectable with arterial involvement, and unresectable locally advanced disease, respectively. Gross liver or peritoneal metastases were detected in 51 patients (10.1%); cytology was positive in 125 (24.8%) and the sole finding in 90 of 141 positive procedures (63.8%). Among 499 patients with quantifiable serum carbohydrate antigen 19-9, unresectable locally advanced disease, body and/or tail location, tumour size ≥ 37 mm, and serum carbohydrate antigen 19-9 ≥ 180 U/ml were independently associated with SL positivity. The model's area under the receiver operating characteristic curve was 0.732 (optimism-corrected, 0.718). Score-specific positivity ranged from 8.6% to 83.3%. A score ≥ 2 prioritized 149 patients; 74 (49.7%) were positive, capturing 52.9% (74 of 140) of positives in the analysis cohort.</p><p><strong>Conclusions: </strong>SL upstaged 28.0% of patients, predominantly through cytology-only disease. The SENDAI-SL score may support prioritization when resources are limited but requires external validation and should not justify omitting SL.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 6","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13733517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149332349","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":"Adult choledochal cyst resection in Scandinavia: uncommon malignancy and considerable morbidity in a multicentre surgical cohort.","authors":"Sondre Busund, Jennie Engstrand, Helena Taflin, Bobby Tingstedt, Linda Lundgren, Jozef Urdzik, Ioannis Gkekas, Ernesto Sparrelid, Sheraz Yaqub, Christian Sturesson","doi":"10.1093/bjsopen/zrag168","DOIUrl":"10.1093/bjsopen/zrag168","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 6","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13729128/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149317715","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":"Colonoscopy surveillance after colorectal cancer surgery: meta-analysis.","authors":"Joni Panula, Kalle E Hokkanen, Toni T Seppälä","doi":"10.1093/bjsopen/zrag117","DOIUrl":"10.1093/bjsopen/zrag117","url":null,"abstract":"<p><strong>Background: </strong>Colonoscopy surveillance is recommended following colorectal cancer (CRC) surgery, yet the evidence supporting the recommendations has major quality issues. This study assessed the independent impact of colonoscopy surveillance within 5 years after CRC surgery.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted. Medline, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception until 18 June 2026 for randomized clinical trials comparing follow-up protocols including colonoscopy surveillance (intervention) to those without colonoscopy surveillance (control) within 5 years after CRC surgery. Risk of bias was assessed using the RoB 2 tool. Random-effects meta-analyses were conducted to estimate the strength of associations with recurrence detection, reoperation rate, and survival. The number needed to scope (NNS) to detect one recurrence and health economic considerations were estimated. The study protocol has been registered in PROSPERO.</p><p><strong>Results: </strong>Of 4381 records, five trials with 2337 patients were included. Four trials enrolled patients between 1983 and 1994, predating subsequent advances in CRC treatment. All trials used additional surveillance modalities, leading to a high risk of bias. Follow-up protocols with colonoscopy were not associated with recurrence profile, with risk ratios (RRs) of 0.74 (95% confidence interval (c.i.) 0.32 to 1.69), 1.23 (95% c.i. 0.93 to 1.63), and 0.93 (95% c.i. 0.76 to 1.14) for intraluminal, locoregional, and distant recurrence, respectively. Colonoscopy during follow-up was associated with a higher rate of asymptomatic recurrence (RR 2.38; 95% c.i. 1.53 to 3.69). More curative-intent reoperations were performed in the intervention than control group (RR 1.66; 95% c.i. 1.16 to 2.37), but this was not translated into improved survival (hazard ratio 0.92; 95% c.i. 0.77 to 1.11). The NNS was 159 (95% c.i. 101 to 267), resulting in estimated cost per colonoscopy-detected recurrence of €104 100 (95% c.i. €66 200 to 174 900).</p><p><strong>Conclusion: </strong>Current evidence from randomized trials does not clearly demonstrate that postoperative colonoscopy surveillance improves survival, although interpretation is limited by the age of the trials and confounding from concurrent surveillance modalities. Contemporary randomized trials are required to better define the independent contribution of colonoscopy within modern multimodal surveillance pathways.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 6","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13732565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149317716","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":"Adjuvant mFOLFOXIRI after curative-intent resection of oligometastatic colorectal cancer: phase II FANTASTIC trial.","authors":"Kozo Kataoka, Takeshi Yamada, Kentaro Yamazaki, Shintaro Kanaka, Takeshi Suto, Manabu Shiozawa, Yasumasa Takii, Masayoshi Yasui, Toshifumi Yamaguchi, Nobuhisa Matsuhashi, Naoto Takase, Kazuma Ito, Erik Spickard, Arkarachai Fungtammasan, Rama S Madhurapantula, Adham Jurdi, Eiji Oki, Hideaki Bando, Yoshiaki Nakamura, Takayuki Yoshino, Masataka Ikeda, Keita Mori, Yukihide Kanemitsu","doi":"10.1093/bjsopen/zrag144","DOIUrl":"10.1093/bjsopen/zrag144","url":null,"abstract":"<p><strong>Background: </strong>Patients with oligometastatic colorectal cancer (mCRC) remain at high risk of recurrence after curative surgery, yet the benefit of adjuvant chemotherapy remains inconclusive. This study evaluated the feasibility and efficacy of adjuvant modified (m)FOLFOXIRI (irinotecan, oxaliplatin, L-leucovorin (L-LV), 5-fluorouracil (5-FU)), as well as the utility of circulating tumour DNA (ctDNA) as a prognostic and predictive biomarker in mCRC.</p><p><strong>Methods: </strong>Between October 2020 and January 2024, patients with histologically confirmed mCRC undergoing complete metastasectomy were enrolled in this multicentre non-randomized phase II study. Eligible and consenting patients received eight cycles of mFOLFOXIRI followed by four cycles of 5-FU/L-LV; ineligible/non-consenting patients received standard of care (SOC; CAPOX (capecitabine and oxaliplatin), 5-FU, or observation). ctDNA was assessed using the tumour-informed personalized Signatera™ assay (Natera, Austin, TX, USA) at 28 days and 7 months after surgery. The primary endpoint was completion of eight cycles of mFOLFOXIRI in a target sample of 36 patients.</p><p><strong>Results: </strong>Of the 83 registered patients, 73 were enrolled (39 mFOLFOXIRI, 34 SOC). The mFOLFOXIRI completion rate was 74% (80% confidence interval 63% to 83%; P < 0.001). ctDNA positivity predicted significantly inferior recurrence-free survival across both the mFOLFOXIRI and SOC treatment groups at 28 days (hazard ratios (HR) 7.27 and 7.17, respectively) and 7 months (HR 3.96 and 4.38, respectively) after surgery. Multivariate analysis identified ctDNA positivity, RAS mutation, metachronous metastases, and mFOLFOXIRI as significant prognostic factors. mFOLFOXIRI improved recurrence-free survival compared with SOC in the overall population (HR 0.44; P = 0.012), with a trend towards benefit in ctDNA-positive but not ctDNA-negative patients. ctDNA clearance rates were 33% (mFOLFOXIRI) and 20% (SOC).</p><p><strong>Conclusions: </strong>This study indicates the feasibility of adjuvant mFOLFOXIRI in patients with mCRC, with an acceptable safety profile and potential clinical benefit among those with ctDNA positivity 28 days after surgery.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 6","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13733536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149332340","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":"Recurrence and mortality after non-operative management of acute gallstone disease: nationwide registry study.","authors":"Maria Söderström, Olov Norlén, Fredrik Linder, Erik Osterman","doi":"10.1093/bjsopen/zrag149","DOIUrl":"10.1093/bjsopen/zrag149","url":null,"abstract":"<p><strong>Background: </strong>Non-operative management of gallstone complications (acute cholecystitis, cholangitis, and biliary pancreatitis) carries a significant risk of recurrence. Nevertheless, definitive surgery is often deferred in co-morbid patients due to their perceived short life expectancy. This study assessed the prevalence of non-operative management, and its associated mortality and recurrence risk, accounting for the competing risk of death due to other causes.</p><p><strong>Methods: </strong>A nationwide cohort of patients admitted with gallstone complications and treated with non-operative management between 2006 and 2019 was identified in the Swedish National Patient Register. Competing risk and Cox proportional hazards models were used to evaluate recurrence and mortality risks.</p><p><strong>Results: </strong>Overall, 82 101 patients were included (median age 68 years, 48% female), of whom 41 283 (50.3%) experienced cholecystitis, 10 272 (12.5%) experienced cholangitis, and 30 546 (37.2%) experienced pancreatitis. Patients with cholangitis were older and had more co-morbidities than those with cholecystitis or pancreatitis. The cumulative recurrence risk at 1 year was 16.0% for cholecystitis, cholangitis, and pancreatitis. At 3 years, the risk was 19.8% for cholecystitis and 23.0% for cholangitis and 22.5% for pancreatitis. In patients aged ≥ 80 years, 3-year mortality was 41.2%, and 17.0% of deaths were gallstone related. In competing risk analyses, cholangitis and pancreatitis were associated with a higher recurrence risk than cholecystitis in alive patients, with hazard ratio (HRs) of 1.22 (95% confidence interval (c.i.) 1.16 to 1.28) and 1.28 (95% c.i. 1.24 to 1.32), respectively, whereas female sex was associated with a lower recurrence risk (HR 0.92; 95% c.i. 0.89 to 0.94). Increasing age (HR 1.08; 95% c.i. 1.08 to 1.09), co-morbidities (HR 1.17; 95% c.i. 1.16 to 1.17), and cholangitis (HR 1.31; 95% c.i. 1.26 to 1.36) were associated with an increased risk of mortality.</p><p><strong>Conclusion: </strong>The risk of recurrent gallstone complications remains clinically important, even among older and co-morbid patients, despite their higher competing risk of death. These findings support consideration of early cholecystectomy in patients with an acceptable operative risk, with the aim of reducing subsequent morbidity and recurrence.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 6","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13732573/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149317718","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":"Beyond breast conservation: is it time to rethink sentinel lymph node biopsy in patients undergoing mastectomy?","authors":"Cicero Urban","doi":"10.1093/bjsopen/zrag132","DOIUrl":"10.1093/bjsopen/zrag132","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575681/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966216","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":"Association between preoperative physical exercise and the risk of postoperative venous thromboembolism: nationwide population-based cohort study.","authors":"Chan-Sik Kim, Bumwoo Park, Hyeong-Seok Yoon, Ji-Hoon Sim","doi":"10.1093/bjsopen/zrag109","DOIUrl":"10.1093/bjsopen/zrag109","url":null,"abstract":"<p><strong>Background: </strong>Although preoperative exercise is widely promoted within prehabilitation programmes, the association between habitual preoperative exercise and postoperative venous thromboembolism (VTE) remains unclear. This study examined the association between the frequency of preoperative exercise and postoperative VTE risk.</p><p><strong>Methods: </strong>Using the National Health Insurance Service-National Sample Cohort (2009-2016), adults who underwent surgery and preoperative health screening were identified. Exercise was classified as exerciser versus non-exerciser and by frequency (none, 1-2, or ≥3 times/week). Multivariable logistic regression adjusted for demographic, clinical, and surgical factors was used to estimate VTE risk, with subgroup analyses across demographic and lifestyle strata.</p><p><strong>Results: </strong>A total of 118 340 patients were enrolled in this study and categorized based on their exercise habits: non-exercisers (n = 33 351; 28.2%) and exercisers (n = 84 989; 71.8%). Engagement in preoperative exercise was significantly associated with a reduced risk of postoperative VTE (adjusted odds ratio [aOR]: 0.69, 95% confidence interval [c.i.]: 0.49-0.99, P = 0.041) compared to the non-exerciser group. A clear dose-response relationship was evident; while exercising 1-2 times per week was associated with a lower but non-significant risk (aOR: 0.79, 95% c.i.: 0.48-1.26, P = 0.334), the lowest and statistically significant risk was observed among patients exercising ≥3 times per week (aOR: 0.66, 95% c.i.: 0.45-0.96, P = 0.031, P for trend = 0.032). Secondary analyses confirmed similar protective trends for deep vein thrombosis, with varying degrees of risk reduction observed for other complications such as stroke. Subgroup analysis indicated that the impact of exercise on outcomes was more pronounced in male and smoking patients.</p><p><strong>Conclusions: </strong>Preoperative exercise is an independent, modifiable factor associated with a dose-dependent reduction in VTE risk, highlighting its role as a non-pharmacological strategy to enhance surgical safety.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918351","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 after robot-assisted versus laparoscopic pancreatoduodenectomy: multicentre propensity-matched comparison from the Italian Group of Minimally Invasive Pancreatic Surgery.","authors":"Giuseppe Quero, Roberta Menghi, Niccolò Napoli, Allegra Ripolli, Giovanni Ferrari, Michele Mazzola, Elisa Bannone, Giovanni Butturini, Massimo Giuseppe Viola, Marco Garatti, Giovanni Tebala, Fabrizio Di Benedetto, Luca Moraldi, Carlo Molino, Sergio Alfieri, Umberto Bracale, Roberto Troisi, Raffaele Dalla Valle, Marco Vivarelli, Elio Jovine, Riccardo Memeo, Gianluca Garulli, Luca Ottaviani, Stefano Berti, Andrea Coratti, Giorgio Ercolani, Roberto Salvia, Luca Morelli, Riccardo Casadei, Roberto Coppola, Alberto Brolese, Vicenzo Tondolo, Alessandro Zerbi, Ugo Boggi","doi":"10.1093/bjsopen/zrag152","DOIUrl":"10.1093/bjsopen/zrag152","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive approaches to pancreatoduodenectomy (PD) are increasingly being adopted worldwide. However, direct comparisons between laparoscopic PD (LPD) and robot-assisted PD (RPD) remain limited and inconclusive. This study aimed to compare perioperative outcomes between LPD and RPD within a national multicentre cohort.</p><p><strong>Methods: </strong>This retrospective multicentre study included patients who underwent LPD or RPD at participating Italian centres within the Italian Group of Minimally Invasive Pancreas Surgery registry between October 2019 and December 2024. Propensity score matching was performed in a 1 : 1 ratio based on age, body mass index, American Society of Anaesthesiologists score, tumour type (pancreatic ductal adenocarcinoma versus other histologies), receipt of neoadjuvant chemotherapy, and requirement for vascular and/or organ resection. Primary outcomes were estimated blood loss and operative time. Secondary outcomes included conversion rate, postoperative morbidity, pancreas-related complications, reoperation, length of hospital stay, histopathological features, and deaths.</p><p><strong>Results: </strong>Among 774 minimally invasive PDs, 163 (21.1%) were LPD and 611 (78.9%) were RPD. After propensity score matching , 161 LPDs were compared with 161 RPDs. RPD was associated with a longer operative time (median 506 (interquartile range (i.q.r.) 427.5-600) versus 500 (411.5-551) minutes; P = 0.030) but lower estimated blood loss (median 200 (i.q.r. 100-337.5) ml versus 250 (150-500) ml; P < 0.001). On multivariable analysis, surgical approach was not an independent predictor of operative time, whereas RPD was independently associated with lower estimated blood loss (β -0.372, 95% confidence interval -0.641 to -0.102; P = 0.007). Conversion to open surgery was significantly more frequent after LPD (24 of 161; 14.9%) than RPD (11 of 161; 6.8%) (P = 0.023). Postoperative outcomes-including major morbidity, pancreas-specific complications, reoperation, length of hospital stay, and in-hospital or 90-day deaths-were comparable between groups. Histopathological findings were also similar.</p><p><strong>Conclusion: </strong>RPD was associated with lower estimated blood loss and a reduced conversion rate compared with LPD. However, these differences were modest in absolute terms and did not translate into clinically meaningful differences in postoperative outcomes, which remained comparable between the two approaches.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148966347","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":"Incidental findings on preoperative computed tomography for the planning of robotic arthroplasty: retrospective cohort study.","authors":"Robin J S Jones, Jonathan R A Phillips, Matthew J Wilson, Michalis Panteli","doi":"10.1093/bjsopen/zrag044","DOIUrl":"10.1093/bjsopen/zrag044","url":null,"abstract":"<p><strong>Background: </strong>The use of robotically assisted arthroplasty has increased substantially in recent years. Some robotic platforms require preoperative computed tomography for surgical planning. These scans frequently include anatomical regions beyond the primary operative field, creating potential for incidental findings. Planning computed tomography is not formally reported routinely, raising the possibility that clinically relevant incidental findings may be overlooked.</p><p><strong>Methods: </strong>The reports of all computed tomography performed for preoperative planning of robotically assisted arthroplasty at the authors' institution between October 2019 and February 2024 were reviewed retrospectively. Incidental findings were noted, and their clinical significance assessed. The notes of patients with significant findings were reviewed to ascertain the final diagnosis and management.</p><p><strong>Results: </strong>A total of 1602 patients (mean age 66.8 years, median 68 (range 16-98) years; 847 women) were identified within the study period. Some 447 patients (27.9%) demonstrated incidental findings, 136 (8.5%) of which were significant, requiring further investigation or management. Eighty-six significant findings (5.4%) were suspicious for malignancy and, of these, five (0.3%) resulted in a new cancer diagnosis.</p><p><strong>Conclusion: </strong>In this study, the rate of significant incidental findings was 8.5% and the risk of discovery of previously undiagnosed malignancy was 0.3%. A new significant finding was demonstrated in 1 in every 12 patients, and a new cancer diagnosis in 1 in every 320 patients. Planning imaging for robotic arthroplasty should be reported by a radiologist to prevent significant findings and malignancy being missed.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988044","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}