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":"Effect of transverse versus midline periumbilical incision on incisional hernia and short-term outcomes after laparoscopic colon cancer surgery: multicentre, open-label, randomized clinical trial.","authors":"Soo Young Lee, Soo Yeun Park, Gi Won Ha, Gyung Mo Son, Dong Keon Yon, Chang Hyun Kim","doi":"10.1093/bjsopen/zraf062","DOIUrl":"10.1093/bjsopen/zraf062","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess the effect of a periumbilical transverse incision compared with a periumbilical midline incision in reducing incisional hernia and improving short-term outcomes after laparoscopic colon cancer surgery.</p><p><strong>Methods: </strong>This multicentre, open-label, randomized clinical trial was conducted at four high-volume hospitals in Korea, between April 2021 and February 2023. Patients were eligible if they were aged ≥ 20 years and had pathologically confirmed colon cancer. Block randomization was undertaken in a 1 : 1 ratio to transverse versus midline groups, stratified by tumour location. The primary endpoint was the incidence of radiological incisional hernia at 12 months after surgery. The secondary endpoints included symptomatic incisional hernia and short-term outcomes such as outcomes during surgery, complications at 30 days after surgery, pain after surgery, hospital stay after surgery, and patient-reported questionnaires.</p><p><strong>Results: </strong>Of 174 enrolled patients, 155 were analysed for primary outcome (79 in transverse group and 76 in midline group). Radiological incisional hernia was significantly less frequent in the transverse group (6%) compared with the midline group (18%) 12 months after surgery (P = 0.022); however, there was no significant difference in the incidence of symptomatic incisional hernia between the two groups (3 versus 8%; P = 0.162). Surgical outcomes, complications after surgery, pain, and length of hospital stay did not differ significantly between the two groups. The transverse group had a shorter incision length (mean(standard deviation) 5.0(0.8) versus 5.3(0.8) cm; P = 0.027) and higher cosmesis score (18.0(3.2) versus 16.6(2.7); P = 0.006) than the midline group.</p><p><strong>Conclusion: </strong>A periumbilical transverse incision significantly reduced radiological incisional hernia compared with a midline incision in laparoscopic colon cancer surgery. Clinical Research Information Service registration number: KCT0006082 (https://cris.nih.go.kr).</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/PMC12131159/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207593","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":"Assessment of nodal staging and risk factors for nodal involvement in gallbladder cancer.","authors":"Anita Balakrishnan, Petros Barmpounakis, Nikolaos Demiris, Bodil Andersson, Alejandro Brañes, Xavier de Aretxabala, Malin Sternby Eilard, Paul Gibbs, Simon J F Harper, Emmanuel L Huguet, Asif Jah, Vasilis Kosmoliaptsis, Javier Lendoire, Siong S Liau, Shishir Maithel, Jack L Martin, Colin Noel, Raaj K Praseedom, Alejandro Serrablo, Volkan Adsay","doi":"10.1093/bjsopen/zraf056","DOIUrl":"10.1093/bjsopen/zraf056","url":null,"abstract":"<p><strong>Background: </strong>Nodal assessment in gallbladder cancer remains challenging, particularly in incidental gallbladder cancer. This understages the number of patients with node-positive disease, resulting in prognostic inaccuracy and insufficient adjuvant treatment. This study aimed to identify risk factors for positive nodes in gallbladder cancer and to compare prognostic discrimination of available nodal staging parameters.</p><p><strong>Methods: </strong>This international cohort study assessed gallbladder cancer resections undertaken between 1 January 2010 and 31 December 2020. Logistic regression was used to identify risk factors for node-positive status and develop a risk prediction score for positive nodes. Nodal staging models, including nodal site, number of positive nodes, and positive node ratio were compared for greatest prognostic discrimination in gallbladder cancer.</p><p><strong>Results: </strong>A total of 3676 patients underwent gallbladder cancer resection across 133 centres in 41 countries. Tumour (T) stage (T2, P = 0.012; T3, P = 0.002; and T4, P < 0.001), lymphovascular and perineural infiltration (P < 0.001), and tumour differentiation (P < 0.001) carried the greatest risk of positive nodes. These three parameters comprised the OMEGA Node Positivity Prediction Score (OMEGA-NOPPS) with C-statistics of 0.81 (95% confidence interval 0.78 to 0.84) in the training data set and 0.79 (0.73 to 0.85) in the test data set for identification of node-positive status, highlighting a ≥ 20% increased risk of positive nodes in poorly differentiated tumours with lymphovascular and perineural infiltration despite T1 disease.</p><p><strong>Conclusion: </strong>Data from this large multicentre study confirmed that the number of positive nodes is the most discriminative prognostic model for nodal staging in gallbladder cancer. OMEGA-NOPPS provides three simple parameters to stratify nodal involvement according to risk. Incidental gallbladder cancer with lymphovascular and perineural infiltration and poorly differentiated tumours, including early T stages, should be considered for further treatment.</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/PMC12100740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207592","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":"Perioperative characteristics and short-term morbidity after surgery for renal hyperparathyroidism: multicentre EUROCRINE® registry study.","authors":"Klaas Van Den Heede, Nele Brusselaers, Martin Almquist, Philipp Riss, Marco Raffaelli, Sam Van Slycke","doi":"10.1093/bjsopen/zraf048","DOIUrl":"10.1093/bjsopen/zraf048","url":null,"abstract":"<p><strong>Background: </strong>Parathyroid surgery is an appropriate alternative for renal hyperparathyroidism (rHPT) in patients in whom medical therapy fails. European morbidity and outcome data for clearly defined cohorts, potentially reflecting contemporary clinical practice, remain scarce.</p><p><strong>Method: </strong>Data were extracted from the EUROCRINE® database on all operations for secondary rHPT between 1 January 2015 and 31 December 2021. Multivariable logistic regression analysis was used to identify risk factors for complications. Subgroup analyses were conducted for the two major surgical approaches (subtotal parathyroidectomy or total thyroidectomy with parathyroid transplantation), as well as for redo and concomitant thyroid surgery. The primary outcome was 30-day morbidity.</p><p><strong>Results: </strong>After excluding 324 patients, data were analysed for 1165 patients, who underwent primary surgery (859), redo surgery (135), or parathyroid surgery with concomitant (planned or unplanned) thyroid surgery (171). The postoperative complication rate was 13.8% (161 patients). Reintervention for bleeding was necessary in 22 patients (1.9%). The length of hospital stay was >1 week in 108 patients (9.8%), and was shorter in the redo parathyroidectomy than first-time parathyroidectomy group (52.0% (66) versus 36.6% (299) discharged within 2 days, respectively). No risk factors for complications could be identified in either the overall or subgroup analyses. In the case of redo surgery or primary surgery with concomitant thyroid surgery, recurrent laryngeal nerve palsy (6.7 versus 3.5%, respectively), revision surgery for bleeding (2.2 versus 1.2%, respectively), and wound infection rates (0.7 versus 0.0%, respectively) remained low.</p><p><strong>Conclusion: </strong>This large European multicentre cohort study demonstrates the safety and low morbidity of parathyroid surgery for rHPT.</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/PMC12159728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274207","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":"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":"Predictors and risk model for positive circumferential resection margin after robot-assisted total mesorectal excision: retrospective cohort study.","authors":"Ritch T J Geitenbeek, Thijs A Burghgraef, Rauand Duhoky, Christina A Fleming, Aurore Moussion, Nabila Bouazza, Eddy Cotte, Anne Dubois, Eric Rullier, Quentin Denost, Philippe Rouanet, Jim Khan, Roel Hompes, Esther C J Consten","doi":"10.1093/bjsopen/zraf027","DOIUrl":"10.1093/bjsopen/zraf027","url":null,"abstract":"<p><strong>Background: </strong>Positive circumferential resection margin (CRM) after total mesorectal excision (TME) is associated with higher local and systemic recurrence rates, affecting overall survival in patients with rectal cancer. Although risk factors for positive CRM have been identified for open, laparoscopic, and transanal TME, these may differ for robot-assisted total mesorectal excision (R-TME). This study aimed to assess the incidence of positive CRM following R-TME and identify the associated preoperative risk factors.</p><p><strong>Method: </strong>An international multicentre retrospective study included patients receiving R-TME between January 2013 and January 2022 in centres based in the Netherlands, UK, and France. Endpoints were the incidence of and predictive factors for positive CRM. Univariable and multivariable logistic regression analyses were performed, and factors associated with positive CRM were then assessed by formulating a predictive model.</p><p><strong>Results: </strong>A total of 1390 patients underwent R-TME, and the incidence of positive CRM was 6.0% (n = 83). Multivariable analysis revealed significant associations between positive CRM and cT4 tumours (OR 2.27), involved mesorectal fascia on staging magnetic resonance imaging at diagnosis (OR 1.89), and non-sphincter-saving surgery (OR 2.22). The predictive model exhibited satisfactory discrimination (area under the receiver-operating characteristic curve > 0.7) and predicted a 26% risk of positive CRM when all identified risk factors were present.</p><p><strong>Conclusion: </strong>Preoperative tumour- and procedure-related factors, rather than patient-related factors, are associated with CRM involvement after R-TME. The proposed predictive model allows preoperative calculation of the risk of positive CRM, offering valuable insights for optimizing patient selection and tailoring treatment approaches to enhance oncological outcomes.</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/PMC12097205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207595","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":"Investigating intraoperative parathyroid hormone criteria for enhanced accuracy and surgical success in treating primary hyperparathyroidism: results from two tertiary referral centres.","authors":"Eleonora Lori, Loredana De Pasquale, Alberto M Saibene, Luca Castellani, Daniele Pironi, Piergaspare Palumbo, Domenico Tripodi, Flavio Forte, Corrado De Vito, Gaetano Gallo, Salvatore Sorrenti","doi":"10.1093/bjsopen/zraf055","DOIUrl":"10.1093/bjsopen/zraf055","url":null,"abstract":"<p><strong>Background: </strong>Primary hyperparathyroidism is a common endocrine disorder necessitating surgical intervention for definitive treatment. Measurement of intraoperative parathyroid hormone (ioPTH) has revolutionized surgical management, but interpreting the results remains a subject of debate. This retrospective study, evaluated the efficacy of the Miami criterion (a > 50% decrease in ioPTH level 10 minutes after parathyroid removal) in predicting surgical success and whether meeting this criterion reduced persistence rates. It also investigated whether achieving a drop in ioPTH concentration to within the normal range, either alone or in combination with meeting the Miami criterion, led to improved outcomes.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients with primary hyperparathyroidism who underwent surgery at two Italian tertiary referral centres. Univariate and multivariate analyses were used to identify predictors of persistence. The diagnostic performances of both ioPTH criteria were assessed, individually and in combination.</p><p><strong>Results: </strong>Data from 380 patients were analysed. Multivariate analysis confirmed the efficacy of both ioPTH criteria, showing a negative association between persistence and both a fall to within the normal range (P = 0.005) and a > 50% decrease in ioPTH level (P = 0.039). The > 50% reduction in ioPTH criterion demonstrated higher sensitivity (95.0%) and lower specificity (45.0%) than the normalization of ioPTH criterion (sensitivity 81.1% and specificity 60.0%). Combining the two criteria resulted in the highest sensitivity (97.5%) and an improved negative predictive value (55.0%) compared with each criterion alone, resulting in the highest accuracy.</p><p><strong>Conclusion: </strong>A fall in ioPTH level to within the normal range helps prevent persistence, whereas a drop of > 50% reduces the rate of unnecessary bilateral neck explorations. Combining the two criteria yields the best results in terms of predicting surgical outcome.</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/PMC12163589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144282311","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}