BJS Open最新文献

{"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":"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":"Role of circulating tumour DNA in predicting complete clinical response and local regrowth after total neoadjuvant therapy for rectal cancer: meta-analysis.","authors":"Nikhil Lal, Siddharth Shukla, Nicola Hodges, Gina Brown, John T Jenkins","doi":"10.1093/bjsopen/zrag142","DOIUrl":"10.1093/bjsopen/zrag142","url":null,"abstract":"<p><strong>Background: </strong>Non-operative management after total neoadjuvant therapy (TNT) has emerged as a potential strategy for patients with locally advanced rectal cancer (LARC) achieving clinical complete response (cCR). Circulating tumour DNA (ctDNA) has been proposed as a systemic biomarker to augment response assessment, but its role in predicting cCR and local regrowth remains uncertain.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were performed of studies evaluating ctDNA dynamics in patients with LARC undergoing TNT. PubMed, EMBASE, and Web of Science databases were searched from database inception to 31 March 2026. Primary outcomes were the association between post-TNT ctDNA status and cCR and sustained cCR. Pooled odds ratios (ORs) were calculated using a random-effects model.</p><p><strong>Results: </strong>Six studies comprising 597 patients were included. ctDNA negativity following TNT was associated with higher likelihood of cCR (OR 8.01; 95% confidence interval (c.i.) 1.43 to 44.90; I2 = 27.0%). The association with sustained cCR was not statistically significant (OR 3.46; 95% c.i. 0.03 to 394.64; I2 = 59.9%). Across studies, post-TNT ctDNA positivity was associated with inferior disease-free, distant recurrence-free, and progression-free survival. ctDNA demonstrated high specificity and positive predictive value for residual disease, but low sensitivity for the detection of residual local disease and local regrowth, with a substantial proportion of patients with residual tumour remaining ctDNA negative at restaging.</p><p><strong>Conclusion: </strong>Post-TNT ctDNA positivity may identify patients at increased risk of adverse oncological outcomes. However, ctDNA negativity was not consistently associated with the absence of residual local disease, limiting its utility as an independent determinant of organ preservation eligibility. ctDNA should be interpreted as a complementary tool for systemic risk stratification alongside established anatomical assessment.</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/PMC13637619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104002","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}

{"title":"Association of the Flemish Triage Risk Screening Tool with postoperative outcomes in older adults after colorectal cancer surgery: retrospective cohort study.","authors":"Federico Ghignone, Giampaolo Ugolini, Isacco Montroni, Filippo Banchini, Fausto Catena, Davide Cavaliere, Giorgio Ercolani, Gianluca Garulli, Andrea Lucchi, Valentina Danesi, Ilaria Massa, Parisa Soleimani, William Balzi, Alice Andalò, Martina Cavallucci, Nicola Gentili, Andrea Roncadori","doi":"10.1093/bjsopen/zrag096","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag096","url":null,"abstract":"<p><strong>Background: </strong>Older adults undergoing colorectal cancer (CRC) surgery are at increased risk of postoperative complications, mortality, and loss of independence. Frailty screening tools may support perioperative risk stratification. This study evaluated the association between the Flemish Triage Risk Screening Tool (fTRST) and postoperative outcomes.</p><p><strong>Methods: </strong>This retrospective multicentre cohort study analysed the Emilia-Romagna Surgical Colorectal Audit. Patients aged ≥ 70 years undergoing CRC surgery (2019-2023) were included. Patients with fTRST scores ≥ 2 and < 2 were matched 1 : 1 using propensity score matching. Primary outcomes were 30-, 90-, and 180-day mortality and complications. Secondary outcomes included prolonged hospital stay and discharge to a non-independent setting. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed.</p><p><strong>Results: </strong>In all, 1539 patients were included in the study. Mortality at 30, 90, and 180 days was 4.2%, 7.1%, and 10.5%, respectively. In the unmatched cohort, each 1-point increase in fTRST score was significantly associated with 30-day mortality (odds ratio (OR) 1.36; 95% confidence interval (c.i.) 1.12 to 1.66), complications (OR 1.12; 95% c.i. 1.02 to 1.23), prolonged hospital stay (OR 1.13; 95% c.i. 1.03 to 1.24), and discharge to a non-independent setting (OR 1.35; 95% c.i. 1.21 to 1.51). After matching 566 pairs, higher fTRST score remained significantly associated with 30-day mortality (OR 1.33; 95% c.i. 1.09 to 1.63) and discharge to a non-independent setting (OR 1.40; 95% c.i. 1.25 to 1.59). ROC analysis using an fTRST cut-off of ≥2 showed moderate discrimination for 30-day mortality and discharge to a non-independent setting, with areas under the ROC curve of 72.4% (negative predictive value 98.2%) and 67.2% (positive predictive value 66.3%), respectively.</p><p><strong>Conclusions: </strong>The fTRST is a simple screening tool for identifying older adults at risk of adverse postoperative and functional outcomes after CRC surgery, supporting perioperative planning.</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/PMC13625654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103844","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":"The impact of a Personal Outpatient Worksheet and Educational Reference form on patient engagement and communication in the surgical clinic: multicentre randomized clinical trial.","authors":"Matheesha Herath, Jesse D Ey, Ellie C Treloar, Scarlotte Kulas, Jessie Martin, Harriett McConville, Martin Bruening, Guy J Maddern","doi":"10.1093/bjsopen/zrag099","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag099","url":null,"abstract":"<p><strong>Background: </strong>In contemporary medicine, time pressure, limited resourcing, human factors, and health literacy are barriers to delivering high-quality patient-centred care. Improving patient engagement may mitigate these barriers. This study evaluated the impact of the Personal Outpatient Worksheet and Educational Reference (POWER) form on patient engagement in the surgical outpatient setting.</p><p><strong>Methods: </strong>A multicentre, randomized clinical trial was conducted in two metropolitan hospitals between July 2022 and January 2025. Patients over 16 attending a general surgical outpatient appointment were eligible for inclusion. Participants were randomized into either intervention or control cohorts using a random number generator with 1 : 1 allocation stratified by sex. All participants underwent a surgical outpatient appointment, which was audio-visually recorded. The intervention cohort received a copy of the POWER form, a document with five suggested questions participants could ask during their appointment. The control cohort received standard care without the POWER form. Participants were telephoned one week after their appointment to complete a survey. The primary endpoint was patient recall, assessed by comparing survey responses with the recorded discussion, using an intention to treat analysis.</p><p><strong>Results: </strong>A total of 143 participants were recruited (71 participants to intervention, 72 to control). Ten participants (five in each group) withdrew and were excluded from analysis of the primary endpoint. Mean recall in the intervention cohort was 88% (95% confidence interval 83 to 92) compared with 31% (26 to 35) in the control group (P < 0.001).</p><p><strong>Conclusion: </strong>Use of the POWER form in the general surgical outpatient setting significantly improves patient recall. Registration number: ACTRN12625000075482 (https://www.anzctr.org.au/).</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/PMC13625642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103940","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":"Multicentre parallel-group open-label non-inferiority randomized clinical trial of recooling versus no recooling after normothermic machine perfusion in liver transplantation: ARANMP-LT protocol.","authors":"Salvatore Gruttadauria, Roberta Vella, Fabrizio Di Francesco, Duilio Pagano, Marco Barbara, Monica Rizzo, Ivan Vella, Sergio Calamia, Alessandro Tropea, Pasquale Bonsignore, Caterina Accardo, Gaetano Burgio, Enzo Andorno, Marco Miggino, Stefania Camagni, Domenico Pinelli, Amedeo Carraro, Alex Borin, Matteo Cescon, Matteo Serenari, Umberto Cillo, Jacopo Lanari, Fabrizio Di Benedetto, Paolo Magistri, Giuseppe Maria Ettorre, Sara Ingallinella, Francesco Frongillo, Marco Maria Pascale, Davide Ghinolfi, Giulia Cirillo, Fabio Melandro, Gianluca Mennini, Francesco Tandoi, Irene Scalera, Giuseppe Tisone, Roberta Angelico, Marco Vivarelli, Federico Mocchegiani, Sergio Li Petri","doi":"10.1093/bjsopen/zrag166","DOIUrl":"10.1093/bjsopen/zrag166","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/PMC13657183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164416","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":"Oncological outcomes of direct versus delayed surgery after neoadjuvant short-course radiotherapy for rectal cancer: national cohort study.","authors":"Najia Azhar, Marie-Louise Lydrup, Pamela Buchwald","doi":"10.1093/bjsopen/zrag146","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag146","url":null,"abstract":"<p><strong>Background: </strong>After the Stockholm III trial, a trend towards delayed surgery after neoadjuvant short-course radiotherapy (5 × 5 Gy) for rectal cancer has emerged in Sweden, driven by the lower short-term complication rates and similar oncological outcomes. This study aimed to examine long-term oncological outcomes after neoadjuvant short-course radiotherapy, comparing direct versus delayed surgery for rectal cancer in a real-world setting.</p><p><strong>Methods: </strong>A registry-based retrospective national cohort study was conducted using prospectively collected data from the Swedish Colorectal Cancer Registry. Patients with rectal cancer receiving neoadjuvant neoadjuvant short-course radiotherapy with surgery between 2016 and 2020 were analysed for oncological outcomes (local recurrence, distant metastasis) and overall survival at 3 years, comparing direct surgery, defined as surgery within 7 days after neoadjuvant short-course radiotherapy, and delayed surgery, defined as surgery after 28-90 days. The rate of patients who underwent surgery within the delayed time frame of the Stockholm III trial was also recorded.</p><p><strong>Results: </strong>A total of 2080 patients were identified, of whom 1208 (58.1%) underwent direct surgery and 872 had delayed surgery. Of note, only 288 patients underwent resection 28-56 days after neoadjuvant short-course radiotherapy (within the time frame of the Stockholm III trial). Although the pathological complete response rate was higher in the delayed-surgery group compared with the direct-surgery group (6.5% versus 0.4%), 3-year local recurrence and distant metastasis rates were, respectively, 1.0% (12 patients) and 6.8% (82) in the direct-surgery group, and 3.4% (30) and 11.9% (104) in the delayed-surgery group. The adjusted hazard ratios for local recurrence and distant metastasis comparing delayed surgery with direct surgery were 3.60 (95 per cent confidence interval 1.75 to 7.39) and 2.17 (1.58 to 2.96), respectively, whereas the adjusted hazard ratio for overall survival was 1.37 (1.06 to 1.77), favouring the direct-surgery group.</p><p><strong>Conclusion: </strong>In a real-world setting, the results indicate that few patients in the delayed-surgery group had surgery within the stipulated time frame. Considering this, delayed surgery was associated with a higher risk of local recurrence, distant metastasis, and reduced overall survival.</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/PMC13660688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179302","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":"The iBRA-NET localization study: international IDEAL 2a/2b multicentre cohort study comparing the safety and effectiveness of wire- and radar-guided localization for impalpable breast lesions.","authors":"Rajiv V Dave, Jenna Morgan, Simon Lowes, Robert Milligan, Rachel Foster, Emma Barrett, Amtul R Carmichael, Suzanne Elgammal, Edward St John, Chris Holcombe, Yazan Masannat, Shelley Potter, Suzanne Krizak, Vidya Raghavan, James Harvey","doi":"10.1093/bjsopen/zrag108","DOIUrl":"10.1093/bjsopen/zrag108","url":null,"abstract":"<p><strong>Background: </strong>Wire-guided localizations have been the historical standard for breast lesion localization; however, they have logistical constraints and can dislodge in the preoperative period. Radar-guided localization has the potential to uncouple localization from the day of surgery, but the technique needs to be evaluated in a direct comparison with wire-guided localization to ensure efficacy and safety.</p><p><strong>Methods: </strong>The iBRA-NET localization study is a prospective platform IDEAL 2a/2b study comparing wire-guided localization with new generation localization devices. This arm describes SCOUT® radar localization for impalpable breast lesions performed between June 2021 and December 2024, compared with a historical cohort of wire-guided localization performed between August 2018 and August 2020. Primary outcome was identification of the index lesion in the excision specimen. Secondary endpoints included safety (complications), margin re-excision, magnetic resonance imaging bloom size, and specimen weight.</p><p><strong>Results: </strong>Data were accrued from 1297 radar localized patients in 27 units. Index lesion identification was 95.2% in radar-guided excisions versus 99.1% in wire-guided excisions (P = 0.001). In a sensitivity analysis excluding patients receiving neoadjuvant chemotherapy, identification rates were 98.9% versus 99.6% (P = 0.114). For a subset of patients having a simple lumpectomy for a unifocal, unilateral breast lesion with no neoadjuvant treatment (1627), positive margins were seen in the main excision specimen in 1003 (15.0%) wire-guided versus 624 (9.0%) radar-guided excisions (P < 0.001). Re-excision was required in 131 (13.2%) wire-guided versus 91 (14.7%) radar-guided excisions (P = 0.442). There was a significant difference in specimen weight/size2 (0.138 g/mm2 wire-guided localization versus 0.182 g/mm2 radar; P < 0.001). The median start time for surgery was earlier in the day for radar-guided localizations compared with wire-guided (12:27 versus 13:40; P < 0.001). All radar placements in axillary nodes (13) led to successful nodal retrieval.</p><p><strong>Conclusion: </strong>SCOUT® radar localizations are a safe and effective localization technique in both the breast and axilla, with outcomes comparable to wires. There were demonstrable logistical advantages in operative start time when using a radar reflector.</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/PMC13559476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918349","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}