BJS Open最新文献

{"title":"Prediagnostic serum iodine and selenium in relation to breast cancer survival.","authors":"Magdalena Szramka, Malte Sandsveden, Kamil Demircan, Signe Borgquist, Ann Rosendahl, Jonas Manjer","doi":"10.1093/bjsopen/zrag047","DOIUrl":"10.1093/bjsopen/zrag047","url":null,"abstract":"<p><strong>Background: </strong>Trace elements like iodine have been suggested to be associated with breast cancer due to their antioxidant properties and ecological differences in incidence and mortality. Yet, there are no epidemiological studies on breast cancer prognosis in relation to iodine levels. The primary aim of this study was to investigate the association between prediagnostic serum iodine levels and breast cancer survival. A secondary aim was to examine if the potential association was modified by serum selenium levels.</p><p><strong>Methods: </strong>This study included women diagnosed with primary invasive breast cancer (1991-2013) from the Malmö Diet and Cancer Study (1991-1996). The patients were divided into quartiles depending on their serum iodine levels at baseline. Crude and multivariable-adjusted Cox regression analyses were used to obtain hazard ratios with 95% confidence intervals, for breast cancer-specific and overall mortality, with follow up until 31 December 2018. Analyses were additionally stratified by selenium levels (below versus above the median).</p><p><strong>Results: </strong>Out of 17 035 female participants of the Malmö Diet and Cancer Study, 918 patients with breast cancer were included in this study. The mean(standard deviation) follow-up time was 11.4(6.0) years. The adjusted hazard ratios for breast cancer-specific and overall mortality for the highest iodine quartile compared with the lowest were 1.26 (95% confidence interval 0.79 to 1.99) and 1.27 (0.92 to 1.75). Among women with high selenium, high iodine levels were associated with a high breast cancer-specific and overall mortality; hazard ratios of 1.90 (1.09 to 3.32) and 1.81 (1.26 to 2.61), respectively. High selenium levels were associated with a lower breast cancer-specific and overall mortality; the adjusted HRs were 0.69 (0.50 to 0.95) and 0.73 (0.58 to 0.91).</p><p><strong>Conclusion: </strong>High serum iodine was weakly associated with mortality overall and significantly associated among women with high selenium, whereas serum selenium alone was inversely associated with mortality.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13270489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148263164","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 faecal microbiome dynamics in patients undergoing rectal cancer surgery in the IMARI-trial.","authors":"Kiedo Wienholts, Anne E Petersen, Claire P M van Helsdingen, Kevin Talboom, Mark Davids, Johannes H W de Wilt, Wouter J de Jonge, Pieter J Tanis, Roel Hompes, Joep P M Derikx","doi":"10.1093/bjsopen/zrag046","DOIUrl":"10.1093/bjsopen/zrag046","url":null,"abstract":"<p><strong>Background: </strong>The gut microbiome influences health by regulating metabolism, modulating the immune system, and protecting against pathogens. Surgical interventions, antibiotics, and dietary changes can disrupt this balance. In rectal cancer surgery, the perioperative microbiome's role in selective digestive decontamination and ileostomy formation remains underexplored. This manuscript aimed to investigate perioperative microbiome dynamics in patients undergoing rectal cancer surgery, focusing on the impact of selective digestive decontamination and ileostomy.</p><p><strong>Methods: </strong>This study was part of the IMARI-trial. Faecal samples were collected before surgery and faecal or ileostomy samples on postoperative day 4. Microbial composition and diversity were assessed using 16S ribosomal RNA sequencing; alpha and beta diversity analyses were stratified by time point, ileostomy status, and selective digestive decontamination administration.</p><p><strong>Results: </strong>Of the 246 enrolled in the IMARI-trial, 214 patients were analysed. Postoperative samples showed significantly lower alpha diversity than preoperative samples, indicating reduced microbial richness and evenness across groups. Beta diversity analyses revealed distinct clustering between pre- and postoperative samples, with surgery explaining the largest variance in microbial composition (R2 = 15.6%; P < 0.001). Ileostomy status (R2 = 9.6%; P < 0.001) and selective digestive decontamination administration (R2 = 3.1%; P = 0.002) also contributed significantly. Notable taxonomic shifts included increased postoperative abundances of Enterococcus and Klebsiella, alongside reduced Firmicutes genera, particularly in ileostomy samples.</p><p><strong>Conclusion: </strong>Surgery and perioperative factors induce significant, early microbiome alterations, favouring facultative anaerobes over obligate anaerobes. Although selective digestive decontamination selectively modulates specific taxa, its overall impact on diversity appears less pronounced than surgery and ileostomy status. These findings underscore the need for studies linking perioperative microbiome trajectories to clinical endpoints and for evaluating microbiome-informed perioperative strategies, including antibiotic stewardship, diet, or microbial therapeutics, in rectal cancer care.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13220757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052386","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":"Preoperative biliary drainage in perihilar cholangiocarcinoma: retrospective multicentre analysis.","authors":"Julien A Luyten, Pim B Olthof, Sander M J van Kuijk, Silvio Nadalin, Hauke Lang, Ruslan Alikhanov, Joris I Erdmann, Johann Pratschke, Shishir K Maithel, Roberto Troisi, Andreas A Schnitzbauer, Ernesto Sparrelid, Peter Lodge, Massimo Malagò, Ulf P Neumann, Erik Schadde, Hassan Z Malik, Keith J Roberts, Baki Topal, Frederik J H Hoogwater, Jeroen Hagendoorn, Andrea Ruzzenente, Concepcion Gomez, William R Jarnagin, Matteo Cescon, Luca Aldrighetti, Bas Groot Koerkamp, Maxime J L Dewulf, Steven W M Olde Damink","doi":"10.1093/bjsopen/zrag048","DOIUrl":"10.1093/bjsopen/zrag048","url":null,"abstract":"<p><strong>Background: </strong>There is no consensus on the use of preoperative biliary drainage for resectable perihilar cholangiocarcinoma. This retrospective cohort study aimed to explore the association of biliary drainage with postoperative mortality and morbidity.</p><p><strong>Methods: </strong>This retrospective observational cohort study included patients who underwent resection of histologically confirmed perihilar cholangiocarcinoma from the Perihilar Cholangiocarcinoma Collaboration Group database across 27 Western hepatobiliary centres (2000-2022). To correct for baseline differences between patients who did or did not undergo drainage, propensity score weighting was applied. Outcomes were compared using propensity score-weighted regression and multivariable analysis.</p><p><strong>Results: </strong>Overall, 2067 patients were included, of whom 350 (16.9%) did not undergo biliary drainage. Before propensity score weighting, patients who did not undergo drainage were less likely to have Bismuth III-IV disease (297 (78.9%) versus 1448 (84.3%); P < 0.001), had lower median bilirubin levels (12.0 versus 85.5 µmol/l; P < 0.001), and a higher proportion had left hepatectomies (150 (42.9%) versus 454 (26.4%); P < 0.001). After propensity score-weighted regression analysis, patients in the drainage group were more likely to experience major postoperative complications (odds ratio 1.43, 95% confidence interval 1.04 to 1.95; P = 0.027) and posthepatectomy liver failure (odds ratio 2.12, 1.25 to 3.58; P = 0.005). In multivariable analysis, only posthepatectomy liver failure remained significant (odds ratio 2.13, 1.29 to 3.54; P = 0.003).</p><p><strong>Conclusion: </strong>In this retrospective propensity score weighting analysis, preoperative biliary drainage was associated with a higher incidence of posthepatectomy liver failure in resectable perihilar cholangiocarcinoma. These findings suggest that a subgroup of patients with perihilar cholangiocarcinoma can be operated safely without biliary drainage. The indication for preoperative biliary drainage should be considered on an individual basis.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13243707/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148197292","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":"Impact of breast cancer characteristics on the development and time to liver metastases: population-based study.","authors":"Marcus Sundén, Elin Lindqvist, Ellen Wahlqvist, Ellen Hansson, Charlotta Wadsten, Anne Andersson, Malin Sund, Oskar Hemmingsson","doi":"10.1093/bjsopen/zrag036","DOIUrl":"10.1093/bjsopen/zrag036","url":null,"abstract":"<p><strong>Background: </strong>Breast cancer (Bc) is the leading cause of cancer-related death in women. In many patients, BC liver metastases (BCLM) are associated with short survival. The aims of this study were to investigate the risk of and time to BCLM in each BC surrogate subtype, and to determine the incidence of BCLM in a population-based setting.</p><p><strong>Methods: </strong>The Swedish national breast cancer registry identified patients with Bc in a regional cohort from 2009 to 2018. The cohort was followed until January 2023. Cox regression analysis was used to determine the risk of BCLM for each subtype. Kaplan-Meier estimates determined the probability of BCLM for each subtype over time.</p><p><strong>Results: </strong>In all, 7292 patients with Bc were included in the study. Distant metastases developed in 755 patients (10.4%); of these, 345 (45.7%) developed BCLM. The BCLM incidence rate was 8 per 1000 person-years. Only 13 patients had oligometastases isolated to the liver. Triple-negative, non-luminal human epidermal growth factor receptor 2 (HER2)-positive and luminal B cancers had the highest risk of BCLM. T category, nodal status, and Nottingham histological grade III were also strongly associated with BCLM. The median time from Bc diagnosis to BCLM was 36 months. Patients with HER2-positive BC subtypes developed BCLM early, at a median of only 9 months.</p><p><strong>Conclusion: </strong>Bc subtype is correlated to the risk and timing of BCLM development. BCLM are common in advanced Bc, but isolated oligometastases are rare.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13166869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926136","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":"Comparative long-term risks of chronic kidney disease and dialysis following conservative treatment, renal artery embolization, or nephrectomy in patients with blunt kidney injuries: retrospective cohort study.","authors":"Jhih-Ming Tang, Ling-Wei Kuo, Jen-Fu Huang, Chih-Po Hsu, Chi-Tung Cheng, Huan-Wu Chen, Cheng-Hsien Wu, Yon-Cheong Wong, Szu-An Chen, Chia-Cheng Wang, Yu-San Tee, Chun-Hsiang Ou Yang, Chih-Yuan Fu, Chien-Hung Liao","doi":"10.1093/bjsopen/zrag051","DOIUrl":"10.1093/bjsopen/zrag051","url":null,"abstract":"<p><strong>Background: </strong>Long-term changes in renal function following blunt kidney injury (BKI) remain insufficiently studied, particularly in patients who undergo renal artery embolization (RAE). The aim of this study was to clarify the long-term risks of chronic kidney disease (CKD) and dialysis in patients with BKI after unilateral nephrectomy, RAE, or conservative treatment. The hypothesis was that both unilateral nephrectomy and RAE would increase these risks compared with conservative treatment, with RAE posing a lower risk.</p><p><strong>Methods: </strong>This retrospective cohort study used data from Taiwan's National Health Insurance Research Database from 2001 to 2019, focusing on patients with BKIs. Outcomes included long-term CKD risks, lifelong dialysis, and all-cause mortality. Inverse probability of treatment weighting was used to minimize confounding.</p><p><strong>Results: </strong>During the study, 19 013 patients were diagnosed with BKIs; of these, 12 709 were analysed (unilateral nephrectomy, 274 (2.1%); RAE, 510 (4.0%); conservative treatment, 11 925 (93.8%)). The mean(standard deviation) age was 39.7(17.1) years, 69.4% were male, and the mean follow-up duration was 10.7(5.2) years. Compared with conservative treatment, patients undergoing unilateral nephrectomy (subdistribution hazard ratio (SHR) 1.97; 95% confidence interval (c.i.) 1.86 to 2.10) or RAE (SHR 1.17, 95% c.i. 1.09 to 1.26) had a higher risk of CKD. In addition, patients in the nephrectomy and RAE groups had an increased risk of lifelong dialysis, with an SHR of 3.97 (95% c.i. 3.09 to 5.10) and 1.46 (95% c.i. 1.07 to 1.99), respectively. Unilateral nephrectomy was associated with a higher risk of all-cause mortality than RAE and conservative treatment, with hazard ratios of 1.14 (95% c.i. 1.06 to 1.23) and 1.63 (95% c.i. 1.52 to 1.75), respectively.</p><p><strong>Conclusions: </strong>Patients with BKIs are at higher risk of long-term CKD and potential lifelong dialysis after both unilateral nephrectomy and RAE, with RAE presenting a lower risk than nephrectomy. Patients with BKIs who undergo unilateral nephrectomy or RAE require follow-up to monitor renal function and receive health education on kidney protection.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13224839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148142591","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 noise isolation during general anaesthesia on the incidence of moderate-to-severe pain after major abdominal surgery: multicentre randomized clinical study.","authors":"Fang Xu, Dong Chen, Cong Wang, Yi Yang, Yingcai Wu, Shuai You, Guangyou Duan","doi":"10.1093/bjsopen/zrag035","DOIUrl":"10.1093/bjsopen/zrag035","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pain remains a major challenge following major abdominal surgery. Noise in the operating room is a modifiable stressor, and the efficacy of targeted noise isolation requires prospective investigation. This study investigated the effects of intraoperative noise isolation on the incidence of moderate-to-severe postoperative pain.</p><p><strong>Methods: </strong>This multicentre randomized clinical trial assessed patients who underwent elective major abdominal surgery under general anaesthesia in four medical centres in China between April, 2024 and May, 2025. Following anaesthesia induction, patients were randomized to either wear noise-cancelling headphones or not (control). The primary outcome of this study was the incidence of moderate-to-severe pain (numeric rating scale (NRS) score ≥ 4) within the 24-hour (h) period after surgery. Secondary outcomes included the incidence of moderate-to-severe pain, cumulative postoperative pain NRS scores within 48 h after surgery, and the consumption of analgesic drugs within 24 and 48 h after surgery.</p><p><strong>Results: </strong>In all, 304 patients were enrolled and randomized; 302 patients were included in the final analysis (150 in the noise isolation group, 152 in the control group). The incidence of moderate-to-severe pain was higher in the control than noise isolation group within 24 h after surgery (49 versus 23%, respectively; relative risk (RR) 0.47; 95% confidence interval (c.i.) 0.33 to 0.65; P  < 0.001) and within 48 h after surgery (51 versus 25%, respectively; RR 0.48; 95% c.i. 0.35 to 0.66; P < 0.001). During the 24-h and 48-h periods after surgery, the number of patient-controlled intravenous analgesia boluses was significantly higher in the control group, which also had a higher extra analgesia requirement and increased total analgesic consumption compared with the noise isolation group. The cumulative and maximum rest and movement pain scores were higher in the control than noise isolation group during the 48-h period after surgery.</p><p><strong>Conclusions: </strong>Intraoperative noise isolation was found to be an effective, safe, and non-invasive preventive intervention that significantly lowered the incidence of moderate-to-severe pain after major abdominal surgery, arguing for its integration into standard multimodal analgesic strategies. Registration number: NCT06316440 (http://www.clinicaltrials.gov).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041120","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":"Drain management after pancreatoduodenectomy: risk-stratified dynamic algorithm.","authors":"Giampaolo Perri, Elisa Bannone, Isabella Frigerio, Riccardo Pellegrini, Martina Guerra, Roberta Vella, Alice Cattelani, Elvira Adinolfi, Umberto Cillo, Giovanni Butturini, Giovanni Marchegiani","doi":"10.1093/bjsopen/zrag068","DOIUrl":"10.1093/bjsopen/zrag068","url":null,"abstract":"<p><strong>Background: </strong>The ability of drain fluid amylase (DFA) to predict pancreatic fistula (POPF) and safely guide early drain removal is unknown in high-risk pancreatoduodenectomy (HR-PD). The aim of this analysis was to develop a new risk-based algorithm for drain management after pancreatoduodenectomy.</p><p><strong>Methods: </strong>All consecutive patients undergoing pancreatoduodenectomy (2019-2024) at two institutions were included. During surgery, patients were stratified into HR-PD, defined according to the International Study Group on Pancreatic Surgery score (soft gland and duct ≤ 3 mm), and non-HR-PD. Postoperative predictors (DFA, serum amylase/lipase, C-reactive protein) were retrieved on postoperative days (PODs) 1 to 5 and correlated to POPF development using a risk-based approach. Results were validated in a retrospective cohort (2015-2019) of pancreatoduodenectomies performed at the same institutions.</p><p><strong>Results: </strong>Out of 825 screened patients, 788 were included. HR-PD (251, 32%) had higher POPF rates (50% versus 9%; P < 0.001) and worse outcomes. In HR-PD, DFA had a lower area under the curve for POPF for POD 1 (0.73 versus 0.85; P = 0.003) and POD 3 (0.74 versus 0.88; P = 0.002) compared with non-HR-PD, but similar for POD 5 (0.83 versus 0.86; P = 0.535), whereas serum amylase/lipase maintained a low area under the curve for POPF compared with non-HR-PD. The optimal criteria for POD 3 drain removal in non-HR-PD were POD 1 DFA < 200 UI/l, POD 3 DFA < 150 UI/l, and absence of elevated serum amylase/lipase on POD 1 (Youden's index 0.674). In HR-PD, the criteria for POD 5 drain removal were POD 5 DFA < 150 UI/l and POD 5 C-reactive protein < 150 mg/ml (Youden's index 0.593).</p><p><strong>Conclusion: </strong>In patients with an intrinsic higher risk of POPF, early predictors are less reliable, and drain management protocols should be tailored. In non-HR-PD, an early removal policy can be recommended based on DFA and serum amylase/lipase. In HR-PD, drain removal may be safely deferred until POD 5 according to DFA and C-reactive protein.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13308533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148337743","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":"Short-term outcomes in robotic-assisted versus conventional laparoscopic surgery for rectal cancer: population-based study.","authors":"Carl Mertens, Pamela Buchwald, Peter Matthiessen, Henrik Jutesten, Soran Gadan, Fredrik Jörgren","doi":"10.1093/bjsopen/zrag050","DOIUrl":"10.1093/bjsopen/zrag050","url":null,"abstract":"<p><strong>Background: </strong>This retrospective cohort study compared short-term outcomes between robotic-assisted and conventional laparoscopic surgery for rectal cancer using data from the Swedish Colorectal Cancer Registry.</p><p><strong>Method: </strong>All patients undergoing elective minimally invasive surgery for rectal cancer between 2014 and 2021 and registered in the Swedish Colorectal Cancer Registry were assessed for eligibility, with patients who underwent robotic-assisted and laparoscopic rectal cancer resection included in the study. The primary outcome was a positive circumferential resection margin (CRM+). Secondary outcomes included conversion to open surgery, total mesorectal excision (TME) specimen quality, and 30-day overall and surgical complications. Multivariable logistic regression analyses were performed.</p><p><strong>Results: </strong>Of 12 703 patients registered during the study period, 10 914 underwent abdominal resection; of these, 5874 were analysed in this study (3578 robotic-assisted; 2296 conventional laparoscopic surgery). There was no difference in CRM+ between the robotic-assisted and conventional laparoscopic surgery groups (6.5% versus 5.9%, respectively; P = 0.291). Conversion to open surgery was more frequent in the conventional laparoscopic surgery group (16.1% versus 9.1%; P < 0.001). In addition, 30-day surgical complications were more common in the robotic-assisted laparoscopic surgery group (21.5% versus 19.3%; P = 0.044), including a higher rate of anastomotic leakage (10.9% versus 7.4%; P = 0.001). In multivariable analysis, neither technique was an independent predictor of CRM+ (odds ratio (OR) 0.99; 95% confidence interval (c.i.) 0.75 to 1.30; P = 0.925). For secondary outcomes robotic-assisted laparoscopic surgery reduced the risk of conversion to open surgery (OR 0.51; 95% c.i. 0.41 to 0.63; P < 0.001), but resulted in fewer complete TME specimens (OR 0.66; 95% c.i. 0.52 to 0.83; P < 0.001).</p><p><strong>Conclusion: </strong>No short-term oncological advantage in terms of radial margin positivity was demonstrated between the two techniques. Findings regarding conversion rates, TME specimen quality, and anastomotic leakage warrant further investigation.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13217427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148041121","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":"Preoperative carbohydrate antigen 19-9 as a prognostic biomarker in colorectal cancer with synchronous peritoneal metastasis: multicentre cohort study.","authors":"Keita Tashiro, Yoshiki Kajiwara, Hideki Ueno, Hirotoshi Kobayashi, Kenjiro Kotake, Kenichi Sugihara, Yoichi Ajioka","doi":"10.1093/bjsopen/zrag060","DOIUrl":"10.1093/bjsopen/zrag060","url":null,"abstract":"<p><strong>Background: </strong>Currently, no international guidelines recommend carbohydrate antigen 19-9 (CA19-9) as a biomarker in colorectal cancer in clinical practice, although it has been reported that tumour cells with high affinity for peritoneal cells strongly express CA19-9. The aim of this study was to determine the utility of preoperative serum CA19-9 levels in predicting prognosis in patients with colorectal cancer and synchronous peritoneal metastasis.</p><p><strong>Methods: </strong>Prognostic analyses were retrospectively performed in patients with colorectal cancer and synchronous peritoneal metastases who received treatment in 16 hospitals between 1991 and 2007 (Cohort 1). The categorization for CA19-9 and carcinoembryonic antigen were established based on the thresholds that minimized Akaike information criterion values for overall survival. A separate validation cohort of patients with synchronous peritoneal metastasis was prospectively registered across 28 institutions between 2012 and 2016 (Cohort 2) to validate these findings.</p><p><strong>Results: </strong>A total of 689 patients were analysed in Cohort 1 and 144 in the validation Cohort 2. The categorized serum CA19-9 and carcinoembryonic antigen levels were significantly correlated with overall survival (P < 0.001 and P < 0.001, respectively). The median postoperative overall survival was 19.0 months for patients with a preoperative CA19-9 level < 100 U/ml compared with 4.1 months for those with a preoperative CA19-9 level of ≥ 10 000 U/ml. Using multivariable analysis, serum CA19-9, but not carcinoembryonic antigen, was an independent prognostic factor for overall survival. These results were confirmed in Cohort 2, revealing that the prognostic power of CA19-9 was superior to that of carcinoembryonic antigen.</p><p><strong>Conclusions: </strong>Preoperative serum CA19-9 outperformed carcinoembryonic antigen as an independent prognostic biomarker in patients with colorectal cancer and peritoneal metastasis.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13198021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148004468","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":"Collagen implant versus gluteus maximus flap for perineal closure after extended abdominoperineal excision: NEAPE randomized clinical trial.","authors":"Martin Rutegård, Johan Svensson, Jörgen Rutegård, Tero Rautio, Per J Nilsson, Olle Sjöström, Marie-Louise Lydrup, Christoffer Odensten, Andreas Söderström, Michael Dahlberg, Markku M Haapamäki","doi":"10.1093/bjsopen/zrag079","DOIUrl":"10.1093/bjsopen/zrag079","url":null,"abstract":"<p><strong>Background: </strong>Optimal reconstruction of the perineal defect after extended abdominoperineal excision remains uncertain, and randomized comparisons between biological mesh and myocutaneous flaps are lacking. This trial assessed whether an acellular porcine collagen implant (APCI) is non-inferior to a gluteus maximus myocutaneous flap (GMF) for pelvic floor reconstruction.</p><p><strong>Methods: </strong>NEAPE was a multicentre, randomized, non-inferiority trial conducted in eight Nordic referral centres. Adults undergoing extended abdominoperineal excision for rectal cancer were randomized to reconstruction with an APCI or unilateral GMF. The primary outcome was the proportion of patients underperforming in the timed-stands test at 6 months, defined relative to age- and sex-matched reference values. The non-inferiority margin was -10%.</p><p><strong>Results: </strong>Eighty-three patients were included in the modified intention-to-treat population (mean(standard deviation) age 68(10) years; 31% female). At 6 months, 71% of patients (25 of 35) in the implant group and 60% of patients (20 of 33) in the flap group underperformed. The risk difference was -11% (one-sided 95% confidence interval -30% to ∞), and non-inferiority was not demonstrated.</p><p><strong>Conclusion: </strong>The APCI did not demonstrate non-inferiority compared with the GMF. The direction of the effect favoured the flap, with results compatible with worse functional outcomes in the implant group.</p><p><strong>Registration number: </strong>ClinicalTrials.gov NCT01347697.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13293247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315658","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}