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{"title":"Postoperative complications in Hartmann's procedure versus intersphincteric abdominoperineal excision in rectal cancer: randomized clinical trial (HAPIrect).","authors":"Maziar Nikberg, Viktor Åkerlund, Torbjörn Swartling, Pamela Buchwald, Kenneth Smedh","doi":"10.1093/bjsopen/zraf093","DOIUrl":"10.1093/bjsopen/zraf093","url":null,"abstract":"<p><strong>Background: </strong>In patients with rectal cancer, when it is not possible to restore bowel continuity with an anastomosis, the optimal surgical method is still a matter of debate. The aim of this trial was to determine 30-day postoperative surgical complication rates after Hartmann's procedure (HP) versus intersphincteric abdominoperineal excision (iAPE) in patients with rectal cancer who were not suitable for restorative surgery.</p><p><strong>Methods: </strong>This multicentre randomized controlled trial (HAPIrect) was performed in Sweden and Finland between 2014 and 2021. Eligible patients with adenocarcinoma of the rectum located ≥ 5 cm from the anal verge and deemed unsuitable for anterior resection with anastomosis were randomized (1:1) intraoperatively to either HP or iAPE. The primary outcome was 30-day postoperative surgical complications. Secondary outcomes were major surgical complications (Clavien-Dindo grade ≥ IIIa), perineopelvic complications, and overall complications. Logistic regression in the intention-to-treat population was the primary method used to compare the surgical approaches.</p><p><strong>Results: </strong>Of 194 eligible patients, 163 were randomized (80 patients to HP and 83 to iAPE). The study was closed before achieving the target accrual. The main reasons for not receiving an anastomosis were advanced age, co-morbidity, or poor anal sphincter function. Mean operating time in the HP and iAPE groups was 291 and 373 minutes, respectively. In the HP and iAPE groups, the surgical complication rate was 39% and 43%, respectively (odds ratio (OR) for HP 0.83; 95% confidence interval (c.i.) 0.44 to 1.54; P = 0.549) and the rate of major surgical complications was 14% and 11%, respectively (P = 0.573). Perineopelvic complications occurred in 21% and 30% of patients in the HP and iAPE groups, respectively (OR for HP 0.63; 95% c.i. 0.31 to 1.28; P = 0.197). The overall complication rate (including both medical and surgical complications) was 45% and 49% in the HP and iAPE groups, respectively (P = 0.574). In multivariable analysis adjusted for sex, preoperative radiotherapy, and surgical procedure, there was no statistically significant difference in surgical complications between the two groups.</p><p><strong>Conclusion: </strong>Although the trial was underpowered and did not reach accrual, in randomized patients, both HP and iAPE are practicable surgical options for patients unsuitable for anastomosis.</p><p><strong>Registration number: </strong>NCT01995396 (http://www.clinicaltrials.gov).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12482908/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198050","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":"Management and risk factors for colonic volvulus: retrospective national cohort study.","authors":"Suvi Rasilainen, Mohamud Aden, Antti J Kivelä, Sakari Pakarinen, Jukka Rintala, Susanna Niemeläinen, Ilona Helavirta, Salla Moilanen, Anne Mattila, Tarja Pinta, Kapo Saukkonen, Pälvi Vento, Niko Turkka, Pasi Pengermä, Jenny Häggblom, Tom Scheinin","doi":"10.1093/bjsopen/zraf113","DOIUrl":"10.1093/bjsopen/zraf113","url":null,"abstract":"<p><strong>Background: </strong>This study evaluated the outcomes of colonic volvulus management in a national cohort, and identified risk factors for morbidity and mortality.</p><p><strong>Methods: </strong>This was a multicentre national retrospective study of patients presenting with colonic volvulus between 2010 and 2019. Main outcome measures were 30-day and 1-year mortality. Multivariable regression and Kaplan-Meier analyses were used to study predictors of mortality and survival.</p><p><strong>Results: </strong>Of the 559 patients presenting with sigmoid volvulus, 381 underwent surgery and 178 received conservative treatment. The 30-day mortality rates were 11.0% and 19.0%, respectively. Emergency surgery (P = 0.030), nursing home residence (P = 0.040), increased co-morbidity (P = 0.017), and male sex (P = 0.029) predicted postoperative 30-day mortality. Primary endoscopic detorsion followed by elective surgery during a subsequent hospital admission resulted in best survival. Of the 342 patients presenting with caecal volvulus, 340 underwent surgery. The 30-day mortality rate was 6.4%. Increased co-morbidity (P = 0.008), nursing home residence (P = 0.002), and necrotic caecum (P = 0.007) predicted 30-day mortality. At 1 year, the mortality rate among patients with sigmoid volvulus was 19.9% after surgery and 43.2% after conservative treatment. Emergency surgery (P = 0.023), nursing home residence (P = 0.009), and increased co-morbidity (P < 0.001) were associated with 1-year postoperative mortality. In patients with caecal volvulus the 1-year mortality rate was 13.1%. Increased co-morbidity (P < 0.001) and nursing home residence (P < 0.001) were predictive. Anastomotic leakage in patients with sigmoid volvulus was associated with an American Society of Anesthesiologists fitness grade of III (P = 0.032) and total colectomy (P = 0.012).</p><p><strong>Conclusion: </strong>Surgery should be recommended for colonic volvulus where co-morbidity, patient preference, and functional status allows. Surgically unfit patients have poorer outcomes. Elective sigmoidectomy after endoscopic detorsion is preferred as it carries the lowest mortality risk. Necrotic bowel, dependency, and co-morbidities predict death for both sigmoid and caecal volvulus.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461565/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136264","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 prehabilitation on postoperative outcomes in patients with upper gastrointestinal tract cancer: meta-analysis.","authors":"Qi Li, Jianhong Liu, Liqing Li, Yeli Luo","doi":"10.1093/bjsopen/zraf091","DOIUrl":"10.1093/bjsopen/zraf091","url":null,"abstract":"<p><strong>Background: </strong>The aim of this meta-analysis was to elucidate the effects of prehabilitation (PR) on outcomes after surgery for upper gastrointestinal tract cancer.</p><p><strong>Methods: </strong>PubMed, Web of Science, Embase, and Cochrane databases were searched from inception up to 21 May 2024 for randomized clinical trials (RCTs) and cohort studies investigating PR interventions in patients with upper gastrointestinal tract cancer. Data were synthesized using standardized mean differences (SMDs) and risk ratios (RRs) with corresponding 95% confidence intervals. Sensitivity and subgroup analyses were used to examine the robustness of the results and find possible sources of heterogeneity. Statistical analyses were performed using Review Manager 5.4 and Stata 16.0.</p><p><strong>Results: </strong>Eight RCTs and eight cohort studies were included in the meta-analysis. Compared with the control group (no PR), the PR group had a significantly shorter postoperative length of hospital stay (SMD -0.27; 95% confidence interval (c.i.) -0.47 to -0.07; P = 0.008), a significant reduction in the occurrence of pneumonia after the surgery (RR 0.71; 95% c.i. 0.50 to 1.00; P = 0.005), and a greater improvement in the 6-minute walk distance (SMD 0.95; 95% c.i. 0.68 to 1.22; P < 0.00001). However, there were no significant differences between the control and PR groups in overall postoperative complications, anastomotic leakage, overall pulmonary complications, operative time, intraoperative blood loss, wound infection rate, in-hospital mortality, or recurrence rate (all P > 0.05).</p><p><strong>Conclusion: </strong>For the population with upper gastrointestinal tract cancer, PR can partially lower the risk of postoperative pneumonia and promote faster postoperative recovery. Given the inherent limitations in the included studies, more large-scale RCTs are needed to verify these findings.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12452279/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112043","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":"Reporting of major complications in randomized clinical trials in pancreatic surgery according to Clavien-Dindo classification.","authors":"Amila Cizmic, Laetitia Hampe, Philipp A Wise, Pascal Probst, Markus K Muller, Christoph Kuemmerli, Philip C Müller, Jan Bardenhagen, Anna Nießen, Faik G Uzunoglu, Jakob Izbicki, Thilo Hackert, Felix Nickel","doi":"10.1093/bjsopen/zraf103","DOIUrl":"10.1093/bjsopen/zraf103","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419532/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028901","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":"Risk factors and clinical consequences of interval cancers arising within faecal immunochemical testing-based colorectal cancer screening programme.","authors":"Adam D Gerrard, Roberta Garau, Yasuko Maeda, Alastair Thomson, Evropi Theodoratou, Malcolm G Dunlop, Farhat V N Din","doi":"10.1093/bjsopen/zraf096","DOIUrl":"10.1093/bjsopen/zraf096","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) screening programmes aim to detect early, asymptomatic cancers and improve survival. This study aimed to establish the proportion of interval cancers, and the consequences with regard to stage, clinical outcome, and overall survival. Risk factors associated with interval CRCs were investigated.</p><p><strong>Methods: </strong>The Scottish Bowel Screening Programme uses faecal immunochemical testing at a threshold of 80 µg haemoglobin per g as a positive trigger for investigation. Screening was offered to all eligible individuals in one region, from November 2017 to October 2021. Cancer registries were cross-checked to ensure complete capture of all cancers including interval CRCs. The primary outcome was rate of interval CRCs among participants with follow-up of 24 months, and its relationship to faecal immunochemical testing results, clinical variables, stage, time to diagnosis, and survival. The secondary outcome was identification of risk factors associated with interval CRCs.</p><p><strong>Results: </strong>The Scottish Bowel Screening Programme generated 316 583 tests during the study period. Participation was 71.0% of the eligible population (212 664 patients); it was greater among women (71.9 versus 70.0%; P < 0.001) and in higher socioeconomic areas (76.9 versus 58.6%; P < 0.001). In the screened population, 546 CRCs were diagnosed within 2 years of screening. Some 289 of these patients (52.9%) had positive bowel screening. There were 257 patients with interval CRCs, who waited a median of 13 (interquartile range 7-20) months for diagnosis. Of CRCs diagnosed, 24.9% had screening faecal immunochemical test results of < 10 µg haemoglobin per g. The interval CRC rate was greater in women, older patients, and among the least socioeconomically deprived. Interval CRCs were associated with worse 2-year all-cause mortality than screen-detected CRCs (23.0 versus 10.8%; P < 0.001). Importantly, 121 of the 257 interval CRCs (47.1%) had detectable faecal immunochemical test results at 10-79 µg haemoglobin per g.</p><p><strong>Conclusion: </strong>Patients with interval CRCs and a detectable faecal immunochemical test result below the predetermined threshold appear to be significantly disadvantaged with respect to stage at presentation and survival. Almost half of interval CRCs diagnosed within 2 years had detectable haemoglobin on screening faecal immunochemical test and would be a target for lower positivity thresholds.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12507088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145249509","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 intraoperative autotransfusion use during liver transplantation for hepatocellular carcinoma on recurrence-free survival: comparative study with propensity score matching.","authors":"Paul Boulard, Charlotte Maulat, Ana Cavillon, Fabien Robin, Frederica Dondero, Chady Salloum, Celia Turco, Flavy Breheret, Valérie Paradis, Chetana Lim, Bruno Heyd, Emmanuel Cuellar, Bertrand Suc, Daniel Azoulay, Isabelle Migueres, François Cauchy, Fabrice Muscari","doi":"10.1093/bjsopen/zraf101","DOIUrl":"10.1093/bjsopen/zraf101","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative autotransfusion remains underutilized in high-risk haemorrhagic oncological procedures, particularly in liver transplantation for hepatocellular carcinoma. This is because of the theoretical risk of tumour cell reinfusion and dissemination, potentially leading to reduced recurrence-free survival. The aim of this study was to evaluate the impact of intraoperative autotransfusion on recurrence-free survival during liver transplantation for hepatocellular carcinoma.</p><p><strong>Methods: </strong>This was a retrospective study of patients receiving liver transplantation for hepatocellular carcinoma with or without intraoperative autotransfusion between 1 January 2011 and 1 January 2020 at five French hospitals, of which one used autotransfusion and four did not. Propensity score matching was used to match the cohorts with and without autotransfusion. The primary endpoint was 5-year recurrence-free survival.</p><p><strong>Results: </strong>Some 113 patients in the study cohort (autotransfusion) were compared with 441 patients in the control cohort. The median volume of autotransfused blood was 1500 ml. Median follow-up was 84.6 months. There was no significant difference in 5-year recurrence-free survival between the cohorts (69.7% in control cohort versus 66.3% in study cohort; P = 0.241). After matching patients based on oncological criteria, the difference remained non-significant, with a 5-year recurrence-free survival rate of 67.1% in the study cohort and 77.6% in the control cohort (P = 0.174).</p><p><strong>Conclusion: </strong>The use of autotransfusion during liver transplantation for hepatocellular carcinoma was not associated with recurrence-free survival.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028982","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":"Tolerability, toxicity, and outcomes following surgical and non-surgical approaches to the management of patients with locally advanced oesophageal squamous cell carcinoma: multicentre retrospective cohort study.","authors":"","doi":"10.1093/bjsopen/zraf078","DOIUrl":"10.1093/bjsopen/zraf078","url":null,"abstract":"<p><strong>Background: </strong>Oesophageal squamous cell carcinoma is the predominant histopathological subtype of oesophageal cancer across the world, representing as many as 90% of all cases; however, within Western cohorts, it is a low-prevalence disease, and, as such, appropriately powered trials to establish a standard treatment paradigm in this population remain challenging. The aim of this study was to assess current practices and compare outcomes for patients with locally advanced oesophageal squamous cell carcinoma across the UK and Ireland.</p><p><strong>Methods: </strong>This was a retrospective multicentre cohort study of patients managed with curative intent for squamous cell carcinoma of the middle or distal oesophagus in 23 hospitals across the UK and Ireland. Consecutive patients diagnosed between 1 January 2012 and 31 December 2016 were included.</p><p><strong>Results: </strong>This study included 1545 patients, of whom 923 (59.7%) received definitive chemoradiotherapy, 286 (18.5%) neoadjuvant chemotherapy + surgery, 218 (14.1%) neoadjuvant chemoradiotherapy + surgery, and 118 (7.6%) surgery alone. Neoadjuvant chemoradiotherapy + surgery was associated with significantly longer survival than neoadjuvant chemotherapy or definitive chemoradiotherapy (median 83.9 versus 27.8 versus 26.5 months). In propensity score-matched analysis of overall survival, patients receiving neoadjuvant chemoradiotherapy + surgery had significantly longer survival than those who had definitive chemoradiotherapy (median 56.8 versus 43.1 months; hazard ratio 0.39, 95% confidence interval 0.20 to 0.78; P < 0.001).</p><p><strong>Conclusion: </strong>This multicentre retrospective cohort study suggests that, despite a majority of patients being treated with definitive chemoradiotherapy, patients undergoing neoadjuvant chemoradiotherapy and surgery have improved survival compared with those receiving definitive chemoradiotherapy or neoadjuvant chemotherapy + surgery. In the absence of robust Western randomized clinical trial data, neoadjuvant chemoradiotherapy + surgery should be considered the standard for well selected patients fit for surgery.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12416563/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145022806","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":"Prognosis of lymph node metastasis confined to lateral pelvic or mesenteric nodes in mid-low rectal cancer: multicentre retrospective cohort study.","authors":"Fei Huang, Tixian Xiao, Sicheng Zhou, Fuqiang Zhao, Fangze Wei, Shuangmei Zou, Qian Liu","doi":"10.1093/bjsopen/zraf097","DOIUrl":"10.1093/bjsopen/zraf097","url":null,"abstract":"<p><strong>Background: </strong>Metastases in the lateral pelvic lymph nodes or mesenteric lymph nodes represent distinct categories of mid-low rectal cancer. This study investigated the patterns of mesenteric and lateral pelvic lymph node metastases in mid-low rectal cancer; the survival benefit of postoperative treatment was also analysed in these groups.</p><p><strong>Methods: </strong>This retrospective multicentre study included consecutive patients with mid-low rectal cancer who underwent total mesorectal excision with lateral pelvic lymph node dissection in three Chinese institutions between 2012 and 2020. The primary outcome was metastatic patterns and clinicopathological features of patients with mesenteric lymph node and lateral pelvic lymph node involvement. The secondary outcome was survival.</p><p><strong>Results: </strong>Of 566 patients treated during the study period, 407 were selected. Four lymph node metastasis patterns were compared: metastasis to both mesenteric and lateral pelvic lymph nodes (68 patients, 17%), metastasis confined to lateral pelvic lymph nodes (24 patients, 6%), metastasis confined to mesenteric lymph nodes (121 patients, 29.7%), and neither mesenteric nor lateral pelvic lymph node metastasis (194 patients, 47.7%). Patients with metastases confined to lateral pelvic nodes had a lower proportion of poor histological types (P = 0.003), lymphatic invasion (P = 0.001), and number of lateral pelvic nodal metastases (P = 0.005) compared with patients with both mesenteric and lateral pelvic lymph node metastases. Independent of preoperative treatment, metastasis confined to the lateral pelvic nodes was associated with a significantly better prognosis than metastasis in both the mesenteric and lateral pelvic lymph nodes (3-year overall survival: 78.6 versus 47.2%, P = 0.007; 3-year disease-free survival: 65.7 versus 24.9%, P = 0.011), and it was similar to that of patients with metastasis confined to the mesenteric nodes (3-year overall survival: 78.6 versus 85.4%, P = 0.559; 3-year disease-free survival: 65.7 versus 70.4%, P = 0.447).</p><p><strong>Conclusion: </strong>Patients with metastasis confined to lateral pelvic lymph nodes have comparable pathological features and prognoses to those with metastasis confined to mesenteric nodes; such disease can be managed and treated in the same way as regional lymph node metastasis.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 5","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12419522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145028904","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":"Comparison of catheter wound infusion, intrathecal morphine, and intravenous analgesia for postoperative pain management in open liver resection: randomized clinical trial.","authors":"Damien Rousseleau, Barthélémy Plane, Julien Labreuche, Adeline Pierache, Younes El Amine, Sabine Ethgen, Jean-Michel Wattier, Cédric Cirenei, Emmanuel Boleslawski, Gilles Lebuffe","doi":"10.1093/bjsopen/zraf074","DOIUrl":"10.1093/bjsopen/zraf074","url":null,"abstract":"<p><strong>Background: </strong>Pain relief is an important aspect of recovery after open liver resection. This randomized open-label single-centre trial assessed the efficacy of intravenous (i.v.) analgesia alone or in combination with catheter wound infusion (CWI) or intrathecal morphine (ITM) after open liver resection.</p><p><strong>Methods: </strong>Adult patients undergoing open liver resection were randomly assigned to receive either i.v. analgesia alone or in combination with ITM or CWI. In this study, i.v. analgesia consisted of systematic i.v. paracetamol and i.v. morphine via a patient-controlled analgesia pump, with i.v. nefopam as rescue analgesia for a Numeric Rating Scale (NRS) score > 4. The primary outcome was cumulative morphine dose at 24 hours (h). Secondary outcomes included pain intensity, cumulative opioid use at 48 and 72 h, and postoperative complications.</p><p><strong>Results: </strong>In all, 186 patients were included in the study (62 patients in each group). The median 24-h morphine dose was 14 (interquartile range (i.q.r.) 6-25) mg in the i.v. analgesia group, 14 (i.q.r. 7-23) mg in the CWI group, and 7 (i.q.r. 3-15) mg in the ITM group. ITM significantly reduced morphine use compared with i.v. analgesia alone (mean difference on log-transformed values 0.57; 95% confidence interval 0.21 to 0.93; Bonferroni-adjusted P = 0.002) and lowered pain scores during the first 12 h. No significant differences were observed between the CWI and i.v. analgesia groups. By 72 h, cumulative opioid use was similar across all groups. Adverse events and postoperative complications were comparable across the three groups.</p><p><strong>Conclusion: </strong>ITM reduced the cumulative morphine dose and pain intensity in the first 24 h after liver resection, providing a valuable option for postoperative analgesia.</p><p><strong>Registration number: </strong>NCT03238430 (http://www.clinicaltrials.gov).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":4.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636099","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":"Management of bilioenteric anastomosis leakage after major liver resection.","authors":"Sepehr Abbasi Dezfouli, Elmira Heidenreich, Mohammadamin Shahrbaf, Elias Khajeh, De-Hua Chang, Miriam Klauss, Markus Mieth, Martin Loos, Markus Büchler, Arianeb Mehrabi","doi":"10.1093/bjsopen/zraf075","DOIUrl":"10.1093/bjsopen/zraf075","url":null,"abstract":"<p><strong>Background: </strong>Post-hepatectomy bile leakage is a challenging issue that can lead to morbidities and mortality after liver resection. This leakage can occur either from a bilioenteric anastomosis (BEA) or from the transected surface of the liver. This study investigated the incidence, risk factors, and effective management of BEA leakage after major liver resection.</p><p><strong>Methods: </strong>Bile leakage was diagnosed through drain fluid analysis based on the International Study Group of Liver Surgery definition. Leakage from a BEA was confirmed via fluoroscopy during percutaneous interventions or reoperation. Perioperative data and data on the management of patients with BEA leakage were collected and analysed. Bivariate analysis used Mann-Whitney U and χ2 tests, and binary logistic regression identified risk factors for BEA leakage, with variables having P < 0.200 included in multivariable analysis.</p><p><strong>Results: </strong>Of 2936 patients undergoing hepatectomy between 2008 and 2023, 229 underwent liver resection with BEA. Leakage from the BEA was identified in 44 patients (19.2%). These patients had a higher rate of post-hepatectomy haemorrhage (P = 0.005), major complications (P = 0.001), BEA stenosis (P = 0.006), and mortality (P = 0.043). The success rate of the management of BEA leakage was 70% for reoperation and 58% for percutaneous transhepatic cholangiography and drainage (PTCD).</p><p><strong>Conclusion: </strong>BEA leakage after major liver resection is a severe complication associated with higher morbidity and mortality rates. Surgical treatment appeared to be more successful than PTCD in the early postoperative phase. PTCD proved to be a valuable additional therapy option following reoperation. These conclusions should be taken with caution and need to be confirmed through further prospective studies.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 4","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636110","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}