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{"title":"One-year results of an eHealth intervention on anxiety in patients undergoing abdominal aortic aneurysm surgery: randomized clinical trial.","authors":"Olga Nilsson, Malin Stenman, Anna Letterstål, Rebecka Hultgren","doi":"10.1093/bjsopen/zrae144","DOIUrl":"10.1093/bjsopen/zrae144","url":null,"abstract":"<p><strong>Background: </strong>The longitudinal effects of educational interventions in people with abdominal aortic aneurysm are largely unexplored. This prospective study investigated whether the anxiety-lowering effect of an eHealth intervention observed at the 1-month follow-up is maintained 1 year after abdominal aortic aneurysm surgery.</p><p><strong>Methods: </strong>Those scheduled for surgical repair of abdominal aortic aneurysm were recruited in a single-centre randomized clinical trial. The control group received care and follow-up per the institution's standard. The intervention group received an eHealth tool along with psychosocial support. The 1-month results have been reported. The primary outcome measure was the anxiety mean score (HADS-A).</p><p><strong>Results: </strong>Of 120 included participants, 96 completed the 1-year follow-up (48 in each treatment group). The mean age was 73 years, a majority (86%) were male and 73% were current or previous smokers. Anxiety symptoms measured with the HADS-A decreased over time in both the intervention group (-0.33) and the control group (-0.35, P = 0.868). The improvements in anxiety symptoms seen in the short-term follow-up were not sustained at the 1-year follow-up. No significant mean score differences were found in the intention-to-treat or per-protocol analyses.</p><p><strong>Conclusion: </strong>In this randomized clinical trial, an eHealth intervention did not result in a sustained reduction in anxiety symptoms compared with standard care in the same cohort. The study provides an insight into the limited acceptability of an eHealth tool in people with abdominal aortic aneurysm and valuable data on the recovery trajectory following open and endovascular abdominal aortic aneurysm surgery. Further research is warranted to evaluate the relevance and long-term effectiveness of eHealth interventions in abdominal aortic aneurysm care.</p><p><strong>Registration number: </strong>NCT03157973 (http://www.clinicaltrials.gov).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11733888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142982672","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":"Organ-specific malperfusion in acute type A aortic dissection: epidemiological meta-analysis of incidence rates.","authors":"Ashwini Chandiramani, Mohammed Al-Tawil, Assem Elleithy, Sahil Kakar, Tharun Rajasekar, Abinash Panda, Haytham Sabry, Assad Haneya, Amer Harky","doi":"10.1093/bjsopen/zrae146","DOIUrl":"10.1093/bjsopen/zrae146","url":null,"abstract":"<p><strong>Background: </strong>Acute type A aortic dissection is a life-threatening clinical emergency that necessitates immediate surgical intervention with an estimated mortality rate of approximately 1-2% per hour. When complicated by malperfusion, the perioperative mortality rate is reported to be increased by up to 39%. Malperfusion can affect many vascular beds with varying incidence and severity, resulting in coronary, cerebral, visceral, peripheral, renal or spinal malperfusion. The primary aim of this systematic review and meta-analysis is to investigate the epidemiology of specific types of organ malperfusion in acute type A aortic dissection and to analyse the impact on the survival outcomes associated with each malperfusion type.</p><p><strong>Methods: </strong>Electronic databases PubMed, MEDLINE and Embase were searched through to September 2024 to identify original studies that presented data on the incidence and the survival outcome of organ malperfusion in association with acute type A aortic dissection. The extracted data included patient characteristics and incidence of organ-specific malperfusion. Primary outcomes were the respective in-hospital mortality rate associated with each organ-specific malperfusion and a proportional meta-analysis was conducted to pool results. Quality assessment was performed using the modified National Institutes of Health quality assessment tool for single-arm observational studies.</p><p><strong>Results: </strong>A total of 40 studies met the inclusion criteria, including a total of 35 361 patients. Peripheral limb malperfusion was the most prevalent with a pooled incidence of 12% (95% c.i. 10 to 14). This was followed by lower limb or iliofemoral with 11% (95% c.i. 9 to 14). Spinal malperfusion was the lowest with 1% (95% c.i. 1 to 2). The pooled mortality rate with organ malperfusion varied between 18 and 36%. Within this population the highest mortality rate was associated with mesenteric malperfusion with 36% (95% c.i. 28 to 45). Following this the highest mortality rate was found with coronary at 33% (95% c.i. 26 to 40) and cerebral at 28% (95% c.i. 24 to 33) malperfusion.</p><p><strong>Conclusion: </strong>Survival during hospital admission after acute type A aortic dissection can vary depending on the presence and type of malperfusion, with mesenteric, coronary and cerebral malperfusion being associated with the highest in-hospital mortality rates. Organ-specific malperfusion syndromes should be considered when assessing the perioperative risk and surgical planning of patients undergoing surgical repair for acute type A aortic dissection.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11720173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944183","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":"High-volume lactated Ringer's solution with human albumin versus standard-volume infusion as a prophylactic treatment for post-endoscopic retrograde cholangiopancreatography pancreatitis: randomized clinical trial.","authors":"Ekaphan Shatsnimitkul, Issaree Laopeamthong, Amarit Tansawet, Suphakarn Techapongsatorn, Wisit Kasetsermwiriya, Poramet Leungon, Pakkapol Sukhvibul","doi":"10.1093/bjsopen/zrae149","DOIUrl":"10.1093/bjsopen/zrae149","url":null,"abstract":"<p><strong>Background: </strong>Adverse events after endoscopic retrograde cholangiopancreatography (ERCP) are rare, and post-ERCP pancreatitis is a serious adverse event. This study aimed to determine the role of aggressive intravenous hydration with lactated Ringer's solution at a specific volume with 20% human albumin before ERCP in reducing the incidence of post-ERCP pancreatitis.</p><p><strong>Methods: </strong>This study was a single-centre randomized clinical trial. The participants were randomly assigned to two groups: those who received aggressive intravenous hydration with 20% human albumin and lactated Ringer's solution (intervention group), and those who received standard-volume intravenous hydration with lactated Ringer's solution (control group). The primary endpoint was post-ERCP pancreatitis. Participants and outcome assessors were blinded to treatment allocation. Comparison was performed using the chi-square, the Fisher's exact, the Student's t, or the Mann-Whitney U tests, where appropriate.</p><p><strong>Results: </strong>Of 300 randomized participants, 149 and 144 participants from the intervention and control group were included in the analysis. There was no significant difference in the post-ERCP pancreatitis rate (n = 10; 6.7% versus n = 9; 6.3%, P = 0.873) between the intervention and control groups. High-risk procedures (that is pancreatic duct wiring, pancreatic duct injection, precut sphincterotomy, and balloon dilation of the ampulla) were significantly associated with post-ERCP pancreatitis compared with low-risk procedures (n = 15; 15% versus n = 4; 2.1%, P < 0.001). In the high-risk procedures population, the intervention and control groups had increased post-ERCP pancreatitis rates (P = 0.716). Two participants in each group developed pulmonary congestion.</p><p><strong>Conclusion: </strong>Aggressive peri-ERCP intravenous hydration with lactated Ringer's solution combined with 50 ml of 20% human albumin did not prevent post-ERCP pancreatitis. None of the subgroups presented with prophylactic effects.</p><p><strong>Trial registration: </strong>Thai Clinical Trials Registry (TCTR20240405003).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749547/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999548","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":"Circulating large extracellular vesicles as diagnostic biomarkers of indeterminate thyroid nodules: multi-platform omics analysis.","authors":"Nada M Ahmed, Mohammad M R Eddama, Kevin Beatson, Rijan Gurung, Jigisha Patel, Georges Iskandar, Alaa Abdel-Salam, Abdullah Al-Omar, Richard Cohen, Tarek Abdel-Aziz, Lucie Clapp","doi":"10.1093/bjsopen/zrae139","DOIUrl":"10.1093/bjsopen/zrae139","url":null,"abstract":"<p><strong>Background: </strong>While most thyroid nodules are benign, 7-15% are malignant. Patients with indeterminate thyroid nodules (specifically Bethesda IV/Thy3f) often undergo diagnostic hemithyroidectomy to reach a diagnosis on final histology. The aim of this study was to assess the feasibility of circulating large extracellular vesicles as diagnostic biomarkers in patients presenting with Thy3f thyroid nodules.</p><p><strong>Methods: </strong>This was a two-gate diagnostic accuracy study; patients with Thy3f thyroid nodules were age, sex and body mass index matched to healthy individuals. Final histology confirmed benign and malignant diagnoses. Plasma large extracellular vesicle counts were quantified using flow cytometry. Large extracellular vesicle microRNA and protein profiles were identified using next generation sequencing and mass spectrometry, respectively.</p><p><strong>Results: </strong>A total of 42 patients with Thy3f nodules (22 with cancer, 20 with non-cancer diagnosis) and 16 healthy controls were included. Total large extracellular vesicle concentrations and the concentrations of extracellular vesicles expressing epithelial cell adhesion molecule and the cancer markers atypical chemokine receptor type 7, extracellular matrix metalloproteinase inducer and syndecan-4 were significantly higher in patients with Thy3f nodules (cancer and non-cancer) compared with healthy individuals. In patients with cancerous versus non-cancer Thy3f nodules, one microRNA was upregulated: mir-195-3p (P < 0.001). Five were downregulated: mir-3176 (P < 0.001), mir-205-5p (P < 0.001), novel-hsa-mir-208-3p (P < 0.001), mir-3529-3p (P = 0.01) and let-7i-3p (P = 0.02). Furthermore, three large extracellular vesicle proteins (kallikrein-related peptidase11 (KLK11) (P = 0.001), alpha-1-acid glycoprotein 2 (A1AG2) (P <0.001) and small integral membrane protein 1 (SMIM1) (P = 0.04)) were significantly upregulated, while 20 large extracellular vesicle proteins were significantly downregulated (most downregulated: chemokine (C-X-C motif) ligand 7 (CXCL7), tubulin beta chain 1 (TBB1), binding immunoglobulin protein (BIP) and actinin alpha 1 (ACTN1) (P < 0.001)) in cancerous compared with non-cancer Thy3f nodules.</p><p><strong>Conclusion: </strong>Circulating large extracellular vesicle miRNA and protein profiles have a high diagnostic value to discriminate between benign and malignant nodules for patients with Thy3f cytology. Further validation for clinical performance will be needed.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683363/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944181","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":"Ovarian cancer risk reduction by salpingectomy during non-gynaecological surgery: scoping review.","authors":"Charlotte Fisch, Malou E Gelderblom, Rosella P M G Hermens, Philip R de Reuver, Simon W Nienhuijs, Diederik M Somford, Joanne A de Hullu, Jurgen M J Piek","doi":"10.1093/bjsopen/zrae161","DOIUrl":"10.1093/bjsopen/zrae161","url":null,"abstract":"<p><strong>Background: </strong>Ovarian cancer is the leading cause of death among gynaecological cancers. The identification of the fallopian tube epithelium as the origin of most ovarian cancers introduces a novel prevention strategy by removing the fallopian tubes during an already indicated abdominal surgery for another reason, also known as an opportunistic salpingectomy. This preventive opportunity is evidence based, recommended and established at the time of gynaecologic surgery in many countries worldwide. To expand interest among surgeons in performing a salpingectomy during non-gynaecological surgery, the aim of this review is to identify knowledge gaps during those surgeries.</p><p><strong>Methods: </strong>A scoping review was performed following the PRISMA-Scoping Review (ScR) checklist. PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) database and Cochrane Library were systematically searched from inception to November 2024. Trial registers were searched for ongoing trials. All studies reporting original data on salpingectomy during non-gynaecological surgery were included. Outcomes were provided narratively.</p><p><strong>Results: </strong>Eighteen studies were identified reporting on the implementation, surgical feasibility, patients' perspectives, physicians' knowledge and cost-effectiveness of an opportunistic salpingectomy during non-gynaecological surgery. Population-level data indicate that an opportunistic salpingectomy is rarely performed in non-gynaecological surgeries. High success rates and no complications of an opportunistic salpingectomy were observed during bariatric surgery and cholecystectomies. However, performing an additional salpingectomy appeared more time-consuming. Patients had strong interest in information on and willingness to undergo opportunistic salpingectomy. Cost-effectiveness analysis encourages opportunistic salpingectomy use, as models show reduced ovarian cancer incidence and mortality rate while being cost-effective.</p><p><strong>Conclusions: </strong>Opportunistic salpingectomy during non-gynaecologic surgery appears to be a promising method to prevent ovarian cancer. Implementing such a strategy will require education of multiple surgical disciplines, training and resolution of organizational issues.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773000/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143051488","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 peri-adventitial superior mesenteric artery dissection on margin status during pancreaticoduodenectomy for resectable pancreatic cancer: the DISSECT RCT protocol.","authors":"Sarah Powell-Brett, Anisa Nutu, Alessandro Parente, Prashant Kadam, Francesco Giovinazzo, James Halle-Smith, David McNulty, Keith Roberts, Nikolaos Chatzizacharias","doi":"10.1093/bjsopen/zrae075","DOIUrl":"10.1093/bjsopen/zrae075","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795644/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188160","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 protective measures for desmoid tumours in familial adenomatous polyposis: retrospective cohort study.","authors":"Emanuele Rausa, Valeria Duroni, Davide Ferrari, Stefano Signoroni, Chiara M Ciniselli, Sara Lauricella, Clorinda Brignola, Maria T Ricci, Alessandro Gronchi, Paolo Verderio, Marco Vitellaro","doi":"10.1093/bjsopen/zrae148","DOIUrl":"10.1093/bjsopen/zrae148","url":null,"abstract":"<p><strong>Background: </strong>Familial adenomatous polyposis is a cancer-predisposing syndrome caused by germline pathogenic variants of the adenomatous polyposis coli gene, leading to numerous colorectal polyps and a high risk of colorectal cancer. Desmoid tumours have become significant in the management of familial adenomatous polyposis after a colectomy, yet the exact incidence remains undetermined due to a lack of dedicated surveillance.</p><p><strong>Methods: </strong>This retrospective study accessed data from the prospectively maintained Hereditary Digestive Tumours Registry from 2000 to 2023. Desmoid-free survival was analysed using Cox regression and Kaplan-Meier curves.</p><p><strong>Results: </strong>A total of 202 patients with familial adenomatous polyposis who underwent colorectal surgery were enrolled. Of the patients, 21 (10.4%) developed intra-abdominal desmoid tumours after surgery. Desmoid tumours were associated with surgical procedure, histology of cancer at the time of surgery, and family history of intra-abdominal desmoid tumours. The overall desmoid-free survival probability at a median follow-up of 84 months was 90%. Histology of cancer at the time of surgery (HR 0.25 (95% c.i. 0.10 to 0.59)), family history of intra-abdominal desmoid tumours (HR 2.92 (95% c.i. 1.22 to 6.97)), an open approach compared with a laparoscopic approach (HR 2.43 (95% c.i. 1.03 to 5.73)), and a proctocolectomy compared with a rectal-sparing total colectomy (HR 3.01 (95% c.i. 1.28 to 7.10)) emerged as significant prognostic factors affecting desmoid-free survival.</p><p><strong>Conclusion: </strong>A minimally invasive rectal-sparing total colectomy appears protective against the development of desmoid tumours. Early surgery does not seem to increase desmoid tumour risk. A dedicated surveillance regimen for desmoid tumours in patients with familial adenomatous polyposis is needed to improve outcomes and quality of life.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683362/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142944184","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 fluid therapy to prevent post-endoscopic retrograde cholangiopancreatography: is there a place for albumin?","authors":"Lucía Guilabert, Enrique de-Madaria","doi":"10.1093/bjsopen/zrae159","DOIUrl":"10.1093/bjsopen/zrae159","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11749779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999498","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":"Primary ventral and incisional hernias: comprehensive review.","authors":"Nadia A Henriksen, Heather Bougard, Mário R Gonçalves, William Hope, Ritu Khare, Jenny Shao, Andrea C Quiroga-Centeno, Eva B Deerenberg","doi":"10.1093/bjsopen/zrae145","DOIUrl":"10.1093/bjsopen/zrae145","url":null,"abstract":"<p><strong>Background: </strong>Primary ventral and incisional hernias are frequent conditions that impact the quality of life of patients. Surgical techniques for ventral hernia repair are constantly evolving and abdominal wall surgery has turned into a highly specialized field.</p><p><strong>Methods: </strong>This is a narrative review of the most recent and relevant literature on the treatment of primary ventral and incisional hernias performed by eight experts in ventral hernia surgery from across the world and includes review of classification systems, preoperative measures, descriptions of surgical techniques, and postoperative complications.</p><p><strong>Results: </strong>Repairs of primary ventral and incisional hernias range from simple open procedures in healthy patients with small defects to complex procedures when patients are co-morbid and have large defects. Optimizing patient-related risk factors before surgery is important to decrease complication rates. Surgical repair techniques from open repairs to minimally invasive procedures are described in detail in the review. Minimally invasive techniques are technically more demanding and take longer, but decrease the risk of surgical-site infections and shorten the duration of hospital stay.</p><p><strong>Conclusion: </strong>Treatment of ventral hernias aims to improve the quality of life of patients. The risks and benefits of procedures should be weighed against patients' complaints and co-morbidities. Optimizing patient-related risk factors before surgery is important.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11788674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143078615","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 the radiological morphology of the mesopancreas on the outcome after pancreatoduodenectomy for pancreatic ductal adenocarcinoma: retrospective study.","authors":"Julie Navez, Martina Pezzullo, Christelle Bouchart, Tatjana Arsenijevic, Pieter Demetter, Jean Closset, Oier Azurmendi Senar, Marie-Lucie Racu, Nicky D'Haene, Jacques Devière, Laurine Verset, Maria A Bali, Jean-Luc van Laethem","doi":"10.1093/bjsopen/zrae134","DOIUrl":"10.1093/bjsopen/zrae134","url":null,"abstract":"<p><strong>Background: </strong>The most frequently invaded margins on pancreatoduodenectomy specimens for pancreatic ductal adenocarcinoma are vascular margins, particularly the superior mesenteric artery (or mesopancreatic) margin. Due to limited exploration of the radiological aspect of the mesopancreas, the aim of this study was to evaluate mesopancreatic infiltration through imaging of patients with pancreatic ductal adenocarcinoma who underwent pancreatoduodenectomy, to correlate these findings with histopathology and evaluate their impact on survival.</p><p><strong>Methods: </strong>Data for all patients who underwent pancreatoduodenectomy for pancreatic ductal adenocarcinoma from 2015 to 2021 were reviewed, including review of surgical margin histopathology and blinded review of preoperative diagnostic imaging. According to qualitative radiological assessment, the mesopancreas was characterized as having normal fat, fat stranding, or solid infiltration. Survival data were analysed using Cox regression.</p><p><strong>Results: </strong>A total of 149 patients were included. At baseline imaging, mesopancreatic fat stranding or solid infiltration was present in 47 patients (31.5%) and 20 patients (13.4%) respectively. Median overall survival and disease-free survival were significantly lower with mesopancreatic solid infiltration (17 and 8 months) compared with normal fat (30 and 14 months) and fat stranding (29 and 16 months) (P = 0.017 and 0.028 respectively). In multivariable analysis, pathological tumour size was an independent prognostic factor for overall survival, and tumour location in the uncinate process and pathological tumour size were independent prognostic factors for disease-free survival.</p><p><strong>Conclusion: </strong>At diagnostic imaging, solid infiltration (but not fat stranding) of the mesopancreas is associated with a poor prognosis for pancreatic ductal adenocarcinoma patients who undergo pancreatoduodenectomy. Pathological tumour size significantly influences the prediction of overall survival, and tumour location in the uncinate process and pathological tumour size significantly influence the prediction of disease-free survival, suggesting further exploration of underlying mechanisms related to retroperitoneal tumoral invasion of vascular margins and the mesopancreas.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726005","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}