BJS Open最新文献

{"title":"Effect of the number of door openings in the operating room on surgical site infections: individual-patient data meta-analysis.","authors":"Hannah Groenen, Hasti Jalalzadeh, Nathan Bontekoning, Antoinette A A Bediako-Bowan, Dennis R Buis, Yasmine E M Dreissen, Anne M Eskes, Jon H M Goosen, Mingyang L Gray, Mitchel Griekspoor, Brian L Hollenbeck, Frank F A IJpma, Maarten J van der Laan, Appiah-Korang Labi, Nina M C Mathijssen, Brett A Miles, Kåre Mølbak, Ricardo G Orsini, Frederik J Prakken, Roald R Schaad, Patrique Segers, Marius A Stauning, Wil C van der Zwet, Stijn W de Jonge, Niels Wolfhagen, Gerjon Hannink, Marja A Boermeester","doi":"10.1093/bjsopen/zraf044","DOIUrl":"10.1093/bjsopen/zraf044","url":null,"abstract":"<p><strong>Background: </strong>The effect of door openings in the operating room on surgical site infections remains a controversial topic and has led to strict door-opening policies. The aim of this individual-patient data meta-analysis was to evaluate the effect of the number of door openings in the operating room on surgical site infection.</p><p><strong>Methods: </strong>MEDLINE (PubMed) and Embase (Ovid) were searched up to 2 December 2024. Authors with individual-patient data on surgical site infections and door openings were invited to collaborate. A one-stage individual-patient data meta-analysis accounting for heterogeneity was performed to examine effects overall and in subgroup analyses (wound class, implant surgery, and income level). The primary outcome was surgical site infection. The risk of bias and Grading of Recommendations, Assessment, Development, and Evaluation framework were used to determine the certainty of evidence.</p><p><strong>Results: </strong>Individual-patient data from 8 observational studies, encompassing 4412 patients, revealed a 6.0% incidence of surgical site infection. Each extra door opening per hour was associated with increased risk of surgical site infection (odds ratio 1.012, 95% c.i. 1.005 to 1.019; τ2 = 0.095; very low certainty of evidence). This means that, for example, at a baseline infection risk of 2%, approximately 35 additional door openings per hour per surgery would be needed to cause one additional surgical site infection per 100 patients. In subgroup analyses, no differences in effect were found. The cumulative effect was more pronounced in patients with a high baseline risk of surgical site infection.</p><p><strong>Conclusion: </strong>Very low certainty of evidence suggests a marginal increase in the risk of surgical site infection for each additional door opening per hour. Although the relative effect is minimal, the cumulative effect has an impact on patients with a higher baseline surgical site infection risk more than others. However, the certainty of the available evidence is too low and the relative effect on clinical outcomes too small to support a rigorous zero door-openings policy to reduce rates of surgical site infections.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274205","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/space surgical site infection and long-term outcomes of rectal cancer surgery: retrospective population-based cohort study.","authors":"Carlota Matallana, Paula Manchon-Walsh, Eloy Espín, Marta Pascual, Sebastiano Biondo, Marta Jiménez-Toscano, Josep Maria Borràs, Josep M Badia, Enric Limón, Luisa Aliste, Rebeca Font, Miguel Pera","doi":"10.1093/bjsopen/zraf052","DOIUrl":"10.1093/bjsopen/zraf052","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic leak and subsequent organ/space surgical site infection (O/S-SSI) after colorectal cancer surgery are associated with poor short-term outcomes; however, the evidence regarding long-term outcomes is inconclusive. This population-based retrospective cohort study aimed to evaluate the association between O/S-SSI and both tumour recurrence and long-term survival after curative rectal cancer surgery.</p><p><strong>Methods: </strong>Data was obtained for all adults who underwent curative oncological resection of the rectum in the periods 2011-2012 and 2015-2016 (n = 2208) in Spain. Multivariable analysis (Cox proportional hazards model) was used to evaluate the effects of clinical and pathological characteristics, as well as the occurrence of O/S-SSI, on recurrence and survival.</p><p><strong>Results: </strong>In all, 2208 adults underwent curative rectal cancer resection, 1464 of whom were male (66.3%); the median patient age was 69.1 years. O/S-SSI occurred in 291 patients (13%). Independent predictors of recurrence included tumour stage III (hazard ratio (HR) 1.95, 95% confidence interval (c.i.) 1.06 to 3.58; P = 0.032), a positive resection margin (HR 4.03, 95% c.i. 2.58 to 6.29; P < 0.001), and poor quality mesorectal excision (HR 1.81, 95% c.i. 1.11 to 2.95; P = 0.018), but not O/S-SSI (HR 1.02, 95% c.i. 0.78 to 1.34; P = 0.888). However, O/S-SSI was independently associated with reduced overall survival at 1 year (HR 2.20, 95% c.i. 1.39 to 3.48; P < 0.001), 2 years (HR 1.75, 95% c.i. 1.25 to 2.43; P < 0.001), and 5 years (HR 1.33, 95% c.i. 1.05 to 1.68; P = 0.017).</p><p><strong>Conclusion: </strong>In this study, O/S-SSI had a negative impact on the long-term survival of patients who underwent rectal cancer surgery, but was not associated with increased tumour recurrence.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274206","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":"Outcomes of intended temporary stomas in Crohn's disease (INTESTINE study): international, multicentre, retrospective study.","authors":"Claire Perrott, Giacomo Calini, Alice Gori, Matteo Rottoli, Maria E Flacco, Lamberto Manzoli, Zoe Garoufalia, Steven D Wexner, Christos Kontovounisios, Muhammed Elhadi, Valerio Celentano","doi":"10.1093/bjsopen/zraf010","DOIUrl":"10.1093/bjsopen/zraf010","url":null,"abstract":"<p><strong>Background: </strong>Patients with ileocolic Crohn's disease often require surgery that can result in temporary stoma formation. Stomas are associated with a morbidity and can negatively impact quality of life. This study aimed to investigate the short-term (6-month) and mid-term (18-month) outcomes of intended temporary stomas in patients with Crohn's disease.</p><p><strong>Methods: </strong>A trainee-led, international multicentre, retrospective study was conducted on all patients who underwent surgery for Crohn's disease in collaborating centres over 4 years (2017-2020). The primary outcome was the proportion of patients with Crohn's disease who underwent stoma reversal surgery by 6- and 18-month postoperative follow-up. Secondary outcomes included: the time interval between formation and reversal of stoma and predictors for non-reversal and stoma-related morbidity (postoperative complications, related readmissions and complications due to stoma reversal surgery).</p><p><strong>Results: </strong>A total of 401 patients underwent stoma formation for Crohn's disease over the 4 years across the 44 collaborating centres. The temporary stomas had been reversed in 30.2% of patients at the 6-month and 56.9% at the 18-month follow-up. Reasons for non-reversal included ongoing medical treatment for Crohn's disease (respectively 6-month and 18-month: 37.6%, 39.3%), patient unfit for surgery (respectively 6-month and 18-month: 14.5%, 16.8%), patient preference (respectively 6-month and 18-month: 12.1%, 20.2%) and due to waiting lists (respectively 6-month and 18-month: 12.1%, 8.1%). Overall, 63.3% of patients had a temporary stoma reversed with a median time interval of 6 months. The stoma-related overall morbidity rate was 29.4%.</p><p><strong>Conclusions: </strong>A large proportion of temporary stomas for Crohn's disease were not reversed at 6 and 18 months following initial surgery. Patients are exposed to the risk of non-reversal and risk of developing stoma complications for significantly longer intervals of time and, in some cases, indefinitely.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12128195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207594","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":"Prophylactic use of incisional negative pressure wound therapy for groin incisions in vascular surgery: randomized clinical trial.","authors":"Alireza Daryapeyma, Olga Nilsson, Jennifer Pettersson, Otto Stackelberg, Eva Torbjörnsson, Rebecka Hultgren","doi":"10.1093/bjsopen/zraf059","DOIUrl":"10.1093/bjsopen/zraf059","url":null,"abstract":"<p><strong>Background: </strong>The efficacy of incisional negative pressure wound therapy (iNPWT) in preventing surgical site infections (SSIs) after infrainguinal vascular surgery remains unclear. This study compared iNPWT with standard gauze dressings to determine the effects on SSI incidence and quality of life.</p><p><strong>Methods: </strong>Patients undergoing infrainguinal vascular surgery were recruited to a regional randomized clinical trial. All patients had a groin incision for either thromboendarterectomy only with a vein or synthetic patch or hybrid procedures with thromboendarterectomy and concurrent endovascular treatment. The control and intervention groups received sterile gauze and iNPWT dressings, respectively. The primary endpoint was the incidence of SSIs within 30 days, measured using the Additional treatment, Serous discharge, Erythema, Purulent exudates, Separation of the deep tissues, Isolation of bacteria and inpatient Stay (ASEPSIS) scoring protocol. Secondary endpoints were scores on the Wound Quality of Life and EQ-5D™ three-level (EQ-5D-3L™) questionnaires.</p><p><strong>Results: </strong>Of the 123 patients randomized, 109 (89%) completed the study. The incidence of SSI was similar in the intervention and control groups (15% versus 25%, respectively; P = 0.340), but was higher in patients with a body mass index (BMI) ≥ 25 kg/m2 than in those with a BMI < 25 kg/m2 (52% versus 21%, respectively). Wound Quality of Life mean scores were similar in the control and intervention groups (10.60 versus 12.85, respectively; P = 0.322); however, the intervention group reported a larger negative impact on everyday life than the control group (7.40 versus 4.91 for the everyday life domain, respectively; P = 0.048). There were no significant differences between the two groups in EQ-5D-3L™ scores.</p><p><strong>Conclusion: </strong>The similar distribution of SSIs regardless of the type of wound dressing, in addition to the negative impact on everyday life, does not support the general use of iNPWT in this or similar patient cohorts. The unique aspect of this trial is the patient perspective on the use of iNPWT, revealing a divergence between the views of patients and healthcare providers regarding optimal wound care. In the setting of individualized care, there may be a place for iNPWT in selected patients with a high BMI and excessive perioperative bleeding, which are associated with a higher SSI risk.</p><p><strong>Registration number: </strong>NCT03395613 (https://clinicaltrials.gov).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12158596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274208","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":"Anatomically resectable versus biologically borderline resectable pancreatic cancer definition: refining the border beyond anatomical criteria and biological aggressiveness.","authors":"Giulio Belfiori, Federico De Stefano, Domenico Tamburrino, Giulia Gasparini, Francesca Aleotti, Paolo R Camisa, Claudia Arcangeli, Marco Schiavo Lena, Nicolo Pecorelli, Diego Palumbo, Stefano Partelli, Francesco De Cobelli, Michele Reni, Stefano Crippa, Massimo Falconi","doi":"10.1093/bjsopen/zraf033","DOIUrl":"10.1093/bjsopen/zraf033","url":null,"abstract":"<p><strong>Background: </strong>The anatomically resectable pancreatic ductal adenocarcinoma treatment sequence is still debated. Heterogeneity in patient characteristics within this group may explain literature discrepancies. To overcome these limits, a biologically borderline resectable pancreatic ductal adenocarcinoma category has been analysed according to institutional criteria. The aim of this study was to examine the characteristics and outcomes of patients with biologically borderline resectable pancreatic ductal adenocarcinoma and determine whether they represent a distinct clinical and prognostic subgroup.</p><p><strong>Methods: </strong>Data from all consecutive patients who underwent surgical resection for pancreatic ductal adenocarcinoma between 2015 and 2022 were retrospectively analysed. Biologically borderline resectable disease was classified by the presence of one or more of the following: carbohydrate antigen 19-9 ≥200 U/ml, cancer-related symptoms lasting >40 days, and radiological suspicion of regional lymph node metastases at diagnosis.</p><p><strong>Results: </strong>In total, 886 patients were included in the study and divided into anatomically borderline resectable (266 patients (30%)) and anatomically resectable (620 patients (70%)), which was further divided into resectable (R; 397 patients (64%)) and biologically borderline resectable (223 patients (36%)). Neoadjuvant treatment was administered in 245 patients (92.1%) in the anatomically borderline resectable group, 82 patients (20.7%) in the R group, and 135 patients (60.5%) in the biologically borderline resectable group. After a median follow-up of 45 (95% c.i. 42 to 48) months, the median disease-specific survival in the biologically borderline resectable group was 40 months compared with 59 months in the R group (P < 0.001) and 40 months in the anatomically borderline resectable group (P = 0.570). In the upfront surgery cohort, the median disease-specific survival was worse for biologically borderline resectable patients compared with R patients (27 versus 54 months respectively, P < 0.001). Biologically borderline resectable was also independently associated with worse disease-specific survival, together with age, tumour size at diagnosis, and anatomically borderline resectable. The same, except for age, were also predictors of worse event-free survival.</p><p><strong>Conclusion: </strong>Despite their identical anatomical appearance, resectable and biologically borderline resectable pancreatic ductal adenocarcinoma represent two distinct prognostic entities, warranting separate evaluation and, potentially, different treatment approaches.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144109458","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 enema for anal surgery: randomized clinical trial.","authors":"Meng-Che Tsai, Ting-Yu Su, Kee-Thai Kiu, Min-Hsuan Yen, Ying-Wei Chen, Ka-Wai Tam, Tuan Ly Huu, Tung-Cheng Chang","doi":"10.1093/bjsopen/zraf023","DOIUrl":"10.1093/bjsopen/zraf023","url":null,"abstract":"<p><strong>Background: </strong>Haemorrhoidal surgery and anal fistula surgery are two of the most common procedures in proctology. Currently, there is no definitive consensus on the need to administer a preoperative enema. The objective of this study was to evaluate the efficacy and benefits of preoperative enemas in anal surgical procedures.</p><p><strong>Methods: </strong>Patients diagnosed with grade III or IV haemorrhoids and anal fistulas at the Taipei Medical University Shuang-Ho Hospital, Taiwan, between 2022 and 2023, were enrolled in a randomized clinical study comparing the use of preoperative enema (intervention) versus no preoperative enema (control). The primary outcome measures included postoperative visual analogue scale scores and analgesic usage from postoperative day 0 to day 7. Secondary outcomes of interest were postoperative complications, including surgical site infection, postoperative bleeding and urinary retention. Subgroup analyses were performed according to the type of procedure for the same outcomes.</p><p><strong>Results: </strong>A total of 266 patients were enrolled in this study, with 133 allocated to the enema group and 133 to the control group. No significant differences were observed in postoperative visual analogue scale scores, analgesic consumption and postoperative complications between the two groups. Subgroup analysis revealed that patients undergoing stapled haemorrhoidopexy and anal fistula surgery also showed no significant differences in postoperative visual analogue scale scores, analgesic consumption, and postoperative complications between the enema and control groups. However, in the subgroup of patients undergoing Milligan-Morgan haemorrhoidectomy, the mean(s.d.) visual analogue scale score was significantly higher in the control group than in the enema group on day 2 (5.69(2.14) versus 3.77(2.45), P = 0.021), day 3 (5.85(2.61) versus 3.92(2.73), P = 0.042) and day 4 (5.23(2.55) versus 3.42(2.18), P = 0.027).</p><p><strong>Conclusion: </strong>Preoperative enema in anal surgery did not yield additional benefits or reduce complications when compared with patients who did not undergo enema before anal surgery. Based on the study findings, its use can be omitted in anal surgery, especially for patients undergoing stapled haemorrhoidopexy and anal fistula surgery.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of morbidity and predictors of wound complications following perineal wound closure after radical anorectal oncologic resection: retrospective cohort study.","authors":"Aron Bercz, Janet Alvarez, Roni Rosen, Matthew Drescher, Hiroyuki Sonoda, Georgios Karagkounis, Iris Wei, Maria Widmar, Garrett M Nash, Martin R Weiser, Philip B Paty, Robert J Allen, Jonas A Nelson, Michelle Coriddi, Joseph H Dayan, Colleen McCarthy, Farooq Shahzad, Evan Matros, Joseph J Disa, Peter G Cordeiro, Babak J Mehrara, Julio Garcia-Aguilar, J Joshua Smith, Emmanouil P Pappou","doi":"10.1093/bjsopen/zraf065","DOIUrl":"10.1093/bjsopen/zraf065","url":null,"abstract":"<p><strong>Background: </strong>Perineal wound management after radical pelvic surgery is complex and diverse. This retrospective study evaluated surgical morbidity and predictors of wound complications associated with different perineal closure techniques.</p><p><strong>Methods: </strong>Medical records of patients who underwent abdominoperineal resection or pelvic exenteration followed by tissue flap reconstruction (TFR) or primary closure (PC) between 2012 and 2020 were reviewed. Postoperative morbidity, including wound dehiscence, infection, flap loss, and Clavien-Dindo complications, were assessed.</p><p><strong>Results: </strong>In all, 414 patients underwent surgery for rectal (364) or anal (50) malignancies, with 150 receiving TFR and 264 receiving PC; an omental flap was used in 81 patients who underwent PC. TFR was more commonly used in complex situations (for example exenteration, sacrectomy, vaginectomy, intraoperative radiation). Compared with PC, TFR was associated with higher 90-day rates of wound dehiscence (27 versus 11%; P  < 0.001), wound infection (25 versus 14%; P  < 0.001) and grade ≥III Clavien-Dindo complications (32 versus 17%; P  = 0.001). Flap loss occurred in 2 patients (1%) who underwent TFR. No differences were observed among TFR subtypes, or between patients who underwent PC with and without an omental flap. Multivariate analysis demonstrated that anal cancer (odds ratio (OR) 5.24, 95% confidence interval (c.i.) 1.07 to 25.58; P = 0.041) and extralevator resection (OR 3.09, 95% c.i. 1.07 to 8.92; P = 0.037) were independent predictors of wound dehiscence, whereas vaginectomy was a predictor of wound dehiscence in the TFR subgroup (OR 17.9, 95% c.i. 1.05 to 304.73; P = 0.046).</p><p><strong>Conclusion: </strong>TFR was associated with higher morbidity due to greater case complexity, but there were no difference in outcomes across flap subtypes. Anal cancer, extralevator resection, and vaginectomy were independent predictors of dehiscence. Omental flaps did not increase the risk of wound complications.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274204","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":"Standardization of the surgical technique and reporting for radical right colectomy with central vascular ligation and complete mesocolic excision (RRoC-STAR): Delphi consensus.","authors":"Giuseppe S Sica, Gabriele Anania, Cristina Fiorani, Leandro Siragusa, Danilo Vinci, Marco Caricato, Paolo Delrio, Antonino Agrusa, Gianandrea Baldazzi, Rossella Reddavid, Gianluca Pellino","doi":"10.1093/bjsopen/zraf066","DOIUrl":"10.1093/bjsopen/zraf066","url":null,"abstract":"<p><strong>Background: </strong>Complete mesocolic excision refers to a radical right hemicolectomy for cancer following embryologically defined anatomical planes. However, heterogeneity in definitions and techniques is a barrier to research. The aim of the Radical Right Colectomy-Surgical Technique Approved Report (RRoC-STAR) collaborative is to provide international expert consensus-based definitions and standardized terminology and surgical steps for right hemicolectomy for locally advanced colon cancer.</p><p><strong>Methods: </strong>Authors of publications reporting on radical right hemicolectomy techniques were invited to complete an ACCORD-compliant Delphi questionnaire (two rounds). A standardized name (for the procedure) and a data sheet for reporting the procedure were proposed, along with 21 items, including terminology and surgical steps. The assembled panel was asked to vote for each item, with consensus considered to have been reached for items that achieved at least 80% agreement.</p><p><strong>Results: </strong>Of 162 invited authors, 67 completed both Delphi rounds. All but 1 of the 21 items received consensus after 2 rounds. Consensus was reached on the use of the proposed data sheet for reporting, the term radical right colectomy (RRC), and the surgical steps deemed necessary for RRC, namely preservation of mesocolic integrity, sharp dissection of the anterolateral surface of the superior mesenteric vein up to the middle colic vein, ligation at the origin of vessels, and dissection of lymphoadipose tissue around the gastrocolic trunk of Henle.</p><p><strong>Conclusion: </strong>This study provides an international expert consensus-based definition and standardization of terminology and the surgical steps required to perform RRC. A comprehensive data sheet for reporting RRC is introduced to enable data homogenization from current and future studies.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144274209","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 for necrotizing enterocolitis in Dutch infants born before 26 weeks' gestation.","authors":"Otis C van Varsseveld, Adinda G H Pijpers, Ceren Imren, Joep P M Derikx, Chris H P van den Akker, Joost van Schuppen, Claudia M G Keyzer-Dekker, Marijn J Vermeulen, Maarten Schurink, Maud Y A Lindeboom, Elisabeth M W Kooi, Jan B F Hulscher","doi":"10.1093/bjsopen/zraf060","DOIUrl":"10.1093/bjsopen/zraf060","url":null,"abstract":"<p><strong>Background: </strong>In infants born at < 26 weeks of gestational age (wGA) who develop necrotizing enterocolitis (NEC), medical and ethical considerations about whether surgery is the optimal treatment are complicated by a lack of group-specific outcome data. This study investigated nationwide 30-day mortality, surgical complications, and preoperative mortality risk factors in infants born at < 26 wGA who underwent surgery during the active phase of NEC.</p><p><strong>Methods: </strong>This retrospective nationwide multicentre study included all infants born at < 26 wGA undergoing surgery for Bell's stage II/III NEC in the Netherlands between 2008 and 2022, regardless of outcome. Severe NEC was defined as Bell's stage III (confirmed by laparotomy and/or leading to death). The primary outcome was postoperative 30-day mortality. The incidence of major postoperative complications (Clavien-Madadi III-IV) was determined after excluding infants undergoing open-close procedures for massive bowel necrosis. Potential risk factors for death after surgery were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>Of 288 infants with NEC Bell's stage ≥ II, 80 (27.8%) survived without surgery, 66 (22.9%) died before laparotomy, and 142 (49.3%) underwent laparotomy. In 142 surgically treated infants with severe NEC (57.0% male), the median gestational age was 25 + 0 (range 23 + 6 to 25 + 6) weeks + days, the median birthweight was 750 (range 485-1070) g, and the median age at surgery was 14 (range 2-66) days. Primary open-close surgery was performed in 34 of 142 infants (23.9%). In the remaining 108 infants, surgical management included stoma creation (63.0%), primary anastomosis (27.8%), or both (9.3%). Overall, the 30-day mortality rate among 142 infants was 47.2% (67 deaths). Death occurred after a primary or second-look open-close procedure in 37 infants, after multiorgan failure in 17, and from other causes in the remaining 13. After excluding 37 infants who died after open-close procedures, 30-day complications occurred in 23 (21.9%) of 105 surgically treated infants. There were 29 events in total, including reoperation for bowel perforation (5, 17%) or anastomotic leak/stenosis (5, 17%). Regression analysis identified no risk factors for 30-day mortality.</p><p><strong>Conclusion: </strong>The 30-day mortality rate was 47.2% in infants born at < 26 wGA undergoing NEC surgery, most of whom died after an open-close procedure. Another 21.9% of infants experienced major complications.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101056/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126290","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":"Intrathoracic versus cervical anastomosis after totally or hybrid minimally invasive transthoracic oesophagectomy for oesophageal cancer: cost-effectiveness analysis alongside the randomized ICAN trial.","authors":"Eric Matthée, Sander Ubels, Bastiaan Klarenbeek, Moniek H P Verstegen, Gerjon Hannink, Frans van Workum, Camiel Rosman, Janneke P C Grutters","doi":"10.1093/bjsopen/zraf061","DOIUrl":"10.1093/bjsopen/zraf061","url":null,"abstract":"<p><strong>Background: </strong>There is a worldwide trend towards minimally invasive oesophagectomy with intrathoracic anastomosis in oesophageal cancer surgery. Minimally invasive oesophagectomy with intrathoracic anastomosis has been shown to result in fewer anastomotic leaks, but cost-effectiveness is yet to be established. The aim of this study was to determine the cost-effectiveness of transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis compared with cervical anastomosis.</p><p><strong>Methods: </strong>A prospective economic evaluation was performed alongside the ICAN trial, a randomized clinical superiority trial. Patients with mid/distal oesophageal or gastro-oesophageal junction cancer were randomly assigned to transthoracic minimally invasive oesophagectomy with either intrathoracic or cervical anastomosis. Quality-adjusted life-years, mean healthcare, and societal costs were assessed for both groups at 9 and 21 months after surgery.</p><p><strong>Results: </strong>A total of 245 patients randomized for transthoracic minimally invasive oesophagectomy with either intrathoracic (122) or cervical (123) anastomosis were included in the cost-effectiveness analysis. After 9 months, the intrathoracic group yielded 0.58 (95% confidence interval (c.i.) 0.55 to 0.61) quality-adjusted life-years per patient, compared with 0.56 (0.52 to 0.58) quality-adjusted life-years for the cervical group. After 9 months, both mean healthcare costs (20 573 (95% c.i. 17 623 to 24 177) versus 28 039 (23 574 to 33 116) euros), and societal costs (24 590 (21 237 to 29 074) versus 33 383 (27 885 to 38 805) euros), per patient were lower in the intrathoracic anastomosis group. Similarly, at 21 months no statistically significant difference was found (mean difference 0.08 (-0.05 to 0.2) quality-adjusted life-years), whereas minimally invasive oesophagectomy with intrathoracic anastomosis was less costly than that with cervical anastomosis (mean difference -9930 (-16 301 to -2521) euros). The higher costs in the cervical anastomosis group were mainly due to longer lengths of stay owing to complications.</p><p><strong>Conclusion: </strong>Transthoracic minimally invasive oesophagectomy with intrathoracic anastomosis was found to be cost-effective compared with transthoracic minimally invasive oesophagectomy with cervical anastomosis.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 3","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101345/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144131980","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}