BJS Open最新文献

{"title":"Regional patterns of early-onset colorectal cancer from the GEOCODE (Global Early-Onset COlorectal Cancer DatabasE)-European consortium: retrospective cohort study.","authors":"Maria Daca-Alvarez, José Perea, Luis Corchete, Antonino Spinelli, Caterina Foppa, Noel F C C de Miranda, Maartje Nielsen, Claire Palles, Helen M Curley, Marc Marti-Gallostra, Mireia Verdaguer, Alfredo Vivas, Sofia Lorenzo, Andrew Latchford, Omar Faiz, Kevin Monahan, Nikhil Pawa, Marek Szczepkowski, Bartosz Ziółkowski, Wieslaw Tarnowski, Mariusz Uryszek, Silviu-Tiberiu Makkai-Popa, Juan S Azagra, Joan Llach, Leticia Moreria, Maria Pellise, Andreana N Holowatyj, Rogelio González-Sarmiento, Francesc Balaguer","doi":"10.1093/bjsopen/zraf024","DOIUrl":"10.1093/bjsopen/zraf024","url":null,"abstract":"<p><strong>Background: </strong>The incidence of early-onset colorectal cancer is increasing, but in Europe this growth shows a heterogeneous pattern in different countries and regions.</p><p><strong>Methods: </strong>Patients from six countries who participated in the Global Early-Onset COlorectal Cancer DatabasE (GEOCODE)-Europe group were included. The inclusion criteria were patients with colorectal adenocarcinoma diagnosed between 18 and 49 years of age, between January 2010 and December 2017, with at least 3 years of follow-up. Patients with inherited colorectal cancer syndromes were excluded.</p><p><strong>Results: </strong>A total of 851 patients were included with almost equal sex distribution, most were diagnosed at age 39 years or older and 42% of patients were overweight or obese. Diagnoses were predominantly at later stages (62.5% stage III-IV) and tumours were predominantly located in the distal colon (76.9% left colon and rectum). Comparative analysis between countries demonstrated that the UK had a younger age at diagnosis and the Italian cohort had a higher prevalence of being overweight or obese. Patients from Luxembourg had more advanced stage diagnoses and those from The Netherlands had more polyps. Patients from the UK had a greater family history of colorectal cancer. Comparison of Mediterranean versus non-Mediterranean countries showed significant differences in the age at diagnosis and body mass index. The prevalence of early-onset colorectal cancer over the age of 40 years in Mediterranean versus non-Mediterranean countries was 71.4% versus 62.1% (P = 0.002), and early-onset colorectal cancer was diagnosed at a more advanced stage in Mediterranean countries versus non-Mediterranean countries (65.3% versus 54.7%; P = 0.033). Family history of colorectal cancer in a first-degree relative was more common in non-Mediterranean versus Mediterranean countries (19.1% versus 11.4%; P < 0.001).</p><p><strong>Conclusion: </strong>This study highlights significant geographical disparities in the clinical, pathological and familial features of early-onset colorectal cancer across European countries.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655982","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":"Stoma versus no stoma prior to long-course neoadjuvant therapy in rectal cancer.","authors":"Gustav Sandén, Petrus Vinnars, Ingrid Ljuslinder, Johan Svensson, Martin Rutegård","doi":"10.1093/bjsopen/zrae169","DOIUrl":"10.1093/bjsopen/zrae169","url":null,"abstract":"<p><strong>Background: </strong>Large bowel obstruction is a possible complication in patients undergoing neoadjuvant treatment for rectal cancer; however, it may be prevented by placing a pretreatment defunctioning stoma. The aim of this retrospective study was to investigate complication rates in patients with rectal cancer undergoing long-course neoadjuvant therapy, comparing those with and without a prophylactic stoma.</p><p><strong>Methods: </strong>All patients with rectal cancer undergoing neoadjuvant therapy between 2007 and 2022 in Region Västerbotten, Sweden, were identified using the Swedish Colorectal Cancer Registry. Patients not planned for curative long-course neoadjuvant therapy and those requiring a stoma due to urgent bowel-related issues before treatment were excluded. The primary outcome was the incidence of complications between diagnosis and resection surgery or end of follow-up. The secondary outcomes were 30-day complications following resection, time to treatment (neoadjuvant therapy and surgery), and overall survival. Multivariable regression analysis was used, with adjustment for age, sex, American Society of Anesthesiologists fitness grade, and clinical tumour stage.</p><p><strong>Results: </strong>Of 482 identified patients, 105 were analysed after exclusion. Among these, 22.9% (24 of 105) received a pretreatment stoma, whereas 77.1% (81 of 105) received upfront neoadjuvant therapy. The complication incidence before resection in the group with a defunctioning stoma and in the group without a defunctioning stoma was 75.0% (18 of 24) and 29.6% (24 of 81) respectively. A considerable number of complications were directly caused by the stoma surgery. Patients in the stoma group had an adjusted OR of 6.71 (95% c.i. 2.17 to 20.76) for any complication. However, for 30-day complications following resection, an adjusted non-significant OR of 2.05 (95% c.i. 0.62 to 6.81) was documented for the stoma group, in comparison with the control group. Neoadjuvant treatment was also delayed for the stoma group (adjusted mean time difference: 21 (95% c.i. 14 to 27) days), whereas the difference was not significant for the time to resection surgery. The median survival after diagnosis was 4.7 years in the stoma group and 12.2 years in the control group (P = 0.015); however, adjustment in the multivariable analysis rendered the estimate non-significant (HR 1.71 (95% c.i. 0.93 to 3.14)).</p><p><strong>Conclusion: </strong>Patients with rectal cancer who receive a stoma before long-course neoadjuvant therapy, in the absence of urgent symptoms, experience more complications than those without a stoma and a delay with regard to the start of neoadjuvant treatment.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647077","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":"Treatment and survival of non-metastatic rectal cancer in patients with inflammatory bowel disease: nationwide cohort study.","authors":"Erik Lundqvist, Karin Westberg, Caroline E Dietrich, Åsa H Everhov, Pär Myrelid, Bengt Glimelius, Anna Martling, Caroline Nordenvall","doi":"10.1093/bjsopen/zraf014","DOIUrl":"10.1093/bjsopen/zraf014","url":null,"abstract":"<p><strong>Background: </strong>Patients with inflammatory bowel disease have an increased risk of colorectal cancer. There is a scarcity of large studies with a focus on rectal cancer in patients with inflammatory bowel disease. This study aimed to compare survival in resected patients with rectal cancer with and without inflammatory bowel disease.</p><p><strong>Methods: </strong>This national population-based study used the Colorectal Cancer Data Base. All Swedish patients ≥18 years of age with a diagnosis of stage I-III rectal cancer between 1997 and 2021, surgically treated with curative intent, were included and followed up until 2022. The outcome of interest was recurrence-free survival. Flexible parametric survival models adjusted for time since surgery, year of diagnosis, sex, age at diagnosis, and Charlson Co-morbidity Index were used to estimate proportional and time-dependent hazard ratios of recurrence-free survival with 95% confidence intervals.</p><p><strong>Results: </strong>Overall, 22 082 patients with rectal cancer were included, among whom 323 (1.5%) had inflammatory bowel disease. Neoadjuvant radiotherapy/chemoradiotherapy was given to 55% and 63% of patients with and without inflammatory bowel disease respectively. The median follow-up time was 5.2 years (interquartile range (i.q.r.) 2.3-10) in patients with inflammatory bowel disease and 5.9 years (i.q.r. 2.9-10) in patients without inflammatory bowel disease. Based on the adjusted proportional hazards model, no overall difference in recurrence-free survival was found (HR 1.05, 95% c.i. 0.87 to 1.26). In the time-dependent adjusted model, patients with rectal cancer with inflammatory bowel disease experienced a lower recurrence-free survival during the first year after surgery (1 year HR 1.36, 95% c.i. 1.06 to 1.73), after which there was no difference in comparison with patients without inflammatory bowel disease (5 years HR 0.77, 95% c.i. 0.56 to 1.06).</p><p><strong>Conclusion: </strong>Despite lower recurrence-free survival during the first year among those with inflammatory bowel disease, there were no long-term differences between patients with or without inflammatory bowel disease.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143708369","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":"Development and validation of prediction models for sentinel lymph node status indicating postmastectomy radiotherapy in breast cancer: population-based study.","authors":"Miriam Svensson, Pär-Ola Bendahl, Sara Alkner, Emma Hansson, Lisa Rydén, Looket Dihge","doi":"10.1093/bjsopen/zraf047","DOIUrl":"10.1093/bjsopen/zraf047","url":null,"abstract":"<p><strong>Background: </strong>Postmastectomy radiotherapy (PMRT) impairs the outcome of immediate breast reconstruction in patients with breast cancer, and the sentinel lymph node (SLN) status is crucial in evaluating the need for PMRT. The aim of this study was to develop and validate models to stratify the risk of clinically significant SLN macrometastases (macro-SLNMs) before surgery.</p><p><strong>Methods: </strong>Women diagnosed with clinically node-negative (cN0) T1-2 breast cancer were identified within the Swedish National Quality Register for Breast Cancer (2014-2017). Prediction models and corresponding nomograms based on patient and tumour characteristics accessible before surgery were developed using adaptive least absolute shrinkage and selection operator logistic regression. The prediction of at least one and more than two macro-SLNMs adheres to the current guidelines on use of PMRT and reflects the exclusion criteria in ongoing trials aiming to de-escalate locoregional radiotherapy in patients with one or two macro-SLNMs. Predictive performance was evaluated using area under the receiver operating characteristic curve (AUC) and calibration plots.</p><p><strong>Results: </strong>Overall, 18 185 women were grouped into development (13 656) and validation (4529) cohorts. The well calibrated models predicting at least one and more than two macro-SLNMs had AUCs of 0.708 and 0.740, respectively, upon validation. By using the prediction model for at least one macro-SLNM, the risk could be updated from the pretest population prevalence of 13.2% to the post-test range of 1.6-74.6%.</p><p><strong>Conclusion: </strong>Models based on routine patient and tumour characteristics could be used for prediction of SLN status that would indicate the need for PMRT and assist decision-making on immediate breast reconstruction for patients with cN0 breast cancer.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of a low-glycaemic-index formula on post-gastrectomy hypoglycaemia in patients with gastric cancer: randomized crossover study.","authors":"Takeshi Kubota, Takuma Ohashi, Keiji Nishibeppu, Kazuya Takabatake, Hiroyuki Inoue, Yudai Nakabayashi, Hirotaka Konishi, Atsushi Shiozaki, Hitoshi Fujiwara, Emi Ushigome, Michiaki Fukui, Eigo Otsuji","doi":"10.1093/bjsopen/zraf001","DOIUrl":"10.1093/bjsopen/zraf001","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing gastrectomy often experience postprandial hypoglycaemia, late dumping syndrome, and night-time hypoglycaemia. However, countermeasures for post-gastrectomy hypoglycaemia rely on the patients' own efforts. We sought to investigate how post-gastrectomy hypoglycaemia could be nutritionally improved in patients with gastric cancer.</p><p><strong>Method: </strong>Single-centre prospective, open-labelled, randomized crossover study including patients aged 20-80 years diagnosed with gastric adenocarcinoma, which have undergone total or distal gastrectomy 1-5 years before the study. The patients consumed 100 ml of a low-carbohydrate/high-monounsaturated fatty acid formula orally 30 min after meals and before sleep (400 kcal/day) during the first or second half of a 14-day glucose-monitoring period. The effects of the low-carbohydrate/high-monounsaturated fatty acid formula on the time below range, that is, the percentage of time during which the glucose concentration was <70 mg/dl, and the coefficient of variation (CV) of the glucose concentration when the ideal time below range and CV were set at <5% and ≤36% respectively were assessed. Dumping symptoms were investigated before and after the study.</p><p><strong>Results: </strong>Thirty-eight patients were included in this study. In patients who had undergone total gastrectomy, the (median) daytime time below range, daytime CV, and night-time time below range remained high at 7.6% ((range) 0.0-45.0), 35.6% ((range) 9.5-50.5), and 10.8% ((range) 0.0-56.3) respectively, even after a long postoperative period. The (median) night-time time below range in patients who had undergone distal gastrectomy and total gastrectomy improved from 3.5% ((range) 0.0-47.9) to 1.4% ((range) 0.0-26.6) (P < 0.001, effect size 0.58) and 10.8% ((range) 0.0-56.3) to 9.4% ((range) 0.0-39.9) (P = 0.078, effect size 0.45) respectively. However, the daytime time below range and CV, as indicators of late dumping syndrome, did not change.</p><p><strong>Conclusion: </strong>The low-carbohydrate/high-monounsaturated fatty acid formula improved post-gastrectomy night-time hypoglycaemia, but not daytime glycaemic variability or hypoglycaemia. Thus, further investigation of nutritional optimization is required.</p><p><strong>Clinical trial registration: </strong>Japan Registry of Clinical Trials, jRCT https://jrct.niph.go.jp/, identifier jRCTs s051210200.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11895506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603725","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":"Correction to: Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery.","authors":"","doi":"10.1093/bjsopen/zraf031","DOIUrl":"10.1093/bjsopen/zraf031","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11925648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143668834","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":"Robotic versus laparoscopic hepatectomy: meta-analysis of propensity-score matched studies.","authors":"Piao Wang, Dan Zhang, Bin Huang, Wen-Hao Zhou, Chang-Song Wang, Shao-Yong Zhao, Song Su, Xiao-Zhong Jiang","doi":"10.1093/bjsopen/zrae141","DOIUrl":"10.1093/bjsopen/zrae141","url":null,"abstract":"<p><strong>Background: </strong>Robotic techniques can theoretically overcome the limitations of laparoscopic liver resection and are currently recognized as safe options; however, it is not known which approach is better. The purpose of this study was to compare the advantages of robotic hepatectomy and laparoscopic hepatectomy.</p><p><strong>Methods: </strong>Electronic databases (the Cochrane Library, PubMed (MEDLINE), Embase and Web of Science) were systematically searched from January 2000 to August 2023 for eligible studies that compared robotic hepatectomy and laparoscopic hepatectomy. Studies that met the inclusion criteria were then reviewed systematically. The reported data were aggregated statistically using RevMan 5.4 software. The parameters of interest included intraoperative, postoperative, survival and financial outcomes. Subgroup analysis was performed according to the type and difficulty level of hepatectomy and the study setting.</p><p><strong>Results: </strong>A total of 26 propensity-score matching comparative trials met the inclusion criteria, which comprised 9355 participants (robotic hepatectomy versus laparoscopic hepatectomy: 3938 versus 5417) in the meta-analysis. For surgical outcomes, lower blood loss, lower open conversion rate and higher R0 resection rate were observed in the robotic hepatectomy group compared with the laparoscopic hepatectomy group (mean difference (MD) -86.22, 95% c.i. -116.49 to -55.95, I² = 87%, P < 0.001; OR 0.51, 95% c.i. 0.38 to 0.69, I² = 40%, P < 0.001; OR 1.31, 95% c.i. 1.03 to 1.67, I² = 0%, P = 0.030 respectively). The lower blood loss (major hepatectomy group: MD -56.88, 95% c.i. -109.09 to -4.28, I² = 76%, P = 0.030; IWATE score (advanced/expert more than 80%) group: MD -0.61, 95% c.i. -1.14 to -0.08, I² = 95%, P < 0.001) and lower open conversion rate (major hepatectomy group: OR 0.41, 95% c.i. 0.30 to 0.56, I² = 0%, P < 0.001; IWATE score (advanced/expert less than 80%) group: OR 0.52, 95% c.i. 0.36 to 0.75, I² = 0%, P = 0.659) advantage persisted across subgroup analyses.</p><p><strong>Conclusion: </strong>The robotic approach had advantages to laparoscopic in terms of lower blood loss and reduced rates of open conversion, especially in difficult hepatectomies.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11957917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143750971","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":"α-Fetoprotein model versus Milan criteria in predicting outcomes after hepatic resection for hepatocellular carcinoma: multicentre study.","authors":"Chao Li, Yong-Kang Diao, Yi-Fan Li, Shao-Dong Lv, Xian-Ming Wang, Xue-Dong Wang, Qi-Xuan Zheng, Hong Wang, Han Liu, Kong-Ying Lin, Ying-Jian Liang, Ya-Hao Zhou, Wei-Min Gu, Ming-Da Wang, Lan-Qing Yao, Xin-Fei Xu, Jia-Hao Xu, Li-Hui Gu, Timothy M Pawlik, Feng Shen, Tian Yang","doi":"10.1093/bjsopen/zraf041","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf041","url":null,"abstract":"<p><strong>Background: </strong>The Milan criteria and the French α-fetoprotein (AFP) model have both been validated for predicting outcomes after liver transplantation for hepatocellular carcinoma, with the Milan criteria also used for predicting outcomes after hepatic resection. The aim of this study was to evaluate the AFP model's predictive value for recurrence and survival following hepatocellular carcinoma resection and compare its performance with that of the Milan criteria.</p><p><strong>Methods: </strong>Data for patients who underwent hepatocellular carcinoma resection between 2002 and 2021 were analysed. For both the AFP model and Milan criteria, patients were divided into two groups: those with hepatocellular carcinoma within and beyond the AFP model (scores ≤ 2 and > 2 points, respectively) and the Milan criteria. Cumulative recurrence and overall survival rates were compared between patients within and beyond the AFP model. Predictions of recurrence and overall survival by the AFP model and Milan criteria were compared using net reclassification improvement and area under the receiver operating characteristic curve analyses.</p><p><strong>Results: </strong>Among 1968 patients evaluated, 1058 (53.8%) and 940 (47.8%) were classified as beyond on the AFP model and Milan criteria, respectively. After controlling for competing factors on multivariable analyses, being beyond the AFP model was independently associated with recurrence and worse overall survival after resection of hepatocellular carcinoma. Time-dependent net reclassification improvement and area under the receiver operating characteristic curve analyses demonstrated that the AFP model was superior to the Milan criteria in predicting recurrence. Of note, patients who were classified as beyond both the Milan criteria and AFP model had an even higher risk of postoperative recurrence and mortality (hazard ratios 1.51 and 1.47, respectively).</p><p><strong>Conclusion: </strong>The French AFP model demonstrated superior prognostic accuracy to the Milan criteria in predicting recurrence and survival after hepatocellular carcinoma resection. The AFP model not only effectively stratified patient risk but also identified a subgroup of high-risk patients among those beyond the Milan criteria.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neoadjuvant treatment versus upfront surgery in borderline resectable and resectable pancreatic ductal adenocarcinoma: meta-analysis.","authors":"Luke D Dickerson, Jayden Gittens, Chris Brunning, Richard Jackson, Michael C Schmid, Ainhoa Mielgo, Daniel Palmer, Christopher M Halloran, Paula Ghaneh","doi":"10.1093/bjsopen/zrae172","DOIUrl":"10.1093/bjsopen/zrae172","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer prognosis remains poor despite advances in adjuvant treatment. Neoadjuvant treatment may improve survival and disease-free survival. This meta-analysis evaluates the outcomes for patients with borderline-resectable (borderline-resectable pancreatic cancer) or resectable disease (resectable pancreatic cancer) in randomized trials of neoadjuvant therapy versus upfront surgery.</p><p><strong>Methods: </strong>The review was performed according to PRISMA guidance. Articles were included from the start of the database until 1 May 2024. The primary outcome was overall survival. Secondary outcomes were progression-free survival, resection rate, R0 rate, N0 rate, vascular resection rate, surgical complications, significant adverse events and rates of adjuvant therapy. Data was collected from study manuscripts or through individual patient-level data extraction. Meta-analysis was performed using a random-effects model with subgroup comparisons for resectability status (resectable pancreatic cancer versus borderline-resectable pancreatic cancer) and treatment modality (chemotherapy versus chemoradiotherapy).</p><p><strong>Results: </strong>Nine trials were included representing 1194 patients. Four trials recruited borderline-resectable pancreatic cancer, four resectable pancreatic cancer and one both. Four trials reported chemotherapy, four chemoradiotherapy and one both treatments. Neoadjuvant treatment improved overall survival (HR 0.73, 95% c.i. 0.55 to 0.98; P = 0.001) and progression-free survival (HR 0.80, 95% c.i. 0.65 to 0.99; P = 0.041). Subgroup analysis demonstrated neoadjuvant treatment improved overall survival for borderline-resectable pancreatic cancer (HR 0.60, 95% c.i. 0.38 to 0.96) but not resectable pancreatic cancer (HR 0.90, 95% c.i. 0.63 to 1.28). The overall resection rate was lower in neoadjuvant treatment (72.6% versus 80.6%, RR 0.94, 95% c.i. 0.89 to 0.99; P = 0.020). R0 rate (43.8% versus 23.0%, RR 1.35, 95% c.i. 1.16 to 1.57; P = 0.002) and N0 rate (30.9% versus 15.0%, RR 2.03, 95% c.i. 1.50 to 2.74; P = 0.001) was improved in neoadjuvant treatment. Significant adverse events occurred more frequently in neoadjuvant treatment (56.1% versus 27.0%, RR 1.92, 95% c.i. 1.28 to 1.89; P = 0.007).</p><p><strong>Conclusion: </strong>Neoadjuvant treatment significantly improves survival in borderline-resectable pancreatic cancer but not resectable pancreatic cancer. It should be regarded as standard of care for these patients. Further work is needed to identify the optimum neoadjuvant regimen and a possible role in the treatment of resectable pancreatic cancer.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11932015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143690974","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":"Laparoscopic versus open repair of perforated peptic ulcer: systematic scoping review and in-depth evaluation of existing evidence.","authors":"Katy A Chalmers, Matthew J Lee, Sian E Cousins, Adam Peckham Cooper, Peter O Coe, Natalie S Blencowe","doi":"10.1093/bjsopen/zrae163","DOIUrl":"10.1093/bjsopen/zrae163","url":null,"abstract":"<p><strong>Background: </strong>Perforated peptic ulcer remains a common contributor to morbidity and mortality rates worldwide. In common with other emergency surgery conditions, there is a trend towards minimally invasive surgery. This review aims to describe current evidence comparing open and laparoscopic management strategies for perforated peptic ulcers, by summarizing patients, intervention, comparator, outcomes, describing intervention components and delivery, outcomes reported and assessing study pragmatism (applicability) using PRagmatic Explanatory Continuum Indicator Summary-2.</p><p><strong>Methods: </strong>Systematic searches of published literature were performed using Ovid MEDLINE and Embase online databases, as well as clinical trial databases. Randomized trials comparing laparoscopic and open repair of peptic ulcer were included. Data extracted included study metadata, patients, intervention, comparator, outcomes elements, technical aspects of interventions and use of co-interventions, and surgeon learning curves/experience. Applicability was assessed using the PRagmatic Explanatory Continuum Indicator Summary-2 tool, to explore whether trials were predominantly pragmatic or explanatory, and study validity assessed using the Cochrane Risk-of-Bias 2 tool.</p><p><strong>Results: </strong>A total of 408 studies were screened for eligibility, with nine finally included (880 patients). Incision, ulcer closure details and lavage were the most frequently reported aspects of laparoscopic repair. Co-interventions such as antibiotic use and analgesia were reported in most articles, whilst nutrition and Helicobacter pylori eradication were not reported. Interventions were generally delivered by high-volume laparoscopic surgeons. Studies were considered at high Risk-of-Bias. PRagmatic Explanatory Continuum Indicator Summary-2 assessment found studies were neither fully pragmatic nor explanatory.</p><p><strong>Conclusion: </strong>Laparoscopic repair of perforated peptic ulcer is a variably defined intervention. Consideration of how intervention components and co-interventions should be optimally delivered is required to facilitate a well designed randomized trial.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11882505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143565904","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}