BJS Open最新文献

{"title":"Incidental findings on preoperative computed tomography for the planning of robotic arthroplasty: retrospective cohort study.","authors":"Robin J S Jones, Jonathan R A Phillips, Matthew J Wilson, Michalis Panteli","doi":"10.1093/bjsopen/zrag044","DOIUrl":"10.1093/bjsopen/zrag044","url":null,"abstract":"<p><strong>Background: </strong>The use of robotically assisted arthroplasty has increased substantially in recent years. Some robotic platforms require preoperative computed tomography for surgical planning. These scans frequently include anatomical regions beyond the primary operative field, creating potential for incidental findings. Planning computed tomography is not formally reported routinely, raising the possibility that clinically relevant incidental findings may be overlooked.</p><p><strong>Methods: </strong>The reports of all computed tomography performed for preoperative planning of robotically assisted arthroplasty at the authors' institution between October 2019 and February 2024 were reviewed retrospectively. Incidental findings were noted, and their clinical significance assessed. The notes of patients with significant findings were reviewed to ascertain the final diagnosis and management.</p><p><strong>Results: </strong>A total of 1602 patients (mean age 66.8 years, median 68 (range 16-98) years; 847 women) were identified within the study period. Some 447 patients (27.9%) demonstrated incidental findings, 136 (8.5%) of which were significant, requiring further investigation or management. Eighty-six significant findings (5.4%) were suspicious for malignancy and, of these, five (0.3%) resulted in a new cancer diagnosis.</p><p><strong>Conclusion: </strong>In this study, the rate of significant incidental findings was 8.5% and the risk of discovery of previously undiagnosed malignancy was 0.3%. A new significant finding was demonstrated in 1 in every 12 patients, and a new cancer diagnosis in 1 in every 320 patients. Planning imaging for robotic arthroplasty should be reported by a radiologist to prevent significant findings and malignancy being missed.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13586754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988044","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":"Association of the Flemish Triage Risk Screening Tool with postoperative outcomes in older adults after colorectal cancer surgery: retrospective cohort study.","authors":"Federico Ghignone, Giampaolo Ugolini, Isacco Montroni, Filippo Banchini, Fausto Catena, Davide Cavaliere, Giorgio Ercolani, Gianluca Garulli, Andrea Lucchi, Valentina Danesi, Ilaria Massa, Parisa Soleimani, William Balzi, Alice Andalò, Martina Cavallucci, Nicola Gentili, Andrea Roncadori","doi":"10.1093/bjsopen/zrag096","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag096","url":null,"abstract":"<p><strong>Background: </strong>Older adults undergoing colorectal cancer (CRC) surgery are at increased risk of postoperative complications, mortality, and loss of independence. Frailty screening tools may support perioperative risk stratification. This study evaluated the association between the Flemish Triage Risk Screening Tool (fTRST) and postoperative outcomes.</p><p><strong>Methods: </strong>This retrospective multicentre cohort study analysed the Emilia-Romagna Surgical Colorectal Audit. Patients aged ≥ 70 years undergoing CRC surgery (2019-2023) were included. Patients with fTRST scores ≥ 2 and < 2 were matched 1 : 1 using propensity score matching. Primary outcomes were 30-, 90-, and 180-day mortality and complications. Secondary outcomes included prolonged hospital stay and discharge to a non-independent setting. Logistic regression and receiver operating characteristic (ROC) curve analyses were performed.</p><p><strong>Results: </strong>In all, 1539 patients were included in the study. Mortality at 30, 90, and 180 days was 4.2%, 7.1%, and 10.5%, respectively. In the unmatched cohort, each 1-point increase in fTRST score was significantly associated with 30-day mortality (odds ratio (OR) 1.36; 95% confidence interval (c.i.) 1.12 to 1.66), complications (OR 1.12; 95% c.i. 1.02 to 1.23), prolonged hospital stay (OR 1.13; 95% c.i. 1.03 to 1.24), and discharge to a non-independent setting (OR 1.35; 95% c.i. 1.21 to 1.51). After matching 566 pairs, higher fTRST score remained significantly associated with 30-day mortality (OR 1.33; 95% c.i. 1.09 to 1.63) and discharge to a non-independent setting (OR 1.40; 95% c.i. 1.25 to 1.59). ROC analysis using an fTRST cut-off of ≥2 showed moderate discrimination for 30-day mortality and discharge to a non-independent setting, with areas under the ROC curve of 72.4% (negative predictive value 98.2%) and 67.2% (positive predictive value 66.3%), respectively.</p><p><strong>Conclusions: </strong>The fTRST is a simple screening tool for identifying older adults at risk of adverse postoperative and functional outcomes after CRC surgery, supporting perioperative planning.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625654/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103844","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 open pancreatoduodenectomy in patients with obesity: propensity score-matched multicentre study.","authors":"Valentina Valle, Tiziana Marchese, Benedetto Ielpo, Annalisa Comandatore, Marcello Spampinato, Leonardo Borgioli, Gregorio Di Franco, Pier Cristoforo Giulianotti, Luca Morelli","doi":"10.1093/bjsopen/zrag107","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag107","url":null,"abstract":"<p><strong>Background: </strong>Obesity increases morbidity after major abdominal surgery. Although the use of robotic pancreatoduodenectomy (RPD) is increasing, evidence of its outcomes in patients with obesity remains limited. This study compared perioperative outcomes of RPD versus open pancreatoduodenectomy (OPD) in patients with obesity.</p><p><strong>Methods: </strong>This was a retrospective multicentre cohort study of patients with a body mass index (BMI) ≥ 30 kg/m2 undergoing RPD or OPD between 2012 and 2024. Propensity score matching (PSM) was used to minimize selection bias. The primary outcome was severe complications (Clavien-Dindo ≥ IIIa). Secondary outcomes included blood loss, clinically relevant postoperative pancreatic fistula (CR-POPF), clinically relevant delayed gastric emptying (CR-DGE), wound infection, length of hospital stay (LOS), 90-day mortality, and R0 resection. Factors independently associated with severe complications and CR-POPF were investigated using multivariable logistic regression. Fistula risk was classified based on the Updated Alternate Fistula Risk Score (Pancreatic Fistula Risk Score, PFRS).</p><p><strong>Results: </strong>In all, 591 patients from 31 centres were analysed. After PSM, 166 patients undergoing RPD were compared to 166 undergoing OPD. In the PSM cohort, RPD was associated with significantly lower rates of severe complications (15.7% versus 27.7%; P = 0.007), CR-POPF (8.4% versus 18%; P = 0.011), CR-DGE (9% versus 18.7%; P = 0.022), and wound infection (4.2% versus 21%; P < 0.001). Median blood loss was lower in the RPD than OPD group (100 versus 200 ml; P < 0.001), as was median LOS (11 versus 17 days; P < 0.001). No differences were observed in 90-day mortality or R0 resection rates. Charlson co-morbidity index (odds ratio (OR) 0.68, 95% confidence interval (CI) 0.59-0.83, P = 0.003), robotic approach (OR 0.39, 95%CI 0.18-0.60, P = 0.002), and institutional experience of ≥ 20 robotic resections (OR 0.36, 95%CI 0.27-0.52, P = 0.007) were independently associated with lower CR-POPF risk, whereas a higher PFRS was associated with increased CR-POPF risk (OR 1.73, 95%CI 1.02-1.85, P = 0.032). Similarly, institutional experience of ≥ 20 robotic resections was independently associated with a lower incidence of severe complications (OR 0.39, 95%CI 0.22-0.81, P = 0.003), whereas a higher PFRS independently predicted severe complications (OR 1.93, 95%CI 1.07-2.31, P = 0.006).</p><p><strong>Conclusions: </strong>RPD is a safe and effective alternative to OPD in patients with obesity when performed in experienced centres. These findings support the adoption of RPD in select high-BMI populations in experienced institutions.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13711665/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149285071","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":"The impact of a Personal Outpatient Worksheet and Educational Reference form on patient engagement and communication in the surgical clinic: multicentre randomized clinical trial.","authors":"Matheesha Herath, Jesse D Ey, Ellie C Treloar, Scarlotte Kulas, Jessie Martin, Harriett McConville, Martin Bruening, Guy J Maddern","doi":"10.1093/bjsopen/zrag099","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag099","url":null,"abstract":"<p><strong>Background: </strong>In contemporary medicine, time pressure, limited resourcing, human factors, and health literacy are barriers to delivering high-quality patient-centred care. Improving patient engagement may mitigate these barriers. This study evaluated the impact of the Personal Outpatient Worksheet and Educational Reference (POWER) form on patient engagement in the surgical outpatient setting.</p><p><strong>Methods: </strong>A multicentre, randomized clinical trial was conducted in two metropolitan hospitals between July 2022 and January 2025. Patients over 16 attending a general surgical outpatient appointment were eligible for inclusion. Participants were randomized into either intervention or control cohorts using a random number generator with 1 : 1 allocation stratified by sex. All participants underwent a surgical outpatient appointment, which was audio-visually recorded. The intervention cohort received a copy of the POWER form, a document with five suggested questions participants could ask during their appointment. The control cohort received standard care without the POWER form. Participants were telephoned one week after their appointment to complete a survey. The primary endpoint was patient recall, assessed by comparing survey responses with the recorded discussion, using an intention to treat analysis.</p><p><strong>Results: </strong>A total of 143 participants were recruited (71 participants to intervention, 72 to control). Ten participants (five in each group) withdrew and were excluded from analysis of the primary endpoint. Mean recall in the intervention cohort was 88% (95% confidence interval 83 to 92) compared with 31% (26 to 35) in the control group (P < 0.001).</p><p><strong>Conclusion: </strong>Use of the POWER form in the general surgical outpatient setting significantly improves patient recall. Registration number: ACTRN12625000075482 (https://www.anzctr.org.au/).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149103940","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":"Multicentre parallel-group open-label non-inferiority randomized clinical trial of recooling versus no recooling after normothermic machine perfusion in liver transplantation: ARANMP-LT protocol.","authors":"Salvatore Gruttadauria, Roberta Vella, Fabrizio Di Francesco, Duilio Pagano, Marco Barbara, Monica Rizzo, Ivan Vella, Sergio Calamia, Alessandro Tropea, Pasquale Bonsignore, Caterina Accardo, Gaetano Burgio, Enzo Andorno, Marco Miggino, Stefania Camagni, Domenico Pinelli, Amedeo Carraro, Alex Borin, Matteo Cescon, Matteo Serenari, Umberto Cillo, Jacopo Lanari, Fabrizio Di Benedetto, Paolo Magistri, Giuseppe Maria Ettorre, Sara Ingallinella, Francesco Frongillo, Marco Maria Pascale, Davide Ghinolfi, Giulia Cirillo, Fabio Melandro, Gianluca Mennini, Francesco Tandoi, Irene Scalera, Giuseppe Tisone, Roberta Angelico, Marco Vivarelli, Federico Mocchegiani, Sergio Li Petri","doi":"10.1093/bjsopen/zrag166","DOIUrl":"10.1093/bjsopen/zrag166","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657183/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164416","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":"Oncological outcomes of direct versus delayed surgery after neoadjuvant short-course radiotherapy for rectal cancer: national cohort study.","authors":"Najia Azhar, Marie-Louise Lydrup, Pamela Buchwald","doi":"10.1093/bjsopen/zrag146","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag146","url":null,"abstract":"<p><strong>Background: </strong>After the Stockholm III trial, a trend towards delayed surgery after neoadjuvant short-course radiotherapy (5 × 5 Gy) for rectal cancer has emerged in Sweden, driven by the lower short-term complication rates and similar oncological outcomes. This study aimed to examine long-term oncological outcomes after neoadjuvant short-course radiotherapy, comparing direct versus delayed surgery for rectal cancer in a real-world setting.</p><p><strong>Methods: </strong>A registry-based retrospective national cohort study was conducted using prospectively collected data from the Swedish Colorectal Cancer Registry. Patients with rectal cancer receiving neoadjuvant neoadjuvant short-course radiotherapy with surgery between 2016 and 2020 were analysed for oncological outcomes (local recurrence, distant metastasis) and overall survival at 3 years, comparing direct surgery, defined as surgery within 7 days after neoadjuvant short-course radiotherapy, and delayed surgery, defined as surgery after 28-90 days. The rate of patients who underwent surgery within the delayed time frame of the Stockholm III trial was also recorded.</p><p><strong>Results: </strong>A total of 2080 patients were identified, of whom 1208 (58.1%) underwent direct surgery and 872 had delayed surgery. Of note, only 288 patients underwent resection 28-56 days after neoadjuvant short-course radiotherapy (within the time frame of the Stockholm III trial). Although the pathological complete response rate was higher in the delayed-surgery group compared with the direct-surgery group (6.5% versus 0.4%), 3-year local recurrence and distant metastasis rates were, respectively, 1.0% (12 patients) and 6.8% (82) in the direct-surgery group, and 3.4% (30) and 11.9% (104) in the delayed-surgery group. The adjusted hazard ratios for local recurrence and distant metastasis comparing delayed surgery with direct surgery were 3.60 (95 per cent confidence interval 1.75 to 7.39) and 2.17 (1.58 to 2.96), respectively, whereas the adjusted hazard ratio for overall survival was 1.37 (1.06 to 1.77), favouring the direct-surgery group.</p><p><strong>Conclusion: </strong>In a real-world setting, the results indicate that few patients in the delayed-surgery group had surgery within the stipulated time frame. Considering this, delayed surgery was associated with a higher risk of local recurrence, distant metastasis, and reduced overall survival.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179302","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":"Multimodal prehabilitation in colorectal cancer surgery: randomized clinical trial.","authors":"Felix Bjerregaard, Klas Pekkari, Daniel Asklid, Claes Anderin, Karin Westberg, Richard Marsk, Ulf O Gustafsson","doi":"10.1093/bjsopen/zrag167","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag167","url":null,"abstract":"<p><strong>Background: </strong>Colorectal cancer (CRC) surgery remains associated with substantial postoperative morbidity despite implementation of enhanced recovery after surgery (ERAS). Prehabilitation improves surgical outcomes, but evidence remains inconsistent. This study evaluated whether multidisciplinary prehabilitation reduces postoperative complications and whether treatment effects vary according to baseline physical function.</p><p><strong>Methods: </strong>This single-centre randomized clinical trial was conducted at a tertiary referral hospital in Stockholm, Sweden (28 October 2021-23 April 2025). Adults with histologically confirmed CRC scheduled for elective resection were randomized 1 : 1 to multidisciplinary prehabilitation (medication review, nutritional counselling, supervised exercise, and targeted risk optimization) or standard care (ERAS). Analyses followed a modified intention-to-treat (mITT) principle. Prehabilitation was initiated within 3 days of enrolment. The primary outcome of interest was postoperative complications (Clavien-Dindo grade ≥ I). Secondary outcomes included severe complications (Comprehensive Complication Index), reoperations, length of hospital stay (LOS), postoperative weight loss, physical performance and function (6-minute walk test, Timed Up and Go test, and 30-second chair stand test), health-related quality of life (EORTC QLQ-C30), mental health (Hospital Anxiety and Depression Scale), and correlation with the Disability Rating Index (DRI) score.</p><p><strong>Results: </strong>Among 328 randomized patients, 242 underwent CRC surgery and were included in the mITT analysis (120 control, 122 intervention). Postoperative complications occurred in 46.2% of patients, with no significant difference between the intervention and control groups (47.5% versus 45.0%, respectively). Severe complications occurred in 19.0% of patients and were numerically less frequent in the intervention group, but the difference was not statistically significant. LOS and reoperation rates were similar. The intervention group had lower postoperative weight loss and modest improvements in physical performance and patient-reported physical function at 30 days. In exploratory analyses, a significant interaction was observed between treatment allocation and baseline DRI score, indicating greater reduction in severe complications among patients with higher levels of preoperative disability (P = 0.011).</p><p><strong>Conclusions: </strong>Multidisciplinary prehabilitation did not reduce postoperative complications after CRC surgery. However, exploratory analyses suggest that patients with greater preoperative disability derive greater benefit, supporting targeted prehabilitation strategies in higher-risk populations. Registration number: NCT04909567 (https://clinicaltrials.gov/).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13692687/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149262299","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":"The iBRA-NET localization study: international IDEAL 2a/2b multicentre cohort study comparing the safety and effectiveness of wire- and radar-guided localization for impalpable breast lesions.","authors":"Rajiv V Dave, Jenna Morgan, Simon Lowes, Robert Milligan, Rachel Foster, Emma Barrett, Amtul R Carmichael, Suzanne Elgammal, Edward St John, Chris Holcombe, Yazan Masannat, Shelley Potter, Suzanne Krizak, Vidya Raghavan, James Harvey","doi":"10.1093/bjsopen/zrag108","DOIUrl":"10.1093/bjsopen/zrag108","url":null,"abstract":"<p><strong>Background: </strong>Wire-guided localizations have been the historical standard for breast lesion localization; however, they have logistical constraints and can dislodge in the preoperative period. Radar-guided localization has the potential to uncouple localization from the day of surgery, but the technique needs to be evaluated in a direct comparison with wire-guided localization to ensure efficacy and safety.</p><p><strong>Methods: </strong>The iBRA-NET localization study is a prospective platform IDEAL 2a/2b study comparing wire-guided localization with new generation localization devices. This arm describes SCOUT® radar localization for impalpable breast lesions performed between June 2021 and December 2024, compared with a historical cohort of wire-guided localization performed between August 2018 and August 2020. Primary outcome was identification of the index lesion in the excision specimen. Secondary endpoints included safety (complications), margin re-excision, magnetic resonance imaging bloom size, and specimen weight.</p><p><strong>Results: </strong>Data were accrued from 1297 radar localized patients in 27 units. Index lesion identification was 95.2% in radar-guided excisions versus 99.1% in wire-guided excisions (P = 0.001). In a sensitivity analysis excluding patients receiving neoadjuvant chemotherapy, identification rates were 98.9% versus 99.6% (P = 0.114). For a subset of patients having a simple lumpectomy for a unifocal, unilateral breast lesion with no neoadjuvant treatment (1627), positive margins were seen in the main excision specimen in 1003 (15.0%) wire-guided versus 624 (9.0%) radar-guided excisions (P < 0.001). Re-excision was required in 131 (13.2%) wire-guided versus 91 (14.7%) radar-guided excisions (P = 0.442). There was a significant difference in specimen weight/size2 (0.138 g/mm2 wire-guided localization versus 0.182 g/mm2 radar; P < 0.001). The median start time for surgery was earlier in the day for radar-guided localizations compared with wire-guided (12:27 versus 13:40; P < 0.001). All radar placements in axillary nodes (13) led to successful nodal retrieval.</p><p><strong>Conclusion: </strong>SCOUT® radar localizations are a safe and effective localization technique in both the breast and axilla, with outcomes comparable to wires. There were demonstrable logistical advantages in operative start time when using a radar reflector.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13559476/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918349","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 Site Infections in Major Lower Limb Amputation (SIMBA): international multicentre study.","authors":"","doi":"10.1093/bjsopen/zrag042","DOIUrl":"10.1093/bjsopen/zrag042","url":null,"abstract":"<p><strong>Introduction: </strong>Surgical site infection (SSI) after major lower limb amputation (MLLA) significantly affects function, mobility, morbidity, and mortality, alongside broader impacts on healthcare services. Limited data exist on the incidence, prevention, and management of SSI after MLLA. Improving outcomes and wound healing have been identified as research priorities for patients following MLLA.</p><p><strong>Methods: </strong>Surgical Site Infection in Major Lower Limb Amputation (SIMBA) is an international, prospective, collaborative observational study. Data were collected for consecutive patients undergoing MLLA over 8 months, with 30-day follow-up. Outcomes included the incidence of SSI (defined using Centers for Disease Control and Prevention criteria), wound dehiscence (defined as any partial or complete separation of the incision or flap, with or without infection), further intervention, mortality, adjunct use, and SSI predictors.</p><p><strong>Results: </strong>Validated data for 1314 MLLAs from 46 centres in the UK (34), Europe (9), Australasia (2), and Asia (1) were collected, comprising 643 (48.9%) transfemoral, 41 (3.1%) through-knee, and 628 (47.8%) transtibial amputations. The most common indications were ischaemia (56.6%, 742) and uncontrolled infection (22.3%, 293). The incidences of SSI and wound breakdown were 10.9% (135 of 1238) and 16.7% (204 of 1217), respectively. Low glomerular filtration rate, cardiac disease, dirty/infected wound class, and transtibial amputations were independent predictors of SSI. SSI was associated with increased postoperative morbidity, wound breakdown, further intervention, and delays in fitness for discharge. The 30-day mortality rate was 7.0% (92 of 1314), with no significant association with SSI.</p><p><strong>Conclusion: </strong>SSI and wound breakdown are common following MLLA, and are associated with increased morbidity, delayed recovery, and revision surgery. These findings identify patient- and procedure-specific factors associated with elevated SSI risk, and a lack of procedure-specific evidence, revealing critical gaps in SSI prevention strategies. Addressing these are essential to improve patient outcomes, reduce healthcare costs, and guide future research.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13543170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148891032","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":"Defining absolute postoperative desmoid risk in familial adenomatous polyposis according to APC genotype and family history: retrospective cohort study.","authors":"Benjamin Zare, Massih Bahar, Susan Clark, Andrew Latchford","doi":"10.1093/bjsopen/zrag090","DOIUrl":"10.1093/bjsopen/zrag090","url":null,"abstract":"<p><strong>Background: </strong>Desmoid disease is a major cause of morbidity and mortality in familial adenomatous polyposis (FAP), particularly after prophylactic colorectal surgery. Although APC genotype and family history are recognized risk factors, previous sizeable studies report relative rather than absolute risks. This study aimed to quantify absolute postoperative desmoid risk in FAP patients undergoing risk-reducing colectomy, stratified by APC genotype, and to assess the modifying effect of family history.</p><p><strong>Methods: </strong>This retrospective observational study used records from a prospectively maintained registry. Patients with an APC pathogenic variant (PV) 3' of codon 1399 were classified as high risk, and those with an APC PV 5' of (or at) codon 1399 were classified as low risk. Patients who had not undergone prophylactic colectomy, with < 5 years of postoperative follow-up, or those with a desmoid diagnosed before or at the time of surgery were excluded. Clinical records were reviewed for details of surgery, desmoid diagnosis, and family history. A positive family history was defined as a first-degree relative with genetically confirmed FAP and a diagnosis of desmoid disease (clinical and/or radiological).</p><p><strong>Results: </strong>Among 48 high-risk patients, 30 (63%) developed desmoid, with no significant difference between colectomy and proctocolectomy (54% versus 70%, respectively; χ2 = 1.42; P = 0.233). Family history was present in 35 of the 48 patients (73%) and increased desmoid risk relative to no family history (80% versus 15%, respectively; P < 0.01). Among the 1213 low-risk patients, 154 (12.7%) developed desmoids, with no significant effect of surgical procedure (13.9% versus 12.1% for proctocolectomy and total/partial colectomy, respectively; χ² = 0.77; P = 0.380). Family history increased desmoid risk relative to no family history (30% versus 10%, respectively; P < 0.01).</p><p><strong>Conclusion: </strong>A family history of desmoid disease appears to be an important determinant of postoperative desmoid risk in FAP. Although APC PV 3' of codon 1399 does confer a high overall risk, this is largely confined to individuals with first-degree relatives with desmoid. In the absence of a family history, postoperative desmoid risk appeared relatively low regardless of genotype. This supports a more individualized approach to perioperative counselling and surgical decision-making in patients with FAP. In addition, these data highlight that patients with both a 3' APC PV and a positive family history are a particularly high-risk subgroup who may represent an appropriate target population for future chemoprevention trials.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13591399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011939","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}