BJS Open最新文献

{"title":"Elective cholecystectomy benchmarks: nationwide registry study.","authors":"Ebba Kihlstedt Pasquier, Ellen Andersson, Johanna Österberg, Per Sandström, Bergthor Björnsson","doi":"10.1093/bjsopen/zrag175","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag175","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstone disease. The aim of this study was to establish clinically relevant benchmarks for elective laparoscopic cholecystectomy (ELC) to guide quality initiatives and support improvements in patient outcomes.</p><p><strong>Method: </strong>The Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography provided data on patients treated with primary ELC for a benign indication between 2015 and 2023. Exclusion criteria were common bile duct stones or stents detected before surgery, suspicion of bile duct obstruction, abnormal or unperformed intraoperative cholangiogram, previous major upper abdominal surgery, concomitant surgical procedures, and robotic surgery. The Achievable Benchmark of Care methodology was used to develop intra- and postoperative benchmarks, with severe postoperative complications (Clavien-Dindo ≥ III) representing the primary outcome. During surgery, serious adverse events were defined as intestinal perforation, bile leakage, or bleeding requiring transfusion or conversion to open surgery. Postoperative outcomes were assessed up to 30 days after surgery. Logistic regression identified risk factors for severe postoperative complications.</p><p><strong>Results: </strong>Overall, 48 564 patients undergoing ELCs across 81 surgical facilities were included. Among these, 69% were women. Median age was 50 (range 18-95) years and 91.4% were classified as American Society of Anesthesiologists classification ≤ II. Ten benchmarks were developed, capturing either intraoperative events (3) or postoperative complications (7). During surgery, 0.5% of the total cohort experienced a serious adverse event (median 0.3%, interquartile range 0.2-0.7% between facilities)-benchmark was 0.2%. Severe postoperative complications occurred in 1.7% of patients (median 1.6%, interquartile range 1.0-2.2% between facilities)-benchmark was 1.0%. Postoperative mortality was low (7 deaths, < 0.1%). At multivariable analysis, American Society of Anesthesiologists classification ≥ III (odds ratio 1.35, 95% confidence interval 1.05 to 1.72; P = 0.018), previous abdominal surgery (odds ratio 2.15, 1.24 to 3.75; P = 0.007), and intraoperative assessment of an altered gallbladder morphology (odds ratio 1.24, 1.01 to 1.52; P = 0.044) were independently associated with severe postoperative complications.</p><p><strong>Conclusion: </strong>This study provides benchmarks for elective laparoscopic cholecystectomy. When compared with real-world performance, these benchmarks highlight potential areas for quality improvement.</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/PMC13660693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179268","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":"Patient-initiated follow-up in surgical specialties: meta-analysis and meta-regression.","authors":"Renato Pitesa, Stephanie Moody, Andrew G Hill","doi":"10.1093/bjsopen/zrag147","DOIUrl":"10.1093/bjsopen/zrag147","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Rising outpatient demand has accelerated adoption of patient-initiated follow-up in surgical practice. This review evaluated whether patient-initiated follow-up safely reduces clinic burden while maintaining patient outcomes across specialties.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;MEDLINE, Embase, and CENTRAL were searched (2014-2025) for studies of patient-initiated follow-up, defined as a model enabling clinically stable patients to self-initiate follow-up when new or concerning symptoms arise, rather than attending prearranged appointments. Primary outcomes included outpatient appointment volume and patient-reported quality of life. Where studies reported single-arm utilization data, a random-effects meta-analysis of proportions was undertaken. Exploratory meta-regression examined pathway-level factors associated with utilization. Randomized clinical trials (RCTs) were assessed using the revised Cochrane risk-of-bias 2 tool, observational cohort studies using the Newcastle-Ottawa Scale, and qualitative studies using the Critical Appraisal Skills Programme checklist.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of 1776 manuscripts identified, 34 studies across 6 surgical specialties (breast, colorectal, otorhinolaryngology, orthopaedics, plastics, and urology) were included: 4 RCTs, 17 observational cohort studies, 11 qualitative studies, and 2 mixed-methods studies. Observational studies consistently reported reductions in routine outpatient attendance-including a reduction from 45·0% to 6·0% in first specialist appointments in patient-initiated follow-up in colorectal surgery (P &lt; 0·001) and 52·5% of patients with high-risk cutaneous squamous cell carcinoma not recontacting the clinic-without evidence of increased adverse outcomes. RCTs demonstrated non-inferior patient-reported quality-of-life outcomes with patient-initiated versus standard follow-up, alongside reductions in physician contact, including a 50% reduction in planned consultations in breast cancer (1·9 versus 3·8 per patient; P &lt; 0·001) and a reduction in specialist contacts from 42·0% to 23·0% in rectal cancer. In a meta-analysis (1806 participants), the pooled patient-initiated follow-up utilization proportion was 0·19 (95% confidence interval 0·09 to 0·36; I2 = 95%), indicating substantial context-dependent variation. In oncological settings-particularly breast, colorectal, melanoma, and head and neck cancer-structured surveillance and rapid-access systems were identified as critical safety adjuncts to implementation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patient-initiated follow-up can reduce outpatient burden in selected surgical populations without compromising patient-reported outcomes; however, its effects are dependent on the clinical context and pathway design. Risk-stratified and hybrid models may be the most appropriate, particularly in oncology. Further high-quality trials and robust economic evaluations are required to define optimal implementation strat","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/PMC13591271/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011854","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":"Role of sentinel lymph node biopsy in patients with early breast cancer undergoing mastectomy.","authors":"Martin Heidinger, Giacomo Montagna, Florian S Halbeisen, Anna-Lena Eberhardt, Nadia Maggi, Marie Louise Frevert, Karol Dollt, Rama Kiblawi, Julie M Loesch, Jelena Winkler, Fabienne D Schwab, Christian Kurzeder, Tibor A Zwimpfer, Walter P Weber","doi":"10.1093/bjsopen/zrag105","DOIUrl":"10.1093/bjsopen/zrag105","url":null,"abstract":"<p><strong>Background: </strong>The oncological non-inferiority of sentinel lymph node biopsy omission in patients with small, clinically and imaging node-negative (cN0/iN0) breast cancer has been demonstrated for patients undergoing breast-conserving surgery and adjuvant radiotherapy, but not for those undergoing mastectomy. This single-centre, retrospective cohort study compared nodal involvement and adjuvant therapy indications in these patients by use of mastectomy versus breast-conserving surgery.</p><p><strong>Methods: </strong>Patients with cT1-T2, cN0/iN0, hormone receptor-positive/human epidermal growth factor receptor 2-negative early breast cancer who underwent upfront surgery including sentinel lymph node biopsy between January 2014 and December 2024 were included. Adjuvant therapy indications were estimated using monarchE (abemaciclib), NATALEE (ribociclib), TAILORx and RxPONDER (chemotherapy), and MA.20 and EORTC22922/10925 (nodal irradiation) eligibility criteria. Multivariable logistic regression models identified factors associated with nodal involvement and adjuvant treatment indications.</p><p><strong>Results: </strong>Among 454 patients, 145 (31.9%) underwent mastectomy who more frequently had multifocal tumours (23.5% versus 9.7%), lobular subtype (21.4% versus 11.3%), and grade 2-3 differentiation (73.8% versus 63.8%) compared with those who underwent breast-conserving surgery. Neither nodal involvement (18.6% versus 14.9%; P = 0.149) nor missed indications for adjuvant abemaciclib (7.6% versus 6.1%; P = 0.550), ribociclib (9.7% versus 7.8%; P = 0.586), and nodal irradiation (4.8% versus 4.5%; P = 1.000) differed between patients who underwent mastectomy or breast-conserving surgery. Lymphovascular invasion was independently associated with nodal involvement (odds ratio 6.8, 95% confidence interval 3.7 to 12.8; P < 0.001) and adjuvant treatment indications (CDK4/6 inhibitors: odds ratio 5.1, 2.6 to 10.1; P < 0.001; nodal irradiation: odds ratio 7.1, 3.6 to 14.4; P < 0.001), whereas type of surgery was not.</p><p><strong>Conclusions: </strong>In patients with cT1-T2, cN0/iN0, hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer, type of breast surgery was not associated with nodal involvement and adjuvant therapy.</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/PMC13542998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890997","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":"Surgery versus observation in patients 65 years or older with primary hyperparathyroidism: randomized clinical trial.","authors":"Anders O J Bergenfelz, Mark Thier, Martin Almquist, Jonas P Ranstam, Erik D Nordenström","doi":"10.1093/bjsopen/zrag151","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag151","url":null,"abstract":"<p><strong>Background: </strong>A substantial portion of surgically treated patients with primary hyperparathyroidism (pHPT) are older than 65 years. The indication for parathyroidectomy in older patients with pHPT and mild hypercalcaemia is unclear. Specifically, it is not known whether parathyroid surgery improves bone mineral density (BMD) in this age group.</p><p><strong>Method: </strong>Patients 65 years or older with pHPT, ionized calcium not exceeding 1.50 mmol/l, and a BMD Z-score above -2.5 standard deviations who were referred to the Department of Surgery, Lund University Hospital, were included in the study. Follow-up was performed over 2 years. The random allocation sequence to surgery or observation was computer generated. There was no blinding. Primary outcome was BMD of the hip, with the primary endpoint being the change in total hip BMD from baseline to the end of follow-up. Secondary outcome was BMD of the lumbar spine. Continuous variables were analysed using Satterthwaite's t-test. Intention-to-treat analysis of change from baseline was performed using a mixed-model repeated-measures ANOVA (MMRM ANOVA).</p><p><strong>Results: </strong>A total of 255 patients were screened and 102 were randomized: 50 to observation and 52 to surgery. The median age was 71 (range 65-85) years. For analysis of the primary endpoint, 41 patients in the surgery group and 40 in the observation group were available. Total hip BMD at 2 years increased by a mean of 1.3% (95% confidence interval -0.2% to 2.8%) in the surgery group and decreased by a mean of -1.4% (-2.6% to -0.2%) in the control group (P = 0.006). Analysis of total hip BMD at the end of follow-up by MMRM ANOVA showed a difference between the two groups of patients (P = 0.006). BMD of the lumbar spine increased by a mean of 4.6% (3.0% to 6.1%) in the surgery group versus 0.2% (-1.1% to 1.4%) in the observation group (P < 0.001). Analysis of lumbar spine BMD at the end of follow-up by MMRM ANOVA showed a difference between the two groups of patients (P < 0.001).</p><p><strong>Conclusion: </strong>At the 2-year follow-up, patients 65 years or older with pHPT and mild hypercalcaemia demonstrated a slight increase in BMD after parathyroidectomy.</p><p><strong>Registration number: </strong>NCT01087619 (http://www.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/PMC13627735/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149104005","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":"Benchmarking paediatric living donor liver transplantation for establishing standards to expand access and save lives: retrospective global cohort study.","authors":"Zhihao Li, Omid Madadi-Sanjani, Yuan Liu, Dimitri A Raptis, Vasanthakumar Gunasekaran, Ashwin Rammohan, Seisuke Sakamoto, Hajime Uchida, Piotr Kaliciński, Marek Stefanowicz, Nicolas Goldaracena, Cornelius J van Beekum, Felix J Krendl, Itsuko Chih-Yi Chen, Bryanna N Domenick, Alfred Kow, Kaihang Wang, Yuji Soejima, Katryn N Furuya, George V Mazariegos, Vidyadhar Padmakar Mali, Stephen C Dunn, Kim M Olthoff, Elizabeth B Rand, Ian Leipnitz, Chao-Long Chen, Deniz Balci, Elvan Onur Kirimker, Silvio Nadalin, Stefan Schneeberger, Debra L Sudan, Moritz Schmelzle, Uta Herden, Lutz Fischer, Blayne A Sayed, Vicky L Ng, Grzegorz Kowalewski, Mureo Kasahara, Mohamed Rela, Dieter C Broering, Qiang Xia, Pierre-Alain Clavien","doi":"10.1093/bjsopen/zrag154","DOIUrl":"10.1093/bjsopen/zrag154","url":null,"abstract":"<p><strong>Background: </strong>Paediatric liver transplantation increasingly incorporates technical variant grafts including living donor liver transplantation (LDLT) to address donor shortages. However, the technical complexity of LDLT and regional outcome variations remain challenging. In settings with such variation and ongoing debate, standardized benchmarks may guide decision-making for broader implementation. This study establishes benchmark cut-off values for paediatric LDLT outcomes to provide a validated framework for quality assessment and safe programme expansion.</p><p><strong>Methods: </strong>An international analysis was conducted of paediatric patients who underwent LDLT at 19 centres between 2019 and 2023. Benchmark cut-off values were derived from 'ideal' patients at seven high-volume institutions, representing the best achievable results under optimal conditions. Surgical complications were graded using the Clavien-Madadi classification, compared against the standard Clavien-Dindo system for accuracy.</p><p><strong>Results: </strong>In all, 2665 patients were included, of which 1988 counted as ideal patients. The median recipient age was 10 (interquartile range (i.q.r.) 6-26) months with median weight of 8.0 (i.q.r. 6.6-11.9) kg. Biliary atresia was the most common diagnosis (68.8%), and most recipients (90.9%) received a left lateral segment graft. The 75th percentile of median centre values were used to define the following benchmark cut-off values: hepatic artery thrombosis ≤ 5%, bile leak ≤ 12%, biliary anastomotic stricture ≤ 6%, and 1-year graft loss or mortality ≤ 6%. Higher centre volume was associated with more selective patient inclusion and fewer major (particularly biliary) complications. An inverse correlation between case volume and failure-to-rescue rate highlighted the critical role of multidisciplinary perioperative management. The Clavien-Madadi classification proved superior to the Clavien-Dindo system, which overclassified grade III complications.</p><p><strong>Conclusions: </strong>This study provides a framework to guide safe programme expansion, improve surgical quality, and reduce waitlist mortality.</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/PMC13614256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149058331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of immunonutrition on postoperative infectious complications and survival after colon cancer surgery: long-term follow up of randomized clinical trial.","authors":"Jaram Lee, Hyeung-Min Park, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim","doi":"10.1093/bjsopen/zrag043","DOIUrl":"10.1093/bjsopen/zrag043","url":null,"abstract":"<p><strong>Background: </strong>A previous randomized clinical trial (RCT) in patients undergoing elective colon cancer surgery showed that preoperative immunonutrition did not reduce short-term postoperative infectious complications. This study reports the long-term follow-up of that RCT, evaluating the impact of preoperative immunonutrition and the association of postoperative infectious complications with survival outcomes.</p><p><strong>Methods: </strong>This secondary analysis used prospectively collected survival data from a prior RCT in which patients were randomized 1:1 to receive either preoperative immunonutrition plus a normal diet or a normal diet alone (control) for 7 days before surgery. The primary endpoints were disease-free survival (DFS) and overall survival (OS). Survival outcomes were analysed in relation to randomized treatment allocation and clinicopathological variables, including postoperative complications, using Kaplan-Meier methods and Cox proportional hazards models.</p><p><strong>Results: </strong>A total of 161 patients were included, with 79 randomized to immunonutrition and 82 to control. The mean age was 65.3 years, and 65.8% were male, with similar baseline characteristics between groups. After a median follow-up of 57 months (range 4-65), preoperative immunonutrition did not affect 5-year DFS (80% versus 86% in controls; P = 0.474) or 5-year OS (88% versus 90%; P = 0.761). In contrast, postoperative infectious complications were associated with lower 5-year OS (74% versus 92%; P = 0.013) and showed a trend towards worse DFS (71% versus 86%; P = 0.065). On multivariable analysis, advanced T category and postoperative infectious complications remained independently associated with poorer DFS (HR 2.53; P = 0.041) and OS (HR 4.14; P = 0.007). The adverse prognostic effect of infectious complications was evident primarily in patients with advanced T category disease.</p><p><strong>Conclusion: </strong>Preoperative immunonutrition did not improve long-term survival after colon cancer surgery. Postoperative infectious complications were independently associated with worse long-term outcomes, providing prospective evidence that supports previous observational findings.</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/PMC13602066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036307","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":"Predictors of morbidity and oncological benefit after liver resection with vascular reconstruction: international collaborative study from expert centres.","authors":"Victor Lopez-Lopez, Francesca Ratti, Cecilia Maina, Juan Gonzalez-Ferez, Sarah Daniels, Nikhil Suresh, Safi Dokmak, Elias Karam, Augustin Suffisseu, Yawen Dong, Zhihao Li, Rory L Smoot, Muhammad Ahmad Nadeem, Federico Aucejo, Emilio Vicente, Enrico Gringeri, Eleonora Nieddu, Jordi Navinés, Lucia Hernandez, Mohammad H Fard-Aghaie, Jens Rolinger, Leyre Serrablo, Sanjay Govil, William Archie, Dionisios Vrochides, Martin de Santibañes, Eduardo de Santibañes, Fabrizio Di Benedetto, Silvio M P Balzan, Cristina Dopazo, Vicente Borrego Estella, Giuseppe Kito Fusai, Fernando Rotellar Sastre, Roberto I Troisi, Alejandro Serrablo, Silvio Nadalin, Karl J Oldhafer, Esteban Cugat, Umberto Cillo, Andrea Schlegel, Patrick Starlinger, Mickael Lesurtel, Luca Aldrighetti, Pierre Alain Clavien, Daniel Azoulay, Peter Lodge, Ricardo Robles Campos","doi":"10.1093/bjsopen/zrag085","DOIUrl":"10.1093/bjsopen/zrag085","url":null,"abstract":"<p><strong>Background: </strong>Liver resection with vascular reconstruction is a highly complex procedure for advanced hepatobiliary tumours. This study evaluated the postoperative and oncological outcomes of this patient cohort.</p><p><strong>Methods: </strong>This retrospective multicentre study included patients undergoing liver resection with vascular reconstruction between 1990 and 2024 across 21 expert centres. Reconstructions involved the inferior vena cava, hepatic veins, portal vein, or hepatic artery. Primary endpoints were postoperative morbidity and 90-day mortality. Secondary endpoints included overall survival (OS), disease-free survival (DFS), and predictors of complications. Multivariable logistic regression, Kaplan-Meier, and Fine-Gray analyses were performed.</p><p><strong>Results: </strong>In all, 532 patients were included and classified according to surgical approach as in situ (455, 85.3%), ante situm (48, 9.2%), or ex situ (29, 5.5%). The most frequent indications were colorectal liver metastases (162, 30.4%), intrahepatic cholangiocarcinoma (139, 26.1%), and perihilar cholangiocarcinoma (106, 19.9%). The median operative time was 390 minutes. Clavien-Dindo ≥ IIIa occurred in 217 patients (40.8%), and the 90-day mortality rate was 9.8% (52). Portal vein reconstruction independently predicted post-hepatectomy liver failure, ascites, infectious complications, and major morbidity, whereas inferior vena cava reconstruction showed a more favourable perioperative profile. Hepatic vein reconstruction was associated with greater transfusion requirements and longer operative time. Vascular graft-related complications occurred in 22.3% (58) of reconstructions and were not associated with graft type. After excluding patients with perihilar cholangiocarcinoma (426), ante situm and ex situ procedures were associated with higher rates of Clavien-Dindo ≥ IIIa than in situ procedures (67.3% (33) and 64.3% (18) versus 35.5% (124), respectively; P < 0.001), longer intensive care unit stay (6.5 and 5 versus 3 days, respectively; P < 0.001), and higher mortality (16.3% (8) and 17.9% (5) versus 8.3% (29), respectively; P = 0.060). DFS was superior for hepatocellular carcinoma (P = 0.011), whereas perihilar cholangiocarcinoma showed a higher risk of recurrence (P = 0.022). Five-year OS was highest for sarcoma (68.8%) and hepatocellular carcinoma (42.7%).</p><p><strong>Conclusion: </strong>Liver resection with vascular reconstruction is feasible in specialized centres but remains associated with substantial morbidity and mortality. The in situ approach showed the most favourable perioperative outcomes, although oncological benefit varied according to tumour biology, highlighting the importance of careful patient selection.</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/PMC13617666/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149069293","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":"Predicting postoperative acute kidney injury after colorectal cancer surgery: development and internal validation of a clinical prediction model using a nationwide cohort.","authors":"Mads Skovsgaard, Philip V Munch, Uffe Heide-Jørgensen, Lene H Iversen, Christian F Christiansen","doi":"10.1093/bjsopen/zrag124","DOIUrl":"10.1093/bjsopen/zrag124","url":null,"abstract":"<p><strong>Background: </strong>Postoperative acute kidney injury (PO-AKI) occurs in 8-20% of patients undergoing colorectal cancer surgery and is associated with increased mortality and morbidity. A prediction model can help in the identification of high-risk patients and guide clinicians in implementing preventive measures. The present study aimed to develop and validate internally a clinical prediction model for the risk of PO-AKI within 7 days after an elective resection of colorectal cancer, using predictors known before surgery.</p><p><strong>Methods: </strong>Using a nationwide clinical quality database, all patients with stage I-IV colorectal cancer undergoing an elective colorectal resection from 2015 to 2021 in Denmark were identified. Patient characteristics, comorbidities, medications, and laboratory values were obtained through linkage across national health registries. The outcome was PO-AKI within 7 days after surgery, defined according to the Kidney Disease Improving Global Outcomes criteria. A logistic regression model was fitted using preoperative predictors, backward selection was applied to derive the final model, and internal validation was performed through two-fold bootstrapping. The performance was assessed using discrimination and calibration measures.</p><p><strong>Results: </strong>Among 26 104 identified patients, 20 277 patients were included, and 1747 (8.6%) developed AKI within 7 days. Fifty-four per cent were men, and the median age was 71 years (interquartile range, 64-78 years). The final model included 14 preoperative predictors. The model showed moderate discriminative performance with an optimism-corrected c-statistic of 0.70 (95% confidence interval 0.68 to 0.71) and was well calibrated at PO-AKI risks between 0% and 20% but somewhat overestimated higher risks (overall slope 0.95; intercept -0.001). The prediction model is available as a calculator at https://po-aki.streamlit.app.</p><p><strong>Conclusion: </strong>The model predicted PO-AKI with moderate accuracy and may support the implementation of preventive measures. However, external validation is required to confirm its applicability.</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/PMC13555295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148910767","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":"Methodological challenges in surgical randomized trials: systematic review of rectal cancer studies.","authors":"Daichi Kitaguchi, Mariano Giménez, Antonello Forgione, Tatsuya Oda, Jacques Marescaux","doi":"10.1093/bjsopen/zrag102","DOIUrl":"10.1093/bjsopen/zrag102","url":null,"abstract":"<p><strong>Background: </strong>Surgical randomized clinical trials (RCTs) have structural features that differ fundamentally from those of non-surgical trials, which may complicate appraisal using standard assessment frameworks. This methodological systematic review used rectal cancer surgery RCTs as a high-complexity exemplar to identify surgically specific methodological challenges and to examine their interaction with established tools for assessing risk of bias and certainty of evidence.</p><p><strong>Methods: </strong>A systematic literature search was conducted in PubMed, Embase, and the Cochrane Library on 1 November 2025. Eligible studies were RCTs evaluating surgery-related interventions for rectal cancer in adult patients, published in English from 2020 onward, with sufficient methodological detail. Included trials were categorized into predefined, mutually exclusive surgical RCT types. Methodological features were descriptively summarized and conceptually mapped to the domains of the revised Cochrane Risk of Bias (RoB 2) tool and the GRADE framework using both quantitative tabulation and narrative synthesis.</p><p><strong>Results: </strong>Of 1529 records identified, 45 publications reporting on 35 RCTs were included. Trials were classified into five surgical RCT categories. Surgically specific methodological challenges were most frequently observed in RoB 2 domains D2 (bias due to deviations from intended interventions) and D4 (bias in measurement of the outcome), as well as in the GRADE domain of indirectness.</p><p><strong>Conclusion: </strong>This review suggests that several challenges encountered when applying RoB 2 and GRADE to surgical RCTs arise from structural characteristics of surgical trial design rather than obvious methodological shortcomings. Contextualizing standard appraisal frameworks within the realities of surgical research may allow for a more nuanced interpretation of existing evidence, inform future trial design, and support more appropriate evidence synthesis.</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/PMC13591274/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149011878","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":"Multiple R1 margins are associated with shorter overall survival: national register-based study on pancreatic cancer.","authors":"Patrik Larsson, Carlos Fernández Moro, Melroy D'Souza, Bobby Tingstedt, Ernesto Sparrelid, Poya Ghorbani","doi":"10.1093/bjsopen/zrag155","DOIUrl":"10.1093/bjsopen/zrag155","url":null,"abstract":"<p><strong>Background: </strong>Resection status is associated with overall survival among patients operated on for pancreatic ductal adenocarcinoma (PDAC). This study investigated whether the number of R1 margins is associated with shorter survival.</p><p><strong>Methods: </strong>Adult patients who underwent pancreatoduodenectomy for primary resectable PDAC between 2017 and 2024 recorded in the Swedish National Pancreatic Registry were included. Overall survival was analysed according to overall R status and the number of R1 margins. Overall survival was analysed using Kaplan-Meier estimates, Cox regression analysis for estimated adjusted survival time, and Laplace regression for analysis of percentile distribution.</p><p><strong>Results: </strong>Overall, 1043 patients were included, 398 patients (38.2%) with R0 and 645 patients (61.8%) with R1 margins. The adjusted median survival was 8.2 (95% confidence interval (c.i.) -12.0 to -4.3) months shorter for patients with R1 versus R0 margins, with a progressively shorter survival with a higher number of R1 margins. Specifically, compared with R0 margins, the adjusted median survival for one, two and three or more R1 margins was 4.6 (95% c.i. -10.2 to 1.0), 6.7 (95% c.i. -11.9 to -1.5), and 12.4 (95% c.i. -16.5 to -8.3) months shorter, respectively.</p><p><strong>Conclusions: </strong>Patients with R1 margins had an adjusted median survival that was 8 months shorter than patients with R0 margins. An increased number of R1 margins was associated with shorter survival. These results suggest that the current practice of reporting binary R status is insufficient, and future guidelines should consider revising this routine and adopt a standardized, detailed margin assessment protocol.</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/PMC13675251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149206564","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}