BJS Open最新文献

{"title":"Sarcopenia, myosteatosis, and frailty parameters to predict adverse outcomes in patients undergoing emergency laparotomy: prospective observational multicentre cohort study.","authors":"Brittany Park, Alain Vandal, Fraser Welsh, Tim Eglinton, Jonathan Koea, Ashish Taneja, Ahmed Barazanchi, Andrew G Hill, Andrew D MacCormick","doi":"10.1093/bjsopen/zraf016","DOIUrl":"10.1093/bjsopen/zraf016","url":null,"abstract":"<p><strong>Background: </strong>Functional compromise contributes significantly to adverse outcomes after emergency laparotomy. Sarcopenia, defined as reduced muscle strength and muscle quantity, has been seldom assessed in patients undergoing emergency laparotomy. The aim of this study was to examine functional compromise in emergency laparotomy using sarcopenia, myosteatosis, and frailty parameters and evaluate impacts on functional and patient-centred outcomes.</p><p><strong>Methods: </strong>Patients aged greater than or equal to 55 years who underwent emergency laparotomy and preoperative computed tomography (CT) at two hospitals in New Zealand between February 2022 and October 2023 were included in a prospective database. Sarcopenia was measured using the SARC-F questionnaire, isokinetic dynamometry to measure hand grip strength, and skeletal muscle quantity according to CT. Myosteatosis was determined using CT and frailty was assessed using the Clinical Frailty Scale. Predictors for rehabilitation, days alive and out of hospital at 90 days, and risk of not returning home were analysed using relative risk and proportional means regression. Secondary outcomes were 3- and 6-month mortality and inpatient morbidity defined using the Clavien-Dindo classification.</p><p><strong>Results: </strong>A total of 101 patients undergoing emergency laparotomy during the study interval were analysed; 21.6% of participants had sarcopenia, 34.7% had myosteatosis, and 24.8% were living with frailty. Muscle strength parameters (low grip strength and a positive SARC-F questionnaire) had significant relationships with primary outcomes. Low grip strength (less than 27 kg for male patients and less than 16 kg for female patients) was most significant for risk of admission for rehabilitation (adjusted risk ratio 5.48 (95% c.i. 2.03 to 14.82)). A positive SARC-F questionnaire (an overall score of greater than or equal to 4 out of 10) was most significant for not returning home (adjusted risk ratio 8.26 (95% c.i. 1.81 to 37.76)). Isolated low muscle quantity (less than 52.4 cm2/m2 for male patients and less than 38.5 cm2/m2 for female patients) demonstrated no relationship. Being frail was most significant for a reduced number of days alive and out of hospital at 90 days (-13.4% compared with non-frail participants (95% c.i. -24.3% to -0.8%)). Sarcopenia and low grip strength were the only parameters to demonstrate a relationship with 3- and 6-month mortality.</p><p><strong>Conclusion: </strong>Sarcopenia and frailty parameters are major determinants of functional compromise and predict adverse outcomes after emergency laparotomy. Muscle strength is more important than mass, and measurable without imaging, streamlining its clinical application.</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/PMC11963623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143762544","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 preoperative frailty with short- and long-term outcomes after hepatic resection for elderly patients with hepatocellular carcinoma: multicentre analysis.","authors":"Yong-Kang Diao, Dan Li, Han Wu, Yi-Fan Yang, Nan-Ya Wang, Wei-Min Gu, Ting-Hao Chen, Jie Li, Hong Wang, Ya-Hao Zhou, Ying-Jian Liang, Xian-Ming Wang, Kong-Ying Lin, Li-Hui Gu, Jia-Hao Xu, Timothy M Pawlik, Wan-Yee Lau, Feng Shen, Tian Yang","doi":"10.1093/bjsopen/zrae171","DOIUrl":"10.1093/bjsopen/zrae171","url":null,"abstract":"<p><strong>Background: </strong>The growing demand for surgical resection in elderly patients with hepatocellular carcinoma highlights the need to understand the impact of preoperative frailty on surgical outcomes. The aim of this multicentre cohort study was to investigate the association between frailty and short- and long-term outcomes after hepatic resection among elderly patients with hepatocellular carcinoma.</p><p><strong>Methods: </strong>A multicentre analysis was conducted on elderly patients with hepatocellular carcinoma (aged greater than or equal to 70 years) who underwent curative-intent resection at ten Chinese hospitals from 2012 to 2021. Frailty was assessed using the Clinical Frailty Scale (with frailty defined as a Clinical Frailty Scale score greater than or equal to 5). The primary outcomes were overall survival and recurrence-free survival; secondary outcomes encompassed postoperative 30-day morbidity and mortality, and 90-day mortality. The outcomes between patients with and without preoperative frailty were compared.</p><p><strong>Results: </strong>Of the 488 elderly patients, 148 (30.3%) were considered frail. Frail patients experienced significantly higher 30-day morbidity (68.9% (102 of 148) versus 43.2% (147 of 340)), 30-day mortality (4.1% (6 of 148) versus 0.6% (2 of 340)), and 90-day mortality (6.1% (9 of 148) versus 0.9% (3 of 340)) compared with non-frail patients (all P < 0.010). During a median follow-up of 37.7 (interquartile range 20.4-57.8) months, frail patients demonstrated significantly worse median overall survival (41.6 (95% c.i. 32.0 to 51.2) versus 69.7 (95% c.i. 55.6 to 83.8) months) and recurrence-free survival (27.6 (95% c.i. 23.1 to 32.1) versus 42.7 (95% c.i. 34.6 to 50.8) months) compared with non-frail patients (both P < 0.010). Multivariable Cox regression analysis revealed frailty as an independent risk factor for decreased overall survival (HR 1.61; P = 0.001) and decreased recurrence-free survival (HR 1.32; P = 0.028).</p><p><strong>Conclusion: </strong>Frailty is significantly associated with adverse short-term and long-term outcomes after resection in elderly patients with hepatocellular carcinoma. The findings suggest that frailty assessment should be incorporated into perioperative and postoperative evaluation for elderly patients undergoing hepatocellular carcinoma resection.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11806262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373711","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":"DiffErential attainment and Factors AssoCiated with Training applications and Outcomes (DE FACTO) for general surgery applications in the UK: retrospective study.","authors":"Sarika Grover, Siddarth Raj, Martina Spazzapan, Beth Russell, Harroop Bola, Noel Biju, Sachin Malde, Simon Fleming, Stella Vig","doi":"10.1093/bjsopen/zrae166","DOIUrl":"10.1093/bjsopen/zrae166","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11780877/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143063426","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-assisted contra open resection for suspected or confirmed gallbladder cancer (ROBOCOP).","authors":"Hannes Wållgren, Meimene Khalil, Helena Taflin, Caroline Williamsson, Stefan Gilg, Dennis Björk, Malin Sternby Eilard, Peter Strandberg Holka, Melroy D'Souza, Linda Lundgren, Christian Cahlin, Bodil Andersson, Ernesto Sparrelid, Per Sandström, Niclas Kvarnström, Magnus Rizell, Jenny Lundmark Rystedt, Bergthor Björnsson, Christian Sturesson","doi":"10.1093/bjsopen/zrae168","DOIUrl":"10.1093/bjsopen/zrae168","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11842188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466792","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":"Minimally invasive versus open lateral pancreaticojejunostomy in patients with painful chronic pancreatitis: systematic review.","authors":"Roberto M Montorsi, Michiel F G Francken, Marja A Boermeester, Olivier R Busch, Freek Daams, Thilo Hackert, Roel Haen, Markus W Hollmann, Hjalmar C van Santvoort, Marc G Besselink","doi":"10.1093/bjsopen/zrae135","DOIUrl":"10.1093/bjsopen/zrae135","url":null,"abstract":"<p><strong>Background: </strong>Patients with painful chronic pancreatitis combined with a dilated main pancreatic duct and a normal size pancreatic head are treated according to guidelines by lateral pancreaticojejunostomy (LPJ). This systematic review compared outcomes of minimally invasive LPJ and open LPJ.</p><p><strong>Methods: </strong>From 1 January 2000 until 13 November 2023, series reporting on minimally invasive LPJ and open LPJ in patients with symptomatic chronic pancreatitis were included. This study was structured in accordance with the PRISMA guidelines. The primary outcome was intraoperative and postoperative complications. Secondary outcomes included long-term clinical outcomes.</p><p><strong>Results: </strong>Overall, 19 retrospective studies were included. Morbidity rate ranged from 0% to 57% after minimally invasive LPJ versus 4% to 68% after open LPJ (median: 25, i.q.r.: 23). Length of hospital stay ranged from 5 to 7 days after minimally invasive LPJ and from 6 to 16 days after open LPJ. The rate of pain relief ranged from 62% to 91% after open LPJ (median: 78.5, i.q.r.: 23) and from 71% to 100% (median: 82.5, i.q.r.: 12.5) after minimally invasive LPJ respectively. New-onset endocrine insufficiency ranged from 21% to 22% in minimally invasive LPJ and 19% to 26% after open LPJ. New-onset exocrine insufficiency was shown in 11% to 27% in minimally invasive LPJ versus 8% to 26% after open LPJ. Weight gain ranged from 60% to 100% (median: 97, i.q.r.: 23) after minimally invasive LPJ.</p><p><strong>Discussion: </strong>This systematic review suggested that minimally invasive LPJ can be performed safely in selected patients with symptomatic chronic pancreatitis. Phase 2 randomized trials should assess potential short-term benefits such as postoperative pain and length of hospital stay after minimally invasive LPJ.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11747668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142999554","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":"Transformational journey in ileo-pouch anal anastomosis surgery for ulcerative colitis.","authors":"Franco Scaldaferri, Franco Sacchetti","doi":"10.1093/bjsopen/zrae157","DOIUrl":"10.1093/bjsopen/zrae157","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11795663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143188181","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":"Inter-rater variability for the American Society of Anesthesiologists classification in patients undergoing hepato-pancreato-biliary surgery (MILESTONE-2): international survey among surgeons and anaesthesiologists.","authors":"Simone Augustinus, Jasper P Sijberden, Matthanja Bieze, Vandana Agarwal, Luca A Aldrighetti, Adnan Alseidi, Francisco C Bonofiglio, Kevin C P Conlon, Katia Donadello, Joris Erdmann, Cristina Ferrone, Michael Guertin, Ronald Harter, Maria E Franceschetti, Guiseppe K Fusai, Bas Groot Koerkamp, Thilo Hackert, Jin-Young Jang, Thomas Kander, Tobias Keck, Dominik Krzanicki, Ho-Jin Lee, Keith Lewis, Giuseppe Natalini, Carla Nau, Timothy M Pawlik, Henry A Pitt, Rafaella Reineke, Roberto Salvia, Eduardo de Santibanes, Shailesh V Shrikhande, Martin Smith, Attila Szijarto, Bobby Tingstedt, Alice C Wei, John Windsor, Mohammed Abu Hilal, Manuel Pardo, Markus W Hollmann, Marc G Besselink","doi":"10.1093/bjsopen/zrae162","DOIUrl":"10.1093/bjsopen/zrae162","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing hepato-pancreato-biliary surgery are typically preoperatively assessed using the American Society of Anesthesiologists (ASA) classification, which is also used for case-mix adjustment when comparing centre outcomes. Studies determining the inter-rater variability of the ASA classification within hepato-pancreato-biliary surgery are currently lacking.</p><p><strong>Methods: </strong>An international survey was collected and a case-vignette study was performed (November 2022-April 2023) regarding the ASA classification in patients undergoing hepato-pancreato-biliary surgery among anaesthesiologists and surgeons from (inter)national societies. The survey consisted of 23 questions and eight case-vignettes. Primary analysis included descriptive statistics and the inter-rater variability was calculated using Light's Kappa.</p><p><strong>Results: </strong>Overall, 1283 participants from 55 countries responded: 1073 (84%) anaesthesiologists and 210 (16%) surgeons. The ASA classification was commonly used, both clinically 1003/1283 (78%) and for research 728/762 (96%). The majority of respondents (n = 1019, 79%) declared that ASA score impacted their perioperative strategy. There inter-rater variability was fair-moderate (Kappa 0.26-0.42) in all case-vignettes. Inter-rater variability differed within and among geographic regions for each case. Over 80% (n = 1138) of respondents stated that they would take the underlying disease (for example cancer) into account, but this changed the preferred ASA score within the case-vignettes by only 1%. Type of surgery changed the preferred score in the case-vignettes (13% difference). The most common suggestions to improve the ASA classification were to clarify whether type of operation should be considered, create a more extensive definition, and provide more examples.</p><p><strong>Conclusions: </strong>Inter-rater variability was present within the ASA classification of patients undergoing hepato-pancreato-biliary surgery, which may impact perioperative strategy and hamper research results. Additional guidance to classify patients according to ASA is urgently needed. Until then, more objective measurements should be considered for case-mix adjustment within research.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143555716","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":"Estimation of the postoperative fatality window in colorectal cancer surgery.","authors":"Martin Rutegård, Peter Matthiessen, Jörgen Rutegård, Markku M Haapamäki, Johan Svensson","doi":"10.1093/bjsopen/zrae153","DOIUrl":"10.1093/bjsopen/zrae153","url":null,"abstract":"<p><strong>Background: </strong>Postoperative death measured 30 days after surgery is a conventional quality metric, whereas intervals up to 90 days are increasingly used, although data-driven time windows have scarcely been investigated.</p><p><strong>Methods: </strong>The Swedish Colorectal Cancer Registry was used to identify all patients subjected resection for colorectal cancer between 2007 and 2020. All patients were followed up until 180 days after surgery. A join-point statistical hazard model was used to model a declining hazard to a transition point, followed by a stable death rate. This method was subsequently applied to describe postoperative deaths for the entire cohort and subgroups according to tumour location (colon and rectum).</p><p><strong>Results: </strong>Some 56 096 patients electively operated on for colorectal cancer during the study interval were included, with a 30-day and 90-day fatality of 805 (1.43%) and 1458 (2.60%) patients respectively. The derived postoperative fatality window, after which the death rate transitioned to a stable rate, was 23.8 (95% c.i. 21.5 to 28.2) days after surgery. There was no significant difference in the time window between rectal cancer (22.9 days; 95% c.i. 15.1 to 28.4) and colon cancer (27.3 days; 95% c.i. 21.4 to 31.8) patients (P = 0.455). However, postoperative fatality time windows were extended in patients aged at least 80 years and with American Society of Anesthesiologists' grade III or IV.</p><p><strong>Conclusion: </strong>The traditional postoperative time window of 30 days was confirmed to be an appropriate metric in elective colorectal cancer surgery when evaluated with a hazards-based statistical framework. Importantly, this time window is influenced by older age and advanced co-morbidity, which could prompt increased vigilance for these patient groups.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031962","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: Operative versus conservative management for inguinal hernia: a methodology scoping review of randomized controlled trials.","authors":"","doi":"10.1093/bjsopen/zrae164","DOIUrl":"10.1093/bjsopen/zrae164","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143031932","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":"Short-term outcomes from the 'Watch and Wait' (WoW) study: prospective cohort study.","authors":"Daniel Rydbeck, Najia Azhar, Lennart Blomqvist, Abbas Chabok, Joakim Folkesson, Anders Gerdin, Linda Hermus, Peter Matthiessen, Anna Martling, Per J Nilsson, Eva Angenete","doi":"10.1093/bjsopen/zrae151","DOIUrl":"10.1093/bjsopen/zrae151","url":null,"abstract":"<p><strong>Background: </strong>Despite absence of level 1 evidence on the long-term oncological safety of non-operative management for rectal cancer (watch and wait), increased implementation has occurred globally over the past decades. In Sweden, a pan-national prospective non-randomized study was initiated in 2017 to assess its implementation.</p><p><strong>Method: </strong>Patients with biopsy-proven rectal cancer receiving neoadjuvant therapy according to national guidelines in whom a clinical complete response was detected at reassessment were eligible for inclusion following informed consent. Only patients with an opportunistic watch-and-wait approach were included. Inclusion and follow-up, according to the study protocol, was managed at the participating study centres. The primary outcome measure of the study is 3-year disease-free survival. Here, the secondary short-term outcomes local regrowth rate, distant metastasis rate and outcomes after surgery for regrowth, at 6 months follow-up, are reported.</p><p><strong>Results: </strong>Between January 2017 and February 2023, 211 patients with a clinical complete response were included in the study. Thirty-three (16%) patients developed suspicious regrowth within 6 months of inclusion. Thirty-two of 33 patients had abdominal resectional surgery for regrowth. The curative intention rate was 94% for patients with regrowth. Three patients (1.4%) developed distant metastases within 6 months of inclusion.</p><p><strong>Conclusion: </strong>This Swedish national study on watch and wait reports regrowth rates after 6 months are in line with previous reports in the literature. Nearly all patients with early regrowth could be treated with salvage surgery and curative intent.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 1","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11758366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143032005","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}