BJS Open最新文献

{"title":"Endoscopic versus robotic myotomy for treatment of achalasia (ERMA trial): protocol for a randomized clinical multicentre trial.","authors":"Elisenda Garsot, Georgina Company-Se, Hugo Uchima, Ingrid Marin, Marta Viciano, Arantxa Clavell, Sonia Fernández Ananin, Mònica Miró, Carlos Guarner, Joan Gornals, Carla Bettonica, Dulce Momblán, M Glòria Fernández Esparrach, Isis Araujo, Lexa Nescolarde","doi":"10.1093/bjsopen/zrae130","DOIUrl":"10.1093/bjsopen/zrae130","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11631189/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806121","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":"Perioperative patient safety recommendations: systematic review of clinical practice guidelines.","authors":"Ismael Martinez-Nicolas, Daniel Arnal-Velasco, Eva Romero-García, Neus Fabregas, Yolanda Sanduende Otero, Irene Leon, Ashish A Bartakke, Javier Silva-Garcia, Anna Rodriguez, Claudia Valli, Sandro Zamarian, Adam Zaludek, Jose Meneses-Echavez, Andrés F Loaiza-Betancur, Paulo Sousa, Carola Orrego, Victor Soria-Aledo","doi":"10.1093/bjsopen/zrae143","DOIUrl":"10.1093/bjsopen/zrae143","url":null,"abstract":"<p><strong>Background: </strong>Surgical-related incidents are a common cause of in-hospital adverse events. Surgical patient safety would benefit from evidence-based practices, but a comprehensive collection of patient safety recommendations is still lacking. This study aimed to compile and assess the perioperative patient safety recommendations for adults.</p><p><strong>Method: </strong>A systematic review of clinical practice guidelines was conducted using Medline, Embase, Cochrane, Virtual Health Library Regional Portal, and Trip Database from 2012 to 2022. Eligibility criteria followed a PICAR strategy for patient safety recommendations in the perioperative care continuum. Guidelines were appraised for quality, particularly focusing on the 'rigour of development' domain of the AGREE-II tool for those containing strong recommendations. Descriptive analyses were conducted, emphasizing guideline quality, recommendation strength, and the supporting level of evidence.</p><p><strong>Results: </strong>From the 267 guidelines, 4666 perioperative patient safety recommendations were extracted, of which 44.9% (2095) were strongly recommended. Of these, 322 had the highest level of evidence, but only 18 guidelines met high standards in the AGREE-II 'rigour of development' domain. A subset of 78 recommendations ranked the highest in the strength of recommendation, level of evidence, and rigour of development of their guidelines. A gap was found within pre-admission and post-discharge care recommendations.</p><p><strong>Discussion: </strong>This review highlights the noteworthy variability in the methodological quality of the guidelines, and a discordance between strength of recommendation and evidence level of the available perioperative patient safety recommendations. These findings provide valuable information for advising policy decisions and promoting best practices to enhance global surgical safety.</p><p><strong>Registration: </strong>PROSPERO (CRD42022347449).</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806125","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 unit volume and reoperation for recurrence following total extraperitoneal groin hernia repairs: nationwide population-based register study.","authors":"Filippa Widman, Mathias Bergström, Björn Widhe, Sven Bringman, Maria Melkemichel","doi":"10.1093/bjsopen/zrae136","DOIUrl":"10.1093/bjsopen/zrae136","url":null,"abstract":"<p><strong>Background: </strong>The quality of total extraperitoneal groin hernia repair and recurrence rates are influenced by various factors, potentially including the annual surgical unit volume of repairs. The precise nature of this relationship remains unclear. The aim of this study was to investigate the influence of surgical unit volume on reoperation rates for recurrence following total extraperitoneal groin hernia repair.</p><p><strong>Methods: </strong>This observational nationwide population-based study utilized prospectively collected data from the Swedish Hernia Register. Patients aged 15 years old or older who underwent a total extraperitoneal groin hernia repair from 1 January 2015 to 31 August 2019 were eligible. Follow-up time was until 31 August 2022. Surgical units were grouped into low-volume (fewer than 12 repairs per year), low-medium-volume (12-50 repairs per year), medium-high-volume (greater than 50-150 repairs per year), and high-volume (greater than 150 repairs per year) units. The primary outcome was reoperation for recurrence. The secondary outcome was postoperative complications.</p><p><strong>Results: </strong>A total of 20 656 elective total extraperitoneal groin hernia repairs were included across 75 surgical units. The reoperation rate for recurrence was higher in all three lower-volume groups (low-volume, 5.3%; low-medium-volume, 3.8%; and medium-high-volume, 3.5%) compared with the high-volume group (2.9%). Adjusted multivariable Cox regression analysis revealed a statistically significant increased HR for reoperation for recurrence in the low-volume group (1.87 (95% c.i. 1.31 to 2.67)) and the low-medium-volume group (1.32 (95% c.i. 1.07 to 1.62)) compared with the high-volume group. No difference was seen between the groups regarding the risk of postoperative complications.</p><p><strong>Conclusion: </strong>The risk of reoperation for recurrence following total extraperitoneal groin hernia repair is significantly increased in surgical units that perform fewer than 51 repairs per year. The findings may influence guidelines on required annual surgical unit volume to improve patient outcomes following total extraperitoneal groin hernia repair.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142812094","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":"Reported outcomes in studies of intermittent claudication - first step toward a core outcome set: systematic review.","authors":"Akam Shwan, Segun Lamidi, Calvin Chan, Elizabeth Daniels, Charlie Song-Smith, Lydia Hanna, Viknesh Sounderajah, John S M Houghton, Rob D Sayers","doi":"10.1093/bjsopen/zrae126","DOIUrl":"10.1093/bjsopen/zrae126","url":null,"abstract":"<p><strong>Introduction: </strong>This review aimed to compile an exhaustive list of all outcome measures and identify different characteristics of the outcomes reported in studies of intermittent claudication as the first step in developing a core outcome set for intermittent claudication.</p><p><strong>Method: </strong>Medline and Embase were searched for all studies including individuals with intermittent claudication and reporting ≥1 outcome from January 2015 to August 2024. Abstract, full text screening and data extraction were performed by two investigators independently. All reported outcome measures were extracted verbatim and categorized by Dodd's domains (Core Outcome Measures in Effectiveness Trials registration: COMIC Study, 1590; https://www.comet-initiative.org/Studies/Details/1590).</p><p><strong>Results: </strong>4985 studies were screened and 408 were included. A total of 541 unique outcomes across 25 Dodd's domains were identified. Ankle-brachial pressure index was the most frequently reported outcome. Among the 541 unique outcomes, 386 outcomes were only reported once. Only 38.9% of the studies exclusively included patients with intermittent claudication. Patient-reported outcomes were reported in 36.2% of studies. There were wide variations in the definition of commonly used outcome measures (for example, major adverse limb event and primary patency) across different studies.</p><p><strong>Conclusion: </strong>There is substantial heterogeneity in reported outcomes in studies of intermittent claudication. Most reported outcomes are clinical/physiology oriented rather than patient centred. Development of a core outcome set for intermittent claudication is vital to improve and standardize reporting in future research.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11529788/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142562618","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":"Long-term follow-up of the conventional versus no-touch isolation technique for resection of primary colon cancer (JCOG1006): randomized clinical trial.","authors":"Koji Komori, Yasumasa Takii, Junki Mizusawa, Yukihide Kanemitsu, Manabu Shiozawa, Masayuki Ohue, Satoshi Ikeda, Takaya Kobatake, Tetsuya Hamaguchi, Hiroshi Katayama, Haruhiko Fukuda","doi":"10.1093/bjsopen/zrae133","DOIUrl":"10.1093/bjsopen/zrae133","url":null,"abstract":"<p><strong>Background: </strong>The Japan Clinical Oncology Group (JCOG) 1006 was a phase III trial of patients with clinical T3/T4 colon cancer comparing the no-touch isolation technique ('No Touch') with the conventional technique ('Conventional'). The planned primary analysis at 3 years failed to confirm the superiority of the No Touch over the 'Conventional'. The present study aimed to compare the 'No Touch' and 'Conventional' using long-term (6-year) follow-up data.</p><p><strong>Methods: </strong>Patients aged 20-80 years who had a clinical classification of T3-4, N0-2, and M0 with histologically proven colon cancer were randomly assigned (1 : 1) to undergo open surgery using 'Conventional' or 'No Touch' techniques. The primary endpoint was disease-free survival.</p><p><strong>Results: </strong>In total, 853 patients from 30 institutions were assigned to the 'Conventional' (427) or 'No Touch' (426) groups between June 2011 and November 2015. The 6-year disease-free survival was 70.3% and 69.4% for 'Conventional' and 'No Touch' arms respectively (HR 1.030; 95% c.i. 0.813 to 1.304; one-sided P = 0.60). The 6-year overall survival was 89.4% and 86.6% respectively (HR 1.276; 95% c.i. 0.902 to 1.807). The 6-year relapse-free survival was 78.9% and 75.0% respectively (HR 1.209; 95% c.i. 0.920 to 1.589). The 6-year liver relapse-free survival was 85.1% and 80.2% respectively (HR 1.311; 95% c.i. 0.961 to 1.787).</p><p><strong>Conclusion: </strong>Long-term follow-up data did not support the superiority of 'No Touch' over 'Conventional' technique in patients with stages II and III colon cancer. These study findings indicate that the conventional technique is still standard surgery for managing colon cancers.</p><p><strong>Trial registration number: </strong>UMIN000004957.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 6","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602131/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738332","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":"Impact of radiotherapy on quality of life in patients with rectal cancer.","authors":"Patricia Tejedor, Quentin Denost","doi":"10.1093/bjsopen/zrae105","DOIUrl":"https://doi.org/10.1093/bjsopen/zrae105","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11387962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142280175","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":"Automated analysis of operative video in surgical training: scoping review.","authors":"Lachlan Dick, Connor P Boyle, Richard J E Skipworth, Douglas S Smink, Victoria Ruth Tallentire, Steven Yule","doi":"10.1093/bjsopen/zrae124","DOIUrl":"10.1093/bjsopen/zrae124","url":null,"abstract":"<p><strong>Background: </strong>There is increasing availability of operative video for use in surgical training. Emerging technologies can now assess video footage and automatically generate metrics that could be harnessed to improve the assessment of operative performance. However, a comprehensive understanding of which technology features are most impactful in surgical training is lacking. The aim of this scoping review was to explore the current use of automated video analytics in surgical training.</p><p><strong>Methods: </strong>PubMed, Scopus, the Web of Science, and the Cochrane database were searched, to 29 September 2023, following PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. Search terms included 'trainee', 'video analytics', and 'education'. Articles were screened independently by two reviewers to identify studies that applied automated video analytics to trainee-performed operations. Data on the methods of analysis, metrics generated, and application to training were extracted.</p><p><strong>Results: </strong>Of the 6736 articles screened, 13 studies were identified. Computer vision tracking was the common method of video analysis. Metrics were described for processes (for example movement of instruments), outcomes (for example intraoperative phase duration), and critical safety elements (for example critical view of safety in laparoscopic cholecystectomy). Automated metrics were able to differentiate between skill levels (for example consultant versus trainee) and correlated with traditional methods of assessment. There was a lack of longitudinal application to training and only one qualitative study reported the experience of trainees using automated video analytics.</p><p><strong>Conclusion: </strong>The performance metrics generated from automated video analysis are varied and encompass several domains. Validation of analysis techniques and the metrics generated are a priority for future research, after which evidence demonstrating the impact on training can be established.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11482280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457408","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 peritoneal and wound lavage with super-oxidized solution on surgical-site infection after open appendicectomy in perforated appendicitis (PLaSSo): randomized clinical trial.","authors":"Harivinthan Sellappan, Dinesh Alagoo, Christina Loo, Kaesarina Vijian, Rohamini Sibin, Jitt Aun Chuah","doi":"10.1093/bjsopen/zrae121","DOIUrl":"10.1093/bjsopen/zrae121","url":null,"abstract":"<p><strong>Background: </strong>Surgical-site infection following open appendicectomy for perforated appendicitis increases length of hospital stay and treatment costs while compromising patients' quality of life. Data from randomized clinical trials (RCTs) evaluating the role of super-oxidized solution in perforated appendicitis are lacking. The study objective was to determine the effect of peritoneal and wound lavage with super-oxidized solution in reducing risk of surgical-site infection following open appendicectomy for perforated appendicitis.</p><p><strong>Methods: </strong>In this multicentre RCT conducted between September 2020 and March 2022, patients aged 13 years and older with perforated appendicitis undergoing open appendicectomy were randomly assigned to receive peritoneal and wound lavage with either super-oxidized solution or normal saline. The primary outcome was surgical-site infection within 30 days after surgery. Randomization was computer-generated, with allocation concealment by opaque, sequentially numbered, sealed envelope. The patients, surgeons, outcome assessors and statisticians performing the analysis were blinded to treatment assigned.</p><p><strong>Results: </strong>A total of 102 consecutive patients (51 in the super-oxidized solution group and 51 in the normal saline group) were randomized and included in the intention-to-treat analysis. The super-oxidized solution group showed a significant reduction in overall surgical-site infection (8 (15.6%) versus 19 (37.2%); relative risk (RR) 0.42; 95% c.i. 0.20 to 0.87; P = 0.014), and superficial surgical-site infection (5 (9.8%) versus 18 (35.3%); RR 0.28; 95% c.i. 0.11 to 0.69; P = 0.002), with a number-needed-to-treat of four patients. There were no adverse events in either group.</p><p><strong>Conclusions: </strong>Peritoneal and wound lavage with super-oxidized solution is superior to normal saline in preventing surgical-site infection after open appendicectomy for perforated appendicitis.</p><p><strong>Trial registration: </strong>ClinicalTrial.gov Identifier: NCT04512196.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11482247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142457411","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":"Impact of an appendicolith and its characteristics on the severity of acute appendicitis.","authors":"Sami Sula, Timo Paananen, Ville Tammilehto, Saija Hurme, Anne Mattila, Tuomo Rantanen, Tero Rautio, Tarja Pinta, Suvi Sippola, Jussi M Haijanen, Paulina Salminen","doi":"10.1093/bjsopen/zrae093","DOIUrl":"10.1093/bjsopen/zrae093","url":null,"abstract":"<p><strong>Background: </strong>Antibiotics have been reported as an efficient and safe treatment option for uncomplicated acute appendicitis without an appendicolith diagnosed using computed tomography (CT). The aim of this study was to assess the association of a CT-diagnosed appendicolith and its characteristics with appendicitis severity.</p><p><strong>Methods: </strong>A large prospective patient cohort with suspected acute appendicitis enrolled between April 2017 and November 2018 was retrospectively reviewed. The initial analysis evaluated the association of a CT-diagnosed appendicolith with complicated acute appendicitis; then, based on the availability of CT images, a subset of patients was analysed for the correlation of appendicolith characteristics with appendicitis severity. The final appendicitis assessment (uncomplicated or complicated-including perforation, gangrene, an abscess, or a tumour) was determined for all patients.</p><p><strong>Results: </strong>Out of 3512 eligible patients, 3085 patients with appendicitis were selected and 380 patients with an appendicolith and with a CT image available for reassessment were included. Out of the 3085 patients with CT-diagnosed acute appendicitis, 1101 (35.7%) patients presented with both acute appendicitis and an appendicolith and, out of these, 519 (47.1%) had complicated acute appendicitis. In the patients without an appendicolith (1984 patients), 426 (21.5%) had complicated appendicitis (P < 0.001). Re-evaluation of CT images for 380 patients showed that a larger appendicolith diameter (OR = 1.15 (95% c.i. 1.06 to 1.25); P < 0.001), appendicolith location at the base of the appendix (55.1% versus 44.9%; P = 0.008), and heterogeneous appendiceal wall enhancement around the appendicolith (68.4% versus 31.6%; P < 0.001) were associated with an increased risk of complicated acute appendicitis.</p><p><strong>Conclusion: </strong>The presence of an appendicolith in patients with acute appendicitis is correlated with the risk of complicated appendicitis. This risk is further increased by a larger appendicolith diameter or appendicolith location at the base of the appendix.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11370785/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142124776","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":"Number of lymph nodes retrieved in patients with locally advanced rectal cancer after total neoadjuvant therapy: post-hoc analysis from the STELLAR trial.","authors":"Yueyang Zhang, Yuan Tang, Huiying Ma, Hao Su, Zheng Xu, Changyuan Gao, Haitao Zhou, Jing Jin","doi":"10.1093/bjsopen/zrae118","DOIUrl":"10.1093/bjsopen/zrae118","url":null,"abstract":"<p><strong>Background: </strong>The current gold standard for extraperitoneal locally advanced rectal cancer is total neoadjuvant therapy (TNT) followed by total mesorectal excision. This research explored the number of lymph nodes in patients with locally advanced rectal cancer after TNT and its correlation with survival.</p><p><strong>Materials and methods: </strong>This is a post-hoc analysis based on the STELLAR trial, including patients with locally advanced rectal cancer from 16 tertiary centres who were randomized for short-term radiotherapy followed by chemotherapy (TNT group) or long-term concurrent chemotherapy group followed by total mesorectal excision between 2015 and 2018. This lymph node-related analysis is based on the TNT group. Subgroups were differentiated based on the lymph node harvest (below the median number: limited lymphadenectomy group, and greater than/equal to the median number: extended lymphadenectomy group). The primary outcomes were overall survival and disease-free survival (DFS). Correlations with clinical/pathological variables, lymphadenectomy categories and use of adjuvant chemotherapy were explored.</p><p><strong>Results: </strong>Among the 451 patients enrolled in the STELLAR trial, 227 patients (50.3%) were assigned to the TNT group, including 29.5% females. The median number of lymph nodes retrieved in the TNT group was 11.0. Patients in the limited lymphadenectomy subgroup exhibited worse overall survival than those with extended lymphadenectomy (HR 2.95 (95% c.i. 1.47 to 5.92), P = 0.001). The overall survival was similar in the ypN0-limited and ypN1-extended subgroups (HR 0.38 (95% c.i. 0.11 to 1.30), P = 0.109). Adjuvant chemotherapy was associated with better overall survival and DFS than no adjuvant chemotherapy overall (P < 0.001) and in the limited lymphadenectomy subgroup (P < 0.001). However, there was no significant difference in overall survival or DFS with or without adjuvant chemotherapy in the extended lymphadenectomy subgroup (P = 0.887 and P = 0.192, respectively).</p><p><strong>Conclusion: </strong>In the STELLAR trial, the median number of lymph nodes harvested was 11. In patients with limited lymphadenectomy, the use of adjuvant therapy after TNT was beneficial and correlated with better prognosis compared with patients who did not receive adjuvant chemotherapy.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"8 5","pages":""},"PeriodicalIF":3.5,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11462327/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387739","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}