BJS Open最新文献

{"title":"The gap between trials and reality.","authors":"Matthew J Lee","doi":"10.1093/bjsopen/zraf021","DOIUrl":"10.1093/bjsopen/zraf021","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11921769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662210","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":"Survival after standard or oncoplastic breast-conserving surgery versus mastectomy for breast cancer.","authors":"Mhairi Mactier, James Mansell, Laura Arthur, Julie Doughty, Laszlo Romics","doi":"10.1093/bjsopen/zraf002","DOIUrl":"10.1093/bjsopen/zraf002","url":null,"abstract":"<p><strong>Background: </strong>Recent evidence suggests a survival advantage after breast-conserving surgery compared with mastectomy. Previous studies have compared survival outcomes after standard breast-conserving surgery, but no studies have compared survival outcomes after oncoplastic breast-conserving surgery. The aim of this study was to compare survival outcomes after breast-conserving surgery + radiotherapy (and an oncoplastic breast-conserving surgery + radiotherapy subgroup) with those after mastectomy ± radiotherapy.</p><p><strong>Methods: </strong>Patients diagnosed with primary invasive breast cancer between 1 January 2010 and 31 December 2019 were identified from a prospectively maintained National Cancer Registry. Overall survival and breast cancer-specific survival outcomes were analysed using Kaplan-Meier analysis and Cox regression analysis adjusting for patient demographics, tumour characteristics, and treatment adjuncts.</p><p><strong>Results: </strong>A total of 14 182 patients were eligible (8537 patients underwent standard breast-conserving surgery + radiotherapy, 360 patients underwent oncoplastic breast-conserving surgery + radiotherapy, 2953 patients underwent mastectomy + radiotherapy, and 2332 patients underwent mastectomy - radiotherapy). The median follow-up was 7.27 (range 0.2-13.6) years. Superior 10-year survival was observed after breast-conserving surgery + radiotherapy (overall survival: 81.2%; breast cancer-specific survival: 93.3%) compared with mastectomy + radiotherapy (overall survival: 63.4%; breast cancer-specific survival: 75.9%) and mastectomy - radiotherapy (overall survival: 63.1%; breast cancer-specific survival: 87.5%). Ten-year overall survival and breast cancer-specific survival after oncoplastic breast-conserving surgery + radiotherapy were 86.1% and 90.2% respectively. After adjusted analysis, breast-conserving surgery + radiotherapy was associated with superior survival outcomes compared with mastectomy + radiotherapy (overall survival: HR 1.34 (95% c.i. 1.20 to 1.51); breast cancer-specific survival: HR 1.62 (95% c.i. 1.38 to 1.90)) and mastectomy - radiotherapy (overall survival: HR 1.57 (95% c.i. 1.41 to 1.75); breast cancer-specific survival: HR 1.70 (95% c.i. 1.41 to 2.05)). Similar survival outcomes were observed amongst patients treated with oncoplastic breast-conserving surgery + radiotherapy compared with mastectomy + radiotherapy (overall survival: HR 1.72 (95% c.i. 1.62 to 2.55); breast cancer-specific survival: HR 1.74 (95% c.i. 1.06 to 2.86)) and mastectomy - radiotherapy (overall survival: HR 2.21 (95% c.i. 1.49 to 3.27); breast cancer-specific survival: HR 1.89 (95% c.i. 1.13 to 3.14)).</p><p><strong>Conclusion: </strong>Breast-conserving surgery + radiotherapy and oncoplastic breast-conserving surgery + radiotherapy are associated with superior overall survival and breast cancer-specific survival compared with mastectomy ± radiotherapy. The findings should inform discussion o","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/PMC11920510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655994","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":"Western and Eastern experience in treating perihilar cholangiocarcinoma: retrospective bi-centre study.","authors":"Hannes Jansson, Atsushi Oba, Aya Maekawa, Christina Villard, Kosuke Kobayashi, Yoshihiro Ono, Jennie Engstrand, Fumihiro Kawano, Hiromichi Ito, Stefan Gilg, Yosuke Inoue, Melroy A D'Souza, Yu Takahashi","doi":"10.1093/bjsopen/zraf019","DOIUrl":"10.1093/bjsopen/zraf019","url":null,"abstract":"<p><strong>Background: </strong>Resection outcomes for perihilar cholangiocarcinoma differ between Western and Eastern centres, but reasons behind these disparities remain unclear. This study aimed to compare current outcomes between a Western and an Eastern expert centre to identify prognostic factors.</p><p><strong>Methods: </strong>Patients who underwent hepatobiliary resection for perihilar cholangiocarcinoma between 2010 and 2022 at Karolinska University Hospital (Stockholm, Sweden) and Cancer Institute Hospital (Tokyo, Japan) were retrospectively included. Primary outcome was overall survival. Secondary outcomes were disease-free survival, postoperative complications and 90-day mortality rate.</p><p><strong>Results: </strong>Two hundred and forty-nine patients were included (Cancer Institute Hospital n = 159, Karolinska n = 90). Median overall survival was 20.4 months at Karolinska and 52.0 months at Cancer Institute Hospital (P < 0.001). Median disease-free survival was 11.9 months at Karolinska and 32.4 months at Cancer Institute Hospital (P < 0.001). Advanced tumours, ASA class ≥III, poor differentiation and radial margin positivity were more common in the Western cohort. Treatment centre, T-status, N1-status, resection side, R1-status, age and carbohydrate antigen 19-9 were prognostic for overall survival. The Eastern cohort had a lower rate of postoperative complications (24.5%) and a lower mortality rate (2.5%) compared with the Western cohort (51.1% and 10.0%).</p><p><strong>Conclusion: </strong>Advanced tumour stage and radial margin positivity contributed to poor long-term survival in the Western cohort. A higher burden of co-morbidity and a higher rate of extended resections with smaller remnant liver volume influenced the Western postoperative mortality rate.</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/PMC11979329/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143810438","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":"External validity of randomized clinical trials in vascular surgery: systematic review of demographic factors of patients recruited to randomized clinical trials with comparison to the National Vascular Registry.","authors":"Joseph Cutteridge, Joseph Barsby, Samuel Hume, Hamish A L Lemmey, Regent Lee, Katarzyna D Bera","doi":"10.1093/bjsopen/zrae156","DOIUrl":"10.1093/bjsopen/zrae156","url":null,"abstract":"<p><strong>Background: </strong>Evidence-based medicine relies on randomized clinical trials, which should represent the patients encountered in clinical practice. Characteristics of patients recruited to randomized clinical trials involving vascular index operations (carotid endarterectomy, abdominal aortic aneurysm repair, infrainguinal bypass and major lower limb amputations) were compared with those recorded in the National Vascular Registry across England and Wales.</p><p><strong>Methods: </strong>MEDLINE, Embase, Web of Science, CENTRAL, clinicaltrials.gov and World Health Organization International Trials Registry Platform (CRD42021247905) were searched for randomized clinical trials involving the index operations. Demographic (age, sex, ethnicity) and clinical (co-morbidities, medications, body mass index, smoking, alcohol, cognition) data were extracted, by operation. Characteristics of operated on patients were extracted from publicly available National Vascular Registry reports (2014-2020). All findings are reported according to PRISMA guidelines. Rayyan.AI, Excel and GraphPad Prism were used for screening and analysis.</p><p><strong>Results: </strong>A total of 307 randomized clinical trials (66 449 patients) were included and compared with National Vascular Registry data for 119 019 patients. Randomized clinical trial patients were younger across all operations; for carotid endarterectomy, bypass and major lower limb amputation randomized clinical trials, there were differences in female patient representation. Further comparisons were limited by the insufficient baseline data reporting across randomized clinical trials, though reporting improved over decades. National Vascular Registry reports lacked information on patient factors such as patient ethnicity or body mass index.</p><p><strong>Conclusions: </strong>There are significant differences in demographic and clinical factors between patients recruited to vascular surgery randomized clinical trials and the real-world National Vascular Registry vascular surgery patient population. Minimum reporting standards for baseline data should be defined to allow future randomized clinical trials to represent real-world patient populations and ensure the external validity of their results.</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/PMC11921775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143662160","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":"Regional patterns of early-onset colorectal cancer from the GEOCODE (Global Early-Onset COlorectal Cancer DatabasE)-European consortium: retrospective cohort study.","authors":"Maria Daca-Alvarez, José Perea, Luis Corchete, Antonino Spinelli, Caterina Foppa, Noel F C C de Miranda, Maartje Nielsen, Claire Palles, Helen M Curley, Marc Marti-Gallostra, Mireia Verdaguer, Alfredo Vivas, Sofia Lorenzo, Andrew Latchford, Omar Faiz, Kevin Monahan, Nikhil Pawa, Marek Szczepkowski, Bartosz Ziółkowski, Wieslaw Tarnowski, Mariusz Uryszek, Silviu-Tiberiu Makkai-Popa, Juan S Azagra, Joan Llach, Leticia Moreria, Maria Pellise, Andreana N Holowatyj, Rogelio González-Sarmiento, Francesc Balaguer","doi":"10.1093/bjsopen/zraf024","DOIUrl":"10.1093/bjsopen/zraf024","url":null,"abstract":"<p><strong>Background: </strong>The incidence of early-onset colorectal cancer is increasing, but in Europe this growth shows a heterogeneous pattern in different countries and regions.</p><p><strong>Methods: </strong>Patients from six countries who participated in the Global Early-Onset COlorectal Cancer DatabasE (GEOCODE)-Europe group were included. The inclusion criteria were patients with colorectal adenocarcinoma diagnosed between 18 and 49 years of age, between January 2010 and December 2017, with at least 3 years of follow-up. Patients with inherited colorectal cancer syndromes were excluded.</p><p><strong>Results: </strong>A total of 851 patients were included with almost equal sex distribution, most were diagnosed at age 39 years or older and 42% of patients were overweight or obese. Diagnoses were predominantly at later stages (62.5% stage III-IV) and tumours were predominantly located in the distal colon (76.9% left colon and rectum). Comparative analysis between countries demonstrated that the UK had a younger age at diagnosis and the Italian cohort had a higher prevalence of being overweight or obese. Patients from Luxembourg had more advanced stage diagnoses and those from The Netherlands had more polyps. Patients from the UK had a greater family history of colorectal cancer. Comparison of Mediterranean versus non-Mediterranean countries showed significant differences in the age at diagnosis and body mass index. The prevalence of early-onset colorectal cancer over the age of 40 years in Mediterranean versus non-Mediterranean countries was 71.4% versus 62.1% (P = 0.002), and early-onset colorectal cancer was diagnosed at a more advanced stage in Mediterranean countries versus non-Mediterranean countries (65.3% versus 54.7%; P = 0.033). Family history of colorectal cancer in a first-degree relative was more common in non-Mediterranean versus Mediterranean countries (19.1% versus 11.4%; P < 0.001).</p><p><strong>Conclusion: </strong>This study highlights significant geographical disparities in the clinical, pathological and familial features of early-onset colorectal cancer across European countries.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920508/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143655982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extent of surgical repair and outcomes after surgery for type A aortic dissection.","authors":"Fausto Biancari, Daniele Fileccia, Luisa Ferrante, Timo Mäkikallio, Tatu Juvonen, Mikko Jormalainen, Giovanni Mariscalco, Zein El-Dean, Matteo Pettinari, Javier Rodriguez Lega, Angel G Pinto, Andrea Perrotti, Francesco Onorati, Konrad Wisniewski, Till Demal, Petr Kacer, Jan Rocek, Dario Di Perna, Igor Vendramin, Daniela Piani, Mauro Rinaldi, Eduard Quintana, Robert Pruna-Guillen, Sven Peterss, Joscha Buech, Caroline Radner, Manoj Kuduvalli, Amer Harky, Antonio Fiore, Michele D'Alonzo, Angelo M Dell'Aquila, Giuseppe Gatti, Lenard Conradi, Andrea Ballotta, Mark Field","doi":"10.1093/bjsopen/zraf003","DOIUrl":"10.1093/bjsopen/zraf003","url":null,"abstract":"<p><strong>Background: </strong>Acute Stanford type A aortic dissection is a severe emergency condition that, if left untreated, is associated with a high mortality rate. The extent of surgical repair may impact the outcomes of these patients.</p><p><strong>Method: </strong>Patients operated for acute type A aortic dissection from a multicentre European registry were included. Patients were categorized based on the following types of surgical intervention: isolated ascending aortic replacement, ascending aortic replacement with concomitant aortic valve replacement, aortic root replacement, partial or total arch replacement, and partial or total arch replacement with concomitant aortic root replacement. The primary outcome was mortality rate, both in-hospital and at 10 years. Secondary outcomes were acute kidney injury requiring dialysis, neurological complications, a composite endpoint including in-hospital death, neurological complications and/or dialysis, and proximal endovascular or surgical aortic re-operations at 10 years.</p><p><strong>Results: </strong>3702 patients were included. The adjusted risk of in-hospital mortality was higher in all subsets of patients compared to those who underwent isolated ascending aortic replacement. The adjusted rates of in-hospital mortality ranged from 16.4% (95% c.i. 15.3 to 17.4) among patients who underwent isolated ascending aortic replacement to 27.7% (95% c.i. 23.3 to 31.2) among those who underwent aortic arch and concomitant aortic root replacement. The adjusted risks of neurological complications, renal replacement therapy and of the composite endpoint were significantly higher in patients who underwent partial/total aortic arch replacement. The adjusted risk estimates of 10-year mortality rate were markedly higher in patients who underwent partial/total aortic arch replacement with or without concomitant aortic root replacement. Extensive aortic repair did not significantly reduce the risk of distal or proximal aortic reoperations.</p><p><strong>Conclusion: </strong>These findings suggest that, when feasible, limiting the extent of aortic replacement for acute type A aortic dissection may be beneficial in reducing mortality rate and major complications both in the short and long term.</p><p><strong>Trial registration: </strong>ClinicalTrials.gov identifier: NCT04831073.</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/PMC11897881/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603761","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 carcinoembryonic antigen-targeted fluorescence and radio-guided cytoreductive surgery for peritoneal metastases of colorectal origin: single-arm confirmatory trial.","authors":"Aaya Darai, Jan Marie de Gooyer, Sander Ubels, Andreas J A Bremers, Philip R de Reuver, Erik H J G Aarntzen, Iris D Nagtegaal, Mark Rijpkema, Johannes H W de Wilt","doi":"10.1093/bjsopen/zraf045","DOIUrl":"10.1093/bjsopen/zraf045","url":null,"abstract":"<p><strong>Background: </strong>Selection of suitable candidates for intraoperative tumour detection and cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is important for improving outcomes for patients with colorectal peritoneal metastases. Previous research demonstrated the use of single-photon emission computed tomography (SPECT), intraoperative radiodetection, and near-infrared fluorescence (NIRF)-guided surgery with a dual-labelled 111In-labelled dodecane tetra-acetic acid (DOTA)-labetuzumab-IRDye800CW tracer to detect peritoneal metastases before operation. The aim of this study was to validate these results.</p><p><strong>Methods: </strong>A single-centre phase II study was conducted to evaluate the safety and feasibility of 111In-labelled DOTA-labetuzumab-IRDye800CW in patients with colorectal peritoneal metastases undergoing CRS-HIPEC. SPECT/computed tomography (CT) was undertaken before surgery, after intravenous administration of 10 mg 111In-labelled DOTA-labetuzumab-IRDye800CW (mean 101.25 MBq). During surgery, radiodetection and NIRF imaging were used for tumour detection. Adverse events were assessed, and tumour-to-background ratios (TBRs) and peritoneal cancer index scores were analysed.</p><p><strong>Results: </strong>Seven patients were included. No study-related severe adverse events were reported. Imaging before surgery revealed previously undetected metastases in one patient. The mean(standard deviation, s.d.) SPECT/CT peritoneal cancer index score was 3(2), and the intraoperative score was 14(7) (P = 0.032). A total of 52 lesions were removed during CRS, of which 37 were malignant. With NIRF imaging, 34 (92%) of 37 malignant lesions were detectable. Of 52 fluorescent lesions, 4 were false-positive. Mean(s.d.) fluorescence TBR was 3.4(1.8) and mean radiodetection TBR was 4.4(1.4).</p><p><strong>Conclusion: </strong>This study confirmed the safety and feasibility of multimodal image-guided surgery in patients with peritoneal metastases.</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/PMC12018875/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143961445","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":"Arterial resection and divestment in pancreatic cancer surgery in the era of multidisciplinary treatment: decadal comparative study.","authors":"Yuki Hirose, Atsushi Oba, Yosuke Inoue, Aya Maekawa, Kosuke Kobayashi, Kojiro Omiya, Atsushi Takahashi, Yoshihiro Ono, Takafumi Sato, Hiromichi Ito, Takafumi Mie, Takashi Sasaki, Masato Ozaka, Naoki Sasahira, Toshifumi Wakai, Yu Takahashi","doi":"10.1093/bjsopen/zraf026","DOIUrl":"https://doi.org/10.1093/bjsopen/zraf026","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to investigate the feasibility and effectiveness of pancreatectomy with arterial resection/divestment for pancreatic cancer with arterial involvement in the modern era of multidisciplinary treatment.</p><p><strong>Methods: </strong>Patients who underwent pancreatectomy with arterial resection/pancreatectomy with arterial divestment for pancreatic cancer with arterial involvement from 2010 to 2021 were retrospectively analysed, and outcomes were compared between the former (2010-2015) and latter interval (2016-2021). Survivals were compared by univariable and multivariable analyses.</p><p><strong>Results: </strong>Among 203 patients included, 76 underwent pancreatectomy with arterial resection and 127 underwent pancreatectomy with arterial divestment. Compared with the former interval, more patients received preoperative chemotherapy (26.6% (n = 21) versus 95% (n = 118), P < 0.001), and underwent pancreatectomy with arterial resection (30.4% (n = 24) versus 41.9% (n = 52), P = 0.287) in the latter interval. The major morbidity rate and pancreatic fistula decreased in the latter interval (major morbidity rate: P = 0.040; pancreatic fistula: P = 0.006), even among patients undergoing pancreatectomy with arterial resection (major morbidity rate: P = 0.013; pancreatic fistula: P < 0.001). Patients in the latter interval had better overall survival (26.0 versus 48.2 months, P = 0.001), even among patients undergoing pancreatectomy with arterial resection (22.0 versus 45.1 months, P = 0.076).</p><p><strong>Conclusions: </strong>Within the context of modern multidisciplinary treatment, radical resection including arterial resection should be justified for patients with pancreatic cancer with arterial involvement, considering the acceptable perioperative risk and prolonged survival.</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/PMC12005265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143967857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stoma versus no stoma prior to long-course neoadjuvant therapy in rectal cancer.","authors":"Gustav Sandén, Petrus Vinnars, Ingrid Ljuslinder, Johan Svensson, Martin Rutegård","doi":"10.1093/bjsopen/zrae169","DOIUrl":"10.1093/bjsopen/zrae169","url":null,"abstract":"<p><strong>Background: </strong>Large bowel obstruction is a possible complication in patients undergoing neoadjuvant treatment for rectal cancer; however, it may be prevented by placing a pretreatment defunctioning stoma. The aim of this retrospective study was to investigate complication rates in patients with rectal cancer undergoing long-course neoadjuvant therapy, comparing those with and without a prophylactic stoma.</p><p><strong>Methods: </strong>All patients with rectal cancer undergoing neoadjuvant therapy between 2007 and 2022 in Region Västerbotten, Sweden, were identified using the Swedish Colorectal Cancer Registry. Patients not planned for curative long-course neoadjuvant therapy and those requiring a stoma due to urgent bowel-related issues before treatment were excluded. The primary outcome was the incidence of complications between diagnosis and resection surgery or end of follow-up. The secondary outcomes were 30-day complications following resection, time to treatment (neoadjuvant therapy and surgery), and overall survival. Multivariable regression analysis was used, with adjustment for age, sex, American Society of Anesthesiologists fitness grade, and clinical tumour stage.</p><p><strong>Results: </strong>Of 482 identified patients, 105 were analysed after exclusion. Among these, 22.9% (24 of 105) received a pretreatment stoma, whereas 77.1% (81 of 105) received upfront neoadjuvant therapy. The complication incidence before resection in the group with a defunctioning stoma and in the group without a defunctioning stoma was 75.0% (18 of 24) and 29.6% (24 of 81) respectively. A considerable number of complications were directly caused by the stoma surgery. Patients in the stoma group had an adjusted OR of 6.71 (95% c.i. 2.17 to 20.76) for any complication. However, for 30-day complications following resection, an adjusted non-significant OR of 2.05 (95% c.i. 0.62 to 6.81) was documented for the stoma group, in comparison with the control group. Neoadjuvant treatment was also delayed for the stoma group (adjusted mean time difference: 21 (95% c.i. 14 to 27) days), whereas the difference was not significant for the time to resection surgery. The median survival after diagnosis was 4.7 years in the stoma group and 12.2 years in the control group (P = 0.015); however, adjustment in the multivariable analysis rendered the estimate non-significant (HR 1.71 (95% c.i. 0.93 to 3.14)).</p><p><strong>Conclusion: </strong>Patients with rectal cancer who receive a stoma before long-course neoadjuvant therapy, in the absence of urgent symptoms, experience more complications than those without a stoma and a delay with regard to the start of neoadjuvant treatment.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11913605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and validation of prediction models for sentinel lymph node status indicating postmastectomy radiotherapy in breast cancer: population-based study.","authors":"Miriam Svensson, Pär-Ola Bendahl, Sara Alkner, Emma Hansson, Lisa Rydén, Looket Dihge","doi":"10.1093/bjsopen/zraf047","DOIUrl":"10.1093/bjsopen/zraf047","url":null,"abstract":"<p><strong>Background: </strong>Postmastectomy radiotherapy (PMRT) impairs the outcome of immediate breast reconstruction in patients with breast cancer, and the sentinel lymph node (SLN) status is crucial in evaluating the need for PMRT. The aim of this study was to develop and validate models to stratify the risk of clinically significant SLN macrometastases (macro-SLNMs) before surgery.</p><p><strong>Methods: </strong>Women diagnosed with clinically node-negative (cN0) T1-2 breast cancer were identified within the Swedish National Quality Register for Breast Cancer (2014-2017). Prediction models and corresponding nomograms based on patient and tumour characteristics accessible before surgery were developed using adaptive least absolute shrinkage and selection operator logistic regression. The prediction of at least one and more than two macro-SLNMs adheres to the current guidelines on use of PMRT and reflects the exclusion criteria in ongoing trials aiming to de-escalate locoregional radiotherapy in patients with one or two macro-SLNMs. Predictive performance was evaluated using area under the receiver operating characteristic curve (AUC) and calibration plots.</p><p><strong>Results: </strong>Overall, 18 185 women were grouped into development (13 656) and validation (4529) cohorts. The well calibrated models predicting at least one and more than two macro-SLNMs had AUCs of 0.708 and 0.740, respectively, upon validation. By using the prediction model for at least one macro-SLNM, the risk could be updated from the pretest population prevalence of 13.2% to the post-test range of 1.6-74.6%.</p><p><strong>Conclusion: </strong>Models based on routine patient and tumour characteristics could be used for prediction of SLN status that would indicate the need for PMRT and assist decision-making on immediate breast reconstruction for patients with cN0 breast cancer.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"9 2","pages":""},"PeriodicalIF":3.5,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11977109/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143802320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}