BJS Open最新文献

{"title":"Mayo Clinic classification of presacral tumors: evolution of classifications and systematic review of pathologies.","authors":"William R G Perry, Scott R Kelley, Dovile Cerkauskaite, Maurish Fatima, Justin T Brady, Amit Merchea, John C Cheville, Rondell P Graham, Eric J Dozois","doi":"10.1093/bjsopen/zrag106","DOIUrl":"10.1093/bjsopen/zrag106","url":null,"abstract":"<p><strong>Background: </strong>Presacral tumours are rare, heterogeneous lesions. Historical classification systems for presacral tumours have provided a valuable framework, but were based on limited available data. This study aimed to develop a contemporary classification aligned with current tumour entities and clinical practice.</p><p><strong>Methods: </strong>A prospectively registered systematic review of surgically managed presacral tumours published from 1975 to 2025 was combined with a retrospective multisite institutional surgical pathology review from 1986 to 2025. Pathological descriptors were extracted, cross-referenced, harmonized to current terminology, and organized through multidisciplinary expert review to obtain a new classification.</p><p><strong>Results: </strong>The systematic review identified 5997 records, of which 203 studies met the inclusion criteria and contributed 181 pathological terms after generic and unclassifiable diagnoses were removed. Review of 3606 pathology reports identified 19 additional terms, bringing the total to 200 pathological terms. After harmonization to current terminology and exclusion of non-neoplastic processes, a contemporary classification was developed using biological descriptors: developmental versus acquired origin; tissue lineage (neurogenic, osseous/haematopoietic, soft tissue, or miscellaneous); and tumour behaviour (benign, locally recurrent without metastatic potential, locally recurrent with low metastatic potential, malignant non-sarcoma, or malignant sarcoma).</p><p><strong>Conclusion: </strong>The Mayo Clinic classification of presacral tumours updates historical systems by reflecting the broader, more modern spectrum of neoplasms and distinguishing lesions by lineage and biological behaviour. It may improve diagnostic clarity, communication, and selection of appropriate observation, multidisciplinary assessment, and treatment pathways.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13501542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148807924","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":"Personalised decision-making in hepatocellular carcinoma: conceptual evolution over two decades.","authors":"Alessandro Vitale, Gordon Guyatt, Masatoshi Kudo, Laura Kulik, David J Pinato, Laura Crocetti, Edoardo G Giannini, Umberto Cillo","doi":"10.1093/bjsopen/zrag113","DOIUrl":"10.1093/bjsopen/zrag113","url":null,"abstract":"<p><strong>Background: </strong>Evidence-based medicine (EBM) was conceived to support decisions for individual patients by integrating the best available evidence, clinical expertise, and patient values. However, the application of EBM in many fields has become associated with rigid algorithms and guideline pathways, sometimes interpreted as prescriptive rather than as aids to decision-making. Hepatocellular carcinoma (HCC) offers an informative case study of this dichotomy. This paper traces the evolution of personalized decision-making in HCC over two decades and its implications for the future of EBM.</p><p><strong>Methods: </strong>This is a narrative, conceptual review. Rather than a systematic synthesis, it draws selectively on landmark staging frameworks, guidelines, and methodological literature to construct a schematic account of how clinical reasoning in HCC has evolved.</p><p><strong>Results: </strong>HCC decision-making has evolved through a sequence of schematic frames: from stage-centred algorithms (the Ptolemaic frame), to recognition of differential treatment effects (the Copernican shift), to multiparametric expert deliberation (the Newtonian perspective), and finally to dynamic, time-dependent, bidirectional strategies (the Einsteinian perspective). The expansion of systemic immunotherapy options has reinforced this bidirectional logic while complicating stage reassessment. This trajectory culminates in a Heisenberg moment, in which uncertainty is acknowledged as intrinsic to individual decisions. The multiparametric therapeutic hierarchy, developed within multidisciplinary HCC practice, reflects this maturation towards a personalized, transparent, context-sensitive approach.</p><p><strong>Conclusion: </strong>HCC is a paradigmatic example of personalized decision-making in complex, multidisciplinary care. The future of EBM lies not in choosing between algorithms and personalization, but rather in transparent approaches that apply evidence rigorously while acknowledging uncertainty and respecting patient values and local context.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13459033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705023","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":"Evaluating quality of colorectal cancer surgery across elective and emergency health systems: secondary analysis of prospective cohort studies in 95 countries.","authors":"Sivesh K Kamarajah, Adewale O Adisa, Ajay Aggarwal, Alazar Berhe, James Glasbey, Ewen Harrison, Parvez D Haque, Ismail Lawani, Sonia Mathai, Ana Minaya Bravo, C S Pramesh, April C Roslani, Chris Varghese, Aneel Bhangu","doi":"10.1093/bjsopen/zrag062","DOIUrl":"10.1093/bjsopen/zrag062","url":null,"abstract":"<p><strong>Background: </strong>The Lancet Oncology Commission on Global Cancer Surgery recommended that access to and the quality of surgical care be improved. This study aimed to understand differences in surgical quality between emergency and elective resection among patients with potentially curative colorectal cancer.</p><p><strong>Methods: </strong>This preplanned secondary analysis included patients undergoing only curative-intent surgery for colorectal cancer from three contemporary global prospective cohort studies (GlobalSurg-3, 5506 patients; CovidSurg-Cancer, 6719 patients; APOLLO, 876 patients) registered from 2018 to 2023. Hierarchical multilevel logistic regression models quantified associations between the urgency of surgery (elective versus emergency) and surgical quality, measured by margin-positive resection, adjusting for patient, disease, and health system factors. Bootstrap multivariable simulations evaluated effect modification by country income level, cancer stage, and location.</p><p><strong>Results: </strong>Of the 45 699 patients registered, 13 101 across 95 countries were included in this analysis. Overall, 678 patients (5.4%) had margin-positive resections, with higher rates in the emergency than elective surgery group (13.7 versus 4.5%; P < 0.0001). In adjusted multilevel models, emergency surgery was associated with increased odds of margin-positive resections (adjusted odds ratio 2.45, 95% confidence interval (c.i.) 1.86 to 3.22), consistent across all country income groups and robust to alternative health system indicators. Bootstrap-derived absolute risk differences revealed the greatest disparities in patients with stage III-IV rectal cancers, with absolute differences of 12.6% (95% c.i. 10.2 to 15.7) in high-income countries, 19.0% (95% c.i. 13.6 to 23.9) in upper middle-income countries, and 14.1% (95% c.i. 10.9 to 16.5) in lower middle- and low-income countries. Variance decomposition demonstrated that hospital- and country-level factors accounted for 76% of the explained variation in surgical quality.</p><p><strong>Conclusion: </strong>Emergency surgery was associated with a two- to threefold increase in the risk of margin-positive resections globally, independent of resource availability, highlighting a neglected area of global surgical practice. These findings challenge the assumption that poorer outcomes after emergency surgery are due to advanced disease stage. For patients presenting as an emergency with potentially curative resection, enhanced decision-making around resectability, ensuring specialist surgeon availability, and developing bridge-to-surgery pathways represent immediate, low-cost strategies to improve global cancer outcomes.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13389820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547609","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":"Socioeconomic, ethnic and geographical disparities in revascularization rates for peripheral arterial disease in England.","authors":"Ravi Maheswaran, Thaison Tong, Jonathan Michaels, Paul Brindley, Stephen Walters, Shah Nawaz","doi":"10.1093/bjsopen/zrag081","DOIUrl":"10.1093/bjsopen/zrag081","url":null,"abstract":"<p><strong>Background: </strong>There are disparities in the prevalence of peripheral arterial disease (PAD). This study examined socioeconomic, ethnic, and geographical variations in population-based revascularization rates for PAD and the associations between these rates and PAD-related major lower limb amputation.</p><p><strong>Methods: </strong>Hospital admissions in England (April 2008-March 2018) for revascularization for moderate and severe PAD, and for major lower limb amputation, were examined using a population-based study design and Poisson and logistic regression.</p><p><strong>Results: </strong>In the 10-year time span, there were 309 839 revascularization admissions (44% severe PAD, 56% moderate PAD; > 90% White ethnicity) and 38 601 major lower limb amputations from a population aged ≥ 25 years of 36 million. Overall, 39.9% of patients with amputation had previously had revascularization. Revascularization rates for moderate and severe PAD and amputation rates increased with increasing socioeconomic deprivation. The ratio of amputations to revascularizations also increased with increasing deprivation, and patients admitted for revascularization from more deprived areas had more severe PAD. Revascularization rates for patients of Black ethnicity were generally substantially lower than those for patients of White ethnicity, the only exception being for severe PAD in patients aged ≥ 65 years. The amputation rate was also lower but the ratio of amputations to revascularizations, and the percentage of revascularization admissions with severe PAD, were higher for patients of Black relative to White ethnicity. Revascularization and amputation rates were substantially lower, and the ratio of amputations to revascularizations was also lower, for patients of Asian relative to White ethnicity, but patients of Asian ethnicity admitted for revascularization had a marginally higher percentage of severe PAD. There was substantial variation in revascularization and amputation rates across Integrated Care Board areas, with high rates in the North and in parts of the Midlands and South West. There was also wide variation in the ratio of amputations to revascularizations.</p><p><strong>Conclusion: </strong>There were substantial socioeconomic, geographical and ethnic disparities in revascularization rates in England.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13439130/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148673029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncological outcomes and treatment characteristics of patients with cT3-4 mesorectal fascia positive rectal cancer operated in 2016: Dutch nationwide cohort with standardized magnetic resonance imaging re-assessment.","authors":"Julie E E A Guicherit, Eline G M van Geffen, Tania C Sluckin, Sanne-Marije J A Hazen, Jacobus W A Burger, Joost Nederend, Jan Willem T Dekker, Johannes H W de Wilt, Cornelis Verhoef, Andreas W K S Marinelli, Jarno Melenhorst, Monique Maas, Pieter J Tanis","doi":"10.1093/bjsopen/zrag100","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag100","url":null,"abstract":"<p><strong>Background: </strong>Rectal cancer with mesorectal fascia involvement (MRF+) requires neoadjuvant downstaging and/or induction therapy, followed by (beyond) total mesorectal excision and/or multivisceral resection (MVR) depending on response. Decisions on the need for MVR and plane of dissection vary. This nationwide cross-sectional study aimed to evaluate treatment and oncological outcomes in MRF+ primary rectal cancer and the impact of MVR types.</p><p><strong>Methods: </strong>Using collaborative research, extensive clinical data on all rectal cancer resections in 2016 across 67 Dutch hospitals were retrospectively collected. Patients with cT3-4 MRF+ primary rectal cancer and standardized re-assessment of primary and restaging magnetic resonance imaging were selected. Patients were categorized by radiologically involved structures or organs and by MVR type. The primary outcome measures were microscopically positive margin (R1) resection rate, 4-year cumulative local recurrence, and 4-year overall survival.</p><p><strong>Results: </strong>Of 3178 patients registered, 571 cT3-4 MRF+ were selected resections, 125 of which were MVR. Tumours remained MRF+ on restaging magnetic resonance imaging in 76.4%. The overall R1 rate was 11.8% (9.7% in cT3/4a MRF+ and 17.9% in cT4b tumours). The R1 rate after MVR was 20.8%. Overall, the 4-year local recurrence rate was 15.1% and 4-year overall survival 67.5%. When comparing total mesorectal excision with MVR and/or beyond total mesorectal excision, the local recurrence rate was 12.7% versus 24.2% (P = 0.001), and overall survival 71.3% versus 53.7% (P < 0.001). Patients with radiological anterior involvement seemed to have a higher R1 rate compared with other locations. Anterior resections in both men and women appeared to be associated with relatively low local recurrence and high overall survival, whereas other resections resulted in numerically lower R1 rates, but worse long-term oncological outcomes. However, neither anatomical location of MRF+ and/or ingrowth nor MVR type was significantly associated with the primary outcomes. Pelvic sepsis (hazard ratio 1.533, 95% confidence interval 1.0 to 2.3) and positive margins (hazard ratio 1.837, 1.2 to 2.8) were independent predictors of worse overall survival.</p><p><strong>Conclusion: </strong>Oncological outcomes of MRF+ rectal cancer were not significantly influenced by the anatomical location of MRF involvement or MVR type.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148757377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-based differences in mortality and failure to rescue after major gastrointestinal cancer resections: real-world evidence from a nationwide cohort.","authors":"Rene Mantke, Ulrike Weber, Markus W Büchler, Richard Hunger","doi":"10.1093/bjsopen/zrag067","DOIUrl":"10.1093/bjsopen/zrag067","url":null,"abstract":"<p><strong>Background: </strong>Sex-based differences in outcomes after oncological surgery remain underexplored despite growing interest in personalized and equitable cancer care. Sex differences in in-hospital mortality and failure-to-rescue rates after major gastrointestinal cancer surgery were analysed using nationwide real-world data.</p><p><strong>Methods: </strong>German Diagnosis Related Groups discharge data from 2010-2023 were analysed, including adult patients undergoing curative-intent resections for colorectal, gastric, pancreatic, and oesophageal cancers. Multivariable generalized linear models were applied to estimate adjusted sex-specific risks of in-hospital mortality and failure to rescue.</p><p><strong>Results: </strong>Among 870 754 patients (376 883, 43.3% women), the overall in-hospital mortality rate was 5.9%. Women had lower adjusted odds of death (20 343 (5.4%) versus 31 265 (6.3%); adjusted odds ratio 0.82, 95% confidence interval 0.81 to 0.84) and failure to rescue (18 097 of 151 616 (11.9%) versus 28 583 of 231 245 (12.4%); adjusted odds ratio 0.92, 0.89 to 0.94) compared with men. The mortality advantage for women was consistent across cancer sites except for oesophageal resection. Temporal analyses showed a continuous decline in mortality and failure to rescue for both sexes over the 14-year study period.</p><p><strong>Conclusion: </strong>Female sex was independently associated with lower in-hospital mortality and failure-to-rescue rates after major gastrointestinal cancer surgery in routine clinical practice. Male sex was associated with a higher risk of adverse short-term outcomes, identifying men as a higher-risk group in routine oncological surgical care. Although causal mechanisms cannot be inferred, the results suggest the need for sex-informed perioperative management and rescue strategies to improve the quality of oncological surgical care.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13329962/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148374427","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":"Single-stapling versus double-stapling technique for rectal anastomosis-meta-analysis.","authors":"Dimitrios Kehagias, Charalampos Lampropoulos, Ioannis Kehagias, David Jayne, Jim Tiernan","doi":"10.1093/bjsopen/zrag078","DOIUrl":"10.1093/bjsopen/zrag078","url":null,"abstract":"<p><strong>Introduction: </strong>The single-stapling technique (SST) is an alternative to the conventional double-stapling technique (DST), particularly in low rectal surgery. This systematic review and meta-analysis compared anastomotic leak (AL) between SST and DST.</p><p><strong>Methods: </strong>A systematic review of the PubMed/MEDLINE, Google Scholar®, and Scopus databases was conducted in accordance with PRISMA guidelines from inception through December 2025. The primary outcome of interest was AL. A random-effects meta-analysis was used to compare AL, blood loss, operative time, and length of hospital stay between SST and DST. Risk ratios (RRs) were calculated for dichotomous outcomes and mean differences or standardized mean differences were calculated for continuous outcomes. Sensitivity and subgroup analyses were conducted according to surgical approach. Risk of bias was assessed, and the certainty of the evidence for AL was evaluated using the GRADE framework.</p><p><strong>Results: </strong>Of 448 articles screened, 14 were included (2 randomized, 12 observational studies), comprising 1326 patients in the SST group and 1720 in the DST group. SST was associated with a significantly lower risk of AL than DST (RR 0.61; 95% confidence interval 0.42 to 0.90; P = 0.012), with moderate heterogeneity. Sensitivity analysis excluding studies with zero events yielded consistent results. Subgroup analyses showed no difference in AL for open intracorporeal SST compared with DST, a trend toward benefit with minimally invasive intracorporeal SST compared with DST, and a pronounced reduction in AL with transanal SST compared with DST.</p><p><strong>Conclusions: </strong>Although the causes of AL are multifactorial, with respect to the stapling technique, SST was associated with a lower risk of AL than DST, and this effect was primarily driven by transanal SST. However, the certainty of evidence is low, and ongoing prospective studies will better define the role of SST.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331353/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381438","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":"Liver perfusion failure after pancreatoduodenectomy: clinical significance and perioperative risk factors.","authors":"Mohammed Al-Saeedi, Julian M Deisenhofer, Hendrik B Sauer, Leonie Frank-Moldzio, Alina S Ritter, Tom Bruckner, Gabriel A Salg, Ali Ramouz, Philipp Mayer, Thomas Hank, Arianeb Mehrabi, Martin Loos, Thilo Hackert, Markus W Büchler, Oliver Strobel","doi":"10.1093/bjsopen/zrag056","DOIUrl":"10.1093/bjsopen/zrag056","url":null,"abstract":"<p><strong>Background: </strong>The definition of liver perfusion failure (LPF) following pancreatic surgery and its perioperative risk factors remain unclear. This study aimed to define clinically significant LPF among patients undergoing partial pancreatoduodenectomy (PD) or total pancreatoduodenectomy (TP) and to identify perioperative risk factors associated with its incidence.</p><p><strong>Method: </strong>Patients undergoing partial PD/TP between 2014 and 2017 were identified from a prospectively maintained database. Various criteria for identifying LPF over time (that is, on postoperative days 1-4) were evaluated for clinical significance based on their association with liver-specific complications. Univariable and multivariable analyses were performed to determine the association of LPF with relevant outcome parameters and perioperative risk factors.</p><p><strong>Results: </strong>In the analysis of 815 patients, the optimal LPF model was identified as an increase in liver enzymes (alanine aminotransferase (ALT) and aspartate aminotransferase (AST)) ≥ 200 U/l for two consecutive days (LPF_2d). LPF severity was categorized as no LPF (AST/ALT < 200 U/l), mild (AST/ALT ≥ 200-< 500 U/l), moderate (AST/ALT ≥ 500-< 1000 U/l), and severe (AST/ALT ≥ 1000 U/l). In all, 81 patients were identified with LPF: 29 (3.6%), 29, and 23 with mild, moderate, and severe LPF, respectively. The occurrence of LPF was significantly associated with postoperative outcomes, including liver-specific complications, liver failure, need for radiological interventions, length of intensive care unit stay, and 90-day mortality. Multivariable analysis identified coeliac axis stenosis, arterial resection, and duration of the operation as independent risk factors for LPF.</p><p><strong>Conclusion: </strong>LPF is an underrated and serious postoperative complication in patients undergoing partial PD or TP. Based on the proposed definition (LPF_2d), LPF occurs in 9% of patients, is clinically relevant, and is associated with postoperative complications.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13387168/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547621","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":"Of surgical dogma and lemonade: managing the drain left after pancreatoduodenectomy.","authors":"Colin M Court, Julie Hallet","doi":"10.1093/bjsopen/zrag104","DOIUrl":"10.1093/bjsopen/zrag104","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13440555/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148676985","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 of a predictive model for postoperative body mass index and diabetes outcomes after metabolic bariatric surgery: retrospective cohort study.","authors":"Vincent Ochs, Lars Kollmann, Ilan Rosenblum, Adisa Poljo, Andreas Heule, Bassey Enodien, Maryna Chumakova-Orin, Eric J DeMaria, Emanuel Burri, Reinhard Stoll, Otto Kollmar, Robert Rosenberg, Pascal Probst, Markus K Muller, Stephanie Taha-Mehlitz, Beat P Müller, Daniel M Frey, Piotr Kalinowski, Marta Przybysz, Mateusz Bartkowiak, Muhammed Said Dalkilic, Abdullah Sisik, Rodrigo Otavio Carvalho De Oliveria, Fatima Martins, Erik Stenberg, Ellen Andersson, Torsten Olbers, Sven Flemming, Florian Seyfried, Florian Ponholzer, Annemarie Weissenbacher, Dietmar Öfner, Johanna Betzler, Mirko Otto, Ralph Peterli, Philippe C Cattin, Anas Taha","doi":"10.1093/bjsopen/zrag054","DOIUrl":"10.1093/bjsopen/zrag054","url":null,"abstract":"<p><strong>Background: </strong>Predicting postoperative body mass index (BMI) trajectories and long-term type 2 diabetes (T2D) remission after bariatric surgery remains challenging. Existing models often rely on baseline variables only and fail to incorporate dynamic postoperative changes. This study aimed to develop and validate a multicentre machine-learning framework that predicts individualized BMI trajectories and T2D remission using routinely available preoperative data and time-dependent weight evolution.</p><p><strong>Methods: </strong>This multicentre retrospective cohort study included adult patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy across 11 European centres (2012-2023). Variables with > 30% missing data were excluded; remaining missing values were imputed iteratively. A two-stage approach was used: a regression model predicting postoperative BMI at 3-60 months using an autoregressive design; and a classification model predicting T2D remission using baseline features and predicted BMI trajectories. Internal performance was evaluated with ten-fold and leave-one-clinic-out cross-validation; external validation used an independent cohort from Linköping, Sweden.</p><p><strong>Results: </strong>Of the 11 457 patients initially identified, 9652 patients with complete baseline and follow-up information were used for the analysis. The best BMI model (HistGradientBoosting) achieved a root mean square error (RMSE) of 1.11 kg/m2 (95% confidence interval 1.07 to 1.14) and a mean absolute error (MAE) of 0.62 kg/m2 across clinics; external testing showed an RMSE of 1.12 kg/m2 (95% confidence interval 1.11 to 1.12) and an MAE of 0.63 kg/m2. The T2D remission classifier (XGBoost) obtained a Macro F1 score of 0.88 (precision 0.87, recall 0.88), with an external F1 score of 0.89. Incorporating predicted BMI trajectories improved discrimination compared with baseline-only models (C-index 0.95 versus 0.93).</p><p><strong>Conclusion: </strong>A two-stage machine-learning framework has high predictive performance for postoperative BMI and T2D remission up to 5 years after bariatric surgery. Dynamic incorporation of predicted weight trajectories enhances metabolic risk prediction and supports individualized counselling and postoperative management.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 4","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13331347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381503","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}