BJS Open最新文献

{"title":"Prognostic importance of tumour deposits with and without concurrent lymph node metastases in patients with stage III colon cancer.","authors":"Clara Brinkmann, Andreas H Nordholm, Peter-Martin Krarup, Nis H Schlesinger, Anisoara Iordache, Camilla Qvortrup, Henry G Smith","doi":"10.1093/bjsopen/zrag112","DOIUrl":"10.1093/bjsopen/zrag112","url":null,"abstract":"<p><strong>Background: </strong>Tumour deposits (TD) are associated with poor prognosis in patients with colon cancer. However, the current staging system only acknowledges TD in patients without lymph node metastases (LNM). This study investigated the prognostic impact of TD with or without LNM in patients with stage III colon cancer.</p><p><strong>Methods: </strong>This was a national retrospective cohort study using the Danish Colorectal Cancer Group database, including patients with stage III colon cancer who underwent curative surgery between 2017 and 2022. Patients were stratified into 3 groups: TD alone; LNM alone; and TD and LNM. The primary endpoint was overall survival (OS).</p><p><strong>Results: </strong>Of the 18 395 patients registered during the study period, 10 241 underwent surgery with curative intent and 9807 had a TD assessment. Of the 3543 stage III CRC patients included, 1091 had TD (30.8%). Of these, 884 had TD and LNM (25.0%), whereas 207 had TD alone (5.8%). Patients with TD and LNM had significantly poorer survival than those with LNM alone (5-year OS 52.2% versus 69.2%; P < 0.001). On subgroup analyses, the presence of TD was associated with poorer OS across all N categories. On multivariable analysis, TD was independently associated with all-cause mortality (hazard ratio 1.25; 95% confidence interval 1.08 to 1.43; P = 0.002). Patients with TD only were significantly less likely to receive adjuvant chemotherapy than those with LNM or TD and LNM (42.5% versus 52.2% and 55.9%, respectively; P = 0.002).</p><p><strong>Conclusion: </strong>TD are common in patients with stage III colon cancer and are associated with poorer prognosis across all N categories.</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/PMC13482985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787236","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":"The fate of the contralateral limb after major lower limb amputation for peripheral arterial disease or diabetes mellitus.","authors":"Robert J Leatherby, Bilal Azhar, Arsalan Wafi, Luis Ribeiro, Peter Holt, Iain Roy","doi":"10.1093/bjsopen/zrag134","DOIUrl":"10.1093/bjsopen/zrag134","url":null,"abstract":"<p><strong>Background: </strong>The contralateral limb is at risk after major lower limb amputation (MLLA) for peripheral arterial disease or diabetes mellitus due to the systemic nature of these diseases, with a subsequent bilateral MLLA required in over 10% of patients. The present study aims to determine the natural history of the contralateral limb after MLLA for peripheral arterial disease or diabetes.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study of patients undergoing MLLA for peripheral arterial disease or diabetes between January 2013 and July 2023 was performed. The primary outcome was clinically relevant contralateral limb disease (CR-CLD), defined as symptomatic disease of the contralateral limb or asymptomatic disease requiring prophylactic intervention. Statistical analysis used both survival analysis and competing risk modelling techniques.</p><p><strong>Results: </strong>A total of 531 patients were included, with 175 (33%) going on to develop CR-CLD. The leading aetiology was chronic limb-threatening ischaemia, with 79.7% of these patients presenting with tissue loss. A total of 67% of CR-CLD presented by 1 year and 81% by 2 years after index MLLA. A diagnosis of diabetes, chronic peripheral arterial disease, ischaemic heart disease, and previous contralateral vascular intervention were identified as independent risk factors for the development of CR-CLD on multivariable analysis. A total of 72.6% of patients with CR-CLD underwent intervention, 28.6% of these requiring contralateral MLLA. For those not undergoing intervention, 56.3% were turned down due to co-morbidity or frailty.</p><p><strong>Conclusion: </strong>CR-CLD after MLLA is common, and presents early after index MLLA but with late-stage clinical disease. High-risk groups are identifiable. Outcomes are poor, with many patients undergoing a contralateral MLLA or being palliated.</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/PMC13487630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787792","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 thromboprophylaxis timing and duration on thromboembolism and bleeding in metabolic bariatric surgery.","authors":"Martin Löfling Skogar, Martina Azzurra Branciforte, Erik Stenberg","doi":"10.1093/bjsopen/zrag097","DOIUrl":"10.1093/bjsopen/zrag097","url":null,"abstract":"<p><strong>Background: </strong>Patients undergoing metabolic bariatric surgery are at risk of both venous thromboembolism (VTE) and bleeding complications, but the optimal thromboprophylaxis strategy remains uncertain. Therefore, this retrospective cohort study evaluated perioperative outcomes depending on the perioperative thromboprophylaxis strategy.</p><p><strong>Methods: </strong>This study used data from the validated nationwide Scandinavian Obesity Surgery Registry, including all primary bariatric procedures in Sweden between 2008 and 2023. Exposures were timing of initiation (preoperative, postoperative, other) and the duration of thromboprophylaxis (< 7, 7-10, 11-14, or > 14 days). The primary outcome was VTE; secondary outcomes were intraoperative and postoperative bleeding. Outcomes were analysed using logistic regression models, adjusting for demographic, clinical, and surgical covariates.</p><p><strong>Results: </strong>Among 83 801 patients (76.9% female, mean age 40.9 years, mean body mass index 41.8 kg/m2), the incidences of VTE, intraoperative bleeding, and postoperative bleeding were 0.1% (76 patients), 0.7% (577), and 1.6% (1373), respectively. No statistically significant associations were observed between the timing of thromboprophylaxis and VTE, or between thromboprophylaxis duration and either VTE or postoperative bleeding. Initiation of prophylaxis after surgery was associated with a lower risk of intraoperative bleeding than preoperative initiation (odds ratio 0.52; 95% confidence interval 0.37 to 0.74). Risk factors for VTE included previous VTE, intraoperative bleeding, and longer operating time, whereas risk factors for postoperative bleeding included higher age, male sex, cardiovascular co-morbidity, and antidepressant use.</p><p><strong>Conclusion: </strong>The overall incidence of thrombotic complications after metabolic bariatric surgery was low, whereas bleeding events were more common. Compared with preoperative thromboprophylaxis initiation, postoperative initiation was associated with reduced intraoperative bleeding, whereas no increase in VTE was detected.</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/PMC13387167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547599","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":"Rationale and design of the SENTRY trial: sentinel node and organ-preserving surgery versus segmental resection in stage I colon cancer.","authors":"Bart C T van de Laar, Daan J Sikkenk, Pieter J Tanis, Paul M Verheijen, Matthijs P Schwartz, Halil Akol, René Arensman, Frank J Voskens, Leon M G Moons, Wouter H de Vos Tot Nederveen Cappel, Henderik L van Westreenen, Wouter B Nagengast, Esther C J Consten","doi":"10.1093/bjsopen/zrag075","DOIUrl":"10.1093/bjsopen/zrag075","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/PMC13387154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148547630","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":"Using Bayesian event probabilities for monitoring clinical quality assurance.","authors":"Edward H Livingston, Ami Hayashi, Kyle D Klingbeil, Anne Y Lin","doi":"10.1093/bjsopen/zrag082","DOIUrl":"10.1093/bjsopen/zrag082","url":null,"abstract":"<p><strong>Background: </strong>Current systems used to monitor clinical quality metrics are expensive and use, not used outdated statistical methodologies. The aim of this study was to develop and test a Bayesian approach for continuous monitoring of clinical outcomes using information easily obtained from the electronic medical record.</p><p><strong>Methods: </strong>An algorithm was developed with the assistance of artificial intelligence to extract surgical outcomes data from electronic medical records and to then calculate the posterior probability distribution for complication occurrence. A test data set was created from a retrospective analysis of the complete medical records of patients receiving surgical care at UCLA Health between 1 January 2016 and 22 September 2024. The 20 most performed inpatient colorectal operations were considered the index cases for the 'major colorectal procedures' group. Complications were identified by diagnostic codes in the medical record and attributed to the index procedure if diagnosed within 1 year after surgery. Bayesian regression was used to determine the posterior probability of complication occurrence for comparison with pre-established acceptability thresholds. A > 50% probability of complication occurrence exceeding the threshold would trigger a quality assurance review for that complication during the period of interest.</p><p><strong>Results: </strong>There were 747 patients who underwent major colorectal operations. Postoperative ileus (7.4%) and anastomotic leak (3.9%) were the most common complications, whereas postoperative bleeding was rare (0.3%). Of the ten complications tracked, the number triggered for chart review ranged from a low of two in 2016 to six in 2022. The largest number of excess complications triggering review was three in any year.</p><p><strong>Conclusion: </strong>A system for real-time monitoring of complications was modelled from retrospective data. It successfully identified time periods in which the probability distribution for experiencing complications exceeded pre-established thresholds, identifying a need for chart review. A Bayesian event probability tracker will be inexpensive to implement, could track clinical outcomes in near real-time (facilitating data review whenever it is desired), and is statistically valid.</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/PMC13381787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519774","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":"Lifestyle-related risk factors and recurrence after ventral hernia surgery: nationwide registry and survey study.","authors":"Sofie Anne-Marie Skovbo Jensen, Siv Fonnes, Anders Gram-Hanssen, Hanne Tønnesen, Hugin Reistrup, Jacob Rosenberg, Susanne Vahr Lauridsen, Sara Nørgård Jensen, Jason Joe Baker","doi":"10.1093/bjsopen/zrag098","DOIUrl":"10.1093/bjsopen/zrag098","url":null,"abstract":"<p><strong>Background: </strong>The study evaluated the associations of individual and combined lifestyle-related risk factors with long-term recurrence after primary and incisional ventral hernia repair compared with patients without lifestyle-related risk factors.</p><p><strong>Methods: </strong>This nationwide study used registry and survey data from Danish patients who underwent ventral hernia repair between 2014 and 2024. Patients were identified in the Danish National Patient Register, after which digital surveys were distributed. Survey data on recurrence and lifestyle factors were linked with data from the Danish Ventral Hernia Database and Danish National Patient Register. The outcome was hernia recurrence (reoperation or self-reported). Average treatment effects were estimated using adjusted logistic regression and standardization (G-computation).</p><p><strong>Results: </strong>In total, 18 959 patients were included in the study, comprising 15 186 patients undergoing primary ventral repair and 3773 undergoing incisional hernia repair (response rate 78%). More than half the patients reported one or more lifestyle-related risk factors. For primary ventral hernia repair, the adjusted population-averaged recurrence prevalence was 14% without lifestyle-related risk factors. Smoking, obesity, and their combination were associated with a higher recurrence prevalence, with absolute differences of 3% (95% confidence interval (c.i.) 0% to 5%), 3% (95% c.i. 2% to 5%), and 6% (95% c.i. 2% to 10%), respectively. Other lifestyle combinations showed similar trends but were less consistently significant across analyses. For incisional hernia repair, the adjusted population-averaged recurrence prevalence was 25% without lifestyle-related risk factors. Smoking and obesity were associated with absolute increases in recurrence prevalence of 6% (95% c.i. 0% to 11%) and 5% (95% c.i. 1% to 9%), respectively.</p><p><strong>Conclusions: </strong>Smoking and obesity were associated with a higher recurrence prevalence after primary ventral and incisional hernia repair. Associations for combined lifestyle factors were less consistent overall. Given the number of analyses performed, the findings should be interpreted with caution.</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/PMC13459032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148705366","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":"Implications and risk of new versus persisting intraductal papillary mucinous neoplasms after pancreatic surgery: meta-analysis.","authors":"Anouk J van Bodegraven, Katharina M Marstaller-Walz, Virginia Padoan, Danhui Heo, Giampaolo Perri, George L Burchell, Martin Loos, Christoph W Michalski, Marc G Besselink, Umberto Cillo, Ingmar F Rompen, Giovanni Marchegiani","doi":"10.1093/bjsopen/zrag087","DOIUrl":"10.1093/bjsopen/zrag087","url":null,"abstract":"<p><strong>Background: </strong>Interpretation of recurrence following resection of intraductal papillary mucinous neoplasms (IPMNs) is hindered by inconsistent terminology and outcome reporting. A distinction between metachronous/de novo IPMN development, progression of residual disease, and true recurrence of invasive entities is rarely considered.</p><p><strong>Methods: </strong>A systematic review and meta-analysis were conducted following PRISMA and Cochrane guidelines (PROSPERO-ID: 1009399). The primary endpoint was postoperative recurrence of non-invasive IPMN and IPMN-derived pancreatic cancer (PC). Recurrence following resection of non-invasive IPMN was reclassified as progression of persistent cysts or de novo metachronous IPMN. Secondary endpoints comprised risk-factors for recurrence.</p><p><strong>Results: </strong>Sixty-six articles with 11 464 patients were included. After a median follow-up of 26 (interquartile range (i.q.r.) 18.0-53.0) to 72 (i.q.r. 5-318) months, the recurrence rate of IPMN-derived PC was 41.9% (1646/3925 patients), with a 5-year pooled recurrence-free survival of 46.6%. Systemic recurrence was most common (1034/1646; 62.8%), followed by locoregional (430/1646; 26.1%). Secondary treatments were administered in 655/1646 patients (39.8%) presenting with recurrence and included chemotherapy (65.5%), surgery (22.1%) and radiation (5.8%). Lymph node involvement (hazard ratio 2.87, 95% confidence interval 1.51 to 5.43) and tubular subtype (hazard ratio 1.68, 1.16 to 2.43) were identified as independent predictors of recurrence-free survival. The overall recurrence rate following pancreatic resection of non-invasive IPMN was 11.2% (831/7446), after median follow-up of 28 (i.q.r. 1-153) to 114 (i.q.r. 12-204) months. Among these, 408 (49.1%) developed as de novo lesions in the remnant pancreas and 174 (20.9%) as progression of pre-existing cyst detected at the time of index surgery; the remaining 249 patients (30.0%) could not be reclassified. Non-invasive recurrence was more common (308; 37.1%) than IPMN-derived PC (118; 14.2%), whereas the type of recurrence was unspecified in 405 patients (48.7%). Secondary treatment data were available for 265 patients, of whom 131 (49.4%) underwent reoperation.</p><p><strong>Conclusion: </strong>The recurrence rate of IPMN-derived PC is high and warrants close surveillance policies. The majority of 'recurring' non-invasive IPMNs are de novo lesions. Standardized reporting, distinguishing true recurrence from de novo development and progression of residual disease, is essential to stratify recurrence risk and optimize surveillance protocols accurately.</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/PMC13361978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148434989","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":"Enhanced recovery after surgery compliance and postoperative outcomes after liver resection: retrospective cohort study.","authors":"Valerie Isabel Nottberg, Eleanor Nottberg, Victoria van Rüth, Freya Brodersen, Alina S Ritter, Jan Bardenhagen, Julia Auinger, Parisa Moll-Khosrawi, Jakob R Izbicki, Maximilian Bockhorn, Thilo Hackert, Tarik Ghadban, Asmus Heumann","doi":"10.1093/bjsopen/zrag066","DOIUrl":"10.1093/bjsopen/zrag066","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) pathways improve postoperative outcomes across surgical specialties, but the impact of ERAS compliance on outcomes after liver resection remains unclear. A retrospective cohort study of consecutive patients undergoing liver resection in an ERAS-certified centre was conducted to examine the association between overall and item-specific ERAS compliance and postoperative morbidity and length of hospital stay (LOS).</p><p><strong>Methods: </strong>This retrospective cohort included elective liver resections performed between 2020 and 2024 at an ERAS-certified centre of excellence. ERAS compliance was prospectively recorded and categorized as high (≥ 70%) versus low/moderate (< 70%). Primary outcomes were any postoperative complication, major morbidity (Clavien-Dindo grade ≥ IIIa), and LOS; these were assessed by univariable and multivariable analyses, including a sensitivity analysis using an early compliance score excluding postoperative items.</p><p><strong>Results: </strong>Data from 637 consecutive liver resections were analysed. Mean (standard deviation) overall ERAS compliance was 64.0 (10.2%) and remained stable over time. High compliance was associated with fewer complications (51% (104) versus 69.8% (303); odds ratio (OR) 0.45; 95% confidence interval (c.i.) 0.30 to 0.67; P < 0.001), lower major morbidity (7.25% (15) versus 12.8% (55); OR 0.25, 95% c.i. 0.10 to 0.64; P = 0.001), and shorter LOS (7.42 versus 10.62 days; mean difference -3.21 days; P < 0.001). In multivariable analyses, high overall compliance was associated with major morbidity (OR 0.16; 95% c.i. 0.04 to 0.56; P = 0.005). Minimally invasive surgery independently decreased overall complications (OR 0.41; 95% c.i. 0.21 to 0.75; P = 0.005), major morbidity (OR 0.13; 95% c.i. 0.01 to 0.66; P = 0.050), and LOS (β = -2.31 days; P = 0.020). In sensitivity analyses, high compliance remained associated with fewer complications (OR 0.62; 95% c.i. 0.40 to 0.96; P = 0.035). Higher intraoperative intravenous fluid volume independently predicted morbidity and prolonged LOS (P < 0.001).</p><p><strong>Conclusion: </strong>Higher ERAS compliance after liver resection is associated with lower severe morbidity and shorter LOS. Prioritizing potentially high-impact items may maximize recovery benefits.</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/PMC13459744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148711308","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":"Target trial emulation and causal machine learning define individualized safety margins for energy exposure near the recurrent laryngeal nerve in thyroidectomy: multicentre cohort study.","authors":"Zhihong Li, Yiliminuer Ahemai, Zimei Li, Beibei Li, Tianruixue Zhang, Wenwen Zheng, Shaohua Wang, Yan Wang, Yingbin Cai","doi":"10.1093/bjsopen/zrag118","DOIUrl":"10.1093/bjsopen/zrag118","url":null,"abstract":"<p><strong>Background: </strong>The aims of this study were to evaluate whether cumulative thermal exposure from surgical energy devices near the recurrent laryngeal nerve (RLN) is associated with postoperative RLN injury (RLNI) and to derive clinically interpretable individualized safety margins.</p><p><strong>Methods: </strong>This retrospective multicentre cohort study included adults who underwent thyroidectomy between 2018 and 2024. The thermal accumulation index (TAI) quantified cumulative activation-level energy exposure within a 2-mm nerve-dense zone. Target trial emulation, generalized propensity score adjustment, doubly robust causal estimation, and causal machine learning were used to estimate population-level and individualized effects.</p><p><strong>Results: </strong>Among 7145 patients, after adjustment for prespecified baseline patient-, disease-, and surgical-domain covariates, as well as PCA-derived proxies for surgeon skill, tissue vulnerability, anatomical variation, and anaesthesia-related factors, a higher TAI was associated with an increased risk of RLNI, with an approximately linear dose-response curve over the observed range (odds ratio 3.01; 95% confidence interval 2.35 to 3.87). In the independent test cohort, the observed RLNI rate was 2.3%; the model-projected rate under a low-TAI strategy was 0.8%, corresponding to a projected relative reduction of 65.9%.</p><p><strong>Conclusion: </strong>TAI provides a candidate quantitative metric for cumulative thermal exposure near the RLN. The individualized thresholds generated in this study should be considered hypothesis-generating and require prospective validation before routine intraoperative use.</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/PMC13513762/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825217","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":"Revisiting lymphatic dissemination in gastric cancer: insights from a large Western multicentre cohort.","authors":"Marcus Fernando Kodama Pertille Ramos, Rubén Aguilar Zapag, Carlos García Carrasco","doi":"10.1093/bjsopen/zrag094","DOIUrl":"10.1093/bjsopen/zrag094","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/PMC13330918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381250","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}