BJS Open最新文献

{"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}

{"title":"Outcomes reported in studies of anal high-grade squamous intraepithelial lesions treatments: systematic review.","authors":"David A Finch, Madhu P Chaudhury, Rebecca Morris, Edward Parkin, Peter Mitchell, Pierre Martin-Hirsch, Andrew G Renehan, Rebecca Fish","doi":"10.1093/bjsopen/zrag061","DOIUrl":"10.1093/bjsopen/zrag061","url":null,"abstract":"<p><strong>Introduction: </strong>Anal high-grade squamous intraepithelial lesion (HSIL) is a precursor of anal squamous cell carcinoma (ASCC). Reported outcomes from treatment trials vary widely, limiting understanding of the effectiveness of different interventions. This systematic review aimed to summarize the outcomes reported in studies evaluating treatments in anal HSIL.</p><p><strong>Methods: </strong>A systematic review of MEDLINE, Embase, CINAHL, and the Cochrane Library (inception to June 2025) was conducted. Eligible studies evaluated any anal HSIL treatment in any population. Verbatim outcomes and associated definitions, measurement tools, and timepoints were extracted and mapped to standardized outcome terms (SOTs), categorized using The Core Outcome Measures in Effectiveness Trials (COMET) Initiative taxonomy.</p><p><strong>Results: </strong>Out of 5488 studies screened, 67 studies were included, comprising 40 observational studies, 23 interventional studies (5 randomized controlled trials), and 4 systematic reviews. A total of 966 outcomes were reported, grouped into 170 SOTs. Outcomes were mapped across all five COMET core areas (Death, Physiological/clinical, Life impact, Resource use, and Adverse events), with Physiological/clinical outcomes most frequently represented (131/170 SOTs; 77%). Substantial heterogeneity was observed, particularly in definitions of disease response, recurrence, and adverse events. For example, across 18 studies reporting 'complete response', definitions varied in assessment modality (clinical assessment alone, histology alone, cytology alone, or combined clinical-histological criteria), stringency (ranging from absence of visible lesions to absence of HSIL, LSIL, or any dysplasia), scope (lesion-specific versus field-wide assessment), and timing, which ranged from 3 weeks to 18 months post-treatment. Only three studies used validated patient-reported outcome measures (PROMs) for quality of life or functioning.</p><p><strong>Conclusion: </strong>Outcome reporting in anal HSIL treatment studies is highly inconsistent, limiting the synthesis of evidence and comparative analysis. These findings support the urgent need for a COS to standardize outcome selection and improve the quality and comparability of future trials.</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/PMC13332405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387129","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":"Postpancreatectomy acute pancreatitis after distal pancreatectomy: tri-institutional international cohort.","authors":"Elisa Romandini, Giampaolo Perri, Aya Maekawa, Elisa Bannone, Mushegh A Sahakyan, Dyre Berg Kleive, Poya Ghorbani, Giovanni Marchegiani, Roberto Montorsi, Alice Cattelani, Stefan Gilg, Åsmund Avdem Fretland, Marcus Holmberg, Ernesto Sparrelid, Knut Jørgen Labori, Bjørn Edwin, Roberto Salvia","doi":"10.1093/bjsopen/zrag069","DOIUrl":"10.1093/bjsopen/zrag069","url":null,"abstract":"<p><strong>Background: </strong>The International Study Group for Pancreatic Surgery (ISGPS) recently introduced a standardized definition and grading system for postpancreatectomy acute pancreatitis (PPAP), which was validated for pancreatoduodenectomy but not for distal pancreatectomy (DP). This study investigated the incidence and predictors of PPAP following DP and its associated postoperative complications.</p><p><strong>Methods: </strong>Patients who underwent DP for all indications between 2015 and 2022 at three European centres were retrospectively analysed. PPAP was defined according to the ISGPS criteria (postoperative serum hyperamylasaemia (POH), radiological findings) and patient clinical deterioration. Standard univariable and multivariable and receiver operating characteristic (ROC) curve analyses were conducted.</p><p><strong>Results: </strong>Among 1192 patients, PPAP occurred in 45 (3.8%): 35 grade B (2.9%) and 10 grade C (0.8%). POH without PPAP occurred in 165 patients (13.8%). Clinical outcomes worsened progressively across patients without POH/PPAP, with POH only, and with PPAP (Clavien-Dindo ≥ IIIa: 17.8%, 21.2%, and 53.3%, respectively; overall P < 0.001). PPAP was associated with higher rates of postoperative complications, including pancreatic fistula (68.9%), delayed gastric emptying (17.8%), and unplanned intensive care unit admission (17.8%). Compared with POH only, PPAP was associated with higher C-reactive protein (CRP) levels on postoperative day (POD) 2 and POD3. Among patients with POH, higher CRP levels on POD3 remained independently associated with PPAP in multivariable analysis (adjusted odds ratio 1.01; P < 0.001), together with multiorgan resection and smoking status. ROC curve analyses supported the discriminatory performance of CRP, particularly on POD3.</p><p><strong>Conclusion: </strong>PPAP is a rare but potentially severe complication after DP. Among patients with POH, elevated early postoperative CRP, particularly on POD3, may allow early risk stratification, identifying those at high risk of PPAP who may benefit from targeted mitigation strategies.</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/PMC13330926/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381257","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":"Hospital costs associated with complications following pancreatoduodenectomy: systematic review.","authors":"Michiel F G Francken, Joey de Hondt, Faridi S Jamaludin, Martijn W J Stommel, Bert A Bonsing, Hjalmar C van Santvoort, Bas Groot Koerkamp, Olivier R Busch, Marcel G W Dijkgraaf, Marc G Besselink","doi":"10.1093/bjsopen/zrag055","DOIUrl":"10.1093/bjsopen/zrag055","url":null,"abstract":"<p><strong>Background: </strong>Pancreatoduodenectomy is associated with postoperative complications in nearly half of all patients. Understanding the financial burden of these complications is relevant to supporting initiatives to improve patient outcome and resource allocation. A contemporary systematic review evaluating the costs of complications following pancreatoduodenectomy is lacking.</p><p><strong>Methods: </strong>A systematic review was conducted following PRISMA 2020 guidelines in PubMed, Embase, and Cochrane Central Register of Controlled Trials from inception to September 2024. Studies reporting on the hospital costs (primary outcome) of complications following pancreatoduodenectomy were included. Costs were adjusted for inflation and purchasing power parity to 2023 Dutch euros (€). Data extraction and risk-of-bias assessments were conducted independently by two reviewers.</p><p><strong>Results: </strong>Overall, 46 studies with 111 215 patients undergoing pancreatoduodenectomy from 13 countries were included. Postoperative pancreatic fistula grade B increased costs by €1998 to €25 228, and grade C by €21 268 to €112 824 versus no clinically relevant postoperative pancreatic fistula (mean or median values). Delayed gastric emptying grade B increased costs by €10 836 to €22 571 and grade C by €28 707 to €61 818 versus no clinically relevant delayed gastric emptying. Postpancreatectomy haemorrhage (various definitions) increased costs by €29 447 to €48 380. Biliary leak grade B increased costs by €7616 and grade C by €22 727. Clavien-Dindo complication grade III added €2785 to €20 294 compared with grade II, and grade IV added €25 190 to €63 644 compared with grade III.</p><p><strong>Conclusion: </strong>Complications following pancreatoduodenectomy increase costs substantially, exceeding €100 000 for a single postoperative pancreatic fistula grade C. These costs can now be used to design cost-effective prophylactic and therapeutic interventions aiming to improve patient outcomes together with optimal use of healthcare resources.</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/PMC13372025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148454562","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":"Hospital factors associated with failure to rescue after surgery: meta-analysis.","authors":"Cameron I Wells, Surya Akash Boppana, Chris Varghese, William Xu, Greg O'Grady, Ian P Bissett","doi":"10.1093/bjsopen/zrag086","DOIUrl":"10.1093/bjsopen/zrag086","url":null,"abstract":"<p><strong>Background: </strong>Failure to rescue (FTR) is a key driver of postoperative mortality and reflects a hospital's ability to recognize, escalate, and treat complications. Although FTR varies substantially between hospitals, the hospital characteristics that underpin this variation are inconsistently described. The aim of this study was to synthesize evidence on hospital-level factors associated with FTR after postoperative complications across surgical populations and health systems.</p><p><strong>Methods: </strong>A systematic review of observational studies evaluating associations between hospital-level characteristics and FTR in surgical patients was undertaken. MEDLINE, EMBASE, and Scopus were systematically searched on 17 July 2024 and updated to 31 December 2025. Hospital factors were classified into structural, staffing, and system domains. Where three or more non-overlapping studies reported adjusted estimates in comparable formats, random-effects meta-analyses were performed; otherwise, findings were summarized narratively. Methodological quality of included studies was assessed using the ROBINS-I tool (version 2).</p><p><strong>Results: </strong>A total of 111 studies encompassing over 137 million patients and 301 hospital factors were included. Meta-analyses demonstrated lower FTR rates in larger hospitals (odds ratio 0.85, 95% confidence interval 0.74 to 0.97), hospitals with greater intensive care unit capacity (odds ratio 0.80, 0.71 to 0.90), and teaching hospitals (odds ratio 0.88, 0.83 to 0.93). Better nursing resources were consistently associated with lower FTR, including patient-to-nurse ratios (odds ratio 1.07, 1.03 to 1.10), higher nurse education (odds ratio 0.95, 0.91 to 0.99), and more favourable work environments (odds ratio 0.93, 0.90 to 0.95). Safety-net hospital status was associated with higher FTR (odds ratio 1.22, 1.03 to 1.45). Substantial heterogeneity was observed across most analyses.</p><p><strong>Conclusion: </strong>Hospital-level structural, staffing, and system characteristics are associated with variation in FTR. Postoperative mortality is closely linked to institutional capacity to detect and manage complications, underscoring the importance of adequate resourcing and system organization to improve surgical 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/PMC13373787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148468727","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":"Quality of life, bowel dysfunction, and long-term oncological outcomes after transanal versus laparoscopic total mesorectal excision for mid- and low- rectal cancer (Ta-LaTME study): multicentre randomized open-label trial.","authors":"Xavier Serra-Aracil, Anna Gonzalez, Josep Bargalló, Anna Serracant, Jordi Roura, Ladislao Cayetano-Paniagua, Salvadora Delgado, Alba Zarate","doi":"10.1093/bjsopen/zrag045","DOIUrl":"10.1093/bjsopen/zrag045","url":null,"abstract":"<p><strong>Background: </strong>Quality of life (QoL) and bowel function are key outcomes in mid- and low rectal cancer. The comparative impact of laparoscopic total mesorectal excision (LaTME) versus transanal total mesorectal excision (TaTME) on patient-reported outcomes and long-term oncological results in randomized trials remains unclear.</p><p><strong>Methods: </strong>This prospective multicentre randomized trial enrolled patients with resectable mid-low rectal adenocarcinoma. QoL was assessed using the 30- and 29-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaires EORTC QLQ-C30 and QLQ-CR29, respectively) and bowel dysfunction was assessed using the Low Anterior Resection Syndrome (LARS) score before surgery and at the long-term follow-up (≥ 12 months after index surgery). The sample size calculation was based on the primary endpoint from the original randomized clinical trial (composite conversion outcome), for which 116 patients were required. The minimum oncological follow-up was 5 years. Modified intention-to-treat (mITT) and per-protocol analyses were prespecified.</p><p><strong>Results: </strong>In all, 116 patients were randomized (LaTME, 57; TaTME, 59); 105 patients were included in the mITT analysis. Sixty-seven valid QoL questionnaires were obtained (63.8%). Postoperative global health status (EORTC QLQ-C30) was high in both groups (median score 83.3) with no significant differences between them, and functional scales remained near maximum, with improved emotional functioning after LaTME only. Using the EORTC QLQ-CR29 score, TaTME showed higher postoperative stool frequency, flatulence, and faecal incontinence, with similar body image and sexual function. LARS scores (assessed only in patients without a permanent stoma) were comparable between LaTME and TaTME (median 24 versus 27, respectively), with major LARS (score 30-42) in 30 and 44% of LaTME and TaTME patients respectively. There were no significant differences between LaTME and TaTME in local recurrence (6.4% versus 3.7%, respectively), distant recurrence (14.9% versus 18.5%, respectively), disease-free survival, and overall survival.</p><p><strong>Conclusion: </strong>Overall QoL and bowel function remained high, with no detectable between-group differences. TaTME was associated with a higher burden of specific evacuatory symptoms on the EORTC QLQ-CR29. Long-term oncological outcomes did not differ significantly between techniques. Registration number: NCT02550769 (http://www.clinicaltrials.gov).</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/PMC13436816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683489","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":"Pancreatic surgery and length of hospital stay: meta-analysis of randomized clinical trials.","authors":"Laetitia Z Hampe, Klaudia Narbekovas, Chenchen Li, Amila Cizmic, Anas A Preukschas, Anna Nießen, Jan Bardenhagen, Faik G Uzunoglu, Ulla Klaiber, Oliver Strobel, Pascal Probst, Thilo Hackert, Felix Nickel, Carl-Stephan Leonhardt","doi":"10.1093/bjsopen/zrag091","DOIUrl":"10.1093/bjsopen/zrag091","url":null,"abstract":"<p><strong>Background: </strong>Length of hospital stay (LOS) is a commonly reported postoperative outcome measure in pancreatic surgery. However, LOS may be influenced by various factors, including healthcare systems, cultural traditions, and readmission rate. This systematic review and meta-analysis investigated LOS in pancreatic surgery.</p><p><strong>Methods: </strong>A meta-analysis was conducted to identify all randomized clinical trials (RCTs) of pancreatic surgery reporting LOS. Analyses were conducted using a random-effects model with mean differences as the effect estimator for the continuous outcome LOS.</p><p><strong>Results: </strong>In all, 186 RCTs published between 1994 and 2025, comprising 28 381 patients, were included. The mean LOS differed significantly by type of resection (P = 0.003) and by country (P < 0.001). Country remained a statistically significant factor after adjusting for readmission rate, year of study, and type of resection. The shortest LOS was observed in the USA, with a pooled value of 11 days (95% confidence interval (c.i.) 9.93 to 12.32) and the longest was seen in Japan, with a pooled value of 28 days (95% c.i. 25.60 to 31.67). Subgroup analysis of studies comparing minimally invasive and open surgery showed a mean LOS difference of 2 days (95% c.i. -2.79 to -0.85; prediction interval -7.70 to 4.06). However, this effect varied across countries, with mean LOS differences ranging from 1 to 6 days.</p><p><strong>Conclusion: </strong>LOS after pancreatic surgery exhibited substantial statistical heterogeneity based on country, the type of operation, and access. This highlights the importance of considering contextual factors when evaluating and comparing LOS as an outcome measure in pancreatic surgery.</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/PMC13499424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787992","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":"Therapeutic strategies and outcomes in the management of ampullary tumours: meta-analysis.","authors":"Anouk J de Wilde, Jan Faes, Karlijn E P E Hermans, Marc G Besselink, Jeska A Fritzsche, Matthias van Haele, Jan-Werner Poley, Rogier P Voermans, Judith De Vos-Geelen, Steven W M Olde Damink, Stefan A W Bouwense","doi":"10.1093/bjsopen/zrag115","DOIUrl":"10.1093/bjsopen/zrag115","url":null,"abstract":"<p><strong>Background: </strong>Ampullary tumours are rare but present important clinical challenges. This meta-analysis aims to evaluate the outcomes of endoscopic resection (ER), transduodenal ampullectomy (TDA) and pancreatoduodenectomy (PD) for both benign and malignant ampullary tumours.</p><p><strong>Methods: </strong>A comprehensive search was performed up to 15 December 2025. Studies were included if they reported short-term outcomes including complete resection rate, recurrence, or complications of ampullary tumours after ER, TDA, or PD. Statistical analyses were performed using both random-effects and fixed-effects models to calculate pooled means. Publication bias was evaluated using funnel plots and Egger's test, and risk of bias was assessed using ROBINS-I V2.</p><p><strong>Results: </strong>A total of 80 studies were included. For complete resection rate, ER showed high heterogeneity (29%-100%), TDA showed a pooled rate of 90% for benign and early-stage tumours and 66% for malignant tumours, whereas PD showed 99% and 97%, respectively. ER and TDA showed both a pooled recurrence rate of 12% for benign and early-stage tumours, whereas PD showed 6%. For recurrence of malignant tumours, TDA showed high heterogeneity (48%-90%) whereas PD had a pooled rate of 16%. For complications, ER and PD exhibited high heterogeneity (9%-95% and 27%-98%, respectively), whereas TDA had a pooled rate of 32%.</p><p><strong>Conclusion: </strong>PD provides the best outcomes in terms of complete resection and recurrence, despite higher morbidity. ER is a viable option for benign tumours, offering lower morbidity and manageable recurrence rates. Further prospective research is needed to optimize preoperative diagnostics to distinguish benign tumours from malignant tumours accurately to select the appropriate treatment.</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/PMC13513765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of multidisciplinary team meetings and survival in gastric cancer patients: nationwide cohort study.","authors":"Jonathan Engborg, Jakob Hedberg, Mats Lindblad, Gustav Linder","doi":"10.1093/bjsopen/zrag126","DOIUrl":"10.1093/bjsopen/zrag126","url":null,"abstract":"<p><strong>Background: </strong>Since 2015, multidisciplinary team (MDT) discussion is recommended for all Swedish patients diagnosed with gastric cancer. However, few studies have explored the association of MDT discussion with survival.</p><p><strong>Methods: </strong>This study included all Swedish patients diagnosed with gastric adenocarcinoma between 2006 and 2021. Multivariable logistic regression was used to investigate the probability of receiving treatment recommendation at an MDT meeting, whereas the association between receiving an MDT treatment recommendation and overall survival was examined using Cox regression and Kaplan-Meier methods.</p><p><strong>Results: </strong>Of 7813 patients, 5279 (68%) were discussed at an MDT meeting. Advanced age (80-89 years; odds ratio (OR) 0.30; 95% confidence interval (c.i.) 0.21 to 0.43) and lower performance status (Eastern Cooperative Oncology Group performance status 1; OR 0.68; 95% c.i. 0.56 to 0.81) were associated with a lower probability of receiving an MDT treatment recommendation. Clinical disease stages II and III, compared with stage I, were associated with a higher probability of an MDT discussion (OR 1.38 (95% c.i. 1.10 to 1.75) and 1.42; (95% c.i. 1.09 to 1.85), respectively), as was a later year of diagnosis (OR 1.37; 95% c.i. 1.35 to 1.40). In adjusted survival analysis with multivariable Cox regression, MDT discussion was associated with better survival (hazard ratio 0.89; 95% c.i. 0.83 to 0.95). In addition, median survival was longer in the group with than without MDT treatment recommendations (12.0 versus 5.9 months).</p><p><strong>Conclusion: </strong>Receiving a treatment recommendation at an MDT meeting was associated with better survival in patients with gastric adenocarcinoma. Patients with advanced disease and older age were less likely to receive an MDT treatment recommendation but, if they did, it was associated with better survival.</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/PMC13513747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825148","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":"Laparoscopic versus open surgery for rectal cancer: individual patient data meta-analysis of the ALaCaRT and Z6051 randomized trials.","authors":"Kilian G M Brown, Andrew R L Stevenson, Michael J Solomon, James Murray, Kate Wilson, Val Gebski, James Fleshman, Qian Shi, Thomas E Read, John Simes","doi":"10.1093/bjsopen/zrag119","DOIUrl":"10.1093/bjsopen/zrag119","url":null,"abstract":"<p><strong>Background: </strong>The multicentre ALaCaRT and ACOSOG Z6051 randomized trials were unable to demonstrate non-inferiority of laparoscopic versus open surgery for rectal cancer with respect to a composite pathology metric indicating successful resection. Neither trial was individually powered to detect differences in long-term recurrence or survival. This planned meta-analysis determined long-term oncological outcomes of laparoscopic versus open proctectomy for rectal adenocarcinoma.</p><p><strong>Methods: </strong>This prospective meta-analysis included individual patient data from patients with cT1-3 N0-2 M0 rectal adenocarcinoma enrolled in the ALaCaRT and ACOSOG Z6051 trials. Pathologically successful resection was defined as complete or near-complete total mesorectal excision, a clear circumferential resection margin (CRM; > 1 mm), and a clear distal resection margin (> 1 mm). The non-inferiority margin for disease-free survival (DFS) was an absolute difference of 5% at least 3 years after surgery.</p><p><strong>Results: </strong>The combined data set included 935 patients (65.6% men, mean age 60.7 years, mean body mass index 26.7 kg/m2) randomized to open (457 patients) or laparoscopic (478 patients) proctectomy. Pathologically successful resection was lower in the laparoscopic than open group (85.1% versus 89.9%, respectively; pooled estimate 4.6% difference; 95% confidence interval (c.i.) -8.6% to -0.5%). The median follow-up was 60.2 (interquartile range 49.9-61.1) months. Three-year DFS was 75.2% (95% c.i. 71.1% to 79.2%) and 76.5% (95% c.i. 72.5% to 80.6%) for the laparoscopic and open groups, respectively (pooled estimate difference -1.5%; 95% c.i. -7.2% to 4.2%). Non-inferiority of laparoscopic surgery was not demonstrated because the lower one-sided 95% c.i. (-6.3% to 100%) crossed -5%. Three-year locoregional recurrence was higher in laparoscopic than open group (5.4% (95% c.i. 3.3% to 7.5%) versus 2.0% (95% c.i. 0.7% to 3.4%), respectively; pooled estimate 3.1% difference (95% c.i. 0.6% to 5.6%)). A clear CRM was the most significant and only pathological predictor of both DFS (P < 0.0001) and overall survival (P < 0.0001).</p><p><strong>Conclusion: </strong>Laparoscopic proctectomy led to a lower rate of pathologically successful resection and a higher rate of locoregional recurrence at 3 years. The possibility of subsequent poorer DFS or overall survival rate requires further evaluation, because this analysis was not specifically powered for these endpoints.</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/PMC13448722/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683499","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}