BJS Open最新文献

{"title":"Influence of KRAS mutation subtypes on response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer: meta-analysis.","authors":"Iannish D Sadien, George Cooper, Veronica Phillips, Heman Joshi, James Wheeler, R Justin Davies","doi":"10.1093/bjsopen/zrag080","DOIUrl":"10.1093/bjsopen/zrag080","url":null,"abstract":"<p><strong>Background: </strong>KRAS mutations are common in colorectal cancer, but the impact of KRAS mutation subtypes on treatment response remains poorly understood. This research aimed to investigate whether different KRAS mutations influence pathological complete response (pCR) rates after neoadjuvant chemoradiotherapy in locally advanced rectal cancer (LARC).</p><p><strong>Methods: </strong>A systematic review and meta-analysis of studies describing genetic determinants of response to neoadjuvant chemoradiotherapy in LARC was conducted, searching for manuscripts published up to March 2026. The primary outcome of interest was the odds ratio for KRAS mutations and pCR. A random-effects model estimated the pooled effect size of KRAS mutations within and outside exon 2 on pCR. Genomic data sets were analysed to investigate the molecular characteristics of KRAS exon 2 and non-exon 2 mutant rectal cancers and their impact on overall and disease-free survival. Finally, a transcriptomic data set was analysed to elucidate the underlying response mechanisms.</p><p><strong>Results: </strong>Out of 11 537 manuscripts identified, 15 studies (3354 patients) were included in the meta-analysis. The odds ratio for any KRAS mutation and pCR was 0.48 (95% confidence interval 0.32 to 0.70), indicating reduced odds of pCR in KRAS-mutant LARC. Subgroup analysis revealed that KRAS mutations in exon 2 accounted for this effect, whereas variants outside exon 2 had no influence (odds ratio 0.96, 95% confidence interval 0.11 to 8.49). Analysis confirmed poorer disease-free survival in patients with exon 2 alterations (P = 0.019) as well as poorer overall survival (P = 0.047). Transcriptomic analysis revealed that non-exon 2 KRAS-mutant tumours were enriched for inflammatory signalling pathways, suggesting that these tumours represent a subgroup with high immune infiltration.</p><p><strong>Conclusion: </strong>The presence of KRAS mutations adversely affects pCR odds after neoadjuvant chemoradiotherapy in LARC, but this effect is specific to exon 2 mutations.</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/PMC13436823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683477","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":"Pattern of lymph node spread in gastric cancer: Western multicenter retrospective study.","authors":"Francesca Blasa, Giuseppe Verlato, Hidde Overtoom, Martina Hermez Chole, Fabrizio Tedone, Federica Filippini, Markos Despotidis, Evgenia Mela, Tania Triantafyllou, Dimitrios Schizas, Dimitrios Theodorou, Magnus Nilsson, Suzanne S Gisbertz, Maria Bencivenga, Ioannis Rouvelas","doi":"10.1093/bjsopen/zrag076","DOIUrl":"10.1093/bjsopen/zrag076","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer is a biologically heterogeneous disease with variable patterns of lymph node (LN) metastasis influenced by tumour biology and anatomical location. Contemporary Western data on LN dissemination remain limited.</p><p><strong>Methods: </strong>This retrospective multicentre study evaluated data from patients with resectable gastric adenocarcinoma who underwent curative-intent gastrectomy at five high-volume European centres. LN retrieval and metastatic involvement were analysed according to tumour location, Lauren histotype, pathological (p) stage, neoadjuvant chemotherapy, and microsatellite status (microsatellite instability (MSI) or microsatellite stable (MSS)). Lymph node stations were analysed individually and grouped into three anatomical tiers based on proximity to the stomach, according to the Japanese Gastric Cancer Association classification.</p><p><strong>Results: </strong>In all, 950 patients were included in the study. The incidence of LN metastasis in diffuse and mixed histotypes was approximately twice that of intestinal-type tumours, along with higher metastatic rates across multiple perigastric first-tier and selected second-tier stations (P < 0.050 to P < 0.001). The anatomical pattern of lymphatic spread was site-specific, with consistent drainage pathways across tumour locations. In early gastric cancer, LN metastases were rare and largely confined to stations 3 and 4. Neoadjuvant chemotherapy reduced overall nodal burden without altering the anatomical distribution of metastatic stations. MSI tumours exhibited lower nodal involvement than MSS tumours, with higher rates of node-negative disease (49.3% versus 41.3%) and fewer patients with pN3 tumours (15.9% versus 27.7%; P = 0.044).</p><p><strong>Conclusions: </strong>Tumour location influenced the anatomical pattern of LN spread, whereas histological and molecular features were associated with differences in metastatic risk and extent. The integration of biological and anatomical factors may support more tailored surgical 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/PMC13330934/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381590","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":"Mesh-fixation combinations and chronic postoperative inguinal pain after laparoscopic groin hernia repair: nationwide cohort study.","authors":"Bengt Novik","doi":"10.1093/bjsopen/zrag073","DOIUrl":"10.1093/bjsopen/zrag073","url":null,"abstract":"<p><strong>Background: </strong>Despite lower prevalence after laparoscopic approach, chronic postoperative inguinal pain (CPIP) remains a major concern. Large-scale comparisons of various mesh-fixation combinations with respect to CPIP risk are scarce. This study evaluated the association between commonly used mesh-fixation combinations and CPIP after laparoscopic groin hernia repair.</p><p><strong>Methods: </strong>This comparative cohort study analysed prospectively collected data from the nationwide Swedish Hernia Registry, including virtually all adult patients undergoing unilateral laparoscopic groin hernia repair in Sweden over a 6-year 4-month period. One year after surgery, a patient-reported outcomes survey assessed CPIP, defined as pain in the operated groin during the preceding week that affected daily activities. This study also classified all patients who underwent reoperation within the first 15 months as CPIP-positive respondents. Multivariable logistic regression estimated adjusted odds ratios for mesh-fixation combinations recorded in > 100 procedures.</p><p><strong>Results: </strong>Of 15 360 eligible patients, 10 525 (68.5%) responded (mean age 59 years; 32.0% women). Three mesh types (flat heavyweight, flat lightweight, and 'three-dimensional') and five fixation modes (absorbable tacks, metal tacks, fibrin glue, self-gripping micro-hooks, and non-fixation) yielded 12 analyzable combinations. The lowest odds of CPIP were observed with three options: heavyweight flat mesh without fixation (reference category; adjusted odds ratio 1.0), lightweight mesh with fibrin glue (adjusted odds ratio 1.0, 95% confidence interval 0.75 to 1.4), and lightweight mesh with self-gripping micro-hooks (adjusted odds ratio 0.94, 95% confidence interval 0.61 to 1.4).</p><p><strong>Conclusion: </strong>Heavyweight flat mesh without fixation was associated with one of the lowest odds of CPIP, while representing the simplest and least costly alternative. Together with previous registry evidence indicating low recurrence risk, these findings support considering this option as a pragmatic default strategy in laparoscopic groin hernia repair.</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/PMC13332403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative outcomes and long-term survival following resection of gallbladder cancer in older adults: retrospective study.","authors":"Anita Balakrishnan, Petros Barmpounakis, Nikolaos Demiris, Bodil Andersson, Alejandro Brañes, Xavier de Aretxabala, Paul Gibbs, Simon J F Harper, Emmanuel L Huguet, Asif Jah, Vasilis Kosmoliaptsis, Javier Lendoire, Siong S Liau, Shishir K Maithel, Jack L Martin, Colin Noel, Raaj K Praseedom, Alejandro Serrablo, Volkan Adsay","doi":"10.1093/bjsopen/zrag052","DOIUrl":"10.1093/bjsopen/zrag052","url":null,"abstract":"<p><strong>Background: </strong>Gallbladder cancer (GBC) is a rare but aggressive disease, and surgical resection remains the only potential curative treatment. Although tumour-related effects on prognosis are well established, the impact of age is less understood. This study aimed to evaluate the influence of age on overall survival (OS), recurrence-free survival (RFS), and perioperative complications in GBC.</p><p><strong>Methods: </strong>Data from patients undergoing curative resection for GBC at 133 centres across 41 countries between 2010 and 2020 were analysed to determine the prognostic association of age ≥ 75 years with OS, RFS, and morbidity. Propensity score matching was used to address confounders between the two age groups.</p><p><strong>Results: </strong>In all, 4138 patients underwent surgery for GBC. Patients with macroscopic tumour remaining after surgery, metastatic disease, only high-grade dysplasia were excluded leaving 3676 patients for analyses. Full data on all relevant parameters was available for 2072 patients aged < 75 years and 633 patients aged ≥ 75 years. Patients aged ≥ 75 years had more co-morbidities, underwent less extensive surgery or lymphadenectomy, and received adjuvant chemotherapy less frequently than younger (< 75 years) patients. Age ≥ 75 years was associated with poorer OS in both the unmatched (hazard ratio (HR) 1.34; 95% confidence interval (c.i.) 1.14 to 1.56; P < 0.001) and matched cohorts (HR 1.31; 95% c.i. 1.12 to 1.54; P < 0.001) cohorts, but was not associated with RFS or 1-year survival. Tumour extent and nodal stage had the greatest association with OS and RFS. Age was not associated with increased complications in either the unmatched (odds ratio (OR) 1.11; 95% c.i. 0.85 to 1.45; P = 0.400) or matched (OR 0.90; 95% c.i. 0.72 to 1.12; P = 0.353) cohorts.</p><p><strong>Conclusions: </strong>Older adults received less extensive surgery and infrequent adjuvant chemotherapy. Age ≥ 75 years was associated with poorer OS following GBC resection but comparable complication rates to younger adults. Older adults of sufficient fitness should not be denied curative treatment based on age, and oncological benefit should be balanced against perioperative risk to personalize treatment and optimize 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/PMC13426238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148648154","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":"Omission of axillary lymph node dissection in ultrasound-detectable axillary metastases in primary breast cancer treated by upfront surgery: prospective randomized SENOMAC-ULTRA non-inferiority trial.","authors":"Jana de Boniface, Tuomo Meretoja, Lisa Rydén, Malin Sund, Per Karlsson, Chiun-Sheng Huang, Hee Jeong Kim, Jai Min Ryu, Stephen Nash, Birgitte Offersen, Henrik Dahl Nissen, Elinore Wieslander, Nadia Maggi, Linda Swedin, Sung-Hsin Kuo, Trine Tramm, Karin Dembrower, Kaori Terata, Ikuno Nishibuchi, Miguel Ángel Luna Tomás, Raquel Ciérvide, Aoife Lowery, Helle Kristine Skjerven, Bent Ejlertsen, Antonios Valachis, Robert Szulkin, Tanja Spanic, Tadahiko Shien, Tove Filtenborg Tvedskov, Sara Alkner","doi":"10.1093/bjsopen/zrag083","DOIUrl":"10.1093/bjsopen/zrag083","url":null,"abstract":"<p><strong>Background: </strong>Axillary lymph node dissection (ALND) in breast cancer causes substantial arm morbidity and long-term functional impairment. Less extensive axillary surgery, such as targeted axillary dissection (TAD), significantly reduces this risk. Although omission of ALND is standard in clinically node-negative disease with limited sentinel node involvement, this is not the case for patients with clinically node-positive disease undergoing upfront surgery. The aim of the SENOMAC-ULTRA trial is to evaluate whether TAD can safely replace ALND in patients with clinically node-positive breast cancer receiving upfront surgery.</p><p><strong>Methods: </strong>SENOMAC-ULTRA is a prospective, international, multicentre, randomized non-inferiority trial. Adults with stage II-III invasive breast cancer and axillary metastases detectable by ultrasound and confirmed by fine needle aspiration or core biopsy are eligible for inclusion. Participants are randomized 1 : 1 to TAD (removal of marked metastatic nodes plus sentinel lymph node biopsy) or standard ALND. The primary endpoint is recurrence-free survival, assessed for non-inferiority using a Cox proportional hazards model. Secondary endpoints include overall survival, locoregional recurrence, regional nodal recurrence, distant relapse-free survival, invasive breast cancer-free survival, patient-reported arm morbidity, and health-related quality of life, as well as performance measures of axillary ultrasound and marking techniques. A sample size of 1380 patients has been calculated to provide 81% power to exclude a hazard ratio > 1.47 for recurrence-free survival at 5 years, adopting a non-inferiority margin of 4.5%. Follow-up is planned for 10 years. The trial protocol has been approved by the Swedish Ethical Review Authority (Dnr 2025-07730-01); each participating country will obtain local ethics approval.</p><p><strong>Conclusion: </strong>It is anticipated that the SENOMAC-ULTRA trial will fill an important knowledge gap guiding the surgical management of patients with clinically node-negative breast cancer. Registration number: NCT06869629 (https://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/PMC13436812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148683461","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":"Multi-outcome prognostic modelling for older adults after trauma: development and validation of the Older Trauma Outcome Predictor (OTOP) model.","authors":"Mayura Iddagoda, Michelle Trevenen, Dieter G Weber, Christopher Etherton-Beer, Leon Flicker","doi":"10.1093/bjsopen/zrag084","DOIUrl":"10.1093/bjsopen/zrag084","url":null,"abstract":"<p><strong>Background: </strong>Older adults account for a rising proportion of trauma admissions, yet most prognostic tools for this group predict mortality alone. A validated multi-outcome model could support early risk stratification and optimize trauma care planning. This study developed and validated the Older Trauma Outcome Prediction (OTOP) model, the first tool designed to estimate multiple inpatient outcomes in older trauma patients.</p><p><strong>Methods: </strong>This study used Western Australia Trauma Registry linked data on patients aged ≥ 50 years admitted after external injury (2000-2020). Predictor variables, identified from a systematic review, included demographic factors, co-morbidities, injury characteristics, physiological measurements, and resuscitation indicators. The cohort was randomly divided into training (80%) and validation (20%) sets. Ridge logistic regression was used for binary outcomes (in-hospital mortality, surgery, intensive care unit (ICU) admission, medical complications), multinomial logistic regression was used for discharge destination, and quasi-Poisson regression was used for hospital length of stay. Model performance was assessed using the area under the curve (AUC), calibration, and error metrics.</p><p><strong>Results: </strong>This study analysed 105 972 trauma admissions aged ≥ 50 years between 2000 and 2020 (84 778 patients in the training cohort, 21 194 in the validation cohort). The mean age of all patients was 74.0 years, and 45.3% were men. Mortality prediction showed excellent discrimination (AUC 0.95), outperforming the Geriatric Trauma Outcome Score (AUC 0.83). The surgery and ICU admission models performed well (AUC 0.97 and 0.96, respectively). Length-of-hospital-stay prediction demonstrated moderate accuracy (mean absolute error 4.9 days), whereas prediction of medical complications was limited (AUC 0.60). Discharge destination was accurately classified into home, rehabilitation, residential care, or death.</p><p><strong>Conclusion: </strong>OTOP is the first validated multi-outcome prognostic model for older trauma patients, providing accurate and clinically relevant predictions to support early decision-making and optimize trauma system resource 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/PMC13381784/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148519742","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":"Parathyroid autotransplantation for inadvertently resected or devascularized glands during total thyroidectomy: large retrospective cohort study.","authors":"Mingjie Jiang, Yongchao Yu, Zan Jiao, Tong Wu, Ke Jiang, Zulu Ye, Zhongyuan Yang, Weichao Chen, Ankui Yang","doi":"10.1093/bjsopen/zrag103","DOIUrl":"https://doi.org/10.1093/bjsopen/zrag103","url":null,"abstract":"<p><strong>Background: </strong>Although recent guidelines recommend parathyroid autotransplantation for inadvertent excision of ischaemic glands, its benefit for the recovery of parathyroid function after total thyroidectomy remains uncertain.</p><p><strong>Methods: </strong>This retrospective study analysed patients with normal parathyroid hormone (PTH) concentrations who underwent primary total thyroidectomy at Sun Yat-sen University Cancer Center between September 2013 and November 2024. Postoperative hypoparathyroidism and PTH trajectories were compared across three groups: autotransplantation, inadvertent parathyroid resection, and all glands preserved in situ. Long-term recovery was modelled using generalized additive mixed models (GAMM).</p><p><strong>Results: </strong>Of 7539 eligible patients, 441 (5.8%) underwent autotransplantation and 814 (10.8%) had inadvertent parathyroid resection. Higher proportions of parathyroid autotransplantation or inadvertent resection were observed among patients undergoing central neck dissection, particularly bilateral procedures. Postoperative (POD) 1 hypoparathyroidism (PTH < 15 pg/ml) occurred in 64.9% and 62.4% of patients in the autotransplantation and inadvertent resection groups, respectively, compared with 50.7% of patients with in situ gland preservation. At 1 month, hypoparathyroidism was present in 17.1% and 22.5% of patients in the autotransplantation and inadvertent resection groups, respectively, compared with 11.9% of patients with in situ gland preservation. Among patients with POD1 hypoparathyroidism, the recovery of parathyroid function at 1 month was similar in the autotransplantation and in situ preservation groups (∼72% and ∼74%, respectively), but lower in the group with inadvertent resection (∼62%). GAMMs showed poorest long-term recovery after inadvertent resection, whereas recovery in the autotransplantation group approached in situ preservation without clear superiority.</p><p><strong>Conclusions: </strong>Parathyroid autotransplantation improved long-term recovery compared with inadvertent resection but did not outperform in situ preservation. These findings support autotransplantation for inadvertently resected parathyroid glands, but not for devascularized glands.</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/PMC13472490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148763742","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":"Robotic gastric Roux-en-Y bypass with or without concomitant cholecystectomy: pilot open label randomized trial.","authors":"Marie Burgard, Marco Bonino, Marion Dietrich, Pouya Iranmanesh, Michael Racine, Guillaume Giudicelli, Stefan P Mönig, Christian Toso, Minoa K Jung","doi":"10.1093/bjsopen/zrag092","DOIUrl":"10.1093/bjsopen/zrag092","url":null,"abstract":"<p><strong>Background: </strong>Debate continues about the need for prophylactic concomitant cholecystectomy (CC) at the time of Roux-en-Y gastric bypass (RYGB). The concerns over higher complication rates should be balanced against the risk of future biliary events. This pilot trial compared RYGB with CC to RYGB alone in patients without preoperative gallstones to inform a future large randomized trial.</p><p><strong>Methods: </strong>Eligible patients without gallstones scheduled to undergo RYGB were randomized before surgery using a 1 : 1 allocation ratio. Surgeons and patients were not blinded. The primary outcome was a composite of intraoperative adverse events and 30-day postoperative complications. In addition, feasibility (time to enrolment, completion of follow-up) was added as a co-primary endpoint after the study started, driven by prolonged enrolment times and independent of trial results. Secondary outcomes included late complications, biliary events, length of operation, length of hospital stay, and quality of life.</p><p><strong>Results: </strong>In all, 96 patients were randomized between July 2018 and January 2023, and 95 were included in the full analysis due to one withdrawal. There were 49 and 46 patients in the RYGB with and without CC arms, respectively. The feasibility endpoint was met with regard to the completion of follow-up (95/95, 100% at 1 month; 88/95 93% at 18 months), but not the time to enrolment (21 patients randomized per year). The composite outcome of intraoperative and postoperative complications occurred in 44.9% and 26.1% of patients with and without CC, respectively (difference 18.8%; 95% confidence interval (c.i.) -0.6 to 36.8; P = 0.098). Patients with CC had a higher early comprehensive complication index score (mean 6.09 versus 2.06; difference 4.03; 95% c.i. 0.23 to 7.83; P = 0.047). Late (> 30 days) complications, length of hospital stay, and quality of life were similar between the two groups. During the 18-month follow-up, biliary events occurred in 3 patients without CC (6.5%), of whom 2 required biliary intervention (4.4%) compared with 1 patient with CC (2%), with no biliary interventions required.</p><p><strong>Conclusion: </strong>The debate over performing CC during RYGB remains unresolved. The incidence of subsequent biliary interventions was low when CC was not performed. As a pilot study, this investigation sets the stage for a large randomized trial. Registration number: NCT04324515 (https://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/PMC13482983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787799","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":"Prophylactic three-dimensional funnel mesh for prevention of parastomal hernia: propensity-score-matched cohort study.","authors":"Jacques-Emmanuel Saadoun, Eleftherios Gialamas, Alexandre Balaphas, Cécile de Chaisemartin, Hélène Meillat, Bernard Lelong, Christian Toso, Emilie Liot, Jérémy Meyer, Guillaume Meurette, Frédéric Ris","doi":"10.1093/bjsopen/zrag072","DOIUrl":"10.1093/bjsopen/zrag072","url":null,"abstract":"","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13245723/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204015","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 preoperative radiotherapy on the risk of postpancreatectomy haemorrhage and major morbidity after resection of pancreatic adenocarcinoma including arterial divestment or arterial resection.","authors":"Thomas F Stoop, Freek R van 't Land, Leonard W F Seelen, Mahsoem Ali, Ahmer Sultan, Ammar A Javed, Casper H J van Eijck, Cornelius A Thiels, D Brock Hewitt, Ernesto Sparrelid, Faik G Uzunoglu, O H Fiete Gehrisch, Freek Daams, Hiroyuki Ishida, Hjalmar C van Santvoort, I Quintus Molenaar, Jennifer L Leiting, Joris I Erdmann, Marie Cappelle, Michael Ginesini, Michael L Kendrick, Niccolo Napoli, Olivier R Busch, Oskar Franklin, Poya Ghorbani, Richard D Schulick, Rimon Dankha, Roeland F de Wilde, Thilo Welsch, Wouter Te Riele, Christopher L Wolfgang, Marc G Besselink, Bas Groot Koerkamp, Ugo Boggi, Mark J Truty, Marco Del Chiaro, Thilo Hackert","doi":"10.1093/bjsopen/zrag058","DOIUrl":"10.1093/bjsopen/zrag058","url":null,"abstract":"<p><strong>Background: </strong>Some centres advocate preoperative radiotherapy in patients with pancreatic cancer and arterial involvement despite a lack of Level 1 evidence on survival benefit. Although it has been suggested that preoperative radiotherapy may increase the risk of postpancreatectomy haemorrhage (PPH) and morbidity, evidence is again lacking. This study investigated the association between preoperative radiotherapy and both PPH and major morbidity following arterial divestment/resection during pancreatic adenocarcinoma resection after chemotherapy.</p><p><strong>Methods: </strong>Consecutive patients diagnosed with pancreatic adenocarcinoma and > 180° arterial involvement who were treated with preoperative chemotherapy with or without radiotherapy followed by pancreatic resection with arterial divestment/resection were included in the study. Logistic regression analyses including propensity score-based overlap weighting were performed to investigate associations between radiotherapy and in-hospital PPH grade B/C and major morbidity, expressed as adjusted risk differences (aRDs).</p><p><strong>Results: </strong>Overall, 246 patients undergoing pancreatic resection with arterial resection (169, 69%) or divestment (77, 31%) were included. Radiotherapy was not associated with PPH (aRD 6%; 95% confidence interval (c.i.) -3 to 14), regardless of arterial divestment (aRD 3%; 95% c.i. -5 to 11) or arterial resection (aRD 12%; 95% c.i. 1 to 23; Pinteraction = 0.189). Radiotherapy was associated with a 14% (95% c.i. 2 to 25) higher risk of major morbidity, especially after arterial resection (aRD 27%; 95% c.i. 11 to 43) compared with arterial divestment (aRD -12%; 95% c.i. -35 to 11; Pinteraction = 0.006) and after external beam radiotherapy (aRD 21%; 95% c.i. 8 to 32) compared with stereotactic body radiotherapy (aRD -12%; 95% c.i. -27 to 6; Pinteraction = 0.0001). Ninety-day mortality was increased, albeit not significantly, after preoperative radiotherapy (10 (8%) versus 3 (3%) deaths with versus without preoperative radiotherapy, respectively; P = 0.067).</p><p><strong>Conclusions: </strong>Radiotherapy before resection of pancreatic cancer with > 180° arterial involvement was associated with an increased risk of postoperative major morbidity when arterial resection, but not arterial divestment, was performed. This risk should be taken into account when considering preoperative radiotherapy in patients who may require arterial resection.</p>","PeriodicalId":9028,"journal":{"name":"BJS Open","volume":"10 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13247997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209945","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}