BJS Open最新文献

{"title":"Continuity of care experienced by patients diagnosed with pancreatic cancer: nationwide multicentre study.","authors":"Jana S Hopstaken, Simone Augustinus, Ignace H J T de Hingh, Marc G Besselink, Hjalmar C van Santvoort, Hanneke W M van Laarhoven, Bert A Bonsing, Sebastiaan Festen, Jan Willem B de Groot, Marjolein Y V Homs, Mike S L Liem, Eric R Manusama, Vincent E de Meijer, Jennifer M J Schreinemakers, Judith de Vos-Geelen, Miriam L Wumkes, Cees J H M van Laarhoven, Pauline A J Vissers, Martijn W J Stommel","doi":"10.1093/bjsopen/zrag033","DOIUrl":"10.1093/bjsopen/zrag033","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/PMC13193582/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147986472","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":"First series of da Vinci single-port robotic-assisted cervical oesophagectomy: single-centre IDEAL stage 2a/2b study.","authors":"Vladimir J Lozanovski, Luca Bellaio, Edin Hadzijusufovic, Olga Adamenko Meier, Franziska Renger, Christoph Wandhoefer, Suzanne S Gisbertz, Richard van Hillegersberg, Hauke Lang, Peter P Grimminger","doi":"10.1093/bjsopen/zrag030","DOIUrl":"10.1093/bjsopen/zrag030","url":null,"abstract":"<p><strong>Background: </strong>Recent advances in robotic technology, particularly the da Vinci single-port (SP) system, have improved transcervical mediastinoscopic access by minimizing robotic arm collisions in confined spaces.</p><p><strong>Methods: </strong>This study, based on IDEAL (Idea, Development, Exploration, Assessment, Long-term) framework, describes the first consecutive da Vinci SP robotic-assisted cervical oesophagectomy (RACE) procedures in patients with oesophageal carcinoma performed at the University Hospital Mainz. Patient demographics, neoadjuvant treatment, resection margins, lymph node yield, intraoperative parameters, postoperative recovery, complications, and mortality were assessed.</p><p><strong>Results: </strong>The study included 20 patients with primarily squamous cell carcinoma, with 70% of all patients having received neoadjuvant treatment. The surgical procedure demonstrated feasibility, evidenced by a 90% R0 resection rate and a mean(standard deviation) lymph node yield of 31(7). The mean(standard deviation) total operative time was 332(88) minutes, and the active console time was 91(48) minutes. Notably, there were no intraoperative complications or conversions. Patients experienced minimal postoperative pain, with no need for epidural or intercostal catheter analgesia; by postoperative day 5, all patients received analgesia on demand. Most patients began ambulating on the first postoperative day, and the median hospital length of stay was 8 (range 5-86) days. Postoperative complications included pneumonia in five patients and anastomotic leakage in four. Two patients died: one from fulminant pulmonary embolism and one from multiple organ failure secondary to sepsis following pneumonia and anastomotic insufficiency.</p><p><strong>Conclusion: </strong>The da Vinci SP system was successfully used for the first time in a clinical series of RACE procedures. SP RACE offers comparable operating times and lymph node retrieval to robotic transthoracic procedures, low postoperative pain and rapid recovery. However, the current scope of the SP RACE procedure is limited, and its outcomes warrant further prospective investigation to better define its role, refine patient selection, and evaluate long-term results.</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/PMC13237595/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148161694","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 between age and surgical resection for patients with stage II or III colorectal cancer: national study.","authors":"Adil Rashid, Helen Blake, Lu Han, Jan van der Meulen, Michael S Braun, Nicola S Fearnhead, Kate Walker","doi":"10.1093/bjsopen/zrag071","DOIUrl":"10.1093/bjsopen/zrag071","url":null,"abstract":"<p><strong>Introduction: </strong>Elderly patients with colorectal cancer (CRC) are less likely to undergo surgical resection. This study investigated the association between age and surgical resection, stratified by Eastern Cooperative Oncology Group performance status (PS), co-morbidities, tumour site, and mode of presentation.</p><p><strong>Methods: </strong>Using national data from 2017-2022, patients diagnosed with stage II-III CRC in the English National Health Service were identified. The primary outcome was receipt of surgical resection. Risk-adjusted rates of surgical resection by age were estimated using multilevel multivariable logistic regression, testing for interactions with PS, co-morbidities, tumour site, and mode of presentation. Between-hospital variation in rates of surgical resection was also examined.</p><p><strong>Results: </strong>Overall, 63 698 of 79 763 patients (79.9%) underwent surgical resection during the study period. PS substantially modified the relationship between age and surgery. After risk adjustment, approximately 90% of fit patients (PS 0 or 1) underwent surgery up to age 75 years, with a steep decline by age 90 years to 61.8% (95% confidence interval (c.i.) 58.3% to 65.3%) and 48.8% (95% c.i. 45.9% to 51.7%) for PS 0 and 1, respectively. For patients too unfit to work (PS ≥ 2), the adjusted rate of surgery was lower and declined earlier, from around 80% at age 60 years, and then more gradually to 25.7% (95% c.i. 23.5% to 27.8%) at age 90 years. After adjustment, between-hospital variation was larger in patients aged > 75 years than in younger patients (interquartile range 60.7-74.7% versus 84.9-90.7%, respectively).</p><p><strong>Conclusion: </strong>In patients fit enough to work, age is not associated with surgical decision-making until around age 75 years. In less fit patients, age is a key factor in decision-making across all ages. Substantial variation in rates of surgery between hospitals highlights the need for evidence-based guidelines to support equitable access to potentially curative treatment.</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/PMC13255999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148223110","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 and surgeon volume versus outcomes after colorectal cancer surgery: umbrella review and meta-analysis.","authors":"Justin Ho, Essam Rama, Alessandro Martinino, Francesco Giovinazzo","doi":"10.1093/bjsopen/zrag074","DOIUrl":"10.1093/bjsopen/zrag074","url":null,"abstract":"<p><strong>Background: </strong>An inverse relationship between surgical volume and outcomes has been suggested, with higher-volume hospitals and surgeons achieving better results, prompting debate over the centralization of surgical services. However, minimum volume thresholds are unclear, and volume is a poor proxy for quality. Despite the significant global burden of colorectal cancer, the benefits of high-volume care remain uncertain. This umbrella review synthesized the evidence on volume-outcome associations in colorectal surgery.</p><p><strong>Methods: </strong>An umbrella review (PRISMA 2020) was conducted to evaluate systematic reviews and meta-analyses of the hospital/surgeon volume-outcome relationship in colorectal cancer. The Cochrane Library, PubMed, Embase, and MEDLINE were searched to 1 October 2025. Volume definitions and outcomes were extracted and meta-analysed by subgroup. A MeaSurement Tool to Assess Systematic Reviews 2 and Risk of Bias in Systematic Reviews were used for analysis of bias.</p><p><strong>Results: </strong>A total of 150 unique records was identified, with 10 systematic reviews meeting the inclusion criteria. High- versus low-volume hospitals demonstrated an inverse relationship in terms of postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.73, 95 per cent confidence interval 0.64 to 0.82), colon cancer (fixed-effect model: odds ratio 0.74, 0.70 to 0.78; random-effects model: odds ratio 0.75, 0.69 to 0.81), and colorectal cancer (fixed- and random-effects models: odds ratio 0.77, 0.67 to 0.88). High- versus low-volume surgeons demonstrated an inverse relationship with respect to postoperative mortality following resection for rectal cancer (fixed- and random-effects models: odds ratio 0.69, 0.59 to 0.81), colon cancer (fixed-effect model: odds ratio 0.70, 0.63 to 0.77; random-effects model: odds ratio 0.68, 0.55 to 0.85), and colorectal cancer (fixed- and random-effects models: odds ratio 0.67, 0.60 to 0.74). There were no consistent significant differences in rates of the secondary outcomes (anastomotic leak rate, permanent stoma formation, local recurrence rate, rate of abdominoperineal excision of the rectum).</p><p><strong>Conclusion: </strong>High-volume hospitals and surgeons are associated with both improved short- and long-term outcomes for patients undergoing colorectal cancer surgery. However, a specific cut-off definition for high- versus low-volume hospitals and surgeons is yet to be elucidated owing to the heterogeneity of existing volume definitions. Future studies are required to confirm a threshold for this dose-response relationship.</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/PMC13293263/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148315641","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":"Neurogenic diarrhoea after superior mesenteric artery divestment or resection for pancreatic adenocarcinoma following preoperative chemotherapy: international multicentre retrospective study.","authors":"Thomas F Stoop, Chiara Croce, Hiroyuki Ishida, Mahsoem Ali, Ammar A Javed, Asif Halimi, Atsushi Oba, Bas Groot Koerkamp, Carl-Stephan Leonhardt, Cornelius A Thiels, Elena Rangelova, Ernesto Sparrelid, Ira Sotirova, Jennifer L Leiting, Jun Tauchi, Kosuke Kobayashi, Marit Klos, Lysanne P M Beuk, Luana Genova, Manuela Mastronardi, Michael L Kendrick, Nabiha A Mughal, Olivier R Busch, Oskar Franklin, Patrik Larsson, Ulla Klaiber, Richard D Schulick, Rutger T Theijse, Oliver Strobel, Poya Ghorbani, Roeland F de Wilde, Salvador Rodriguez Franco, Toshitaka Sugawara, Johanna W Wilmink, Wells Messersmith, Marc G Besselink, Christopher L Wolfgang, Yosuke Inoue, Mark J Truty, Marco Del Chiaro","doi":"10.1093/bjsopen/zrag057","DOIUrl":"10.1093/bjsopen/zrag057","url":null,"abstract":"<p><strong>Background: </strong>The increased use of superior mesenteric artery (SMA) divestment has been a driver behind the increased resection rate for locally advanced pancreatic cancer following preoperative therapy. This has also resulted in an increase in the rate of postoperative neurogenic diarrhoea, but knowledge about postoperative neurogenic diarrhoea is lacking. The aims of this study were to determine the incidence, risk factors, management, and outcomes of neurogenic diarrhoea after SMA divestment/resection for pancreatic adenocarcinoma.</p><p><strong>Methods: </strong>This multicentre retrospective study included consecutive patients undergoing pancreatic adenocarcinoma resection, including SMA divestment/resection, after preoperative chemotherapy with or without radiotherapy between 2016 and 2022. Primary endpoints were the incidence of postoperative neurogenic diarrhoea, associated factors, treatment strategies, and outcomes. Secondary endpoints were the rate of adjuvant chemotherapy and the impact of neurogenic diarrhoea on overall survival (OS).</p><p><strong>Results: </strong>Overall, 291 patients who underwent pancreatic resection with concomitant SMA divestment (240, 82%) or resection (51, 18%) were included in the study. Postoperative neurogenic diarrhoea was diagnosed in 193 patients. The adjusted risk of developing neurogenic diarrhoea was 59% (95% confidence interval (c.i.) 46 to 73) after ≤ 180° SMA divestment, 80% (95% c.i. 67 to 93) after > 180° SMA divestment, and 77% (95% c.i. 66 to 88) after SMA resection. Postoperative neurogenic diarrhoea was treated with non-opioid drugs (29, 15%), non-opium opioids (140, 73%), opium tincture (69, 36%), and/or octreotide (49, 25%), and normalized in 51% of patients. After adjusting for confounders, neurogenic diarrhoea was not significantly associated with OS (hazard ratio 0.83; 95% c.i. 0.55 to 1.25).</p><p><strong>Conclusion: </strong>Neurogenic diarrhoea occurred in two-thirds of patients following resection of pancreatic adenocarcinoma with concomitant SMA divestment/resection, particularly after > 180° SMA divestment or SMA resection. Although challenging to manage, neurogenic diarrhoea is not associated with impaired OS. Evidence-based treatment strategies are needed for adequate management.</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/PMC13247994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148209889","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":"Cost-effectiveness of the gluteal turnover flap for perineal wound closure after abdominoperineal resection: randomized clinical trial.","authors":"R van den Berg, G D Musters, C Verhoef, H M Blommestein, P J Tanis","doi":"10.1093/bjsopen/zrag059","DOIUrl":"10.1093/bjsopen/zrag059","url":null,"abstract":"<p><strong>Background: </strong>In rectal cancer patients undergoing abdominoperineal resection (APR), a gluteal turnover flap has been proposed to reduce perineal morbidity; however, its cost-effectiveness remains unclear. This multicentre randomized clinical trial evaluated the cost-effectiveness of perineal closure with a gluteal turnover flap compared with primary closure after APR for rectal cancer.</p><p><strong>Methods: </strong>This secondary analysis of the BIOPEX-2 trial enrolled patients undergoing APR for rectal cancer at 19 hospitals (18 in the Netherlands, 1 in the UK) who were randomized in 1:1 to primary closure or gluteal turnover flap closure. Outcome assessors for wound healing and interviewers collecting cost and quality-of-life data were blinded to allocation. The outcome of interest was 12-month cost-effectiveness, including procedural costs, post-hospitalization care, wound care, rehospitalization, workforce participation, and health-related quality of life (QoL), as measured by EQ-5D™ and EQ-VAS scores collected via blinded telephone interview at ≥ 24 months. Missing data were handled by multiple imputation. Mean costs were calculated, and bootstrapping was used to estimate cost differences. QoL was compared between groups according to the presence of perineal complications.</p><p><strong>Results: </strong>The BIOPEX-2 trial randomized 175 patients; of these, 165 patients were analysed for the cost-effectiveness study (86 in the primary closure group, 79 in the gluteal turnover flap closure group). The mean total cost was €53 397 (95% confidence interval (c.i.) €46 645 to €60 149) for primary closure and €45 079 (95% c.i. €42 201 to €47 957) for gluteal turnover flap closure, yielding a mean cost reduction of €8318 (95% c.i. €928 to €15 709) favouring the gluteal turnover flap. The primary closure group had higher outpatient (total €71 316 versus €53 387), specialized wound (mean €1200 versus €720), and home care (mean €3842 versus €2504) costs. Patients with perineal complications reported significantly lower EQ-VAS and EQ-5D™ scores. Although these complications occurred more frequently in the primary closure group, no significant differences in QoL were observed between the randomization groups.</p><p><strong>Conclusion: </strong>Gluteal turnover flap closure is a cost-saving strategy for perineal wound closure following APR in patients with rectal cancer. These findings support broader implementation and offer potential benefits for both patients and healthcare providers. Registration number: NCT04004650 (http://www.clinicaltrials.gov).</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/PMC13274466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148270211","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":"Negative-pressure wound therapy in thoracic and abdominal surgery: meta-analysis of randomized trials.","authors":"Adil S Lakha, Salma Neves, Younis Alemour, Hannah McGivern, Alex Gordon-Weeks","doi":"10.1093/bjsopen/zrag027","DOIUrl":"10.1093/bjsopen/zrag027","url":null,"abstract":"<p><strong>Background: </strong>Around 30 000 patients undergo emergency laparotomy in the UK each year, and a similar number of patients undergo open cardiothoracic surgery. Surgical site infection is a common complication associated with increased morbidity, prolonged hospital stay, and higher healthcare costs. Negative-pressure wound therapy has been proposed as a prophylactic strategy to reduce wound complications, but trial evidence has been inconsistent.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was carried out using PRISMA guidelines and was registered prospectively in PROSPERO (CRD420251010516). A literature search was carried out in March 2025 (updated December 2025), and titles and abstracts were screened against predefined inclusion criteria. Trials assessing patients undergoing open thoracic or abdominal surgery for any indication in adult patients assessing the risk of surgical site infection as an outcome were included. Quality assessment was performed using Cochrane's risk-of-bias 2 tool. Summary statistics for outcomes of interest underwent meta-analyses to a confidence interval of 95% and are presented as forest plots.</p><p><strong>Results: </strong>Some 12 427 patients across 45 randomized trials in abdominal and thoracic surgery were included for analysis. Negative-pressure wound therapy significantly reduced surgical site infection compared with standard dressings (odds ratio (OR) 0.53, 95% confidence interval 0.42 to 0.66). The effect was consistent across commercial devices (PICO™ and Prevena™). Negative-pressure wound therapy was associated with shorter hospital stay (mean difference -1.67 (95% confidence interval -3.19 to -0.16) days), but not with reduced risk of organ/space infection (OR 0.92, 0.67 to 1.25), wound dehiscence, or reoperation. Only three studies included thoracic surgery and no significant difference in surgical site infection was found (OR 0.44, 0.00 to 45.25). Publication bias was detected; trim-and-fill analysis attenuated but did not eliminate the benefit (adjusted OR 0.70, 0.54 to 0.90). Adverse events and patient-reported outcomes were reported infrequently, and showed no consistent differences.</p><p><strong>Conclusion: </strong>Negative-pressure wound therapy was associated with a nearly 50% reduction in SSI and shorter hospital stay after open abdominal surgery, with consistent benefit across device types. However, evidence of publication bias, and limited long-term and patient-reported outcome data suggest that effect size may be overestimated. Selective use in high-risk patients is supported.</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/PMC13188150/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147970130","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":"FRIES score: predicting conversion in robotic liver surgery.","authors":"Raphael Venezia, Guillaume Millet, Stylianos Tzedakis, Heithem Jeddou, Bastien Le Floch, Alain Valverde, Nicolas Peru, Patrick Pessaux, Fabio Giannone, Jean Yves Mabrut, Kayvan Mohkam, Antonio Sa Cunha, Chady Salloum, Pierre Yves Blanc, Bertrand Le Roy, Ruth Bustamante, Claire Goumard, Olivier Scatton, David Fuks, Stéphanie Truant, Daniele Sommacale, Olivier Soubrane, Raffaele Brustia","doi":"10.1093/bjsopen/zrag065","DOIUrl":"10.1093/bjsopen/zrag065","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/PMC13245731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148204048","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":"Cancer vaccines: comprehensive review.","authors":"Rachael E Clifford, Nichola Manu, Qian Yang, Zeeshan Arif, David Aggen, Michael E Bryan, Aditi Gupta, Heather Shaw, David Church, Philippa Corrie, Natalia Savelyeva, Christian Ottensmeier, Sarah Danson, Robert Jones","doi":"10.1093/bjsopen/zrag041","DOIUrl":"10.1093/bjsopen/zrag041","url":null,"abstract":"<p><strong>Background: </strong>There has been an increasing focus on the potential of cancer vaccines as a therapeutic oncological option, aiming to harness the immune system to recognize and eliminate malignant cells. Unlike traditional therapies, vaccines exploit tumour-associated antigens and neoantigens to generate durable, tumour-specific immune responses.</p><p><strong>Methods: </strong>This review provides a comprehensive overview of current vaccine strategies, their clinical applications, and implications for surgical oncology.</p><p><strong>Results: </strong>Clinical trials highlight promising results in high-mutational burden cancers such as melanoma, lung, and bladder cancer, as well as in traditionally 'cold' tumours like pancreatic cancer. Combination strategies, particularly with checkpoint inhibitors, have shown enhanced efficacy, exemplified by messenger RNA-4157/V940 and autogene cevumeran in adjuvant settings. Off-the-shelf tumour-associated antigen vaccines offer scalability but face challenges of tolerance and limited specificity. Early data suggest vaccines may improve relapse-free survival and induce antigen spreading, broadening immune responses beyond the initial targets.</p><p><strong>Conclusion: </strong>Cancer vaccines are poised to complement surgery and systemic therapies, particularly in the perioperative window. Their integration into multimodal treatment strategies may redefine precision oncology, offering durable disease control and improved patient outcomes.</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/PMC13220758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148052401","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":"Video-based assessment tool for workflow analysis in minimally invasive colorectal surgery: expert consensus-based development and multicentre validation of ColoWorkflow.","authors":"Pooja P Jain, Pietro Mascagni, Giuseppe Massimiani, Nabani Banik, Marta Goglia, Lorenzo Arboit, Britty Baby, Andrea Balla, Ludovica Baldari, Gianfranco Silecchia, Claudio Fiorillo, Sergio Alfieri, Salvador Morales-Conde, Deborah S Keller, Luigi Boni, Nicolas Padoy","doi":"10.1093/bjsopen/zrag038","DOIUrl":"10.1093/bjsopen/zrag038","url":null,"abstract":"<p><strong>Background: </strong>Minimally invasive colorectal surgery is characterized by significant procedural variability, a difficult learning curve, and complications that affect patient outcomes. Video-based assessment offers an opportunity to generate data-driven insights to reduce variability, optimize training, and improve surgical performance. This mixed-methods study aimed to develop and validate a video-based assessment tool for workflow analysis across minimally invasive colorectal procedures.</p><p><strong>Methods: </strong>An international steering committee panel of seven members coordinated a three-round modified Delphi process. Experts in colorectal surgery and video-based assessment were invited to reach consensus (≥ 70% agreement) on the phases and steps that describe workflows across colorectal surgery procedural videos. The resulting framework informed the development of ColoWorkflow. Four independent raters then applied ColoWorkflow to a multicentre video data set of laparoscopic and robotic colorectal procedures. Applicability and inter-rater reliability were evaluated.</p><p><strong>Results: </strong>Of 66 invited experts, 41 (62%) from 11 countries completed round 1, 40 (98%) completed round 2, 20 attended the final online consensus meeting, and all (40 of 40) approved the final workflow descriptors. Consensus was achieved on nine procedure-agnostic phases (port placement and abdomen exploration; vascular dissection and ligation, mesocolon/mesorectum dissection, additional lymphadenectomy; colon and/or rectum mobilization; colorectal transection; anastomosis; completion of operation; preplanned additional procedures; unplanned procedures; extracorporeal procedures) and 34 procedure-specific steps that describe colorectal surgery workflows. ColoWorkflow was developed and applied to 54 colorectal surgery videos (left and right hemicolectomies, sigmoid and rectosigmoid resections, and total proctocolectomies) from five centres in four countries. The tool demonstrated broad applicability, as all phase and step labels, except one, were represented in at least one video. Inter-rater reliability was moderate, with a mean Cohen's κ value of 0.72 for phases and 0.67 for steps. Most discrepancies arose at phase transitions and step boundary definitions.</p><p><strong>Conclusion: </strong>Based on this preliminary work, ColoWorkflow is a promising tool for workflow analysis across minimally invasive colorectal procedures. Its adoption may help standardize training, accelerate competency acquisition, and advance data-informed surgical quality improvement.</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/PMC13167257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147926104","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}