Aditi Nijhawan,Ewoud Ter Avest,Callum J Twohig,Stacey J Webster,Jason Morris,Robbie Lendrum,Virginia Fitzpatrick-Swallow,David J Lockey,Zane B Perkins
INTRODUCTIONIn mature trauma systems, most trauma deaths occur soon after injury yet studies often only include patients who survive to hospital admission. These studies exclude pre-hospital deaths and introduce substantial survival bias. Understanding trauma fatalities across all phases of care is essential to identify opportunities to further improve trauma outcomes.METHODSThis retrospective cohort study analysed adult trauma fatalities attended by London's Air Ambulance from 1 January 2019 to 31 December 2020. Deaths were classified as pre-hospital if traumatic cardiac arrest occurred before hospital arrival. Timing of death was recorded as minutes from injury to arrest for pre-hospital cases and days from admission to death for in-hospital cases. A multidisciplinary panel determined the likely cause of death using clinical, radiological, and post-mortem findings.RESULTSAmong 3,089 adult trauma patients attended, 497 (16.1%) died. Most deaths (77.1%) occurred pre-hospital, with a median time from injury to traumatic cardiac arrest of 12 minutes (IQR 6-24). Haemorrhage and traumatic brain injury accounted for 81.9% of deaths overall, but their distribution differed markedly by phase of care: 96.2% of haemorrhage deaths occurred pre-hospital, whereas 84.2% of in-hospital deaths were due to traumatic brain injury. In addition, deaths from all other potentially reversible causes, and 95.1% of penetrating trauma deaths, occurred pre-hospital.CONCLUSIONIn mature trauma systems, most trauma deaths now occur before arrival in hospital, with many due to potentially reversible causes. The greatest opportunities to improve trauma outcomes now lie in the pre-hospital phase of care.
{"title":"Epidemiology of trauma deaths across a mature regional trauma system: patterns of pre-hospital and in-hospital fatalities.","authors":"Aditi Nijhawan,Ewoud Ter Avest,Callum J Twohig,Stacey J Webster,Jason Morris,Robbie Lendrum,Virginia Fitzpatrick-Swallow,David J Lockey,Zane B Perkins","doi":"10.1093/bjs/znag030","DOIUrl":"https://doi.org/10.1093/bjs/znag030","url":null,"abstract":"INTRODUCTIONIn mature trauma systems, most trauma deaths occur soon after injury yet studies often only include patients who survive to hospital admission. These studies exclude pre-hospital deaths and introduce substantial survival bias. Understanding trauma fatalities across all phases of care is essential to identify opportunities to further improve trauma outcomes.METHODSThis retrospective cohort study analysed adult trauma fatalities attended by London's Air Ambulance from 1 January 2019 to 31 December 2020. Deaths were classified as pre-hospital if traumatic cardiac arrest occurred before hospital arrival. Timing of death was recorded as minutes from injury to arrest for pre-hospital cases and days from admission to death for in-hospital cases. A multidisciplinary panel determined the likely cause of death using clinical, radiological, and post-mortem findings.RESULTSAmong 3,089 adult trauma patients attended, 497 (16.1%) died. Most deaths (77.1%) occurred pre-hospital, with a median time from injury to traumatic cardiac arrest of 12 minutes (IQR 6-24). Haemorrhage and traumatic brain injury accounted for 81.9% of deaths overall, but their distribution differed markedly by phase of care: 96.2% of haemorrhage deaths occurred pre-hospital, whereas 84.2% of in-hospital deaths were due to traumatic brain injury. In addition, deaths from all other potentially reversible causes, and 95.1% of penetrating trauma deaths, occurred pre-hospital.CONCLUSIONIn mature trauma systems, most trauma deaths now occur before arrival in hospital, with many due to potentially reversible causes. The greatest opportunities to improve trauma outcomes now lie in the pre-hospital phase of care.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"8 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147471447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O U Rithya,Xavier Muller,Kayvan Mohkam,Jean-Yves Mabrut,Julie Perinel,Mustapha Adham,Thomas Rimmelé,Guillaume Monneret
{"title":"Early Immunoparalysis in Patients Undergoing Pancreatoduodenectomy based on mHLA-DR Profiling.","authors":"O U Rithya,Xavier Muller,Kayvan Mohkam,Jean-Yves Mabrut,Julie Perinel,Mustapha Adham,Thomas Rimmelé,Guillaume Monneret","doi":"10.1093/bjs/znag031","DOIUrl":"https://doi.org/10.1093/bjs/znag031","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"2 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Piers R Boshier,Daryl Kai Ann Chia,Sri Ganeshamurthy Thrumurthy,Jun Liang Teh,Maria Wobith,Maria Bencivenga,Federica Filippini,Teodora Dumitra,Miguel Burch,Hyoung-Il Kim,Benjamin Kobitzsch,Liudmila L Kodach,Judith S E Quik,Vo Duy Long,Micha J de Neijs,Pieter C van der Sluis,Alberto M Leon-Takahashi,Yanghee Woo,Mickael Chevallay,Massimo Framarini,Paolo Morgagni,Ewelina Frejlich,Heike I Grabsch,Sheraz R Markar,Daniele Marrelli,Do Joong Park,Raghav Sundar,Zekuan Xu,Kay Khine Linn,Han Kwang Yang,Joji Kitayama,Zhenggang Zhu,Sun Young Rha,Bas Wijnhoven,Hiroharu Yamashita,Wei Peng Yong,Christelle de la Fouchardière,Magnus Nilsson,Hironori Ishigami,Johanna W Van Sandick,Florian Lordick,Brian D Badgwell,Jimmy Bok-Yan So
INTRODUCTIONGastric cancer peritoneal metastasis (GCPM) is a common manifestation of advanced gastric cancer, associated with poor prognosis.METHODSThe International Gastric Cancer Association (IGCA) convened a multidisciplinary working group of 42 global experts from 15 countries to develop a total of thirteen consensus statements addressing diagnosis, treatment, and research priorities for GCPM. Using ACCORD-compliant methodology, the group conducted systematic literature searches and applied a structured Delphi process with anonymous Likert-scale voting and ≥70% consensus threshold to generate and refine consensus statements.RESULTSConsensus was achieved for all thirteen statements among the working group during the first Delphi round with 75-100% of respondents selecting either "Strongly Agree" or "Agree". Coefficients of variation values were ≤ 0.23. Polling of a broader group of experts (n=63) that included members of the working group (n=21) during the IGCC (2025) GCPM Consensus Session demonstrated agreement for twelve of the thirteen statements. This broader group of experts, that had greater representation from medical oncologists, did not reach consensus (52% agreement) on best practice for systemic treatment of patients with GCPM, possibly due the rapidly evolving developments in this field of metastatic gastric cancer.CONCLUSIONThis consensus exercise provides a foundation for globally relevant GCPM management strategies and highlights critical research needed to address significant evidence gaps that will improve patient outcomes.
{"title":"Management of Gastric Cancer Peritoneal Metastasis: IGCA Working Group Consensus Statements.","authors":"Piers R Boshier,Daryl Kai Ann Chia,Sri Ganeshamurthy Thrumurthy,Jun Liang Teh,Maria Wobith,Maria Bencivenga,Federica Filippini,Teodora Dumitra,Miguel Burch,Hyoung-Il Kim,Benjamin Kobitzsch,Liudmila L Kodach,Judith S E Quik,Vo Duy Long,Micha J de Neijs,Pieter C van der Sluis,Alberto M Leon-Takahashi,Yanghee Woo,Mickael Chevallay,Massimo Framarini,Paolo Morgagni,Ewelina Frejlich,Heike I Grabsch,Sheraz R Markar,Daniele Marrelli,Do Joong Park,Raghav Sundar,Zekuan Xu,Kay Khine Linn,Han Kwang Yang,Joji Kitayama,Zhenggang Zhu,Sun Young Rha,Bas Wijnhoven,Hiroharu Yamashita,Wei Peng Yong,Christelle de la Fouchardière,Magnus Nilsson,Hironori Ishigami,Johanna W Van Sandick,Florian Lordick,Brian D Badgwell,Jimmy Bok-Yan So","doi":"10.1093/bjs/znag027","DOIUrl":"https://doi.org/10.1093/bjs/znag027","url":null,"abstract":"INTRODUCTIONGastric cancer peritoneal metastasis (GCPM) is a common manifestation of advanced gastric cancer, associated with poor prognosis.METHODSThe International Gastric Cancer Association (IGCA) convened a multidisciplinary working group of 42 global experts from 15 countries to develop a total of thirteen consensus statements addressing diagnosis, treatment, and research priorities for GCPM. Using ACCORD-compliant methodology, the group conducted systematic literature searches and applied a structured Delphi process with anonymous Likert-scale voting and ≥70% consensus threshold to generate and refine consensus statements.RESULTSConsensus was achieved for all thirteen statements among the working group during the first Delphi round with 75-100% of respondents selecting either \"Strongly Agree\" or \"Agree\". Coefficients of variation values were ≤ 0.23. Polling of a broader group of experts (n=63) that included members of the working group (n=21) during the IGCC (2025) GCPM Consensus Session demonstrated agreement for twelve of the thirteen statements. This broader group of experts, that had greater representation from medical oncologists, did not reach consensus (52% agreement) on best practice for systemic treatment of patients with GCPM, possibly due the rapidly evolving developments in this field of metastatic gastric cancer.CONCLUSIONThis consensus exercise provides a foundation for globally relevant GCPM management strategies and highlights critical research needed to address significant evidence gaps that will improve patient outcomes.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"15 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147495169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BACKGROUNDThe current evidence for preoperative low energy diets (LEDs) for patients with body mass index (BMI) > 30 kg/m2 prior to non-bariatric surgery rests on high-risk of bias studies. A randomized clinical trial (RCT) is warranted to bridge this knowledge gap. Prior to a larger RCT, we conducted a pilot feasibility RCT to address potential hurdles for the larger trial.METHODSThe pilot feasibility multicenter trial was conducted in Canada at four centers between January and October 2024. Patients were randomized (1:1 randomly permuted online blocked allocation) to receive a 3-week LED protocol or standard care. All patients older than 18 years of age with BMI body greater than 30kg/m2 undergoing elective non-bariatric intra-abdominal or orthopedic surgery were evaluated for enrollment. Main exclusion criteria were contraindications to LED and surgery scheduled without at least 3 weeks notice. The primary outcome was descriptive including the following feasibility outcomes: recruitment rate, randomization percentage, intervention adherence, and follow-up completion. Clinical outcomes included anthropometric data. The primary outcome analysis was descriptive. Additionally, a random effects meta-analysis was performed using previously published RCT data for 30-day postoperative morbidity. Last follow-up date was January 14th, 2025.RESULTSThere were 91 patients randomized (LED n=45, control n=46). Out of 373 eligible patients, 57% (95%CI 51.4-63.1%) were randomized. Out of these 91 randomized patients, 81 (89%, 95%CI 80.7-94.6%) had complete follow-up. LED adherence was 81.7% (95%CI 74.1-89.3%). Analysis of covariance suggested patients in the LED group lost more weight during the 3-week intervention period (MD 4.5kg, 95%CI -5.6 to -3.5). The pooled meta-analysis of 5 RCTs suggested a 18% relative risk reduction in postoperative morbidity favouring the intervention (RR 0.82, 95%CI 0.52-1.28, p=0.38, I2=0%).CONCLUSIONSThe feasibility targets of this pilot RCT were not met for recruitment rate, randomization percentage, and complete follow-up. Pooled meta-analysis suggests that LED prior to non-bariatric surgery can effectively induce weight loss with reduced postoperative morbidity, which needs to be validated by a larger noninferiority RCT with additional centers to meet the feasibility targets.TRIAL REGISTRATIONClinicaltrials.gov: NCT03935451.
{"title":"Preoperative low-energy diets for patients with body mass index >30kg/m2 undergoing non-bariatric surgery: A pilot feasibility randomized clinical trial and a systematic review and meta-analysis of efficacy data.","authors":"Tyler McKechnie,Olivia Kuszaj,Heather Perks,Sahaar Rattansi,Carolina Meyhofer Pedroso,Phillip Staibano,Alex Thabane,Jordan Leitch,Deborah DuMerton,Sally Griffin,Dimitrios A Koutoukidis,Karim Ramji,Sunil V Patel,Aristithes Doumouras,Cagla Eskicioglu,Sameer Parpia,Lehana Thabane,Mohit Bhandari","doi":"10.1093/bjs/znag023","DOIUrl":"https://doi.org/10.1093/bjs/znag023","url":null,"abstract":"BACKGROUNDThe current evidence for preoperative low energy diets (LEDs) for patients with body mass index (BMI) > 30 kg/m2 prior to non-bariatric surgery rests on high-risk of bias studies. A randomized clinical trial (RCT) is warranted to bridge this knowledge gap. Prior to a larger RCT, we conducted a pilot feasibility RCT to address potential hurdles for the larger trial.METHODSThe pilot feasibility multicenter trial was conducted in Canada at four centers between January and October 2024. Patients were randomized (1:1 randomly permuted online blocked allocation) to receive a 3-week LED protocol or standard care. All patients older than 18 years of age with BMI body greater than 30kg/m2 undergoing elective non-bariatric intra-abdominal or orthopedic surgery were evaluated for enrollment. Main exclusion criteria were contraindications to LED and surgery scheduled without at least 3 weeks notice. The primary outcome was descriptive including the following feasibility outcomes: recruitment rate, randomization percentage, intervention adherence, and follow-up completion. Clinical outcomes included anthropometric data. The primary outcome analysis was descriptive. Additionally, a random effects meta-analysis was performed using previously published RCT data for 30-day postoperative morbidity. Last follow-up date was January 14th, 2025.RESULTSThere were 91 patients randomized (LED n=45, control n=46). Out of 373 eligible patients, 57% (95%CI 51.4-63.1%) were randomized. Out of these 91 randomized patients, 81 (89%, 95%CI 80.7-94.6%) had complete follow-up. LED adherence was 81.7% (95%CI 74.1-89.3%). Analysis of covariance suggested patients in the LED group lost more weight during the 3-week intervention period (MD 4.5kg, 95%CI -5.6 to -3.5). The pooled meta-analysis of 5 RCTs suggested a 18% relative risk reduction in postoperative morbidity favouring the intervention (RR 0.82, 95%CI 0.52-1.28, p=0.38, I2=0%).CONCLUSIONSThe feasibility targets of this pilot RCT were not met for recruitment rate, randomization percentage, and complete follow-up. Pooled meta-analysis suggests that LED prior to non-bariatric surgery can effectively induce weight loss with reduced postoperative morbidity, which needs to be validated by a larger noninferiority RCT with additional centers to meet the feasibility targets.TRIAL REGISTRATIONClinicaltrials.gov: NCT03935451.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"33 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439464","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J M Blazeby,H S Richards,S Cousins,L Wallis,A Clarke,S Metcalfe,W Frost,S Waters,S Shah,J Grover,J Byrne,D Ward,R Dacombe,L Wickham,M D Gardiner,B Bal,C Steel,S Pywell,M Etemadi,J Ives,R Huxtable,K N L Avery,L Rooshenas,D Elliott
{"title":"The Governance of Surgical Innovation in the UK National Health Service.","authors":"J M Blazeby,H S Richards,S Cousins,L Wallis,A Clarke,S Metcalfe,W Frost,S Waters,S Shah,J Grover,J Byrne,D Ward,R Dacombe,L Wickham,M D Gardiner,B Bal,C Steel,S Pywell,M Etemadi,J Ives,R Huxtable,K N L Avery,L Rooshenas,D Elliott","doi":"10.1093/bjs/znag024","DOIUrl":"https://doi.org/10.1093/bjs/znag024","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"12 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147439511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Fear of cancer recurrence in patients undergoing active surveillance versus standard surgery for oesophageal cancer (SANO-trial).","authors":"Sanjiv S G Gangaram Panday, ","doi":"10.1093/bjs/znag028","DOIUrl":"https://doi.org/10.1093/bjs/znag028","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"15 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147393811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hugo C Temperley,Matthew Coalter,Ben Creavin,Patrick Jordan,Andrew Hogan,Jacintha O'Sullivan,Donal O'Shea,Paul H McCormick,Emily Harold,Michael E Kelly
Total neoadjuvant therapy (TNT) has become a standard treatment approach for rectal cancer, providing higher rates of pathological complete response and improved long-term survival. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown significant advantages in weight loss, systemic metabolic regulation, and anti-inflammatory effects. Emerging evidence also points to possible anticancer properties, with observational data suggesting a lower incidence of obesity-related cancers, including colorectal cancer. This narrative review aims to examine the biological basis and potential therapeutic benefits of combining GLP-1 RAs with TNT for the management of locally advanced rectal cancer. We explore how GLP-1 RAs may affect tumour biology and treatment tolerance, including their impact on visceral fat, insulin resistance, and systemic inflammation. Preclinical and clinical data are reviewed to determine whether GLP-1-induced metabolic changes can improve the effectiveness of chemotherapy and enhance surgical and oncological results. Although evidence is evolving, the integration of GLP-1 receptor agonists into rectal cancer treatment pathways represents a promising area for further investigation, particularly in metabolically vulnerable populations.
{"title":"Evaluating the impact of GLP-1 receptor agonists in combination with total neoadjuvant therapy for locally advanced rectal cancer.","authors":"Hugo C Temperley,Matthew Coalter,Ben Creavin,Patrick Jordan,Andrew Hogan,Jacintha O'Sullivan,Donal O'Shea,Paul H McCormick,Emily Harold,Michael E Kelly","doi":"10.1093/bjs/znag029","DOIUrl":"https://doi.org/10.1093/bjs/znag029","url":null,"abstract":"Total neoadjuvant therapy (TNT) has become a standard treatment approach for rectal cancer, providing higher rates of pathological complete response and improved long-term survival. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown significant advantages in weight loss, systemic metabolic regulation, and anti-inflammatory effects. Emerging evidence also points to possible anticancer properties, with observational data suggesting a lower incidence of obesity-related cancers, including colorectal cancer. This narrative review aims to examine the biological basis and potential therapeutic benefits of combining GLP-1 RAs with TNT for the management of locally advanced rectal cancer. We explore how GLP-1 RAs may affect tumour biology and treatment tolerance, including their impact on visceral fat, insulin resistance, and systemic inflammation. Preclinical and clinical data are reviewed to determine whether GLP-1-induced metabolic changes can improve the effectiveness of chemotherapy and enhance surgical and oncological results. Although evidence is evolving, the integration of GLP-1 receptor agonists into rectal cancer treatment pathways represents a promising area for further investigation, particularly in metabolically vulnerable populations.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"45 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147383704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sex-dimorphisms in surgery and biology of colorectal liver metastasis.","authors":"Torhild Veen,Kjetil Søreide","doi":"10.1093/bjs/znag021","DOIUrl":"https://doi.org/10.1093/bjs/znag021","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"127 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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