Carmen Rubio-Alarcón,Andrew Georgiadis,Ingrid A Franken,Haoyue Wang,Sietske C M W van Nassau,Suzanna J Schraa,Dave E W van der Kruijssen,Karlijn van Rooijen,Theodora C Linders,Pien Delis-van Diemen,Maartje Alkemade,Anne Bolijn,Marianne Tijssen,Margriet Lemmens,Lana Meiqari,Steven L C Ketelaars,Adria Closa-Mosquera,Miranda M W van Dongen,Mirthe Lanfermeijer,Birgit I Lissenberg-Witte,Linda J W Bosch,Teunise Bisschop-Snetselaar,Bregje C Adriaans,Amy Greer,David Riley,James R White,Christopher Greco,Liam Cox,Jesse Fox,Kaitlin Victor,Catherine Leech,Samuel V Angiuoli,Niels F M Kok,Cornelis J A Punt,Daan van den Broek,Miriam Koopman,Gerrit A Meijer,Victor E Velculescu,Jeanine M L Roodhart,Veerle M H Coupé,Mark Sausen,Geraldine R Vink,Remond J A Fijneman,
BACKGROUNDCirculating tumour DNA (ctDNA) is a promising biomarker to guide clinical decision-making. The aim of this study was to investigate the prognostic value of postoperative ctDNA in patients with stage III colon cancer who received adjuvant chemotherapy (ACT).METHODSPROVENC3 was a multicentre prospective study of patients who underwent resection of pathological stage III colon cancer. Blood samples were collected at a median of 13 (interquartile range 4-20) days after resection. The presence of minimal residual disease was determined using Labcorp® Plasma Detect™, a novel tumour-informed whole genome sequencing (WGS) ctDNA test. The primary endpoint was 3-year time to recurrence (TTR). ctDNA status was further combined with pathological risk status to investigate the combined prognostic value.RESULTSThe median follow-up of the 209 patients who were included was 40 months. In total, 28 patients (13%) had detectable ctDNA after surgery. Postoperative ctDNA-positive patients had a worse TTR compared with ctDNA-negative patients (HR 6.2 (95% c.i. 3.4 to 11.2); P < 0.001). Of all ctDNA-positive patients, 36% did not develop recurrences during 3-year follow-up. Detectable ctDNA after ACT was associated with worse TTR (HR 7.9 (95% c.i. 3.9 to 15.9); P < 0.001). ctDNA status combined with pathological risk classification resulted in a 3-year recurrence risk that varied from 82% for pathological high-risk (pT4/N2) ctDNA-positive patients to 7% for pathological low-risk (pT1-3 N1) ctDNA-negative patients (HR 28.5 (95% c.i. 10.5 to 77.2); P < 0.001).CONCLUSIONPostoperative ctDNA detection using a tumour-informed WGS test improves prognosis stratification in stage III colon cancer and may help to personalize adjuvant treatment.
{"title":"Circulating tumour DNA in patients with stage III colon cancer: multicentre prospective PROVENC3 study.","authors":"Carmen Rubio-Alarcón,Andrew Georgiadis,Ingrid A Franken,Haoyue Wang,Sietske C M W van Nassau,Suzanna J Schraa,Dave E W van der Kruijssen,Karlijn van Rooijen,Theodora C Linders,Pien Delis-van Diemen,Maartje Alkemade,Anne Bolijn,Marianne Tijssen,Margriet Lemmens,Lana Meiqari,Steven L C Ketelaars,Adria Closa-Mosquera,Miranda M W van Dongen,Mirthe Lanfermeijer,Birgit I Lissenberg-Witte,Linda J W Bosch,Teunise Bisschop-Snetselaar,Bregje C Adriaans,Amy Greer,David Riley,James R White,Christopher Greco,Liam Cox,Jesse Fox,Kaitlin Victor,Catherine Leech,Samuel V Angiuoli,Niels F M Kok,Cornelis J A Punt,Daan van den Broek,Miriam Koopman,Gerrit A Meijer,Victor E Velculescu,Jeanine M L Roodhart,Veerle M H Coupé,Mark Sausen,Geraldine R Vink,Remond J A Fijneman, ","doi":"10.1093/bjs/znaf281","DOIUrl":"https://doi.org/10.1093/bjs/znaf281","url":null,"abstract":"BACKGROUNDCirculating tumour DNA (ctDNA) is a promising biomarker to guide clinical decision-making. The aim of this study was to investigate the prognostic value of postoperative ctDNA in patients with stage III colon cancer who received adjuvant chemotherapy (ACT).METHODSPROVENC3 was a multicentre prospective study of patients who underwent resection of pathological stage III colon cancer. Blood samples were collected at a median of 13 (interquartile range 4-20) days after resection. The presence of minimal residual disease was determined using Labcorp® Plasma Detect™, a novel tumour-informed whole genome sequencing (WGS) ctDNA test. The primary endpoint was 3-year time to recurrence (TTR). ctDNA status was further combined with pathological risk status to investigate the combined prognostic value.RESULTSThe median follow-up of the 209 patients who were included was 40 months. In total, 28 patients (13%) had detectable ctDNA after surgery. Postoperative ctDNA-positive patients had a worse TTR compared with ctDNA-negative patients (HR 6.2 (95% c.i. 3.4 to 11.2); P < 0.001). Of all ctDNA-positive patients, 36% did not develop recurrences during 3-year follow-up. Detectable ctDNA after ACT was associated with worse TTR (HR 7.9 (95% c.i. 3.9 to 15.9); P < 0.001). ctDNA status combined with pathological risk classification resulted in a 3-year recurrence risk that varied from 82% for pathological high-risk (pT4/N2) ctDNA-positive patients to 7% for pathological low-risk (pT1-3 N1) ctDNA-negative patients (HR 28.5 (95% c.i. 10.5 to 77.2); P < 0.001).CONCLUSIONPostoperative ctDNA detection using a tumour-informed WGS test improves prognosis stratification in stage III colon cancer and may help to personalize adjuvant treatment.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"29 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937837","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}
Ignacio Fernandez-Hurtado,Naila Pages-Valle,Maria F Sarubbo,Olga Claramonte-Bellmunt,Santiago Baena-Bradaschia,Jose A Cifuentes-Rodenas,Xavier Serra-Aracil
BACKGROUNDOpen excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease, offering low recurrence but notable postoperative pain. Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence. The aim of this trial was to compare the 1-year efficacy of both techniques using validated symptom and quality-of-life scores.METHODSA prospective, single-centre, randomized, open-label trial was conducted in patients with grade III haemorrhoids. The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline. Additionally, the predefined, pragmatic composite endpoint-the clinical failure rate (CFR), defined as a ≤50% improvement in both HDSS and SHS-HD-was compared. Secondary outcomes included postoperative pain, time to return to work, complications, and reoperation.RESULTSFrom August 2021 to February 2023, 50 patients were randomized (25 OEH patients and 25 THD patients). Three patients were lost to follow-up (2 THD patients and 1 OEH patient). CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001). Both procedures reduced symptom and quality-of-life scores (P = 0.002 and P < 0.001). OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010).CONCLUSIONOEH is more effective than THD but is associated with greater early postoperative pain.REGISTRATION NUMBERNCT06420986 (http://www.clinicaltrials.gov).
{"title":"Open excisional haemorrhoidectomy versus transanal haemorrhoidal dearterialization for grade III haemorrhoids: open-label randomized clinical trial.","authors":"Ignacio Fernandez-Hurtado,Naila Pages-Valle,Maria F Sarubbo,Olga Claramonte-Bellmunt,Santiago Baena-Bradaschia,Jose A Cifuentes-Rodenas,Xavier Serra-Aracil","doi":"10.1093/bjs/znaf282","DOIUrl":"https://doi.org/10.1093/bjs/znaf282","url":null,"abstract":"BACKGROUNDOpen excisional haemorrhoidectomy (OEH) remains the standard treatment for advanced haemorrhoidal disease, offering low recurrence but notable postoperative pain. Transanal haemorrhoidal dearterialization (THD) is an alternative with reduced pain but potentially higher recurrence. The aim of this trial was to compare the 1-year efficacy of both techniques using validated symptom and quality-of-life scores.METHODSA prospective, single-centre, randomized, open-label trial was conducted in patients with grade III haemorrhoids. The primary outcome was the relative change at 12 months in Haemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale adapted for Haemorrhoidal Disease (SHS-HD) from baseline. Additionally, the predefined, pragmatic composite endpoint-the clinical failure rate (CFR), defined as a ≤50% improvement in both HDSS and SHS-HD-was compared. Secondary outcomes included postoperative pain, time to return to work, complications, and reoperation.RESULTSFrom August 2021 to February 2023, 50 patients were randomized (25 OEH patients and 25 THD patients). Three patients were lost to follow-up (2 THD patients and 1 OEH patient). CFR was significantly higher in the THD group (14 of 23 (61%)) versus the OEH group (2 of 24 (8%)) (P <0.001). All eigth reoperations occurred in the THD group (P = 0.001). Both procedures reduced symptom and quality-of-life scores (P = 0.002 and P < 0.001). OEH was associated with greater early postoperative pain and a longer time to return to work (median of 21 versus 14 days; P = 0.010).CONCLUSIONOEH is more effective than THD but is associated with greater early postoperative pain.REGISTRATION NUMBERNCT06420986 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"42 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994880","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}
Odd Bjørn Salte,Rolf E Hagen,Marius Svanevik,Morten Wang Fagerland,Hilde Risstad,Jøran Hjelmesæth,Jon A Kristinsson,Rune Sandbu,Tom Mala
OBJECTIVEIdentifying the optimal metabolic bariatric surgery approach for patients with severe obesity with a BMI ≥50 kg/m2 remains challenging. The aim of this long-term follow-up of a randomized clinical trial (RCT) was to compare distal long alimentary limb Roux-en-Y gastric bypass (RYGB) with standard RYGB for 10-year weight loss and nutritional outcomes.METHODSecondary analysis of a 10-year follow-up of an RCT with initially 113 patients (BMI 50-60 kg/m2) randomized to either standard (n = 57, 50 cm biliopancreatic/150 cm alimentary limb) or distal long alimentary limb RYGB (n = 56, 50 cm biliopancreatic/150 cm common limb) from March 2011 to April 2013 at two Norwegian hospitals. The final data collection date was 15 August 2023. The primary focus was weight loss (BMI reduction, %total weight loss) and other secondary outcomes included cardiometabolic risk factors, nutritional status, and health-related quality of life (HRQOL).RESULTSOf 113 patients, 79 (69.9%, mean age 50 (s.d. 8.7) years, 50 (63%) females) patients were available for 10-year follow-up (41 standard RYGB, 38 distal RYGB). The 10-year mortality rate was 3.5% (4/113) and all deaths occurred after distal RYGB. One death may have been associated with the surgery in a patient with previously undiagnosed liver cirrhosis at the time of operation. Mean BMI reduction from baseline was 12.0 kg/m2 (95% c.i., 10.8 to 13.2) after standard RYGB and 14.7 kg/m2 (95% c.i., 13.5 to 15.9) after distal RYGB with a between-group difference of 2.7 kg/m2 (95% c.i., 1.0 to 4.5, P = 0.002). The mean percentage total weight loss from baseline was 23.0% (95% c.i., 20.8 to 25.2) after standard RYGB and 28.2% (95% c.i., 26.0 to 30.5) after distal RYGB, with a between-group difference of 5.3% (95% c.i., 2.1 to 8.4, P = 0.001). The distal RYGB group had higher rates of malnutrition (1/57 standard versus 5/56 distal; P = 0.12), diarrhoea (7/57 standard versus 15/56 distal; P = 0.05), and vitamin D deficiency (24/41 standard versus 32/38 distal; P = 0.01). There were no differences between the groups in the prevalence of type 2 diabetes, hypertension, dyslipidaemia, or metabolic syndrome at 10-year follow-up. Four patients underwent revisional surgery due to malnutrition after distal RYGB. There were no statistically significant differences in HRQOL scores between the groups at 10 years (SF-36 physical 44.2 versus 44.1, mental 50.3 versus 47.3; OWLQOL 63 versus 61; all P > 0.2).CONCLUSIONSDistal long alimentary limb RYGB resulted in greater weight loss after 10 years with a higher risk of malnutrition, diarrhoea, and vitamin D deficiency.TRIAL REGISTRATIONClinicaltrials.gov NCT00821197.
{"title":"Effect of standard versus long alimentary limb distal Roux-en-Y gastric bypass on weight loss and nutritional outcomes at 10 years in patients with BMI 50-60 kg/m2-a secondary analysis of a randomized clinical trial.","authors":"Odd Bjørn Salte,Rolf E Hagen,Marius Svanevik,Morten Wang Fagerland,Hilde Risstad,Jøran Hjelmesæth,Jon A Kristinsson,Rune Sandbu,Tom Mala","doi":"10.1093/bjs/znaf285","DOIUrl":"https://doi.org/10.1093/bjs/znaf285","url":null,"abstract":"OBJECTIVEIdentifying the optimal metabolic bariatric surgery approach for patients with severe obesity with a BMI ≥50 kg/m2 remains challenging. The aim of this long-term follow-up of a randomized clinical trial (RCT) was to compare distal long alimentary limb Roux-en-Y gastric bypass (RYGB) with standard RYGB for 10-year weight loss and nutritional outcomes.METHODSecondary analysis of a 10-year follow-up of an RCT with initially 113 patients (BMI 50-60 kg/m2) randomized to either standard (n = 57, 50 cm biliopancreatic/150 cm alimentary limb) or distal long alimentary limb RYGB (n = 56, 50 cm biliopancreatic/150 cm common limb) from March 2011 to April 2013 at two Norwegian hospitals. The final data collection date was 15 August 2023. The primary focus was weight loss (BMI reduction, %total weight loss) and other secondary outcomes included cardiometabolic risk factors, nutritional status, and health-related quality of life (HRQOL).RESULTSOf 113 patients, 79 (69.9%, mean age 50 (s.d. 8.7) years, 50 (63%) females) patients were available for 10-year follow-up (41 standard RYGB, 38 distal RYGB). The 10-year mortality rate was 3.5% (4/113) and all deaths occurred after distal RYGB. One death may have been associated with the surgery in a patient with previously undiagnosed liver cirrhosis at the time of operation. Mean BMI reduction from baseline was 12.0 kg/m2 (95% c.i., 10.8 to 13.2) after standard RYGB and 14.7 kg/m2 (95% c.i., 13.5 to 15.9) after distal RYGB with a between-group difference of 2.7 kg/m2 (95% c.i., 1.0 to 4.5, P = 0.002). The mean percentage total weight loss from baseline was 23.0% (95% c.i., 20.8 to 25.2) after standard RYGB and 28.2% (95% c.i., 26.0 to 30.5) after distal RYGB, with a between-group difference of 5.3% (95% c.i., 2.1 to 8.4, P = 0.001). The distal RYGB group had higher rates of malnutrition (1/57 standard versus 5/56 distal; P = 0.12), diarrhoea (7/57 standard versus 15/56 distal; P = 0.05), and vitamin D deficiency (24/41 standard versus 32/38 distal; P = 0.01). There were no differences between the groups in the prevalence of type 2 diabetes, hypertension, dyslipidaemia, or metabolic syndrome at 10-year follow-up. Four patients underwent revisional surgery due to malnutrition after distal RYGB. There were no statistically significant differences in HRQOL scores between the groups at 10 years (SF-36 physical 44.2 versus 44.1, mental 50.3 versus 47.3; OWLQOL 63 versus 61; all P > 0.2).CONCLUSIONSDistal long alimentary limb RYGB resulted in greater weight loss after 10 years with a higher risk of malnutrition, diarrhoea, and vitamin D deficiency.TRIAL REGISTRATIONClinicaltrials.gov NCT00821197.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"29 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145994881","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}
BACKGROUNDAortic arch pathologies are complex to treat. Alternatives include open surgery, hybrid surgery (endovascular aortic stent-grafting and open surgical debranching procedures) and total endovascular solutions with branched stent-grafts. Branched stent-grafts are the mainstream approach for endovascular repair, but they are primarily available only as dedicated custom-made devices. The aim of this study was to evaluate the safety and effectiveness of a non-customized modular aortic arch stent-graft.METHODThis trial was led by the Chinese PLA General Hospital and 16 additional aortic centres in China. All included patients were treated with a non-customized modular inner branched stent-graft (Endonom Medtech, Hangzhou, China). The study endpoints were 30-day death and stroke, technical success, clinical success, early and late complications, reintervention, and death during follow-up. Follow-up via clinical examination and CT angiography scan were scheduled post surgery at 1, 6, and 12 months, and annually thereafter.RESULTSFrom June 2021 to December 2024, a total of 88 patients were enrolled in this study. Technical success rate was 100%. The mean follow-up was 28.6 ± 11.7 months. The overall 30-day mortality rate was 3%, and the 30-day stroke rate was 9%. Overall survival was 91% ± 3%, 86% ± 4%, and 81% ± 4% at 12, 24, and 36 months respectively. A total of 10 patients developed endoleaks, none of which required reintervention.CONCLUSIONModular branched stent-graft repair for aortic arch disease is feasible and with comparative rates of safety with custom made branched endovascular stent-grafts, hybrid techniques and open surgery. Long-term comparative effectiveness studies are required to establish whether it is superior to alternative interventions.
{"title":"Outcomes of endovascular aortic arch repair with an off-the-shelf modular inner branched stent-graft: an IDEAL 2a prospective multicentre trial.","authors":"Wei Guo,Dan Rong,Hongkun Zhang,Leiyang Zhang,Hui Zhuang,Hua Peng,Xuejun Wu,Kunmei Gong,Wei Wang,Zhen Li,Weiguo Fu,Xiaoming Zhang,Mingjin Guo,Guangqi Chang,Xiangchen Dai,Jian Zuo,Yingqiang Guo,Bing Chen,Lei Zhang,Taoran Zhang,Hongpeng Zhang","doi":"10.1093/bjs/znaf279","DOIUrl":"https://doi.org/10.1093/bjs/znaf279","url":null,"abstract":"BACKGROUNDAortic arch pathologies are complex to treat. Alternatives include open surgery, hybrid surgery (endovascular aortic stent-grafting and open surgical debranching procedures) and total endovascular solutions with branched stent-grafts. Branched stent-grafts are the mainstream approach for endovascular repair, but they are primarily available only as dedicated custom-made devices. The aim of this study was to evaluate the safety and effectiveness of a non-customized modular aortic arch stent-graft.METHODThis trial was led by the Chinese PLA General Hospital and 16 additional aortic centres in China. All included patients were treated with a non-customized modular inner branched stent-graft (Endonom Medtech, Hangzhou, China). The study endpoints were 30-day death and stroke, technical success, clinical success, early and late complications, reintervention, and death during follow-up. Follow-up via clinical examination and CT angiography scan were scheduled post surgery at 1, 6, and 12 months, and annually thereafter.RESULTSFrom June 2021 to December 2024, a total of 88 patients were enrolled in this study. Technical success rate was 100%. The mean follow-up was 28.6 ± 11.7 months. The overall 30-day mortality rate was 3%, and the 30-day stroke rate was 9%. Overall survival was 91% ± 3%, 86% ± 4%, and 81% ± 4% at 12, 24, and 36 months respectively. A total of 10 patients developed endoleaks, none of which required reintervention.CONCLUSIONModular branched stent-graft repair for aortic arch disease is feasible and with comparative rates of safety with custom made branched endovascular stent-grafts, hybrid techniques and open surgery. Long-term comparative effectiveness studies are required to establish whether it is superior to alternative interventions.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"50 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937821","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}
Thomas Daoulas,Jean-Christophe Courtil,Erik Zanchetta,Hoel Letissier,Muriel Pardon-Labonnelie
{"title":"Reflections on the absence of jointed scissors in Greco-Roman surgery.","authors":"Thomas Daoulas,Jean-Christophe Courtil,Erik Zanchetta,Hoel Letissier,Muriel Pardon-Labonnelie","doi":"10.1093/bjs/znaf266","DOIUrl":"https://doi.org/10.1093/bjs/znaf266","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"74 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145823869","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":"From missions to systems: rethinking international surgical support in low- and middle-income countries.","authors":"George Wharton,David Jones,Robert Yates","doi":"10.1093/bjs/znaf212","DOIUrl":"https://doi.org/10.1093/bjs/znaf212","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"364 1","pages":"xv15-xv17"},"PeriodicalIF":9.6,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710962","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}
Gerard McKnight,Hassan Ali Daoud,Rocco Friebel,Rachel Hargest
INTRODUCTIONPrioritizing resources is essential for low-income countries aiming to improve surgical systems effectively. Few validated tools exist to facilitate this. The authors aimed to address this through the novel application of an existing training needs analysis (TNA) tool to a surgical context in a low-income country.METHODSA questionnaire was designed as a mixed-methods, online survey to capture quantitative and qualitative data based on the Hennessy-Hicks training needs analysis (HHTNA) Questionnaire. The survey was distributed by collaborating organizations in Somaliland.RESULTSResponses were received from 41 anaesthesia providers (APs) and 69 surgical providers (SPs), giving a response rate of approximately 59% of APs, 33% of surgeons, and 21% of obstetricians in Somaliland. The HHTNA of APs highlighted that emergency front of neck access (cricothyroidotomy) was a 'high intervention priority' procedure among APs. Regional anaesthesia, medical management of co-morbidities, and anaesthesia in geriatric populations were also considered performance outliers and should also be the focus of further intervention. Importantly, mixed interventions were desired, indicating that training alone would be insufficient, and that improvements to the work situation also need to be addressed.CONCLUSIONThis study has demonstrated that conducting a pragmatic TNA of the surgical team in a low-resource setting, such as Somaliland, is both feasible and can generate useful data to guide training and professional development.
{"title":"Training needs analysis of surgical teams in Somaliland.","authors":"Gerard McKnight,Hassan Ali Daoud,Rocco Friebel,Rachel Hargest","doi":"10.1093/bjs/znaf216","DOIUrl":"https://doi.org/10.1093/bjs/znaf216","url":null,"abstract":"INTRODUCTIONPrioritizing resources is essential for low-income countries aiming to improve surgical systems effectively. Few validated tools exist to facilitate this. The authors aimed to address this through the novel application of an existing training needs analysis (TNA) tool to a surgical context in a low-income country.METHODSA questionnaire was designed as a mixed-methods, online survey to capture quantitative and qualitative data based on the Hennessy-Hicks training needs analysis (HHTNA) Questionnaire. The survey was distributed by collaborating organizations in Somaliland.RESULTSResponses were received from 41 anaesthesia providers (APs) and 69 surgical providers (SPs), giving a response rate of approximately 59% of APs, 33% of surgeons, and 21% of obstetricians in Somaliland. The HHTNA of APs highlighted that emergency front of neck access (cricothyroidotomy) was a 'high intervention priority' procedure among APs. Regional anaesthesia, medical management of co-morbidities, and anaesthesia in geriatric populations were also considered performance outliers and should also be the focus of further intervention. Importantly, mixed interventions were desired, indicating that training alone would be insufficient, and that improvements to the work situation also need to be addressed.CONCLUSIONThis study has demonstrated that conducting a pragmatic TNA of the surgical team in a low-resource setting, such as Somaliland, is both feasible and can generate useful data to guide training and professional development.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"31 1","pages":"xv43-xv49"},"PeriodicalIF":9.6,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710977","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}
Thomas Ashley,Hannah F Ashley,Andreas Wladis,Pär Nordin,Michael Ohene-Yeboah,Isaac O Smalle,Jessica H Beard,Jenny Löfgren,Håkon A Bolkan,Alex J van Duinen
BACKGROUNDInguinal hernia repair is one of the most performed surgical procedures, but, nevertheless, there is a high unmet need, with over 200 million people worldwide living with an inguinal hernia. The aims of this study were to evaluate 5-year outcomes after anterior mesh inguinal hernia repair, to assess the safety of a training intervention, and to compare the outcomes of patients operated on by a medical doctor (MD) versus an associate clinician (AC).METHODSAdult men with a primary inguinal hernia were included either as training patients or in the randomized trial, with surgical treatment performed by an MD or an AC. Patients were followed up mostly at hospital or at home; questionnaire information was collected and physical examinations were performed. Outcomes of training and trial patients were compared and outcomes of patients who underwent surgeries performed by MDs or ACs during the trial were compared.RESULTSIn total, 129 patients were included in the training group and 229 patients were included in the randomized trial group. At 5-year follow-up, 288 patients (80.4%) were alive, 40 patients (11.2%) had died, and 30 patients (8.4%) were lost to follow-up. The overall recurrence rate was 5.0% and the all-cause mortality rate was 11.2%. Mortality and recurrence were not significantly different between the training and trial patients or between the patients who underwent surgeries performed by MDs or ACs during the trial.CONCLUSIONLong-term outcomes after primary elective inguinal mesh hernia repair indicate that hands-on short-course training can be implemented effectively and that task sharing is safe and effective.
{"title":"Outcomes after elective inguinal hernia repair with mesh performed by associate clinicians versus medical doctors in Sierra Leone: 5-year follow-up of a randomized clinical trial.","authors":"Thomas Ashley,Hannah F Ashley,Andreas Wladis,Pär Nordin,Michael Ohene-Yeboah,Isaac O Smalle,Jessica H Beard,Jenny Löfgren,Håkon A Bolkan,Alex J van Duinen","doi":"10.1093/bjs/znaf221","DOIUrl":"https://doi.org/10.1093/bjs/znaf221","url":null,"abstract":"BACKGROUNDInguinal hernia repair is one of the most performed surgical procedures, but, nevertheless, there is a high unmet need, with over 200 million people worldwide living with an inguinal hernia. The aims of this study were to evaluate 5-year outcomes after anterior mesh inguinal hernia repair, to assess the safety of a training intervention, and to compare the outcomes of patients operated on by a medical doctor (MD) versus an associate clinician (AC).METHODSAdult men with a primary inguinal hernia were included either as training patients or in the randomized trial, with surgical treatment performed by an MD or an AC. Patients were followed up mostly at hospital or at home; questionnaire information was collected and physical examinations were performed. Outcomes of training and trial patients were compared and outcomes of patients who underwent surgeries performed by MDs or ACs during the trial were compared.RESULTSIn total, 129 patients were included in the training group and 229 patients were included in the randomized trial group. At 5-year follow-up, 288 patients (80.4%) were alive, 40 patients (11.2%) had died, and 30 patients (8.4%) were lost to follow-up. The overall recurrence rate was 5.0% and the all-cause mortality rate was 11.2%. Mortality and recurrence were not significantly different between the training and trial patients or between the patients who underwent surgeries performed by MDs or ACs during the trial.CONCLUSIONLong-term outcomes after primary elective inguinal mesh hernia repair indicate that hands-on short-course training can be implemented effectively and that task sharing is safe and effective.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"39 1","pages":"xv50-xv57"},"PeriodicalIF":9.6,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710978","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}
The year 2015 was a landmark year for global surgical care due to the publication of the 2030 targets of the Lancet Commission on Global Surgery. The Lancet report catalysed the global surgery movement amidst warnings of the movement's fragmentation, exclusivity, and leaning towards the Global North. Since then, there has been positive growth in academic global surgery programmes and centres, surgery coalitions, student advocacy, infrastructure, and task-sharing models, and a shift in the framing of global surgery from brief north-south mission trips to an academic discipline with burgeoning literature. Since 2016, four of the commission's six indicators have been integrated into the World Development Indicators. However, there has been a significant decline in the national reporting of these indicators (in some instances to 0% globally), making it difficult to objectively assess progress. The aim of this article is to discuss the progress and controversies surrounding the commission's benchmarks for specialist surgical workforce density, geographical access to surgical care, financial risk protection for surgical care, and surgical volume and reporting of perioperative mortality, as well as to discuss some unintended consequences since the commission, including the challenge of negative framing, the creation of a surgeon-focused movement, the expansion of a largely academic field with little focus on implementers, emphasis on high-level advocacy without a similar focus on grassroots advocacy, hyper-emphasis on surgical plans without appropriate focus on implementation capacity, relegation of community-based care and prevention as a component of global surgery, and the challenge of the use of 10-year-old data, 5 years to the finish line. Finally, broad recommendations for progress are suggested using a nine-pronged framework.
{"title":"Five years to the finish line: progress and unintended consequences since the Lancet Commission on Global Surgery.","authors":"Barnabas T Alayande,Abebe Bekele","doi":"10.1093/bjs/znaf205","DOIUrl":"https://doi.org/10.1093/bjs/znaf205","url":null,"abstract":"The year 2015 was a landmark year for global surgical care due to the publication of the 2030 targets of the Lancet Commission on Global Surgery. The Lancet report catalysed the global surgery movement amidst warnings of the movement's fragmentation, exclusivity, and leaning towards the Global North. Since then, there has been positive growth in academic global surgery programmes and centres, surgery coalitions, student advocacy, infrastructure, and task-sharing models, and a shift in the framing of global surgery from brief north-south mission trips to an academic discipline with burgeoning literature. Since 2016, four of the commission's six indicators have been integrated into the World Development Indicators. However, there has been a significant decline in the national reporting of these indicators (in some instances to 0% globally), making it difficult to objectively assess progress. The aim of this article is to discuss the progress and controversies surrounding the commission's benchmarks for specialist surgical workforce density, geographical access to surgical care, financial risk protection for surgical care, and surgical volume and reporting of perioperative mortality, as well as to discuss some unintended consequences since the commission, including the challenge of negative framing, the creation of a surgeon-focused movement, the expansion of a largely academic field with little focus on implementers, emphasis on high-level advocacy without a similar focus on grassroots advocacy, hyper-emphasis on surgical plans without appropriate focus on implementation capacity, relegation of community-based care and prevention as a component of global surgery, and the challenge of the use of 10-year-old data, 5 years to the finish line. Finally, broad recommendations for progress are suggested using a nine-pronged framework.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"55 1","pages":"xv3-xv9"},"PeriodicalIF":9.6,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710960","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}
BACKGROUNDIn many low- and middle-income countries (LMICs), domestic investments to strengthen surgical services compete with services delivered by international missions. While addressing the high burden of unmet surgical need is a priority, there remains limited evidence on the comparative economic value of different delivery options to guide investment decisions.METHODSFour databases and grey literature were searched for publications in any language from January 2013 to January 2023. Eligible studies evaluated the cost-effectiveness, cost-utility, or cost-benefit of international missions and domestic initiatives used for scale up of surgical care. Average cost-effectiveness ratios were computed for each intervention and then converted to 2022 international dollars (I$). Findings were synthesized narratively.RESULTSA total of 32 studies were identified (17 studies evaluated domestic surgical system strengthening programmes, 14 studies assessed international missions, and 1 study directly compared a domestic surgical development initiative against international missions). Financial protection schemes, investments in physical infrastructure, surgical residency training, and local missions were cost-effective, as were most of the international missions, compared with status quo or no intervention. However, when compared head-to-head, the unit costs per disability-adjusted life-year averted of domestic initiatives were significantly lower relative to the international missions-mean (standard deviation) I$27 051 (I$65 360) and median (interquartile range) I$498 (I$602) versus mean (standard deviation) I$515 500 (I$1 528 716) and median (interquartile range) I$5068 (I$31 618). The difference was statistically significant (Wilcoxon rank-sum test: z = 2.412; P = 0.016).CONCLUSIONInvestments in domestic surgical system strengthening efforts provide better value for money than international missions and should be prioritized over international missions.
背景在许多低收入和中等收入国家，加强外科手术服务的国内投资与国际特派团提供的服务存在竞争。虽然解决未满足手术需求的高负担是一个优先事项，但关于不同交付选择的比较经济价值来指导投资决策的证据仍然有限。方法检索4个数据库和灰色文献，检索2013年1月至2023年1月所有语种的出版物。符合条件的研究评估了用于扩大外科护理规模的国际任务和国内倡议的成本效益、成本效用或成本效益。计算每项干预措施的平均成本效益比，然后转换为2022年国际美元（I$）。研究结果以叙述的方式综合。结果共纳入32项研究（17项研究评估了国内外科系统加强方案，14项研究评估了国际任务，1项研究直接比较了国内外科发展倡议与国际任务）。与现状或不干预相比，财政保护计划、有形基础设施投资、外科住院医师培训和当地特派团与大多数国际特派团一样具有成本效益。然而，当进行正面比较时，国内计划的每个残疾调整生命年的单位成本明显低于国际任务-平均（标准差）27051美元（65 360美元）和中位数（四分位数范围）498美元（602美元）与平均（标准差）515500美元（1528716美元）和中位数（四分位数范围）5068美元（31 618美元）。差异有统计学意义（Wilcoxon秩和检验：z = 2.412; P = 0.016）。结论加强国内手术系统的投资比国际任务更有价值，应优先于国际任务。
{"title":"Economic value of international missions and domestic initiatives to strengthen surgical care in low- and middle-income countries: systematic review.","authors":"Martilord Ifeanyichi,Yannis Reissis,Rebecca Hakim,Maeve Bognini,Meskerem Kebede,Rachel Hargest,Rocco Friebel","doi":"10.1093/bjs/znaf207","DOIUrl":"https://doi.org/10.1093/bjs/znaf207","url":null,"abstract":"BACKGROUNDIn many low- and middle-income countries (LMICs), domestic investments to strengthen surgical services compete with services delivered by international missions. While addressing the high burden of unmet surgical need is a priority, there remains limited evidence on the comparative economic value of different delivery options to guide investment decisions.METHODSFour databases and grey literature were searched for publications in any language from January 2013 to January 2023. Eligible studies evaluated the cost-effectiveness, cost-utility, or cost-benefit of international missions and domestic initiatives used for scale up of surgical care. Average cost-effectiveness ratios were computed for each intervention and then converted to 2022 international dollars (I$). Findings were synthesized narratively.RESULTSA total of 32 studies were identified (17 studies evaluated domestic surgical system strengthening programmes, 14 studies assessed international missions, and 1 study directly compared a domestic surgical development initiative against international missions). Financial protection schemes, investments in physical infrastructure, surgical residency training, and local missions were cost-effective, as were most of the international missions, compared with status quo or no intervention. However, when compared head-to-head, the unit costs per disability-adjusted life-year averted of domestic initiatives were significantly lower relative to the international missions-mean (standard deviation) I$27 051 (I$65 360) and median (interquartile range) I$498 (I$602) versus mean (standard deviation) I$515 500 (I$1 528 716) and median (interquartile range) I$5068 (I$31 618). The difference was statistically significant (Wilcoxon rank-sum test: z = 2.412; P = 0.016).CONCLUSIONInvestments in domestic surgical system strengthening efforts provide better value for money than international missions and should be prioritized over international missions.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"29 1","pages":"xv18-xv29"},"PeriodicalIF":9.6,"publicationDate":"2025-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145710961","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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