Andreas Kuehnl, Christoph Knappich, Felix Kirchhoff, Bianca Bohmann, Vanessa Lohe, Shamsun Naher, Hans-Henning Eckstein, Michael Kallmayer
Background: Carotid endarterectomy and carotid artery stenting are common procedures for the treatment of carotid artery stenosis. The aim of this study was to identify factors that modify the effect between type of treatment and outcome, and could thus be used to refine the selection of treatment procedure.
Methods: All patients who underwent either carotid endarterectomy or carotid artery stenting between 2012 and 2018 in German hospitals were included. The analysis of effect modification was focused on baseline patient characteristics. The outcome was a composite of any stroke or death until discharge from hospital. For multivariable analyses, a generalized linear mixed regression model was used.
Results: Some 221 282 patients were included, of whom 68% were male. In patients who underwent carotid endarterectomy or carotid artery stenting, the risk of any stroke or death was 2.3% and 3.7% respectively. Patient age was statistically significantly associated with a higher risk of a composite outcome of any stroke or death (main effect of age: adjusted OR 1.21 (95% c.i. 1.17 to 1.26), P < 0.001). The age effect was stronger in patients treated with carotid artery stenting (interaction effect: adjusted OR 1.29 (95% c.i. 1.20 to 1.38), P < 0.001). Statistically significant interaction effects were identified for side of treatment, ASA grade, contralateral degree of stenosis, and the time interval between the index event and treatment.
Conclusion: This analysis shows that carotid artery stenting may be particularly disadvantageous in older patients, in patients with right-sided stenosis, and in symptomatic patients treated within the first 2 days after the index event. In patients with contralateral occlusion, carotid artery stenting appears equivalent to carotid endarterectomy.
{"title":"Identification of patient characteristics that may improve procedure selection for the treatment of carotid stenosis.","authors":"Andreas Kuehnl, Christoph Knappich, Felix Kirchhoff, Bianca Bohmann, Vanessa Lohe, Shamsun Naher, Hans-Henning Eckstein, Michael Kallmayer","doi":"10.1093/bjs/znae227","DOIUrl":"10.1093/bjs/znae227","url":null,"abstract":"<p><strong>Background: </strong>Carotid endarterectomy and carotid artery stenting are common procedures for the treatment of carotid artery stenosis. The aim of this study was to identify factors that modify the effect between type of treatment and outcome, and could thus be used to refine the selection of treatment procedure.</p><p><strong>Methods: </strong>All patients who underwent either carotid endarterectomy or carotid artery stenting between 2012 and 2018 in German hospitals were included. The analysis of effect modification was focused on baseline patient characteristics. The outcome was a composite of any stroke or death until discharge from hospital. For multivariable analyses, a generalized linear mixed regression model was used.</p><p><strong>Results: </strong>Some 221 282 patients were included, of whom 68% were male. In patients who underwent carotid endarterectomy or carotid artery stenting, the risk of any stroke or death was 2.3% and 3.7% respectively. Patient age was statistically significantly associated with a higher risk of a composite outcome of any stroke or death (main effect of age: adjusted OR 1.21 (95% c.i. 1.17 to 1.26), P < 0.001). The age effect was stronger in patients treated with carotid artery stenting (interaction effect: adjusted OR 1.29 (95% c.i. 1.20 to 1.38), P < 0.001). Statistically significant interaction effects were identified for side of treatment, ASA grade, contralateral degree of stenosis, and the time interval between the index event and treatment.</p><p><strong>Conclusion: </strong>This analysis shows that carotid artery stenting may be particularly disadvantageous in older patients, in patients with right-sided stenosis, and in symptomatic patients treated within the first 2 days after the index event. In patients with contralateral occlusion, carotid artery stenting appears equivalent to carotid endarterectomy.</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shaun Chandler,Dharmenaan Palamuthusingam,Carmel M Hawley,Elaine M Pascoe,David W Johnson,Stephen McDonald,Neil Boudville,Matthew D Jose,Nicholas B Cross,Magid Fahim
{"title":"Bariatric surgery outcomes in patients on chronic kidney replacement therapy in Australia and New Zealand.","authors":"Shaun Chandler,Dharmenaan Palamuthusingam,Carmel M Hawley,Elaine M Pascoe,David W Johnson,Stephen McDonald,Neil Boudville,Matthew D Jose,Nicholas B Cross,Magid Fahim","doi":"10.1093/bjs/znae251","DOIUrl":"https://doi.org/10.1093/bjs/znae251","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436100","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":"Widespread non-adherence to guidelines in the operative management of diabetes-related foot disease complications.","authors":"","doi":"10.1093/bjs/znae231","DOIUrl":"10.1093/bjs/znae231","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11448333/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bo P Smalbroek,Ritch T J Geitenbeek,Lea M Dijksman,Jim Khan,Quentin Denost,Philippe Rouanet,Roel Hompes,Esther C J Consten,Anke B Smits,,
{"title":"Laparoscopic and robotic total mesorectal excision in overweight and obese patients: multinational cohort study.","authors":"Bo P Smalbroek,Ritch T J Geitenbeek,Lea M Dijksman,Jim Khan,Quentin Denost,Philippe Rouanet,Roel Hompes,Esther C J Consten,Anke B Smits,,","doi":"10.1093/bjs/znae259","DOIUrl":"https://doi.org/10.1093/bjs/znae259","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448049","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}
Esther N Dekker,Raja R Narayan,Mohamed A Ahmami,Anis Meddouch,Eva M M Verkolf,Anne M Gehrels,Marc G H Besselink,Casper H J van Eijck,Marjolein Y V Homs,Bianca Mostert,Grainne M O'Kane,Roeland F de Wilde,Johanna W Wilmink,Eileen M O'Reilly,Motaz Qadan,Bas Groot Koerkamp
BACKGROUNDPatients with localized (that is non-metastatic) pancreatic ductal adenocarcinoma with an inadequate response or toxicity to first-line chemotherapy may benefit from chemotherapy switch. The aim was to explore the available data on the use and effect of chemotherapy switch, as reported in the literature.METHODSA systematic search was conducted in Embase, MEDLINE (Ovid), the Web of Science, Cochrane, and Google Scholar on 1 December 2023. The main outcomes were the proportion of patients who underwent chemotherapy switch and the carbohydrate antigen 19-9 response and resection, R0 resection, and ypN0 resection rates after chemotherapy switch. Data were pooled using a random-effects model.RESULTSA total of five retrospective studies, representing 863 patients with localized pancreatic ductal adenocarcinoma, were included and 226 of the 863 patients underwent chemotherapy switch. In four studies, first-line chemotherapy consisted of 5-fluorouracil/leucovorin/irinotecan with oxaliplatin ('FOLFIRINOX') and patients were switched to gemcitabine with nab-paclitaxel. Reasons for chemotherapy switch included an inadequate biochemical, clinical, or radiological response, or toxicity. Three studies compared patients who underwent chemotherapy switch with patients who only received first-line chemotherapy and found that the proportion of patients who underwent chemotherapy switch was 20.5% (95% c.i. 10.5% to 36.3%). The pooled resection rate after chemotherapy switch was 42.0% (95% c.i. 16.6% to 72.5%). Two studies compared the chance of resection after chemotherapy switch versus first-line chemotherapy alone and found a risk ratio of 0.88 (95% c.i. 0.65 to 1.18). Two studies, with a combined total of 576 patients, found similar postoperative survival for patients who underwent chemotherapy switch and patients who only received first-line chemotherapy.CONCLUSIONOne in five patients with localized pancreatic ductal adenocarcinoma underwent chemotherapy switch after an inadequate response or toxicity to first-line chemotherapy. The pooled resection rate after chemotherapy switch was 42% and similar in overall survival compared with first-line chemotherapy only. Three ongoing trials are investigating chemotherapy switch in patients with an inadequate radiological or carbohydrate antigen 19-9 response.
背景对一线化疗反应不佳或毒性不足的局部（即非转移性）胰腺导管腺癌患者可能会从化疗转换中获益。方法2023年12月1日在Embase、MEDLINE (Ovid)、Web of Science、Cochrane和谷歌学术中进行了系统检索。主要结果为接受化疗转换的患者比例以及化疗转换后碳水化合物抗原19-9的反应和切除率、R0切除率以及ypN0切除率。结果共纳入了五项回顾性研究，代表了863例局部胰腺导管腺癌患者，863例患者中有226例接受了化疗转换。在四项研究中，一线化疗包括5-氟尿嘧啶/亮紫杉烷/伊立替康加奥沙利铂（"FOLFIRINOX"），然后患者改用吉西他滨加纳布-紫杉醇。化疗转换的原因包括生化、临床或放射学反应不充分或毒性。三项研究将接受化疗转换的患者与只接受一线化疗的患者进行了比较，发现接受化疗转换的患者比例为20.5%（95% c.i.10.5%至36.3%）。化疗转换后的总切除率为 42.0%（95% 置信区间：16.6% 至 72.5%）。两项研究比较了化疗转换后切除的几率与单纯一线化疗的几率，发现两者的风险比为0.88（95% c.i.0.65至1.18）。结论每五名局部胰腺导管腺癌患者中就有一人在对一线化疗反应不佳或出现毒性反应后接受了化疗转换。化疗转换后的总切除率为42%，总生存期与仅接受一线化疗的患者相似。目前有三项试验正在研究对放射学反应或碳水化合物抗原19-9反应不充分的患者进行化疗转换。
{"title":"Chemotherapy switch for localized pancreatic cancer: a systematic review and meta-analysis.","authors":"Esther N Dekker,Raja R Narayan,Mohamed A Ahmami,Anis Meddouch,Eva M M Verkolf,Anne M Gehrels,Marc G H Besselink,Casper H J van Eijck,Marjolein Y V Homs,Bianca Mostert,Grainne M O'Kane,Roeland F de Wilde,Johanna W Wilmink,Eileen M O'Reilly,Motaz Qadan,Bas Groot Koerkamp","doi":"10.1093/bjs/znae244","DOIUrl":"https://doi.org/10.1093/bjs/znae244","url":null,"abstract":"BACKGROUNDPatients with localized (that is non-metastatic) pancreatic ductal adenocarcinoma with an inadequate response or toxicity to first-line chemotherapy may benefit from chemotherapy switch. The aim was to explore the available data on the use and effect of chemotherapy switch, as reported in the literature.METHODSA systematic search was conducted in Embase, MEDLINE (Ovid), the Web of Science, Cochrane, and Google Scholar on 1 December 2023. The main outcomes were the proportion of patients who underwent chemotherapy switch and the carbohydrate antigen 19-9 response and resection, R0 resection, and ypN0 resection rates after chemotherapy switch. Data were pooled using a random-effects model.RESULTSA total of five retrospective studies, representing 863 patients with localized pancreatic ductal adenocarcinoma, were included and 226 of the 863 patients underwent chemotherapy switch. In four studies, first-line chemotherapy consisted of 5-fluorouracil/leucovorin/irinotecan with oxaliplatin ('FOLFIRINOX') and patients were switched to gemcitabine with nab-paclitaxel. Reasons for chemotherapy switch included an inadequate biochemical, clinical, or radiological response, or toxicity. Three studies compared patients who underwent chemotherapy switch with patients who only received first-line chemotherapy and found that the proportion of patients who underwent chemotherapy switch was 20.5% (95% c.i. 10.5% to 36.3%). The pooled resection rate after chemotherapy switch was 42.0% (95% c.i. 16.6% to 72.5%). Two studies compared the chance of resection after chemotherapy switch versus first-line chemotherapy alone and found a risk ratio of 0.88 (95% c.i. 0.65 to 1.18). Two studies, with a combined total of 576 patients, found similar postoperative survival for patients who underwent chemotherapy switch and patients who only received first-line chemotherapy.CONCLUSIONOne in five patients with localized pancreatic ductal adenocarcinoma underwent chemotherapy switch after an inadequate response or toxicity to first-line chemotherapy. The pooled resection rate after chemotherapy switch was 42% and similar in overall survival compared with first-line chemotherapy only. Three ongoing trials are investigating chemotherapy switch in patients with an inadequate radiological or carbohydrate antigen 19-9 response.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":9.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436098","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":"Laparoscopic Pancreatoduodenectomy: The Intermediate Approach.","authors":"Kui Long, Dingwei Xu, Jie Huang","doi":"10.1093/bjs/znae247","DOIUrl":"https://doi.org/10.1093/bjs/znae247","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142454005","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":"Risk-reducing mastectomy in mutation carriers.","authors":"Alexandra M Zaborowski, Michael R Boland","doi":"10.1093/bjs/znae264","DOIUrl":"https://doi.org/10.1093/bjs/znae264","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491491","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":"Correction to: Global access to technologies to support safe and effective inguinal hernia surgery: A prospective, international cohort study.","authors":"","doi":"10.1093/bjs/znae275","DOIUrl":"10.1093/bjs/znae275","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Charlotta L Wenzelberg, Peder Rogmark, Olle Ekberg, Ulf Petersson
Background: The aim was to investigate whether adding a reinforced tension-line (RTL) suture to a standard 4 : 1 small-bite closure would reduce the incidence of incisional hernia after colorectal cancer surgery.
Methods: Patients aged at least 18 years, who were scheduled for elective colorectal cancer surgery through a midline incision at two Swedish hospitals (2017-2021), were randomized in a 1 : 1 ratio to either fascial closure with RTL and 4 : 1 small-bite closure with polypropylene sutures (RTL group) or 4 : 1 small-bite closure with polydioxanone suture alone (PDS group). The primary outcome was CT-detected incisional hernia 1 year after surgery. CT interpreters were blinded regarding treatment group.
Results: In all, 160 patients were randomized, 80 in each group. The study closed early to recruitment and follow-up. Some 134 patients were analysed at 1 year: 63 in the RTL group and 71 in the PDS group. Nineteen patients were found to have an incisional hernia: 4 (6%) in the RTL group and 15 (21%) in the PDS group (OR 3.95, 95% c.i. 1.24 to 12.60; P = 0.014). No unintended effects were found in either group.
Conclusion: Adding an RTL suture at fascial closure decreased the incidence of incisional hernia in patients undergoing surgery for colorectal cancer. Trial registration: NCT03390764 (https://clinicaltrials.gov).
{"title":"Reinforced tension-line suture after laparotomy: early results of the Rein4CeTo1 randomized clinical trial.","authors":"Charlotta L Wenzelberg, Peder Rogmark, Olle Ekberg, Ulf Petersson","doi":"10.1093/bjs/znae265","DOIUrl":"10.1093/bjs/znae265","url":null,"abstract":"<p><strong>Background: </strong>The aim was to investigate whether adding a reinforced tension-line (RTL) suture to a standard 4 : 1 small-bite closure would reduce the incidence of incisional hernia after colorectal cancer surgery.</p><p><strong>Methods: </strong>Patients aged at least 18 years, who were scheduled for elective colorectal cancer surgery through a midline incision at two Swedish hospitals (2017-2021), were randomized in a 1 : 1 ratio to either fascial closure with RTL and 4 : 1 small-bite closure with polypropylene sutures (RTL group) or 4 : 1 small-bite closure with polydioxanone suture alone (PDS group). The primary outcome was CT-detected incisional hernia 1 year after surgery. CT interpreters were blinded regarding treatment group.</p><p><strong>Results: </strong>In all, 160 patients were randomized, 80 in each group. The study closed early to recruitment and follow-up. Some 134 patients were analysed at 1 year: 63 in the RTL group and 71 in the PDS group. Nineteen patients were found to have an incisional hernia: 4 (6%) in the RTL group and 15 (21%) in the PDS group (OR 3.95, 95% c.i. 1.24 to 12.60; P = 0.014). No unintended effects were found in either group.</p><p><strong>Conclusion: </strong>Adding an RTL suture at fascial closure decreased the incidence of incisional hernia in patients undergoing surgery for colorectal cancer. Trial registration: NCT03390764 (https://clinicaltrials.gov).</p>","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":8.6,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142542320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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